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{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7300 }
Medical Text: Admission Date: [**2166-12-30**] Discharge Date: [**2167-1-9**] Date of Birth: [**2109-11-1**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / Codeine / Benadryl Attending:[**First Name3 (LF) 1505**] Chief Complaint: right flank pain Major Surgical or Invasive Procedure: CABGx4(LIMA-LAD,SVG-OM, SVG-PVL, SVG-Diag)[**1-1**] History of Present Illness: 57 yo F admitted to [**Hospital3 **] with right flank pain, had chest pain prior to dialysis and ruled in for MI. Transferred to [**Hospital1 18**] cath lab. Past Medical History: HTN, ^chol, ESRD/HD(polycystic KD), PAFib, Anxiety, Gout, +tob Tonsillectomy, Tubal [**Last Name (LF) **], [**First Name3 (LF) **] tumor removal Social History: works as stay at home mom + tobacco - 1.5 ppd x 30 years denies etoh lives with husband and son Family History: mother deceased from MI at 44 Physical Exam: Admission: VS HR 76 RR 22 BP 218/83 NAD Rt subclavian tunneled cath Lungs CTAB RRR 2/6 systolic murmur Abdomen soft/NT/ND, obese Extrem warm, trace edema Varicosities none Neuro grossly intact Discharge: VS T98.2 HR 68SR BP 155/84 RR 18 O2sat 94% RA Gen NAD Neuro A&Ox3, nonfocal exam Pulm Decreased Left base, otherwise clear. Rt subclav tunnel line CV RRR, no M/R/G. Sternum stable, incision CDI Abdm soft, NT/ND/+BS Ext warm, 2+ pedal edema Pertinent Results: [**2166-12-30**] 10:05PM PLT COUNT-145* [**2166-12-30**] 02:30PM GLUCOSE-149* UREA N-31* CREAT-5.5*# SODIUM-131* POTASSIUM-4.2 CHLORIDE-98 TOTAL CO2-20* ANION GAP-17 [**2166-12-30**] 02:30PM ALT(SGPT)-13 AST(SGOT)-13 CK(CPK)-23* ALK PHOS-70 AMYLASE-90 TOT BILI-0.6 [**2166-12-30**] 02:30PM CK-MB-NotDone cTropnT-0.53* [**2166-12-30**] 02:30PM ALBUMIN-3.6 [**2166-12-30**] 02:30PM %HbA1c-5.3 [**2166-12-30**] 02:30PM WBC-7.4 RBC-2.93*# HGB-8.8* HCT-25.8* MCV-88# MCH-29.9 MCHC-34.0 RDW-17.6* [**2166-12-30**] 02:30PM PT-28.9* PTT-77.9* INR(PT)-2.9* [**2167-1-9**] 06:30AM BLOOD WBC-7.9 RBC-3.21* Hgb-9.6* Hct-28.8* MCV-90 MCH-29.9 MCHC-33.3 RDW-17.6* Plt Ct-246 [**2167-1-9**] 06:30AM BLOOD Plt Ct-246 [**2167-1-4**] 02:50AM BLOOD PT-12.3 PTT-25.9 INR(PT)-1.0 [**2167-1-9**] 06:30AM BLOOD Glucose-105 UreaN-34* Creat-5.6* Na-134 K-4.1 Cl-96 HCO3-25 AnGap-17 [**2166-12-30**] 02:30PM BLOOD ALT-13 AST-13 CK(CPK)-23* AlkPhos-70 Amylase-90 TotBili-0.6 RADIOLOGY Preliminary Report CHEST (PA & LAT) [**2167-1-8**] 8:24 AM CHEST (PA & LAT) Reason: eval for pleural effusions [**Hospital 93**] MEDICAL CONDITION: 57 year old woman s/p CABG REASON FOR THIS EXAMINATION: eval for pleural effusions INDICATION: 57-year-old status post CABG. COMPARISON: [**2167-1-2**]. PA AND LATERAL CHEST: The patient is status post median sternotomy and CABG. A right subclavian hemodialysis catheter terminates in the distal SVC. Moderate degree of cardiomegaly appears unchanged. Mediastinal and hilar contours are stable. There is slight increased size of a moderate left and small right pleural effusion. There is improved aeration at the left lung base. No pneumothorax is identified. Mild degenerative changes are noted in the mid thoracic spine. IMPRESSION: Slight interval increase in a moderate left and small right pleural effusion. Improving left basilar atelectasis. DR. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**] [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 30530**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 30531**] (Complete) Done [**2167-1-1**] at 9:37:47 AM 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: [**2109-11-1**] Age (years): 57 F Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: CABG ICD-9 Codes: 402.90, 786.05, 786.51, 799.02, 440.0, 424.0 Test Information Date/Time: [**2167-1-1**] at 09:37 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 #: 2008AW1-: Machine: [**Pager number 30532**] Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *1.5 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *4.7 cm 0.6 - 1.1 cm Left Ventricle - Ejection Fraction: 40% to 45% >= 55% Aorta - Ascending: 2.9 cm <= 3.4 cm Aorta - Descending Thoracic: 2.2 cm <= 2.5 cm Aortic Valve - Valve Area: 3.2 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. LV WALL MOTION: Regional left ventricular wall motion findings as shown below; remaining LV segments contract normally. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. No AS. MITRAL VALVE: Mildly thickened mitral valve leaflets. Moderate mitral annular calcification. No MR. TRICUSPID VALVE: Physiologic 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. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions Pre-CPB: No spontaneous echo contrast is seen in the left atrial appendage. The lateral wall of the LV is hypokinetic. The remaining left ventricular segments contract normally. Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. There is no pericardial effusion. Post bypass: Good RV systolic fxn. The lateral LV wall shows some improved systolic fxn. Trace MR. [**First Name (Titles) **] [**Last Name (Titles) **]. Aorta intact. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2167-1-1**] 16:04 Brief Hospital Course: Cardiac cath showed 3VD. She was transferred to the CCU for hypertensive urgency and was weaned from her hydralazine, nipride and nicardipine. She was continued on argatroban instead of heparin for concern of HIT, and she was seen by hematology. She continued on dialysis. HIT was negative and she was taken to the operating room on [**1-1**] where she underwent a CABG x 4. She was transferred to the ICU in stable condition. She was extubated on POD #1. She was given 48 hours of vanocmycin as she was in the hospital preoperatively. She was transfused. She was transferred to the floor on POD #3. She continued on HD M-W-F. She was ready for discharge home on POD8 HD is set up at [**Location (un) **] Dialysis Center. Medications on Admission: Lipitor 80', ASA 81', Imdur 120' Lopressor 75", Renegal 400''', Nephrocap 1', Diazepam 2.5 Q8/prn, PhosLo 667 QMon/Wed, 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. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 3. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet(s)* Refills:*0* 4. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*0* 5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*0* 6. Diazepam 5 mg Tablet Sig: 0.5 Tablet PO resume preop schedule as needed. 7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 932**] Area VNA Discharge Diagnosis: CAD s/p CABG HTN, ^chol, ESRD/HD(polycystic KD), PAFib, Anxiety, Gout, +tob Tonsillectomy, Tubal [**Last Name (LF) **], [**First Name3 (LF) **] tumor removal 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: Dr. [**Last Name (STitle) **] 4 weeks Dr. [**Last Name (STitle) 4469**] 2 weeks Dr. [**Last Name (STitle) 10543**] 2 weeks Completed by:[**2167-1-9**] ICD9 Codes: 5856, 2875, 2767, 2724, 3051
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7301 }
Medical Text: Admission Date: [**2138-7-25**] Discharge Date: [**2138-9-4**] Date of Birth: [**2072-7-20**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: Respiratory Failure Major Surgical or Invasive Procedure: Tracheostomy Intubation R Thoracentesis (x2) Central Line Placement PICC Line Placement HD line placement Hemodialysis (CVVH) PEG Placement History of Present Illness: 61 year old man, PMH of DM type II, with recent hospital admission ([**5-22**]) for enterococcal bacteremia and aortitis, presented to OSH on [**2138-7-22**] complaining of 6 weeks of back pain and bowel incontinence. Patient said onset of severe back pain began approximately 6 weeks ago in lower right side, worse with sitting or standing. If attempted to stand, he experience pain shooting up his back. He last walked approximately 6 weeks ago. The pain has been stable, not worsening. He reports mild improvement. He is now able to roll in bed. Yesterday patient was unable to turn his head to the side. That has since resolved. . Two weeks ago, patient developed bowel incontinence. He can not sense when he is going. He has loss of stool approximately 3-4x/day. Also reports decreased urine output with no leakage or dribbling. Patient feels he is dehydrated. He decided to go to the hospital when after attempting to get out of bed he felt very dizzy and "things went black." Also became concerned about his decreased urine output. . At OSH: MRI was notable for an L2-L3 epidural abscess. Notable findings at the OSH include ampicillin sensitive enterococcal bacteremia, CT scan findings of possible aortitis and a right pleural effusion. He was started on ampicillin and gentamycin, and transferred to [**Hospital1 18**] for surgical evaluation. Pt was started on flagyl for diarrhea. . Mr. [**Known lastname 6228**] is a 6xyo male with DM, CAD recently s/p NSTEMI with EF 20-30%, PVD, hypoalbuminemia and COPD initially transferred from OSH for management of C5-6 and L2/L3 osteomyelitis and enterococcal bacteremia. . Past Medical History: 1.CAD, NSTEMI [**5-22**] refused Cath -complicated by cardiomyopathy, with EF =45% -negative stress test [**11/2137**] - ECHO in [**5-/2138**] with reported paradoxical motion of LV apex, hypokinesis of septum and anterior wall infarct ischemia. 2.Diabetes Mellitus Type II 3.Peripheral vascular disease -s/p left great toe ampuation 4.History of enterococcal bacteremia -Admitted to [**Hospital **] hospital with this earlier in [**5-22**]. Received ampicillin and gentamycin, and there was suspicion for aortitis vs infected clot. Patient left AMA on linezolid after refusing vascular surgery intervention. 5. HTN 6. h/o osteomyelitis 7. COPD, not on steroids, per pt never intubated 8. L great toe amputation [**2-/2138**] Social History: Retired electrician, lives with wife. 100 pkyr tobacco hx, prior ETOH use 6pk/day (quit 6mos ago), no illicit drug use Family History: Sister Diabetes [**Name2 (NI) 6229**] deceased at age 65 Physical Exam: at micu admission VITALS: T 94.4 BP 103/66 HR 86 O2Sat 95%RA * PHYSICAL EXAM Gen: Elderly male lying in bad in moderate distress with movement HEENT: EOMI, PEERL, anicteric, oropharynx clear NECK: supple, no [**Doctor First Name **], CHEST: poor air movement, diffuse wheezes throughout Back: No vertebral tenderness, R paraspinal tenderness at T8 CV: RRR, S1S2, no m/r/g Abd: protuberant, tympanitic, nontender, distended, + BS Ext: L foot s/p great toe amputation, flaking, red skin with partial thickness ulcer on L foot Scrotal Edema Neuro: CN II-XII intact, B/L UE 5/5 strength, B/L hip flexors [**3-20**] limited by pain, Dorsi/plantar flexion [**4-19**], Sensation saddle-decreased but present, Pertinent Results: Initial MRI L Spine: Findings indicative of discitis and osteomyelitis at L2-3 and L4-5 level. Inflammatory changes posterior to the thecal sac at L2-3 level could be due to phlegmon or a small epidural abscess. Inflammatory changes are also seen involving the right psoas muscle and posterior musculature at L4-5 level. Epidural enhancing soft tissues due to phlegmon are also seen. Examination is limited and for better evaluation if clinically indicated, a repeat study with proper sedation is recommended. . MRI C/T/L spine [**2138-7-27**]: Discitis and osteomyelitis at C5-C6 level. No overt change in the extent of discitis and osteomyelitis at L4-L5 level, incompletely assessed at L2-L3 level. Probable pelvic fluid, incompletely assessed. . TTE [**7-22**]: The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. Overall left ventricular systolic function is severely depressed (LVEF= 20-30 %) secondary to severe hypokinesis of the anterior septum and anterior free wall, moderate hypokinesis of the inferior septum and lateral wall, and extensive apical akinesis. There is no ventricular septal defect. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. There are filamentous strands on the aortic leaflets consistent with Lambl's excresences (normal variant), although small vegetations cannot be excluded with certainty. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. No mass or vegetation is seen on the mitral valve. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. No vegetation/mass is seen on the pulmonic valve. There is a small to moderate sized pericardial effusion. The effusion appears circumferential. There are no echocardiographic signs of tamponade. Brief Hospital Course: Mr. [**Known lastname 6228**] is a 66yo male with DM, CAD recently s/p NSTEMI with EF 20-30%, PVD, hypoalbuminemia and COPD initially transferred from OSH for management of C5-6 and L2/L3 osteomyelitis and enterococcal bacteremia. His hospital course is summarized as follows: He was initially followed on the medical floor for medical management of his MI and bacteremia but then transferred to the MICU on [**7-29**] when he became hypoxemic with an associated respiratory acidosis. In the MICU, patient was diuresed. Initially Abx extended to vanco/zosyn/amp/gent for presumed PNA. However CXR more consistent with worsening CHF and pleural effusion. PICC was placed for longterm antibiotic therapy. . Pt was called out to floor on [**2138-7-31**]. On the floor, he initially was stable then on [**8-2**] became more SOB. CXR revealed moderate R pleural effusion as well as worsening CHF. Diuresis with Lasix plus albumin with minimal response. . On [**8-3**], he was transferred to MICU for closer monitoring for SOB. MICU PROBLEM BASED COURSE SINCE [**8-3**]: . 1. Respiratory Failure: Pt was initially intubated for respiratory distress with subsequent multiple failed planned and self-extubations throughout MICU course. His respiratory failure was likely secondary to large pleural effusions [**1-17**] CHF (EF 10-15%). Hypoalbuminemia due to nephrotic syndrom also playing large role as pt reaccumulated fluid s/p thoracentesis and additionally, he has underlying COPD. On [**8-9**] extubated, R Thoracentesis removed 2L fluid. CXR improved following but clinical scenario without change. Pt refused re-intubation overnight. Worsening gas on bipap. Pleural fluid labs: transudate. On [**8-10**] Reintubated (pt w/ barely adequate O2 resp function on BiPap). On [**8-13**] Pt self-extubated and [**8-14**] re-intubated secondary to increasing hypoxia, hypercarbia. On [**8-20**] extubated x1hr to speak with wife but was briefly hypotensive with reintubation, requiring levophed. On [**8-23**] pt extubated himself, agreed to reintubation. [**8-26**] R Thoracentesis removed 1.8 L, stopped due to hypotension requiring levophed temporarily. On [**8-27**] Trach placed by IP and respiratory status remained stable through remaining hospital course. He is able to breath off the vent for 8-10 hours on some days, but then tires and requires to be replaced on the vent. . 2. Hypotension: Pt originally presented hypotensive: Thought most likely cardiogenic shock, although he did have many reasons to be septic (osteomyelitis, TV vegetation, retropharyngeal fluid collection). Pt started on levophed [**8-3**]. remained pressor dependant despite negative cultures since [**8-3**]. Tried dobutamine trial ~[**8-6**] and [**8-11**] , pt failed (became hypotensive, tachycardic). Attempted vasopressin [**8-12**] w/ goal of levophed wean: unsuccessful. D/ced vasopressin [**8-15**]. Also considered component of hypovolemic shock given depleted intravascular status w/ hypoalbuminemia, pt transfused to HCT 30 ([**2061-8-12**]) w/o improvement in pressor requirement (continued levophed requirement). Considered adrenal insufficiency, stim test on : cosyntropin stim normall originally, normal on repeat [**8-14**]. On [**8-19**]-started Hydrocort trial: 100mg IV x1; allowed successful wean off levophed. Continued steroids w/ 6 day tapering course, finished [**8-25**]. [**Date range (1) 6230**] while on steroids pt w/ stable BP. The pt had 2L dialyzed off on [**8-24**] and pt with hypotension w/ sbp 70 overnight responsive to 750 cc bolus. On [**8-26**], temporary hypotensive episode requiring levophed due to 1.8L volume removal thoracentesis. [**8-29**] pt hypotensive when in chair, standing valium decreased to 2.5 TID (from 5), and hydrocortisone restarted at 50 q 6. Given hypotension, the fentanyl patch and valium were d/c'd and Fludrocortisone 0.2mg daily was started for orthostasis. Pt BP has thus been stable. . 3. Anxiety / depression: Patient intermittently angry, attempting to lash out at nurses and making rude, offensive statements. Evaluated by psychiatry given pt refused HD and unclear if he is competent to make any decisions. -Unclear if pts current "anger" is part of his pre-morbid personality vs delirium. Zyprexa started [**8-21**], Started SSRI, celexa [**8-25**], using standing valium to wean from midazolam drip s/p trach. After psych evaluation began Haldol 5mg IV BID, then held Celexa in setting of poor renal function. On D/C haldol 5mg TID has been working well and soothing his agitation. . 4. Tracheitis: pt w/ thick secretions decreasing. sputum w/ + growth for Kleibsiella oxtocea, enterobacter cloacae on [**8-13**], both sensitive to cefepime. [**8-18**] and [**8-25**] sputum remains + for gram - rods. Continue cefepime (had started cefepime and vanco [**8-13**], changed temporarily to ceftriaxone for better gram - coverage prior to sensitivites, reverted back to cefepime [**8-18**])through [**9-2**] for 15d course . 5. Renal Failure: F: likely prerenal F, as pt w/ hypotension and pressor requirement. Pt also w/ diabetic nephropathy. total protein 3207g=nephrotic syndrome. Hypoalbuminemia playing large role in cardiovascular compromise as pt third spacing tremendous amount of fluid (+8L prior to CVVH, now +7L on intermittent HD). CVVH used as temprorary bridge for volume removal. clinical condition did not improve. CVVH stopped as was not considered to be permanent solution given ICU requirement. renal plan for renal biopsy when/if pt stable to determine if any aspect of nephrotic dz would be steroid responsive. After successful levophed wean pt attempted on HD trials: trials of intermittent HD successful thus far, pt has tolerated fluid removal and remained hemodynamically stable. . 6. Pleural effusion: reaccumulated w/i 48 hrs s/p thoracentesis on [**8-9**], quick reaccumulation suspected to be related to hypoalbuminemia. Likely contributing to pts resp distress. c/s IP to discuss feasability of successful pleurodesis: IP does not believe procedure would be successful. IP performed thoracentesis on [**8-26**], removed 1.8 L on [**8-26**], stopped fluid removal secondary to hypotensive episode. . 7. Vertebral osteo: osteomyelitis at L2-3, L4-5, C5-6. [**7-27**]: MRI total spine [**7-27**]: retropharyngeal fluid collection at level of C1-C5; may be pre-vertebral as opposed to retropharyngeal,adjacent to C5-6 vertebrae w/ appearance c/w osteomyleitis. [**8-6**]: MRI neck: improved retropharyngeal fluid collection. Continued appearance of edematous and enhancing C5 vertebral body and C [**4-20**] interval disc space. Ortho spine evaluated and no concern for fluid collection itself compromising vital structures; therefore no need surgical intervention. Treatment continues wtih ampicillin for osteomyelitis. . 8. Endocarditis: TEE [**8-15**] confirms large TV vegetation, +AV vegetation. Continue ampicillin x8 weeks. . 9. Enterococcus bacteremia per OSH (E. Faecalis): Was on amp/gent from OSH for synergistic coverage for presumed endocarditis. Recently on amp alone as all blood cx here (from [**7-25**] onward) have been negative, possible sources (TV veg on TTE, osteo, cervical fluid collection). tx for endocarditis and osteo: abx x minimum 8wks. at [**Hospital1 18**] was on vanco/zosyn [**Date range (1) 6231**], changed back to amp on [**8-5**]. blood cx negative at [**Hospital1 18**] since [**7-25**]. 8 wk course = ampicillin until [**9-28**] for osteo and endocarditis. . 10. Diabetes Mellitus: Pt originally on ISS w/ good control. The pts sugars elevated when steroids started so insulin drip was used. The drip was d/ced [**8-25**] as steroid course finished and pt put on ISS. . 11. L foot ulcers: Likely secondary to poor wound healing and Diabetes, no evidence of osteo on foot films. Also small ulcer on right foot. Pt seen and evaluated by wound care. . 12. Aortitis: There was a oncern for infrarenal aortitis on OSH studies. On vascular read, also with possible ascending aortitis. Final radiology CT read: chronic/dormant aortitis. Per vascular surgery- no surgical intervention necessary. . 13. Abdominal pain: Pt had intermittent episodes of abdominal pain [**Date range (1) 6232**], appear to have resolved though pt intubated/sedated: central/RUQ. Difficult to fully abscess given intubation. Chest pain worked up as above. Possibly constipation. [**8-11**] RUQ US -, LFTs nl except mild lipase elevation at 64. Issue resolved on own. . 14. Chest pain: Intermittent episodes of chest pain during MICU admission. The last episode [**8-18**] early morning pt hypotensive w/ chest pain and diaphoresis. The levophed increased, pain resolved. Cardiac enzymes were sent but ?relevance of results given pt on CVVH. At micu admission pt w/ known CAD, cardiac ischemia, elevated troponins (~6) w/ hypotension and tachycardia thought to be likely demand ischemia versus ACS. Hx=NSTEMI [**5-22**], pt refused cath. [**8-15**] TEE w/ EF of [**9-29**]% which is decreased from prior estimate (8/14 20-30%). Pt medically managed (asa, statin, plavix. We were unable to pursue cath at this time due to + valve vegetations . 15. A. [**Name (NI) 6233**] Pt started on amiodarone bolus/drip started [**8-9**] and subsequently converted to PO. On [**8-10**]: pt converted to NSR at ~1030 On [**8-11**]: pt w/ irregular rhythm, ? aflutter w/ irreg block. As of [**8-17**] pt has been stable on amiodarone. . 16. [**Name (NI) 300**] pt found to be hypernatremia, continues to receive free water bolus through NGT. . Medications on Admission: Meds: on admission to OSH: Nitro PRN Flomax pravastatin ASA NPH folic acid . MEDS on transfer: Ampicillin 2q4h Gentamicin 100mg q8h NPH 45 qAM, 31qPM captopril 12.5 tid metoprolol 12.5tid vitamin C 500bid znSo4 220qdaily heparin SC 5000tid diazepam 5mg qdaily asa finasteride 5mg qdaily lasix 80 [**Hospital1 **] folic acid 1mg qdaily pravastatin 40qdaily protonix 40IV oxycodone 5 q6hPRN ibuprofen 800 q6h PRN tylenol 650 q4h PRN had one dose of albumin metronidazole 500tid Discharge Medications: 1. Ascorbic Acid 500 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 2. Folic Acid 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 3. Acetaminophen 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 4. Oxycodone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 5. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 6. Atorvastatin 40 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily). 7. Albuterol 90 mcg/Actuation Aerosol [**Hospital1 **]: Six (6) Puff Inhalation Q4-6H () as needed. 8. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Hospital1 **]: Six (6) Puff Inhalation Q4-6H () as needed. 9. Docusate Sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2 times a day). 10. Amiodarone 200 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day). 11. Midodrine 5 mg Tablet [**Hospital1 **]: Two (2) Tablet PO TID (3 times a day). 12. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1) Injection TID (3 times a day). 13. White Petrolatum-Mineral Oil Cream [**Hospital1 **]: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for to feet. 14. Lactulose 10 g/15 mL Syrup [**Hospital1 **]: Thirty (30) ML PO Q4H (every 4 hours) as needed. 15. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 16. Aspirin 325 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 17. Clopidogrel 75 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 18. Fludrocortisone 0.1 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 19. Ampicillin Sodium 1 g Recon Soln [**Last Name (STitle) **]: One (1) Recon Soln Injection Q6H (every 6 hours). 20. Haloperidol Lactate 5 mg/mL Solution [**Last Name (STitle) **]: One (1) Injection TID (3 times a day) as needed for agitation. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Enterococcus Sepsis Endocarditis Vertebral Osteomyelitis Retropharyngeal Abscess Tracheitis Renal Failure Respiratory Failure s/p tracheostomy Hypoalbuminemia Hypernatremia Recurrent Pleural Effusion CHF AFib CAD Diabetes Mellitus Anxiety Discharge Condition: Alert, able to communicate and speak via Passy Muir Valve. Able to move all extremities. Occasionally anxious. Knows name and hospital. Blood blister on L foot. Able to sit for short periods in chair. Discharge Instructions: You are being discharged to [**Hospital1 **] for intensive rehabilitation. - you will continue to receive dialysis - you will continue to be ventilated with a machine for a good portion of the day. - you continue to have infections which will require intravenous antibiotics Followup Instructions: PCP Completed by:[**2138-9-4**] ICD9 Codes: 5849, 4280, 2760, 4254
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7302 }
Medical Text: Admission Date: [**2191-3-3**] Discharge Date: [**2191-3-11**] Date of Birth: [**2128-11-24**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 905**] Chief Complaint: syncope, abdominal pain, nausea, vomiting Major Surgical or Invasive Procedure: nasogastric tube placement History of Present Illness: 62yF with hx of hypothyroidism, HTN, hyperlipidemia, and diverticulosis presents following a syncopal episode this AM. Pt reports reducing her PO intake over the weekend [**2-1**] work-related stress and then feeling lightheaded and nauseated this morning on her bus ride to work. She reached her office but fainted while sitting at her desk. She reports vomiting once (no blood). She denies chest pain, shortness of breath, palpitations, diaphoresis, tongue-biting, or incontinence associated with this syncopal episode. She denies hitting her head in the fall. She had a similar syncopal episode two months ago, evaluted in the [**Hospital1 18**] EW, thought to be non-cardiogenic in nature. No other recent history of pre-syncope or syncope. She reports that her general health is "good." On questioning, she admits to feeling a constant diffuse abdominal pain for "a while," probably on the order of weeks to months. The pain is crampy, worse with eating (small meals are best), better with movement, not associated with nausea/vomiting. Nothing else makes the pain better or worse, and she has not sought medical attention for this issue. She suffers from constipation (no BM in past week), punctuated by occasional episodes of diarrhea (approx 1 episode per month). No frankly dark or bloody stools. She denies fevers, sweats, and weight loss, though she endorses occasional chills. She denies sick contacts or recent antibiotic use. She had a bleeding gastric ulcer 30 yrs ago. She had a colonoscopy one month ago that revealed diverticulosis. She admits to occasional non-adherence to medications (misses PM dose of verapamil). . In the ED, initial VS were: T 96.8 HR 119 BP 140/103 (91/36 15min later) RR 16 O2 99% RA Labs @ 10am: 16.2 > 33.2 < 468 MCV 100 134 98 9 -----------< 142 3.5 16 1.0 Ca: 9.2 Phos:4.9 MG: 1.4 Anion Gap: 24 Lactate 6.1 AST 27 ALT 15 AP 85 Tbil 0.2 Lip 51 Alb 3.4 PTT 22.0 INR 0.8 Foley was placed. UA: Positive for nitrates, with 21-50 WBC. CXR was normal. CT demonstrated pancolitis with marked bowel wall thickening but no signs of obstruction, also intrahepatic and CBD dilation terminating in the head of the pancreas, concerning for a pancreatic mass. CT Head revealed no acute intracranial process. Pt received 5.5L NS, lactate dropped to 3.3, hypotension resolved. Blood cx were sent. Pt was started on vanco, zosyn, flagyl. CVL (triple lumen cordis) placed in the RIJ. Placement confirmed with CXR. NGT placed --> 50cc bilious fluid. General surgery was consulted, felt abdomen to be non-surgical. . On the floor, hemodynamically stable, but with continued nausea/vomiting/watery diarrhea. Received 1L NS. . Review of sytems: (+) Per HPI. Also: occasional joint pain in hands and knees; neck pain; occasional incontinence of urine. (-) Denies headache, vision changes, dysphagia, URI symptoms, CP, SOB, cough, dysuria, hematuria, crampy leg pain, changes in appetite or energy. Past Medical History: HTN Hypercholesterolemia Hypothyroidism Diverticulosis h/o breast CA - last mammogram [**2186**] (normal) R, [**2173**]: invasive CA treated with lumpectomy and radiation L, [**2182**]: DCIS treated with excision, radiation, tamoxifen x5 yrs h/o gastric ulcer 30 yrs ago Social History: Drinks 1 shot gin per night. Denies EtOH-related withdrawal sx or seizures. Remote tobacco use in teens. No illegal drugs. Lives with sister in community living situation. One cat. Works in billing at [**Hospital3 1810**]. Finds this work and her commute stressful. Family History: Mother died of colon cancer at age 55. Physical Exam: Vitals: T:99.1 BP: 129/64 P:98 R: O2: on 97% General: Pale, sweaty, fatigued, with coarse tremor in both hands, but in no acute distress HEENT: Fine hair; bilateral proptosis; MMM; oropharynx clear w/o exudates; poor dentition Neck: CVL in R IJ; no thyromegaly; JVP not elevated Lungs: Clear to auscultation bilaterally w/o wheezes, crackles, ronchi CV: RRR, nl S1, S2, no murmurs Abdomen: Soft, distended but not tympanitic, +BS, tender to deep palpation without rebound or guarding GU: Foley Ext: Warm, well-perfused; DPs 2+ bilaterally Pertinent Results: [**2191-3-11**] 05:38AM BLOOD WBC-12.2* RBC-2.82* Hgb-8.7* Hct-27.7* MCV-98 MCH-31.0 MCHC-31.5 RDW-11.8 Plt Ct-528* [**2191-3-11**] 05:38AM BLOOD Plt Ct-528* [**2191-3-11**] 05:38AM BLOOD Glucose-100 UreaN-4* Creat-0.6 Na-134 K-3.6 Cl-100 HCO3-25 AnGap-13 [**2191-3-11**] 05:38AM BLOOD ALT-9 AST-15 AlkPhos-98 TotBili-0.2 [**2191-3-11**] 05:38AM BLOOD Calcium-8.1* Phos-4.1 Mg-1.1* [**2191-3-3**] 09:25AM WBC-16.2* RBC-3.33* HGB-10.8* HCT-33.2* MCV-100* MCH-32.4* MCHC-32.6 RDW-11.8 [**2191-3-3**] 09:25AM NEUTS-80.1* LYMPHS-13.5* MONOS-2.0 EOS-4.2* BASOS-0.2 [**2191-3-3**] 09:25AM PT-10.2* PTT-22.0 INR(PT)-0.8* [**2191-3-3**] 09:25AM TSH-0.76 [**2191-3-3**] 09:25AM ALBUMIN-3.4* CALCIUM-9.2 PHOSPHATE-4.9* MAGNESIUM-1.4* [**2191-3-3**] 09:25AM ALT(SGPT)-15 AST(SGOT)-27 ALK PHOS-85 TOT BILI-0.2 [**2191-3-3**] 09:25AM LIPASE-51 [**2191-3-3**] 09:25AM GLUCOSE-142* UREA N-9 CREAT-1.0 SODIUM-134 POTASSIUM-3.5 CHLORIDE-98 TOTAL CO2-16* ANION GAP-24* [**2191-3-3**] 10:32AM LACTATE-6.1* [**2191-3-3**] 10:00PM FREE T4-1.2 [**2191-3-3**] 10:52PM LACTATE-1.1 [**2191-3-4**] 05:00AM BLOOD WBC-12.4* RBC-2.81* Hgb-9.6* Hct-28.5* MCV-101* MCH-34.2* MCHC-33.8 RDW-11.1 Plt Ct-333 [**2191-3-4**] 11:32AM BLOOD WBC-12.2* RBC-2.82* Hgb-9.6* Hct-28.3* MCV-101* MCH-34.2* MCHC-34.0 RDW-11.5 Plt Ct-328 [**2191-3-5**] 04:02AM BLOOD WBC-11.6* RBC-2.82* Hgb-9.4* Hct-29.1* MCV-103* MCH-33.4* MCHC-32.3 RDW-11.8 Plt Ct-322 [**2191-3-6**] 05:36AM BLOOD WBC-11.8* RBC-2.87* Hgb-9.4* Hct-28.0* MCV-98 MCH-32.6* MCHC-33.4 RDW-11.5 Plt Ct-281 [**2191-3-6**] 02:35PM BLOOD Hct-28.1* [**2191-3-7**] 05:20AM BLOOD WBC-16.2* RBC-2.97* Hgb-9.9* Hct-29.8* MCV-100* MCH-33.3* MCHC-33.1 RDW-11.8 Plt Ct-307 [**2191-3-8**] 06:02AM BLOOD WBC-13.9* RBC-2.81* Hgb-9.0* Hct-27.2* MCV-97 MCH-32.0 MCHC-32.9 RDW-11.8 Plt Ct-297 [**2191-3-9**] 05:40AM BLOOD WBC-11.1* RBC-2.83* Hgb-9.2* Hct-27.9* MCV-99* MCH-32.3* MCHC-32.8 RDW-11.8 Plt Ct-362 [**2191-3-10**] 05:45AM BLOOD WBC-13.4* RBC-2.86* Hgb-9.1* Hct-27.9* MCV-98 MCH-31.8 MCHC-32.6 RDW-11.8 Plt Ct-476* [**2191-3-5**] 04:02AM BLOOD Neuts-86.1* Lymphs-9.3* Monos-3.5 Eos-1.0 Baso-0.1 [**2191-3-9**] 05:40AM BLOOD PT-11.9 PTT-27.4 INR(PT)-1.0 [**2191-3-3**] 09:25AM BLOOD Glucose-142* UreaN-9 Creat-1.0 Na-134 K-3.5 Cl-98 HCO3-16* AnGap-24* [**2191-3-3**] 10:00PM BLOOD Glucose-124* UreaN-13 Creat-0.6 Na-138 K-4.0 Cl-109* HCO3-20* AnGap-13 [**2191-3-4**] 05:00AM BLOOD Glucose-92 UreaN-12 Creat-0.7 Na-135 K-4.9 Cl-109* HCO3-21* AnGap-10 [**2191-3-5**] 04:02AM BLOOD Glucose-66* UreaN-5* Creat-0.5 Na-137 K-3.8 Cl-105 HCO3-21* AnGap-15 [**2191-3-6**] 05:36AM BLOOD Glucose-121* UreaN-3* Creat-0.5 Na-134 K-3.0* Cl-101 HCO3-22 AnGap-14 [**2191-3-7**] 05:20AM BLOOD Glucose-140* UreaN-3* Creat-0.5 Na-130* K-4.2 Cl-98 HCO3-23 AnGap-13 [**2191-3-8**] 06:02AM BLOOD Glucose-99 UreaN-3* Creat-0.5 Na-132* K-3.5 Cl-99 HCO3-26 AnGap-11 [**2191-3-9**] 05:40AM BLOOD Glucose-101* UreaN-3* Creat-0.6 Na-131* K-3.4 Cl-99 HCO3-27 AnGap-8 [**2191-3-10**] 05:45AM BLOOD Glucose-102* UreaN-4* Creat-0.6 Na-134 K-3.7 Cl-99 HCO3-24 AnGap-15 [**2191-3-3**] 09:25AM BLOOD ALT-15 AST-27 AlkPhos-85 TotBili-0.2 [**2191-3-4**] 05:00AM BLOOD ALT-14 AST-37 AlkPhos-57 TotBili-0.2 [**2191-3-8**] 06:02AM BLOOD ALT-11 AST-15 AlkPhos-53 TotBili-0.2 [**2191-3-9**] 05:40AM BLOOD ALT-9 AST-15 AlkPhos-62 TotBili-0.2 [**2191-3-10**] 05:45AM BLOOD ALT-11 AST-16 LD(LDH)-166 AlkPhos-114* TotBili-0.2 [**2191-3-3**] 09:25AM BLOOD Albumin-3.4* Calcium-9.2 Phos-4.9* Mg-1.4* [**2191-3-10**] 05:45AM BLOOD Albumin-2.5* Calcium-8.3* Phos-4.1 Mg-1.5* [**2191-3-3**] 09:25AM BLOOD TSH-0.76 [**2191-3-3**] 10:00PM BLOOD TSH-0.46 [**2191-3-4**] 05:00AM BLOOD TSH-0.77 [**2191-3-3**] 10:00PM BLOOD Free T4-1.2 [**2191-3-4**] 05:00AM BLOOD Free T4-1.2 [**2191-3-3**] 09:25AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2191-3-3**] 10:32AM BLOOD Lactate-6.1* [**2191-3-3**] 03:47PM BLOOD Lactate-3.3* [**2191-3-3**] 10:52PM BLOOD Lactate-1.1 [**2191-3-4**] 05:15AM BLOOD Lactate-0.7 [**2191-3-4**] 05:15AM BLOOD freeCa-1.04* CT Head ([**2191-3-3**])- FINDINGS: There is no acute hemorrhage, mass effect, edema, or infarct. The ventricles and sulci are mildly prominent, consistent with age-related volume loss. Note is made of bilateral cavernous carotid calcifications. Mucosal retention cysts are noted in the left maxillary and right sphenoid sinuses. There is opacification of a few ethmoid air cells. The remaining paranasal sinuses and mastoid air cells are clear. IMPRESSION: No acute intracranial process. CT Torso ([**2191-3-3**])- IMPRESSION: 1. Pancolitis, likely infectious or inflammatory in etiology. 2. Dilated intra and extrahepatic bile ducts, with abrupt cutoff in the visualization of the distal CBD at the level of the pancreatic head, but no gross pancreatic head mass or intraluminal lesion is visualized. Recommend MRCP for further assessment. 3. 2.8 cm right ovarian cyst, abnormal in postmenopausal female, and not seen on prior CT from [**2179**]. Recommend pelvic ultrasound to further characterize. RUQ U/S- 1. 1.9 cm measuring echogenic lesion in the posterior right lobe of the liver which was not visualized on the CT of [**2191-3-3**]. This likely represents a hemangioma, however, MRI of the liver is warranted for further workup. 2. Cholelithiasis without cholecystitis. 3. Small amount of free fluid in the anterior perihepatic space. Knee X-ray ([**2191-3-5**])- Three views of the left knee demonstrate mild medial and lateral compartmental osteoarthritis with chondrocalcinosis. There is severe osteoarthritis of the patellofemoral compartment with joint space narrowing and large osteophyte formation with subchondral cystic change. In addition, there is mild periosteal reaction of the medial aspect of the distal femur. This is of unclear etiology. There is a large joint effusion with apparent soft tissue mass within the suprapatellar region. This may be better assessed with MRI. It is unclear as to whether the periosteal reaction is reactive to the suprapatellar process. There are multiple intra-articular bodies. MRCP ([**2191-3-7**])- 1. Incomplete study prematurely terminated at the patient's request. No IV gadolinium administered. 2. Mild intra- and extra-hepatic bile duct dilatation with the common bile duct measuring up to 8-9 mm. Abrupt caliber change of the common duct at the level of the ampulla of uncertain significance. No periampullary or pancreatic mass detected. However, sensitivity of this examination is limited without contrast. Clinical correlation with symptoms and LFT values recommended, and an ERCP can be obtained for further evaluation. 3. Cholelithiasis. 4. Small bilateral pleural effusions and retroperitoneal edema related to pancolitis. 5. Left renal cysts. 6. Hiatal hernia. 7. No correlate identified to suspected echogenic lesion of the right hepatic lobe on ultrasound [**2191-3-4**]. 8. Duodenal diverticulum. EUS ([**2191-3-10**])- No mass seen Brief Hospital Course: 62yF with HTN, HLD, hypothyroidism, and diverticulosis, who presented with an episode of non-cardiogenic syncope and subsequently was found to have pancolitis on CT. #) Pancolitis: CT demonstrated bowel wall thickening and mild fat stranding throughout colon with no evidence of obstruction, perforation, or abscess. Pt with low-grade fever, leukocytosis, moderate NGT output and watery diarrhea, but benign abdominal exam. Infectious etiology suspected, viral vs bacterial pathogen. Pt initially received zosyn and flagyl for antibiotic coverage. The zosyn was switched to cipro on ICU Day 1, given low suspicion for biliary source of gut infection. C diff negative x1. Trace guaiac positive, likely [**2-1**] gut irritation vs NGT suction. Stool cultures were negative. Inflammatory etiology less likely, given no evidence of inflammation on colonoscopy one month ago. Surgery followed patient from ED, felt abdomen to be non-surgical. GI was consulted for input on infectious vs inflammatory pancolitis, specifically CT findings out of proportion to those expected with a gastroenteritis. GI initially recommended MRCP but study was limited by pain. It showed CBD dilation of 8-9mm but no discrete pancreatic mass (see below). Given this result, patient underwent EUS on [**3-10**] which did not show any mass. The study was limited by prior Bilroth I anastamosis. Patient's symptoms improved while here. She was kept on cipro and flagyl and will complete a 14 day course (last day is [**2191-3-16**]). Upon discharge, she denied diarrhea, abdominal pain. She was afebrile and tolerating a regular diet. #) Syncope: Thought to be secondary to vasovagal event (given prodromal symptoms) vs dehydration (given hypotension, poor PO intake prior to admission). A cardiac etiology was thought unlikely, given normal EKG, no tele events, no murmurs on exam, no signs of LV dysfunction on stress MIBI from [**2181**]. Patient's hypotension was corrected and she remained asymptomatic. Her BP meds were resumed slowly- first lisinopril and then verapamil daily to [**Hospital1 **]. We ask that her PCP recheck [**Name Initial (PRE) **] BP and HR on [**2191-3-18**]. #) Hypotension: Fluid responsive after 4L NS, therefore most likely [**2-1**] dehydration rather than sepsis. Pt remained normotensive on the floor. Infectious work-up was unrevealing. Patient continued on cipro and flagyl while here and will complete a 10 day course of each (last day is [**2191-3-12**]). Hypotension resolved and patient resumed on home BP meds. #) Hypoalbuminemia: On admission, albumin low at 3.4, down to 2.6 on ICU Day 1. No baseline albumin in system. This is concerning for underlying nutritional deficiency and decreased hepatic production vs protein wasting gastroenteropathy. Patient has no obvious edema on exam. Most likely due to poor nutrition in recent weeks. We ask that patient sees a nutritionist while at rehab. #) UTI: UA positive for nitrates and WBCs, the latter of which may have been [**2-1**] overwhelming inflammatory process in the gut. Pt is without dysuria or frequency. The antibiotics for presumed GI infection would also treat any UTI. Patient continued on cipro while here. Last day will be [**2191-3-16**]. #) Anemia with macrocytosis: HCT down to 28 on ICU Day 1, down from baseline 32 on admission. This may represent hemo-dilution vs GI bleeding in setting of inflamed gut. Pt was typed and screened. Pt's baseline MCV is 100. [**Month (only) 116**] be [**2-1**] folate and/or vitamin B12 deficiency, given history of nightly, if moderate, EtOH intake and possibly poor diet, though pt has had normal B12 and folate in past. Per chart, pt also has a remote history of iron deficiency anemia. Hct remained near 28-29 while here. No signs of blood in diarrhea. MCV of 98 on discharge. Patient is being discharged on daily folate and thiamine. #) Hypothyroidism: Pt carries dx of hypothyrodism but had several signs/sx of hyperthyroidism on admission, including tremor (gone the following morning), proptosis, fine hair, warm skin. TSH came back normal at 0.77. Free T4 came back normal at 1.2. Pt was continued on home dose levothyroxine 75mcg PO daily once tolerating POs. #) Pancreatic mass: Bile duct dilatation seen on CT but LFTs normal. Concern for mass in head of pancreas. This is a possible explanation for patient's history of abd pain, though pt has no other signs/sx of systemic illness, including wt loss, appetite loss, etc, and pancreatic CA would not explain patient's pancolitis. GI was consulted and patient underwent MRCP and EUS, both of which did not show pancreatic mass. Patient will follow-up with Dr. [**Last Name (STitle) **] in GI on [**2191-3-22**] at 3:00pm. #) Ovarian cyst: Seen on CT. Non-urgent outpatient evaluation recommended. #) HTN: Lisinopril and verapamil initially held in setting of hypotension. Antihypertensives were re-introduced gradually following stabilization of pt's BP. Discharged on home doses of both medications (lisinopril 20mg daily, verapamil 240mg PO BID). #) Hyperlipidemia: Pt was continue on her home dose simvastatin 20mg PO daily once tolerating POs. #) Hypomagnesium- Patient had low magnesium while here of unknown etiology. She received supplemental magnesium and responded well. She is being discharged on PO magnesium. We ask that her rehab facility checks daily magnesium and repletes as needed. #) Rash- Patient developed a rash in her groin while here that was treated with topical miconazole to which she responded well. She also had a rash on her left buttock that was noticed by nursing on [**3-9**]. Denied any itching or pain. It was slightly improved on discharge. #) Knee pain- Patient developed knee pain while here. Joint thought to be swollen. Aspirate taken- did not show signs of infection or crystal arthritis. Cultures negative. X-rays showed osteoarthritis. Pain improved with tylenol (avoided NSAIDs given recent GI symptoms). Patient worked with PT while here. By discharge, pain was drastically improved. Medications on Admission: Levothyroxine 75 mcg Tablet Verapamil 240mg PO BID Lisinopril 20mg PO daily Simvastatin 20mg PO daily ASA 81mg PO daily Ergocalciferol 1000 unit pacsulte PO daily Ferrous Gluconate 240mg PO daily Aleve 220 mg POD [**Hospital1 **]-TID Discharge Medications: 1. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 5. Ergocalciferol (Vitamin D2) 400 unit Capsule Sig: 2.5 Capsules PO once a day. 6. Ferrous Gluconate 240 mg (27 mg Iron) Tablet Sig: One (1) Tablet PO once a day. 7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 6 days: last day- [**3-16**]. Disp:*18 Tablet(s)* Refills:*0* 10. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 6 days: last day- [**3-16**]. Disp:*12 Tablet(s)* Refills:*0* 11. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 12. Calcium 600 + D(3) 600-400 mg-unit Tablet Sig: One (1) Tablet PO once a day. 13. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO once a day: until [**3-16**]. 14. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed for irritation. 15. Verapamil 240 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital1 **] - [**Location 4288**] Discharge Diagnosis: Primary: Colitis- resolved. Secondary: Hypertension, hyperlipidemia, hypothyroidism Discharge Condition: Mental Status: Clear and coherent Activity Status: Ambulatory - requires assistance or aid (walker or cane) Level of Consciousness: Alert and interactive Discharge Instructions: You were admitted to the hospital after passing out. While here, it was found that you had an inflammation of your small bowel. In addition, they found a dilation of your bile duct. The gastroenterologist team evaluated you and performed an MRCP followed by an endoscopic ultrasound, which did not show any pancreatic mass. Your symptoms improved while here and your remained hemodynamically stable. You tolerated a regular diet without difficulty. You experienced some knee pain but it improved on its own. Upon discharge, you were stable and comfortable. The following changes were made to your medications: 1. Please continue taking ciprofloxacin 500mg by mouth twice a day (last day- [**2191-3-16**]) 2. Please continue taking metronidazole 500mg by mouth three times a day (last day- [**2191-3-16**]) 3. Please START taking folic acid 1mg by mouth daily 4. Please START taking thiamine- 1 tablet by mouth daily 5. Please START taking magnesium oxide 400mg by mouth daily while on cipro and flagyl (until [**2191-3-16**]) 6. Please START taking calcium plus vitamin D daily 7. Please do not take Aleve anymore given your recent GI symptoms. Followup Instructions: Please follow-up with your primary care physician (Dr. [**First Name (STitle) 6624**] on Friday, [**2191-3-18**] at 11:00am Please follow-up with Dr. [**Last Name (STitle) **] (Gastroenterology) on [**2191-3-22**] at 3:00pm. This will be on the [**Hospital Ward Name 516**] in the [**Last Name (un) 6625**] building ([**Location (un) 448**]). You can contact him at [**Telephone/Fax (1) 463**] [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**] Completed by:[**2191-3-11**] ICD9 Codes: 5990, 2762, 4589, 4019, 2449, 2724, 2859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7303 }
Medical Text: Admission Date: [**2167-9-27**] Discharge Date: [**2167-10-2**] Date of Birth: [**2099-1-22**] Sex: F Service: [**Hospital Unit Name 196**] Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2074**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: pericardiocentesis pacer lead revision History of Present Illness: Ms. [**Known lastname **] is a 68 year old female with h/o TIAs, HTN, PAF s/p SSS s/p pacer presented to OSH with 1 week nausea, SOB, palpitations. Found to have small left pleural effusion and small pericardial effusion without tamponade. Also her atrial fibrilliation was controlled initially with amiodarone, and now she is on a diltiazem drip. Transferred to [**Hospital1 18**] for possible lead revision versus removal of pacemaker if perforation. She had slight CHF by BNP but actually sounding pretty clear on CXR. Also with transient facial numbness. Past Medical History: cardiac tamponade pericardial effusion pleural effusion atrial fibrillation tachy/ brady syndrome s/p pacemaker h/o TIA diverticulosis hypertension peptic ulcer disease Social History: Lives alone. No alcohol or tobacco. Retired. Physical Exam: 98.8, 87, 140/61, 16, 96%2L, 98.7kg Cor: irregularly irregular, normal rate, 10mmHg pulsus Chest: decreased breathsounds at L>R base with egophany. Pertinent Results: [**2167-9-28**] 02:40AM BLOOD WBC-9.9 RBC-3.10* Hgb-10.1* Hct-29.4* MCV-95 MCH-32.8* MCHC-34.5 RDW-12.9 Plt Ct-330 [**2167-9-28**] 02:40AM BLOOD Glucose-112* UreaN-20 Creat-0.9 Na-142 K-3.5 Cl-104 HCO3-26 AnGap-16 [**2167-9-29**] 01:05PM BLOOD Type-ART O2 Flow-2 pO2-69* pCO2-49* pH-7.42 calHCO3-33* Base XS-5 Intubat-NOT INTUBA Comment-NASAL [**Last Name (un) 154**] [**2167-9-29**] 01:00PM OTHER BODY FLUID WBC-5300* Hct,Fl-2.5* Polys-48* Lymphs-43* Monos-5* Eos-2* Basos-1* Mesothe-1* [**2167-9-29**] 01:00PM OTHER BODY FLUID TotProt-4.7 Glucose-82 LD(LDH)-2093 Amylase-18 Albumin-2.7 ELECTROCARDIOGRAM PERFORMED ON: [**2167-9-28**] Atrial fibrillation. Nonspecific ST-T wave changes Echo [**9-28**]: The left atrium is normal in size. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF 60-70%). Right ventricular chamber size and free wall motion are normal. Right ventricular systolic function is normal. The aortic valve leaflets (3) are mildly thickened but not stenotic. Trace aortic regurgitation is seen. Trivial mitral regurgitation is seen. There is a moderate to large sized pericardial effusion. The effusion appears circumferential. There is brief right atrial collapse. There is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling and early cardiac tamponade. A pacemaker wire is seen in the right heart [**Doctor Last Name 1754**]; the tip is at the apex of the right ventricle. Perforation cannot be excluded with certainty, but the tip of the wire was not visualized outside the epicardial surface of the heart. Impression: moderate-to-large circumferential pericardial effusion with early cardiac tamponade. Catheterization: INDICATIONS FOR CATHETERIZATION: Pericardial effusion FINAL DIAGNOSIS: 1. Successful pericardiocentesis. 2. Mild pulmonary hypertension. COMMENTS: 1. Limited resting hemodynamics prior to pericardiocentesis showed a mildly elevated pulmonary pressure (PA mean 28 mmHg). The left and right sided filling pressures were elevated and entrained in the pericardial pressure (RA mean 14 mmHg, PCW mean 19 mmHg, RVEDP 19 mmHg, Pericardium mean 15 mmHg). The cardiac output was normal (CO 4.5 l/min, CI 2.15 l/min/m2). 2. The mean right atrial and pericardial pressure after pericardiocentesis of 600 ml of fluid was 7 mmHg and 4 mmHg, respectively. Cardiac output and index were essentially unchanged (CO 5.0 l/min, CI 2.4 l/min/m2). 3. An echocardiogram after pericardiocentesis showed minimal residual fluid in the pericardium. 4. The pacemaker lead positions were confirmed with fluroscopy together with the electrophysiology team. Echo: [**10-1**] Left ventricular wall thickness, cavity size, and 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 subtending the right atrial and right ventricular free walls. The effusion is echo dense, consistent with blood, inflammation or other cellular elements. There are no echocardiographic signs of tamponade. No right atrial diastolic collapse is seen. Compared with the findings of the prior study (tape reviewed) of [**2167-9-30**], no major change is evident; a small-to-moderate sized pericardial effusion without evidence of cardiac tamponade persists. CXR: FINDINGS: Note is made of dual chamber cardiac pacemaker, with two leads, one terminating in the right atria appendage and the other one terminating in the right ventricle. No evidence of pneumothorax. Again note is made of cardiomegaly. The mediastinal and hilar contours are unchanged compared with previous study. Again note is made of bilateral pleural effusions with left lower lobe atelectasis, which is likely increased compared to prior study. Pulmonary vasculatures are within normal limits, and there is no evidence of cardiac failure. There is no suspicious lesion in skeletal structures. IMPRESSION: Cardiac pacemaker leads as described above. No pneumothorax. Cardiomegaly. Increased bilateral pleural effusion and atelectasis. Brief Hospital Course: Ms. [**Known lastname **] is a 68 yo woman who underwent pacemaker placement two weeks prior to admission, found to have subsequent pericardial and pleural effusions with moderate tamponade. She then underwent pericardiocentesis draining 600cc of fluid. Following the procedure she was observed in the CCU, where she remained stable until returning to the cardiology service a few days later. After her pericardiocentesis, she underwent pacer lead revision. A repeat Echo showed stable small to moderate effusion without evidence for tamponade. She did have bilateral pleural effusions, which were not clinically significant given that her ambulatory saturations were >90% on room air. Regarding her atrial fibrilliation, we titrated up her beta-blocker because she was tachycardic upon exertion. Cardioversion was not completed because anticoagulation is contraindicated after pericardiocentisis. Discharge Medications: 1. Citalopram Hydrobromide 20 mg Tablet Sig: Two (2) Tablet PO QD (once a day). 2. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 4. Multivitamin Capsule Sig: One (1) Cap PO QD (once a day). 5. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO QD (once a day). 6. Dorzolamide HCl 2 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO QD (once a day). 8. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 9. Keflex 500 mg Capsule Sig: One (1) Capsule PO three times a day for 3 days. Disp:*9 Capsule(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) **] Nursing Services Discharge Diagnosis: cardiac tamponade pericardial effusion pleural effusion atrial fibrillation tachy/ brady syndrome s/p pacemaker h/o TIA diverticulosis hypertension peptic ulcer disease Discharge Condition: stable Discharge Instructions: please call your doctor or go to the emergency room if you develop worsening shortness of breath Followup Instructions: with Primary care physician within one to two weeks of discharge please call your cardiologist for a follow up appointment in [**12-19**] weeks after discharge Please keep scheduled appointment with Dr [**Last Name (STitle) 1911**] ([**Telephone/Fax (1) 55291**] in [**Location (un) **]. Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 55292**] Call to schedule appointment ICD9 Codes: 4280, 5119, 4019
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Medical Text: Admission Date: [**2156-12-8**] Discharge Date: [**2156-12-20**] Date of Birth: [**2094-3-28**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 695**] Chief Complaint: ETOH Cirrhosis and HCC now s/p orthotopic liver transplant Major Surgical or Invasive Procedure: [**2156-12-8**]: Orthotopic liver transplant [**2156-12-17**]: ERCP History of Present Illness: 62 y.o. male with ETOH cirrhosis/HCC with diuretic-resistant ascites despite placement of a TIPS shunt and resultant significant hydrocele and possible inguinal hernia. He is requiring paracentesis approximately every 7 to 10 days. Last tap 2 weeks ago and was scheduled for a tap today at [**Hospital1 3325**]. Past Medical History: 1. Alcohol-related cirrhosis status post TIPS placement [**2154-10-8**] requiring dilatation [**2154-10-15**] 2. Upper GI bleeding in [**2152**]. Patient was treated at an outside hospital and it is unclear whether his upper GI bleed was secondary to esophageal varices or peptic ulcer disease. 3. Coronary artery disease status post angioplasty in the [**2129**]. 4. Diabetes mellitus type 2 diagnosed in [**2152**]. Hemoglobin A1c [**2154-10-4**] was 6.3 5. Umbilical hernia status post repair [**2154-11-3**] 6. Right knee surgery 7. Depression 8. HCC, growth [**Last Name (un) 64259**] 2.5x2.5cm confirmed on [**2156-9-8**] at the dome of the liver 9. Recurrent recent paracentesis due to refractory ascites Social History: Married with two adult sons. Formerly worked as a vice president of a trucking company. Drank from the age of 20 until [**2154-9-19**]. He never smoked. Denies IV drug use. Family History: Father and brother died of MI at the age of 52. His mother and sister have diabetes. Physical Exam: 98.3 59 123/72 20 99%RA 5'8", wt 104.8kg A&O x3, nervous, wife present anicteric sclerae, mmm, pharynx wnl, upper dentures Neck: no LAD, no TM, 2+ bilat carotids without bruits Luns: clear Cor: RRR, no murmur Abd: Large/ascites/tense, ventral hernia obvious with head to chin tuck, NT Back: R flank lipoma, no cvat tenderness GU: large Right hydrocele Vasc: 1+ femoral pulses, no bruits Ext: trace ankle edema, 2+ DPs, no cyanosis Neuro: A&O x3, no asterixis/flap, toes down Bilat. strength 5/5 bilaterally & equal, skin: [**Location (un) **] erythema Pertinent Results: On Admission: [**2156-12-8**] WBC-5.3 RBC-3.27* Hgb-10.5* Hct-29.8* MCV-91 MCH-32.1* MCHC-35.3* RDW-14.4 Plt Ct-156 PT-13.6* PTT-31.7 INR(PT)-1.2* Fibrino-486* Glucose-153* UreaN-21* Creat-1.7* Na-135 K-4.1 Cl-102 HCO3-24 AnGap-13 ALT-25 AST-43* AlkPhos-127* Amylase-50 TotBili-1.6* Lipase-44 On Discharge [**2156-12-20**] WBC-7.7 RBC-2.74* Hgb-8.4* Hct-24.3* MCV-89 MCH-30.9 MCHC-34.7 RDW-17.3* Plt Ct-182 Fibrino-271 Glucose-111* UreaN-28* Creat-1.8* Na-134 K-4.5 Cl-104 HCO3-22 AnGap-13 ALT-55* AST-22 AlkPhos-171* Amylase-84 TotBili-0.8 Lipase-114* Albumin-2.4* Calcium-7.6* Phos-2.9 Mg-1.9 Iron Studies: [**2156-12-19**] Brief Hospital Course: 62 y/o male with Hepatitis C virus cirrhosis and hepatocellular carcinoma is admitted for Orthotopic (piggyback) donor after cardiac death (DCD) liver transplant, portal vein-portal vein anastomosis, branch patch (recipient) to celiac patch (donor), common bile duct to common bile duct anastomosis (no T tube) with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Please see the operative note for surgical details. In addition it should be noted that this is a DCD donor who also was HTLV1 and HTLV2 serologically positive. Prior to surgery this was discussed in detail with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 724**] in infectious disease and Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**] in hepatology. It was determined that the risk of continued progression of his hepatocellular carcinoma and risk of complications and death from his end-stage liver disease was greater than the risk of transmission and the development of disease related to the HTLV1 and HTLV2 positivity. This was discussed with Mr. and Mrs. [**Known lastname 64260**] in great detail and informed consent was given. At the time of exploration the patient had approximately 12 liters of ascites that was cloudy and appeared chylous. It did not smell or appear grossly infected. There was no fibrin in the peritoneal cavity and no inflammation suggestive of peritonitis. The fluid was sent for Gram stain which returned 1+ polys. Cultures were sent which were returned as no growth.He was given vancomycin and Zosyn in addition to his preoperative Unasyn and in addition received routine induction immunosuppression. He had a small cirrhotic liver with normal anatomy. There was a tumor in theright lobe of the liver, but no evidence of any extrahepatic spread. The donor liver had a replaced left hepatic artery. Patient was transferred to the SICU following surgery. He was extubated on POD 2, and subsequently transferred the same day. Seen by [**Last Name (un) **] for blood glucose management. He was managing glucose at home prior to surgery with diet but will be discharged home on Lantus and a humalog sliding scale. Patient and wife received teaching and meds/syringes/supplies were ordered. On POD 6 the patient suffered a hypotensive episode with tachycardia that appeared to be AFib on telemetry. He denied chest pain, SOB or palpitations. He received a NS bolus for BP of 80/P. Cardiology was consulted. Enzymes were cycled (normal, metoprolol was continued. An Echo was performed showing an EF of 35%. In addition findings included comparison with the prior study (images reviewed) of [**2155-4-16**], showing the regional left ventricular systolic dysfunction is new and c/w interim ischemia/infarction (mid-LAD distribution). No anticoagulation ws recommended, Metoprolol was increased to 25 [**Hospital1 **]. On POD 4 the medial drain started with more output and a drain bili was sent with a result of 7.7. A CT was done showing no drainable collections. After the patient fall he had an U/S of the liver done to evaluate blood flow which was normal. This output was followed for several days, and output was replaced with albumin for each liter of output. When no relief of drainage, patient was sent for an ERCP on [**12-17**] (POD 9) Cholangiogram showed leak of contrast at the anastomotic site of the [**Last Name (un) 28791**] and native bile duct and a 9cm by 10F Cotton [**Doctor Last Name **] biliary stent was placed successfully across the anastomotic leak site. Patient did have post ERCP pancreatitis, which was treated with continued clears for an additional day. By POD 11 he was tolerating regular diet and the amylase and lipase normalized. On POD 12 (day of discharge) the final drain was removed and suture placed. He will go home with VNA for help with medications and blood sugar management as this is a new therapy for him. Medications on Admission: Celexa 40', Furosemide 80', Spironolactone 25', Flomax 0.4', Oxycodone 5'hs, Lactulose PRN, Discharge Medications: 1. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 2. Prednisone 5 mg Tablet Sig: Four (4) Tablet PO once a day for 3 days: Follow Prednisone Taper per transplant clinic guidelines. 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): Continue as long as taking pain medication and as needed. Disp:*60 Capsule(s)* Refills:*2* 4. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID PRN as needed for constipation. Disp:*60 Tablet(s)* Refills:*0* 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 11. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* 12. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 13. Insulin Glargine 100 unit/mL Solution Sig: Twenty (20) units Subcutaneous at bedtime: Then continue sliding scale Humalog. 14. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO twice a day. 15. Tacrolimus 0.5 mg Capsule Sig: One (1) Capsule PO twice a day: Total 2.5 mg [**Hospital1 **]. Discharge Disposition: Home With Service Facility: [**Location (un) 6138**] Home Care Services Discharge Diagnosis: ETOH cirrhosis and HCC now s/p liver transplant Discharge Condition: Good Discharge Instructions: Call the transplant office at [**Telephone/Fax (1) 673**] if you experience any of the following symptoms: fever > 101, chills, nausea, vomiting, diarrhea, inability to eat, or inability to take or keep down medications. Monitor for pain over the incision site or liver, yellowing of the skin or eyes, an increase in abdominal girth. Monitor incision for redness, drainage or bleeding. Do not drive if you are taking narcotics. Take your medications exactly as directed. No heavy lifting You may shower, pat incision dry Have labs drawn every Monday and Thursday and have them faxed to [**Telephone/Fax (1) 697**]. CBC, Chem 10, AST, ALT, Alk Phos, Albumin, T Bili and trough Prograf Level Followup Instructions: Please call [**Telephone/Fax (1) 673**] for appointment with Dr [**Last Name (STitle) **] on Wednesday [**12-22**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**] Completed by:[**2156-12-20**] ICD9 Codes: 9971, 3572, 4280
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Medical Text: Admission Date: [**2150-2-18**] Discharge Date: [**2150-3-10**] Date of Birth: [**2124-5-17**] Sex: M Service: CARDIOTHORACIC Allergies: Hurricaine Attending:[**First Name3 (LF) 5790**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: Thoracentesis [**2150-2-19**] Bronchoscopy, Right VATS with lung decortication and chest tube placement [**2150-2-20**] Bronchoscopy, Right VATS, evacuation of hematoma [**2150-2-25**] Transesophageal Echocardiogram [**2150-3-6**] History of Present Illness: This is a 25 year old gentleman with a history of IV drug abuse who presented to [**Hospital1 **] [**Location (un) 620**] on [**2150-2-17**] with 2 weeks of pleuritic chest pain and was found to have a large right-sided pleural effusion and a left lower lobe infiltrate. The patient reports pain with deep inspiration and coughin. He describes chills. He has no prior history of pneumonia or pulmonary problems. At [**Name2 (NI) **] he was febrile to a temp of 102 and cultures were drawn; he was started empirically on ceftriaxone and zithromax. He became progressively hypoxic to 88 on room air (up to 95% on 4 liters). A thoracentesis was performed but failed and his effusion worsened. Past Medical History: Depression Polysubstance Abuse Suicidal Ideation Motor Vehicle Accident Social History: The patient has a history of IV heroin and cocaine use. He smokes 4 packs of tobacco/week. He completed some community college. He lives with his mother in [**Name (NI) 932**], MA. He is working in construction. Family History: Noncontributory Physical Exam: ON admission: v/s 101.8, 148/66, pulse 120 sinus, 27, 93% on 4 L Gen: answering questions appropriately, falling asleep (sedatives on-board) HEENT: PERRL, EOMI, MMM Neck: no LAD CV: sinus tachycardia, no murmur Chest: poor inspiratory effort, bronchial breath sounds at right base, crackles at left base Abd: soft, + BS, nontender Extr: warm, 2+ DP, no edema Neur: CN 2-12 grossly intact, strength 5/5 throughout Pertinent Results: SEROLOGIES [**2150-2-18**] 09:41PM BLOOD WBC-24.4* RBC-4.19* Hgb-12.3* Hct-34.5* MCV-82 MCH-29.5 MCHC-35.8* RDW-13.0 Plt Ct-354 [**2150-2-19**] 06:45PM BLOOD WBC-18.3* RBC-3.21* Hgb-9.8* Hct-27.0* MCV-84 MCH-30.4 MCHC-36.1* RDW-13.2 Plt Ct-276 [**2150-2-19**] 11:53PM BLOOD WBC-20.5* RBC-3.74* Hgb-11.0* Hct-31.3* MCV-84 MCH-29.4 MCHC-35.1* RDW-13.1 Plt Ct-349 [**2150-2-23**] 10:40AM BLOOD WBC-12.9* RBC-2.97* Hgb-9.2* Hct-24.9* MCV-84 MCH-30.9 MCHC-36.9* RDW-13.1 Plt Ct-500* [**2150-2-26**] 03:29PM BLOOD WBC-16.6* RBC-2.90* Hgb-8.7* Hct-24.4* MCV-84 MCH-30.1 MCHC-35.9* RDW-13.5 Plt Ct-571* [**2150-3-6**] 06:00AM BLOOD WBC-12.7* RBC-3.50* Hgb-9.9* Hct-29.0* MCV-83 MCH-28.3 MCHC-34.1 RDW-13.4 Plt Ct-592* [**2150-3-7**] 10:00AM BLOOD WBC-10.5 RBC-3.36* Hgb-9.6* Hct-27.8* MCV-83 MCH-28.6 MCHC-34.5 RDW-13.4 Plt Ct-541* [**2150-3-8**] 04:35AM BLOOD WBC-9.6 RBC-3.56* Hgb-10.5* Hct-29.3* MCV-82 MCH-29.4 MCHC-35.8* RDW-13.3 Plt Ct-474* [**2150-2-18**] 09:41PM BLOOD PT-14.3* PTT-35.3* INR(PT)-1.4 [**2150-2-20**] 01:58AM BLOOD PT-13.6* PTT-33.2 INR(PT)-1.2 [**2150-3-5**] 11:46AM BLOOD Fibrino-738* [**2150-3-6**] 06:00AM BLOOD Fibrino-767* [**2150-3-6**] 09:00AM BLOOD Eos Ct-490* [**2150-2-21**] 01:16PM BLOOD Ret Aut-1.0* [**2150-2-18**] 09:41PM BLOOD Glucose-123* UreaN-8 Creat-0.7 Na-132* K-4.0 Cl-96 HCO3-26 AnGap-14 [**2150-2-19**] 06:45PM BLOOD Glucose-97 UreaN-7 Creat-0.6 Na-134 K-4.0 Cl-97 HCO3-28 AnGap-13 [**2150-2-20**] 01:58AM BLOOD Glucose-119* UreaN-9 Creat-0.6 Na-135 K-3.8 Cl-97 HCO3-29 AnGap-13 [**2150-3-6**] 06:00AM BLOOD Glucose-89 UreaN-21* Creat-1.8* Na-142 K-4.8 Cl-103 HCO3-26 AnGap-18 [**2150-3-7**] 10:00AM BLOOD Glucose-91 UreaN-23* Creat-1.8* Na-140 K-4.5 Cl-104 HCO3-26 AnGap-15 [**2150-3-8**] 04:35AM BLOOD Glucose-104 UreaN-24* Creat-1.7* Na-141 K-4.2 Cl-104 HCO3-26 AnGap-15 [**2150-2-18**] 09:41PM BLOOD ALT-13 AST-17 LD(LDH)-197 AlkPhos-75 TotBili-0.6 [**2150-2-18**] 09:41PM BLOOD Albumin-3.5 Calcium-9.1 Phos-3.9 Mg-1.7 [**2150-2-19**] 06:45PM BLOOD Albumin-3.3* Calcium-8.9 Phos-4.3 Mg-1.8 [**2150-2-21**] 01:16PM BLOOD Calcium-8.1* Phos-3.8 Mg-1.9 Iron-10* [**2150-2-20**] 01:58AM BLOOD VitB12-714 Folate-7.2 [**2150-2-21**] 01:16PM BLOOD calTIBC-183* Ferritn-465* TRF-141* [**2150-2-20**] 01:58AM BLOOD TSH-2.7 [**2150-3-6**] 09:00AM BLOOD C3-210* C4-50* [**2150-2-26**] 05:13PM BLOOD HIV Ab-NEGATIVE [**2150-2-22**] 06:00AM BLOOD Vanco-7.2* [**2150-2-22**] 09:02PM BLOOD Vanco-4.4* [**2150-2-28**] 08:34PM BLOOD Vanco-18.5* [**2150-3-2**] 04:34PM BLOOD Vanco-24.2* [**2150-3-4**] 09:45AM BLOOD Vanco-17.4* RADIOLOGY: [**2150-2-18**] CXR: There is a large right pleural effusion. Cannot exclude loculation and decubitus chest radiograph could be performed if indicated. The large pleural effusion obscures the detail of the lung parenchyma. The left lung demonstrates only mild atelectasis of the left base. No focal consolidations of the left lung is seen. The pleural effusion is causing mass effect and mild shift of the mediastinal structures to left side. There is no evidence of pneumothorax. [**2150-2-19**] CT Chest: 1) Massive right-sided pleural effusion, with associated atelectasis of the entire right lung. No hematocrit level. No particular loculations are seen, and the density attenuation values are at the upper limits of normal for simple fluid. Empyema should be considered in patient with history of IVDA. Differential diagnosis includes TB, malignancy, and trauma (no evidence of active or recent bleeding). 2) Left-sided peripheral ground glass opacities are likely infectious. Septic emboli should be considered given history of IVDA. [**2150-2-23**] CT Chest: 1. Interval placement of two right-sided chest tubes, as detailed above, with decrease in size of massive right-sided effusion. 2. Residual loculated fluid collections within the right hemithorax as detailed above with higher attenuation collections near the right lung apex, which could represent areas of hemothorax. 3. Small focal area of consolidation in the left lung base medially, which could represent an area of rounded atelectasis or small developing infiltrate. [**2150-2-27**] Renal US: . No evidence of hydronephrosis. 2. Large kidneys bilaterally with relatively echogenic cortices. [**2150-3-4**] Ultrasound: No evidence of DVT in either lower extremity. [**2150-3-6**] TEE: A catheter is seen in the right atrium that extends to the tricuspid annulus. There is no associated thrombus/vegetation. No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses and cavity size are normal. Overall left ventricular systolic function is low normal (LVEF 50-55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. No masses or vegetations are seen on the aortic valve. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. No mass or vegetation is seen on the mitral valve. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. A TEE procedure related complication occurred (see comments for details). IMPRESSION: Low normal LV systolic function with mild mitral regurgitation. Mild mitral regurgitation with normal valve morphology. No definite evidence of endocarditis. PATHOLOGY: Pleural rind": - Scant fibroadipose tissue and granulation tissue with abundant fibrinopurulent exudates. - No malignancy identified. MICROBIOLOGY: [**2150-2-19**] Pleural fluid culture: negative [**2149-2-20**] Bronchial Fluid culture: negative Brief Hospital Course: This is a 25 year old gentleman with polysubstance abuse who presented from [**Hospital1 18**] [**Location (un) 620**] with fevers and a large right pleural effusion that was not drainable via thoracentesis. He was admitted to the medical intensive care unit. He was started on broad-spectrum antibiotics. Ultrasound-guided thoracentesis was performed on admission but was unsuccessful in draining adequate fluid. Thoracic surgery was consulted and the pateint underwent a VATS with mechanical pleurodesis and placement of a chest tube and [**Doctor Last Name 406**] drain on [**2150-2-19**] (please see the operative note of Dr. [**Last Name (STitle) **] for full details). Infectious disease consultation was obtained and the patient was started on Zosyn and Vancomycin; AFB and sputum cultures were sent but were negative. Given the patient's aggitation on admission and substance abuse history, psychiatric consultation services were obtained and recommended refraining from benzodiazepenes and Haldol/Seroquel prn. On post-operative day 4 a CT scan revealed worsening effusion and the patient again was taken for VATS with evacuation of hemothorax. He did well post-operatively with no pain-related or respiratory complications. A Trans-esophageal echocardiogram was performed on [**2150-3-3**] but discontinued secondary to hypoxia from meth-hemoglobinemia; a repeat TEE performed on [**2150-3-7**] revealed no evidence of endocarditis. The patient developed a rise in his creatinine around this time and Renal consultation was obtained; it was thought that he developed acute interstitial nephritis from his antibiotics and the Vancomycin was discontinued. He remained afebrile with the Zosyn and his leukocytosis resolved. His [**Doctor Last Name 406**] drain was changed to a Heimlich valve on [**2150-3-5**]. His chest-tube was removed on [**2150-3-6**] and his [**Doctor Last Name 406**] drain on [**2150-3-8**]. A PICC was placed for outpatient continuation of his 4 weeks of antibiotics. Because of the patient's substance abuse history, he was not deemed a candidate for home antibiotic therapy and a rehabilitation hospital was found for him. He was discharged with continuation of his inpatient medications and planned follow-up with thoracic surgery, infectious diseases, and psychiatry. All questions were answered to his satisfaction upon discharge. Medications on Admission: Motrin Discharge Medications: 1. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*30 Tablet(s)* Refills:*0* 2. Senna Oral 3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 4. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q2-3 PRN () as needed for pain. 6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml Injection [**Hospital1 **] (2 times a day). 8. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO QID (4 times a day) as needed for prn agitation. 9. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift 10. Haloperidol 5 mg IV Q4H:PRN agitation 11. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: 4.5 g Recon Solns Intravenous Q8H (every 8 hours): Continue for total of 4 weeks, through [**2150-3-24**]. 12. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN 10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units heparin) each lumen Daily and PRN. Inspect site every shift. 13. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift Discharge Disposition: Extended Care Facility: [**Hospital6 2222**] - [**Location (un) 538**] Discharge Diagnosis: Primary: Right-sided hemothorax Secondary: polysubstance abuse, depression, acute renal failure from interstitial nephritis Discharge Condition: Tolerating POs. Good pain control. Afebrile. Discharge Instructions: Take all medications as prescribed. You should call the office with any worsening shortness of breath or chest pain, or fevers to 102. Only take narcotics as necessary for pain control, and note that they can cause confusion and nausea. You may shower and resume your regular diet and physical activity, but refrain from strenuous activity for 3 weeks. Please call with any questions. Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4340**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2150-3-24**] 11:30 [Infectious [**Hospital 2228**] Clinic] You should follow-up in the office with Dr. [**First Name (STitle) **] [**Name (STitle) **] (thoracic surgery) within 2 weeks-- call for an appointment at a time of your convenience at [**Telephone/Fax (1) 170**] Follow-up with your outpatient psychiatrist (Dr. [**Last Name (STitle) 64786**] [**Telephone/Fax (1) 64787**]) within 2 weeks. Completed by:[**2150-3-9**] ICD9 Codes: 486, 5845, 2859
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Medical Text: Admission Date: [**2129-3-17**] Discharge Date: [**2129-3-23**] Date of Birth: [**2101-10-19**] Sex: M Service: UROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 824**] Chief Complaint: 27 yoM otw healthy male who presents from OSH bladder perforation Major Surgical or Invasive Procedure: Repair Bladder perforation History of Present Illness: 27 yoM otw healthy male who presents from OSH with peritoneal sxs, WBC 27, intraperitoneal fluid collection, and extraperitoneal urine leak. Mr. [**Known lastname 1356**] [**Last Name (Titles) 5058**] this AM with dark urine and severe abdominal pain radiating into L groin. OSH work-up revealed WBC 27 (18% bands), UA suspicious for UTI, and CT with air around SVs. Foley was placed and patient was transferred to [**Hospital1 **] where follow-up CT revealed increasing size in intraperitoneal fluid collection, and posterior bladder/urethra urine leak on cystogram. Patient has been given morphine with some relief of pain. History notable for fall one month ago(he was pushing [**Female First Name (un) 72809**] up ramp, ramp broke, and he fell onto the handlebar of the [**Female First Name (un) 72809**] from a hight of 4 feet - handlebar hit his scrotum) He noted injury to right anterior scrotum, requiring dermabond closure in ED. Per patient report, has healed well. Patient reports increased frequency (q1hr) and nocturia (1-2x per night) that has started recently (unsure exactly when). He denies hematuria/pneumaturia/fecaluria. No incontinence. No history of kidney stones. Past Medical History: none, no prior surgeries or hospitalizations Social History: Works in construction Family History: noncontributory Physical Exam: alert, nad rrr, cta abd s/nt/nd incision cdi, no evidence of infection foley in place, fastened, draining clear urine Pertinent Results: ....RADIOLOGY [**3-17**] CT Urogram: IMPRESSION: 1. On delayed imaging (301B:24), there is evidence of a superoposterior leak within the bladder, close to the site of junction with prostatic urethra, with active but relatively contained extravasation from this site. This finding suggests that the significant free intrapelvic fluid represents urine ascites. There is no foreign body identified within this site, though this would be an unusual site of post-traumatic rupture. 2. No abnormality within the ischiorectal fossa fat and there is no intrinsic abnormality within the rectosigmoid region to specifically suggest rectal or other bowel injury or fistula to bladder. 3. Two non-calcified pulmonary nodules noted in the right base. In the absence of known malignancy recommend one-year follow up to ensure stability. COMMENT: These findings are most suggestive of a relatively acute bladder rupture or perforation, with significant intra- and and small extraperitoneal (retroperitoneal) components, given the minute air bubbles in the seminal vesicles and ventral to the psoas muscle. There is no evidence of involvement of the extraperitoneal space of Retzius. . [**3-20**] CT Urogram: IMPRESSIONS: 1. Superior posterior bladder leak, in the same position as on the prior examination. The extravasation appears, given technique, less than before. 2. Bilateral atelectasis and/or airspace disease. . [**3-21**] CT Cystogram: IMPRESSION: Findings are consistent with extravasation of contrast from the superoposterior aspect of the bladder. Contrast remains between the bladder and the seminal vesicles. There is no evidence of intraperitoneal extravasation of contrast. Findings are similar to those described on the CT scan performed approximately 12 hours earlier. Brief Hospital Course: Given the CT findings Mr. [**Known lastname 1356**] [**Last Name (Titles) 1834**] an uncomplicated repair of bladder perforation. He was kept in ICU on first day for close observation. His post-op course was uneventful. After surgery, patients WBC continued to fall and his pain resolved. He was extubated on POD1 and his pain was conrolled with a dilaudid PCA. His diet was advanced on POD2 and he was started on oral pain medications. On POD3 he was transferred out of the SICU to 12 [**Hospital Ward Name 1827**]. However, he was noted on POD3 to have increasing abdominal pain. A CT urogram was done on [**3-20**] which showed on intraperitoneal leak and only a small retroperitoneal leak. This was confirmed with a CT urogram on [**3-21**]. He continued to be stable and his pain improved over the next several days. On POD6 his JP drain was removed and he was discharged home with a catheter in place, on a 10 day course of ciprofloxacin. He will follow up with Dr. [**Last Name (STitle) 770**] as an outpatient in 1 week. Medications on Admission: none Discharge Medications: 1. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 2. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours) as needed for pain. 3. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical QID (4 times a day): apply to tip of penis while catheter is in. 4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q 24H (Every 24 Hours) as needed for constipation. 5. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: continue while taking percocet. 6. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO once a day: do not take at the same time as milk of mag. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Bladder perforation Discharge Condition: Stable Discharge Instructions: Call if you develop fever greater than 101.5 or new nausea or vomiting. Call if your incision becomes more red or has new drainage. Call your doctor [**First Name (Titles) **] [**Last Name (Titles) 9140**] pain not controlled by pain medications. You may shower, but no hot tubs/swimming for 2 weeks. Shower daily and clean any debris of the catheter. No lifting greater than 15 pounds until follow up. The catheter and staples will be removed at your follow-up appointment. Continue the ciprofloxacin until your follow up appointment. Followup Instructions: Call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office to arrange follow-up in [**11-23**] weeks. ([**Telephone/Fax (1) 7707**] Completed by:[**2129-3-23**] ICD9 Codes: 5990, 5180
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Medical Text: Admission Date: [**2156-1-10**] Discharge Date: [**2156-1-19**] Date of Birth: [**2071-4-23**] Sex: M Service: MEDICINE Allergies: Robitussin Pediatric / Hytrin / Hydrochlorothiazide Attending:[**First Name3 (LF) 2763**] Chief Complaint: Fall Major Surgical or Invasive Procedure: HD line placement, intubation History of Present Illness: 84 year old male with hx of HTN, CVA, cirrhosis, known ascites, presents s/p fall. Patient says that he got up from his couch, felt unsteady, and fell on his right shoulder and back. Says he may have felt a little dizzy prior to falling, but is not sure. The fall was unwitnessed. Patient doesn't think that he hit his head or lost consciousness, but son reported that there was LOC. He had had a beer and a sip of brandy prior to getting up off the couch. He's had [**4-3**] other falls in the past. The most recent of which was 1 week ago. Says that he had gotten his foot caught on the carpetting and fell. Has felt slightly weaker in the past week. Denies chest pain, SOB, palpitations, n/v. . Patient also complains of having diarrhea off and on. He had diarrhea starting this morning, saying that he's had [**1-14**] episodes of diarrhea already. Last incidence of diarrhea was about 1-2 weeks prior to this one. Denies any fevers, abdominal pain, nausea, vomiting. . In the ED, a bedside abdominal ultrasound was done to check for abdominal bleeding, which returned positive. This prompted a CT of the torso which showed no bleed. He received 2 L of fluids in the ED for a lactate of 2.2. Lactate improved to 0.9. Orthostatics reported to be normal. He was also noted to be hyponatremic at 125. . On the floor patient is feeling comfortable. Not complaining of anything other than a little soreness in his shoulder and back from where he fell. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, constipation or abdominal pain. No dysuria. Denied arthralgias or myalgias. Past Medical History: HTN BPH h/o ascites CVA - [**2140**] visual field loss right eye. ?amaurosis. By report, no etiol found. [**4-8**] ? h/o one week of right facial weakness. Subtle asymmetry on exam. Began ASA. Carotid U/S shows <40% stenosis bilat. [**8-8**] branch retinal artery occlusion, Rx conservatively (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 23333**]). Previous w/u for embolic source neg. Resumed ASA. Cirrhosis - [**8-7**] U/S suggestive of fibrosis Allergic rhinitis B12 deficiency anemia EtOH abuse Social History: Drinks 5 beers and has a "couple of shots" of brandy a day, 12 pack year smoking hx quit [**2103**]. Retired, worked as a police officer Recently widowed Family History: Sister had rectal cancer, brother with a history of brain cancer. Physical Exam: On admission: Vitals: 98.1, 174/87, 81, 20, 100%4L General: AAOx3, NAD HEENT: PERRLA, EOMI, OP clear, no JVD, no LAD, neck supple Lungs: slight dullness to auscultation in right lower lobe, otherwise clear breath sounds, no w/r/r CV: S1S2, RRR, no m/r/g Abd: soft, distended, +ascites, nontender, +BS Ext: no e/c/c, 1+ peripheral pulses Neuro: no nystagmus, CN II-XII grossly intact, 5/5 strength throughout, good coordination On discharge: Pertinent Results: [**2156-1-10**] 02:50PM GLUCOSE-94 UREA N-14 CREAT-1.5* SODIUM-125* POTASSIUM-4.3 CHLORIDE-93* TOTAL CO2-19* ANION GAP-17 [**2156-1-10**] 02:50PM ALT(SGPT)-13 AST(SGOT)-38 ALK PHOS-204* TOT BILI-0.4 [**2156-1-10**] 02:50PM ETHANOL-25* [**2156-1-10**] 02:50PM WBC-6.7 RBC-3.82* HGB-10.5* HCT-31.3* MCV-82 MCH-27.5 MCHC-33.6 RDW-15.1 [**2156-1-10**] 02:50PM PT-13.2 PTT-29.4 INR(PT)-1.1 [**2156-1-10**] 02:55PM LACTATE-2.2* [**2156-1-19**] 02:42AM BLOOD Hct-18.2*# [**2156-1-19**] 09:42AM BLOOD Hct-26.7* [**2156-1-19**] 05:44AM BLOOD PT-22.8* PTT-57.0* INR(PT)-2.2* [**2156-1-19**] 03:24AM BLOOD Glucose-105* UreaN-75* Creat-5.7* Na-131* K-4.7 Cl-97 HCO3-17* AnGap-22* [**2156-1-19**] 03:24AM BLOOD ALT-11 AST-24 LD(LDH)-145 AlkPhos-134* TotBili-5.9* DirBili-4.5* IndBili-1.4 [**2156-1-19**] 03:24AM BLOOD Albumin-3.3* Calcium-7.5* Phos-3.9 Mg-2.1 [**2156-1-19**] 05:47AM BLOOD Type-ART Temp-35.5 pO2-146* pCO2-33* pH-7.30* calTCO2-17* Base XS--8 Intubat-INTUBATED Micro: [**2156-1-19**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-PRELIMINARY INPATIENT [**2156-1-19**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-18**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-17**] MRSA SCREEN MRSA SCREEN-PENDING INPATIENT [**2156-1-17**] Rapid Respiratory Viral Screen & Culture Respiratory Viral Culture-FINAL; Respiratory Viral Antigen Screen-FINAL INPATIENT [**2156-1-17**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-16**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-16**] URINE Legionella Urinary Antigen -FINAL INPATIENT [**2156-1-15**] Rapid Respiratory Viral Screen & Culture Respiratory Viral Antigen Screen-FINAL; Respiratory Viral Culture-FINAL INPATIENT [**2156-1-15**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-14**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL INPATIENT [**2156-1-14**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-14**] BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2156-1-13**] PLEURAL FLUID GRAM STAIN-FINAL; FLUID CULTURE-FINAL; ANAEROBIC CULTURE-PRELIMINARY INPATIENT [**2156-1-13**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL INPATIENT [**2156-1-13**] PERITONEAL FLUID GRAM STAIN-FINAL; FLUID CULTURE-FINAL; ANAEROBIC CULTURE-PRELIMINARY INPATIENT [**2156-1-13**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2156-1-13**] BLOOD CULTURE Blood Culture, Routine-FINAL {STAPH AUREUS COAG +}; Anaerobic Bottle Gram Stain-FINAL; Aerobic Bottle Gram Stain-FINAL INPATIENT [**2156-1-12**] URINE URINE CULTURE-FINAL INPATIENT [**2156-1-12**] BLOOD CULTURE Blood Culture, Routine-FINAL {STAPH AUREUS COAG +}; Aerobic Bottle Gram Stain-FINAL; Anaerobic Bottle Gram Stain-FINAL INPATIENT SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | CLINDAMYCIN-----------<=0.25 S ERYTHROMYCIN----------<=0.25 S GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- 0.25 S OXACILLIN------------- 0.5 S TRIMETHOPRIM/SULFA---- <=0.5 S [**2156-1-10**] STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B TEST-FINAL INPATIENT [**2156-1-10**] BLOOD CULTURE Blood Culture, Routine-FINAL EMERGENCY [**Hospital1 **] Brief Hospital Course: MEDICAL FLOORS COURSE: Mr [**Known lastname 23334**] is an 84 M with HTN, h/o prior CVA, EtOH abuse who presented s/p fall, subsquently found to have MSSA bacteremia, SBP and transuduative pleural effusion; transferred to MICU on [**1-17**] with altered mental status. . # Fall. Per report appears to have syncopized in setting of hypovolemia (poor PO intake as well as diarrhea in days preceding hospitalization). No indication of seizure activity (no incontinence, no post-itcal state) No evidence of cardiac cause as telemetrey monitored without evident, biomarkers negative. CT head: negative. . # Cirrhosis/ascites/sbp. Regarding risk factors patient with known h/o EtOH abuse as well as hep B infection which had been cleared based on serologies. Hep C negative. Patient without formal diagnosis of cirrhosis in past though hypothesized due to [**2153**] US with nodular liver characterized. On admission physical patient with signs of cirrhosis: tense peri-hepatic ascites, bilateral peripheral edema, splenomegaly, spider angiomas, Duputrons contractures. Diagnostic paracentitis performed with peritoneal fluid consistent with SBP. Patient started on ceftriaxone which was later switched to cipro/flagyl. Patient received albumin per SBP protocal. Liver consulted for assistance in management. Due to preserved synthetic function there was question regarding etiology of ascites ? cirrhosis vs cardiac however [**Year (4 digits) **] demonstrated preserved systolic function with EF>55%. RUQ US obtained which demonstrated nodular hepatic architecture, no focal liver lesion, no biliary dilatation, mild splenomegaly, no e/o portal vein thrombosis. . # Cough. Patient with 3-4months of productive cough which he attributed to allergies. Admission CT with moderate right pleural effusion with adjacent compressive atelectasis. Patient found to be dyspneic on Day 2. Diuresis with IV Lasix 20mg attempted without improvement of symptoms. Decision made to proceed with diagnostic and therapeutic thoracentitis. Fluid consistent with exudate ?parapneumonic. Urine legionella negative. Repeat CXR with improved effusion with RLL opacity: atelectasis/fluid though underlying consolidation could not be ruled out. Patient initially treated for commmunity-acquired pneumonia with ceftriaxone and azithromycin. ID consulted. In setting of multiple infections drug regimen transitioned to naficillin, azithromycin, cipro/flagyl. Due to nature of cough concern for pertussis for which the patient was placed in isolation and treated with a 5day course of azithromycin. . # MSSA bacteremia. Patient spiked a fever on [**1-12**]. Cultures with gram positive cocci. Patient initially placed on vancomycin. Switched to nafcillin when speciated out to MSSA on [**1-14**]. ?Source: endocarditis vs skin source as patient with several areas of excoriation on forearm and shins. TEE ordered however patient unable to tolerate procedure to examine for vegatations. Physical on the floor notable for stable, unchanged murmur, negative for additonal exam findings consistent with endocarditis. ID consulted. Recommended treating with IV Nafcillin for likely 6weeks as endocarditis could not be ruled out. . # Acute kidney injury. Patient with baseline chronic kidney disease with creatinine at baseline 1.6. On admission, creatinine 1.6. Bump in creatinine from 1.6 -> 2.2 noted on [**1-14**]. Urine labs notable for negative eosinophilia, lytes notable for Fena<.1 consistent with pre-renal vs hepatorenal syndrome. Renal US negative for hydronephrosis ruling out post-renal obstruction. Primary team concerned for hepatorenal syndrome. Liver and renal consulted for question hepatorenal syndrome especially in setting of SBP. At that time patient without signs of decompensated liver failure via laboratory data. Patient continued on albumin. Octreotide and midodrine were not started. Renal suggested fluid challenge of 1-2L to rule out pre-renal etiology also question contrast-induced nephropathy as patient received CTA on [**1-10**]. Unable to spin urine to assess for presence of casts. Patient did not respond appropriately to fluids and became anuric on [**1-16**]. Decision made to place a HD catheter on [**1-16**] in anticipation of renal replacement. . # HTN - Patient continued on home amlodipine and atenolol on admission. Atenolol switched to [**Hospital1 **] metoprolol in setting of [**Last Name (un) **]. . # Diarrhea. Per report patient with multiple episodes of diarrhea on day prior to admission. C. diff negative and stool studies negative in house. Diarrhea resolved in house. # h/o CVA. Residual deficits: mild dysarthria. CT head negative on admission for new stroke. Patient continued on ASA on the floor. . MICU course: 1. Altered Mental Status: Patient was initially transferred to MICU for concern of stroke, though upon discussion with neuro and radiology, imaging did not suggest this. Seizure not suspected. More likely toxic metabolic in the setting of liver failure, multiple infections, renal failure, SBO, and GI bleed. Patient intubated on early morning of [**1-19**] for airway protection in setting of AMS. 2. Sepsis: Patient known to have MSSA bacteremia of unclear source (negative [**Name (NI) **], refused TEE), for which he had been on vancomycin-->nafcillin. Also with SBP, treated with ceftriaxone-->cipro/flagyl. Patient hypothermic and hypotensive to systolic pressures in 60's in MICU. Also ? evidence of retrocardiac opacity on CXR. Would have broadened treatment to cover for HCAP but family soon after decided not to pursue aggressive measures. Transiently on peripheral dopamine before family decided to make patient CMO. 3. Acute drop in hematocrit: Patient noted to have 10 point Hct drop from evening of [**1-18**] to [**1-19**], also in setting of coagulopathy (due to liver failure versus early DIC). He received a total of 3 units PRBC and 1 bag of FFP. NG lavage with blood tinged fluid, no gross blood. No plans to scope for GI bleed in setting of critical illness and multiorgan failure by AM of [**1-19**]. 4. Acute renal failure: Thought initially to be due to contract induced nephropathy, though urine sediment never obtained as pt was oliguric during MICU stay. Urine lytes with Na<10, certainly possible that he developed HRS in the setting of SBP and acute liver decompensation. CVVH was not pursued based on goals of care discussion. 5. Liver failure: Patient with e/o cirrhosis given nodularity of liver and splenomegaly on ultrasound, in addition to presence of ascites. On admission bilirubin 0.4 and INR 1.1, which progressed to bilirubin peaking at 7 and INR peaking at 2.5, suggesting acute liver decompensation. Possible precipitants may have been sepsis causing cholestatic picture versus antibiotic effect (ceftriaxone, nafcillin) in a poor substrate. Patient not a candidate for transplant per liver team given critical illness and multiorgan failure. 6. Goals of care discussion: Per discussion with HCP, son, [**Name (NI) **], patient was full code for first 24 hours of course in MICU. On [**1-19**], family meeting held with 3 children including HCP, and given critical illness/multiorgan failure as well as low likelihood of meaningful recovery, patient was made comfort measures only at 10am on [**2156-1-19**] and expired later in the day. Medications on Admission: amlodipine 5 mg daily atenolol 100 mg daily finasteride 5 mg daily Vitamin B12 ASA 81 mg daily Iron supplement Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: expired Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2764**] ICD9 Codes: 486, 5845, 5180, 2761, 2762, 5715, 5859, 4280, 2875
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Medical Text: Admission Date: [**2170-2-7**] Discharge Date: [**2170-2-11**] Date of Birth: [**2170-2-7**] Sex: M Service: NEONATOLOG HISTORY OF PRESENT ILLNESS: Baby [**Name (NI) **] [**Known lastname 46344**] [**Known lastname 4249**] delivered at 35 and 5/7 weeks gestation weighing 2,845 grams and was admitted to the Intensive Care Nursery around three hours of age for management of respiratory distress. estimated date of delivery of [**2170-3-9**]. Prenatal screens included blood type A positive, antibody screen negative, hepatitis B surface antigen negative, RPR nonreactive, Rubella immune and group B strep unknown. The pregnancy was uncomplicated until the mother presented with preterm labor on the day of delivery. There was no maternal fever. Membranes were ruptured about four hours prior to delivery antibiotics for mitral valve prolapse and unknown group B strep with prematurity. The mother received inter partum antibiotics around five hours prior to delivery. The infant emerged vigorous and was dry bulb suctioned. Apgar scores were 9 and 9 at 1 and 5 minutes respectively. The infant was transferred to Newborn Nursery. Around three hours of age the baby was transferred to the Intensive Care Nursery secondary to tachypnea grunting and nasal flaring. PHYSICAL EXAM ON ADMISSION: Weight, 2,845 grams (75th percentile); length, 48 cm (50 to 75th percentile); head circumference, 35 cm (90th percentile); follow up head circumference on day of life 4, 33 1/4 cm which is less (75 to 90th percentile). On admission, active, alert male without rashes. Anterior fontanelle, open, flat, soft. No cleft. Tachypnea, intermittent grunting and nasal flaring. Breath sounds clear and equal. Heart rate, regular without murmur. Pulses, 2+. Abdomen without hepatosplenomegaly. No masses. Testes descended bilaterally with normal phallus. Anus, patent. Spine, straight and intact without dimple. Hips, stable. Tone and reflexes, appropriate for gestational age. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: 1. Respiratory - Mild respiratory distress on admission that resolved by day of life 1. Never had an oxygen requirement. Clinical course and chest x-ray consistent with TTN 2. Cardiovascular - Cardiovascular has been hemodynamically stable throughout admission. No murmur. Recent blood pressure, 82/41 with a mean of 59 3. Fluids, electrolytes, nutrition - Fluids, electrolytes and nutrition was initially maintained on D10W then started feeds on day of life 1. Advanced to full feeds by breast or bottle by day of life 3. Has been feeding well every two to four hours. Discharge transfer weight, 2,500 grams. 4. Gastrointestinal - Started phototherapy on day of life 3 for a bilirubin total of 14.4, direct .4. Initially on a single phototherapy light was placed with a bili blanket over night and bilirubin is pending. 5. Hematology - Hematocrit on admission, 48.5 percent. 6. Infectious Disease - A CBC and blood culture was drawn on admission. CBC showed a white count of 15,000; 59 polys; 1 band; 346,000 platelets. Did not receive antibiotics. 7. Neurological - On exam, age appropriate. 8. Sensory - A hearing screening is pending. CONDITION AT TRANSFER: Four day old, former 35 and [**5-30**] weeker, feeding well, with jaundice under phototherapy. DISPOSITION: Transfer to Newborn Nursery. NAME OF PRIMARY PEDIATRICIAN: [**Doctor First Name **] Bhimakivapu and telephone number is ([**Telephone/Fax (1) 46345**]. CARE RECOMMENDATIONS: 1. Feeds ad lib demand, breast or bottle feeding. 2. Medications, none. 3. Car seat. Position screening has not been done and will need prior to discharge as the infant was less than 37 weeks gestation at birth. 4. State newborn screening was drawn on [**2170-2-10**] and is pending. 5. Immunizations received - Received Hepatitis B immunization on [**2170-2-11**]. 6. Follow-up bilirubin to be checked with pediatrician on day follwoing discharge. DISCHARGE DIAGNOSIS: 1. AGA 35 5/7 weeks, preterm now. 2. Transient tachypnea of the newborn, resolved. 3. Rule out sepsis. 4. Indirect hyperbilirubinemia. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 36142**], M.D. [**MD Number(1) 36143**] Dictated By:[**First Name3 (LF) 37154**] MEDQUIST36 D: [**2170-2-11**] 16:27 T: [**2170-2-11**] 16:29 JOB#: [**Job Number 46346**] ICD9 Codes: 7742, V290, V053
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Medical Text: Admission Date: [**2136-8-14**] Discharge Date: [**2136-8-24**] Date of Birth: [**2058-3-25**] Sex: F Service: SURGERY Allergies: Demerol / Epinephrine / Fosamax / Latex / Dilaudid Attending:[**First Name3 (LF) 6088**] Chief Complaint: Right lower extremity rest pain/nonhealing ulcer Major Surgical or Invasive Procedure: [**2136-8-20**]: Right common femoral to anterior tibial artery bypass with nonreversed saphenous vein graft. History of Present Illness: Mrs. [**Known lastname 33172**] has a history of severe degenerative spine disease and also carotid artery disease. She recently has developed increasing pain in her foot. She is very disabled by her back. She does walk but uses a wheelchair a lot and is having severe pain in her right foot. This is bad at all times but particularly severe at night and she has now developed some small ulcerations. She saw Dr. [**Last Name (STitle) **] at [**Hospital6 33**] who did some noninvasives and told that her circulation was really poor and suggested that she see Dr. [**Last Name (STitle) **]. It was recommended that she be admitted to the hospital for an arteriogram. Past Medical History: history of b/l hip and ankle ulcers Chronic diarrhea / constipation of unclear etiology Colonic polyps PUD with hx of GIB HTN Fibromyalgia Hypothyroidism Glaucoma Cataracts "Irregular heartbeat" h/o benign fallopian tumor, removed [**2085**] SBO [**3-7**] adhesions [**2117**] IBS Gastritis s/p multiple spinal fusions amd kyphoplasty Osteoarthritis h/o R hip fracture frequent falls h/o L CEA for "93% blockage" per pt hx MRSA 35% burn s/p skin grafting Social History: She does smoke at least [**2-7**] pack per day, and has a 50 year smoking history but does not drink alcohol. She has spent most of the past several months in rehab. Needs assistance with ADLs. Family History: Mother with breast cancer and osteoarthritis. Father with diabetes type 2. Her family history is negative for colorectal cancer or inflammatory bowel disease. Physical Exam: On discharge: Tm 98.0, Tc 96.0, HR 87, BP 98.58, RR 16, 93% on RA AAO x3, in no acute distress chest clear to auscultation bilaterally, heart rate regular. abdomen soft, nontender, nondistended. Right lower extremity warm, with palpable DP pulse, surgical incision healing, with areas of serosanguinous drainage. Small nonhealing ulcer at right lateral malleolus. No clubbing, cyanosis, or edema. Pertinent Results: [**2136-8-24**] 04:53AM BLOOD WBC-5.0 RBC-3.06* Hgb-9.5* Hct-28.4* MCV-93 MCH-31.1 MCHC-33.5 RDW-15.3 Plt Ct-216 [**2136-8-24**] 04:53AM BLOOD Glucose-92 UreaN-15 Creat-0.6 Na-142 K-3.9 Cl-112* HCO3-26 AnGap-8 [**2136-8-23**] 04:49AM BLOOD Calcium-8.7 Phos-2.6* Mg-2.1 [**8-21**] UCx: no growth (FINALIZED) [**8-21**] U/A: >182 WBC, no epis, large leuks, no nitrites [**8-21**] MRSA swab: positive Brief Hospital Course: Ms. [**Known lastname 33172**] [**Last Name (Titles) 1834**] a diagnostic angiography of her right lower extremity on [**2136-8-14**], which revealed moderate to severe stenosis in the SFA with complete occlusion distally, reconstituting into the popliteal, but occluding again at the PT, with moderate to severe stenosis of a diminutive DP. No intervention was attempted. She went back to the operating room on [**2136-8-20**] for a right femoral-AT bypass with nonreversed saphenous vein. Please see operative report dictated [**2136-8-20**] for full details of the operation. Postoperatively, she was somewhat hypotensive and anemic, so a fluid bolus was given and a blood transfusion attempted. However, soon after starting the blood transfusion she became rigorous, acutely hypotensive, and temporarily developed stridor with decreased O2 sats that resolved spontaneously. She was transferred to the ICU for closer monitoring. The blood bank was notified of a possible transfusion reaction, and a complete workup was performed which turned out negative for transfusion reaction. She was transfused two more units of blood the next day without issue. She was transferred back to the VICU on [**2136-8-21**], and her hematocrits stabilized. her foley catheter and arterial line were discontinued, and she was started on a regular diet. Her right foot was much warmer postsurgery, and she developed a strong palpable pulse of her right foot, as well as a dopplerable PT signal. She got out of bed to a chair on POD 2 and ambulated minimally with full assistance on POD3. By POD4 she was tolerating a regular diet, her pain was controlled, and her incisions were healing nicely. She was discharged to an extended care facility for intensive rehabilitation. Medications on Admission: amytriptyline 75''' PRN anxiety Amlodipine 5' Clonazepam 1-2 mg QHS PRN insomnia Cosopt 0.5-2% 1gtt OU daily Latanoprost 0.005% 1gtt OU QPM Synthroid 100' Lidocaine patch Lovastatin 1 QPM mesalamine 800''' Oxycodone PRN Oxycodone extended release 40'' protonix 40' KCl Promethazein 25'' Vitamin C Colace Vitamin D Iron Loperamide 2mg PRN diarrhea MVI Discharge Medications: 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO TID (3 times a day). 4. olanzapine 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. amitriptyline 75 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for anxiety. 6. clonazepam 1 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 7. dorzolamide-timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic DAILY (Daily). 8. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 9. levothyroxine 50 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. lipase-protease-amylase 5,000-17,000 -27,000 unit Capsule, Delayed Release(E.C.) Sig: Two (2) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 12. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 13. polyvinyl alcohol-povidone 1.4-0.6 % Dropperette Sig: [**2-5**] Drops Ophthalmic PRN (as needed) as needed for dryness. 14. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 15. insulin aspart 100 unit/mL Solution Sig: Zero (0) units Subcutaneous QACHS: adjust sliding scale as needed. 16. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): LAST DAY [**2136-8-26**]. 17. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime). 18. gabapentin 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 19. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 20. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital 38**] Rehab Discharge Diagnosis: right lower extremity nonhealing ulcer right lower extremity bypass Discharge Condition: Alert and oriented x3 ambulating with [**Last Name (LF) **], [**First Name3 (LF) **] assist Full weight bearing Discharge Instructions: What to expect when you go home: 1. It is normal to feel tired, this will last for 4-6 weeks ?????? You should get up out of bed every day and gradually increase your activity each day ?????? Unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have swelling of the leg you were operated on: ?????? Elevate your leg above the level of your heart (use [**3-8**] pillows or a recliner) every 2-3 hours throughout the day and at night ?????? Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time ?????? You will probably lose your taste for food and lose some weight ?????? Eat small frequent meals ?????? It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: ?????? No driving until post-op visit and you are no longer taking pain medications ?????? Unless you were told not to bear any weight on operative foot: ?????? You should get up every day, get dressed and walk ?????? You should gradually increase your activity ?????? You may up and down stairs, go outside and/or ride in a car ?????? Increase your activities as you can tolerate- do not do too much right away! ?????? No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? You may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? Take all the medications you were taking before surgery, unless otherwise directed ?????? Take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? Call and schedule an appointment to be seen in 2 weeks for staple/suture removal What to report to office: ?????? Redness that extends away from your incision ?????? A sudden increase in pain that is not controlled with pain medication ?????? A sudden change in the ability to move or use your leg or the ability to feel your leg ?????? Temperature greater than 100.5F for 24 hours ?????? Bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions Followup Instructions: Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1490**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2136-9-6**] 1:45 Completed by:[**2136-8-24**] ICD9 Codes: 4019, 2859, 4589
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Medical Text: Admission Date: [**2125-4-8**] Discharge Date: 3/17/7 Date of Birth: [**2125-4-8**] Sex: F Service: Neonatology MATERNAL HISTORY: A 32-year-old gravida I, para II woman with past medical history notable for infertility. Prenatal screens were as follows: A positive, DAT negative, hepatitis B negative, RPR nonreactive, rubella immune and GBS positive. Antenatal history: [**Last Name (un) **] was [**2125-5-24**]. Pregnancy was clomiphene induced, dichorionic, diamniotic 33 week twin gestation, complicated by gestational insulin-dependent diabetes and by cervical shortening and dilatation. The mother was initially admitted at 23 weeks and was then placed on bedrest. She received betamethasone at that time. She had progressed at 33 weeks of dilatation and was progressed with cesarean section under spinal epidural anesthesia for transverse position of twin #2. There was no intrapartum fever or other clinical evidence of chorioamnionitis and intrapartum antibiotic therapy was not given. Membranes were ruptured at delivery and yielded clear amniotic fluid. NEONATAL COURSE: The infant was vigorous at delivery. She was bulb suctioned, dried and subsequently was pink in no distress in room air. Apgars were 8 at one minute and 9 at five minutes. She was transferred to the NICU for prematurity. PHYSICAL EXAMINATION: A well appearing moderately preterm infant with examination consistent with 33 weeks gestation. Heart rate 160 to 170, respiratory rate 40s to 60s, temperature was 98.3 with a blood pressure of 75/30 with a mean of 47 and saturations were 96% in room air. Birth weight was 1795 grams which was at the 25th to 50th percentile, length was 41.7 cm at 10th to 25th percentile, head circumference was 30 cm at 25th to 50th percentile. Head, eyes, ears, nose and throat: Anterior fontanelle was soft and flat. Nondysmorphic. Palate intact. Neck and mouth normal. Normocephalic. No nasal flaring. Chest: Without retractions, breath sounds equal and clear. No adventitious sounds. Cardiovascular: Well perfused, heart rate regular rate and rhythm, femoral pulses normal, no murmur. Abdomen: Soft, nondistended, no organomegaly, no masses, bowel sounds active, patent anus, 3 vessel umbilical cord. GU: Normal female genitalia. CNS: Active, alert, responds to stimulation, tone AGA and symmetric, moves all extremities. Suck intact. Skin: Turgor normal. Normal spine, limbs, hips and clavicles. HOSPITAL COURSE: Respiratory: The infant has been stable in room air since birth. Respiratory rate 30s to 40s. Breath sounds equal and clear. The infant does have occasional self resolving apnea and bradycardic episodes. Has not required methylxanthine therapy. Cardiovascular: No murmur. Heart rate 120s to 160s with regular rate and rhythm. Blood pressure 73/43 with a mean of 57. Fluid, electrolytes and nutrition: The infant initially NPO. Initial IV fluids of D10 began during the newborn day. Enteral feeds begun on day of life #1 of special care 20 or breast milk at 30 per kilo per day, was advanced to 15 ml per kilo b.i.d. Her most recent electrolytes were sodium 142, K 4.3, Cl 108, and CO2 18. The infant feeds presently at 140 ml/kg/day of BM or SSC 20 cal/oz and most recent weight 1680grams. GI: Phototherapy initiated on day of life #3 for a bilirubin of 10.1/0.3. Her phototherapy was stopped on [**2125-4-14**] for a bilirubin of 4.1/0.3. Hematology: Initial hematocrit was 55.6 with a platelet count of 308,000 on admission to NICU. The infant has not required transfusion and no blood products have been done. ID: CBC with diff, blood culture screen on admission to NICU. Antibiotics discontinued after 48 hours negative blood culture. Initial CBC, white count of 10.4, with 24 polys, 3 bands, 1 meta with a platelet count of 308,000. Neurology: Infant does not meet criteria for head ultrasound. Sensory: Audiology: Hearing screen will be performed prior to discharge to home as recommended. Ophthalmology: Does not meet criteria. Psychosocial: [**Hospital1 18**] social worker involved with family. The [**Hospital1 **] social worker can be contact[**Name (NI) **] at this number, [**Telephone/Fax (1) **]. CONDITION AT TRANSFER: Stable. Discharged to a level 2 nursery. Name of pediatrician has not been determined. CARE AND RECOMMENDATIONS: 1. Feeds as SSC or BM 20 cal/oz at 140 cc/kg/day. 2. Infant is not on any current medications at this time. 3. Car seat position screening should be done prior to discharge home. 4. State newborn screening sent on [**2125-4-11**], results are pending. 5. Hepatitis B vaccine was given [**2125-4-13**]. 6. Immunizations recommended: Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following 3 criteria: 1. Born at less than 32 weeks, 2. Born between 32 and 35 weeks with 2 of the following: Daycare during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities or school age sibling 3. with chronic lung disease. Influenza immunization is recommended annually in the fall for all infants once they reach 6 months of age. Before this age and for the first 24 months of the child's life, immunization against influenza is recommended for household contacts and out of home caregivers. DISCHARGE DIAGNOSES: 1. Prematurity at 33 and 3/7 weeks, twin gestation. 2. Infant of an insulin-dependent gestational diabetic mother. 3. Sepsis evaluation, resolved 4. Apnea of prematurity. 5. Hyperbilirubinemia, resoloved [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 48738**], MD [**MD Number(2) 55708**] Dictated By:[**Doctor Last Name 72140**] MEDQUIST36 D: [**2125-4-12**] 19:15:50 T: [**2125-4-12**] 20:17:40 Job#: [**Job Number **] ICD9 Codes: 7742, V290
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Medical Text: Admission Date: [**2138-8-15**] Discharge Date: [**2138-8-20**] Date of Birth: [**2062-8-24**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: mild fatigue, mild DOE Major Surgical or Invasive Procedure: Coronary artery bypass grafting times 5; left internal mammary artery graft to left anterior descending, reverse saphenous vein grafts to the ramus intermedius, marginal branch, right coronary artery and diagonal branch. History of Present Illness: 75 yo M with PMH significant for hypertension, hyperlipidemia, and diabetes with recent abnormal stress echo. He endorses only mild fatigue and dyspnea on exertion and denies chest discomfort or other anginal symptoms. He presented for cardiac catheterization and was found to have 3VD and [**1-22**]+MR. We are asked to consult for surgical revascularization and possible mitral valve repair or replacement Past Medical History: Hypertension, Hyperlipidemia, Type I Diabetes on insulin pump, Ulcerative Colitis, Prior remote GI Bleed, none in 10 yrs, GERD, h/o broken right ankle, s/p total right hip arthroplasty [**11/2137**], s/p tonsillectomy Social History: Family History:no CAD Race:Caucasian Last Dental Exam:[**2138-5-20**] Lives with:wife at [**Name (NI) **] Retirement Community. Wife has significant memory issues. Occupation: Tobacco:quit [**2091**] ETOH:prior heavy drinking, quit last year Family History: Has 2 sons. Former marathon runner Father had a stroke at around 70 years of age. Physical Exam: Pulse:76 Resp:18 O2 sat:98% RA B/P Right:157/76 Left:156/71 Height:5'8" Weight:155 lbs 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 II/VI SEM Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities: None [x] Neuro: Grossly intact Pulses: Femoral Right: Dressing Left: +2 DP Right: +2 Left: +2 PT [**Name (NI) 167**]: +2 Left: +2 Radial Right: +2 Left: +2 Carotid Bruit Right/Left: Transmitted murmur Pertinent Results: Preop [**2138-8-15**] 07:43AM HGB-12.4* calcHCT-37 [**2138-8-15**] 07:43AM GLUCOSE-206* LACTATE-1.0 NA+-134* K+-4.2 CL--99* [**2138-8-15**] 11:25AM WBC-6.2 RBC-2.94*# HGB-9.8*# HCT-27.3*# MCV-93 MCH-33.2* MCHC-35.8* RDW-14.0 [**2138-8-15**] 11:25AM PT-15.3* PTT-35.9* INR(PT)-1.3* [**2138-8-15**] 11:25AM FIBRINOGE-193 [**2138-8-15**] 12:31PM UREA N-14 CREAT-0.6 SODIUM-139 POTASSIUM-3.7 CHLORIDE-108 TOTAL CO2-24 ANION GAP-11 Discharge [**2138-8-15**] 11:25AM BLOOD WBC-6.2 RBC-2.94*# Hgb-9.8*# Hct-27.3*# MCV-93 MCH-33.2* MCHC-35.8* RDW-14.0 Plt Ct-124* [**2138-8-15**] 11:25AM BLOOD PT-15.3* PTT-35.9* INR(PT)-1.3* [**2138-8-15**] 12:31PM BLOOD UreaN-14 Creat-0.6 Na-139 K-3.7 Cl-108 HCO3-24 AnGap-11 [**2138-8-17**] 02:36AM BLOOD Calcium-7.8* Phos-2.1* Mg-1.8 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *4.7 cm <= 4.0 cm Left Atrium - Four Chamber Length: 4.8 cm <= 5.2 cm Left Ventricle - Inferolateral Thickness: 1.0 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 5.4 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 55% to 60% >= 55% Aorta - Annulus: 2.1 cm <= 3.0 cm Aorta - Sinus Level: 3.1 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.7 cm <= 3.0 cm Aorta - Ascending: 3.0 cm <= 3.4 cm Aorta - Arch: 2.5 cm <= 3.0 cm Aorta - Descending Thoracic: 2.5 cm <= 2.5 cm Aortic Valve - LVOT diam: 2.2 cm Findings Multiplanar reconstructions were generated and confirmed on an independent workstation. LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size. Normal RV systolic function. AORTA: Normal aortic diameter at the sinus level. Normal ascending aorta diameter. Normal aortic arch diameter. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Normal aortic valve leaflets (3). Mild (1+) AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild to moderate ([**12-21**]+) MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Mild 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. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. Conclusions PREBYPASS The left atrium is mildly dilated. No spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. 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 is normal with normal free wall contractility. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. The mitral annulus is dilated (4.4 cm in the long axis and 3.3 cm in the short axis) but the leaflets coapt well. Mild to moderate ([**12-21**]+) mitral regurgitation is seen. Mitral regurgitation is not worsened by fluid administration or afterload augmentation. There is no pericardial effusion. POSTBYPASS The patient is AV paced and is not on any inotropes. Left ventricular systolic function remains normal (LVEF>55%). Mild aortic regurgitation persists. Mitral regurgitation is slightly improved and is now mild. The leaflets continue to coapt well. The thoracic aorta is intact. Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting physician Radiology Report CHEST (PORTABLE AP) Study Date of [**2138-8-17**] 11:23 AM Final Report HISTORY: Chest tube removal, to assess for pneumothorax. FINDINGS: In comparison with study of [**8-15**], all of the monitoring and support devices have been removed. Specifically, there is no evidence of pneumothorax. Bibasilar atelectatic changes persist. DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**] Brief Hospital Course: Admitted same day surgery and was brought to the operating room for coronary artery bypass graft surgery. See operative report for further details. In summary he had: Coronary artery bypass grafting times 5, with left internal mammary artery graft to left anterior descending, reverse saphenous vein grafts to the ramus intermedius, marginal branch, right coronary artery and diagonal branch. His bypass time was 92 minutes with a crossclamp time of 79 minutes. He tolerated the operation well and was transferred post-operatively to the intensive care unit for recovery and further management. Received cefazolin for perioperative antibiotics. In first twenty four hours he was weaned from sedation, awoke neurologically intact and was extubated without complications. On post operative day one he remained in the intensive care unit for blood glucose management and due to bradycardia requiring pacing so he was not started on beta blockers. All tubes line and drains were removed per cardiac surgery protocol. He remained in the intensive care unit waiting for an available floor bed. He was transferred to the stepdown floor on post operative day three. The remainder of his hospital course was uneveventful. Physical therapy worked with him on strength and mobility. He continued to progress and was ready for discharge home with services on post operative day 5. He is to follow up with Dr [**Last Name (STitle) **] in clinic in 3 weeks. Medications on Admission: Atenolol 25mg po daily Folic Acid 1mg po daily Levothyroxine 100mcg po daily Niacin 1000mg po qHS Simvastatin 40mg po daily Sulfasalazine 1000mg po BID Valsartan 160mg po daily ASA 81mg po BID Calcium carbonate 500mg po PRN Centrum Silver Amoxicillin 2g po 1 hour before dental procedures Discharge Medications: 1. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO once a day for 2 weeks. Disp:*28 Tablet Sustained Release(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Aspirin 81 mg 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. Subcutaneous Insulin Pump Miscellaneous 5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Niacin 500 mg Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO HS (at bedtime). Disp:*60 Capsule, Sustained Release(s)* Refills:*2* 9. Sulfasalazine 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 10. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 12. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for (R)forearm phlebitis for 10 days. Disp:*40 Capsule(s)* Refills:*0* 13. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 14. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 10 days. Disp:*10 Tablet(s)* Refills:*0* 15. Multivitamin Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital3 **]Hospice Discharge Diagnosis: Coronary artery disease s/p Coronary artery bypass grafting times 5; left internal mammary artery graft to left anterior descending, reverse saphenous vein grafts to the ramus intermedius, marginal branch, right coronary artery and diagonal branch. PMHx: Hypertension, Hyperlipidemia, Type I Diabetes on insulin pump, Ulcerative Colitis, Prior remote GIB, none in 10 yrs, GERD, h/o broken right ankle, s/p total right hip arthroplasty [**11/2137**], s/p tonsillectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Percocet Incisions: Sternal - healing well, no erythema or drainage Leg bilateral EVH sites- healing well, no erythema or drainage. Edema: 1+ pedal edema bilat Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments: Surgeon: [**Name6 (MD) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2138-9-11**] 1:15 Cardiologist: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9751**] is away on vacation. Dr [**Last Name (STitle) **] office will schedule f/u appointment and call you next week to let you know when it is. Please call to schedule appointments with your Primary Care Dr [**Last Name (STitle) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 56850**] in [**3-24**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2138-8-20**] ICD9 Codes: 4111, 4019, 2724
