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162 | Admission Date :
2015-09-14
Discharge Date :
2015-09-19
Service :
NEONATOLOGY
HISTORY OF PRESENT ILLNESS :
The patient is a 3285 gm infant born at 37 5/7 weeks to a 21 year old G3 P1 now 2 mother with prenatal screens as follows :
O positive , antibody negative , hepatitis B surface antigen negative , RPR nonreactive , GBS negative .
Unremarkable pregnancy except for minor fullness of the left renal pelvis reported during the week prior to delivery .
Past OB history remarkable for postpartum depression .
Mother was admitted in labor .
Baby was delivered by repeat C-section with rupture of membranes at delivery .
Apgars were 8 and 9 .
CMED CSRU staff was called about 30 minutes of age for grunting , flaring and retractions and the baby was admitted to the CMED CSRU .
HOSPITAL COURSE:
1. Respiratory .
The Athol Memorial Hospital hospital course was initially consistent with transient tachypnea of the newborn .
Chest x-ray revealed mild streakiness of the lung fields .
He was initially placed on nasal cannula with subsequent resolution of respiratory distress .
Nasal cannula was weaned off on day of life 3 and he initially was maintaining O2 sat above 94% and breathing comfortably .
He was subsequently placed back on nasal cannula for mild oxygen desaturation and was requiring 25 c/min flow at the time of discharge .
No apneic or brady episodes .
2. Cardiovascular .
The patient 's cardiovascular status has been stable throughout his CMED CSRU stay .
No murmur on exam .
3. FEN .
The patient had been tolerating oral feeding as of day of life 2 and is currently taking Enfamil 20 p.o. ad lib .
He has been weaned off IV fluids and has been maintaining good blood glucose .
His birth weight was 3285 gm .
His weight is 3015 gm on day of life 5 .
4. GI .
The patient 's bilirubin level at 24 hours of life was 4.6.
No phototherapy was started .
5. ID .
The patient was not started on antibiotics , given lack of sepsis risk factors .
His initial CBC showed no left shift .
Blood culture had remained no growth to date .
6. Heme .
The patient 's initial hematocrit was 35.8 .
No transfusion during this admission .
CONDITION ON TRANSFER :
The patient has been doing well on low flow nasal cannula. He has been tolerating p.o. ad lib feeds . | [
{
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{
"text": "37 5/7 weeks",
"start_char": 148,
"end_char": 160,
"id": "T3",
"type": "DURATION",
"val": "p37w5d",
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},... | null | null | null |
348 | ADMISSION DATE :
3-26-93
DISCHARGE DATE :
4-3-93
HISTORY OF PRESENT ILLNESS :
The patient is a 73 year old female who was transferred for cardiac catheterization after ventricular fibrillation arrest in the setting of an acute inferior myocardial infarction and a urinary tract infection .
The patient was admitted on 3-16-93 to Diy Hospital for an E. coli urinary tract infection .
The patient was readmitted on 3-20-93 because of fever , chills and a sudden onset of ventricular fibrillation arrest , successfully cardioverted back to rapid atrial fibrillation and finally to sinus rhythm , where an electrocardiogram then showed ST elevation in inferior leads .
Peak CPK was 2494 with 18% MB 's .
She required intubation for mild to moderate congestive heart failure , treated with diuretics , intravenous nitroglycerin and heparin .
She had post-infarction angina , was transferred here for angiography and possible percutaneous transluminal coronary angioplasty .
HOSPITAL COURSE :
On 3-27-93 , patient underwent cardiac catheterization , coronary and left ventricular angiography without complications .
Review of these angiograms demonstrated a dominant right coronary artery with a focal 50% stenosis in the mid-portion .
The left main coronary artery was clear .
The left anterior descending had moderate plaques with a 50% proximal stenosis of the right anterior oblique caudal view .
The proximal diagonal D1 had a 50% stenosis .
The circumflex had a long 30% stenosis proximally and an 80% stenosis at the origin of the second major marginal artery .
The left ventricular angiogram showed akinesis of the posterobasal walls , severe hypokinesis of the diaphragmatic wall and trace mitral regurgitation .
The patient was maintained on heparin anticoagulation .
An exercise tolerance test with Thallium was to be performed in order to assess myocardial viability in the infarct zone .
The right coronary artery lesion was complex and there was severe stenosis in the obtuse marginal 1 .
The patient had no further angina .
On 4-2-93 , she underwent a Persantine Thallium study .
This showed no diagnostic electrocardiogram changes for ischemia and no angina pectoris .
The thallium images showed a large region of persistently reduced blood flow involving the apex and inferoposterior segments of the left ventricular wall .
This was consistent with scar .
There was no definite perfusion abnormality in the circumflex zone .
In view of these findings , it was elected to discharge her on her present medical program .
The patient is to return to the follow up care of Dr. Ko Kollciem at the Diy Hospital .
CHPO E. JESCOBEA , M.D.
TR :
sq / bmot
DD :
06-13-93
TD :
06/15/93
CC :
Dr. Ko Kollciem , Retchard Healthcare to Dr. Wall | [
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"text": "3-26-93",
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"id": "T0",
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572 | Admission Date :
12/12/1996
Discharge Date :
12/16/1996
HISTORY / REASON FOR HOSPITALIZATION :
The patient is a 42 year old gravida II , para I female with a long history of menorrhagia and pelvic pain .
She also has a history of endometriosis that is symptomatic .
She used Danocrine for approximately nine months and was pain free , but was unable to tolerate the side effects .
She is status post several laparoscopies in the past with which she was diagnosed with endometriosis .
She has recently been on Depo-Provera and has had episodes of break-through bleeding for six weeks at a time .
She desired surgical therapy .
HOSPITAL COURSE :
On 12/12/96 she had an uncomplicated total abdominal hysterectomy and bilateral salpingo-oophorectomy .
Estimated blood loss was 100 cc and she tolerated the procedure well .
On postop day number one she was afebrile and doing well with a PCA for pain control .
On postop day number two she was also afebrile and had not passed any flatus yet .
She was ambulating frequently .
Her hematocrit was 34.2 and stable from her preoperative value .
On postop day number three her abdomen was noted to be distended with a few bowel sounds and she still had not passed gas .
The patient decreased the amount of Demerol she was using and supplemented with Tylenol and continued her frequent ambulation .
On postop day number four she had passed flatus and was feeling much better .
She was discharged to home in good condition on the following medications .
DISCHARGE MEDICATIONS :
Demerol for pain .
Motrin for pain .
Colace stool softener .
DISPOSITION :
The patient should follow-up with Dr. Side in two weeks .
Dictated By :
IEDEARC SIDE , M.D. LB28
Attending :
MITERY D. LOSS , M.D. CB51 II795/2112
Batch :
42100
Index No. ZMFX3O4G1
D :
01/04/97
T :
01/06/97
CC :
1. MITERY D. LOSS , M.D. NT11
[ report _ end ] | [
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"mod": "NA"
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"id": "T8",
"type": "DATE",
"val": "1996-12-16"... | null | null | null |
201 | ADMISSION DATE :
03/11/2002
DISCHARGE DATE :
03/14/2002
DISCHARGE DATE :
03/14/2002
HISTORY OF PRESENT ILLNESS :
This is a 62-year-old hospice chaplain who was referred by Dr. Tomedankell Flowayles and Dr. Es Oarekote for evaluation of his right hip pain .
He states that his pain has been of seven to eight durations , and rated as moderate to severe ( 7/10 ) .
He does limp .
He does not use a cane and he requires a bannister for going up and down stairs .
He has trouble with his shoes and socks .
He uses a walker .
He can walk about a quarter of a mile without stopping .
HOSPITAL COURSE :
The patient was taken to the operating room on March 11 , 2002 , and underwent an uncomplicated right total hip replacement .
The patient tolerated the procedure well and was transferred to the Post Anesthesia Care Unit and then to the floor in stable condition .
On postoperative check , he was doing well .
He was afebrile and his vital signs were stable .
He was neurovascularly intact .
His hematocrit was 34.7 .
He was started on Coumadin for DVT prophylaxis and Ancef for routine antimicrobial coverage .
He was made partial weight-bearing for his right lower extremity .
He was placed on posterior hip dislocation precautions and was out of bed with physical therapy and occupational therapy .
On postoperative day one , there were no active issues .
He was afebrile .
His vital signs were stable .
He was neurovascularly intact .
On postoperative day two , he was afebrile , vital signs were stable .
His incision was clean , dry and intact with no erythema .
He remained neurovascularly intact .
His hematocrit was 34.8 .
On postoperative day three , lower extremity noninvasive ultrasounds were performed , which showed no evidence of deep venous thrombosis in the lower extremities .
The remainder of his hospitalization was uncomplicated . | [
{
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"type": "DATE",
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"mod": "NA"
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"text": "day two",
"start_char": 1452,
"end_char": 1459,
"id": "T5",
"type": "DATE",
"val": "2002-03-13",
"mod": "NA"
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... | null | null | null |
567 | Admission Date :
2013-09-05
Discharge Date :
2013-09-12
Service :
MEDICINE
History of Present Illness :
HPI : This is a 79 y/o M with h/o of HTN , DM , recent CVA Theresa , chronic respiratory failure on vent , trached , ESRD on HD who was sent from rehab facility for worsening mental status .
Per refferal notes , he went to hemodyalisis today in the morning .
1 L was removed .
At about 2:30 pm , he was found to have worsening mental status .
In that setting he was hypotensive down to the 92/45 , and was given 1 L NS .
Fs was also checked 179 .
At that time , it seems that he had been on T peace since 4 am today .
At 2:30 he was also found with sats in the 90% .
ABG done 7.1 , 89/72 - he was placed on AC 600 / 0.4 and 6 PEEP - sats up to 94% .
Given persistent lethargy , patient was sent to Falkener Amanda .
Of note , after interview with HCP , at around 07-23 , patient started having episodes of dizziness , and had unstable gait .
he was taken to Williams ICU until 08-09 when he was discharged to Waltham/Weston Hospital Rehab .
he had a peg tube and tracheostomy prior to d/c .
He had been chronicallyl vent dependent .
His companion states that they have been trying to wean him down at rehab .
his basline mental staus apparently responds with his head shaking , and also try to write sentences .
In the Amanda : VS T 103 rectal BP90/44 HR : 84 RR 16 Sats : 98 + guiac stool .
He received tylenol , levofloxacin 500 mg IV , Flagyl 500 mg and Vancomycin and I L NS .
ROS : difficult to obtain 2x2 to patient mental status baselin
Brief Hospital Course :
Assessment and Plan :
This is a 79 y/o M with h/o HTN , DM , recent CVA , chronic ventilatory failure , CRI on HD who presents with change in MS and febrile in the Amanda , admitted to CMED .
# Altered mental status : Ct scan with no evidence of new intracraneal bleeding .
Patient febrile in the Amanda .
High WBC .
It was thought that it could have been a combination of hypotension , hypercapnia and infection .
He was initially started on broad spectrum antibiotics .
Despite having a profund limitation communicating given his neurological status , his mental changes seemed to improved initially .
However later on during his course , his mental status deteriorated , being even less responsive .
# ID :
Patient febrile and with a high WBC on admission .
After starting broad spectrum antibiotics - cefepime - vancomycin and flagyl ( for initial concern of aspiration pneumonia ), he responded clinically .
Urine cx from Rehab showed gram negative rods > 100 K enterobacter cloacae .
Urine Cx in house grew Citrobacter Freundi and his sputum grew Acinetobacter Baummani .
Since there was no more evidence of gram positive infections , vancomycin was discontinued and cefepime was kept .
# Fevers : in the Amanda , high WBC , possible pneumonia .
Also possible source sinus infections given findings on intial CT ( see summary in significant studies ). He did not spike any fevers after being transfer to the CMED from the Amanda .
# Resp : Patient was intermitentely switched from AC to Pressure support trials .
However , after Patient did well .
Then trach mask trials were done .
He tolerated this well , although he required PS overnight .
# ESRD on hemodyalisis : Renal service was consulted and HD was continued .
# CV :
Rhythm : NSR , not tachycardic .
Pump : With trace of lower extremity edema .
X ray suggested some pulmonary edema on admission .
Despite this findings , he was supported with 40% FIO2 most of the time .
CAD : On admission Ck low normal , MB not done .
Troponin 0.44.
It was more likely due to CRI .
Second set 12 hours apart , showed no changes .
s/p stroke : continue aspirin , statin , plavix
# Hypotension : per referral form .
Intially concern for sepsis in the setting of fevers and high blood count .
His BP medications were held on admission .
Patient did not require pressors .
His blood pressure remained stable and BP meds were restarted .
# FEN :
Tube feedings were started thorugh peg tube .
On 2013-09-08 , patient pulled out peg tube .
Temporary foley was placed and on 2013-09-11 ,
On 2013-09-12 after deterioration of his mental status and also of his blood pressure , goals of care were discussed with his HCP .
It was decided to direct goals of care towards confort care .
Patient passed away accompanied by his significant other . | [
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{
"text": "overnight",
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"... | null | null | null |
413 | ADMISSION DATE :
5-3-93
DISCHARGE DATE :
5-12-93
HISTORY OF PRESENT ILLNESS :
Mr. Stain was transferred from the Oreiewlefell Merkane I Penaltbridgesgreat University Medical Center for progressive respiratory failure and adult respiratory distress syndrome superimposed on a history of chronic obstructive pulmonary disease , perhaps asthma , and ulcerative colitis .
His only positive result was a sputum culture for Pseudomonas and this came after he had already been on antibiotics .
HOSPITAL COURSE :
The patient was seen in consultation by Dr. Wire who felt that manipulation of the tracheal tube was the best approach to the air leak since it was a new trach and he was requiring such high ventilator support that it was risky to change it .
He also felt that lung biopsy at this time was rather risky .
The patient was therefore completely cultured again and begun on antibiotic coverage which would take care of the Pseudomonas he was known to have .
The steroids were tapered .
He was also begun on anti-Candida regimen for his urinary tract infection with yeast being seen .
Because of the story of hemoptysis , he also underwent an exotic bleeding work up for such things as Wegner 's and Goodpasture 's .
These results were all negative .
He continued to require very high FIO2 .
He was found to have a DVT by ultrasound .
He underwent a trial of TPA followed by heparin .
This produced substantially further hemoptysis and the need for transfusion .
He stabilized from this , but on the fifth while continuing to have extremely ventilator requirement .
In consultation with his family , it was decided that enough support had been done .
At that time , therefore , ventilator support was withdrawn under the comfort measures of morphine .
STAIN J. A , M.D.
TR :
sj / bmot
DD :
6-4-93
TD :
06/05/93
CC : | [
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"id": "T1",
"type": "DATE",
"val": "1993-05-03",
"mod": "NA"
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"te... | null | null | null |
407 | Admission Date :
2017-04-26
Discharge Date :
2017-05-01
Service :
CARD CMED
HISTORY OF PRESENT ILLNESS :
This is a 62 year old gentleman who underwent an exercise treadmill test for screening through the Beth Israel Deaconess Hospital-Needham Clinic .
The test was positive for EKG changes and shortness of breath .
The patient has no history of chest pain; no history of myocardial infarction .
The patient was referred to Cambridge Health Alliance for cardiac catheterization .
Cardiac catheterization showed an ejection fraction of 50% , left ventricular end diastolic pressure of 20 , 90% left anterior descending lesion , 80% left circumflex lesion , 80% mid right coronary artery lesion and 80% distal right coronary artery lesion .
The patient was referred to Dr. Rota for coronary artery bypass grafting .
HOSPITAL COURSE :
The patient was admitted to Saint Vincent Hospital on 2017-04-26 and underwent a coronary artery bypass graft times four with left internal mammary artery to left anterior descending , saphenous vein graft to right coronary artery , saphenous vein graft to PDA and saphenous vein graft to obtuse marginal with Dr. Rota .
Please see the Operative Note for further details .
The patient was transferred to the Intensive Care Unit in stable condition on Neo-Synephrine infusion .
The patient was weaned the next day from mechanical ventilation on his first postoperative night .
Postoperative days one and two , the patient continued to require Neo-Synephrine to maintain systolic blood pressures greater than 100 .
On postoperative day two , the patient 's hematocrit was noted to be 23.1 ; he was transfused one unit of packed red blood cells as well as given a dose of Lasix .
The Neo-Synephrine was weaned off by postoperative day number three .
The patient 's chest tubes were removed on postoperative day three without incident .
The patient was started on low dose Lasix and Lopressor which he tolerated well .
On postoperative day number four , the patient was transferred from the Intensive Care Unit to the regular part of the hospital where he began working with Physical Therapy and on his first session he was able to ambulate 500 feet and climb one flight of stairs while remaining hemodynamically stable without requiring any oxygen .
On postoperative day number five , the patient continued to remain hemodynamically stable .
The patient 's epicardial pacing wires were removed without incident and the patient was cleared for discharge to home . | [
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... | null | null | null |
188 | Admission Date :
2015-10-26
Discharge Date :
2015-10-30
Service :
SURGERY
History of Present Illness :
17 yo male pedestrian who was struck by auto at unknown speed ; +LOC .
He was medflighted to The Hospital for Orthopedics for ongoing trauma care .
Upon arrival GCS 15 , alert and oriented x3 .
Brief Hospital Course :
He was admitted to the trauma service . Orthopedics and Neurosurgery were consulted because of his injuries .
His Neurosurgical issues were nonoperative ; he was loaded with Dilantin ; serial head CT scans were performed and were stable .
He will need to follow up with Dr. Mckinney in 4 weeks for repeat head imaging and continue with Dilantin for one month .
His right tib / fib fracture was repaired by Orthopedics on 10-27 ; postoperatively there were no complications .
Weight bearing status was increased to weight bearing as tolerated .
He was fitted with a hinged Mcdonald brace for his LLE .
He will need to continue on Lovenox injections for at least 4-6 weeks .
He was transfused with 3 u packed cells for a hematocrit of 21 , post transfusion HCT was 26.1 ; there was a questionable transfusion reaction at the end of his first unit of packed cells ; he did subsequently receive the remaining 2 units without any further reaction .
Physical and Occupational therapy were consulted and have recommended home with services . | [
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611 | ADMISSION DATE :
11/3/92
DISCHARGE DATE :
12/6/92
HISTORY OF PRESENT ILLNESS :
The patient is a 68 year old , right handed caucasian female , former R.N. who complained of several days of vertigo , one day of double vision , dysarthria and worsening of vertigo .
She was seen at the outside hospital and put on aspirin for two days .
An magnetic resonance imaging study showed basilar artery disease , questionable aneurysm .
The patient was transferred to the Fairm of Ijordcompmac Hospital .
An angiogram on 11/3 was consistent with thrombosis at the mid basilar artery .
The patient was put on heparin and was stable since .
HOSPITAL COURSE :
The patient was taken to the Intensive Care Unit after her angiogram .
She was aggressively anticoagulated with heparin .
A small intimal tear in the arch of the aorta during the angiogram , was without sequelae .
She was doing well with at least 4+ strength in all of her extremities , when on 11/13 , she had an acute drop in her systolic blood pressure to 70 for unclear reasons and without evidence of acute sepsis .
This was accompanied by substantial decrement in neurologic function .
For a short time , she seemed " locked in " .
She has made slow progress since then and at the time of discharge has 4-strength at the left elbow and 4+ in the left wrist and hand .
Trace movement of the right elbow and 4-strength of the right wrist and hand .
4-to 4+ strength at the left ankle , 4+ strength at the right knee and right ankle .
She is unable to lift either foot off the bed .
The extra ocular movements are full .
Tongue protrudes 4 cm .
She is drowsy at times , but generally alert , responsive , interactive , able to talk in two to three word sentences when she wants to .
She has severe memory deficits , but nevertheless , is able to engage in conversation , answers questions , names things well , does calculations and recognizes family members and states preferences .
She has been working with Speech Therapy , occupational therapy and physical therapy closely and should continue to show improvement .
She is anticoagulated on Coumadin and this has been stable .
She is do not resuscitate in agreement with the wishes of her multiple family members .
Follow up computerized tomography scans and magnetic resonance imaging studies have shown infarction in bilateral basis pontis , mid brain , the superior cerebellar areas , left thalamus , bilateral temporal lobes medially and inferiorly and left posterior communicating artery .
The patient had fevers sporadically during this hospitalization with rising white blood counts .
A chest X-ray documented a progressing left lower lobe infiltrate .
Initially this improved on Clindamycin and Cefotetan , but fevers recurred on this antibiotic regimen .
Sputum grew out Klebsiella pneumoniae , and she was treated with Gentamicin and Ancef for 14 days intravenous ( bug being sensitive to these two drugs ) .
A left pleural effusion developed and this was tapped with ultrasound guidance , and found to be sterile , and without evidence of empyema .
The patient is on Ciprofloxacin .
The day of discharge is day #3 of 7 , after which antibiotics should be totally discontinued .
She has developed bad thrush in this setting , she is not yet able to swallow and so she is on Nystatin swish and spit five times a day .
She also gets Peridex to clean out her mouth .
Once her liver enzymes are completely normal , a seven day course of Fluconazol may be helpful if the thrush is not spontaneously resolving off of antibiotics .
She has been afebrile for greater than 10 days , including several days on oral antibiotics .
The patient 's liver enzymes were noted to be elevated mid way through her hospital course , to about three times normal , especially the SGOT and SGPT .
These have spontaneously reversed , and are nearly normal at the time of discharge .
A right upper quadrant ultrasound documented gallstones , without evidence of common bile duct dilatation or active cholecystitis .
The exact cause of her liver enzyme elevation is unclear , but we are being careful about administering drugs , which might irritate the liver .
The patient had a steady decline in her hematocrit during this hospitalization .
Iron studies are all entirely normal , her anemia is attributed to anemia or chronic disease with hypoproliferation as well as multiple phlebotomies .
The plan is to give her folic acid , but not iron .
The patient 's potassiums have been repeatedly low and require daily checks and repletion .
This is thought due to the extensive course of Gentamicin which she received .
This must be carefully checked despite the standing order for potassium .
The patient has had low sodiums during this hospitalization .
This may due to her central nervous system process or her pulmonary process , with fluids administered as described , she should not have any problems from this .
Her sodiums were never below 130 .
She does well with tube feeds .
Her tube feeds orders are as follow :
full strength Replete with fiber at 70 cc. per hour .
In addition , the patient gets 250 cc. of juice ( not water ) three times a day .
She also gets Lactinex granules three packages in each bottle of tube feeds .
She also gets Metamucil one teaspoon with the first bolus of juice each day .
Please note that evaluation by the swallowing therapist , showed that the patient is aspirating at this time , but there is great hope from the nature of her deficit and the good movements of her tongue that normal swallowing should return soon .
It is for this reason that she is discharged with an nasogastric tube and that no plans for G tube placement are made at this time .
She has a history of of angina without myocardial infarction that has not been worked up .
She did have brief chest pain twice during this admission that did not correlate with electrocardiogram changes .
In the first week of November , her electrocardiogram showed T wave inversions in the lateral leads , correlating with an increase in the LDH , but not CK .
This did not normalize with administration of Isordil and the patient denied chest pain at this time .
As of 4/7 , her electrocardiogram had reverted back to normal and there is no evidence of congestive heart failure or continued electrocardiogram changes , and chest pain is absent .
Her cholesterol was 350 here .
She has been off of her hypercholesterol medicines .
These can be restarted when it is deemed reasonable , in view of her acute disease and recently elevated liver enzymes .
Note that the liver enzymes were normal on admission , at which time she was taking all of the above cholesterol medicines . | [
{
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... | null | null | null |
177 | Admission Date :
2012-11-21
Discharge Date :
2012-11-28
Service :
Transplant
HISTORY OF PRESENT ILLNESS :
This is a 37-year-old female who presents on an elective basis for a living-related kidney transplant .
The patient has a history of end-stage renal failure secondary to type 1 diabetes with a baseline creatinine of around 5 .
She is receiving a kidney from her sister .
The patient has a history of hypertension , coronary artery disease , and insulin-dependent diabetes for 32 years .
She is status post myocardial infarction in April of this year and subsequently underwent coronary artery bypass surgery .
She present electively on the morning of her surgery with no recent changes in her medical problems .
HOSPITAL COURSE :
The patient was admitted to the preoperative holding area and taken electively to the operating room .
She underwent a living-related renal transplant in the right iliac fossa .
The operation was somewhat technically difficult secondary to a short segment of ureter which was anastomosed over a stent to the bladder .
Otherwise , there were difficulties , and estimated blood loss was minimal .
She was taken postoperatively to the recovery room already making a large amount of urine .
Intraoperatively , for immunosuppression she received thymoglobulin and Solu-Medrol .
She was started on Prograf and CellCept in the postoperative period .