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Medical Text: Unit No: [**Numeric Identifier 71942**] Admission Date: [**2159-3-22**] Discharge Date: [**2159-3-28**] Date of Birth: [**2159-3-22**] Sex: M Service: NB HISTORY: Baby [**Name (NI) **] [**Known lastname **] [**Known lastname 4597**] was born at 33-1/7-weeks gestation and admitted to the NICU with prematurity and respiratory distress. He is a 2610-gram product of a 33-1/7- weeks gestation pregnancy born to a 20-year-old G3, P1, now 2 mother with an [**Name (NI) 37516**] of [**2159-5-9**]. Prenatal labs were blood type B-positive, antibody negative, RPR nonreactive, rubella immune, HBsAg negative, GBS unknown. This pregnancy was notable for gestational diabetes treated with insulin requiring several earlier hospitalizations. This pregnancy was also complicated recently by development of pregnancy induced hypertension and preterm labor prompting initial admission to [**Hospital 1474**] Hospital and then transfer to [**Hospital1 18**] on [**2159-3-17**]. She was treated with betamethasone and complete on [**2159-3-19**], magnesium sulfate and ampicillin. Contractions initially abated; but due to the persistent hypertension, labor was subsequently augmented leading to a vaginal delivery. There was no maternal fever during labor and rupture of membranes occurred 4 hours prior to delivery. At delivery, the infant emerged with a good cry and tone requiring blow-by oxygen for duskiness with quick improvement. Apgars were 8 and 9 at 1 and 5 minutes, and the infant was brought to the NICU for prematurity. Infant was placed on CPAP initially for intermittent apnea and moderate work of breathing. PHYSICAL EXAM ON ADMISSION: Birth weight 2610 grams which is greater than 95th percentile, head circumference 32 cm which is 75th percentile, length 45 cm which is 50th-75th percentile. This is an LGA premature infant, mildly reduced activity at rest, mild work of breathing on CPAP. Skin: Warm and dry, no rash. HEENT: Fontanel soft and flat. Positive molding. Palate intact. Ears and nares: Normal. Neck: Supple, no lesions. Chest: Moderate aeration, mild retractions and tachypnea on CPAP, symmetric breath sounds. Cardiac: Normal rate and rhythm, no murmur, well perfused. Abdomen: Soft, no hepatosplenomegaly, no mass, quiet bowel sounds. GU: Normal male. Testes descended. Anus patent. Extremities, hips, back normal. Neuro: Mildly reduced tone and activity. Intact Moro and grasp. SUMMARY OF HOSPITAL COURSE BY SYSTEMS: 1. Respiratory: The infant remained on CPAP of 6 and low FIO2 until day of life 2 at which time he weaned to low- flow nasal cannula, weaned to room air by [**2155-3-26**], day of life 3 and has been stable on room air since. He has presented with mild apnea of prematurity having approximately [**2-5**] quick self-resolved spells per day and has not been treated with any methylxanthine therapy thus far. He does remain comfortably tachypneic at times with respiratory rates in the 60s-90s range, clear and equal breath sounds, and very minor retractions. 2. Cardiovascular: He has maintained a stable cardiovascular status with no murmurs, normal heart rate and blood pressures throughout. 3. Fluid, electrolytes, and nutrition: He was made NPO on admission to the NICU due to the respiratory distress and a peripheral IV was placed. He was given IV fluids at that time. His D-sticks have remained normal with no hypoglycemia documented ever. Enteral feedings were initiated on [**2159-3-24**], day of life 2. His enteral feedings were slowly advanced over the next 4 days. He achieved full enteral feedings by [**2159-3-28**] and is presently taking Special Care 20 at 120 mL per kilogram per day tolerating his feedings well. His most recent weight is 2445 grams. He is voiding and stooling normally. His most recent set of electrolytes was on [**2159-3-24**]: Sodium 142, K of 5.3 which was slightly hemolyzed, chloride 105, and CO2 29. A magnesium level drawn on the newborn day and it was 2.8. 4. GI: He developed hyperbilirubinemia with a peak bilirubin level of 13.5/0.3 which was on [**2159-3-25**], day of life 3 at which time he started phototherapy and had received 4 days of phototherapy which phototherapy lights were discontinued on [**2159-3-28**], in the a.m. Most recent bilirubin prior to that was 8.7/0.3 on [**2159-3-27**]. The plan was a repeat bilirubin level on [**2159-3-29**], as a rebound. He has had no other GI issues. 5. Hematology: Hematocrit at birth was 53 with a platelet count of 308. No further hematocrits or platelets have been measured. He has received no blood product transfusions. 6. Infectious disease: The CBC and blood culture were screened on admission to the NICU due to the premature labor and premature delivery. The CBC was within normal limits with no bands and no left shift. A blood culture was drawn also on the newborn day. The infant received a total of 48 hours of ampicillin and gentamicin which were subsequently discontinued when the blood culture remained negative at that time. There had been no further issues with sepsis. 7. Neurology: The infant has maintained a normal neurologic exam for gestational age after the initial hypotonia and hypoactivity mentioned in the 1st 24 hours of life. No neurologic testing has been done on this infant. 8. Sensory: A hearing screen has not yet been performed, but will need to be performed prior to discharge to home. CONDITION AT DISCHARGE: Fair. DISCHARGE DISPOSITION: Transferred to [**Hospital3 417**] Hospital's special care nursery. Name of primary pediatrician is Dr. [**First Name (STitle) **] [**Name (STitle) 71943**] from [**Hospital1 1474**]; telephone number ([**Telephone/Fax (1) 71944**]. CARE AND RECOMMENDATIONS: 1. Feedings: Continue to advance feedings as needed and continue to concentrate caloric density as needed. Infant is currently on Special Care 20 at 1120 mL per kilogram per day with a plan to advance by 15 mL per kilogram q.12 hours to a maximum intake of 150 mL per kilogram per day. 2. Medications: None. 3. Car seat position screening is recommended prior to discharge from special care nursery. 4. State newborn screen was sent on [**2159-3-26**]. Results are pending. 5. Immunizations - baby has not received any immunizations as of yet. 6. Immunizations recommended. Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following 4 criteria: 1) born at less than 32-weeks gestation; 2) born between 32-35 weeks with 2 of the following: Daycare during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities, or school-age siblings; 3) chronic lung disease; or 4) hemodynamically significant congenital heart defect. Influenza immunization is recommended annually in the fall for all infants once they reach 6 months of age. Before this age and for the 1st 24 months of the child's life, immunization against influenza is recommended for household contacts and out-of-home caregivers. This infant has not received rotavirus vaccine. The American Academy of Pediatrics recommends initial vaccination of preterm infants at or following discharge from the hospital if they are clinically stable and at least 6 weeks, but fewer than 12 weeks of age. Follow-up appointments should be with a pediatrician after discharge from the hospital. DISCHARGE DIAGNOSES: Prematurity born at 33-1/7-weeks gestation, respiratory distress resolving, sepsis ruled out, infant of a diabetic mother, apnea of prematurity ongoing, hyperbilirubinemia ongoing, large for gestational age infant. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55750**] Dictated By:[**Name8 (MD) 62299**] MEDQUIST36 D: [**2159-3-27**] 22:11:51 T: [**2159-3-28**] 07:27:21 Job#: [**Job Number 71945**] ICD9 Codes: 7742, 769, V290
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Medical Text: Admission Date: [**2184-5-25**] Discharge Date: [**2184-6-20**] Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1234**] Chief Complaint: Afib / dehtyration Major Surgical or Invasive Procedure: None History of Present Illness: 84M s/p SFA -> AT bypass ([**5-10**]) initially presenting to Dr. [**Name (NI) 22122**] office with dehydration/diarrhea, R foot infection. In ED patient was found to be in rapid afib, with resultant positive cardiac enzymes thought to be due to demand ischemia in setting of hct to 24 and dehydration Past Medical History: CAD HTN Hypercholesterolemia DM2 MI'[**74**] Peripheral arterial disease post-polio contractures Social History: no tobacco, occiasional EtOH married, lives with wife Family History: non-contributory Physical Exam: afvss frail a/o cts ireg / ireg benign fem palp b/l, non palp distal pulses ecept left DP Pertinent Results: [**2184-6-18**] 05:15AM BLOOD WBC-12.7* RBC-3.99* Hgb-12.0* Hct-36.0* MCV-90 MCH-30.1 MCHC-33.3 RDW-17.4* Plt Ct-453* [**2184-6-18**] 05:15AM BLOOD PT-28.3* PTT-37.3* INR(PT)-2.9* [**2184-6-18**] 05:15AM BLOOD Glucose-46* UreaN-5* Creat-0.5 Na-133 K-3.7 Cl-105 HCO3-20* AnGap-12 [**2184-6-18**] 05:15AM BLOOD Calcium-7.7* Phos-2.8 Mg-1.8 [**2184-6-5**] 03:04AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.043* URINE Blood-MOD Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG URINE RBC-[**4-5**]* WBC-1 Bacteri-RARE Yeast-NONE Epi-0 [**2184-6-3**] 1:32 pm STOOL CONSISTENCY: WATERY Source: Stool. CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2184-6-4**]): CLOSTRIDIUM DIFFICILE. FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. Brief Hospital Course: 84M with CAD, DM, hx Polio, s/p SFA -> AT bypass ([**5-10**]) initially presenting to Dr.[**Name (NI) 10879**] office with dehydration/diarrhea, R foot infection. In ED patient was found to be in rapid afib, with resultant positive cardiac enzymes thought to be due to demand ischemia in setting of hct to 24 and dehydration. TTE revealed no WMA. Patient admitted to CCU for volume resuscitation and anticoagulation. Pt did r/i for MI - demand ishemia from rapid afib. Afib resolved Pt started on coumdin INR monitered throught out the hospital course. In DC 2.9 Pt inability to eat speech and swallow, psych consulted. His appetite has been poor but he manages to "force" himself to finish his meals. At present, pt's presentation does not appear to be c/w with the dx of a major depressive episode. Rather, his hypothyroidism is likely to have contributed to some if not all of the symptoms, such as psychomotor retardation and anorexia. This prompted an endocrine consult - Check anti-TPO - Check thyroglobulin and anti-thyroglobulin - Follow TFTs as an outpatient Pt to schedule an appointment for follow-up. Pt became febrile / pan cx'd / found to have C-Diff/ treated in hospital for 14 days of flagyl. Problem has resolved. Family requested GI consult. CT scan did confirm colitis. Pt had prolong hospital stay, family difficult to understand need for PT and nutrition for the patient. All doctors recommend feeding [**Name5 (PTitle) **] for nutritional status. Then when patient regains strength, can work on PT A variety of social / ethic/ geriatric/ psych consults where obtained during this hospital stay. Pt family refused to let the pt leave the hospital. A family meeting was held on [**7-18**]. Family finally agreed to put pt at reb. They still do not agree to feeding [**Month/Year (2) **]. pt stable on DC Medications on Admission: [**Last Name (un) 1724**]: Plavix 37.5', Metoprolol 50", Lisinopril 20', Glyburide 5', Prilosec, Zocor 5mg 3x/wk Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO MWF (Monday-Wednesday-Friday). 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **] AND PRN (). 6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 7. Clopidogrel 75 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 10. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Warfarin 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime): INR goal [**3-6**]. 12. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed. 13. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itch/rash. 14. Menthol-Cetylpyridinium Cl 2 mg Lozenge Sig: One (1) Lozenge Mucous membrane PRN (as needed). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Afib - demand ischemia resulting in pos cardiac enzymes FTT dehydration R foot dry gangrene/ulcers/ PAD c-diff DM2 Discharge Condition: Stable Discharge Instructions: When To See Your Doctor You should contact your doctor if you have a fever and any of these other symptoms. When fever lasts for more than 48 hours. When accompanied by vomiting or diarrhea that lasts more than 12 hours or is bloody. When accompanied by a cough that produces yellow, green, tan or bloody mucous. When accompanied by a severe headache, neck stiffness, drowsiness and vomiting. This is a medical emergency - go to the Emergency Room immediately. When fevers come and go, you have night sweats and swollen lymph nodes. When a mild fever comes and goes along with sore throat and tiredness. When accompanied by a sore throat and headache for more than 48 hours. When accompanied by severe stomach pain, nausea and vomiting. When accompanied by an earache. When you have been exposed to high temperatures outside and you cannot get your temperature down after attempting cool down measures. When you have recently started taking a new medicine and have no other symptoms. When you have pain or burning when urinating or back pain. When temperature remains above 103 degrees despite medication and other cool down measures (ie.taking a cool bath, cool compresses on head and under arms, drinking cool drinks). Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2184-7-6**] 2:30 call Dr [**Last Name (STitle) **] office and schedule an appointmnet ([**Telephone/Fax (1) 10085**] ICD9 Codes: 2761, 2720, 4019, 2449, 412
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Medical Text: Admission Date: [**2110-11-14**] Discharge Date: [**2110-11-26**] Service: CCU HISTORY OF PRESENT ILLNESS: The patient is an 81 year old female with a history of chronic obstructive pulmonary disease, hypertension, no known coronary artery disease who was in her usual state of health until the afternoon of admission when she experienced the sudden onset of substernal chest pain after arranging grocery bags. The pain was 10 out of 10 with associated shortness of breath, but no nausea, vomiting or diaphoresis. Her husband called emergency medical services. REVIEW OF SYSTEMS: Positive paroxysmal nocturnal dyspnea/orthopnea times four to five years, dyspnea on exertion with heavy lifting. In the Emergency Department the patient received beta blocker Nitroglycerin and heparin bolus. PAST MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease, etiology felt to be from emphysema from a history of multiple pneumonias as a teenager. 2. Hypertension. 3. Lupus. 4. Osteoporosis. 5. Total abdominal hysterectomy. ALLERGIES: Morphine causes nausea. MEDICATIONS: Fosamax, Advair, Singular, Prednisone, Albuterol prn, Plaquenil. FAMILY HISTORY: Mom died in 60s of heart disease, grandmother died at 62 of heart disease. SOCIAL HISTORY: No tobacco, occasional alcohol. Lives in [**Location 745**] with husband. She worked as a former bookkeeper and secretary. PHYSICAL EXAMINATION: General: Patient in mild respiratory distress, pursed lip breathing, using accessory muscles. Vital signs, 95.6, 105, 88/56. Head, eyes, ears, nose and throat: Pupils equal, round and reactive to light, oropharynx clear. Neck, jugulovenous pressure approximately 9 cm, no thyromegaly. Cardiovascular, tachycardiac, regular rhythm, S1 and S2, positive S3. Pulmonary, decreased breathsounds with bibasilar rales, diffuse wheezes. Abdomen, positive bowel sounds, soft, nontender, nondistended. Extremities, no cyanosis, clubbing or edema. 2+ pedal pulses bilaterally. Neurological, alert and oriented times three moving all extremities, symmetric deep tendon reflexes. LABORATORY DATA: White count 6.5/40.8/274. Potassium 4.9, BUN 17, creatinine 0.7, creatinine kinase 125, troponin less than 0.01. Electrocardiogram, sinus tachycardia, 128 beats/minute, 3 to [**Street Address(2) 5366**] elevations in V1 through V6, [**Street Address(2) 28585**] elevation in AVL. HOSPITAL COURSE: 1. Coronary artery disease. Upon arrival the patient was taken immediately to the Catheterization Laboratory for anterior ST elevation myocardial infarction. The catheterization revealed - 1. One vessel coronary artery disease with a 95% left anterior descending thrombotic lesion involving the first major diagonal intervened upon with a hepacoat stent. Also found was a 60% distal right coronary artery lesion that was not intervened upon. 2. Increased right-sided and left-sided pressures, with RAV of 19, RV 51/21, PCWP 35. 3. The procedure was complicated by a profound hypotensive episode, requiring Dopamine and intra-aortic balloon pump. After the procedure the patient was transferred to the CCU. The patient did well in the CCU. A cardiac regimen of beta blocker and ACE was titrated and intra-aortic balloon pump was discontinued without incident. The patient was subsequently transferred to the floor. While on the floor, the patient experienced a hypotensive episode with systolic pressures in the 70s and responded to fluid bolus. Etiology was felt to be secondary to medications. At the time of discharge, the patient's antihypertensive regimen consisted of Captopril 6.25 b.i.d. and Coreg 12.5 b.i.d., attempts at higher doses of Captopril were limited by her blood pressure. At the time of discharge, systolic pressures ranged 90 to 110 and heartrate was 90 to 100, the patient remained chest pain free throughout her stay. 2. Congestive heart failure - Post procedure, the patient had an echocardiogram which revealed - A. Ejection fraction of 25 to 30% with apical akinesis and severe hypokinesis of the anterior septum and anterior wall. She had normal right ventricular function. B. Moderate to severe (3+) tricuspid regurgitation, trivial mitral regurgitation, no aortic stenosis or aortic regurgitation. Moderate pulmonary hypertension was also noted. After her catheterization the patient was continued on heparin and was eventually started on Coumadin for prophylaxis of left ventricular thrombus. The patient was maintained on prn diuretics with stable respiratory status and oxygen saturations until the day prior to admission where she experienced worsening shortness of breath felt to be secondary to pulmonary edema. Therefore the patient was initiated on a standing dose of Lasix prior to discharge. 3. Rhythm - The patient experienced transient episode of atrial fibrillation during stay with no further recurrence. She was in normal sinus rhythm at the time of discharge. 4. Gastrointestinal - After hypotensive episode on the floor, the patient experienced the onset of abdominal pain and small amount of lower gastrointestinal bleeding. Her abdominal pain persisted and a gastrointestinal consult was obtained secondary to concerns for ischemic colitis. Gastrointestinal consult agreed with concern for an ischemic event and recommended computerized tomography scan of the abdomen. Computerized axial tomography scan revealed a thickened wall of the descending limb of the colon consistent with colonic ischemic but did not reveal any pneumatosis or free air. General Surgery was consulted and recommended observation of hemodynamics, intravenous fluids, and triple antibiotics. The patient's antihypertensives were discontinued at this time. She was started on Ampicillin, Levofloxacin and Flagyl and was transferred back to the CCU for closer monitoring. Heparin and Coumadin were also discontinued at this time secondary to the lower gastrointestinal bleeding. The patient's clinical status rapidly improved with resolution of her abdominal pain. She remained abdominal pain-free throughout the rest of the stay. At the time of discharge she was tolerating a p.o. diet, was guaiac negative, and had her antihypertensive regimen reinstituted without further onset of abdominal pain. 5. Pulmonary - The patient maintained stable oxygen saturations throughout her stay. She experienced some episodes of shortness of breath which were responsive to her metered dose inhalers and nebulizers. Additionally she experienced an episode of shortness of breath as previously described and this was felt to be secondary to pulmonary edema which responded to intravenous Lasix. 6. Renal - The patient's creatinine remained stable throughout the stay with baseline of 0.5 to 0.6 at the time of discharge. 7. The patient was found to have a left adnexa cystic lesion on computerized tomography scan done when evaluated for ischemic colitis. Radiology recommended this be followed up with a pelvic ultrasound. Ultrasound was not done at the time of discharge, and it is recommended follow up as an outpatient. A Physical therapy consult was obtained who felt the patient had decreased mobility, endurance and balance, and therefore recommended acute rehabilitation. The patient was screened and subsequently discontinued to [**Hospital1 **] for cardiac rehabilitation. CODE STATUS: The patient is full code. CONDITION ON DISCHARGE: The patient discharged in stable condition without supplemental oxygen requirement. The patient was discharged to [**Hospital **] Rehabilitation Facility. DISCHARGE DIAGNOSIS: 1. Anterior ST elevation myocardial infarction status post PCI of left anterior descending. 2. Congestive heart failure. 3. Ischemic colitis. 4. Chronic obstructive pulmonary disease. 5. Cystic mass of left adnexa. DISCHARGE MEDICATIONS: 1. Aspirin 325 p.o. q. day 2. Plavix 75 mg p.o. q. day 3. Captopril 6.25 mg p.o. b.i.d. 4. Carvedilol 12.5 mg p.o. b.i.d. 5. Digoxin 0.125 mg p.o. q. day 6. Lasix 20 mg p.o. q. day 7. Lipitor 10 mg p.o. q. day 8. Prednisone 5 mg p.o. q. day 9. Plaquenil 200 mg p.o. q. day 10. Atrovent inhaler 11. Albuterol prn 12. Flovent 13. Serevent 14. Protonix 40 mg p.o. q. day 15. Colace prn 16. Senna prn FOLLOW UP PLAN: The patient is to call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] office for follow up upon discharge from rehabilitation. [**Name6 (MD) **] [**Name8 (MD) **], MD [**MD Number(1) 21980**] Dictated By:[**Name6 (MD) 54516**] MEDQUIST36 D: [**2110-11-26**] 07:46 T: [**2110-11-26**] 07:59 JOB#: [**Job Number 54517**] ICD9 Codes: 4280, 5789
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7315 }
Medical Text: Admission Date: [**2166-12-10**] Discharge Date: [**2166-12-17**] Date of Birth: [**2101-6-19**] Sex: M Service: MEDICINE Allergies: Benadryl / Morphine / Ativan / Compazine / Dilaudid Attending:[**First Name3 (LF) 30**] Chief Complaint: Neck Pain Major Surgical or Invasive Procedure: Anterior Cervical diskectomy History of Present Illness: 65Y M ESRD, CHF EF<20% with recuurent Listeria bacteremia X 2, had complained of neck pain for several weeks. Pt was seen in the ED treated with IV dilaudid. PT became sensitive and developed respiratory distress and failure to normal doses of IV narcotics in the ED. Pt eventually admitted to MICU, scheduled for C-spine MRI in the setting of unstable respiratory status. Pt coded in MRI holding underwen limited MRI studies which were inconclusive. Pt was subsequently intubated for final MRI w/ gado. MRI eventually was suspicious for osteomyelitis of C4 with inflammation of C3C4, C4C5. Pt wwas scheduled for bone biosy with tissue cx sent for micro and cyptococcal ag. Pt was stablized, extubated, received HD after MRI and transferred to the floor for pain control. Upon transfer, pt desated to 88% on RA with complaint of SOB but no CP. Pt's HR was 100, increased to RR 28, BP was 120/74. Pt immediately received O2. O2 was titrated SpO2 >96%. Pt also received lopressor 25mg po to control his rate. Pt was eventually stable on 2L. PT c/o shoulder pain o/n. Past Medical History: 1. Coronary artery disease: Myocardial infarction in [**2155**], MQWMI in [**2160**]. Most recent cath, [**2163-10-18**]: LCx stenting; previous RCA stent patent at that time. 2. Nonischemic dilated cardiomyopathy; EF [**12-6**] 33%. EF [**2164-1-11**] to 25% 3. Diabetes greater than 20 years; with triopathy. 4. Hypertension. 5. End stage renal disease on hemodialysis, q. Monday, Wednesday and Friday via right arteriovenous fistula. 6. Hypothyroidism. 7. Chronic obstructive pulmonary disease. 8. Hepatitis C. 9. Chronic pancreatitis. 10. Peptic ulcer disease. 11. Right perinephric hematoma; status post embolization. 12. Obstructive sleep apnea on CPAP. 13. Ruptured right groin abscess; recurrent right groin abscess in [**2162-12-4**]. 14. Peripheral [**Year (4 digits) 1106**] disease. 15. Status post R PFA to BK [**Doctor Last Name **] bypasss graft with vein 16. Status post 2nd and 3rd toe amps 17. Status post left CFA to AK [**Doctor Last Name **] with PTFE 18. Status post L inguinal hernia repair 19. Status post umbilical hernia repair 20. Ischemic left foot 21. A - Fib- not well documented. Followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of cardiology who notes he was previously on coumadin. Social History: Lives in [**Location 686**] with wife, has older children tobacco: 1 ppd x 60 yrs. quit 3 months ago, no EtOH. +Hx of narcotic abuse. Should avoid IV pain medications, especially dilaudid, morphine Family History: Non contributory Physical Exam: T 98.7 BP 140/74 HR 97 RR 16 SpO2 100 on 2L, FSBS: 113mg/dl Gen: AOX3 HEENT: perrlA, EOMI. mmm Neck: neck collar in place Lung: CTA b/l Heart: RRR nl S1S2 no M/R/G Abdomen: Soft, ND/NT. No rebound or guarding [**Location **]: Multiple toe amputations. Dopplerable DP pules b/l Pertinent Results: [**2166-12-10**] 11:56PM TYPE-ART TEMP-35.6 PO2-113* PCO2-48* PH-7.40 TOTAL CO2-31* BASE XS-4 [**2166-12-10**] 11:56PM LACTATE-0.8 [**2166-12-10**] 11:20PM GLUCOSE-70 UREA N-31* CREAT-4.8*# SODIUM-140 POTASSIUM-5.2* CHLORIDE-98 TOTAL CO2-28 ANION GAP-19 [**2166-12-10**] 11:20PM CK(CPK)-35* [**2166-12-10**] 11:20PM CK-MB-NotDone cTropnT-0.18* [**2166-12-10**] 11:20PM CALCIUM-9.7 PHOSPHATE-7.0* MAGNESIUM-2.2 [**2166-12-10**] 11:20PM WBC-6.4 RBC-3.91* HGB-12.2* HCT-38.3* MCV-98 MCH-31.3 MCHC-32.0 RDW-16.6* [**2166-12-10**] 11:20PM NEUTS-54 BANDS-0 LYMPHS-19 MONOS-18* EOS-7* BASOS-2 ATYPS-0 METAS-0 MYELOS-0 [**2166-12-10**] 11:20PM HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-OCCASIONAL TARGET-OCCASIONAL [**2166-12-10**] 11:20PM PLT SMR-NORMAL PLT COUNT-232 [**2166-12-10**] 11:20PM PT-13.0 PTT-33.2 INR(PT)-1.1 [**2166-12-10**] 03:35AM GLUCOSE-116* UREA N-53* CREAT-6.0* SODIUM-139 POTASSIUM-5.5* CHLORIDE-92* TOTAL CO2-30 ANION GAP-23* [**2166-12-10**] 03:35AM CALCIUM-10.3* PHOSPHATE-8.4*# MAGNESIUM-2.5 [**2166-12-10**] 03:35AM CRP-5.1* [**2166-12-10**] 03:35AM WBC-5.8 RBC-4.19* HGB-13.0* HCT-40.2 MCV-96 MCH-30.9 MCHC-32.3 RDW-16.6* [**2166-12-10**] 03:35AM NEUTS-35* BANDS-0 LYMPHS-40 MONOS-17* EOS-5* BASOS-3* ATYPS-0 METAS-0 MYELOS-0 [**2166-12-10**] 03:35AM HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-OCCASIONAL MACROCYT-1+ MICROCYT-1+ POLYCHROM-NORMAL [**2166-12-10**] 03:35AM PLT SMR-NORMAL PLT COUNT-238 [**2166-12-10**] 03:35AM PT-13.4* PTT-34.6 INR(PT)-1.2* [**2166-12-10**] 03:35AM SED RATE-5 [**2166-12-10**] 03:06AM TYPE-ART RATES-/24 O2 FLOW-5 PO2-99 PCO2-75* PH-7.22* TOTAL CO2-32* BASE XS-0 INTUBATED-NOT INTUBA [**2166-12-10**] 03:06AM O2 SAT-92 [**2166-12-9**] 06:13PM LACTATE-2.4* [**2166-12-9**] 06:10PM GLUCOSE-169* UREA N-48* CREAT-5.8* SODIUM-140 POTASSIUM-5.1 CHLORIDE-92* TOTAL CO2-31 ANION GAP-22* [**2166-12-9**] 06:10PM estGFR-Using this [**2166-12-9**] 06:10PM WBC-6.8 RBC-4.29* HGB-13.2* HCT-41.3 MCV-96 MCH-30.9 MCHC-32.0 RDW-16.7* [**2166-12-9**] 06:10PM NEUTS-55 BANDS-0 LYMPHS-27 MONOS-10 EOS-4 BASOS-1 ATYPS-3* METAS-0 MYELOS-0 [**2166-12-9**] 06:10PM PLT COUNT-242 [**2166-12-9**] 06:10PM NEUTS-55 BANDS-0 LYMPHS-27 MONOS-10 EOS-4 BASOS-1 ATYPS-3* METAS-0 MYELOS-0 CXR [**2166-12-10**]: no acute cardiopulmonary process. ET tube 2cm above carina. [**12-14**]: Right infrahilar consolidation has increased since [**12-11**] consistent with worsening pneumonia. mid and lower left lung atelectasis persists. [**12-15**]: some progressive clearing of the right perihilar and infrahilar consolidation, consistent with some improvement in the pneumonia . MRI C-spine [**2166-12-10**]: Discitis, osteomyelitis C4 with paraspinal phlegmon or abscess. Indicative of infectious etiology. However, rarely florid inflammatory response to renal spondyloarthopathy may demonstrate a similar picture. . US UE :Appropriate flow within the fistula with no surrounding fluid collections/abscess Brief Hospital Course: 65 yo male with a past medical history of CAD, dilated CHF (EF < 20%), Type 2 Diabetes Mellitus, ESRD on HD, COPD, and recent recurrent bacteremia (GBS bacteremia in [**7-10**] and Listeria Bacteremia in [**9-9**]) is being transferred to the floor after MICU admission for respiratory failure. . On [**2166-11-27**], patient complained of 3 weeks of neck pain. He [**Date Range 1834**] an outpatient MRI on [**12-9**] which demonstrated C4-C5 discitis with destructive osteomyelitis, including pre-vertebral involvement. No epidural abscess was seen at that time. He was then sent to the ED for further evaluation by neurosurgery, where he was found to have mild LUE weakness and unchanged decreased sensation at fingertips and toes. This study was limited by gado so they perform another MRI. Repeat MRI w/ gado on [**12-10**] demonstrated known C4-5 spondylodiscitis, and no evidence of an epidural component, but the study was limited by patient motion. . Overnight, patient triggered for decreased responsiveness and decreased SaO2 to 55% RA, increasing to 80% on 5L NC. He was noted to be snoring at the time. He had received significant amounts of dilaudid (4mg IV over the past few hours) and ativan prior to this episode. RR was [**11-16**]. ABG was 7.22/75/99 on 5L NC (PCO2 significantly above baseline). CXR showed clear lung fields. 0.2mg Narcan was administered with immediate improvement in mental status and oxygenation, improving to 98-100% on 5L, which was quickly weaned. He immediately c/o [**11-12**] pain and demanded additional pain medicine, and an additional 0.5mg IV dilaudid was given. He was also noted to intermittently refuse the hard c-collar. . Since the first two MRIs were limited (the first by lack of gado, the second by motion), a third MRI was done with anesthesia to definitively assess for epidural abscess. He was intubated for the MRI and given midazolam and fentanyl. He was initially extubated after the MRI but afterward has decreased respirations and was reintubated for respiratory distress. After he awoke, he complained of neck pain and was given fentanyl boluses, a total of 100mcg. His BP was down to 80s/40s and he was given a 500c bolus without improvement. A dopamine drip was ordered but the patient improved to 90s/50s and the drip was held. As he woke up, his BP improved to 120s/60s. He was transferred to the MICU. Pt was transferred from MICU after having HD. Patient's Spo2 reduced to 88% on RA after bed transfer, with complaint of SOB but no CP. Pt's HR was 100, increased to RR 28, BP was 120/74. Pt [**Name (NI) **]2 was titrated with NC to > 96%. Pt initially had increased oxygen requirements. Pain control was initially started with ketorolac and acetaminophen and subsequent to po percoicet. Patient problems of respiratory failure and hypotension resolved after all IV narcotics were stopped. Osteomyelitis/Discitis: Tissue biopsy and surgery results failed to confirm infectious etiology. Path results were consistent with cartilaginous degenerative changes and bone fragments.The neck pain was to be degenerative and inflammatory in etiology. A rare disorder in chronic renal patient was known as destructive renal spondyloarthopathy was suspected although there is no clear diagnosis of this phenomenon. It was decided to continue a 3 week course of at hemodialysis to prophylax against osteomyelitis given patient previous history of listeria bacteremia. Pneumonia: Chest xrays was concerning for worsening pneumonia although pt did no show any clinical signs of the disease. Endocarditis: Previous echo reports not consistent with endocarditis while patient was in house. No additional measure was taken to pursue. Pain control: For his neck pain, patient has been well-controlled on mild pain medications. He has previously been VERY sensitive to IV narcotics. Respiratory failure. Resolved Pt tolerated room air since all IV narcotics were stopped. Ambulated without shortness of breadth. Hypotension: Normalized since all IV narcotics were stopped. ESRD on HD: Pt continued to receive dialysis on regular schedule after additional HD to remove gadolinum contrast dye. DM: Pt remained euglycemic during the course of his stay with a sliding scale. Congestive Heart Failure EF < 20: Pt was restricted to low Na diet and 1500ml fluid restriction. Pt was continued on home medications. COPD: treatment was continued with Albuterol/Atrovent MDI prn SOB, dyspnea CAD: There was no evidence of active ischemia while in hospital. Management continued with home regimen and heart-healthy diet Medications on Admission: albuterol 1-2p q6h prn amiodarone 100 qd citalopram 20 qd RISS levoxyl 50 m-f/75 sat-sun lipitor 10 qd lisinopril 2.5 qd percocet q4-6h prn [**Name (NI) 4532**] 75 qd reglan 5 qd renagel 400 qd toprol xl 25 qd on non-HD days Meds on transfer Acetaminophen 650 Q6H PRN ALbuterol INH Q6H PRN Amiodarone 100mg PO Daily Atorvastatin 10mg daily Bisacodyl 10mg PO/PR daily Citalopram 20mg PO daily [**Name (NI) **] 75mg daily Colace 100mg po BID Reglan 5mg PO daily Toprol XL 25mg po daily percocet 1-2 tabs po Q4H prn Sevelamer 400mg PO TID meals Levothyroxine 50mcg PO dailiy Lisinopril 2.5 mg PO daily Insulin SC Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation every six (6) hours as needed for shortness of breath or wheezing. [**Name (NI) **]:*qs qs* Refills:*0* 3. Amiodarone 200 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). [**Name (NI) **]:*15 Tablet(s)* Refills:*2* 4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Name (NI) **]:*30 Tablet(s)* Refills:*2* 5. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Name (NI) **]:*30 Tablet(s)* Refills:*2* 6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Name (NI) **]:*30 Tablet(s)* Refills:*2* 7. Humulin N 100 unit/mL Suspension Sig: One (1) Subcutaneous twice a day: Please continue your insulin according to your sliding scale. . 8. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Name (NI) **]:*40 Tablet(s)* Refills:*2* 9. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). [**Name (NI) **]:*15 Tablet(s)* Refills:*2* 10. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO three times a day. [**Name (NI) **]:*45 Tablet(s)* Refills:*2* 11. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). [**Name (NI) **]:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 13. Sevelamer 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). [**Name (NI) **]:*45 Tablet(s)* Refills:*2* 14. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1) Intravenous HD PROTOCOL (HD Protochol): You will receive 1 gram of vancomycin at dialysis through [**2166-12-31**]. . 15. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation every six (6) hours as needed for shortness of breath or wheezing. [**Month/Day/Year **]:*1 inh* Refills:*2* 16. Outpatient Lab Work Please send weekly results of the following Labs to Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 4020**]. Fax: ([**Telephone/Fax (1) 4591**] 1. CBC 2. Chem 10 3. Vancomycin Trough. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Cervical spinal inflammatory process NOS. 2. Right lower lobe pneumonia. 3. Acute respiratory failure. SECONDARY DIAGNOSIS: 1. Coronary artery disease: Myocardial infarction in [**2155**], MQWMI in [**2160**]. Most recent cath, [**2163-10-18**]: LCx stenting; previous RCA stent patent at that time. 2. Chronic systolic heart failure-Ischemic dilated cardiomyopathy; EF [**12-6**] 33%. EF [**2164-1-11**] to 25% 3. Diabetes greater than 20 years; with triopathy. 4. Hypertension. 5. End stage renal disease on hemodialysis, q. Monday, Wednesday and Friday via right arteriovenous fistula. ` 6. Hypothyroidism. 7. Chronic obstructive pulmonary disease. 8. Hepatitis C. 9. Chronic pancreatitis. 10. Peptic ulcer disease. 11. Right perinephric hematoma; status post embolization. 12. Obstructive sleep apnea on CPAP. 13. Ruptured right groin abscess; recurrent right groin abscess in [**2162-12-4**]. 14. Peripheral [**Year (4 digits) 1106**] disease. 15. Status post R PFA to BK [**Doctor Last Name **] bypasss graft with vein 16. Status post 2nd and 3rd toe amps 17. Status post left CFA to AK [**Doctor Last Name **] with PTFE 18. Status post L inguinal hernia repair 19. Status post umbilical hernia repair 20. Ischemic left foot 21. A - Fib- not well documented. Followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of cardiology who notes he was previously on coumadin. Discharge Condition: Good. Patient is ambulating, tolerating oral intake, and has returned to his baseline condition. Discharge Instructions: You were admitted to the hospital because of your neck pain. An MRI was performed which was concerning for an infection of your bone or the tissue around your bone. You were admitted to the hospital for further evaluation of your neck pain and IV antibiotics. A biopsy of your neck bone was taken for analysis and did not demonstrate any infection. However given your history of prior infections and blood infections, we decided to treat you with a 3 week course of antibiotics. You will continue to be treated with an antibiotic called vancomycin which you will receive at dialysis. You should receive your last dose on [**2167-1-7**]. While evaluating your neck pain, we needed to perform an MRI with sedation. Unfortunately, you were very sensitive to the sedating medicine and developed difficulty breathing, requiring intubation and a short stay in the intensive care unit. You were extubated without difficulty and have been breathing on room air since then. Please continue close management of your heart failure with the following management: - Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. - Adhere to 2 gm sodium diet - Fluid Restriction:1500ml/ day Please continue to take all of your medications as prescribed. If you have any symptoms of fevers, chills, night sweats, headaches, worsening or changing neck pain, back pain, change in appetite,numbness, tingling sensation in your neck/ shoulders/ fingers, worsening cough or shortness of breath, leg swelling, or chest pain, please seek immediate medical attention. Followup Instructions: Please follow-up with your neurosurgeon Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 548**]. We have scheduled an appointment for you on [**1-7**] at 1pm. His office is lcoated at [**Last Name (NamePattern1) 439**]. You will also need an MRI prior to this appointment. Dr.[**Name (NI) 2845**] office will call you with an appointment time for your repeat neck MRI. Again, you should wear your cervical collar AT ALL TIMES until your appointment with Dr. [**Last Name (STitle) 548**]. Please also follow-up with your Infectious Disease Doctor, Dr. [**First Name8 (NamePattern2) 108567**] [**Last Name (NamePattern1) 4020**]. We have scheduled an appointment for you on Thursday [**1-8**] at 9:30am. Her office is located at [**Last Name (NamePattern1) 108568**]. If you need to reschedule, please call her office at [**Telephone/Fax (1) 457**]. Please also follow-up with your primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. We have scheduled an appointment for you on [**2167-1-8**] at 12pm. If you need to reschedule, please call his office at [**Telephone/Fax (1) 250**]. Please also continue with your previously scheduled appointments with the [**Telephone/Fax (1) 1106**] lab on [**2166-12-18**] at 1:45pm. If you need to rescehedule, please call them at [**Telephone/Fax (1) 1237**]. You will also have labwork drawn weekly at dialysis and faxed to your infectious disease doctor Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 4020**]. Completed by:[**2166-12-19**] ICD9 Codes: 4254, 486, 5180, 5856, 3572, 2449, 496, 4280
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7316 }
Medical Text: Admission Date: [**2174-3-12**] Discharge Date: [**2174-4-7**] Date of Birth: [**2129-9-27**] Sex: F Service: MEDICINE Allergies: Narc.Analgesic, Non-Salicyl.Analg.&Barb. Attending:[**Male First Name (un) 5282**] Chief Complaint: Jaundice, anemia Major Surgical or Invasive Procedure: PICC placement Dobhoff placement Paracentesis History of Present Illness: Ms. [**Known lastname 81279**] is a 44 year old female who was admitted on [**2174-3-9**] with lethargy, weakness, confusion, and new onset jaundice. Per her husband, she had had diarrhea (green colored but no melena) for 2 weeks prior and she was taking immodium prn. Per patient and husband, no new medication. She had had intermittent productive cough as well. No report of chest pain, shortness of breath, or lightheadedness at that time. Per husband, she was disoriented and confused and had slowed speech. Her skin turned pale and jaundiced over the next week. She had been taking "a lot" tylenol for plantar fasciitis prior to admission. . Upon arrival to [**Hospital3 **], she was found to be anemic with an initial Hct of 9.1 and jaundiced although predominantly and indirect bilirubinemia. She was also hyponatremic to 116. Her INR was 1.6, platelets of 62. Her tox screen was positive for opiates, tylenol, and benzos. A non-contrast head CT was negative. She was hemodynacmially stable but she was admitted to the MICU. . In the MICU, She was trasfused 10 units of PRBCs in 3 days. She had no obvious signs of GI bleeding, although she did have ongoing diarrhea though she was not on lactulose and was c.diff negative. Hematology was consulted due to the predominance of indirect hyperbilirubinemia and they felt her anemia was multifactorial. She was treated with Unasyn 1.5 g q6 hours since [**2174-3-10**] for unclear reasons. . Upon arrival to the MICU, she denies fevers, chills, nausea, vomiting, melena, BRBPR, chest pain, shortness of breath. She does report ongoing diarrhea. She reports increased abdominal distention over the past few weeks. She reports chronic lower extremity edema. She denies suicidal ideation. . Review of sytems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, constipation or abdominal pain. No dysuria. Denied arthralgias or myalgias. Past Medical History: Presumed alcoholic cirrhosis Alcohol abuse with daily alcohol use, last drink [**2174-2-12**] Bipolar disorder Plantar Fascitis Endometriosis Social History: Patient is married, she previously drinks [**12-31**] a bottle of alcohol/day, last drink [**2174-2-12**]. She denies current or former IV drug use. She smokes [**5-4**] cigarrettes/day. Family History: Non-contributory Physical Exam: Vitals: T: BP: 121/63 P:99 R: 21 O2: 97% on RA General: Alert, oriented, no acute distress, slowed speach HEENT: Sclera icteric, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, + systolic murmur, no rubs, gallops Abdomen: soft, non-tender, + distended with ascites, bowel sounds present, no rebound tenderness or guarding, unable to assess hepatosplenomegaly Ext: Warm, well perfused,+ b/l LE pitting edema Pertinent Results: Admission Labs: [**2174-3-12**] 04:05PM BLOOD WBC-9.1 RBC-3.02* Hgb-10.5* Hct-27.7* MCV-92 MCH-34.6* MCHC-37.7* RDW-24.7* Plt Ct-37* [**2174-3-12**] 04:05PM BLOOD Neuts-90.8* Lymphs-5.7* Monos-2.5 Eos-0.4 Baso-0.6 [**2174-3-12**] 04:05PM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-OCCASIONAL Macrocy-2+ Microcy-OCCASIONAL Polychr-1+ Target-OCCASIONAL Schisto-OCCASIONAL [**2174-3-12**] 04:05PM BLOOD PT-24.1* PTT-50.4* INR(PT)-2.3* [**2174-3-12**] 04:05PM BLOOD Fibrino-112* [**2174-3-12**] 04:05PM BLOOD FDP-40-80* [**2174-3-12**] 04:05PM BLOOD Ret Aut-3.4* [**2174-3-12**] 04:05PM BLOOD Glucose-105 UreaN-27* Creat-0.8 Na-128* K-3.3 Cl-88* HCO3-32 AnGap-11 [**2174-3-12**] 04:05PM BLOOD ALT-18 AST-75* LD(LDH)-221 CK(CPK)-20* AlkPhos-43 Amylase-11 TotBili-37.3* DirBili-23.1* IndBili-14.2 [**2174-3-12**] 04:05PM BLOOD Lipase-33 [**2174-3-12**] 04:05PM BLOOD Albumin-2.5* Calcium-8.9 Phos-2.8 Mg-2.1 Iron-150 [**2174-3-12**] 04:05PM BLOOD calTIBC-157* VitB12-GREATER TH Folate-5.7 Hapto-<20* Ferritn-1462* TRF-121* [**2174-3-12**] 04:05PM BLOOD HBsAb-POSITIVE HBcAb-NEGATIVE HAV Ab-POSITIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE [**2174-3-12**] 04:05PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2174-3-12**] 04:05PM BLOOD HCV Ab-NEGATIVE [**2174-3-12**] 04:42PM BLOOD Type-MIX Temp-36.5 pO2-110* pCO2-45 pH-7.49* calTCO2-35* Base XS-9 Intubat-NOT INTUBA Comment-QUESTION S [**2174-3-12**] 04:42PM BLOOD Lactate-2.3* . Micro: HBV Viral Load - Not detectable HCV Viral Load - Not detectable [**3-13**] Stool Studies: No Salmonella, Shigella, Campylobacter. No C. diff. E.Coli 0157:H7 negative. [**3-13**] Peritoneal Fluid: Gram Stain 2+ PMNs, no organisms. Cultures negative. [**3-15**] Peritoneal Fluid: Gram Stain 2+ PMNs, no organisms. Cultures negative. [**3-20**] Peritoneal Fluid: Gram Stain 1+ PMNs, no organisms. Cultures negative. [**3-21**] Urine Cx: Yeast >100,000. IMAGING: [**2174-3-12**] CXR - The right subclavian line tip, the low SVC/cavoatrial junction. Cardiomediastinal silhouette is unremarkable. Lung volumes are very low with bibasilar opacities most likely consistent with atelectasis. No pneumonia. No pneumothorax or appreciable pleural effusion was demonstrated. The high position of the diaphragms may be explained by ascitis. [**3-12**] RUQ Ultrasound: 1. Nodular, shrunken heterogeneous appearance of the liver, consistent with cirrhosis. 2. Ascites. 3. Splenomegaly. 4. Main portal vein thrombosis. CT ABDOMEN W/O CONTRAST; CT PELVIS W/O CONTRAST [**2174-3-13**]: IMPRESSION: Cirrhosis with ascites and splenomegaly. The presence of portal venous thrombosis, seen on the earlier ultrasound, cannot be assessed, particularly given the lack of intravenous contrast administration. CT HEAD W/O CONTRAST [**2174-3-13**]: No acute intracranial process. Portable TTE (Complete) [**2174-3-14**]: The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. [**3-14**] CT Abd - 1. No apparent filling defects within the main portal vein to suggest thrombosis. 2. Findings consistent with cirrhosis including ascites, varices, and nodular and shrunken appearance of the liver with caudate hypertrophy. 3. Sludge within the gallbladder, unchanged. No evidence of intrahepatic or extrahepatic biliary dilatation. 4. Subcentimeter hypodensity within the right lobe of the liver (2, 37), incompletely characterized on this single phase study. [**3-17**] KUB - Ascites. No evidence of obstruction or ileus. CT ABDOMEN W/O CONTRAST; CT PELVIS W/O CONTRAST [**2174-3-20**]: 1. Severe ascites with interval development of intraperitoneal hemorrhage. 2. Small hypodense abnormality compatible with clot demonstrated projecting from the right flank parietal peritoneum. This may be the sequelae of recent instrumentation. 3. New development of right lower lobe consolidation, incompletely evaluated on this examination. PORTABLE ABDOMEN [**2174-3-23**]: IMPRESSION: Severe ascites. No evidence of obstruction. CHEST (PORTABLE AP) [**2174-3-25**]: IMPRESSION: Since [**2174-3-23**], Dobhoff tube now ends in the upper-to-mid esophagus. Right PICC ends in the upper SVC. Cardiomegaly is unchanged. Multifocal opacities, more prominent on the right increased, worrisome for progression of multifocal pneumonia. Brief Hospital Course: 44 year old female with cirrhosis presumed secondary to alcohol abuse and tylenol overuse, s/ p 2 week stay in the MICU ([**Date range (1) 81280**]), briefly transferred to floor, then transferred back to MICU on [**3-25**] with worsening renal function, mental status change, and respiratory distress thought likely secondary to narcotics; after stabilization in mental status and improved UOP and respiratory status, transferred back to floor on Liver service. Given poor prognosis and worsening liver disease and encephalopathy, pt was ultimately made CMO by family. #. Anemia: Hematocrit on admission to outside hospital was 9.1. The patient received 10U of PRBCs prior to transfer and hematocrit on admission to our ICU was 27.7. Etiology of profound anemia is likely multifactorial, including anemia of chronic disease (according to iron studies), low-grade GI bleed (with guaiac positive stool), and possible viral gastroenteritis plus alcohol use resulting in marrow supresssion. Reticulocyte count of 4 from OSH argues against hemolysis and more towards marrow supression. There was concern for DIC or TTP given low fibrinogen, elevated PTT, and thrombocytopenia, rare schistocytes; however, our suspecion was that these abnormalities are secondary to liver failure. MCV of 120 suggestive of alcohol abuse and liver failure. The liver service did not feel that concern for GI bleed was high enough to warrant endoscopy or colonoscopy during ICU course. In addition, the patient had acute blood loss from intraperitoneal bleed likely secondary to paracenteses in the setting of coagulopathy. She had a diagnostic paracentesis on [**3-13**] and on repeat diagnostic para on [**3-15**], ascitic fluid was blood-tinged. Over the next several days the patient required 7U PRBCs for multiple Hct drops. Therapeutic paracentesis on [**3-20**] removed 2.5L of grossly bloody fluid with an ascitic Hct of 8. CT Abd at that time showed evidence of hemoperitoneum with possible bleeding vessel on the right parietal peritoneum. The patient was transfused multiple units of FFP (8-12U per day x 4days) and platelets. She was evaluated by both general surgery and transplant surgery, and neither team felt that operative correction of her bleeding was appropriate due to her extremely high mortality rate. By [**3-22**], the patient's hematocrit had stabilized and she no longer required blood transfusions or further FFP. #. Cirrhosis: On admission, and throughout ICU course, patient had mild transaminitis with thrombocytopenia, ascites, LE edema, hepatosplenomegaly, and elevated INR to 2.5. This is likely secondary to cirrhosis from alcoholism, with a potential contribution of recent heavy tylenol use. Per patient and husband, the patient had not been drinking for 1 month prior to admission. The patient had no history of liver biopsy, no prior EGD/[**Last Name (un) **], and had never seen a hepatologist. The patient also had an ultrasound which showed portal vein thrombosis, which was not observed on CT scan. However, per radiology, ultrasound is a more sensitive test and thus the patient was presumed to have an acute portal vein thrombosis contributing to her worsening ascites and splenomegaly. The patient was not a candidate for anticoagulation or thrombolysis due to her high risk for bleeding complications. The liver team followed along while in the MICU and the patient was treated with N-acetylcysteine for 3 days. She was also maintained on lactulose, octreotide, rifaximin, and a PPI. In addition, the patient had 2 diagnostic paracenteses, the second of which showed evidence of SBP. Bladder pressures were monitored, and when bladder pressure was elevated >20mmHg on [**3-20**], the patient had a therapeutic paracentesis to remove 2.5L bloody ascitic fluid. #. SBP: On second paracentesis, the patient had evidence of SBP. She was treated with Unasyn x3days, Ceftriaxone x2days, and finally vancomycin/zosyn for 9 days. She was then transitioned to ciprofloxacin to complete a 2 week course on [**3-28**]. Ascitic fluid cultures were negative. The patient also had 2 KUBs to rule out obstruction as cause of abdominal distension and abdominal pain, both of which were negative for obstruction. #. Acute Renal Failure: The patient had elevation in Creatinine with peak of 3.0. FeNa was <1%. Differential included prerenal and hepatorenal syndrome. Creatinine normalized after albumin infusion x3, which argues against hepatorenal. On HD 12, Creatinine again elevated from 0.5 to 1.5, in the setting of having d/c'd octreotide and midodrine for one day. Albumin infusion was given again, but discontinued on the floor. Cr stabilized at 1.5. #. Diarrhea: Patient had diarrhea prior to admission and was not on lactulose/rifaximin. All stool studies were negative, though concern remained for viral gastroenteritis vs. med effect (was on magnesium oxide at OSH). The patient was started on lactulose/rifaximin during this admission and she continued to have mild diarrhea on this regimen. Pt also experienced rectal prolapse during this time. #. Hyperbilirubinemia. Patient has first onset jaundice in setting of heavy alcohol abuse and recent heavy tylenol use due to plantar fascitis. Concerning for jaudice due to liver failure, though per OSH report on presentation, hyperbilirubinemia was predominantly indirect (T. bili 17.1, D. bili 5.4). In the setting of getting 10 units of blood, T. bili rose to 37 with D. bili of 23. Suspect that hyperbilirubinemia is related to liver failure, but may have element of hemolysis (though labs do not substantiate this - retic count 4, LDH normal, hapto undectable but liver patient). Pt did not have any new signs of active bleeding or hematoma and no localizing symptoms. . #. Altered mental status. Patient had AMS that waxed and waned but improved slowly in the ICU. This was likely secondary to hepatic encephalopathy, SBP, and initially hyponatremia, which became hypernatremia during the second half of ICU stay. Head CT showed no evidence of acute intracranial process. Mental status improved on day of transfer to floor from MICU. Patient was oriented x [**12-31**] on the floor, with speech continuing to remain slow. Mental status and level of alertness continued to wax and wane throughout stay prior to her expiration. #. Thrombocytopenia: Likely secondary to liver failure and sequestration due to splenomegaly. Patient had evaluation for TTP and DIC, which was difficult to interpret due to liver failure, but was not highly suspicious. Rare schistocytes on smear with elevated PTT, low fibrinogen, and hyperbilirubinemia. However, LDH normal. As above, suspicion for DIC and HUS was very low. The patient received 2 U platelets while she had intraperitoneal bleed. Platelets stabilized in the 50s. #. Hyponatremia: Patient was hyponatremic on admission, likely secondary to ascites and LE edema. Once tube feeds were started, the patient became hypernatremic. Free water boluses and D5W was continued to correct serum sodium. . # Urinary Tract Infection: The patient's urine grew yeast on [**3-22**] and foley was changed. Patient was receiving Cipro for SBP already and thus no further antibiotics were added. . #. LE edema: The patient had bilateral LE pitting edema on admission, which was thought to be related to liver failure. However, cardiac function was evaluated with an echocardiogram, which showed normal LV systolic function and mild pulmonary hypertension. Her edema persisted throughout the admission. . # H/O Alcohol Abuse: The patient completed 5 days of high dose thiamine. She was continued on multivitamins and folate. . # CMO: At family meeting, was ultimately decided by family, including husband [**Name (NI) 382**] that pt would not want to continue with aggressive medical management under these circumstances. Pt was made CMO, with Morphine IV/PO SL made available. Hospice arrangements were initiated. Pt eventually expired prior to discharge to hospice, with family present at bedside. Medications on Admission: Tylenol prn Xanax 0.5 QID PRN lexapro 30 mg daily (takes intermittently) zolpiden prn hydrocodone prn (not prescribed to her) Discharge Medications: N/A, Expired Discharge Disposition: Expired Discharge Diagnosis: Cardiopulmonary arrest ETOH cirrhosis Discharge Condition: N/a, Expired Discharge Instructions: N/a, Expired Followup Instructions: N/a, Expired Completed by:[**2174-6-1**] ICD9 Codes: 5849, 2761, 2851
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Medical Text: Admission Date: [**2132-7-27**] Discharge Date: [**2132-8-25**] Date of Birth: [**2050-9-9**] Sex: M Service: CARDIOTHORACIC Allergies: Lasix / Bumex Attending:[**First Name3 (LF) 1505**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: [**2132-8-8**] Coronary Artery Bypass Graft x 5 (Left internal mammary artery > Left anterior descending, saphenous vein graft > diagonal, saphenous vein graft > obtuse marginal 1, saphenous vein graft > obtuse marginal 2, saphenous vein graft > posterior descending artery) [**2132-7-30**] Cardiac Catherization History of Present Illness: 81M complains of "constant tiredness" over 10-12 days, worse than previous chronic intermittent breathing problems; sudden onset [**8-12**] "heavy feeling" in abdomen; 2-3 days coryza, cough, sore throat, chills. [**7-26**] T 99.6F PO. No dizziness, no changes in chronic BLE edema, no N/V, and reports no other symptoms. . 81 y/o with h/o HTN, valvular diseas 1+MR, 1+ [**Last Name (LF) **], [**First Name3 (LF) **] 60% ([**2131-9-10**])who presents with few days of increasing SOB. He notes that he has been feeling poorly over the last few days and has had a heavy feeling in his stomach. While he has been having increased DOE x last few days, he feels that this is part of a more chronic process that has been going on for the past few months. Denied any chest pain/discomfort, but noted DOE. He is still able to climb 1 flight of stairs. Notes Orthopnea, denied PND. + Dry cough, + Chills, + rhinnorhea last two days. Denied fever, palpitations, irregular heart beats, worsening of chronic [**Location (un) **] (had for years. Complaiant with all his meds. Denied any dietary indiscretions. Past Medical History: HTN CAD Mitral regurg Aortic regurg Dyslipidemia Hypothyroidism Gout Bladder CA (12 years ago) pericarditis (remote) Social History: Pt. is a semi-retired CPA. Pt. lives with his family. Pt. has never smoked, does not drink alcohol, and has never used recreational drugs. Family History: Pt. does not have any family history of premature coronary artery disease. Physical Exam: T: 97.5 BP:148/70 P:70 RR:20 O2 sats: 95% on 2L Gen: Obese male sleeping comfortably HEENT: PEERL EOMI OP dry Neck: JVD could not be appreciated [**3-7**] girth. Supple CV: +s1+s2. No murmurs appreciated. RRR Resp: CTA B/L No RRW Abd: Obese. NTND Back: Seborrheic keratoses and skin tags Ext: 2+ peripheral edema up to knees Pertinent Results: [**2132-7-27**] 04:40PM CK-MB-17* MB INDX-12.1* cTropnT-0.33* proBNP-7201* [**2132-7-27**] 04:40PM CK(CPK)-141 [**2132-7-28**] 01:15AM CK-MB-15* MB Indx-10.7* cTropnT-0.41* [**2132-7-28**] 07:20AM CK-MB-11* MB Indx-10.4* cTropnT-0.38* . [**2132-8-1**] 06:55AM WBC-5.0 RBC-2.70* Hgb-8.9* Hct-25.7* MCV-95 MCH-33.1* MCHC-34.7 RDW-14.9 Plt Ct-201 . [**2132-8-2**] 07:15AM Glucose-106* UreaN-70* Creat-2.5* Na-141 K-4.2 Cl-103 HCO3-31 AnGap-11 [**2132-8-7**] 07:10AM Glucose-104 UreaN-58* Creat-1.9* Na-145 K-4.4 Cl-105 HCO3-35* AnGap-9 . [**2132-8-6**] 06:30AM proBNP-4448* . EKG: 5pm in ED: Sinus bradycardia with 1 degree AVB. Normal axis. Qt not prolonged. No EKGs in last 10 years to compare to. . CXR: [**2132-7-27**] FINDINGS: Lateral blunting of the right costophrenic sulcus is stable and unchanged compared to the most recent examination. This is likely scondary to pleural thickening. The cardiac silhouette is moderately enlarged. The pulmonary vasculature is mildly prominent. Prominence of the central pulmonary arteries is unchanged compared to the most recent examination. Right apical pleural thickening is unchanged. A small calcified focus projected over the right clavicle consistent with calcified granuloma is also unchanged compared to previous examinations. The lungs are grossly clear. There are no pleural effusions. The soft tissues and osseous structures are unremarkable. IMPRESSION: No direct evidence of CHF. Evidence of probably interstial lungn disease in the mid-lower lungs with associated prominent hila/bilateral lymphadenopathy. Pulmonary arterial prominence likely reflects underlying pulmonary hypertension. Relatively unchanged examination compared to most recent radiographs of [**2131-9-4**]. . CXR: [**2132-8-7**] Brief Hospital Course: He awaited stable creatinine and hematacrit prior to undergoing CABG on [**2132-8-8**]. After surgery he was transferred to the SICU in critical but stable condition on epi and neo. Post op oliguria improved with volume and natrecor. He was followed closely by Renal. He was extubated on POD #2. His creatinine continued to worsen, he continued on diuril and torsemide and a dialysis catheter was placed. CVVH was started on [**8-13**] to aid in fluid removal. He was started on amiodartone and coumadin for atrial fibrillation. His kidney function and urine output improved and CVVH was stopped. He was transferred to the floor on POD #12. He was started on vancomycin and levofloxacin for erythema of his sternal incision, which improved and the vanco was discontinued. He was ready for discharge to rehab on [**8-25**] with a wound check in one week. Medications on Admission: Torsemide 60 mg [**Hospital1 **] Terazosin 10 mg [**Hospital1 **] Norvasc 10 mg [**Hospital1 **] Clonodine 0.3 mg [**Hospital1 **] Allopurinol 200 mg daily Synthroid 0.025 mg daily Lipitor 10 mg daily Diovan 320 mg daily Toprol XL 50 mg daily Lexapro 20 mg daily Ranitidine 150 mg daily MVI Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Capsule(s) 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Torsemide 20 mg Tablet Sig: Three (3) Tablet PO twice a day. 5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 8. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 10. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day). 12. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) Injection QMOWEFR (Monday -Wednesday-Friday). 13. Lexapro 20 mg Tablet Sig: One (1) Tablet PO once a day. 14. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 15. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed. 16. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 7 days. 17. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for 2 days. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Coronary Artery Disease s/p CABG Acute tubular necrosis Heart Failure - diastolic dysfunction Hypercholesteremia Hypertension Hypothyroidism Gout Discharge Condition: Good Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: 1000 Please shower daily including washing incisions, no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 101 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for approximately one month No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Please call to schedule all appointments Dr [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] Dr [**Last Name (STitle) 58**] after discharge from rehab [**Telephone/Fax (1) 3329**] Dr [**Last Name (STitle) **] 2 weeks Completed by:[**2132-8-25**] ICD9 Codes: 5859, 5845, 2762, 4019, 2720, 2749, 2449
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Medical Text: Admission Date: [**2104-3-26**] Discharge Date: [**2104-4-1**] Date of Birth: [**2104-3-26**] Sex: M Service: NB HISTORY OF PRESENT ILLNESS: The patient is the 2.35 kg product of a 33-week gestation born to a 38-year-old, G1, P0 mom. OB history is significant for diet controlledgestational diabetes, maternal obesity, rupture of membranes on [**3-23**], adequate antibiotic coverage and betamethasone complete. The infant delivered by cesarean section due to fetal heart decelerations with Pitocin. Apgar scores were 9 and 9. PHYSICAL EXAMINATION: General: On admission birth weight was 2.35 g, length 47.5 cm, head with significant molding, anterior fontanel soft and flat. Eyes, ears, nose and mouth: Appear within normal limits. Oropharynx: Within normal limits. Eyes: With red reflex. Neck: Clavicles within normal limits. Chest: Symmetric breath sounds. Shallow intermittent grunting. Cardiovascular: Heart sounds appear within normal limits. No murmur. Well perfused. Normal peripheral pulses. Abdomen: No hepatosplenomegaly or masses. Nontender. Soft, full, 3-umbilical vessels. Genitalia: Normal premature male. Anus patent. Back: Within normal limits. Skin: Within normal limits. Extremities: Appear normal. Neurologic: Normal for premature infant of tone, posture movement, cry and normal state changes. HOSPITAL COURSE: Respiratory: The infant was admitted to the newborn intensive care unit and placed on nasal prong CPAP for management of increased work of breathing. Chest x-ray revealed mild to moderate respiratory distress syndrome. The infant was intubated. He received 1 dose of surfactant and was extubated by 24 hours of age. He was on nasal cannula oxygen for 48 hours and transitioned to room air. He remained stable in room air. He had occasional apnea of bradycardia episodes since starting caffeine citrate on [**3-28**]. He is currently receiving 7 mg/kg/day. Cardiovascular: No issues. Fluids and electrolytes: Birth weight was 2.35 kg. Discharge is . The infant initially started on 80 cc/kg/day of D10W. Enteral feedings were initiated on day of life #1 and advanced to full enteral feedings by day of life #4 and is currently on 140 cc/kg/day of premature Enfamil or breast mild 20 calories. On admission, he had a dextrose stick of 24, required a D10 bolus. The infant euglycemic since that time. Most recent set of electrolytes were on [**3-29**]; sodium 145, potassium 5.0, chloride 108, total CO2 24. GI: Peak bilirubin on day of life #2 was 9.7/0.3. He received phototherapy which was discontinued on the 26th. Rebound bilirubin was 9/0.2. His most recent bilirubin was on [**2104-4-1**], and the result is epmding at the time of discharge. Will contact [**Name (NI) **] with this result when available. . Hematology: Hematocrit on admission was 50.6. He has not required any blood transfusions. Infectious disease: CBC and blood culture were obtained on admission. CBC was benign, and blood culture remained negative at 48 hours at which ampicillin and gentamicin were discontinued. Initial showed a white count of 11.2, platelets 257, 16 polys, 1 band, 66 lymphs. Sensory: Hearing screen has not yet been performed but should be done prior to discharge home. Psychosocial: A social worker has been involved with the family and can be reached at [**Telephone/Fax (1) 8717**]. CONDITION ON DISCHARGE: Stable. DISPOSITION: To a level [**Hospital **] hospital. PRIMARY PEDIATRICIAN: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 66076**], [**Telephone/Fax (1) 58419**]. FEEDS AT DISCHARGE: Continue 140 cc/kg/day of breast milk or Premature Enfamil 20 calorie. Advance caloric intake as appropriate. MEDICATIONS: Continue caffeine citrate of 7 mg/kg/day. CAR SEAT POSITION SCREENING: Has not been performed. STATE NEW BORN SCREENING: Has been sent; most recently on [**3-29**], has been within normal limits. IMMUNIZATIONS RECEIVED: The infant received hepatitis B vaccine on [**2104-3-28**]. DISCHARGE DIAGNOSIS: Premature infant born at 32 and 2/7 weeks' gestation, respiratory distress syndrome, rule out sepsis with antibiotics, infant of a diabetic mother, hyperbilirubinemia, apnea and bradycardia of prematurity. [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2104-3-31**] 19:48:58 T: [**2104-3-31**] 20:20:05 Job#: [**Job Number 66077**] ICD9 Codes: 769, 7742, V290, V053
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Medical Text: Admission Date: [**2194-7-16**] Discharge Date: [**2194-7-24**] Date of Birth: [**2121-10-22**] Sex: M Service: TSURG Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern1) 1561**] Chief Complaint: right-sided chest pain and shortness of breath Major Surgical or Invasive Procedure: s/p apical wedge/talc pleuredhesis on [**2194-7-7**] and axillary thoracotomy with drainage on [**2194-7-16**]. History of Present Illness: 72M admitted to an outside hospital with a diagnosis of right-sided spontaneous pneumothorax. A chest tube was placed but the patient continued to have a persistent air leak. On [**2194-7-7**] he underwent broncoscopy and VAWR of the right upper lobe with talc pleuredhesis for a bronchopleural fistula. He was found to have a bulla on the apical segment of the RUL. During this admission he was diagnosed with MRSA and started on vancomycin and tobramycin. He also developed new onset afib. V/Q scan was indeterminate and head CT (obtained for a change in mental status) was negative for acute changes. He was transferred to [**Hospital1 18**] for further evaluation. Past Medical History: probably COPD high cholesterol s/p appy umbilical hernia s/p hemmoroidectomy afib Social History: quit smoking 21 years ago drinks EtOH daily Family History: n/c Physical Exam: T 96.9 HR 95-129 and afib BP 110/64 oxygen 93% HEENT: PERRLA, no JVD Lungs: left CTA, right decreased at base, chest tube draining Heart: irregularly irregular Abdomen: + BS, NT/ND Neuro: A + O x 3 Pertinent Results: [**2194-7-16**] 02:17AM WBC-14.3* RBC-3.88* HGB-11.9* HCT-34.1* MCV-88 MCH-30.7 MCHC-34.9 RDW-13.7 [**2194-7-16**] 02:17AM PLT COUNT-187 [**2194-7-16**] 02:17AM PT-13.8* PTT-28.3 INR(PT)-1.3 Brief Hospital Course: The patient was s/p for a R VAWR/talc pleuredhesis/bleb resection. He was taken to the operating room on [**2194-7-16**] for a right axillary thoracotomy and drainage of empyema. He tolerated the procedure wellHe was admitted to the ICU and remained intubated. CT revealed a dominant apical fluid collection. He continued to be weaned from his sedation, his pressors, and was extubated. He was trasferred to the floor on [**2194-7-19**]. He continued to drain fluid from both chest tubes. His heparin was discontinued and he was placed first on 3mg of coumadin, and later down to 2.5mg. He continued to void and ambulate appropriately. On [**2194-7-23**] one of his chest tubes was removed and his central line was removed. A PICC line was placed as well. On [**2194-7-24**] the patient pulled out his PICC line by accident and it had to be replaced. His second chest tube was converted to a drain and he was discharged to [**Hospital 5503**] rehab facility. Medications on Admission: vancomycin 1g q12 tequin Discharge Medications: 1. Amiodarone HCl 200 mg Tablet Sig: Two (2) Tablet PO three times a day. Disp:*180 Tablet(s)* Refills:*2* 2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* 3. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO Q12H (every 12 hours). Disp:*30 Tablet(s)* Refills:*2* 5. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 6. Vancomycin HCl 10 g Recon Soln Sig: 1 vial Recon Soln Intravenous Q12H (every 12 hours) for 4 weeks: 1g q12h. Disp:*qs Recon Soln(s)* Refills:*2* 7. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. 8. Potassium Chloride 20 mEq Packet Sig: One (1) PO once a day. Discharge Disposition: Extended Care Facility: TBA Discharge Diagnosis: status/post apical wedge/talc pleuredhesis on [**2194-7-7**] and axillary thoracotomy with drainage on [**2194-7-16**]. hypercholesterolemia umbilical hernia status/post hemmorhoidectomy appendectomy new atrial fibrillation Discharge Condition: good Discharge Instructions: Go to an Emergency Room if you experience new and continuing nausea, vomiting, fevers (>101.5 F), chills, or shortness of breath. Also go to the ER if your wound becomes red, swollen, warm, or produces pus. You may remove your dressings 2 days after your surgery if they were not removed in the hospital. Leave the steri strips on until they begin to peel, then you may remove them. If you experience clear drainage from your wounds, cover them with a clean dressing and stop showering until the drainage subsides for at least 2 days. No heavy lifting or exertion for at least 6 weeks. No driving while taking pain medications. Narcotics can cause constipation. Please take an over the counter stool softener such as Colace or a gentle laxative such as Milk of Magnesia if you experience constipation. Be sure to take your complete course of antibiotics. You may resume your regular diet as tolerated. You may take showers (no baths) after your dressings have been removed from your wounds. Followup Instructions: Call to set up an appointment with Dr. [**Last Name (STitle) **] in 1 week. Call to schedule a follow up appointment in [**12-27**] weeks with Dr. [**Last Name (STitle) 952**] ([**Telephone/Fax (1) 1504**]). The patient's primary care physician will follow him for his coumadin therapy as well as the drain care. The drain should be withdrawn [**12-27**] inches per week until it is out. PCP is [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 15170**] MD, ([**Telephone/Fax (1) 50234**]. ICD9 Codes: 496, 2720
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Medical Text: Admission Date: [**2172-1-4**] Discharge Date: [**2172-1-8**] Date of Birth: [**2096-8-19**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 3276**] Chief Complaint: right hip pain and cellulitis of left lower extremity Major Surgical or Invasive Procedure: none History of Present Illness: 75 M with history of cardiomyopathy with EF35% 2/2 rheumatic fever, atrial flutter, HTN, HL, mantle cell lymphoma in remission, right hip pain secondary to degenerative hip disease presents with fevers, chills, increasing generalized weakness for 3 days as well as productive cough with yellowish phlegm x2 weeks. Patient reports that for the past few [**Last Name (un) 32460**] he has felt increasingly lethargic. He has been taking frequent naps which is unusual for him. He also noted progressively worsening mobility due to pain/stiffness in his joints. He has chronic right hip and knee pain. This morning, he was unable to change positions from sitting to standing. He remained in bed due to weakness. He denies worsening swelling or erythema in his lower extremities. He did have some mild pain in his left leg and knee. He developed chills around 7:15 am and came to the ER for evaluation. In addition, he reports 2.5 weeks of cough productive of grey/yellow sputum. He denies any chest pain or shortness of breath associated with cough. He notes that it has improved in the last several days. . Of note, patient went to the podiatrist Tuesday and had his toe nails clipped. Left second toe was accidentally cut. He did not really notice that his left leg was erythematous until he got to the ED. Says that his left leg is usually more swollen anyway since his ankle injury. . In the ED, initial VS were as follows: 99.6 86 137/71 18 95% RA. Was noted to be in Afib with heart rates to 120s, but holding blood pressure. Was given IV fluids with return to normal sinus rhythm. Tmax in ED was [**Age over 90 **]F. He was noted to have erythema of right leg. He was also noted to be soaked in urine and with stage 1 ulcer overlying swelling of right posterior hip. He was also noted to have a dressing on his left 2th toe that had adhered to nailbed from his podiatry appointment on Wednesday; dressing was removed with gauze in ED. He was given a dose of vancomycin to treat cellulitis. His hip was considered for septic joint, however exam showed that his hip joint was rangeable. His CXR was not very concerning for pneumonia, but given that he was producing sputum and having fever, was given levofloxacin. . Vitals in ED at time of bed request were as follows: 99.6 86 137/71 18 95%RA. About half hour after getting a dose of oxycodone, his blood pressures were 87/50s while asleep, blood pressure responded to IV fluids. Patient intermittently would continue to dip down into the 80s, each time responsive to IV fluids. Received a total of 3 L NS. Lactate improved from 2.7 to 1.1. VS in ED prior to transfer were as follows: 82, 96/41, 17, 96% RA . On arrival to the ICU, vital signs were T103.0 BP 119/51 HR 90 saturating on RA. He was talkative and had no complaints of pain. . Past Medical History: # Rheumatic heart disease with mitral regurgitation - Status post acute rheumatic fever and pericarditis in [**2103**] # Cardiomyopathy, non-ischemic - initially thought to be secondary to chemotherapy, then attributed to potential tachycardia-induced cardiomyopathy - echocardiogram on [**2171-5-17**] showed moderate LV global hypokinesis (EF 35%) # Atrial flutter - on warfarin - plan by cardiologist to set up Holter in 6 months ([**6-/2172**]) and consider stopping anticoagulation if no recurrence of arrhythmia # Hypertension # Hyperlipidemia # Prediabetes # Mantle Cell Lymphoma - s/p chemotherapy, 6 cycles Bendamustine/Rituxan - last session [**2171-4-5**] - currently in remission, followed by Dr. [**Last Name (STitle) **] - on rituximab for maintenance, started [**12/2171**] # Adenocarcinoma of prostate with [**Doctor Last Name **] score of 6 - status post radiation in [**2158**] # Right knee degenerative joint disease # Status post left scapular fracture # Status post right big toe fracture # Status post right leg osteomyelitis at age 30 years old # Gout associated with hyperuricemia # Status post volar plate injury of right fifth digit # Abdominal sepsis in [**2149**] # Allergic rhinitis # Chronic pedal edema # Cervical disc disease # Lumbar disc disease associated with right sciatica # Vitamin D deficiency # s/p Open reduction and internal fixation left ankle post-fracture. Social History: Patient lives with his wife and his two children lvie with their families in the same building. He has three grandchildren. He is retired, but used to work as a maintenance, as machinist and in shipyard (he was exposed to asbestos from [**2136**] and [**2142**]). He quit smoking 25 years ago. He used to smoke for 10 years approximately one pack per week. He is consuming alcohol occasionally Family History: Negative for any type of cancer, leukemia, or lymphoma; however, his sister has anemia and significant weight loss. Physical Exam: Vitals: T: 103.0 BP: 119/51 P: 90 R: 18 O2: 94% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, PERRL, oropharynx dry but without exudate or erythema. Neck: supple, JVP not elevated, no lymphadenopathy palpated Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding GU: no foley Ext: RIGHT LOWER EXTREMITY- right hip with limited active range of motion, full passive range of motion without pain. No swelling or erythema of hip, swelling without erythema of right knee. Full active/passive ROM of ankle. 2+ pitting edema to knee. LEFT LOWER EXTREMITY- full active/passive ROM of hip/knee/ankle. Strength 5/5. Skin: Right lower extremity with superficial excoriation on right shin without surrounding erythema and no exudate. Left 2nd toe with dried blood above nailbed, no swelling of toe. Erythema from base of left MTPs tracking up to knee and then continuing in lymphatic pattern into medial aspect of thigh. Mild induration, mostly 2+ pitting edema. + warmth. no tenderness. . ON DISCHARGE: PE: AF Tmax 99.6 BP 102-120/70 70s 20 97% RA Appearance: alert, NAD Eyes: eomi, perrl, anicteric ENT: OP clear s lesions, mmm, no JVD, neck supple Cv: +s1, s2 -m/r/g, 1+ peripheral lower extr edema Pulm: clear bilaterally Abd: soft, obese, nt, nd, +bs Msk: 5/5 strength throughout, + left ankle deformity, no cyanosis or clubbing Neuro: cn 2-12 grossly intact, no focal deficits. pt can not lift his left leg off the bed Skin: LLE erythema - improved, mildly tender, some wrinkling of skin, erythema significantly reduced, 2+ pitting edema Walking with walker with limp, but able to apply weight to both legs FROM of left hip Psych: appropriate, pleasant Heme: no cervical [**Doctor First Name **] Pertinent Results: ADMISSION LABS: [**2172-1-4**] 09:20AM BLOOD WBC-12.8*# RBC-3.19* Hgb-10.2* Hct-32.7* MCV-102* MCH-31.9 MCHC-31.2 RDW-18.8* Plt Ct-207 [**2172-1-4**] 09:20AM BLOOD Neuts-82* Bands-8* Lymphs-6* Monos-4 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2172-1-4**] 09:20AM BLOOD PT-33.7* PTT-46.9* INR(PT)-3.3* [**2172-1-4**] 09:20AM BLOOD ESR-60* [**2172-1-4**] 09:20AM BLOOD Glucose-117* UreaN-22* Creat-0.9 Na-137 K-6.6* Cl-98 HCO3-25 AnGap-21* [**2172-1-4**] 09:20AM BLOOD proBNP-1199* [**2172-1-4**] 09:20AM BLOOD cTropnT-0.03* [**2172-1-5**] 04:08AM BLOOD cTropnT-0.02* [**2172-1-4**] 09:20AM BLOOD CRP-47.7* [**2172-1-4**] 09:40AM BLOOD Lactate-2.7* K-5.5* [**2172-1-4**] 03:46PM BLOOD Lactate-1.1 Micro: UA ([**2172-1-4**]) - negative blood cultures x2 ([**2172-1-4**]) - pending . Images: LLE LENI ([**2172-1-4**]) - No evidence of DVT, although the left peroneal veins not visualized . CXR ([**2172-1-4**]) - my read - mild cardiomegaly, no pleural effusion, no infiltrate . DISCHARGE LABS: [**2172-1-8**] 05:45AM BLOOD WBC-4.6 RBC-2.26* Hgb-7.6* Hct-23.3* MCV-103* MCH-33.8* MCHC-32.8 RDW-17.8* Plt Ct-106* [**2172-1-8**] 05:45AM BLOOD PT-26.2* INR(PT)-2.5* [**2172-1-8**] 05:45AM BLOOD Glucose-101* UreaN-21* Creat-0.7 Na-136 K-3.7 Cl-100 HCO3-28 AnGap-12 [**2172-1-8**] 05:45AM BLOOD Calcium-8.5 Phos-4.5 Mg-1.6 Brief Hospital Course: BRIEF HOSPITAL COURSE: This is a 75 M with history of degenerative hip disease, mantle cell lymphoma, presenting with fevers, chills, fatigue, right hip pain, and cough, noted to be intermittently hypotensive in the ED, concern for sepsis who was admitted to the ICU briefly for stabilization then transferred to the floor for management of cellulitis. . ACTIVE ISSUES: #. Hypotension/Cellulitis - Met SIRS criteria with fever and white count. Hypotensive to SBP to 80s in the ED, which was fluid responsive. CBC with differential showing 8% bands. Most likely source seems to be from left lower extremity cellulitis, point of entry probably from the cut on his toe. He also has skin breakdown on his right leg however with no localized erythema. Patient complains of a nagging cough, but CXR without any signs of pneumonia. Ortho examined the patient and felt hip unlikely to be source or septic joint. His blood pressure and anti-hypertensive medications were held. He was started on vancomycin for treatment of his cellulitis with significant improvement in his leg exam. He was called out to the floor on HD 2. Pt remained normotensive, vancomycin was discontinued and bactrim and keflex were started. Pt has penicillin allergy but he stated it made him turn red and he never had any difficulty breathing. He also felt that he recalled being treated with keflex in the past. His home bp meds were also restarted on HD 2. Tolerated PO abx well with continued improvement in leg exam. . #. Afib w/ RVR - Patient was tachycardic in the ED which persisted on arrival to [**Hospital Unit Name 153**] with HR stably in 130-140s - afib with rapid ventricular response on EKG. He has a history of paroxysmal afib that failed cardioversion this summmer. Thought [**3-6**] fluid depletion and infection. He was given IVF, started on PO metoprolol and given IV metoprolol 2.5 with initial conversion into sinus. His cardiologist was emailed regarding his admission and recommended that no significant changes be made to his medication list. Accordingly he was sent out on his home dose of carvedilol and warfarin. He had no episodes of A fib on telemetry on the Oncology floor. Was continued on coumadin, last INR 2.5 on [**1-8**]. Pt needs INR closely monitored as this is a rapid overnight change. Additionally he was started on bactrim which can alter warfarin levels. . INACTIVE ISSUES: #. Right Hip pain- limited ROM, concerning for seeded joint from initial cellulitis leading to bacteremia. Orthopaedics evaluated joint and felt joint not septic. . #. Hypertension - intermittently hypotensive, held home antihypertensives while in [**Hospital Unit Name 153**] but restarted on the floor prior to discharge without issue. . #. h/o rheumatic heart disease - TTE in [**5-/2171**] shows moderate LV global hypokinesis with EF 35%. CXR shows a heart silouette that is larger than it had been in the past. Pt to follow up with cardiologist. . #. Hyperlipidemia - not on statin at home, did not start here. . #. Pre-diabetes - had been on metformin in the past, but currently not on anything at home. Pt was maintained on insulin sliding scale and sent home without medications for blood sugar management as he had been admitted without those as well. . #. Mantle Cell Lymphoma - s/p 6 cycles of Bendamustine/Rituxan (last session [**2171-4-5**]). Currently in remission, maintained on rituximab, last dose on [**2171-12-23**]. Followed by Dr. [**Last Name (STitle) **] with tentative plan for dose at next appointment. . #. Gout- continued allopurinol . TRANSITIONAL ISSUES: - Follow-up: Pt needs INR checked tomorrow [**2172-1-9**]. INR [**1-7**] of 1.9 and [**1-8**] of 2.5. Coumadin restarted [**1-6**]. Pt was sent out on his home dose of warfarin, 5mg daily. - Appointment with Dr. [**Last Name (STitle) **] on [**1-20**] for Oncology follow up . Pt was maintained as full code throughout the course of this hospitalization. Contact: wife [**Name (NI) **] [**Telephone/Fax (1) 110899**] - son [**Name (NI) **] [**Telephone/Fax (1) 110900**] - [**Name2 (NI) **]ter [**Name (NI) 2411**] [**Telephone/Fax (1) 110901**] Medications on Admission: allopurinol 300 mg daily carvedilol 3.125 mg [**Hospital1 **] furosemide 40 mg [**Hospital1 **] hydrocodone-acetaminophen 5 mg-500 mg Tablet - 1-2 tabs q6h prn pain lisinopril 5mg daily lorazepam 0.5 mg q6h prn anxiety omeprazole 20 mg daily ondansetron 8 mg q8h prn nausea polyethylene glycol daily prn constipation warfarin 5 mg daily acetaminophen 325-650 mg q6h prn fever, pain docusate sodium 100 mg [**Hospital1 **] prn constipation senna 2 tabs qhs Discharge Medications: 1. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety. 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO q8prn as needed for nausea. 8. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) dose PO daily:prn. 9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 12. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 13. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever, pain. 14. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 9 days. 15. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 9 days. 16. neomycin-bacitracnZn-polymyxin 3.5-400-5,000 mg-unit-unit/g Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for abrasion. Discharge Disposition: Extended Care Facility: [**Hospital **] Rehab Discharge Diagnosis: Primary: Left lower leg cellulitis Secondary: Follicular lymphoma Chronic systolic heart failure 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 **], It was a pleasure taking care of you during your hospitalization. You were admitted because of a severe cellulitis of your left lower leg. Your blood pressure was low initially so you were admitted to the ICU. They stabilized you and you were transferred to the Oncology floor. You were initially getting IV antibiotics, but we switched these to oral antibiotics and watched for 24 hours on them; you did fine. You were seen by our physical therapists who recommended rehab placement to give you some extra support while you increase your strength. . We are keeping you on your same regimen for your heart disease. . We made the following changes to your medications: Bactrim DS 2 tabs by mouth twice daily for 9 more days Keflex 500mg by mouth every 6 hours for 9 more days Bacitracin ointment to be applied to the scab on your right foreleg Followup Instructions: Department: HEMATOLOGY/ONCOLOGY When: MONDAY [**2172-1-20**] at 9:00 AM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 22**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: BMT CHAIRS & ROOMS When: MONDAY [**2172-1-20**] at 9:30 AM Department: HEMATOLOGY/ONCOLOGY When: MONDAY [**2172-1-20**] at 9:30 AM With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 13863**], RN [**Telephone/Fax (1) 3241**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**] ICD9 Codes: 0389, 4254, 4280, 4019, 2749
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Medical Text: Admission Date: [**2176-10-6**] Discharge Date: [**2176-10-14**] Service: CCU HISTORY OF PRESENT ILLNESS: This is a 79 year old female with past medical history including chronic obstructive pulmonary disease, aortic insufficiency, mitral stenosis, and hypertension who presented from an outside hospital with pneumonia and congestive heart failure exacerbation. In outside hospital notes, notes record that the patient's daughter reports that the patient had some shortness of breath on the evening prior to admission. It was worse on the morning of admission and so EMS was called to transport the patient to the hospital. On their arrival, they found the patient to be severe respiratory distress with oxygen saturation of 80% in room air and unable to speak. The patient was given 80 mg of Lasix and easily intubated. She was extubated in the Emergency Department at the outside hospital and initially did well on BiPAP. However, while on 100% nonrebreather, the patient's oxygen saturation decreased to 93% and she was tachypneic at 34 to 38. Arterial blood gases at that time revealed pH of 7.22, pCO2 of 55 and pO2 of 90. The patient was intubated and transferred to the outside hospital Coronary Care Unit. In the Coronary Care Unit at the outside hospital, chest x-ray was consistent with congestive heart failure with extensive infiltrate in the right lung. White blood cell count was 24.0. The patient was started on Levofloxacin for presumed community acquired pneumonia. During this time, the patient was ruled out for a myocardial infarction with negative enzymes times three. However, her electrocardiogram showed symmetric deep T wave inversion. When an attempt was made to wean the patient off the ventilator, she developed rapid atrial fibrillation with a rate of 150. She received Diltiazem and Lopressor with a decrease in her rate to the 80s. She was subsequently started on Heparin drip and cardioverted. The patient was then transferred to [**Hospital1 1444**] for further care. PAST MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease. 2. Type 2 diabetes mellitus. 3. Aortic insufficiency/aortic stenosis/mitral stenosis. 4. History of rheumatic fever. 5. Paroxysmal atrial fibrillation. 6. Hypertension. 7. Congestive heart failure. 8. Coronary artery disease. ALLERGIES: Sulfa. MEDICATIONS ON ADMISSION: 1. Glucophage 1000 mg twice a day. 2. Glyburide 5 mg p.o. once daily. 3. Prilosec 20 mg p.o. once daily. 4. Coumadin. 5. Tiazac 120 mg three times a day. 6. Lasix 20 mg p.o. once daily. 7. Lanoxin 0.125 mg p.o. once daily. 8. Diovan 80 mg p.o. once daily. 9. Folic Acid 1 mg p.o. once daily. 10. Evista 60 mg p.o. once daily. 11. Vitamin B6 25 mg p.o. once daily. 12. Vitamin B12 250 mg p.o. once daily. 13. Advair two puffs once daily. 14. Rhinocort 32 mg two puffs once daily. PHYSICAL EXAMINATION: On admission, physical examination revealed a temperature of 99.0, blood pressure 114/74, heart rate 68. The patient was intubated. Vent settings were assist control with a tidal volume 600, respiratory rate 10, PEEP 5 and FIO2 of 0.4. In general, the patient was sedated on ventilator, nonresponsive. Cardiovascular - regular rate and rhythm, S1 and S2, III/VI systolic ejection murmur at the base. No carotid bruits, no appreciable jugular venous distention. Pulmonary - coarse breath sounds bilaterally. The abdomen is soft, nontender, nondistended, positive bowel sounds, no hepatosplenomegaly. Extremities revealed no cyanosis, clubbing or edema, 2+ dorsalis pedis pulses. LABORATORY DATA: Sodium 139, potassium 3.8, chloride 108, bicarbonate 25, blood urea nitrogen 28, creatinine 0.8, glucose 121, calcium 8.5, magnesium 2.1, phosphorus 3.6. White blood cell count 14.1, hematocrit 31.2, platelet count 368,000. Prothrombin time 22.2, partial thromboplastin time 45.3, INR 3.3. Chest x-ray on admission revealed a heart size the upper limits of normal. Upper zone redistribution with mild diffuse vascular blurry consistent with congestive heart failure, probable right effusion. Increased retrocardiac density consistent with left lower lobe collapse and/or consolidation. Minimal atelectasis at the right base. HOSPITAL COURSE: 1. Cardiac - Coronaries - The patient ruled out for myocardial infarction at outside hospital. On admission, electrocardiogram revealed sinus rhythm at 60 beats per minute with deep T wave inversion throughout the precordium. Very well, T waves were considered as possible explanation given the patient's negative cardiac enzymes. A CT of the head was obtained on the evening of admission which was normal. Cardiac catheterization was subsequently performed on [**2176-10-10**], to evaluate the size of the patient's coronary arteries. It revealed a right dominant system with mild single vessel disease. The left main coronary artery had no angiographically appearing flow limiting stenosis. The left anterior descending had no angiographically appearance of flow limiting stenosis. The left circumflex had no angiographically flow limiting stenosis. The right coronary artery had no significant disease, and the posterior descending artery had a focal 70% tubular lesion in the distal vessel. Resting hemodynamics revealed normal right sided filling pressures with a mean right atrial pressure of 5 mmHg. There were elevated left sided filling pressures with a left ventricular end diastolic pressure of 12. The cardiac index was normal at three liters per minute per meter square. There was moderate pulmonary hypertension with a pulmonary artery pressure of 36 mmHg. Left ventriculography revealed 1+ mitral regurgitation, no wall abnormalities, and calculated ejection fraction of 55%. Further evaluation of the aortic valve revealed a peak gradient across the aortic valve of 21 and a mean gradient of 16. Calculated valve area was 1.3 centimeter squared. Evaluation of the mitral valve revealed a mean gradient of 12. Although the patient had no critical coronary artery disease on cardiac catheterization, given her history of diabetes mellitus, she was started on a statin during the admission. A lipid panel from [**2176-10-11**], revealed a triglyceride level of 114, HDL of 50 and LDL of 74. Rhythm - The patient had a history of paroxysmal atrial fibrillation in the past and an episode of rapid atrial fibrillation during extubation attempt at the outside hospital. She was electrically cardioverted at the outside hospital and arrived to [**Hospital1 69**] on an Amiodarone drip. On her arrival, the patient was in sinus rhythm. She was continued on the Amiodarone 400 mg p.o. twice a day. This dose was continued for one week at which time the patient's Amiodarone dose was decreased to 400 mg p.o. once daily for a total of one week. At the end of this period, the patient will be on a standing Amiodarone dose of 200 mg p.o. once daily. In addition, the patient was anticoagulated for her atrial fibrillation while in the hospital. This was initially accomplished with a Heparin drip as it was the plan for the patient to go for catheterization. Following catheterization, the patient was restarted on Coumadin with a Heparin bridge until therapeutic. The patient remained in sinus rhythm throughout the hospitalization. Pump - The patient with a history of congestive heart failure. On admission, the patient did not appear volume overloaded. An echocardiogram was obtained on [**2176-10-8**], to evaluate her pump status. It revealed moderate dilation of the left and right atrium. There was mild symmetric left ventricular hypertrophy with normal cavity size and systolic function with a left ventricular ejection fraction of greater than 55%. Regional left ventricular wall motion was normal. The aortic valve leaflets were moderately thickened with mild 1+ aortic regurgitation. The mitral valve leaflets were moderately thickened. They show characteristic rheumatic deformity with diffuse commissures and tethering of the leaflet motion. There was mild mitral annular calcification. There was moderate mitral stenosis. Mild to moderate 1 to 2+ mitral regurgitation was also seen. Mild to moderate 1 to 2+ tricuspid regurgitation was seen. There was mild pulmonary artery systolic hypertension. There was a small pericardial effusion. With the information obtained from the echocardiogram and subsequent cardiac catheterization, it was determined that the patient did not require immediate valve repair. However, this is the likely possibility in the future. Early during the admission, the patient was gently diuresed for her congestive heart failure. 2. Pulmonary - The patient arrived from outside hospital with diagnosis of community acquired pneumonia. However, the infiltrate which had been visualized at the outside hospital was no longer present on chest x-ray the morning following admission. Therefore, it is most likely that the patient's acute respiratory decompensation and pulmonary symptoms were due to congestive heart failure exacerbation. However, a seven day course of Azithromycin and Ceftriaxone were completed for the presumed community acquired pneumonia. The patient tolerated the ventilator well during the first few days of admission. She was extubated on [**2176-10-9**], without events. She continued to do well throughout the remainder of the admission with oxygen saturation in the high 90s in room air. The patient's inhalers for chronic obstructive pulmonary disease were continued throughout the admission. 3. Hypertension - The patient's hypertensive medications were titrated up over the course of the admission. Her probable final doses on discharge will be Metoprolol 50 mg p.o. twice a day and Lisinopril 40 mg p.o. once daily. 4. Hematology - The patient anticoagulated for atrial fibrillation with Heparin drip early in the admission in preparation for subsequent cardiac catheterization. Elevated INR was reversed with Vitamin K times two doses. Following cardiac catheterization, the patient was restarted on Coumadin with a Heparin bridge until she had a therapeutic INR. The patient's hematocrit remained stable throughout the hospitalization. She did not require any transfusion. 5. Diabetes mellitus, type 2 - The patient continued on sliding scale insulin and scheduled insulin throughout the admission. American Diabetic Association diet. 6. Prophylaxis - The patient anticoagulated with Heparin for her atrial fibrillation essentially covering her for deep vein thrombosis prophylaxis. Proton pump inhibitor for gastrointestinal. 7. Rehabilitation - The patient worked with physical therapy as an inpatient. It was felt that she would benefit from a short stay in acute rehabilitation facility. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: The patient will be discharged to acute rehabilitation facility for a short stay. DISCHARGE DIAGNOSES: 1. Congestive heart failure. 2. Mitral stenosis. 3. Aortic valve insufficiency. 4. Hypertension. 5. Chronic obstructive pulmonary disease. 6. Respiratory distress. 7. Diabetes mellitus type 2. 8. Paroxysmal atrial fibrillation. 9. History of rheumatic fever. MEDICATIONS ON DISCHARGE: 1. Fluticasone 110 mcg two puffs inhaled twice a day. 2. Ipratropium 18 mcg two puffs inhaled four times a day. 3. Pantoprazole 40 mg p.o. once daily. 4. Aspirin 325 mg p.o. once daily. 5. Amiodarone 400 mg p.o. once daily until [**2176-10-21**], and from that time on, the patient will be taking 200 mg p.o. once daily. 6. Atorvastatin 10 mg p.o. once daily. 7. Eucerin cream topical four times a day p.r.n. 8. Metoprolol 50 mg p.o. once daily. 9. Docusate Sodium 100 mg p.o. twice a day. 10. Lisinopril 40 mg p.o. once daily. 11. Glucophage 1000 mg p.o. twice a day. 12. Glyburide 5 mg p.o. once daily. 13. Folic Acid 1 mg p.o. once daily. 14. Evista 60 mg p.o. once daily. FOLLOW-UP PLANS: The patient will follow-up with her cardiologist, Dr. [**Last Name (STitle) 82074**], at the [**Hospital6 15291**]. She will schedule this appointment to suit her convenience. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], M.D. [**MD Number(1) 9615**] Dictated By:[**Name8 (MD) 315**] MEDQUIST36 D: [**2176-10-13**] 13:00 T: [**2176-10-13**] 13:46 JOB#: [**Job Number 100914**] ICD9 Codes: 496, 486, 4019
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Medical Text: Admission Date: [**2201-7-22**] Discharge Date: [**2201-7-24**] Date of Birth: [**2117-11-13**] Sex: F Service: MEDICINE Allergies: Penicillins / Phenergan Plain / Aldactone / Digoxin Attending:[**First Name3 (LF) 30**] Chief Complaint: Weakness Major Surgical or Invasive Procedure: none History of Present Illness: 83 female with history of CAD s/p CABG and DES to LMCA, dCHF, DMII, ESRD on HD (started last month), COPD, HL, PVD, HTN, recent admission for colitis ([**2201-5-23**] to [**2201-5-28**]) who reports never feeling quite same since last discharge. She was doing well until three days ago when she fell on her back without head trauma, LOC, chest pain or palpatations while getting up because her legs gave up. She presented to the ED and was noted to have hypoglycemia to 42 which improved with D50. She was discharged home but represented yesterday as she still felt weak and did not think she could tolerated dialysis yesterday. . In the ED initial vital signs were 98.6 HR 68 BP 188/48 RR 16 97%RA Exam was notable for poor joint sense in L>R LEs, stance and gait unsteady, unable to ambulate without assistance. Slow but intact heel-shin. CN II-XII intact, strength 5/5 throughout, sensation intact. No spine tenderness. Patient was given kayexelate for K=5.8. CXR was done revealing mild fluid overload and could not exclude pneumonia. Initially she was medically cleared for discharge from ED, but patient failed PT eval. She was seen by case management and admitted to [**Hospital1 **] observation for dialysis tomorrow morning since she missed HD yesterday. However, upon getting ready to transfer to the floor, BP was noted to be 208/59. She was given metoprolol and hydralazine IV with no improvement in BP. Denied HA, blurry vision or CP at any time throughout episode. Given the persistently elevated BP, the decision was made to admit her to the MICU yesterday. . In the MICU, she received dialysis this morning with removal of 2L to her dry weight of 63 kg. She was restarted on her home antihypertensive regimen with nifedipine, metoprolol and lisinopril. She was tranferred to medicine floor for further evaluation and management of her weakness. . On the floor, she does not report headache, fever, chills, chest pain, shortness of breath, myalgias, abdominal pain, back pain, nausea, vomiting or dysuria. She reports bilateral ankle pain L > R. Past Medical History: - CAD: s/p 5V CABG [**2180**]; echo [**3-24**] 45-50%; cath [**4-20**] showed 3V disease. Cath [**4-1**] w successful stenting of the LMCA into LAD with Endeavor DES. - Chronic diastolic CHF - CVA: subacute stroke R MCA in [**12/2197**] - COPD: [**4-20**] PFT showed reduced FVC with low-normal TLC - Hyperlipidemia - PVD - s/p angioplasty in LLE and s/p bypass in RLE - Sensorineural hearing loss - partial loss in Left ear, with hearing aid; complete loss in R ear - HTN - Chronic low back pain - ESRD on HD - DM-II - Diabetic neuropathy - s/p cataract surgery - Depression Social History: - Former school secretary - Involved in senior citizens club with active social life - Tobacco: 120 pack-year smoking history - etOH: Rare - Illicits: Denies Family History: - 2 parents and 6 siblings all died of DM and heart disease Physical Exam: PHYSICAL EXAM: VS: 96.4 56 116/60 100%2LNC General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple Chest: Tunneled HD catheter in R subclavian Lungs: Bibasilar crackles CV: Regular rate and rhythm, normal S1, split 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: CN 2-12 intact. [**5-21**] LE strength (able to stand up from sitted position). Sensation intact. Normal gait. 2+ DTR. Discharge PE PHYSICAL EXAM: VS: 96.0 P 66 BP 135/77 O2 100%RA General: NAD HEENT: MMM, oropharynx clear Neck: supple, no JVD Chest: Tunneled HD catheter in R subclavian Lungs: CTAB CV: Regular rate and rhythm, normal S1, split 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: CN 2-12 intact. [**5-21**] LE strength. Sensation intact. Normal gait. 2+ DTR. Pertinent Results: [**2201-7-22**] 12:10PM GLUCOSE-208* UREA N-57* CREAT-6.2*# SODIUM-141 POTASSIUM-5.8* CHLORIDE-100 TOTAL CO2-27 ANION GAP-20 [**2201-7-22**] 12:10PM CALCIUM-9.3 PHOSPHATE-3.6 MAGNESIUM-2.0 [**2201-7-22**] 12:10PM WBC-6.2 RBC-3.93* HGB-12.3 HCT-40.2 MCV-102* MCH-31.2 MCHC-30.5* RDW-14.9 [**2201-7-22**] 12:10PM NEUTS-61.7 LYMPHS-29.7 MONOS-5.9 EOS-2.5 BASOS-0.2 [**2201-7-22**] 12:10PM PLT COUNT-224 [**2201-7-23**] WBC 7.4, Hgb 12.4 Hct 39.6 Plt 225 B12: 705, folate: WNL [**2201-7-24**] glucose 52, BUN 36, Cr 4.7, Na 141, K 4.3 Cl 96 HCO3 34 TSH 1.6 ECG [**2201-7-23**] Sinus bradycardia. Left ventricular hypertrophy with secondary repolarization abnormalities. Compared to the previous tracing of [**2201-7-22**] repolarization abnormalities are somewhat more pronounced, a non-specific finding. [**2201-7-23**] CXR Findings compatible with fluid overload with possible pneumonia in the right lower lung. Brief Hospital Course: 83 year old female with ESRD on HD, CAD s/p CABG, chronic diastolic CHF, diabetic neuropathy who presented with subacute progressive weakness and subsequently missed HD admitted to ICU with hypertensive urgency. . # Hypertensive Urgency: Was likely due to volume overload from missing HD. BP was unresponsive to medications, but after HD the following day, her pressures normalized. 2L of fluid was removed with HD and she returned to dry weight. She was discharged with all of her home antihypertensives and on discharge she was normotensive. # Weakness/Gait instability: Progressive weakness seems to have been present over several months. Neuro exam nonfocal. Pt does have h/o spinal stenosis, PVD and diabetic neuropathy which could certainly contribute to feelings of weakness and gait instability. She also reported that this has happened after HD, which is a common HD side effect. Lastly, on presentation to ED, she was hypoglycemic which might have explained weakness. A B12, folate and ESR level were all normal indicating that weakness is not secondary to B12/folate deficiency or inflammatory condition like PMR. Pt is followed by neurology at [**Hospital1 18**] for previous CVA and will be followed up by neurology post discharge. PT evaluated pt and determined that she was able to be discharged with home PT. . # ESRD: Was dialysed twice during hospital stay. Will continue to HD on MWF at [**Hospital1 18**]. She was discharged home on sevelamer, nephrocaps and Iron. #Type II Diabetes Mellitus: throughout hospital course, pt was on ISS. She was discharged on home regimen and continued with gabapentin for peripheral neuropathy. . #Hyperlipidemia: Pt was discharged home on normal statin dose. . #Chronic back pain: Likely secondary to spinal stenosis, which as per patient will not be managed surgically. . #CVA prophylaxis/CAD: Discharged on home regimen of aspirin, clopidogrel, BB and statin. No pending results or reports at time of discharge. . Medications on Admission: ATORVASTATIN [LIPITOR] - 40 mg Tablet - 1 Tablet(s) by mouth once a day chol B COMPLEX-VITAMIN C-FOLIC ACID [NEPHROCAPS] - 1 mg Capsule - 1 Capsule(s) by mouth once a day Selimi CLOPIDOGREL [PLAVIX] - 75 mg Tablet - 1 Tablet(s) by mouth once a day hx stent GABAPENTIN - 300 mg Capsule - 1 Capsule(s) by mouth at bedtime leg cramps, restless leg syndrome LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day bp METOPROLOL TARTRATE - 50 mg Tablet - 1 Tablet(s) by mouth three times a day bp, cad NIFEDIPINE - 30 mg Tablet Extended Rel 24 hr - 1 Tablet(s) by mouth once a day for bp NITROGLYCERIN - 0.4 mg Tablet, Sublingual - 1 Tablet(s) sublingually as directed as needed for chest pain can repeat every 5minutes three times, call 911 if chest pain not resolved ONDANSETRON HCL - 4 mg Tablet - 1 Tablet(s) by mouth twice a day as needed for nausea POLYETHYLENE GLYCOL 3350 - 17 gram/dose Powder - 2 tsp by mouth 4 oz water daily hs SEVELAMER HCL [RENAGEL] - (Prescribed by Other Provider) - Dosage uncertain ASPIRIN - 325 mg Tablet, Delayed Release (E.C.) - 1 Tablet, Delayed Release (E.C.)(s) by mouth DAILY (Daily) prevention INSULIN REGULAR HUMAN [HUMULIN R] - 100 unit/mL Solution - inject sq qpm 5 units or ut dict NPH INSULIN HUMAN RECOMB [HUMULIN N] - 100 unit/mL Suspension - inject 30 units qam, 16units q pm Discharge Medications: 1. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 3. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 5. lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 6. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 7. nifedipine 30 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 8. polyethylene glycol 3350 17 gram/dose Powder Sig: Two (2) tsp PO DAILY (Daily) as needed for constipation. 9. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. insulin regular human 100 unit/mL Solution Sig: Five (5) units Injection at bedtime. 11. Humulin N 100 unit/mL Suspension Sig: Thirty (30) units Subcutaneous qAM. 12. Humulin N 100 unit/mL Suspension Sig: Sixteen (16) units Subcutaneous at bedtime. 13. sevelamer HCl Oral 14. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO twice a day as needed for nausea. 15. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual PRN as needed for Chest Pain: take for chest pain can repeat every five minutes for a max dose of three times, call 911 if chest pain not resolved. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary: - Intermittent gait instability NOS - Hypertensive Urgency - Hyperkalemia 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 Mrs. [**Known lastname **], It was a pleasure taking care of you. You were admitted to the hospital because of your gait instability and hypertensive urgency. You were hemodialysed and all of your home medications were restarted. Your blood pressure improved. In addition, physical therapy re-evaluated you and believe that you can go home with services to assist with ambulation. Please continue all of your home medications. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please follow up with the following physicians: Department: [**Hospital1 18**] [**Location (un) 2352**] When: TUESDAY [**2201-8-4**] at 1:50 PM With: [**First Name4 (NamePattern1) 1575**] [**Last Name (NamePattern1) 1576**], MD [**Telephone/Fax (1) 1144**] Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site Department: NEUROLOGY When: TUESDAY [**2201-8-18**] at 4:30 PM With: [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**], MD, PHD [**Telephone/Fax (1) 657**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 5856, 2767, 4280, 3572, 2724
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Medical Text: Admission Date: [**2190-9-1**] Discharge Date: [**2190-9-3**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1674**] Chief Complaint: Cough and sob Major Surgical or Invasive Procedure: None History of Present Illness: 87 year old female with from nursing facility, non-productive cough for 2 weeks. Nursing home found her more short of breath today using accessory muscles to breathe with RR 22-24 and 82%RA, Temp 98.9F, HR 106, BP 170/82. She was placed on 2L nasal canula and sent to ED for further evaluation. Patient denies shortness of breath, chest pain, leg swelling, PND, orthopnea. Main complaint is cough. Was started on keflex at NH on [**8-18**], unclear reasons although per pt for cough. Past Medical History: Hyperthyroidism (toxic multinodular goiter) Hypertension h/o fainting/falls with transient syncope - Admission [**4-28**] initially sinus bradyarrhytmia, resolved when HR>60; Admit [**6-26**] r/o MI; no evidence of arrhytmia on tele - Last echo [**10-26**]: EF > 55%, Normal wall motion, mildly dilated left atrium, trivial MR, E/A 0.50 GERD Recurrent UTIs (last [**4-28**]) CRI: baseline Creatinine 1.2-2.0 ORIF femoral fracture h/o B12 deficiency dementia Social History: Lives in nursing home. Some distant tobacco use, denies etoh. Previously worked as a receptionist. Son, [**Name (NI) 3924**] [**Name (NI) 97379**] (HCP/POA: [**Telephone/Fax (1) 97380**]) lives in [**Location 7349**]. Family History: No history of CAD, sudden death Physical Exam: V: 97.0F HR 80 BP 155/64 RR 26 94/6L n.c. Gen: awake, alert and oriented x 2+ (not oriented to month/day but oriented to year), tachypneic, frequent rattling cough but able to speak in short sentences HEENT: PERRL, EOMI, OP clear, MM sl dry Neck: supple, JVP 7cm CV: RRR, S1, S2, no murmurs appreciated Pulm: bilateral coarse breath sounds, crackles left base, right with scattered rhonchi and prolonged exp wheeze Abd: Normoactive BS, soft, ND/NT Ext: WWP, no edema, dry skin skin: seborrheic keratosis and multiple bruises but no rash Pertinent Results: WBC 11.0 Hct 34.4 Plt 214 N:83 Band:10 L:4 M:3 E:0 Bas:0 . 136.|.100.|.31 258 --------------- 4.2.|.21.|.1.4 . 8:00 p.m. CK: 108 MB: 3 Trop-T: <0.01 . proBNP: 1461 . UA: large leuks, neg nitrites, small blood, [**5-2**] WBC, 0-2 RBC, few bacteria . lactate:2.7 . CXR: New right middle and right lower lung zone opacities and bilateral peribronchial cuffing representing either multifocal pneumonia, asymmetric pulmonary edema, or bronchitis. . EKG: Sinus tachy 108, normal axisand intervals. TWIS III old. Only change from prior is tachycardia. Brief Hospital Course: In the ED upon first arrival Temp 102.4F and given tylenol. Given Vancomycin 1g x 1 and Levofloxacin 750mg x 1. Given Albuterol and Ipratropium Nebs and solumedrol 125mg x 1. UA was negative. Blood and urine cultures done. EKG done without evidence of acute ischemia. Oxygen increased from 2L to 6L (Oxygen sat 94%/6L). And she was admitted to ICU for further monitoring. After 1 day in the ICU she was deemed stable, and though direct discharge from ICU was considered, decision was made to monitor one more day on the general medical floor. Course as outlined below: # Pneumonia - Given fever, elevated white count with bands, hypoxia and RML, RLL opacities consistent with pneumonia. Most c/w with CAP, no history of aspiration. No h/o COPD. Urine legionella negative. Did well the night of admit with minimal O2 requirements, cough remained unproductive so no sputum culture was obtained. Throughout stay continued to deny SOB or increased WOB, was afebrile throughout hospital stay. Originally started on Levo/vanc for HAP and flagyl for possible aspiration PNA. Antiobiotics narrowed the morning of admission at recommendation of pulmonary ICU attending to Levofloxacin, renally dosed, with projected duration of 10 days for CAP, last dose to be [**2190-9-10**]. On day of discharge o2 sat 93% RA. # Elevated BNP - Did have some crackles in bases on lung exam consistent with atelectasis, does not appear volume overloaded, no peripheral edema. Was monitored for signs of volume overload but did not develop overt heart failure during hospitalization. # CRI - Creatinine on admit at baseline. CRI felt to be due to HTN. Throughout stay was monitored for worsening renal function but none was observed. All medications renally dosed during stay. At discharge creatinine was 1.3 down from 1.4 on admission. # HTN - Well controlled at baseline. Not an issue since admit. Was continued on home norvasc dosing. All other chronic medical issues did not necessitate medical intervention or medication adjustments during her hospitalization. Any necessary communication was with her son: [**Name (NI) 3924**] [**Name (NI) 97379**], HCP/POA: [**Telephone/Fax (1) 97380**] FULL CODE reconfirmed by son and pt. Medications on Admission: amlodipine 5mg daily donepezil 10mg po qhs raloxifene 60mg daily methimazole 5mg daily ASA 325mg daily cholecalciferol 400unit daily Calcium Carbonate 500 mg po q12hours colace/senna/dulcolax/MOM prn Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for Pain or Fever. 2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 4. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO Daily (). 5. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 6. Methimazole 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for Constipation. 9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO DAILY (Daily) as needed for Constipation. 11. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q48H (every 48 hours) for 7 days: last dose [**2190-9-10**]. Discharge Disposition: Extended Care Facility: [**Hospital1 599**] of [**Location (un) 55**] Discharge Diagnosis: pneumonia Discharge Condition: stable Discharge Instructions: Please call your primary care doctor or return to the ER with any increased shortness of breath or other concerning symptoms. Followup Instructions: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**] Completed by:[**2190-9-3**] ICD9 Codes: 486, 5990, 5859
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Medical Text: Admission Date: [**2170-8-13**] Discharge Date: [**2170-10-18**] Date of Birth: [**2102-6-15**] Sex: F Service: SURGERY BLUE HISTORY OF PRESENT ILLNESS: Briefly, this is a 67 year old female who presented to an outside hospital with abdominal pain, distention, nausea, for approximately three days. Her last bowel movement was approximately the day prior to her admission which was in [**2170-2-10**]. She had had a history of small bowel obstructions and had felt these symptoms in previous episodes. Of note, the patient had a history of a gastric bypass performed several years ago as well as an incarcerated hernia repair. The patient was admitted to an outside hospital and ultimately underwent an exploratory laparotomy and repair of hernia and was being taken care of at the outside hospital. However, during her hospital course there, she was found to have serous drainage from her wound and was found to have developed a significant enterocutaneous fistula. Therefore, it was decided at the outside hospital that she would be transferred to [**Hospital1 190**] for further management by Dr. [**Last Name (STitle) 957**]. PAST MEDICAL HISTORY: 1. Hypothyroidism. 2. Pancreatitis. 3. Asthma. 4. History of pneumonia. 5. History of varicose veins. 6. History of small bowel obstructions in the past. PAST SURGICAL HISTORY: 1. Gastric bypass approximately fifteen years ago. 2. Cholecystectomy. 3. Exploratory laparotomy and lysis of adhesions times two for small bowel obstruction. 4. Breast reduction surgery. 5. Several ventral hernia repairs. ALLERGIES: Penicillin and Iodine. MEDICATIONS ON TRANSFER: 1. Octreotide. 2. Fentanyl patch. 3. Levaquin. 4. Flagyl. 5. Dilaudid PCA. 6. Lopressor. 7. Vancomycin. 8. Atrovent nebulizers. 9. TPN. She also had a PICC line which was placed at the outside hospital and was having wet to dry dressing changes to her abdominal wound. A G-J tube had been placed during her operation at the outside hospital and those were kept on intermittent suction. She also had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1661**]-[**Location (un) 1662**] drain which was also to bulb suction. PHYSICAL EXAMINATION: On admission to [**Hospital1 190**], the patient was afebrile and her vital signs were stable. She was an obese female in no apparent distress. She was saturating 98% on two liters nasal cannula. Her lungs had some mild crackles but were clear. Her heart was regular. Her abdomen was obese, nontender, and she had an open enterocutaneous fistula times three and open surgical wound on her belly with retention sutures in place and Foley catheter was also in place. Her extremities were severely edematous which stated by her was her baseline. LABORATORY DATA: The patient's laboratories are all within normal limits. HOSPITAL COURSE: The patient was admitted to the Blue Surgery service and was continued on TPN for preoperative nutritional enhancement and it was planned the patient would ultimately undergo exploratory laparotomy and repair of the enterocutaneous fistula. On [**2170-8-31**], the patient was taken t the operating room for an attempted revision of her multiple enterocutaneous fistulas. The patient did well from the operation, however, postoperatively she developed single enterocutaneous fistula which caused wound breakdown and again she was started on tube feeding as well as TPN for nutritional enhancement. The enterocutaneous fistula was not able to be closed with just nutritional enhancement. Therefore, it was decided that the patient would have to return to the operating room on [**2170-9-13**], for a reexploration and component separation and flap closure, split thickness skin graft closure for this enterocutaneous fistula. Dr. [**Last Name (STitle) **], the plastic surgery service, was consulted for this workup and followed this patient along throughout her entire hospital course. The patient was taken to the operating room on [**2170-9-13**], where closure of her enterocutaneous fistula was done and split thickness skin graft was also performed as well as a revision of her G-J tube. Postoperatively, the patient was transferred to the Intensive Care Unit for blood pressure support and prolonged ventilatory support. The patient was slowly weaned from the ventilator postoperatively, however, after extubation, she had significant respiratory distress and required significant fluid management. Therefore, she was reintubated and continued in the Intensive Care Unit. Again, she required prolonged pressor support for her blood pressure and fluid management. She slowly improved from a pulmonary standpoint after the second intubation and she was able to be diuresed gently from her fluid. She was started on TPN and she was successfully able to be weaned from the ventilator postoperatively. The patient also had episodes of temperature spikes and was found to have gram positive cocci in blood cultures as well as on line cultures. Therefore, she was started on broad spectrum antibiotics. She was continued on multiple antibiotics and ultimately completed a twenty-two day course of Zosyn for the positive blood cultures and for her line sepsis. She continued to improve slowly in her Intensive Care Unit stay and her bowel function slowly returned. Her tube feeds were slowly advanced through this time frame which she was able to tolerate. She was extubated on [**2170-9-19**], and was able to tolerate for a day, however, she had an episode of bradycardia and asystole on [**2170-9-20**], requiring emergent intubation. She responded to Epinephrine and returned to sinus rhythm with her blood pressure returning to greater than 200. It was noted that the patient had increased distention of her abdomen after this event of respiratory failure with difficulty to intubate and she was noted to have some increased erythema around the graft site. Her gastrostomy tube was placed to gravity due to the distention and nasogastric tube which had been placed was removed. The patient was successfully extubated again after response of her respiratory failure. She continued to slowly improve after these events. She slowly improved from her ventilatory standpoint and she was continued on TPN for support for this. A vac was placed over her wound site for her erythema and she was diuresed for her pulmonary status as well as for her fluid overload. The vac was managed by the plastic surgery service and was changed multiple times with assessment of her skin graft on every change. Her donor site was doing well and continued on blow drying of the wound site and dressing changes. Just prior to discharge to rehabilitation, her vac dressing was removed and two small areas of questionable success and viability of the graft were noted. It was decided that Xeroform gauze dressing changes would be used over the skin graft site for continued wound care. She was restarted no her tube feeds on [**2170-9-26**], after being held and which she tolerated. Her tube feeds were slowly increased over the next couple days. The patient continued on broad spectrum antibiotics including Vancomycin, Levofloxacin, Flagyl, Zaroxolyn, Fluconazole and as stated before Zosyn. She was also given a course of Linezolid. She was able to be weaned over a very long period down to a pressure support of 5 and PEEP of 5 and it is planned that the patient would be extubated after being successfully diuresed. Her [**Location (un) 1661**]-[**Location (un) 1662**] drains which had been placed intraoperatively were removed by the plastic surgery service after decreased output was noted. After significant diuresis, the patient was able to tolerate extubation as well as able to tolerate low pressure support and minimal vent settings. Therefore, it was decided the patient would be extubated. The patient was extubated on [**2170-10-4**], which she was able to successfully maintain her oxygenation and breathe comfortably. The patient was started on a clear liquid diet on [**2170-10-5**], which she tolerated. She had return of bowel function during her Intensive Care Unit stay and her wounds remained clean, dry and intact. Physical therapy as well as occupational therapy were consulted for ambulation as well as strength training as well as to manage all her deconditioning. Speech and swallow was also consulted for a bedside evaluation which she did well with. Orthopedics was consulted early due to knee pain and was found to have osteoarthritic changes of her knee. Her white blood cell count rose after being off antibiotics and it was felt the patient had a line infection and therefore, she was started on Zosyn. Her TPN was stopped. She responded well to the Zosyn and her white blood cell count had normalized prior to discharge. Neurosurgery was also consulted for low back pain which was a chronic issue which she had had for multiple years. Ultimately, it was felt that this pain was chronic degenerative changes and there was no plan for change in management. The patient also had some mild diarrhea which was controlled with Imodium. Her stool cultures were negative. The patient also underwent calorie counts which she did well with. On [**2170-10-10**], plastic surgery took her back to the operating room for a repeat split thickness skin graft which she successfully underwent. This graft as mentioned before had two areas that ultimately looked questionable for viability and therefore, Xeroform dressing changes were done. However, the remainder of the wound site was viable and nice. Therefore, it was felt that the graft had taken quite nicely. Her tube feeds were began to be cycled at that time and the patient was transferred out to the floor. She continued to do well and continued to do well from a dietary standpoint on regular diet and her tube feeds which were cycled were able to be stopped completely prior to discharge. She also completed as stated before a twenty-two day course of Zosyn for infected line as well as for bacteremia. The vac was removed on [**2170-10-17**], which again showed viable graft site. Physical therapy had seen the patient and it was decided the patient should return to [**Hospital3 **] which is where she had been previously prior to long hospital course for further rehabilitation. The patient was tolerating a regular diet. It was planned also that the patient would keep her Foley catheter for the time being and when the patient was more ambulatory and more functional, it could be removed in the rehabilitation facility. The patient was also planned to follow-up with Dr. [**Last Name (STitle) 957**] in three weeks time for evaluation as well as wound care check. She is also to be followed by Dr. [**Last Name (STitle) **] in the plastic surgery service for her skin graft and also for her abdominal closure. The patient was planned for discharge on [**2170-10-18**], and was tolerating a regular diet without needing tube feeds. It was planned that the patient would be discharged to rehabilitation facility. DISCHARGE DIAGNOSES: 1. Enterocutaneous fistula, status post repair times two including a component separation and split thickness skin grafting by plastic surgery service. 2. Small bowel obstruction, status post exploratory laparotomy and lysis of adhesions times two. 3. Gastric bypass in the past. 4. Cholecystectomy. 5. Breast reduction. 6. Multiple ventral hernia repairs. 7. Enterocutaneous fistula formation previously from that. 8. Hypothyroidism. 9. Pancreatitis. 10. Asthma. 11. History of pneumonia. 12. History of varicose veins. 13. Status post respiratory failure requiring emergent reintubation. 14. Multiple line infections and bacteremia requiring multiple antibiotic treatments with prolonged treatment times. MEDICATIONS ON DISCHARGE: 1. Protonix 40 mg p.o. once daily. 2. Ativan 0.5 to 1 mg p.o. q4hours p.r.n. 3. Ambien 5 mg p.o. q.h.s. 4. Dilaudid 2 to 4 mg p.o. q4hours p.r.n. 5. Loperamide 2 mg p.o. twice a day. 6. Zinc Sulfate 220 mg p.o. twice a day. 7. Lopressor 75 mg p.o. twice a day. 8. Paroxetine 20 mg p.o. once daily. 9. Tylenol 325 to 650 mg p.o. q4hours p.r.n. 10. Levoxyl 300 mcg p.o. once daily. 11. Insulin sliding scale. 13. Ipratropium inhaler four puffs four times a day. 14. Albuterol four puffs q4hours p.r.n. 15. Phenazopyridine 200 mg p.o. three times a day. 16. Cycled tube feeds, one half strength Impact, at 20cc per hour from 7:00 p.m. to 6:00 a.m. DISCHARGE STATUS: The patient was discharged to rehabilitation facility in stable condition. FOLLOW-UP: The patient is instructed to follow-up with Dr. [**Last Name (STitle) 957**] in three weeks time, with Dr. [**Last Name (STitle) **] in two to three weeks time, as well as follow-up with her primary care physician. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 4007**] Dictated By:[**First Name (STitle) **] MEDQUIST36 D: [**2170-10-17**] 18:29 T: [**2170-10-17**] 19:11 JOB#: [**Job Number 22339**] ICD9 Codes: 5185, 0389