She was also maintained on Bactrim postoperatively and did not require ganciclovir , as she and her sister were cytomegalovirus negative .
The patient 's initial postoperative course was relatively uneventful .
Her creatinine , which was 5 initially postoperatively , slowly dropped over the next few days until eventually reaching a low of 1 .
She did receive pamidronate on postoperative day one and received a total of four doses thymoglobulin .
Her steroid doses were slowly tapered over her hospital course , and her Prograf level was adjusted to maintain therapeutic values between 10 and 15 .
She continued to make good urine over the first few days and had her urine losses replaced with intravenous fluids .
On postoperative day three , the patient had an episode of shortness of breath that was evaluated by both the Renal and surgical residents .
It was found that she was in acute pulmonary edema and required transfer to the Surgical Intensive Care Unit .
Her blood pressure at the time of this incident was in the range of 200/120 .
Her electrocardiogram showed no specific ST changes , but there was some loss of her R wave progression laterally .
Serial enzymes were drawn , and Cardiology was consulted .
With blood pressure control via a nitroglycerin drip and fluid restriction , the patient quickly improved and a had a relatively short stay in the Intensive Care Unit .
Throughout this time , her creatinine continued to drop , and there was no apparent deleterious effect on her transplant from this episode .
Her beta blocker was progressively increased , and her nitroglycerin drip was weaned down .
Two days after this event , she underwent an echocardiogram which was significant for slightly depressed left ventricular systolic function with severe posterior wall hypokinesis .
This was a change from her prior echocardiogram and demonstrated evidence of a small myocardial infarction .
Clinically , she did much better and her blood pressure was optimized prior to discharge .
She was transferred out of the Intensive Care Unit on postoperative day five and was stable on the floor for the next two days . | [
{
"text": "the next few days",
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"id": "T6",
"type": "DATE",
"val": "2012-11-22",
... | null | null | null |
163 | Admission Date :
2010-05-17
Discharge Date :
2010-05-29
Service :
HISTORY OF PRESENT ILLNESS :
HISTORY OF PRESENT ILLNESS :
This is an 86-year-old female with a past medical history of diabetes and hypertension who presented to the Emergency Department with a two day history of shortness of breath and easy fatigability .
She also noted increased dyspnea on exertion .
Prior to this patient could walk upstairs but now cannot .
She denies chest pain , orthopnea , paroxysmal nocturnal dyspnea .
However , the patient has noted some abdominal pain , intermittent times a couple of days , none on the day of admission .
Denied nausea , vomiting , diaphoresis , bowel movement changes .
She has noted increased urinary frequency .
Denies fever or chills .
Of note , she has had recent medication changes which included discontinuing Diovan and starting terazosin .
HOSPITAL COURSE :
The patient was admitted to the Cardiac Medicine Service and treated for presumed diastolic and systolic dysfunction .
Echocardiogram was obtained which showed moderately depressed left ventricular systolic function as well as hypokinesis of the lower half of septum and apex .
Also of note was the distal lateral wall hypokinesis .
The wall motion abnormalities were noted to be new .
It was believed that a troponin on admission in addition to the wall motion abnormalities she underwent a non-Q wave myocardial infarction prior to resulted in her current cardiac failure .
Throughout hospital course patient 's troponin trended down to less than 0.3 .
Heart Failure Service was involved .
She was continued with aggressive diuresis .
She was started on _________ with excellent diuresis , however , her renal functioning worsening .
A cardiac catheterization was deferred until the renal issue could be resolved .
However , her creatinine continued to increase .
Diuresis was halted and without improvement in creatinine .
Renal was consulted .
A renal ultrasound was obtained .
It showed a right kidney size of 6.3 cm and a left kidney size of 8.4 cm .
Given her hypertension which was very difficult to control , it was felt that she had renal artery stenosis and thus she underwent MRA of the kidney which showed severe right renal artery stenosis at its origin .
There was also moderate to severe focal stenosis of the left renal artery approximately 1.3 cm from its origin .
Dr. ______________ consulted on the case .
She was transferred to the unit overnight to assess volume which was noted to be optimal .
On 05-25 she underwent catheterization and subsequent stenting of the left renal artery .
Due to dye load required to assess the coronary disease were not visualized .
After the procedure the patient did well .
However , her creatinine has worsened up to 4.2 .
However , her urine output has improved .
She has not required hemodialysis at this time .
She will need close follow up of her renal functioning .
The patient is discharged to an extended discharge facility . | [
{
"text": "2010-05-17",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "2010-05-17",
"mod": "NA"
},
{
"text": "overnight",
"start_char": 2440,
"end_char": 2449,
"id": "T6",
"type": "DURATION",
"val": "PT12H",
"mod": "NA"
},
{
... | null | null | null |
411 | Admission Date :
02/08/1990
Discharge Date :
02/13/1990
HISTORY OF PRESENT ILLNESS :
The patient is a 43-year-old gravida II para II white female referred by Dr. Ca Shuff for evaluation .
She was in her usual state of good health until December when she was seen emergently for treatment of a perforated colon cancer .
That area was resected with no evidence of metastatic disease .
She has had subsequent CEA's and scans which were negative .
A tumor was noted on her vulva which was biopsied and revealed squamous cell carcinoma in situ .
ALLERGIES :
NO KNOWN DRUG ALLERGIES .
MEDICATIONS :
None .
PAST SURGICAL HISTORY :
As above with colostomy .
HOSPITAL COURSE :
The plan was for right radical vulvectomy .
1. Vulvectomy :
The patient on 2/8/90 underwent a right radical vulvectomy with excellent results and negative margins on frozen section .
Her postoperative course was unremarkble .
She was kept on bedrest for two days and then was ambulating and voiding well without trouble on postoperative day number three when the Foley catheter was discontinued .
She has been doing Betadine paint and blow drying the area several times a day and after each bowel movement and urine without incident . | [
{
"text": "several times a day",
"start_char": 1130,
"end_char": 1149,
"id": "T6",
"type": "FREQUENCY",
"val": "RPT6H",
"mod": "APPROX"
},
{
"text": "02/08/1990",
"start_char": 18,
"end_char": 28,
"id": "T0",
"type": "DATE",
"val": "1990-02-08",
"mod": "NA... | null | null | null |
388 | Admission Date :
04/21/1994
Discharge Date :
04/29/1994
HISTORY OF PRESENT ILLNESS :
Patient is an 88 year old female with fatigue and decreased short term memory for the past six months .
The past six weeks , she has also been complaining of hot sensation and tingling sensation in the hands bilaterally .
For the past five weeks , the patient has experienced dragging of the right leg with weakness throughout that side .
Head CT was done which patient reported demonstrated three lesions in the left parietal region of the brain .
Bone scan , CT of the abdomen , chest X-Ray , and mammogram were all negative .
Patient noted the foot dragging to have worsened over the past few weeks but improved since on Decadron the past week before admission .
Patient is now admitted for elective left parietal stereotactic biopsy of the tumor .
PAST MEDICAL / SURGICAL HISTORY :
Significant for a history of hypertension , basal cell carcinoma of the nose six years ago , cataracts , and a hysterectomy .
ALLERGIES :
No known drug allergies .
CURRENT MEDICATIONS :
Hydrochlorothiazide 25 mg q.d. and Decadron 25 mg b.i.d.
HOSPITAL COURSE :
Patient was taken to the Operating Room on April 21 where patient underwent a left parietal stereotactic guided brain biopsy .
Patient tolerated the procedure well without any complications and was taken to the Recovery Room awake and stable then subsequently transferred to the floor .
Patient did well post-operatively , continued to have a right sided deficit , and Physical Therapy and Occupational Therapy visited the patient , worked with the patient , and determined that patient needed rehabilitation with Physical Therapy .
The patient was evaluated by Doing and was subsequently accepted into that program .
Patient is now discharged to Harl Wa Healthcare Network on April 29 , 1994 in stable condition . | [
{
"text": "q.d.",
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"end_char": 1105,
"id": "T7",
"type": "FREQUENCY",
"val": "RP1D",
"mod": "NA"
},
{
"text": "b.i.d.",
"start_char": 1125,
"end_char": 1131,
"id": "T8",
"type": "FREQUENCY",
"val": "RPT12H",
"mod": "NA"
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{
"tex... | null | null | null |
203 | Admission Date :
2015-11-09
Discharge Date :
2015-11-16
Service :
CMED CCU
HISTORY OF PRESENT ILLNESS :
Baby girl Fritsche is the 1670 gram product of a 31 and 06-17 week gestation born to a 34 - year-old G2 P1 now 2 woman .
Fetal screens , O positive , antibody negative , RPR nonreactive , rubella immune , hepatitis surface antigen negative , GBS unknown .
IVF pregnancy complicated by IUGR , 2 vessel cord , normal fetal echo reverse diastolic flow and demise of twin A at 27 weeks .
Twin B with normal fetal survey was transferred to Boston Medical Center at 26 and 2/7 weeks with IUGR of twin A was first noted , presented with preterm labor at 31 weeks .
Betamethasone complete at approximately 26 weeks and 31 weeks .
Mother was on clindamycin since 11-04 .
PPROM with bleeding and transverse lie prompted cesarean section .
Abruption noted .
Apgars were 6 and 9 .
HOSPITAL COURSE :
Respiratory .
Mills was admitted to the newborn intensive care unit with moderate respiratory distress .
Infant placed on CPAP .
X-ray revealed mild respiratory distress syndrome .
She remained on CPAP for a total of 24 hours at which time she transitioned to room air and continues to be stable in room air .
Caffeine citrate was initiated on 11-14 for apnea and bradycardia of prematurity .
She is currently receiving 11 mg po every day .
Cardiovascular .
Has been cardiovascular stable throughout hospital course .
Heart ranges 130 s to 160 s.
Blood pressure most recently 60/37 with a mean of 44 .
Fluid and electrolyte .
Birth weight was 1670 grams 50 th percentile , length 43 cm 50 th percentile .
Head circumference not done .
Infant was initially started on 80 cc per kilo per day of D10W .
Enteral feedings were initiated on day of life #1 .
Infant achieved full enteral feedings by day of life 6 .
She is currently receiving 150 cc per kilo per day of Special Care 20 .
Her discharge weight is 1477 gm .
Her most recent set of electrolytes were on 2015-11-13 with a sodium of 143 , a potassium of 6.3 hemolyzed , a chloride of 113 and a total CO2 of 17 .
She will need advance calorie density for better growth .
GI . Bilirubin peaked on day of life #2 of 9.0 / 0.3 .
Infant is under phototherapy , which was discontinued on 11-13 .
Most recent bilirubin was on 11-14 of 4.8 / 0.3 .
Hematology .
Hematocrit on admission was 53.7 .
She has not required any blood transfusions .
Infectious disease .
A CBC and blood culture obtained on admission .
CBC had a white blood cell count of 9 , 17 polys , 0 bands , platelets of 326 .
She received 48 hours of ampicillin and gentamycin with negative blood cultures and antibiotics were discontinued .
Neurological .
She has been appropriate for gestational age .
Head ultrasound was performed on 2015-11-16 and was normal .
Sensory , hearing screen has not yet been performed , but should be done prior to discharge . | [
{
"text": "24 hours",
"start_char": 1109,
"end_char": 1117,
"id": "T12",
"type": "DURATION",
"val": "PT24H",
"mod": "NA"
},
{
"text": "11-14",
"start_char": 1236,
"end_char": 1241,
"id": "T13",
"type": "DATE",
"val": "2015-11-14",
"mod": "NA"
},
{
... | null | null | null |
571 | ADMISSION DATE :
06-30-93
DISCHARGE DATE :
07-06-93
HISTORY OF PRESENT ILLNESS :
The patient is a 67 year old white male with a recent history of urinary frequency Q2-3H , stranguria , nocturia x 3-4 per night .
He was found on physical exam to have an asymmetric prostate with prominence on the left and a question of a nodule .
Repeat exam one month later showed a firm left-sided lobe .
Transrectal ultrasound showed a hypoechoic left-sided mass in the peripheral zone .
A biopsy showed moderately to poorly differentiated Grade III-IV adenocarcinoma on the left .
The right lobe was within normal limits .
This was done on 05/05/93 at FIH .
He also had a 3-4 year history of impotence .
HOSPITAL COURSE :
The patient was brought to the operating room on 06/30/93 after informed consent was obtained .
A radical retropubic prostatectomy with bilateral lymph node dissection was done .
He was afebrile postoperatively with vital signs stable .
His potassium was 3.7 and his hematocrit 33 .
His postoperative course was remarkable for a low grade temperature to 101.7 .
His blood cultures and chest X-ray were negative .
He had flatus on postoperative day # 3 .
His Jackson-Pratt drained about 35-40 cc per day and was discontinued on postoperative day # 3 .
His hematocrit on 07/03 was 28.1 .
On that day he was slightly diaphoretic with some tachycardia to 100 .
The remaining unit of autologous packed red blood cells was transfused .
A cardiology consult was obtained for this episode of diaphoresis with tachycardia , as well as for an EKG being read as having anterolateral changes .
He had no symptoms of chest pain or myocardial ischemia .
A repeat EKG showed no changes .
He subsequently did well , with a repeat hematocrit of 34.3 after the transfusion .
His creatinine was 1.2 on postoperative day # 5 .
On postoperative day # 6 his low grade temperature resolved .
His vital signs were stable .
He was discharged home on Percocet and Keflex .
He was discharged in good condition .
He will follow up with Dr. Iechalette Cancer in his office .
SIE ROOM , M.D. | [
{
"text": "postoperative day # 3",
"start_char": 1140,
"end_char": 1161,
"id": "T9",
"type": "DATE",
"val": "1993-07-02",
"mod": "NA"
},
{
"text": "postoperative day # 3",
"start_char": 1237,
"end_char": 1258,
"id": "T10",
"type": "DATE",
"val": "1993-07-02",
... | null | null | null |
216 | ADMISSION DATE :
5/14/92
DISCHARGE DATE :
5/19/92
DISCHARGE DATE :
5/19/92
HISTORY OF PRESENT ILLNESS :
The patient is a 71 year old white female with metastatic ovarian carcinoma , who recently underwent an exploratory laparotomy on 5/2 by Dr. Korcblinknud .
She was found to have widely metastatic ovarian carcinoma .
There was sigmoid narrowing near a large left ovarian mass , and distal ileal narrowing by a right ovarian mass .
The patient had an ileostomy performed and had had her first course of chemotherapy and later debulking operation by Dr. Median .
She was well at home until 8:30 p.m. on the day of admission , when she developed acute onset of right foot pain , which was worse with walking .
She complained of increased numbness of the right foot over time , and was seen at Sephsandpot Center , where she was found to have palpable right femoral and popliteal pulses , and no pedal pulses .
The patient was transferred to the Fairm of Ijordcompmac Hospital .
She had previous history of claudication .
HOSPITAL COURSE :
ON 5/14/92 , the patient received an arteriogram which demonstrated an embolus in the right profunda / femoral artery .
There was an occlusion in the proximal calf , of the peroneal and anterior tibial arteries .
There was an occlusion of posterior tibial artery at the ankle .
She was taken urgently to the operating room , where she underwent embolectomy of the profunda superficial femoral vessels .
The estimated blood loss was 200 cc. and she tolerated the procedure well .
Postoperatively , she was again noted to have a cold right lower extremity with diminished pulses and was again taken to the operating room , where she underwent a right popliteal exploration and thrombectomy .
She again tolerated the procedure well and did well postoperatively .
On 5/19 , she had an echocardiogram done which was to be evaluated as an out patient .
By discharge she was walking and taking PO's without problem . | [
{
"text": "5/14/92",
"start_char": 1043,
"end_char": 1050,
"id": "T5",
"type": "DATE",
"val": "1992-05-14",
"mod": "NA"
},
{
"text": "5/14/92",
"start_char": 18,
"end_char": 25,
"id": "T0",
"type": "DATE",
"val": "1992-05-14",
"mod": "NA"
},
{
"tex... | null | null | null |
438 | ADMISSION DATE :
06-22-93
DISCHARGE DATE :
06-27-93
HISTORY OF PRESENT ILLNESS :
Mrs. Cast is a 50 year old white female with a history of chronic obstructive pulmonary disease and evidence of severe lobular emphysema , who has progressive shortness of breath and inability to carry on with activities of daily living without assistance .
She was admitted to the hospital for a pre lung transplant evaluation .
The patient has been steroid dependent for two years and has been intubated in the past only once for a surgical repair of trigeminal neuralgia .
Her previous occupation was an executive secretary , home trainer / nurse , rental aide .
She has no history of asbestos exposure or tuberculosis exposure .
HOSPITAL COURSE :
The patient was seen in consultation by a variety of consultants including Infectious Disease , Cardiology , Endocrine , Psychiatry , ENT , and Neuro-ophthalmology .
She was noted to have mild cataracts , possibly due to chronic steroids , as well as a subtle temporal disc pallor OD , possibly due to previous episode of optic neuritis .
No acute pathology was noted and no treatment was necessary at this time .
Dr. Koteelks indicated that the patient did not have sinus problems currently but thought that the trigeminal pain might be investigated further and that the sphenoid might account for some of the patient 's discomfort .
If so , he considers the possibility that this could be opened .
This is left for further follow up as an outpatient .
Dr. Tikkerth felt that the patient had mild adjustment related anxiety under good control with a history of tobacco abuse in the past .
The patient completed the studies and to be informed of the results as an outpatient .
She knows to return to her local physician for her routine care with her condition unchanged at the time of discharge .
I L. STERPSKOLK , M.D.
TR :
bg / bmot
DD :
09-08-93
TD :
09/09/93
CC : | [
{
"text": "this time",
"start_char": 1135,
"end_char": 1144,
"id": "T4",
"type": "DATE",
"val": "1993-06-27",
"mod": "NA"
},
{
"text": "06-22-93",
"start_char": 18,
"end_char": 26,
"id": "T1",
"type": "DATE",
"val": "1993-06-22",
"mod": "NA"
},
{
"... | null | null | null |
362 | Admission Date :
2017-05-08
Discharge Date :
2017-05-16
Service :
CARDIOTHORACIC
History of Present Illness :
Mr. Williams is an 85 yo gentleman who has a known cardiac history and has had a h/o worsening chest pain and shortness of breath .
He had an echocardiogram which showed an EF 40-45% and severe aortic stenosis .
He underwent cardiac catheterization which showed an 80% LAD lesion , chronically occluded RCA , anneurysmal mid LCX w/50% lesion .
He was refered to Dr. Barber for surgical treatment .
Brief Hospital Course :
Mr. Williams was admitted to Hallmark Health System on 05-08 and taken to the operating room with Dr. Barber for a CABGx2 and AVR w/ 25 mm pericardial valve .
Please see operative note for full details .
He was transfered to the ICU in stable condition .
He was weaned and extubated from mechanical ventillation on POD#1 without difficulty .
He was transfered to the regular part of the hospital on POD#2 , where he began working with physical therapy .
He developed atrial fibrillation on POD#2 with well controlled rate and hemodynamically stable .
He was started on heparin and coumadin for anticoagulation on POD#5 .
On POD#7 he was cleared for discharge to home by physical therapy and on POD#8 he was discharged . | [
{
"text": "POD#2",
"start_char": 1023,
"end_char": 1028,
"id": "T8",
"type": "DATE",
"val": "2017-08-10",
"mod": "NA"
},
{
"text": "POD#5",
"start_char": 1146,
"end_char": 1151,
"id": "T5",
"type": "DATE",
"val": "2017-05-13",
"mod": "NA"
},
{
"tex... | null | null | null |
376 | ADMISSION DATE :
05/08/95
DISCHARGE DATE :
05/14/95
HISTORY OF PRESENT ILLNESS :
The patient is a 72-year-old right-handed gentleman with a history of coronary artery disease status post myocardial infarction in 1984 .
Also with a history of noninsulin dependent diabetes mellitus , now presenting with acute blurry vision on the left side , which is homonymous .
The patient woke up as usual on May 8 , 1995 .
At 8 a.m. the patient was looking at his wife with the background outside a large window .
The patient had sudden onset of blurred vision , where the right side of his wife 's face looked blurred .
The patient did not notice change of vision in the background .
The blurred vision was homonymous , which he had blurred in each eye in the left visual field .
The same blurred vision was also noticed later when the patient was watching television and also when he was reading .
The patient was seen at the Ochtuheihugh Put University Medical Center and then he was referred to the Purckecation Balpoingdelt Pabarnes- Campa Memorial Hospital .
At 8 p.m. the patient seen at the Purckecation Balpoingdelt Pabarnes- Campa Memorial Hospital and was examined and assessed .
The patient was referred to Ph University Of Medical Center for rule out transient ischemic attack and rule out stroke .
The patient denies any nausea , vomiting , ataxia , motor deficits , speech deficits or sensory deficits .
The patient lightly bumped his head on the top three times on the previous night and the patient had frontal headaches and a tight neck .
One hour after he had physical activity on the previously night as well .
ALLERGIES :
The patient denies any drug allergies .
HOSPITAL COURSE :
The patient was admitted with a right occipital cerebral infarction .
The patient was started on intravenous heparin and had the studies as described above for rule out source of embolic strokes including carotid noninvasives , transcranial Dopplers , Holter electrocardiogram and echocardiogram .
The patient also had serial electrocardiogram , which showed no change .
The patient also had serial creatinine kinase with MB fractions studied , which revealed MB fraction too low to be tested .
The patient also experienced a feeling of moving back and forth when lying down with neck extended during the magnetic resonance imaging study and also in bed .
This moving sense , with normal electroencephalogram , was thought to be a mild vestibular dysfunction or from the acute episode of the stroke .
The patient will have these symptoms only when the eyes are closed .
Our opinion was not to intervene or have any further studies for acute period and to continued to observe .
The patient did have a hypotensive episode and the systolic blood pressure was 80 , after the patient received his regular cardiac medications .
The patient had been off his regular medications since during the admission and will be discharged off his medications .
Otherwise , there were no further episodes of blurred vision .
The patient was stable with an unchanged neurological and physical examination and was discharged on aspirin 325 mg po qd , on May 14 , 1995 .
The patient will be randomized on the Wars study early next week by the Stroke Service at Ph University Of Medical Center . | [
{
"text": "8 p.m.",
"start_char": 1062,
"end_char": 1068,
"id": "T7",
"type": "TIME",
"val": "1995-05-08T20:00",
"mod": "NA"
},
{
"text": "three times",
"start_char": 1460,
"end_char": 1471,
"id": "T8",
"type": "FREQUENCY",
"val": "R3",
"mod": "NA"
},
... | null | null | null |
612 | Admission Date :
2014-08-07
Discharge Date :
2014-08-09
Service :
NEUROSURG
HISTORY OF PRESENT ILLNESS :
This is a 56 - year-old man without any significant past medical history who presented to the emergency room after the sudden onset of headache while he was riding a bicycle .
He characterized this headache as the worst headache of his life and had associated nausea and vomiting times one .
He also complained of dizziness at the time of headache onset .
He presented to the Edith Nourse Rogers Memorial VA Hospital emergency room , where an initial head CT scan was read as negative .
However , a lumbar puncture was done , in which tube 1 showed 4800 red blood cells and tube 4 showed 4000 red blood cells .
The patient was sent for an MRI of the head , which raised the question of a right posterior cerebral artery aneurysm .
The CT scan was revealed and , on second analysis , it was thought that it was suspicious for a subarachnoid hemorrhage in the suprasellar cistern .
The patient was then admitted for further evaluation .
HOSPITAL COURSE :
The patient was admitted to the surgical intensive care unit , where a continued cerebral angiogram was done that was essentially normal , without evidence of any obvious aneurysm .
The patient was observed for two days with a repeat CT scan showing no changes from the previous examination .
The headache stabilized after the patient was transferred to the floor .
The patient continued to do well and the decision was made to discharge him . | [
{
"text": "two days",
"start_char": 1270,
"end_char": 1278,
"id": "T3",
"type": "DURATION",
"val": "P2D",
"mod": "NA"
},
{
"text": "2014-08-07",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "2014-08-07",
"mod": "NA"
},
{
"te... | null | null | null |
602 | Admission Date :
2011-06-10
Discharge Date :
2011-06-13
Service :
CMED CSRU
HISTORY OF PRESENT ILLNESS :
This is a 35-year-old gentleman with HIV on HAART with last CD4 count of 268 and undetectable viral load who was referred to the emergency room via his PCP for progressive throat pain and edema .
His throat pain began 2 to 3 days prior to admission , initially treated with ibuprofen , seen in an outside hospital emergency room day prior to admission where he received IV penicillin and was sent home .
In clinic today , the patient desaturated to low 90 s with ambulation and also had complaints of progressive swelling " like my throat is going to close up " with increasing drooling , unable to swallow the HIV medications .