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Medical Text: Admission Date: [**2126-6-29**] Discharge Date: [**2126-7-23**] Date of Birth: [**2077-7-17**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 974**] Chief Complaint: Multiple stab wounds to chest, abdomen, neck, and head Major Surgical or Invasive Procedure: 1. Trauma laparotomy with repair of stab wound enterotomies x36 and total mobilization left colon. 2. Bilateral neck exploration 3. Laparotomy and lysis of adhesions, reduction of internal hernias and volvulized small bowel segment. History of Present Illness: 48 yo male patient with MS, [**First Name3 (LF) **], and substance abuse presents with multiple stab wounds to chest/abdomen/neck/head with an ice pick. He presented with tension PTX. 2 chest tubes were placed and he was taken to OR for multiple stab wounds. Past Medical History: MS [**First Name (Titles) **] [**Last Name (Titles) 7344**] abuse Social History: -[**Name (NI) **], wife of 23 years, left him in [**3-14**] -sister [**Name (NI) 5627**] [**Name (NI) 83433**] ([**Telephone/Fax (1) 83434**]) is his health care proxy -patient living in his mother's house in [**Location (un) 5503**] Family History: Not applicable to current care Physical Exam: Upon admission: T:100.6 BP:165/78 HR:97 RR:30 O2Sats:95% on shovel mask at 95% Gen: Patient is agitated and leans to the right side in the bed. HEENT: Right orbit is swollen shut, ecchymotic, and erythematous Pupils:were dilated by opthamology today - 8mm bilaterally EOMs-impaired in the right eye, intact in the left eye Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, +tenderness, there are multiple stab wounds, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, somewhat uncooperative with exam, flat affect. Orientation: Oriented to person and hospital. Language: Slight dysarthria, perseverative. Does not appear able to comprehend complex commands. Cranial Nerves: I: Not tested II: Pupils have both been dilated by opthamology and are 8mm bilaterally. III, IV, VI: Extraocular movements intact on the left and impaired on the right. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**4-9**] on the right side. The LUE 5-/5 and the LLE is [**4-9**] in IP and [**3-10**] distally. Unable to participate with pronator drift testing. Sensation: Intact to light touch bilaterally. Toes downgoing bilaterally Pertinent Results: [**2126-6-29**] 11:15PM TYPE-ART TEMP-36.9 RATES-18/ TIDAL VOL-450 PEEP-0 O2-60 PO2-138* PCO2-48* PH-7.25* TOTAL CO2-22 BASE XS--6 INTUBATED-INTUBATED VENT-CONTROLLED [**2126-6-29**] 11:03PM GLUCOSE-142* UREA N-14 CREAT-0.9 SODIUM-149* POTASSIUM-4.0 CHLORIDE-120* TOTAL CO2-22 ANION GAP-11 [**2126-6-29**] 11:03PM WBC-13.6* RBC-3.19* HGB-10.6* HCT-33.4* MCV-105* MCH-33.4* MCHC-31.8 RDW-14.4 [**2126-6-29**] 11:03PM PLT COUNT-343 [**2126-6-29**] 11:03PM PT-13.0 PTT-26.5 INR(PT)-1.1 [**2126-6-29**] 01:39PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2126-6-29**] 01:39PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG Brief Hospital Course: Mr [**Known lastname 45957**] is a 48 year old male w/ PMH of multiple sclerosis who was admitted to the Trauma service; in the ED he was noted with tension pneumothorax upon arrival and received a chest tube. He was taken to the operating room for trauma laparotomy secondary to multiple stab wounds; 35 enterotomies were found in his small intestine and were oversewn. He was rewarmed in the unit and taken back to the OR for exploration of 3 stab wounds to his neck. Head CT showed intraventricular hemorrhage and a neurosurgical consult was obtained. It was felt that this bleed did not require surgical management. Serial head CT scans were followed and the initial follow up scan did reveal an increase in the intraventricular hemorrhage. His neurologic status was watched closely, a repeat head CT on the next day remained stable with no interval increase. Presently his mental status is that he is alert, oriented x2-3, with some short term memory loss; and he is cooperative with his care. He will follow up as an outpatient with Dr. [**Last Name (STitle) 548**] for repeat head imaging. During his hospitalization, Mr. [**Known lastname 45957**] was seen by Psychiatry and his meds were adjusted to decrease agitation and avoid sedation. He was seen by Ophthalmology, Plastics, and Neurology for damage to his right eye which prevents him from opening the lid, although he has preserved vision. An MR of his head and orbits were done which did show a right inferior rectus muscle into the fracture defect. Plastics felt that this was caused by superior orbital fissure syndrome and recommended that he see Dr. [**First Name8 (NamePattern2) 2398**] [**Last Name (NamePattern1) **] at [**Hospital3 2576**] for evaluation and treatment in the next several weeks. No procedures were done in the hospital for his eye; he was prescribed eye drops. While in the hospital, he was treated with vancomycin/Cipro/Zosyn for fever and altered mental status. He had a fever work-up which revealed pan-sensitive E. coli in his urine. He completed a course of Cipro and antibiotics were discontinued. On HD # 18 he acutely developed nausea and vomiting requiring an NGT placement. A CT scan of his abdomen confirmed a post-operative mechanical obstruction. He was taken back to the operating [**2126-7-16**] for laparotomy and lysis of adhesions. He was admitted back to the floor and made NPO with NGT and maintained on IVF. On POD 1 the NGT was removed and his diet was slowly advanced as tolerated. He is currently tolerating a regular diet. He was followed by Social work due to the nature of his trauma. He was also evaluated by Physical and Occupational therapy and is being recommended for short term rehab following his acute hospital stay. Medications on Admission: Confirmed from pharmacy: Paroxetine 40mg qhs (from Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]); trazadone 100mg qhs, topiramate 100mg [**Hospital1 **] (filled [**6-12**]), seroquel 50mg TID prn agitation (filled [**6-26**])-these 3from Dr. [**Last Name (STitle) 83435**]; excelon 6mg [**Hospital1 **],baclofen, naproxen Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 2. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for heartburn. 3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 4. Tetracaine HCl 0.5 % Drops Sig: Three (3) drops Ophthalmic once a day: OU. 5. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for PRN agitation. 6. Topiramate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Rebif 44 mcg/0.5 mL Syringe Sig: One (1) Subcutaneous 3 times per week . 8. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: hold for loose stools. 9. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's PO twice a day as needed for constipation. 10. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. 11. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5,000 Units Injection TID (3 times a day). Discharge Disposition: Extended Care Facility: [**Hospital3 672**] Hospital Discharge Diagnosis: s/p Multiple stab wounds to abdomen, chest, face, and neck Left maxilla fracture Bilateral orbital roof fractures w/ right inferior rectus entrapment Samll intraventricular hemorrhage Pneumomediastinum Small bowel obstruction Discharge Condition: Hemodynamically stable; pain adequately controlled and tolerating a regular diet Discharge Instructions: Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 548**], Neurosurgery in 3 weeks with head CT. Please call [**Telephone/Fax (1) 2992**] for this appt. Please call Dr. [**First Name8 (NamePattern2) 2398**] [**Last Name (NamePattern1) **] at [**Hospital3 **] to schedule an appointment for ongoing evaluation and treatment of your eye. The number is:([**Telephone/Fax (1) 83436**] Please follow-up with Dr. [**Last Name (STitle) **] in trauma clinic in 2 weeks for evalaution following your small bowel surgery. The number to call and schedule an appointment is [**Telephone/Fax (1) 2359**]. Please follow up with your primary care Neurologist Dr. [**Last Name (STitle) 77121**] after discharge from rehab for continued management of your multiple sclerosis. Completed by:[**2126-7-23**] ICD9 Codes: 5990, 2762, 5070, 2760, 3051, 2859
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Medical Text: Admission Date: [**2127-11-11**] Discharge Date: [**2127-11-24**] Date of Birth: [**2055-5-26**] Sex: M Service: HISTORY OF PRESENT ILLNESS: This was a 71-year-old male who was struck by a car and found to have a GCS of 5 on the scene and was intubated by EMS. He was initially hypertensive and tachycardiac and was then flighted to [**Hospital6 649**]. PAST MEDICAL HISTORY: Right hip repair. ALLERGIES: PENICILLIN, PERCOCET. MEDICATIONS ON ADMISSION: None. PHYSICAL EXAMINATION: Vital signs: He was intubated and tachycardiac at 110, and hypertensive at 174/100. His GCS was 6T. HEENT: Pupils equal, round and reactive to light; however, he did have blood in his left tympanic membrane. The rest of his exam showed deformities of the right tibia, as well as scalp laceration, as well as an elbow laceration. LABORATORY DATA: Within normal limits. HOSPITAL COURSE: The patient was admitted to the Trauma Service and ultimately required a craniotomy for a subdural hematoma. He also ended requiring a washout of his left open tibia-fibular fracture and was transferred to the Intensive Care Unit. He had a prolonged Intensive Care Unit stay including multiple antibiotics for infection, prolonged ventilation, and ventriculostomy drain for control of his subdural hematoma. An IVC filter was also placed postoperative for prophylaxis against deep venous thrombosis. Due to his bleed, he was unable to receive Heparin. The patient continued to have significant hemodynamic instability and was unable to wean off of his ventilator during his hospital course. He was taken to the Operating Room for his tibia-fibular repair and again was continued on multiple antibiotics for CSF infection, as well as pneumonia. He was given tube feeds for nutritional support through his hospital stay, and he was given Dilantin for seizure prophylaxis. He had elevated fevers throughout his hospital stay. Ultimately a family meeting was held on [**2127-11-22**], and it was decided by the family that the patient would be DNR. It was decided on [**2127-11-22**], after further discussion with the family that the patient be made CMO. On [**2127-11-23**], he was made DNR. The vent drain was removed. The patient was extubated, and he was put on a Morphine and Fentanyl drip for comfort. The patient expired on [**2127-11-24**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D. [**MD Number(1) 2214**] Dictated By:[**Last Name (NamePattern4) **] MEDQUIST36 D: [**2128-3-23**] 09:53 T: [**2128-3-23**] 09:53 JOB#: [**Job Number 53461**] ICD9 Codes: 5185
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Medical Text: Admission Date: [**2114-7-12**] Discharge Date: [**2114-7-29**] Date of Birth: [**2040-9-4**] Sex: F Service: CME HISTORY OF PRESENT ILLNESS: The patient was originally admitted to the Vascular Surgery Service and was then transferred three to four days later to the C-MED Service. This is a 73-year old female with coronary artery disease (status post coronary artery bypass grafting and multiple cardiac catheterizations and percutaneous interventions at outside hospitals), peripheral vascular disease, chronic renal insufficiency, and insulin-dependent diabetes mellitus who was transferred to [**Hospital1 69**] from an outside hospital to the Vascular Surgery Service with a right lower extremity gangrenous ulceration. The reason for transfer was for possible vascular intervention. On arrival to the Vascular Surgery Service the patient's INR was elevated as she had been on Coumadin for atrial fibrillation. She was given two units of fresh frozen plasma to reverse her coagulopathy and developed jaw pain (her anginal equivalent) and went into acute cardiogenic pulmonary edema. The patient was nearly intubated but improved with a nitroglycerin drip and Natrecor. She was then transferred to the C-MED Service for further diuresis and because her exercise tolerance test sestamibi obtained following her acute cardiogenic pulmonary edema showed reversible anterior defects as well as partially reversible lateral wall defects. Her creatine kinase and troponin were flat at the time of the acute cardiogenic pulmonary edema. The patient did report some baseline shortness of breath, but felt that it was worse at the time of transfer to C-MED Service. However, at baseline the patient can only walk 15 feet with a walker and is limited by anginal pain or shortness of breath. The patient did report paroxysmal nocturnal dyspnea, orthopnea, and lower extremity edema in the past - but not currently. The patient uses 2 liters of oxygen at home. PAST MEDICAL HISTORY: Diabetes mellitus. Coronary artery disease; status post coronary artery bypass grafting and multiple percutaneous coronary interventions. Chronic renal insufficiency. Peripheral vascular disease; status post lower extremity interventions. History of deep venous thrombosis with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**] filter placement. Congestive heart failure with an ejection fraction of 35 percent. Parkinson disease. Anemia of chronic disease. Atrial fibrillation (on amiodarone and Coumadin). Gout. Gastroesophageal reflux disease. Depression. Polymyalgia rheumatica. Status post cholecystectomy. MEDICATIONS ON TRANSFER TO THE C-MED SERVICE: 1. Mucomyst 600 mg twice per day. 2. Allopurinol 100 mg once per day 3. Albuterol as needed. 4. Aspirin 81 mg once per day. 5. Amiodarone 20 mg once per day. 6. Wellbutrin 25 mg once per day 7. Famotidine 20 mg twice per day. 8. Subcutaneous heparin. 9. Heparin drip. 10. Insulin sliding scale and NPH insulin. 11. Lactulose. 12. Vancomycin. 13. Simvastatin. 14. Ropinerole 0.25 four times per day. 15. Prednisone 5 mg once per day. 16. Nitroglycerin drip. 17. Nitroglycerin patch. 18. Toprol 25 mg once per day. 19. Levaquin 250 once per day. 20. Synthroid 50 mcg once per day. SOCIAL HISTORY: The patient is widowed and has two daughters. She does not smoke or drink. PHYSICAL EXAMINATION ON PRESENTATION: Vital signs revealed a temperature of 99.2, heart rate was 69 (range 60 to 69), blood pressure was 147/35 (range 120 to 141/29 to 63), and 98 percent on 4 liters. In general, the patient was a chronically ill-appearing elderly female sitting upright in mild respiratory distress. Head, eyes, ears, nose, and throat examination the pupils were equal, round, and reactive to light. The extraocular movements were intact. The moist mucous membranes. Neck revealed jugular venous pressure approximately 14 but difficult to assess given the patient's neck pannus. Cardiovascular examination revealed a regular rate and rhythm. A 2/6 systolic murmur at the left upper sternal border. Lungs with bibasilar rales halfway up. The abdomen was obese, slightly distended, left-sided scar, and nontender. Extremities revealed trace edema of right and left foot. PERTINENT LABORATORY VALUES ON PRESENTATION: Significant for a hematocrit of 31.8, INR of 1.5, a partial thromboplastin time of 58.8, and creatinine of 1.4. PERTINENT RADIOLOGY-IMAGING: The patient's previous catheterization in [**2105**] at the [**Hospital6 1708**] showed saphenous vein graft to left anterior descending patent, and saphenous vein graft to posterior descending artery patent, skip graft to the obtuse marginal from the posterior descending artery which was occluded. The left circumflex was totally occluded with collaterals. The right coronary artery with 95 percent tubular stenosis. No intervention was done at this last previous catheterization in [**2105**]. SUMMARY OF HOSPITAL COURSE: 1. CONGESTIVE HEART FAILURE ISSUES: The patient was transferred to the C-MED Service and initiated on Natrecor as well as intravenous Lasix. The patient's volume status throughout her hospital course was difficult to evaluate given her lack of neck veins; however, her lungs had shown evidence of volume overload as did her chest x-ray. The patient did respond with much diuresis with the Natrecor. An ACE inhibitor was initiated as the patient had not been on it previously and a low ejection fraction. The following day - after two doses of captopril and continuing the Natrecor - the patient developed acute-on-chronic renal failure with a creatinine that bumped to 2 and hypotension which responded to a 250-cc normal saline bolus. Her captopril was held, and the patient's blood pressure stabilized. The following day the patient was transferred to the Coronary Intensive Care Unit for possible Swan-Ganz catheter placement. As the patient's respiratory status had appeared to become depressed, and secondary to increased creatinine, the diuresis was not going well. In the Coronary Care Unit the Natrecor was restarted. A nitroglycerin drip was also initiated. The patient did not further diurese but did improve respiratory wise and was called back out to the C-MED Service floor. The patient was continued on Natrecor and was also tried on Lasix as well as Bumex and Zaroxolyn. The patient did respond somewhat to the Zaroxolyn and Lasix combination, but her sodium subsequently dropped from 130 to 125 two days status post Zaroxolyn, and this was again held. The patient did again have a further episode of what appeared to be acute cardiogenic pulmonary edema on [**7-24**] which responded to nitroglycerin, morphine, and hydralazine, as well as the Natrecor which was already present. During all of these episodes the patient was very hypertensive, and it was thought that impaired filling was causing the acute decompensation. The patient's creatinine did improve enough that she was able to go for a cardiac catheterization. The cardiac catheterization also had a right heart catheterization which was performed to the neck secondary to the [**Initials (NamePattern4) 228**] [**Last Name (NamePattern4) 260**] filter. The pulmonary capillary wedge pressure was 24, and her right atrial pressure was 12 during that catheterization. Following this cardiac catheterization, the patient was back to the floor and the plan was to further diurese her because her lungs still sounded wet. However, the patient was not responding to the Natrecor and Lasix - and the problems mentioned above of electrolytes occurring with the Zaroxolyn also began to complicate matters. The patient seemed very hyponatremic on [**7-29**]; probably either from over diuresis or from worsening heart failure and hypovolemic hyponatremia. On [**7-29**], the patient had an episode of extreme hypotension and severe respiratory distress which was again thought to be acute cardiogenic pulmonary edema. Again, the patient had not been significantly diuresed even since admission. During this acute decompensation required intubation and was transferred to the Coronary Care Unit on [**7-29**]. 1. ISCHEMIA ISSUES: The patient did have several episodes of anginal pain with occasional small troponin leaks of up to 0.19. The cardiac catheterization demonstrated distal 20 percent left main coronary artery, patent high diagonal in the left anterior descending, but left anterior descending occluded after the diagonal origin, the left circumflex with ostial stem with 30 percent in-stent restenosis, him obtuse marginal occluded, LPL 50 percent, and right coronary artery with ostial 50 percent, mid 80 percent, and then total occlusion. The saphenous vein graft to left anterior descending showed mild plaquing, and the mid left anterior descending filling retrograde with moderate- to-severe diffuse disease. The saphenous vein graft to posterior descending artery was patent, but the segment to the obtuse marginal was occluded. Given the patent stents and vein grafts, no intervention was done at the time. The patient was continued on her aspirin, statin, and beta blocker. 1. RHYTHM ISSUES: The patient has a history of paroxysmal atrial fibrillation. She remained on a heparin drip but was intermittently transitioned to Lovenox in an attempt to cut down on her fluid intake. She was then switched to a heparin drip on transfer back to the Coronary Care Unit the second time. The patient was also continued on her amiodarone dose. She was thought to go into atrial fibrillation during her final episode of acute cardiogenic pulmonary edema, but then converted back to a sinus rhythm after transfer to the Coronary Care Unit. 1. PERIPHERAL VASCULAR DISEASE ISSUES: The patient had bilateral foot ulcerations; right greater than left. They was thought to be dry gangrene. The Vascular Surgery team followed and did debride the wound once during this hospitalization. The patient's wound had grown methicillin-resistant Staphylococcus aureus at an outside hospital. Thus, the patient was continued on vancomycin (renally dosed). She was initially of Levaquin on transfer from the hospital, and this was continued but then discontinued when the culture data was followed up on. The overall plan was for the patient to go for an angiogram of her bilateral lower extremity so that the possibility for intervention could be assessed. At the time of this dictation, the patient had still had not become stable enough or have an appropriate creatinine to tolerate the angiogram, and this was postponed for this reason. 1. CHRONIC RENAL INSUFFICIENCY ISSUES: The patient's creatinine went from approximately 1.3 to 2.5 during her hospital course. It remained mostly in the 1.3 to 1.6 range. Medications were renally dosed, and the chronic renal insufficiency made diuresis very limited. On transfer to the Coronary Care Unit a workup was begun for renal artery stenosis, and this was in progress at the time of this dictation. 1. DIABETES ISSUES: The patient was continued on her NPH dose and regular insulin. She was significantly hyperglycemic during her admission. 1. PARKINSON DISEASE ISSUES: The patient was continued on her ropinirole. 1. HEMATOLOGIC ISSUES: The patient did have an anemia of chronic disease, and her hematocrit drifted down during her hospital admission. She did require one unit of blood which she tolerated well, with Lasix following the transfusion. The patient's hematocrit then remained stable at around 30. This Discharge Summary covers the admission up until [**2114-7-29**]. The rest of the dictation will be dictated by the Coronary Care Unit intern. [**Name6 (MD) **] [**Last Name (NamePattern4) 2862**], [**MD Number(1) 2863**] Dictated By:[**Last Name (NamePattern1) 2864**] MEDQUIST36 D: [**2114-7-30**] 14:23:17 T: [**2114-7-30**] 16:56:23 Job#: [**Job Number 2865**] ICD9 Codes: 4280, 5849, 2761
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Medical Text: Admission Date: [**2198-6-27**] Discharge Date: [**2198-7-13**] Date of Birth: [**2123-8-22**] Sex: F Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1390**] Chief Complaint: upper GI bleed Major Surgical or Invasive Procedure: [**2198-6-28**] Exploratory laparotomy, duodenotomy, ligation of duodenal bleeder [**2198-7-7**]: PICC line placement History of Present Illness: The patient is a 74-year-old female with a history of pyloric channel ulcer on nonsteroidal anti- inflammatory drugs chronically without proton pump inhibitor or H2 blocker presented due to GI bleed to an outside hospital. Reports diarrhea and melena for approximately 3 weeks. She passed out 3 times leading to admission at [**Hospital3 **] where she was transferred to the [**Hospital1 69**] for further management. She was admitted to the ICU and underwent brief resuscitation and EGD which revealed a very large 3 cm ulcer with visible clot, which was not amenable to any endoscopic treatment per the gastroenterologist. Additionally interventional radiology was not available to assist with her case immediately, and she did continue to bleed requiring several units of blood and hemodynamic instability. We elected to take her emergently to the operating room. She was mentating appropriately and as such we discussed risks, benefits, and alternatives to exploratory laparotomy with the patient, including but not limited to bleeding, infection, injury to surrounding structures, duodenal leak, fistula, death, gastric outlet obstruction, recurrence of ulcer disease, injury to the bile duct, pancreatic duct, and other issues. The patient did wish to go ahead and proceed with surgery. Past Medical History: Pyloric ulcer and pre-pyloric ulcer obstructing 80% of the pylorus and antrum, HTN, T12 compression fracture, Osteoporosis, Severe COPD, Malnutrition, Depression, Glaucoma, AAA (4.4cm) PSH: Denies (lower midline incision present) ALL: NKDA [**Last Name (un) 1724**]: Celecoxib 100 [**Hospital1 **], Flagyl 250''', KCL, Tramadol 50''', Neurontin (unk dose), Vicodin 5/500''':PRN Social History: Tobacco: 2ppd, current, EtOH: Rare, IVDU/Illicits: Denies Family History: nc Physical Exam: On admission: VS: T 98.6, HR 108st, BP 89/57, RR 25, SaO2 100%2Lnc GEN: NAD, A/Ox3, pale appearing HEENT: EOMI, dry mucus membranes CV: sinus tachycardia, no M/R/G PULM: CTAB ABD: soft, well-healed lower midline incisional scar, no masses, mild tenderness in midepigastrium, no rebound or guarding, no fluid wave PELVIS: rectal tube in place, 300-400cc frank blood and clots in drainage bag EXT: WWP, thready radial pulses PSYCH: Nl judgment On discharge: VS: T 98.0 90/56 90 16 94% RA GEN: A&O, NAD PULM: CTAB ABD: midline surgical incision with steristrips intact, dry. No errythema. Abd soft, appropriately minimally tender at incision site, nondistended. EXTR: Warm, pink, well-perfused. No edema Pertinent Results: [**2198-7-3**] 05:35AM BLOOD WBC-15.4* RBC-3.32* Hgb-9.8* Hct-30.4* MCV-92 MCH-29.5 MCHC-32.1 RDW-14.8 Plt Ct-176# [**2198-7-2**] 12:12PM BLOOD Hct-31.3* [**2198-7-2**] 04:50AM BLOOD WBC-14.8* RBC-3.15* Hgb-9.6* Hct-28.4* MCV-90 MCH-30.6 MCHC-34.0 RDW-15.0 Plt Ct-117* [**2198-6-28**] 04:32AM BLOOD WBC-12.7* RBC-2.03*# Hgb-6.1*# Hct-19.1* MCV-94 MCH-30.0 MCHC-31.8 RDW-13.7 Plt Ct-132* [**2198-6-27**] 10:21PM BLOOD WBC-16.4* RBC-3.74* Hgb-11.5* Hct-34.4* MCV-92 MCH-30.7 MCHC-33.4 RDW-15.7* Plt Ct-133*# [**2198-6-27**] 07:50PM BLOOD WBC-14.9* RBC-4.63 Hgb-14.2 Hct-42.0 MCV-91 MCH-30.8 MCHC-33.9 RDW-15.4 Plt Ct-297 [**2198-6-28**] 07:26AM BLOOD Neuts-73* Bands-5 Lymphs-17* Monos-2 Eos-1 Baso-0 Atyps-1* Metas-1* Myelos-0 [**2198-7-3**] 05:35AM BLOOD Plt Ct-176# [**2198-6-29**] 02:08AM BLOOD PT-11.3 PTT-25.5 INR(PT)-1.0 [**2198-6-28**] 05:40AM BLOOD Fibrino-175*# [**2198-6-28**] 04:32AM BLOOD Fibrino-94* [**2198-7-3**] 05:35AM BLOOD Glucose-123* UreaN-8 Creat-0.5 Na-141 K-3.0* Cl-103 HCO3-31 AnGap-10 [**2198-7-2**] 04:50AM BLOOD Glucose-147* UreaN-9 Creat-0.4 Na-138 K-3.0* Cl-101 HCO3-31 AnGap-9 [**2198-6-27**] 07:50PM BLOOD Glucose-154* UreaN-26* Creat-1.0 Na-139 K-4.4 Cl-106 HCO3-18* AnGap-19 [**2198-6-29**] 02:08AM BLOOD ALT-22 AST-55* LD(LDH)-366* AlkPhos-40 TotBili-0.6 [**2198-6-27**] 07:50PM BLOOD ALT-14 AST-32 AlkPhos-75 TotBili-2.0* [**2198-6-27**] 07:50PM BLOOD Albumin-3.0* Calcium-8.2* Phos-6.4* Mg-1.6 [**2198-6-29**] 02:24AM BLOOD Type-ART pO2-139* pCO2-39 pH-7.45 calTCO2-28 Base XS-3 [**2198-6-29**] 02:24AM BLOOD Glucose-93 Lactate-1.7 K-3.4 [**2198-6-28**] 06:25AM BLOOD Hgb-9.7* calcHCT-29 O2 Sat-98 [**2198-6-29**] 02:24AM BLOOD freeCa-1.22 [**2198-6-27**]: EKG: Baseline artifact. Sinus tachycardia. Left axis deviation. Possible inferior wall myocardial infarction of indeterminate age. Low QRS voltages in the limb leads. No previous tracing available for comparison. [**2198-6-28**]: chest x-ray: FINDINGS: As compared to the previous radiograph, the patient has received a new left subclavian catheter. The course of the catheter is unremarkable, the tip of the catheter projects over the middle parts of the SVC, no evidence of complications, notably no pneumothorax. [**2198-6-29**]: chest x-ray: IMPRESSION: Interval development of bilateral pleural effusions with adjacent atelectasis, on a background of severe bullous emphysema. [**2198-7-1**]: EKG: Severe baseline artifact. Likely atrial fibrillation with controlled ventricular response. Markedly diminished precordial limb lead voltages. Compared to the previous tracing of [**2198-6-27**], the rhythm now appears to be atrial fibrillation. Otherwise, no diagnostic interim change. [**2198-7-1**]: upper GI/contrast: IMPRESSION: Delayed gastric emptying with only minimal passage of contrast from the stomach into the small bowel. No duodenal leak is demonstrated but minimal contrast opacification limits sensitivity in this setting. An NG tube is recommended to suction out the contents in the stomach given the delayed gastric emptying. [**2198-7-3**]: chest x-ray: FINDINGS: AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of [**2198-6-29**]. Previously described left subclavian approach central venous line remains in unchanged position. Previously present endotracheal tube has been removed. No pneumothorax has developed. The previously identified NG tube is again seen and reaches now further down below the diaphragm indicating its position in a distended stomach. There is status post recent abdominal surgery with cutaneous sutures in the midline and one drainage tube terminating in the fundus area of the stomach. The heart size has not changed, and no pulmonary congestion has developed. There exist, however, hazy densities bilaterally in the lung bases with moderate blunting of the pleural sinuses. Comparison with examination of [**6-29**] indicates stable findings. No new parenchymal infiltrates have developed, but the crowded appearance of the pulmonary vasculature on the bases related to the pleural effusions remains. [**2198-7-4**]: EKG: Atrial fibrillation with rapid ventricular response. Low QRS voltage, particularly in the limb leads. Diffuse T wave flattening. Compared to the previous tracing of [**2198-7-1**], the rate is little faster. Otherwise, no diagnostic change. [**2198-7-4**]: CTA abdomen: IMPRESSION: 1. No evidence of active GI bleed. 2. Filling defect in proximal portion of the GDA. This appearance is concerning for thrombosis or possibly related to recent surgery. 3. 4.6 cm infrarenal abdominal aortic aneurysm. 4. L1 vertebral body compression fracture, age indeterminate. 5. Bilateral large pleural effusions with associated atelectasis. 6. Left adrenal adenoma. [**2198-7-5**]: x-ray of the abdomen: IMPRESSION: No evidence of obstruction or free air. No oral contrast seen on these radiographs. [**2198-7-7**]: chest line placment: There has been placement of right-sided PICC line whose distal tip is in the distal SVC. There is a left-sided central venous catheter with the distal tip at the mid SVC. Heart size is normal. There is a nasogastric tube whose tip and side port are below the GE junction. Small bilateral pleural effusions are seen. The heart size is normal. HELICOBACTER PYLORI ANTIBODY TEST (Final [**2198-7-2**]): POSITIVE BY EIA. (Reference Range-Negative). [**2198-7-5**] 2:51 pm URINE Source: Catheter. **FINAL REPORT [**2198-7-7**]** URINE CULTURE (Final [**2198-7-7**]): Culture workup discontinued. Further incubation showed contamination with mixed fecal flora. Clinical significance of isolate(s) uncertain. Interpret with caution. MORGANELLA MORGANII. >100,000 ORGANISMS/ML.. Piperacillin/tazobactam sensitivity testing available on request. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ MORGANELLA MORGANII | CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM------------- 0.5 S NITROFURANTOIN-------- 128 R TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S Brief Hospital Course: The patient was admitted to the acute care service with upper GI bleed. Prior to admission, she required blood products and pressors for blood pressure support. A GI consult was obtained and PPI, octreitide infusion was recommended. An EGD was done which showed a 3cm ulcer with overlying clot which was not clipped or injected. She was admitted to the intensive care unit for monitoring. On HD #2, the patient continued to bleed and was taken to the operating room where she underwent an exploratory laparotomy, duodenotomy with oversewing of bleeding duodenal ulcer with a visible vessel, and an omental patch. During the operative procedure, she required several blood products including crystalloid, fresh frozen plasma, packed red blood cells, platelets, and cryoprecipitate. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 406**] drain was placed in the right upper quadrant. She remained intubated after the procedure and transported to the intensive care unit for further monitoring. She was weaned and extubated in 24 hours. The [**Last Name (un) **]-gastric tube remained to suction, but later removed by the patient. Her vital signs remained stable and she was transferred to the surgical floor. On POD #3, she passed a large melanotic stool, followed by coffee-ground emesis. She remained hemodynamically stable. Because of a recurrence of bleeding, she was transferred to the intensive care unit for serial hematocrits. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-gastric tube was placed with the removal of coffee ground fluid. Her hematocrit remained stable. Her [**Last Name (un) **]-gastric tube was removed on POD # 4 and she was started on clear liquids and transferred to the surgical floor. The [**Initials (NamePattern4) 228**] [**Last Name (NamePattern4) **]-gastric tube was again removed and she had recurrence of nausea and vomiting. She required replacement of the tube and was made NPO. An upper GI study was done which showed delayed gastric emptying with only minimal passage of contrast from the stomach into the small bowel. She was placed on reglan to help promote motility. She was reported to have an irregular heart rate on POD #7. An EKG was done which showed atrial fibrillation. Her electrolytes were repleted and she has remained in intermittent atrial fibrillation at a controlled rate. On HD #9, because of her lack of oral intake, a PICC line was placed and she was started on intravenous nutrition. She began to move her bowels on POD # 11 and she was started on clear liquids and slowly advanced to a regular diet. She has needed encouragement to eat. Marinol was added to help stimulate her appetite and ensure nutritional supplements were added. He TPN was weaned off. Her staples were removed from the surgical wound and the [**Doctor Last Name 406**] drain was discontinued. She was reported to have urinary frequency and a urine culture was sent which grew Morganella. Her foley catheter was removed and she was started on a 3 day course of ciprofloxacin. During her hospitalization, she was reported to have a positive serology for H. Pylori and on POD # 12 she was started on a 2 week course of amoxicilllin, biaxin, and prilosec for treatment. Her vital signs have been stable and she has been afebrile. Her white blood cell count has decreased to 10 and her hematocrit has stabilized at 27. She has been evaluated by Physical therapy and was reported to be functioning below her baseline status. Recommendations were made for discharge to a rehabilitation facillity where she can further regain her strength and mobility. She is preparing for discharge with follow-up appointments with the acute care service and with the GI service. Medications on Admission: Celecoxib 100 [**Hospital1 **], Flagyl 250''', KCL, Tramadol 50''', Neurontin (unk dose), Vicodin 5/500''':PRN Discharge Medications: 1. Amoxicillin 500 mg PO Q8H Duration: 2 Weeks last dose [**2198-7-23**] 2. Clarithromycin 500 mg PO Q12H Duration: 2 Weeks last dose [**2198-7-23**] 3. Heparin 5000 UNIT SC TID 4. Pantoprazole 40 mg PO Q24H 5. Ciprofloxacin HCl 500 mg PO Q12H 3 day course, last day [**7-14**] 6. Metoclopramide 10 mg PO QIDACHS please discontinue on [**2198-7-16**] 7. Citalopram 20 mg PO DAILY 8. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain 9. Klor-Con M10 *NF* (potassium chloride) 10 mEq Oral daily 10. Gabapentin 100 mg PO BID 11. Hydrocodone-Acetaminophen (5mg-500mg 1 TAB PO Q4H:PRN pain 12. Dronabinol 2.5 mg PO BID Discharge Disposition: Extended Care Facility: [**Doctor First Name 391**] Bay Skilled Nursing & Rehabilitation Center - [**Hospital1 392**] Discharge Diagnosis: bleeding duodenal ulcer hypovolemia shock gastroparesis h.pylori urinary tract infection Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted to the hospital with a bleeding from your stomach. You required blood products and medication to support your blood pressure. You were taken to the operating room where you were found to have an ulcer which was oversewn. You were monitored in the intensive care unit after the procedure. Once your vital signs stabilized, you were transferred to the surgical floor. You required placement of the [**Last Name (un) **]-gastric tube in your stomach to help relieve the nausea and vomiting and you were started on intravenous nutrition. Your nausea and vomiting subsided and the tube in your stomach was removed. You were started on a regular diet and are slowly regaining your strength. You are preparing for discharge to a rehabilitation facility where you can further regain your strength. Followup Instructions: Department: GENERAL SURGERY/[**Hospital Unit Name 2193**] When: TUESDAY [**2198-7-24**] at 3:15 PM With: Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] 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 Department: DIV. OF GASTROENTEROLOGY When: FRIDAY [**2198-8-3**] at 9:30 AM With: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 11716**] [**Name8 (MD) 11717**], 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:[**2198-7-13**] ICD9 Codes: 5990, 5180, 496, 311, 3051
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Medical Text: Admission Date: [**2191-3-29**] Discharge Date: [**2191-3-31**] Date of Birth: [**2116-9-12**] Sex: M Service: MEDICINE Allergies: Sulfa (Sulfonamide Antibiotics) Attending:[**Doctor First Name 1402**] Chief Complaint: Complete heart block Major Surgical or Invasive Procedure: Placement of dual chamber pacemaker History of Present Illness: Mr. [**Known lastname 3903**] is a 74 year old obese male with PMH of HTN, [**Hospital **] transferred from OSH with symptomatic heart block. Patient complains of worsening dyspnea on exertion with nonradiating chest pressure x 1 -2 weeks. + dizziness, no syncope, nausea/ vomiting, diaphoresis or other associated symptoms. Symptoms of dyspnea have progressed so that patient can not walk > 1 block without needing to rest. No preceding fevers, sore throat or recent tick bites. Of note, the patient has complained of intermittent DOE for approx 10 yrs with comprehensive evaluation by both cardiology and pulmonary, including PFT, stable persantine stress test (last in [**6-/2190**]), coronary CT scan and PFTs. Today, presented to his PCP office where HR was in the 40s so sent for further evaluation to ED. At [**Hospital1 **] [**Location (un) 620**], VS: T98.4 P44 RR18 BP181/74 and SaO2 97%. Initial labs were remarkable for negative cardiac enzymes; EKG showed 2:1 heart block with PR prolongation and intraventicular conduction delay and then complete heart block. Given ASA 325mg and fentanyl x 1. After consultation with cardiology, the patient was transferred to [**Hospital1 18**] for evaluation and management by EP. On arrival to the CCU, patient had HR in the 30s, but was asymptomatic- denying any chest pain, shortness of breath, confusionor other complaint. On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. 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. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, + Hypertension 2. OTHER PAST MEDICAL HISTORY: - s/p R hip replacement [**8-/2190**] - s/p L hip replacement - hydrocele - s/p R knee arthroscopy Social History: Lives with wife, used to work as a courrier of a local newspaper but now works as a house inspector for the bank - Tobacco history: quit 40yrs ago, previously smoked 3ppd - ETOH: quit 6 yrs ago, moderate previous use - Illicit drugs: none Family History: - Mother: CAD requiring CABG in 60s - Father: active tuberculosis in 40s Physical Exam: On Admission: VS: T= 97.2 BP= 146/84 HR= 40 RR= 12 O2 sat= 95% RA GENERAL: NAD. Oriented x3. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM NECK: Supple with JVP of 7 cm, no hepatojugular reflex CARDIAC: bradycardia, regular rhythm. S1 S2. no m/r/g LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, obese, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Discharge Exam: Tc: 96.8, P: 62, BP: 152/99, RR: 13, 99% on RA GENERAL: NAD. Oriented x3. HEENT: NCAT. MMM NECK: Supple with JVP of 7 cm CARDIAC: distant heart sounds, regular rate rhythm. Normal S1, S2. no m/r/g LUNGS: mild crackles at bilateral bases, otherwise CTAB ABDOMEN: Soft, obese, NTND. No HSM or tenderness. EXTREMITIES: no edema SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: + DP 2+ PT 2+ Pertinent Results: Admission Labs ([**3-29**]): WBC-6.4 RBC-4.53* Hgb-13.3* Hct-39.0* MCV-86 MCH-29.4 MCHC-34.1 RDW-15.0 Plt Ct-249 Neuts-55.2 Lymphs-33.5 Monos-6.3 Eos-3.5 Baso-1.5 PT-13.6* PTT-23.4 INR(PT)-1.2* ESR-5 TSH-2.0 CRP-2.9 Glucose-100 UreaN-21* Creat-1.3* Na-142 K-4.8 Cl-108 HCO3-25 ALT-38 AST-31 CK(CPK)-63 AlkPhos-64 Calcium-9.5 Phos-4.2 Mg-2.0. CK-MB-4 cTropnT-<0.01 . Imaging: CXR Pa/Lat ([**2191-3-31**]): pacer lead in place over right atrium and right ventricle. final read pending. . Discharge Labs: [**2191-3-31**] 05:05AM BLOOD WBC-5.9 RBC-4.39* Hgb-13.3* Hct-37.5* MCV-86 MCH-30.4 MCHC-35.6* RDW-14.9 Plt Ct-199 [**2191-3-31**] 05:05AM BLOOD Glucose-89 UreaN-17 Creat-1.1 Na-138 K-4.1 Cl-105 HCO3-25 AnGap-12 [**2191-3-31**] 05:05AM BLOOD Calcium-9.1 Phos-4.6* Mg-2.0 Other: [**2191-3-29**] 08:29PM BLOOD TSH-2.0 [**2191-3-29**] 08:29PM BLOOD CRP-2.9 [**2191-3-29**] 08:29PM BLOOD ESR-5 Brief Hospital Course: 74 y/o obese male with PMH of HTN, [**Hospital **] transferred from OSH with symptomatic complete heart block. # Heart block: EKGs showed significant conduction disease with underlying rhythm complete heart block. QT interval was prolonged placing patient at risk of torsades. Patient was asymptomatic at rest with no indications for emergent transcutaneous/transvenous pacing. Etiology remained unclear although given risk factors, most likely cause would be ischemic heart disease vs idiopathic fibrotic reaction. Sarcoidosis, lymes disease, tuberculosis are much less likely, although still on differential. Endocarditis affecting conduction system extremely unlikely with lack of systemic symptoms. Pt was monitored on tele overnight with no changes. ESR/CRP and TSH were normal. Made NPO after midnight for pacemaker placement and pacer successfully placed on afternoon of [**2191-3-30**]. Rate had been mid 30s before pacing and was paced around 60 after placement. Pt did well post-proceedure and was discharged home the next day. ACEI level still pending at time of discharge and pt will be considered for outpt MRI to further eval possible etiology of complete heart block. # HTN: Hypertensive with SBP in the 140- 180s in the setting of bradycardia. Although patient has known HTN, may be high catecholamine response to maintain organ perfusion. As patient asymptomatic, so initial treatment deferred until pacer placed. Despite hx of HTN, pt not on any home medications. After pacer was placed, systolic BPs up to 200s. There was thought that in setting of high catecholamines and new increased cardiac output with pacer placed that BP had been further elevated. Pt was started on captopril 12.5mg TID to titrate to dose with BP falling into 150s systolic over next 12 hrs. Will plan to discharge on lisinopril 20 mg po daily and follow-up BP for further titration as outpatient. # HLD: Per prior records, LDL elevated to 153 with [**Location (un) 47**] 10 yr cardiovascular risk of 44% indicating that patient would likely benefit from statin therapy. Pt not on any home medications, though previously on red rice yeast until 4-5 months ago. He was started on simvastatin 10 mg po daily. # Coronaries: No know history of CAD but multiple risk factors including age, HTN, HL, prior smoking. C/o symptoms consistent with stable angina for years although evaluation with stress test has shown stable reversible defect alone. As above, heart block is mostly likely related to ischemia. He was started on aspirin 81 mg po daily. #Code: Full Code (confirmed with patient) #Transition of Care: -ACE level pending -Consider cardiac MRI as outpatient to further evaluate etiology of heart block -Follow electrolytes as patient has been started on an ACE inhibitor. Medications on Admission: None Discharge Medications: 1. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 4 doses. Disp:*4 Capsule(s)* Refills:*0* 2. aspirin 81 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* 3. simvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 4. lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 5. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for pain for 3 days. Disp:*10 Tablet(s)* Refills:*0* 6. Outpatient Lab Work Please check electrolytes on [**2191-4-7**]: Na, K, Cl, HCO3, BUN, Creatinine. Please fax results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 22882**] at Fax # [**Telephone/Fax (1) 82575**] Discharge Disposition: Home Discharge Diagnosis: Primary: Complete Heart Block Secondary: Hypertension Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 3903**], You were admitted to the hospital due to a slow heart rate and EKG findings showing complete heart block. You were monitored in the cardiac intensive care unit overnight and had a pacemaker successfully placed the next day. After pacemaker placement, your blood pressure was running high so you were started on a medication for blood pressure control. You may need to have a cardiac MRI to further evaluate the cause of your low heart rate. You should discuss the need for further testing with Dr. [**Last Name (STitle) **]. New medications started this admission: - Cephalexin 500 mg by mouth every 6 hours for 4 more doses. This is an antibiotic to prevent an infection at the pacemaker site. - Lisinopril 20 mg by mouth once a day for high blood pressure - Aspirin 81 mg by mouth once a day for heart protection - Simvastatin 10 mg by mouth once a day to lower cholesterol - Percocet 1 tab every 4 hours as need for pain control You should follow-up with your cardiologist, Dr. [**Last Name (STitle) **] on [**2191-4-14**] at 1:30 pm. Followup Instructions: You have an appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**2191-4-14**] at 1:30 pm [**Name (NI) **] Brothers [**Name (NI) **], [**Name (NI) **], [**Location (un) **], MA Ph: [**Telephone/Fax (1) 8725**] If you need to change this appointment please call [**Doctor Last Name 1022**] at [**Hospital1 18**] at [**Telephone/Fax (1) 1536**]. ICD9 Codes: 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7330 }
Medical Text: Admission Date: [**2138-12-2**] Discharge Date: [**2138-12-8**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 898**] Chief Complaint: BRBPR Major Surgical or Invasive Procedure: none History of Present Illness: 83 F with PMH HTN, vertigo, tx from [**Hospital3 2558**] for evaluation of BRBPR. Pt woke up this AM with red blood and clots on bedsheet and diaper. In ED, passed 2 clots and 20 cc red blood in diaper. She denies LH/abd pain/n/v/melena/diarrhea/. Per her report, she had normal BM without blood the day prior. ROS is otherwise negative. In ED, 500cc via NG lavage was clear but complicated by brief vasovagal episode. Pt admitted to MICU for observation and planned for o/n prep and colonoscopy following AM. Past Medical History: HTN Depression chol MR LVH Osteoporosis h/o Fall cataracts Vertigo ([**12-17**] Cervicogenic vertigo- previously had MRI with mild intracranial atherosclerotic changes; carotid U/S with <40%stenosis b/l and [**Doctor Last Name **] of hearts monitor) Social History: lives alone; denies tobacco use, reports occassional alcohol use; former French teacher; She has a brother who was a former cardiologist (Dr. [**Name (NI) **] [**Name (NI) 13534**] - son of Dr. [**Known lastname 13534**] of [**Known lastname 13534**]-Parkinson-White syndrome) at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] and is involves with her care. Family History: Non-contributory Physical Exam: 97.8 165/58 68 18 98%(2L) Gen: AOx3, lying comfortably, NAD HEENT: PERRL, EOMI, Neck: supple, no LAD, no thyromegaly CV: RRR, [**1-18**] harsh systolic murmur throught precordium Pulm: CTA b/l Abd: soft/nt/nd, +bs, no hepatosplenomegly Ext: no edema, +2 dorsalis pedis pulses b/l Rectal (per ED notes): large clot in diaper, blood in vault, no hemorrhoids; pt refused digital rectal exam Pertinent Results: [**2138-12-1**] 07:10PM WBC-7.6# RBC-3.56* HGB-12.2 HCT-35.1* MCV-99* MCH-34.3* MCHC-34.8 RDW-15.2 [**2138-12-1**] 07:10PM NEUTS-76.6* LYMPHS-16.9* MONOS-4.5 EOS-1.7 BASOS-0.3 * [**2138-12-1**] 07:10PM GLUCOSE-129* UREA N-24* CREAT-0.7 SODIUM-137 POTASSIUM-4.1 CHLORIDE-98 TOTAL CO2-32* ANION GAP-11 [**2138-12-1**] 07:10PM ALT(SGPT)-23 AST(SGOT)-26 TOT BILI-0.3 [**2138-12-1**] 07:10PM ALBUMIN-2.8* Brief Hospital Course: Pt admitted to ICU and transfused 2U pRBC. Pt refused prep in MICU and pt transferred to floor on following day [**12-2**]. On that day, she had large BRBPR and SBP dropped from 130's--> 100's. Pt subsequently transferred back to MICU. Tagged RBC scann was scheduled by in scanner pt refused testing. She was monitored in the ICU with stable hct. Again she refused go-lytely prep. Colonoscopy was performed but aborted due to large amount of stool. Pt transferred to floor on [**12-4**]. Pt hct remained stable during rest of hospital course and no further episodes of BRBPR. After further discussions with her brother [**Name (NI) 382**] and her PCP (Dr. [**Last Name (STitle) 1728**] pt agreed to attempt bowel prep. 3 attempts at NGT placement were made but pt was not able to tolerate and refused further attempts. She was given fleet phospho-soda prep PO x2 with dulcolax laxatives. Pt had large BM but still had stool in rectal vault. Multiple enemas were attempted but patient did not tolerate procedure [**12-17**] discomfort. Pt was asked to take go-lytely prep again as tolerated over course of 2 days ([**12-6**] and [**12-7**]) but again pt refused. Medications on Admission: lipiotor 40 PO Qday aspirin 81 mg PO Qday Buproprion 150 mg PO BID calcium carbonate PO TID tylenol prn Lacutlose colace senna atenolol 25 mg PO Qday Lisinopril 20 mg PO Qday Vit D 800 mg PO Qday maalox prn celexa 20 mg PO Qday Discharge Medications: 1. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 3. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). 4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: 1. Lower GI bleeding Discharge Condition: good Discharge Instructions: 1. if have large bright red stools or black stools call 911 or go to the nearest ER for evaluation. 2. please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1728**], in the next 1 week. 3. please see your gastroenterologist, Dr. [**Last Name (STitle) 7307**] on [**12-17**] @ 3:20 pm in [**Hospital Ward Name 23**] [**Location (un) 436**]. Followup Instructions: 1. See Dr. [**Last Name (STitle) 1728**] in 1 week to check your hematocrit; call 617-731- * 2. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Where: [**Hospital6 29**] MEDICAL SPECIALTIES Phone:[**Telephone/Fax (1) 1954**] Date/Time:[**2138-12-17**] 3:20 ICD9 Codes: 5789, 2765, 2851, 2720, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7331 }
Medical Text: Admission Date: [**2101-9-27**] Discharge Date: [**2101-10-6**] Date of Birth: [**2032-10-27**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 1505**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2101-9-28**] Aortic Valve Replacement (21mm [**Company 1543**] Mosaic Porcine Valve), Augmentation Aortoplasty with Pericardial patch History of Present Illness: 68 y/o female with known aortic stenosis with dyspnea on exertion and decreased exercise tolerance who was experiencing increased heart failure symptoms. She has known critical aortic stenosis with normal coronaries and LV function. Also was on Coumadin for paroxysmal atrial fibrillation. Being admitted prior to surgery for Heparin. Past Medical History: Aortic Stenosis, Congestive Heart Failure - Diastolic, Paroxysmal Atrial Fibrillation, Thoracic Lymphadenopathy, Hypertension, Obesity, Mild COPD, Goiter, s/p C-section x 2, s/p Hysterectomy, s/p Excision of Liver cyst Social History: Quit smoking 20yrs ago after 20pk/yrhx Social ETOH use 2 drinks/month Family History: Father died from CAD at 60 Physical Exam: At discharge: VS:T98 BP87/44 P86 SB RR20 Gen:NAD Chest:CTA Bilaterally Heart:RRR, Sternum stable Abd:S, NT, ND Ext:1+ LE Incision:distal pole MSI beefy, no drainage Pertinent Results: [**9-28**] Echo: Pre Bypass: No thrombus is seen in the left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. 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 complex (>4mm) atheroma in the aortic root. There are complex (>4mm) atheroma in the aortic arch. There are complex (>4mm) atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. There is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. Post Bypass: Preserved biventricular function. A bioprosthetic aortic valve is seen. (#21 [**Company **] mosaic ultra per surgeons). No perivalvular leaks. Trace central AI. Peak gradient 62-65 mm Hg, mean gradient 22-25 mm Hg. Mitral regurgitation remains 1+. Aortic contours intact. Remaining exam is unchanged. All findings discussed with surgeons at the time of the exam. [**2101-10-6**] 05:20AM BLOOD WBC-13.2* RBC-3.43* Hgb-10.2* Hct-30.7* MCV-90 MCH-29.8 MCHC-33.3 RDW-14.8 Plt Ct-429# [**2101-10-6**] 05:20AM BLOOD Plt Ct-429# [**2101-10-6**] 05:20AM BLOOD Glucose-107* UreaN-27* Creat-1.1 Na-134 K-4.6 Cl-100 HCO3-24 AnGap-15 Brief Hospital Course: As mentioned in the HPI, Ms. [**Known lastname 80397**] was admitted one day prior to surgery. She was started on Heparin and underwent usual pre-operative work-up. On [**9-28**] he was brought to the operating room where he underwent a aortic valve replacement. Please see operative report for surgical details. Following surgery he was transferred to the CVICU for invasive monitoring. Within 24 hours he was weaned from sedation, awoke neurologically intact and extubated. She was found to be in atrial fibrillation and amiodarone was started. EP was consulted and suggested medical treatment with amiodarone instead of electrical cardioversion. Her chest tubes were removed and she was transferred to the floor. Her wires were removed and she was started on coumadin. She was agressively diuresed. By post-operative day 8 she was ready for discharge to home. Medications on Admission: Cardizem 120mg qd, Lisinopril 10mg qd, MVI, Coumadin 4mg qd (stopped [**9-23**]) 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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 3. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*0* 4. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO TID (3 times a day): take 2.5 tablets for a total of 125mg three times per day. Disp:*225 Tablet(s)* Refills:*0* 5. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours) for 5 days: sternal erythema. Disp:*15 Capsule(s)* Refills:*0* 6. Warfarin 1 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for 1 doses: please take 1 mg daily or as directed by the office of Dr. [**Last Name (STitle) 47403**]. Disp:*40 Tablet(s)* Refills:*0* 7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 9. Outpatient Lab Work INR to be drawn on Monday [**2101-10-10**] with results sent to the office of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47403**], fax ([**Telephone/Fax (1) 80398**] Discharge Disposition: Home With Service Facility: TBA Discharge Diagnosis: Aortic Stenosis s/p Aortic Valve Replacement Congestive Heart Failure - Diastolic PMH: Paroxysmal Atrial Fibrillation, Thoracic Lymphadenopathy, Hypertension, Obesity, Mild COPD, Goiter, s/p C-section x 2, s/p Hysterectomy, s/p Excision of Liver cyst 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: Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 11763**] Dr. [**Last Name (STitle) 3321**] in [**12-26**] weeks Dr. [**Last Name (STitle) 47403**] in [**11-24**] weeks ([**Telephone/Fax (1) 80399**]. INR to be drawn on Monday with results sent to the office of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 47403**], fax ([**Telephone/Fax (1) 80398**]. Plan confirmed with [**Doctor First Name 4134**]. Completed by:[**2101-10-6**] ICD9 Codes: 4241, 5990, 4280, 4019, 496
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Medical Text: Admission Date: [**2162-7-30**] Discharge Date: [**2162-8-14**] Date of Birth: [**2162-7-30**] Sex: F Service: NEONATOLOGY INTERIM SUMMARY - HISTORY: Baby Girl [**Known lastname **] is a now 15-day-old ex 1,185 gm infant born at 30-3/7's week gestation to a 40-year-old G4, P2 mom ,whose pregnancy was complicated by chronic hypertension requiring labetalol and hydralazine. Mom was admitted in the beginning of [**Month (only) 216**] for these symptoms and treated with increasing doses of meds to control her hypertension. She did receive a course of betamethasone on [**7-12**]. Her prenatal screens were complete and unremarkable including O+ status. Mom was taken to C-section when concerns for abnormal fetal heart tracings. Infant emerged with decreased tone and respiratory activity, requiring bag mask ventilation for approximately 1 minute at resus. The heart rate was over 100 throughout. Apgar scores ultimately were 4 and 9. The patient was brought to the NICU for further care. PHYSICAL EXAM: Birth Weight 1,185 gm(25%) Discharge wgt 1245 Birth length 37.5 cm (>10 %) Birth HC 27.5 (25 %) Active, nondysmorphic infant, well-perfused with saturations in the high-90s on blow-by O2. Skin without lesions but bruising noted on legs. HEENT within normal limits. Cardiovascular - normal S1, S2, no murmur. Lungs - coarse breath sounds bilaterally, mild grunting, flaring and retracting. Abdomen benign. Nonfocal neuro exam and age-appropriate. Hips normal. Genitalia normal. Spine intact. SUMMARY OF HOSPITAL COURSE BY SYSTEM - 1) RESPIRATORY: The patient required intubation within the first few hours of life with subsequent surfactant x 2. She was able to be extubated prior to 24 hours and remained on CPAP through day of life #4. Since that time, she has gradually weaned on nasal cannula, and is currently on 100 % 25 cc with persistent mild tachypnea. The patient was started on caffeine citrate on day of life #5 with apnea bradycardia spells. These have responded well to medication. Her current dose of caffine citrate is 9 mg po/pg=7.2 mg/kg/day 2) CARDIOVASCULAR: A murmur was noted on day of life #3 concerning for PDA. An echo was obtained at that time and confirmed the presence of a large duct. Indocin was subsequently initiated with good response. A follow-up echo was obtained [**8-5**] (day of life #6) for acidosis and concerns of a silent PDA recurrence. This study demonstrated that Indocin had resulted in duct closure and was wnl She currently is stable with no murmur. 3) FEN: The patient was supported with PN starting on day of life #1. Enteral feedings were started on feeds at day of life #3 prior to Indocin course, then held during treatment. Once it was apparent the PDA was closed, enteral feedings were restarted and advanced to full feedings without incident. SHe is currently feeding BM24cals per ounce with 4 cals per ounce of hmf. She has some small spits and gavage feedings have been extended to run over 1 hr 10 minutes to help with nonbilious aspirates. Total fluids are 150 cc/kg/d. Plan is to continue to advance caloric density and add promod. th. Current weight is 1,245. Most recent electrolytes on [**8-7**] are 143, 5.4 112, 20, and a glucose of 68. 4) GI: The patient has had mild hyperbilirubinemia peaking of day of life #4 at 7.1 with gradual decline. Rebound was 3.5/.4 3.1 5) HEMATOLOGY: CBC obtained at admission had a hematocrit of 55.5, white count 7.1 with out shift, platelet count 211. Follow-up CBC on day of life #6 (with concerns of acidosis) was hematocrit 43.6 and stable platelets and white blood cell count. Mom is known to be O+. Baby is also O+, Coomb's negative. No blood products were required during this admission. 6) INFECTIOUS DISEASES: The patient received a rule out sepsis at delivery with ampicillin and gentamicin for 48 hours. Antibiotics were discontinued with negative blood culture. Additional blood culture obtained on day of life #6 with concerns for acidosis. The culture remained negative with improvement of labs. 7) NEUROLOGY: Cranial ultrasound obtained on [**8-6**] within normal limits. Plan to repeat at 1 month. 8) SOCIAL: Parents are appropriately concerned, but coping well with patient's prematurity. They look forward to transition closer to home CONDITION AT TIME OF Transfer: Stable. PRIMARY PEDIATRICIAN: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**] CARE/RECOMMENDATIONS: 1. Feeds: BM24=150 cc/kg/d Intention to advance caloric density if tolerated. 2. Medications: Caffeine IV at 9 mg/kg/D, nasal cannula O2 3. Car seat positioning: Pending. 4. State newborn screen: Sent. 5. Immunizations received: None. INTERIM DIAGNOSES LIST: 1. Prematurity at 30-3/7 week's gestation. 2. Patent ductus arteriosus, status post Indocin. 3. Hyperbilirubinemia, resolved. 4. Hyaline membrane disease, status post surfactant, resolving 5. Metabolic acidosis, resolved. 6. Apnea of prematurity [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. Dictated By:[**Last Name (NamePattern1) 52192**] : [**2162-8-6**] 14:00 T: [**2162-8-6**] 14:34 JOB#: [**Job Number 52193**] ICD9 Codes: 769, 7742
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Medical Text: Admission Date: [**2109-2-11**] Discharge Date: [**2109-2-14**] Date of Birth: [**2067-2-14**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5880**] Chief Complaint: Stab wound to left arm Major Surgical or Invasive Procedure: [**2109-2-11**] Repair of left brachial artery and vein ligation History of Present Illness: 41 yo male s/p self inflicted stab wound to left arm sustaining injury to his left brachial artery. He was taken to an area hospital where he was transfused with 2 units PRBC's and was intubated. He was then transferred to [**Hospital1 18**] for further care. Past Medical History: Substance abuse Depression Social History: Substance and EtOH abuse, drinks beer daily [**3-31**]/day with occasional cocaine use Family History: Noncontributory Pertinent Results: [**2109-2-11**] 04:06PM GLUCOSE-81 UREA N-12 CREAT-0.7 SODIUM-140 POTASSIUM-4.3 CHLORIDE-117* TOTAL CO2-20* ANION GAP-7* [**2109-2-11**] 04:06PM CALCIUM-7.7* PHOSPHATE-3.5 MAGNESIUM-2.5 [**2109-2-11**] 12:05PM PT-13.3* PTT-30.8 INR(PT)-1.2* [**2109-2-11**] 08:37AM WBC-16.6* RBC-3.77* HGB-11.4* HCT-34.0* MCV-90 MCH-30.3 MCHC-33.6 RDW-15.4 [**2109-2-11**] 08:37AM PLT COUNT-143* [**2109-2-11**] 08:37AM PT-15.1* PTT-150* INR(PT)-1.4* CT HEAD W/O CONTRAST Reason: FOUND UNRESP. [**Hospital 93**] MEDICAL CONDITION: 41 year old man with selfinflicted wound to L arm, found unresponsive REASON FOR THIS EXAMINATION: eval: bleed CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: 41-year-old man with self-inflicted wound to left arm. Found unresponsive. Evaluate for bleed. CT HEAD WITHOUT CONTRAST: There is no evidence of hemorrhage, mass effect, shift of normally midline structures, or infarction. There are two subcentimeter foci of hypodensity adjacent to each other in the deep white matter of the right frontal lobe, which may represent small vessel ischemic infarcts. The ventricular size is normal. Fixation screws, likely from prior trauma are seen near the right frontozygomatic suture. Visualized paranasal sinuses and mastoid air cells are clear. IMPRESSION: 1. No evidence of acute intracranial hemorrhage or acute fractures. 2. Two subcentimeter foci of decreased CT attenuation in the deep white matter of the right frontal lobe are consistent with chronic small vessel ischemic infarcts. CHEST (PORTABLE AP) Reason: tube position [**Hospital 93**] MEDICAL CONDITION: 41 year old man with ett s/p stab wound to arm, ETT, CVL REASON FOR THIS EXAMINATION: tube position EXAMINATION: AP supine chest. INDICATION: Intubation. A single AP view of the chest is obtained [**2109-2-11**] at 0912 hours and is compared with the radiograph performed approximately five hours previously. Patchy linear opacity at both bases may be secondary to subsegmental atelectasis or may reflect the relative degree of hypoinflation of the lungs on this image. The ET tube is approximately 4.5 cm above the carina. There is no evidence of acute consolidation or large pleural effusion visible on the current study. Brief Hospital Course: He was admitted to the Trauma Service under the care of Dr. [**Last Name (STitle) **]. He underwent CT imaging; no intracranial hemorrhage or solid organ injuries were identified. Vascular surgery was consulted because of the left brachial artery injury; he was taken to the operating room for repair of this along with ligation of the vein. There were no intraoperative complications and postoperatively he has done well. Daily dry sterile dressing changes are being performed; currently his wounds are clean, and without any visible signs of infection. Pain is being controlled with Percocet prn. His chemistry and CBC panels have been followed closely. Because of the blood loss associated with his injury his hematocrit did drop from low 30's to mid 20's. Hemodynamically he has been stabile. It is expected that his hematocrit will improve given his age and lack of co-morbidities. Psychiatry was also consulted given that this was a suicide attempt; he also has a history of substance abuse and depression. He was placed on 1:1 sitters; Ativan was started prn per CIWA protocol and agitation. Haldol was recommended if Ativan not effective. He has been cooperative with his care and at this point there have been no behavioral issues. Discharge Medications: 1. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain. 3. Haldol Sig: 1-2 MG PO every 6-8 hours as needed for agitation. 4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 5. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's PO twice a day as needed for constipation. 6. Lopressor 50 mg Tablet Sig: [**1-31**] Tablet PO twice a day. Discharge Disposition: Extended Care Discharge Diagnosis: Stab wound to left arm Left brachial artery injury Discharge Condition: Stable Discharge Instructions: DO NOT bear any weight on your left upper extremity. You should return to the Emergency room if you develop any fevers, chills, increased redness, drainage, swelling from your surgical site and/or any other symptoms that are concerning to you. Followup Instructions: Follow up with Vascular Surgery in [**8-6**] days for re-evaluation of your left arm and removal of sutures. Call [**Telephone/Fax (1) 1237**] for an appointment. Follow up as needed in Trauma Clinic by calling [**Telephone/Fax (1) 6429**] to schedule an appointment if needed. Completed by:[**2109-2-18**] ICD9 Codes: 2851
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7334 }
Medical Text: Admission Date: [**2115-5-17**] Discharge Date: [**2115-5-30**] Date of Birth: [**2051-7-24**] Sex: F Service: MEDICINE Allergies: Codeine / Penicillins / Iodine; Iodine Containing / Shellfish Attending:[**First Name3 (LF) 5644**] Chief Complaint: Acute renal failure Major Surgical or Invasive Procedure: None History of Present Illness: The patient is a 63 year old female with a history of CAD s/p angioplasty 10 years ago who presented to [**Hospital3 **]Hospital on [**2115-5-16**] for the chief complaint of fevers, chills, diarrhea and abdominal pain. The patient first noted symptoms on Saturday when she developed fevers to 102. As a result, she began to take approximately 12 advils for her fevers Monday to Tuesday and then subsequently developed "dark" diarrhea with diffuse abdominal pain and lower back pain (chronic). She also experienced nausea with minimal, non-bilious vomiting. She denies any sick contacts. She admits to having increased urinary frequency, urgency, but denies any dysuria. She had not been taking any antibiotics before the onset of her diarrhea. The patient has a history of pyelonephritis approximately 10 years ago. She has had a recent colonoscopy with no abnormalities. She currently admits to having nonbloody diarrhea. At [**Location (un) **], the patient was found to have an anion gap of 22 with a Cr of 5.0 which rose to 5.4 with a K of 5.6. She has no known baseline renal insufficiency (Cr 0.9-1.0 in [**2111**]). A CT scan of the abdomen reportedly showed pyelonephritis with bilateral kidney enlargement and soft tissue, perinephritic stranding. The patient was started on Ceftriaxone 1 gm. She was given kayexelate and given IVF with 1 amp of HCO3. Her stool was described as yellow with her urine cultures pending. ROS: No chest pain, shortness of breath. The patient has never had substernal chest pain - her anginal equivalent is right arm pain. Past Medical History: 1)CAD s/p cath [**2111**] (right dominant, single vessel disease, 50% eccentric LAD, RCA diffusely diseased with 100% mid with left-right collaterals) 2) h/o hematuria- posterior wall thickening noted on CT abd/pelvis in [**6-/2114**], with normal appeearing kidneys, cr normal at 0.9, cystoscopy showed no abnormalities, urethral scrituring from inflammation (treated w/ macrodantoin). Social History: The patient lives with her husband in [**Name (NI) **]. She is married with 3 children. She is a former smoker (quit 10 years ago) and formerly smoked 1 pdd x 30 years. She denies any EtOH/drug use. Family History: Mother - multiple medical problems, deceased from unknown cause Father - CABG in 70s Brother - DM h/o SLE in family Physical Exam: Tc=98.7 P=102 BP=133/55 98% O2 on RA Gen - NAD, AOX3 HEENT - Dry [**Last Name (LF) 5674**], [**First Name3 (LF) 13775**] Heart - RRR, no M/R/G Lungs - Bibasilar crackles bilaterally Abdomen - Soft, mildly diffusely tender, active bowel sounds, no rebound/guarding Ext - No C/C/E, + 2 d. pedis Pertinent Results: Admission Labs ([**5-17**]): CBC: WBC-16.2* RBC-4.13* HGB-13.0 HCT-37.0 MCV-90 MCH-31.4 MCHC-35.1* RDW-14.9 * DIFF: NEUTS-83* BANDS-9* LYMPHS-6* MONOS-2 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 * CHEM: GLUCOSE-125* UREA N-73* CREAT-5.3* SODIUM-140 POTASSIUM-4.2 CHLORIDE-102 TOTAL CO2-19* ANION GAP-23* ALBUMIN-3.2* CALCIUM-8.0* PHOSPHATE-4.9* MAGNESIUM-1.8 URIC ACID-9.5* CHOLEST-88 * ABG: Lactate- 1.9, ABG-PO2-71* PCO2-39 PH-7.23* TOTAL CO2-17* BASE XS--10 * LFTs: ALT(SGPT)-96* AST(SGOT)-146* LD(LDH)-409* ALK PHOS-156* AMYLASE-49 TOT BILI-1.0 LIPASE-15 GGT-27 * Lipids: TRIGLYCER-154* HDL CHOL-12 CHOL/HDL-7.3 LDL(CALC)-45 * Urine Studies ([**5-17**]): -------------------- *BLOOD-LGE NITRITE-NEG PROTEIN-500 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG *UROBILNGN-NEG PH-6.5 LEUK-MOD RBC>50 WBC>50 BACTERIA-FEW YEAST-NONE *EOS-POSITIVE Moderate EOS *OSMOLAL-347 *COLOR-LtAmb APPEAR-Cloudy SP [**Last Name (un) 155**]-1.010 *RANDOM CREAT-42 SODIUM-90 *RANDOM CREAT-49 TOT PROT-334 PROT/CREA-6.8 * Micro Data: ------------ [**5-17**] Urine Culutre- 10-100,000 pan sensitive [**5-17**] Stool Culture- No salmonella, shigella,campylobacter. Cdiff neg. [**5-17**] Blood Culture- No growth [**5-21**] Stool Culutre- No O&P. Few PMN's. Charcot-[**Location (un) 5244**] Crystals. [**5-21**] Stool- E.Coli 0157:H7 pending * Other Labs: ----------- [**2115-5-21**] Ret Aut-0.5 [**2115-5-18**] Fibrino-904 D-Dimer-5737 [**2115-5-18**] Fibrino-909 D-Dimer-5772 [**2115-5-21**] Fibrino-594 D-Dimer-7665 [**2115-5-21**] calTIBC-150 VitB12->[**2110**] Folate-15.1 Ferritn-556 TRF-115 [**2115-5-20**] Hapto-291 [**2115-5-19**] HBsAg-NEGATIVE HBsAb-NEGATIVE [**2115-5-22**] [**Doctor First Name **]-PND [**2115-5-19**] HCV Ab-NEGATIVE [**2115-5-21**] freeCa-0.94 [**2115-5-22**] freeCa-0.90 * Lipase Trend: ------------ [**2115-5-17**] Lipase-15 [**2115-5-18**] Lipase-29 [**2115-5-21**] Lipase-981 [**2115-5-22**] Lipase-534 [**2115-5-22**] Lipase-300 [**2115-5-23**] Lipase-294 * Chemistry Trend: --------------- [**2115-5-17**] Glucose-125* UreaN-73* Creat-5.3* Na-140 K-4.2 Cl-102 HCO3-19 [**2115-5-17**] Glucose-101 UreaN-92* Creat-5.7* Na-138 K-4.4 Cl-102 HCO3-16 [**2115-5-18**] Glucose-67* UreaN-104* Creat-6.4* Na-137 K-3.9 Cl-101 HCO3-13 [**2115-5-19**] Glucose-101 UreaN-125* Creat-7.4* Na-131* K-4.0 Cl-96 HCO3-16 [**2115-5-19**] Glucose-79 UreaN-132* Creat-8.4* Na-132* K-4.3 Cl-94* HCO3-15 [**2115-5-20**] Glucose-75 UreaN-114* Creat-7.3* Na-131* K-4.4 Cl-94* HCO3-15 [**2115-5-20**] Glucose-82 UreaN-79* Creat-5.5* Na-138 K-4.3 Cl-100 HCO3-20 [**2115-5-21**] Glucose-95 UreaN-86* Creat-6.0* Na-137 K-4.5 Cl-100 HCO3-19 [**2115-5-22**] Glucose-66* UreaN-94* Creat-6.5* Na-134 K-4.6 Cl-97 HCO3-18 [**2115-5-22**] Glucose-137* UreaN-95* Creat-6.5* Na-134 K-4.7 Cl-99 HCO3-15 [**2115-5-22**] Glucose-124* UreaN-96* Creat-6.4* Na-131* K-4.7 Cl-98 HCO3-16 [**2115-5-23**] Glucose-101 UreaN-94* Creat-6.3* Na-133 K-4.7 Cl-100 HCO3-16 * Reports: -------- Abd U/S [**5-17**]: The liver demonstrates no focal or textural abnormality. The gallbladder is mildly distended with no evidence of stones or acute cholecystitis. The right kidney measures 12.2 cm in length and appears mildly full. The cortex appears echogenic diffusely. There are no stones, masses, or evidence of hydronephrosis. The left kidney measures 11.4 cm; Conclusion- Echogenic renal cortices raising the possibility of chronic renal parenchymal disease. The kidneys appear mildly full with no evidence of obstruction or perinephric collection. * CXR [**5-17**]: No radiographic evidence of acute cardiopulmonary process * CT Abd [**5-21**]: 1. Bilateral enlarged, edematous kidneys without perinephric stranding. This appearance may be consistent with medical renal disease. Other considerations are bilateral renal vein thrombosis, although the renal veins are do not appear expanded on this noncontrast study and toxic metabolic injury. 2. Peripancreatic stranding consistent with pancreatitis without focal fluid collection in the peripancreatic bed. 3. Small right-sided effusion. 4. Atherosclerotic disease of the aorta. * ECHO: Conclusions- 1.The left atrium is normal in size. 2.There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size is normal. Right ventricular systolic function is normal. 4. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. 5.The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 6.There is mild pulmonary artery systolic hypertension. 7.There is no pericardial effusion. There is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. 8. While the study is technically limited, there does not appear to be an overt evidence of an infilatrative cardiomyopathy. Brief Hospital Course: The patient is a 63 year old female with a history of CAD s/p angioplasty who presented to [**Hospital3 7571**]Hospital on [**2115-5-16**] with acute renal failure with a history of excessive NSAID use in the setting of E. coli pyelonephritis and bacteremia now thrombocytopenia, anemia, resolving transaminitis and acute pancreatitis s/p ERCP with sphincterotomy on [**5-22**]. . Bilateral Pyelonephritis - with 1 week of fever, 9% bandemia and gram negative rods in urine culture from [**Location (un) **] with white cell casts - original CT scan from Nashobam showed "perineprhic fat stranding" although no perinephric stranding seen on ultrasound and enlarged kindeys on ultrasound which renal believes is consistent with acute bilateral pyelonephritis. - [**Location (un) **] showed Gram (-) rods in 2 blood culture bottles and the patient has E.coli in her urine that is pansensitive. - Pt was treated with a total 14day course of renally dosed Levaquin 250 mg. . Acute renal failure with oliguria and proteinuria - baseline Cr in [**7-8**] is 0.9; Her Cr continued to rise with worsening gap acidosis this was deemed to be from combination of volume depletion [**2-6**] diarrhea, NSAIDs and pyelonephritis. Renal ultrasound showed no obstruction and in fact, ? signs of chronic renal changes which after discussing with renal, may be consistent with bilateral pyelonephritis. The patient's Cr continued to climb on [**5-19**] and she became more lethargic indicating uremia and thus renal felt the patient needed HD which she received on [**5-19**] with good effect. She had another round of HD on [**5-20**]. The patient had a RSCL tunneled catheter placed on [**5-22**] and received her last HD tx on [**2115-5-23**] for a total of three treatments. Her mental status change (lethargy) was felt to be due to uremia and after HD, improved significantly. Upon transfer to the floor her creatinine began to normalize and she was making good urine. At the time of d/c her creatinine was 2.0. She was instrucred to follow up with nephrology in one month's time. . Pancreatitis - A CT scan of her abdomen on [**5-21**] showed pancreatitis most likely caused by an obstructing stone/sludge not seen on CT. GI was consulted on [**5-21**] and an ERCP was performed on [**5-22**] which showed large craters in the stomach and duodenum, sludge in the CBD that does not explain her symptoms with no stones/ductal dilatation. A sphincterotomy was performed. Her pain was controlled with MSO4. She was restarted on a PPI which was initially discontinued secondary to her thrombocytopenia. She was made NPO and given TPN. Eventually she started to tolerate po's and her pancreatic enzymes began to normalize. She was eating a normal diet at the time of d/c. . Thrombocytopenia - The patient is HIT negative. A prior DIC panel showed an elevated DDimer which is nonspecific in setting of infection with normal fibrinogen and FDP. A repeat D-dimer showed an increased value which again is nonspecific and hematology feels this is most likely [**2-6**] infection. Hematology was consulted on [**5-21**] for ?TTP/ITP/DIC. They feel her anemia and thrombocytopenia were consistent with infection, not necessarily TTP/ITP/DIC. Her platelets eventually stabilized. . Anemia - Iron studies showed chronic disease with a low reticulocyte count that likely represents bone marrow suppression with active infection. - The patient's baseline Hct is 39 and dropped to 26.9 with no clear guaiac but evidence of large craters in her stomach and duodenum. She was transfused 1 unit on [**5-22**] with a goal Hct of > 28. - on [**5-24**], her Hct has dropped from 30-27 with no clear source. She was transfused another unit of PRBCs. It was thought that she had bone marrow suppression from her infection. She remained guiac negative. . Transaminitis: - After speaking to her PCP [**Last Name (NamePattern4) **] [**5-20**], it is clear that the patient has no underlying liver abnormality with normal LFTs in 6'[**14**]. - She did receive vitamin K and FFP for INR>1.5. - She is HepB surface Ab negative, hep C negative. Viral hepatitis seems unlikely although a core antibody was not obtained. Abdominal ultrasound showed no abnormalities. - A CT scan showed pancreatitis and her transaminitis was attributed to possible microlithiasis/sludge and post-sphincterotomy, have returned to [**Location 213**]. -Her tbili rose and she appeared mildly jaundiced after her LFTs have normalized. Her lipase significantly decreased post-ERCP. Her jaudice also began to resolve prior to d/c. . CAD: - Bblocker D/C'd initially in setting for potential sepsis, statin, d/c ASA in face of interstitial nephritis and potential for renal biopsy. She was started on lopressor 50 [**Hospital1 **] on [**2115-5-24**] (she was taking atenolol but this is renally cleared)given her extensive ectopy on [**5-23**] with frequent runs of NSVT (thought believed to be secondary to electrolyte abnormalities). She was eventually d/c with metoprolol, norvasc, and artovastatin . Disp - the patient was d/c to home and told to f/u with her pcp in one week. Medications on Admission: Norvasc 1.25 mg PO QD Atenolol 50 mg [**Hospital1 **] ASA Vitamin E 400 units daily Calcium Carbonate 600 mg PO BID Discharge Medications: 1. Norvasc 2.5 mg Tablet Sig: [**1-6**] Tablet PO once a day. Disp:*15 Tablet(s)* Refills:*2* 2. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 3. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY (Daily). Disp:*30 Capsule(s)* Refills:*2* 4. Zocor 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO once a day for 1 days. Discharge Disposition: Home Discharge Diagnosis: pyelonephritis pancreatitis Discharge Condition: stable Discharge Instructions: Please call your primary care physician if you experience back pain, painful urination, decreased urination, blood in urine, abdominal pain, continuous nausea and vomiting, fevers, chills, bloody stool. . Please do not take your aspirin until after you have seen your primary care physician. Followup Instructions: Please make an appointment to see your primary care physician within the next two weeks. . Please call the nephrology clinic at [**Hospital1 18**] to be seen in the next month ([**Telephone/Fax (1) 773**]. ICD9 Codes: 5845, 2875, 4280, 2765, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7335 }
Medical Text: Admission Date: [**2151-2-15**] Discharge Date: [**2151-2-25**] Service: MEDICINE Allergies: Hydrochlorothiazide / Neomycin Attending:[**First Name3 (LF) 5827**] Chief Complaint: Sepsis Major Surgical or Invasive Procedure: [**2151-2-15**] Placement of left suclavian line, right radial arterial line. History of Present Illness: [**Age over 90 **] y/o F w/COPD, CHF, recent admit for COPD/pna and hip pain, sent from NH where she was noted to be "unresponsive, inaudible bp, pulse 47, 67% on RA." Transferred to [**Hospital1 18**] ER for urgent care. . She was admitted from [**Date range (1) 66385**] and discharged to a nursing home with a prednisone taper and levofloxacin and pain service f/u for likely radicular pain. . In the ED she was hypotensive to 70s, sat 88%RA. BP raised to 90s with 3L IVF, UOP 35 cc while in ED, lactate 2.0. New ARF - Cr 3.6(baseline 1.4), K 8.3 (not hemolyzed, given calcium, glucose/insulin, bicarb), WBC 20. . Given vanc/zosyn in ER, started on peripheral dopamine given hypotension. Also found to have guaiac positive brown stool on exam (per NH has had recent blood in stool accompanied by constipation). . Transferred to ICU for further management. Arterial line and L SC catheters placed. On arrival, patient intubated, sedated, but able to respond yes/no to posed questions appropriately: notes hip pain, denies any other pain. She denies any antecedent trauma. Past Medical History: 1. COPD 2. CHF - EF 50% 3. CKD 4. Spinal Stenosis 5. HTN Social History: Used to work at a factory, no smoking, no EtOH. Remainder of SH unable to be obtained secondary to mental status. Family History: Non-contributory Physical Exam: T 97.2 BP 109/54 P 88-104 RR 21 O2 sat 90% on A/C, FiO2 0.5, Vt 480, PEEP 5 General: Intubated, lying in bed, responsive, following commands. HEENT: Pupils reactive bilaterally. No neck stiffness, negative Brudzinski's sign. Heart: S1 S2 with no MRG, no S3/S4. Lung: CTA anteriorly. Abd: Soft, nondistended. Ext: No edema, 1+ distal pulses. Neuro: Somewhat sedated but following commands, moving all four extremities. Skin: Scattered ecchymoses on stomach consistent with heparin / SC injection irritation. Pertinent Results: [**2151-2-24**] 05:16AM BLOOD WBC-12.0* RBC-2.70* Hgb-8.4* Hct-25.2* MCV-94 MCH-31.1 MCHC-33.2 RDW-15.0 Plt Ct-332 [**2151-2-15**] 07:50PM BLOOD WBC-20.0*# RBC-3.31* Hgb-10.5* Hct-30.3* MCV-92 MCH-31.6 MCHC-34.5 RDW-14.7 [**2151-2-20**] 03:41AM BLOOD PT-11.8 PTT-23.4 INR(PT)-1.0 [**2151-2-24**] 05:16AM BLOOD Glucose-80 UreaN-20 Creat-0.8 Na-141 K-4.1 Cl-102 HCO3-33* AnGap-10 [**2151-2-15**] 07:50PM BLOOD Glucose-146* UreaN-106* Creat-3.6*# Na-129* K-8.3* Cl-87* HCO3-31 AnGap-19 [**2151-2-16**] 11:54AM BLOOD ALT-18 AST-21 LD(LDH)-225 AlkPhos-50 TotBili-0.4 [**2151-2-15**] 09:10PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-SM Urobiln-NEG pH-5.0 Leuks-NEG [**2151-2-15**] 09:10PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020 . MICROBIOLOGY: [**2151-2-16**] 3:35 am SPUTUM Source: Endotracheal. **FINAL REPORT [**2151-2-19**]** GRAM STAIN (Final [**2151-2-16**]): [**10-6**] PMNs and <10 epithelial cells/100X field. 3+ (5-10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 1+ (<1 per 1000X FIELD): YEAST(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM NEGATIVE DIPLOCOCCI. RESPIRATORY CULTURE (Final [**2151-2-19**]): SPARSE GROWTH OROPHARYNGEAL FLORA. STAPH AUREUS COAG +. MODERATE GROWTH. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. Rifampin should not be used alone for therapy. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | CLINDAMYCIN----------- =>8 R ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- =>8 R OXACILLIN------------- =>4 R PENICILLIN------------ =>0.5 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- <=1 S VANCOMYCIN------------ <=1 S . Imaging: CXR [**2-15**] 1. Interval improvement in right base opacity. 2. Subtle left mid zone opacity that may represent an early pneumonic process. 3. Vascular redistribution without overt CHF. . Renal U/S [**2-16**] IMPRESSION: Normal renal ultrasound. . Head CT [**2-16**] IMPRESSION: No evidence of acute intracranial hemorrhage. . Brief Hospital Course: [**Age over 90 **] yo with h/o COPD, CHF (EF 50%) presents with hypotension, hyperkalemia, and sepsis from unknown source, likely pulmonary / pneumonia. . 1. Hypotension/Sepsis: On presentation, pt was found down. Pt was admitted to the [**Hospital Unit Name 153**] and treated with initial pressors, and intubated for pulmonary support. Pt was placed on IV Vanco/Zosyn for presumptive empiric coverage and was pancultured. Sputum cultures later returned back MRSA and patient was treated as presumptive MRSA pneumonia complicated by sepsis. Pt responded well to aggressive fluid hydration and was able to be extubated, with pressors weaned 1 day after initiation. Her Zosyn was discontinued and pt was transferred to the floor and continued on IV Vanco to complete a 14 day course. Pt continued to improve clinically, remained afebrile, and blood cultures remained negative on day of discharge. Pt was eventually discharged to a rehab hospital once stable for continued rehab after discharge. . 2. COPD Exacerbation Pt with symptoms consistant with a COPD exacerbation and had previously still been on an prednisone taper from her previous discharge. Pt was placed on IV solumedrol while in the ICU but gradually transitioned to Prednisone 40mg daily when she was transferred to the floor. Nebulizers, and inhaled steroids were continued throughout her admission. Pt's symptoms improved and patient was discharged on Pred 20mg daily to complete a slow 2 week taper off of steroids. . 3. Acute renal failure: Has baseline CRI but creatinine acutely elevated on elevated which was largely attributed to prerenal azotemia from hypotension and volume depletion. Pt was aggressively hydrated while in the ICU and her Creatinine rapidly returned to [**Location 213**]. A renal u/s was obtained that was negative for any postrenal obstruction. . 4. CHF - Pt with a h/o CHF with a baseline EF of 50%, with some chronic vascular markings c/w chronic changes attributable to CHF. Despite aggressive hydration, clinically pt did not exhibit any signs of CHF. Pt was continued on her home dose of ASA and ACE. Pt is not on a bblocker due to her COPD. Pt to continue to f/u as an outpt. . 5. Proph: Per Dr. [**Last Name (STitle) **], MRSA precautions not indicated unless patient has cough. . 6. Dispo/Code: Full Code. Pt was to be discharged to rehab to complete a 14 day course of IV Vanco for her MRSA pneumonia. Pt is to f/u with her outpt PCP once able. Medications on Admission: Meds per nursing home. 1. Aspirin 325 mg po qd 2. Pantoprazole 40 mg po qd 3. Acetaminophen 500 mg po q 6 hrs 4. Levofloxacin 250 mg q 48 for 7 days (finish [**2-17**]) 5. Tizanidine 2 mg po qHS 6. Lisinopril 2.5 mg po qd 7. Prednisone (has received 40 mg qd since [**2-10**]) Disp:*30 tabs* Refills:*1* 8. Gabapentin 300 mg po HS 9. Oxycodone 10 mg po q4-6 hr prn 10. MOM 30 cc prn, dulcolax, fleet enema prn. 11. Duonebs q 4 hr prn. 12. Spiriva inhaler qd. Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). Disp:*qs units* Refills:*2* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day for 10 days. Disp:*10 Tablet(s)* Refills:*0* 4. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day for 10 days: Please take as taper after the 10 days of prednisone 20mg daily. Disp:*10 Tablet(s)* Refills:*0* 5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 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. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*15 Tablet(s)* Refills:*2* 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. Disp:*30 Tablet(s)* Refills:*0* 9. Albuterol 90 mcg/Actuation Aerosol Sig: One (1) nebulizer treatment Inhalation every six (6) hours as needed for shortness of breath or wheezing. Disp:*qs nebulizer treatments* Refills:*0* 10. Ipratropium Bromide 0.02 % Solution Sig: One (1) inhalation Inhalation Q6H (every 6 hours). Disp:*qs nebulizer* Refills:*2* 11. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 12. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) gram Intravenous Q 24H (Every 24 Hours) for 3 days: Begin with dose on [**2-25**]. Disp:*3 gram* Refills:*0* 13. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. Disp:*60 Tablet(s)* Refills:*0* 14. Gabapentin 300 mg Tablet Sig: One (1) Tablet PO at bedtime. Disp:*30 Tablet(s)* Refills:*2* 15. Tizanidine 2 mg Tablet Sig: One (1) Tablet PO at bedtime. Disp:*30 Tablet(s)* Refills:*2* 16. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN 10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units heparin) each lumen Daily and PRN. Inspect site every shift. Discharge Disposition: Extended Care Facility: [**Hospital **] [**Hospital **] Nursing Home - [**Location (un) **] Discharge Diagnosis: Primary Diagnosis: Sepsis secondary to MRSA Pneumonia COPD Exacerbation . Secondary Diagnosis: CHF EF 50% COPD Discharge Condition: Stable to be discharged to rehab Discharge Instructions: 1. Please follow up with Dr. [**Last Name (STitle) 5351**] after discharge. Please call [**Telephone/Fax (1) **] to schedule that appointment. . 2. Please take medications as below. . 3. Per Dr. [**Last Name (STitle) **], MRSA precautions . 4. If develop chest pain, fever or chills, shortness of breath, or any other symptoms, please call Dr. [**Last Name (STitle) 5351**] or report to the nearest ER. Followup Instructions: (Your pain management appointment needs to be rescheduled) Please follow-up with Dr. [**Last Name (STitle) 5351**] within 1 week. Completed by:[**2151-2-25**] ICD9 Codes: 0389, 5849, 4280, 2767, 5859, 4019
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Medical Text: Admission Date: [**2180-9-4**] Discharge Date: [**2180-10-20**] Date of Birth: [**2109-8-6**] Sex: M Service: CARDIAC CARE UNIT HISTORY OF THE PRESENT ILLNESS: The patient is a 71-year-old male with a history of biventricular pacer and AICD with CHF who had a mechanical fall and bruised his left side. Approximately one week ago, he began to develop fevers, chills, as well as warmth and erythema around the area of his pacer pocket. He had a flu shot one day prior and thought that the fevers and chills were related to that. He went to an outside hospital and was diagnosed with cellulitis, given one dose of IV antibiotics and sent home. He was told to return to the hospital and was given IV Unasyn. An ultrasound of the area was done. No blood cultures were recorded. The patient was transferred for medical management and possible surgical drainage removal of pacer. PAST MEDICAL HISTORY: 1. CAD: Two vessel disease of RCA and mid LAD which were findings noted on catheterization in [**2171**]. He has 2+ MR. The patient is status post MI in [**2171**]. 2. CHF: Ejection fraction of 20% in [**2180-4-23**]. Status post upgrade ICD to biventricular ICD because of increasing symptoms and left bundle branch block. 3. Bronchiolar alveolar carcinoma of the lung. 4. Chronic renal insufficiency. 5. Spinal stenosis. 6. Melanoma removed in [**2169**]. 7. Hypercholesterolemia. 8. Hypertension. 9. Left cerebellar CVA. SOCIAL HISTORY: Tobacco history, quit 15 years ago at 60 pack years. History of alcohol use. Lives with wife and two children. FAMILY HISTORY: Noncontributory. ALLERGIES: The patient has no known drug allergies. ADMISSION MEDICATIONS: 1. Aldactone 12.5 b.i.d. 2. Aspirin 325 q.d. 3. Lipitor 20 q.d. 4. Coreg 6.25 b.i.d. 5. Fluoxetine 40 q.d. 6. Lasix 20-40 b.i.d. 7. Sectral 400 q.d. 8. Zestril 10 q.d. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Temperature 98, blood pressure 108/52, heart rate 80, respirations 18, 02 saturations 100% on room air. General: The patient was calm, in no acute distress. HEENT: Anicteric, mucosa moist, JVD at 9 cm, no lymphadenopathy. Chest: Clear to auscultation bilaterally. Cardiovascular: Distant heart sounds, no murmurs, rubs, or gallops. Abdomen: Soft, nontender, nondistended. Extremities: No clubbing, cyanosis or edema. Chest wall: Area of left pacer pocket mildly erythematous, fluctuant, nontender, with one area of induration on lateral aspect. LABORATORY/RADIOLOGIC DATA: From the outside hospital: White blood cell count 15.5, crit 40, platelets 165,000, neutrophils 82, lymphs 6, monophils 10, eosinophils 2. PT 13.7, PTT 24.6, INR 1.1. Sodium 130, potassium 4.2, chloride 97, bicarbonate 20, BUN 57, creatinine 1.9, glucose 102. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**MD Number(1) 1009**] Dictated By:[**Last Name (NamePattern1) 2548**] MEDQUIST36 D: [**2180-10-20**] 12:06 T: [**2180-10-20**] 12:19 JOB#: [**Job Number 2549**] ICD9 Codes: 4280, 7907, 5849
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Medical Text: Admission Date: [**2176-7-20**] Discharge Date: [**2176-7-23**] Date of Birth: [**2109-7-29**] Sex: M Service: CCU HISTORY OF PRESENT ILLNESS: The patient is a 66 year old gentleman with a history of obesity, peripheral vascular disease, hypertension and heavy tobacco use was admitted initially to [**Hospital3 1280**] on [**7-19**] complaining of chest pressure, dizziness, weakness, diaphoresis and hypotension. He was in his usual state of health until 11:00 p.m. that night when he took a double dose of Zestril and suffered an episode of nausea, vomiting, diaphoresis and chest pressure [**5-25**] without relief which lasted about three hours until he came to the emergency department. In the E.D. patient's blood pressure was 90/58, heart rate 82. Within an hour patient's systolic blood pressure dropped to 45, heart rate dropped to 32 and patient was found in 2:1 heart block. Patient received 0.5 mg of atropine and 1 mg of epi after which patient went into SVT at a rate of 180. Patient was cardioverted out of this rhythm with 50 joules after which patient's systolic blood pressure dropped to the mid-60s and patient was started on dopamine 10 mcg per kg per hour. Patient was transferred to the CCU at [**Hospital3 1280**]. His EKG showed sinus tachycardia with frequent ectopy. Per notes from the outside hospital, his EKG was suspicious for right sided MI especially in the context of receiving aggressive fluid replacement, close to 4 liters, and remaining persistently hypotensive. Patient was started on acute coronary syndrome protocol, aspirin, heparin drip, Integrilin drip. Beta blocker was held secondary to bradycardia. Dopamine drip was weaned off and Neo drip was started. The next morning patient had an echocardiogram which showed ejection fraction of 40% and inferior/right ventricular hypokinesis. Patient's CK peaked at 1293. Patient was transferred to [**Hospital1 188**] for cardiac catheterization. On arrival to [**Hospital1 1444**], patient was chest pain free. He was on Neo-Synephrine drip with blood pressure of 140/100, pulse 75. PAST MEDICAL HISTORY: Hypertension. Peripheral vascular disease, status post right carotid endarterectomy in [**2172**]. History of TIA. History of anxiety disorder. History of obesity. History of heavy tobacco use. MEDICATIONS: Zestril, Paxil 5 mg p.o. q.d., Xanax 0.25 mg p.o. q.i.d., aspirin. MEDICATIONS ON TRANSFER: Aspirin, heparin, Integrilin, Neo-Synephrine 20 mcg per minute, Protonix 40 p.o. q.d., Paxil 10 p.o. q.d., Xanax, Levaquin 500 p.o. q.d. ALLERGIES: No known drug allergies. FAMILY HISTORY: Coronary artery disease. Father died of myocardial infarction at the age of 79. Diabetes in patient's mother. Hepatocellular carcinoma in patient's father. SOCIAL HISTORY: More than 50 pack year smoking history. Alcohol use one to two drinks per day. Patient is retired. He has four children. PHYSICAL EXAMINATION: On transfer to the cardiac intensive care unit, the patient's temperature was 98.2, pulse 82, blood pressure 112/66, respirations 22, 95% on 3 liters, pulsus paradoxus 3 to 5 mm. Patient was on Neo-Synephrine 0.2 mcg per minute. In general, patient demonstrated labored breathing, was speaking in short sentences, was lying in bed in mild respiratory distress. HEENT patient had very mild right eyelid droop. Pupils were equal, round, and reactive to light and accommodation. There was poor dentition, but normal oropharyngeal mucosa. Neck no carotid bruits. There was 3 to 4 cm jugular venous distention above the clavicle. Pulmonary there was poor air movement, extensive audible wheezing in all fields, difficult to appreciate crackles. Cardiovascular distant heart sounds with no murmurs, gallops or rubs noted. Abdomen positive bowel sounds, distended and tight, but no fluid wave, no hepatosplenomegaly. Extremities no cyanosis, clubbing or edema. Normal peripheral pulses. Neurologic was intact. LABORATORY DATA: Peak CK 1500. White count 16.5, hematocrit 39.3, platelets 183. Sodium 138, potassium 4.4, chloride 104, bicarb 28, BUN 17, creatinine 1.0, glucose 122. Normal LFTs. UA showed small blood, positive nitrite, positive leukocyte esterase, more than 100 WBC, 20 to 30 RBC. EKG showed normal sinus rhythm, T wave inversions in leads 2, 3 and aVF and development of progressive Q waves in leads 2, 3 and aVF. HOSPITAL COURSE: The patient underwent cardiac catheterization which showed right atrial pressure of 19, pulmonary artery pressure of 51/30, pulmonary capillary wedge pressure (PCWP) of 27, cardiac output of 4.6, cardiac index of 2.0. Patient showed left dominant system and one vessel disease with totally occluded mid-circumflex just after large obtuse marginal. Patient's left sided PDA filled via left to left collaterals. PTCA and stenting were done with no residual stenosis and TIMI 3 flow. LV-gram was not performed due to reported creatinine of 1.6 at the outside hospital. Patient had a chest x-ray which showed bilateral opacities consistent with pulmonary edema, no hyperinflation. 1. Cardiovascular. The patient is status post PTCA and stenting of mid-circumflex, status post inferior posterior MI [**97**] hours prior to presentation complicated by hypotension and bradycardia, still requiring pressors during cardiac catheterization. Upon transfer from the cardiac catheterization lab, aspirin, Plavix and Integrilin were continued. Patient was started on Lipitor. Cardiac enzymes were cycled q.eight hours and were followed to the peak. It was postulated that patient's persistent hypotension was due to heightened vagal tone since there was no evidence of right sided MI by cardiac catheterization. Patient was subsequently weaned off Neo-Synephrine and was started on ACE inhibitor which he tolerated well. Initially beta blockers were held due to presumed COPD exacerbation, although patient does not have an official diagnosis of COPD. Patient was given Lasix 20 mg p.o. once and showed good urinary output response to that, since patient did appear in mild pulmonary edema. However, most of patient's wheezing and shortness of breath were secondary to pulmonary etiology. Patient has done very well in the intensive care unit and was subsequently transferred to the general medical floor. Patient was started on a low dose beta blocker and tolerated that well. Patient is to have cardiology followup. It was suggested that patient could follow up with a physician at [**Hospital1 69**], however, patient preferred to have followup set up by his primary care physician in his community. 2. Pulmonary. The patient does not have a documented history of COPD, however, given his extensive history of smoking and extensive wheezing and good response to bronchodilators, patient most likely does have COPD. Patient was given continuous neb treatments which we were able to change to metered dose inhalers. Patient did receive appropriate education about their use. Patient would greatly benefit from outpatient pulmonary function tests for proper diagnosis of COPD. Patient received excessive education on the necessity of quitting smoking. That was done repeatedly during daily conversations with the patient. 3. GI. The patient was treated with Protonix for prophylaxis. 4. Renal. The patient received Mucomyst pre-cath and post-cath. Patient's creatinine and electrolytes remained stable throughout the hospitalization. 5. ID. The patient had E.coli UTI per records from the outside hospital. Patient was started on Levaquin at the outside hospital. Here the antibiotic was changed to Bactrim which patient is to take for the few consecutive days during his hospitalization. 6. Anxiety. The patient was continued on Xanax and Paxil. 7. Nutrition. The patient is to follow a cardiac, low sodium diet. The patient received extensive education about the importance of adhering to this diet regimen. CONDITION ON DISCHARGE: Good. DISCHARGE STATUS: To home. DISCHARGE DIAGNOSIS: Status post myocardial infarction. DISCHARGE MEDICATIONS: 1. Aspirin. 2. Plavix. 3. Toprol XL 12.5 mg p.o. b.i.d. 4. Lipitor 20 mg p.o. b.i.d. 5. Lisinopril 10 mg p.o. b.i.d. 6. Serevent MDI two puffs p.o. b.i.d. 7. Albuterol MDI two puffs q.four to six hours p.r.n. FOLLOWUP: The patient is to follow up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 10269**], on [**2176-7-26**] at 3:45 p.m., phone number [**Telephone/Fax (1) 52278**]. Patient's primary care physician is to schedule outpatient cardiology followup for patient about two weeks after discharge. Patient will also need an echocardiogram four weeks after discharge. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**MD Number(1) 1009**] Dictated By:[**Doctor Last Name 51186**] MEDQUIST36 D: [**2176-7-28**] 23:07 T: [**2176-8-2**] 09:50 JOB#: [**Job Number 52279**] cc:[**Last Name (NamePattern4) 52280**] ICD9 Codes: 496, 5990, 4111, 4019
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Medical Text: Admission Date: [**2107-1-10**] Discharge Date: [**2107-1-27**] Date of Birth: Sex: M Service: MEDICINE HISTORY OF PRESENT ILLNESS: This is a 49 year old male with a past medical history of Hepatitis C and alcoholic hepatitis and cirrhosis which is complicated by three to four months of ascites and spontaneous bacterial peritonitis. He had extensive ascites and a history of a gastrointestinal bleed. No history of encephalopathy; no history of hypertension; diabetes mellitus; asthma or epilepsy. He was admitted for an elective TIPSS procedure for the indication of his refractory ascites which was requiring paracentesis every five days. Prior to the procedure a routine EKG showed normal sinus rhythm with decreased voltage. A chest x-ray showed question of interstitial lung disease with reticular shadowing. An echocardiogram showed mild pulmonary artery hypertension but normal systolic function with an ejection fraction greater than 55%. PAST MEDICAL HISTORY: 1. Cirrhosis secondary to hepatitis C and alcohol. 2. Spontaneous bacterial peritonitis. 3. History of upper gastrointestinal bleed. 4. Hypertension. 5. Chronic obstructive pulmonary disease. ALLERGIES: Codeine. MEDICATIONS: 1. Aldactone 50 mg p.o. q. day. 2. Lasix 120 mg twice a day. 3. Inderal 10 mg twice a day. 4. Imdur 30 mg q. day. 5. Lactulose. 6. Protonix. SOCIAL HISTORY: The patient lives with his mother. [**Name (NI) **] has a history of tobacco and extensive alcohol use. PHYSICAL EXAMINATION: Temperature 98.5 F.; blood pressure 94/66; respiratory rate 20; pulse 86; oxygen saturation 91% on room air. The patient in general is in no acute distress. He is alert and oriented times three. His Head, Eyes, Ears, Nose and Throat are remarkable for the absence of icterus. His neck is supple without bruits. His chest is clear bilaterally without crackles or wheezes. His heart has a regular rate and rhythm with no murmurs, rubs or gallops. His abdomen is soft and nontender, with extensive ascites to percussion. His extremities have no edema. Neurologically, he has no flap. LABORATORY: White blood cell count 10.9; hematocrit 47.3, platelets 116. Sodium 129, potassium 4.2, chloride 97; bicarbonate 28, BUN 19, creatinine 1.1, glucose 96. ALT 37, AST 66, alkaline phosphatase 120, total bilirubin 1.0, direct bilirubin 0.4, albumin 2.3. Alpha fetoprotein 1.7. HIV serology is negative. EKG as noted above. Echocardiogram as noted above. Chest x-ray as noted above. HOSPITAL COURSE: The patient was admitted for elective TIPSS procedure for his refractory ascites. Prior to admission he was noted to have a question of interstitial lung disease on routine chest x-ray. An echocardiogram showed mild pulmonary hypertension and normal systolic function. He underwent the procedure on [**2107-1-11**]. The procedure was complicated by desaturation of his oxygen levels to 89% and drop in his blood pressure to the 80s. His heart rate was also in the 150s. He became agitated and his oxygen saturation dropped further. He was given Adenosine without effect. His endotracheal tube was suctioned with copious white clear secretions and improved compliance. He was then given Esmolol which, as his heart rate was elevated, with a decrease in his heart rate to 116 and the blood pressure in the 120s. Extubation was then attempted, however, the patient did not tolerate extubation and he was quickly re-intubated. His blood pressure again dropped to 80 systolic and a STAT chest x-ray showed that he was in congestive heart failure. He was given Lasix, Midazolam, and transferred to the Post Anesthesia Care Unit where he became unstable. He was started on Levophed which initially had good effect with elevation in his blood pressure to 130s and heart rate to 100. His oxygen saturation remained in the 90s. At that point, the Medical Intensive Care Unit Service was consulted. An emergent echocardiogram revealed extensive left ventricular dysfunction and an ejection fraction of less than 20% with global hypokinesis, right ventricular dilatation and dysfunction. The patient was continued on Levophed. A Swan-Ganz catheter was passed which revealed a pulmonary wedge pressure of 30 and a systemic vascular resistance of 1,016 and a cardiac output of 4.8 with an index of 2.58. The patient was started empirically on broad-spectrum antibiotics. His ascitic fluid which had been removed prior to the TIPSS procedure was not indicative of SBP. Cardiac enzymes indicated that the patient did not have a myocardial infarction. The patient was started on Dobutamine in addition to Levophed for inotropic support. During his hospital course, the patient remained hypoxic and hypotensive. The source for his heart failure remained unclear. It was felt that most likely he had an underlying cardiomyopathy that was exacerbated and/or revealed by the hemodynamic changes from the TIPSS procedure. Repeated blood cultures and ascites cultures were negative. The patient was continued on pressors and broad-spectrum antibiotics and remained intubated. He did develop low-grade DIC as indicated by his hematology labs. Repeated attempts to wean off his pressor support were unsuccessful. Ultimately, given the patient's extensive underlying disease and poor overall prognosis, after extensive discussion between the Medical Team and the patient's family, the family elected to withdraw care. Care was withdrawn on [**2107-1-26**], after meeting with the family and answering all their questions. The patient expired on [**2107-1-26**], of cardiac failure and hepatic failure following TIPSS for refractory ascites from alcoholic and viral hepatitis. DIAGNOSES AT DEATH: 1. Congestive heart failure. 2. Hepatic failure. 3. Status post TIPSS. 4. DIC. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3795**] Dictated By:[**Last Name (NamePattern1) 11548**] MEDQUIST36 D: [**2107-5-23**] 12:15 T: [**2107-5-23**] 19:56 JOB#: [**Job Number 36898**] ICD9 Codes: 4280, 486, 496
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Medical Text: Admission Date: [**2132-5-16**] Discharge Date: [**2132-5-20**] Date of Birth: [**2102-4-14**] Sex: M Service: MEDICINE Allergies: Penicillins / Amoxicillin Attending:[**First Name3 (LF) 348**] Chief Complaint: Alcohol withdrawal w/seizure Major Surgical or Invasive Procedure: None History of Present Illness: 30 y/o male with h/o ETOH abuse, seen 1 week ago at [**Hospital1 **] ER for alcohol intoxication, discharged home, and resumed drinking. This admission the patient presents s/p ?seizure (witnessed by wife, pt unable to describe event further) after "self-tapering" EtOH intake over the past week. Pt states he has been drinking about 1 L of whiskey per day, then quit alcohol and his prescription meds simultaneously on [**2132-5-16**]. He was told by his wife he had a seizure that evening while watching television. . In the ED VS = 97.9 163 163/93 20 99%RA. He received 4L NS, 45 mg IV valium, levofloxacin (for unclear indication), and remained tremulous. He reported n/v x 1, which improved with zofran. His labs were notable for lactate 4.1 (venous), INR 1.0, HCO3 15, GAP 31, TBIL 2.0, and ALT 203, AST 404, PLT 69. Serum ETOH 82. CXR without focal infiltrate. ECG revealed sinus tachycardia. He received 3L IVF and 200mg IV thiamine. His HR improved to the 90s. At the time of transfer, VS=100.4 101->97 bpm 143/112 26 100%RA Past Medical History: - s/p fall/abrasion [**5-/2130**] - hx of EtOH abuse, began drinking at age 14, consuming [**11-23**] - [**12-25**] handle of whiskey, s/p detox 2 years ago but resumed drinking one month ago after losing job. Alcohol intoxication (BAL 373) on [**9-/2131**] - ? hx of suicidal ideation - HTN Social History: He reports having had a problem with alcohol from a young age. 2 years ago went to a detox program. Was successful until he was laid off from his management consulting job. He has never had any seizures or DTs from withdrawal. Patient denied IVDU. Remote hx of marijuana and cocaine during his college years (none recently). Denies heroin. + 1 ppd smoking since age 15. College graduate, was working as a manager in a company. Married Family History: Significant for alcohol addiction in the patient's mother and maternal grandmother Physical Exam: General: Alert, oriented, still somewhat tremulous HEENT: Sclera anicteric, oropharynx clear, no nystagmus Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation anteriorally, no wheezes, rales, ronchi CV: tachy, reg rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender (including RUQ), non-distended, bowel sounds present, no rebound tenderness or guarding, neg [**Doctor Last Name **] sign, no organomegaly appreciated Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: pupils 5 mm --> 4 mm bilaterally, moving all extremities, oriented x 3 Pertinent Results: [**2132-5-16**] 11:08PM URINE HOURS-RANDOM [**2132-5-16**] 11:08PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2132-5-16**] 11:08PM URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.018 [**2132-5-16**] 11:08PM URINE BLOOD-TR NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG [**2132-5-16**] 11:08PM URINE RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE EPI-<1 [**2132-5-16**] 11:08PM URINE MUCOUS-MOD [**2132-5-16**] 10:39PM GLUCOSE-88 UREA N-10 CREAT-0.6 SODIUM-140 POTASSIUM-3.2* CHLORIDE-103 TOTAL CO2-24 ANION GAP-16 [**2132-5-16**] 10:39PM CK(CPK)-142 DIR BILI-0.8* [**2132-5-16**] 10:39PM ALBUMIN-3.8 MAGNESIUM-1.8 [**2132-5-16**] 09:46PM TYPE-[**Last Name (un) **] PO2-142* PCO2-35 PH-7.42 TOTAL CO2-23 BASE XS-0 [**2132-5-16**] 09:46PM LACTATE-4.1* [**2132-5-16**] 08:31PM PT-12.1 PTT-28.0 INR(PT)-1.0 [**2132-5-16**] 07:50PM GLUCOSE-135* UREA N-13 CREAT-1.0 SODIUM-140 POTASSIUM-4.1 CHLORIDE-94* TOTAL CO2-15* ANION GAP-35* [**2132-5-16**] 07:50PM estGFR-Using this [**2132-5-16**] 07:50PM ALT(SGPT)-203* AST(SGOT)-484* TOT BILI-2.0* [**2132-5-16**] 07:50PM LIPASE-50 [**2132-5-16**] 07:50PM OSMOLAL-320* [**2132-5-16**] 07:50PM ASA-NEG ETHANOL-82* ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2132-5-16**] 07:50PM WBC-4.7 RBC-4.61 HGB-15.1 HCT-45.3 MCV-98# MCH-32.7* MCHC-33.3 RDW-16.0* [**2132-5-16**] 07:50PM NEUTS-55.9 LYMPHS-36.2 MONOS-6.4 EOS-0.9 BASOS-0.7 [**2132-5-16**] 07:50PM PLT SMR-VERY LOW PLT COUNT-69* CT HEAD W/O CONTRAST Study Date of [**2132-5-17**] 7:56 AM Final Report HISTORY: 30-year-old male with seizure. COMPARISON: None available. TECHNIQUE: Axial imaging is performed from the cranial vertex to the foramen magnum without IV contrast. HEAD CT WITHOUT IV CONTRAST: There is no fracture, hemorrhage, edema, mass effect, shift of midline structures, or other evidence of acute process. The ventricles and sulci are normal in size and configuration for the patient's age. Soft tissues and osseous structures appear unremarkable. IMPRESSION: No evidence of acute process. ECG Study Date of [**2132-5-18**] 6:35:38 AM Sinus rhythm. Compared to the previous tracing of [**2132-5-17**] mild QTc interval prolongation is again present with prominent precordial voltage which could be due to a physiologic variant or left ventricular hypertrophy. Non-diagnostic RSR' pattern in leads V1-V2 which may be seen as a physiologic variant. Brief Hospital Course: 30 y/o male with h/o ETOH abuse, seen 1 week ago at [**Hospital1 **] ER for alcohol intoxication, discharged home, and resumed drinking. This admission the patient presents s/p ?seizure (witnessed by wife, pt unable to describe event further) after "self-tapering" EtOH intake over the past week. Pt states he has been drinking about 1 L of whiskey per day, then quit alcohol and his prescription meds simultaneously on [**2132-5-16**]. He was told by his wife he had a seizure that evening while watching television. . In the ED VS = 97.9 163 163/93 20 99%RA. He received 4L NS, 45 mg IV valium, levofloxacin (for unclear indication), and remained tremulous. He reported n/v x 1, which improved with zofran. His labs were notable for lactate 4.1 (venous), INR 1.0, HCO3 15, GAP 31, TBIL 2.0, and ALT 203, AST 404, PLT 69. Serum ETOH 82. CXR without focal infiltrate. ECG revealed sinus tachycardia. He received 3L IVF and 200 mg IV thiamine. His HR improved to the 90s. His vitals upon transfer to the ICU were VS=100.4 101->97 bpm 143/112 26 100%RA. In the ICU, the patient was at times combative, on at least two occasions tore out his IV and tried to leave. He was for a time in 4-point restraints and receiving Haldol for agitation and combativeness. His agitation resolved and his vitals and labs normalized. But he remained somewhat tremulous and had low platelet counts. He was discharged to the medicine floor where his platelet counts rose up to above 100. # Alcohol withdrawal: He had consults with social work and with our addiction management experts. Received thiamine, folate. Patient was informed he could not drive for 6 months because of his seizure history. . # Thrombocytopenia - rose from 30s-> 52-> 102 at d/c. Never symptomatic (e.g. no bleeding, petechiae, etc.) Likely secondary to EtOH toxicity. Resolved. Medications on Admission: - Atenolol 75mg PO daily - Seroquel 75mg PO daily - Klonopin 1mg PO AM, 2mg PO PM Discharge Medications: 1. Atenolol 25 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). Disp:*90 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary: Alcohol withdrawal Secondary: Alcohol dependence Withdrawal-induced seizure Hypertension Discharge Condition: Able to ambulate, tolerating food well, HR 80s-90s, calm, cheerful, no acute issues. Discharge Instructions: You've been admitted to the hospital with a short stay in the Intensive Care Unit for alcohol withdrawal and seizure. While you were here we monitored your withdrawal, and you progressed safely. Our alcohol specialists spoke with you and you have developed a plan with them to remain sober. Please note that because of your seizure you are not allowed to drive a car for 6 months. There have been no changes to your medications. Please call your doctor or 911 if you experience any seizures, withdrawal symptoms such as sever shaking, hallucinations, chest pain, trouble breathing or any other concerning medical symptoms. Followup Instructions: Please call Dr. [**Last Name (STitle) 62488**] tomorrow morning at [**Telephone/Fax (1) 2261**] and make an appointment to see him in the next 1-2 weeks. We have provided you with other resources including Alcoholics Anonymous information which we strongly encourage you to use. Completed by:[**2132-5-30**] ICD9 Codes: 2762, 4019, 3051
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Medical Text: Admission Date: [**2110-8-11**] Discharge Date: [**2110-8-14**] Service: MEDICINE Allergies: Penicillins / Amoxicillin / Sulfa (Sulfonamide Antibiotics) / Tetracycline / Erythromycin Attending:[**First Name3 (LF) 2195**] Chief Complaint: SOB- found to have gallstone pancreatitis/cholangitis Major Surgical or Invasive Procedure: ERCP History of Present Illness: Ms. [**Name13 (STitle) **] is a [**Age over 90 **]yo woman with hx of dementia, endometrial ca, and prior CVA who initially presented to [**Hospital3 3583**] from her nursing facility with SOB on [**2110-8-10**]. In the ambulance she was given lasix 20mg IV x 1 and at [**Hospital3 **] she was given levofloxacin 750mg IV x 1 and solumedrol 125mg IV x 1 for possible asthma / COPD flare (no known history of this.) Labs revealed lipase >5000, TBili 1.8 at [**Hospital1 46**] so the patient was transferred to [**Hospital1 18**] for ERCP. She underwent ERCP and there was difficulty navigating the duodenem due to tortuosity so the ERCP was aborted with a plan for percutaneous biliary drain. The patient was improving symptomatically improving and lipase/LFTs were improving. Given her improvement and discussions with her health care proxy ([**Name (NI) **] [**Name (NI) 87604**] [**Telephone/Fax (1) 87605**]) plan was made to conservatively manage with IV abx levo/flagyl x 2 weeks and readdress perc biliary drain should she worsen. In addition the patient's blood cultures from [**Hospital3 3583**] from [**8-10**] grew gram negative rods, prelim pan sensitive without speciation yet. Blood cultures from [**Hospital1 18**] [**8-11**] no growth to date. Prior to transfer from the [**Hospital Ward Name 332**] ICU the patient feels well, denies N/V, no abd pain, no SOB, no chest pain. She is pleasantly demented and AOx1-2 but states in general she feels well. During her ICU stay the patient rec'd IV abx, underwent unsuccessful ERCP as above, and was 2.6 L + legnth of stay. She was not intubated nor on pressors. Past Medical History: Alzeimer's dementia osteoporosis Gout PMR on prednisone 5mg po daily depression anxiety anemia h/o fall frequent UTIs Past Surgical History: R THR tendon repair L hamstring TAH sebaceous cyst Social History: Nursing home resident, otherwise unknown Family History: unknown Physical Exam: VS T 98.7 HR 80 BP 114/79 RR 16 O2 99% on 3L, 97% on RA GEN: NAD, AOx1-2 (name, [**Month (only) 216**], unsure of year, thinks she is in [**Location (un) **], MA) HEENT: No scleral icterus, mucus membranes moist CV: RRR, 3/6 SEM > RUSB PULM: Crackles R side [**12-29**] way up with bilateral mild wheezes diffusely ABD: Soft, nondistended, tender on deep palpation of LLQ, no guarding or rebound tenderness, +BS Ext: No LE edema, LE warm and well perfused Pertinent Results: Imaging: RUQ US [**8-11**] IMPRESSION: Limited study demonstrating no evidence of gallbladder disease or biliary dilation. CXR PA/L [**8-11**]: IMPRESSION: Bibasilar atelectasis and small effusions. Limited exam. CXR [**2110-8-12**]: In comparison with the study of [**8-11**], the outer portion of the right hemithorax has been excluded from the image. Low lung volumes with technically limited study make it difficult to assess the size of the heart. Tortuosity of the aorta is seen in a patient with prominent kyphosis that limits evaluation on the frontal projection. Some prominence of interstitial markings could reflect elevated pulmonary venous pressure. The left hemidiaphragm is not sharply seen, raising the possibility of some atelectasis or effusion at the left base. ERCP [**2110-8-11**]: The stomach was entered and seemed to be very friable. The was severe external duodenal compression and deformity and the scope not be safely passed into the second portion. [**2110-8-12**] 04:15AM BLOOD WBC-13.4* RBC-3.25* Hgb-9.9* Hct-29.6* MCV-91 MCH-30.4 MCHC-33.4 RDW-13.6 Plt Ct-117* [**2110-8-12**] 04:15AM BLOOD Neuts-82* Bands-5 Lymphs-9* Monos-3 Eos-0 Baso-0 Atyps-1* Metas-0 Myelos-0 [**2110-8-12**] 04:15AM BLOOD Glucose-81 UreaN-41* Creat-1.4* Na-144 K-4.4 Cl-111* HCO3-25 AnGap-12 [**2110-8-12**] 04:15AM BLOOD ALT-259* AST-240* LD(LDH)-224 AlkPhos-89 TotBili-0.6 [**2110-8-12**] 04:15AM BLOOD Lipase-462* [**2110-8-12**] 04:15AM BLOOD Calcium-8.0* Phos-4.0 Mg-2.3 [**2110-8-12**] 04:50AM BLOOD Lactate-1.6 Discharge Labs: [**2110-8-14**] 06:30AM WBC-10.0 RBC-3.29* Hgb-9.7* Hct-30.9* MCV-94 Plt Ct-117* Glucose-80 UreaN-29* Creat-1.0 Na-142 K-4.1 Cl-107 HCO3-29 AnGap-10 ALT-115* AST-51* AlkPhos-74 TotBili-0.6 Brief Hospital Course: Cholangitis: Likely secondary to common bile duct obstruction with stone. ERCP was unsuccessful, but patient clinically improved and LFT's and lipase decreased. She remained afebrile and pain free on Levofloxacin and Flagyl, and had her diet advanced without difficulty. She should complete a total of ten days of antibiotics. Blood cultures are pending from the 16th and 18th, but are currently no growth to date. Given friability of gastric mucosa seen on endoscopy patient was started on a PPI. Pancreatitis: Likely secondary to gallstones as above; patient never experienced abdominal pain and tolerated a PO diet. Acute Renal Failure: Resolved with IV fluids. Duodenal Extrinsic Compression: When clinically improved from current illness, discuss with patient and family further workup including further imaging with CT abd/pelvis. No current evidence of bowel obstruction Dementia: No difficulties with agitation or sundowning. Mood stable. PMR: Patient was continued on Prednisone 5mg po daily Code Status: DNR/DNI Medications on Admission: - Prednisone 5mg po daily - Folate 1mg po daily - Miralax daily - Tylenol 1g qam - Alphagan 0.1% dropps - one drop both eyes [**Hospital1 **] - Pepcid OTC 20mg po daily - Tums 500mg po daily - Vitamin D 400 units [**Hospital1 **] - Calcium 600mg po bid - Milk of mag prn Discharge Medications: 1. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 2. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) inhalation Inhalation Q6H (every 6 hours) as needed for SOB. 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 5. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Inhalation Q6H (every 6 hours). 6. Flagyl 500 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for shortness of breath or wheezing for 7 days. 7. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO every other day for 3 doses. 8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 9. Tums 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. Discharge Disposition: Extended Care Facility: Lifecare of [**Location (un) 3320**] Discharge Diagnosis: Cholangitis Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Discharge Instructions: You were transferred to the [**Hospital1 **] [**First Name (Titles) **] [**Last Name (Titles) 19806**] ERCP to remove a gallstone. The procedure was unsuccessful, but you continued to improve with antibiotics. You were also started on nebullizers for wheezing, and were weaned off of oxygen. Aside from being started on antibiotics, no changes were made to your home medications. Followup Instructions: Please follow-up with your primary care provider within one week of discharge. ICD9 Codes: 5849, 2749, 2859, 5859
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Medical Text: Admission Date: [**2104-2-19**] Discharge Date: [**2104-2-22**] Date of Birth: [**2032-12-8**] Sex: M Service: MEDICINE Allergies: Vicodin Attending:[**First Name3 (LF) 2901**] Chief Complaint: Chest Pain. Transfer for STEMI. Major Surgical or Invasive Procedure: Cardiac Catheterization - LAD total occlusion, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 2. History of Present Illness: Patient is a 71 year old gentleman who was experiencing 3 weeks of intermittent chest and back pain and presented to [**Hospital1 2519**] with 4 days of constant chest pain, worse [**10-5**], in addition to tingling down both arms (ulnar distribution in hands), back pain, nausea and diaphoresis. He was noted to have an ST eleveation MI, elevations in V2-V5. CK peaked at [**2093**], and Trop peaked at 74. He was given a heparin bolus and started on a heparin drip, then transferred to [**Hospital1 18**] for Cardiac Catheterization. Review of Systems: Patient complains of dyspnea on exertion for the last 2-3 weeks. He has 2pillow orthopnea at home. He has had anginal symptoms in the past for years, just worsened in the last few weeks. He admits to pain in legs when walking, particularly in right groin, improves after resting for a long period of time. He denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, black stools or red stools. He denies recent fevers, chills or rigors. He does admit to chronic diffuse abdominal pain. Past Medical History: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension 2. CARDIAC HISTORY: None 3. OTHER PAST MEDICAL HISTORY: Acid Reflux Lower extremity edema Neuropathy BPH COPD (?- used Advair in past without memorable benefit) Chronic back pain, sciatica per patient, and foot pain Hemorrhoids 4. PAST SURGICAL HISTORY: Bunionectomy left foot Tonsillectomy sinus surgery Bilateral lens transplants 5. PREVENTION: Colonoscopy, [**2100-2-24**] PSA 17.4, [**2101-2-24**] Social History: Married, 4 children, used to work for [**Company 2318**] -Tobacco history: 50 years x 1ppd, quit 8 years ago. -ETOH: occasional glass of wine. Family History: Mother [**Name (NI) 2481**] disease. Mother had MI in 50s or 60s, older brother with MI age 70s (several months ago) and peripheral vascular disease. Father's cardiac history unknown. Patient endorsed positive stroke history for mother and father. Physical Exam: At admission to CCU s/p PCI: VS: T=100.4 BP=117/69 HR=74 RR=19 O2 sat= 97% 4L NC GENERAL: Well nourished male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. CN II-XII intact. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. NECK: Supple with JVD of 10+ cm. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. soft systolic murmur. LUNGS: No chest wall deformities. Resp unlabored, no accessory muscle use. Diffuse crackles, increased at bases bilaterally. ABDOMEN: Soft, obese, mildly distended, diffusely mildly tender. EXTREMITIES: Trace bilateral lower extremity edema. Right groin site tender in one spot, no hematomas, bruits, or bleeding, clean/dry/intact. PULSES: Right: Carotid 2+ DP 2+ Left: Carotid 2+ DP 2+ Pertinent Results: Outside Hospital Labs: TROP-I 74.8 WBC 14.0 HCT 48.0 NA 139 BUN/CR 11/1.2 Admission Labs: [**2104-2-19**] 07:31PM BLOOD WBC-14.5* RBC-4.54* Hgb-13.0* Hct-39.5* MCV-87 MCH-28.7 MCHC-33.0 RDW-13.5 Plt Ct-145* [**2104-2-19**] 07:31PM BLOOD Neuts-83.1* Lymphs-8.5* Monos-7.5 Eos-0.7 Baso-0.2 [**2104-2-19**] 04:30PM BLOOD Glucose-107* UreaN-11 Creat-1.0 Na-137 K-3.5 Cl-103 HCO3-24 AnGap-14 [**2104-2-19**] 07:31PM BLOOD PT-12.9 PTT-24.7 [**Month/Day/Year 263**](PT)-1.1 [**2104-2-19**] 07:31PM BLOOD Calcium-8.6 Phos-2.7 Mg-1.5* Cardiac Biomarkers: [**2104-2-19**] 04:30PM BLOOD CK-MB-147* MB Indx-48.5* cTropnT-8.62* [**2104-2-19**] 07:31PM BLOOD CK-MB-122* MB Indx-6.7* cTropnT-16.72* [**2104-2-20**] 05:08AM BLOOD CK-MB-75* MB Indx-5.6 Cardiac Risk Factors: [**2104-2-20**] 05:08AM BLOOD %HbA1c-5.5 eAG-111 [**2104-2-20**] 05:08AM BLOOD Triglyc-85 HDL-42 CHOL/HD-4.0 LDLcalc-111 Discharge Labs: [**2104-2-22**] 05:55AM BLOOD WBC-8.5 RBC-4.19* Hgb-12.2* Hct-35.7* MCV-85 MCH-29.1 MCHC-34.1 RDW-13.3 Plt Ct-157 [**2104-2-22**] 05:55AM BLOOD Glucose-110* UreaN-19 Creat-1.3* Na-138 K-4.2 Cl-102 HCO3-22 AnGap-18 [**2104-2-22**] 05:55AM BLOOD PT-13.6* PTT-64.2* [**Month/Day/Year 263**](PT)-1.2* Urine Analysis: [**2104-2-20**] 12:50PM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG Microbiology: [**2104-2-21**] 3PM BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2104-2-21**] 4PM BLOOD CULTURE Blood Culture, Routine-PENDING INPATIENT [**2104-2-19**] MRSA SCREEN MRSA SCREEN-PENDING INPATIENT EKG: Persistent elevations in V2-V5 . [**2104-2-20**] Transthoracic Echocardiogram demonstrates EF30%. Moderate to severe regional left ventricular systolic dysfunction with mid to distal septal, anterior, antero-lateral and apical hypokinesis to akinesis. No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size is normal with borderline normal free wall function. Trivial pericardial effusion. Trivial MR. [**2104-2-21**] Chest X-ray: Cardiac silhouette is upper limits of normal in size, and pulmonary vascularity is within normal limits for portable semi-upright technique. Patchy opacities in both infrahilar areas, most prominent in the left retrocardiac region, could be due to atelectasis, aspiration and less likely developing infection. . Cardiac catheterization: [**2104-2-19**] COMMENTS: 1. Selective coronary angiography in this left dominant system demonstrated single vessel disease. The LMCA, LCx and RCA had minimal disease. The LAD had a total occlusion mid-vessel. 2. Successful PCI of the mid-LAD with non-overlapping Promus DES: 2.5x18mm distally and 3.0x23mm proximally (post-dilated to 3.5mm). 3. Successful closure of the right femoral arteriotomy site with a 6F Perclose device. FINAL DIAGNOSIS: 1. One vessel coronary artery disease. 2. Successful PCI of the LAD with DES. Brief Hospital Course: 71 year-old male presenting with 4 days of severe chest pain with elevated cardiac biomarkers transferred to [**Hospital1 18**] for cardiac catheterization and stent placement. #STEMI: Patient presented s/p [**Hospital **] transferred from outside hospital with peak CK [**2093**] and Trop-I of 74, reportedly after 4 days of constant chest pain. Two drug-eluting stents were placed in the mid-LAD and the mid-distal LAD for total occlusion. He was transferred to the CCU where he recieved frequent morphine boluses and a nitroglycerin drip for chest pain. Patient continued to endorse chest pain overnight post procedure. It was similar in quality and site to presentation pain, but less intense. Chest pain persisted intermittently on the day following procedure, but only with exertion, which was also accompanied by SOB. Patient completed integrilin drip for 18hrs post procedure. EKG shows persistent ST elevations in leads V2-V5 after intervention. Post-procedure TTE demonstrated EF30% as well as moderate to severe regional left ventricular systolic dysfunction with mid to distal septal, anterior, antero-lateral and apical hypokinesis to akinesis. No VSD, masses, or thrombi are seen in the left ventricle. Trivial pericardial effusion. Trivial MR. In addition to aspirin patient was treated with prasugrel as an anti-platelet [**Doctor Last Name 360**] indicated for this patient with post-PCI angina and to reduce stent thrombosis and ischemic events. Metoprolol 25mg [**Hospital1 **] was initiated, well tolerated by blood pressure during hospitalization. Low dose ACE inhibitor was started upon discharge, held initially in the setting of acute kidney injury. #Apical hypokinesis. Patient noted to have Left ventricular akinesis on Echo, so he was started on anticoagulation for prevention of LV thrombus formation. He was started on a heparin IV drip then lovenox injections for bridge to longterm warfarin anticoagulation. He was discharged with lovenox, to be injected daily by visiting nurse [**First Name (Titles) 4**] [**Last Name (Titles) 263**] becomes therapeutic on warfarin. Patient will require anticoagulation for at least 3 months to 1 year. He should be reevaluated with echocardiogram at 3 months for reassessment of longterm anticoagulation needs. #Acute Systolic Congestive Heart Failure. Patient noted to have decreased EF of 30% on Echo. Acute systolic congestive heart failure secondary to decreased EF post infarction and likely stunned myocardium post MI. There was likely a chronic element based on endorsed PND, orthopnea, and LE swelling. Patient was intermittently diuresed with IV furosemide, responding well to 20mg boluses. Patient's pulse oximetry demonstrated 95% on room air on day of discharge. Patient will be discharged on 20mg furosemide PO daily. Potassium levels should be re-assessed at follow-up. #Acute Kidney Injury Acute Kidney Injury demonstrated by elevated Cr to 1.6 from 1.0 on admission following PCI. Contrast nephropathy likely given Cr peak roughly 48 hours post PCI with 130mL of contrast, less likely atheroemboli. Decreased heart function post MI may have contributed to poor forward flow. ACEi started on discharge. #Hyperlipidemia. Patient was treated and discharged on high dose statin. LDL was elevated at 111 post-MI justifying continued high dose statin thearpy at discharge. #Hypertension: Patient remained normotensive during hospitalization except for episodes of agitation with metoprolol and lasix PRN dyspnea. #Benign Prostate Hyperplasia: Patient was treated with Doxazosin and Tamsulosin during admission. Per outside hospital records, patient had recent elevated PSA of 17. Note that patient also has history of lower back pain. #COPD: Patient has significant smoking history and was intermittently wheezy on exam. Albuterol/Ipratropium nebulizer treatments were used intermittently. Medications on Admission: Ambien Cardura (doxazosin) 1mg qhs celebrex 200mg daily cyclobenzaprine 10mg qhs diazide (triamterene/hctz) 37.5/25mg qday flexeril 10mg qhs flomax (tamsulosin) 0.4mg qday levitra 20 mg prn oxycodone prn pain Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Prasugrel 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*11* 3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 4. Doxazosin 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. Disp:*30 Tablet(s)* Refills:*2* 6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO ONCE (Once). Disp:*30 Tablet(s)* Refills:*2* 7. Metoprolol Succinate 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* 8. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for chronic back pain. 10. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 11. Flexeril 10 mg Tablet Sig: One (1) Tablet PO at bedtime. 12. Lovenox 150 mg/mL Syringe Sig: One (1) Subcutaneous once a day. Disp:*4 syringes* Refills:*2* 13. Outpatient Lab Work Please get your [**Last Name (Titles) 263**] checked by the VNA on Monday [**2-25**] and call results to Dr. [**Last Name (STitle) 18323**] at [**Telephone/Fax (1) 18325**]. The office will send a standing order to [**Hospital3 4107**] lab. 14. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual every 5 minutes as needed for chest pain: Take 5 minutes apart. If you still have chest pain after 2 doses, call 911. Disp:*25 tablets* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: ST Elevation Myocardial Infarction Acute systolic Dysfunction Hypertension Benign Prostatic Hypertrophy Discharge Condition: Mental Status: Clear and coherent Level of Consciousness: Alert and interactive Activity Status: Ambulatory - Independent Discharge Instructions: You had a large heart attack and required 2 drug eluting stents to open your left anterior descending coronary artery. You had some chest pain after the catheterization that has now resolved. You will need to take Prasugrel and aspirin every day for the next year in order to keep the stents open and prevent another heart attack. Do not stop taking Prasugrel for any reason unless Dr. [**Last Name (STitle) 10543**] tells you to. Your heart is weak after your heart attack and you developed some fluid in your lungs because of this. You are at risk for having more fluid in your lungs and have been started on Furosemide (Lasix) daily to prevent this. Weigh yourself every morning, call Dr. [**Last Name (STitle) 18323**] if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. Medication changes: 1. Stop taking all of your medicines at home except Cardura, oxycodone, Flexaril and Flomax. Please talk to Dr. [**Last Name (STitle) 18323**] about continuing to take Levitra. 2. Start taking Aspirin and Prasugrel every day to keep the stent open. Missing doses or stopping this medicine will result in another heart attack. 3. Start taking Furosemide to prevent fluid buildup in your lungs 4. Start taking Lisinopril to keep your blood pressure low and prevent fluid buildup 5. Start taking Metoprolol long acting to keep your heart rate low and prevent another heart attack. 6. Start taking Simvastatin (Zocor) to lower your cholesterol. 7. Start taking Lovenox once daily to prevent blood clots. You will use this until your coumadin level is > 2.0. The VNA can give you these injections. 8. Start taking coumadin to prevent blood clots. You will need to take this for at least a few months. Followup Instructions: Primary care: Dr [**Last Name (STitle) 18323**] Phone: [**Telephone/Fax (1) 18325**], [**Street Address(2) **] [**Hospital1 **] (next to hospital) Date/Time: Thursday [**2-28**] at 2:00pm with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6164**] PA. Dr.[**Name (NI) 72943**] office will tell you how much coumadin to take every day. Cardiology: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10543**] ([**Telephone/Fax (1) 24747**] [**Apartment Address(1) **], [**Street Address(2) 86092**], [**Hospital1 **]. Date/time: Thursday [**3-13**] at 10am. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**] ICD9 Codes: 5849, 4019, 2724, 496, 4280
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Medical Text: Admission Date: [**2151-8-20**] Discharge Date: [**2151-9-12**] Date of Birth: [**2070-5-18**] Sex: F Service: MEDICINE Allergies: Prochlorperazine / Metoclopramide / Cephalosporins / Penicillins Attending:[**First Name3 (LF) 2160**] Chief Complaint: Sepsis Major Surgical or Invasive Procedure: IR guided replacement of blocked J-tube History of Present Illness: 87 yo NH resident with h/o cervical ca and XRT, vescicovaginal/rectovesicle/rectovaginal fistulas, s/p bilateral percutaneous nephrostomy, and recurrent UTIs presents with fevers, rigors, fatigue, and decreased UOP. She presented to the hospital when her family noticed that she was not feeling well, acting lethargic, and producing less urine from her bilateral nephrostomy. The patient did not complain of chest pain, SOB, cough, or GI symptoms. These symptoms have been relatively new, as she had felt well in the week prior to admission. Her activity level is limited by her functional status, and has not traveled as a result. Her daughter also denies obvious sick contacts. . Of note, the patient has been admitted multiple to times for dislodged nephrostomy tubes, as well as recurrent UTIs. Her most recent UTI consisted of ESBL Klebsiella resulting in sepsis, central line placement, and treated with Meropenem and Flagyl x 2wks for question of C. diff infection. Previous UTIs have included VRE/MRSA bacteria, treated with linezolid and vancomycin. . In the ED, 97.0, 82, 102/50, 16, 97 % RA. She was noted to have rigors, and her BP decreased to 70's/40's. She was also tachycardic to the 110's. She was given IVF and sent to the MICU for close observation. While in the ED, the patient and her family refused central line placement. Pt recieved 5 L NS. . Admitted to [**Hospital Unit Name 153**] for sepsis. Past Medical History: 1. Cervical Cancer 30 yrs ago, treated with XRT. Known vesicovaginal fistula, with recently discovered rectovaginal fistula, and rectovesical fistula. Per d/c summary, she is a poor surgical candidate for repair of this, but could consider a diverting colostomy done endoscopically, however patient did not want any further invasive procedures. Status post bilateral nephrostomy tubes which per notes were last placed [**2151-4-8**]. 2. Type 2 DM 3. Hypothyroidism 4. History of VRE, MRSA UTIs 5. Bipolar d/o 6. Anemia of chronic disease, baseline around 28. 7. delirium. 8. UTI's with Klebsiella, VRE/MRSA, s/p meropenem, vancomycin, and linezolid therapy. 9. Pressure sores- stage IV decubitus ulcer Social History: Living at [**Hospital3 2558**] currently. Daughter [**Name (NI) **] is HCP. Family History: Non-contributory Physical Exam: VITALS: 76/33, 79, 16, 100% 5L NC (upon admission to [**Hospital Unit Name 153**]) GEN: Lying in bed, pale appearing, sleeping. HEENT: PERRL, anicteric sclera, dry MM, conjunctival pallor Neck: supple, no JVD appreciated Lung: Poor inspiratory effort, decreased BS on left Heart: Distant sounds, RRR, no m/r/g Abd: Soft, NT/ND Ext: warm, perfused, 1+ DP pulses, R PICC, bilat heels dressed Back: buttock dressing dry, intact Skin: pale apprearing, no ecchymosis or rashes noted Neuro: no focal deficits appreciated Pertinent Results: [**2151-8-20**] 12:27AM BLOOD Lactate-6.5* [**2151-8-30**] 04:00AM BLOOD calTIBC-88* VitB12-854 Folate-12.4 Ferritn-867* TRF-68* [**2151-8-19**] 08:38PM BLOOD Glucose-245* UreaN-19 Creat-0.6 Na-133 K-4.3 Cl-100 HCO3-25 AnGap-12 [**2151-8-20**] 05:40AM BLOOD WBC-17.2* RBC-2.47* Hgb-6.1* Hct-21.1* MCV-85 MCH-24.7* MCHC-29.0* RDW-18.2* Plt Ct-704* [**2151-9-4**] 05:45AM BLOOD WBC-5.6 RBC-3.00* Hgb-8.0* Hct-25.5* MCV-85 MCH-26.7* MCHC-31.5 RDW-19.6* Plt Ct-429 . [**2151-8-30**] CATHETER TIP-IV WOUND CULTURE-FINAL INPATIENT: No growth [**2151-8-23**] BLOOD CULTURE AEROBIC BOTTLE-FINAL {[**Female First Name (un) **] PARAPSILOSIS}; ANAEROBIC BOTTLE-FINAL INPATIENT [**2151-8-20**] URINE URINE CULTURE-FINAL {MORGANELLA MORGANII, 2ND ISOLATE}; ANAEROBIC CULTURE-FINAL INPATIENT [**2151-8-20**] BLOOD CULTURE AEROBIC BOTTLE-FINAL {KLEBSIELLA PNEUMONIAE, PROTEUS MIRABILIS}; ANAEROBIC BOTTLE-FINAL {KLEBSIELLA PNEUMONIAE, KLEBSIELLA PNEUMONIAE} EMERGENCY [**Hospital1 **] [**2151-8-20**] BLOOD CULTURE AEROBIC BOTTLE-FINAL {STAPHYLOCOCCUS, COAGULASE NEGATIVE, STAPHYLOCOCCUS, COAGULASE NEGATIVE}; ANAEROBIC BOTTLE-FINAL {KLEBSIELLA PNEUMONIAE} EMERGENCY [**Hospital1 **] . CTA Chest/Abdomen INDICATION: 81-year-old female with cervical cancer status post CRT with rectovesicovaginal fistulas, bilateral nephrostomy tubes and sacral decubitus ulcer. . TECHNIQUE: MDCT acquired axial images of the pelvis were obtained without IV contrast. IV contrast enhanced images of the chest were obtained per PE protocol with preliminary non-contrast enhanced images of the chest. Multiplanar reformations were obtained. . CT PELVIS WITHOUT IV CONTRAST: Stool and oral contrast are seen within what appears to be the vagina. The rectum contains moderate wall thickening with small amount of perirectal stranding. The inferior small and large bowel are otherwise unremarkable. There is a small amount of free fluid within the pelvis, with multiple surgical sutures along the pelvic sidewalls. Surrounding subcutaneous tissues contain diffuse soft tissue stranding consistent with third spacing. . The patient is status post right hip replacement. There is a soft tissue defect extending to the lower sacrum/coccyx with surrounding soft tissue density with no evidence of lytic changes or sclerotic changes to suggest osteomyelitis. . CTA CHEST: There is no evidence of filling defects within the pulmonary arterial vasculature. No evidence of pulmonary embolism. The aorta is of normal caliber throughout its visualized thoracic course with no evidence of dissection. There are coronary artery and aortic calcifications present. There are no pathologically enlarged nodes within the mediastinum, hila, or axilla. There is bilateral atelectasis with no focal areas of consolidation. . BONE WINDOWS: No suspicious lytic or sclerotic bony lesions. Unchanged bilateral sacroiliac sclerotic changes. . IMPRESSION: . 1. Stool and oral contrast seen anterior to the rectum consistent with rectovaginal fistula. The urinary bladder is not clearly visualized. 2. Rectal wall thickening. Etiologies for this appearance include infection, inflammatory change and malignancy. 3. Sacral decubitus ulcer with no evidence of osteomyelitis. 4. No evidence of pulmonary embolism or aortic dissection . [**8-30**] Echo: 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 root is mildly dilated. The aortic valve leaflets are moderately thickened. No masses or vegetations are seen on the aortic valve. There is mild to moderate aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. No mass or vegetation is seen on the mitral valve. Trivial mitral regurgitation is seen. Transmitral Doppler and tissue velocity imaging are consistent with Grade I (mild) left ventricular diastolic dysfunction. The tricuspid valve leaflets are mildly thickened. The estimated pulmonary artery systolic pressure is normal. There is a small pericardial effusion. There are no echocardiographic signs of tamponade. . CXR [**9-1**]: There is a new left PICC terminating in the expected location of the left brachiocephalic vein. There is interval removal of the right PICC. There is a persistent left-sided pleural effusion, with probable left lower lobe atelectasis. No evidence of pneumothorax. The right lung is clear. No pleural effusion is appreciated on this frontal view of the chest on the right. There are aortic calcifications. There are bilateral nephrostomy tubes in place, seen within the abdomen. SUPINE PORTABLE RADIOGRAPH OF THE CHEST: A left-sided PICC line is seen with the tip in the left brachiocephalic vein. Differences in opacity of the lungs are most likely due to layering of the previously seen pleural effusions on this supine radiograph. Hazy opacity in the right upper lung is likely atelectasis. The heart size is stable. Again noted are bilateral nephrostomy pigtail catheters. Note is made of air-filled stomach and several air-filled bowel loops in mid abdomen. IMPRESSION: 1. Tip of left-sided PICC line in left brachiocephalic vein. 2. Bilateral layering pleural effusions with mild right upper lobe atelectasis. PORTABLE ABDOMEN Reason: r/o obstruction [**Hospital 93**] MEDICAL CONDITION: 81 year old woman with MMP, including multiple intrapelvic fistulas, now with increasing abdominal distension and lower GI bleeding. Hypoactive BS on exam. Please eval for obstruction. REASON FOR THIS EXAMINATION: r/o obstruction INDICATION: Recent abdominal distention, lower GI bleeding, please rule out obstruction. COMPARISON: CT scan [**2151-9-8**]. FINDINGS: Multiple distended small bowel loops are present, measuring up to 4.5 cm. The stomach is distended with air. The large bowel is collapsed. There is a foreign body in the right lower quadrant, confirmed by later CT available at the time of dictation. Bilateral nephrostomy tubes are present as well as right proximal femoral hardware. IMPRESSION: Small-bowel obstruction. Dr. [**Last Name (STitle) **] was aware of these findings at the time of dictation. CT ABDOMEN W/O CONTRAST [**2151-9-8**] 5:15 PM CT ABDOMEN W/O CONTRAST; CT PELVIS W/O CONTRAST Reason: r/o SBO [**Hospital 93**] MEDICAL CONDITION: 81 year old woman with MMP including multiple intrapelvic fistulas and recurrent UTIs, tx to [**Hospital Unit Name 153**] for hypotension. Developing abd distension, [**Month (only) **] BS, abd XR worrisome for SBO. REASON FOR THIS EXAMINATION: r/o SBO CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: 81-year-old female with multiple medical problems and intrapelvic fistulas now with hypotension and abdominal distention. COMPARISON: [**2151-8-20**]. TECHNIQUE: MDCT axial images of the abdomen and pelvis were obtained without IV contrast. Multiplanar reformatted images were also performed. CT ABDOMEN WITHOUT IV CONTRAST: There are small bilateral pleural effusions, left greater than right with associated atelectasis. There is a small pericardial effusion. Given the limitations of evaluation without IV contrast, the liver, gallbladder, spleen, and adrenal glands are unremarkable. There is a small amount of perihepatic fluid. A hyperdensity within the pancreatic duct, likely represents refluxed contrast. Bilateral percutaneous nephrostomy tubes are again seen. A catheter is seen within the stomach. There is massive gastric dilatation as well as massive dilation of the loops of small bowel. There are scattered air fluid levels. Contrast reaches the level of the proximal small bowel. Marked wall thickening is seen at this level and vascular compromise cannot be excluded. A G-tube plug is seen in the terminal ileum. The loops of small bowel distal to this plug are collapsed. This likely represents the site of obstruction. A small amount of fluid is seen surrounding the small bowel loops at this location. Contrast within the ascending colon likely represents retained contrast from the previous examination. CT PELVIS WITHOUT IV CONTRAST: There is a moderate amount of fluid within the pelvis. Stool is likely seen within the bladder consistent with the patient's known rectovaginal fistula. A fixation pin is seen within the proximal femur. A soft tissue defect in the lower outer sacrum/coccyx is seen with no evidence of cortical destruction to suggest osteomyelitis. BONE WINDOWS: Again demonstrate bilateral sacroiliac sclerotic changes. Multiplanar reformatted images confirmed the above findings. IMPRESSION: 1. Mechanical small-bowel obstruction with transition point in the terminal ileum likely secondary to G-tube plug. A small amount of fluid surrounds the small bowel loops at the point of obstruction. Wall thickening of the proximal small bowel is concerning for vascular compromise. 2. Bilateral small pleural effusions. 3. Small pericardial effusion. 4. Sacral decubitus ulcer. 5. Findings consistent with known rectovaginal fistula. The findings were discussed with Dr. [**Last Name (STitle) **] at 9:20 p.m. on [**2151-9-8**]. WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2151-9-11**] 04:34AM 10.8# 3.43* 9.1* 32.5* 95# 26.6* 28.1* 19.1* 608* [**2151-9-10**] 06:05AM 6.5 3.22* 8.8* 28.3* 88 27.2 31.0 18.9* 410 [**2151-9-9**] 06:22AM 7.6 2.94* 8.0* 25.3* 86 27.2 31.7 19.0* 348 [**2151-9-8**] 04:34AM 5.5 3.32* 8.8* 29.1* 88 26.4* 30.1* 18.9* 402 [**2151-9-7**] 09:06PM 29.0* Fibrino FDP D-Dimer [**2151-9-7**] 06:00AM 0-10 [**2151-9-7**] 06:00AM [**Telephone/Fax (1) 32812**]* [**2151-9-7**] 01:47AM 234 951* Glucose UreaN Creat Na K Cl HCO3 AnGap [**2151-9-11**] 04:34AM 172* 12 0.7 134 4.3 104 27 7* [**2151-9-10**] 06:05AM 103 10 0.5 139 3.9 110* 25 8 [**2151-9-9**] 09:55PM 113* 11 0.6 138 3.9 108 27 7* [**2151-9-9**] 06:22AM 92 12 0.6 141 3.2* 109* 29 6* [**2151-9-8**] 04:34AM 188* 13 0.5 140 3.4 107 30 6* Brief Hospital Course: Hospital Course: 1. Polymicrobial Bacteremia/Sepsis due to Coagulase Negative Staphlococcus, ESBL-Klebsiella, Proteus Mirabilis, Candidia Parapsilosis: the patient was initially hospitalized and stablized in the ICU, and started on broad spectrum antibiotics. Blood cultures grew the organisms as listed above. She had two Echos which did not reveal any evidence of vegetations. Given her fungemia, the patient had an eye exam by Opthamology which did not reveal any evidence of endopthalmitis. Her original PICC line (R sided) was changed over a wire to a double-lumen PICC, but after new fungemia, this was removed and a new L sided PICC line was placed. Following antibiotics were continued- IV Vancomycin, Meropenem, Fluconazole, and Metronidazole (as C diff ppx) -initial planned for stopping on [**2151-9-14**]. Also per ID, she was not a candidate for long term suppressive therapy; the etiology of her polymicrobial sepsis was most likely the numerous intra-abdominal fistulas that provide a conduit for blood stream infections. . 2. Urinary Tract Infection secondary to Morganella Morganii: as above, this organism was sensitive to Meropenem. 3. Aspiration s/p failed speech and swallow evaluation: the patient was noted to cough frequently while fed. Several speech and swallow evaluations confirmed that the patient was aspirating, and the speech/swallow specialists recommended keeping the patient strict NPO with J tube feeds. The patient was started on tube feeding during her hospitalization as she was noted to be extremely malnourished (albumin < 2). This issue of feeding for comfort was brought up with the daughters, given her limitied life expectancy, but during the family meeting one daughter was so interested in her decubitus ulcer that this issue could not be resolved. However, eventually the J-tube was clogged and [**Company 19015**] and bicarb did not unclog the tube. She subsequently underwent IR guided replacment of her J-tube. . 4. Multifocal Atrial Tachycardia, resolved after repletion of her K/Mg and treatment with IV Beta Blocker. . 5. Bilateral Pleural Effusions/LE edema: likely secondary to volume overload and third spacing. Once on abx, she did not have any fevers or leucocytosis to suggest complicated parapneumonic effusions or empyema. Etiology of effusions and LE edema likely secondary to IVF given during sepsis-resuscitation and very low albumin (1.7). As mentioned, no evidence of CHF on Echos. 6. Anemia of Chronic Disease: as noted by high Ferritin/low TIBC. HCT remained stable. . 7. Stage IV decubitus Ulcer: this was treated aggressively during her hospitalization with frequent dressing changes/debridement. She was turned frequently and aggresive wound care was maintained. . 8. Blocked J-tube s/p IR guidied replacement: As above, the patient's J-tube was clogged, and therefore she underwent IR guided replacement of her J-tube. Eventually in view of the bowel obstruction (see below) - [**Company 32813**] was started in the ICU (second transfer) at the request of daughter - [**Name (NI) 1060**]. . 9. Vesicovaginal, Rectovaginal, Rectovesicular Fistulas: pt deemed not to be surgical candidate per discussion with patients PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 335**] [**Last Name (NamePattern1) 5351**]. 10. Hypotension: The patient was retransferred to the ICU for hypotension resulting from a vaginal bleed. Pressors were not started as per family preferance (see below). The BP responded transiently to boluses of IV fluids. 11. Bowel obstruction: 3-4 days prior to the patient's death - when she was in the ICU for hypotension - It was noted that the patient's abdomen was distended, sluggish bowel sounds and also constipation was noted. Flat plate and CT abdomen showed small bowel obstruction with possible ichemia of bowel . Surgery was consulted and their recommendation was that the patient was a very poor surgical candidate. The family also did not want operative intervention at this time. The results of conservative management for ischemic bowel and obstruction was made clear to the patient's family as well as the fact that she will likely progress in terms of the bowel ostruction and ischemia and will have a very poor prognosis. Their questions were answered. . 12. End of Life issues: Several family meetings were held between the hospitalists, Dr. [**Last Name (STitle) 5351**], and her two daughters. One daughter seemed almost fixed on her decubitis ulcer and steered the conversation away from any and all end-of-life issues such as feeding for comfort; what to do when the patient develops sepsis again, etc. On [**2151-9-10**], in the ICU, the patient had a bowel movement. However, the patient continued to remain hypotensive (SBP 70's). BP responded to small boluses of IV fluids. Family did not want central lines or pressors. On [**2151-9-10**] - After a long family conference with the ICU physicians - the family came to a consensus that there would be no escalation of care, including central lines and pressors. Morphine drip was started to make the patient comfortable and pt transferred to the medical floor. Overnight, on the floor the morphine drip was stopped because of decrease in resp rate to [**6-24**]/min. The patient was noted to be in no pain or discomfort, was not moaning. On [**2151-9-11**] - the patient was not responding to verbal or pain commands and agonal respirations were noted. Both daughters - [**Name (NI) **] (- HCP) and [**Doctor Last Name **] were at the bedside. The hospitalist had a long discussion with them - In view of very poor prognosis, there was a discussion regarding pursuing 'comfort care only'. However, the family wanted to discuss further about this among themselves but did say that they wanted to stop the antibiotics, give morphine only if patient was noted to be in discomfort and asked that no further fluid boluses be given for the low BP and no throat suction for secretions. They also did not want scopolamine patch or levsin sublingual to dry out the oral and throat secretions. They still wanted their mother to get the [**Name (NI) 32813**]. There was a conflict of opinion noted between the two sisters [**Name2 (NI) **] who was the HCP and [**Name (NI) 1060**]) during this decision making process. All their questions and concerns were appropriately answered. Assistance of palliative care team was obtained over the telephone and social worker was consulted to offer help to the family. At about 5-15am on [**2151-9-12**] - the patient was pronounced dead by the oncall doctor, Dr [**Last Name (STitle) 9570**]. Family requested an autopsy. Clinical details were provided to the pathologist performing the autopsy. Medications on Admission: Zyprexa, synthroid, gabapentin, oxycodone, iron, prilosec, MVI, megace 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. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 2. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 U U Injection TID (3 times a day). Disp:*qs U* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 5. Fluconazole in Normal Saline 200 mg/100 mL Piggyback Sig: Two Hundred (200) mg Intravenous once a day: Note: course to end on [**9-14**]. Disp:*qs qs* Refills:*2* 6. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. Disp:*qs Tablet(s)* Refills:*0* 7. Meropenem 500 mg Recon Soln Sig: Five Hundred (500) mg Intravenous Q6H (every 6 hours): Note: course to end on [**9-14**]. Disp:*[**Numeric Identifier **] mg* Refills:*2* 8. Oxycodone 5 mg/5 mL Solution Sig: Five (5) mg PO Q6H (every 6 hours) as needed. Disp:*qs mg* Refills:*0* 9. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty (30) mg PO DAILY (Daily). Disp:*qs mg* Refills:*2* 10. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed. Disp:*qs Capsule(s)* Refills:*0* 11. Metronidazole in NaCl (Iso-os) 500 mg/100 mL Piggyback Sig: Five Hundred (500) mg Intravenous Q8H (every 8 hours): Note: course to end on [**9-14**]. Disp:*qs mg* Refills:*2* 12. Zinc Oxide-Cod Liver Oil 40 % Ointment Sig: One (1) Appl Topical PRN (as needed). Disp:*qs qs* Refills:*2* 13. Lidocaine HCl 5 % Ointment Sig: One (1) Appl Topical PRN (as needed). Disp:*qs qs* Refills:*2* 14. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for rash. Disp:*qs qs* Refills:*0* 15. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) gm Intravenous Q 24H (Every 24 Hours): Note: course to end on [**9-14**]. Disp:*30 gm* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Primary Diagnoses: Death: 1. Polymicrobial Bacteremia/Sepsis: Coagulase Negative Staphlococcus, ESBL-Klebsiella, Proteus Mirabilis, Candidia Parapsilosis 2. Urinary Tract Infection secondary to Morganella Morganii 3. Aspiration s/p failed speech and swallow evaluation 4. Multifocal Atrial Tachycardia, resolved 5. Bilateral Pleural Effusions, likely secondary to volume overload and third spacing 6. Anemia of Chronic Disease 7. Stage IV decubitus Ulcer 8. Blocked J-tube s/p IR guidied replacement 9. Vesicovaginal, Rectovaginal, Rectovesicular Fistulas: pt deemed not to be surgical candidate 10. Small bowel obstruction/ischemia Secondary Diagnoses: 1. h/o Cervical Cancer s/p XRT 2. Hypothyroidism 3. Bipolar Disorder Discharge Condition: Patient died in hospital Discharge Instructions: Patient died in hospital Followup Instructions: Patient died in hospital ICD9 Codes: 5990, 5070, 4271, 2449
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Medical Text: Admission Date: [**2109-9-30**] Discharge Date: [**2109-10-2**] Date of Birth: [**2065-9-15**] Sex: M Service: MEDICINE Allergies: Vioxx Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Seizure Major Surgical or Invasive Procedure: Intubation History of Present Illness: 44 yo M with h/o HIV/AIDS, last CD4 123, most recent VL <50 (one month prior), and hx of CNS [**Hospital 38229**] transferred from [**Hospital3 56608**]Med Center after an episode of witnessed tonic clonic seizures that lasted 10 minutes while riding in a car. Pt arrived in ED with seizure. Seizure was broken with 8mg ativan in the ED. Pt was reported to have a significant post ictal period and was intubated to protect his airway. Pt was loaded with dilantin at [**Location (un) **]. Prior to this episode pt had experienced 2 days of fever, and uri sx. The pt's wife reports the first episode of seizure was approximately 1.5 years ago. This led to a workup that revealed CNS toxoplasmosis and his diagnosis of HIV. The seizure left the pt with a residual left hemiparesis. His second episode of seizure occured two month ago when he was witnessed to have had letward head deviation, altered awareness and picking movements o his right hand towards his left hand. HIV was diagnosed in the setting of his first seizure as above. He has been treated with HAART in the past with a ?compliance and poor response. The patient is currently being tx'd with epivir, ritonovir and atazanavir (2PPI+NRTI). He has not had any other opportunistic infections in the past (aside from toxo). He was recently taken off azithromycin due to CD 4 count of 123. . Past Medical History: 1. SZ - two prior episodes (1st one 1.5years ago, 2nd one two months previous) 2. HIV 3. DM - off all insulins due to repeated episodes of hypoglycemia 4. CRI - baseline Cr of 2.5-5 as per outpatient renal. refused bx. 5. COPD/Asthma 6. HTN Social History: Pt is married and lives with wife and kids. Family History: NC Physical Exam: PE: -VS: BP: 170/80 Hr: 65 RR: 24 SaO2: 100% on 80% -Drips: Propofol -Vent settings: AC with TV 600 and RR 24, FiO2 0.8, PEEP 5 -Gen: middle age male lying in bed at 30 degrees on vent with propafol gtt. -Neck: supple (full ROM not tested as pt has ET tube in place) -CV: RRR, S1, S2, no murmurs, rubs, gallops -Chest: bibasilar crackles on back -Abd: soft, NT, ND, BS+ bilaterally -Ext: warm to touch, no clubbing, cyanosis, edema -Neuro: Pupils 4mm bilaterally and sluggishly reacts to light. Pt moves all extremities spontaneously, DTP is +1 on knee jerk and ankle jerk and +2 on biceps. Positive bilateral babinksi sign. Pertinent Results: [**2109-9-30**] 10:50AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.013 [**2109-9-30**] 10:50AM URINE BLOOD-MOD NITRITE-NEG PROTEIN-500 GLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2109-9-30**] 10:50AM URINE RBC-[**2-8**]* WBC-0-2 BACTERIA-FEW YEAST-NONE EPI-0-2 [**2109-9-30**] 10:50AM WBC-6.3 LYMPH-18 ABS LYMPH-1134 CD3-85 ABS CD3-966 CD4-7 ABS CD4-76* CD8-76 ABS CD8-864* CD4/CD8-0.1* [**2109-9-30**] 10:50AM PT-12.5 PTT-23.7 INR(PT)-1.0 [**2109-9-30**] 10:50AM PLT COUNT-222 [**2109-9-30**] 10:50AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2109-10-1**] 01:30AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG [**2109-9-30**] 10:50AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.013 [**2109-9-30**] 10:50AM URINE Blood-MOD Nitrite-NEG Protein-500 Glucose-250 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2109-9-30**] 10:50AM URINE RBC-[**2-8**]* WBC-0-2 Bacteri-FEW Yeast-NONE Epi-0-2 [**2109-9-30**] 10:50AM PHENYTOIN-10.7 [**2109-9-30**] 10:50AM ALBUMIN-3.9 CALCIUM-8.3* [**2109-9-30**] 10:50AM PHOSPHATE-5.7* MAGNESIUM-2.1 [**2109-9-30**] 10:50AM LIPASE-55 [**2109-9-30**] 10:50AM ALT(SGPT)-16 AST(SGOT)-21 LD(LDH)-251* CK(CPK)-434* ALK PHOS-114 AMYLASE-66 TOT BILI-1.0 [**2109-9-30**] 10:50AM GLUCOSE-196* UREA N-52* CREAT-4.2* SODIUM-136 POTASSIUM-6.2* CHLORIDE-110* TOTAL CO2-16* ANION GAP-16 [**2109-9-30**] 10:56AM LACTATE-1.0 [**2109-9-30**] 01:30PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-1* POLYS-0 LYMPHS-0 MONOS-0 [**2109-9-30**] 01:30PM CEREBROSPINAL FLUID (CSF) PROTEIN-47* GLUCOSE-117 [**2109-9-30**] 02:00PM URINE HOURS-RANDOM CREAT-55 SODIUM-55 POTASSIUM-47 CHLORIDE-49 TOT PROT-269 PROT/CREA-4.9* [**2109-9-30**] 10:50AM BLOOD WBC-6.3 Lymph-18 Abs [**Last Name (un) **]-1134 CD3%-85 Abs CD3-966 CD4%-7 Abs CD4-76* CD8%-76 Abs CD8-864* CD4/CD8-0.1* [**2109-10-2**] 07:35AM BLOOD Glucose-170* UreaN-39* Creat-4.0* Na-139 K-4.4 Cl-108 HCO3-20* AnGap-15 [**2109-10-2**] 07:35AM BLOOD WBC-5.5 RBC-2.69* Hgb-8.3* Hct-24.8* MCV-92 MCH-31.0 MCHC-33.5 RDW-14.5 Plt Ct-179 . . "[**2109-9-30**] 1:30 pm CSF;SPINAL FLUID:TUBE 3. GRAM STAIN (Final [**2109-9-30**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. FLUID CULTURE (Preliminary): NO GROWTH. CRYPTOCOCCAL ANTIGEN (Final [**2109-10-1**]): CRYPTOCOCCAL ANTIGEN NOT DETECTED. Performed by latex agglutination. Reference Range: Negative. Results should be evaluated in light of culture results and clinical presentation. FUNGAL CULTURE (Pending)" . . "[**2109-9-30**] 5:58 pm SPUTUM Site: ENDOTRACHEAL Source: Endotracheal. GRAM STAIN (Final [**2109-10-1**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): MULTIPLE ORGANISMS CONSISTENT WITH OROPHARYNGEAL FLORA. RESPIRATORY CULTURE (Preliminary): SPARSE GROWTH OROPHARYNGEAL FLORA" . . Blood cultures, fungal culturs, AFB cultures: pending" . . Renal US [**2109-9-30**]: "The right kidney measures 13.5 cm, and the left kidney measures 11.3 cm. Images of the left kidney are somewhat limited. Both kidneys demonstrate normal cortical thickness and echogenicity. There is no evidence of hydronephrosis, stone, or mass in either kidney. No perinephric fluid collections are seen. A Foley catheter is seen within a collapsed bladder. IMPRESSION: No evidence of hydronephrosis. " . . CXR [**2109-9-30**]: "CLINICAL INDICATION: Status post seizure. Intubated. An endotracheal tube is in satisfactory position. A nasogastric tube terminates within the proximal stomach, but the side port is likely above the GE junction level. Cardiac and mediastinal contours are normal. There are patchy opacities present in the infrahilar regions bilaterally. The lungs otherwise appear grossly clear. IMPRESSION: 1. Satisfactory position of ET tube. 2. Nasogastric tube side port is likely above the GE junction. 3. Patchy opacities in the infrahilar regions bilaterally, which may be due to aspiration or atelectasis. " . . CXR [**2109-10-1**]: "IMPRESSION: 1) Satisfactory position of ET tube. 2) Unchanged position of the nasogastric tube, whose side port may lie above the gastroesophageal junction. 3) New areas of linear segmental patchy atelectasis bilaterally. 4) Possible mild left ventricular failure." . . EEG [**2109-9-30**]: "FINDINGS: ABNORMALITY #1: There are scattered theta frequency intrusions most prominent over the right centro-parietal region at the T4, P4 contacts. These are of mild amplitude. ABNORMALITY #2: Occasional mild theta frequency slowing was also seen over the left temporal region. ABNORMALITY #3: There is occasional low amplitude generalized delta frequency slowing. BACKGROUND: Is obscured by beta frequency activity in the 15 Hz frequency range. HYPERVENTILATION: Was not performed due to the patient's clinical condition. INTERMITTENT PHOTIC STIMULATION: Was not performed because the study was a portable study. SLEEP: Normal transitions of the sleep architecture were not seen; however, variations within the amplitude of the background rhythm over the course of the record was observed with increased amplitude in the setting of movement. CARDIAC MONITOR: Normal sinus rhythm with a rate of 66 bpm. IMPRESSION: This is an abnormal portable EEG due to the presence of scattered theta frequency intrusions most prominent in the right centro-parietal region and less often seen in the left temporal region. These findings suggest subcortical dysfunction in the right centro-parietal and left temporal regions. Occasional generalized delta frequency slowing that was of low amplitude was also observed which suggests deep midline subcortical dysfunction and may reflect the effects of Propofol. In addition, beta frequency activity was superimposed on the background rhythm and this is likely a medication effect. No epileptiform abnormalities were seen during the recording. " . . ECG [**2109-9-30**]: Normal Sinus Rhythm at 62. nml axis, nml intervals, LVH, QS in V2 - ? due to lead placement. No previous tracing . . MRI of head [**2109-10-1**]: "FINDINGS: There are multiple areas of T2 signal abnormality in the brain one of which is in the right cerebellar white matter and the rest are in the cortical-subcortical junction region in the cerebral hemispheres. There is no definite evidence of abnormal contrast enhancement associated with these. There is no definite mass effect. There is no definite evidence of hemorrhage except for the lesion in the right cerebellar hemisphere. There is no evidence of a focal extra-axial lesion or fluid collection. There is increased signal in the mastoid and paranasal sinuses. IMPRESSION: Multiple lesions of the brain of unknown etiology. These could represent treated CSF infections such as toxoplasmosis. The appearance does not strongly suggest neoplasm." . . Brief Hospital Course: A/P: A/P: 44yo male with HIV (CD4 of 123 and VL <50) and seizure hx transferred from OSH with episode of seizure that lasted >10min and broke with 8mg ativan in ED and prolonged post ictal period. Pt intubated for airway protection resulting in ICU transfer. Pt initially presented with 1st episode of seizure 1.5 years ago resulting in diagonsis of CNS toxo and HIV. Since then, the patient has only had one other episode of seizure two month previous. This episode of seizure preceded by some fever and URI sx in recent weeks. . 1. Sz: Pt arrived to the [**Hospital1 18**] [**Hospital Ward Name 332**] ICU sedated with endotracheal tube in place. The etiology of the seizure remains unclear, however it is most likely secondary to known focal toxoplasmosis. Other infectious etiologies of seizures were fuled out with an LP which found only 1 WBC, 1RBC, 47 protein and 117 glucose, which is not consistent with bacterial, HSV, fungal, or TB infection. The CSF was also analyzed for [**Country **] ink which was negative for cryptococcus. A CT scan at the OSH showed multiple ring enhancing lesions which could be consistent with lymphoma. No cells were found in the CSF however and an MRI done the following day was inconsistent with lymphoma. The patient was also ruled out for toxic injection or withdrawal with a serum and urine tox screen both of which were negative. Other metabolic syndromes were also ruled out with normal electrolytes, glucose, and SaO2. In addition, the patient also received an EEG which revealed no obvious epileptiform foci. The work up left us with our most likely diagnosis of resistant or previously treated toxo as a possible seizure focus and the MRI was consistent with lesions that may represent previously treated toxo. A neurology consult was called who recommendation we stop the dilantin (as it can interfer with his HAART medication) and start Keppra 250mg [**Hospital1 **] (renal dosing). The patient was monitored overnight while sedated on the ventilator as well as another over night off sedation and the ventilator without a witnessed episode of seizure while being treated with Keppra. The patient was discharged home from the ICU on Keppra 250mg [**Hospital1 **], with instruction to have his blood levels of Keppra measured at [**University/College **] the following day and with follow up appointments made with his PCP-[**Last Name (NamePattern4) **]. [**Last Name (STitle) 56609**], as well as ID-Dr. [**Last Name (STitle) 56610**], and Renal-Dr. [**Last Name (STitle) 56611**] (all or whom are at [**University/College **]: [**Telephone/Fax (1) 56612**]). His PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 56609**] has agreed to follow up on the results of the blood and urine cultures still pending. The patient was instructed to arrange follow up for a neurologist at [**University/College **] upon discussion with his PCP. . 2. Respiratory: Pt was intubated for airway protection and aspiration risk at the outside hospital. Upon admission to the [**Hospital Unit Name 153**], we placed the patient on a propofol gtt and a ventilator with the following settings: AC mode with RR 18 and Tv 600 (ovserved Tv of 640), FiO2 of 0.5, PEEP of 5 and Plateau pressure of 14 and Peak inspiratory pressure of 18 and i/e: 1.28. A CXR demonstrated proper ET tube placement. The patient was weaned off the ventilator the following day with a successful spontaneous breathing trial. The patient denied any swelling or pain in the neck/throat after extubation and several hours later was found to be eating without any discomfot, talking in full complete sentences and in NAD. The patient was observed overnight for signs of laryngeal swelling or trauma but none were found. The patient was discharged in good condition, completely independent of the ventilator and with no complications. The patient was saturating well (>97%) at room air and was breathing at a rate of [**9-17**] in no acute distress. The rest of his vital signs were also stable. The CXR at the time did however reveal some questionable increased vascularity in LLL suggestive of atelectasis. However the patient was found to have some mild crackles and decreased breath sounds in association with a slight bandemia on WBC count. This was thought to be a possible aspiration pneumonia (most likely at the time of the seizure) and the patient was treated with clindamycin 600mg IV q8hours. On discharge the patient was not complaining of any SOB, cough or fever. The patient was discharged with a prescription for clindamycin 600mg PO TID for seven days and referred for outpatient follow up. . 3. CRI: Pt with baseline Cr of 2.5 to 5 as per outpatient nephrologist. On admission to [**Hospital1 18**] was found to have a Cr of 4.2 which is within the baseline for this patient. The pt appeared slightly dry on exam and an ABG showed the following: 7.28/39/353 with gap of 14 (non-gap metabolic acidosis most likely due to chronic renal failure). The patient was therefore given 1L of D5W with 3 amps of bicarb (to create isotonic solution without giving Cl as part of NaCl as Cl is already at 110). The electrolytes and fluid status were monitored very carefully during the admission and on HD#2, the AM bicarb was found to be 20 thereby obviating the need for D5W with bicarb as pt does not have a significant bicarb defecit. At this point the IVF were held and as patient was extubated, he was encouraged to take PO. At discharge the patient had a Creatinine of 4, which is within his baseline range and slightly improved from admission. The patient was also followed by the renal consult service while in house. . 4. HIV: The patient continued to receive his full HIV meds during the admission. His CD4 count was found to be 74 during this hospitalization which is basically unchanged to slightly lower than his previous finding of 123 1 month previously. The patient also continued to receive his HIV prophylaxis in the form of sulfadiazne, pyrimethamine and leukovorin. The MRI performed on HD#2 wa suggestive of old toxo lesions that were previously treated. The patient was discharged with follow up arranged at his outpatient ID physician at [**Name9 (PRE) **]. . 5. DM: As per wife, the patient is not currently on any insulin due to repeated episodes of hypoglycemia although his records show he was previously on lantus with a RISS. Due to high infection risk as well as risk of repeated seizures, while in the ICU, the patient was started on a RISS with QID FS. At time of discharge, the patient was back on a sliding scale, however he was not re-started on his lantus. It is recommended that he discuss his diabetes management in more detail with his PCP. . 6. HTN: Pt on outpatient norvasc 5mg once daily with 200mg once daily of metoprolol XL. However at time of admission, there was no need for anti-hypertensives as the propofol had dropped his SBP to 130s. Once the propofol was discontinued prior to extubation, the patient was re-started on his antihypertensive medication with good success. The patient was discharged on the same outpatient regimen as he came in on. . 7. HCV: As per wife, this is not an active issue. As he had no abdominal findings on exam, or lab tests this issue was deferred for managemtent by his PCP. . 8. Asthma/COPD: Although the patient carries a diagnosis of asthma and COPD, the exact nature of this medical condition is unclear. There were no baseline PFTs done and this does not seem like an active issue as pt is only on MDIs at home. Even after successful extubation, the patient never complained of tighness, SOB, or cough and was never found to be wheezing. An outpatient PFT is recommended once his trial of antibiotics are completed. . 9. Anemia: Pt with baseline anemia. During this particular hospital course, the patient was found to be guaiac negative and a type and screen was sent in case of emergencies. At time of discharge, the patient did have a low Hct of 24.8, down from 28 at admission. However the patient received several liters of IVF and the other blood lines were also decreased suggesting this was most likely due to hemodilution. Due to the patient's chronic anemia, the nephrologists at [**Hospital1 18**] recommended the pt receive procrit 4000 units sub cutaneous injections three times a week. Unfortunately the patient could not be started on procrit due to his short length of stay. This will be followed up with his outpatient nephrologist. In addition, the patient will have his Hct checked tomorrow Thurs [**2109-10-3**] while at the lab to follow up on his levels of Keppra (see above). . 10 Oxybutynin: Althought the patient's wife provided us with a complete list of his medications, she was unclear as to the reason why he was taking oxybutynin. Therefore this particular medication was not started during his current hospital admission. It is recommended that the patient follow up with his PCP regarding the necessity of this medication. . 11. Prophylaxis: Pt received heparin sub Q TID for DVT prophylaxis. No PPI were given as patient was anticipated to have only a intubation course. . 12. Code: Full code . Medications on Admission: 1. Epivir 150mg once daily 2. Ritonivir 100mg once daily 3. Atazanavir 150mg [**Hospital1 **] 4. Leucovorin 5mg [**Hospital1 **] 5. Oxybutynin 5mg once daily 6. Daraspin 25mg once daily 7. Sulfadiazne 500mg TID 8. Norvasc 5mg once daily 9. Insulin Lantis and regular as needed 10. Toprol XL 200mg once daily 11. Tylenol 325mg as needed Discharge Medications: 1. Lamivudine 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 3. Leucovorin Calcium 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 5. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). 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. 8. Pyrimethamine 25 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. Sulfadiazine 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 10. Levetiracetam 250 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 11. Atazanavir Sulfate 100 mg Capsule Sig: Three (3) Capsule PO DAILY (Daily). 12. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 13. Insulin Lispro (Human) 100 unit/mL Solution Sig: One (1) Subcutaneous ASDIR (AS DIRECTED). 14. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO once a day. 15. Clindamycin HCl 300 mg Capsule Sig: Two (2) Capsule PO three times a day for 7 days. Disp:*42 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary: Seizure Secondary: DM, HIV, CRI, HTN Discharge Condition: Good. Discharge Instructions: Please take all of your medication. Please follow up with all of your doctors. Followup Instructions: Primary Care: Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 56609**]. There is already an appointment scheduled for you for [**10-11**] (Fri) at 2:30PM. Infectious Disease: Please follow up with your infectious disease doctor Dr. [**Last Name (STitle) 56610**]. [**Name2 (NI) **] has already been informed regarding your hospital course here at [**Hospital1 18**] and will call you with an appointment date at home upon discharge. Neurology: Please have Dr. [**Last Name (STitle) 56609**] arrange for a follow up with a neurologist at [**University/College **] at your next earliest convenince. Renal: Please follow up with Dr. [**Last Name (STitle) 56613**] regarding your kidney function. He can also arrange for injections of epoiten (procrit) 4000units three times a week for your anemia. The nephrologists at [**Hospital1 18**] has already contact[**Name (NI) **] him regarding your current medical issues. Laboratory: Please have your blood levels of Keppra, as well as your Hct checked on Thurs ([**2109-10-3**]) at [**University/College **]. Dr. [**Last Name (STitle) 56609**]/[**Last Name (STitle) 56610**] will contact you regarding changing the dose of keppra (your seizure medication). [**Doctor First Name **], Dr.[**Name8 (MD) 56614**] NP has already arranged for a lab slip to be left at the laboratory in [**University/College **], please anticipate her call. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2109-10-2**] ICD9 Codes: 5849, 2762, 2767, 2859
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Medical Text: Admission Date: [**2192-10-20**] Discharge Date: [**2192-10-23**] Date of Birth: [**2114-7-6**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1928**] Chief Complaint: Lower back pain, fevers Major Surgical or Invasive Procedure: placement of right internal jugular central line History of Present Illness: 78 y/o with Dementia, urinary incontinence presents with 4 days of lower back pain, and rigors/fevers. [**Name (NI) **] husband reports abrupt change in his wife's behavior on Tuesday morning. Wednesday night she had chills and sweats as well as back ache. He also notes that she is not walking properly, but is not focally weak. She has had decreased PO intake during this time as well. Mild diarrhea during this time. No abd pain. Denies dysuria or hematuria. Husband reports patient is normally oriented x 3. Review of systems: No SOB, cough. No NS. No chest pain, no palpatations. No abd pain. No N/V. No rash. In the emergency department VS 99.6, 108/76, 78, 18, 100% RA. In ED spiked to 103. BP to 69/42. Received 4 L NS. Peripheral dopamine was started and titrated up to 15 mcg/kg/min. Given Cipro 400mg IV, Ceftriaxone IV and tylenol 1gm PO x 1. VS prior to transfer 98.2, 92, [**11/2152**], 14, 100% 4-6L NC. Right IJ placed in ED. After withdrawing RIJ 2 cm developed transient SOB. On tranfer to the floor, she had no complaints. She was having difficulty remembering why she had come into the hospital, but after reorientation, understood this. She had no chest pain, shortness of breath, abdominal pain, fevers, chills, night sweats, nausea, vomting, dysuria, hematuria. Past Medical History: Dementia Chronic constipation Osteopenia Spinal stenosis posterior vitreous attachment right eye urinary incontinence s/p hysterectomy [**2153**] h/o Lyme disease h/o hepatitis Social History: Lives with husband [**Name (NI) 95086**], has son who is involved w/ care Family History: Mother died with lymphoma, age 80, [**2173**] Father died age 67 colon cancer One brother, 18 months younger, in [**Location (un) **], healthy with some heavy alcohol use 5 pregnancies, first ended at 7 months with stillbirth of siamese twins; 3 spontaneous vaginal deliveries of healthy children all alive and well; one miscarriange Diabetes: aunt Physical Exam: GENERAL: Pleasant, well appearing, in NAD HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or [**Last Name (un) 549**]. JVP not elevated LUNGS: crackles L base > R, good air movement biaterally. ABDOMEN: NABS. Soft, NT, ND. No HSM EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. SKIN: No rashes/lesions, ecchymoses. NEURO: Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. Gait assessed on the day after transfer to floor and gait was wnl. PSYCH: Listens and responds to questions appropriately, pleasant Pertinent Results: [**2192-10-20**] 11:03AM GLUCOSE-145* UREA N-13 CREAT-1.1 SODIUM-138 POTASSIUM-3.6 CHLORIDE-106 TOTAL CO2-22 ANION GAP-14 [**2192-10-20**] 05:28PM HCT-31.4* [**2192-10-20**] 04:51AM cTropnT-<0.01 [**2192-10-19**] 06:00PM URINE BLOOD-LG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2192-10-19**] 06:00PM URINE RBC-[**5-30**]* WBC-[**11-9**]* BACTERIA-MOD YEAST-NONE EPI-0 [**2192-10-19**] 06:00PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.002 [**2192-10-19**] 08:23PM ALT(SGPT)-34 AST(SGOT)-45* ALK PHOS-57 TOT BILI-0.3 CT Abd: 1. Abnormal striated hypoenhancement in the right kidney, compatible with infectious process such as pyelonephritis and focal nephronia. No renal abscess or perinephric fluid collection. 2. No psoas abscess. 3. 3-cm right adnexal cyst, comparable in size compared to the prior ultrasound. Also: A 2-mm calcified nodule noted in the right lower lobe is compatible with a calcified granuloma. [**10-23**] CXR Cardiac size is top normal. Small bilateral pleural effusions are unchanged. Right lower lobe atelectasis has improved. Left lower lobe retrocardiac opacity has also improved, consistent with improved atelectasis. Mild degenerative changes in the thoracic spine. Brief Hospital Course: Ms. [**Known lastname 27644**] is a 78 year-old lady with Dementia and urinary incontinence who presented with fevers and back pain, consistent with urosepsis from pyelonephritis. She was admitted to the ICU for hypotension requiring pressors in the Emergency Department and then transferred to the floor on [**2192-10-22**]. 1. UROSEPSIS- secondary to pyelonephritis given findings on CT abdomen, urinalysis and physical exam. She received IV Ciprofloxacin and Ceftriaxone in the Emergency Department. Due to persistent hypotension in the ED, she required pressors and was transferred to the unit. In the ICU, Admission Chest X-rays were negative for infection and non-focal neuro exam suggested against meningitis. Dopamine (initial pressor) was changed to levophed, and mean arterial pressure was titrated to > 65 mmHg. IV Ceftriaxone was contuned in-house. Patient's urine output continued to improve during her ICU course and her blood pressures improved. On [**10-21**], pressors were discontinued and patient was observed- her blood pressures remained stable over 24 hours off pressors. She was converted to levofloxacin for HAP (see below) and should continue this for a total of 2 weeks. On discharge, she was afebrile. 2. Pneumonia - due to presence of increased left lower lobe opacity and probable evidence for superimposed infection in the bilateral basis, decision was made to treat with levofloxacin 750mg q48hrs, but repeat CXR showed improvement in bilateral atelectasis. Given these findings, she did not have pneumonia, but atelectasis from prolonged bedrest in the ICU. 3. Altered Mental Status: Pt with baseline dementia. Per husband, she is usually oriented. On admission, she was disoriented to time and place which could be due to a combination of her baseline, infection, and delrium. Sedatives were avoided, and patient was frequently reoriented to her surroundings. Mental status improved to her baseline during her ICU stay and per her husband and son, she was at her baseline prior to transfer to floor and on discharge 4. Acute renal failure - Admission Creatinine was 1.4 which was likely prerenal given her hypotension. Creatinine trend continued to improve during her course and was at her baseline on discharge. 5. Chest pain - Overnight on [**10-20**], the pt had an episode chest pain overnight with ST depressions laterally in the setting of urosepsis and infection. She had troponins cycled which were negative. Repeat EKG on [**10-21**] showed resolution of her EKG changes. She had no recurrent chest pain and no events on telemetry. She had lipids checked and revealed LDL of 100 and triglycerides of 188. She had not recurrence of chest pain during her hospital stay. She would benefit from an outpatient stress test given the above history. She was not started on ASA as this is on her list of allergies. She is already scheduled for follow up with her primary care on [**11-7**]. Medications on Admission: Medications (from OMR): ascorbic acid 500 mg daily B-complex vitamins calcium citrate-vitamin d cyanocobalamin glucosamine/chondroitin omega-3 Discharge Medications: 1. Cyanocobalamin 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Colace 100 mg Capsule Sig: Two (2) Capsule PO once a day as needed for constipation. 3. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q48H (every 48 hours) for 11 days. Disp:*4 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Pyelonephritis Dementia Urinary urgency Discharge Condition: Stable Discharge Instructions: You were admitted with fevers, chills and rigors. In the emergency room, your blood pressure was low and you were given fluids, antibiotics and were sent to the ICU. Your CT scan images showed that you had an infection in your kidney. You also had a chest X ray that was concerning for a pneumonia, but the repeat imaging does not look like you have this. You were started on a new medication called levofloxacin for your kidney infection. You will have to continue this for 2 weeks. Antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamin preparations with zinc, should not be taken within 2 hours before or after LEVAQUIN?????? administration Please return to the emergency room if you develop persistent fevers, chills, night sweats, nausea, vomiting, back pain. Followup Instructions: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7869**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2192-11-22**] 1:30 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6310**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 250**] Date/Time:[**2192-11-7**] 3:20 ICD9 Codes: 0389, 5849, 5180, 2859
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Medical Text: Admission Date: [**2167-2-26**] Discharge Date: [**2167-3-11**] Date of Birth: [**2093-4-25**] Sex: F Service: CSU HISTORY OF PRESENT ILLNESS: The patient is a 73 year old woman with known aortic stenosis and mitral stenosis, admitted in [**2164-3-23**], with acute congestive heart failure and a myocardial infarction. Catheterization at that time showed no significant coronary artery disease. The patient was again admitted in [**2166-11-24**], with congestive heart failure and referred for stress testing. Stress test done in [**Month (only) 404**] showed an ejection fraction of 70 percent with no inducible ischemia. Catheterization done on [**2167-2-20**], showed three vessel disease as well as aortic and mitral stenosis. The patient was then referred to Cardiothoracic Surgery for aortic valve replacement, mitral valve replacement, coronary artery bypass graft. Transesophageal echocardiogram done [**2167-2-10**], showed an aortic valve area of 0.5 to 0.6 centimeter squared with one plus aortic insufficiency and moderate to severe mitral stenosis with a mitral valve area of 1.4 and two plus mitral regurgitation. It also showed severe mitral annular calcification and left ventricular hypertrophy with an ejection fraction of 65 percent. PAST MEDICAL HISTORY: Hypertension. Hyperlipidemia. Diabetes mellitus. Congestive heart failure. Aortic stenosis. Mitral stenosis. Peripheral vascular disease. Gastroesophageal reflux disease. Osteoporosis. PAST SURGICAL HISTORY: Right carotid endarterectomy done in [**2163**]. ALLERGIES: The patient states no known drug allergies. MEDICATIONS ON ADMISSION: 1. Lasix 40 mg daily. 2. Lipitor 40 mg daily. 3. Toprol 12.5 mg daily. 4. Lotrel 5 to 20 mg daily. 5. Aspirin 81 mg daily. 6. Protonix 40 mg daily. 7. K-Lor 20 daily. 8. Fosamax 70 mg weekly, typically taken on Sunday. SOCIAL HISTORY: Widowed, livers with son in [**Name (NI) 3494**]. Remote tobacco history, quit over twenty years ago, and rare alcohol use. FAMILY HISTORY: Significant for mother who died of myocardial infarction at age 57 and father who died of myocardial infarction at age 80. PHYSICAL EXAMINATION: Height five feet, weight 151 pounds. Vital signs revealed temperature 98, heart rate 66, sinus rhythm, blood pressure 105/38, respiratory rate 18, oxygen saturation 97 percent in room air. In general, she is lying in bed in no acute distress. Neurologically, she is alert and oriented times three, moves all extremities, follows commands, nonfocal examination. Respiratory is clear to auscultation bilaterally. Cardiovascular regular rate and rhythm, S1 and S2, with a IV/VI systolic ejection murmur radiating bilaterally to the carotids. Abdomen is soft, nontender, nondistended, with normoactive bowel sounds. Extremities are warm and well perfused with no edema or varicosities. Pulses - Radial two plus bilaterally, dorsalis pedis and posterior tibial one plus bilaterally. LABORATORY DATA: White blood cell count 5.4, hematocrit 30.0, platelet count 165,000. Prothrombin time 14.0, partial thromboplastin time 28.0, INR 1.2. Sodium 135, potassium 4.5, chloride 104, CO2 23, blood urea nitrogen 30, creatinine 1.2, glucose 88. Liver function tests within normal limits. Urinalysis is negative. Carotids with mild plaque bilaterally with no hemodynamic significance. HOSPITAL COURSE: The patient was a direct admission to the operating room where she underwent an aortic valve replacement, mitral valve replacement, coronary artery bypass graft times three. Please see the operative report for full details. In summary, the patient had an aortic valve replacement with a number 19 St. [**Male First Name (un) 923**] mechanical valve, mitral valve replacement with a number 25 St. [**Male First Name (un) 923**] mechanical valve and a coronary artery bypass graft times three with left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft to obtuse marginal and saphenous vein graft to right coronary artery. Her bypass time was 223 minutes with a cross clamp time of 198 minutes. The patient tolerated the operation and was transferred from the operating room to the Cardiothoracic Intensive Care Unit. At the time of transfer, the patient had Milrinone at 0.25 mcg/kg/minute and Neo-Synephrine at 1.5 mcg/kg/minute. The patient did well in the immediate postoperative period. Her anesthesia was reversed. She was weaned from all sedation, moved all extremities to commands and then was resedated during the course of the operative night. On postoperative day number one, her sedation was again lightened. She was weaned from the ventilator and successfully extubated. She remained hemodynamically stable throughout this period. On postoperative day number two, the patient continued to progress. She was begun on beta blockade. Her Swan-Ganz catheter was removed and her activity level was advanced with the assistance of the nursing staff. Later in the day of postoperative day number two, the patient went into a rapid atrial fibrillation which she did not tolerate well hemodynamically and therefore she remained in the Cardiothoracic Intensive Care Unit. Additionally, an Amiodarone infusion was begun. On postoperative day number three, the patient was hemodynamically stable on beta blockade as well as Amiodarone drip. Diuretics were also begun at that time. She was transfused with two units of packed red blood cells and her chest tubes were removed. Because of intermittent atrial fibrillation, the patient remained in the Cardiothoracic Intensive Care Unit. Postoperative day number four, the patient continued to have episodes of rapid atrial fibrillation which she did not tolerate hemodynamically. Amiodarone infusion continued. The patient was also begun on Heparin at that time. Additionally, she was loaded with Digoxin which seemed to slow her ventricular response rate. Ultimately, the patient returned to a sinus rhythm, however, during this period, the patient had poor urine output and during that time she was begun on a Natrecor infusion as well. Postoperative day number five, the patient had improved hemodynamically. She remained in sinus rhythm with adequate cardiac output and index. She was aggressively diuresed. he Swan-Ganz catheter was removed on postoperative day number six. The patient continued to make progress hemodynamically. Her Amiodarone infusion was stopped and she was begun on oral Amiodarone. Her Natrecor infusion was weaned. She was placed on oral diuretics postoperative day number seven. The patient continued to do well. Her beta blockade was increased. Her temporary pacing wires were removed. Her right IJ was removed. On postoperative day number eight, she was transferred to the floor for continued postoperative care and cardiac rehabilitation. Additionally, the patient was begun on oral Coumadin. Once on the floor, the patient had an uneventful postoperative course. Her activity level was increased with the assistance of the nursing staff as well as the physical therapy staff. On postoperative day thirteen, it was decided that the patient was stable and ready to be discharged to home with visiting nurses. At the time of this dictation, the patient's physical examination is as follows: Temperature 100, heart rate 80 and sinus rhythm, blood pressure 123/62, respiratory rate 18, oxygen saturation 95 percent in room air. Weight preoperatively 69 kilograms and at discharge 67.3 kilograms. Laboratories showed sodium 140, potassium 4.1, chloride 101, CO2 32, blood urea nitrogen 25, creatinine 1.3, glucose 107. Prothrombin time 14.0, partial thromboplastin time 75, INR 2.3. White blood cell count is 4.5, hematocrit 38.0, platelet count 467,000. Physical examination, neurologically, the patient is alert and oriented times three, moves all extremities, follows commands, nonfocal examination. Pulmonary is clear to auscultation bilaterally. Cardiac regular rate and rhythm, sternum stable and incision with Steri-Strips without drainage or erythema. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well perfused with trace edema. Right endoscopic saphenous vein graft harvest site with Steri-Strips, open to air, clean and dry. Left open saphenous vein graft harvest site with staples, open to air, clean and dry. CONDITION ON DISCHARGE: Good. DISCHARGE DIAGNOSES: Coronary artery disease, status post coronary artery bypass grafting times three, left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft to obtuse marginal and saphenous vein graft to right coronary artery. Aortic stenosis, status post aortic valve replacement with number 19 St. [**Male First Name (un) 923**] mechanical valve. Mitral stenosis, status post mitral valve replacement with number 25 St. [**Male First Name (un) 923**] mechanical valve. Diabetes mellitus. Hypertension. Hypercholesterolemia. Congestive heart failure. Peripheral vascular disease. Gastroesophageal reflux disease. Osteoporosis. Status post right carotid endarterectomy. DISCHARGE STATUS: The patient is to be discharged home with visiting nurses. FOLLOW UP: She is to have follow-up with Dr. [**Last Name (STitle) **] in one to two weeks, with Dr. [**Last Name (STitle) **] in two to four weeks, and with Dr. [**Last Name (STitle) **] in four weeks. MEDICATIONS ON DISCHARGE: 1. Colace 100 mg p.o. twice a day. 2. Aspirin 81 mg daily. 3. Percocet 5/325 one to two tablets q4-6hours as needed. 4. Captopril 12.5 mg three times a day. 5. Prilosec 40 mg daily. 6. Lipitor 40 mg daily. 7. Amiodarone 400 mg daily times seven days, then 200 mg daily. 8. Metoprolol 75 mg three times a day. 9. Lasix 40 mg daily. 10. Potassium Chloride 20 mEq daily. 11. Warfarin as directed with a target INR of 3.0 to 3.5. Initial INR check is on Friday, [**2167-3-13**], with results to be called to Dr.[**Name (NI) 58873**] office. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**] Dictated By:[**Last Name (NamePattern4) 1718**] MEDQUIST36 D: [**2167-3-11**] 16:56:31 T: [**2167-3-11**] 19:06:18 Job#: [**Job Number 58874**] ICD9 Codes: 9971, 4019, 2720, 4439, 412
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Medical Text: Admission Date: [**2127-12-4**] Discharge Date: [**2127-12-13**] Date of Birth: [**2056-4-26**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 165**] Chief Complaint: Positive stress test Major Surgical or Invasive Procedure: [**2127-12-5**] - Urgent off-pump coronary artery bypass graft x3: Left internal mammary artery to left anterior descending artery and saphenous vein grafts to diagonal and posterior descending arteries. [**2127-12-4**] - Cardiac catheterization History of Present Illness: This is a 71 year old male with polycystic kidney disease, dialysis dependent who was in the process of kidney transplant evaluation. The patient had CT chest on [**2127-10-1**] revealing a 2.2 x 2.1 x 2.4 cm right upper lobe lung nodule, which was treated with antibiotics. He then had a repeat CT chest [**2127-11-6**] revealing increased size to 2.9 x 2.5 x 2.6 cm. Patient was being worked up for a right upper lobe nodule removal and was found to have a positive stress test. Upon telephone interview with patient he states he gets fatigue very easily, he denies chest discomfort. Patient complains of shortness of breath on exertion for the past six months. Past Medical History: Hypertension COPD Polycystic Kidney Disease on HD since [**1-5**] 3x week M-W-F Left leg claudication Ventral Hernia Hypercholesterolemia Cardiac Arrest [**2124**] GERD Arthritis Past Surgical History Cerebral artery aneurysm clipping [**2114**] Abdominal Aortic aneurysm repair [**2124**] at [**Hospital1 112**] Social History: Lives with:Married with a son and daughter [**Name (NI) 2270**] who is his health care proxy, his wife has [**Name (NI) 2481**]. Occupation:retired Tobacco:denies (quit 3 years ago), smoked 1ppd for 50 yrs ETOH:denies (quit 3 yrs ago) Family History: Family History:adopted, family history unknown Physical Exam: Pulse: 67 Resp: 14 O2 sat: 99% RA B/P Right: 184/78 on nitro Height:6'1" Weight:214lbs General: Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x](distant) Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x]large abdominal incision, midline Extremities: Warm [x], well-perfused [x] Edema Varicosities: None [x] Neuro: Grossly intact[x] Pulses: Femoral Right: 1+ Left:1+ DP Right: 1+ Left:1+ PT [**Name (NI) 167**]: 1+ Left:1+ Radial Right: 1+ Left:1+ Carotid Bruit Right: - Left:- LEFT ARM FISTULA Pertinent Results: [**2127-12-4**] Cardiac Catheterization 1. Coronary angiography in this right dominant system demonstrated a distal lesion in the LMCA extening in the proximal LAD of 60-70% stenosis. The LAd had a 60-70% mid ulcerated lesion with a 90% distal lesion into the diag bifurcation. The Lcx was normal. The RCA had a 60% mid and 70% distal lesion. 2. Limited hemodynamics revealed severe centralized hypertenison to 193mm Hg that was treated with a nitroglycerine drip during the procere. 3. In the post procedure holding are the patient developed a mild-moderate size hematoma in the right groin that was easily controlled and regressed with manual pressure [**2127-12-5**] ECHO Intraoeprative findings: No spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is mildly depressed (LVEF= 45 %). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. There are simple atheroma in the ascending aorta. The aortic arch is mildly dilated. There are complex (>4mm) 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. There is no aortic valve stenosis. No aortic regurgitation is seen. Mild to moderate ([**12-28**]+) mitral regurgitation is seen. Dr. [**Last Name (STitle) 7772**] was notified in person of the results. [**2127-12-5**] Carotid ultrasound Mild heterogeneous plaque bilaterally with bilateral 1-39% ICA stenosis. Vertebral abnormalities as described above without any significant evidence of inflow disease on the left. [**2127-12-5**] Femoral ultrasound Normal study, without pseudoaneurysm, AV fistula, or hematoma. [**2127-12-10**] 07:01AM BLOOD WBC-7.4 RBC-2.67* Hgb-8.8* Hct-26.3* MCV-99* MCH-32.9* MCHC-33.3 RDW-15.1 Plt Ct-174# [**2127-12-5**] 05:07PM BLOOD PT-14.9* PTT-28.4 INR(PT)-1.3* [**2127-12-10**] 07:01AM BLOOD Glucose-125* UreaN-65* Creat-8.1*# Na-137 K-4.7 Cl-95* HCO3-26 AnGap-21* [**Known lastname 21376**],[**Known firstname 21377**] [**Medical Record Number 21378**] M 71 [**2056-4-26**] Radiology Report CHEST (PA & LAT) Study Date of [**2127-12-9**] 9:04 AM [**Last Name (LF) **],[**First Name3 (LF) **] CSURG FA6A [**2127-12-9**] 9:04 AM CHEST (PA & LAT) Clip # [**Clip Number (Radiology) 21379**] Reason: r/o inf, eff [**Hospital 93**] MEDICAL CONDITION: 71 year old man with s/p cabg REASON FOR THIS EXAMINATION: r/o inf, eff Final Report CLINICAL HISTORY: Status post CABG, evaluate for pleural effusion. COMPARISON: Multiple radiographs dating back to [**2127-12-5**], most recently [**2127-12-6**]; outside CT [**2127-11-6**] and PET [**2127-11-15**]. FINDINGS: Compared to [**2127-12-6**], lung volumes are improved. There is mild bibasilar atelectasis with improvement in retrocardiac atelectasis. A tiny left pleural effusion is seen. There is no pneumothorax or pulmonary vascular congestion. A calcified granuloma is at the right lung base. A right medial apical mass corresonds to mass seen on outside CT and PET. The heart is stably enlarged. The mediastinal width is decreased since [**2127-12-6**] in this patient status post CABG. A right internal jugular catheter terminates in the mid SVC. IMPRESSION: 1. Tiny left pleural effusion. 2. Improved retrocardiac atelectasis with mild persistent bibasilar atelectasis. 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) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**] Approved: TUE [**2127-12-9**] 1:41 PM Brief Hospital Course: Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2127-12-4**] for a cardiac catheterization following a positive stress test. He underwent stress testing due to an enlarging right upper lobe lung nodule which is being followed by thoracic surgery with planned future surgical intervention. His catheterization revealed severe left main and three vessel disease. Given the severity of his disease, the cardiac surgical service was consulted. Mr. [**Known lastname **] was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed mild bilateral internal carotid artery disease. On [**2127-12-5**], Mr. [**Known lastname **] was taken to the operating room where he underwent off-pump coronary artery bypass grafting to three vessels. Please see operative note for details. Postoperatively he was taken to the intensive care unit for monitoring. Over the next 24 hours, he awoke neurologically intact and was extubated. Beta blockade, aspirin and a statin were resumed. Plavix was started and is to be continued for 3 months given his off-pump surgery. He resumed his hemodialysis as per preoperatively. The renal service followed him closely while recovering from his cardiac surgery. On postoperative day one, he was transferred to the step down unit for further recovery. The physical therapy service was consulted for assistance with his postoperative strength and mobility. Lasix was resumed at 40mg daily per the renal service and per preoperatively. He continued to not make a significant amount of urine. He had a short episode of atrial fibrillation which quickly converted back to normal sinus rhythm with amiodarone. He continued to make steady progress and was discharged home on postoperative day 6. He will follow-up with Dr. [**First Name (STitle) **], Dr. [**Last Name (STitle) 7047**] and Dr. [**Last Name (STitle) 17918**] as an outpatient. He will also resume his normal hemodialysis schedule as an outpatient. He will follow-up with Dr. [**First Name (STitle) **] of thoracic surgery on [**1-6**] @ 9AM regarding management of his lung nodule. He will get home PT with VNA services. Medications on Admission: Medications - Prescription ALBUTEROL SULFATE - (Prescribed by Other Provider) - 90 mcg HFA Aerosol Inhaler - [**12-28**] every four (4) hours as needed for shortness of breath or wheezing B COMPLEX-VITAMIN C-FOLIC ACID [NEPHROCAPS] - (Prescribed by Other Provider) - 1 mg Capsule - one Capsule(s) by mouth daily CALCIUM ACETATE - (Prescribed by Other Provider) - 667 mg Capsule - two Capsule(s) by mouth three times daily EPOETIN ALFA [EPOGEN] - (Prescribed by Other Provider) - 2,000 unit/mL Solution - 2400 units 3x/week FUROSEMIDE - (Prescribed by Other Provider) - 40 mg Tablet - 1 Tablet(s) by mouth daily LABETALOL - (Prescribed by Other Provider) - 300 mg Tablet - 1 Tablet(s) by mouth twice a day PARICALCITOL [ZEMPLAR] - (Prescribed by Other Provider) - 2 mcg/mL Solution - 3mcg three times a week with dialysis REMVELA - (Prescribed by Other Provider) - - two tablets three times daily SIMVASTATIN - (Prescribed by Other Provider) - 40 mg Tablet - 1 Tablet(s) by mouth daily VERAPAMIL - (Prescribed by Other Provider) - 180 mg Cap,24 hr Sust Release Pellets - 0.5 (One half) Cap(s) by mouth four times a week, S,T,T, S Medications - OTC DOCUSATE SODIUM - (Prescribed by Other Provider) - 100 mg Capsule - 1 Capsule(s) by mouth twice a day FERROUS SULFATE - (Prescribed by Other Provider) - 325 mg (65 mg iron) Tablet - one Tablet(s) by mouth daily FIBER - (Prescribed by Other Provider) - 0.52 gram Capsule - 2 (Two) Capsule(s) by mouth twice daily Discharge Medications: 1. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*0* 2. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day for 3 months. Disp:*90 Tablet(s)* Refills:*0* 3. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*180 Tablet(s)* Refills:*0* 4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO Daily in the evening. Disp:*30 Tablet(s)* Refills:*0* 5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 1 months. Disp:*60 Capsule(s)* Refills:*0* 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:*0* 7. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 8. paricalcitol 5 mcg/mL Solution Sig: 3mcg Intravenous 3X/WEEK (TU,TH) as needed for w/ HD. 9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day for 1 weeks: Then switch to 1 tablet, 200mg daily thereafter. Disp:*37 Tablet(s)* Refills:*0* 10. labetalol 300 mg Tablet Sig: One (1) Tablet PO twice a day: hold until after HD on dialysis days . Disp:*60 Tablet(s)* Refills:*0* 11. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 12. Epogen 2,000 unit/mL Solution Sig: 2400 (2400) Units Injection Three times per week with hemodialysis. 13. 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. Disp:*qs qs* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] home care Discharge Diagnosis: Coronary artery disease s/p off pump CABG Atrial Fibrillation Hypertension Chronic obstructive pulmonary disease Polycystic Kidney Disease on HD Left leg claudication Ventral Hernia Hypercholesterolemia Cardiac Arrest [**2124**] Gastroesophageal reflux disease Arthritis Calcified aorta Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with percocer Incisions: Sternal - healing well, no erythema or drainage Leg: Left - healing well, no erythema or drainage. Edema +1 bilateral 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 again in the evening. Please also take your temperature, these should be written down on the chart provided. 4) No driving for approximately one month and while taking narcotics. This 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) Continue hemodialysis per your schedule and as instructed by your nephrologist [**Doctor First Name **] [**Doctor Last Name **]. 7) Take amiodarone 400mg (Two tablets) daily for 1 week and then decrease to 200mg (1 tablet) daily until otherwise instructed by your cardiologist and/or PCP. 8) Take plavix 75mg daily for 3 months then stop. This is for your off-pump surgery. 9) Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Surgeon: Dr. [**First Name (STitle) **] Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2128-1-5**] 1:00 Thoracic Surgery: Dr [**First Name (STitle) **] [**0-0-**] Date/Time:[**2128-1-6**] 9:00 Please call to schedule appointments with your Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17918**] in [**3-31**] weeks [**Telephone/Fax (1) 17919**] Cardiologist: Dr. [**Last Name (STitle) 7047**] in 4 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:[**2127-12-11**] ICD9 Codes: 5856, 496, 2720
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Medical Text: Admission Date: [**2177-4-29**] Discharge Date: [**2177-5-13**] Date of Birth: [**2110-4-28**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 9853**] Chief Complaint: Hemoptysis DVT Major Surgical or Invasive Procedure: PICC placement Transfusion of packed red blood cells Ventilator use (hooked up to tracheostomy) IVC filter placement IR coiling of laryngeal artery Tooth extraction History of Present Illness: This is a 67 yo man w/ HTN, CVA, COPD, hyponatremia, EtOH abuse, and SCC of the larynx s/p coil embolization of right inferior thyroid artery for hypopharyngeal bleed [**3-/2177**], s/p tracheostomy and PEG [**3-/2177**], recently discharged to rehab from MICU [**Location (un) **], who was admitted to the floor on [**4-29**] for right LE DVT. His right leg has become more warm and edematous, with mild pain, compared to the left x3 days, and LENIs showed a right partially occluded distal femoral and popliteal DVT. Given his recent bleed, anticoagulation was not started, and he was transferred to [**Hospital1 18**] for consideration of an IVC filter. Also completing course of antibiotics for suspected aspiration pneumonia from prior admission. While on the floor early morning of [**4-30**] he started coughing and was noted to have bleeding from his trache. He did not have any respiratory difficulties, and ~150cc of blood was suctioned out through the trach, the cuff was inflated for airway protection and he was transfered to MICU green for monitoring. ENT saw the patient, who was known to them, suspected bleeding from mass on direct visualization. Pt was being taken down to IR for IVC filter when he began to bleed again from his trach site. At that time he was placed on the ventilator, paralyzed and sedated. ENT packed his oral cavity. Pt then transported to IR for IVC filter placement. Given that his bleeding has been attributed to his mass, he is being transfered to the [**Hospital Ward Name **] ICU for ongoing care while he initiates XRT to his mass. Hematocrit was stable and he was HD stable, so he is being transferred to the ICU for closer airway monitoring. Denies CP, SOB, palpitations, change in chronic productive cough. No other bleeding. Denies fever, chills, dysuria. Currently pain free. Past Medical History: Cerebrovascular accident, treated at [**Hospital1 2025**] [**2157**] with residual gait weakness Chronic obstructive pulmonary disease Hypertension Gout Hyponatremia SCC of the larynx diagnosed [**2177-3-31**], s/p coil embolization of right inferior thryroid artery for hypopharangeal bleed S/p tracheostomy and peg [**2177-4-1**] at [**Hospital1 34**] EtOH abuse Social History: Former smoker quit at day of dx, EtOH 14 beers daily up until 1 month ago. Family History: Per report-lymphoma and lung ca. Physical Exam: GEN:Chronically ill appearing, pleasant, NAD, frequently suctioning with yankauer HEENT: nc/at MM dry OP clear with thick clear secretions CV: Distant. RRR No m/r/g Resp: Coarse rhonchorous BS throuhgout. No w/r Abd: Soft. NTND +BS. No HSM Ext: 2+RLE edema to upper calf with erythema. Trace edema LLE Neuro: AAOx3. CM [**2-6**] intact. MAE. Pertinent Results: Labs at Admission: [**2177-4-29**] 09:00PM BLOOD WBC-14.4* RBC-3.15* Hgb-9.6* Hct-28.5* MCV-90 MCH-30.6 MCHC-33.8 RDW-13.9 Plt Ct-584*# [**2177-5-1**] 04:06AM BLOOD Neuts-85.6* Lymphs-7.2* Monos-6.2 Eos-0.6 Baso-0.3 [**2177-4-29**] 09:00PM BLOOD PT-12.4 PTT-26.3 INR(PT)-1.0 [**2177-4-29**] 09:00PM BLOOD Glucose-93 UreaN-15 Creat-0.4* Na-128* K-4.2 Cl-91* HCO3-30 AnGap-11 [**2177-4-29**] 09:00PM BLOOD Calcium-8.8 Phos-4.5 Mg-2.1 Iron-30* [**2177-4-29**] 09:00PM BLOOD calTIBC-230* VitB12-GREATER TH Folate-18.1 Ferritn-217 TRF-177* [**2177-4-30**] 02:05AM BLOOD Osmolal-270* [**2177-4-30**] 09:59PM BLOOD Type-ART Tidal V-500 PEEP-5 FiO2-50 pO2-170* pCO2-45 pH-7.43 calTCO2-31* Base XS-5 [**2177-5-1**] 10:17AM BLOOD Hgb-9.5* calcHCT-29 . Imaging Studies: [**4-30**] Procedure: IMPRESSION: Prominent bilateral superior thyroidal arteries and left inferior thyroidal artery supplying hypervascular oropharyngeal mucosa. Successful embolization of blood supply to hypervascular tumor via the bilateral superior thyroidal arteries and left inferior thyroidal artery. . [**5-5**] Panorex: read pending . [**5-5**] CT head: IMPRESSION: 1. No acute intracranial process; specifically no evidence for enhancing masses. MR is more sensitive for the detection of small masses. 2. Bilateral maxillary sinus mucosal disease. . [**5-5**] CT neck: IMPRESSION: 1. Extensive hypopharyngeal mass appearing similar to prior with evaluation of supraglottic extension difficult. 2. No obvious lymphadenopathy. 3. Persistent left vertebral artery nonvisualization and plaque in the left carotid bifurcation. . [**5-5**] CT Chest: IMPRESSION: 1. New multifocal ground-glass opacity and consolidation in left lung, mostly in the peribronchial and peripheral distribution, with one wedge shaped peripheral opacity. Findings are nonspecific but could be due to infection such as angioinvasive fungus (for example, mucormycosis); hemorrhage; or, alternatively, with history of DVT, this could reflect infarct from non- visualized pulmonary embolism. 2. Thickening and calcification of the anterolateral wall of the trachea and both mainstem bronchi, could be idiopathic or related to relapsing polychondritis. Diffuse bronchial wall thickening, slightly more prominent on the left associated with left lower lobe mucoid impaction could be related to infection or inflammation. 3. Minimal emphysema. 4. Moderate left and small right pleural effusion. Small pericardial effusion. Bibasilar atelectasis. 5. Enlargement of main pulmonary artery, suggesting possible pulmonary hypertension. 6. Severe calcifications of the left main coronary artery. 7. Secretions in the carina and both mainstem bronchi, which could be blood in setting of tracheal bleed. 8. Please see separately dictated neck CT. Brief Hospital Course: Patient is a 67 year old man with history of HTN, CVA, COPD, status post recent diagnosis of SCC of larynx status post coil embolization of right inferior thyroid artery for hypopharyngeal bleed [**3-/2177**], status post trach and PEG [**3-/2177**], recently discharged to rehab approximately 1 month ago, who initially presented and was admitted to the floor on [**4-29**] for right LE DVT, with subsequent complicated hospital course for bleeding at tracheostomy site. # Bleeding from tracheostomy site: 24 hours after admission to floor, patient was noted to have coughing and bleeding from his tracheostomy site. This was initially managed by inflating the cuff for airway protection, as well as transfer to the MICU (initially to [**Hospital Ward Name **] MICU) for closer monitering. He also received 2 units of packed RBC. ICU course: Despite the cuff inflation, the patient had intermittent bleeding from his tracheostomy site, requiring placement on the ventilator. ENT was involved, and site was packed (where patient was transiently on prophylactic clindamycin). He went to IR for IVC filter placement to address his DVT, at which time he also underwent coiling of a thyroid artery. Oncology was also involved during his hospital course, and he was ultimately transferred from the [**Hospital Ward Name **] MICU to the [**Hospital Ward Name **] [**Hospital Unit Name 153**] for initiation of emergent radiation to be able to stop the bleeding. He therefore underwent salvage radiation with control of the bleeding, and was successfully weaned off the ventilator, and currently remains stable on trach mask. FLOOR COURSE: After stabilization in the ICU, patient was transferred back to regular medical floor where bleeding remained stable. Cancer was addressed as below. # Right lower extremity deep venous thrombosis: Patient was admitted to the floor on [**4-29**] for right lower extremity DVT. His initial complaints were right leg pain, warmth, edema x 3 days, with lower extremity ultrasound (performed at rehab) demonstrating a right partially occluded distal femoral and popliteal DVT. He was sent to [**Hospital1 18**] with above for consideration of IVC filter (as no plans for anti-coagulation given recent hypopharyngeal bleed). He successfully underwent placement of IVC filter in IR on [**4-30**] without complication. # Laryngeal Cancer: As above, complicated by recurrent bleeds, now status post 2 coil artery embolizations, status post trach and PEG. Oncology, radiation oncology, ENT involved early during hospital course. Patient required dental work prior to initiation of regular radiation therapy, and chemotherapy waiting on regular radiation therapy. Given this delay of therapy, panorex was obtained, dental consult and maxillofacial surgery consults were obtained. Patient underwent tooth extraction in OR on [**2177-5-8**], where evaluation by ENT under anaesthesia was also performed. Patient also underwent CT head/neck/chest for further evaluation of the cancer. Following the tooth extraction, radiation oncology and medical oncology were consulted and recommended initiation of cetuximab on [**5-15**] as well as radiation therapy, tentatively scheduled for [**5-21**]. XRT treatments will be daily Monday through Friday for seven weeks; he underwent radiation treatment planning in-house before discharge. Cetuximab will be administered weekly by his oncologists. The patient should follow up with ENT (Dr. [**Last Name (STitle) 1837**] in [**2-26**] weeks. # Aspiration pneumonia: He has a history of aspiration PNA on admission and completed a 10-day course of ceftaz and Vanco on the day after admission. # Hypertension: We continued his home lisinopril 40 mg daily. # Anemia: Stable from recent baseline 25-28. Likely secondary to bleed and inflammation. Iron studies suggest anemia of chronic disease. Patient received 2 units pRBC on [**4-30**]. # Hyponatremia: Chronic, improved over the course of his hospitalization. # Chronic obstructive pulmonary disease: Continued home nebulizers PRN. # Status post cerebrovascular accident: There were no active issues. He is not on aspirin due to bleeding risk. # FEN: Tube feeds # Code status: Full Medications on Admission: B12 1000 mcg IM qmonth Folic acid 1 Lisinopril 40 Ranitidine 150 [**Hospital1 **] Thiamine 100 Allopurinol 300 Mulitivitamin Ceftazidime 1 q8 x 10 days for HAP, last day [**2177-4-30**] Colace 100 [**Hospital1 **] Vancomycin 1000 IV bid last day [**2177-4-30**] ? sq heparin Dulcolax Senna Tylenol Lorazepam 1mg IV q4PRN Nebs prn Oxycodone 5 q4 PRN Discharge Medications: 1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): per PEG tube. 2. Therapeutic Multivitamin Liquid Sig: Five (5) ML PO DAILY (Daily): per PEG tube. 3. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs PO Q4H (every 4 hours) as needed for pain. 4. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed for mouth care for 1 weeks. 5. Senna 8.8 mg/5 mL Syrup Sig: 8.8 MLs PO BID (). 6. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg PO BID (2 times a day) as needed for constipation. 7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 8. Allopurinol 100 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): per PEG tube. 9. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): per PEG tube. 10. Ranitidine HCl 15 mg/mL Syrup Sig: One [**Age over 90 1230**]y (150) mg PO BID (2 times a day): per PEG tube. 11. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): per PEG tube. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Primary: Right lower extremity DVT Bleeding from tracheostomy site, acute blood loss anemia Secondary: SCC of larynx Tracheostomy/PEG tube COPD Hypertension Discharge Condition: good, stable, managing secretions with suctioning, alert, interactive Discharge Instructions: You were admitted to the hospital from rehab with DVT, but also had complications with bleeding from your tracheostomy site. You were stable at time of discharge. Please take medications as directed. Please follow up with appointments as directed. Please contact physician if bleeding at tracheostomy site recurs (bring to emergency room immediately), any respiratory distress, fevers/chills, any other questions or concerns. Followup Instructions: Follow up with oncology (Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 1852**]). You have an appointment on Thursday [**5-15**] at 11:30am at which point you will be started on chemotherapy (cetuximab). Call Dr.[**Name (NI) 21829**] office at [**0-0-**] or Dr.[**Name (NI) 22252**] office at [**Telephone/Fax (1) 22**] with any questions. Provider: [**Name10 (NameIs) **] [**Name8 (MD) 490**], MD, PHD[**MD Number(3) 708**]:[**0-0-**] Date/Time:[**2177-5-15**] 11:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6050**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2177-5-15**] 11:30 Provider: [**Name10 (NameIs) 8111**] [**Name11 (NameIs) 8112**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2177-5-15**] 1:00 Follow up with the ENT surgeons. Dr.[**Name (NI) 20390**] office was contact[**Name (NI) **] for an appointment in [**2-26**] weeks, and they will call your facility with the time and date. If they do not hear from them, they can call his office at [**Telephone/Fax (1) 41**]. Follow up with your primary care physician 1-2 weeks asfter discharge from rehab. ICD9 Codes: 2761, 2851, 4019, 496, 2749
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Medical Text: Admission Date: [**2146-10-9**] Discharge Date: [**2146-10-11**] Date of Birth: [**2090-12-22**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: Altered mental status Major Surgical or Invasive Procedure: none History of Present Illness: 55 y/o man with PMH significant for depression, type 2 diabetes mellitus, and HTN admitted through the ED with mental status changes and fever. Per report, pt was in his normal state of health this morning when he went out to buy groceries. He had a normal conversation with his wife on his cell phone at approximately 1:00 PM. Then, at around 3:00 PM, his wife noted him to be confused and diaphoretic. He was apparently talking giberish. EMS was called and his VS were 162/90 130 16 98%. Pt was given narcan with no improvement in his mental status and he was brought to the [**Hospital1 18**] ED for further care. In the ED, the pt's VS were 102.3 ---> 103.8 134 153/96 25 97% 2L NC. He had a head CT which did not show any acute process. Pt had a LP. His urine tox screen was positive for opiates. In the ED, the pt received ceftriaxone 2 gm IV x1, flagyl 500 mg IV x1, acyclovir 800 mg IV x1, ampicillin 2 gm IV x1, and vancomycin 1 gm IV x1. He also received multiple doses of ativan and valium. . In further discussion, pt reports that he has been SOB recently but is unable to tell me how long. Per report he has had increased wheezing and SOB over the past few weeks and received a Z pack without any improvement in his symptoms. Pt reports that he had a headache this morning. He is unable to give any further ROS. Past Medical History: 1. Depression- Per report, pt has been more depressed than baseline over the last two months. 2. COPD 3. Type 2 diabetes mellitus 4. Hypercholesterolemia 5. Hypertension 6. Substance abuse- Cocaine and percocet. Physical Exam: 101.1 152/90 101 22 92% 2L NC Weight- 103 kg Gen- Alert to person and year. Talking very quickly and antimatedly. NAD. HEENT- NC AT. PERRL. EOMI. Anicteric sclera. Mildly dry mucous membranes. No lesions in the oropharynx. Cardiac- RRR. S1 S2. No m,r,g. Pulm- Diffuse end expiratory wheezing bilaterally. No rales or rhonchi. Abdomen- Obese. Soft. NT. ND. Positive bowel sounds. Extremities- Warm. No c/c/e. 2+ DP pulses bilaterally. Neuro- Alert to person and year. No oriented to place. Talking very quickly with waxing and [**Doctor Last Name 688**] attention. Able to spell "world" forward but not backward. Able to remember three words immediately but not in five minutes. CN II-XII intact. [**3-31**] strength in upper and lower extremities bilaterally. Symmetric DTRs bilaterally. [**Name2 (NI) **] within normal limits. Pertinent Results: ECG- Sinus tach at 130 beats per minute. No ST-T wave changes. . CXR- Left costophrenic angle is partially excluded from the radiograph. Heart size and mediastinal contours appear within normal limits. Prominence of the upper zone pulmonary vasculature may relate to supine positioning. Within the left lung base, there is a focal area of patchy opacity that could represent atelectasis versus early consolidation. A rounded opacity seen at the right lung base laterally could represent a nipple shadow. No pleural effusion or pneumothorax are identified. Osseous structures appear within normal limits. . CT head- Study is limited by patient motion. No gross intracranial hemorrhage or mass effect. There is no shift of midline structures. Differentiation of [**Doctor Last Name 352**] and white matter appears preserved. no hydrocephalus is demonstrated and sulci are within normal limits. Sulci and basal cisterns appear unremarkable. Minimal mucosal thickening is demonstrated within both ethmoid sinuses. Small amount of mucosal thickening is also seen within the right maxillary sinus. Pt is s/p left anterior maxillary wall surgery. Remaining visualized paranasal sinuses and mastoid air cells are clear. Brief Hospital Course: 55 y/o man with PMH significant for depression, type 2 diabetes mellitus, and HTN admitted through the ED with mental status changes and fever. . 1. Delirium: It is unclear why he would be having this. Included in the differential diagnosis are infection, overdose, serotonin syndrome, neuroleptic malignant syndrome, and hyperthyroidism. MRI did not show any reason for acute change in MS: no sign of HSV encephalitis; did show Tiny nonspecific elevated FLAIR signal intensity foci in the cerebral white matter and mid- pons. TSH was within normal limits. It is unlikely the pt's PNA alone would have caused his delirium as he is relatively young and healthy and the PNA does not seem abnormally severe. Most likely ethanol or withdrawal were the cause of his delirium. He denied drinking but was taking benzodiazepines and opioids that he has obtained on the street. He was given 110 mg of diazepam before significant decrease in his agitation making benzodiazepine or alcohol withdrawal the likely etiology. Urine tox screen was negative for amphetamines. Speaking with his wife, she had found two bottles of meds in his room at home but was not sure what they were as they had been placed in spare bottles. Pills were found to be ibuprofen 600mg, tramadol, and xanax 1mg. The patient's med list was obtained from his PCP's office on [**10-10**]. no psychotropic medications are prescribed. the [**Doctor First Name **] pharmacy also had no record of psychotropic medications being filled. His PCP confirmed [**Name Initial (PRE) **]/o substance abuse but the patient reported being clean at last visit on [**10-5**]. Patient was treated with diazepam for CIWA>10. His agitation, hypertension and fever resolved by the morning after admission. He was alert and oriented but was still with pressured speech. Despite our recommendations he left the hospital against medical advice. 2. [**Name (NI) **] Pt found to have an infiltrate on CXR in addition to being febrile and having an elevated WBC count. Also concern for concurrent COPD exacerbation. He was treated with steroids, azithromycin and oxygen to maintain sats around 93 %. Ct scan was planned to further characterize this process. However, the patient left before this study could be completed. He was strongly advised to follow up with his PCP to follow up his chest x-ray abnormality. . 3. HTN- [**Doctor First Name **] pharmacy was contact[**Name (NI) **] and it was found that he was taking lisinopril, carvedilol, Lipitor and niacin. These medications were continued during his hospital stay. . 4. Type 2 [**Name (NI) 1568**] Pt takes insulin at home but his wife is unaware of the dose. Metformin and Humulin were held during admission. Fingersticks were well controlled with RISS. . Discharge Disposition: Home Discharge Diagnosis: Altered metal status Discharge Condition: Left AMA Discharge Instructions: Left AMA but was strongly advised to get follow up of his chest x-ray. Followup Instructions: as above ICD9 Codes: 486, 496, 4019, 2720, 3051
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Medical Text: Admission Date: [**2201-1-31**] Discharge Date: [**2201-2-4**] Date of Birth: [**2154-5-25**] Sex: M Service: MEDICINE Allergies: Codeine Attending:[**First Name3 (LF) 689**] Chief Complaint: Altered mental status s/p fall, drowsiness Major Surgical or Invasive Procedure: None History of Present Illness: The patient is a 46 yo male with a history of bilateral AVN s/p hip replacement x2, DM2, depression, and OSA on CPAP who presented s/p 2 falls at home. 2 days prior to admission, he was walking at home at 2 am, and reports a mechanical fall in which he hit the side of a cabinet while walking, and fell back and hit the back of his head. The fall was unwitnessed, and the patient is unsure if he had LOC. He denied palpitations, prodrome, or loss of bowel or bladder function. He believes the fall may be secondary to cold symptoms vs. his diabetes. He reports that he had not been checking FSBGs, but he had felt a little diaphoretic. During the 2 days s/p the fall, his family reported that he was more confused and lethargic than usual. Then on the day of admission, he was walking and again fell. He landed on his knees but did not hit his head. He called out to his mother for help, but she did not respond so he pushed his life line button for EMS. Of note, he has had several falls in the past year secondary to his obesity and chronic pain. . Mother reports that patient put on Wellbutrin in past 2 weeks for smoking cessation. Last year, was at [**Location (un) 38**] at which time started celexa, buspar, and haldol. . His SaO2 was 83% on RA in ambulance. Vital signs in the ED were temp 96.9, HR 96, bp 154/83, RR 13, SaO2 up to 91% on 4L NC, FSBG 143. He was found to be Pickwickian, and was alert and oriented x2. EKG showed NSR at a rate of 83. Head CT showed no acute intracranial process, and CT C-Spine showed no cervical spine fracture or malalignment. Blood cultures were sent, CXR was a l imited study given low lung volume but no definite acute cardiopulmonary process detected, and he was given Levaquin 750 mg IV x1. ABG showed 7.28/74/63, and he was put on BiPAP and given Narcan 0.4 mg IV x1. He was admitted for hypercarbic respiratory acidosis. . The patient was initially admitted to the floor, and on the evening of admission felt agitated as if he was withdrawing from his medications. He was A&Ox3. He was given Ativan 1 mg PO x2, Oxycodone 5 mg PO x1, and Dilaudid 0.5-1 mg IV x1. Psych was consulted and recommmended continuing short-acting opioids and withholding long-acting opioids. He was started on Oxycodone 5-10 mg PO q4 hr prn, Ativan 1 mg PO q6hr prn, and Morphine 2 mg IV q2 hr prn. He then developed altered mental status and somnolence, and ABG showed 7.41/60/40. He received Narcan 0.4 mg IV x1 then 2 mg IV x2. He was transferred to the MICU, and his mental status improved with CPAP and brief Narcan gtt. He remained hemodynamically stable, and ABG improved to 7.47/53/79. . The patient currently reports [**3-28**] pain, and localizes his pain to his back, hips, and knees. He denies nausea. Past Medical History: -DM2 has been followed at [**Last Name (un) **] -OSA on CPAP at home -Hepatits C - s/p aborted course of interferon -Major depressive disorder, ? of schizophrenia and bipolar disorder -Hypertension -Bilateral avascular necrosis of femoral heads s/p hip replacements in '[**79**] and '[**85**] -s/p L1/L2 kyphoplasty after fall [**6-25**] -s/p left distal radius fracture after fall [**6-25**] -Bilateral lower extremity edema, thought to be secondary to venous stasis -DJD of his back -Osteoporosis -Morbid Obesity Social History: - On disability, lives with his mother, attends a day program. - Smokes 1.5 ppd for > 10yrs, no EtoH for 15 years or illicits for the past 13 years - Stopped IVDA in [**2186**] aver 3 years of use, cocaine with heroin use. - Has been in psychiatric partial hospitalization program in [**Location 1268**] for the past six years. Family History: Non contributory Physical Exam: vitals- T 99.4F, BP 142/96, HR 90, RR 22, O2 96% 3L, Weight: 350 lbs gen- morbidly obese, sitting in chair, in mild discomfort secondary to leg pains. heent- EOMI. OP clear. pulm- CTA b/l. no r/r/w cv- RRR. normal S1/S2. no m/r/g abd- soft, NT/ND. well healed surgical scars. Normal active bowel sounds ext- 2+ pitting edema b/l LEs. + Erythema anterior shins b/l LEs, warm to touch, w/o associated ulceration; symmetric. no evidence of lymphangitic spread or palpable cords; distal pulses palpable 1+ b/l. neuro- alert and oriented x 3. motor strength 5/5 b/l. unable to flex or extend hips due to previous surgeries. Pertinent Results: LABS: [**2201-2-1**] 08:00AM BLOOD WBC-7.1 RBC-4.43* Hgb-13.4* Hct-40.9 MCV-92# MCH-30.3 MCHC-32.9 RDW-15.8* Plt Ct-133* [**2201-2-4**] 07:15AM BLOOD WBC-5.1 RBC-4.43* Hgb-13.3* Hct-40.9 MCV-92 MCH-30.0 MCHC-32.5 RDW-16.6* Plt Ct-117* [**2201-2-1**] 08:00AM BLOOD Neuts-84.8* Lymphs-12.7* Monos-2.2 Eos-0.1 Baso-0.2 [**2201-2-1**] 01:23PM BLOOD Neuts-86.2* Lymphs-11.8* Monos-1.7* Eos-0.1 Baso-0.1 [**2201-2-1**] 08:00AM BLOOD PT-13.5* PTT-25.9 INR(PT)-1.2* [**2201-2-1**] 01:23PM BLOOD Fibrino-305 [**2201-1-31**] 10:15AM BLOOD ESR-8 [**2201-1-31**] 10:15AM BLOOD Glucose-113* UreaN-11 Creat-0.7 Na-140 K-4.6 Cl-96 HCO3-38* AnGap-11 [**2201-2-4**] 07:15AM BLOOD Glucose-231* UreaN-9 Creat-0.6 Na-136 K-3.3 Cl-94* HCO3-35* AnGap-10 [**2201-1-31**] 10:15AM BLOOD ALT-143* AST-134* LD(LDH)-193 CK(CPK)-63 AlkPhos-83 Amylase-26 TotBili-0.3 [**2201-2-1**] 01:23PM BLOOD ALT-119* AST-90* LD(LDH)-210 CK(CPK)-176* AlkPhos-75 Amylase-34 TotBili-0.6 [**2201-1-31**] 10:15AM BLOOD Lipase-20 [**2201-2-1**] 01:23PM BLOOD Lipase-21 [**2201-1-31**] 10:15AM BLOOD cTropnT-<0.01 [**2201-2-1**] 01:23PM BLOOD CK-MB-6 cTropnT-<0.01 [**2201-2-1**] 08:00AM BLOOD Calcium-9.5 Phos-2.2* Mg-1.0* [**2201-2-1**] 01:23PM BLOOD Albumin-3.7 Calcium-9.9 Phos-2.7 Mg-1.0* UricAcd-5.0 Iron-72 Cholest-132 [**2201-2-4**] 07:15AM BLOOD Calcium-9.1 Phos-2.5* Mg-1.5* [**2201-2-1**] 01:23PM BLOOD calTIBC-471* Ferritn-94 TRF-362* [**2201-2-3**] 08:10AM BLOOD %HbA1c-6.5* [**2201-2-1**] 01:23PM BLOOD Triglyc-86 HDL-56 CHOL/HD-2.4 LDLcalc-59 [**2201-2-1**] 01:23PM BLOOD TSH-0.16* [**2201-2-1**] 01:23PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2201-1-31**] 10:26AM BLOOD Type-ART pO2-63* pCO2-74* pH-7.28* calTCO2-36* Base XS-4 [**2201-2-1**] 01:07PM BLOOD Type-ART Temp-37 pO2-45* pCO2-54* pH-7.43 calTCO2-37* Base XS-9 Intubat-NOT INTUBA Comment-NON-REBREA [**2201-2-1**] 01:12PM BLOOD Type-ART Temp-37 pO2-40* pCO2-60* pH-7.41 calTCO2-39* Base XS-10 Intubat-NOT INTUBA Comment-NON-REBREA [**2201-2-1**] 05:12PM BLOOD Type-ART PEEP-11 pO2-79* pCO2-53* pH-7.47* calTCO2-40* Base XS-12 Intubat-NOT INTUBA [**2201-1-31**] 10:42AM BLOOD Lactate-2.5* [**2201-1-31**] 01:12PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.014 [**2201-2-1**] 10:33PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.018 [**2201-1-31**] 01:12PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2201-2-1**] 10:33PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG [**2201-2-1**] 10:33PM URINE bnzodzp-POS barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG . MICRO: Blood Cx ([**1-31**]): No growth x2 Blood Cx ([**2-1**]): No growth Urine Cx ([**2-1**]): <10,000 organisms/ml . IMAGING: ECG ([**1-31**]): Sinus rhythm at a rate of 83. Compared to the previous tracing of [**2200-9-8**] no change. . CXR Portable ([**1-31**]): Study is limited secondary to lordotic positioning and low lung volumes. The cardiomediastinal silhouette is grossly within normal limits given AP and lordotic positioning. Perihilar vascular crowding is believed secondary to low lung volumes. No focal consolidation is appreciated. Degenerative changes are noted at the left acromioclavicular joint and a well-corticated ossific density is present superior to this joint. IMPRESSION: Limited study given low lung volume, AP technique and lordotic positioning. No definite acute cardiopulmonary process detected. . Head CT ([**1-31**]): There is no evidence of hemorrhage, edema, mass, mass effect or infarction. The ventricles and sulci are normal in size and configuration. There is no fracture. IMPRESSION: No acute intracranial process. . CT C-Spine ([**1-31**]): There is no cervical spine fracture or malalignment. There is minimal straightening of normal cervical spine lordosis. Prevertebral and paraspinal soft tissues are not enlarged. Visualized outline of the thecal sac appears unremarkable, please note however, that CT is unable to provide intrathecal detail comparable to MRI. Incidental note is made of increased ground-glass attenuation, and interlobular septal thickening at the lung apices, which could be suggestive of increased volume status. IMPRESSION: No cervical spine fracture or malalignment. . CXR Portable ([**2-1**]): There are low lung volumes. There is prominence of the central pulmonary vasculature, but the lungs are probably clear, with the exception of mild atelectasis at the left costophrenic angle. IMPRESSION: Atelectasis left costophrenic angle, otherwise probably clear. Brief Hospital Course: # Altered Mental Status: The patient presented with increased lethargy and confusion s/p 2 falls at home. The falls sounded mechanical as he reported hitting the side of a cabinet, but he did hit the back of his head during the first fall. Head CT showed no acute intracranial process, and CT C-Spine showed no cervical spine fracture or malalignment. Blood cultures showed no growth, and Urine culture showed <10,000 organisms/mL. The patient became agitated on the night of admission possibly secondary to withdrawal from his medications, and received Ativan 1 mg PO x2, Oxycodone 5 mg PO x1, and Dilaudid 0.5-1 mg IV x1. He then developed altered mental status and somnolence, and ABG showed 7.41/60/40. He received Narcan 0.4 mg IV x1 then 2 mg IV x2. He was transferred to the MICU for oversedation, and his mental status improved with CPAP and a brief Narcan gtt. He remained hemodynamically stable, and ABG improved to 7.47/53/79. His altered mental status was thought to be due to a combination of fall (post-concussion) with polypharmacy from his home narcotic medications. His mental status was clear at the time of discharge. He was discharged on his home doses of Oxycontin 100 mg PO q8hr, Percocet 5-325 mg, 1-2 Tablets PO q6 hr prn, Alprazolam 2 mg PO qid, Buspirone 10 mg tid, Citalopram 40 mg daily, Haldol 5 mg PO bid, and Quetiapine 200 mg PO qhs. His Temazapam and Wellbutrin were held during this admission, and can be added back as an outpatient. . # Pain management: The patient is on multiple pain medications at home given his chronic back, hip, and knee pain. The pain service was consulted during this admission. He was placed on a Clonidine patch TTS 1 qweekly during this admission, but this was not continued at the time of discharge. His other pain medications include Oxycontin 100 mg PO q8 hr and Percocet [**11-19**] tabs q6 hr prn breakthrough pain. . # OSA: The patient has a history of OSA and is intermittently on CPAP at home. He may have a component of obesity hypoventilation leading to hypoxia and wheezing. TTE [**8-25**] showed borderline pulmonary artery systolic hypertension. The patient was given Nasal BiPap at night, and satted well on room air. He was given Albuterol and Atrovent nebs prn. He was scheduled for an outpatient follow up appointment with Pulmonary in the Sleep Clinic. . # Hypertension: The patient was continued on Toprol XL 100 mg daily. He was started on Lisinopril 5 mg daily, and this can be titrated up as an outpatient for further blood pressure control. . # Diabetes Mellitus Type 2: His last HgA1c was 6.2% in [**6-25**], and a repeat HgA1c during this admission was 6.5%. He was continued on Metformin 1000 mg [**Hospital1 **]. . # Depression/Anxiety: The patient has a history of depression and has had auditory hallucinations for the past 3 years. During this admission he continued to have auditory hallucinations of voices telling him he is a fraud and that he should be able to walk. He denied visual hallucinations. He denied suicidal ideation, but does wonder "what will my life become" given his frequent pain. Psychiatry was consulted during this admission. He was continued on Haldol 5 mg [**Hospital1 **], Seroquel 200 mg qhs, Celexa 40 mg daily, Xanax 2 mg qid, Buspar 10 mg tid. His Temazapam and Wellbutrin were held per psychiatry recommendations, and these can be added back as an outpatient as needed. His TSH was slightly low at 0.16 during this admission, and will need to be rechecked as an outpatient. . # Tobacco Abuse: He was started on a Nicotine patch 14 mg daily. Medications on Admission: Medications on Admission (Psych confirmed with Strand Pharmacy) -Alprazolam 2 mg QID -Buspirone 10 mg tid -Celexa 40 mg daily vs. 30 mg [**Hospital1 **] -Docusate Sodium 100 mg Capsule [**Hospital1 **] -Haloperidol 5 mg Tablet [**Hospital1 **] -Magnesium Oxide 400 mg [**Hospital1 **] -Metoprolol Succinate (Toprol XL) 100 mg daily -Metformin 1000 mg [**Hospital1 **] -Hexavitamin daily -Oxycodone 100 mg Tablet Sustained Release q8hr -Quetiapine 200 mg qhs -Tylenol 1000 mg qid prn pain -Wellbutrin SR 100 mg [**Hospital1 **] -Temazapam 30 mg qhs -Zocor 80 mg daily . Allergies: Codeine Discharge Medications: 1. Alprazolam 1 mg Tablet Sig: Two (2) Tablet PO four times a day. 2. Buspirone 10 mg Tablet Sig: One (1) Tablet PO three times a day. 3. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for constipation. Disp:*30 Tablet(s)* Refills:*2* 6. Haloperidol 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO twice a day. 8. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 9. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 10. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 11. Oxycodone 60 mg Tablet Sustained Release 12 hr Sig: 1.5 Tablet Sustained Release 12 hrs PO Q8H (every 8 hours). **** Please note: This should actually read Oxycodone 100 mg PO q8 hr (not 90 mg PO q8hr). The patient was aware of this at the time of discharge. 12. Quetiapine 100 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for breakthrough pain. 14. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). Disp:*30 Patch 24 hr(s)* Refills:*2* 15. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: PRIMARY: Altered Mental Status Respiratory Depression Hypertension . SECONDARY: Diabetes Mellitus Obstructive Sleep Apnea Depression Anxiety Tobacco Abuse Discharge Condition: Afebrile, awake and alert, ambulating with PT Discharge Instructions: 1. If you develop chest pain, shortness of breath, fever >101.5, confusion or mental status changes, falls, loss of consciousness, lightheadedness or dizziness, weakness or numbness, or any other symptoms that concern you, call your primary care physician or return to the ED. 2. Take all medications as prescribed. 3. Attend all follow up appointments. 4. Your Temazapam and Wellbutrin were held during this admission. You should ask your primary care physician or psychiatrist if and when these medications should be restarted. 5. You were started on Lisinopril 5 mg daily to help with your blood pressure. 6. You were started on a Nicotine Patch to help you stop smoking. Followup Instructions: You will need to follow up with Dr. [**Last Name (STitle) 2204**], you primary care physician ([**Telephone/Fax (1) 2205**]) in the next 1-2 weeks. His office will call you in the next few days with an appointment date and time. . You have a follow up appointment with [**Doctor First Name **] in Vascular ([**Telephone/Fax (1) 1237**]) on [**2201-2-16**] at 1:00 in VASCULAR [**Apartment Address(1) 871**] of the [**Hospital Unit Name **], [**Location (un) **]. You then have an appointment with Dr. [**Last Name (STitle) **] in Vascular ([**Telephone/Fax (1) 1237**]) on [**2201-2-16**] at 2:00. . You have a follow up appointment with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **] in the Pulmonary Sleep Clinic ([**Telephone/Fax (1) 612**]) on [**2-17**] at 9:30 in the [**Hospital Ward Name 23**] Center [**Location (un) 858**]. ICD9 Codes: 2762, 4019, 3051