Also noted to have low-grade temperature of 99 to 100 degrees with productive cough and yellow sputum times 1 day with
right ear pain .
No subjective shortness of breath .
The patient describes whole body numbness .
He currently notes improvement in his throat pain after some Decadron and clindamycin .
He was seen by CMED CSRU in the emergency room and the exam was consistent with supraglottitis .
REVIEW OF SYSTEMS :
Review of systems was negative for history of opportunistic infections or prior hospitalizations .
Of note , his CD4 count was less than 200 last winter .
He believes he is up-to-date on all his vaccines .
HOSPITAL COURSE :
This is a 35-year-old gentleman with HIV on HAART , last CD4 count 268 with undetectable viral load who was initially admitted to the CMED CSRU for supraglottitis with significant edema .
PROBLEM LIST :
1. Epiglottitis / supraglottitis .
The patient was observed in the CMED CSRU for 48 hours and noted to have decrease in swelling on serial exams .
He was followed by the CMED CSRU Service and was started on IV Decadron initially in addition to IV Unasyn , which he tolerated well .
His edema was improving and was starting to tolerate p.o.
His airway and symptoms continued to improve and remained stable .
The patient was stable for transfer to the floor , was treated with over 72 hours of IV Unasyn , and then transitioned to oral regimen of Augmentin to be continued as an outpatient .
Eventually , his IV steroids were transitioned to a p.o. steroid taper , which he tolerated well , and was discharged on a steroid taper also with CMED CSRU follow-up as an outpatient .
His oxygenation and symptoms remained stable and again tolerated p.o. without difficulty .
Eventually , as the patient remained hemodynamically stable , his airway remained stable , and he was tolerating PO s, he was transitioned to the floor where he remained otherwise stable and asymptomatic .
His voice improved during the course of his stay and was talking clearly by the time of discharge .
He remained afebrile during the course of his stay after transfer to the floor and per CMED CSRU was to be discharged on a 2-week course of Augmentin with follow-up with Dr. Thibodeau in 2 weeks ' time in addition to a Medrol Dosepak .
1. HIV .
Once , the patient was tolerating p.o. , the patient was restarted on his HAART regimen and remained stable from that perspective . | [
{
"text": "last winter",
"start_char": 1297,
"end_char": 1308,
"id": "T6",
"type": "DATE",
"val": "2010",
"mod": "END"
},
{
"text": "48 hours",
"start_char": 1664,
"end_char": 1672,
"id": "T7",
"type": "DURATION",
"val": "p48h",
"mod": "NA"
},
{
"t... | null | null | null |
366 | Admission Date :
01/11/1996
Discharge Date :
01/19/1996
HISTORY OF PRESENT ILLNESS :
Ms. Less is a 79 year old white female with history of non small cell lung cancer diagnosed in 02/95 .
She underwent a resection for stage I in 10/95 and treated with XRT .
She presented to the hospital with a numb right leg this morning and underwent an emergent embolectomy . | [
{
"text": "01/11/1996",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "1996-01-11",
"mod": "NA"
},
{
"text": "02/95",
"start_char": 181,
"end_char": 186,
"id": "T3",
"type": "DATE",
"val": "1995-02",
"mod": "NA"
},
{
"text": ... | null | null | null |
212 | Admission Date :
2017-06-28
Discharge Date :
2017-07-02
Service :
CMED CCU
HISTORY OF PRESENT ILLNESS :
A 40-year-old female with history of non-ST-elevation myocardial infarction in 2016-09-30 with stent to the LAD and 50% to the mid LAD , had instent restenosis in 2017-04-02 and then underwent brachytherapy to the RCA , who presented to Baldpate Hospital with several weeks of chest pain similar to her anginal equivalent and MI in the past .
It started at rest .
No relief with nitroglycerin x3 .
Radiates to the left arm .
Positive shortness of breath .
Troponins have been less than 0.01.
With history , will go for cardiac catheterization evaluation .
Still getting chest pain intermittently , but relieved by morphine sulfate .
Was on a Heparin and nitroglycerin drip with only intermittent relief .
HOSPITAL COURSE:
1. Chest pain :
The patient ruled out for myocardial infarction .
However , with her history of disease , patient underwent a cardiac catheterization .
The patient was found at cardiac catheterization to have mild diffuse instent restenosis in the mid stent , otherwise hemodynamically normal and the coronary arteries otherwise were without flow-limiting stenoses .
The patient was then continued on her cardiac medications .
It was felt that if we attempted aspirin desensitize her while an inpatient , then she would benefit from the use of aspirin and Plavix .
The patient was sent to the CCU and underwent aspirin desensitization protocol , which she tolerated well .
She had mild worsening of her asthma attacks , which was relieved by Benadryl and occasionally albuterol .
The patient found that if she took the aspirin in the evening with her Benadryl that she takes for sleep , that the asthma exacerbation did not occur .
Aspirin no longer should be considered an allergy for this patient , and she is going to take this as an outpatient .
2. Hyperlipidemia :
The patient 's Lipitor was increased to 80 mg q.d.
3. Back pain :
This is a chronic issue and was controlled with Flexeril and Vicodin . | [
{
"text": "2017-06-28",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "2017-06-28",
"mod": "NA"
},
{
"text": "2016-09-30",
"start_char": 184,
"end_char": 194,
"id": "T3",
"type": "DATE",
"val": "2016-09-30",
"mod": "NA"
},
{
... | null | null | null |
776 | Admission Date :
02/08/1991
Discharge Date :
02/18/1991
HISTORY OF PRESENT ILLNESS :
Mr. Breutzfarstxei is a 30 year old man with recently diagnosed acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia who presented with pneumonia , developed adult respiratory distress syndrome , and died in the hospital after failed efforts of ventilatory support .
Mr. Breutzfarstxei was recently diagnosed with acquired immunodeficiency syndrome when he had Pneumocystis carinii pneumonia on 01/17/91 .
He was admitted to the Retelk County Medical Center at that time and was treated with Bactrim and steroids .
He was actually intubated and underwent bronchoscopy where the diagnosis was made with a positive toluidine blue study .
He initially did well after extubation and completed approximately two weeks of Bactrim and a steroid taper .
At discharge after about two weeks post-extubation , he had an O2 saturation of approximately 95% on room air .
He was seen by Dr. Seen and Dr. Seen as an out-patient .
On 02/06/91 , he was seen in FLFDMC and at that point , his temperature was noted to be 101.4 and he had malaise and diarrhea .
He was evaluated in the Emergency Room .
At that time , his oxygen saturation was only 90% on room air and his chest X-Ray showed no change .
Cultures were taken and he was sent out .
On 02/08/91 , the patient called Dr. Seen because of increased shortness of breath and malaise .
He was seen in FLFDMC where he was noted to have jaundice and newly palpable liver edge .
Review of liver function tests revealed a cholestatic picture which was not previously found and it was felt that this was secondary to the Bactrim which had been recently stopped anyway .
His oxygen saturation at that time was only 86% on room air and he was admitted .
HOSPITAL COURSE :
The patient was admitted for work-up of his cholestatic jaundice picture along with work-up for his pulmonary process and treatment of both .
In terms of pulmonary function , it was felt that one possibility was that the patient was a Bactrim failure for PCP although this was unusual .
He was started on Pentamidine , especially in light of the fact that it was felt that his liver function tests were due possibly to Bactrim .
The patient was also covered with Erythromycin and Gentamicin for coverage of community acquired pneumonias and gram negative rods .
He was given supplemental oxygen .
In terms of his liver abnormalities , it was felt that viral hepatitis was in the differential as well as several opportunistic infections of the liver but also was felt that Bactrim could be a cause of these abnormalities .
Titers for CMV and Epstein-Barr virus were sent and a titer for toxoplasma was sent .
Stool was sent for ova and parasites .
Gastrointestinal was consulted .
Initially , the patient did well in terms of his pre-status and required less oxygen .
However , on 02/10/91 , his respiratory rate increased and his oxygen saturation decreased .
Actually in reviewing the records at this point , it appears that Pentamidine was not started initially so on the antibiotics of Erythromycin and Gentamicin , the patient 's respiratory status worsened and his LDH climbed so he began Pentamidine on 02/10/91 .
On 02/11/91 , the patient again appeared more comfortable this time with 50% facemask but then required more oxygen , dropped his O2 saturations , and was intubated on 02/11/91 .
He was transferred to the Intensive Care Unit on 12/12/90 on Gentamicin , Vancomycin , Pentamidine , and Prednisone .
Also of note at that point , hepatitis C virus serologies had come back positive .
However , at this point , his liver function test abnormalities appeared more consistent with a cholestatic picture with his direct bilirubin being 12.1 and total being 14.1 .
The patient 's abdominal CT scan showed no liver disease and no obstruction .
The patient 's liver function tests appeared to improve .
The patient 's penile ulcer was cultured and grew positive herpes simplex virus and the patient was started on Acyclovir .
On 02/13/91 , the patient had a bronchoalveolar lavage performed which showed a toluidine blue with many pneumocysts noted .
No other cultures grew out and the patient 's clinical status deteriorated .
The patient required 100% oxygen to maintain adequate oxygen saturations on the ventilator .
He required elevated ventilatory pressures with PIPS often above 60 .
Fortunately , no evidence of baratroma was ever discerned .
However , the patient 's respiratory status continued to decline and we were unable to maintain oxygen saturations above 80% even using reverse I to E ventilation , paralysis , sedation , and other modes of ventilation .
Patient underwent liver biopsy on 02/16/91 and the results of this were pending when the patient died .
The patient actually developed decreasing counts with white count as low as 1.75 , hematocrit as low as 26 , and platelets as low as 68 noted on 02/15/91 .
These were supported with blood products and Hematology was consulted .
They felt that it was most likely secondary to Bactrim and these actually were getting better when the patient died .
Bone marrow biopsy was not attempted .
Discussions were begun with the family regarding limits of supportive care .
Due to continued worsening pulmonary status and an overall grim prognosis , the family decided , in consultation with the Medical Team , to withdraw ventilatory support .
This was done on the evening of 02/18/91 .
Patient expired after the endotracheal tube was withdrawn at 6:40 p.m. | [
{
"text": "02/06/91",
"start_char": 1021,
"end_char": 1029,
"id": "T4",
"type": "DATE",
"val": "1991-02-06",
"mod": "NA"
},
{
"text": "that time",
"start_char": 1190,
"end_char": 1199,
"id": "T14",
"type": "DATE",
"val": "1991-02-06",
"mod": "NA"
},
{
... | null | null | null |
777 | Admission Date :
2018-05-24
Discharge Date :
2018-05-29
Service :
CARDIOTHORACIC
History of Present Illness :
s/p AVR 05-14 .
Postop course c/b right upper extremity DVT and postop Afib .
Discharged home 05-19 with instructions to f/u in vascular clinic .
Had vascular clinic f/u on day of admission .
At that time had UE duplex which revealed RUE DVT involving IJ , Axillary , subclav , brachial , and basilic veins .
Then referred to ER for Tx
Brief Hospital Course :
Pt admitted 05-24 from ER after positive RUE DVT finding in vascular lab .
During ER evaluation pt was noted to have some degree of dyspnea as well as mental status changes , including loss of short term memory and brief unresponsive period after one dose of IV Benadry and steroids prior to CT scan .
The CT was negative for CVA but positive for Pulmonary embolism .
He was transferred to CSRU for evaluation .
Neurology was consulted and the pt also had MRI which was negative .
The pt was begun on heparin gtt and was noted to have platelet drop > 50% after infusion began , hepain was d/c 'd.
Argatroban was started abd a HIT panel was sent , HIT panel was positive .
Hematology was consulted .
By the following mornig all mental status changes had cleared and the pt was transferred to the floors for continued care .
Over the next several days the patient was maintained on Argatroban when coumadin therapy was initiated .
On HD#6 the pt had a therapeudic INR ( 4.4 ) off Argatroban and wad discharged home .
He was to have f/u INR check with Dr Lewis on 05-31 .
Additionally the pt should f/u with the hematology clinic . | [
{
"text": "the following mornig",
"start_char": 1173,
"end_char": 1193,
"id": "T8",
"type": "DATE",
"val": "2018-05-25",
"mod": "START"
},
{
"text": "05-14",
"start_char": 119,
"end_char": 124,
"id": "T3",
"type": "DATE",
"val": "2018-05-14",
"mod": "NA"
... | null | null | null |
213 | Admission Date :
2016-07-18
Discharge Date :
2016-07-21
Service :
MEDICINE
History of Present Illness :
46 - yo-man w/ active cocaine use presents w/ LE edema .