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Medical Text: Admission Date: [**2201-5-15**] Discharge Date: [**2201-5-17**] Date of Birth: [**2123-7-21**] Sex: M Service: MEDICINE Allergies: Cefazolin Attending:[**First Name3 (LF) 8404**] Chief Complaint: hypotension Major Surgical or Invasive Procedure: right internal jugular central venous catheter insertion History of Present Illness: 77 year old male with a history of known 5 cm AAA and penetrating thoracic aortic ulcerations, CHF with EF 30-35%, DM, ESRD on HD(MWF) via LUE AV fistula, carotid disease, chronic dyspnea on 3LNC, previous MSSA bacteremia presents from dialysis with hypotension. Pt here from dialysis after full run with c/o bright red blood from rectum on toilet paper. Denies abd pain, CP, SOB, lightheadedness, or dizziness in dialysis. Of note, patient admitted from [**Date range (1) 29411**] for similar presenation after dialysis. He had a CT scan at that point which ruled out AAA rupture. He was initially on dopamine but once it was determined that thigh BPs were higher than arms, he was quickly weaned off. It was ultimately thought that BPs low from intravascular depletion after dialysis. He had an episode of somnolent and delirium after receiving ativan. During this admission he was also intubated on admission after reaction while getting blood and Vancomycin while hypertensive so thought to have flash pulm edema. This resolved quickly. He was guaic positive previously. . In the ED initial vitals were: 96.8 72 97/68 20 93% 3L. Triggered for BPs to 70s -> bolus. Prior to transfer, 98.6, HR 74 paced, 103/67, 16 100% 3l n/c. V-Paced, [**Doctor Last Name **] to prior. Brwn stool, guaiac positive. CBC- hct stable. Pt SBPs 90s, int then dropped to 70s, trigger x3 but asymptomatic. Cautious IVF->500cc fluids x2. Asictes thought [**1-14**] CHF in past. RIJ placed in ED for levofed on 0.01 BPs now 96/65 77. Mentating ok. Doesn't urinate a lot. . Upon arrival to the ICU, patient was asking for food but was otherwise without complaints. His SBPs in thighs showed SBPs in 200s and levofed was immediately shut off. There was noticeable difference in upper ext BPs by 100mmHG lower which had been reported previously. He reported not feeling well in the months prior but no recent changes in symptoms since recent hospital discharge. Reports having occasional episodes of spots bright red blood in toilet but no profuse bleeding. Denied CP, SOB, cough, fever, dizziness, N/V/D but did endorse abdomen more distended. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, or constipation. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: -HTN -DM -ESRD on HD MWF -PVD -Carotid stenosis -infrarenal AAA -DVT [**2195**] -Dementia -UC - quiet x 25 years -R adrenal adenoma -Gout -Prostate Ca -Kidney stones -Fe deficiency anemia -Aphasic episode - ? CVA PSH: -PM ([**Company 1543**] pacemaker, Sensia SEDR01) [**2-19**] -s/p L BK [**Doctor Last Name **]-DP w RGSVG [**6-20**] -s/p LUE AVF [**12-19**], s/p mult angioplasties -s/p prostatectomy 00 - L ureteral stent [**92**] Social History: Quit smoking at age 73. Retired as a chemical mixer from a leather tannery. No alcohol or illicit drug use. Family History: Brother had liver cancer. Father and mother had CVAs. Paternal grandfather had rectal cancer. Physical Exam: VS: Temp: 98.6 BP: 118/92 HR:78 RR: 24 O2sat 100%3L GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, jvd difficult to appreciate with line, no carotid bruits, no thyromegaly or thyroid nodules RESP: crackles at left bases, no wheezes or rhonchi CV: RR, S1 and S2 wnl, 2/6 SEM best heard at LUSB, no r/g ABD: distended with ascites, +b/s, soft, TTP in LLQ, no masses or hepatosplenomegaly appreciated, no rebound or guarding EXT: no c/c, 1+ edema to b/l knees, left 2nd toe s/p amputation, DP dopplerable b/l SKIN: no jaundice/no splinters, erythema in b/l legs c/w venous stasis changes NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. No pass-pointing on finger to nose. 2+DTR's-patellar and biceps Pertinent Results: Admission labs: [**2201-5-15**] 12:30PM BLOOD WBC-12.2*# RBC-2.74* Hgb-8.8* Hct-27.5* MCV-101* MCH-32.2* MCHC-32.0 RDW-21.6* Plt Ct-140* [**2201-5-15**] 12:30PM BLOOD PT-13.9* PTT-27.1 INR(PT)-1.2* [**2201-5-15**] 12:30PM BLOOD Glucose-77 UreaN-13 Creat-3.6* Na-145 K-3.4 Cl-97 HCO3-38* AnGap-13 [**2201-5-15**] 12:30PM BLOOD cTropnT-0.72* [**2201-5-15**] 12:30PM BLOOD CK-MB-4 [**2201-5-15**] 12:43PM BLOOD Glucose-78 Na-145 K-3.4* Cl-92* calHCO3-38* . Discharge labs: [**2201-5-16**] 08:32PM BLOOD Hct-25.6* . Microbiology: Blood culture [**2201-5-15**]: no growth to date at time of discharge MRSA screen [**2201-5-16**]: pending at time of discharge . EKG: Vpaced at 77bpm, unchanged from prior [**2201-4-4**] . Imaging: . CXR (portable AP) [**2201-5-15**]: Again seen is a pacemaker with dual leads seen projecting in the right atrium and right ventricle. The degree of enlargement of the cardiac silhouette is unchanged. There is haziness of the pulmonary vasculature suggesting mild failure. There are no pleural effusions. There is trace atelectasis seen in the left lower lobe. IMPRESSION: Mild pulmonary edema. Brief Hospital Course: 77 year old male with a 5 cm AAA and penetrating thoracic aortic ulcerations, CHF with EF 30-35%, DM, ESRD on HD(MWF) via LUE AV fistula, carotid disease, chronic dyspnea on 3LNC, previous MSSA bacteremia presents from dialysis with hypotension. . #. Hypotension/hypertension: The patient was initially thought to be hypotensive, with blood pressures in his right arm as low as the 70s. He was never symptomatic. In the emergency department, he was treated with IV fluids. Additoinally, a central venous catheter was placed in the ED, norepinephrine, and the patient was transferred to the MICU. . In the MICU, prior records were reviewed, including the partially-completed discharge summary from the patient's [**Date range (1) 29412**] admission for asymptomatic hypotension after dialysis. During this prior admission, it was determined that the blood pressures in his right upper extremity were significantly different (by 100 points) from his right thigh pressures, and it was recommended that blood pressures be checked in the patient's thigh. Based on this information, the patient's right thigh pressure was checked and was found to be in the 200s. Norepinephrine was shut off, with improvement in the patient's right thigh pressure to the 160s. As before, the patient had a significant difference between his his right arm and thigh blood pressures. Antihypertensives were initially held, but the right thigh blood pressure rose to the 230s during ultrafiltration on [**2201-5-17**]. Lisinopril and metoprolol were restarted, with improvement in the patient's right blood pressure to the 160s. The patient was never symptomatic. . Consideration was given to whether the patient's arm-thigh blood pressure difference might be a sign of acute aortic pathology. The same concern was raised during the patient's [**Date range (1) 29411**] admission, during which CT angiography of the chest from showed extensive but stable aortic atherosclerotic disease, and CTA of the abdomen and pelvis showing the patient's known abdominal aortic aneurysm without evidence of leak or rupture. . The patient's arm-thigh blood pressure difference was discussed with the vascular team who cared for the patient during his prior admission. They concluded that it was very difficult to determine the patient's true aortic blood pressure, which was probably somewhere in between the blood pressures that were being measured in the patient's arm and thigh. They thought the patient's arm pressure was probably more accurate, but that it might not be completely accurate given the patient's extensive peripheral vascular disease and the fact that he was hypotensive in the right arm but asymptomatic. . At the time of discharge, the patient's right thigh blood pressure was in the 160s, and his right arm blood pressure was in the 110s with a pediatric cuff. The patient was discharged without any medication changes, with instructions to follow up with his vascular surgeon and his primary care physician for further management of his hypertension. . #. Leukocytosis: WBC count was elevated to 12.2 on admission, but the patient had no fever or focal signs of infection. CXR showed some atelectasis but no infiltrate. The patient's oxygen requirement remained at his baseline of 3L. The patient refused to be catheterized for urinalysis and culture. A blood culture showed no growth to date at the time of discharge. . #. Right red blood per rectum: The patient's hematocrit remained stable during his admission. However, the nurses noted a very small amount of blood in the commode after the patient used it. The patient's stool was brown but guaiac positive. The reported that he occasionally saw blood on his toilet paper at home. The nurses were not certain if the bleeding was coming from the patient's GI or GU tract, but the patient refused urinalysis for further evaluation of this. The patient was instructed to follow up with his primary care doctor for further evaluation of the bleeding. . #. Anemia: Chronic. Hct stable. Likely related to chronic kidney disease +/ chronic blood loss. No concern for acute bleeding. The patient was instructed to follow up with his primary care doctor regarding the bleeding. . # Thrombocytopenia: Platelet count at baseline. . # ESRD: The patient is dialyzed on a MWF schedule and also receives ultrafiltration on Saturdays. He received ultrafiltration on [**4-16**]. He continued phoslo and B complex vitamins. . # Ascites: Tapped on previous admission with SAAG 1.3 c/w portal hypertension. Likely related to CHF. . # Peripheral vascular disease: Followed by vascular surgery as outpatient for toe amputation. The wounds appeared clean dry and intact. Aspirin, plavix, and simvastatin were continued. The patient was instructed to follow up with vascular surgery. . # DM2: On glipizide at home. The patient was monitored on an insulin sliding scale while in house and was discharged on his home dose of glipizide. . TRANSITIONAL ISSUES: -PCP [**Name9 (PRE) 702**] for bright red blood on toilet paper. The patient may also require further evaluation with colonoscopy. -Vascular surgery follow-up for recent toe amputation. -Vascular surgery and PCP [**Name9 (PRE) 702**] for [**Name9 (PRE) 29413**] BP difference and further management of hypertension. The patient should undergo arterial ultrasound of his right upper extremity to evaluate for peripheral vascular disease, although he is unlikely a candidate for intervention unless he develops symptoms. -Important info for all providers: Mr. [**Known lastname **] has very significant peripheral vascular disease and BP varies very widely in each limb. -Labs pending at time of discharge: blood culture, MRSA screen Medications on Admission: Medications at home: (discharge summary [**2201-5-7**]) 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: 1.5 (one and a half) Tablet Extended Release 24 hrs PO once a day. 4. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day: PLEASE HOLD on days of dialysis ([**Month/Day/Year 766**], Wednesday, Friday). 5. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. PhosLo 667 mg Capsule Sig: Two (2) Capsule PO three times a day: with meals. 7. glipizide 2.5 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO twice a day. 8. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 9. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 10. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary: Peripheral vascular disease Hypertension Hypotension . Secondary: End stage renal disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You came to the hospital with low blood pressure. It was determined that there is a difference between the blood pressure in your arm and the blood pressure in your thigh. Please discuss this with your vascular surgeon Dr. [**Last Name (STitle) 1391**] when you see him this week. Please also discuss this discrepancy with your primary care physician. You got some IV fluids in the emergency department and were treated with ultrafiltration on [**2201-5-16**]. You had a small amount of blood in your urine or stool, but your blood counts were stable. There are no changes to your medications. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Call your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 766**] to arrange to be seen within the next week for further management of your blood pressure. Talk to your primary care doctor about the blood that you have had in your stool and possibly your urine. Department: HEMODIALYSIS When: [**Last Name (Titles) **] [**2201-5-18**] at 7:30 AM Department: CARDIAC SERVICES When: FRIDAY [**2201-6-12**] at 11:40 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4511**], MD [**Telephone/Fax (1) 62**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 8405**] ICD9 Codes: 5856, 4280, 2749, 2875
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Medical Text: Admission Date: [**2147-9-21**] Discharge Date: [**2147-9-25**] Date of Birth: [**2075-3-2**] Sex: M Service: CARDIOTHORACIC Allergies: All allergies / adverse drug reactions previously recorded have been deleted Attending:[**Known firstname 1406**] Chief Complaint: Asymptomatic Major Surgical or Invasive Procedure: [**2147-9-21**] Coronary artery bypass graft x 3 with left internal mammary artery to left anterior descending artery, and reverse saphenous vein graft to the first diagonal artery and the first obtuse marginal artery. History of Present Illness: This 72 year old man has a history of hypertension, hyperlipidemia and CAD s/p OM and LAD stenting in [**2141-8-22**], s/p Taxus stenting of ISR of the OM1 in [**2142-7-22**]. The patient has been feeling well and recently underwent surveillance stress testing. This was notable for abnormal ST and BP response to exercise. Anterior, lateral and apical reversible defects were noted. LVEF was reported as 20% in the immediate post exercise images, 45% on resting images. He was referred for coronary angiography which showed left main disease and now is referred for surgery. Past Medical History: Coronary artery disease s/p OM and LAD stenting [**8-28**], Taxus stenting of OM1 restenosis in [**2142**] Hypertension Hyperlipidemia [**2137**] prostate cancer, s/p brachytherapy/hormone therapy ? Reiter's syndrome (patient reports no arthritis symptoms in 20 years) Squamous cell skin cancer s/p resection on [**9-5**] Social History: Race:caucasian Last Dental Exam:two weeks ago, Dentist [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] in [**Location (un) **] Lives with:Married two his second wife. [**Name (NI) **] has three children from his first marriage. Contact: [**Name (NI) 2411**] [**Name (NI) 36055**] (wife) Cell Phone #[**Telephone/Fax (1) 36056**] Occupation: Patient is a retired airline pilot. Cigarettes: Never smoked Other Tobacco use:denies ETOH: < 1 drink/week [] [**2-28**] drinks/week [x] >8 drinks/week [] Illicit drug use: Denies Family History: Family History:Sister with CABG at age 70. Physical Exam: Pulse: 41 Resp:15 O2 sat:99% B/P 145/63mmHg Height:5 feet 10 inches Weight:193 pounds 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 [] grade ______ Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds +[x] Extremities: Warm [x], well-perfused [x] Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right: 1+ Left: 1+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 1+ Left: 1+ Radial Right: 2+ Left: 2+ Carotid Bruit Right:- Left:- Pertinent Results: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 36057**] (Complete) Done [**2147-9-21**] at 9:25:57 AM PRELIMINARY Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**Known firstname **] C. Division of Cardiothoracic [**Doctor First Name **] [**First Name (Titles) **] [**Last Name (Titles) **] [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2075-3-2**] Age (years): 72 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: Intracardiac echo guidance provided for CABG. ICD-9 Codes: 410.91, 786.51 Test Information Date/Time: [**2147-9-21**] at 09:25 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2012AW3-: Machine: u/s 3 Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: 0.9 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: 1.1 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: *5.9 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 40% to 45% >= 55% Aorta - Annulus: 2.0 cm <= 3.0 cm Aorta - Sinus Level: 3.2 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.0 cm <= 3.0 cm Aorta - Ascending: 3.3 cm <= 3.4 cm Aortic Valve - Peak Velocity: *2.1 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: 17 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 7 mm Hg Aortic Valve - LVOT diam: 2.0 cm Aortic Valve - Valve Area: *1.6 cm2 >= 3.0 cm2 Findings LEFT ATRIUM: Normal LA size. Good (>20 cm/s) LAA ejection velocity. No thrombus in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal interatrial septum. LEFT VENTRICLE: Normal LV wall thickness. Mildly dilated LV cavity. Mildly depressed LVEF. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending aorta diameter. Simple atheroma in ascending aorta. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. MITRAL VALVE: Normal mitral valve leaflets with trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Written informed consent was obtained from the patient. The patient was under general anesthesia throughout the for the patient. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions Prebypass: The left atrium is normal in size. No thrombus is seen in the left atrial appendage. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. Overall estimated left ventricular systolic function is mildly depressed (LVEF= 40-45 %). There is mild hypokinesis of the anterior and anterioseptal walls of the left ventricle. Right ventricular chamber size and free wall motion are normal. 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) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results on [**2147-9-21**] at 0900. Postbypass: There is no evidence of aortic dissection. There is improved left ventricular function with estimated Ejection Fraction of 50-55%. The anteroseptal wall has improved function. I certify that I was present for this procedure in compliance with HCFA regulations. Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting physician ?????? [**2138**] CareGroup IS. All rights reserved. [**2147-9-25**] 05:45AM BLOOD WBC-8.0 RBC-3.05* Hgb-9.5* Hct-27.3* MCV-90 MCH-31.0 MCHC-34.6 RDW-13.4 Plt Ct-230 [**2147-9-21**] 11:10AM BLOOD WBC-8.5# RBC-3.38*# Hgb-10.5*# Hct-30.5*# MCV-90 MCH-30.9 MCHC-34.3 RDW-13.3 Plt Ct-168 [**2147-9-22**] 02:02AM BLOOD PT-11.5 PTT-28.1 INR(PT)-1.1 [**2147-9-21**] 11:10AM BLOOD PT-13.6* PTT-27.5 INR(PT)-1.3* [**2147-9-25**] 05:45AM BLOOD UreaN-15 Creat-0.9 Na-136 K-4.4 Cl-100 [**2147-9-21**] 12:20PM BLOOD UreaN-15 Creat-0.9 Na-142 K-4.2 Cl-110* HCO3-26 AnGap-10 [**2147-9-25**] 05:45AM BLOOD Mg-2.4 Brief Hospital Course: Mr. [**Name13 (STitle) **] was a same day admit and brought directly to the operating room where he underwent a coronary artery bypass graft x 3(with left internal mammary artery to left anterior descending artery,and reverse saphenous vein graft to the first diagonal artery and the first obtuse marginal artery) with Dr.[**Last Name (STitle) **]. Please see operative note for surgical details. Following surgery he was transferred to the CVICU for invasive monitoring in stable condition. Later this day he was weaned from sedation, awoke neurologically intact and extubated. He weaned off pressor support. All lines and drains were discontinued per protocol. Beta-blocker/Statin/ASA and diuresis were initiated.POD#1 he transferred to the step down unit for further monitoring. Physical Therapy was consulted to evaluate his strength and mobility. The remainder of his hospital course was essentially uneventful. He continued to progress. By the time of discharge on POD#4 he was ambulating well and his incisions were clean/dry/ and intact. He was discharged to home with VNA services. All follow up appointments were advised. Medications on Admission: ATENOLOL - (Prescribed by Other Provider) - atenolol 25 mg tablet 0.5 (One half) tablet(s) by mouth qam ATORVASTATIN [LIPITOR] - (Prescribed by Other Provider) - Lipitor 80 mg tablet 1 Tablet(s) by mouth qpm CLOPIDOGREL [PLAVIX] - (Prescribed by Other Provider) - Plavix 75 mg tablet 1 Tablet(s) by mouth qam EZETIMIBE [ZETIA] - (Prescribed by Other Provider) - Zetia 10 mg tablet 1 tablet(s) by mouth daily LISINOPRIL - (Prescribed by Other Provider) - lisinopril 20 mg tablet 1 tablet(s) by mouth qam NITROGLYCERIN - (Prescribed by Other Provider) - nitroglycerin 0.4 mg sublingual tablet 1 Tablet(s) sublingually every five minutes for chest discomfort. Call 911 if pain persists longer than 15 minutes Medications - OTC ASPIRIN - Prescribed by Other Provider) - aspirin 325 mg tablet 1 Tablet by mouth qam Discharge Medications: 1. Aspirin EC 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 2. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 3. Ezetimibe 5 mg PO DAILY RX *ezetimibe [Zetia] 10 mg 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 4. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 6. Metoprolol Tartrate 25 mg PO BID Hold for HR < 55 or SBP < 90 and call medical provider. [**Last Name (NamePattern4) 9641**] *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 7. Oxycodone-Acetaminophen (5mg-325mg) [**1-23**] TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen [Percocet] 5 mg-325 mg [**1-23**] tablet(s) by mouth q4-6 hours Disp #*50 Tablet Refills:*0 8. Potassium Chloride 20 mEq PO DAILY Duration: 7 Days Hold for K+ > 4.5 RX *potassium chloride 20 mEq 1 tab by mouth daily Disp #*7 Tablet Refills:*0 9. Ranitidine 150 mg PO DAILY RX *ranitidine HCl [Zantac] 150 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 10. Furosemide 20 mg PO DAILY Duration: 7 Days RX *furosemide [Lasix] 20 mg 1 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Coronary artery disease s/p Coronary artery bypass graft x Past medical history: Hypertension Hyperlipidemia s/p OM and LAD stenting [**8-28**], Taxus stenting of OM1 restenosis in [**2142**] [**2137**] prostate cancer, s/p brachytherapy/hormone therapy ? Reiter's syndrome (patient reports no arthritis symptoms in 20 years) Squamous cell skin cancer s/p resection on [**9-5**] Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema 1+ Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Surgeon: Dr. [**Last Name (STitle) **], office #[**Telephone/Fax (1) 170**], will contact you to arrange follow up appointment and wound check Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], please call to arrange follow up visit in [**1-23**] weeks Please call to schedule appointments with your Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**] in [**4-27**] 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:[**2147-9-25**] ICD9 Codes: 4019, 2724
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Medical Text: Admission Date: [**2198-3-2**] Discharge Date: [**2198-3-3**] Date of Birth: [**2144-5-1**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: GIB Major Surgical or Invasive Procedure: Endoscopy History of Present Illness: 53F with history of HCV Cirrhosis, ? ETOH, and Varices s/p banding in [**2190**] as well as known PUD, past admissions for GIB with portal hypertensive gastropathy most recently on [**11/2197**] who presents with one episode of coffee ground emesis today. Patient states that her abd has been more distended over the last 2 weeks. She was planning to have a therapeutic para, but her sister passed way this week and she missed her appointment. She has never had a paracentesis before and this is the most abd distension she has noticed. She had ~ 2.5 glasses of wine last night and today she had nausea and vomitted ~ 0.5 cup of coffee ground emesis. She denies having any bright red blood. No abd pain, no fever, no chills. She had a small amount of loose stool today. No sick contacts. [**Name (NI) **] unusual foods. She has not been able to drink or eat. She has been taking her protonix and nadolol, but may have missed one dose yesterday. This is similar to her prior upper GI episodes and she came into the ED. On arrival to the ED, 98.6 120 124/81 18 100% on arrival. She had another episode of coffee ground emesis ~ 400 mls. She was given zofran 8mg, Lorazepam 2mg, octreotide gtt, one dose of Protonix, and erythromycin. She had no NG lavage and has refused to have NG tube placed. She had a transient drop on her O2, then quickly return to 100% on 2L N/C. Her vitals have remained stable. Her labs were notable for Hct of 23.9 (her last Hct at Atrius was 21.9 in [**2199-1-5**]), INR of 2.5. Of note during her last admission in [**Month (only) **], she had EGD, colonoscopy and capsule study which did not show esophageal varices, but portal hypertensive gastropathy, angioectasias in the cecum and terminal ileum. No active source of bleeding was identified. Pt has been followed by hepatology, her last viral load was 173,000 IU/mL on 09/[**2197**]. On arrival to the ICU, pt was retching and only had scant amount of brownish fluid/bile emesis. She was given one dose of Zofran and Ativan. She refused to have NG tube placed. She denies having any pain . Review of systems: Neg for fever, chills. Feeling fatigue. Increase in abd girth. Occ SOB, no cough. No abd pain, + n/v today (as noted above), no blood or black tarrry stools noted. Voiding without difficulty, yellow urine. No yellowing of the skin. Occ muscle aches and pain for which she takes Ultram with good result. Past Medical History: - Hepatitis C c/b by varices s/p banding in [**5-15**] - h/o PUD and antral erosions in past s/p H. pylori treatment in [**9-/2194**] - Iron deficiency anemia - GERD - Hypertension Social History: She lives alone, works in marketing for the Mayor's office. Her family is in NJ. Her sister just passed away this week and she is planning to leave to NJ on Sun morning. She states that she will leave AMA if not ready for d/c on Mon morning. She states to have supportive friends. - [**Name2 (NI) 1139**]: denies - Alcohol: occasionally has a few glasses of wine when out with her friends. [**Name (NI) **] ETOH intake yesterday, ~ 2.5 glasses - Illicits: denies Family History: NC Physical Exam: General Appearance: In distress due to vomiting, pleasant and conversing HEENT: scleara non-icteric, conjuctiva non-injected, PERLA, MM dry CV: RRR, tachy, Normal S1 and S2, no m/r/g LUNGs: CTAB, no c/w/r Abd: very distended, + ascitis with fluid wave, soft, non-tender to palpation Extremities: Trace of edema on bil ankles, no cyanosis, or clubbing, no asterixus, warm, dry Neurologic: A+O x3, following commands. conversing Pertinent Results: Admission Labs: [**2198-3-2**] 06:00PM BLOOD WBC-6.3# RBC-2.68*# Hgb-6.6*# Hct-23.9*# MCV-89 MCH-24.7*# MCHC-27.7*# RDW-22.1* Plt Ct-210# [**2198-3-3**] 05:03AM BLOOD Hypochr-2+ Anisocy-1+ Poiklo-2+ Macrocy-1+ Microcy-NORMAL Polychr-OCCASIONAL Ovalocy-1+ Burr-1+ Tear Dr[**Last Name (STitle) 833**] [**2198-3-2**] 05:20PM BLOOD PT-25.7* PTT-31.9 INR(PT)-2.5* [**2198-3-2**] 06:00PM BLOOD Glucose-103* UreaN-14 Creat-0.5 Na-144 K-3.5 Cl-107 HCO3-22 AnGap-19 [**2198-3-2**] 06:00PM BLOOD ALT-29 AST-99* AlkPhos-79 TotBili-1.5 [**2198-3-2**] 06:00PM BLOOD Albumin-2.6* [**2198-3-3**] 12:03AM BLOOD Calcium-7.5* Phos-3.4 Mg-1.4* [**2198-3-2**] 06:00PM BLOOD ASA-NEG Ethanol-89* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2198-3-2**] 06:04PM BLOOD Hgb-7.1* calcHCT-21 Discharge Labs: [**2198-3-3**] 03:10PM BLOOD Hct-26.7* [**2198-3-3**] 05:03AM BLOOD WBC-5.1 RBC-2.61* Hgb-6.8* Hct-22.9* MCV-88 MCH-26.0* MCHC-29.6* RDW-21.2* Plt Ct-123* [**2198-3-3**] 05:03AM BLOOD Neuts-74.9* Bands-0 Lymphs-17.7* Monos-6.5 Eos-0.5 Baso-0.4 [**2198-3-3**] 05:03AM BLOOD Plt Smr-LOW Plt Ct-123* [**2198-3-3**] 05:03AM BLOOD PT-28.0* PTT-36.0 INR(PT)-2.7* [**2198-3-3**] 05:03AM BLOOD Glucose-129* UreaN-13 Creat-0.6 Na-145 K-3.6 Cl-113* HCO3-24 AnGap-12 [**2198-3-3**] 05:03AM BLOOD ALT-25 AST-85* AlkPhos-67 TotBili-1.6* [**2198-3-3**] 05:03AM BLOOD Calcium-7.2* Phos-2.9 Mg-1.4* Imaging: CXR: FINDINGS: Allowing for differences in technique, the cardiac, mediastinal and hilar contours appear unchanged. The lung volumes are low. No focal opacities are demonstrated. There is no pleural effusion or pneumothorax. IMPRESSION: Low lung volumes. No evidence of acute disease. Abdominal Ultrasound: prelim: IMPRESSION: Preliminary ReportLimited study demonstrates a cirrhotic liver with patent portal veins with Preliminary Reporthepatopetal flow along with moderate ascites. Endoscopy: Impression: 2 cords of grade I varices -- no evidence of recent bleeding 5-7mm clean based ulcer in the body of the stomach Edematous gastric folds with mosaic pattern consistent with hypertensive portal gastropathy Friable duodenum with multiple polyps Antral polyps Otherwise normal EGD to third part of the duodenum Recommendations: Stop protonix and octreotide gtts Monitor h/h -- transfuse to keep h/h [**8-12**] Protonix 40 mg po bid Continue nadolol - titrate as BP and HR tolerate Repeat endoscopy in 4 weeks to re-evaluate gastric ulcer Brief Hospital Course: ****Patient left Against Medical Advice**** 53F with history of HCV Cirrhosis, recent ETOH use (although patient denies despite positive serum levels) and Varices s/p banding in [**2190**] as well as known PUD, past admissions for GIB with portal hypertensive gastropathy most recently on [**11/2197**] who presents with coffee ground emesis after drinking ETOH and worsening abdominal distention. Despite multiple attempts to have patient stay for close monitoring and paracentesis after EGD, the patient decided to leave AMA. # Upper GI bleed: Received 2 units prbcs with appropriate rise in Hematocrit. Started on octreotide and pantoprazole gtts as well as ceftriaxone. EGD performed in the MICU and patient did not have any active bleeding. She continued to have varices, portal gastropathy, and a known gastric ulcer. It was felt her bleeding was likely from the portal gastropathy in setting of recent ETOH use. The patient continued to have melana and was strongly encouraged to stay for close monitoring, but the patient left AMA from the MICU despite knowing the risk of re-bleeding and death. It was also advised that she undergo a diagnostic paracentesis, but the patient did not want to wait for this procedure. She was advised to continue her pantoprazole [**Hospital1 **], nadalol and was given cipro to be taking antibiotics for 5 days. She will need a re-scope in 4 weeks. She was strongly advised to call her PCP and gastroenterologist on Monday. . # ETOH Abuse: No signs of withdrawal. Gave a banana bag as well as thiamine, folic acid, MVI and placed on CIWA protocol, but did not score. TRANSITIONAL ISSUES: - Will need repeat EGD in 4 weeks Medications on Admission: -Nadolol 60 [**Hospital1 **] (on last d/c) -Tramadol 50mg [**Hospital1 **] PRN (only taking occ) -Folic acid 1mg daily- not currently taking this -Thiamine 1mg daily - not currently taking this med -Flonase -Protonix 40mg [**Hospital1 **] - Monthly iron infusions - Iron daily Discharge Medications: 1. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. 2. nadolol 20 mg Tablet Sig: One (1) Tablet PO twice a day. 3. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 4. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day. 5. multivitamin Capsule Sig: One (1) Capsule PO once a day. 6. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 4 days. Disp:*8 Tablet(s)* Refills:*0* 7. ferrous sulfate 325 mg (65 mg iron) Tablet Sig: One (1) Tablet PO three times a day. 8. Flonase 50 mcg/Actuation Spray, Suspension Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. Discharge Disposition: Home Discharge Diagnosis: Upper GI bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted because you were vomiting blood. You were given two units of blood and the gastroenterologists performed and endoscopy and this showed an ulcer in the stomach, enlarged blood vessels in the esophagus called varices, and changes in the stomach secondary to elevated blood pressures in your gut. These findings are all secondary to your cirrhosis. You were advised to stay in the hospital for further monitoring and a paracentisis, but you left against medical advice. It is important that you stop drinking and take your medications. You should continue all of your medications with the following important addition. Cipro 500 mg twice a day for 4 more days starting [**2198-3-4**] Followup Instructions: You should follow up with your GI doctor and primary care doctor this week. PCP: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 2261**] Gastroenterologist: Dr. [**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 26390**] Phone: [**Telephone/Fax (1) 2296**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] ICD9 Codes: 2851, 4019
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Medical Text: Admission Date: [**2148-8-1**] Discharge Date: [**2148-8-6**] Date of Birth: [**2096-5-16**] Sex: F Service: CARDIOTHORACIC Allergies: Sulfa (Sulfonamide Antibiotics) / Vicodin Attending:[**First Name3 (LF) 1505**] Chief Complaint: Dyspnea on exertion, Fatigue & Palpitations Major Surgical or Invasive Procedure: Closure of ASD and baffling of anaomolous pulmonary vein [**2148-8-1**] History of Present Illness: 52 year old female with history of hypertension, non-ST segment elevation MI in [**2147-11-6**] treated with a drug-eluting stent in the mid RCA and PTCA of the posterolateral branch at [**Hospital3 **] Hospital. Was also found to have a dilated right ventricle on a TEE, but without clear-cut left to right shunting at a degree that would cause such a dilation of the right ventricle. For further exploration she underwent a cardiac MRI at [**Hospital1 18**] on [**2-16**] that showed a significant left to right shunting with Qp/Qs flow at 2.6. However, the level of the shunting was not able to be identified clearly. As a result, she then underwent a chest CTA on [**4-11**], which conclusively showed the presence of anomalous pulmonary vein return with the right superior pulmonary vein draining into the right atrium and also the right inferior pulmonary vein being confluent with the left atrium and right atrium. The patient reports having an episode week prior to cath where her heart "was racing" and she was feeling lightheaded/dizzy for about an hour and a half. She did not have any chest pain but she took 2 SL nitroglycerin and then took her night dose metoprolol finally with improvement. This is the only episode of palpitations she has had since having the MI. She continues to complain of feeling extremely fatigued. She denies any chest pain. She did report dyspnea in the hot weather and a one week history of LE edema, worsening at night. Her activity level has been low. She presented for cardiac catherization prior to correction of her anomalous pulmonary veins which showed no significant coronary artery disease. She had an E coli urinary tract infection which was treated prior to her same day admission for surgery. Past Medical History: Coronary artery disease s/p Non-ST segment elevation MI in [**2147-11-6**] treated with a drug-eluting stent in the mid RCA and PTCA of the posterolateral branch at [**Hospital1 **] Episode of Atrial Fibrillation following PCI/stenting, s/p DCCV Hypertension Obesity Past Surgical History: s/p Left ankle surgery s/p C-sections x 2 s/p Tonsillectomy Social History: Race: Caucasian Lives with: Husband Occupation: Currently unemployed Tobacco: Never smoked ETOH: Rare Family History: Remarkable for early coronary artery disease. Her brother had quintuple CABG at age 50. Her father had an MI in his 60's and her mother had an MI in her 70's Physical Exam: Pulse: 67 Resp: 13 O2 sat: 100% RA B/P Right: 139/83 Left: Ht: 5'8" Weight 115.2 kg General: No acute distress, pleasant 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 - none Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Obese Extremities: Warm [x], well-perfused [x] trace LE edema Varicosities: Both GSV were suitable without varicosities, varicose veins bilaterally behind knees Neuro: Grossly intact Pulses: Femoral Right: cath site Left: 1 DP Right: 1 Left: 1 PT [**Name (NI) 167**]: 1 Left: 1 Radial Right: 1 Left: 1 Carotid Bruit Right: none Left: none Pertinent Results: [**2148-8-5**] 04:42AM BLOOD WBC-12.8* RBC-3.19* Hgb-10.0* Hct-29.3* MCV-92 MCH-31.2 MCHC-34.0 RDW-13.9 Plt Ct-176 [**2148-8-5**] 04:42AM BLOOD Glucose-106* UreaN-16 Creat-0.6 Na-138 K-4.3 Cl-102 HCO3-29 AnGap-11 [**2148-8-4**] 05:31AM BLOOD WBC-15.9* RBC-3.14* Hgb-9.8* Hct-28.8* MCV-92 MCH-31.1 MCHC-33.9 RDW-14.0 Plt Ct-151 [**2148-8-4**] 05:31AM BLOOD UreaN-18 Creat-0.6 Na-135 K-4.2 Cl-102 [**2148-8-6**] 06:32AM BLOOD WBC-12.8* RBC-3.39* Hgb-10.5* Hct-30.4* MCV-90 MCH-31.0 MCHC-34.5 RDW-13.5 Plt Ct-241 [**2148-8-6**] 06:32AM BLOOD Glucose-97 UreaN-17 Creat-0.7 Na-136 K-3.9 Cl-97 HCO3-28 AnGap-15 [**2148-8-3**] 06:41AM BLOOD PT-12.3 INR(PT)-1.0 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 88206**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 88207**] (Complete) Done [**2148-8-1**] at 9:56:57 AM 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: [**2096-5-16**] Age (years): 52 F Hgt (in): 68 BP (mm Hg): 149/92 Wgt (lb): 253 HR (bpm): 69 BSA (m2): 2.26 m2 Indication: Intraoperative TEE for repair of ASD, repair of anomalous pulmnonary veins ICD-9 Codes: 746.9, 424.1, 424.2 Test Information Date/Time: [**2148-8-1**] at 09:56 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: Saline Tech Quality: Adequate Tape #: 2011AW2-: Machine: U/S 6 Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Ejection Fraction: >= 65% >= 55% Aorta - Ascending: 2.3 cm <= 3.4 cm Aorta - Descending Thoracic: 1.6 cm <= 2.5 cm Aortic Valve - Peak Velocity: 2.0 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: 16 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 8 mm Hg Aortic Valve - LVOT diam: 1.6 cm Findings LEFT ATRIUM: No spontaneous echo contrast or thrombus in the LA/LAA or the RA/RAA. Good (>20 cm/s) LAA ejection velocity. At least one pulmonary vein entering the right atrium. RIGHT ATRIUM/INTERATRIAL SEPTUM: PFO is present. Sinus venosus ASD. Prominent Eustachian valve (normal variant). LEFT VENTRICLE: Normal regional LV systolic function. Overall normal LVEF (>55%). RIGHT VENTRICLE: Dilated RV cavity. Normal RV systolic function. AORTA: Focal calcifications in aortic root. Normal ascending aorta diameter. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. No AS. Mild to moderate ([**1-7**]+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS. Trivial MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Mild to moderate [[**1-7**]+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. There is a congenital defect. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions PRE BYPASS No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. At least one pulmonary vein may be entering the right atrium. A patent foramen ovale is present. A sinus venosus atrial septal defect is present. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricular cavity is dilated with normal free wall contractility. 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. Mild to moderate ([**1-7**]+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST BYPASS The patient is atrially paced. There is normal biventricular systolic function. The mitral regurgitation is now mild. The sinus venosus defect has been closed though small residual flow can not be completely ruled out. The foramen ovale has also been closed. Very small pin-hole flow can be seen in the area of the foramen ovale. 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) **] [**2148-8-1**] 11:36 ?????? [**2140**] CareGroup IS. All rights reserved. Brief Hospital Course: Ms.[**Known lastname **] presented for cardiac catherization prior to correction of her anomalous pulmonary veins which showed no significant coronary artery disease. Her preoperative workup revealed an E coli urinary tract infection which was treated prior to her same day admission for surgery. On [**2148-8-1**] she was taken to the operating room and underwent repair of partial anomalous pulmonary venous return and sinus venosus atrial septal defect, and closure of patient foramen ovale. Please see operative report for further details. She tolerated the procedure well and was transferred to the CVICU intubated and sedated. She awoke neurologically intact and was extubated without difficulty. Beta-blocker/Statin/Aspirin was initiated. Diuresis was initiated. Plavix was resumed for her history of stents. All lines and drains were discontinued when criteria was met. POD#1 she was transferred to the step down unit for further monitoring. Physical Therapy was consulted for evaluation of strength and mobility. She continued to progress and was cleared for discharge to home on POD# 5. All follow up appointments were advised. Medications on Admission: Lisinopril 20 mg daily Aspirin 81 mg daily - has not been taking consistently recently secondary to GI irritation - instructed to take daily with PPI Plavix 75 mg daily Metoprolol 25 mg [**Hospital1 **] Simvastatin 80 mg daily Fish oil 1000 mg TID Allergies: Sulfa - rash Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 4. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 5. metoprolol tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*90 Tablet(s)* Refills:*2* 6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 7. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 8. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO Q12H (every 12 hours). Disp:*120 Tablet Extended Release(s)* Refills:*2* 9. Lasix 40 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Closure of ASD and baffling of anaomolous pulmonary vein [**2148-8-1**] Coronary artery disease s/p Non-ST segment elevation MI in [**2147-11-6**] treated with a drug-eluting stent in the mid RCA and PTCA of the posterolateral branch at [**Hospital1 **], Episode of Atrial Fibrillation following PCI/stenting, s/p DCCV, Hypertension, Obesity, s/p Left ankle surgery, s/p C-sections x 2, s/p Tonsillectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Tylenol Incisions: Sternal - healing well, no erythema or drainage 1+ 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 in the cardaic surgery office [**Hospital Unit Name **] Surgeon: Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] on *********** in the [**Hospital **] medical office building [**Hospital Unit Name **]. Cardiologist: [**Doctor First Name **] [**Doctor Last Name 1911**] Please call to schedule appointments with your Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 88208**] in [**4-9**] 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:[**2148-8-6**] ICD9 Codes: 4019, 412
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7354 }
Medical Text: Admission Date: [**2180-7-21**] Discharge Date: [**2180-8-5**] Date of Birth: [**2100-2-14**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 165**] Chief Complaint: Myocardial infarction Major Surgical or Invasive Procedure: [**2180-7-31**] coronary artery bypass surgey x2 (LIMA to LAD, SVG to OM 1 ) Biopsy of abdominal mass History of Present Illness: 80 y/o M PTOH w/CP and dyspnea. ECG showed 1 mm STE in V2-V3 w/bifasic T waves in V3-4, and laterally T wave inversion. EF 20% and Trop T: 0.11. Tx: ASA, lasix, NTG and taken to the cath.lab: 70%LM and 90% LAD stenosis. IABP placed at 1:1. Transfered to [**Hospital1 18**] for surgical revascularization. Pt on coumadin for AFIB, INR 3,4. Past Medical History: chronic Afib on coumadin, HTN, NIDDM, HL, CRI, MI, ccy in [**2153**], appy [**2117**] Social History: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: The blood pressure was 1442/47 mmHg supine. The pulse was 83 bpm. The respiratory rate was 18. The patient was afebrile. Generally the patient appeared to be well developed, well nourished and well groomed. The patient was oriented to person, place and time. There was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. The neck was supple with JVP of 8 cm water. The carotid waveform was normal. There was no thyromegaly. The were no chest wall deformities, scoliosis or kyphosis. The respirations were not labored and there were no use of accessory muscles. The lungs had rales at bases bilaterally 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 were irregular with a normal S1 and physiologically split S2. There were no rubs, murmurs, clicks or gallops. The abdominal aorta was not enlarged by palpation. There was no organomegaly or tenderness. 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. Pertinent Results: Conclusions PRE BYPASS The left atrium is markedly dilated. Mild spontaneous echo contrast is seen in the body of the left atrium. The left atrial appendage emptying velocity is depressed (<0.2m/s). A left atrial appendage thrombus is not seen but cannot be completely excluded. The right atrium is dilated. A patent foramen ovale is present. A left-to-right shunt across the interatrial septum is seen at rest. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is moderate regional left ventricular systolic dysfunction with mild to moderate hypokinesis of the anterior, anterolateral, anteroseptal, and apical walls. Overall left ventricular systolic function is moderately depressed (LVEF= 35 %). The right ventricle displays mild global free wall hypokinesis. There are simple atheroma in the aortic arch. The descending thoracic aorta is mildly dilated. 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 mildly thickened. Mild to moderate ([**1-14**]+) mitral regurgitation is seen. There is a small 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 in a junctional rhythm and is receiving epinephrine by infusion. There is normal biventricular systolic function with an LVEF of 55%. The mitral regurgitation is improved - now trace to mild. The tricuspid regurgitation is slightly worsened but still in the mild to moderate range. The PFO remains with left to right flow evident. The thoracic aorta appears intact. No other significant changes. 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) **] [**2180-7-31**] 18:03 ?????? [**2174**] CareGroup IS. All rights reserved. Brief Hospital Course: Mr. [**Known lastname 82846**] was admitted to the [**Hospital1 18**] on [**2180-7-21**] for further management of his myocardial infarction. As his INR was elevated due to coumadin, he was placed on heparin while awaiting his INR to to trend down. He was worked-up in the usual preoperative manner. He was noted to have a dropping hematocrit and a CT scan was performed to rule out a retroperitoneal bleed. IABP was removed. Scan showed no evidence of a retroperitoneal bleed however showed a spiculated mesenteric soft tissue mass with a punctate foci of calcification, and numerous omental/peritoneal soft tissue implants. Markedly enlarged diaphragmatic lymph nodes were also seen in the chest making the mass highly suggestive of a malignancy. The gastroenterology service was consulted for assistance in his care who suggested a biopsy. The cardiology service was also consulted in the event that a malignancy was diagnosed and stenting was a possible option. Oncology consulted and CT guided biopsy suggested carcinoid tumor. When his INR was normal, he was taken to OR on [**7-31**] for surgery with Dr. [**Last Name (STitle) **]. Transferred to the CVICU in stable condition on epinephrine, propofol, and insulin drips. Extubated the next morning and awoke neurologically intact. Transferred to the floor on POD #1 . His temporary pacing wires and chest tubes were removed per protocol. He was in atrial fibrillation and developed brdaycardia. Electrophysiology and a pacer was considered by deemed not necessary as his heart rate stabilized. His couamdin for atrial fibrillation was resumed. Dr. [**Last Name (STitle) **] will resume coumadin follow up. Mr [**Known lastname 82846**] was evaluated by physical therapy and cleared for discharge to home on POD #5. Medications on Admission: Glyburide, Atenolol, Zestril, Coumadin Discharge Medications: 1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 1 months. Disp:*60 Tablet(s)* Refills:*0* 2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 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. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 7 days. Disp:*7 Tablet(s)* Refills:*0* 8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 9. Warfarin 1 mg Tablet Sig: Six (6) Tablet PO DAILY (Daily): dosed by Dr. [**Last Name (STitle) **]. 10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. 11. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day. 12. Outpatient Lab Work INR check on monday [**2180-8-7**] and call results to Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 64750**] Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Coronary artery disease s/p coronary artery bypass surgey x2 MI Abdominal mass PMH: Atrial fibrillation, hypertension, diabetes, hyperlipidemia, chronic renal insufficiency PSH: open Cholecystectomy [**2153**], open appendectomy [**2117**], right shoulder surgery remote Discharge Condition: good Discharge Instructions: no lotions, creams , or powders on any incision shower daily and pat incisions dry no driving for one moneth AND off all narcotics no lifting greater than 10 pounds for 10 weeks call for fever greater than 100, redness, drainage, or weight gain of 2 pounds in 2 days or 5 pounds in one week. follow the instructions provided for your [**Doctor Last Name **] of hearts monitor. call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Dr. [**Last Name (STitle) **] in 3 weeks at [**Hospital1 **] for wound check and post-op follow-up : [**Telephone/Fax (1) 6256**] Dr. [**Last Name (STitle) 14334**] in 3 weeks Next INR check on monday [**2180-8-7**] Dr. [**Last Name (STitle) **] will follow your INR and dose your coumadin also make a follow up appointment to be seen by Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 64750**] in 2 weeks [**Doctor Last Name **] of Hearts - Dr. [**Last Name (STitle) 73**] (cardiologist)to follow [**Telephone/Fax (1) 62**] Follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (surgery) [**Telephone/Fax (1) 673**] and Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (oncologist)[**Telephone/Fax (1) 9645**] reagrding your abdominal biopsy. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2180-8-5**] ICD9 Codes: 4280, 4019, 2724
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Medical Text: Admission Date: [**2184-4-7**] Discharge Date: [**2184-4-21**] Date of Birth: [**2112-6-18**] Sex: F Service: MEDICINE Allergies: Morphine Attending:[**First Name3 (LF) 1253**] Chief Complaint: Melena Major Surgical or Invasive Procedure: EGD PICC line placement History of Present Illness: 71 year old female with history of AF on coumadin, CHF with EF 35%, t2DM on insulin, CAD/PVD s/p multiple stenting and interventions presents with 4 days of dark stools. She has been stooling about 3x/day for these past 4 days, accompanied by a decrease in appetite and headaches. 1 day prior to admission, she began to feel increasingly dizzy and weak, with the onset of chills but no documented fevers. She was unable to walk today on her own and was instructed to be taken to the Emergency Room. She denies any recent weight loss, hematemesis, hematochezia, bruising/mucosal bleeding, chest pain, or palpitations. No recent NSAID use. She does endorse shortness of breath with minimal activity, no different than her baseline. She also states that while someone comes to her house every week to check her INR, no one had come this week and she missed her check (confusion with not hearing the doorbell when VNA arrived). She was supposed to have it checked this Friday. In the ED, initial vitals were 98.0, 88/60, 57, 20 and 97% on RA. Labs notable for BUN 132, Cr 2.1, WBC 20.1 (N 86, 0 bands), Hb 5.9 / Hct 19.0 (re-check 17), INR 4.1. U/A large blood, mod bact, trace leuks. Patient was given 1 unit FFP, 2 units pRBCs, vit K 10mg IM, and acetaminophen x1 for headache. She was seen by GI who recommended reversing the INR, PPI drip, and NG lavage (which patient refused), and blood cx's. She was sent to the ICU with an 18g in R foot and 22g in R hand. No other available peripheral access. Vitals on transfer: 97.1, 105/64, 72, 16 and 100% on 2L. In the ICU, she is hemodynamically stable and is pleasant and conversive, visiting with family. She still has a headache, but has not had a melenotic stool yet. Review of systems: (+) Per HPI (-) Denies fever, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations. Denies nausea, vomiting, diarrhea. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. Past Medical History: 1. Diabetes 2. Hypertension 3. Coronary artery disease - MI [**2168**] - PCI [**2173-6-29**] - Cath [**7-21**] 4. Atrial fibrillation 5. CHF, EF 35% ([**Hospital1 112**] TTE on [**11/2182**]), LVH, mod TR/pulm HTN 6. PVD s/p multiple lower ext bypasses 7. CKD (baseline Cr 1.2) 8. Colonic adenoma (on [**2180-4-13**]) 9. Anxiety 10. Gout Social History: Lives with daughter, spends most of the day alone, but has a "lifeline" for emergencies. Able to get up and down her stairs with some difficulty. Occupation: homekeeper Tobacco: quit in [**2178**], 10pack years, EtOH: denies Family History: Lung cancer - son CAD/PVD - mother, maternal grandmother Physical Exam: Vitals: T: 98.5, BP: 111/42, P: 57, R: 20, O2: 100% on 2L General: Alert, oriented, no acute distress, pleasant HEENT: NC/AT, PERRL, EOMI, sclera anicteric, conjunctivae pale, dry MM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: irregularly irregular, normal S1 + S2, II/VI holosystolic murmur best heard over LLSB; no rubs or gallops Abdomen: obese, soft, mildly tender in RUQ (no [**Doctor Last Name 515**]), non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly appreciated GU: foley in place Ext: trace edema B/L, right leg slightly cooler than the left, 1+ pulses; no clubbing, cyanosis; scarring from previous bypass surgeries over left lower leg Pertinent Results: EGD ([**2184-4-8**]): Erythema and erosion in the stomach body compatible with gastritis. Diverticulum in the unlcear - somewhere between the second and fourth part of the duodenum. Just proximal to the diverticulum a large necrotic area was seen on the side wall of the duodenum. The full extent could not be visualized. There was fresh and old blood pooling throughout the duodenum with no obvious source. With extensive washing this was confined to the regiion between the second and fourth portions of the duodenum. There were several large clots in this area preventing full visualzation of the underlying mucosa. Otherwise normal EGD to third part of the duodenum. . CT ABD & PELVIS W/O CONTRAST Study Date of [**2184-4-10**] Final Report INDICATION: Recent GDA embolization. Assess for duodenal wall ischemia. TECHNIQUE: Axial imaging post-oral contrast medium was performed from the lung bases to pubic symphysis. Intravenous contrast was not administered due to renal impairment. FINDINGS: The majority of the oral contrast had passed through the duodenum at the time of imaging. A 2.3 x 3.1 cm duodenal diverticulum is present at the junction of D3 and D4 (series 2, image 35). Oral contrast is retained within the diverticulum with evidence of layering. No proximal obstruction is identified. No intramural air is present and there is no significant stranding around the duodenum. Embolization clips are present in the gastroduodenal artery. . Non-contrast imaging of the liver, spleen, pancreas are normal. The gallbladder appears distended and hyperdense. The increased density is likely related to vicarious excretion of the contrast from the embolization procedure. The renal cortex also appears dense again likely related to delayed excretion of the contrast from the embolization procedure. A 17-mm nodule is present in the left adrenal gland with mean Hounsfield units of -100. Features consistent with a myelolipoma. The right adrenal gland is normal. Extensive colonic diverticulosis is present. PELVIS: No small or large bowel obstruction. Diverticulosis as noted above. Review of the lung bases demonstrates right-sided linear atelectasis with pleural thickening. Minor pleural thickening is also present in the left base. Cardiomegaly is noted. Bone review is unremarkable. IMPRESSION: There is a duodenal diverticulum at the junction of D3 and D4. The duodenal wall appears normal. . [**2184-4-21**] ABDOMEN (SUPINE & ERECT) Preliminary Report !! PFI !! No evidence of obstruction or perforated viscus. . URINE CULTURE (Final [**2184-4-16**]): ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. Piperacillin/tazobactam sensitivity testing available on request. ENTEROCOCCUS SP.. 10,000-100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | ENTEROCOCCUS SP. | | AMPICILLIN------------ 8 S <=2 S AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S <=16 S TETRACYCLINE---------- <=1 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S VANCOMYCIN------------ 1 S . . [**2184-4-7**] 11:14AM BLOOD WBC-20.1*# RBC-2.28*# Hgb-5.9*# Hct-19.0*# MCV-83 MCH-25.9* MCHC-31.2 RDW-18.6* Plt Ct-307 [**2184-4-20**] 03:04AM BLOOD WBC-8.2 RBC-3.34* Hgb-9.8* Hct-28.4* MCV-85 MCH-29.4 MCHC-34.5 RDW-16.8* Plt Ct-474* [**2184-4-7**] 11:14AM BLOOD Glucose-156* UreaN-132* Creat-2.1* Na-137 K-4.8 Cl-103 HCO3-20* AnGap-19 [**2184-4-21**] 04:17AM BLOOD Glucose-162* UreaN-42* Creat-1.1 Na-138 K-4.5 Cl-106 HCO3-27 AnGap-10 [**2184-4-21**] 04:17AM BLOOD Calcium-9.1 Phos-2.6* Mg-1.8 [**2184-4-21**] 04:17AM BLOOD Triglyc-186* . INR (On Warfarin 5 mg po q day since [**4-14**]); dose increased at discharge. [**4-17**] 1.3 [**4-19**] 1.5 3.9 1.3 Brief Hospital Course: 1. Gastrointestinal bleed. Presented with upper GI bleed requiring massive transfusion (9 units within first 24 hours). EGD showed large necrotic duodenal lesion of unclear nature. After patient declined surgerical intervention, interventional radiology performed angiography with prophylactic embolization of the gastroduodenal artery. Given desire to promote as much healing as possible, patient was kept NPO and TPN was initiated. After bowel rest for ~week, oral feeding was restarted and attempted to wean TPN off, however pt continued to have poor po intake and some nausea with po intake. GI is to see the patient in follow-up on [**2184-4-22**] with possible repeat EGD for biopsy to be scheduled. Per discussion with Gastroenterology consult, planning for EGD/biopsy approx [**7-20**] weeks to allow stabilization of embolized territory. Regarding anti-coagulation, given history of CAD with prior MI and stenting, aspirin was felt ideal with low-dose (81 mg) used. Similarly, given stroke risk in atrial fibrillation, warfarin was restarted. She was started on Warfarin 5 mg po q day, but her INR did not increase, so her dose was increased at discharge to 7 mg po q day. 2. Congestive heart failure. No evidence of fluid overload on admission, but did devlop some SOB and crackles after massive transfusion in the ICU. At the time of discharge, remained off furosemide with excellent saturations. Her other chronic CHF medication, metoprolol, was also held during much of the hospitalization. Initially this was in setting of her GI bleed. Over the last days of admission, her HR would range in the 40s-50s (asymptomatic) so it remained on hold. 3. Acute on chronic renal failure. Elevated to 2.1 in the setting of hypovolemia; improved with blood. Pt later developed worsened Bun/Cr in the setting of treatment of UTI with Bactrim; her Cr gradually improved after discontinuation. 4. Diabetes mellitus. Patient presented on high-dose of lantus insulin. While NPO she did not require lantus and while on TPN she recieved 15 units with each infusion. 5. Coronary artery disease. Aspirin as above. Metoprolol was discontinued due to GI bleed and persistent bradycardia. 6. Right buttock pain. Chronic in nature. Used dilaudid/lyrica; lidocaine patch was not helpful. 7. Urinary tract infection. Noted to have dysuria and positive UA with bactrim sensitive e.coli. Pt received Bactrim for 3 days with resolution of symptoms. Communication: [**Name (NI) 46144**] [**Known lastname 174**] - son and HCP ([**Telephone/Fax (1) 46145**]) Code: Full (discussed with patient) Medications on Admission: Medications (confirmed with HCP and prior records): *Calcium 600mg daily *ASA 325mg daily *Colace 100mg daily *Coumadin 8mg daily *Simvastatin 40mg daily *Metoprolol 25mg [**Hospital1 **] *Lasix 40mg QAM *Lasix 40mg QAM (M,W,F) *Lasix 20mg QPM (T,Th,[**Last Name (LF) **],[**First Name3 (LF) **]) *Omeprazole 20mg [**Hospital1 **] *Allopurinol 100mg daily *Lyrica 300mg daily *Trazodone 50mg-100mg QHS *Lantus 52 units qhs *Novolog sliding scale Discharge Medications: 1. calcium carbonate 600 mg (1,500 mg) Tablet Sig: One (1) Tablet PO once a day. 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 5. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 7. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. pregabalin 75 mg Capsule Sig: Four (4) Capsule PO DAILY (Daily). 9. trazodone 50 mg Tablet Sig: 1-2 Tablets PO at bedtime as needed for insomnia. 10. Humalog 100 unit/mL Solution Sig: as directed Subcutaneous four times a day: Please see attached sliding scale. 11. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO every eight (8) hours as needed for nausea. 13. polyvinyl alcohol-povidone 1.4-0.6 % Dropperette Sig: [**2-15**] Drops Ophthalmic PRN (as needed) as needed for dry eyes. Discharge Disposition: Extended Care Facility: [**Hospital **] Rehab Discharge Diagnosis: 1. Acute blood loss anemia 2. Duenodenal necrosis 3. GI bleeding 4. CAD, native vessel 5. Diabetes, type II, controlled with complications 6. CKD, stage II 7. Malnutrition, moderate 8. Atrial fibrillation 9. Urinary tract infection Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Clear and coherent. Discharge Instructions: You were admitted with bleeding from your gastrointestinal tract (possibly from a large necrotic lesion in the duodenum). After many blood transfusions your blood counts have stabilized. Given that you need to be on aspirin and coumadin long-term, it will be important that you remain attentive to the possibility of future bleeding. Followup Instructions: Rehabilitation will schedule a follow-up appointment with your PCP. Name: [**Last Name (LF) 26390**], [**First Name7 (NamePattern1) 449**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Specialty: Gastroenterology Location: [**Hospital1 641**] Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 2296**] Appointment: Thursday, [**4-22**] at 2:40PM ICD9 Codes: 2851, 5849, 5990, 2761, 5859, 4280
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7356 }
Medical Text: Admission Date: [**2184-9-12**] Discharge Date: [**2184-9-21**] Service: MEDICINE Allergies: Penicillins / Sulfonamides / Tetracyclines Attending:[**First Name3 (LF) 710**] Chief Complaint: generalized weakness, anorexia Major Surgical or Invasive Procedure: Left internal jugular tunneled hemodialysis catheter [**2184-9-16**] History of Present Illness: [**Age over 90 **] y/o [**Age over 90 **] y/o F w/ AFib on coumadin, tachy-brady syndrome s/p PPM, CKD, and diastolic CHF a/w malaise, weakness, and decreased PO intake for two days and an episode of urinary incontinence the night prior to admission. Per the patient's family, she felt well until 2 days ago when she noted multiple episodes of diarrhea in the setting of an increase in her laxative regimen intended to treat constipation and associated abdominal discomfort. She has not had any recent antibiotic use or health care exposures. She denies fevers, chills, dysuria, hematuria, flank pain, or changes in mental status. Family does state that renal function has steadily declined over the past 6 months for which she has been followed closely by a nephrologist. . In the ED VS 96.2, 60, 110/64 19 99% 2L. EKG unchanged from prior. Had transient fluid-responsive systolic hypotension to SBP 85. Received levofloxacin 750 mg x1. She was transferred to the MICU for close observation given hypotension in the setting of delicate volume status. Past Medical History: AFib Tachy-brady s/p PPM [**3-9**] CKD stage IV b/l ~Cr 2.2 SCC leg and neck s/p radiation [**1-9**] 4+ TR 2+ MR [**First Name (Titles) **] [**Last Name (Titles) **] HTN Hypothyroidism HTN IBS Anemia b/l Hct ~34% Diverticulosis Social History: Retired. No current alcohol or tobacco use. Dtrs very active in her care. Lives in house in [**Location (un) 10059**] with live-in aide. Family History: Noncontributory Physical Exam: ADMISSION PHYSICAL EXAM VS: 96.2 108/60 72 18 96% RA Gen: NAD, Alert, Oriented to Location, Person, but not to date HEENT: PERRLA, EOMI, Dry MM Neck: Supple, No LAD, No appreciable JVD CV: reg rate (paced) nl S1S2 no m/r/g [**Location (un) **]: Decreased BS on R Abd: Soft, mildly-distended, NT BS+ Extrem: warm, dry 2+ pitting edema to knees bilaterally Pertinent Results: [**2184-9-19**] HEPARIN DEPENDENT ANTIBODIES TEST RESULT ---- ------ HEPARIN DEPENDENT ANTIBODIES NEGATIVE COMMENT: NEGATIVE FOR HEPARIN PF4 ANTIBODY BY [**Doctor First Name **] . [**2184-9-12**] 11:30AM URINE BLOOD-MOD NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-TR [**2184-9-12**] 11:30AM URINE RBC-[**5-11**]* WBC-[**5-11**]* BACTERIA-MOD YEAST-NONE EPI-0-2 . [**2184-9-12**] 9:24 pm URINE Site: CLEAN CATCH Source: Catheter. **FINAL REPORT [**2184-9-17**]** URINE CULTURE (Final [**2184-9-17**]): IDENTIFICATION AND SENSITIVITIES REQUESTED BY DR.[**Last Name (STitle) 99804**]. STAPH AUREUS COAG +. ~1000/ML. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- =>8 R NITROFURANTOIN-------- <=16 S OXACILLIN------------- =>4 R PENICILLIN G---------- =>0.5 R TETRACYCLINE---------- <=1 S TRIMETHOPRIM/SULFA---- <=0.5 S VANCOMYCIN------------ <=1 S . [**2184-9-12**] CHEST RADIOGRAPH, PA AND LATERAL Dual-lead right pectoral pacemaker with right atrial and right ventricular leads is unchanged from prior studies. Cardiomegaly is again noted, although the right heart border is now obscured by right basilar opacity which also obscures the right hemidiaphragm, consistent with moderate-sized pleural effusion and related atelectasis, although underlying pneumonic consolidation cannot be excluded. There is also a small left pleural effusion with milder left retrocardiac atelectasis. The remainder of the lungs are grossly clear, without evidence of overt pulmonary edema or lung consolidation . There is no evidence of pneumothorax. Calcifications are again noted along the aorta. Old right lateral rib fracture is unchanged. IMPRESSIONS: Increased right basilar opacity, with increased and now moderate-sized right pleural effusion, and related atelectasis, although underlying pneumonic consolidation cannot be excluded. Small left pleural effusion with left basilar atelectasis. . [**2184-9-14**] TTE The left atrium is mildly dilated. The right atrium is markedly dilated. The estimated right atrial pressure is 10-20mmHg. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF 55-60%). The right ventricular cavity is moderately dilated with mild global free wall hypokinesis. There is abnormal diastolic septal motion/position consistent with right ventricular 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. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. The tricuspid valve leaflets fail to fully coapt. Severe [4+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. Significant pulmonic regurgitation is seen. The main pulmonary artery is dilated. There is a trivial/physiologic pericardial effusion. IMPRESSION: Dilated right ventricle with mild global systolic dysfunction and evidence of volume overload. Normal global and regional left ventricular systolic function. Mild aortic regurgitation. Mild mitral regurgitation. Severe functional tricuspid regurgitation. Compared with the prior study (images reviewed) of [**2184-7-2**], findings are similar. Left ventricular systolic function may have been slightly underestimated on the prior study. . [**2184-9-16**] VASCULAR U/S-GUIDED CATHETER PLACEMENT FINDINGS: 1. Patent left internal jugular vein, accessed under son[**Name (NI) 493**] guidance. 2. Placement of tunneled 15.5 French x 27 cm cuff-to-tip angiodynamics hemodialysis catheter via the left internal jugular vein. 3. Post-procedure chest radiograph showed the catheter tip in the right atrium with no kinks along the course of the catheter and no pneumothorax. Incidental note is made of atrioventricular pacing wires in expected position placed through the right subclavian vein. IMPRESSION: Successful placement of left internal jugular tunneled hemodialysis catheter. The catheter is ready for immediate use. Brief Hospital Course: #CKD stage IV - The patient presented with symptoms consistent with uremia. Volume overload was refractory to diuretic therapy due to worsening renal function. Left IJ tunneled HD catheter was placed on [**9-16**] with subsequent initiation of hemodialysis that day, followed by [**9-17**], [**9-18**], [**9-20**], and [**9-21**]. Nephrocaps were added. Lasix and [**Last Name (un) **] were discontinued. Phosphate binder therapy was not added as the calcium-phosphate product was approximately 18. PPD was read as 0 mm induration on [**9-19**]. The patient will continue to receive HD as an outpatient. . #Acute on chronic diastolic CHF - Admission CXR showed a moderately-sized right pleural effusion with associated atelectasis and a small left pleural effusion with left basilar atelectasis. TTE [**9-14**] showed a dilated RV with mild global systolic dysfunction and evidence of volume overload, normal global and regional LV systolic function (LVEF 55-60%), and severe functional TR and mild AR/MR. Respiratory status remained stable with adequate room air oxygenation. Volume status was managed with HD, as above. . #Thrombocytopenia - The patient did not have clinical signs or symptoms of bleeding or thrombosis. Attributed to an effect of cephalosporin therapy but other possible offending medications including heparin, protonix, and atorvastatin were discontinued. Indwelling catheter was flushed with citrate solution rather than heparin during HD sessions. PF4 antibody was negative. The patient will have a repeat CBC two days after discharge to continue to monitor platelet count. . #Anemia of chronic kidney disease - Hematocrit remained stable, obviating the need for transfusion. She may continue to receieve erythropoeitin therapy as an adjunct to hemodialysis. . #UTI - Admission urinalysis showed [**5-11**] WBC, moderate bacteria, and trace leukocyte esterase. She was treated with 3 days of ceftriaxone until urine culture revealed ~1000 colonies MRSA, likely a skin contaminant. She was placed on contact precautions accordingly. . #Atrial fibrillation - Anticoagulation was reversed with vitamin K and FFP prior to HD catheter placement. Coumadin was resumed after the procedure with a goal INR 2.0-3.0. The patient will be discharged with VNA services to monitor INR and adjust coumadin dosing accordingly. . #Hypertension - Blood pressure was low-normal during the hospitalization and metoprolol was decreased to 25 mg qHS due to concerns for hypotension, particularly in the setting of hemodialysis. . #Hypothyroidism - Continued levothyroxine. . #Nutrition - Heart-healthy diet. Calcium and vitamin D were continued. Medications on Admission: ATORVASTATIN 10 mg PO daily EPOETIN ALFA 40,000 units SC Q2wks FUROSEMIDE 20 mg PO QOD HYDROCORTISONE-PRAMOXINE CREAM (1 %-1%) TP to hemorrhoids TID LEVOTHYROXINE 50 mcg PO daily LOSARTAN 25 mg PO daily METOPROLOL SUCCINATE - 50 mg PO QAM, 25 mg PO QPM PANTOPRAZOLE - 40 mg PO Daily POLYETHYLENE GLYCOL 1 tablespoon powder PO Daily WARFARIN 2.5 mg Tablet PO Daily Restasis *NF* 0.05 % OU [**Hospital1 **] to each eye Citalopram Hydrobromide 10 mg PO QHS CALCIUM CARBONATE 600 mg (1,500 mg) Tablet - 2 Tabs PO BID ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 400 unit Tablet 1 tab PO daily Discharge Medications: 1. Cyclosporine 0.05 % Dropperette Sig: One (1) Dropperette Ophthalmic [**Hospital1 **] to each eye (). 2. Citalopram 10 mg Tablet Sig: One (1) Tablet PO at bedtime. 3. Lactaid 3,000 unit Tablet Sig: One (1) Tablet PO QAC (). 4. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Polyethylene Glycol 3350 100 % Powder Sig: One (1) tablespoon powder PO once daily as directed. 6. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 7. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM: Adjust dose as directed to maintain INR 2.0-3.0. 8. Nystatin 100,000 unit/g Cream Sig: One (1) application Topical twice a day as needed for itching. 9. Outpatient Lab Work Please check complete blood count on Thursday, [**9-23**] and fax the results to the office of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 716**]. 10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO twice a day: hold for sbp<100. 11. Home Equipment Please provide a hospital bed for home. 12. Citracal + D 315-200 mg-unit Tablet Sig: Two (2) Tablet PO twice a day. 13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for constipation. Disp:*30 Tablet(s)* Refills:*0* 14. Medication You may continue taking your hydrocortisone-lidocaine compound topically as needed for discomfort due to hemorrhoids. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary 1) Chronic kidney disease stage V on hemodialysis 2) Acute on chronic diastolic heart failure 3) Thrombocytopenia 4) Urinary tract infection Secondary 1) Atrial fibrillation 2) Anemia of chronic kidney disease 3) Hypothyroidism Discharge Condition: clinically improved with stable vital signs. Discharge Instructions: You were admitted to the hospital with generalized weakness and poor appetite most attributable to worsening kidney function, or uremia. A catheter was placed and hemodialysis was initiated on [**2184-9-16**]. Your next hemodialysis session is at [**Location (un) **] [**Location (un) **] on Thursday, [**9-23**] at 3:00 PM. You will continue to have dialysis on Tuesdays, Thursdays, and Saturdays. You were also found to have a low platelet count likely due to an effect of medication. Antibiotics, protonix, and lipitor, all of which can cause this problem, were discontinued. Please have a complete blood count checked on Thursday, [**9-23**] and ensure that the results are faxed to the office of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 716**]. The follow medications were changed: 1) Vitamins called nephrocaps were started. 2) Lasix and losartan were discontinued as you will continue to receive hemodialysis. 3) Metoprolol was decreased to 12.5 mg twice daily due to low blood pressure. 4) Calcium and vitamin D were changed to a combination pill called Citracal+D, 2 tablets twice daily. 5) Citalopram (celexa) was increased to 10 mg (1 full tablet) daily. Please weigh yourself daily and call your physician if your weight increases by more than 3 pounds. Please adhere to diet containing than 2 grams of sodium daily. Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Wednesday [**9-29**] at 4:00 PM. If you need to reschedule this appointment, please call [**Telephone/Fax (1) 719**]. Please call your physician or return to the Emergency Department immediately if you experience fever, chills, sweats, dizziness, lightheadedness, passing out, falling, chest pain, palpitations, shortness of breath, cough, abdominal pain, vomiting, diarrhea, bloody or dark stools, discomfort with urination, or leg swelling or pain. Followup Instructions: Your next hemodialysis session is at [**Location (un) **] [**Location (un) **] on Thursday, [**9-23**] at 3:00 PM. You will continue to have dialysis on Tuesdays, Thursdays, and Saturdays. Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Wednesday [**9-29**] at 4:00 PM. If you need to reschedule this appointment, please call [**Telephone/Fax (1) 719**]. Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2184-10-22**] 10:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2184-10-22**] 10:40 Completed by:[**2184-9-21**] ICD9 Codes: 5849, 5990, 4280, 2875, 2859
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Medical Text: Unit No: [**Numeric Identifier 64480**] Admission Date: [**2180-11-4**] Discharge Date: [**2181-4-20**] Date of Birth: [**2180-11-4**] Sex: F Service: NB This is a discharge addendum. A prior discharge dictation has already been dictated. Please see prior discharge summary for detailed history of present illness, physical exam and hospital course up until [**2181-4-12**]. This is a discharge addendum discussing her hospital course from [**4-12**] to [**2181-4-20**]. Respiratory: [**Known lastname 64481**] returned from her G-tube placement on [**2181-4-12**], and required a mild amount of nasal cannula oxygen postoperatively. She continued to require this oxygen for 2-3 days following the G-tube placement and developed a cough and some mild rhinorrhea. At this time a viral respiratory panel was sent. It was found that she had parainfluenza virus. She continued on nasal cannula oxygen until [**2181-4-18**], and since that time has remained in room air. She has occasional desaturations for which she responds spontaneously. Her cough is much improved at this time. She has been off oxygen for 3 days prior to discharge and is doing well. She should be followed closely. The parents have been instructed as to what symptoms to watch for for signs and symptoms of croup. Gastrointestinal: [**Known lastname 64481**] had her G-tube placed on [**2181-4-12**]. We were able to start using it on [**2181-4-13**]. She had no problems with this. She had some mild erythema around it to which bacitracin was placed, but now it is looking well. It is just to be cleaned with tap water daily. There are no concerns about the use of the G-tube, and she is tolerating it well. She is currently receiving 165 cc/kg per day of Enfamil. The grandmother has been taught how to use the G- tube. She is to receive 4 bolus G-tube feeds during the day and continuous feeds from 11 p.m. to 5 a.m. Her growth has been good on this regimen. She is to be discharged with this. Her discharge weight is 4775 grams. ID: Parainfluenza virus was obtained from nasal secretions on [**2181-4-17**]. She did have symptoms including a conjunctivitis, rhinorrhea and a cough that were all consistent with this infection. She was treated for a 7-day course of erythromycin ointment for conjunctivitis. This has cleared nicely. She has been off any ointment for 2 days prior to discharge. CONDITION ON DISCHARGE: Stable. DISCHARGE DISPOSITION: To home with her grandparents. She is in DSS custody, but her grandparents will have physical custody. PRIMARY PEDIATRICIAN: Dr. [**Last Name (STitle) **] in [**Location (un) 5165**], [**State 350**]; phone number [**Telephone/Fax (1) 64482**]. CARE RECOMMENDATIONS: She is being discharged to home on Enfamil 20 calories per ounce at 165 cc/kg per day with a regimen of 4 bolus feeds during the daytime and continuous feeds at nights. MEDICATIONS: 1. Zantac. 2. Reglan. 3. Iron as described in the prior dictation. She has passed a carseat examination. She has received newborn state screening as above. She received her immunizations as dictated in the prior discharge summary. DISCHARGE DIAGNOSES: As above in the prior discharge summary and additional. 1. Parainfluenza virus. 2. Gastrostomy tube placement. 3. Aspiration. [**First Name11 (Name Pattern1) 3692**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 27992**], MD Dictated By:[**Last Name (NamePattern4) 64483**] MEDQUIST36 D: [**2181-4-20**] 12:16:12 T: [**2181-4-20**] 12:56:19 Job#: [**Job Number 64484**] ICD9 Codes: 769, 7742, V053
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7358 }
Medical Text: Admission Date: [**2197-12-13**] Discharge Date: [**2197-12-18**] Date of Birth: [**2142-10-5**] Sex: M Service: CARDIOTHORACIC Allergies: Antihistamines - 1st Generation Classif. / Nsaids Attending:[**First Name3 (LF) 922**] Chief Complaint: unstable angina Major Surgical or Invasive Procedure: Coronary artery bypass grafts x 3 (LIMA-LAD, SVG-OM, SVG-DG) [**12-15**] left heart catheterization, coronary angiography History of Present Illness: This 55 year old white male had the onset of angina with minimal exertion two months ago. he had a positive exercise stress test and was referred for catheterization. This was done to reveal 50% left main and double vessel disease of the left system. He was kept in house for revascularization. Past Medical History: hypertnsive hypercholesterolemia s/p lens implant O.D. Social History: remote smoker social ETOH use works in an office lives with his wife Family History: grandfather had an MI at age 59 Physical Exam: Admission: VSS, Afebrile Neuro- intact lungs- clear Cor-RSR w/o murmur Exts- benign. Pulses symmetric and normal Pertinent Results: [**2197-12-17**] 06:40AM BLOOD WBC-12.0* RBC-2.99* Hgb-9.2* Hct-25.1* MCV-84 MCH-30.7 MCHC-36.6* RDW-13.3 Plt Ct-210 [**2197-12-16**] 01:41AM BLOOD WBC-15.4* RBC-3.49* Hgb-10.7* Hct-29.1* MCV-83 MCH-30.6 MCHC-36.8* RDW-13.1 Plt Ct-292 [**2197-12-17**] 06:40AM BLOOD Glucose-123* UreaN-14 Creat-1.0 Na-137 K-4.1 Cl-104 HCO3-25 AnGap-12 [**2197-12-16**] 01:41AM BLOOD Glucose-78 UreaN-8 Creat-0.7 Na-139 K-3.9 Cl-109* HCO3-26 AnGap-8 [**2197-12-13**] 09:50AM BLOOD ALT-50* AST-20 CK(CPK)-41 AlkPhos-69 Amylase-23 TotBili-0.8 [**2197-12-15**] 06:34PM BLOOD Type-ART pO2-128* pCO2-45 pH-7.37 calTCO2-27 Base XS-0 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 80696**] (Complete) Done [**2197-12-15**] at 3:52:21 PM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 177**] C. [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2142-10-5**] Age (years): 55 M Hgt (in): 66 BP (mm Hg): 120/60 Wgt (lb): 176 HR (bpm): 60 BSA (m2): 1.90 m2 Indication: coronary artery disease ICD-9 Codes: 786.05 Test Information Date/Time: [**2197-12-15**] at 15:52 Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2009AW01-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *1.3 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.3 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 4.6 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 55% >= 55% Aorta - Ascending: 3.4 cm <= 3.4 cm Aortic Valve - Peak Velocity: 1.0 m/sec <= 2.0 m/sec Findings LEFT ATRIUM: No spontaneous echo contrast or thrombus in the LA/LAA or the RA/RAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or color Doppler. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and regional/global systolic function (LVEF>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal ascending, transverse and descending thoracic aorta with no atherosclerotic plaque. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. No AR. MITRAL VALVE: Normal mitral valve leaflets with trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic 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. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. See Conclusions for post-bypass data Conclusions PRE-BYPASS: No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 45 cm from the incisors. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. Dr. [**Last Name (STitle) 914**] was notified in person of the results on [**Known lastname **] at 8AM before surgery start. . POST-BYPASS: Preserved biventricular systolic function. LVEF 55% Intact thoracic aorta. Minimal MR [**First Name (Titles) **] [**Last Name (Titles) **]. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2197-12-15**] 15:56 [**Known lastname **],[**Known firstname **] G [**Medical Record Number 80697**] M 55 [**2142-10-5**] Cardiology Report C.CATH Study Date of [**2197-12-13**] *** Not Signed Out *** BRIEF HISTORY: Mr. [**Known firstname **] [**Known lastname **] is 55 years old with a history of hypertension and dyslipidemia referred for cardiac catheterization in the setting of exertional chest pain. He underwent exercise stress testing with nuclear imaging on [**2197-12-5**] during which he completed 8 minutes of [**Doctor First Name **] protocol, stopped due to chest pain, with distal anteroseptal and apical reversible perfusion defect. INDICATIONS FOR CATHETERIZATION: CAD, Exertional chest pain, Abnormal stress test PROCEDURE: Left Heart Catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 French angled pigtail catheter, advanced to the left ventricle through a 5 French introducing sheath. Coronary Angiography: was performed in multiple projections using a 5 French JL4 and a 5 French JR4 catheter, with manual contrast injections. Left Ventriculography: was performed in the 30 degrees [**Doctor Last Name **] projection, using 39 ml of contrast injected at 13 ml/sec, through the angled pigtail catheter. Conscious Sedation: was provided with appropriate monitoring performed by a member of the nursing staff. HEMODYNAMICS RESULTS BODY SURFACE AREA: 1.87 m2 HEMOGLOBIN: gms % ENTRY **PRESSURES LEFT VENTRICLE {s/ed} 134/22 AORTA {s/d/m} 134/78/80 LEFT VENTRICULOGRAPHY: Volumetric data: LV end diastolic volume index (nl 50-90 ml/m2). 44.5 LV end systolic volume index (nl 15-30 ml/m2). 16 LV stroke volume index (nl 35-75 ml/m2). 28.5 LV ejection fraction (nl 50%-80%). 64 Regurgitant fraction. 0 Qualitative wall motion: [**Doctor Last Name **]: 1. Antero basal - normal 2. Antero lateral - normal 3. Apical - normal 4. Inferior - normal 5. Postero basal - normal Other findings: Mitral valve was normal. Aortic valve was normal. **ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM **LEFT CORONARY 5) LEFT MAIN DISCRETE 50 6) PROXIMAL LAD DISCRETE 50 7) MID-LAD DISCRETE 80 9) DIAGONAL-1 DISCRETE 70 12) PROXIMAL CX DISCRETE 80 TECHNICAL FACTORS: Total time (Lidocaine to test complete) = 0 hour30 minutes. Arterial time = 0 hour11 minutes. Fluoro time = 6.7 minutes. Contrast injected: Non-ionic low osmolar (isovue, optiray...), vol 119 ml, Indications - Renal Premedications: ASA 325 mg P.O. Fentanyl 25 mcg iv Versed 0.5 mg iv Anesthesia: 1% Lidocaine subq. Anticoagulation: Heparin 0 units IV Cardiac Cath Supplies Used: - ALLEGIANCE, CUSTOM STERILE PACK - [**Company **], LEFT HEART KIT 5FR [**Company **], MULTIPACK COMMENTS: 1. Coronary angiography of this right dominant system revealed left main and 2 vessel CAD. The LMCA had a 50% distal stenosis extending into the ostium of the LAD and circumflex vessels. The LAD had a 50% ostial stenosis and an 80% proximal stenosis across the origin of the first diagonal branch, which itself had a 70% ostial stenosis. The LCx had an 80% ostial stenosis. The RCA had mild luminal irregularities. 2. Entry hemodynamics revealed elevated left sided filling pressures with LVEDP of 22 mm Hg. Systemic arterial pressures were mildy elevated with aortic systolic pressure of 134 mm Hg. 3. Left ventriculography revealed no mitral regurgitation. LVEF was calculated at 64%. FINAL DIAGNOSIS: 1. Left main and 2 vessel CAD. 2. Normal left ventricular systolic function. 3. Left ventricular diastolic dysfunction. ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. REFERRING PHYSICIAN: [**Name10 (NameIs) 80698**],[**Name11 (NameIs) 80699**] [**Name Initial (NameIs) **]. CARDIOLOGY FELLOW: [**Last Name (LF) 80700**],[**First Name3 (LF) **] J. ATTENDING STAFF: [**Last Name (un) 80698**],[**Last Name (un) 80699**] J. Brief Hospital Course: He was admitted after catheterizationa nd remained pain free. Workup was completed and on [**12-15**] he went to the Operating Room where triple bypass grafting was accomplished. He weaned from bypass on Propofol. He was easily weaned from the ventilator, extubated and begun on beta blockers. CTs were removed on the day after surgery and diuresis was begun. He was transferred to the floor where he made an uneventful recovery. He was cleared by physical therapy for d/c to home on POD#3. Medications on Admission: Metoprolol 25mg [**Hospital1 **] ASA 325mg/D Propecia 1 tab/D Crestor 20mg/D Valerian Root Extract Discharge Medications: 1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 2 weeks. Disp:*28 Tablet(s)* Refills:*0* 4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 8. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). Disp:*90 Tablet(s)* Refills:*0* 9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*75 Tablet(s)* Refills:*0* 10. Propecia 1 mg Tablet Sig: One (1) Tablet PO once a day. Tablet(s) Discharge Disposition: Home With Service Facility: VNA of Southeastern Mass. Discharge Diagnosis: Coronary artery disease s/p coronary artery bypass grafts x3 hypertension hyperlipidemia Discharge Condition: good Discharge Instructions: no driving for 4 weeks no lifting more than 10 pounds for 10 weeks shower daily, no baths or swimming no lotions, creams or powders to incisions report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain greater than 2 pounds a day or 5 pounds a week take all medications as directed Followup Instructions: Dr. [**Last Name (STitle) 914**] in 4 weeks wound clinic on [**Hospital Ward Name 121**] 6 in 2 weeks Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] in [**11-17**] weeks ([**Telephone/Fax (1) 27360**]) Dr. [**Last Name (STitle) **] [**Name (STitle) **] in 2 weeks ([**Telephone/Fax (1) 52395**]) Please call for appointments Completed by:[**2197-12-18**] ICD9 Codes: 4111, 4019, 2724
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Medical Text: Admission Date: [**2133-2-2**] Discharge Date: Date of Birth: [**2133-2-2**] Sex: M Service: NEONATOLOG HISTORY OF THE PRESENT ILLNESS: The infant is a full-term boy born to a 42-year-old gravida 5, para 4 to 5 mom, hepatitis B surface antigen negative, RPR nonreactive, antibody negative, rubella immune, GBS negative, A positive mom. [**Name (NI) 37516**] [**2133-1-23**]. Infant was born at 41 and [**2-5**] week estimated gestational age and induced due to post dates. Otherwise, pregnancy was uncomplicated. LABOR AND DELIVERY HISTORY: Infant was a brow presentation with evidence of late decelerations on fetal monitoriong necessitating a stat cesarean section. Rupture of membranes occurred ten hour prior to delivery. In the operating room the infant was depressed. The infant was flaccid with poor color and heart rate of less than 100. 1 minute Apgar of 1. The infant received positive pressure ventilation and eventual intubation; 5 and 10 minute Apgars were 5 and 7 respectively. Prior to transfer to NICU the infant self extubated and had a strong cry. The infant appeared pale with poor perfusion, but with spontaneous respirations and adequate aeration. The infant was transferred to the NICU for further management. PHYSICAL EXAMINATION: Examination on admission revealed the weight of 3815 grams, 98th percentile. Height: 21.5 cm, 95th percentile. OFC: 35.5 cm, 75th percentile. Vigorous, pale infant with strong cry. Weak distal pulses noted. There was a large frontal hematoma with bruising. The eyelids were swollen. The anterior fontanelle was open, flat, and soft. The neck was slightly bruised. The clavicles were intact. Chest was clear with adequate aeration. Heart was regular with normal S1 and S2. There were no murmurs. Abdomen was slightly distended, but soft. Liver was 1 cm below the costal margin. There was normal male genitalia. Testes were down and the anus was patent. Neurological examination was nonfocal. #1. RESPIRATORY: Initial impression was respiratory distress in the delivery room necessitating intubation as part of the resuscitative effort. After self extubation in the delivery room, however, the infant did not have persistent respiratory problems and was on room air throughout the remainder of the course in the NICU. The infant has not demonstrated any apnea or impaired respiratory drive. Chest was clear at the time of discharge to the Newborn Nursery. #2. CARDIOVASCULAR: Perfusion was poor in the early NICU course. The infant was given boluses of normal saline and bicarbonate to correct metabolic acidosis. ABG showed pH of 7.3, pCO2 28, with bicarbonate of 14, and base deficit of -10. This corrected with aggressive fluid resuscitation. Repeat blood gas after resuscitation showed a pH of 7.39 with resolved metabolic acidosis and a base excess of only -2. #3. FLUIDS, ELECTROLYTES, AND NUTRITION: Infant was kept NPO in the immediate postnatal period, but then slowly allowed to feed. Currently, the baby is taking ad lib p.o. feeds by breast and bottle. Electrolytes have not been obtained. #4. GASTROINTESTINAL: The infant is stooling without difficulty and has no active GI issues. #5. HEMATOLOGY: The infant had hematocrit on admission of 43 with platelet count of 295,000. There have been no concerns. #6. INFECTIOUS DISEASE: The infant had a white count on admission of 21.8 with 27% polys, 2% bands, and 58% lymphs. The infant received 48 hours of antibiotics and cultures have been negative. There was no prolonged rupture of membranes. Mom was GBS negative. There was no maternal fever or any other sepsis risk factors. Antibiotics were started empirically simply for poor perfusion after delivery. Likely, this was due to head compression immediately prior to delivery of the infant. There have been no other concerns for infection. #7. NEUROLOGICAL: Upon transfer to the Newborn Nursery the infant had a nonfocal neurological examination. CONDITION ON TRANSFER: Stable and appropriate for transfer to the Newborn Nursery. DISCHARGE DISPOSITION: Newborn Nursery, [**Hospital1 346**]. Primary pediatrician: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Street Address(1) 38837**] Pediatrics in [**Location (un) 5176**]. CARE RECOMMENDATIONS: Feeding: Ad lib p.o. feeding, either mother's milk nursing or bottle feeding as desired. Medications: None. State Newborn Screens: Sent and need to be followed up. Immunizations received: The infant has not yet received hepatitis B immunizations. DISCHARGE DIAGNOSES: 1. Perinatal depression. 2. Sepsis evaluation. 3. Full-term baby boy. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 37233**], M.D. [**MD Number(1) 36463**] Dictated By:[**Name8 (MD) **] MEDQUIST36 D: [**2133-2-4**] 15:26 T: [**2133-2-4**] 15:33 JOB#: [**Job Number 38838**] ICD9 Codes: 769, 2762, V290, V053
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7360 }
Medical Text: Admission Date: [**2195-1-12**] Discharge Date: [**2195-1-29**] Date of Birth: [**2116-10-23**] Sex: F Service: SURGERY Allergies: Morphine Sulfate / Iodine-Iodine Containing / Oxycodone / Minocycline / Erythromycin Base / Dust & Pollen Filter Mask / water, dove soap, seasonal allergies / water Attending:[**First Name3 (LF) 598**] Chief Complaint: nausea and vomitting Major Surgical or Invasive Procedure: Central line placment [**2195-1-17**] Diagnostic paracentesis PICC line Nasogastric tube History of Present Illness: HISTORY OF PRESENTING ILLNESS This patient is a 78 year old female who complains of vomiting. This patient is one-week status post right hemicolectomy for a cecal volvulus. She's been having vomiting and retching for the last several days. She went to the [**Hospital 620**] campus where she had a KUB which showed: a 12 cm colon. She has no real abdominal pain but is complaining of some "heartburn". She was given Cipro and Flagyl and sent. They also put a Foley catheter in and found 500 cc of urine. No fevers or chills. She actually denies abdominal pain. She has been having difficulty urinating but denies any dysuria or any hematuria. Timing: Sudden Onset, Intermittent Quality: Mostly retching, Severity: 5 times in the last 24 hours Duration: Several days, Context/Circumstances: See above Associated Signs/Symptoms: Decreased p.o. intake Past Medical History: PMH: - rectocele and rectal prolapse s/p multiple surgeries (see below) - colonic adenomas s/p sigmoid colectomy [**2182**] (last colonoscopy [**2192**], sigmoidoscopy [**2193**]) - diverticulosis - hemorrhoids - severe anxiety / depression - osteopenia - degenerative joint disease, planned for L hip surgery with Dr. [**Last Name (STitle) **] [**2195-1-13**] - lumbar spondylosis - chronic pain - chronic constipation - asthma - syncope / vasovagal episodes PSH: - cholecystectomy [**2180**] - sigmoid colectomy for tubobillous adenoma [**2182**] - rectopexy and rectocele repair ([**Doctor Last Name 1120**] [**2191**]) - posterior colporraphy ([**Doctor Last Name **] [**2192**]) - removal of retained sigmoid suture ([**Doctor Last Name **] [**2193**]) Social History: Former smoker, quit 25 years ago; no EtOH, no IVDU; lives with husband. PCP is [**Last Name (NamePattern4) **]. [**Last Name (STitle) 67282**] ([**Hospital1 18**]). Family History: - father: deceased of colon cancer (age unknown), mother: CVA and endometrial cancer, brother: lung cancer, DM and MI, son: lung cancer Physical Exam: PHYSICAL EXAMINATION: upon admission: [**2195-1-17**] Temp:99.2 HR:90 BP:132/83 Resp:16 O(2)Sat:95 Normal Constitutional: Comfortable HEENT: Extraocular muscles intact Mucous membranes moist Chest: Clear to auscultation Cardiovascular: Normal first and second heart sounds without murmur Abdominal: Soft, Nontender without distention and with clean-looking staple line GU/Flank: No costovertebral angle tenderness a Foley catheter is in a draining clear yellow urine. Extr/Back: Mild edema on both sides Neuro: Speech fluent Psych: Normal mood Physical examination upon discharge: [**2195-1-29**] General: Sitting in chair, alert and oriented, skin warm, dry, pink vital signs: t=98.6, hr=88, bp=130/90, resp. rate=20, oxygen saturation room air=96% CV: Ns1, s2, -s3, -s4 LUNGS: Diminished bases ( left >right) ABDOMEN: Suture line clean and dry, no exudate, non-tender, soft EXT: Mild edema lower ext., + dp bil. Pertinent Results: [**2195-1-27**] 05:18AM BLOOD WBC-11.2* RBC-3.00* Hgb-8.8* Hct-25.4* MCV-85 MCH-29.2 MCHC-34.4 RDW-14.0 Plt Ct-519* [**2195-1-26**] 05:10AM BLOOD WBC-12.6* RBC-3.22* Hgb-8.9* Hct-27.3* MCV-85 MCH-27.6 MCHC-32.6 RDW-14.0 Plt Ct-567* [**2195-1-25**] 05:22AM BLOOD WBC-10.7 RBC-3.19* Hgb-9.0* Hct-27.1* MCV-85 MCH-28.3 MCHC-33.4 RDW-13.9 Plt Ct-582* [**2195-1-12**] 05:55PM BLOOD WBC-17.9*# RBC-4.53# Hgb-12.9# Hct-38.0# MCV-84 MCH-28.5 MCHC-34.0 RDW-13.6 Plt Ct-590*# [**2195-1-15**] 05:58AM BLOOD Neuts-80.3* Lymphs-13.0* Monos-4.3 Eos-2.0 Baso-0.5 [**2195-1-27**] 05:18AM BLOOD Plt Ct-519* [**2195-1-23**] 05:33AM BLOOD PT-11.7 PTT-26.3 INR(PT)-1.0 [**2195-1-18**] 02:10AM BLOOD Fibrino-313 [**2195-1-17**] 05:32PM BLOOD Fibrino-385 [**2195-1-27**] 05:18AM BLOOD Glucose-149* UreaN-21* Creat-0.5 Na-138 K-3.5 Cl-107 HCO3-25 AnGap-10 [**2195-1-26**] 05:10AM BLOOD Glucose-128* UreaN-16 Creat-0.5 Na-136 K-3.4 Cl-103 HCO3-25 AnGap-11 [**2195-1-25**] 05:22AM BLOOD Glucose-186* UreaN-15 Creat-0.5 Na-137 K-4.2 Cl-106 HCO3-26 AnGap-9 [**2195-1-17**] 05:32PM BLOOD Glucose-240* UreaN-26* Creat-0.9 Na-137 K-3.8 Cl-100 HCO3-24 AnGap-17 [**2195-1-17**] 04:58AM BLOOD Glucose-163* UreaN-22* Creat-0.8 Na-130* K-3.8 Cl-93* HCO3-30 AnGap-11 [**2195-1-17**] 01:30AM BLOOD Glucose-227* UreaN-19 Creat-0.8 Na-131* K-3.5 Cl-94* HCO3-29 AnGap-12 [**2195-1-22**] 05:49AM BLOOD ALT-30 AST-19 AlkPhos-65 Amylase-9 TotBili-0.2 [**2195-1-18**] 02:10AM BLOOD ALT-183* AST-137* CK(CPK)-203* AlkPhos-69 TotBili-0.2 [**2195-1-17**] 05:32PM BLOOD ALT-211* AST-248* CK(CPK)-60 AlkPhos-76 TotBili-0.3 [**2195-1-18**] 09:04AM BLOOD CK-MB-6 cTropnT-0.02* [**2195-1-18**] 02:10AM BLOOD CK-MB-8 cTropnT-0.03* [**2195-1-17**] 05:32PM BLOOD CK-MB-3 cTropnT-0.01 [**2195-1-12**] 07:25AM BLOOD cTropnT-<0.01 [**2195-1-27**] 05:18AM BLOOD Calcium-8.0* Phos-3.2 Mg-2.1 [**2195-1-22**] 05:49AM BLOOD calTIBC-159* TRF-122* [**2195-1-18**] 10:23AM BLOOD D-Dimer-[**Numeric Identifier **]* [**2195-1-18**] 05:11PM BLOOD Type-ART pO2-92 pCO2-34* pH-7.48* calTCO2-26 Base XS-2 [**2195-1-18**] 09:21AM BLOOD Type-ART pO2-142* pCO2-34* pH-7.48* calTCO2-26 Base XS-3 [**2195-1-18**] 09:21AM BLOOD Glucose-91 Lactate-0.6 [**2195-1-18**] 03:33AM BLOOD Lactate-0.8 [**2195-1-17**] 06:14PM BLOOD Hgb-10.2* calcHCT-31 [**2195-1-12**]: EKG: Sinus rhythm. Low voltage. Mild Q-T interval prolongation. ST-T wave abnormalities. Since the previous tracing of [**2194-12-30**] precordial ST-T wave abnormalities are more prominent. Clinical correlation is suggested. TRACING #1 [**2195-1-14**]: Abdominal cat scan: IMPRESSION: 1. Mild dilation of the proximal and mid small bowel loops measuring up to a maximum of 3.5 cm in diameter. There is no definite discrete transition point in small bowel although proximal bowel is somewhat more dilated than distal residual small bowel. However, noting marked colonic dilatation on the recent prior radiographs, which has improved, this evolution is suggestive of an ileus. Small bowel obstruction is not entirely excluded, however, and if it were confirmed, then ascites could suggest considerable congestion or even potentially ischemia in the appropriate clinical setting, although there is no bowel wall thickening. 2. Moderate amount of ascites, new since the prior study, and could be secondary to fluid resuscitation/ cardiac / hepatic dysfunction. Peritoneal inflammation with secondary ileus and ascites could also be considered in the differential, noting substantial ascites and ileus, which together could be seen with peritonitis although the findings are non-specific. Although ascites does not appear loculated, if clinical concern persists, then an examination with intravenous contrast would be more sensitive for the possibility of any potential early abscess formation. 3. Malpositioned nasogastric tube with a retrograde turn and terminating in the distal esophagus. 4. Small exophytic left renal lesion; suggest follow-up ultrasound evaluation [**2195-1-15**]: Diagnostic paracentesis: IMPRESSION: Successful, ultrasound-guided diagnostic and therapeutic paracentesis yielding 2.2 liters of reddish fluid [**2195-1-16**]: Liver/gallbladder ultrasound: IMPRESSION: 1. Patent hepatic vasculature, note is made that the midline vessels are obscured from view by overlying bowel. 2. Minimal ascites and a small right pleural effusion. 3. No liver lesion and no biliary dilatation. [**2195-1-18**]: Chest x-ray: IMPRESSION: Evidence for pulmonary vascular congestion. Left pleural fluid. Bilateral subsegmental atelectasis and possibly focal consolidation. The right internal jugular catheter terminates at the level of the right atrium. There is distended colon below the level of the diaphragm (see accompanying report) [**2195-1-23**]: EKG: Artifact is present. Sinus rhythm. Low voltage in the precordial leads. Compared to the previous tracing of [**2195-1-23**] limb lead voltage has improved marginally [**2195-1-24**]: KUB: FINDINGS: Moderate-to-severe intestinal distention with multiple air-fluid levels but no evidence of wall thickening. Given the multiple overlays of gas-filled bowel loops no change in caliber can be clearly determined. Therefore, CT is recommended. No evidence of free air. No safe evidence of pathological calcifications. Contrast material in the rectum [**2195-1-24**]: Chest x-ray: FINDINGS: The nasogastric tube that has newly been placed is in the stomach. A right internal jugular vein catheter projects into the basal parts of the right atrium, the device should be pulled back by approximately 7 cm. Unchanged moderately distended segments of the colon. Subtle bilateral areas of atelectasis at the lung base. Borderline size of the cardiac silhouette without pulmonary edema. [**2195-1-25**]: Chest x-ray: FINDINGS: The patient has received a new PICC line. The line can be followed over its entire course, the tip projects over the right atrium, the line should be pulled back by approximately 4 cm to ensure position within the mid-to-low SVC. No evidence of pneumothorax, the other monitoring and support devices are unchanged. Mildly increasing colonic distention. Brief Hospital Course: 78 year old female s/p right hemi-colectomy re-admitted to the Acute Care Service with vomitting. Upon admission, she was made NPO, given intravenous fluids, and had imaging studies of her abdomen which showed an ileus and ascites. Because of her abdominal distention and nausea, she had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-gastric tube placed. A diagnostic paracentesis was done for the fluid collection in her abdomen. It did not grow any bacteria. Her fluid status was tenuous during this time and she did require additional fluid to maintain an adequate urine output. In order to maintain her nutritional staus, she was started on TPN on [**1-16**] after a nutrition consult. On [**1-17**], she was transported to the Intensive Care Unit after she sustained a PEA arrest vs. vaso-vagal event. She was intubated and her cardiac enzymes were cycled. Her EKG did not show any evidence of a myocardial infarction. An echocardiogram showed possible antero-septal hypokinesis with an EF> 50%. She was bronched with no evidence of aspiration. Ultrasound was negative for DVT. She was extubated within 24 hours and discharged from the Intensive Care Unit. Upon return to the floor, she had a follow-up GI consult who recommended a bowel regimen to alleviate her constipation and reduce her abdominal distention. Her [**Last Name (un) **]-gastric tube was discontinued on [**1-22**] after she tolerated it being clamped. She was started on clear liquids with the gradual advancement to a regular diet. She did continue to have an elevated white blood cell count and was found to have a urinary tract infection for which she is currently on ampicillin until [**1-30**]. Because of her colonic inertia, her narcotics were discontinued and she was given mineral oil, reglan, and azithromycin with successful passage of stool. Her abdominal distention has diminished and she is tolerating a regular diet. Her TPN has been discontinued on [**1-26**]. She has been evaluated by physical therapy and has been seen by the social worker for additional emotional support. She is preparing for discharge to a extended care facility where she will be able to increase her strength and stamina through physical therapy and ADL's. Her vital signs are stable and she is tolerating a regular diet without complaint of nausea, but her appetite is still diminished. Her foley catheter is to gravity drainage. She has been followed by the Nurtritionist who has made recommendations about her diet. She has been ambulating with assistance. Follow-up visit is recommended with her primary care provider where she will need further investigation about the left renal lesion. In addition to this, she will need to follow up with her Dr. [**Last Name (STitle) 79**], who will make recommendations about the length of time for azithromycin usage for colonic motility. She will need to schedule an appointment with the Acute care service in 2 weeks. Of note: MRSA + Medications on Admission: [**Last Name (un) 1724**]: albuterol 1-2 puffs inh QID prn, clonazepam 1mg PO BID, compazine 5mg PO prn, flovent 110 mcg 3 puffs inh TID, Anusol ointment prn, lidocaine 2% prn, Metrogel 1% prn, simvastatin 10mg Discharge Medications: 1. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) cc Injection TID (3 times a day). 2. Cepacol Sore Throat + Coating 15-5 mg Lozenge Sig: One (1) lozenger Mucous membrane every 4-6 hours as needed for throat pain. 3. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation Q4H (every 4 hours) as needed for wheezing. 4. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: Two (2) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for back and chest pain . 5. azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 6. mineral oil Oil Sig: Thirty (30) ML PO EVERY OTHER DAY (Every Other Day). 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 9. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for anxiety. 10. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 11. acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 12. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 13. ampicillin 250 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) for 1 days: 1 dose this pm, and 2 doses 1/28...then d/c. Disp:*6 Capsule(s)* Refills:*0* 14. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO DAILY (Daily). 15. calcium carbonate 250 mg Tablet, Chewable Sig: [**1-4**] Tablet, Chewables PO three times a day: as needed for heartburn. Discharge Disposition: Extended Care Facility: [**Location (un) 1036**] - [**Location (un) 620**] Discharge Diagnosis: Ileus Post-operative ascites Enterococcus urinary tract infection PEA arrest 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 recently discharged from the hospital after you had a portion of your bowel removed for a cecal vovulus. You were discharged to a rehabilitation center but returned 3 days later with inability to tolerate food and nausea. Since your re-admission, you have had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-gastic tube placed to allerviate your nausea. You also were noted to have a collection of fluid in your abdomen which was cultured, did not show any bacteria. Your bowels were slow to move, but since you have been off narcotics, and with laxatives, you have successfully moved your bowels. You have been able to tolerate a diet. You are now preparing for discharge to a rehabiltation facility with the following instructions: Please call your doctor or return to the emergency room if you have 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. * 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, especially the bowel regimen which has been prescribed Followup Instructions: Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2195-2-17**] 1:20 Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1114**], M.D. Date/Time:[**2195-5-12**] 12:20 (please reschedule this appointment so that your visit will be withing the next 2-3 weeks. You will also need follow-up ultrasound for the kidney lesion. Please follow up with the Acute Care Service in 2 weeks, you can schedule this appointment by calling #[**Telephone/Fax (1) 600**]. You will also need ultra-sound follow-up for the kidney lesion was was noted. [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**] Completed by:[**2195-1-29**] ICD9 Codes: 4275, 5990, 5119, 2768
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7361 }
Medical Text: Admission Date: [**2165-12-19**] Discharge Date: [**2165-12-25**] Service: MEDICINE Allergies: Levaquin Attending:[**First Name3 (LF) 4760**] Chief Complaint: hypoglycemia Major Surgical or Invasive Procedure: none History of Present Illness: This is a 86 year-old male multiple medical problems who presents with hypoglycemia since last night. The patient was admitted to the hospital from [**Date range (1) 68760**] wtih hypoglycemia. He was evaluated by endocrinology at that time and the most likely etiology of his hypoglycemia was felt to be pre-diabetes causing hyperinsulinemia. Work-up revealed an elevated C-peptide (18.1), elevated insulin level of 41, negative sulfonylurea screen, and low beta-hydroxybutyrate. These labs had all been pending at the time of discharge. He was discharged home with instructions to eat frequent small meals (to prevent hyperinsulinemia), follow fasting and post-prandial fingersticks, and follow-up with his [**Date range (1) 3390**] and endocrinology. Family has been checking FS multiple times daily, mostly ranging 80-150's. Reportedly had a similar episode at some point in the '90s. . Pt had been feeling in his usual state of health until several days ago when he developed cough, low-grade fevers (to 38 degrees celsius over the weekend, more recently normal) and dyspnea with ambulation. He was seen by his [**Date range (1) 3390**] yesterday and was found to have rales at the R mid and lower lung fields, afebrile, breathing comfortably. He was started on levoquin for empiric CAP coverage. PA and lateral CXR was negative for pneumonia. . Last night around 10pm he became tremulous and diaphoretic. FS was noted to be in the 40s. His family gave him juice and honey. At 2am, he had a similar episode with tremors, FS in the 40s, and again received juice and honey. He slept well until 8am when he had a third episode. At this point, they called EMS. On arrival, FS was 48. He was given an amp of D50 and his FS improved to 180. Family declined having him brought to the ED. Less than one hour later, his FS again dropped to the 40s. At this point, EMS was called again and he was brought to the ED. . In the ED, initial vitals were T 96.7, BP 145/115, HR 70, RR12, 100% on RA. Mental status was at baseline. Exam notable for left-sided rhonchi. CXR was clear. UA negative. No leukocytosis. Given levofloxacin. FS on arrival was 49 and he received 1 amp D50. FS dropped again to 40s within an hour, symptomatic with tremors, and he was given another amp of D50. Started D5 drip and admitted to the [**Hospital Unit Name 153**] for close FS monitoring. Past Medical History: #. Tension headache #. Benign Essential Tremor #. ? Alzheimer's Dementia #. CAD s/p CABG #. Chronic Diastolic CHF, EF 60% #. Sick sinus s/p PPM - comlpicated by pacer infection [**2159-2-23**] with note of significant cognitive problems since that prolonged hospitalization0 #. Paroxysmal atrial fibrillation - on coumadin #. Peripheral vascular disease #. s/p aorto-iliac bypass #. Chronic kidney disease #. Dyslipidemia #. Hypertension #. Colonic adenoma #. s/p cholecystectomy #. Anemia #. Benign prostatic hypertrophy Social History: The patient is Russian-speaking only and lives with his wife in [**Name (NI) **]. The patient was previously employed as an electrician. They have a home aide that comes twice a week to help with cooking, cleaning and bathing the patient. He walks with a cane at baseline, is able to dress himself, transfer to commode, feed himself. Tobacco: None ETOH: Rare social use previously Illicits: None Family History: noncontributory Physical Exam: Vitals: T: 97 BP: 177/57 HR: 64 RR: 19 O2Sat: 99% on RA GEN: Well-appearing, well-nourished, elderly male no acute distress HEENT: EOMI, PERRL, sclera anicteric, mildly dry MM, OP Clear NECK: No JVD, no bruits, no cervical lymphadenopathy, trachea midline COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: rales at R mid-lower lung fields, otherwise clear, no wheezes ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and year. 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: scattered ecchymoses on his bilateral upper extremities Pertinent Results: [**2165-12-19**] 11:03AM COMMENTS-GREEN TOP [**2165-12-19**] 11:03AM LACTATE-2.1* [**2165-12-19**] 10:50AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013 [**2165-12-19**] 10:50AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2165-12-19**] 10:25AM GLUCOSE-36* UREA N-63* CREAT-2.7* SODIUM-140 POTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-21* ANION GAP-18 [**2165-12-19**] 10:25AM WBC-5.2 RBC-4.54* HGB-12.2* HCT-36.7* MCV-81* MCH-26.9* MCHC-33.3 RDW-16.7* [**2165-12-19**] 10:25AM WBC-5.2 RBC-4.54* HGB-12.2* HCT-36.7* MCV-81* MCH-26.9* MCHC-33.3 RDW-16.7* [**2165-12-19**] 10:25AM PLT COUNT-165 [**2165-12-19**] 10:25AM PT-30.2* PTT-71.8* INR(PT)-3.1* . CXR:[**Hospital 93**] MEDICAL CONDITION: 86 year old man with h/o chf but now with recent fevers, cough, rales right lung fields REASON FOR THIS EXAMINATION: r/o pneumonia Final Report INDICATION: 86-year-old man with history of CHF, now with recent fevers, cough, rales in the right lung field. Rule out pneumonia. COMPARISON: Multiple chest radiographs, most recent on [**12-2**], [**2164**]. TECHNIQUE: PA and lateral views of the chest. FINDINGS: Left-sided pacer leads are intact and terminate in the expected location in the right atrium and ventricle, unchanged. Midline sternotomy wires are again noted with a small fracture in the third wire, which is unchanged since [**2159**]. Vascular engorgement has improved since the prior study. The lungs appear clear with no evidence of pneumonia. Cardiomegaly is stable. The aorta is calcified and slightly tortuous. IMPRESSION: No evidence of pneumonia. Improved vascular engorgement since prior study. . Renal Ultrasound: NDINGS: This study is limited by patient body habitus and limited ability to cooperate with the exam. The left kidney measures 9.9 cm and the right kidney measures 9.1 cm. There is no nephrolithiasis or hydronephrosis in either kidney. There is a simple cyst arising from the mid pole of the left kidney. The bladder is obscured by shadowing from the air within the urinary bladder, likely due to air of Foley catheter placement. IMPRESSION: 1. Limited study. No hydronephrosis. 2. Non-visualization of the bladder due to air within the bladder. If further evaluation is required, consider alternative imaging methods (MR) or cystoscopy. . CT abdomen/pelvis [**2165-12-23**]: NDICATION: Dementia, hematuria and anticoagulation with drop in hematocrit. Please evaluate for retroperitoneal bleed. COMPARISON: CT abdomen [**2161-9-17**]. TECHNIQUE: MDCT axially acquired images were obtained from the lung bases to the symphysis without contrast. Multiplanar reformatted images were obtained and reviewed. CT ABDOMEN WITHOUT CONTRAST: There are small bilateral pleural effusions with associated passive atelectasis. Evaluation of the lung parenchyma is limited given respiratory motion. No large mass is detected. Pacer wires are detected within the right ventricle and right atrium. There is CT evidence of anemia. No pericardial effusion is present. Evaluation of intra-abdominal and intrapelvic parenchymal organs is limited given lack of IV contrast administration. However, no focal mass lesion is identified within the liver. Tiny hypoattenuating lesions within the liver are too small to adequately characterize. The spleen, stomach and pancreas appear grossly unremarkable. There is calcification of the abdominal aorta and iliac branches with a small ectasia of the infrarenal aorta measuring maximum diameter of 2.3 cm. There is atrophy of the right kidney with respect to the left. A probable AML is again noted within the interpolar region of the left kidney. There is a splenule within the splenic hilum. Dense calcified atherosclerotic plaque is noted within the tortuous splenic artery. Dense calcified atherosclerotic plaque is present within the SMA with approximately 50% luminal narrowing (series 3: image 28). There is no evidence of bowel obstruction or retroperitoneal bleed. CT PELVIS WITHOUT CONTRAST: The prostate is enlarged measuring 5.5 cm in greatest transverse dimension. The bladder wall is subjectively thickened with foci of intraluminal air within the bladder lumen. No pelvic or inguinal adenopathy is detected. OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesions are identified. Multilevel degenerative changes are present within the lumbar spine with intervertebral body disc space narrowing and vacuum phenomenon most prominent at L4-5 and L5-S1. IMPRESSION: 1. No retroperitoneal bleed. 2. Prostatic enlargement with subjective bladder wall thickening. Foci of gas within the bladder lumen is presumed secondary to Foley catheter placement. Please correlate clinically. 3. Small bilateral pleural effusions. 4. Anemia. 5. Dense calcified atherosclerotic plaque within the abdominal aorta and major branches without aneurysmal dilitation. , CXR [**2165-12-23**]: FINDINGS: Cardiomediastinal contours are unchanged. Increased opacity overlying the lower thoracic spine on the lateral view likely localizes to the posterior basilar segment of the right lower lobe on the PA projection, and could be due to atelectasis, aspiration, or a developing pneumonia. Followup radiographs may be helpful in this regard. Probable small right pleural effusion. Brief Hospital Course: This is an 86 year-old male with a history of CAD, CHF, afib, HTN, CKD who presented with recurrent hypoglycemia, acute renal failure and delerium. He was initially admitted to the ICU. . # Hypoglycemia: Differential diagnosis on admission included reactive hypoglycemia/pre-diabetes, medication effect from levofloxacin, and insulinoma. Pt had been admitted earlier this month for hypoglycemic episodes, thought to be due to hyperinsulinemia in the setting of pre-diabetes and decreased renal clearance. On the last admission, his insulin levels and C peptide levels were elevated with low hydroxybutyrate which could be consistent with insulinoma. However, these test results are difficult to interpret in the setting of having just received glucagon prior. Per the family, the pt had been checking his fingersticks with his wife up to 4 times a day after his last discharge, with most values in the 100s. The pt was diagnosed with bronchitis or CAP the day prior to admission this time, and was started on levofloxacin. In the ICU the patient required IV d5 overnight to keep FSG>60 (with q1hour FS checks). Endocrine was consulted who originally recommended supervised fast to discern between reactive hypoglycemia and insulinoma. However, the patient had ST depressions overnight with slight bump in his troponins so it was decided not to stress the heart by fasting. On the day after admission the patient started taking PO (diabetic/consistent carb diet). His FSG was maintained >100 overnight and he was called out to the floor. After the pt had been off of levofloxacin for 72 hours, endocrine wanted to pursue a fasting trial for 48 hours, as 90-95% of pts can be diagnosed with insulinoma with only a 48 hr fast (as opposed to 72) hr fast. The lowest his fingerstick dropped to was 79, at which point insulin, beta-hydroxybutyrate, and proinsulin levels were drawn (pending at discharge). He fingerstick quickly came back up to 90 on its own. Endocrine felt based on this fasting test, the pt likely has reactive hypoglycemia and not an insulinoma. The patient should not ever take a fluoroquinolone again given risk of hypoglycemia. He should continue to follow a diabetic diet, eat small and frequent meals (to prevent post-prandial hyperinsulinemia), and check fingersticks fasting in the morning and at various times during the day at home. (in the morning and before meals at rehab). He was provided with a glucagon emergency kit on his last admission. He has outpatient endocrine follow up. . #Acute Renal Faiure: Patient's creatinine increased to 3.1 in the ICU. We stopped lasix and spironolactone. Urine output remained stable, urine lytes were c/w FeUrea of 25%. He was continued on IVF and creatinine fell to 2.3 (back to baseline) at time of discharge. His lasix and aldactone can be restarted if he gains more than 3 lbs or has any evidence of volume overload. . #Demand Ischemia/ Tachycardia; Patient became tachycardic overnight on admission->CK: 55 MB: 11 MBI: 20.0 Trop-T: 0.23, started heparin gtt and called cardiology consult. Cardiology did not feel his presentation was consistent with ACS, so we stopped heparin, and started aspirin 81. CE trended down-> 48/9/0.20 then 37/7/0.21. . # Community-acquired pneumonia: Patient reported cough for the past few days with dyspnea on exertion and R-sided crackles. We had started the patient on levofloxacin but per endocrine there are case reports of levoflox causing hypoglycemia so we changed to cefpodoxime and azithromycin to complete a 5 day course. The pt did have noted RLL ronchi, and later in the hospital stay CXR did show a small RLL infiltrate. He continues to have a cough and some ronchi, which is likely residual from his PNA, +/- bronchitis. Was satting 97% RA at discharge. . # Anemia CKD/Hematocrit drop: Pt had hct drop from 29 to 24 over [**Date range (1) 94100**], down from baseline of 30. At baseline pt is anemic likey due to CKD, and has been receiving epogen as an outpatient. Hct on admission was 36, which is higher than his baseline. Suspect in part this drop was due to dilution. It is possible his hematuria caused a small amount of hct drop as well, but his hematuria resolved over 2 days with some blood clots, but not significant enough to explain [**4-30**] pt hct drop. CT of the abdomen/pelvis was performed to r/o RP bleed, but this was negative. Repeat hct was 26, and the following day was 25. He was given 1 unit PRBC with hct rising to 27 prior to discharge. . # Atrial Fibrillation: Goal INR is 1.5-2.5 per [**Month/Day (3) 3390**] [**Name Initial (PRE) 626**]. INR supratherapeutic at 3.1 on admission, (likely [**1-26**] levoquin and decreased PO intake). No signs of active bleeding. Coumadin was held. On discussion through email with pts [**Month/Day (2) 3390**], [**Name10 (NameIs) **] was decided to hold pts coumadin in the setting of these recent hypoglycemic episodes and risk of fall. He was started on ASA 81 mg a day for his demand ischemia. Given his hematuria and hct drop while here, increasing it to 325 mg daily was deferred. . # Delirium: Pt has underlying dementia, but from caring for pt on last admission pt was less oriented and agitated. Pt had pulled his foley in the ICU, causing hematuria, and a 3 way foley was placed. Upon transfer to the floor the 3 way foley was removed as were soft wrist restraints. He received zyprexa 2.5 mg once with good effect. Delirium was cleared by 48 hours of discharge, but at baseline pt does have some sundowning. . # Hypertension: Patient arrived hypertensive with SBP 170s. We held lopressor as it can mask symptoms of hyperglycemia. His BP was well controlled on hydralazine and Imdur. In the setting of demand and tachycardia, however, his beta blocker was restarted. . # Hematuria: Pt had pulled his foley in the ICU, causing hematuria, and a 3 way foley was placed. Upon transfer to the floor the 3 way foley was removed and the pt continued to pass blood clots without any PVR. No hematuria for 72 hours prior to discharge. . # Coronary Artery Disease s/p CABG: Patient was continued on simvastatin. Lopressor was restarted and ASA was started after it was noted pt had demand ischemia. . # Chronic diastolic CHF: Appears euvolemic/dry. He was continued on imdur, but we held lasix and spironolactone in the setting of acute renal failure. . # Dementia: Continued donepezil and aricept . # Hyperlipidemia: cont statin . # BPH: cont finasteride Medications on Admission: 1. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY OTHER DAY (Every Other Day). 2. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 4. Hydralazine 50 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). 6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): If you are on lipitor then resume taking lipitor. 8. Spironolactone 25 mg 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). 10. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Memantine 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 12. Glucagon Emergency 1 mg Kit Sig: One (1) injection Injection once as needed for low blood glucose : Give for fingerstick less than 60 and symptoms unresponsive to food/candy. Disp:*2 kits* Refills:*1* 13. Outpatient Lab Work CBC, PT, PTT, INR, sodium, potassium, chloride, bicarbonate, BUN, creatinine, and glucose to be drawn on [**2165-12-6**] 14. Accu-Chek Aviva Strip Sig: One (1) strip In [**Last Name (un) 5153**] as directed. 15. Accu-Chek Multiclix Lancet Misc Sig: One (1) lancet Miscellaneous as directed. Disp:*100 lancets* Refills:*2* Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 4. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 5. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO MWF (Monday-Wednesday-Friday). 6. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). 10. Hydralazine 50 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 13. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection [**Hospital1 **] (2 times a day). Discharge Disposition: Extended Care Facility: [**Location (un) 1036**] - [**Location (un) 620**] Discharge Diagnosis: Hypoglycemia Acute on chronic renal failure Demand cardia ischemic Community acquired pneumonia . Secondary: Dementia Coronary artery disease Atrial fibrillation Discharge Condition: stable Discharge Instructions: You were admitted with hypoglycemia (low blood sugar), felt to be the cause of your symptoms. Your hypoglycemia is thought to be due to pre-diabetes and having taken the antibiotic levofloxacin. You should not take this antibiotic in the future, nor any other antibiotic in its class. . You were treated for pneumonia with antbiotics. You have completed this course of antibiotics. . Your coumadin was stopped upon discussion with Dr. [**Last Name (STitle) **]. We feel that with these recent episodes of low blood sugar, you are at risk of falling and hitting your head. If you are on coumadin, this can increase your risk of bleeding. We would like you to start taking aspirin instead.. . You were noted to have acute kidney failure. Your lasix was held while you were here. Your kidney failure improved with IV fluids. . You received 1 unit of blood for your anemia while you were here. . You should check your fingerstick fasting (before breakfast) and 2 hours after breakfast several mornings a week, and bring these readings with you to Dr. [**Last Name (STitle) **]/Abrahmson of endocrine at [**Last Name (un) **]. . You were provided with a glucagon pen on your last admission. This is an injection that someone can give you if you are found to have low blood sugars again (fingerstick less than 60) and unable to eat. The glucagon pen is for emergencies only when you cannot eat with a low fingerstick. If your fingerstick is less than 70, you should drink juice or eat candy to try to bring your fingerstick up to at least 70s-80s. If your fingerstick is very low (less than 60) or you have symptoms of low blood sugar, you should eat candy and sugar, then use the glucagon emergency kit if your fingersticks are still low and don't respond to food. (ie remains less than 60) . You should eat small and frequent meals (5 small meals a day as opposed to 3 large meals a day. This is to prevent your sugar levels from dropping. . Call your doctor or return to the ER for recurrent shaking, fingerstick less than 60 or symptoms from low blood sugar, odd facial/bodily movements, confusion, lightheadedness/fainting, nausea/vomiting, fevers, palpitations, or any other concerning symptoms. Followup Instructions: 1. Primary Care: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9001**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2166-1-3**] 3:40 PM . 2. Endocrine: Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 10145**] and Dr. [**Last Name (STitle) **] at the [**Hospital **] Clinic [**1-5**], 3:00 PM, [**Hospital Ward Name 517**] [**Hospital1 **]; Address: One [**Last Name (un) **] Place [**Location (un) 86**], [**Numeric Identifier 718**] General Info and Appointments: ([**Telephone/Fax (1) 4847**] . Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2166-3-31**] 1:00 Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 720**], M.D. Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2166-4-23**] 11:30 ICD9 Codes: 5849, 486, 2930, 5859, 4280, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7362 }