10 days ago , he developed b/l LE edema that has gotten progressively worse until now .
Three days ago , he developed dyspnea on exertion when climbing stairs , assoc w/ 2-pillow orthopnea and PND .
He denies any recent chest pain , palpitations , headache , confusion , weakness , numbness , abd pain , or hematuria .
No recent viral syndromes or URI s.
He does admit to cocaine use last night .
Today , his wife convinced him to present to the Deanna for evaluation .
In the Deanna , his BP was 230/170 .
BNP was elevated at 7500 .
CXR revealed evidence of cardiomegaly and pulm edema .
He was treated w/ ASA 325 mg , lasix 10 mg IV , and hydralazine 10 mg IV x 2 .
He responded well to lasix w/ good UOP , but diastolic BP remained elevated at 170 , prompting initiation of nitroprusside gtt .
He is now admitted to the CCU for further care .
Brief Hospital Course :
46 - yo-man w/ cocaine abuse presents w/ LE edema and DOE likely from diastolic heart failure in the setting of cocaine use complicated by hypertensive urgency .
Hypertensive urgency :
BP 230/170 on presentation , most likely from chronic HTN exacerbated by cocaine use .
No signs of end-organ damage at present except for elevated creatinine , which is more likely a chronic problem .
The patient was started on labetalol and Lisinopril .
His blood pressure was taken down from 230 systolic to approx 160 systolic / 100 diastolic on discharge .
His lower extremity edema improved with diuresis .
An echo performed on admission showed an LF EF of 25% .
It is hoped with good blood pressure control and use of an ACE-I with follow up in addition to cocaine abstaining will improved his cardiac function .
Renal Failure : creatinine on admission was 1.6 Likely acute hypertensive nephropathy plus probalbe long-standing hypertensive disease .
discharged on ACE-I .
Substance Use : Social work saw patient and counceled him regarding substance abuse .
Discharged with Margaret Hallock , cardiology follow up as well as scheduled appointment with a new PCP @ Newton Health Center . | [
{
"text": "10 days ago",
"start_char": 162,
"end_char": 173,
"id": "T2",
"type": "DATE",
"val": "2016-07-08",
"mod": "NA"
},
{
"text": "2016-07-18",
"start_char": 18,
"end_char": 28,
"id": "T0",
"type": "DATE",
"val": "2016-07-18",
"mod": "NA"
},
{
... | null | null | null |
367 | Admission Date :
2013-10-21
Discharge Date :
2013-10-31
Service :
CARDIOTHORACIC
History of Present Illness :
This is an 85 year old female with prior history of non-hodgkins lymphoma , s/p Cytoxan in 2003 a with recurrence in 2009 .
Follow up examinations have found a suspicious left lower lobe finding .
Cardiac workup prior to left lower lobe resection led to cardiac catheterization which found severe three vessel disease with 04-05+ mitral regurgitation .
She now present for surgical intervention .
Brief Hospital Course :
Mrs. Mandelbaum was admitted and underwent three vessel coronary artery bypass grafting by Dr. Larry Mckinney .
Of note , intraoperative transesophageal echocardiogram evaluation showed only mild mitral regurgitation , so no repair/replacement was indicated .
Following the operation , she was brought to the CSRU .
On postoperative day one , she was noted to be largely unresponsive with left hemiparesis .
Restlessness with body tremors were also noted .
A stat MRI was notable for multiple abnormal foci consistent with systemic emboli .
These were found in the right cerebellar , occipital and anterior parietal lobes .
The neurology service was consulted and attributed these findings to cholesterol emboli .
Due to seizure activity , Dilantin was started .
Anticoagulation was not recommended .
Over the next several days , her neurological status slowly improved .
She was eventually extubated without incident .
She went on to experience paroxysmal atrial fibrillation which was initially treated with intravenous Amiodarone .
She concomitantly had loose stools which were C. diff negative .
Her clinical status stablized and she transferred to the step down unit on postoperative day six .
She remained mostly in a normal sinus rhythm and transitioned to oral Amiodarone which will need to continue for three months postop .
She tolerated beta blockade which was slowly advanced as tolerated .
She worked daily with physical and occupational therapy .
Her neurological status continued to improve .
Acyclovir was eventually increased from her maintenance dose for a herpes zoster breakout on her right upper back .
In addition , she was empirically started on Flagyl for persistent diarrhea ( despite negative C. diff cultures ) , however she developed an additional rash on her buttocks after the first dose of flagyl , so the flagyl was discontinued .
She developed a urinary tract infection for which she was started on Bactrim .
A foley catheter was inserted given her mutiple episodes of incontinence that were adding to skin irritation .
On insertion she was found to be retaining 1400 cc of urine , so the foley catheter was left in .
She continued to make clinical improvements and was cleared for discharge to rehab on postoperative day 10 . | [
{
"text": "the next several days",
"start_char": 1338,
"end_char": 1359,
"id": "T6",
"type": "DURATION",
"val": "p3d",
"mod": "APPROX"
},
{
"text": "postoperative day six",
"start_char": 1707,
"end_char": 1728,
"id": "T7",
"type": "DATE",
"val": "2013-10-27",
... | null | null | null |
373 | ADMISSION DATE :
06/29/92
DISCHARGE DATE :
07/27/92
HISTORY OF PRESENT ILLNESS :
Mr. Villesatelkscurb is a fifty year old black gentleman with a long history of hepatitis C , believed to be contracted during transfusions in a previous trauma .
The patient had recently prior to this admission , had a rise in his alpha feta protein and a biopsy of his liver had shown hepatocellular carcinoma .
The patient was admitted for liver transplant workup and to await liver transplant .
PAST MEDICAL and
SURGICAL HISTORY :
Significant for motor vehicle accident in 1966 , requiring exploratory laparotomy and splenectomy , tonsillectomy as a child , pneumonia in the past , hepatitis C and recent diagnosis of hepatocellular carcinoma .
ADVERSE DRUG REACTIONS :
no known drug allergies .
MEDICATIONS ON ADMISSION :
On admission medications included Lasix and iron .
HOSPITAL COURSE :
Preoperatively , the patient underwent chemo-embolization for his hepatocellular carcinoma .
The remainder of his preoperative course was benign .
On July 15 , 1992 , a liver became available , and the patient underwent hepatectomy and orthotopic liver transplant .
His operation was complicated by severe coagulopathy requiring fifty-nine units of packed red blood cells , 64 units of FFP and 34 units of platelets .
Postoperatively , the patient continued to have a coagulopathy requiring re-exploration on postoperatively day 2 , with findings only of hematoma and no active bleeding .
Initially , the patient did well in the Intensive Care Unit , mentally alert , and oriented , however , he continued to be coagulopathic and was requiring large amounts of blood and FFP transfusions , with a resultant pulmonary edema .
He developed renal failure felt to be ATN secondary to ischemia of his kidneys .
The patient remained intubated in the Intensive Care Unit for twelve days prior to his death .
He had daily transfusions of FFP and blood , and continued coagulopathy .
He also developed thrombocytopenia , requiring persistent platelet transfusions on a daily basis .
His immunosuppression was OKT3 and Solu Medrol , and he underwent hemodialysis and ultra filtration to remove fluid .
While in the ICU he developed seizures , requiring large amounts of intravenous Valium to break his seizures , and he was maintained on Tegretol and Dilantin .
However , he became progressively more mentally obtunded .
During the seizure , he bit his tongue , resulting in a large bleed from his tongue , which was sutured by the ENT Service , however , his continued coagulopathy resulted in bleeding from his nasopharynx , which could never be identified , and also upper gastrointestinal bleeding .
Endoscopy never revealed specific sources of bleeding , although he appeared to have a diffuse duodenitis .
He was started on Pitressin to try to control the gastrointestinal bleeding , but he continued to have severe bleeding , and became progressively hypotensive , with eventual bradycardia and cardiac arrest .
He was pronounced dead at 3:49 PM on July 27 , 1992 . | [
{
"text": "July 15 , 1992",
"start_char": 1028,
"end_char": 1042,
"id": "T4",
"type": "DATE",
"val": "1992-07-15",
"mod": "NA"
},
{
"text": "postoperatively day 2",
"start_char": 1387,
"end_char": 1408,
"id": "T5",
"type": "DATE",
"val": "1992-07-17",
"mod... | null | null | null |
167 | Admission Date :
2019-06-25
Discharge Date :
2019-07-01
Service :
CARDIOTHORACIC
History of Present Illness :
69yoM with OA having workup for knee replacements found to be in Afib , had stress test that was positive followed by cardiac catheterization which revealed severe 3VD .
Then referred for CABG
Brief Hospital Course :
69 yo M with known Atrial fibrillation and coronary artery disease admitted preop for transition fro Coumadin to Heparin .
Brought to the OR on 06-26 for CABG , please see OR report for details .
In summary pt had off pump CABGx4 with LIMA-LAD , SVG OM-Y graft - Diag , SVG-PDA .
Pt tolerated surgery well and was transferred to CT CMED ICU .
He did well in immediate post-op period was extubated and on POD1 he was transferred to the step down floor .
On POD2 his chest tubes and epicardial pacing wires were removed and his Coumadin was restarted .
Over the next several days his activity was advanced on POD5 it was decided he was stable and ready to be discharged home with visiting nurses . | [
{
"text": "2019-06-25",
"start_char": 18,
"end_char": 28,
"id": "T0",
"type": "DATE",
"val": "2019-06-25",
"mod": "NA"
},
{
"text": "2019-07-01",
"start_char": 46,
"end_char": 56,
"id": "T3",
"type": "DATE",
"val": "2019-07-01",
"mod": "NA"
},
{
"t... | null | null | null |
173 | Admission Date :
2009-05-01
Discharge Date :
Date of Birth :
Service :
Surgery
HISTORY OF PRESENT ILLNESS :
The patient is a 39 year-old gentleman admitted on 2009-05-01 to the Jewish Memorial Hospital referred from South Cove Community Health Center .
He is a 39 year-old gentleman with hyperlipidemia and smoking who presented with acute onset of chest pain since five in the morning with radiation to the left arm and nausea .
Symptoms resolved spontaneously .
He was taken to the Cath Lab at the Pinewood , Norfolk that evening where a stent procedure to the RCA was complicated by guidewire entrapment inside of a stent requiring CT surgery to do a thoracotomy with bypass and excision of the wire .
The case was complicated by an episode of coffee ground emesis and a bleed from femoral access site prior to CT surgery .
Gastroenterology was consulted and they recommended Protonix and felt it was due to peptic ulcer disease .
HOSPITAL COURSE :
The patient was diagnosed as having an acute myocardial infarction .
The patient was taken emergently to the operating room on 2009-05-02 for his CABG , right coronary endarterectomy , removal of RCA stents and retrieval of the aortic guidewire .
Postoperatively he did well and was transferred to the Cardiac Surgery Intensive Care Unit where he was on pressor support of Neo-Synephrine and he was extubated .
The patient slowly weaned off Neo-Synephrine as tolerated .
He was transferred to the floor on 2009-05-04 .
His chest tube had been discontinued .
Upon arrival to the floor the patient 's wires were discontinued on 2009-05-05 and his Foley catheter was discontinued .
The patient was seen by Physical Therapy .
His electrolytes were repleted and the patient was discharged home on 2009-05-06 after tolerating a level V .
MEDICATIONS : His prescriptions shall include
1. Lopressor 25 milligrams po bid .
2. Lipitor 20 milligrams po q HS .
3. Niferex 150 milligrams caplet one cap per day .
4. Protonix 40 milligrams po q day .
5. Colace 100 milligrams po bid .
6. Percocet one to two tablets q four H prn for pain .
He will get 60 of those .
7. Plavix 75 milligrams po q day times three months .
8. Aspirin 325 milligrams po q day .
9. Lasix 20 milligrams po times 30 days .
10. KCL 20 milliequivalents po q d times three days . | [
{
"text": "2009-05-02",
"start_char": 1080,
"end_char": 1090,
"id": "T4",
"type": "DATE",
"val": "2009-05-02",
"mod": "NA"
},
{
"text": "2009-05-04",
"start_char": 1459,
"end_char": 1469,
"id": "T5",
"type": "DATE",
"val": "2009-05-04",
"mod": "NA"
},
... | null | null | null |
72 | Admission Date :
06/26/2004
Discharge Date :
07/08/2004
HISTORY OF PRESENT ILLNESS :
The patient is a 38-year-old gentleman , Spanish-speaking , from the Taheimpromong , with no significant past medical history , who presents with shortness of breath x 2 months as well as a dry cough x 1 month .