Medical Text: Admission Date: [**2137-2-25**] Discharge Date: [**2137-3-2**] Date of Birth: [**2077-7-8**] Sex: M Service: MEDICINE Allergies: Penicillins / Zestril / Heparin Agents / Heparin,Beef Attending:[**First Name3 (LF) 898**] Chief Complaint: GIB Major Surgical or Invasive Procedure: EGD History of Present Illness: 59M with hx COPD, HTN, UGIB (duodenitis) [**2135**] and [**Year (4 digits) 1291**] [**2137-1-16**] with complicated post op course highlighted by shock liver, ARF, afib and respiratory failure necessitating trach and PEG, with 3 days of ?dark stools at [**Hospital1 **]. [**2-13**] Hct 28.7 [**2-18**] Hct 21 -> 2 u pRBC -> Hct 26 [**2-23**] profuse epistaxis, Hct 23 -> 2 u pRBC [**2-25**] at [**Hospital1 18**] ED: Hct 20, G+ black stool, NG lavage negative Past Medical History: Hypertension severe COPD s/p vasectomy s/p rhinoplasty as a child because of fx h/o adrenal mass s/p removal of skin cancers [**2132**]- hx L hip osteomyelitis, s/p hip replacement [**2133**]- L wrist septic arthritis [**2135**]- duodenitis, UGIB [**2136**]- Aortic stenosis -> [**Year (4 digits) 1291**] [**1-5**] [**Company **] porcine valve, p/op course c/b delerium, ARF, afib, shock liver, repiratory failure (re-intubated X 2 after surgery) trach and PEG, PNA (Staph, tx with Vanc until [**2-18**]) EF 40% h/o HIT Social History: Married, retired fire fighter.Cigs: smoked [**2-3**] ppd x 30-40 years and quit in 7/04ETOH: weekend beer drinker Family History: + CAD Physical Exam: At admission: T 98.9 HR 75 BP 107/99 R 22 sat 98% RA gen NAD A+OX3 HEENT mmm no JVD CV [**4-7**] sys m at RUSB, RRR pulm bilat exp wheezes abd s/nt/nd +BS extr no edema, 2+ pulses rectal: guiac positive black stool Pertinent Results: Studies: CXR [**2-26**] poor film, ?perihilar fullness (CHF vs new infiltrate) but poor study, re-shoot film EKG: [**2-26**] NSR 90 bpm inverted T II, III, F, V1-V6, 0.5-1.[**Street Address(2) **] dep II, F, V3-V5, ST dep slightly more prominent c/t [**2137-2-5**] EKG [**2137-2-25**] 05:15PM PT-14.1* PTT-27.6 INR(PT)-1.3 [**2137-2-25**] 05:15PM PLT COUNT-175# [**2137-2-25**] 05:15PM NEUTS-80* BANDS-1 LYMPHS-11* MONOS-7 EOS-0 BASOS-1 ATYPS-0 METAS-0 MYELOS-0 NUC RBCS-2* [**2137-2-25**] 05:15PM WBC-8.5 RBC-2.38*# HGB-6.6*# HCT-20.8*# MCV-88 MCH-27.6# MCHC-31.5 RDW-20.2* [**2137-2-25**] 05:15PM DIGOXIN-0.8* [**2137-2-25**] 05:15PM GLUCOSE-82 UREA N-35* CREAT-1.0 SODIUM-140 POTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-34* ANION GAP-9 Brief Hospital Course: 1. GIB: NG lavage negative in ED, hx of duodenitis, EGD showed gastric ulcer (non bleeding) [**2-13**] Hct 28.7 [**2-18**] Hct 21 -> 2 u pRBC -> Hct 26 [**2-23**] profuse epistaxis, Hct 23 -> 2 u pRBC [**2-25**] at [**Hospital1 18**] ED: Hct 20, G+ black stool, NG lavage negative Pt admitted to floor team, but transferred to [**Hospital Unit Name 153**] [**3-6**] concern for respiratory distress and possible need for ventilation during c-scope- [**2-27**] transferred back to medical floor s/p procedure Hct 28 [**2-28**] a.m. hct 28, no evidence of epistaxis but 1 black stool bleeding in oropharynx and posterior pharynx upon removal of endoscope(resolved). received vanc and gent X 1 dose for ppx prior to scope -PPI -Pt should follow up in [**Hospital **] clinic in [**2-3**] months -no biopsy taken during this EGD, h. pylori neg in '[**34**] -Hx of HIT + which most likely caused the patient to have decreased platelets. Platelets at admission were ~140. However, on smear patient has some plasma cells, (no schistocytes), may need repeat smear to differentiate the cause of his thrombocytopenia. -Needs repeat hct in 2 days, would add differential to check for plasma cells. -given Vitamin K since INR was 1.6 (most likely from abx) 2. COPD flare: --COPD flare: prednisone taper (st [**2-27**] at 40mg daily) --Given nebs q3hr prn --goal O2 sat 90-94% --frequent suctioning --sputum GS grew GPC, started levo given COPD flare (cont for 10 days) --speaking valve was placed [**Hospital 8890**] transfer to ICU, ABG 7.4/51/67 HCO3 34 (resp acid + met alk), hypoxic 3. CV: Pump, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1291**], [**First Name3 (LF) **] 40% --lasix 40 mg PO qD (held at admission, resumed after egd) CV: Rhythm, hx of afib, now in sinus (throughout hospitalization), there were no events on tele --amio was continued, held digoxin (d/c'd at discharge), continued on diltiazem --needs to follow up in cardiology clinic regarding length of amioderone, digoxin was d/c'd during this hospitalization CV: Cor, lat ST dep on EKG --held digoxin [**First Name3 (LF) 1291**]: [**First Name3 (LF) 1291**] on [**2137-1-29**], surgical clips removed [**2137-2-27**] 4. Psych: --continue olanzapine but hold valproate given change in MS [**Name13 (STitle) 8891**] level 23 5. HTN: continued valsartan and diltiazem 6. Code: full 7. FEN: was npo for EGD and then tube feeds were restarted with no complications. 8. PPx: pneumoboots, PPI, Insulin while on steroids Medications on Admission: Meds on transfer: protonix 40 IV BID Atrovent neb q6 Amio 200 qD pulmicort 0.25 [**Hospital1 **] Digoxin 0.125 qD Dilt 120 QID Valsartan 80 qD Folic Acid 1 qD Thiamine 100 Qd Olanzapine 10 [**Hospital1 **] Valproate 125 [**Hospital1 **] Vanc 1g X 1 Gent X 1 Azith 500 IV qD Methylpred 60 IV TID Insulin SQ NS 100cc/hr X 2L allergy: All: PCN, zestril, h/o HIT Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Primary Diagnoses: Gastrointestinal Bleed- s/p egd Gastric ulcer COPD Flare Secondary Diagnoses: Thrombocytopenia Hypertension s/p vasectomy s/p rhinoplasty as a child because of fx h/o adrenal mass s/p removal of skin cancers [**2132**]- hx L hip osteomyelitis, s/p hip replacement [**2133**]- L wrist septic arthritis [**2135**]- duodenitis, UGIB [**2136**]- Aortic stenosis -> [**Year (4 digits) 1291**] [**1-5**] [**Company **] porcine valve, p/op course c/b delerium, ARF, afib, shock liver, repiratory failure (re-intubated X 2 after surgery) trach and PEG, PNA (Staph, tx with Vanc until [**2-18**]) EF 40% h/o HIT Discharge Condition: stable Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: 2 liters Please return to the ED if you feel short of breath or if you have chest pain or if you have continued black stools or if you have increased cough. Call your doctor if you have any concerning symptoms. Followup Instructions: Please follow up with your pcp [**Last Name (NamePattern4) **]. [**Last Name (STitle) 4127**] within 1 week CAll [**Telephone/Fax (1) 2660**] for an appointment Please follow up with gastroenterology in [**3-7**] months Call ([**Telephone/Fax (1) 8892**] for an appointment Please follow up with cardiology in 1 month Call ([**Telephone/Fax (1) 2037**] for an appointment Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7145**] ORTHOPEDIC PRIVATE PRACTICE Where: [**Last Name (NamePattern4) 7145**] ORTHOPEDIC PRIVATE PRACTICE Date/Time:[**2137-5-15**] 11:00 ICD9 Codes: 2851, 2875, 4019
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Medical Text: Admission Date: [**2130-11-29**] Discharge Date: [**2130-12-5**] Date of Birth: [**2073-10-14**] Sex: F Service: ORTHOPAEDICS Allergies: Carbamazepine Attending:[**First Name3 (LF) 11415**] Chief Complaint: Pedestrian struck Major Surgical or Invasive Procedure: [**2130-11-30**]: ORIF left tibial plateau fracture History of Present Illness: Ms. [**Known lastname **] is a 57 year old female who was a pedestrian struck by a car traveling approximately 30-40mph. She was taken to the [**Hospital1 18**] for further evaluation and care. Past Medical History: PMH: seizures, DM-2, HLD PSH: R femur rod placed Social History: no EtOH, tobacco, or drug use Family History: noncontributory Physical Exam: On discharge: Afebrile, All vital signs stable General: Alert and oriented, No acute distress Extremities: left lower extremity in hinged knee brace; incision C/D/I with staples; 2+ pulses, sensation intact in foot, full toe flexion and extension Weight bearing: LLE touchdown weightbearing, RLE weightbearing as tolerated Pertinent Results: [**2130-11-29**] 09:50AM PT-13.5* PTT-27.4 INR(PT)-1.2* [**2130-11-29**] 09:50AM PLT COUNT-226 [**2130-11-29**] 09:50AM WBC-3.8* RBC-4.07* HGB-12.9 HCT-38.2 MCV-94 MCH-31.6 MCHC-33.7 RDW-13.4 [**2130-11-29**] 09:50AM UREA N-14 CREAT-0.6 [**2130-11-29**] 09:55AM GLUCOSE-109* LACTATE-1.8 NA+-141 K+-4.0 CL--93* TCO2-32* [**2130-11-29**] 12:08PM HGB-12.3 calcHCT-37 [**2130-11-29**] L leg xray: There is an extensively comminuted depressed lateral tibial plateau fracture. A component of the fracture does extend medial to the medial tibial eminence as well. Baseline chondrocalcinosis is suspected as well. There is underlying lipohemarthrosis. No further fracture is identified. [**2130-11-29**] CT pelvis: . Bilateral superior and inferior pubic rami fractures as well as a left horizontal sacral ala fracture. There is no widening of the sacroiliac joints and these injuries are most consistent with a type 1 lateral compression fracture. [**2130-11-29**] CT LLE: Left lateral tibial plateau fracture with 12 cm of central displacement and extension to the medial tibial eminence. There is also a nondisplaced fibular head fracture as well as a fracture through the medial aspect of the inferior pole of the patella. There is resultant lipohemarthrosis. Brief Hospital Course: Ms. [**Known lastname **] presented to the [**Hospital1 18**] on [**2130-11-29**] after being a pedestrian struck by a car. She was evaluated by the trauma surgery and orthopaedic surgery service. She was admitted to the T/ICU for monitoring. On [**2130-11-30**] she was taken to the operating room and underwent an ORIF of her left proximal tibia fracture. She tolerated the procedure well. On [**2130-12-1**] she was transferred from the T/SICU to the floor for further care. She was seen by physical therapy to improve her strength and mobility. The rest of her hospital stay was uneventful with her lab data and vital signs within normal limits and her pain controlled. She is being discharged today in stable condition. Medications on Admission: Keppra 1500 [**Hospital1 **], Phenobarbital 60 QHS, Lamictal 100'', Simvastatin 40 QHS, Metformin 1000'', Calcium, Ferrous sulfate''', Zonisamide 100 [**Last Name (LF) 24018**], [**First Name3 (LF) **], Phosamax. Discharge Medications: 1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 2. phenobarbital 30 mg Tablet Sig: Two (2) Tablet PO QPM (once a day (in the evening)). 3. lamotrigine 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 5. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 6. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe Subcutaneous at bedtime for 4 weeks. 8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. 9. levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 10. levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. zonisamide 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 12. insulin regular human 100 unit/mL Solution Sig: One (1) unit Injection ASDIR (AS DIRECTED). 13. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at [**Hospital6 1109**] - [**Location (un) 1110**] Discharge Diagnosis: Pedestrian struck LC1 pelvic fracture Left tibial plateau fracture Left fibula head fracture Left medial platella fracture 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: Continue to be touchdown weight bearing on your left leg Continue your lovenox injections as instructed for a total of 4 weeks after surgery Please take all your medication as prescribed If you have any increased redness, drainage, or swelling, or if you have a temperature greater than 101.5, please call the office or come to the emergency department. You have been prescribed a narcotic pain medication. Please take only as directed and do not drive or operate any machinery while taking this medication. There is a 72 hour (Monday through Friday, 9am to 4pm) response time for prescription refil requests. There will be no prescription refils on Saturdays, Sundays, or holidays. Please plan accordingly. Physical Therapy: Activity: As tolerated Left lower extremity: Touchdown weight bearing [**Doctor Last Name **] brace unlocked/ROM knee as tolerated Brace may come off for daily care/hygeine Treatments Frequency: Staples out 14 days after surgery Dry dressing as needed for comfort over knee with brace Followup Instructions: Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2 weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**] ICD9 Codes: 2724
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Medical Text: Admission Date: [**2109-10-16**] Discharge Date: [**2109-10-24**] Date of Birth: [**2041-12-28**] 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: [**2109-10-18**] - Coronary artery bypass grafting x3 with the left internal mammary artery to the left anterior descending artery and reversed saphenous vein grafts to the obtuse marginal artery and the second diagonal artery. History of Present Illness: Mr. [**Known lastname 33059**] is a 67 year old male with a history of hypertension, hypercholesterolemia, palpitations, and coronary artery disease who was transferred from [**Hospital3 19345**] after a cardiac catheterization revealed lesions in his left anterior descending and left circumflex coronary arteries. Ruled in for myocardial infarction based on CK and troponin Past Medical History: Hypertension, Dyslipidemia, h/o palpitations with APC and VPCs on Holter monitor, hiatal hernia, GERD, colonic polyps s/p polypectomy, mild carotid disease, s/p melanoma L shoulder resection, s/p cholecystectomy, s/p L knee surgery, s/p tonsillectomy as child Social History: Mr. [**Known lastname 33059**] lives alone, as his wife passed away 3 days ago. He has three children (one daughter is [**Name8 (MD) **] RN). He is the assistant director of athletics at [**University/College 33060**]. He quit smoking 37 years ago. He occasionally drinks alcohol and denies recreational drug use. Family History: non-contributory Physical Exam: General: Middle aged 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] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema - none Varicosities: None [x] Neuro: Grossly intact Pulses: Femoral Right: 2 Left: 2 DP Right: 1 Left: 1 PT [**Name (NI) 167**]: 1 Left: 1 Radial Right: 2 Left: 2 Carotid Bruit Right: none Left: none Pertinent Results: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 33061**] (Complete) Done [**2109-10-18**] at 9:17:17 AM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 18**] - Department of Cardiac S [**Last Name (NamePattern1) 439**], 2A [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2041-12-28**] Age (years): 67 M Hgt (in): 71 BP (mm Hg): 113/57 Wgt (lb): 90 HR (bpm): 50 BSA (m2): 1.50 m2 Indication: Intra-op TEE for CABG ICD-9 Codes: 410.91, 786.51, 424.1 Test Information Date/Time: [**2109-10-18**] at 09:17 Interpret MD: [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 929**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2009AW01-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 5.0 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 55% >= 55% Findings RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or color Doppler. LEFT VENTRICLE: Mild symmetric LVH. Normal regional LV systolic function. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Normal ascending aorta diameter. Normal aortic arch diameter. Normal descending aorta diameter. AORTIC VALVE: Three aortic valve leaflets. Mildly thickened aortic valve leaflets (3). No AS. Mild to moderate ([**12-28**]+) AR. Eccentric AR jet. MITRAL VALVE: No MS. Trivial MR. TRICUSPID VALVE: Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus rhythm. Results were personally reviewed with the MD caring for the patient. See Conclusions for post-bypass data The post-bypass study was performed while the patient was receiving vasoactive infusions (see Conclusions for listing of medications). Conclusions PRE-BYPASS: No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy. 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 three aortic valve leaflets. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. Mild to moderate ([**12-28**]+) aortic regurgitation is seen. The aortic regurgitation jet is eccentric and directed towards the interventricular septum. Trivial mitral regurgitation is seen. POST-BYPASS: For the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and is in sinus rhythm. 1. Biventricular function is normal 2. Aortic contours appear intact post decannulation 3. Other findings are unchanged Dr. [**Last Name (STitle) **] was notified in person of the results. Brief Hospital Course: Transfer from outside hospital for surgical evaluation, he [**Last Name (STitle) 1834**] preoperative workup. On [**10-18**] Mr. [**Known lastname 33059**] [**Last Name (Titles) 1834**] a coronary artery bypass grafting times three (LIMA to LAD, SVG to DIAG, and SVG to OM) with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He tolerated this procedure well and was transferred to the intensive care unit. He was extubated and weaned from his pressors. His chest tubes were removed and he was transferred to the surgical step down floor. His epicardial wires were removed and he was diuresed toward his pre-operative weight. His lopressor was increased as tolerated. He was seen in consultation by the physical therapy service. On post operative day four he had episode of nausea with diaphoresis that progressed to dizzness, he was found to be hypotensive and was transferred to the intensive care unit for evaluation. Echocardiogram ruled out tamponade and chest CT ruled out aortic dissection. He had no further episodes and was transferred back to the floor on postoperative day five. He continued to progress, physical therapy saw he evaluation. He was ready for discharge home with services on post operative day six with plan for daughter to stay with him for assistance. Medications on Admission: Atenolol 50mg po daily Lisinopril 5mg po daily Omeprazole 20mg po daily ASA 81mg po daily Discharge Medications: 1. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*50 Tablet(s)* Refills:*0* 3. 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* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. 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* 6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 8. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 9. xanax you make take Xanax as previously prescribed by PCP as needed Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: coronary artery disease s/p CABG Non ST elevation myocardial infarction Vasovagal episode Hypertension Dyslipidemia hiatal hernia GERD colonic polyps s/p polypectomy carotid disease s/p melanoma L shoulder resection s/p cholecystectomy s/p L knee surgery s/p tonsillectomy as child 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 100.5 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for approximately one month No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Dr [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) - [**2109-11-13**] at 1pm [**Hospital **] medical buiding [**Hospital Unit Name **] - [**Doctor First Name **] Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 12816**] (PCP) - Tuesday [**11-12**] at 10 am ([**Telephone/Fax (1) 33062**] Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4450**], M.D. Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2109-11-13**] 11:40 Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse ([**Telephone/Fax (1) 3071**]) Completed by:[**2109-10-24**] ICD9 Codes: 4241, 4019, 2724
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Medical Text: Admission Date: [**2128-5-9**] Discharge Date: [**2128-6-1**] Date of Birth: [**2050-6-10**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 618**] Chief Complaint: Change in mental status Major Surgical or Invasive Procedure: Tracheostomy placemnet PEG tube placement IVC filter placement History of Present Illness: The patient is a 77 year old man with a h/o atrial fibrillation transferred from an outside hospital for unresponsiveness (intubated/sedated at OSH). Patient reportedly has not been his "normal self" lately. He has been more agitated (getting ativan), confused, and lethargic at times. He had had several hospital visits for a pneumonia and had been on vancomycin and levoquin. Patient reportedly found unresponsive with "eyes rolled back". He was not shaking or tremoring. An ambulance was called and he was taken to [**Hospital **] Hospital. There he was found to be minimally responsive, blood pressures 170s to 180s over 80's, with a fever to 102.2, his blood sugar was 61, and NIH stroke scale was calculated at 24 primarily for minimal movement on the right, no verbal output, and decreased level of attention. He was treated with unasyn, levaquin, IVF and loaded with dilantin. Two hours later the patient received a head ct which showed a left frontal hypodensity. Three hours later, he remained lethargic and was intubated for airway protection (etomidate, succin., vecuron.). He was transferred and arrived at [**Hospital1 18**] approximately 90 minutes later. Past Medical History: -h/o recent LLL pna -deafness since 20yrs ago - blindness since childhood - optic nerve atrophy? -adult onset diabetes -h/o decreased vision -h/o dvt's -h/o atrial fibrillation -esophagitis -h/o seizures -h/o closed head injury Social History: Sister is HCP Resident of [**Location (un) 511**] Home for Deaf. The patient lives at the home for the deaf, and does not smoke or drink alcohol. Family History: No family history of strokes. Physical Exam: Vitals: 102.2 126 164/102 20 General: older man in no distress, intubated Neck: supple Lungs: decreased breath sounds at bases CV: tachcardic, no murmur appreciated Abdomen: non-tender, non-distended, bowel sounds present Ext: warm, no edema Neurologic Examination: intubated and sedation; no eye opening to loud voice or [**Last Name (un) **]; agitated to sternal rub; pupils reactive to light 3 to 1 mm b/l; no blink to threat b/l, intact corneal; facial asymmetry difficult to appreciate with intubation tube; slightly increased tone throughout (L>R), spontaneous mvt in left arm and leg, withdraws to noxious stimuli on right arm and leg (left side too), reflexes 2+ at knees, 1 at ankles, 2 in Bic, Tric, [**Last Name (un) 1035**], toe up on right, equiv. on left EXAM AT DISCHARGE: Pertinent Results: MRA BRAIN W/O CONTRAST [**2128-5-9**] 9:04 PM MRI OF THE BRAIN WITH MRA OF THE CIRCLE OF [**Location (un) **] CLINICAL INDICATION: Infarction and neurologic deficit. Multiplanar T1- and T2-weighted images of the brain was obtained. MRA of the circle of [**Location (un) 431**] was performed according to standard departmental protocol. No prior brain MRIs are available for comparison. There is a moderate-sized area of diffusion abnormality involving the left frontal lobe and a smaller region involving the left internal capsule consistent with areas of subacute infarction. These might contain byproduct of blood due to susceptibility. The ventricular system is symmetrical without hydrocephalus. Scattered areas of magnetic susceptibility are noted within the left basal ganglia and the right parietal [**Doctor Last Name 352**]-white junction. These could represent areas of hemosiderin deposition or foci of amyloid angiopathy. Correlation with CT of the brain would be helpful to exclude the possibility of hemorrhagic lesions. T2 hyperintensity is noted within the brainstem and periventricular white matter suggestive of chronic microvascular ischemic or gliotic changes. No subdural hemorrhage is seen. The study is degraded by motion artifact. There is opacification of the paranasal sinuses. Signal flow voids are present along the intracranial portions of the carotid and basilar arteries. There is absence of signal flow void within the right vertebral artery suggestive of total occlusion. IMPRESSION: Diffusion abnormality involving the left internal capsule and the left frontal lobe most likely consistent with areas of subacute infarction. Overall study was degraded by a motion artifact. Scattered foci of magnetic susceptibility suggestive of possible amyloid angiopathy. There is suggestion of a small left-sided developmental venous anomaly involving the left parietal lobe. Correlation with gadolinium-enhanced images might be helpful along with followup. Areas of chronic ischemia are seen within the brainstem and thalami. MRA of the circle of [**Location (un) 431**] was performed according to standard departmental protocol. There is significant ectasia and dilatation of the distal vertebrobasilar circulation with slight aneurysmal fusiform dilatation of the proximal basilar artery. There is significant tortuosity of the cavernous ICA. The right distal vertebral artery is not visualized and is probably totally excluded. No intracranial aneurysms are seen involving the anterior or middle cerebral arteries. IMPRESSION: Significant ectasia of the distal vertebrobasilar circulation with mild fusiform aneurysmal dilatation of the proximal basilar artery. Total occlusion of the right distal vertebral artery. The intracranial circulation was otherwise patent. CT HEAD W/O CONTRAST [**2128-5-11**] 9:20 AM FINDINGS: There is redemonstration of the large left posterior frontal acute infarction with a small amount of hemorrhagic contents. Infarction also appears to extend to the posterior limb of the left internal capsule where the largest hemorrhagic component, approximately 3 mm in size is visualized. These findings were demonstrated on the prior MR study. There is a minor amount of mass effect caused by the infarct, as shown by continued demonstration of a few millimeters rightward bowing of the septum pellucidum. There has been no change in ventricular size. The prominently ectatic and partially calcified visualized distal left vertebral artery as well as basilar artery are imaged. There are likely ectatic as well as calcified components involving the cavernous portion of the left internal carotid artery with atherosclerotic calcification of the cavernous portion of the right internal carotid artery. There is a moderate amount of mucosal thickening in the right ethmoid sinus, with a meniscus-shaped soft tissue density, probably fluid and mucosal thickening, within the posterior aspect of the right and left sphenoid air cells. CAROTID SERIES COMPLETE PORT [**2128-5-10**] 1:03 PM FINDINGS: Duplex evaluation was performed of both carotid arteries. Minimal plaque was identified. On the right, peak systolic velocities are 107, 84, 104 in the ICA, CCA, and ECA respectively. The ICA to CCA ratio is 1.3. This is consistent with less than 40% stenosis. On the left, peak systolic velocities are 115, 92, 140 in the ICA, CCA, and ECA respectively. The ICA to CCA ratio is 1.3. This is consistent with less than 40% stenosis. The right vertebral artery was not visualized due to an IV line and the jugular vein. There is antegrade flow in left vertebral artery. IMPRESSION: Minimal plaque with bilateral less than 40% carotid stenosis. Cardiology Report ECHO Study Date of [**2128-5-12**] MEASUREMENTS: Left Atrium - Long Axis Dimension: 3.2 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: 5.1 cm (nl <= 5.2 cm) Right Atrium - Four Chamber Length: 4.8 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: 3.6 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: >= 60% (nl >=55%) Aorta - Valve Level: 3.6 cm (nl <= 3.6 cm) Aorta - Ascending: *3.6 cm (nl <= 3.4 cm) Aortic Valve - Peak Velocity: 1.5 m/sec (nl <= 2.0 m/sec) Mitral Valve - E Wave: 0.6 m/sec Mitral Valve - A Wave: 0.8 m/sec Mitral Valve - E/A Ratio: 0.75 Mitral Valve - E Wave Deceleration Time: 215 msec TR Gradient (+ RA = PASP): *19 to 27 mm Hg (nl <= 25 mm Hg) INTERPRETATION: Findings: LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic root diameter. Mildly dilated ascending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets. No AS. Mild (1+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. Mild PA systolic hypertension. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. PERICARDIUM: No pericardial effusion. Conclusions: The left atrium is normal in size. 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 ascending aorta is mildly dilated. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. No cardiac source of embolus identified (cannot definitively exclude). Agitated saline contrast study at rest (2 injections) revealed evidence of intracardiac shunt consistent with the presence of an atrial septal defect (or stretched patent foramen ovale). Neurophysiology Report EEG Study Date of [**2128-5-12**] OBJECT: 77-YEAR-OLD MAN WITH LEFT FRONTAL STROKE, R/O SEIZURE ACTIVITY. THE HEART WAS MONITORED BECAUSE DISORDERS OF HEART RHYTHMS [**Month (only) **] PRODUCE NEUROLOGICAL COMPLAINTS AS DESCRIBED ABOVE DISORDERS SUCH AS SEIZURES, WHEN SYMPTOMATIC, [**Month (only) **] PRODUCE CARDIAC ARRHYTHMIAS. TIME SAMPLES: In wakefulness, the background over the entire left hemisphere is low voltage and slow in the 7 Hz theta frequency range. In addition, there is diffuse delta frequency slowing seen over the entire left hemisphere. In addition, there are bursts of generalized slowing in the [**2-9**] Hz delta frequency range. BACKGROUND: Over the right hemisphere is also slow with the [**7-14**] Hz theta frequency range but well-defined. There are sharp features over the right parietal region with phase reversing around P4. PUSHBUTTONS: There is one pushbutton event recorded. There is no seizure activity recorded in this file. AUTOMATIC SEIZURE DETECTIONS: Captured three events. Two events represent movement artifact due to manipulation of the respiratory tubes. The third event is due to a technical artifact over the O2 lead. AUTOMATIC SPIKE DETECTIONS: This algorithm captured 186 events. The majority of the events were due to movement artifact. Some events show moderate to high voltage sharp slowing with phase reversing around P4. SLEEP: Review of the time sample showed some prolonged episodes of slow wave sleep. In this episode, the background asymmetry was not as emphasized as in wakefulness. CARDIAC MONITOR: Normal sinus rhythm wtih a rate of 84 bpm. IMPRESSION: This is an abnormal 24-hour discontinuous EEG telemetry obtained in wakefulness progressing to stage IV sleep due to the presence of slow background activity and low voltage activity over the entire left hemisphere with intermixed delta frequency slowing. In addition, there is sharp slowing with phase reversing in the right parietal region. This finding suggests cortical and subcortical dysfunction over the entire left hemisphere with cortical dysfunction over the right parietal region. The background activity suggests deep, midline subcortical dysfunction and is consistent with a mild diffuse encephalopathy. There were no clear epileptiform discharges seen. PERC G/G-J TUBE PLMT [**2128-5-14**] 7:55 AM PHYSICIANS: [**First Name8 (NamePattern2) **] [**Doctor Last Name 26181**] and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3175**] with Dr. [**First Name (STitle) 3175**], the attending radiologist, present and supervising during the procedure. PROCEDURE: Following written informed consent, the patient was positioned supine on the angiography table. A preprocedure timeout was performed to confirm patient, procedure, and site. Standard sterile prep and drape of the ventral abdomen. Initial fluoroscopy confirmed appropriate positioning of the nasogastric tube within the proximal stomach. Air outlined the transverse colon which is situated inferior to the gastric air bubble. Air was insufflated through the nasogastric tube to distend the stomach. Local anesthesia with 10 cc of 1% lidocaine subcutaneously. Using fluoroscopic guidance and a 19-gauge needle, two percutaneous T-fasteners were placed in the stomach near the junction of the proximal two-thirds and distal one-third. In each instance confirmation of positioning of the needle in the stomach lumen was confirmed by efflux of air from the needle and by the instillation of contrast outlining rugal folds of the stomach. After placing the second T- fastener, a 0.035-inch guidewire was advanced through the needle into the stomach and the needle was exchanged for a 5-French Kumpe catheter. Using a guidewire and Kumpe catheter, the guidewire was advanced beyond the ligament of Treitz into the jejunum. The catheter was exchanged for 10-French and then 12-French fascial dilators and then a 14-French peel-away sheath. A 14-French [**Doctor Last Name 9835**] gastrojejunostomy catheter was placed over the guidewire through the sheath and positioned with its tip in the proximal jejunum. The peel-away sheath and guidewire were removed. The catheter's locking loop was formed within the second portion of the duodenum. Contrast injection through the catheter confirmed appropriate positioning of the catheter tip within the jejunum. Peristalsis was present within the opacified jejunal loops. The catheter was flushed with saline and then capped. The catheter was fixed in place with a StatLock device and a sterile dressing was applied. The catheter can be used in four hours post- procedure if there are no signs of peritonitis. The cotton roll anchors for the T-fasteners should be removed in seven- ten days. IMPRESSION: Successful placement of a 14-French [**Doctor Last Name 9835**] gastrojejunostomy catheter with tip in the jejunum. The catheter can be used four hours post- procedure if there are no signs of peritonitis. [**2128-5-9**] 05:45PM %HbA1c-10.0* [Hgb]-DONE [A1c]-DONE [**2128-5-9**] 04:21PM LACTATE-3.5* NA+-140 K+-5.1 [**2128-5-9**] 08:24PM CEREBROSPINAL FLUID (CSF) PROTEIN-65* GLUCOSE-134 [**2128-5-9**] 08:24PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-16* POLYS-81 LYMPHS-19 MONOS-0 [**2128-5-9**] 08:24PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-67* POLYS-90 LYMPHS-10 MONOS-0 [**2128-5-9**] 04:21PM HGB-15.0 calcHCT-45 [**2128-5-9**] 04:20PM GLUCOSE-281* UREA N-9 CREAT-0.9 SODIUM-134 POTASSIUM-7.9* CHLORIDE-98 TOTAL CO2-20* ANION GAP-24* [**2128-5-9**] 04:20PM ALT(SGPT)-45* AST(SGOT)-71* LD(LDH)-995* ALK PHOS-120* AMYLASE-105* TOT BILI-0.8 [**2128-5-9**] 04:20PM LIPASE-29 [**2128-5-9**] 04:20PM ALBUMIN-3.7 CALCIUM-9.0 PHOSPHATE-3.2 MAGNESIUM-1.8 [**2128-5-9**] 04:20PM TRIGLYCER-170* [**2128-5-9**] 04:20PM TSH-0.69 [**2128-5-9**] 04:20PM PHENYTOIN-20.1* [**2128-5-9**] 04:20PM ASA-NEG ETHANOL-NEG ACETMNPHN-6.0 bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2128-5-9**] 04:20PM WBC-9.4 RBC-4.73 HGB-15.1 HCT-43.8 MCV-93 MCH-31.9 MCHC-34.5 RDW-15.0 [**2128-5-9**] 04:20PM NEUTS-79.5* LYMPHS-15.1* MONOS-4.2 EOS-0.4 BASOS-0.7 [**2128-5-9**] 04:20PM PLT COUNT-429 [**2128-5-9**] 04:20PM PT-13.8* PTT-21.9* INR(PT)-1.2* Title: WOUND CARE Asked to evaluate Mr. [**Known lastname 66946**] for impairment in skin integrity. He is a 77 year old male admitted from NH for the deaf in [**Location (un) 4047**]. Medical history: Afib, PNA, DM, DVT's, Seizures, Closed Head Injury, deafness. He has had frequent stooling. He has an erythematous rash with fungal involvement B/L groin, medial thighs, perianal tissue, gluteals, and coccyx. There are two partial thickness ulcers B/L gluteals related to excoriation. Each site is approx. 1.5 x 1 cm., 100% pink and superficial, irregular wound edges, no drainage, periwound tissue is erythemic with fungal infection. There is no edema, induration, crepitus, or fluctuance. Alb 2.7 on [**5-16**], Hgb 10.4, Hct 32.2, Glucose 149, BUN 3 Recommendations: Pressure relief measures per pressure ulcer guidelines. On Atmos Air Air Mattress for pressure relief Turn and repostion every 1-2 hours off back If OOB, limit sit time to one hour at a time and sit on a pressure relief cushion Gentle cleansing perianal and gluteal tissue with foam cleanser Pat dry Apply antifungal ointment to affected skin, follow with Double Guard Zinc Oxide Paste - esp over partial thickness ulcers on gluteals follow with Aloe Vesta Moisture Barrier Ointment TID and prn Support nutrition CXR [**5-24**]: CHEST AP: There is interval development of left retrocardiac opacity and an evolving opacity in the left perihilar region. A right IJ line is seen with its tip in the right atrium. Tracheostomy tube is in place. Linear atelectasis is present in the right lung base. An IVC filter is in place. Splenic artery calcification is noted. IMPRESSION: New retrocardiac consolidation with an evolving left hilar pneumonia. CTA [**5-19**]: INDICATION: Tachypnea, fever, and increased sputum in a patient with known deep venous thrombosis. COMPARISON: No previous chest CT. Abdominal CT of one day prior is available for correlation. TECHNIQUE: Axial multidetector CT images of the chest were obtained without contrast utilizing low-dose technique and then with intravenous Optiray administered at 2 cc per second via a central venous catheter. Multiplanar reformatted images were obtained. CHEST CT ANGIOGRAM: Good opacification of the pulmonary arteries was achieved despite the slow rate of injection. Filling defects are present in the lobar arteries to the right upper and right lower lobes, as well as in many of their segmental and subsegmental branches, consistent with acute pulmonary embolism. No left-sided pulmonary emboli are identified. Extensive atherosclerotic calcifications are present in the aorta and coronary arteries. There is no pericardial effusion. Small bilateral pleural effusions are present, previously noted on the abdominal CT of one day earlier. There is no enhancement of pleural surfaces and no evidence of loculation to suggest empyema, although empyema cannot be excluded by CT scan. There is moderate atelectasis in both lower lobes. The tracheobronchial tree is patent to the subsegmental levels. The imaged portions of the liver and spleen appear unremarkable. Extensive splenic artery calcifications are noted. There are no suspicious lytic or sclerotic bone lesions. CT RECONSTRUCTIONS: Multiplanar reconstructions confirm the findings demonstrated on the axial images. Value grade is 2. Findings were discussed with Dr. [**First Name8 (NamePattern2) 2270**] [**Last Name (NamePattern1) **] at 5 p.m. on [**2128-5-18**]. IMPRESSION: 1. Pulmonary emboli in the right upper and right lower lobar arteries and their segmental and subsegmental branches. 2. Small bilateral pleural effusions. Empyema cannot be excluded by CT scan. 3. Moderate bibasilar atelectasis. 4. Atherosclerosis in the aorta and coronary arteries. LE U/S: FINDINGS: Grayscale and Doppler son[**Name (NI) 1417**] of both common femoral, superficial femoral and popliteal veins were performed. Thrombus is identified in both lower extremities extending from the common femoral veins to the popliteal veins. The thrombus appears occlusive on the left side. On the right, there is a large rounded but nonocclusive thrombus within the right common femoral vein. It appears somewhat unstable in appearance. More echogenic contours in the right superficial femoral vein may represent chronic thrombus. These findings were discussed with Dr. [**Last Name (STitle) 724**] at 4:45 p.m., [**2128-5-14**]. IMPRESSION: Extensive bilateral lower extremity DVTs as described above. Brief Hospital Course: The patient is a 77 year old man with a history of afib p/w fever and decreased responsiveness. Neuroimaging consistent with subacute left frontal infarction with hemorrhagic conversion and chronic hypertensive microangiopathy. 1. Neurologic: The patient is deaf and legally blind at baseline. His initial exam on presentation: No eye opening to noxious stimuli (although has opened eyes briefly to sternal rub). Pupils: briskly reactive, left irregular post-surgical. Right faical weakness, OCRs and corneals intact. Withdraws left arm, and both legs to noxious stimuli, minimal proximal withdrawal of right arm to noxious. Both toes up bilaterally. MRI/MRA was performed and showed left frontal DWI bright, T2 FLAIR hyperintensity, likely aubacute infarction; susceptibility artefact into left frontal stroke bed and ipsilateral posteior internal capsule with extension into posterior [**Doctor Last Name 534**] of left lateral ventricle. Carotid U/S showed < 40% stenosis. EEG was abnormal 24-hour discontinuous EEG telemetry obtained in wakefulness progressing to stage IV sleep due to the presence of slow background activity and low voltage activity over the entire left hemisphere with intermixed delta frequency slowing. In addition, there is sharp slowing with phase reversing in the right parietal region. Corrected dilantin levels were initially slightly supratherapeutic. The patient was in the ICU for several weeks with no neurological improvement. Trach and peg were placed as he could not be weaned from the vent or fed. When transferred to the floor, dilantin was discontinued for no real suggestion of seizure activity (medication had been started for EEG rather than clinical finding). After several weeks of no neurological progress on the floor, and several days after dilantin was discontinued, he began to wake up and move both extremities spontaneously. He was treated with coumadin due to the likely embolic nature of the stroke, as well as various comorbidities (including afib, dvt's and PEs). On the day of discharge, he was awake and alert; he could not follow verbal commands (deaf and legally blind) but appeared to be scanning sentences when written in large, dark, block letters. He had no speech production. He did, however, pick up on nonverbal cues at times, lifting his arm appropriately when presented with a blood pressure cuff. He continued to move his arms and legs very well, thought could not follow commands to test specific muscle strength; he could get out of bed to chair with a lot of assistance. He showed normal sensation to light tactile stimulation on four extremites and face (tickling) with localization. He worked well with PT and had made some neurological progress; rehab facility was suggested, and he was transferred there when medically stable. 2. Respiratory: He initially had a pneumonia treated with Zosyn + Flagyl x 7 day course early in the hospitalization. For failure to wean from the vent, a trach was placed. He tolerated trachmask, and was transferred to the stepdown unit on the floor. Later, on the floor, after DVT's had been detected on LE u/s, and after a filter had been placed and the patient started on coumadin, he developed persistent tachycardia, tachypnea and low sats; CTPA was performed and revealed several PE's in the right lung. He was continued on coumadin and heparin (discontinued when coumadin therapeutic) and respiratory rate and tachycardia improved greatly within 3-4 days. He also developed increased secretions and the need for suctioning the trach site; chest xray showed a new pneumonia and he was initially treated with flagyl and levaquin; this was switched to flagyl + zosyn when he dropped his bp to 80s as well as sats once again. He improved the following day, and as his clinical status improved, he made neurological headway as well. He should remain on flagyl + zosyn for completion of 14 day course(to be completed at rehab facility on [**2128-6-7**]). 3. CVS - He was found to be in atrial fibrillation initially requiring rate control; Echo showed EF>55%, ASD (likely) vs PFO. He was treated with heparin and coumadin, and transitioned to coumadin alone when INR was therapeutic. His rate normalized later in the hospitalization once infections and pulmonary embolus were better treated. Lower extremity ultrasounds were checked revealing bilateral LE DVTs: thrombus occlusive on the left side. Nonocclusive thrombus right common femoral vein, unstable in appearance. More echogenic contours in the right superficial femoral vein may represent chronic thrombus. He had a R IVC placed; arteriogram was performed to evaluate IVC filter via R IJ; duplicate left renal system noted and left iliac vein not seen. Subsequent to filter placement, abdominal CT-venogram was performed which revealed a tortuous renal artery (see results section). Subsequent to filter placement, he developed pulmonary embolism and 4. Endocrine: he was placed on an insulin sliding scale, close fingersticks were checked. Blood sugars were elevated and Hba1c >10. Sliding scale was tightened around the time of discharge. 5. Renal: monitor ins/outs; occasionally he had low urine output and required fluid boluses. Ins and outs were even and renal function was adequate at discharge. 6. ID: Bcx, UCx, CSF Cx were negative. LP had been performed and CSF was not suspicious for meningitic/encephalitic picture. He was treated twice for pneumonia (see above). He does have a history of cdiff, but is on flagyl currently. He had no cdiff during this admission. 7. GI: he underwent PEG (G-J tube) placement by IR, and tube feeds were started and eventually achieved goal. Hospital course was complicated by GI bleeding and dropping hematocrits, requiring blood transfusions. As his INR was not therapeutic at the time, this was thought potentially related to bowel ischemia. Coumadin was continued despite GI bleeding, as he had overwhelming coagulopathic disorders (PEs, DVTs, ASD in heart, stroke). GI was consulted and recommended PPI; they did not feel scope would be beneficial as it would not change management, and that he would need to be continued on coumadin. GI bleeding stopped when INR was therapeutic, and he tolerated coumadin well. Tube feeds had been held for GI workup, and were restarted once the patient's GI bleeds had stablized. He has brown OB+ stool at this time. He should have egd and colonoscopy as an outpatient. 8. CODE STATUS: This was addressed with his HCP, his sister [**Name (NI) 66947**] [**Name (NI) 66946**] [**Telephone/Fax (1) 66948**]. He was made DNR/DNI. Medications on Admission: -insulin -plavix -protonix -scopalamine patch -glyburide -trazodone -milk of magnesia -colace Discharge Medications: 1. Insulin Regular Human 100 unit/mL Cartridge [**Telephone/Fax (1) **]: use as directed below Injection ASDIR (AS DIRECTED): Check BG 4x/d -If bg<70 give [**2-9**] amp d50 -If bg 71-150 do nothing -If bg 151-200 give 3 units insulin -If bg 201-250 give 6 units insulin -If bg 251-300 give 9 units insulin -If bg 301-350 give 12 units insulin -If bg >350 give 12 units insulin and notify MD. 2. Acetaminophen 325 mg Tablet [**Month/Day (2) **]: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for fever. 3. Docusate Sodium 150 mg/15 mL Liquid [**Month/Day (2) **]: One (1) PO BID (2 times a day) as needed. 4. Senna 8.6 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO BID (2 times a day) as needed. 5. Warfarin 2 mg Tablet [**Month/Day (2) **]: Two (2) Tablet PO HS (at bedtime). 6. Piperacillin-Tazobactam 4.5 g Recon Soln [**Month/Day (2) **]: One (1) Recon Soln Intravenous Q8H (every 8 hours) for 7 days: please continue until [**2128-6-7**]; d/c central line when abx complete. 7. Metronidazole 500 mg IV Q8H 8. Flagyl 500 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO three times a day for 7 days: please continue until [**2128-6-7**]. 9. 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 10. Prevacid 15 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] twice a day. Discharge Disposition: Extended Care Facility: [**Hospital **] Medical Center - [**Hospital1 3597**] Discharge Diagnosis: Left frontal stroke Bilateral lower extremity DVT Pulmonary Embolism Duplicate left renal system Atrial fibrillation GI Bleed - likely related to bowel ischemia Atrial septal defect (vs PFO) Pneumonia x 2 Discharge Condition: Stable - please see d/c summary for d/c exam. Discharge Instructions: Please [**Name8 (MD) 138**] MD or return to ED if new symptoms of focal weakness or new neurological impairment. Followup Instructions: Please call Dr.[**Name (NI) 35878**] office for f/u appointment (neurology) after discharge from rehab (in [**7-15**] weeks) ([**Telephone/Fax (1) 7394**]. [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**] Completed by:[**2128-6-1**] ICD9 Codes: 5180, 486, 5789, 5070
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Medical Text: Admission Date: [**2194-1-1**] Discharge Date: [**2194-1-21**] Date of Birth: [**2116-5-12**] Sex: F Service: SURGERY Allergies: Sulfa (Sulfonamide Antibiotics) / Bactrim / Cozaar / Captopril Attending:[**First Name3 (LF) 4691**] Chief Complaint: s/p fall Major Surgical or Invasive Procedure: 1. right-sided thoracentesis [**2194-1-3**] 2. left-sided thoracentesis [**2194-1-4**] 3. right chest tube placement [**2194-1-6**] 4. right subclavian CVL [**2194-1-6**], replaced [**2194-1-12**] 5. trach/PEG [**2194-1-10**] History of Present Illness: 77F s/p fall from standing; initially seen at OSH; she reportedly became agitated when a c-collar was placed, and required sedation, and was subsequently intubated for respiratory distress. She was transferred to [**Hospital1 18**] for further care. Her injuries noted were a C7 fracture, and chronic-appearing bilateral pleural effusions. Past Medical History: 1. CHF 2. AF 3. HTN 4. NHL 5. ?radiation treatment to thyroid Pertinent Results: [**2194-1-1**] CT cspine: 1. Acute fracture involving the superior endplate of C7 vertebral body with approximately 2 mm of retropulsion of the posterior cortex without significant canal stenosis. 2. Degenerative disease with facet changes as described above. Widening at C3-4 on the right is likely chronic. 3. Bilateral pleural effusions and atelectatic changes are better assessed on corresponding CT torso performed concurrently." [**2194-1-2**] ECHO: "Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mild calcific aortic stenosis. Mild aortic regurgitation. Moderate mitral regurgitation. Moderate pulmonary hypertension." [**2194-1-2**]: "1. C7 compression fracture and T2 horizontal vertebral body fracture without evidence of ligamentous injury or cord injury." [**2194-1-4**] BAL: MSSA 10,000-100,000 ORGANISMS/ML.. Brief Hospital Course: Neuro: Identified C7 fracture on imaging; she was placed in a [**Location (un) 2848**]-J collar. A spine consult was obtained and recommended that she remain in the collar until they would be able to examine her clinically (off sedation). An MR was also obtained. She was switched to a softer collar that allowed for slightly more flexion. She is to remain in the collar until follow up with Dr. [**Last Name (STitle) 363**] on roughly [**2194-1-20**] for reevaluation. She was sedated with propofol, but alert and oriented. A geriatrics consult was obtained -- her nighttime agitation was subsequently managed with Seroquel 25mg QHS. CV: An ECHO on [**1-2**] did not demonstrate significant cardiac abnormalities. Mild aortic stenosis was noted. She was maintained on her home beta blocker dose. She did require neosynephrine while on propofol, which was given while intubated and post-intubation for agitation. Geriatrics was consulted and suggested giving seroquel 12 mg qhs for agitation instead. Resp: In contact with her PCP who noted that her pleural effusions were chronic. We attempted extubation on Hd #2, but she developed tachypnea and respiratory distress and was reintubated. It was thought that her pleural effusions may have contributed to her respiratory compromise, and she had a right and left-sided thoracentesis on Hd #3 and 4 (respectively). Extubation was attempted a 2nd time, but again, she quickly failed after an hour, and was once again reintubated. A CVL was also placed at this time -- on imaging, she was noted to have persistent right pleural effusion and a small apical pneumothorax. Given concern that she had respiratory distress upon extubation, and was now currently on positive pressure ventilation, a 20Fr chest tube was placed in her right side. Pleural fluid analyses demonstrated a transudative fluid, which was not infected. Follwoing the chest tube placement, a 3rd extubation was attempted, but she again required reintubation. At this point, there was concern that there may be an anatomic component to her respiratory failure -- Interventional Pulmonary was asked to evaluate the patient's airways. Her son had given a vague history of a possible prior tracheostomy, and radiation to her neck -- perhaps causing some tracheal stenosis. On bronchoscopy, close evaluation demonstrated upper airway edema, with no leak when the cuff was down. She was placed on steroids, but given these findings, the decision was made to proceed with a trach/peg, expecting a longer than expected vent-dependence. She had her trach/PEG on [**2194-1-10**]. On [**1-11**] she had a episode of desaturation to the 80s for which she underwent another bronchoscopy that revealed thick brown sputum. She was placed on Vancomycin and Zosyn empirically until sputum cultures and BAL returned negative. At the time of discharge, she was tolerating increase intervals on trach mask and off the vent. GI: She received tube feeds through a dobhoff tube, then through her PEG tube. On [**1-11**] she had several loose stools and the tube feedings were held. Stool cultures x 2 were sent and found to be negative. Tube feedings were restarted on [**1-13**]. Heme: She is on Coumadin at home for her history of atrial fibrillation; she was maintained on a heparin drip while in the unit until she became therapeutic. GU: She maintained a stable creatinine and adequate urine output. ID: A [**1-4**] BAL demonstrated only 10^4 organisms of MSSA -- she was, however, on steroids, and the ICU team placed her on Levofloxacin. On [**1-11**] she had an episode of desaturation and a bronch revealed thick brown mucous. She was placed on empiric Vancomycin, Zosyn for three days until cultures returned negative. On [**1-11**] she also had an episode of hypotension concerning for septic physiology. Labs drawn at the time showed WBC = 29. Blood cultures were still negative at 4 days out. Endocr: She received a 48 hour course of dexamethasone for her supraglottic swelling, in hopes that this would improve her chances of extubation. These were discontinued following her tracheostomy. [**1-3**]: s/p R thoracentesis [**1-4**]: s/p L thoracentesis, bronch with bal [**1-5**]: cxr shows increased R apical PTX; failed extubation, will likely need trach so not starting coumadin for now, on hep gtt [**1-6**]: LMA bronch, R 20F CT, failed extubation (x3) [**1-7**]: Repositioned CT [**1-8**]: CT to WS, added levofloxacin for MSSA on BAL in setting of steroids [**1-9**]: bronch ([**Last Name (un) **], ETT) - narrowed, edematous nasopharynx, no air leak even with cuff down; pulm -> resp alkylosis (likely overbreathing [**12-30**] agitation, baseline CO2 likely 48, consider decrease MV by decreasing PS (no change in peep) to allow increased CO2 prior to extubation (maximizing respiratory drive) [**1-10**]: Trach and Peg. #8 Portex. [**1-11**]: TM for 4 hrs, then mucus plug requiring return to vent, hypotensive, pan-cx, CT pulled, vanc/zosyn started [**1-12**] CVL L removed (tip cxr sent), R subclavian placed, flagyl started for ?cdiff (diarrhea, mild abd pain, 1st set cdiff neg); bronch -> unremarkable, BAL sent, small but stable R apical PTX [**1-13**]: new small left apical ptx; hep gtt stopped [**1-14**]: ? new small pneumomediastinum, abx stopped; ger c/s - low dose Seroquel 12.5 po QHS for agitation [**1-15**]: [**Female First Name (un) **] c/s -> switch to PPI (less agitation), seroquel 25 qhs and qam PRN agitation [**1-16**]: PMV during day, agitated pm; [**Female First Name (un) **] recs - lopressor 12.5 [**Hospital1 **] (avoid atenolol), seroquel 25mg ghs and gam, NO olanzapine, DC famotidine [**1-18**]: doing well, required some pressors over night [**1-19**]: off neo, doing well on CPAP/trach mask Medications on Admission: Coumadin Atenolol Lasix ASA Calcium Discharge Medications: 1. Chlorhexidine Gluconate 0.12 % Mouthwash [**Month/Year (2) **]: One (1) ML Mucous membrane [**Hospital1 **] (2 times a day). 2. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: One (1) PO BID (2 times a day). 3. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler [**Hospital1 **]: Six (6) Puff Inhalation Q4H (every 4 hours) as needed. 4. Bisacodyl 10 mg Suppository [**Hospital1 **]: One (1) Suppository Rectal DAILY (Daily) as needed. 5. Insulin Regular Human 100 unit/mL Solution [**Hospital1 **]: One (1) Injection ASDIR (AS DIRECTED). 6. Camphor-Menthol 0.5-0.5 % Lotion [**Hospital1 **]: One (1) Appl Topical TID (3 times a day) as needed. 7. Acetaminophen 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q4H (every 4 hours) as needed. 8. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day) as needed for constipation. 9. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 10. Clonidine 0.1 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a day). 11. Midodrine 5 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO TID (3 times a day). 12. Quetiapine 25 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO QHS (once a day (at bedtime)). 13. Levothyroxine 200 mcg Recon Soln [**Last Name (STitle) **]: 200mcg Recon Solns Injection DAILY (Daily). 14. Warfarin 2.5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day: 2.5-3.0 mg qday. Tablet(s) Discharge Disposition: Extended Care Facility: [**Hospital6 1293**] - [**Location (un) **] Discharge Diagnosis: - C7 fx - bilateral pleural effusions s/p thoracentesis - right pneumothorax s/p right chest tube placement - mild AS/AR - atrial fibrillation - hypertension - ?CHF Discharge Condition: Stable Discharge Instructions: If you have fevers/chills, persistent nausea/vomiting, severe abdominal pain, difficulty breathing, please [**Name8 (MD) 138**] MD. Followup Instructions: Please follow up with your PCP [**Last Name (NamePattern4) **] [**11-29**] weeks. Call for an appointment. Please follow up with Dr. [**Last Name (STitle) **] in trauma clinic in [**1-1**] weeks, call for an appointment at [**Telephone/Fax (1) 6429**] Please follow up with Dr. [**Last Name (STitle) 363**] (Orthopedics/Spine) in [**11-29**] weeks. Call [**Telephone/Fax (1) 3573**] Completed by:[**2194-1-21**] ICD9 Codes: 2930, 4280, 4019, 496, 4241
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7367 }
Medical Text: Admission Date: [**2167-10-13**] Discharge Date: [**2167-11-21**] Date of Birth: [**2097-2-20**] Sex: F Service: SURGERY/BLUE REASON FOR ADMISSION: The patient is a 70-year-old female, with COPD, 100-pack year tobacco use and currently still smoking 1-pack per day, coronary artery disease status post MI, and PTCA with stent in [**2162**], hypercholesterolemia, hypothyroidism, who fell down two steps on the [**10-8**] suffering multiple ribs fractures on the left. The patient presented to an outside hospital, [**Hospital 1562**] Hospital, Emergency Department and became hypotensive, and a needle thoracostomy was performed for decompression followed by a tube thoracostomy. The patient was intubated and taken to the ICU there. She remained intubated over the weekend and continued to have worsening subcu emphysema, and persistent air leaks from the chest tube. She was extubated the day prior to transfer and then sent to the thoracic surgery service at [**Hospital1 18**] for further work-up and treatment. PAST MEDICAL HISTORY: As above. MEDS AT HOME: 1. Atenolol 50 qd. 2. Losartan 50 [**Hospital1 **]. 3. Lasix 20 qd. 4. Aspirin 325 qd. 5. Zantac 150 [**Hospital1 **]. 6. Prilosec 20 qd. 7. Norvasc 10 qd. 8. Zocor 10 qd. 9. Synthroid 0.1 qd. 10.Atarax prn. 11.Motrin prn. 12.Colace 100 [**Hospital1 **]. 13.Atrovent MDI prn. 14.Albuterol MDI prn. ALLERGIES: Penicillin. SOCIAL HISTORY: Smoking as above and occasional alcohol. PHYSICAL EXAM ON ADMISSION: Vitals - 97.4, 85, 162/94, 18, 94% on 2 liters. General - The patient was an elderly, pleasant female in no acute distress. Pupils equally round and reactive to light. There was extensive subcu emphysema of the left eye and face, as well as the neck and chest. The trachea was midline. Chest exam was limited by crepitus. There was no hyperresonance to percussion. There was ecchymosis of the left chest wall, and a 24 French chest tube. The site was without erythema. Heart was regular rate and rhythm. Abdomen was soft, nontender. There was slight increased firmness to the left midabdominal and subcostal area. No discrete masses. No organomegaly. Back showed ecchymosis to the left flank. Extremities - a right femoral central line was in place. There was no clubbing, cyanosis or edema, and there were palpable femoral, popliteal, dorsalis pedis and posterior tibial pulses bilaterally. Rectal showed no mass and was guaiac negative. PERTINENT LABS: The patient's white count was 14.5, crit 39.1, platelets 305, sodium 131, potassium 3.9, chloride 94, CO2 29, BUN 11, creatinine 0.5, glucose 114. [**Name (NI) 2591**] - PT 12.9, PTT 22.9, INR 1.1. ABG was 7.47, 41, 68, 31 and 5, 93% on 2 liters. Chest x-ray showed extensive subcu emphysema, chest tube in place, and no residual pneumothorax, rib fractures. IMPRESSION: The patient is a 70-year-old female with severe, underlying lung disease, status post left chest blunt trauma with rib fractures and pulmonary parenchymal injury leading to pneumothorax and persistent air leak. HOSPITAL COURSE: The patient was admitted and had a chest x-ray which showed a small pneumomediastinum, chest tube, and posterior rib fractures 6 through 9 which were displaced, and extensive subcu air. SUMMARY OF PATIENT'S PROCEDURES THIS ADMISSION: On [**10-14**], the patient went to the OR for a left video-assisted thoracoscopic surgery with debridement of the broken rib spicules, as well as wedge resection of the damaged lung parenchyma. On [**10-16**], the patient was taken to the OR for an acute abdomen and was found to have a gangrenous right colon. She underwent a right colectomy, end-ileostomy, and transverse colon mucous fistula. The small bowel was found to have patchy areas of ischemia. On [**10-19**], the patient was taken back to the OR for a second-look laparotomy, and underwent small bowel resection and end-ileostomy. On [**10-23**], the patient was taken back for a third-look laparotomy and was found to have a bowel perforation x 2. She had further bowel resection with end-jejunostomy, resulting in a total bowel length of approximately 3'. On [**11-9**], the patient underwent percutaneous tracheostomy, and on [**11-17**], the patient underwent left ultrasound-guided thoracentesis. Additionally, the patient had multiple monitoring lines placed this admission. HOSPITAL COURSE BY SYSTEM - 1) CENTRAL NERVOUS SYSTEM: The patient had no mental status changes during this admission. Earlier in her acute hospital course, she required a morphine drip for pain control and intermittent ativan for sedation, as well as a propofol drip early-on. Most recently, her pain has been managed with dilaudid prn, as well as a dilaudid PCA. 2) CARDIOVASCULAR: The patient had a septic physiology through her initial three laparotomies requiring Swan-Ganz catheter placement and monitoring with pressor management including Levophed and vasopressin. The patient underwent an echo after the initial laparotomy to look for an embolic source; however, no clot was identified on the limited study, and her ejection fraction was 55%. On serial cardiac enzymes, the patient was found not to have any evidence of myocardial ischemia. At this time, the patient is hemodynamically stable and is receiving metoprolol for beta blockade at a dose of 25 mg [**Hospital1 **]. She is in sinus rhythm, and her blood pressure is 143/59. 3) RESPIRATORY: Due to the patient's persistent air leak, she was taken by the thoracic service on the 10 for a VATS procedure. The broken ends of the ribs were debrided which had punctured and damaged the lung parenchyma, resulting in a persistent air leak. This section was lung was resected. On postop day #1 from that, the patient was stable and was transferred to the floor, and her chest tube was DC'd. However, the patient developed respiratory distress and was reintubated on the [**10-15**], with an ABG showing a PCO2 of greater than 100, and a pH of 7.0. A new left chest tube was placed with a moderate egress of air. Additionally, a left subclavian Cordis was placed, a Swan-Ganz catheter, and a right femoral A-line was placed. Resulting chest x-ray showed no pneumothorax. The patient then had an acute abdomen and was transferred to the general surgery service. Her chest tube was kept in place to suction and was finally put to water-seal and then DC'd on the [**10-29**]. The patient had multiple attempts at vent weaning, however failed spontaneous breathing trials, and this was felt to be multifactorial due to her underlying lung disease, as well as malnutrition, volume loss in her left thorax, and a residual pleural effusion on the left, as well as a pneumonia. The patient underwent percutaneous tracheostomy on the [**11-9**] to facilitate pulmonary toilet, as well as weaning, and an ultrasound-guided left thoracentesis for 250 cc on the [**11-17**]. This showed no organisms on Gram stains, and no neutrophils, and grew nothing on culture. On [**11-5**], the patient had a sputum positive for Klebsiella pneumoniae for which she was treated with a course of aztreonam and gentamycin double-antibiotic coverage. Despite this, the patient has been persistently unable to tolerate weaning trials and is currently vent dependent on pressure support of 10 and PEEP of 5, with a RSBI of 55, and a PCO2 of 55. 4) ABDOMEN: After the patient's reintubation on the 11, the patient was found to be persistently hypotensive and acidotic requiring pressors, and a new abdominal finding of distention and tenderness was noted. A general surgery consult was obtained on the [**10-16**]. At this point, the patient had a white count of 19.7 and a lactate of 1.6, and she was on a Neo drip for blood pressure support. The patient was placed on broad-spectrum antibiotic coverage of vancomycin, Levofloxacin and Flagyl. A rigid sigmoidoscopy was done at the bedside which showed viable sigmoid mucosa. A KUB showed a dilated colon. The patient was taken later that day on the [**10-16**] to the OR for an exploratory laparotomy where a gangrenous right colon was resected. There were several patchy areas of small bowel ischemia which were left alone initially, and the patient was given an end-ileostomy, a transverse colon mucous fistula, and was sent back to the ICU for further resuscitation with a planned second-look laparotomy. At this time, the patient was on Levophed for blood pressure support and was continued on broad-spectrum antibiotics. On the [**10-19**], the patient was taken to the OR for a second-look where frankly necrotic small bowel was resected, and the end-ileostomy was refashioned. The transverse mucous fistula was left in place. At this time, the patient was also evaluated for sources of possible embolic phenomenon with an echo which did not show any mural thrombus. A vascular consult was also obtained, and the patient's ischemic bowel was felt likely due to a low-flow state. On the [**10-20**], the patient was started on TPN, and then on the 18 the patient had a desaturation episode. A CTA was negative for a PE and did show a left upper lobe infiltrate. She was requiring more fluid, had a persistent acidosis, and was on increasing Levophed and pressor requirements. Fluconazole was added to the vanc, levo and Flagyl. The levo was then DC'd and imipenem was started. The patient's white count was now 31.7, and on the [**10-23**] the patient was taken to the OR again and found to have two small bowel perforations which were resected, and the patient was given an end-jejunostomy with a resultant approximate 3' of small bowel remaining. The patient was persistently hypotensive and vasopressin was added to her pressor management. On the [**10-29**], due to refractory leukocytosis, an ID consult was obtained, and recommendation was made to increase her fluconazole dose. Tube feeds were also instituted at a trophic rate of 10 cc/h of half strength alimental tube feeds. Following the third laparotomy, the patient gradually stabilized over the remainder of her hospital course, and her tube feeds were gradually advanced. Her ostomies remained viable, and her abdominal exam improved. The lower portion of her lower wound separated and has been managed by [**Hospital1 **] wet-to-dry packings. Most recently, it has required some debridement if some fibrinous exudate at the base of the wound. Today, the patient's abdomen is soft. Her ostomies, that is her jejunostomy and mucous fistula, are pink and viable. Her lower wound separation is granulating laterally with a fibrinous exudate at the base with visible fascial sutures at the base of the wound. This will be managed with [**Hospital1 **] wet-to-dry dressing changes. 5) GU AND RENAL: The patient's renal function remained stable throughout all of her septic complications. She had a Foley in place throughout this hospitalization and maintained good urine output. Following her final laparotomy, the patient did require diuresis to facilitate weaning of her ventilator. However, this has not helped with the vent weaning. The patient is currently on lasix 40 per NG tube [**Hospital1 **]. 6) INFECTIOUS DISEASE: The patient has had multiple infectious complications during this complicated admission. Her swab from the laparotomy on the 15 grew out yeast and Klebsiella. Additionally, she had Klebsiella grown out of her sputum on the 13, and yeast of the sputum on the 16, as well as MRSA. On the 18, an additional sputum culture grew out Klebsiella, and her urine from the 18 grew out yeast. Wound culture from the 19 and 23 grew out yeast. These were all sensitive to fluconazole. Currently, the patient is on aztreonam day 11 and gentamicin day 12 of a 14-day course for a Pseudomonas and Klebsiella culture that was grown out from her sputum on the [**11-5**]. Additionally, she is on a fluconazole course also to be completed for a 14-day course. The patient has remained afebrile over the last week, and currently her refractory leukocytosis is at 17.1. 7) HEMATOLOGY: The patient has had rare transfusion requirements after her laparotomies. Additionally, after her initial laparotomy she required a platelet transfusion for a thrombocytopenia, and her heparin was also held at that point, and a HIT antibody was sent which ultimately came back negative, and she was restarted on heparin for DVT prophylaxis. Currently, her crit is 31.2 and her platelets 249. Her INR is 1.1, and PTT is 27.2. 8) FEN: The patient has become TPN dependent essentially. She is also receiving tube feeds at a rate of 60 an hour using Impact with fiber 3/4 strength, and this is felt not to be adequately absorbed with her short-gut syndrome. So, she is also on essentially goal TPN calories. She also has hyponatremia of 129. Her K is 4.6, chloride 94, mag 1.8, phos 2.7, calcium 8.4. The hyponatremia is being treated with decreasing her free-water intake. 9) ENDOCRINE: The patient has been managed with a regular Insulin sliding scale. 10) PROPHYLAXIS: The patient has received GI prophylaxis using a proton pump inhibitor. Currently, she is on lansoprazole 30 per NG tube qd. Additionally, she is receiving heparin in her TPN, and has Pneumoboots in place for DVT prophylaxis. TUBES, LINES AND DRAINS: Currently, the patient has a Foley, a transpyloric feeding tube, a tracheostomy tube, a PICC line, and A-line. DISCHARGE DIAGNOSES: 1. Multiple left rib fractures. 2. Left pneumothorax. 3. Status post left video-assisted thoracic surgery (VATS) with debridement of rib fragments and wide-resection of injured lung segment. 4. Infarcted small bowel and right colon. 5. Status post laparotomy with right colectomy, end-ileostomy, and transverse colon mucous fistula. 6. Second-look laparotomy with small bowel resection and redo end-ileostomy. 7. Third-look laparotomy for small bowel perforation x 2, status post further small bowel resection, end-jejunostomy. 8. Short-gut syndrome with total parenteral nutrition dependence. 9. Klebsiella and Pseudomonas pneumoniae. 10.Peritoneal fluid yeast positive culture. 11.Ventilator dependence, status post tracheostomy. 12.Coronary artery disease, status post myocardial infarction with percutaneous transluminal coronary angioplasty and stent in [**2162**]. 13.Chronic obstructive pulmonary disease. 14.Hypercholesterolemia. 15.Hypothyroidism. 16.Hyponatremia. 17.Leukocytosis. 18.Midline laparotomy wound infection, status post wet-to-dry dressing changes [**Hospital1 **]. DISCHARGE MEDICATIONS: 1. Tincture of opium per NG tube qid. 2. Sodium chloride 1 tablet tid. 3. Lansoprazole 30 per NG tube qd. 4. Dilaudid prn. 5. Lasix 40 per NG tube [**Hospital1 **]. 6. Levothyroxine 100 per NG tube qd. 7. Metoprolol 25 per NG tube [**Hospital1 **]. 8. Fluconazole 400 per NG tube qd. 9. Albuterol and Atrovent nebs per tracheostomy prn. 10.Gentamicin 400 mg IV qd, day 12 of 14. 11.Aztreonam 1 gm IV q 8, day 11 of 14. 12.Regular Insulin sliding scale. DISCHARGE PLAN: Discharge to [**Hospital3 **] pending bed availability, and further addendums will be dictated in a separate report. [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D. [**MD Number(1) 845**] Dictated By:[**Last Name (STitle) 50865**] MEDQUIST36 D: [**2167-11-20**] 12:14 T: [**2167-11-20**] 12:27 JOB#: [**Job Number 50866**] ICD9 Codes: 5185
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Medical Text: Admission Date: [**2148-8-11**] Discharge Date: [**2148-8-22**] Date of Birth: [**2089-11-5**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Known firstname 6169**] Chief Complaint: Induction chemotherapy for MDS transformed to AML Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname 66632**] is a 58 year old male with a history of MDS /myeloproliferative disease overlap syndrome that has transformed to AML. He was admitted to the Heme Malignancies service on [**2148-8-11**] for initiation of induction chemotherapy. Past Medical History: 1. MDS/Myeproliferative disease overlap syndrome--> AML 2. Glaucoma 3. h/o HTN 4. GERD Social History: Custodian at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Occasional ETOH. No drug use. 30 year smoking history, at least 3 packs/week. Family History: Older sister with some type of cancer, not very close Physical Exam: Physical Exam: VS: T: 99.4 HR: 105 BP: 140s/70s RR: 20s O2: 93-98% cool neb Gen: Patient lying in bed. Appears older than stated age. HEENT: MMM, no thrush. Sclerae anicteric. Neck: Bilateral swelling in submandibular area. CV: S1, S2. Tachy. No m/r/g. Lungs: CTA anteriorly. Abdomen: Distended. Spleen is palpable 4-6 cm below the left costal margin. Liver edge is palpable 4-6 cm below the right costal margin. No ascites or tender to deep palpation. No rebound, no inguinal or femoral adenopathy. Skin: His right leg, he has a skin graft that is healing well, cutaneous ulcer approximately 2 x 3 cm that is granulating well. Extremities: Bilateral +1 pitting edema. Pertinent Results: [**2148-8-11**] 08:36PM POTASSIUM-3.5 [**2148-8-11**] 08:36PM LD(LDH)-467* [**2148-8-11**] 08:36PM PHOSPHATE-4.4# URIC ACID-9.1* [**2148-8-11**] 08:36PM WBC-55.7* RBC-3.20* HGB-9.3* HCT-26.2* MCV-82 MCH-29.1 MCHC-35.5* RDW-18.7* [**2148-8-11**] 08:36PM NEUTS-23* BANDS-2 LYMPHS-8* MONOS-41* EOS-1 BASOS-2 ATYPS-0 METAS-1* MYELOS-2* BLASTS-20* [**2148-8-11**] 08:36PM PLT COUNT-17*# [**2148-8-11**] 07:30PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010 [**2148-8-11**] 07:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2148-8-11**] 11:45AM GLUCOSE-102 UREA N-24* CREAT-1.2 SODIUM-137 POTASSIUM-3.7 CHLORIDE-102 TOTAL CO2-23 ANION GAP-16 [**2148-8-11**] 11:45AM ALT(SGPT)-23 AST(SGOT)-31 ALK PHOS-178* [**2148-8-11**] 11:45AM ALBUMIN-3.1* CALCIUM-7.9* PHOSPHATE-2.5* MAGNESIUM-1.5* URIC ACID-8.4* [**2148-8-11**] 11:45AM WBC-97.2* RBC-2.82* HGB-8.2* HCT-24.2* MCV-86 MCH-29.2 MCHC-34.0 RDW-19.0* [**2148-8-11**] 11:45AM PLT COUNT-40* . [**8-17**] CT Neck with contrast IMPRESSION: 1. Soft tissue stranding within the subcutaneous and underlying soft tissue of the entire neck most notable within the right infra-auricular region where there is a marked amount of skin thickening. Thickening of soft-tissues in larynx. These findings could represent cellulitis in the appropriate clinical setting or could be due to radiation therapy. 2. Likely diffuse reactive lymphadenopathy. 3. No evidence of focal drainable fluid collections. . A note should be made that this patient coded in the CT scanner (CT scanner #2). Findings were discussed with the code team at approximately 12:45 p.m. The patient is currently intubated. . [**8-18**] CT Head w/o contrast 1. No hemorrhage or mass effect. . [**8-19**] Soft tissue U/S of neck IMPRESSION: 1. No evidence of internal jugular or subclavian vein thrombosis. 2. No evidence of fluid collections concerning for abscess. 2. 2.1 cm right thyroid nodule. . [**8-20**] EEG IMPRESSION: Mildly slowed posterior background suggestive of a mild diffuse encephalopathy. No discharging features were noted. Brief Hospital Course: He was found to have C diff colitis on admission, so his induction therapy was delayed a few days. The patient was administered his first treatment with MEC (mitoxantrone, etoposide, and Ara-C) on [**2148-8-13**]. . In the morning on [**2148-8-14**], the patient was noted to have tumor lysis, with a potassium level elevated at 7.0. The patient was also noted to have poor urine output, abdominal distention, and respiratory distress. The patient was transferred to the [**Hospital Unit Name 153**] for further management. He initially required blood pressure support with Levophed. The Renal team was consulted, and the patient underwent hemodialysis given his persistently elevated potassium and episodes of widened QRS and transient complete heart block on EKG/telemetry. The patient also had a coagulopathy, and he requried transfusion of FFP prior to placement of his hemodialysis catheter. The patient's potassium level then normalized. During his admission, he required more than seven packed red blood cell transfusions, and eight platelet transfusions. He required more than six units of FFP. . Developed neck swelling on Friday ([**8-16**]) morning which was dramatically worse on Saturday am ([**8-18**]). CT scan of neck was ordered on Friday am but not completed by Sat am. Sat am, ENT was consulted with concern for airway given that pt was having trouble swallowing. ENT scoped him and said that he was okay to go to CT scan. Had a respiratory arrest in the CT scanner and was in PEA when we arrived. Anesthesia got an LMA in as we were not able to bag him. Pulse back after about 10 minutes. In afib when arrived to the floor with hypotension on levophed. Syncronized cardio brought him back to sinus rhythm at 1:00 pm [**2148-8-17**] and was hemodynamically stable after that on the vent. . With consult from Neuro, Mr. [**Known lastname **] was assessed to have suffered hypoxic brain injury secondary to his code on [**8-18**] and he had not improved his mental status beyond corneal blink and moving eyes for more than 48 hours after he suffered PEA. His wife decided to withdrawl ventilatory support due to his poor prognosis and the fact that he was very unlikely to regain any functional status. . He died on [**8-22**], just a few hours after he was extubated. Medications on Admission: His medicines have included allopurinol 300 daily, hydroxyurea, recently increased to 3 g daily, prednisone 20 mg PO qd, Voriconazole 200 mg PO BID, Timolol 0.25% eye drops [**Hospital1 **], Bactrim three times a week, ACV 600 mg PO TID, and PCN 500 mg PO TID. Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: AML Discharge Condition: Expired Discharge Instructions: None Followup Instructions: None ICD9 Codes: 5849, 2767, 2762, 4275, 4019
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Medical Text: Admission Date: [**2190-8-19**] Discharge Date: [**2190-8-19**] Date of Birth: [**2113-12-17**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 3984**] Chief Complaint: Hypotension Major Surgical or Invasive Procedure: None History of Present Illness: The patient is a 76M with metastatic cholangiocarcinoma who presented to [**Hospital 47255**] with coffee ground emesis. The patient was given IV fluids, blood transfusion, protonix IV. There was concern for obstruction of small intestine. He was transferred to [**Hospital1 18**] for duodenal stent on [**2190-8-19**]. There he was noted to be hypotensive to the 50s systolic, refractory to IVF. He was transferred to the ICU. Past Medical History: Mr. [**Known lastname 20083**] was in his usual state of good health until the summer of [**2187**] when he began to feel unwell. He eventually underwent imaging, which showed a left kidney mass. In [**Month (only) 359**] [**2187**], this was resected via a left nephrectomy and pathology on this was reportedly benign. He then developed flu-like symptoms in [**2188-12-5**] and was admitted for three days with increasing LFTs as well as a fever. He then developed increased jaundice and was taken for an ERCP at an outside institution on [**2189-1-26**], which revealed a common bile duct stricture. He then was seen here at [**Hospital1 **] by Dr. [**First Name (STitle) **] [**Name (STitle) **] who repeated his ERCP on [**2189-2-2**], which revealed a malignant appearing irregularity of the common bile duct just distal to the confluence of the right and left hepatic ducts with intrahepatic biliary dilation. Two stents were placed at the end of the examination. The biopsies from the ERCP revealed a biliary tissue with high-grade dysplasia and features highly suggestive of invasive adenocarcinoma. On [**2189-2-16**], he underwent a CT scan, which showed that he was status post biliary stent placement with residual minimal dilation of the left biliary system. There was a vague perihilar enhancement concerning for intrahepatic involvement cholangiocarcinoma. There was also an enlarged portacaval lymph node. On [**2189-2-27**], Dr. [**First Name (STitle) **] took him to the operating room and performed an exploratory laparotomy and extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy. Pathology from this procedure showed adenocarcinoma of the bile duct consistent with cholangiocarcinoma. In addition, both the distal and proximal margins were involved with adenocarcinoma. Also, the tumor was arising in a background of high-grade dysplasia with focal papillary architecture, which involved essentially all of the evaluable biliary system. There were no lymph nodes removed for evaluation. He completed concomitant chemotherapy with external beam radiation and capecitabine (1000 mg [**Hospital1 **]) on [**6-5**]. He commenced adjuvant, weekly cisplatin (25 mg/m2) and gemcitabine (800 mg/m2) two of every three weeks on [**7-3**] and completed his seventh cycle [**2190-5-16**]. . He was admitted first to [**Hospital3 **] and then to [**Hospital1 18**] from [**12-26**] to [**1-3**]. He grew streptococcus anginosus from his blood and completed a four week course of ceftriaxone. He has since commenced prophylactic levofloxacin under the direction of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 724**]. . Other Past Medical History: -GIB [**5-/2190**], d/t gastritis -Hypertension. -Status post resection of benign nodules of the left kidney in [**2187**] -GERD -H/o PUD [**2163**] -h/o of streptococcus anginosus [**12-15**] - chronically on levofloxacin by Dr. [**Last Name (STitle) 724**] Family History: Older brother died of pancreatic cancer at age of 67, another brother died of prostate cancer at the age of 81. No other history of cancer in his family. Physical Exam: GEN: pleasant, awake, communicates w/ son in [**Name (NI) 73060**] HEENT: [**Name (NI) 22116**] not elevated LUNG: CTA bilaterally CV: S1, S2 increased rate, normal rhythm ABD: soft, distended, catheter in place capped in LUQ EXT: warm, palpable femoral pulse Pertinent Results: [**2190-8-19**] 06:15PM BLOOD WBC-22.6*# RBC-3.23* Hgb-10.3* Hct-29.2* MCV-90 MCH-31.8 MCHC-35.3* RDW-17.4* Plt Ct-104* [**2190-8-19**] 06:15PM BLOOD Neuts-90* Bands-2 Lymphs-2* Monos-4 Eos-0 Baso-0 Atyps-0 Metas-2* Myelos-0 [**2190-8-19**] 06:15PM BLOOD Plt Ct-104* [**2190-8-19**] 06:15PM BLOOD Albumin-2.0* Calcium-7.3* Phos-3.8 Mg-1.9 Iron-57 Brief Hospital Course: HYPOTENSION: He was started on vasopressors. A CVL was placed on arrival to the MICU. Labs were notable for leukocytosis concerning for sepsis likely from abdominal source. He experienced an episode of billious vomitting. Soon after he became bradycardic and unresponsive. He expired on 7:44PM with his son at his side. Medications on Admission: Unknown Discharge Medications: deceased Discharge Disposition: Expired Discharge Diagnosis: deceased Discharge Condition: deceased Discharge Instructions: deceased Followup Instructions: deceased [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**] ICD9 Codes: 0389, 2761, 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7370 }
Medical Text: Admission Date: [**2157-8-4**] Discharge Date: [**2157-8-12**] Date of Birth: [**2104-5-13**] Sex: M Service: SURGERY Allergies: Peanut Attending:[**First Name3 (LF) 4691**] Chief Complaint: S/P assault with mul Major Surgical or Invasive Procedure: [**2157-8-4**] 1. Bilateral neck exploration and packing and closure. 2. Direct laryngoscopy and esophagoscopy. [**2157-8-4**] 1. Repair of complex 2 cm laceration of the right neck. 2. Repair of simple 1 cm laceration of right neck. 3. Repair of complex 5 cm laceration of the right neck. 4. Repair of 1 cm simple laceration of the left neck. 5. Bronchoscopy. History of Present Illness: 53 M brought by EMS with multiple stab wounds. He is noted to be somewhat lethargic in the field. No vital signs were available prior to arrival. Upon arrival the patient had blood pressure in the 70 systolic and was tachycardic. He has multiple stab wounds throughout his neck anteriorly or posteriorly with in zone 2 and 3. He also has multiple stab wounds in the posterior aspect of his thorax to the right side of his chest in the midline. The patient gives no history regarding the attack. Past Medical History: PMH: asthma PSH: none Social History: Divorced, lives alone, 2 children ETOH Tobacco Family History: NC Physical Exam: Per ED Trauma eval: On admission Constitutional: Patient with GCS of 14 Multiple stab wounds Chest: Breath sounds bilaterally but multiple stab wounds on the posterior aspect on the right Cardiovascular: Tachycardic Abdominal: Soft, Nontender, Nondistended Pertinent Results: [**2157-8-4**] 03:21AM GLUCOSE-270* LACTATE-4.9* NA+-134* K+-3.8 CL--110 [**2157-8-4**] 03:21AM HGB-9.9* calcHCT-30 [**2157-8-4**] 03:15AM PLT COUNT-128*# [**2157-8-4**] 02:01AM GLUCOSE-301* LACTATE-10.2* NA+-137 K+-3.3* CL--98* TCO2-16* [**2157-8-4**] 05:57AM ALT(SGPT)-9 AST(SGOT)-19 ALK PHOS-27* TOT BILI-0.7 [**2157-8-4**] CTA Neck: 1. Nonopacification of V2 segment of right vertebral artery closely abutting site of right submandibular laceration is highly concerning for dissection or intimal injury. 2. Apparent contrast extravasation within superficial right submandibular laceration and post surgical exploration site (3, 167), possibly contiguous with adjacent venous structures. 3. Short segment left internal jugular vein non-opacification below the jugular foramen may indicate vascular injury with thrombosis. 4. Multiple stab wounds and extensive superficial and deep soft tissue emphysema including air extending within the danger space into the mediastinum. 5. Bilateral pneumothorax with chest tubes in place. Small right hemothorax. [**2157-8-3**] CT Chest : 1. No vascular or solid organ injury identified. Predominantly simple fluid noted within the abdominal cavity with slightly denser fluid noted within the pelvic cavity. While this may simply reflect third spacing from vigorous fluid resuscitation, occult mesenteric or bowel injury cannot be entirely excluded although. 2. Small right and minimal left remaining pneumothoraces with bilateral chest tubes in place of which the right is partially intrafissural and the left has portions completely surrounded by lung likely related to lung collapsed around the tube within the pleural space (less likely the tube may be partially intraparenchymal in location). 3. Bilateral lower lobe patchy opacities which may reflect pulmonary contusion or underlying aspiration pneumonitis/pneumonia. 4. Subcutaneous emphysema within the superior mediastinum, neck, and chest with no large intramuscular hematoma noted. 5. Slight hyperenhancement of the bowel mucosa suggestive of underlying hypertension/shock. Multiple scattered mesenteric lymph nodes of uncertain significance but presumably reactive. Brief Hospital Course: Mr. [**Known lastname **] was evaluated in the Emergency Room by the Trauma team and bilateral chest tubes were placed. He was then emergently taken to the Operating Room for neck exploration & packing, esophagoscopy and laryngoscopy. His admission hematocrit was 31 and fell to a low of 22. He was resuscitated with multiple units of packed cells and fresh frozen plasma as he had greater than a liter of blood drain from each chest tube. Following this initial resuscitation he was taken back to the Operating Room for reexploration and closure of his wounds. He maintained stable hemodynamics and remained intubated overnight. He was extubated on [**2157-8-5**] but had an episode of desaturation while turning and was immediately reintubated. Subsequent bronchoscopy revealed multiple bilateral airway mucous plugging and some airway edema. A BAL showed only minimal GNR's. He underwent vigorous pulmonary toilet and was diuresed. He was successfully extubated on [**2157-8-8**]. Following transfer to the Surgical floor he continued to make good progress. His hematocrit was stable, his bilateral chest tubes were removed without difficulty and then his ability to cough and deep breath improved. He was gradually able to tolerate a regular diet and he was seen by both Physical Therapy and Occupational Therapy to help increase his mobility. The Social Worker was involved with both he and his family to help with coping during this difficult period. There was also a question of the patient being sexually assaulted by the intruder and for that reason was seen by the Center for Violence Prevention. He underwent testing for hepatitis and HIV and was prophylactically placed on anti virils. He wiil need to follow up with the Infectious Disease service following discharge for management of these drugs. Treatment is anticipated to go over 4 weeks. Mr. [**Known lastname **] multiple surgical sites were healing well although his right shoulder wound may need a skin graft in time. He was discharged to his former wife's home with VNA follow up for wound care and general assessment. He has multiple follow up appointments in the next few weeks to both keep a close check on his physical and emotional progress. Medications on Admission: none Discharge Medications: 1. Outpatient Occupational Therapy Dx: Mulitple stab wounds to neck, shoulder, arms and right hand. s/p EXPLORATION & CLOSURE W/PACKING MULTIPLE NECK & BACK WOUNDS, LARYNGOSCOPY, ESOPHAGOSCOPY, REPAIR OF MULTIPLE RIGHT HAND LACERATIONS, REPAIR LEFT EAR LACERATIONS 2. Outpatient Physical Therapy Dx: Mulitple stab wounds to neck, shoulder, arms and right hand. s/p EXPLORATION & CLOSURE W/PACKING MULTIPLE NECK & BACK WOUNDS, LARYNGOSCOPY, ESOPHAGOSCOPY, REPAIR OF MULTIPLE RIGHT HAND LACERATIONS, REPAIR LEFT EAR LACERATIONS 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain, fever. 7. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* 8. Lopinavir-Ritonavir 200-50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*1* 9. Santyl 250 unit/g Ointment Sig: One (1) appl Topical once a day: to right shoulder. Disp:*1 tube* Refills:*2* Discharge Disposition: Home With Service Facility: VNA of Eastern Mass Discharge Diagnosis: S/P assault 1. Bilateral zone 2 neck wounds 2. Posterior deep neck wound over spine 3. Three right back stab wounds 4. One posterior left back stab wound 5. Superficial neck wound 6. Bilateral pneumothoraces 7. Acute blood loss anemia 8. Right basilic vein thrombosis 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 multiple stab wounds and a collapsed lung which happened during your assault. * You were taken to the Operating Room ffor hemostasis and wash out of the wounds. Currently they are healingwell. * Should you develop any shortness of breath or chest pain you should return to the Emergency Room. * Continue to increase your activity, stay hydrated and eat well to heal all of your wounds. * Should you have any fevers or redness or drainage from your neck and back wounds please call the [**Hospital 2536**] Clinic. Followup Instructions: Urgent Care Infectious Disease Clinic [**2157-8-18**] at 9:30 AM in the [**Hospital **] medical Building, basement floor [**Telephone/Fax (1) 457**] [**Hospital 2536**] Clinic on Tuesday, [**2157-8-16**] at 3 PM ([**Telephone/Fax (1) 600**]) in the [**Hospital Unit Name **] [**Last Name (NamePattern1) **]. [**Location (un) 470**] 3A Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 2349**] for a follow up appointment with Dr. [**First Name (STitle) **] in [**12-11**] weeks. Call Dr. [**Last Name (STitle) 60967**] for an appointment in [**12-11**] weeks. Completed by:[**2157-8-12**] ICD9 Codes: 5185, 2851, 3051
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Medical Text: Admission Date: [**2106-11-24**] Discharge Date: [**2106-12-3**] Date of Birth: [**2082-11-1**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4691**] Chief Complaint: jaundice after blunt trauma Major Surgical or Invasive Procedure: aspiration and drainage of hepatic fluid collection endoscopic retrograde cholangiopancreatography R tube thoracostomy History of Present Illness: 24M s/p blunt liver and spleen injury, managed non-operatively with IR guided embolization. Doing well at home, and felt better, tolerating food, until the patient noticed that he became frankly jaundiced. Patient presented to his pcp and told to report to the ED for definitive care. Today he is noticably jaundiced with a tbili of 6.7. otherwise, the patient notes fevers to 101 within the last twenty-four hours, but he has otherwise felt great and done well. Interventional Procedure from previous admission: IR placed 4 coils to 2 branches of replaced R hepatic artery, L hepatic gel foam, 1 upper splenic branch coil + gel foam. Past Medical History: Non contributory Social History: Lives with wife. + etoh use, denies illicts Family History: Non contributory Physical Exam: Afebrile, hemodynamically stable A+Ox3, NAD clearly icteric CTAB RRR distended and firm but mildly tender diffusely, no peritoneal signs, no guarding, no rebound Pertinent Results: [**2106-11-24**] 06:40PM URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.016 [**2106-11-24**] 06:40PM URINE BLOOD-LG NITRITE-NEG PROTEIN-25 GLUCOSE-NEG KETONE-NEG BILIRUBIN-MOD UROBILNGN-8* PH-7.0 LEUK-NEG [**2106-11-24**] 06:40PM URINE RBC-[**2-26**]* WBC-[**2-26**] BACTERIA-OCC YEAST-NONE EPI-<1 [**2106-11-24**] 04:03PM LACTATE-1.5 [**2106-11-24**] 03:55PM GLUCOSE-99 UREA N-16 CREAT-0.7 SODIUM-124* POTASSIUM-3.6 CHLORIDE-85* TOTAL CO2-28 ANION GAP-15 [**2106-11-24**] 03:55PM ALT(SGPT)-499* AST(SGOT)-119* ALK PHOS-148* TOT BILI-6.7* DIR BILI-4.1* INDIR BIL-2.6 [**2106-11-24**] 03:55PM LIPASE-31 [**2106-11-24**] 03:55PM CALCIUM-8.5 PHOSPHATE-3.4 MAGNESIUM-2.3 [**2106-11-24**] 03:55PM WBC-15.5* RBC-3.69* HGB-11.5* HCT-31.8* MCV-86 MCH-31.0 MCHC-36.1* RDW-13.0 [**2106-11-24**] 03:55PM NEUTS-72* BANDS-1 LYMPHS-11* MONOS-12* EOS-1 BASOS-0 ATYPS-0 METAS-3* MYELOS-0 [**2106-11-24**] 03:55PM HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL MACROCYT-OCCASIONAL MICROCYT-OCCASIONAL POLYCHROM-OCCASIONAL OVALOCYT-OCCASIONAL [**2106-11-24**] 03:55PM PLT SMR-NORMAL PLT COUNT-352# [**2106-11-24**] 03:55PM PT-12.9 PTT-22.6 INR(PT)-1.1 BCx [**2106-11-24**]: Coag neg staph [**12-26**] sets only RUQ U/S [**2106-11-24**]: 1. Large hematoma involving the right lobe of the liver, in the region of the known lacerations. Echogenic foci within the region of hematoma compatible with gas likely related to recent gelfoam embolization. Biloma cannot be excluded on this imaging study. 2. Large amount of complex fluid within the abdomen, compatible with hemoperitoneum. 3. Probable sludge within the gallbladder. 4. No intra- or extra-hepatic biliary ductal dilatation. CTAP [**2106-11-25**]: 1. Status post embolization of several hepatic arterial branches as well as splenic artery branches. Post-procedural changes are noted in the liver including air within the embolized hepatic parenchyma. 2. No evidence for biliary obstruction from the known hematoma. 3. Hemoperitoneum is slightly increased in size from prior study; however, this likely represents continuous bleeding before the embolization procedure. 4. Hematoma of the right adrenal gland is stable. 5. New bilateral pleural effusion, moderate on the right and small on the left with complete atelectasis of the right lower lobe and mild atelectasis of the left lower lobe CT guided aspiration [**2106-11-25**]: Technically successful percutaneous transhepatic aspiration of right liver laceration/hematoma yielding 1-2 cc of bloody aspirate, specimen sent to microbiology as above. [**Month/Day/Year **] [**2106-11-26**]: Successful biliary cannulation. Extravasation was noted from at least three smaller biliary radicles off the right intrahepatic duct. This is consistent with bile leak status post blunt trauma to the liver and known liver laceration. Successful sphincterotomy to faciliatate stent placement. Two 7cm by 10FR Cotton [**Doctor Last Name **] biliary stent were placed successfully in the main duct. Otherwise normal [**Doctor Last Name **] to third part of the duodenum CTAP [**2106-12-1**]: 1. Stable right liver lobe hematoma extending into the subphrenic space. 2. Unchanged hemoperitoneum. 3. Stable left upper pole splenic laceration. Brief Hospital Course: Mr. [**Known lastname 88473**] was admitted to the Acute Care Surgery Service with hyperbilirubinemia and general feeling of unwellness. A RUQ ultrasound showed a large fluid collection around his lacerated liver. Blood cultures from [**2106-11-24**] grew out coag neg staph and he was placed empirically on vanc/zosyn for fevers. He underwent IR drainage of the perihepatic fluid collection on [**2106-11-25**]. On [**2106-11-26**], he underwent [**Date Range **] which demonstrated extravasation from at least three smaller biliary radicles off the right intrahepatic duct, consistent with bile leak status post blunt trauma to the liver and known liver laceration. He had a sphincterotomy and placement of two 7cm by 10FR Cotton [**Doctor Last Name **] biliary stents in the main duct to decompress the biliary tree. After the procedure, he developed respiratory distress but was able to be extubated in the PACU. A CXR showed a large R pleural effusion for which a R chest tube was placed. He ultimately improved in the ICU and was advanced to regular diet and transferred to the floor. He was offered surgery to deal with his large perihepatic hematoma, but as he appeared to remain stable, he opted to hold off on surgical exploration at that point. As his chest tube output decreased, it was placed on water seal and then removed, with a small, stable residual post-pull pneumothorax. As he was feeling better and did not desire surgical options at that time, he was discharged home on [**2106-12-3**] with close follow up in the Acute Care Surgery Clinic. He agreed to return should any further problems arise and so was sent out. Medications on Admission: percocet Discharge Medications: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. 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* 4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 5. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 4 doses. Disp:*4 Tablet(s)* Refills:*0* 6. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 6 doses. Disp:*6 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 8300**] VNA & Hospice Discharge Diagnosis: s/p tractor rollover accident liver laceration 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 abdominal pain and underwent drainage of a collection around your liver as well as an [**Location (un) **] which showed some small bile leaks due to your recent tractor accitdent. Followup Instructions: You have a follow up appointment in Acute Care Surgery Clinic next Tuesday at 2:15 PM on the [**Location (un) **] of the [**Hospital **] Medical Office Building at [**Last Name (NamePattern1) 439**], [**Location (un) 86**], MA You also have an appointment for [**Location (un) **] to determine status of your bile leak as outlined below: Provider: [**Name Initial (NameIs) **] 2 ([**Hospital Ward Name **] 4) GI ROOMS Date/Time:[**2106-12-28**] 1:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2839**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2106-12-28**] 1:00 ICD9 Codes: 5185, 5119
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Medical Text: Admission Date: [**2155-8-16**] Discharge Date: [**2155-8-20**] Date of Birth: [**2096-11-3**] Sex: M Service: MEDICINE Allergies: Morphine Attending:[**First Name3 (LF) 678**] Chief Complaint: Hyperkalemia, AFIB RVR Major Surgical or Invasive Procedure: none History of Present Illness: 57yo M with a h/o systolic (EF 20-25) and grade 4 diastolic heart failure, ESRD [**2-15**] DM on HD, atrial fibrillation with RVR, severe depression, crack cocaine use presents with hyperkalemia to 7.4 and atrial fibrillation with RVR to 150s in setting of missing dialysis for the past week, of note patient with long history of missing dialysis sessions. Patient recently discharged on [**8-10**] with c.diff colitis, claims did crack cocaine 2 days ago and has had persistent diarrhea. He has missed dialysis for the past week, he states he was told not to go to HD since he was having active diarrhea. In the ED, was treated for hyperkalemia with 2 grams calcium gluconate, dextrose, IV regular insulin, 30g kayexalate, bicarb. Renal was consulted and will plan on HD tomorrow a.m. Cards was consulted for afib RVR and rec IV labetalol which converted him back into SR in the 110s. . ROS: patient with depressed mental status Past Medical History: ESRD on hemodialysis (Tues/Thurs/Sat, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9449**] Dialysis, [**Location 1268**], [**Telephone/Fax (1) 69669**]) Type II diabetes mellitus CAD s/p MI (pt does not recall), MIBI in [**11-19**] showed reversible defects inferior/lateral CHF with EF 20-25% (from echo in [**6-/2155**]) and severe global hypokinesis Hypertension Dyslipidemia Atrial fibrillation History of gastrointestinal bleed: Duodenal, jejunal, and gastric AVMs, s/p thermal therapy; sigmoid diverticuli. Chronic pancreatitis Hepatitis C GERD Gout s/p arthroscopy with medial meniscectomy [**5-/2149**] Depression s/p multiple hospitalizations due to SI Polysubstance abuse: crack cocaine, EtOH, tobacco Erectile dysfunction s/p inflatable penile prosthesis [**5-/2148**] Social History: Smokes 3 cigarettes/day. 42 pack year history. Hx of alcohol abuse, with DTs and detoxification. Last crack cocaine use was day prior to admission. Lives with a female partner. Family History: Father with alcoholism. Cousin with [**Name2 (NI) 14165**] cell. Mother with renal failure, d. 58. Son with diabetes. Physical Exam: VS- 95.7 115 (Afib) 135/88 24 95%4L NC 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 . [**2155-8-16**] 09:00PM PT-17.8* PTT-33.6 INR(PT)-1.6* [**2155-8-16**] 09:00PM PLT COUNT-335 [**2155-8-16**] 09:00PM WBC-5.1 RBC-5.38 HGB-16.1# HCT-49.7 MCV-92 MCH-29.8 MCHC-32.3 RDW-16.6* [**2155-8-16**] 09:00PM NEUTS-74.0* LYMPHS-17.5* MONOS-6.0 EOS-0.4 BASOS-2.1* [**2155-8-16**] 09:00PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2155-8-16**] 09:00PM CALCIUM-11.1* PHOSPHATE-6.9*# MAGNESIUM-2.9* [**2155-8-16**] 09:00PM CK-MB-12* MB INDX-11.8* [**2155-8-16**] 09:00PM cTropnT-0.34* [**2155-8-16**] 09:00PM LIPASE-39 [**2155-8-16**] 09:00PM ALT(SGPT)-45* AST(SGOT)-69* CK(CPK)-102 ALK PHOS-153* TOT BILI-1.8* [**2155-8-16**] 09:00PM GLUCOSE-117* UREA N-85* CREAT-10.4*# SODIUM-137 POTASSIUM-7.4* CHLORIDE-99 TOTAL CO2-19* ANION GAP-26* [**2155-8-16**] 09:02PM freeCa-1.13 [**2155-8-16**] 09:02PM HGB-17.5 calcHCT-53 O2 SAT-85 CARBOXYHB-3.8 MET HGB-0.0 . CXR [**2155-8-16**] IMPRESSION: Increased moderate-to-large right pleural effusion and slightly decreased small left effusion. Slightly worsened pulmonary edema. . At time of transfer frm ICU to medical floor on [**2155-8-19**] the patient's K+ was 4, Na 139, Cl 98, Bicarb 26, BUN 37 and Cr 7 and Glu 172 and CBC showed wbc 4.7, Hgb 14.2, Hct 44.3, Plts 246 and 2 sets Blood Cultures drawn [**8-16**] are still pending. . Discharge Labs: [**2155-8-20**] 06:15AM BLOOD WBC-4.1 RBC-4.24* Hgb-13.1* Hct-39.6* MCV-94 MCH-30.9 MCHC-33.0 RDW-15.9* Plt Ct-217 [**2155-8-20**] 06:15AM BLOOD Glucose-127* UreaN-42* Creat-8.0* Na-138 K-4.3 Cl-102 HCO3-25 AnGap-15 [**2155-8-18**] 07:20AM BLOOD ALT-64* AST-76* CK(CPK)-69 AlkPhos-111 TotBili-1.0 Brief Hospital Course: 58yo M with a hx of systolic (EF 20-25%) and grade 4 diastolic heart failure, ESRD [**2-15**] DM on HD, atrial fibrillation with RVR, severe depression, and recent crack cocaine use presents with hyperkalemia to 7.4 and atrial fibrillation with RVR to 150s in the setting of missing dialysis for the past week. Of note, patient has had a long history of missing dialysis sessions. . Upon presentation to ED, patient was treated for hyperkalemia with 2 grams calcium gluconate, dextrose, IV regular insulin, 30g kayexalate, and bicarb. Renal was consulted and urgent HD was [**Month/Day (2) 1988**] for [**8-18**] in the early a.m. hours and approximately 1 Liter of fluid was removed. Cardiology was also consulted for afib with RVR and recommended IV labetalol, which converted him back into SR in the 110s. During his stay in the unit, pt remained rate controlled in the 90s-110s and was NSr at time of transfer to the general medical floor. Patient was resumed on his home dose of Labetalol. . Lisinopril was initially held due to hyperkalemia setting but plan was to resume his oupatient dose once discharged. Potassium this morning, [**8-19**], was K 4.0 and team felt comfortable switching patient back to his Ace-inhibitor. Additional ESRD medications, cinacalcet and sevelamer were also continued for electrolyte/Phos level control. . During admission, the patient also complained of intermittent non-radiating chest pressure. SL Nitro was given with no effect. Pain episodes would eventually resolve without intervention. Repeat EKGs showed no change from admission, and no new ischemia/infarction. The pain was reproducible on physical exam at the lower edge of xiphoid and epigastric region and responded to Maalox and it was felt that these complaints were large GI related vs. cardiac. He continued to have chest pain while on the floor, and again it was relieved with tylenol and maalox, thought to be more GI related at that time. . Patient was discharged from recent hospital stay on [**8-10**] with C. Diff colitis and still has about a week left of his Flagyl therapy. Patient continues to c/o daily diarrhea at this time but the frequency has decreased. Flagyl was continued during this admission. He had three days left of treatment at the time of discharge. . The patient has a history of DM-2 and was initially placed on Humalog sliding scale after acute presentation. Now that patient has stabilized he can return to his usual NPH daily schedule of 15 Units a.m. and 10 Units p.m. . For his history of depression he was continued on daily Zoloft home dose. . On the floor, he was seen by a social work to address his absence from dialysis the week before admission. He obviously has insight into the medical problems it causes, but continues to do crack cocaine and miss his sessions. He has an appointment at the [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to follow up his substance abuse and was discharged with goals of staying sober and attending all his dialysis sessions. He will continue his Tues, Thurs, Sat schedule as an outpatient. Medications on Admission: Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS Atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY Senna 8.6 mg Tablet Diphenhydramine HCl 25 mg Capsule q6h prn Camphor-Menthol 0.5-0.5 % Lotion B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Nitroglycerin 0.3 mg Tablet, Sublingual Sig: [**1-15**] Sublingual Acetaminophen 500 mg Capsule Sig: Two (2) Capsule PO Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Labetalol 100 mg Tablet Sig: One (1) Tablet PO TID Insulin Lispro 100 unit/mL Solution sliding scale Metronidazole 500 mg Tablet Sig: TID x 14 days started [**8-10**] Insulin NPH Human Recomb 15 qam and 10 qpm Discharge Medications: 1. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). [**Month/Year (2) **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Month/Year (2) **]:*30 Tablet(s)* Refills:*2* 6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. B-Complex with Vitamin C Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 3 days. [**Month/Year (2) **]:*9 Tablet(s)* Refills:*0* 10. Labetalol 100 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 11. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Fifteen (15) units Subcutaneous QAM. 12. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Fifteen (15) units Subcutaneous every morning. 13. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. [**Month/Year (2) **]:*30 Tablet(s)* Refills:*2* 14. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for itching. 15. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig: 15-30 MLs PO QID (4 times a day) as needed for chest/abdominal discomfort. 16. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 17. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed). 18. Insulin NPH Human Recomb 300 unit/3 mL Insulin Pen Sig: Ten (10) units Subcutaneous every night. [**Month/Year (2) **]:*1 pen* Refills:*2* 19. Insulin Lispro 100 unit/mL Insulin Pen Sig: One (1) unit Subcutaneous as directed by sliding scale. [**Month/Year (2) **]:*1 pen* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary: 1. End Stage Renal Disease on hemodialysis 2. Type II diabetes mellitus 3. Congestive Heart Failure . Secondary: 3. CAD s/p MI 4. CHF with EF of 20-25% 5. Hypertension 6. Atrial fibrillation 7. Polysubstance abuse: crack cocaine Discharge Condition: vital signs stable, afebrile, breathing room air comfortably, ambulating without difficulties, normal mentation. Discharge Instructions: You were admitted for high potassium levels in the setting of missed dialysis visits. You were dialyzed here in the hospital and we continued treatment for your c difficile colitis. . Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet. . Please return to the hospital for worsening chest pain, shortness of breath, abdominal pain, fainting, nausea, vomitting or any other concerns. Call 911 if it is an emergency. Followup Instructions: Please follow up in hemodialysis, it is very important that you continue to make these appointments. Your schedule is Tues, Thursday, Saturday at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9449**] Dialysis. Their phone number is [**Telephone/Fax (1) 69669**]. . Please see your PCP: [**Name Initial (NameIs) 2169**]: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2155-8-27**] 10:10 [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(1) 684**] Completed by:[**2155-8-22**] ICD9 Codes: 5849, 4280, 2767, 5856
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Medical Text: Admission Date: [**2160-9-19**] Discharge Date: [**2160-9-28**] Date of Birth: [**2097-12-31**] Sex: M Service: MEDICINE Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 99**] Chief Complaint: Respiratory distress Major Surgical or Invasive Procedure: Tracheal stent placed twice Inominate vein stent placed Radiation therapy Intubation Midline placement History of Present Illness: This 62 year old male with a history of COPD presented to [**Hospital **] with acute shortness of breath. He was unwell one week prior to admission, with shortness of breath making it difficult to sleep. He also had experienced some chest tightness and notes non-painful mass in the side of his neck. At admission he denied fever, vomiting or diarrhea. He had wheezes on exam and was given bronchodilators with some improvement. He was hypertensive at the time of arrival 180/100. His WBC was elevated to 15.5, ABG 7.28/73/63. At [**Hospital6 **] a CXR showed right upper lobe mass. A CT was performed which showed a spiculated mass in the right upper lobe with contiguous and marked mediastinal adenopathy, compression and distortion of the superior vena cava, extending up into the superior mediastinum in the supraclavicular area and compression of the right brachiocephalic vein, narrowing of the trachea. The patient had elevated CE at the OSH, he was started on Heparin despite the most likely diagnosis being demand ischemia in the setting of hypoxia. He was on BiPap at the OSH for his decreased saturation. He was transfered to [**Hospital1 18**] for bronchoscopy to obtain tissue for diagnosis. He currently feels well except for some shortness of breath. He also notes that his face feels warm and eyes are iritated. Past Medical History: 1. COPD - no intubations, no home O2 2. Alcoholic cirrhosis 3. Hematuria 4. Hypertension 5. Chronic back pain s/p laminectomy 6. Splenectomy s/p motor vehicle accident 7. Obstructive sleep apnea 8. Prior PEs Social History: occasional alcohol, prior history of heavy drinking quit smoking one year ago, 80 pack year history Was in the military then worked for airlines, no known asbestos exposure, reports some exposure to epoxy without mask. Currently lives in [**Location **] with two roomates, sister is his HCP Family History: Mother with DM, Father with heart trouble Physical Exam: Vitals Temp 98.7 BP 134/60, HR 85, RR 26, 90% on 5L NC Gen: alert, oriented, cooperative male resting comfortably HEENT: MMM, OP clear, face red, PERRL Lungs: clear to auscultation bilaterally, distant BS CV: distant HS, RRR, nl S1S2, no murmers Abd: obese, soft, non-tender, normal BS Ext: trace edema Neuro: grossly intact Pertinent Results: [**2160-9-19**] 03:17PM BLOOD WBC-18.7* RBC-4.97 Hgb-16.2 Hct-49.2 MCV-99* MCH-32.6* MCHC-33.0 RDW-13.6 Plt Ct-241 [**2160-9-24**] 04:26AM BLOOD WBC-15.6* RBC-4.98 Hgb-15.7 Hct-49.2 MCV-99* MCH-31.4 MCHC-31.8 RDW-13.0 Plt Ct-215 [**2160-9-28**] 09:34PM BLOOD Hct-27.8* [**2160-9-19**] 03:17PM BLOOD Glucose-130* UreaN-22* Creat-1.0 Na-136 K-4.7 Cl-95* HCO3-31 AnGap-15 [**2160-9-28**] 03:46AM BLOOD Glucose-149* UreaN-54* Creat-2.6* Na-137 K-3.9 Cl-93* HCO3-35* AnGap-13 [**2160-9-24**] 02:58AM BLOOD Type-ART pO2-77* pCO2-76* pH-7.32* calHCO3-41* Base XS-8 Brief Hospital Course: He was diagnosed with likely NSCLC (definitive pathology had not returned). A CT showed tracheal compression and compression of [**Last Name (LF) 17911**], [**First Name3 (LF) **] he underwent a tracheal stent and inominate stenting. He was trasiently intubated for hypoxia but improved. On [**9-23**], Mr. [**Known lastname **] was transferred to the [**Hospital Unit Name 153**] for radiation therapy. However, following his first treatments of chemo and radiotherpay the patient requested to have his code status changed to DNR/DNI on [**2160-9-28**]. He refused telemetry. He was found later that night after having expired. The [**Hospital 228**] health care proxy, his sister [**Name (NI) **], refused a postmortem. The [**Hospital 228**] health care proxy, his sister [**Name (NI) **], was notified of the patient's demise. 1. Respiratory status: He has respiratory distress due to both the lung cancer and COPD. He has been retaining CO2 and on transfer his PCO2 was 76. He also was desatting into the mid 80s at night and positive pressure ventiulation was attempted using both face mask and nasal positive pressure, however the patient was extremely uncomfortable and didn't tolerate the positive pressure. Therefore, at night he had been on face mask with FiO2 titrated to keep his oxygen saturation at 90 or above. During the day he had been satting in the mid 90s on nasal cannula oxygen. On [**2160-9-28**], he became acutely hypoxic from a presumed PE and expired. 2. Lung CA: The pathology suggests stage IIIb non small cell lung cancer. Tissue was obtained from both bronchoscopy and mediastinoscopy. A head CT was negative for metastases, as was a bone scan for osseous metastases. He will be treated with a 5 week course of radiotherapy four times per week along with weekly radiosensitizing chemotherapy of carbaplatin and paclitaxel. He received his first dose of radiation therpay on [**9-24**] and his first dose of chemotherpay on [**9-25**]. He was quite nauseous after the first dose of chemo requiring antiemetics. He was also put on atovaquone for PCP [**Name Initial (PRE) 1102**]. There were no immediate side effects of the radiation therapy. 3. Vena Cava Syndrome: Shortly after arrival to the [**Hospital Ward Name 332**] ICU, the patient had a stent placed in his right inominate artery. His facial swelling decreased after the stent, thoguh he continued to have facial flushing. A follow up CT venogram showed persistent narrowing the the [**Hospital Ward Name 17911**]. The patient was also anticoagulated with heparin with a goal PTT of 60-80 for the vascular stent, however this was discontinued on [**2160-9-26**] after the patient developed a retroperitoneal bleed. 4. Fever: During his hospital course, the patient began spiking fevers to 101 and developed a new infiltrate in his right upper lung field concerning for pneumonia. penumonia. He was started on a 10 day course of zosyn. It is possiblke that the poneumonia was postobstructive from the lung cancer or alternatively from aspiration following the tracheal stent placement. 5. Retroperitoneal bleed: Shortly after beginning anticoagulation therapy, a retroperitoneal bleed was noted on the patient's follow up CT scan. His hct dropped 10 points, and his heparin was discontinued. 6. The patient's code was changed to DNR/DNI on [**9-28**]. He was very clear that he wanted this change in code status. Medications on Admission: Albuterol Atrovent Levothyroxine Atenolol Meloxicam Discharge Disposition: Expired Discharge Diagnosis: Respiratory Distress Presumed Non-small cell lung cancer Superior vena cava syndrome Tracheal compression with stent placement Retroperitoneal bleed Secondary: 1. COPD - no intubations, no home O2 2. Alcoholic cirrhosis 3. Hematuria 4. Hypertension 5. Chronic back pain s/p laminectomy 6. Splenectomy s/p motor vehicle accident 7. Obstructive sleep apnea 8. Prior PEs Discharge Condition: Expired ICD9 Codes: 496, 486, 5849, 4275, 4019, 2449
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Medical Text: Admission Date: [**2139-10-6**] Discharge Date: [**2139-10-12**] Date of Birth: [**2099-6-16**] Sex: M Service: OTOLARYNGOLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 8480**] Chief Complaint: right neck swelling Major Surgical or Invasive Procedure: [**2139-10-6**]: Incision and drainage of right neck abscess History of Present Illness: 40 y/o M with h/o IVDA (last used 4 months ago) who presented to OSH with R neck swelling and odynophagia. Sore throat began on Saturday, neck swelling began on Sunday. He went to [**Hospital 4199**] hosp on Monday who told him he had a blocked salivar gland, and started augmentin. His swelling worsened today and he went back to [**Hospital 4199**] hospital where they obtained a neck CT which was read as a having a cystic neck mass with some compression of airway. He was given decadron 10 x1, and unasyn and transferred to [**Hospital1 18**]. He states he has some difficulty breathing through his mouth, but breathing easily through his nose. He is tolerating po's. He has some deepening of his voice. Denies fevers, chills, dysphagia, fevers, chills, diplopia, blurry vision, cp, sob, n, v, abd pain, otalgia, ear complaints, headache, numbness, weakness. Per report negative HIV 6 months ago. Of note the patient self-aspirated 1cc of pus from right neck mass. Last po intake 1pm. No previous neck infections. Past Medical History: PMH: IVDA 4 months ago last use, Hep C, Chronic LBP, rcotic dependence PSURG Hx: bilateral hip surgeries, adenoidectomy, tonsillectomy as a child Social History: On disability, 2ppd x 27 years, non drinker, former cocaine and heroin user. Family History: non-contributory Physical Exam: 98.0 80 115/80 16 99 RA NAD RRR CTA B moderate right neck swelling, much improved from before. CN [**Last Name (LF) **], [**First Name3 (LF) 81**], and XII intact Pertinent Results: [**2139-10-5**] 10:03PM PT-13.5* PTT-27.6 INR(PT)-1.2* [**2139-10-5**] 10:03PM WBC-10.4 RBC-4.23* HGB-11.8* HCT-35.7* MCV-84 MCH-27.8 MCHC-33.0 RDW-14.1 [**2139-10-5**] 10:03PM PLT COUNT-176 [**2139-10-5**] 10:03PM GLUCOSE-120* UREA N-8 CREAT-0.8 SODIUM-137 POTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-26 ANION GAP-12 [**2139-10-5**] 10:06PM LACTATE-0.7 [**2139-10-6**] 05:07AM PT-14.2* PTT-27.3 INR(PT)-1.2* [**2139-10-6**] 05:07AM WBC-8.1 RBC-3.94* HGB-11.3* HCT-32.9* MCV-84 MCH-28.8 MCHC-34.4 RDW-14.7 [**2139-10-6**] 05:07AM PLT COUNT-184 [**2139-10-6**] 05:07AM GLUCOSE-164* UREA N-9 CREAT-0.7 SODIUM-139 POTASSIUM-4.3 CHLORIDE-105 TOTAL CO2-25 ANION GAP-13 [**2139-10-6**] 05:07AM CALCIUM-9.0 PHOSPHATE-2.3* MAGNESIUM-2.3 CT OSH, Second Opinion Read from [**2139-10-5**]: 1. Large rim-enhancing fluid collection below the right angle of mandible, centered in the right parapharyngeal space and extending to the submucosa as described above, displacing adjacent structures. Diagnostic possibilities include an abscess and a superinfected branchial cleft cyst. 2. Extension of hypodense material from the collection to the retropharyngeal and prevertebral spaces at C3-C6, concerning for phlegmon or early abscess formation. C5-6 endplate irregularities are most likely degenerative, but infection cannot be excluded. Cervical spine MRI is suggested for further evaluation. MRI Spine [**2139-10-8**]: Extensive soft tissue edema and residual right parapharyngeal fluid collection as described above. Extremely limited study due to motion and lack of IV contrast. Please refer to concurrent CT neck for details. CT Neck [**2139-10-8**]: 1. Interval drainage of a large rim-enhancing right neck fluid collection with multiple small residual collections in the operative bed, colectively measuring upto 3.6 cm. Brief Hospital Course: Mr. [**Known lastname 67102**] was transferred from an OSH for a large right neck abscess and odynophagia. The patient was taken to the OR for operative drainage. Please see dedicated operative report for full details. The patient was kept intubated and taken to the ICU for overnight observation. On POD 1, the patient was extubated and his diet was advanced. He stayed one more day in the ICU while awaiting a bed and was then transferred to the floor. He had been started on vanc/unasyn in the ED here at [**Hospital1 18**] and cultures were obtained, which grew out beta lactamase negative Haemophilus influenzae. Due to continuing concern about his neck, an MRI was attempted on [**2139-10-8**], but the patient could not tolerate the procedure. A follow up CT was then obtained and further drainage was deemed unnecessary based on those results. An ID consult was obtained and the antibiotics were changed to cefepime and flagyl. They also suggested an HIV test, which was negative. The patient responded well on this regimen. During his hospital stay, he had good pain control on oral meds, had normal hemodynamics and oxygen saturations, was ambulatory, and tolerated an oral diet. On Monday, [**2139-10-12**], the patient expressed a desire to go home. ID recommendations included a week of IV antibiotics. Thus, the patient decided to sign himself out of the hospital against medical advice. He will be completing a course of oral antibiotics, will have VNA services for dressing changes, and will follow up with Dr. [**First Name (STitle) **] soon. The patient was counseled as to the risks of his going home, and he decided to leave against medical advice to go home. Medications on Admission: Methadone 100mg QD, oxycodone 15mg q6 prn pain Discharge Medications: 1. Methadone 40 mg Tablet, Soluble Sig: 2.5 Tablet, Solubles PO DAILY (Daily) as needed for home maintenence dose. 2. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). Disp:*30 Patch 24 hr(s)* Refills:*2* 3. Oxycodone 5 mg/5 mL Solution Sig: Five (5) mL PO Q6H (every 6 hours) as needed for pain. Disp:*300 mL* Refills:*0* 4. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a day for 21 days. Disp:*42 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: right neck abscess Discharge Condition: Stable Discharge Instructions: VNA will come to change your packing and dressing once a day. Call your doctor's office or go to the ED if you start to have fevers/chills, increasing difficulty breathing, new redness or swelling at the surgical site, or if you have any other concerns. Followup Instructions: Call Dr.[**Name (NI) 18353**] office at [**Telephone/Fax (1) 2349**] to schedule a follow-up appointment to be seen in [**8-14**] days. ICD9 Codes: 3051
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Medical Text: Admission Date: [**2105-12-26**] Discharge Date: [**2106-1-7**] Date of Birth: [**2082-3-9**] Sex: F Service: ORTHOPAEDICS Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Doctor Last Name 1350**] Chief Complaint: Paralysis of bilateral legs Major Surgical or Invasive Procedure: T4-T8 laminectomy with excision of dorsal epidural abscess. History of Present Illness: Patient is a 23 y/o F IVDA, who noted four days worth of back pain prior to presentation. She presented to the emergency room on [**2105-12-26**] with paralysis of her bilateral lower extremities, MRI showed an epidural abscess in her T spine and was taken urgently to the OR. Past Medical History: IVDA Physical Exam: Afebrile BUE: [**4-14**] deltoid, biceps, triceps, WF, WE, FF, FAb BUE: SILT C4-T1 BLE: no motor below T9 BLE: no sensation BLE T9-S1. incontinent of bowel and bladder, foley catheter dependent poor rectal tone Pertinent Results: [**2105-12-26**] 03:55PM WBC-18.7* RBC-3.28* HGB-10.0* HCT-29.0* MCV-88 MCH-30.6 MCHC-34.6 RDW-12.6 [**2105-12-25**] 10:57PM CRP-GREATER TH [**2105-12-25**] 10:57PM WBC-19.8* RBC-4.22 HGB-12.8 HCT-36.6 MCV-87 MCH-30.3 MCHC-34.9 RDW-12.5 [**2105-12-25**] 10:57PM SED RATE-75* [**2105-12-25**] 10:57PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.017 [**2105-12-25**] 10:57PM URINE BLOOD-TR NITRITE-NEG PROTEIN-25 GLUCOSE-NEG KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG [**2105-12-25**] 10:57PM URINE RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE EPI-0-2 Brief Hospital Course: The patient was taken emergently to the operating room on the day of presentation. She underwent a decompression from T5-T8 (Laminctomies). Frank pus was removed from the epidural space which was shown to be + for MRSA. She was taken to the SICU immediately after surgery. Her SICU course was uneventful and she was discharged to the floor. She was given a PICC line for a total of a 10 week course of vancomycin to be followed by infectious disease. See discharge instructions for follow-up information. She was discharged to a spinal cord rehabilitation facility once her insurance company provided approval. Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily). 4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain/fever > 100.4, pain. 5. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 6. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q8H (every 8 hours). 8. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours) as needed for if no BM in > 24 hours. 9. Hydromorphone 4 mg Tablet Sig: 1 [**12-12**] to 2 [**12-12**] Tablet PO Q3H (every 3 hours) as needed for pain. 10. Methadone 10 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours): Methadone is being for pain management as per the recommendation of chronic pain management services. 11. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for anxiety. 12. Fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 13. Diphenhydramine HCl 25 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) as needed for rash/itching. 14. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itching. 15. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 16. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 17. Vancomycin 500 mg Recon Soln Sig: 2 [**12-12**] Recon Solns Intravenous Q 8H (Every 8 Hours). 18. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML Intravenous PRN (as needed) as needed for line flush. Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: Thoracic epidural abscess from T4-T8 Discharge Condition: Stable. Tolerating oral diet. Alert and oriented. Discharge Instructions: Immediately after the operation: - Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit or stand more than ~45 minutes without moving around. - Rehabilitation/ Physical Therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. You can walk as much as you can tolerate. o Limit any kind of lifting. - Diet: Eat a normal healthy diet. You may have some constipation after surgery. You have been given medication to help with this issue. - Brace: You may have been given a brace. This brace is to be worn when you are walking. You may take it off when sitting in a chair or lying in bed. - Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Cover it with a sterile dressing and call the office. - You should resume taking your normal home medications. - You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on [**Hospital Ward Name 23**] 2. We are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - Follow up: o Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o At the 2-week visit we will check your incision, take baseline X-rays and answer any questions. We may at that time start physical therapy. o We will then see you at 6 weeks from the day of the operation and at that time release you to full activity. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. -For your vancomycin, please have a weekly CBC with differential, ESR, CRP, and vancomycin trough faxed to the Infectious Disease clinic at [**Telephone/Fax (1) 1419**] attention Dr. [**Last Name (STitle) **] [**Name (STitle) 84167**] Physical Therapy: OOB to chair, Passive ROM in ankle, knee and hip joints. Wheelchair mobilization. Treatments Frequency: IV antibiotics through the PICC line. Physical therapy in the form of OOB to chair. Removal of staples in 3 weeks. Followup Instructions: Follow up in 6 weeks with Dr [**Last Name (STitle) 1007**]. Please call [**Telephone/Fax (1) 9769**] to make an appointment. Follow up in Six weeks at the infectious disease clinic at [**Hospital1 1535**] [**Hospital Ward Name 516**]. Please follow-up in six weeks. Please call office to schedule an appoinement. Follow-up with the Chronic Pain service, Dr. [**Last Name (STitle) 13284**], [**Hospital1 1535**], in four to six weeks. Please call his office to schedule an appointment. Completed by:[**2106-1-7**] ICD9 Codes: 7907, 3051
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Medical Text: Admission Date: [**2156-4-17**] Discharge Date: [**2156-4-30**] Date of Birth: [**2093-7-2**] Sex: M Service: MEDICINE Allergies: Ativan / Diovan Attending:[**First Name3 (LF) 5037**] Chief Complaint: Back pain and leg weakness Major Surgical or Invasive Procedure: Thoracentesis Hemodyalisis History of Present Illness: Mr. [**Known lastname 68820**] is a 62yo M with history of Hepatitis C with cryoglobulinemia s/p renal transplant in [**2152**] who presented to an outside hospital with midthoracic back pain and left leg weakness. He was transferred to [**Hospital1 18**] when he was found to be in worsening renal failure. . Of note, he had a right pleural effusion drained a week ago. On this presentation, he complains of some increased shortness of breath and CXR at OSH showed reaccumulation of his pleural effusion. Patient has had pleuritic chest pain almost constantly for an unclear period of time but at least since Thursday which is worse with inspiration. His pain briefly improved after thoracentesis for R pleural effusion but worsened soon after. He decided to see his doctor yesterday after he awoke with left leg weakness and difficulty picking up his leg. . Over the past couple of weeks, he was found to be hypertensive and started on amlodipine in addition to his other antihypertensives. After patient's thoracentesis, he continued these antibiotics and was hypotensive at the OSH to 94. . In the ED, initial vs were: T 98.3 P 81 BP 103/41 R 20 O2 sat 100% 2L NC. Patient's labs were significant for a K of 6.7 and Cr of 7.1. The patient was given calcium gluconate, Insulin and D50, and Kayexelate. He was given 750mg IV Levofloxacin x1, Zofran, Valium 5mg. He was started on levophed briefly for hypotension and weaned prior to arrival to the MICU. MRI of the spine was performed which was negative for cord compression. . In the ICU, he complains of diffuse pain, mostly in his back and left flank. He had back pain at baseline and it worsened a week ago after seeing his chiropracter. His review of systems is positive for intermittent headaches, pleuritic chest pain, back pain and leg numbness and weakness. He has had decreased urine output over the past day. Past Medical History: -ESRD dx [**2146**] [**2-4**] HTN now s/p LRRT [**2152-3-28**] -HTN -CAD, s/p MI with stent -Hyperlipidemia -HCV genotype 1,PEG interferon monotherapy for 28 weeks and then was stopped due to low blood counts. Bx 06 showed chr hep c -paraproteinemia/paraproteinuria of uncertain significance. -H/o coagulation disorder due to reaction to HCV medication resulting in DVT and ensuing vascular compromise/gangrene resulting in a lower extremity amputation. -Anemia of chronic disease Social History: On disability. was working as [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3456**]. social etoh, 42 pack year h/o smoking and still smokes Family History: No family h/o cad, brother has renal cell ca-fully treated and dtr with chronic kidney disorder of uncertain etiology. His mother had DM Physical Exam: ADMISSION PHYSICAL: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, strabismus and blindness in R eye, MM slightly dry, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Some decreased air movement at right base, otherwise clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender graft in RLQ, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Back: Tenderness over left upper flank, no spinal process tenderness, tenderness over left SI joint Ext: warm, well perfused, R AKA and LLE without edema or cyanosis, 2+ DP on LLE, strength 3+/5 in LLE, [**5-6**] in bilateral upper extremities Pertinent Results: STUDIES: CXR [**2156-4-17**]: FINDINGS: Frontal and lateral views of the chest are obtained. Again seen is a moderate right pleural effusion with overlying atelectasis. A trace left pleural effusion is likely also present, as noted on the lateral view. Increased markings along the right lung may relate to layering effusion although slightly asymmetric interstitial edema may be present. Underlying infection cannot be excluded. The cardiac silhouette, while cannot be accurately assessed due to the right effusion, may be mildly enlarged. The aorta is calcified and tortuous. . SKULL X-RAY [**2156-4-18**]: FINDINGS: Two views of the skull demonstrate no radiopaque metallic foreign body in and about the orbits. Sinuses are clear. . MRI L-SPINE [**2156-4-18**]: CONCLUSION: No evidence of cord or cauda equina compromise. Mild degenerative changes. Vertebral body hypointensity as discussed above. . RENAL TX U/S [**2156-4-18**]: Preliminary Report !! PFI !! PFI: 1. Transplant kidney with no definite perinephric collections. 2. Main renal artery and main renal vein are patent. Resistive indices in interlobular arteries are 0.78, 0.87, and 0.83 in the upper, mid, and lower poles, respectively. . LENI LLE [**2156-4-18**]: IMPRESSION: No evidence of DVT in the left lower extremity. . CXR [**2156-4-19**]: FINDINGS: Frontal view of the chest is compared to multiple prior examinations. Since the prior study, there is interval worsening in the appearance of the chest, with accumulation of moderate-to-large right-sided pleural effusion, right lower lobe consolidation, left lower lobe consolidation increased. Mild congestive failure has developed. Heart is top normal in size. Mediastinum is stable. . MICRO: UCX [**2156-4-18**]: NO GROWTH BCX [**4-18**], [**4-19**]: PENDING Labs: [**2156-4-17**] 07:50PM BLOOD WBC-6.9 RBC-2.99* Hgb-8.4* Hct-27.1* MCV-91 MCH-28.1 MCHC-31.0 RDW-20.6* Plt Ct-228 [**2156-4-27**] 05:10AM BLOOD WBC-12.2* RBC-2.95* Hgb-7.8* Hct-26.3* MCV-89 MCH-26.3* MCHC-29.6* RDW-20.4* Plt Ct-374 [**2156-4-17**] 07:50PM BLOOD PT-15.0* PTT-27.7 INR(PT)-1.3* [**2156-4-27**] 05:10AM BLOOD PT-14.9* PTT-29.5 INR(PT)-1.3* [**2156-4-17**] 07:50PM BLOOD Glucose-104* UreaN-64* Creat-7.1*# Na-136 K-6.7* Cl-108 HCO3-17* AnGap-18 [**2156-4-27**] 05:10AM BLOOD Glucose-66* UreaN-33* Creat-4.0* Na-136 K-4.2 Cl-103 HCO3-23 AnGap-14 [**2156-4-17**] 07:50PM BLOOD ALT-30 AST-65* AlkPhos-172* TotBili-0.3 [**2156-4-26**] 05:45AM BLOOD ALT-16 AST-25 LD(LDH)-280* AlkPhos-176* TotBili-0.3 [**2156-4-17**] 07:50PM BLOOD cTropnT-0.04* [**2156-4-18**] 02:00AM BLOOD cTropnT-0.03* [**2156-4-18**] 08:46AM BLOOD CK-MB-6 cTropnT-0.04* [**2156-4-18**] 02:32PM BLOOD CK-MB-6 cTropnT-0.03* [**2156-4-26**] 05:45AM BLOOD calTIBC-121* Ferritn-724* TRF-93* [**2156-4-21**] 12:00PM BLOOD PTH-113* [**2156-4-21**] 05:25AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-POSITIVE [**2156-4-17**] 07:50PM BLOOD RheuFac-561* [**2156-4-26**] 11:20AM BLOOD C3-112 C4-4* [**2156-4-27**] 05:10AM BLOOD HIV Ab-NEGATIVE [**2156-4-27**] 05:10AM BLOOD Cyclspr-88* [**2156-4-26**] 05:45AM BLOOD Cyclspr-92* [**2156-4-25**] 06:55AM BLOOD Cyclspr-79* [**2156-4-21**] 05:25AM BLOOD HCV Ab-POSITIVE* [**2156-4-17**] 10:21PM BLOOD K-5.2 Brief Hospital Course: Mr. [**Known lastname 68820**] was a 62 year-old man with a history of hepatitis C with cryoglobulinemia status post renal transplant in [**2152**] presenting with pleural effusion and worsening renal failure. . ACTIVE ISSUES: # Acute on chronic renal transplant failure: Patient had progressively worsening renal transplant failure, most recently CKD stage 4. He had been followed by nephrology as an outpatient and was in discussions to start peritoneal dialysis in the near future. He was evaluated by the renal serivce and his urine sediment was found to be relatively [**Name2 (NI) 29734**] without any casts to suggest GN or muddy brown casts. His worsened renal function was consistent with graft failure and he was started on hemodialysis. He was continued on cyclosporine, cellcept and bactrim. He will continue hemodialysis as an outpatient and follow up with his transplant nephrologist. . # Pleural effusion: He reported having thoracentesis at OSH on Thursday and had reaccumulation of pleural effusion on here that drained by the interventional pulmonology service with analysis consistent a transudative effusion. Following his thoracentesis, he was saturating well on room air. It was suspected that his pleural effusion resulted from poor nutrition with a low albumin and worsening of renal failure. Rapid reaccumulation of his pleural effusion was not appreciated. His pleural effusion will be followed by his primary care physcian in one week. . # Pleuritic chest pain: His pleuritic chest pain was likely due to his pleural effusion or MSK pain. MI was unlikely and he had two sets of cardiac enzymes in the ER that were reassuring. PE is also a possibility but low likelihood given his lack of tachycardia and stable oxygen saturations. Left LENI was negative for DVT. His pleuritic chest pain improved significantly following draining of pleural effusion. On the day of discharge, his pain was well controlled on with tylenol and lidocain patches. . # Back pain: He had diffuse back pain and left flank that was difficult to localize. It was suspected that his back pain resulted from his pleural effusion. Muscle strain in setting of chiropracter manipulation was also a consideration. Cord compression and neoplastic disease was considered unlikely in the setting of reassuring C/T/L spine MRI. His pain was controlled with low dose oxycodone, tylenol and lidocaine patches. He was discharged on tylenol and lidocaine patches. . # Hep C: He was previously being treated with interferon but had been discontinued for unclear reasons. He will follow up with liver clinic as an outpatient. Medications on Admission: 1. Doxazosin 4mg po daily 2. Furosemide 40mg po daily 3. Lisinopril 20mg po daily 4. Metoprolol tartrate 50mg po bid 5. CellCept 250mg po bid 6. Omeprazole 20 mg po bid 7. Interferon -unknown dose 8. Simvastatin 40 mg po daily 9. Procrit sc weekly 10. Bactrim one daily 11. Cyclosporine 75 mg in am and 50 mg in pm twice 12. Aspirin 81mg po daily 13. Oxycodone prn Discharge Medications: 1. Fish Oil 1,000 mg Capsule Sig: One (1) Capsule PO once a day. 2. multivitamin Capsule Sig: One (1) Capsule PO once a day. 3. B Complex Capsule Sig: One (1) Capsule PO once a day. 4. doxazosin 4 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO HS (at bedtime). 5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 7. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. mycophenolate mofetil 250 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. cyclosporine modified 25 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*2* 10. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day: Please take on days that you do not go to dialysis. Disp:*30 Tablet(s)* Refills:*2* 11. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 12. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for back pain. Disp:*qs Adhesive Patch, Medicated(s)* Refills:*0* 13. ampicillin 250 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours) for 12 days: On dialysis days please take morning dose after dialysis. Disp:*48 Capsule(s)* Refills:*0* 14. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 15. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 16. Renvela 800 mg Tablet Sig: One (1) Tablet PO three times a day. 17. Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for nausea for 7 days. Disp:*21 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 635**] vna Discharge Diagnosis: Transudative Pleural Effusion Renal Transplant Graft Failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 68820**], You were admitted to the hospital for fluid accumulating around your lungs. You were evaluated and treated by the medicine service. The fluid around your lungs was drained and studied. There was no evidence of infection or cancer found in this fluid. You were also found to have worsening of your renal failure. You were started on hemodialysis. You will continue hemodialysis as an outpatient. Please take your medications as prescribed and keep your outpatient appointments. If you continue to not urinate on your own, please straight catheterize yourself twice daily to ensure your bladder remains empty. The following changes have been made to your home medications. 1. You have been STARTED on Lidoderm patch for your back pain. 2. You have been STARTED on Ampicillin 500mg twice daily for eleven more days, Please take morning dose after dialysis 3. You have been STARTED on Nephrocaps daily 4. You have been STARTED on Lisinopril 20mg daily 5. You have been STARTED on Zofran every 8 hours for nausea for 7 days 6. Your Cyclosporin dose has been CHANGED to 25mg twice daily 7. Your Furosemide has been CHANGED to 80mg daily on non-dialysis days 8. Your Metoprolol has been STOPPED please discuss this change with your kidney doctor 9. Your Norvasc has been STOPPED please discuss this chage with your kidney doctor. . No other changes have been made to your home medication. Followup Instructions: Name: [**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - It is recommeneded that a repeat chest X-ray to follow the fulid in your lungs and urine analysis and urine culture for your urinary tract infection be collected after you finish your ampicillin. Location: [**Location (un) **] FAMILY MEDICINE Address: [**Street Address(2) 68821**], [**Location (un) **],[**Numeric Identifier 18235**] Phone: [**Telephone/Fax (1) 62646**] Appointment: Wednesday [**5-5**] at 10AM Department: SURGICAL SPECIALTIES When: WEDNESDAY [**2156-5-5**] at 2:00 PM With: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 921**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: TRANSPLANT CENTER When: TUESDAY [**2156-5-18**] at 1:40 PM With: [**Name6 (MD) 2105**] [**Name8 (MD) 2106**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: LIVER CENTER When: WEDNESDAY [**2156-6-16**] at 10:00 AM With: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 2422**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage [**Name6 (MD) 2105**] [**Name8 (MD) 2106**] MD [**MD Number(2) 5038**] ICD9 Codes: 5856, 5849, 5990, 2767, 412, 2724, 3051
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Medical Text: Admission Date: [**2183-3-20**] Discharge Date: [**2183-3-23**] Date of Birth: [**2135-12-12**] Sex: M Service: MEDICAL INTENSIVE CARE UNIT CHIEF COMPLAINT: Hematemesis and melena. HISTORY OF THE PRESENT ILLNESS: The patient is a 47-year-old Russian male with no significant past medical history who presents with three to four episodes of hematemesis and three days of melena following a one week history of epigastric "heaviness". One week prior to admission, the patient reports new onset epigastric heaviness which was described as intermittent and worse following eating. The patient also noted several days of black tarry stools, three to four stools per day. The day of admission, the patient reports progressive onset of fatigue and anorexia with nausea. While laying down, the patient became acutely nauseous with vomiting "maroon-colored material". On rising, the patient turned pale and fainted (falling into the cough without head trauma). The patient reportedly vomited coffee ground material three to four times before presenting to the Emergency Department. The patient denied bright red blood per rectum, history of NSAID (nonsteroidal anti-inflammatory drugs), heavy alcohol use, anticoagulant medications, and prior similar episodes. In the Emergency Department, the patient was found afebrile with a blood pressure of 118/84, heart rate 112, and oxygen saturation 96% on room air. Two large boar peripheral intravenous catheters were placed and the patient was started on normal saline intravenous fluid wide open. The patient was NG lavaged with greater than 2 liters without clearing (bloody pink fluid was withdrawn), and the Gastroenterology Service was consulted for emergent endoscopy. The patient's initial hematocrit was 35.8 and the patient was typed and screened without initial transfusion. PAST MEDICAL HISTORY: 1. Status post appendectomy. 2. Status post right shoulder dislocation. ADMISSION MEDICATIONS: None (the patient denied over the counter medications). ALLERGIES: The patient has no known drug allergies. SOCIAL HISTORY: The patient is married and lives with his wife and daughter. The patient reports a 1 [**12-12**] pack per day tobacco history of 25 years with occasional social alcohol use. The patient denied intravenous drug use. FAMILY HISTORY: Without significant history of GI disease including colon cancer, gastric cancer, no premature coronary artery disease (father with an MI at the age of 71), hypertension, or cerebrovascular accidents. REVIEW OF SYSTEMS: The patient denied chest pain, shortness of breath, dyspnea on exertion, abdominal pain, easy bruising or bleeding, fevers, chills, diarrhea, as well as rash. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Temperature 97.1, heart rate 97, blood pressure 142/82, respiratory rate 15, oxygen saturation 100% on 2 liters nasal cannula, weight 76.5 kilograms. General: The patient is a well-developed, well-nourished male resting comfortably, in no acute distress. HEENT: Normocephalic, atraumatic. Anicteric sclerae. Moist mucous membranes. Small dried blood in the oropharynx. Neck: No jugular venous distention or lymphadenopathy. Cardiovascular: Regular rate and rhythm with normal S1, S2, no murmurs, rubs, or gallops. Pulmonary: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Abdomen: Soft, normoactive bowel sounds, nontender, nondistended, no hepatosplenomegaly, guarding, or rebound. Extremities: Warm and well perfuse with no clubbing, cyanosis or edema. LABORATORY DATA ON ADMISSION: CBC with a white blood cell count of 14.9, hematocrit 35.8 (baseline unknown), platelets 162,000 with a normal white blood cell differential. Chem-7 with a sodium of 140, potassium 3.8, chloride 104, bicarbonate 25, BUN 37, creatinine 1.0, glucose 141. LFTs with an ALT of 10, AST 12, alkaline phosphatase 47, total bilirubin 0.4, amylase 61, lipase 33. Coagulations: PT 13.1, INR 1.1, PTT 22.5. Initial EKG revealed sinus tachycardia at 129 with normal axis, normal intervals, and isolated Q wave in lead II. No ST or T wave changes. HOSPITAL COURSE: The patient was admitted to the Medical Intensive Care Unit and underwent an emergent upper endoscopy where he was found to have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-[**Doctor Last Name **] tear in the distal esophagus as well as a single-cratered 10 mm ulcer in the proximal duodenum with evidence of recent bleeding. The ulcer was injected with epinephrine without incident. The patient received a total of 2.5 liters normal saline overnight on hospital day number one with a decrease in his hematocrit from 35.7 to 25.7. The patient was without further episodes of hematemesis, however, had several episodes of melenic stool over the initial night of hospitalization. The patient was transfused 1 unit of packed red blood cells with an appropriate bump in his hematocrit. The patient had no further episodes of melena or hematemesis and the patient's hematocrit remained stable for the remainder of the hospitalization. The patient was diagnosed with Helicobacter pylori by serum antibody and was started on PrevPak (amoxicillin, Clarithromycin, and lansoprazole) for a 14 day course. The patient was started on a clear liquid diet on hospital day number two and his diet was advanced without difficulty. The remainder of the [**Hospital 228**] hospital course was complicated by several episodes of orthostasis by heart rate (asymptomatic without change in blood pressure). The patient received an additional several liters of normal saline with resolution of orthostasis. CONDITION ON DISCHARGE: Good, tolerating oral diet without further hematemesis, stable hematocrit without orthostasis. DISCHARGE DIAGNOSIS: 1. Duodenal ulcer, Helicobacter pylori positive. 2. Upper gastrointestinal bleed. MEDICATIONS ON DISCHARGE: 1. Lansoprazole 30 mg p.o. b.i.d. (complete a 14 day course). 2. Clarithromycin 500 mg p.o. b.i.d (to complete a 14 day course). 3. Amoxicillin 500 mg p.o. b.i.d. (to complete a 14 day course). DISCHARGE INSTRUCTIONS: The patient was discharged to home with instructions to complete a two week course of amoxicillin, Clarithromycin, and lansoprazole for the treatment of H. pylori with duodenal ulcer. The patient was instructed to follow-up with his primary care physician in one week postdischarge. The patient was also recommended to discontinue the use of caffeine, alcohol, as well as tobacco products. In case of recurrent melena and/or hematemesis, the patient was instructed to return to the Emergency Department for further evaluation. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 4561**] Dictated By:[**Name8 (MD) 4935**] MEDQUIST36 D: [**2183-3-23**] 02:36 T: [**2183-3-23**] 18:03 JOB#: [**Job Number 29717**] ICD9 Codes: 2765, 3051
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Medical Text: Admission Date: [**2156-12-20**] Discharge Date: [**2156-12-23**] Date of Birth: [**2108-3-22**] Sex: M Service: MEDICINE Allergies: All allergies / adverse drug reactions previously recorded have been deleted Attending:[**First Name3 (LF) 3984**] Chief Complaint: Hypoxemia. Major Surgical or Invasive Procedure: Thoracentesis. History of Present Illness: Mr. [**Known lastname 88321**] is a 48 year old gentleman with a PMH significant for HCV cirrhosis and a recent admission for a traumatic fall with multiple IPH requiring bolt placement, multiple orthopedic fractures s/p surgeries, trach/PEG with hospital course complicated by Serratia pneumonia treated with pip/tazo now admitted for hypoxemia. The patient was admitted to [**Hospital1 18**] from [**Date range (1) 88322**] after a 30 foot fall from height with multiple IPH s/p intracranial bolt placement for elevated ICP, multiple orthopedic fractures requiring surgical intervention, splenectomy, and trach/PEG. He was noted to develop a VAP that speciated as pan-sensitive Serratia and he completed a course of pip/tazo, and also had a right-sided pneumothorax requiring chest tube placement. Per report, the patient was noted at rehab to have been progressively hypoxemic over the past 2 days with a outpatient CXR concerning for right-sided pneumonia. He did not have increased sputum production or fevers. He was then sent to the [**Hospital1 18**] ED for further evaluation. In the [**Hospital1 18**] ED, initial VS 98.1 62 92/54 18 95% 40% FM. CXR notable for right-sided complete opacification, for which the patient received vanco and pip/tazo. He was placed on volume cycled assist control, and was sent for a CT chest to rule out diaphragmatic rupture. While at CT, he received 5 haldol iv and 2 iv ativan for agitation, after which he was arousable to stimulation. He was then transferred to the [**Hospital Unit Name 153**] for further management. Currently, the patient is on mechanical ventilation, minimally responsive to verbal stimuli. ROS: Limited given somnolence. Past Medical History: Admitted [**Date range (1) 88323**] for 30 foot fall from roof. Multiple IPH(multiple intraparenchymal petechial, hemorrhages at [**Doctor Last Name 352**]-white matter junction, as well as involving the right mid brain, consistent with diffuse axonal injury), facial fractures, bilateral arm fractures as well as right knee fracture. Underwent splenectomy, multiple orthopedic surgeries. - Surgeries [**11-18**] -> ex-lap with splenectomy - Bolt placed on [**11-19**] - Trach/PEG on [**11-24**] - Facial ORIF on [**12-1**] - IVC filter placed [**12-7**] - HCAP treated with vanco and pip/tazo, speciated as pan-sensitive Serratia. - No evidence of seizure activity during admission, EEG demonstrating encephalopathy. Arousable to voice and stimulation with opening of eyes and localization to voice. Intermitently follows commands. - Discharged on 35% trach collar. - Received all appropriate vaccinations Social History: Worked as a roofer. Drinks 6-12 pack of beer daily, quit smoking recently. Family History: Non-contributory. Physical Exam: VS: 97.5 62 97/66 14 95% AC 550x14, 5, 50%. Gen: Vented. HEENT: Pupils 2->1 mm bilaterally. Sclerae anicteric. MM dry. CV: Nl S1+S2 Pulm: Bronchial breath sounds on right, rhonchorous on left anteriorly. Abd: Midline incision healing, no signs of surrounding erythema. G-tube in place. +bs. Ext: Right arm, right knee/RLE, LLE in braces. No c/c/e. Neuro: Opens eyes to verbal stimuli, not following commands. Pertinent Results: Labs at Admission: [**2156-12-20**] 03:30PM BLOOD WBC-15.8* RBC-3.46* Hgb-11.4* Hct-35.7* MCV-103* MCH-33.0* MCHC-32.0 RDW-15.8* Plt Ct-278 [**2156-12-20**] 03:30PM BLOOD Neuts-56.4 Lymphs-28.2 Monos-5.9 Eos-8.6* Baso-0.9 [**2156-12-20**] 03:30PM BLOOD PT-13.4 PTT-35.9* INR(PT)-1.1 [**2156-12-20**] 03:30PM BLOOD Glucose-93 UreaN-17 Creat-0.6 Na-132* K-7.8* Cl-100 HCO3-26 AnGap-14 [**2156-12-20**] 03:30PM BLOOD ALT-51* AST-139* LD(LDH)-646* AlkPhos-174* TotBili-0.4 [**2156-12-20**] 10:16PM BLOOD Calcium-8.6 Phos-3.9 Mg-2.0 [**2156-12-20**] 03:30PM BLOOD Albumin-2.7* [**2156-12-20**] 10:16PM BLOOD VitB12-1546* Folate-GREATER TH [**2156-12-20**] 03:40PM BLOOD Glucose-92 Lactate-1.3 Na-134* K-7.7* Cl-96* calHCO3-30 [**2156-12-20**] 09:57PM BLOOD Lactate-1.2 Labs at Discharge: [**2156-12-23**] 06:04AM BLOOD WBC-14.3* RBC-3.66* Hgb-11.7* Hct-37.6* MCV-103* MCH-32.1* MCHC-31.3 RDW-15.0 Plt Ct-316 [**2156-12-23**] 06:04AM BLOOD Neuts-51.9 Lymphs-29.0 Monos-8.5 Eos-9.8* Baso-0.8 [**2156-12-23**] 06:04AM BLOOD Glucose-122* UreaN-11 Creat-0.7 Na-141 K-4.1 Cl-104 HCO3-29 AnGap-12 [**2156-12-22**] 04:40AM BLOOD ALT-53* AST-100* LD(LDH)-242 AlkPhos-198* TotBili-0.5 [**2156-12-23**] 06:04AM BLOOD Calcium-8.9 Phos-2.7# Mg-2.0 Pleural Fluid Analysis: [**2156-12-21**] 5:37 pm PLEURAL FLUID GRAM STAIN (Final [**2156-12-21**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. FLUID CULTURE (Preliminary): NO GROWTH. ANAEROBIC CULTURE (Preliminary): NO GROWTH. ACID FAST SMEAR (Final [**2156-12-22**]): NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. ACID FAST CULTURE (Preliminary): PLEURAL ANALYSIS WBC RBC Polys Lymphs Monos Eos Meso Macro [**2156-12-21**] 17:37 850* [**Numeric Identifier 3652**]* 21* 17* 3* 56* 2* 1* PLEURAL CHEMISTRY TotProt Glucose LD(LDH) Cholest Triglyc [**2156-12-21**] 17:37 4.6 82 272 61 39 OTHER BODY FLUID pH [**2156-12-21**] 18:04 7.39 Pleural Fluid: NEGATIVE FOR MALIGNANT CELLS. Mesothelial cells, histiocytes, lymphocytes, and neutrophils. Imaging Studies: Chest CT without contrast ([**2156-12-20**]): 1. No evidence of diaphragmatic hernia. 2. Large right and moderate left simple pleural effusions. Consolidation and volume loss in the lower lobes bilaterally, right greater than left, may represent atelectasis however, aspiration or superimposed infection cannot entirely be excluded. 3. Healing rib and clavicle fractures, as described above. 4. No pneumothorax. Chest x-ray ([**2156-12-21**]): In comparison with the earlier study of this date, there has been removal of a substantial amount of right pleural effusion with a small residual. No evidence of pneumothorax. Tracheostomy tube remains in place and there is again evidence of volume loss at the left base. Transthoracic echocardiogram ([**2156-12-21**]: The left atrium and right atrium are normal in cavity size. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. The aortic valve appears bicuspid with mildly thickened leaflets, eccentric closure point and fused right and left raphe. A gradient could not be assessed, but there does not appear to be significant aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The estimated pulmonary artery systolic pressure is normal. There is an anterior space which most likely represents a prominent fat pad. IMPRESSION: Probable bicuspid aortic valve with fused right/left raphe and no significant stenosis or regurgitation. Dilated ascending aorta. Mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. If there is a clinical suspicion for an aortic dissection - a thoracic CT/MRI or TEE are suggested. Brief Hospital Course: Mr. [**Known lastname 88321**] is a 48 year old gentleman with a PMH significant for HCV cirrhosis and a recent admission for a traumatic fall with multiple IPH requiring bolt placement, multiple orthopedic fractures s/p surgeries, trach/PEG with hospital course complicated by Serratia pneumonia treated with pip/tazo now admitted for hypoxemia. # Hypoxemia/leukocytosis: CTAP demonstrates a new right-sided pleural effusion with RLL collapse and volume loss throughout right side. Compressive atelectasis was considered, although could not rule out HCAP. With regard to new pleural effusion, LFTs were largely unchanged from prior, making hepatic hydrothorax unlikely. This may be a parapneumonic effusion with underlying pneumonia, or could also be from new heart failure. Would also consider chylothorax given history of trauma. The patient underwent thoracentesis on the first hospital day and 1.2 liters of exudative fluid were removed from the right pleural space. Cultures from the fluid came back negative, and the antibiotics were stopped. Trauma surgery was consulted who felt that the pleural fluid might be secondary to trauma. They recommended for repeat imaging in [**2-4**] days to see if the fluid was reaccumulating. Also, they recommended for repeat imaging if the patient develops any new respiratory symptoms. Interestingly, the fluid from the thoracentesis had an eosinophilic predominance (56% eosinophils). At the same time, the patient was noted to have a peripheral blood eosinophilia. This was all felt to be secondary to Depakote, which had been recently started. The divalproex was therefore stopped. Notably, after the thoracentesis, the patient's respiratory status improved markedly and he was able to be weaned back to the trach mask. With regard to work-up for other causes of pleural effusion, a transthoracic echocardiogram did not show any cardiac dysfunction, and infectious studies, as above, all returned negative. Cytologic analysis showed no malignant cells. Antibiotics were stopped after the first hospital day. Due to the calficifications noted on CT scan, a tuberculin skin test was placed to the right forearm on [**12-22**]. This should be interpreted on [**12-24**] or [**12-25**]. The spot of the PPD placement is marked with a bandaid. # Mental status: His mental status remained at baseline, per family members and rehab facility notes. He was agitated and minimally interactive. He required prn doses of Haldol and Ativan for agitation. With regard to the history of traumatic brain injury, neurosurgery was consulted during this admission and did not feel there was any need for intervention. Head CT was deferred. He was continued on Keppra for seizure prophylaxis. Divalproex, as above, was stopped due to peripheral blood and pleural fluid eosinophilia. # Anemia: Hematocrit was 35.8 on admission, baseline during last admission 27-33 with macrocytosis. His hematocrit remained stable. # Orthopedics: Orthopedics was contact[**Name (NI) **] during this admission. Follow-up plans are outlined in the discharge orders. # HCV cirrhosis: LFTs were at baseline. # Depression: Continue home psychotropic regimen. # Ulcerative colitis: Not currently treated. # Nutrition: pnt recieved TF's FEN: TF. . # PPx: recieved Heparin SQ. . # Access: Double lumen PICC in LAC; this was removed during the admission as patient was no longer needing antibiotics or continuous intravenous medicines. . # Code: Confirmed FULL [**Telephone/Fax (1) 88324**]. . # Contact: [**Name (NI) **] [**Name (NI) 88325**] (Sister). # Dispo: ICU level of care, transferred back to rehab after the thoracentesis and improvement in respiratory status. Medications on Admission: Albuterol nebs Dulcolax Chlorhexidine QID citalopram 20 mg qam Clonidine 0.1 mg Q12H. Clotrimazole topical tid divalproex sprinkles 250 Q8H Erythromycin eye ointment QID Famotidine 20 mg [**Hospital1 **] Ferrous sulfate 300 mg QAM Folate Heparin SQ Levetiracetam 1000 mg Q12H Methadone 5 mg Q8H MVI Quetiapine 25 mg QAM, 50 mg QPM Thiamine Trazodone 50 mg qhs APAP prn Ativan 0.5 mg prn quetiapine 25 mg Q6H prn 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. Tablet, Delayed Release (E.C.)(s) 2. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day) as needed for Constipation. 3. docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 4. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: Four (4) Puff Inhalation Q6H (every 6 hours) as needed for wheezing. 5. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. levetiracetam 100 mg/mL Solution Sig: Ten (10) PO BID (2 times a day): 1000 mg PO BID. 8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain or fever. 10. quetiapine 25 mg Tablet Sig: Two (2) Tablet PO QHS (once a day (at bedtime)). 11. quetiapine 25 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 12. quetiapine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for Agitation. 13. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 15. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety or agitaiton. 16. methadone 5 mg Tablet Sig: One (1) Tablet PO every eight (8) hours: Hold for sedation/ RR<10. 17. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**] Discharge Diagnosis: Primary: Drug induced pulmonary infusion Secondary: Traumatic brain injury secondary to mechanical fall Mutliple skeletal fractures secondary to mechanical fall Hepatitis C Virus Cirrhosis Depression Alcoholic Cirrhosis with history of withdrawal Ulcerative colitis Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted to the hospital due to worsening shortness of breath. You came to the hospital and had a chest xray which showed an accumulation of fluid around the right lung. The fluid around your lung was drained, and your shortness of breath improved. We felt the fluid accumulation was due to the new medication you started called "Depakaote". As a result, we discontinued this medication. You should follow up with your psychiatrist to make sure your medications are appropriately controlling your agitation. CHANGES TO YOUR MEDICATIONS: DEPAKOTE---> STOP TAKING THIS MEDICATION Followup Instructions: Please follow up at the [**Hospital1 18**] orthopedic hand clinic within 2 weeks by Tuesday [**2157-1-4**]. Please call to confimr appointment. Hand Clinic - Dr. [**First Name8 (NamePattern2) 951**] [**Last Name (NamePattern1) **] Department: Orthopedics Location: [**Hospital Ward Name 23**] 2 [**Hospital1 18**] Phone: ([**Telephone/Fax (1) 32269**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**] Completed by:[**2156-12-23**] ICD9 Codes: 5715
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Medical Text: Admission Date: [**2178-5-4**] Discharge Date: [**2178-5-8**] Date of Birth: [**2106-11-24**] Sex: M Service: MEDICINE Allergies: Lisinopril / Tetracycline Attending:[**First Name3 (LF) 3984**] Chief Complaint: CC:[**Hospital3 66910**] Major Surgical or Invasive Procedure: none History of Present Illness: HPI: 71-year-old male who was transfered from NWH for septic shock with neutropenia, gram negative rod bacteremia, acute DIC, and multiple organ system dysfunction. He was recently diagnosed with Stage II Anal Squamous Cell Carcinoma and had undergone chemotherapy with 5-FU and Cisplatin at NECM in later [**2178-3-28**]. He was discharged home, but failed at home due to falls and dehydration so he was sent to a rehab facility. On [**2178-5-3**] he was sent to NWH for acute onset shortness of breath, and in the emergency department there he was hypoxic in the 70's on a non-rebreather and he was hypotensive from septic shock. He was intubated, IV access was obtained, and he was fluid rescusitated and started on dopamine. He was admitted to the ICU where his vasopressors were changed to Levophed and Vasopressin. His initial lactate was 9, and his pH was 7.04. . In addition to fluids, he was treated with Vancomycin, Metronidazole, Moxifloxacin, and Ceftazidime. Bicarbonate was administered. He quickly developed anuric renal failure (35 cc urine output over 24 hours) with evidence for "muddy brown casts" in his urine. He was also noted to be in DIC with a platelet count of 19,000, INR of 2.2, and a PTT of 38.2. He was neutropenic with a WBC of 0.2. He also was noted to have bilateral leg swelling and LENIs revealed bilateral DVTs with the left leg occluded from calf to upper thigh, and the right with clot below the knee. In addition, he was noted to have 700cc's of coffee grounds suctioned from his OG Tube with guaiac positive stool (he also has radiation injury to the rectum with some small bleeding). GI was consulted, but he was too unstable for endoscopy. He was transfused 2 units of PRBCs and one 6-pack of platelets. Due to his anuric renal failure, he was transfered to [**Hospital1 18**] with the possibility that he may require dialysis (CVVH). Past Medical History: PMHX: 1. GERD 2. Hypertension 3. H/o previous MVA with head trauma and residual right-sided weakness 4. Right Hemiparesis 5. BPH, s/p TURP 6. Stage II anal squamous cell cancer - s/p 5-FU and Cisplatin in [**3-/2178**] Social History: SOCHX: He is reportedly independent at home and with his ADLs. He reportedly has not had any contact with family in almost 20 years. His brother, [**Name (NI) **] [**Name (NI) 19219**], is listed as next of [**Doctor First Name **] and has had no contact with him for the past 18 years. PCP = [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], at [**Hospital1 336**] Oncologist = Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 66911**] at [**Hospital1 336**] Radiation Oncologist = Dr. [**Last Name (STitle) 66912**] at [**Hospital1 336**] [**Telephone/Fax (1) 66913**] Family History: FAMHX: Unknown Physical Exam: EXAM: T 96.0, HR 111, BP 98/55, RR 22, O2 sat 96% VENT: AC/450/5 rate 16, Fio2 = 60% GEN: Intubated. Unresponsive to pain or voice. Mottled skin. HEENT: Supple neck. Pupils 3-4 mm and minimally responsive to light. Dry MM membranes. CV: Regular tachycardia, no murmurs. LUNGS: Diffuse rhonchi bilaterally on anterior exam. ABD: Soft, non-distended. EXT: Mottled, cool, grey NEURO: Nonresponsive even to pain. Loss of occulocephalic reflexes. Pupils minimally reactive. Pertinent Results: LABS: WBC 0.2, HCT 30.8, PLT 19 Na 140, K 3.7, Cl 110, HCO3 11, BUN 83, Creat 2.8 Calcium = 5.90, ALB 1.9 CK 48 -> 643 -> 1159 -> 1293 AST 1446, ALT 828, TB 2.7, DB 2.3, [**Doctor First Name 674**] 157, LIP 11 INR 2.2, PTT 38.2, PT 24.9 . [**Last Name (un) **] Stim = Baseline 51.2, 30 min 51.78, 60 min 52.63 . UA: Urine Na <10. Trace LE. Muddy brown casts in urine. . CXR: Bilateral patchy airspace opacities, pulmonary edema, ETT in proper position, left IJ TLC in SVC. . ECHO: EF 25%, global HK. Inferior and basal walls are akinetic. Decreased RV function. No shunts or effusion. . MICRO DATA: [**1-31**] Blood cultures with GNR Brief Hospital Course: A/P: 71-year-old male s/p chemotherapy for local anal squamous cell carcinoma who is now neutropenic in severe septic shock with multiple organ system dysfunction. . 1. Septic Shock with neutropenia, gram negative rod bacteremia, possible acute DIC, and multiple organ system dysfunction - The presumed source is pulmonary with GNR bacteremia. However, given his neutropenia he could have multiple sources and could be fungemic as well. Pt was on vanco, cefepime, flagyl, caspofungin. He had no signs of reversing his shock, though his pressor requirement had decreased somewhat. . 2. Coagulopathy - He has a complicated picture that includes ischemic hepatitis possibly resulting in synthetic liver dysfunction. He also has thrombocytopenia that may be due to sepsis vs. DIC vs. pancytopenia from chemotherapy. Given the lack of schistocytes acute DIC seems less likely, and hepatic failure more likely. The pt remained transfusion dependent to prevent massive bleeding. . 3. Anuric Renal Failure - not a HD candidate and no sign of return of kidney function . 4. Upper GI Bleed - transfusion dependent with melena and unstable HCT. . 5. Respiratory Failure - Possible aspiration plus pulmonary edema. Vent dependent with very few periods during which he was overbreathing the vent . 7. Mental status - He is non-responsive and has lost occulo-cephalic reflexes. It is possible that he has had an intracranial/brain stem hemorrhage. CT showed diffuse hypodense lesions throughout the brain. . 10. Code Status - CPR not indicated due to the futility of CPR given his severe critical illness and multi-organ system dysfunction (including evidence for neurological dysfunction). Per the legal department, his brother and only family was HCP by default. He agreed that the pt should be DNR and decided, ultimately, to withdraw care based on what he knew of the patient's wishes. . . . After a complicated hospital course, when the patient's prognosis appeared very grim, conversations with the patient's brother regarding end of life care and decision making were initiated. The patient's brother had conversations with his brother at the time of their mother's death during which the patient stated that he would not want to be chronically maintained on a ventilator. Because the patient was not expected to ever become liberated from the ventilator, the patient's brother directed the treating team to withdraw care and focus on comfort measures. The patient was seen by the chaplain and had the sacriment of the sick performed. Thereafter, ventilator and pressors were discontinued. After a brief period, the patient passed away quietly. Medications on Admission: MEDS on Transfer: Vancomycin dosed by level Flagyl 500 mg IV Q8 Moxifloxacin Ceftazidime Sodium Bicarbonate Regular Insulin Sliding Scale Discharge Medications: Deceased Discharge Disposition: Expired Discharge Diagnosis: death Discharge Condition: death Discharge Instructions: none Followup Instructions: none [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**] Completed by:[**2178-5-9**] ICD9 Codes: 0389, 5849, 2875, 2859
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Medical Text: Admission Date: [**2148-5-29**] Discharge Date: [**2148-6-5**] Date of Birth: [**2079-2-1**] Sex: F Service: DENTAL Allergies: Penicillins Attending:[**First Name3 (LF) 51674**] Chief Complaint: left dental infection Major Surgical or Invasive Procedure: 1) Tooth extraction, 2)incision and drainage of neck abscess History of Present Illness: 69yo F with remote hx of breast ca s/p bilateral radical mastectomy without radiation and h/o sternum osteomyelitis in '[**23**] s/p resection, who had a tooth extraction and post placement anticipating for a new implant about 4 weeks ago. She was placed on an antibiotic which she doesn't recall its name on the day of dental procedure and was on it for a total of 7 days. After finishing her abx, she started feeling unwell and total body achiness. Denies other focal symptoms. Then about 9 days after the dental procedure, she developed a sore throat and neck swelling which progressively worsened. She called her PCP who advised just watchful waiting. Pt tried NSAIDS and mouthwash with a temporary slight relief. . Her symptoms worsened to the point that she couldn't swallow. She called her PCP [**Name9 (PRE) 96315**] who prescribed Z-pack 10 days prior to her admission. Despite z-pack, her symptoms worsened but no fevers. Past Medical History: Osteomyelitis of sternum '[**23**] s/p resection- was on pcn for 6 weeks until she developed rash so PCN reported as allergy. Breast cancer s/p bilateral radical mastectomy in '[**12**] without radiation and breast implants '[**23**] Mutliple dental work years ago HTN Hypothyroidism Sciatica, chronic low back pain s/p tonsillectomy and hemorrhoidectomy Recurrent cellulitis of L arm in the setting of even slight trauma as minor cut since lymph node resection during breast mastectomy. Social History: EtOH: {}N {x}Y Amount: occasional social Tobacco: {x}N {}Y Amount: prior smoker 12year pack year hx. quit in [**2112**] Drugs: {x}N {}Y Amount: Married: {}N {x}Y Divorced {} SO {} Occupations: Interior design Exposures: NA Travel:NA Pets: NA Family History: n/c Physical Exam: Vitals: Afebrile, AVSS Well appearing elderly white female NAD, A x O x 3 TTP L oral floor with firmness; no TTP L dental implant prep site; no erythema; soft on Right side. OP clear; no erythema or exudate Voice mildly hoarse; no stridor; trachea midline Significant swelling to submandibular glands B, L>R No appreciable LAD to ant., post., or supraclavicular chains SCOPE: Fullness to Left base of tongues, left epiglottis and extending to false cord left. Bilateral true cords are crisp and mobile with widely patent airway. RRR, no m/r/g CTA B, no r/r/c, no stridor, no sterdor ABD soft, NT/ND, NABS EXT no c/c/e Pertinent Results: [**2148-5-29**] 06:35PM PLT COUNT-286 [**2148-5-29**] 06:35PM WBC-11.6*# RBC-3.89* HGB-12.5 HCT-36.2 MCV-93 MCH-32.2* MCHC-34.6 RDW-14.0 [**2148-5-29**] 06:35PM GLUCOSE-95 UREA N-13 CREAT-0.7 SODIUM-139 POTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-28 ANION GAP-13 [**2148-5-29**] 08:12PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG Brief Hospital Course: Patient was admitted on [**2148-5-29**] from the [**Hospital1 18**] ED for left dental infection with a resulting neck abscess. She was started on IV clindamycin, but her symptoms did not improve. On [**6-1**] she was taken to the OR by OMFS for drainage of her abscess and extraction of tooth #20. She tolerated this well. She was then taken to the ICU where she remained for airway monitoring. She was extubated on POD 1 without difficulty. On POD#2 she was able to be transfered to a regular floor room. ID was consulted and recommended to keep her on IV clindamycin for at least 14 more days. She was discharged on [**2148-6-5**] after OMFS removed her drains and she had remained afebrile for several days with decreasing neck swelling to nearly normal. She was discharged with clear instructions to follow up with Dr. [**First Name (STitle) **] as well as her oral surgeon. Medications on Admission: Levothyroxine 100 daily, Lisinopril 10 daily, Fosamax weekly Discharge Medications: 1. Clindamycin HCl 150 mg Capsule Sig: Three (3) Capsule PO every six (6) hours for 10 days. Disp:*120 Capsule(s)* Refills:*1* 2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. Disp:*10 Tablet(s)* Refills:*1* Discharge Disposition: Home Discharge Diagnosis: 1) Neck Abscess 2) Dental Infection Discharge Condition: Afebrile with stable vital signs. Tolerating soft diet. Moderate left neck swelling much improved. No respiratory distress. No drainage from intraoral or neck wounds. Discharge Instructions: 1) Rinse with water after each meal 2) Keep neck wound dry for 4 more days 3) Stay on Followup Instructions: 1) Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - oral surgery [**2148-6-10**] (Already arranged) 2) Dr. [**First Name4 (NamePattern1) 10827**] [**Last Name (NamePattern1) **] - otolaryngology [**2148-6-11**] (call [**Telephone/Fax (1) 2349**] to confirm appointment) [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 925**] DMD [**MD Number(1) 51675**] Completed by:[**2148-6-5**] ICD9 Codes: 4019, 2449
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Medical Text: Admission Date: [**2179-11-28**] Discharge Date: [**2179-12-3**] Date of Birth: [**2104-5-7**] Sex: F Service: HISTORY OF PRESENT ILLNESS: Patient is a 75-year-old woman who was in her usual state of health until 10 p.m. on the day of admission when she was having a bowel movement in the rest room and complained of severe headache and spinning sensation and then vomited. She was brought to an outside hospital and found to have pneumonia. She had an INR of 2.5 and a cerebellar hemorrhage that was seen on head CT. She was given vitamin K and decadron IV, and transferred to [**Hospital1 188**] for further management. PAST MEDICAL HISTORY: 1. Breast cancer status post XRT. 2. Pulmonary embolus. 3. Hypertension. 4. Hypothyroidism. 5. Left eye TIA. 6. Incontinent. ALLERGIES: 1. Penicillin. 2. Sulfa. PHYSICAL EXAMINATION: Temperature 98.9, blood pressure 153/85, heart rate 75, respiratory rate 18, and sats 98%. Pupils are equal, round, and reactive to light. EOMs were full. Lungs were clear. Cardiac: Regular, rate, and rhythm, S1, S2. GI: Abdomen is soft, nondistended, awake, alert, and oriented times three. Tends to keep eyes closed. She has no drift. Speech is somewhat slurred. Cranial nerves II through XII are intact. Her strength is [**5-3**] in all muscle groups. Her reflexes are 2+ throughout. Her sensation is intact. She had no dysmetria and visual fields were intact. HOSPITAL COURSE: Patient was admitted to the ICU for close observation. She had a MRI scan to look for underlying lesion. No underlying lesion could be detected on MRI scan due to the amount of hemorrhage present. The patient remained neurologically stable and was transferred to the floor to have a heavy vena cava filter placed for protection against further DVTs and PEs. She was transferred to the floor on [**2179-12-1**]. She remained neurologically stable. She was seen by Physical Therapy and Occupational Therapy and found to be safe for discharge to home on [**2179-12-3**]. MEDICATIONS ON DISCHARGE: 1. Lisinopril 10 mg p.o. q.d. 2. Metoprolol 50 mg p.o. b.i.d. 3. Hydrochlorothiazide 50 mg p.o. q.d. 4. Levothyroxine 50 mcg p.o. q.d. 5. Lantoprost 0.005 ophthalmic solution one drop O.U. q.h.s. 6. Famotidine 20 mg p.o. b.i.d. 7. Colace 100 mg p.o. b.i.d. CONDITION ON DISCHARGE: Patient's condition was stable at the time of discharge. FOLLOW-UP INSTRUCTIONS: She will follow up with her primary care doctor early next week for blood pressure check. She will be sent home with VNA services for blood pressure checks and home safety evaluation.She also needs to FU with Dr [**Last Name (STitle) 739**] in [**6-6**] weeks with an MRI of Brain with/without contrast to R/O tumor. [**Name6 (MD) 742**] [**Name8 (MD) **], M.D. [**MD Number(1) 743**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2179-12-3**] 10:52 T: [**2179-12-3**] 10:58 JOB#: [**Job Number 54132**] ICD9 Codes: 431, 4019, 2449, 2768
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Medical Text: Admission Date: [**2194-12-24**] Discharge Date: [**2194-12-28**] Date of Birth: [**2140-11-28**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1115**] Chief Complaint: BRBPR Major Surgical or Invasive Procedure: colonoscopy History of Present Illness: Patient is a 54 yo M with h/o hypertension and asthma who presents with BRBPR after colonscopy with biposy yesterday. He had a repeat colonscopy for the purpose of polypectomy yesterday. He had a sessile 2 x 3.5 cm polyp in the cecum that was biopsied. He woke up this morning with some lower abdominal cramping that was somewhat relieved by passing gas. He had a normal, brown bowel movement this morning. Then at 4PM, he developed further abdominal cramping and when he went on the toilet he noted fresh blood, no clots. Then while he was driving, he had crampy abdominal pain, felt dizzy, and was incontinent of blood clots. . He presented to Sturdy ED. HCT was 38.1. He was hemodynamically stable. He was transferred to [**Hospital1 18**] given his procedure here. . In the [**Hospital1 18**] ED, initial VS were: 98.8, 98, 134/88, 14, 100% RA. During his ED visit, he became diaphoretic, nauseous and BP fell to 67/48. His SBP came up to 120s during a fluid bolus. Bloody stool was noted on the pad. HCT was 35.9. Coags were normal. He has received about 2L IVFs and 2 units PRBCs. GI has been consulted and is requesting a prep (Golytely) for tomorrow. For access, he has 2 18 and 1 16 PIVS. VS on transfer are: 86, 120/82, 17, 97%. . (+) Per HPI + urinary retention (-) Denies fever, chills, headache, shortness of breath, wheezing, chest pain, palpitations. Denies dysuria, frequency, or urgency. Past Medical History: 1. Hypertension 2. Asthma 3. H/o colonic polyps Social History: Patient is a truck driver. He denies any tobacco, etoh, and IVDA Family History: Colon cancer and polpys on both sides of the family Physical Exam: Vitals: T: BP: P: R: 18 O2: Orthostatics: supine 81, 152/80; sitting 94, 129/93 General: Alert, oriented, 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: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, RLQ tender to palpation, no guarding, no rebound, non-distended, bowel sounds present GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: [**2194-12-24**] 09:43PM BLOOD WBC-15.4* RBC-4.23* Hgb-12.3* Hct-35.9* MCV-85 MCH-29.0 MCHC-34.1 RDW-12.6 Plt Ct-285 [**2194-12-25**] 05:47AM BLOOD WBC-16.8* RBC-4.02* Hgb-12.0* Hct-34.0* MCV-84 MCH-29.9 MCHC-35.4* RDW-12.7 Plt Ct-215 [**2194-12-26**] 04:07AM BLOOD WBC-11.8* RBC-4.02* Hgb-12.2* Hct-34.7* MCV-86 MCH-30.3 MCHC-35.0 RDW-12.9 Plt Ct-179 [**2194-12-24**] 09:43PM BLOOD PT-12.9 PTT-22.1 INR(PT)-1.1 [**2194-12-24**] 09:43PM BLOOD Glucose-167* UreaN-15 Creat-0.8 Na-138 K-4.6 Cl-106 HCO3-23 AnGap-14 [**2194-12-25**] 05:47AM BLOOD Glucose-130* UreaN-17 Creat-0.7 Na-140 K-3.9 Cl-105 HCO3-23 AnGap-16 [**2194-12-26**] 04:07AM BLOOD Glucose-109* UreaN-8 Creat-0.7 Na-139 K-3.6 Cl-105 HCO3-24 AnGap-14 Colonoscopy: Ulcer in the cecum at the site of previous polypectomy - three endosocpic clips were applied for hemostasis. Blood in the whole colon Brief Hospital Course: 54 yo M who presents with BRBPR after colonoscopy with polypectomy. GI Bleed / Acute blood loss anemia. He was initially admitted to the MICU. He was transfused four units of pRBCs with stabilization of his hematocrit. GI was consulted and performed colonoscopy on admission to the ICU; a large ulcer was found at site of polypectomy with bright red blood throughout the colon; the ulcer was clipped and hemostasis was attained. He had a fever and leukocytosis and this was likely in the setting of stress but he was placed on emipiric antibiotics x 48 hours to cover GI organisms (amp, cipro, flagyl). These were quickly peeled off as he defervesed. He was transferred to the general medical [**Hospital1 **] on hospital day 3 where he remained stable and his leukocytosis resolved. HTN, benign: His lisinopril was resumed prior to discharge. Asthma, without exacerbation: His advair was continued. Medications on Admission: Lisinopril 10 mg daily Advair Albuterol prn Discharge Medications: 1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Outpatient Lab Work [**2194-12-31**]: Please check CBC. Results to: [**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 275**], [**Location (un) **], [**Location (un) **],[**Numeric Identifier 6698**], [**Hospital1 **] HEALTHCARE - [**Location (un) **] phone: [**Telephone/Fax (1) 6699**] Fax: [**Telephone/Fax (1) 84090**] Discharge Disposition: Home Discharge Diagnosis: Primary: cecal ulcer secondary to post-polypectomy bleed Secondary: asthma, benign hypertension 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 because you were bleeding from your rectum. You had another colonoscopy and you had an ulcer where the polyp was removed. This was clipped by the endoscopist. You required blood transfusion due to the bleeding (4 units of red cells); following the transfusion your counts remained stable. Do not take any advil, aleve, aspirin or other NSAIDs for 72 hours. You may take Tylenol if needed. Followup Instructions: Follow up with your PCP this week. You need to have repeat blood work at this visit. Due to the large size of the polyp, you should have a repeat colonoscopy with Dr. [**Last Name (STitle) **] in 6 months to make sure that there is no residual polyp at the site where this large polyp was removed. Please call ([**Telephone/Fax (1) 2306**] to schedule your repeat colonoscopy with anesthesia. ICD9 Codes: 2851
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Medical Text: Admission Date: [**2157-9-23**] Discharge Date: [**2157-10-3**] Date of Birth: [**2095-10-13**] Sex: F Service: CARDIOTHORACIC Allergies: Aspirin / Erythromycin Base / Latex / Nsaids Attending:[**Last Name (NamePattern1) 1561**] Chief Complaint: Tracheobronchomalacia, diffuse, and mucopurulent tracheobronchitis. Major Surgical or Invasive Procedure: Dr. [**Last Name (STitle) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]: 1. Right thoracotomy with posterior membranous wall tracheoplasty with mesh. 2. Right mainstem and bronchus intermedius posterior membranous wall plasty with mesh. 3. Left main posterior membranous wall bronchoplasty with mesh. 4. Flexible bronchoscopy. . Dr. [**Last Name (LF) **],[**First Name3 (LF) **]: Bronchoscopy History of Present Illness: [**Known lastname 68103**] is a 61-year-old classical singer who developed a severe cough two years ago, which has continued to worsen to the point that it is intractable, severe and debilitating. It was initially felt to be potentially related to upper respiratory tract infection for which she has been treated with without any improvement in her cough. Her cough has become so severe that it results in stress incontinence and syncopal episodes. She ultimately underwent a bronchoscopy by Dr. [**Last Name (STitle) 1712**] and was found to have thick inspissated secretions throughout the trachea. These were removed and her breathing improved. Dynamic bronchoscopy was perforemed and she was diagnosed severe tracheobronchomalacia. Her associated symptoms have also been dyspnea on exertion and wheeze. However, she suffers from postpolio syndrome and therefore does not exert herself particularly. She has no significant orthopnea although she has a sleep disturbance. She has had significant colds but has had no severe infection such as pneumonias. Despite the treatment for her gastroesophageal reflux disease with proton pump inhibitors, she has had no improvement in her cough. She now presents for surgical intervention. Past Medical History: HTN, postpolio syndrome, tracheobronchomalacia, s/p lap chole, TAH-BSO, mult RLE surgeries, and b/l knee replacements Social History: former opera singer. non-smoker. Rare ETOH use Family History: non-contributory Pertinent Results: [**2157-10-3**] 05:36AM BLOOD WBC-9.0 RBC-3.66* Hgb-11.4* Hct-32.8* MCV-90 MCH-31.2 MCHC-34.7 RDW-13.8 Plt Ct-305 [**2157-10-3**] 05:36AM BLOOD Glucose-109* UreaN-6 Creat-0.8 Na-141 K-4.1 Cl-101 HCO3-27 AnGap-17 [**2157-10-3**] 05:36AM BLOOD Calcium-9.5 Phos-3.8 Mg-1.9 . [**2157-10-2**] 10:25 pm STOOL CONSISTENCY: WATERY **FINAL REPORT [**2157-10-3**]** CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2157-10-3**]): FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA. Reference Range: Negative. . [**2157-10-1**] 4:27 pm STOOL CONSISTENCY: LOOSE Source: Stool. **FINAL REPORT [**2157-10-2**]** CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2157-10-2**]): FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA. Reference Range: Negative. . CHEST PORT. LINE PLACEMENT [**2157-9-30**] 3:16 PM REASON FOR THIS EXAMINATION: please check placement of right median cub. PICC line 50 cm please page IV nurse [**First Name (Titles) 151**] [**Last Name (Titles) **] [**Location (un) 1131**] thanks [**Doctor First Name **] #[**8-/2590**] INDICATION: Right PICC placement. Patient is status post tracheoplasty. IMPRESSION: Right pleural effusion, unchanged. Right PICC tip in distal SVC. Brief Hospital Course: Patient was admitted to the [**Hospital1 18**] with respiratory symptoms. She underwent bronchoscopy on [**2157-9-25**] that showed moderate tracheomalacia and inspisated sputum. On [**2157-9-26**] she underwent a right thoracotomy with posterior membranous wall tracheoplasty with mesh, right mainstem and bronchus intermedius posterior membranous wall plasty with mesh, left main posterior membranous wall bronchoplasty with mesh, flexible bronchoscopy. For operative details, seed dictated report. She was continued on antibiotics (Zosyn, Nafcillin). She tolerated the procedure well and was extubated and transferred to the ICU for monitoring. Chest tube was maintained on suction. Pain was well controlled with an epidural catheter that was managed by the Acute Pain Service team. On POD 1 aggressive pulmonary toilet was begun. Pain was well controlled and incentive spirometry was encouraged. Diet was advanced. CXR showed patchy opacity in the right upper lobe and right lower lobe consistent with a developing air space disease or atelectasis. Linear atelectasis in the left base, findings consistent with post-operative changes. There was no evidence of pneumothorax. On POD 2, physical therapy service was consulted. She continued to do well. Diet was advanced. ON POD 3, chest tube was removed. ON POD 4, she continued to do well. Antibiotics were continued. Epidural and IV pain medications were adjusted to achieve better control. CXR showed a small right loculated air collection most likely due to loculated pneumothorax. This was unchanged from previoius study and was thought to be due to post-operative changes. POD 5, Bronchoscopy performed and showed a normall right and left bronchial tree with no airway colapse with expiration, inspiration or cough. Epidural was removed and patient was transitioned to PO and IV medications with adequate results. PICC line was placed for long-term IV antibiotic administration. Patient developed a significant yeast infection requiring topical creams as well as Diflucan. POD 6, patient developed several episodes of loose stool. C.difficile cultures were negative. Chest PT/physical PT and incentive spirometry was continued. POD 7, her C.diff cultures were sent and were negative. She continued to remain afebrile and her antibiotics was continued, with empiric flagyl started. POD 8, she continued to remain afebrile and with return of her sensitivities, her antibiotics were switched from naficillin to levofloxacin, and the zosyn and flagyl were continued. She was deemed stable for discharge and will be discharged home with VNA. She will continue to zosyn and levofloxacin for 3 weeks, flsgyl for 4 weeks and was instructed to call Dr.[**Name (NI) 1816**] office to schedule a follow-up appointment. Medications on Admission: Percocet Atenolol Nexium Zantac Colace Senna Amytriptyline Lamictal Discharge Medications: 1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 21 days. Disp:*21 Tablet(s)* Refills:*0* 2. Zosyn in Saline 4.5 g/100 mL Piggyback Sig: One (1) Intravenous every eight (8) hours for 21 days. Disp:*qs qs* Refills:*0* 3. Heparin Flush 100 unit/mL Kit Sig: Five (5) ml Intravenous once a day: 5 ml (100unit/mL) heparin to each lumen Daily via SASH. Disp:*qs qs* Refills:*2* 4. Normal Saline Flush 0.9 % Syringe Sig: Five (5) mL Injection once a day: 5 mL NS to each lumen Daily via SASH. Disp:*qs qs* Refills:*2* 5. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 26 days. Disp:*78 Tablet(s)* Refills:*0* 6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for 21 days. Disp:*qs qs* Refills:*0* 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*30 Capsule(s)* Refills:*2* 8. Amitriptyline 25 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Lamotrigine 25 mg Tablet Sig: Four (4) Tablet PO QHS (once a day (at bedtime)). 11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 12. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). Disp:*1 1* Refills:*2* 13. Acyclovir 5 % Ointment Sig: One (1) Appl Topical 6X/D (6 times a day). Disp:*1 1* Refills:*0* 14. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital 5065**] Healthcare Discharge Diagnosis: Tracheobronchomalacia Discharge Condition: Stable Discharge Instructions: Call Dr.[**Last Name (STitle) 952**]/ Thoracic Surgery office ( [**Telephone/Fax (1) 170**] ) for: fever, shortness of breath, chest pain, exscessive foul smelling drainage from incision sites . Call to schedule your follow up appointment. . Please follow-up with your primary care physician as soon as possible. . *Continue medications as previous to surgery as stated on discharge instructions. Please discontinue your percocet and atenolol until follow-up with your primary care physician. . *Take new medications as directed and as needed, stated on discharge instructions. . You may shower. No tub baths or swimming for 3-4 weeks. Followup Instructions: Call Dr.[**Last Name (STitle) 68104**]/ Thoracic Surgery office [**Telephone/Fax (1) 170**] to schedule your follow up appointment. ICD9 Codes: 4019, 311
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Medical Text: Admission Date: [**2185-3-4**] Discharge Date: [**2185-3-11**] Date of Birth: [**2104-5-2**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: s/p fall, sepsis Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname 15138**] is an 80 year old Russian-speaking man with a h/o colon cancer s/p hemicolectomy, bladder cancer s/p ureterostomy, HTN, & CKD who presents to the [**Hospital1 18**] after falling out of his chair at his nursing home. He was found on the floor by the nursing home personell though he denied hip pain. He was also noted to be increasingly agitated at rehab. . In the ED, his vitals were T 98.8, HR 72, BP 97/59, RR 16, 95% on RA. He became hypotensive and was not responding to 5L of IV fluids, so a Right IJ was placed. He got a hip film which showed no fracture. His labs were notable leukocytosis and obstructive LFTs. [**Name (NI) 5283**] sono showed no cholecystitis. Surgery was consulted and recommended ERCP consult. . Upon arrival to the [**Hospital Unit Name 153**], patient has dementia and is russian speaking only so no further history is obtained. Per his daughter, his appetite decreased over the past few days. . Of note, patient was recently admitted to the [**Hospital Unit Name 153**] for enteroccus sepsis. Given that the source of the sepsis was felt to be the ampullary tumor which was untreatable and the likelihood for recurrence, the decision was made to make the patient DNR/DNI with no central lines. Therefor, EGD/ERCP was not pursued. Past Medical History: #. Saddle pulmanary emboli [**2181-12-3**] s/p IVC filter. - warfarin therapy eventually discontinued secondary to SDH [**7-/2182**] #. Left acoustic neuroma s/p XRT, left cerebello-pontine angle mass still present on subsequent imaging, stable since [**2173**] #. colon cancer (per chart, initially dx in [**2172**] with resection), per daughter was dx in [**12-9**] (GIB while on coumadin), underwent hemicolectomy [**1-9**] with primary reanastomosis. no adjuvant chemo/xrt. note, path 13.X6cm mass, adenoca. Margins clear BUT 2 of 18 LN examined were +cancer (T3N1). #. Bladder cancer s/p bladder resection [**2166**] s/p ureterostomy #. recurrent UTIs #. lower back pain: L3-4 disc bulging, had admission in [**2178**] for inability to walk #. Severe DJD #. HTN #. OSA #. Iron deficiency Anemia #. Hyperlipidemia # CKD, creat has been around 2.0 since [**11-8**], previously was 1.1, unclear etiology and was never worked up. Social History: Patient currently residing in a nursing home. Per his family, he is alert & oriented x 1 at baseline. He has 2 daughters that live nearby. Tobacco: Quit >35 yrs ago after ~15 pack-yrs EtOH: Rare Illicits: None Family History: No family history of premature coronary artery disease, sudden cardiac death, thyroid disease, colon cancer, diabetes, or hypertension. Physical Exam: Vitals: T 97.6, HR 77, RR 11, 96% on RA, 97/55 HEENT: dry mucous membranes CV: RRR, no m/r/g Pulm: CTA b/l anteriorly Abd: Soft, NT, ND, + BS, + ureterostomy tube with urine Ext: 2+ pitting edema bilaterally, cool extremities Pertinent Results: [**2185-3-3**] 10:55PM BLOOD WBC-20.9*# RBC-2.96* Hgb-7.4* Hct-25.0* MCV-85 MCH-25.1* MCHC-29.7* RDW-21.2* Plt Ct-343 [**2185-3-4**] 01:15AM BLOOD WBC-18.9* RBC-2.37* Hgb-6.0* Hct-20.4* MCV-86 MCH-25.2* MCHC-29.3* RDW-21.2* Plt Ct-292 [**2185-3-10**] 05:07AM BLOOD WBC-20.0* RBC-3.63* Hgb-9.7* Hct-32.7* MCV-90 MCH-26.7* MCHC-29.7* RDW-21.1* Plt Ct-140* [**2185-3-3**] 11:42PM BLOOD PT-15.0* PTT-23.3 INR(PT)-1.3* [**2185-3-10**] 05:07AM BLOOD PT-41.8* PTT-41.0* INR(PT)-4.4* [**2185-3-3**] 10:55PM BLOOD Glucose-121* UreaN-40* Creat-1.7* Na-135 K-4.9 Cl-101 HCO3-19* AnGap-20 [**2185-3-10**] 05:07AM BLOOD Glucose-65* UreaN-73* Creat-4.0* Na-137 K-6.0* Cl-114* HCO3-12* AnGap-17 [**2185-3-3**] 10:55PM BLOOD ALT-71* AST-108* LD(LDH)-340* AlkPhos-858* TotBili-4.7* [**2185-3-8**] 03:31AM BLOOD ALT-80* AST-142* LD(LDH)-397* AlkPhos-700* TotBili-6.5* [**2185-3-4**] 12:32PM BLOOD Calcium-7.2* Phos-4.2 Mg-1.9 [**2185-3-10**] 05:07AM BLOOD Calcium-7.2* Phos-7.5*# Mg-2.2 [**2185-3-7**] 05:49AM BLOOD Vanco-27.5* [**2185-3-9**] 03:45AM BLOOD Vanco-22.8* [**2185-3-4**] 01:17AM BLOOD Glucose-118* Lactate-3.8* K-4.2 HIP film IMPRESSION: 1. No fracture. 2. Chronic degenerative changes in the hips, right greater than left. [**Year/Month/Day 5283**] US: 1. Multiple isoechoic liver lesions most likely representing metastatic colon cancer in the setting. 2. Gallbladder dilation, sludge, and CBD dilation of 14 mm; concerning for acute cholecystitis, recommend HIDA. 3. Stent in CBD; not clear if same position or in lower CBD. Brief Hospital Course: Mr. [**Known lastname 15138**] is an 80 year old Russian-speaking man with h/o multiple malignancies including recurrent colon cancer s/p hemicolectomy and recent metastatic adenocarcinoma with unknown primary and ampullary mass, HTN, & CKD who presents with septic shock secondary to cholangitis. He had biliary stent placed in [**Month (only) 404**]. [**Name (NI) 5283**] sono demonstrates CBD dilitation suggestive of obstruction (likely from the ampullary mass). Also he was recently treated for enteroccus endocarditis (finished Ampicillin course [**3-2**]). He was placed on broad spectrum antibiotics during this hospitalization; however, no bacteria isolates were obtained from his blood culture. Patient has history of several recent bleeds on top of baseline iron deficiency anemia. He has a baseline Creatinine of 1.4-1.6. Additionally, he has a history of multiple malignancies including bladder, colon (with reucurrence), acoustic neuroma, and new metastatic adenocarcinoma with unknown primary with mets to the liver, large pericardial effusion, and necrotic ampullary mass. Oncology was consulted on prior admission and felt that he was not a candidate for therapy. At baseline, patient A&O x 1. Requires 24 hour assistance for all of his ADL's. Now living at a rehab facility since prior admission. Hospital course: He became cutely agitated, hypertensive, clamp down (cyanosis perioral and in toes), tachycardic to 120s. He was transiently placed on nitro gtt and BPs reduced but then hypotensive, nitro gtt was stopped. EKGs done were without signs cardiac ischemia. Family consulted and decided only IVF, abx, O2 but no other interventions. ERCP was deferred. He had worsening renal function, worsening LFT. Sacral decub was noted - likely from prior to hospitalization, wound care consulted. IVF boluses were given for low BP and low UOP, but persistent low blood pressure, so levophed was started. Patient became very agitated at night with minimal response to haldol and zyprexa. He developed arrythemias going in and out of AVNRT repeatly. He was maintained on medical care geared towards comfort and eventually became bradycardic and passed away from cardiac arrest. Code: DNR/DNI (confirmed with daughter) Communication: Patient & patient's family (daughter, [**Name (NI) 15139**] [**Name (NI) 15140**] [**Telephone/Fax (1) 15141**] cell [**Telephone/Fax (1) 15142**] home) Medications on Admission: Ferrous sulfate 325 mg daily Colace prn Remeron 15 mg qhs Vicoden prn Tylenol prn MOM prn [**Name2 (NI) 10687**] prn Bisacodyl prn Verapamil 80 mg q 8 hours Metoprolol Tartrate 25 mg q 6 hours Completed Ampicillin [**2185-3-2**] . Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: septic shock Ampullary mass with path positive for adenocarcinoma (biliary stent placed due to prior episode of cholangitis in [**12-22**]) Liver metastases (unknown primary) Bladder cancer s/p bladder resection & ureterostomy, [**2166**] Colon cancer s/p resection, [**2172**] with recurrence (T3N1) s/p hemicolectomy, [**2181**] L acoustic neuroma s/p XRT, [**2173**] Saddle PE s/p IVC filter, [**2181**] h/o SDH, [**2181**] A-fib s/p cardioversion Recurrent UTI's L3-4 disc herniation, [**2178**] DJD HTN OSA Iron deficiency Anemia Hyperlipidemia CKD (baseline Cr 1.2-1.4) from bilateral hydronephrosis Dementia Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] ICD9 Codes: 0389, 5859
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7385 }
Medical Text: Admission Date: [**2129-3-16**] Discharge Date: [**2129-3-21**] Date of Birth: [**2051-11-2**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 165**] Chief Complaint: Chest Pain Major Surgical or Invasive Procedure: none History of Present Illness: 77 y/o male who was admitted at OSH with chest pain. Initial ECG in ER was suspicious of ACS and he was treated as such. Chest CT was later done to exclude PE or dissection. The CT revealed a dissection that started at the aortic arch (just above the left SCA) and extended to 7 cm long. He was transferred to [**Hospital1 18**] after starting Esmolol for BP control. Past Medical History: Benign Prostatic Hypertrophy, s/p Prostatic surgery Social History: Current smoker approx 1-1.5 ppd x 50+ yrs. -ETOH. Family History: Non-contributory Physical Exam: VS: 130/85 68SR HEENT: EOMI, PERRL, NCAT Neck: Supple, FROM, -JVD, -Carotid bruit Pulm: CTAB -w/r/r Heart: RRR w/ [**12-28**] SM Abd: Soft, NT/ND, +BS Ext: Warm, well-perfused, -c/c/e Neuro: A&O x 3, MAE, non-focal Pertinent Results: [**3-16**] Chest CT: 1. Extensive type B aortic dissection, not significantly changed compared to the outside exam of earlier in the same day. Both studies were reviewed with the Cardiothoracic Surgery service at 10:30 p.m., [**2129-3-16**]. 2. Emphysema. 3. Cholelithiasis. 4. Massive enlargement of the prostate gland. There is an extensive type B aortic dissection extending from just distal to the take-off of the left subclavian artery through to just superior to the renal arteries. Contrast is seen opacifying a 5-cm segment of the false lumen at the level of the mid-descending thoracic aorta. There is no evidence of pericardial effusion or hemopericardium, or extension into the aortic root, coronary arteries or valve apparatus. The celiac artery and superior mesenteric artery are supplied by the true lumen. The descending aorta measures up to 3.6 cm in diameter. [**3-19**] Chest CT: 1. Again seen is extensive type B aortic dissection extending from the aortic arch to just above the renal arteries. There is a focal area of outpouching of the true lumen, which was seen on the prior study, and is smaller suggesting partial interval thrombosis. There is no increase in the caliber of the true or false lumen or the extent of dissection. Intramural hematoma at the aortic arch noted as before. 2. Pneumobilia, which is increased slightly in comparison to prior study. [**2129-3-16**] 08:50PM BLOOD WBC-17.6* RBC-4.28* Hgb-13.2* Hct-39.8* MCV-93 MCH-30.8 MCHC-33.2 RDW-15.2 Plt Ct-397 [**2129-3-20**] 06:00AM BLOOD WBC-15.3* RBC-4.03* Hgb-12.7* Hct-36.9* MCV-92 MCH-31.4 MCHC-34.3 RDW-15.3 Plt Ct-378 [**2129-3-16**] 08:50PM BLOOD PT-13.5* PTT-54.5* INR(PT)-1.2* [**2129-3-20**] 06:00AM BLOOD PT-12.6 PTT-31.1 INR(PT)-1.1 [**2129-3-16**] 08:50PM BLOOD Glucose-91 UreaN-17 Creat-0.8 Na-143 K-3.9 Cl-110* HCO3-24 AnGap-13 [**2129-3-20**] 06:00AM BLOOD Glucose-91 UreaN-21* Creat-0.9 Na-139 K-4.0 Cl-105 HCO3-29 AnGap-9 [**2129-3-20**] 06:00AM BLOOD Calcium-8.1* Phos-1.6* Mg-2.0 Brief Hospital Course: Mr. [**Known lastname **] was admitted to the CSRU for tight blood pressure control and underwent a chest CT on day of admission. CT confirmed outside results of a Type B aortic dissection just distal to left SCA and extended to above renal arteries. Vascular surgery was consulted on day of admission. He remained in the CSRU for several days receiving blood pressure control. Beta blockers were started and were titrated throughout hospital course the maximum BP control. On hospital day three his Foley catheter was removed and he was transferred to the telemetry floor for further medical management. He remained on the floor for several more days and underwent several more CT scans during hospital course which showed no change of dissection. On hospital day six he was discharged home with the appropriate medications and follow-up appointments. Medications on Admission: At home: none On transfer: Esmolol Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 2. 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:*2* 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). Disp:*270 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital **] Home Health Care Discharge Diagnosis: Type B aortic dissection Discharge Condition: good Discharge Instructions: take all of your medications as prescribed Followup Instructions: with Dr. [**Last Name (STitle) 26225**] in [**12-25**] weeks with Dr. [**First Name (STitle) **] in 1 month ([**Telephone/Fax (1) 1504**] with Dr. [**Last Name (STitle) **] in 1 month ([**Telephone/Fax (1) 2867**] Please call for appointments [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2129-3-21**] ICD9 Codes: 4019
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7386 }
Medical Text: Admission Date: [**2163-2-22**] Discharge Date: [**2163-2-24**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: CC:[**CC Contact Info 89949**] Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **] yo F PMH dementia presented to OSH following evaluation at nursing home for cough, decreased appetite that demonstrated creatinine increase to 3.6. Patient describes recent cough (per HCP 1 week duration) but denies fever or chills. Denies abdominal pain, nausea, vomiting. Denies chest pain or shortness of breath. Per HCP patient has not been eating well last several months. . Patient presented to OSH found to have T 94.5, creatinine 3.6, WBC 8.6 (N80%), bilirubin of 8 and an ALP of almost 1400. Her ultrasound showed some thickening of the GB wall, and did not comment on her CBD. There were stones and sludge reported. CXR demonstrated increased opacity right lung base medially and left retrocardiac region. She was transferred to [**Hospital1 18**] for further management. . On arrival to our ED VS T 97.7, BP 96/54, HR 90, O2Sat 95% 2L. SBP dropped to 60 which improved to SBP 90s with 3 L of NS. Labs notable for lactate 2.1, creatinine 3.5 (from baseline of 1.1), ALT 58, AST 120, AP 1061, Tbili 6.1, Alb 2.9, lipase 13, WBC 7.1 (N 79, L 14), INR 1.3. Gallbladder ultrasound demonstrated markedly distended GB with sludge/stones but no thickening or definite [**Doctor Last Name 515**] sign. CBD irregular in appearance measuring up to 1 cm in diameter. Moderate to large amount of ascites. Patent main portal vein. Blood and urine cultures sent. Patient given Levofloxacin (received Unasyn at OSH). Surgery was consulted - patient's HCP declined surgery but will consider ERCP. Consequently patient is being admitted to the MICU. . On arrival to the ICU, patient overall looks well and is conversant. . ROS: The patient denies any fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath. Patient has chronic edema. Describes increase in urinary frequency but no dysur Past Medical History: Dementia Glaucoma HTN Cholelithiasis GERD Osteopenia Spinal stenosis Lymphedema Right hip replacement Social History: Patient lives in long-term care facility Blueberry [**Doctor Last Name **]. Son is HCP. [**Name (NI) **] history of tobacco abuse Family History: Non-contributory Physical Exam: GEN: elderly female, no acute distress HEENT: Dry mucosa, EOMI, PERRL, sclera icteric, no epistaxis or rhinorrhea, OP Clear. NECK: No JVD COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Decreased breath sounds throughout ABD: Soft, moderately distended, non-tender to light and deep palpation. No fluid wave. No rebound or gaurding. + BS. EXT: 3+ pitting edema b/l, no palpable cords NEURO: alert, oriented to place and season. CN II ?????? XII grossly intact. Moves all 4 extremities. SKIN: + jaundice. Pertinent Results: [**2163-2-22**] 06:30PM WBC-7.1 RBC-3.82* HGB-11.5* HCT-35.5* MCV-93 MCH-30.0 MCHC-32.3 RDW-16.0* [**2163-2-22**] 06:30PM PLT COUNT-202 [**2163-2-22**] 06:30PM NEUTS-79.6* LYMPHS-14.1* MONOS-5.4 EOS-0.6 BASOS-0.3 [**2163-2-22**] 06:30PM PT-14.8* PTT-24.6 INR(PT)-1.3* [**2163-2-22**] 06:30PM GLUCOSE-110* UREA N-110* CREAT-3.5* SODIUM-141 POTASSIUM-5.0 CHLORIDE-99 TOTAL CO2-26 ANION GAP-21* [**2163-2-22**] 06:30PM ALT(SGPT)-58* AST(SGOT)-120* CK(CPK)-51 ALK PHOS-1061* TOT BILI-6.1* DIR BILI-5.2* INDIR BIL-0.9 [**2163-2-22**] 06:30PM LIPASE-13 [**2163-2-22**] 06:30PM cTropnT-0.09* [**2163-2-22**] 06:30PM CK-MB-5 [**2163-2-22**] 06:31PM LACTATE-2.1* [**2163-2-22**] 07:00PM URINE RBC-0-2 WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-0-2 [**2163-2-22**] 07:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-5.0 LEUK-TR [**2163-2-22**] 07:00PM URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.011 [**2163-2-22**] 09:54PM URINE HOURS-RANDOM CREAT-71 SODIUM-61 POTASSIUM-33 CHLORIDE-54 . Renal US: The right kidney measures 9.2 cm and shows cortical thinning but no hydronephrosis. The left kidney is only partially seen but it too shows no evidence of hydronephrosis. The spleen is not enlarged. The bowel is predominantly pulled posteriorly suggesting that the cause of the ascites is intra-abdominal spread of malignancy.Neither pancreas or aorta could be seen. IMPRESSION: Pancreas and aorta not seen. Extensive ascites that is probably malignant. . EXAM: Right upper quadrant ultrasound. COMPARISONS: None available. FINDINGS: There is a large amount of intra-abdominal ascites. The liver demonstrates no focal or textural abnormalities. There is irregularity of the common bile duct which measures up to 10 mm. The gallbladder is distended containing layering stones and sludge. There is no appreciable gallbladder wall thickening. There was a negative son[**Name (NI) 493**] [**Name (NI) **] sign. The main portal vein is patent with appropriate hepatopetal flow. The pancreas is not well visualized. IMPRESSION: 1. Markedly distended gallbladder containing stones and sludge. No gallbladder wall thickening or pericholecystic fluid. However, in the appropriate clinical setting, acute cholecystitis would be of concern and further evaluation with HIDA scan could be obtained. 2. Large amount of intra-abdominal ascites. 3. Irregularity of the common bile duct, which measures up to 10mm. The study and the report were reviewed by the staff radiologist . CXR: HISTORY: [**Age over 90 **]-year-old woman with cough and hypotension. IMPRESSION: AP chest reviewed in the absence of any prior chest imaging: Pulmonary edema is at least mild in severity. Large region of opacification in the left lower lobe, seen through the cardiac silhouette, obscures the left diaphragmatic pleural surface and could be pneumonia or left lower lobe collapse, but could also be mediastinal abnormality such as a thoracic aortic aneurysm or large hiatus hernia. Lateral view would be very helpful. Small bilateral pleural effusions are presumed. Heart is at least moderately enlarged if not severely. Elevation of the left main bronchus suggests substantial left atrial dilatation, and a ring-like calcification could be in the mitral annulus. Once again, lateral view would be very helpful. Dr. [**First Name (STitle) 89950**] and I discussed these findings by telephone. Brief Hospital Course: [**Age over 90 **] year-old female with a history of dementia trasnferred from OSH for obstructive jaundice. . # Jaundice: Initial concern for choledocholithiasis and patient covered with antibiotics. After review, growing concern for malignant etiology: cholangiocarcinoma vs pancreatic malignancy. Discussion held with family regarding goals of care. Central venous line, ERCP and surgery declined. Palliative care consulted. Decision made to return to [**Hospital3 **] facility with hospice. Interventions were miniminalized prior to discharge. Antibiotics were discontinued, pressors were weaned off. # Goals of care. Palliative care consulted shortly after admission. Referral made to Hospice [**Location (un) 1121**] for palliative care at Blueberry [**Doctor Last Name **]. Family counseled and prepared regarding likely upcoming events such as continued anorexia secondary to the natural consequence of aging, cancer, dying process as well as further inability to ambulate. Palliative care recommended: trial of pain medication of low dose morphine 2.5 mg prn. Tylenol avoiding in setting of abnormal liver function tests. Patient was without complaints of pain at time of discharge. . # Hypotension. On admission patient with asymptomatic hypotension in the 70s. Started on low dose pressor support. After discussion regarding goals of care decision made to wean pressors unless symptomatic. All anti-hypertensives medications held. Patient hemodynamically stable at time of transfer. . # Renal failure: Most likely pre-renal versus ATN from shock. Renal US without hydronephrosis. Creatinine improved with trial of fluids. Renal function was not trended after goals of care discussion took place. . # Glaucoma: Continue Lumigan. . # GERD: Continue prilosec. . #. CAD. Continued Aspirin. Held ACE in setting of hypotension and renal failure. Medications on Admission: ASA 81 Colace 100 mg [**Hospital1 **] Lisinopril 10 mg qd Prilosec 20 mg daily Lasix 40 mg daily Lumigan 0.03% one drop each at bedtime Robitussin Discharge Medications: 1. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 3. docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 4. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 5. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 8. codeine-guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6 hours) as needed for cough. 9. morphine 10 mg/5 mL Solution Sig: 2.5 mg PO Q4H (every 4 hours) as needed for pain: Please use if tylenol ineffective. 10. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Discharge Disposition: Extended Care Facility: Blueberry [**Doctor Last Name **] Healthcare - [**Hospital1 **] Discharge Diagnosis: Primary Obstructive Jaundice . Secondary Dementia Congestive Heart Failure Lymphedema Discharge Condition: Mental status: confused at times Unable to ambulate Discharge Instructions: Dear Ms [**Known lastname 89951**], you were admitted to [**Hospital3 **] Hospital for further evaluation of your distended belly. . Shortly after arrival to the ICU decisions were made to avoid invasive intervention and refocus goals of care on continued comfort. The palliative care team was consulted. The plan is for you to return to Blue [**Doctor Last Name 3646**] [**Doctor Last Name **] with additional supports in place. . CHANGES TO YOUR MEDICATIONS: Stop take Lisinopril Hold Lasix given low blood pressure. Start taking low dose Morphine as needed for pain Start taking cough suppressants for comfort Followup Instructions: Plan to return to Blue [**Doctor Last Name 3646**] [**Doctor Last Name **] with hospice [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2163-2-24**] ICD9 Codes: 5845, 4019
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Medical Text: Admission Date: [**2132-8-2**] Discharge Date: [**2132-8-4**] Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2698**] Chief Complaint: Epistaxis and hypotension Major Surgical or Invasive Procedure: L nares cauterized History of Present Illness: 85 year old man with CAD s/p CABG and CHF who was admitted with recurrent epistaxis. He was transferred to the MICU for hypotension. He first had epistaxis one week ago and went to [**Hospital **] clinic on [**7-24**] where he was cauterized. Five days later, he presented to [**Hospital1 18**] ENT on [**7-29**] for recurrent epistaxis and was packed by ENT consult. Two nights ago, he presented to the ED again for epistaxis and was cautarized. He has not bled since. In the ED, his vitals were 96.8, HR: 46, BP:167/74, RR:20, O2 95%RA. He was kept overnight in the ED then admitted to the Medicine team in the morning. He recieved all his BP meds including metoprolol, lisinopril, lasix and imdur. At the time, he was also straining to move his bowels. His SBP dropped from 120's to 80's over the course of the morning. His vitals were: 96.5, 88/40, 50, 94%RA. He remained asymptomatic; making urine, ambulating and mentating. He recieved 650cc's of NS without improvement, and given his h/o CHF, he was then transferred to the MICU for closer monitoring and care. In the MICU the pt received an additional 1L NS in boluses and 1L NS over 10 hrs with improvement in his SBPs to the 120-140s. This am, he had an episode of L sided chest pressure without SOB, diaphoresis, n/v, lightheadedness, palpitations. Stated this was his anginal equivalent which occurs 1-2xs/week. EKG was without any new ischemic changes and pain relieved with SL nitro. Was transfused 2 units pRBC for Hct 23.9 which bumped to 28.7. Transferred to floor for further care. Baseline, he can walk 1 flight of stairs and would get SOB. Baseline [**2-9**] pillow orthopnea. He has occasional chest pain and relieves it with nitro. Past Medical History: -CAD: Severe 3 vessel disease s/p 3v CABG [**2108**](SVG=>D1=>LAD, SVG=>OM1=>OM3, SVG= >AM). SVG=>D1=>LAD was stented [**2128**]. Repeat cath [**7-11**] showed inoperable disease. During admit [**10-11**], had CP a/w some dynamic ST segment depressions in anterior leads, medically managed with aspirin, plavix, ACE, imdur, and betablocker. LVEF >55% on Echo done [**12/2131**] -Incarcerated paraesophageal hernia s/p laparoscopic repair with fundoplication in [**10-11**]; associated gastric outlet obstruction resolved with surgical repair -Lower gastrointestinal bleed secondary to hemorrhoids and colonic polyps, admit [**2129-11-20**] -Hypertension with mild symmetric LVH -Afib, first noted post-op during [**10-11**] admission post op after paraesophageal hernia repair, converted to NSR on 11/[**2131**]. Off coumadin [**2-8**] significant bleeding issues. -Hyperlipidemia -Diabetes type II -By MRI/MRA: left posterior parietal infarct, chronic periventricular microvascular ischemic changes, moderate disease resulting in 60-70% stenosis of the right precavernous and cavernous ICA -s/p bilateral carotid endarterectomy -Peripheral vascular disease status post left toe amputation -History of prostate cancer status post radiation therapy -Cataracts Social History: Never smoked No illicit drugs He denies alcohol use Walks with walker at home, recently limited by SOB. Followed by [**Hospital 119**] [**Name (NI) 2256**] [**Name (NI) 269**], PT, OT. Lives with his wife [**Name (NI) 1446**], has son [**Name (NI) **] who is active in his care. Family History: History of MI in mother (death 89), father (death 67). Physical Exam: Vitals 97.5, 145/60, 57, 15, 100% room air GEN- NAD, pleasant, cooperative HEENT- MMM, OP clear, pale conjunctiva, no signs of active bleeding NECK- JVP 9 cm above sternal notch CV- Normal S1 and S2. Soft apical holosystolic murmur. No S3. PULM- Bibasilar crackles at bases, no rhonchi or wheezes EXT- 1+ edema, 2+ pulses posterior tibialis and dorsalis pedis bilaterally Pertinent Results: HCT 23.9 on [**2132-8-3**] 0600 improving to 28.7 on [**2132-8-3**] [**2055**]. HCT stable at 27.2 on [**2132-8-4**] Troponin T negative x two proBNP 1798 on [**2132-8-2**] EKG on [**2132-8-2**] Probable ectopic atrial rhythm. Occasional atrial premature beats. Right bundle-branch block. Probable old inferior wall myocardial infarction. Prolonged QTc interval. Low QRS voltage in the precordial leads. Compared to the previous tracing of [**2132-7-29**] atrial ectopy is new. Otherwise, no significant diagnostic change. Brief Hospital Course: Briefly, 85 year old man with CAD s/p CABG and CHF who was admitted with recurrent epistaxis, transferred to the MICU for hypotension. He first had epistaxis on one week ago and went to [**Hospital **] clinic on [**7-24**] where he was caudarized. Five days later, he presented to [**Hospital1 18**] ENT on [**7-29**] for recurrent epistaxis and was packed by ENT consult. Two nights ago, he had to come to the ED again for epistaxis and was cautarized. He has not bled since. In the ED, his vitals were 96.8, 46, 167/74, 20, 95%RA. . He was then admitted to the Med team in the morning. He recieved all his BP meds including metoprolol, lisinopril, lasix and imdur. At the time, he was also straining to move his bowels. His SBP dropped from 120's to 80's over the course of the morning. His vitals were: 96.5, 88/40, 50, 94%RA. He remained assymtomatic; making urine, ambulating and mentating. He recieved 650cc's of NS without improvement, and given his h/o CHF, he was then transferred to the MICU for closer monitoring and care. In the MICU the pt received an additional 1L NS in boluses and 1L NS over 10 hrs with improvement in his SBPs to the 120-140s. This am, he had an episode of L sided chest pressure without SOB, diaphoresis, n/v, lightheadedness, palpitations. Stated this was his anginal equivalent which occurs 1-2xs/week. EKG was without any new ischemic changes and pain relieved with SL nitro. Was transfused 2 units pRBC for Hct 23.9 which bumped to 28.7. Transferred to floor for further care. . Baseline, he can walk 1 flight of stairs and would get SOB. Baseline [**2-9**] pillow orthopnea. He has occasional chest pain and relieves it with nitro. [**2132-8-4**] Patient had episode of bradycardia during the night of [**2132-8-3**]. Went down to 22, patient was aymptomatic and sleeping comfortably. Heart rate rose back into baseline of 50s, blood pressure was 140/44. Tele otherwise unremarkable. Decision was made to continue with metoprolol due to his significant coronary disease. Blood pressure have held, systolic in the 120s-130s for the past 24 hours. Patient is not a candidate for revascularization or surgery, needs optimal medical management. No signs of epistaxis s/p cautery in the emergency room. Patient is stable and decision for discharge was made today. Medications on Admission: MEDICATIONS ON TRANSFER FROM FLOOR: # Aspirin 81 mg PO DAILY # Clopidogrel Bisulfate 75 mg PO DAILY # Metoprolol 25 mg PO TID # Lisinopril 20 mg PO DAILY # Furosemide 20 mg PO DAILY # Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY # Nitroglycerin SL 0.3 mg SL PRN # Clindamycin 300 mg PO Q6H # Sodium Chloride Nasal 2 SPRY NU TID # Mupirocin Nasal Ointment 2% 1 Appl NU [**Hospital1 **] Duration: 5 Days # Pantoprazole 40 mg PO Q24H # Atorvastatin 40 mg PO DAILY # FoLIC Acid 1 mg PO DAILY # Ferrous Sulfate 325 mg PO DAILY # Insulin SC (per Insulin Flowsheet) # Atropine Sulfate 1 mg IV ASDIR Discharge Medications: 1. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 7. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 10. Dorzolamide-Timolol 2-0.5 % Drops Sig: Two (2) Drop Ophthalmic [**Hospital1 **] (2 times a day). 11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 12. Sodium Chloride 0.65 % Aerosol, Spray Sig: Two (2) Spray Nasal QID (4 times a day). Disp:*2 bottles* Refills:*2* 13. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Mupirocin 2 % Ointment Sig: One (1) application Topical twice a day for 2 days. 15. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) for 3 days. Disp:*24 Capsule(s)* Refills:*0* 16. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. Disp:*30 Tablet, Sublingual(s)* Refills:*0* 17. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO twice a day. Disp:*30 Tablet(s)* Refills:*2* 18. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] [**Hospital 2256**] Discharge Diagnosis: CAD- severe 3 vessel disease s/p CABG in [**2108**], LAD stent placed [**2128**], repeat cath [**7-/2131**] showed inoperable disease Diastolic heart failure- EF 65-70% Hypertension Atrial fibrillation- converted, off coumadin due to bleeding problems Paraesophageal hernia- s/p fundplication Epistaxis chronic anemia Chronic lower GI bleed Diabetes type 2 Hyperlipidemia PAF h/o CVA s/p bilat CEA h/o prostate ca s/p radiation cataracts PVD- s/p left toe amputation Discharge Condition: Good Patients blood pressures holding in the 120-130s systolic Heart rate in the 50s, baseline No active bleeding Discharge Instructions: You were admitted to the hospital to monitor your blood pressure which was found to be low during the event of a prolonged nosebleed. Continue to use Ocean nasal spray to both nares 4 time a day. Just allow the fluid to drip into your nose to keep your nose moist. Clindamycin is an antiboitic. Please continue for 2 more days. Continue all medicines as prior to this admission. Contact Dr [**First Name (STitle) **] [**Telephone/Fax (1) **] if you have nose discomfort or concerns about bleeding. Followup Instructions: Dr [**First Name (STitle) **] on Wednesday [**8-6**] 2:15 at [**Location (un) 55**] Office [**Telephone/Fax (1) **] Please follow up with you primary care doctor Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1609**] within 1-2 weeks. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1609**]. Her phone number is [**Telephone/Fax (1) 2740**] ICD9 Codes: 2851, 5789, 4280, 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7388 }
Medical Text: Admission Date: [**2132-1-30**] Discharge Date: [**2132-2-2**] Date of Birth: [**2077-2-8**] Sex: F Service: MEDICINE Allergies: Sulfa (Sulfonamides) / Procardia Attending:[**First Name3 (LF) 1257**] Chief Complaint: GI Bleed Major Surgical or Invasive Procedure: Colonoscopy Right femoral line History of Present Illness: 54 year old woman with past medical history significant for diverticulosis, hypertension, hyperlipidemia, rhythm controlled afib not on coumadin and chronic diastolic CHF who now presents with bright red blood per rectum for the past 12 hours. . Patient states her symptoms began last night about 8:15pm. She had lower abd cramps and an episode of dark colored stool. She had nausea with no emesis. Since then has had about 20 bloody BMs, dark red in color, with some clots. She states she had undercooked red meat and steamed vegatable for dinner last night at Friend's home. Her friend had severe diarrhea overnight, but no rectal bleeding. Pt denies fever/chill, NSAIDs use, but she is on ASA 81mg daily. She complaints of dizziness last night. Pt's abdominal pain is much improved now. . In the ED, initial vs were: T 96.4 P 97 BP 82/27 R 15 O2 sat 100% RA. Patient was given 1 liter NS and her BP improved. On exam she had lower abdominal tenderness. She has dark red blood on rectal exam but no more BMs in ER. GI and surgery were called. NG lavage was negative for blood. Hct was 26 from baseline of 43, so she was given 2 unit of blood (emergency unit) and 6 units were cross matched. She was alert during these encounter. Intravenous Protonix given and Cipro and flagyl were also given. Access of PIV 18 gauge x 2 was established. At the time of transfer to the ICU were 73 97/52 15 100%2L. . During her MICU course, GI and Surgery followed. She received total of 6 U PRBC (last one at 8 AM today) 1 U FFP and her last Bloody BM was 4:30 PM on [**1-30**]. Access was difficult, so despite having 2 18G, a femoral line was placed and will be kept until the morning. GI convinced her to have colonoscopy and so started bowel prep tonight. . REVIEW OF SYSTEMS: No fevers, chills, weight loss, headache, visual changes, sore throat, chest pain, shortness of breath, nausea, vomiting, abdominal pain, constipation, pruritis, easy bruising, dysuria, skin changes, pruritis. Past Medical History: #. pAfib - maintained on Propafenone - CHADS1, on aspirin #. Chronic Diastolic CHF, EF 55% #. Diverticulosis #. Adrenal Adenoma #. Chronic rhinitis #. Bladder cancer - dx'ed 3 yrs ago s/p resection, no chemo - Single papillary tumor at the left dome. #. Hypertension #. Chronic bronchitis (normal spirometry in [**2129**]) #. Hyperlipidemia #. Osteoarthritis #. Tenosynovitis #. Low Back Pain Social History: The patient currently lives in [**Location **] alone. She is single, 1 son. The patient has no HCP. The patient is currently on disability for arthritis. She previously worked in food services, bartending, catering. Tobacco: [**1-5**] PPD x 40 years ETOH: Prior heavy use, has since quit Illicits: None Family History: Mother with DM, HTN, diverticulitis, angina at the age of 38 and CVA at age 48 from which she passed away. Physical Exam: On transfer out of MICU to floor: VS: T96.7 HR86 BP124/88 RR18 98% RA GEN: No apparent distress, alert and oriented, comfortable SKIN: Erythema and excoriations of bilateral upper extremities HEENT: EOMI, normal oro/nasopharynx, moist mucus membranes, no JVD/LAD. Neck soft and supple. PULM: CTAB, no wheezing/rhonchi/rales CARDIAC: Regular rate and rhythm; no murmurs/gallops/rubs ABDOMEN: No apparent scars. Non-distended, non-distended, soft, +BS (slightly hyperactive) EXTREMITIES: Trace peripheral edema, warm and well perfuse, +DP/PT pulses, right femoral line in place - c/d/i Pertinent Results: Chem 10 141 111 28 93 AGap=13 4.1 21 1.0 Ca: 7.7 Mg: 1.5 P: 3.6 ALT: AP: Tbili: Alb: AST: LDH: 129 Dbili: TProt: [**Doctor First Name **]: Lip: . FDP: 0-10 . CBC 11.7 9.8 175 28.8 N:72.7 L:22.1 M:3.4 E:1.5 Bas:0.2 . PT: 12.6 PTT: 26.7 INR: 1.1 Fibrinogen: 259 . Trop-T: <0.01 . ECHO ([**2130-11-10**]) The left atrium is mildly dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (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 mild pulmonary artery systolic hypertension. There is an anterior space which most likely represents a fat pad. IMPRESSION: Normal global and regional biventricular systolic function. Mild pulmonary hypertension. Compared with the prior study (images reviewed) of [**2129-4-22**], the patient is now in atrial fibrillation. Mild pulmonary hypertension is identified. The other findings appear largely similar. LV function is difficult to compare directly between the studies given the current degree of tachycardia. . COLONOSCOPY: Findings: ([**2131-1-12**]) Contents: Red blood was seen in the rectum and sigmoid colon. Excavated Lesions Multiple diverticula were seen in the sigmoid colon. Diverticulosis appeared to be severe, with no identifiable single bleeding diverticulum. Impression: Blood in the rectum and sigmoid colon Diverticulosis of the sigmoid colon Otherwise normal colonoscopy to proximal sigmoid colon Recommendations: Unable to pass sigmoid due to spasm, dicomfort and blood contents. No identifiable bleeding lesion in this limited exam. If bleeding persists, please obtain bleeding scan, contact IR. Consider surgical consult. . [**2132-2-1**]: Mutiple diverticuli throughout the colon. Able to get to ileocecal valve this time with general sedation. Brief Hospital Course: 54 year old woman with past medical history of diverticulosis with past GI bleeds, atrial fibrillation (CHADS1, not on coumadin) who presented with acute bright red blood per rectum, hypotension and 20 point hematocrit drop. Patient was initially in the MICU and then transferred to the floor where she tolerated bowel preparation and underwent colonoscopy showing diffuse diverticular disease but no more active bleeding. . # Bright red blood per rectum: Gastroenterology and General Surgery followed the patient closely in-house. Hematocrit stabilized after 6 units pRBC, 1 unit FFP. Etiology likely diverticular bleed given her long-standing history of constipation and history of significant diverticular bleeds. Also on the differential but lower include ischemic colitis given atrial fibrillation (without coumadin) and lactate 4.2 initially. Repeat colonoscopy revealed extensive diverticular disease throughotu patient's colon. Her IV pantoprazole was discontinued and patient started on clears diet which she tolerated well; her diet was eventually advanced. Patient was educated on dietary/bowel management for diverticuli and discharged with close follow-up in GI and Gen [**Doctor First Name **] clinics. Patient is to discuss surgical option, such as bowel resection, given her significant history of dangerous diverticular bleeds in the past (X3-4?) . # PRURITIC RASH: Slightly erythematous and excoriated. Responded to Sarna lotion. Patient felt the IV pantoprazole caused her rash. . # PAROXYSMAL ATRIAL FIBRILLATION: Patient remained in sinus rhythm. Given her GI bleed, aspirin was held, to be restarted upon discharge. She was continued on Propafenon short acting, to resume her home long acting version upon discharge. . # CHRONIC DIASTOLIC HEART FAILURE: Well compensated, although likely tolerates rapid ventricular response very poorly. No crackles and trace lower extremity edema on exam. After her colonoscopy, patient's home Diltiazem dose was restarted in short-acting form. Her enalapril was held to be restarted when patient was discharged home. . # OSTEOARTHRITIS: Stable and pain well controlled with tylenol and oxycodone PRN . # BLADDER TUMOR: No clinical evidence of recurrence and was stable. . # Right Femoral line: Difficult access and initial IJ was attempted unsuccessfully. Patient had two peripheral IVs as well and after colonoscopy, had the right femoral line removed without issues. Site remained clean, dry and intact until after discharge. . # CODE: Full, discussed and confirmed in ICU Medications on Admission: DILTIAZEM HCL - 240 mg Capsule ENALAPRIL MALEATE - 20 mg Tablet [**Hospital1 **] FUROSEMIDE - 40 mg Tablet daily OXYCODONE-ACETAMINOPHEN - 5 mg-325 mg q6H:PRN Pain PROPAFENONE [RYTHMOL SR] - 225 mg Capsule [**Hospital1 **] DOCUSATE SODIUM - 100 mg Capsule ASPIRIN 81mg daily Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for back pain. 2. Propafenone 225 mg Capsule, Sust. Release 12 hr Sig: One (1) Capsule, Sust. Release 12 hr PO twice a day. 3. Cartia XT 240 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO once a day. 4. Docusate Sodium 250 mg Capsule Sig: One (1) Capsule PO twice a day. 5. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 6. Enalapril Maleate 20 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary: Diverticular bleed Secondary: Paroxysmal atrial fibrillation, chronic diastolic CHF, hypertension/hyperlipidemia, osteoarthritis Discharge Condition: Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - Independent Discharge Instructions: -You were admitted with bright red blood in your bowel movements. You were briefly in the ICU but stabilized well with 6 units of red blood cells. Colonoscopy showed you likely had a bleed from the many diverticuli (outpouchings) you have in your colon. . -It is important that you continue to take your medications as directed. We made the following changes to your medications during this admission: --> HOLD Furosemide 40mg daily until you discuss with your primary care doctor --> RESUME Aspirin 81mg daily --> RESUME Rhythmol SR 225mg twice daily --> RESUME Enalapril 20mg twice daily . -Contact your doctor or come to the Emergency Room should your symptoms return. Also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. Followup Instructions: Appointments: . ** Please call the General Surgery Clinic to make an appointment to be seen in [**1-5**] weeks. You should discuss with them surgical options for managing your significant diverticulosis. Their phone number: ([**Telephone/Fax (1) 30009**] . * Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2-6**] at 11am. Her number is [**Telephone/Fax (1) 17826**] if you need to reschedule. She should check your blood counts and blood pressure. Please discuss with her about re-starting Furosemide (aka Lasix). . * Gastroenteroloy - Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2132-2-12**] 2:00pm . * Urology - [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4653**], MD Phone:[**Telephone/Fax (1) 5727**] Date/Time:[**2132-2-14**] 3:20pm . * Cardiology - DR. [**First Name11 (Name Pattern1) 275**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2132-10-2**] 10:40am ICD9 Codes: 2851, 4280, 4019, 2724, 3051