The patient was in his usual state of health until two months prior to admission when he began to notice shortness of breath on climbing flights of stairs .
He stated that this became worse over the last month until he was noted to be short of breath at rest .
He also states that he has had a dry and nonproductive cough for one month .
He denied any fevers , chills , or night sweats .
No nausea , vomiting , or diarrhea .
He did note some weight loss over the past several months , though the amount was unknown .
He denied any contact with TB positive patients .
He describes a negative PPD one year prior to admission when he was in prison for one week .
He did travel to the Taheimpromong , last in 01/2004 for three weeks .
He did note multiple female sexual partners , although described using condoms except with his wife .
He denies any IV drug use , did describe cocaine use last two months ago .
He did drink alcohol three drinks per day , no withdrawal symptoms .
In emergency room , he was noted to be afebrile with stable vital signs , was treated with IV fluids , azithromycin , and cefuroxime .
HOSPITAL COURSE BY SYSTEM :
1. Pulmonary / Infectious Disease :
The patient 's differential diagnosis included initially a question of an atypical pneumonia or PCP .
His PPD has been negative one year prior to admission , PPD was rechecked during this admission and was negative .
He was ruled out for tuberculosis with an induced sputum x 3 , which showed no AFB .
Chest CT showed bibasilar diffuse infiltrates , PCP was negative .
Thus initially he had been started on prednisone and Bactrim , this was discontinued .
He was continued on azithromycin and cefuroxime until bronchoscopy results were known , negative .
Thus they were discontinued .
He initially had refused HIV testing , however , was finally consented , HIV was noted to be negative .
Pulmonary consult was invited , initially the patient refused bronchoscopy , however , did agree to it during his hospital stay .
The results were negative for Micro , most likely diagnosis as per review of pathology is organizing pneumonia with possible diagnosis of BOOP and chronic inhalational injury was a possibility .
The patient required supplemental oxygen to keep his oxygen saturation greater than 93% .
Ambulatory saturation was 82% on room air .
He was treated with supportive medical therapy for his cough .
He was to follow up with pulmonary as an outpatient .
2. Cardiovascular :
Echocardiogram was checked to rule out CHF , showed LVH and trace TR , ejection fraction of 60% without any pulmonary hypertension .
3. Heme
/ID :
Hepatitis serologies were negative .
4. FEN :
The patient was kept on a house diet .
His electrolytes were repeated p.r.n.
5. Prophylaxis :
Lovenox .
6. Code status :
Full .
7. Disposition :
The patient was discharged to home in satisfactory condition with home oxygen .
Multiple conversations were had with the patient as well as an interpreter stating the importance of not smoking and keeping flames away from his oxygen tank .
He was sent home with LDAMC services to help with his medications as well as oxygen education .
He was told to call a doctor or come to the emergency room should he have any further troubles , breathing , chest pain , or fevers .
He was to follow up with Dr. Malta at Firmert Hospital on 07/23/04 at 3:00 p.m. , as well as Dr. Shawn Leick at the Stonho Health Care pulmonary division as directed . | [
{
"text": "01/2004",
"start_char": 1003,
"end_char": 1010,
"id": "T4",
"type": "DATE",
"val": "2004-01",
"mod": "NA"
},
{
"text": "three weeks",
"start_char": 1015,
"end_char": 1026,
"id": "T5",
"type": "DURATION",
"val": "P3W",
"mod": "NA"
},
{
"t... | null | null | null |
8 | Admission Date:
2011-02-08
Discharge Date :
2011-02-14
Service :
CMED
HISTORY OF THE PRESENT ILLNESS :
Briefly , this is a 57-year-old gentleman with a history of COPD , status post intubation six years ago but not on home 02 with recent FEV1 27% of predicted value , and FEV1/FVC ratio 56% of hypercholesterolemia , who was admitted for COPD exacerbation and worsening of upper respiratory tract infection symptoms for a week prior to admission .
He was afebrile with stable vital signs on presentation to
HOSPITAL COURSE :
He was started on p.o. steroids and to CMED for management of COPD exacerbation but he appeared in more respiratory distress overnight and was started on IV Solu-Medrol and more frequent nebulizers for COPD .
He was also started on antibiotics for possible bronchitis or community-acquired pneumonia .
Given his tenuous respiratory status , he was transferred to the FICU with closer observation .
He did not require intubation and improved with q. two hour nebulizers and chest PT .
He was again transferred to the CMED Service for further management of his COPD exacerbation .
He was continued on p.o. prednisone and frequent nebulizers for COPD .
He was evaluated by the physical therapist in the hospital and was found to desaturate to 84% with ambulating on room air .
Therefore , home 02 was recommended on discharge . | [
{
"text": "2011-02-08",
"start_char": 17,
"end_char": 27,
"id": "T1",
"type": "DATE",
"val": "2011-02-08",
"mod": "NA"
},
{
"text": "six years ago",
"start_char": 194,
"end_char": 207,
"id": "T0",
"type": "DATE",
"val": "2005-02-08",
"mod": "APPROX"
},
... | null | null | null |
417 | Admission Date :
2017-09-13
Discharge Date :
2017-09-15
Service :
NSU
HISTORY OF PRESENT ILLNESS :
The patient is a 45 - year-old female here for a diagnostic cerebral angiogram with coiling .
HOSPITAL COURSE :
On admission , the patient 's vital signs were stable .
Her blood pressure was 102/82 .
Her heart rate was 71 .
Her SPO2 was 98 percent on room air .
MEDICATIONS ON ADMISSION :
1. Plavix 75 mg times 6 doses .
2. Xanax q.d.
3. Prozac 20 mg q.d.
4. Cyclobenzaprine 10 mg q.d.
5. Aspirin 325 mg times 3 doses .
6. Vitamin E .
PAST SURGICAL HISTORY :
Tubal ligation , 1986 .
Cystectomy , 1992 and 1998 .
Breast lesion excision , 1989 .
ALLERGIES :
TETRACYCLINE .
SOCIAL HISTORY :
The patient uses alcohol socially ; was a smoker , used tobacco , she quit 4 years ago ; denies using recreational drug .
HOSPITAL COURSE :
On 2017-09-13 , the patient was brought to the operating room and underwent a coiling with stent placement of the left carotid ophthalmic aneurysm .
The patient underwent coiling and stent placement without complications .
She was discharged to the PACU in stable condition .
Postoperative check , the patient 's vital signs were stable .
Her temperature was 96.3 degrees , blood pressure was 128/63 .
Her pulse was 61 , respirations 12 , and her O2 saturation was 98 percent on room air .
Her labs showed a white blood count of 7.7 , hematocrit of 33.3 , and platelets were 305 .
Her coags , her PT was 14.5 , PTT was 143.4 , and her INR was 1.3 .
Her electrolytes were all within normal limits .
On physical exam , the patient was awake , alert , and oriented times 3 .
She had a symmetric smile .
Her extraocular movements were full .
Her pupils were 3 to 2 bilaterally , briskly reactive .
The visual fields were intact .
Her strength was 05-31 throughout except for right was not tested due to the angiocele in her groin .
Angiocele was intact without hematoma , and she exhibited strong pedal pulses on the right side .
The assessment at that time was she was neurologically stable .
The plan was q. 1-hour neuro checks .
She was started on a heparin drip at 800 per hour .
Her PTT goes 50 to 60 at that time .
She was cleared to take sips of clear fluids and was to remain flat for 4 hours .
On postoperative day 1 , the patient was alert and oriented times 3 .
She exhibited no drift .
Her IPs were full at 5/5 .
She had no hematoma in her groin site .
Visual fields were full , her pupils were round and reactive bilaterally .
Her vital signs were stable with a temperature of 97.8 degrees , blood pressure was 104 to 121 over 50s .
Pulse was 60 to 70 .
Respirations were 15 , and she was saturating at 96 percent on room air .
Her PTT at that time was 67.8 .
She was started on aspirin 325 mg q.d. and Plavix 75 mg q.d.
On 2017-09-14 , she was transferred to the regular floor at Far 5 .
Postoperative day 2 , the patient was stable without events , all vital signs were stable .
She was moving all extremities and exhibiting good strength .
Her visual fields were intact .
Her extraocular movements were full .
Angio site was clean , dry , and intact without bleeding or drainage .
She was to be discharged today and encouraged to ambulate on her own .
Discharge condition for this patient was good .
She was ambulating on her own and tolerating a p.o. diet .
She was discharged to home in stable condition . | [
{
"text": "2017-09-13",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "2017-09-13",
"mod": "NA"
},
{
"text": "that time",
"start_char": 1972,
"end_char": 1981,
"id": "T17",
"type": "DATE",
"val": "2017-09-13",
"mod": "NA"
},
{
... | null | null | null |
577 | Admission Date :
2009-06-23
Discharge Date :
2009-07-12
Service :
CMI ; then to Medcine ; then transferred to CCU
HISTORY OF PRESENT ILLNESS :
The patient is an 83-year-old male with a history of diabetes mellitus , steroid-treated polymyalgia rheumatica , hypertension , benign prostatic hypertrophy , and high cholesterol who presented for a lower extremity peripheral angiography for bilateral foot ulcers , and he was found to an evaluated blood urea nitrogen , and creatinine , and potassium .
The patient notes he developed worsening foot pain and ulcers four months ago .
Due to his worsening blood glucose , he was started on insulin .
His foot ulcers continued to develop , and the patient complained of pain in his feet ; primarily at night .
The patient was referred to for Vascular consultation because of the ulcerations and pain and scheduled for a lower extremity angiography on the day of admission , but due to his renal failure the procedure was cancelled .
The patient showed peaked T waves on electrocardiogram , and he was transferred to Medicine .
The patient denied any oliguria , hematuria , dysuria , foamy urine , flank pain , abdominal pain , or urinary hesitancy .
He has complained of fatigue , anorexia , and a 10-pound weight loss in the last four months .
He gets short of breath with one flight of stairs .
He denies any fevers , chills , recent infections , chest pain , orthopnea , nausea , vomiting , diarrhea , hematemesis , melena , or hematochezia .
The patient also notes he has had hoarseness for the last two to three weeks .
HOSPITAL COURSE :
The patient is an 83 - year-old male with a history of diabetes , steroid-treated polymyalgia rheumatica , hypertension , benign prostatic hypertrophy , and high cholesterol without presented to the hospital for lower extremity angiograph ; however , that was deferred due to new onset renal failure .
1. RENAL FAILURE :
The patient was initially thought to be prerenal , and his renal status improved after hydration and increased oral intake .
He did have a magnetic resonance angiography of his kidneys which showed mild right-sided renal artery stenosis .
His renal function fluctuated throughout his hospital stay , and when he was in the Medical Intensive Care Unit he did have decreased urine output in the setting of cardiogenic shock .
2. CARDIOVASCULAR :
The patient with severe peripheral vascular disease .
During his hospital stay , he developed some nonsustained ventricular tachycardia .
He also became hypotensive on 07-02 in the setting of infection .
The patient had a central line placed and went into sustained ventricular tachycardia that was treated with lidocaine .
After being treated with lidocaine , the patient became apneic requiring intubation and transfer to the Coronary Care Unit .
His nonsustained ventricular tachycardia was treated with a lidocaine drip .
It was found that he had elevated troponins and likely an ischemic event on the 07-02 .
A repeat echocardiogram showed a decreased ejection fraction from prior .
He had a cardiac catheterization which revealed 3-vessel disease .
Cardiothoracic Surgery was consulted , and due to the patient 's acute illness , they wanted to re-evaluate after the patient was extubated .
The patient continued to have intermittent episodes of ventricular tachycardia .
He was continued on lidocaine and eventually changed over to amiodarone .
He was noted to be cardiogenic shock requiring pressors .
Of note , he likely suffered a second ischemic event during his Coronary Care Unit stay .
The patient did have a Swan-Ganz catheter in place and had a low cardiac output .
The patient 's family eventually decided to withdraw care , and the patient was extubated and passed away on 2009-07-12 .
2. INFECTIOUS DISEASE :
The patient was initially treated with levofloxacin for a left lower lobe infiltrate and a urinary tract infection .
He then developed positive blood cultures with Staphylococcus aureus sensitive to levofloxacin , and that was continued .