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Medical Text: Admission Date: [**2102-3-28**] Discharge Date: [**2102-4-7**] Date of Birth: [**2049-7-19**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4679**] Chief Complaint: Arm pain, left lung empyema Major Surgical or Invasive Procedure: 1. left video-assisted thoracoscopic converted to left thoracotomy, decortication of lung History of Present Illness: This is a 52 year old male who presents for management of cervical osteomyelitis. He was healthy up until he went on an alcohol binge [**12-24**] mos ago, leading to an admisison to [**Hospital1 **]. There, he had withdrawal seizures, and was intubated with aspiration pneumonia and bacteremia, treated for blood cultures growing MSSA which was treated with oxacillin and then cefpodoxime. He also had a left pleural effusion that was tapped, and a left knee effusion that was tapped (results not present). He was discharged to rehab after a 3 week admission, and has since been discharged back home. He has remained abstinent of EtOH since that admission (7 weeks). He notes losing 20 lbs over the course of these recent events. . Today, he saw his PCP for [**Name Initial (PRE) **] few days of neck pain and right posterior upper arm pain, associated with numbness and tingling in the right fingertips. He notes generalized, but not focal, weakness. C-spine plain films were abnormal so he had an outpatient MRI showing C6-7 osteomyelitis (although some parts of the record indicate C2-3). He went to [**Hospital3 **] ED where he was afebrile, with labs showing WBC 15, plt 677, CRP 153. He was given vancomycin 1gm, ceftriaxone 2gm, and morphine 12mg total. He was transferred to the [**Hospital1 18**] ED, where his vitals were: 99.1 80 115/85 16 98RA, with a generally benign exam. . Review of Systems: (+) Per HPI (-) Denies fever, chills, night sweats. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations. Denies cough, shortness of breath, or wheezes. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No black or bloody stools. No dysuria. Denies arthralgias or myalgias. Denies rashes. Past Medical History: EtOH abuse, hypertension, left knee surgery, HTN, HLD Social History: Lives with girlfriend. [**Name (NI) 1403**] as a national accounts manager for a [**Location (un) **] manufacturer. - EtOH abuse, reported sober since [**2102-1-23**] - tobacco: 30pk-yr history, quit [**11-30**] - illicits: none Family History: non-contributory Physical Exam: On admission: VS: 98.9 147/90 75 18 97RA GEN: Alert, pleasant, NAD HEENT: MMM NECK: C-collar in place CV: RRR no m/r/g PULM: CTA B ABD: NABS. S/NT/ND. EXT: WWP, 2+ PT and radial pulses, no edema. NEURO: 5/5 strength in all ext, except [**3-27**] in R forearm extension and abd at shoulder (limited by pain). Sensation intact to lt touch in all ext. . upon initial consult General: NAD, AOx3 Chest: no egophony, absent BS LLL, dull to percussion CV: RRR, S1/S2 appreciated, no R/M/G Abdomen: soft, NT/ND Ext: no C/C/E Pertinent Results: CT c-spine [**3-28**]: 1. Mixed lytic/sclerotic destruction of endplates at multiple levels of the cervical spine consistent with chronic osteomyelitis. 2. Multilevel degenerative changes and mild spinal canal stenosis at the level of C6. . CXR [**3-28**]: No previous images. There is a moderately large left pleural effusion with underlying compressive atelectasis. No evidence of acute focal pneumonia. . [**3-28**]: MRI thoracic/lumbar spine-1. Anterior and posterior epidural abscesses extending from the thoracic into the lumbar spine as described above, with abnormal thickening and enhancement of the dura as well as several nerve roots in the cauda equina. 2. Incompletely assessed abnormal signal and enhancement within the C6-7 intervertebral disc and C7 vertebral body, better seen on the recent MRI of the cervical spine, compatible with the known discitis/osteomyelitis. Probable hemangioma in the T11 vertebral body anteriorly; continued attention to this area on follow up is recommended to exclude any superimposed infection. 3. Abnormal signal within the thoracic cord at T10-11 without abnormal enhancement. This could represent edema or ischemic change resulting from the surrounding abnormalities. No thoracic or lumbar cord compression. 4. Abnormal signal in the posterior soft tissues of the lumbar spine suggestive of inflammation. Abnormal enhancement within the right psoas muscle without discrete fluid collection. Left L4-5 facet effusion. 5. Loculated fluid collection within the left lower lobe of the lung. 6. Dark bone marrow signal diffusely on T1 weighted images suggestive of chronic anemia versus bone marrow replacement. . ECHO [**3-30**]: 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 60%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic root is moderately dilated at the sinus level. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. No masses or vegetations are seen on the aortic valve. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. No mass or vegetation is seen on the mitral valve. Trivial mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. No vegetation/mass is seen on the pulmonic valve. There is no pericardial effusion. IMPRESSION: no vegetations seen If clinically suggested, the absence of a vegetation by 2D echocardiography does not exclude endocarditis. . [**3-30**]: fluoro aspiration: Successful epidural aspiration at L4-5 and L2-3. . [**3-31**] CT head: 1)Moderate sized left pleural effusion with smooth pleural thickening and probable loculation is incompletely evaluated in the absence of IV contrast. 2)Diffuse tiny centrilobular nodules are predominantly in the left lower lobe, suggesting a diffuse bronchiolitis, possibly due to a viral infection. 3)Mediastinal and epicardial lymph node enlargement is most likely reactive. 4)A left side PICC line is directed into the left IJV and should be repositioned. The PICC will be repositioned by IR today . [**3-31**] UE US: Thrombophlebitis involving the distal aspect of the left cephalic vein. No evidence of deep venous thrombus. . [**4-2**]: cp-spine: Unchanged sequelae of cervical spine osteomyelitis. Brief Hospital Course: The patient was admitted to [**Hospital1 18**] on [**2102-3-28**] for evaluation and treatment of cervical osteomyelitis as well as aspiration pneumonia and bacteremia, after having recently received treatment at an outside hospital for aspiration pneumonia and bacteremia. On [**2102-4-4**], the patient underwent a left video-assisted thoracoscopic converted to left thoracotomy and decortication of lung, which went well without complication (please refer to Operative Note for details). Post-operatively, the patient was transferred to the thoracic surgery service and the patient remained intubated for positive pressure to maintain lung inflation and was transferred to the TSICU for post-operative care. . -Osteomyelitis: pt was admitted for evaluation of his cervical osteomyelitis. He was seen by orthopedics who recommended no immediate surgical intervention and c-collar for 6 weeks. Pain: He was treated with oxycodone, acetaminophen, tramadol and neurontin for pain control with good effect. Blood cxs remained negative throughout the admission, however several were pending on discharge and will require follow up. . -Epidural abcesses: pt was noted to have multiple thoracic/lumbar epidural abcesses which were drained by interventional neurology. Fluid was sent for gram stain/cx with no evidence of organisms or growth. Neuro exam was normal throughout the admission. . -pleural effusion: known from prior admission, without any evidence of respiratory compromise. Given his history of bacteremia, an attempt at thorocentesis was made but was unsuccessful, necessitating thoracotomy and decortication procedure. . -anemia - Pt with a history of heavy EtOH use and has a normocytic anemia. Iron studies are indicative of an anemia of chronic disease. *monitor Hct . -leukocytosis-likely due to osteomyelitis, epidural abcesses and surgical intervention. Initially improved with abx. . -thrombocytosis - likely reactionary, secondary to cervical osteomyelitis . -htn - pt was continued on his home dose of atenolol . -hyperlipidemia - pt was continued on his home statin . -Thrombophlebitis-noted in LUE after treatment with vanco. US showed no clot. . Neuro: No issues CV: The patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. Pulmonary: The patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. Good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. GI/GU/FEN: Post-operatively, the patient was made NPO with IV fluids. Diet was advanced when appropriate, which was well tolerated. Patient's intake and output were closely monitored, and IV fluid was adjusted when necessary. Electrolytes were routinely followed, and repleted when necessary. ID: The patient's white blood count and fever curves were closely watched for signs of infection. The patient's osteomyelitis and epidural abscess was determined to be non-operative and to be to be treated with a course of IV antibiotics. Blood cxs remained negative throughout the admission. He was followed by infectious disease recommended 6 week course of Vancomycin [**Date range (1) 86699**] in the setting of osteomyelitis, epidural abcesses and hx of MSSA bacteremia as well as MRSA growth in endotracheal tube at last admission and in the nares. Goal Vancomycin trough 15-20. His Vancomycin trough on [**2102-4-7**] was 9.0 his dose was increased to 1.5g. Repeat trough level will be checked on Monday [**4-10**] and results will be faxed to the ID whom will make further recommendations. PICC line: Single lumen placed [**2102-3-31**] left basilic 47 cm terminated in SVC. Endocrine: The patient's blood sugar was monitored throughout his stay; insulin dosing was adjusted accordingly. Hematology: The patient's complete blood count was examined routinely; no transfusions were required. Prophylaxis: The patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Disposition: He was discharged to home with Critical Care Systms in [**Location (un) 8985**]. Phone [**Telephone/Fax (1) 86700**], fax [**Telephone/Fax (1) 86701**]. He will follow-up with ID, Spine and Dr. [**First Name (STitle) **] as an outpatient. Medications on Admission: Atenolol 25, Ferrous sulfate 325'', Folic acid 1, Protonix 40, Simvastatin 40, Tamsulosin 0.4, MVI, Percocet 2 tabs q4H Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) scoop PO DAILY (Daily). 7. Oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*90 Tablet(s)* Refills:*0* 8. Gabapentin 600 mg Tablet Sig: One (1) Tablet PO every eight (8) hours. Disp:*90 Tablet(s)* Refills:*2* 9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 10. Vancomycin 500 mg Recon Soln Sig: 1500 (1500) mg Intravenous every twelve (12) hours for 5 weeks: Goal Trough 15-20. Disp:*qs solution* Refills:*0* Discharge Disposition: Home With Service Facility: Critical Care Systems Discharge Diagnosis: 1. left-sided loculated pleural effusion 2. cervical spine osteomyelitis w/spinal epidural abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Call Dr[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience: -Fevers greater than 101 chills, or shakes -Increased shortness of breath, cough or sputum production -Chest pain -Difficulty or painful swallowing, nausea, vomiting -You may shower. No tub bathing or swimming for 4 weeks -Incision develops drainage: staples remain until seen by Dr. [**First Name (STitle) **] [**Name (STitle) 86702**] bandaid over left chest tube site and change daily until healed Followup Instructions: Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] [**4-20**] 9:00am on the [**Hospital Ward Name 5074**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**]. Chest X-Ray 30 minutes before your appt on the [**Location (un) 861**] Radiology Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name12 (NameIs) **] ID WEST (SB) Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2102-4-17**] 10:00 in the [**Last Name (un) 2577**] Building Ground Floor [**Last Name (NamePattern1) 10357**] Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 3736**] Spine Center Date/Time:[**2102-5-8**] 10:45 ortho [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) **] Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 16976**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2102-5-15**] 9:30 infectious disease [**Last Name (un) 2577**] Building Ground floor [**Last Name (NamePattern1) **] Weekly labs: Please fax results to ID RN [**Telephone/Fax (1) 432**] Completed by:[**2102-4-11**] ICD9 Codes: 5119, 2859, 4019, 2724
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Medical Text: Admission Date: [**2145-7-6**] Discharge Date: [**2145-7-11**] Date of Birth: [**2145-7-5**] Sex: M Service: NBB [**Doctor Last Name 5045**] [**Known lastname 63127**], boy #1, was born at 32 and 4/7 weeks gestation by cesarean section for worsening maternal pregnancy induced hypertension. The mother is a 34 year old gravida I, para 0, now II woman. Her prenatal screens are blood type A positive, antibody negative, rubella immune, RPR nonreactive, hepatitis surface antigen negative and group B strep positive. This pregnancy was complicated by pregnancy induced hypertension, gestational diabetes and cervical shortening with cerclage placement. The mother received a complete course of betamethasone prior to delivery. Rupture of membranes occurred at the time of delivery. Meconium stained amniotic fluid was noted for twin #1. He was intubated in the delivery room. There was no meconium noted below the cord. The infant's birth weight was 2450 grams. The infant remained at [**Hospital **] Hospital in the special care nursery on continuous positive airway pressure and was transferred to [**Hospital1 **] due to worsening respiratory distress syndrome and lack of available bed space at [**Hospital **] Hospital. On admission to the [**Hospital3 **] NICU on [**2145-7-6**], the infant was a premature infant, active, with moderate work of breathing on continuous positive airway pressure. Anterior fontanelle soft and flat. Palate intact. Neck supple and without mass. Chest with moderate aeration, moderate grunting, flaring and retracting. The heart was regular rate and rhythm, no murmur. Abdomen soft, nontender and nondistended, no hepatosplenomegaly. Testes descended bilaterally, Patent anus. Stable hip exam and age appropriate tone and activity. NICU COURSE BY SYSTEMS: Respiratory status: He was intubated soon after admission. He received 2 doses of Surfactant and then weaned to nasopharyngeal continuous positive airway pressure on day of life #2 and weaned to room air on day of life #3 where he has remained. On exam, he has some very mild subcostal retractions. Lung fields are clear and equal. He has had 1-4 episodes of apnea and bradycardia in a 24 hour period. He has not been treated with caffeine. Cardiovascular status: He has remained normotensive throughout his NICU stay. On exam, his heart has a regular rate and rhythm and no murmur. Fluid, electrolyte and nutrition status: At the time of discharge, his weight is 2275 grams. Enteral feeds were begun on day of life #3 and advanced without difficulty to full volume feeding on day of life #6. At the time of discharge, he is eating on full feeds of total fluids 140 ml/kg per day of preemie Enfamil 20 calories per ounce by gavage. He has remained euglycemic throughout his NICU stay with adequate amounts of urine and passing meconium stool. Gastrointestinal status: Phototherapy was begun on day of life #4 for his peak bilirubin which was total 12.2 and direct 0.4. A bilirubin is being done on the day of discharge. Hematology status: He has received no blood product transfusions during his NICU stay. His hematocrit on admission at [**Hospital **] Hospital was 44, platelets 232,000. Infectious disease status: He was started on ampicillin and gentamicin at the time of admission for sepsis risk factors. Antibiotics were discontinued after 48 hours when the blood cultures were negative and the infant was clinically well. His white count at the time of admission was 12.2 with a differential of 50 polys and 0 bands. The blood cultures remained negative. Sensory: Audiology hearing screen has not yet been performed. It was recommended prior to discharge. Psychosocial: The parents have been involved in the infant's care throughout the NICU stay. The mother was transferred to [**Hospital1 **] on day of life #2. The infant is discharged in good condition. The infant is transferred back to [**Hospital **] Hospital Special Care Nursery. Primary pediatric care will be provided by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 44793**] of [**Location (un) 37540**] Pediatrics. Address [**Last Name (un) **], [**Hospital1 **], [**State 350**]. Telephone number [**Telephone/Fax (1) 63128**]. RECOMMENDATIONS AFTER DISCHARGE: 1. Feedings: Total fluids of 140 ml/kg/day of preemie Enfamil 20 calories per ounce, increasing calories as needed. 2. The infant is discharged on no medications. 3. Car seat position screening test is recommended prior to discharge. 4. A State newborn screen was sent on [**2145-7-8**]. 5. The infant received his first hepatitis B vaccine on the day of delivery at [**Hospital **] Hospital. DISCHARGE DIAGNOSES: Prematurity at 32 and 4/7 weeks gestation. Twin #1. Status post respiratory distress syndrome. Sepsis ruled out. Hyperbilirubinemia of prematurity. Apnea of prematurity. [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2145-7-11**] 03:00:13 T: [**2145-7-11**] 09:59:25 Job#: [**Job Number 63129**] ICD9 Codes: 769, 7742
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Medical Text: Admission Date: [**2150-7-2**] Discharge Date: [**2150-7-4**] Date of Birth: [**2150-7-2**] Sex: F Service: Neonatology HISTORY OF PRESENT ILLNESS: Baby Girl [**Known lastname 43174**], [**Name2 (NI) 37336**] #3, was born at 35 weeks gestation to a 28 year old Gravida 6, Para 4, now 6 woman. Her prenatal screens are blood type 0 positive, antibody negative, Rubella immune, RPR nonreactive, hepatitis surface antigen negative and group B Streptococcus negative. Her prenatal course was significant for this [**Name2 (NI) 37336**] in [**Last Name (un) 5153**] fertilization, pregnancy-induced hypertension with normal laboratory values and no medication required except for magnesium on the day of delivery. Obstetrical history is remarkable for pregnancy-induced hypertension with pregnancy in [**2139**] requiring a primary cesarean section. Repeat cesarean section at 36 weeks gestation in [**2141**] and [**2148**], a tubal ligation in [**2148**] and a failed reversal of a tubal ligation in [**2150**]. She was therefore treated with in [**Last Name (un) 5153**] fertilization which resulted in this [**Last Name (un) 37336**] pregnancy. Maternal history is remarkable for history of a seizure disorder requiring no medications during pregnancy and the last seizure occurring 1 1/2 years ago. Due to contractions noted and maternal hypertension, the infants were delivered by cesarean section. This infant emerged active with good respiratory effort. Apgars were 8 at one minute and 9 at five minutes. The birthweight was 1,985 gm, 25th to 60th percentile and head circumference was 31 cm in the 25th percentile. PHYSICAL EXAMINATION: The admission physical examination reveals an active vigorous preterm infant. The anterior fontanelle is open and flat, mild intercostal and subcostal retractions. Breathsounds were clear. Normal S1 and S2 breathsounds. Pink and well perfused. Soft abdomen, nontender and nondistended. Appropriate and symmetric tone and reflexes. Stable hip examination, patent anus, fine intact and normal preterm external female genitalia. HOSPITAL COURSE: Respiratory status - The respiratory distress resolved within a few hours of admission to the Nursery Intensive Care Unit. The infant has always remained in room air. Lungsounds are clear and equal. Cardiovascular status - The infant has remained normotensive throughout her Nursery Intensive Care Unit stay. She has a normal S1, S2 heartsound and no murmur. There are no cardiovascular issues. Fluids, electrolytes and nutrition - Her weight at the time of transfer is 1,910 gm. She is eating Enfamil 20 or breastfeeding on an ad lib schedule. She has kept her glucoses in the 60s to 70s range during her Nursery Intensive Care Unit stay. Gastrointestinal status - The bilirubin drawn on [**2150-7-4**] is a total of 5.2, direct 0.3. She has passed meconium stool. Hematological status - Her hematocrit at the time of admission was 48, platelets 340,000. She has received no blood products during this Nursery Intensive Care Unit stay. Infectious disease status - Blood culture was sent at the time of admission for sepsis suspect, the infant is clinically well and blood culture remains negative at the time of transfer to the Nursery Intensive Care Unit. Social status - The mother was transferred here to [**Hospital6 1760**] from [**State 1727**]. The infant is in good condition on transfer to the Newborn Nursery for continuing care. Primary pediatric care will be provided in [**State 1727**] by Dr. [**Last Name (STitle) 43178**], telephone [**Telephone/Fax (1) 43179**]. CARE RECOMMENDATIONS: (At the time of transfer) 1. Feedings - The infant is eating Enfamil 20 or breastfeeding with PC formula until the mother's milk is well established on a three hour schedule. 2. Medications - The infant is transferred on no medications. 3. Carseat screening - A carseat position screening test has not been done but will need to be done prior to discharge. 4. State newborn screen - Needs to be sent prior to discharge. 5. The infant has received no immunizations. 6. Newborn hearing screening should be performed prior to discharge to home. DISCHARGE DIAGNOSIS: 1. Prematurity 35 weeks gestation 2. [**Telephone/Fax (1) **] #3 3. Status post transitional respiratory distress 4. Rule out sepsis [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 37237**], M.D. [**MD Number(1) 37238**] Dictated By:[**Last Name (NamePattern1) 37333**] MEDQUIST36 D: [**2150-7-4**] 20:20 T: [**2150-7-4**] 20:56 JOB#: [**Job Number 43181**] ICD9 Codes: V290
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Medical Text: Admission Date: [**2175-4-14**] Discharge Date: [**2175-4-25**] Date of Birth: [**2115-2-26**] Sex: M Service: CCU CHIEF COMPLAINT: Dyspnea, respiratory failure. HISTORY OF PRESENT ILLNESS: This is a 63-year-old male with long tobacco use history, known coronary artery disease, severe chronic obstructive pulmonary disease, status post myocardial infarction in [**2170**], and restenosis in [**2172**], now transferred from [**Hospital6 2910**] for cardiac catheterization. Patient of Dr. [**Last Name (STitle) **], presented to Dr. [**Last Name (STitle) **] earlier this month with a complaint of increased dyspnea and stress test showed severe reversible inferior ischemia. The patient was taken to cardiac catheterization on [**2175-4-11**] at [**Hospital6 1322**] which showed RA pressure of 6, PA pressure of 46/20, LV pressure of 112/26, RV pressure of 46/6, and pulmonary capillary wedge pressure of 14. Patient had a cardiac index of 2.05, and a SVR of 1494. He was also shown to have moderate luminal irregularities in the mid RCA. There was 99% stenosis of the prior stent in the RCA distally. The left circumflex artery was patent, as was the left main and the left anterior descending artery. Ejection fraction of 30-40% with global hypokinesis, no MR, there was a question of a 60% stenosis of the external iliac. Status post catheterization, patient went into hypoxic respiratory failure. He was suctioned without improvement, and was transferred to [**Hospital6 2910**] MICU, where he was intubated. He was thought to be in congestive heart failure and was diuresed and extubated on [**2175-4-12**]. He was also given steroids for presumed chronic obstructive pulmonary disease exacerbation. Postintubation, the patient again became dyspneic and tachypneic, and had to be reintubated. There is a question of a right lower lobe infiltrate. The patient was bronched with mucus plug aspirate from the right lower lobe and left lower lobe. Of note, the patient's systolic blood pressure at [**Hospital6 2910**] decreased into the 70s to 80s when he was sedated. Nutrition evaluation revealed moderate malnutrition. Patient was transferred to [**Hospital1 188**] for PTCA and brachytherapy of instent restenosis. Cardiac catheterization on [**2175-4-14**] at [**Hospital1 190**] revealed 99% right coronary artery lesion, successfully PTCA with brachytherapy. His pressures were RA 43/13, RV 45/14, PA 44/27, pulmonary capillary wedge was 20, and aortic outflow was 118/76. PAST MEDICAL HISTORY: 1. Ankylosing spondylitis. 2. Status post gastrectomy. 3. Peripheral vascular disease. 4. Paget's disease. 5. Chronic obstructive pulmonary disease, on home O2 through trache. 6. Coronary artery disease, status post inferior and anterior myocardial infarction in [**2170**] with cardiogenic shock requiring intra-aortic balloon pump. LAD, LCX, RCA stented. Restenosis and PTCA in [**4-/2173**] 7. MRSA, two years ago. 8. Congestive heart failure with ejection fraction of 25-30% in [**2170**]. TRANSFER MEDICATIONS: 1. Percocet prn. 2. MS Contin 100 mg po q8h. 3. [**Last Name (un) **]-Dur SR 100 mg po q day. 4. Aldactone 25 mg po q day. 5. Zestril 5 mg po q day. 6. Plavix 75 mg po q day. 7. Propofol. 8. Protonix 40 mg po q day. 9. Flovent. 10. Reglan. 11. Prednisone at home, discontinued. 12. Solu-Medrol 50 mg IV q6h. 13. Zithromax 500 mg po q day taken from [**4-12**] through [**4-14**]. 14. Zoloft 50 mg po q day. 15. Lopressor 2.5 mg IV q4h. 16. Lasix 40 mg IV q day. 17. Ativan prn. LABORATORIES FROM [**Hospital6 **] ON [**2175-4-13**]: white count 13.3, hematocrit 30.2, platelets 472. PTT 66.8, INR 1.0. Sodium 140, potassium 4.1, chloride 104, bicarb 21, BUN 22, creatinine 0.7, glucose 194. Albumin 2.3, total protein 5.6, total bilirubin 0.3, direct bilirubin 0.1. Alkaline phosphatase 282, ALT 16, AST 45, Theophylline 308. CK trended from 42 to 106 to 76, troponin trended from 2.4 to 2.7 to 1.5. Electrocardiogram: Precath shows Q waves in leads II, III, and aVF which are old, low voltage, T-wave inversions in aVL. Postcatheterization electrocardiogram from [**Hospital1 346**] shows low voltage, old Q waves in II, III, and aVF, and T-wave inversion in V2. PHYSICAL EXAMINATION: Vital signs: Temperature 99.0, blood pressure 127/82, heart rate 109, respiratory rate 20, vent sating is AC at 60%, tidal volume of 600, respiratory rate of 14, and a PEEP of 5. In general, the patient is emaciated appearing, older than his age. HEENT: Jugular venous pressure at 10-11 cm. Chest: Crackles at the right base laterally. Cardiovascular: Tachycardic, no murmurs, rubs, or gallops. Abdomen is soft, nontender, nondistended, chest wall is severely hyperexpanded. Extremities: 2+ dorsalis pedis pulses bilaterally. Neurologic: Intubated, following commands. HOSPITAL COURSE: In short, this is a 60-year-old male with history of severe chronic obstructive pulmonary disease, coronary artery disease, who presents with instent restenosis, status post PTCA and brachytherapy with respiratory failure. 1. Coronary artery disease: After his catheterization in-house, the patient did not complain of any kind of chest pain or discomfort. He was placed on a good cardiac regimen. He was continued on aspirin, started on Plavix. He was also continued on Lopressor 25 mg po bid. Patient's lisinopril dose was titrated up to 10 mg po q day as his pressure tolerated. Patient did not receive Integrilin postcatheterization as per Dr. [**Last Name (STitle) **]. 2. Pump: Patient's echocardiogram from [**4-14**] shows an ejection fraction of 30% with inferior akinesis and a hypokinetic RV. During the patient's hospitalization, he did have an episode of hypoxia, and it was thought that there was a contribution from failure. His regular Lasix dose was not sufficing. Patient received 40 of IV Lasix which led to good diuresis, but the patient was quite sensitive in terms of his blood pressure. Otherwise, the patient's lisinopril dose was able to be titrated up to 10 mg po q day over several days as his hemodynamics improved. 3. Blood pressure: The patient had an episode of hypertension while on the vent, going down to 75/48. This was thought to be secondary to Lasix. 4. Rhythm: Patient did not have any arrhythmias while in-house. 5. Pulmonary: Patient was overall difficult to wean, which extended his hospital stay. This was thought to be due to a combination of his chronic obstructive pulmonary disease and developing pneumonia in his lower lung bases. The Pulmonary team was consulted. Patient was initially on AC mode ventilation. While he tolerated this, he was quite easily able to transition to pressure support mode, and it was not felt that the patient was tiring out. However, at one point, the patient may have received too much in terms of narcotics, which elevated his pCO2. This is still unclear as the patient has a very high narcotic threshold. While in-house, the patient received bronchoscopy. This revealed clean bronchial tree. There was very little that was suctioned out. Once the infection was under control with the proper antibiotics, we were able to lower his PEEP enough that he could be extubated. Patient was extubated on [**Last Name (LF) 2974**], [**4-21**]. Overall, his chest x-ray was consistent with bilateral atelectasis versus pneumonia, with varying degrees of pulmonary edema. Once the patient was extubated, he was placed on 6 liters of O2 through his trache stoma, and 12 liters of shovel mask as needed. Given his pulmonary improvement, the patient did not need any revision of his trache stoma as it had originally been thought during his stay here. Patient's gas from [**4-22**] after he was extubated was 7.42, 51, 50. We believe that the patient generally has a very low pAO2 baseline around 45-50. We have been targeting his O2 saturation to high 80's to low 90's. Patient was also weaned off of his steroids as he was not really thought to be in chronic obstructive pulmonary disease exacerbation. Patient is currently on 5 mg of prednisone. That will be continued for one week, through [**2175-4-30**]. 6. ID: During the patient's hospitalization, he spiked up to 102. Blood cultures from [**4-19**] showed 1/2 bottles that eventually grew Serratia marcescens, sensitive to ceftazidime, which was the antibiotic with the lowest MIC other than meropenem. In addition, the patient's sputum from [**4-19**] grew MRSA, sensitive to Vancomycin and clindamycin. Patient was started on ceftazidime and Vancomycin for a two week course. A single lumen PICC line was placed without difficulty. After commencing antibiotics, the patient no longer had any spikes. Patient's white blood cell count remained stable. 7. Pain control: The patient is normally on MS Contin for his ankylosing spondylitis. He was converted to MSIR while intubated. He was placed back on MS Contin at 60 mg po q8h. This is lower than his normal dose. He was also given prn oxycodone. He may need to have his MS Contin dose raised. CONDITION ON DISCHARGE: Stable. DISCHARGE MEDICATIONS: 1. Lasix 40 mg po q day. 2. Alprazolam 0.25 mg po tid. 3. Lopressor 25 mg po bid. 4. Protonix 40 mg po q day. 5. Theophylline SR 100 mg po bid. 6. Lisinopril 10 mg po q day. 7. MS Contin 60 mg po q8h. 8. Xanax 0.25 mg po tid prn. 9. Prednisone 5 mg po q day. 10. Oxycodone 5-10 mg po q4-6h prn. 11. Digoxin 0.125 mg po q day. 12. Vancomycin 1 mg IV q12h, through [**2175-5-4**]. 13. Atrovent MDI four puffs IH [**Hospital1 **]. 14. Insulin-sliding scale. 15. Lactulose 30 mL po q8h prn constipation. 16. Ceftazidime 1 gram IV q8h through [**2175-5-4**]. 17. Heparin 5,000 units subQ q12h. 18. Aspirin 325 mg po q day. 19. Albuterol two puffs IH q6h and 1-2 puffs IH q2h prn. 20. Zoloft 50 mg po q day. 21. Colace 100 mg po bid. 22. Salmeterol two puffs IH [**Hospital1 **]. 23. Fluticasone 110 mcg, six puffs IH [**Hospital1 **]. 24. Aldactone 25 mg po q day. 25. Tylenol 325-650 mg po q4-6h prn. 26. Plavix 75 mg po q day, duration 30 days. DISCHARGE INSTRUCTIONS: Patient will followup with Dr. [**Last Name (STitle) **] for his cardiac needs. Otherwise, he will complete the two week course of Vancomycin and ceftazidime for presumed pneumonia. DISCHARGE DIAGNOSES: 1. Severe chronic obstructive pulmonary disease, with difficulty weaning from ventilator. 2. Pneumonia. 3. Coronary artery disease, status post percutaneous transluminal angioplasty and brachytherapy of right coronary artery stent. 4. Ankylosing spondylitis with chronic pain. [**Name6 (MD) **] [**Name8 (MD) **], MD [**MD Number(1) 21980**] Dictated By:[**Name8 (MD) 4990**] MEDQUIST36 D: [**2175-4-25**] 07:02 T: [**2175-4-25**] 07:28 JOB#: [**Job Number 96297**] ICD9 Codes: 486, 496, 7907, 4280, 412
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Medical Text: Admission Date: [**2145-12-28**] Discharge Date: [**2146-1-14**] Date of Birth: [**2064-8-10**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Chest Pain Major Surgical or Invasive Procedure: [**2145-12-30**] Coronary Artery Bypass Graft x 4 (Left internal mammary artery to left anterior descending, Saphenous vein graft to Diagonal, Saphenous vein graft to Ramus, Saphenous vein graft to Obtuse Marginal) [**2145-12-29**] Cardiac cath History of Present Illness: Ms. [**Known lastname 102405**] is a 81 female with multiple coronary artery disease risk factors and previous strokes with dementia who presented with acute onset chest pain. ED initially was not concerned as patient had negative MIBI [**4-17**] and was originally going to be ruled out and scheduled for a stress test. However her troponin returned elevated at 0.21 so patient was started on a heparin drip, got Aspirin 325mg, and was transferred to the floor without plavix load. Past Medical History: Stroke w/ residual left sided weakness, Hypertension, Hyperlipidemia, Diabetes Mellitus, Dementia, Gastroesophageal Reflux Disease, Recurrent urinary tract infections, Iron defiency anemia, Recurrent falls, s/p Hysterectomy Social History: Lives at [**Hospital3 **]- Country Club Heights in [**Location (un) 246**]. Has daughter lives close by in [**Name (NI) 2436**]. She needs assitance with showers. She is independent in ambulating with a walker, eating and toileting IADLS: Need assitance with shopping, bills, daughter does meds, food preparation. She is independent with telephone use Quit smoking 30 to 40 years ago. Occasional ETOH. She has pre-existent home care services + H/o fall within 3 months + Unsteady gait? + Visual aides Family History: father had afib and CVA in 70s. Two cousins with [**Name2 (NI) 499**] cancer. Physical Exam: Admission VS - 97.0 162/77 86 18 100% on RA Gen: elderly F in NAD. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. Neck: Supple with JVP of 3 cm at 45' angle. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Chest: slight crackles at the bases. Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: wwp, no edema. slight brawny stasis dermatitis. Discharge VS T 97.4 HR 72SR BP 130/75 RR 18 O2sat 96%-RA Gen NAD Neuro A&Ox3, residual left sided weakness. Able to ambulate with walker. Pulm CTA-bilat CV RRR, no M/R/G. Sternum stable, incision CDI Abdm soft, NT/+BS Ext warm well perfused. 1+ pedal edema bilat. Small rt arm phlebitis- improving over last few days Pertinent Results: [**2145-12-28**] 09:30PM CK(CPK)-78 [**2145-12-28**] 09:30PM PT-12.4 PTT-32.8 INR(PT)-1.0 [**2145-12-28**] 01:00PM GLUCOSE-135* UREA N-19 CREAT-0.9 SODIUM-138 POTASSIUM-4.6 CHLORIDE-102 TOTAL CO2-26 ANION GAP-15 [**2145-12-28**] 01:00PM cTropnT-0.21* [**2145-12-28**] 01:00PM WBC-9.9 RBC-3.98* HGB-11.8* HCT-34.6* MCV-87 MCH-29.7 MCHC-34.2 RDW-13.6 [**2145-12-28**] 01:00PM PLT COUNT-336 [**2145-12-28**] 01:00PM PT-11.7 PTT-22.2 INR(PT)-1.0 [**2146-1-14**] 05:06AM BLOOD WBC-11.5* RBC-3.48* Hgb-10.8* Hct-31.1* MCV-89 MCH-31.1 MCHC-34.8 RDW-15.0 Plt Ct-688* [**2146-1-14**] 05:06AM BLOOD Plt Ct-688* [**2146-1-7**] 12:08PM BLOOD PT-12.6 PTT-28.6 INR(PT)-1.1 [**2146-1-14**] 05:06AM BLOOD Glucose-141* UreaN-25* Creat-1.3* Na-137 K-4.4 Cl-100 HCO3-28 AnGap-13 [**2145-12-29**] 10:10AM BLOOD %HbA1c-7.2* [**2145-12-29**] Cardiac Cath: 1- Selective coronary anguiography of this left-dominant system demonstrated severe diffuse three vessel coronary artery disease with markedly calcific vessels. The distal LMCA/ostial LCX had 80% stenosis and the mid and distal LCX had each 70% stenosis serially. The LAD had 70% diffuse bifurcation stenosis at mid vessel with 60% stenosis in the ostial major diagonal brancg. There was a small high diagonal vessel(RI) with 30% stenosis. The RCA was a diminutive vessel with 40% diffuse stenosis throughout. 2- Limited resting hemodynamic assessment revealed normal systemic arterial pressure (121/60 mmHg). The left-sided filling pressures were normal at baseline (LVEDP 11 mmHg, increased to 16 mmHg after LV gram). 3- Left ventriculography revealed normal LVEF (60-65%) without regional wall motion abnormalities or mitral regurgitation. [**2145-12-29**] Carotid U/S: Less than 40% stenosis of the internal carotid arteries bilaterally. [**12-30**] Head CT:1. No significant interval change from prior MR examination from [**2142-5-20**] with no acute infarction or hemorrhage identified. 2. Multiple old lacunar infarctions of the bilateral cerebellar hemispheres and pons, and changes consistent with chronic small vessel ischemic disease. [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 102406**] (Complete) Done [**2145-12-30**] at 10:02:05 AM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 177**] C. [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2064-8-10**] Age (years): 81 F Hgt (in): BP (mm Hg): 108/65 Wgt (lb): HR (bpm): 75 BSA (m2): Indication: intraoperative management of CABG. ICD-9 Codes: 440.0, 424.1, 424.0 Test Information Date/Time: [**2145-12-30**] at 10:02 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2008AW2-: Machine: 2 Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.2 cm <= 4.0 cm Left Atrium - Four Chamber Length: 5.0 cm <= 5.2 cm Left Ventricle - Septal Wall Thickness: *1.2 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 3.7 cm <= 5.6 cm Left Ventricle - Systolic Dimension: 2.8 cm Left Ventricle - Fractional Shortening: *0.24 >= 0.29 Left Ventricle - Ejection Fraction: 60% >= 55% Aorta - Sinus Level: 3.2 cm <= 3.6 cm Aorta - Sinotubular Ridge: 2.5 cm <= 3.0 cm Aorta - Ascending: 3.0 cm <= 3.4 cm Aorta - Arch: 2.5 cm <= 3.0 cm Aorta - Descending Thoracic: 2.4 cm <= 2.5 cm Aortic Valve - LVOT diam: 1.8 cm Aortic Valve - Valve Area: *1.4 cm2 >= 3.0 cm2 Aortic Valve - Pressure Half Time: 738 ms Mitral Valve - Pressure Half Time: 77 ms Mitral Valve - MVA (P [**2-10**] T): 2.8 cm2 Mitral Valve - E Wave: 1.0 m/sec Mitral Valve - A Wave: 0.9 m/sec Mitral Valve - E/A ratio: 1.11 Findings LEFT ATRIUM: Moderate LA enlargement. Elongated LA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal interatrial septum. No ASD by 2D or color Doppler. LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal diameter of aorta at the sinus, ascending and arch levels. Complex (>4mm) atheroma in the aortic arch. Normal descending aorta diameter. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AS. Mild (1+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. Mild mitral annular calcification. No MS. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. 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. No TEE related complications. Results were Conclusions PREBYPASS 1. The left atrium is moderately dilated. The left atrium is elongated. No atrial septal defect or PFO is seen by 2D or color Doppler. 2. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size and free wall motion are normal. 4. There are complex (>4mm) atheroma in the aortic arch. There are complex (>4mm) atheroma in the descending thoracic aorta. 5. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. 6. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. 7. There is no pericardial effusion. 8. Dr.[**Last Name (STitle) 914**] was notified in person of the results in the OR at the time of surgery POSTBYPASS 1. Patient is on XX infusions. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2146-1-3**] 14:46 Radiology Report CHEST (PA & LAT) Study Date of [**2146-1-12**] 9:13 AM [**Hospital 93**] MEDICAL CONDITION: 81 year old woman with s/p cabg REASON FOR THIS EXAMINATION: EVALUATE EFFUSIONS Provisional Findings Impression: MLKb WED [**2146-1-12**] 10:50 AM Decrease in amount of pleural effusion. Final Report HISTORY: 81-year-old female, status post CABG. Evaluate effusions. COMPARISON: Prior study, [**2146-1-10**]. FINDINGS: Status post sternotomy with surgical clips post-CABG. There is decreasing amount of pleural effusion seen on the lateral views. Right-sided PICC line is again seen with the tip in the SVC. Unchanged appearance of the cardiomegaly and bilateral bibasal atelectasis. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) 75229**] [**Name (STitle) **] DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**] Approved: WED [**2146-1-12**] 12:20 PM Brief Hospital Course: As mentioned in the HPI, Mrs. [**Known lastname 102405**] was admitted from the emergency room after she was found to have a non-ST segment elevation myocardial infarction. She was appropriately medically managed and worked up for cardiac surgery. On [**12-30**] she was brought to the operating room where she underwent a coronary artery bypass graft x 4. The procedure was performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**]. Please see operative report for surgical details. In summary she had CABG x4 with LIMA-LAD, SVG-Diag, SVG-Ramus, SVG-OM. She tolerated the operation well and following surgery she was transferred to the CVICU for invasive monitoring in stable condition. She remained intubated for three days after surgery secondary to a difficult airway and fluid overload. She was weaned from her pressors and her chest tubes were removed. She was fed via a dobhoff tube after surgery secondary to somnolence. She was noted to be confused after the surgery, but also has a baseline history of dementia. Her beta blockade was titrated up as tolerated. On post-operative day seven she was transferred to the surgical step down floor. She had intermitant episodes of atrial fibrillation with hypotension and was returned to the surgical intensive care unit, where she converted to sinus rhythm after adjustment of Bblockers and initiation of amiodarone. Her mediastinal incision was noted to have some purulent drainage and she was started on Vancomycin and ciprofloxacin. She was transferred back to the step down floor on post-operative day nine. Sternal drainage subsided and her sternum remained stable. As discussed with Dr.[**Last Name (STitle) 914**], Cipro was discontinued and upon discharge, Vancomycin will be continued for 7 days. She was seen by phyisical therapy. On post-operative day 15 she was discharged to rehabilitation at [**Hospital6 **]. Medications on Admission: Alendronate 70 mg PO qweekly, Imipramine 20 mg PO QHS, Lisinopril 10 mg PO qAM, Metoprolol XL 50 mg PO QHS, MVI (noon), Nitrofurantoin 100 mg PO 3x/week MOWFri, Prilosec 20 mg PO [**Hospital6 **], Simvastatin 20 mg PO [**Last Name (LF) **], [**First Name3 (LF) **] 81 mg PO daily, Calcium Carbonate 750 mg PO TID, Vitamin D3 800 PO [**First Name3 (LF) **], Ferrous Sulfate 325 mg PO [**First Name3 (LF) **], Aggrenox 200-25 mg PO BID, Simethicone 80 mg PO QID, Glyburide 1.25 mg PO QAM, Metformin 500 mg PO QAM, Glucovance 5-500 PO BID before breakfast and supper) Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed. Disp:*60 Tablet(s)* Refills:*0* 2. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*0* 4. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 hr Sig: One (1) Cap PO BID (2 times a day). Disp:*60 Cap(s)* Refills:*0* 5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TIDAC (3 times a day (before meals)). Disp:*90 Tablet, Chewable(s)* Refills:*0* 6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. Glyburide Micronized-Metformin 5-500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* 10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 5 days. Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 11. Vancomycin 1,000 mg Recon Soln Sig: One (1) Intravenous once a day for 7 days. 12. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 15. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 16. Sodium Chloride 0.65 % Aerosol, Spray Sig: Two (2) Spray Nasal Q6H (every 6 hours). Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4 Myocardial Infarction, Postop atrial fibrillation PMH: Stroke w/residual left sided weakness, Hypertension, Hyperlipidemia, Diabetes Mellitus, Dementia, Gastroesophageal Reflux Disease, Recurrent urinary tract infections, Iron defiency anemia, Recurrent falls, s/p Hysterectomy Discharge Condition: Stable Discharge Instructions: Please shower daily , no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 100.5 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for one month and off [**Doctor Last Name **] narcotics No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns: [**Telephone/Fax (1) 170**] Followup Instructions: Dr. [**Last Name (STitle) 914**] in 4 weeks Dr. [**Last Name (STitle) **] in [**3-14**] weeks Dr. [**Last Name (STitle) **] in [**2-10**] weeks Completed by:[**2146-1-14**] ICD9 Codes: 5185, 9971, 2851, 4019, 2724
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Medical Text: Admission Date: [**2120-1-8**] Discharge Date: [**2120-1-13**] Date of Birth: [**2060-1-28**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2009**] Chief Complaint: BRBPR Major Surgical or Invasive Procedure: Colonoscopy History of Present Illness: The patient is a 59 yo F with a psychiatric history, colectomy s/p anastamosis, A fib recently started on dabigutran, COPD and hepatitis C who presents with several weeks of BRBPR. The patient came to the ED yesterday complaining of 2 weeks of bloody stools, which have been intermittent since [**12-25**]. The patient reports that she began taking Dabigutran at the end of [**Month (only) 1096**], without evidence of any bleeding until mid-[**Month (only) 404**]. Since that time, she has been having approximately [**4-12**] stools per day, which she describes as red liquid and clots. No fever, chills, nausea, vomiting or abdominal pain. She initially came to the ED over the weekend and was admitted for monitoring and possibly colonoscopy, but left AMA after being told that she could not leave the hospital to smoke a cigarette. According to the patient, she went home last night, ate fish filet, Ziti and milk, and then had a BM that consisted of blood mixed with stool this AM. She spoke to her PCP today and was advised to return to the ED for further workup. . In the ED, initial vitals were: 0 98.9 88 86/57 22 98%. Patient triggered for hypotension on arrival, received 1.5 L IVF and BP improved to 90s/50s. Her rectal exam was notable for maroon stool. Labs were significant for a leukocytosis to 14 (down from 17.5 yesterday) with a mild neutrophilia and a Hct of 40.2 (stable >24hrs). U/A and CXR were unremarkable and the patient was admitted to the medical service for further monitoring. Vitals on transfer were HR low 100s in atrial fibrillation, rr 18, BP 91/54 and 96% RA. . On the floor, patient reports feeling excellent, and being annoyed with her liquid diet. She denies any chest pain, worsened SOB (patient has baseline chronic SOB [**1-10**] COPD), dizziness, abdominal pain, fever, chills, nausea or vomiting. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Has chronic cough and SOB. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, constipation or abdominal pain. No recent change in bladder habits. No dysuria. Denied arthralgias or myalgias. Past Medical History: s/p colectomy for unclear reasons AFib back pain COPD ? Hepatitis C ? paranoid schizophrenia and borderline personality disorder - as told to psychiatry to the patient over the weekend Social History: Has a longstanding relationship with her boyfriend, [**Name (NI) 1169**] [**Name (NI) **] (w[**Telephone/Fax (1) 14520**], c[**Telephone/Fax (1) 14521**]). Lives independently with 7 animals. Currently, her son lives with her as well. Also has an extensive trauma history. Currently smokes > 1.5 ppd, sober from EtOH > 16 years, smokes marijuana regularly. Denies other illicits. Family History: Son with Bipolar disorder, DM on mother's side of family, psychiatric illness on father's side of family. . Physical Exam: Admission Exam: Vitals: T: 98 BP: 106/71 P: 50-140s in afib/flutter R: 18 O2: 100% on RA General: Alert, extremely agitated, swearing, shaking and shouting throughout interview. HEENT: NCAT, Sclera anicteric, MMM, oropharynx clear, very poor dentition Lungs: Coarse breath sounds throughout, otherwise no discrete wheezes, rales, ronchi CV: irregularly irregular and tachycardic, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Rectal: Several small nonbleeding external hemorrhoids, no stool in vault Psych: labile, tangential with pressured speech and extremely agitated to the point of shaking bed and self during interview Discharge Exam: VS: 99 122/89 100s AFib 22 99% RA GEN: hyperalert and oriented, pleasant HEENT: PERRL, EOMI, anicteric, dry MM, OP without lesions RESP: decreased breath sounds throughout, no wheezes CV: irregular rhythm, tachycardic, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c/e, warm and well-perfused, good distal pulses SKIN: no rashes, jaundice or ecchymosis Pertinent Results: Admission Labs: [**2120-1-8**] 03:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-25 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2120-1-8**] 11:05AM GLUCOSE-111* UREA N-22* CREAT-1.0 SODIUM-137 POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-22 ANION GAP-15 [**2120-1-8**] 11:05AM PT-12.5 PTT-28.8 INR(PT)-1.1 [**2120-1-8**] 11:00AM WBC-14.0* RBC-4.36 HGB-13.9 HCT-40.2 MCV-92 MCH-31.8 MCHC-34.6 RDW-15.0 [**2120-1-8**] 11:00AM NEUTS-78.7* LYMPHS-17.8* MONOS-2.3 EOS-0.8 BASOS-0.4 [**2120-1-7**] 10:51AM WBC-13.2* RBC-4.32 HGB-13.5 HCT-40.1 MCV-93 MCH-31.2 MCHC-33.6 RDW-14.8 [**2120-1-7**] 02:23AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-25 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG [**2120-1-7**] 01:11AM ALT(SGPT)-29 AST(SGOT)-33 LD(LDH)-280* ALK PHOS-69 TOT BILI-0.4 [**2120-1-7**] 01:11AM LIPASE-42 [**2120-1-7**] 01:11AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2120-1-7**] 01:11AM WBC-17.4* RBC-4.43 HGB-13.7 HCT-40.9 MCV-93 MCH-31.0 MCHC-33.5 RDW-14.6 Discharge Labs: [**2120-1-13**] 06:30AM BLOOD WBC-7.2 RBC-4.22 Hgb-13.5 Hct-39.2 MCV-93 MCH-31.9 MCHC-34.3 RDW-16.2* Plt Ct-183 [**2120-1-13**] 06:30AM BLOOD Plt Ct-183 [**2120-1-13**] 06:30AM BLOOD PT-13.0 PTT-28.8 INR(PT)-1.1 [**2120-1-13**] 06:30AM BLOOD Glucose-87 UreaN-15 Creat-0.6 Na-142 K-3.6 Cl-111* HCO3-21* AnGap-14 [**2120-1-13**] 06:30AM BLOOD Calcium-8.0* Phos-3.5 Mg-1.8 Imaging: CXR: IMPRESSION: 5-mm right granuloma. Dense opacity projecting over the left heart may reflect costochondral calcifications, however a parenchymal opacity is possible and a PA and lateral chest radiograph is recommended to further assess initially. CXR: FINDINGS: A single upright AP view of the chest was obtained. The cardiomediastinal silhouette is stably enlarged. A streaky retrocardiac opacity likely in the left lower lobe is new compared to the prior study possibly representing a developing pneumonia. A calcified granuloma is again noted inferior to the right minor fissure. Calcification projecting over the lower left heart border likely represents mitral annular calcifications. There are no pleural effusions or pneumothorax. No osseous abnormalities are identified. Colonoscopy Findings: Protruding Lesions: Non-bleeding grade 1 internal hemorrhoids were noted. Excavated LesionsL: End to side small bowel to colon anastomosis at about 20 cm from anal verge. At the anastomosis there was a large area of ulceration with stigmata of recent bleeding (red spots). No active bleeding. No intervention performed. No biopsies secondary to anticoagulation and bleeding. Impression: Ulcer in the colon Grade 1 internal hemorrhoids Otherwise normal colonoscopy to 30 cm Recommendations: End to side small bowel to colon anastomosis at 20 cm from anal verge with ulceration with stigmata of recent bleeding (red spots) at site. Recommend repeat colonoscopy with biopsies in 2 weeks. If continued bleeding recommend surgical evaluation as likely result of ischemia at site of anastomosis. Brief Hospital Course: This is a 59 yo F with A fib on dabigutran, COPD, hx of colectomy and bipolar d/o who presented with several weeks of BRBPR which is attributed to an ulcer at the site of a previous colonic anastamosis. . # LGIB: The patient was immediately transferred to the MICU upon admission for brisk LGIB and tachycardia. She was intubated for a colonoscopy which revealed a ulcer at the site of her anastamoses from a previous colonic anastamosis ([**Hospital1 2025**] records obtained, and colectomy was apparently performed for severe constipation). She received 2 units PRBCs and HCT remained stable. Patient's HCT was stable for 3 days upon discharge and without recurrent rectal bleeding. GI recommmended a followup colonoscopy in 2 weeks which they will schedule during a followup appointment. Upon their recommendation, her anticoagulation will be held until then. This was discussed with her outpatient cardiologist, Dr. [**Last Name (STitle) 14522**] who agreed to holding anticoagulation until after colonoscopy in two weeks. . # Afib with RVR: The patient had a history of atrial fibrillation prior to admission. She developed RVR in the MICU. This was thought to be secondary to hypovolemia secondary to bleeding and she was rate controlled with an esmolol gtt and diliazem gtt; she was subsequently transitioned back to PO medication. The patient had one episode of afib with RVR after being transferred to the floor, but was well rate controlled in the HR 80s before discharge. She was discharged on her home dose of Diltiazem with increased dose Metoprolol. . # Cardiomyopathy: The patient's cardiac history was discussed with her cardiologist Dr. [**Last Name (STitle) 14522**], who reported that a recent Echo showed LVEF 40-45%, Mod MR, Asymmetrical septal hypertrophy, LA 5.2cm. She has a question of non-obstructive hypertrophic cardiomyopathy. He also reported that she has no history of CAD on Cath. He had started her on Dabigatran for anti-coagulation for afib because she had variable INRs on Coumadin. . # Schizophrenia/borderline personality d/o: Upon transfer to the MICU, the patient became agitated and required risperdal and haldol. She was seen by psychiatry who did not feel she had capacity at that time to make decisions regarding code status, etc. She was much more calm upon transfer to the floor, but was started on Risperdal and Clonazepam upon discharge per Psychiatry reccs. Psychiatry spoke to her PCP who states that she is willing to follow the patient on these new medications. . # COPD: Continue inhalers . # Tobacco: Nicotine patch daily Medications on Admission: metoprolol XR 100 mg qd MgO 400 mg qd diltiazem 240 mg qd furosemide 20 m qd advair 250/50 [**Hospital1 **] Spiriva daily Tylenol 1000 gm q4-6 hr prn Albuterol inh prn prednisone 10 mg qd as part of a steroid taper since [**12-28**] Bactrim recently finished a 10 day course "for COPD" Dabigitran/Pradaxa 150 mg daily since end of [**Month (only) 1096**] Discharge Medications: 1. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 2. metoprolol succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day: Take with 50mg Tablet for total daily dose of 150mg once a day. Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 3. Mag-Oxide 400 mg Tablet Sig: One (1) Tablet PO once a day. 4. diltiazem HCl 240 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO once a day. 5. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: 1-2 puffs Inhalation every 4-6 hours as needed for shortness of breath or wheezing. 7. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 8. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain or fever. 9. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*0* 10. clonazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime. Disp:*30 Tablet(s)* Refills:*0* 11. Risperdal 2 mg Tablet Sig: Two (2) Tablet PO at bedtime. Disp:*30 Tablet(s)* Refills:*0* 12. metoprolol succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day: Take with 100mg tablet, for total daily dose of 150mg each day. . Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Lower GI bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Ms. [**Known lastname 185**], You were admitted to the hospital because you were bleeding from you GI tract. You were treated in the ICU and we performed a colonoscopy that showed the location of the bleeding. The blood thinner darbigatran likely caused the bleeding. You will have to stay OFF this medication until your next endoscopy. Please speak with your cardiologist about restarting the darbigatran. You were also treated for atrial fibrillation with a rapid heart beat while you were here. On discharge, your heart rate had decreased back to your baseline. We have made the following changes to your medications: STOP Dabigatran. This medication contributed to your bleeding. You will need to stay off this medication until you have an EGD in 2 weeks. Thereafter, you should talk to your primary provider and cardiologist about when to restart this or other anti-coagulation. START Clonazepam 0.5 mg by mouth twice daily and Clonazepam 1 mg at night daily START Risperidone 2 mg by mouth at night daily INCREASED Metoprolol XL to 150 mg once daily - 100 mg XL Daily and 50 mg XL daily Please go to the scheduled followup appointments with GI and your primary care doctor. Followup Instructions: 1. GI followup: Department: GASTROENTEROLOGY When: TUESDAY [**2120-1-30**] at 9:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 1983**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage You have an appointment to see you primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14523**], on Monday [**1-15**] at 8AM. She will followup your new psychiatric medications and make decisions about when to restart your anticoagulation. ICD9 Codes: 4254, 4589, 5789, 496, 3051
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Medical Text: Admission Date: [**2149-6-3**] Discharge Date: [**2149-6-13**] Date of Birth: [**2091-10-13**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2195**] Chief Complaint: Dyspnea x 3 days Major Surgical or Invasive Procedure: None. History of Present Illness: 57 year old man with history of DMII, IPF on prednisone 20, chronic MRSA osteomyelitis since [**9-17**] after ankle fracture, PAF on coumadin presents to [**Hospital3 **] ED on [**2149-6-3**] after 3 days of worsening dyspnea. The patient has a long and complicated hospital course neatly outlined in previous discharge summary. In brief, the patient was recently discharged from [**Hospital1 18**] on [**2149-5-23**], admitted on [**2149-5-21**] for failed osteomyelitis treatment on vanc and switched to daptomycin. His bactrim PCP [**Name9 (PRE) **] was also discontinued for concern of worseing CKD and after a 5 day gap was switched to dapsone on [**2149-5-27**]. The patient started noticing dyspnea on exertion, fatigue, and increasing O2 requirement on [**2149-5-31**] up to 6LNC from his baseline of 1-2LNC. On the day prior to admission he developed an increasingly productive cough of clear/white sputum. He decided to present to the ED. . In the [**Hospital3 **] ED he initially presented with the following VS: 98 87 28 181/67 98% on NRB. He was switched off to 6LNC, desated to 87% and replaced on NRB. Sent set of blood cx and gave him Duonebs and Solumedrol 125mg IV ONCE. HCT came back at 23. Pt then taken off NRB and satting 90-93% on 6LNC. Vitals at transfer were 98.4 81 182/69 22 93%6LNC. His labs were notable for CO2 of 36, creatinine of 2.5, BUN of 91, WBC 14.9, HCT of 23.3 (MCV 84), K 5.4, INR 3.2, Troponin <0.015. Rectal exam was guiac negative. . In the ED, his vital signs were 97.8 84 160/80 20 92% 6L RA initially. He was given gabapentin 400mg PO ONCE, vancomycin 1gm IV ONCE, cefepime 2mg IV ONCE, azithromycin 500mg IV ONCE. Past Medical History: 1) Interstitial lung disease on prednisone 20 daily 2) Diabetes II 3) Osteomyelitis of right ankle on daptomycin (s/p vanc failure) 4) HTN 5) HLP 6) PAF on coumadin 7) Provoked DVT in remote past 8) Obesity Hypoventilation syndrome on BIPAP Social History: Former businessman, on disability at present. Does not smoke, drink, or use drugs. Good social support from wife. Family History: No family hx of lung disease. Mother with MI at age 48. Physical Exam: Admission Physical Exam GEN: pleasant, morbidly obese, unable to complete full sentences HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, RESP: CTA b/l with good air movement throughout except bibasilar rales CV: RR, S1 and S2 wnl, no m/r/g ABD: obese nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c 3+ edema bl SKIN: no rashes/no jaundice/no splinters NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. No pass-pointing on finger to nose. 2+DTR's-patellar and biceps Discharge Physical Exam VS: 98.2 142-150/68-75 80-83 22-24 94%2LNC I/O: 1500/3400 CBG:152/130/61/182 GEN: pleasant, morbidly obese, able to complete full sentences HEENT: PERRL, EOMI, anicteric, MMM, OP clear without lesions NECK: supple, unable to evaluate JVD given habitus RESP: CTAB. No crackles or wheezing noted CV: RRR, S1 and S2 wnl, no m/r/g ABD: +BS, obese, soft, nontender, nondistended, no masses or hepatosplenomegaly, +pitting edema of skin EXT: wwp, DP 2+ bilaterally, 3+ LE edema to the thighs SKIN: no rashes/no jaundice/no splinters NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. Pertinent Results: [**2149-6-3**] 07:35PM BLOOD WBC-13.9* RBC-3.20* Hgb-8.6* Hct-27.9* MCV-87 MCH-26.8* MCHC-30.8* RDW-17.1* Plt Ct-266 [**2149-6-6**] 03:32AM BLOOD WBC-14.9* RBC-3.04* Hgb-8.2* Hct-26.0* MCV-86 MCH-26.9* MCHC-31.4 RDW-16.0* Plt Ct-274 [**2149-6-9**] 05:43AM BLOOD WBC-11.7* RBC-3.26* Hgb-9.0* Hct-28.2* MCV-87 MCH-27.7 MCHC-32.0 RDW-16.9* Plt Ct-250 [**2149-6-12**] 05:59AM BLOOD WBC-12.8* RBC-3.23* Hgb-8.8* Hct-28.3* MCV-87 MCH-27.2 MCHC-31.1 RDW-17.2* Plt Ct-244 [**2149-6-6**] 03:32AM BLOOD PT-28.2* PTT-27.3 INR(PT)-2.7* [**2149-6-7**] 05:57AM BLOOD PT-21.4* PTT-25.4 INR(PT)-2.0* [**2149-6-8**] 06:07AM BLOOD PT-18.9* PTT-23.7 INR(PT)-1.7* [**2149-6-9**] 05:43AM BLOOD PT-16.5* PTT-23.2 INR(PT)-1.5* [**2149-6-11**] 06:12AM BLOOD PT-17.5* PTT-22.6 INR(PT)-1.6* [**2149-6-12**] 05:59AM BLOOD PT-20.0* INR(PT)-1.8* [**2149-6-13**] 04:57AM BLOOD PT-22.4* INR(PT)-2.1* [**2149-6-4**] 01:49AM BLOOD Ret Aut-2.7 [**2149-6-3**] 07:35PM BLOOD Glucose-139* UreaN-85* Creat-2.2* Na-141 K-5.2* Cl-96 HCO3-35* AnGap-15 [**2149-6-5**] 03:38AM BLOOD Glucose-321* UreaN-68* Creat-1.9* Na-142 K-4.2 Cl-94* HCO3-37* AnGap-15 [**2149-6-7**] 05:57AM BLOOD Glucose-191* UreaN-71* Creat-1.6* Na-141 K-4.4 Cl-96 HCO3-39* AnGap-10 [**2149-6-8**] 02:56PM BLOOD Glucose-216* UreaN-64* Creat-1.6* Na-139 K-4.4 Cl-95* HCO3-37* AnGap-11 [**2149-6-10**] 04:18AM BLOOD Glucose-217* UreaN-53* Creat-1.4* Na-140 K-4.9 Cl-97 HCO3-39* AnGap-9 [**2149-6-12**] 05:59AM BLOOD Glucose-297* UreaN-47* Creat-1.6* Na-138 K-4.8 Cl-96 HCO3-35* AnGap-12 [**2149-6-13**] 04:57AM BLOOD Creat-1.4* Na-141 K-4.5 Cl-96 [**2149-6-3**] 07:35PM BLOOD ALT-20 AST-16 LD(LDH)-390* AlkPhos-93 TotBili-0.3 [**2149-6-4**] 01:49AM BLOOD proBNP-1356* [**2149-6-4**] 01:49AM BLOOD Calcium-8.8 Phos-4.1 Mg-2.2 Iron-22* [**2149-6-4**] 01:49AM BLOOD calTIBC-244* Ferritn-253 TRF-188* [**2149-6-4**] 03:34PM BLOOD B-GLUCAN-Test negative TTE ([**2149-6-6**]) There is mild symmetric left ventricular hypertrophy with normal cavity size. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. No mitral regurgitation is seen. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Preserved left ventricular function. No pathologic structural valvular disease identified, but views are limited. CT Chest 1. The appearance of the lungs, while significantly obscured by motion artifact and extensive multifocal consolidations, is not typical for idiopathic pulmonary fibrosis as there is no evidence of basilar reticulation or honeycombing. The appearances are more in keeping with a multifocal pneumonia rather than an acute flare of pulmonary fibrosis. When the patient's clinical condition has improved, a HRCT may then be performed to assess for subtle pulmonary fibrosis. 2. Moderately severe pulmonary enlargement suggesting pulmonary hypertension. Brief Hospital Course: 57 year old man with history of DMII, IPF on prednisone 20, chronic MRSA osteomyelitis since [**9-17**] after ankle fracture, PAF on coumadin presents to [**Hospital3 **] ED on [**2149-6-3**] after 3 days of worsening dyspnea. # Hypoxia/respiratory failure: Patient on home 2L 02 and admitted with hypoxic respiratory distress and required full face bipap (failed nasal CPAP) for the first 24-36 hours. Etiology was unclear but felt likely multifactorial IPF (history of this, on 20mg po prednisone) vs. Pneumonia (increased cough, sputum production and leukocytosis) vs. CHF (bnp . He was treated with high dose IV steroids (125 q6 for 48 hours) for ? IPF flare, Vanc/Cefepime/Levoflox for HAP and he was diuresed with IV lasix. Over the course of 3 days his respiratory status improved so that he was satting 90-95% on 3-4L by NC, though he desatted to the 80s every time he moved. He was net negative almost 10 Liters over this time. His prednisone was decreased to 60 then 50 then 40mg po. His antbiotics were continued for an 8 day course. He was continued on full face Bipap overnight rather than nasal Bipap. He was eventually transitioned to po bumetamide and discharged home with physical therapy as he was able maintained good oxygen saturation with ambulation on 3LNC. # History of IPF: Patient's pulmonologist was on vacation when he was admitted, but OSH records showed that patient was initially admitted on [**4-/2148**] with bilateral pneumonia, and during this admission he was bronch'd and infectious etiologies were ruled out and he had a transthoracic biopsy which was used to get the diagnosis of IPF. Since then the patient's steroid requirement was as low as 10mg po daily but the he was hopsitalized in [**State **] last [**Month (only) 205**] with respiratory failure and since then has remained on 20mg prednisone and home 02. Patient's CT scan here was not consistent with IPF and it is not the usual standard here to diagnose IPF on transbronchial biopsy (typically transthoracic). Patient was continued on Dapsone for PCP [**Name Initial (PRE) 1102**] (concern at an earlier admission that he had renal failure from Bactrim). Vitamin D, Calcium, and a PPI were initially for his steroid course. # [**Last Name (un) **]: Patient's creatinine 2.2 on admission, up from 1.6 recently. After significant diuresis the kidney function improved to baseline at 1.6, likely poor forward flow from CHF. # Anemia: HCT down to 25 from baseline 30, normocytic, guiac negative. Hemolysis unlikely with nl bili and other hemolysis labs normal. Initially concerned for GI bleed still in ddx esp with INR of 3.5 but patient guiac negative and had no BRBPR. Patient's iron studies showed iron deficiency. # PAF: Anticoaggulated for remote DVT, PAF, and immobility with osteo. INR supratherapeutic, so his warfarin was initially held which led to it being subtherapeutic. Coumadin was increased to 7.5 mg to maintain goal INR [**3-13**]. # Chronic osteomyelitis: Patient on Daptomycin, which was held when he was treated for HAP. Daptomycin was subsequently restarted after he completed 8 days of his HAP regimen. # DM: Exacerbated by steroids at present. He was maintained on Lantus 70 QAM, 60 QPM plus SSI. [**Last Name (un) **] was consulted with eventual lantus of 75 qam and 55 qpm upon discharge. # HTN: His home antihypertensives were initially held and were subsequently restarted. Follow up for PCP 1. Please check electrolytes and kidney function at the next visit and decide whether to decrease bumetamide to qdaily instead of [**Hospital1 **] based on volume status and kidney function. 2. Please discuss with pulmonologist regarding further evaluation of IPF 3. Please check INR and adjust coumadin dose according. Follow up for ID 1. Please check kidney function and ajdust Daptomycin dose frequency accordingly. Medications on Admission: 1) Daptomycin 1300mg Q48H since [**6-2**] 2) Neurontin 400mg PO TID 3) Nortryptaline 50 PO BID 4) Prednisone 20mg PO daily 5) Coumadin 5mg PO daily 6) Norvasc 10 daily 7) Coreg 25mg PO BID 8) Paxil 40mg PO daily 9) Bumex 3mg PO BID 10) Lantus 70 units QAM, 60 units QPM 11) SSI 12) Dapsone 100mg PO daily 13) Metolazone 5mg PO BID 14) Pantoprazole 40mg PO Daily Discharge Medications: 1. daptomycin 500 mg Recon Soln Sig: 1300 (1300) mg Intravenous once a day. Disp:*30 doses* Refills:*0* 2. gabapentin 400 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 3. nortriptyline 50 mg Capsule Sig: One (1) Capsule PO twice a day. 4. prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 PM. Disp:*30 Tablet(s)* Refills:*2* 6. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 7. carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day. 8. paroxetine HCl 40 mg Tablet Sig: One (1) Tablet PO once a day. 9. bumetanide 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. insulin glargine 100 unit/mL Solution Sig: Seventy Five (75) units Subcutaneous qam. 11. insulin glargine 100 unit/mL Solution Sig: Fifty Five (55) units Subcutaneous qpm. 12. dapsone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Discharge Disposition: Home With Service Facility: [**Hospital **] Home Health Care Discharge Diagnosis: Primary Diagnosis: Multilobar pneumonia, Acute on chronic diastolic heart failure, Acute on chronic kidney injury Secondary Diagnosis: OSA, obesity hypoventilation syndrome, Hypertension, Type 2 Diabetes 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: It was a pleasure taking care of you during your stay here at [**Hospital1 18**]. You were admitted for shortness of breath and increasing oxygen requirements. CT scan revealed a multilobar pneumonia. You were started on IV antibiotics for a total eight day course. In addition, you had an exacerbation of your diastolic heart failure. Your heart is slightly stiff as a result of high blood pressure. It is not as effective at pumping the fluid through your body. You were given IV diuretics to help remove this fluid and eventually transitioned to bumetanide orally. Your steroids were increased while in the ICU, but a taper was initiated thereafter. Please discuss your steroid course with your outpatient lung doctor. The following changes were made to your medication regimen: INCREASE PRENDISONE to 40 mg by mouth once a day. Please discuss your steroid course with your outpatient lung doctor. INCREASE COUMADIN to 7.5 mg by mouth once a day. Please discuss with your primary care doctor next week about continuing on current dose or decreasing the current dose. START BUMETANIDE 2 mg by mouth twice a day. Please discuss with your primary care doctor next week about continuing on current dose or decreasing the current dose. STOP METALOZONE 5 mg by mouth once a day INCREASE your morning lantus to 75 units while DECREASING your pm lantus to 55 units Followup Instructions: Name: BROWN,[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Location: FAMILY MEDICINE ASSOCIATES Address: [**State 90014**], [**Location **],[**Numeric Identifier 14085**] Phone: [**Telephone/Fax (1) 14086**] Appointment: Tuesday [**2149-6-17**] 9:45am Department: PULMONARY FUNCTION LAB When: THURSDAY [**2149-7-10**] at 12:10 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: MEDICAL SPECIALTIES When: THURSDAY [**2149-7-10**] at 12:30 PM With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 612**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage **You have also been placed on a cancellation list. The office will contact you if a sooner appointment becomes available. Department: INFECTIOUS DISEASE When: [**Hospital Ward Name **] [**2149-6-23**] at 9:50 AM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 457**] Building: LM [**Hospital Unit Name **] [**Hospital 1422**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: PODIATRY When: [**Hospital Ward Name **] [**2149-6-23**] at 11:10 AM With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM [**Telephone/Fax (1) 543**] Building: Ba [**Hospital Unit Name 723**] ([**Hospital Ward Name 121**] Complex) [**Location (un) **] Campus: WEST Best Parking: [**Street Address(1) 592**] Garage Department: PULMONARY FUNCTION LAB When: THURSDAY [**2149-7-10**] at 12:10 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage ICD9 Codes: 486, 5849, 4280, 4019, 2724
{ "dataset_link": "https://huggingface.co/datasets/ricardosantoss/ehrcomplete_icdfiltered", "dataset_name": "ehrcomplete-icdfiltered", "id": 7396 }
Medical Text: Admission Date: [**2195-8-28**] Discharge Date: [**2195-9-8**] Date of Birth: [**2142-7-7**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2777**] Chief Complaint: acute left lower extremity ischemia and hypotension Major Surgical or Invasive Procedure: [**2195-8-29**] Mesenteric arteriogram, SMA stent, thrombectomy of left limb or aortobifemoral graft, endarterectomy of left CFA/SFA/PFA, left lower leg fasciotomy History of Present Illness: 52 year-old gentleman with a complicated h/o peripheral vascular disease s/p aorto-bifemoral bypass in [**2191**], pancreatic mass s/p Whipple in [**2192**], and esophageal cancer s/p esophagectomy with colonic interpostion 4 months ago complicated by necrosis of the neoesophagus and development of an enterocutaneous fistula who presents with altered mental status. Pt was found by his wife to have altered mental status this AM and presented to an OSH. He was found to be hypotensive, hypernatremic and hyperchloremic, abd was fluid resuscitated, and started on levophed. He had a CXR which showed a right middle lobe pneumonia. Pt was started on abx prior to being transferred to [**Hospital1 18**]. His left leg was found to be acutely ischemic with no dopplerable signals in the left foot with coolness up to the left mid-thigh. Past Medical History: Aorto-bifemoral bypass [**8-19**] MI HTN R CEA ([**7-19**]) Knee athroscopy Whipple operation ([**Doctor Last Name 468**]) in [**2192**] for benign pancreatic mass Esophagectomy with colonic interposition complicated by neoesophagus necrosis requiring resection and spit fistula creation ([**2195-4-22**]) Social History: Pt lives with family. He works on an assembly line at a brickyard. He formerly smoked 2 PPD x 40 years. Family History: Father with liver cirrhosis from ETOH use Physical Exam: Afebrile/VSS No distress, alert and oriented x 3 PERLA, EOMI, anicteric Neck with spit fistula draining to ostomy appliance RRR, no murmurs, lungs clear Abdomen soft, nontender, midline wound healing by secondary intention with good granulation tissue in place; known ECF in right aspect of wound drainge brown fluid Left groin incision C/D/I, left lower leg fasciotomy incisions C/D/I . Pulses: palpable femorals, dopplerable PTs bilaterally Pertinent Results: Admission: [**2195-8-28**] 07:55PM BLOOD WBC-12.9*# RBC-4.19*# Hgb-11.9*# Hct-39.8*# MCV-95# MCH-28.5 MCHC-30.0* RDW-17.2* Plt Ct-170 [**2195-8-28**] 07:55PM BLOOD Neuts-78.4* Lymphs-16.0* Monos-5.2 Eos-0.2 Baso-0.3 [**2195-8-28**] 08:08PM BLOOD PT-14.4* PTT-24.9 INR(PT)-1.2* [**2195-8-28**] 07:55PM BLOOD Glucose-247* UreaN-42* Creat-1.1 Na-177* K-2.7* Cl-GREATER TH HCO3-17* [**2195-8-28**] 07:55PM BLOOD CK(CPK)-1423* . CK trends: [**2195-8-29**] 12:10PM BLOOD CK(CPK)-3334* [**2195-8-30**] 12:59AM BLOOD CK(CPK)-4913* [**2195-8-30**] 04:25PM BLOOD CK(CPK)-7135* [**2195-8-30**] 10:13PM BLOOD CK(CPK)-7338* [**2195-8-31**] 12:20PM BLOOD CK(CPK)-6963* [**2195-9-1**] 04:47AM BLOOD CK(CPK)-5514* [**2195-9-1**] 12:07PM BLOOD CK(CPK)-4823* . Discharge: [**2195-9-7**] 05:05AM BLOOD WBC-4.7 RBC-3.19* Hgb-9.4* Hct-28.9* MCV-91 MCH-29.4 MCHC-32.5 RDW-16.7* Plt Ct-308# [**2195-9-8**] 04:13AM BLOOD PT-17.5* PTT-74.0* INR(PT)-1.6* [**2195-9-7**] 05:05AM BLOOD Glucose-219* UreaN-13 Creat-0.4* Na-136 K-4.2 Cl-104 HCO3-25 AnGap-11 [**2195-9-8**] 04:13AM BLOOD Mg-1.7 Brief Hospital Course: Mr. [**Known lastname 60925**] was admitted on [**2195-8-28**] with hypotension and an acutely ischemic left leg. A CT revealed a SMA stenosis with concerns for acute mesenteric ischemia given the patients hypotension requiring a vasopressor. It also revealed that the left limb of his previous aorto-bifemoral graft was thrombosed causing his left leg to be ischemic. On [**2195-8-29**] he was taken emergently to the operating room where an arteriogram and SMA stent were performed. Simultaneously, his left groin was explored and a thrombectomy performed of the left limb of his aortobifemoral graft. An endarterectomy was performed of his left CFA, SFA, and PFA. Due to concerns for ischemia and potential compartment syndrome formation, a left lower leg fasciotomy was performed. He was taken to the CVICU and continued on broad spectrum antibiotics post-operatively. . Pulses: He left foot had no dopplerable signals and his femoral was weakly dopplerable. Post operatively his exam was notable for a palpable femoral pulse and a strong dopplerable left PT signal. Initially, in the post-operative period, his left PT signal was weak, but this was due to global hypoperfusion and vasopressors. Once his pressors were weaned down, his PT signal became very strong. His fasciotomy incisions are healing nicely. . Neuro: Post-operatively he required propofol and then fentanyl and versed to maintain adequate sedation and pain control while intubated. His neuro exam remained intact and these were discontinued when he was extubated. He is currently on prn dilaudid for pain control. He does have left drop foot requiring a multipodis boot. . Cardiovascular: He required vasopressor support post-operatively and aggressive resuscitation. He remained in vasodilatory shock for a number of days and the neosynephrine was finally able to be weaned off on [**2195-9-4**]. He remained hemodynamically stable and was able to be transferred out of the CVICU and into the VICU. He is stable. . Pulmonary: He remained intubated until POD4. On POD zero, he was noted to have increased opacification of his right hemithorax. He underwent a bronchoscopy where copious secretions were encountered and suctioned. His post-bronch CXR showed improved aeration of his lungs. He was continued on broad spectrum antibiotics with double coverage for Pseudomonas due to his recent hospitalization being complicated by resistant Pseudomonal pneumonia. His BAL specimen never grew any organisms and his antibiotics were discontinued by one antibiotic daily. . Gastrointestinal: He was able to be started on trophic tube feeds while in the CVICU. Once he was off pressors and stable, these were able to be advanced to goal. He continues to have a spit fistula that drains to an ostomy appliance. His known enterocutaneous fistula started to have feculent drainage. General and Thoracic surgery were consulted and a wound vac was placed in attempts to isolate the fistula. The was continued leakage of fistula output and the vac was only functioning part of the time. Thoracic surgery is managing his fistula and recommended discontinuing the wound vac and starting moist to dry dressing changes to his abdominal wound. . Genitourinary: He had more than adequate urine output beginning in the immediate post-operative period. His foley catheter was able to be removed once he was out of the ICU and he voids without difficulty. . Heme: He was maintained on a heparin gtt to maintain patency of his circulation. He is currently being transitioned to coumadin. His did require transfusion of 3 units of PRBC in the early post-operative period, but his hematocrit has remained stable since transfusion. . Endocrine: His blood sugars have been well controlled on sliding scale insulin. . Infectious Disease: Due to his septic physiology on admission he was placed on broad spectrum antibiotics empirically. On POD zero there were concerns for pneumonia based on CXR and bronchoscopy so double coverage was started for his history of Pseudomonas pneumonia. Infectious disease was consulted. All of his culture date returned negative so his antibiotics were discontinued one at a time. He is currently on no antibiotics and his WBC is normal. . He is discharged in good condition to rehab. He will need physical therapy and nursing care for his spit fistula, enterocutaneous fistula, and healing midline abdominal wound. Medications on Admission: Atenolol 50mg daily, Simvastatin 40mg daily, Diovan 160-25mg daily, percocet prn Discharge Medications: 1. Acetaminophen 650 mg Suppository [**Date Range **]: One (1) Suppository Rectal Q6H (every 6 hours) as needed for fever/pain. 2. Clopidogrel 75 mg Tablet [**Date Range **]: One (1) Tablet PO DAILY (Daily) for 30 days: For 30 days only. 3. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 4. Insulin Lispro 100 unit/mL Solution [**Last Name (STitle) **]: per sliding scale units units Subcutaneous ASDIR (AS DIRECTED): glucose dose 121-140 2 units 141-160 4 units 161-180 6 units 191-200 8 units 201-220 10 units 221-240 12 units 241-260 14 units 261-280 16 units 281-300 18 units. 5. Nystatin 100,000 unit/mL Suspension [**Last Name (STitle) **]: Five (5) ML PO QID (4 times a day) as needed for thrush. 6. HYDROmorphone (Dilaudid) 0.5-1 mg IV Q4H:PRN pain 7. Warfarin 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Once Daily at 4 PM: Goal INR of [**2-17**]. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Acute left leg ischemia Mesenteric ischemia Enterocutaneous fistula Discharge Condition: Good Discharge Instructions: Incision Care: Keep clean and dry. -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. -If you have staples, they will be removed during at your follow up appointment. . 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 skin, or the whites of your eyes become yellow. * 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. * 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. * Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * Continue to ambulate several times per day. * No heavy ([**10-29**] lbs) until your follow up appointment. . * Continue tube feeds * Continue coumadin with a goal INR of [**2-17**], adjust dose accordingly * Continue spit fistula care * Continue abdominal wound and enterocutaneous fistula care * Continue physical therapy daily * Continue to wear multipodis boots Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2195-9-24**] 11:00 ICD9 Codes: 0389, 2762, 2760, 2875, 4019, 412
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Medical Text: Admission Date: [**2113-5-4**] Discharge Date: [**2113-5-8**] Date of Birth: [**2036-5-25**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 898**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: Right IJ sepsis triple lumen placed History of Present Illness: 76 year old woman with h/o Myasthenia [**Last Name (un) 2902**], atrial fibrillation was well until one week prior to admission when she developed runny nose, fatigue, and malaise. She then noted a cough with green sputum. She originally was afebrile, but a few days prior to admission, developed chills and subjective fevers. She was so weak, she was confined to her bed. At that point, her family took her to the ED. In the ED, 102.7, 75, 133/66, 18, 95% RA. CXR with RML PNA. Lactate 4.4. Code sepsis was called and Right IJ line placed. She was given levofloxacin, ceftriaxone, flagyl, hydrocortisone (stress dose), and tylenol. She was then admitted to the MICU. She was given levophed per protocol, but this was quickly weaned off. Past Medical History: Myasthenia [**Last Name (un) 2902**] on chronic prednisone atrial fibrillation hyperlipidemia Social History: Lives with her husband, she has a 25 pack year smoking history, but quit 25 years ago. No alcohol or drug use. Family History: brother with DM Physical Exam: on admission: V/S: 102.7, 133/66, 75, 18, 95% RA GEN: in NAD HEENT: PERRL, conjunctiva normal, nasal mucosa wnl, oropharynx dry. neck supple without JVD COR: irreg, irreg, II/VI systolic murmer\ LUNGS: coarse breath sounds right base Abd; Soft, mild RUQ tenderness, nd, +BS ext: no LE edema Pertinent Results: [**2113-5-4**] 04:00PM WBC-15.2* RBC-4.90 HGB-15.4 HCT-44.6 MCV-91 MCH-31.5 MCHC-34.6 RDW-13.4 [**2113-5-4**] 04:00PM PLT SMR-NORMAL PLT COUNT-276 [**2113-5-4**] 04:00PM NEUTS-86.2* BANDS-0 LYMPHS-10.2* MONOS-3.1 EOS-0.2 BASOS-0.2 [**2113-5-4**] 04:00PM CORTISOL-35.0* [**2113-5-4**] 04:08PM LACTATE-4.4* [**5-8**]: urine sodium 85 Brief Hospital Course: 1) pneumonia complicated by sepsis: patient was seen in the ED and a "code sepsis" was called based on fever, tachycardia, and a lactate of 4.4. She had a chest x ray demonstrating a right middle lobe pneumonia. She had transient hypotension and was on Levophed. She was admitted to the MICU and placed on ceftriaxone and azithromycin. She had received a dose of levofloxacin in the ED, but this was stopped due to potential reaction with myasthenia. Her Levophed was quickly weaned off and she was quickly hemodynamically stable. She remained on O2, but this was also stopped after a couple of days. Her NIFs and vital capacities were monitored to ensure no myasthenic crisis. These remained stable. She was called out to the floor and did well. Her d/c NIF was -22 and vital capacity was -1100. She was discharged home and will complete a course of cefpodoxime and azithromycin. She will follow her respiratory status as azithromycin can also provoke a myasthenic crisis. She was also given a dose of Pneumovax prior to her discharge. No organism was identified as the etiology of her pneumonia. 2) myasthenia [**Last Name (un) 2902**]: patient was maintained on prednisone and Mestinon at her home doses. Dr. [**Last Name (STitle) **] and neurology followed her initially. She did well and had no complications from her myasthenia. She will be followed as an outpatient. She was started on Bactrim for pneumocystis prophylaxis given her chronic steroid use. 3) mineralocorticoid deficiency: Ms. [**Known lastname 12289**] had persistently low blood pressures upon leaving the intensive care unit. SBP in the 80s when sitting, improved to low 100s when lying in bed. These were minimally responsive to fluid boluses. She also did not appear volume depleted. Given her chronic prednisone use(relatively glucocorticoid specific), a urine sodium was checked. This was >80. It was thought that she had a mineralocorticoid deficiency and was started on Florinef. Her blood pressure appeared to rise following it use. She will be discharged on this medication. 4) atrial fibrillation: the patient remained in atrial fibrillation as an inpatient. She had several runs of rapid ventricular response to 140s-150s. Initially her b blocker was held due to low blood pressure. A smaller amount was restarted in order to control her heart rate. This was effective and she was discharged home on a lower dose of b blocker as well as coumadin. INR at time of d/c was 2. Medications on Admission: atenolol 50 mg po daily coumadin prednisone 35 mg po daily metinon 30 mg po daily protonix 40 mg po daily fosamax 70 mg po qsunday Discharge Medications: 1. Cefpodoxime Proxetil 200 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 10 days. Disp:*20 Tablet(s)* Refills:*0* 2. Prednisone 10 mg Tablet Sig: 3.5 Tablets PO DAILY (Daily). Disp:*105 Tablet(s)* Refills:*0* 3. Fludrocortisone Acetate 0.1 mg Tablet Sig: One (1) Tablet PO 3X/WEEK ([**Doctor First Name **],TU,TH). Disp:*90 Tablet(s)* Refills:*0* 4. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 5. Pyridostigmine Bromide 60 mg Tablet Sig: 0.5 Tablet PO QAM (once a day (in the morning)). 6. Alendronate Sodium 70 mg Tablet Sig: One (1) Tablet PO QSUN (every Sunday). 7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Calcium Carbonate 1,250 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 10. Warfarin Sodium 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): As directed by PCP. [**Name10 (NameIs) 357**] have your INR checked regularly. 11. Outpatient Lab Work Please check INR. Discharge Disposition: Home Discharge Diagnosis: 1. Pneumonia complicated by sepsis 2. Myasthenia [**Last Name (un) **] on chronic steroids 3. Atrial fibrillation 4. Mineralocorticoid deficiency Discharge Condition: Good, oxygenating well on room air and ambulating without assistance. NIF -22 Discharge Instructions: You are discharged to home and should continue all medications as prescribed. Please contact your physician or present to the ER if you experience fevers, chills, night sweats, cough, shortness of breath, chest pain or other concerns. Please make a follow-up appointment with your primary care physician. Followup Instructions: Please make a follow-up appointment with your primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 553**] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3329**]) within one week after discharge. It is important that you have your INR (Coumadin level) checked regularly. These results should be available to Dr. [**Last Name (STitle) **] who will adjust your Coumadin dose accordingly. ICD9 Codes: 0389, 486, 2762, 4019, 2720, 2859
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Medical Text: Admission Date: [**2148-11-27**] Discharge Date: [**2148-12-5**] Date of Birth: [**2092-1-16**] Sex: F Service: OMED CHIEF COMPLAINT: Pain. HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname **] is a 56 year-old female with no past medical history who presented for an initial visit with outpatient oncologist on [**2148-11-27**]. Her pertinent oncologic history began eight months ago when she noticed a lump in her right breast. She did not seek medical attention until [**Month (only) 1096**] due to desire to spare her family pain of dealing with cancer. The patient's family recently lost a son to [**Name (NI) **] sarcoma six years ago. The patient finally sought medical attention when her back pain became too severe to ignore. The patient's back pain had begun in [**Month (only) 216**] and waxed and waned over the fall. The patient saw her primary care nurse [**First Name8 (NamePattern2) 3639**] [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7749**] at the [**Hospital 14840**] Health Center and was referred to a surgeon. The patient underwent excisional breast biopsy on [**2148-11-18**] revealing an infiltrating carcinoma grade 3 out of 3 with a lobular component, ER positive, HER-2/neu negative. Bone scan done one week ago shows uptake in multiple ribs and vertebral bodies as well as lighter areas of uptake in the right femur and right hip. Formal report of this study is not available. The patient's family reports that her pain control had been very inadequate and they had been up with her q one hour giving her breakthrough liquid Oxycodone in addition to a Fentanyl patch, which has been up from 25 to 75 over the last two weeks. They also report that her breathing has become labored and she has not eaten anything and taking only liquids for two weeks as well. The patient has had sweats, but no fevers, headache, no bowel movements for one week. The patient has been essentially bedridden since last Thursday. PAST MEDICAL HISTORY: Benign breast biopsy twenty years ago. MEDICATIONS: Fentanyl patch 75 micrograms, Oxycodone for breakthrough pain, Zantac liquid b.i.d. ALLERGIES: No known drug allergies. SOCIAL HISTORY: Married with three living children. Son died six years ago from [**Doctor First Name **] sarcoma. The patient has a 100 pack year history of tobacco. Previously drank three to four beers per day, but none since [**2148-11-2**]. The patient worked as a teacher and then stayed home with the kids. Recently was working as a retail store manager. PHYSICAL EXAMINATION: Temperature 99.2. Pulse 100. Blood pressure 112/84. Respiratory rate 24. O2 sat 94% on 4 liters. Cachectic, ill appearing female in mild respiratory distress. HEENT temple wasting, anicteric sclera. Oropharynx dry with no thrush. No cervical adenopathy. Lungs decreased breath sounds bilaterally. Cardiac regular. Normal S1 S2. No murmurs, rubs or gallops. Breast examination fresh surgical biopsy on the right with extensive ecchymosis. Left breast unremarkable. Abdomen flat with hypoactive bowel sounds. Nontender, nondistended. No organomegaly. Extremities no clubbing, cyanosis or edema. Neurological lethargic with poor recalls. Cranial nerves II through XII are intact. Strength 4 out of 5 throughout. Decreased sensation to light touch in right arm and left leg. Reflexes 2+ throughout. Down going Babinski. LABORATORY: White blood cell count 8.4, hematocrit 39.3, platelets 328, PT 13.9, INR 1.3, PTT 27.7, sodium 126, potassium 4.4, chloride 83, bicarb 32, BUN 13, creatinine 0.3, ALT 15, AST 31, LDH 479, alkaline phosphatase 132, total bilirubin 0.6, albumin 2.9, calcium 9.3, CEA 24, CA27-29 pending. IMAGING: Head CT from [**2148-11-29**] showed no intracranial metastases with possible cystic lung lesions. Chest CT from [**2148-11-29**] showed bolus emphysema, small bilateral pleural effusions. No metastasis. Spinal MR from [**2148-12-1**] showed multiple areas of metastatic disease in the cervical, thoracic and lumbar spine. No evidence of cord compression. Mild pathologic compression fracture of T3 and T6, bilateral small pleural effusions. HOSPITAL COURSE: 1. Pulmonary: The patient was in moderate respiratory distress on arrival with an O2 sat of 80% on room air that increased to 94% on 4 liters. The patient was also given significant amount of narcotics as well as benzodiazepines for pain and anxiety. The patient became more lethargic and arterial blood gases showed hypercarbic respiratory failure. The patient was intubated on the floor and taken to the _________ Intensive Care Unit. The patient initially got a single dose of Azithromycin in the Intensive Care Unit and remained on the ventilator until she self extubated on [**2148-12-1**]. The patient did well with multiple Atrovent and Albuterol nebulizers. Flovent was added to her pulmonary regimen. The patient remained extubated and did well and was transferred to the floor. Pulmonary function tests will be obtained on [**2148-12-5**] to assess her emphysema. A chest CT showed large bolus emphysema. The patient has a long significant history of smoking. Will schedule Ms. [**Known lastname **] with outpatient follow up with Dr. [**Last Name (STitle) 575**] in the Pulmonary Department. Tolerated O2 sat at 92% given patient's tendency to retain CO2. Also need to avoid increasing her narcotics or giving her any benzodiazepines given her propensity to retain CO2. 2. Oncologic: The patient has significant skeletal metastases of her breast cancer. The patient was started on Arimidex and given pamidronate in the Intensive Care Unit. The patient will continue on Rumidex for hormonal treatment of her breast cancer and will receive monthly doses of pamidronate. The patient will follow up with her Dr. [**Last Name (STitle) 26065**] her oncologist in one month for dose of Pamidronate and to assess the effectiveness of the Arimidex. 3. Pain: The patient's pain was better controlled after her Intensive Care Unit stay when her Fentanyl patch was increased to 100. She was on low dose NSIR for breakthrough. In addition, will add NSAIDS for breakthrough pain Ibuprofen 600 mg t.i.d. Any changes in her narcotics should be discussed with Dr. [**Last Name (STitle) 26065**] her primary oncologist. Should avoid increasing her narcotics due to her demonstrated ability to retain CO2 and develop hypercarbic respiratory failure. If the patient's pain again becomes difficult to manage will consider palliative radiation therapy, but at this time there is no acute indication for radiation therapy given no evidence of sinal cord compression. DISCHARGE MEDICATIONS: Multiple vitamin one tab po q.d., Atrovent MDI two puffs meter dose inhaler q 6 hours, Albuterol MDI two puffs q 2 hours prn, Albuterol Atrovent nebulizers q 4 hours prn, heparin subQ 500 units b.i.d., Arimidex 1 mg po q day, Fentanyl patch 100 micrograms po q 72 hours, Colace 100 mg po b.i.d., Boost one po b.i.d., Flovent 110 micrograms per puff four puffs b.i.d., Ibuprofen 600 mg po q 8 hours prn should be used initially prior to using narcotics for breakthrough. NSIR 10 mg po q 4 hours prn if NSAIDS do not relieve pain. Dulcolax 10 mg po pr q day prn. Senna one tab po q.h.s. DISCHARGE STATUS: To rehab. DISCHARGE CONDITION: Fair. DISCHARGE DIAGNOSES: 1. Breast cancer with skeletal metastasis. 2. Bolus emphysema. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 26066**], M.D. [**MD Number(1) 26067**] Dictated By:[**Last Name (NamePattern1) 16516**] MEDQUIST36 D: [**2148-12-4**] 12:02 T: [**2148-12-4**] 13:05 JOB#: [**Job Number 37309**] ICD9 Codes: 2765, 2930
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Medical Text: Admission Date: [**2151-1-27**] Discharge Date: [**2151-3-23**] Date of Birth: [**2071-8-27**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: hypotension Major Surgical or Invasive Procedure: intubation and mechanical ventilation placement of gallbladder drain Central venous line Hemodialysis Percutaneous jejunostomy tube placement PICC line History of Present Illness: 79M with CAD s/p recent CABG & AVR, CHF (EF 20%), DM2, hyperlipidemia, and HTN who has been at [**Hospital **] Rehab for the past 2 weeks following a prolonged hospitalization at [**Hospital1 112**] for CHF, CABG, AVR c/b difficulty weaning and trach placement (since removed), G-tube placement, line infection, ileus, oral candidiasis, and sacral decub ulcer. On day of admission, pt was in an ambulance on his way to a scheduled cardiology appt when his SBP was noted to be in the 60s and he was instead brought to the ED for further evaluation. <br> Of note, pt had increased sputum at [**Hospital1 **] and was started on [**First Name9 (NamePattern2) 64983**] [**1-26**] for presumed bronchitis vs PNA. This AM, covering rehab MD [**First Name (Titles) 8706**] [**Last Name (Titles) 7968**] UOP, elevated HR, and "low but unchanged SBP in 100-120 range." In addition, pt's lisinopril 5 mg daily was held due to creatinine 2.2 (up from 1.3 per report). <br> Upon arrival to [**Name (NI) **], pt's BP 67/44, HR 110s, temp 101.2, Sat 97% 2L NC. SBP improved to 90s within ~ 2 hours after IVF given. In addition, patient was found to have RUQ tenderness so CT abd/pelvis was obtained & showed "sludge within a distended appearing gallbladder. There may also be pericholecystic fluid or wall edema that is concerning for acute cholecystits." CT also revealed pericardial and bilat pleural effusions, moderate ascites, and R-inguinal hernia with nonobstucted small bowel. Surgery was consulted & recommended IV antibiotics and urgent percutaneous GB drainage catheter placement by IR. Labs were signif for WBC 15 w/88% neut, 0% bands, Hct 24, K+ 5.7, proBNP 30,000. Lactate 1.5, INR 2.2 on coumadin. Pt rec'd [**Name (NI) 64983**], flagyl, vancomycin, 2U PRBC, 1L NS, and Tylenol PR. Two sets blood Cx sent. <br> Upon my eval in the ED, he denies any abdom pain, F/C, N/V, or diarrhea (in fact is slightly constipated). He has noted increased sputum production (yellow, thick) over the past few days. Pt also c/o pain in his buttocks at the site of skin breakdown. Denies CP, SOB, palpitations. Pt also denies any lightheadedness, visual changes, or known confusion when his BP was low. Also denies BRBPR, melena, hematuria, or new bruises. No known aspiration or choking episodes. Past Medical History: -CAD s/p stents in [**2146**]; s/p CABG, AVR(bioprothetic), pericardial stripping on [**2150-12-16**] at [**Hospital1 112**]. On coumadin. -DM2 x ~40 yrs on oral hypoglycemics at home -hyperlipidemia -HTN (although SBP 100-120 & only on lisinopril 5 @ rehab) -Atrial fibrillation -GERD Social History: -transferred from [**Hospital **] Rehab -remote TOB: ~10 pack-yrs; quit >40 yrs ago. -HCPs is son & daughter Physical Exam: -VS: temp 101.2->96.3 (after Tylenol in ED), HR 75-85, BP 106/30 (in ED), repeat BP 83/55 with MAP 67 (in ICU), RR 20, Sat 100% NC. Pulsus <10 mmHg. -Gen: cachectic elderly M sitting in stretcher in NAD -Skin: former trach site w/thick, yellowish mucus; sacral dressing over known decub; G-tube site without erythema; sternotomy site intact, nonerythematous. -HEENT: OP clear, dry MM, poor dentition. [**Name (NI) 3899**], [**Name (NI) 64984**] ptosis (per family, has been like this x years). ~1 mm pupils bilaterally. -Neck: JVD to mandible, supple, full ROM -Heart: S1S2, irreg irreg, II/VI SM -Lungs: coarse upper airway sounds anteriorly. Posteriorly: [**Name (NI) 7968**] B.S. R-lower [**12-29**] and L-base. Crackles 1/2 up on right and 1/3 up on left. Fair air movement. No wheezes appreciated. -Abdom: mild tenderness to palp in RUQ; somewhat tense muscles but no rebound or guarding. +B.S. -Extrem: thin; 1+ pitting edema bilat LEs up to knees; 1+ pitting sacral edema; trace DP pulses bilat; 1+ radial pulses bilat. -Neuro/Psych: A&Ox3, answers ?s in [**12-28**] word phrases, speech fluent but difficult as former trach site still open. [**4-30**] strength in upper extrem. 2/5 strength in lower extrem. CN2-12 intact. Pertinent Results: Admission labs <BR> [**2151-1-27**] 01:45PM GLUCOSE-174* UREA N-77* CREAT-2.1* SODIUM-137 POTASSIUM-5.7* CHLORIDE-106 TOTAL CO2-22 ANION GAP-15 [**2151-1-27**] 01:45PM ALT(SGPT)-27 AST(SGOT)-26 CK(CPK)-17* ALK PHOS-141* AMYLASE-22 TOT BILI-1.0 [**2151-1-27**] 01:45PM CK-MB-4 cTropnT-0.31* proBNP-[**Numeric Identifier 64985**]* [**2151-1-27**] 01:45PM ALBUMIN-2.5* [**2151-1-27**] 01:45PM CALCIUM-8.5 PHOSPHATE-3.6 MAGNESIUM-2.8* [**2151-1-27**] 01:45PM HAPTOGLOB-268* [**2151-1-27**] 01:45PM DIGOXIN-2.2* [**2151-1-27**] 01:45PM WBC-15.0* RBC-2.69* HGB-8.1* HCT-23.9* MCV-89 MCH-29.9 MCHC-33.7 RDW-20.1* [**2151-1-27**] 01:45PM NEUTS-88.8* BANDS-0 LYMPHS-6.7* MONOS-4.2 EOS-0.1 BASOS-0.2 . Discharge Labs: WBC 8.9, Hct 34, plt 156 inr 1.3, ptt 34 na 143, k 5.2, cl 109, bicarb 26, bun 51, creat 2.8 ca 9.2, phos 3.2, mag 1.8 alt 14, ast 19, ap 171, Tbili 0.4, amylase 18, lipase 7 PTH 52 Vanco (random, [**2151-3-16**]) = 33.2 Digoxin ([**2151-3-17**]) 0.8 ABG 7.46/40/95 ([**2151-3-11**]) <BR> CT OF THE ABDOMEN WITHOUT IV CONTRAST: There is a small pericardial effusion. There are coronary artery calcifications. A metallic clip is seen in the region of the pericardium. There are moderate large bilateral pleural effusions, right greater than left. There is bibasilar atelectasis/consolidation, as well as consolidation/collapse within the right middle lobe. There is a 4-mm calcified nodule in the left lower lobe. There is also fluid in the left major fissure. On the unenhanced scan, the liver, adrenal glands, kidneys, and pancreas are unremarkable. Multiple calcifications are seen within the spleen. There are multiple vascular calcifications within the abdomen. There is atherosclerotic calcification of the descending aorta, including at the major branch points of the celiac axis, and inferior mesenteric arteries, as well as bilateral renal arteries. There is high attenuation layering within the gallbladder consistent with sludge. There is a small-to-moderate amount of ascites seen adjacent to the liver, spleen, and pancreas. There also appears to be fluid in the gallbladder fossa, some of which may represent wall edema or pericholecystic fluid. The gallbladder itself is distended. Lymph nodes are seen within the mesentery measuring approximately 7-8 mm. There are similar appearing left paraaortic lymph nodes. There is a G-tube in place. There is also stranding of the mesentery. There are no dilated loops of large or small bowel. <BR> CT OF THE PELVIS WITHOUT IV CONTRAST: 1 Pericardial effusion, and moderate bilateral pleural effusions. Bibasilar atelectasis/consolidation. 2 Moderate ascites. 3 Sludge within a distended appearing gallbladder. There may also be pericholecystic fluid or wall edema. This is concerning for acute cholecystits in the appropriate clinical setting. 4. Right inguinal hernia containing nonobstructed small bowel and fluid. <BR> PORTABLE CHEST RADIOGRAPH: The patient is status post median sternotomy with sternal wires seen. The patient is status post mitral valve replacement. There are bibasilar opacities which could be secondary to pulmonary edema and/or overlying consolidation. There are bilateral pleural effusions, left greater than right. IMPRESSION: Developing pulmonary edema with possible underlying consolidations. <BR> [**2-12**] NON-CONTRAST CT SCAN OF THE NECK: An endotracheal tube is in place. Contrast is visualized around the upper aspect of the endotracheal tube and in the cervical esophagus. No definite sizeable masses are identified in the neck. No definite free fluid collections within the neck are identified. There is a right subclavian catheter. <BR> IMPRESSION: Contrast material visualized within the upper airway perhaps secondary to reflux from placement of contrast material for CT of the torso obtained at the same time. No definite evidence of pathologic fluid collection in the neck. <BR> EKG (admit): Atrial fibrillation with rapid ventricular response, Multifocal PVCs, Poor R wave progression, Nonspecific ST-T wave changes, No previous tracing available for comparison Rate PR QRS QT/QTc P QRS T 117 0 98 [**Telephone/Fax (2) 64986**] 157 <BR> ECHO: The left atrium is moderately dilated. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is moderately depressed (ejection fraction 40 percent), mainly due to abnormal left ventricular electrical/mechanical activation sequence. 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. A bileaflet aortic valve prosthesis is present. The aortic prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. Impression: ventricular dyssynchrony with reduced left ventricular ejection fraction <BR> FINDINGS T-tube cholangiogram: Appropriate position of cholecystostomy tube. Normal opacification of gallbladder, common bile duct, and intrahepatic bile ducts with drainage into the duodenum. Small amount of retrograde flow of contrast along the cholecystostomy tube likely of little clinical significance in the absence of the patient's symptoms. <BR> RENAL ULTRASOUND: The right kidney measures 10.7 cm, the left kidney measures 10.7 cm. There are no renal stones, masses or hydronephrosis. A Foley catheter is within the bladder. A small amount of ascites is seen within the right upper quadrant. IMPRESSION: No hydronephrosis. <BR> CHEST (PORTABLE AP) [**2151-3-13**] 10:17 AM: The right pleural effusion has [**Month/Day/Year 7968**] since the previous exam, however, there is suggestion of larger effusion on the left extending along the lateral chest wall. Overall the parenchymal opacities remain stable with compressive atelectasis in the left lung base. The degree of the pulmonary edema shows no change since the previous exam. <BR> There is a right PICC line with the tip in SVC and left subclavian dialysis catheter. A tracheostomy tube is in place. The patient is status post CABG and AVR. <BR> [**2151-2-5**] 11:01 am SPUTUM Source: Endotracheal. GRAM STAIN (Final [**2151-2-5**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM NEGATIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS. <BR> RESPIRATORY CULTURE (Final [**2151-2-7**]): OROPHARYNGEAL FLORA ABSENT. ENTEROBACTER CLOACAE. HEAVY GROWTH. This organism may develop resistance to third generation cephalosporins during prolonged therapy. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. For serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. _________________________________________________________ ENTEROBACTER CLOACAE | CEFEPIME-------------- 4 S CEFTAZIDIME----------- =>64 R CEFTRIAXONE----------- =>64 R CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S IMIPENEM-------------- <=1 S LEVOFLOXACIN---------- =>8 R MEROPENEM-------------<=0.25 S PIPERACILLIN---------- =>128 R TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S <BR> [**2151-2-2**] 2:56 pm SWAB R/O VANCOMYCIN RESISTANT ENTEROCOCCUS (Final [**2151-2-6**]): ENTEROCOCCUS SP.. MODERATE GROWTH. SENSITIVITIES: MIC expressed in MCG/ML <BR> _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ =>32 R CHLORAMPHENICOL------- 8 S LEVOFLOXACIN---------- =>8 R LINEZOLID------------- 2 S PENICILLIN------------ =>64 R VANCOMYCIN------------ =>32 R <BR> [**2151-2-8**] 10:52 am BRONCHIAL WASHINGS GRAM STAIN (Final [**2151-2-8**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. <BR> RESPIRATORY CULTURE (Final [**2151-2-11**]): 10,000-100,000 ORGANISMS/ML. OROPHARYNGEAL FLORA. STAPH AUREUS COAG +. 10,000-100,000 ORGANISMS/ML.. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. Rifampin should not be used alone for therapy. Please contact the Microbiology Laboratory ([**6-/2451**]) immediately if sensitivity to clindamycin is required on this patient's isolate. _________________________________________________________ STAPH AUREUS COAG + | ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- =>8 R OXACILLIN------------- =>4 R PENICILLIN------------ =>0.5 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- <=1 S VANCOMYCIN------------ <=1 S <BR> [**2151-3-14**] 2:36 am SPUTUM Source: Endotracheal. <BR> GRAM STAIN (Final [**2151-3-14**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE ROD(S). CONSISTENT WITH CORYNEBACTERIUM AND PROPIONIBACTERIUM SPECIES. <BR> RESPIRATORY CULTURE (Preliminary): SPARSE GROWTH OROPHARYNGEAL FLORA. STAPH AUREUS COAG +. SPARSE GROWTH. Please contact the Microbiology Laboratory ([**6-/2451**]) immediately if sensitivity to clindamycin is required on this patient's isolate. STAPH AUREUS COAG +. SPARSE GROWTH. 2ND STRAIN. Please contact the Microbiology Laboratory ([**6-/2451**]) immediately if sensitivity to clindamycin is required on this patient's isolate. GRAM NEGATIVE ROD(S). SPARSE GROWTH. <BR> SENSITIVITIES: MIC expressed in MCG/ML _<BR>________________________________________________________ STAPH AUREUS COAG + | STAPH AUREUS COAG + | | ERYTHROMYCIN---------- =>8 R =>8 R GENTAMICIN------------ <=0.5 S <=0.5 S LEVOFLOXACIN---------- =>8 R =>8 R OXACILLIN------------- =>4 R =>4 R PENICILLIN------------ =>0.5 R =>0.5 R RIFAMPIN-------------- <=0.5 S <=0.5 S TETRACYCLINE---------- <=1 S <=1 S VANCOMYCIN------------ <=1 S <=1 S Brief Hospital Course: 79M with CAD s/p CAGB, AS s/p AVR, DM2, Afib admitted to MICU for hypotension, suspected cholecystitis, likely PNA, and ARF. Hospital course outlined by problem. . HYPOTENSION: Initially BP stabilized after NS and PRBCs, but intermittently became hypotensive during the begining of his hospital stay thought to be related to sepsis. Blood cultures remained persistently sterile. [**Last Name (un) **] stim showed preservation of adrenal function with baseline at 21.9 and a rise to 38 after 1 hour after cosyntropin. Regardless was transiently placed on hydrocort. Continued to be hypotensive during CVVH only, but later was able to maintain his BP during HD sessions as time went on. Blood pressure meds should be held on his HD days for more effective ultrafiltration. Over the latter part of his hospital course, he has maintained systolic blood pressures greater than 90. He was able to tolerate small doses of hydralzyine 10 q 6 hours (holding for sbp than 90) and was recently started on toprol 12.5 mg qd. He has been aggressively dialyzed and bp meds should be held during hd days. . POSSIBLE ACUTE CHOLECYSTITIS: noted on CT abd/pelvis. RUQ tenderness but no peritoneal signs. Percutaneous gallbladder drain placed by IR on Febuary 3 & drained well, and initially covered on levo/flagyl/amp. IR study showed good drainage contrast into duodenum, so drain was clamped and LFT's/AlkP were followed with the surgery team. After the labs remained stable, this drain was pulled. Remained afebrile without abdominal pain after his course of antibiotics was completed. . RECURRENT PNA: he initially noted increased sputum, fever, and some infiltrates on CXR (CHF vs infiltrate) c/w PNA. Initially on levo/flagyl/amp and vanco for empiric coverage for cholecystitis, pneumonia, and skin flora. Sputum Cx grew back MRSA and enterobacter, changed to CTX after sensitivity panel. He later was treated for 2 full courses Vanc and Meropenem for PNA which was completed on [**3-6**]. There was evidence of aspirated contrast by CT initially, so pt's PEG was changed to PEJ to help prevent aspiration. Approximately 6 days prior to his hospital discharge he began having copious secretions. His CXR showed no evidence of a new pulmonary infiltrate. His WBC count rose slightly. Sputum grew MRSA and he was started on a 10 day course of vancomycin for MRSA tracheobronchitis. His vanc levels were dosed at 1g to keep levels >25 for good pulmonary penetration. His last vanco course will be completed on [**2151-3-20**]. . RESPIRATORY FAILURE: With his worsening respiratory difficult a trach was re-placed at the site of his prior trach site and he was vented as tolerated in the setting of CHF and PNA. Attempts were made to wean his from the trach, but were difficult in the setting of CHF, PNA, and severe deconditioning. He was gradually weaned off the vent with removal of fluid through hemodialysis / ultrafiltration and treatment of his pneumonias. He was on trach mask for >1 week prior to his discharge. He was speaking with a passy muir valve, however care must be taken to suction his secretions intermittently while the valve is on. He is able to cough some of his secretions into his mouth and has a good gag. . CHF: EF reportedly ~20% pre-CABG. ProBNP markedly elevated in ED but O2 sat stable on NC even after 2U PRBC in ED. JVD and crackles. Digoxin was held for serum level 2.2 and evidence of dig toxicity on EKG (accelerated junctional rhythm). He required two doses of digibind before his rhythm improved. Repeat EF showed EF of 30%. His bioprosthetic aortic valve was noted to be well seated. His CHF is complicated by severe malnutrition and low albumin, creating for marked third spacing. He has improved with aggressive ultrafiltration as alluded to above but still requires ultrafiltration at least 3 days per week. Hydralzyine was started in hopes of providing afterload reduction for improved forward flow - given his marginal pressures, he does not have much room to titrate up. In consultation with cardiology and given his atrial fibrillation, he was restarted on digoxin. However, near the end of his course, there were again concerns about av block and as such dig has been d/c'd. Finally, he was started on low dose beta-blocker, metoprolol 12.5 [**Hospital1 **] to help w/ ventricular remodeling. As mentioned below, pending renal function, an ACEI may be considered. . ARF: creat was 2.1 in ED, but apparently creat was 1.2 in recent past per rehab note. Initially thought to be ATN given prolonged hypoTN in ambulance and initially in ED. He later became anuric, and underwent CVVH for fluid removal. A tunned HD line was placed by renal, and he later tolerated full HD sessions without difficulty. He continues to require hemodialysis and hasn't made any signs of renal recovery. The etiology of his renal function remains unclear. [**Name2 (NI) **] did have renal u/s demonstrating normal blood flow and no evidence of obstructive physiology. As such, he continues w/ UF on Tuesday, Thursday, and Saturday. Recently, he has been able to tolerate as much as 4L removal during these sessions. Nephrology feels that he may regain his renal function and have recommended that he not be placed on an ACEI. This will need to be readdressed over time as he will benefit from an ACEI from a CHF and blood pressure standpoint. . AFIB/CAD: it was initially unclear if pt is chronically in Afib or paroxysmal, however he remained in AFIB throughout his entire hospital stay. Upon talking w/ daughter later in hospitlization, it appears that pt may chronically be in afib. It was presumed he was on coumadin for AVR & Afib. While here he had a GIB with an episode of hypotension in the setting of a supratherapeutic INR. Coumadin was stopped and was not be restarted during his stay. GI was consulted who recommended an outpatient coloscopy. In the setting of his acute renal failure, he developed dig toxicity with EKG changes (accelerated junctional rhythm). He required two rounds of digibind before this resolved and dig was discontinued. He was started on IV amiodarone (load) and was tolerating PO amio but maintained in atrial fibrillation. Later in his hospitalization, cardiology (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**]) was reconsulted regarding the utility of continuing amiodarone in the setting of likely chronic afib w/ enlarged atria, chf, and respiratory failure (making conversion to SR unlikely). It was recommended to d/c amiodarone and to restart his digoxin at a low dose 0.625 qod while checking dig levels frequently to keep his dig level <1.5. Dig was contineud but recently there were concerns about ?AV block on dig. Given his history of dig toxicity and renal failure, it was decided to d/c dig on [**3-19**]. Subsequent rate control will be through beta-blockade, metoprolol 12.5 [**Hospital1 **]. His rates have generally been well controlled although occasionally noted to be in low 100's during HD and during pain. As mentioned above, given his recent bleeding, it was elected not to anti-coagulate pt. He will be maintained on ASA. Future discussions regarding re-anticoagulation could be revisited by cardiologist or PCP. [**Name10 (NameIs) **] was initiated on metoprolol for CHF and rate control. He was s/p CABG 1 month ago prior to admission w/ bioprosthetic aortic valve placed during [**11-30**]. He was continued on an ASA and statin. . GIB/ANTICOAGULATION: he was restarted on Coumadin and then began to have bright red blood per rectum, and hypotension in the setting of supratherapeutic INR. Coumadin was stopped, vitamin K IV, FFP, and PRBCs administered. GI consulted and reluctant to scope patient in tenous clinical situation. Despite this reversal, his INR continued to be elevated for unclear reasons. It was questioned what his true need for Coumadin is since he has a bioprosthetic valve with Afib. After his GIB is was felt that Coumadin should be held during this hospitalization, and that he should continue an ASA and re-address risks of Coumadin after discharge. He has no further bleeding during the last [**1-29**] weeks of hospitlization and no further transfusion requirements. . DECUB: he has significant sacral decub ulcers that were evaluated by the wound care team, as well as a L-heel pressure ulcer that was followed as well. He continues to have SEVERE pain in the buttock region. We have been increasing his fentanyl patch and using morphine IV for breakthrough pain. Zinc and vitamin C were given orally daily. His wound has been slowly improving. He requires frequent turning and an air mattress. His fentanyl patch was increased to 200mcg/hr on [**3-17**]. It will be important to titrate this medication upwards but mindful not to avoid oversedation. In fact, pt was found heavily sedated on [**3-18**] - this was attributable to this increased narcotic dosage and subsequently has been reduced to 125 mg every 3 days (last changed [**3-18**]). His mental status has subsequently returned to baseline. Nutrition will be important in hopes of improving decub. Diabetes: He was maintained on sliding scale insulin and Lantus 10. Given chronic tube feeds, this dose may be titrated according to sliding scale measurements. Malnutrition: Pt did have PEG placed for nutrition. Earlier in hospital course, it was demonstrated that pt was in fact aspirating and as such, PEG was converted to PEJ to reduce risk for aspiration. He did have repeat swallow study which continued to demonstrate high risk for aspiration. As such, he should continue on current tube feeding recommendations. There is mild erythema at site of PEJ that is felt to represent inflammation rather than infection. This should be followed closely. Access: He has double lumen PICC placed earlier in [**Month (only) 958**]. Only one port is flushing at this point but not clear that pt requires a great deal of IV medications so this will suffice. In the future, it could be decided to remove PICC. Finally, he does have left subclavian dialysis port. . GOALS OF CARE: it was addressed several times about the goals of care, and the family repeatedly insisted that all aggressive measures should be taken. They have been advised about the severity of his many illnesses and the chance for recurrent complications or repeat hopsitilzations. There was question if the patient had expressed wished to withhold aggressive care, but was unclear if he truly understood scenario and this goes against his family's wishes. Communication with his son [**Name (NI) **] [**Telephone/Fax (1) 64987**] and daughter [**Name (NI) **] who is the HCP. This will need to be reevaluated now that he is speaking with his Passy Muir valve. Medications on Admission: -lasix 40 daily -coumadin 5 mg daily -digoxin 0.125 mg daily -lisinopril 5 daily (held starting today at [**Hospital1 **] due to K+) -aspirin daily -simvastatin 40 daily -sucralfate 1 gm [**Hospital1 **] -Epo qWed -insulin SS -nystatin TID -iproatrop neb prn -albut neb prn -artificial tears prn -zinc sulfate 220 mg daily -Mg hydroxide 30 mL daily -lansoprazole 30 daily -lactulose 20 daily -Na bicarb 10 cc daily -MVI -ferrous sulfate 300 daily -oxycodone 5 mg q4h prn Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Albuterol 90 mcg/Actuation Aerosol Sig: Six (6) Puff Inhalation Q4H (every 4 hours) as needed. 3. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 5. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY (Daily). 6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Six (6) Puff Inhalation QID (4 times a day). 8. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 9. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 10. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day). 11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) injection Injection TID (3 times a day). Disp:*90 injection* Refills:*2* 13. Hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours): hold for sbp less than 90 and during HD days. 14. Fentanyl 100 mcg/hr Patch 72HR Sig: One (1) unit Transdermal Q72H (every 72 hours): last change was on [**3-18**]. 15. Fentanyl 25 mcg/hr Patch 72HR Sig: One (1) patch Transdermal every seventy-two (72) hours: last patch of 125 on [**3-18**]. 16. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed. 17. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Five (5) ML Intravenous DAILY (Daily) as needed. 18. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day): please hold on HD days and for sbp less than 85 and hr less than 60. 19. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 20. Albuterol Sulfate 0.083 % Solution Sig: One (1) nebulizer Inhalation Q6H (every 6 hours) as needed. 21. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 22. Insulin Glargine 100 unit/mL Cartridge Sig: 10 units units Subcutaneous once a day. 23. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: sliding scale units Subcutaneous every six (6) hours: Sliding Scale Sugar Insulin 0-60 1 amp d50 61-150 0 units 151-200 2 units 201-250 4 units 251-300 6 units 301-350 8 units 351-400 10 units >401 12 units. 24. Outpatient [**Name (NI) **] Work Pt should have chemistry 7 w/ ca/mag/phos checked every other day - please fax to covering nephrologist 25. ultrafiltration Please continue w/ ultra-filtration every monday, wednesday, and friday Please call Dr. [**Last Name (STitle) 174**] at [**Telephone/Fax (1) 60**] for questions with regards to dialysis 26. Outpatient Speech/Swallowing Therapy Pt is deemed to be aspiration risk and should be maintained NPO from mouth. A repeat swallow eval could be performed in [**12-28**] weeks to determine if improved. 27. PICC line One port of LUE PICC not flushing. Pt has minimal IVF needs and could consider removal of PICC line as condition continues to improve. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Acute Renal Failure now on hemodialysis GIB in setting of coumadin pneumonia with MRSA aspiration pneumonia sepsis MRSA tracheobronchitis sacral and heel decubitus ulcers secondary: CAD s/p cabg aortic stenosis s/p AVR Discharge Condition: fair Discharge Instructions: When the patient's clinical status improves, he needs a colonoscopy for his GIB. If he has no lesions, anti-coagulation with coumadin could be considered. Patient is to be out of bed to chair at least once per day. He should have labs (chem 7 w/ calcium, mag, phos and digoxin) checked atleast every other day (with HD). Followup Instructions: Follow up with his PCP [**Name9 (PRE) 6983**] [**Name9 (PRE) **] (see phone above) within 7 days of his discharge. Hemodialysis/Ultrafiltration three times weekly Monday, Wednesday, and Friday ICD9 Codes: 0389, 5845, 4280, 5070, 5789