When the patient became hypotensive and required intubation and pressors , his antibiotics were broadened , and he was put on stress-dose steroids .
He was found to have bilateral Staphylococcus pneumonia .
3. PULMONARY :
The patient required intubation in the setting of hypotension and ventricular tachycardia .
He was actually extubated on 07-09 , but then reintubated one hour later due to hypoxia .
He was also found to have a bilateral Staphylococcus pneumonia . | [
{
"text": "the last four months",
"start_char": 1266,
"end_char": 1286,
"id": "T4",
"type": "DURATION",
"val": "P4M",
"mod": "NA"
},
{
"text": "the last two to three weeks",
"start_char": 1539,
"end_char": 1566,
"id": "T5",
"type": "DURATION",
"val": "P17D",
... | null | null | null |
576 | ADMISSION DATE :
5-28-93
DISCHARGE DATE :
6-4-93
HISTORY OF PRESENT ILLNESS :
The patient is a 58 year old right hand dominant white male with a long history of hypertension , changed his medications from Aldomet to Clonidine six weeks ago .
The patient has a history of adult onset diabetes mellitus , ankylosing spondylitis , status post myocardial infarction in '96 ( ? ) now with acute onset of left face and arm greater than leg hemiplegia and primary hemisensory loss on the left .
Briefly , he was talking to a friend at 5:30 p.m. the day prior to admission , when he had to grab his locker and sit down .
His voice became slurred and he had a mild central dull headache .
He was unable to move the left side of his body and felt numb on that side .
He was taken to Wayskemedcalltown Talmi and transferred to Heaonboburg Linpack Grant Medical Center with a computerized tomography scan showing a 1x2 thalamic capsular hemorrhage without superficial mass effect .
His blood pressure was 220/110 there .
He denies any visual symptoms or cortical-type symptoms .
He is a heavy smoker and drinks 2-3 shots per day at times .
MEDICATIONS ON ADMISSION :
Vasotec 40 mg q.day , Soma 1 tablet q.day , Demerolprn , Clonidine .
ALLERGIES :
The patient has no known drug allergies .
HOSPITAL COURSE :
The patient was admitted to the floor for observation .
The neurological examination on discharge was no movement in the hand on the left or arm .
Slight abductive and adductive movement on the left only in the upper extremity .
On the lower extremity , could wiggle toes , flexor and plantar , 3+/5 , quadriceps 4/5 on the left .
2. hypertension .
The patient was managed with Vasotec , Nifedipine and Clonidine with blood pressure under good control at the time of discharge , average 125 systolic , 70 diastolic , heart rate of 72 .
Also managed with Valium 5 mg PO t.i.d.
Muscle spasms were managed with Flexeril 10 PO t.i.d.
3. diabetes mellitus .
The patient was started on 2.5 of Micronase with resulting sugars as low as 63 , decreased to 1.25 mg q.day .
The patient is discharged in fair condition with medical approval to the Pasi . | [
{
"text": "2-3 shots per day",
"start_char": 1105,
"end_char": 1122,
"id": "T5",
"type": "FREQUENCY",
"val": "RP8H",
"mod": "APPROX"
},
{
"text": "q.day",
"start_char": 1175,
"end_char": 1180,
"id": "T6",
"type": "FREQUENCY",
"val": "RP1D",
"mod": "NA"
}... | null | null | null |
172 | Admission Date :
2018-04-23
Discharge Date :
2018-05-01
Service :
MEDICINE
History of Present Illness :
95 yo male with PMH large right thyroid cystic mass eroding into trachea , who presented to St. Anne 's Hospital 2018-04-22 with hemoptysis and respiratory distress , now diagnosed with anaplastic thyroid carcinoma .
.
Pt reports that he noticed a right neck mass last October .
The mass grew larger , to the size of a baseball .
It appears that FNA was performed but was non-diagnostic ( probably because anaplastic tumors tend to be necrotic ) .
The mass appears to be cystic in nature and has been aspirated at least 3 times , which decrease in size each time .
Now size is 6.5cm*6.5cm .
Plan for surgery in Oct was deferred 04-05 syncope and pacer placement for SSS; again deferred 2 weeks ago 04-05 URI; was planned for surgery this Thurday .
.
Pt was o/w in his USOH until 2-3 weeks ago when he developed a URI with symptoms of dry cough; no fever , chills , sore throat , myalgias .
Pt was treated with 3 days of an antibiotics , followed by a 10 day course of levaquin ( completed 2 days PTA ) .
Per pt and son , no James pna .
2 days prior to admission , pt developed hemoptysis; states he coughed up 4 tsp of blood .
1 day PTA , pt developed stridorous breathing and respiratory distress .
Pt was initially seen at Lahey North , where he was given steroids , with improvement in respiratory status .
Pt was transferred to New England Baptist Hospital , where his surgeon is located .
There he was admitted to the CMED .
Thyroid cyst was aspirated with removal of 300cc of fluid .
Pt was given racemic epinephrine and Decadron 10mg IV x1. CT neck showed tracheal mass per nursing s/o ( pt brought CT ) .
.
Pt now breathing more comfortably .
He has not had fever and night sweats but reports weakness and weight loss for several months recently .
Brief Hospital Course :
Pt was transferred here for further mgmt of airway and large thyroid mass by our IP team .
IP found endotracheal obstructing tumor and extrinsic compression of the high trachea by thyroid mass .
After rigid bronchoscopy with removal of the intratracheal tumor component on 2018-04-24 , stat pathology showed anaplastic tumor .
He was tranferred to the CMED .
Subsequently extubated and his respiratory Sx are now improved .
Pt was seen by Rad Onc , who recommended transfer to the East Campus for XRT .
On the morning of possible radiation , patient and family met with interventional pulmonary team who explained that the most recent CT showed further invasion of the tumor into the trachea .
After a long discussion , patient and family asked to be made CMO .
Patient was started on morphine drip and palliative care team was consulted with recommendations to ensure comfort .
Mr . Davison died approximately 24 hours after decision to be CMO , on 2018-05-01 .
Discharge Disposition :
Expired
Discharge Diagnosis :
NC
Discharge Condition :
NC
Discharge Instructions :
NC
Followup Instructions :
NC
John Iris MD 70-363
Completed by :
Patricia Rojas MD 73-701 2018-05-06 @ 1434
Signed electronically by :
DR. John J. Booker on :
WED 2018-05-30 5:50 PM
( End of Report ) | [
{
"text": "3 days",
"start_char": 1015,
"end_char": 1021,
"id": "T10",
"type": "DURATION",
"val": "P3D",
"mod": "NA"
},
{
"text": "a 10 day course",
"start_char": 1054,
"end_char": 1069,
"id": "T12",
"type": "DURATION",
"val": "P10D",
"mod": "NA"
},
{
... | null | null | null |
98 | Admission Date :
2015-09-16
Discharge Date :
2015-09-21
Service :
CARDIOTHOR
HISTORY OF PRESENT ILLNESS :
The patient is a 52 year old Czech speaking gentleman with a history of severe mitral regurgitation .
For the past several years , the patient has continued to have significant exercise intolerance which has limited his ability to work .
He reports severe dyspnea on exertion .
The patient had a recent admission earlier in the month and he was discharged on 2015-09-10 , after undergoing cardiac catheterization .
This was significant for demonstrating no flow-limited disease in the coronaries but several fistulae
from the left anterior descending to the PA .
Several of these were coil embolized during this admission .
He tolerated this well , was sent home , and now returns for his mitral valve repair .
HOSPITAL COURSE :
On the day of admission , the patient went to the Operating Room and underwent a minimally invasive
mitral valve repair .
He tolerated this procedure well .
The patient was brought to the cardiothoracic Intensive Care Unit in stable condition on minimal pressor support .
He was successfully weaned off this support .
The patient was fully weaned from ventilatory support secondary to a persistent acidemia .
This was treated with sodium bicarbonate and a Swan-Ganz was placed to provide close hemodynamic monitoring .
The patient was found to have stable hemodynamics with appropriate mixed venous saturations in the 70% range .
The patient was corrected to a normal pH of 7.41 by the first postoperative night and remained stable .
He was then weaned off of ventilatory support and was successfully extubated .
The patient did have a slight bit of confusion early in post-extubation course which cleared .
This was also compounded by a language barrier since the patient cannot speak English .
In addition , the patient 's early postoperative course had a tremendous urine output .
It was equally up to 700 cc. an hour and a renal consultation was obtained .
He underwent a head CT scan to rule out intracranial pathology leading to diabetes insipidus .
This was negative .
The patient 's serum and urine electrolytes indicated that this diuresis was appropriate .
The patient 's urine output has decreased and his BUN and creatinine remained normal .
The patient 's Foley was discontinued .
He had developed some hematuria which has resolved .
The patient has remained stable and is now ready for discharge to home with follow-up in approximately four weeks . | [
{
"text": "the first postoperative night",
"start_char": 1518,
"end_char": 1547,
"id": "T8",
"type": "DATE",
"val": "2015-09-16",
"mod": "END"
},
{
"text": "post-extubation course",
"start_char": 1705,
"end_char": 1727,
"id": "T9",
"type": "DATE",
"val": "2015... | null | null | null |
166 | Admission Date :
07/04/1999
Discharge Date :
07/09/1999
Discharge Date :
07/09/1999
HISTORY OF THE PRESENT ILLNESS :
This is a 49 year-old male with a history of a low anterior resection in May of 1998 and a recurrence of metastasis with asleeve of section of left colon diverting ileostomy for recurrent metastasis later in May of 1999 who presents with anterior midepigastric abdominal pain .
The patient states that the pain began at 10:30 on the day of admission with increase during the day of admission with positive nausea and vomiting , no diarrhea , decreased output from the ostomy , and the pain was radiating to the back .
HOSPITAL COURSE :
Assessment was continued with laboratory studies which showed the patient to have a white blood cell count of 9 , hematocrit 39 , and platelets 470 .
The patient had a normal amylase and lipase , and a normal basic metabolic panel .
The patient had KUB that showed multiple dilated loops of small bowel and was admitted for a partial small bowel obstruction .
An nasogastric tube was placed and had an H2 blocker started , and was admitted for bowel rest and decompression .
The patient tolerated the nasogastric tube well .
The nasogastric tube was removed on hsp day # 3 .
The pain improved quickly and the patient was started on a clear liquid diet which was advanced as tolerated .
On 7/9/99 , the patient was tolerating a house diet .
The patient had some minimal back pain that occurred after food but with negative urinalysis and negative fever spikes over the entire course of this stay .
The patient will be discharged home on Zantac , Simethicone , and preoperative medications with follow-up with Dr. Ur in two weeks .
Dictated By :
NISTE BLOCKER , M.D. AQ36
Attending :
STIE FYFE , M.D. BW3 BL436/5666
Batch :
85114
Index No.
FNQXCX58 EM
D :
07/09/99
T :
07/09/99 HP8 | [
{
"text": "hsp day # 3",
"start_char": 1215,
"end_char": 1226,
"id": "T7",
"type": "DATE",
"val": "1999-07-07",
"mod": "NA"
},
{
"text": "7/9/99",
"start_char": 1343,
"end_char": 1349,
"id": "T3",
"type": "DATE",
"val": "1999-07-09",
"mod": "NA"
},
{
... | null | null | null |
28 | Admission Date :
2012-04-30
Discharge Date :
2012-05-14
Service :
O-CMED CCU
HISTORY OF PRESENT ILLNESS :
The patient is a 55 - year-old male with recently diagnosed abdominal carcinomatosis .
The patient presented with abdominal pain and bloating and was found to have a large omental mass .
Biopsy revealed adenocarcinoma .
Histochemical stains are consistent with hepatobiliary origin .
Endoscopies were negative except for an extrinsic mass present on the stomach .
The patient presents with increased abdominal pain and poor oral intake as well as generalized weakness .
On presentation , the patient denied chest pain , shortness of breath , and cough .
HOSPITAL COURSE :
The patient was admitted to the O-CMED
Service .
He was placed on a patient-controlled analgesia for pain control .
He was administered intravenous fluids and oral diet as tolerated .
On the night of 05-01 , the patient complained of increased vomiting .
He also complained of increased shortness of breath and " difficulty catching his breath ."
On room air , the patient 's oxygen saturation was 80% .
His saturation increased to 87% on a nonrebreather .
A chest x-ray disclosed a left pleural effusion .
The patient was bolused with intravenous heparin due to concern for pulmonary embolism .
The patient expressed a desire to be full code , so he was transferred to the Intensive Care Unit .
The patient became more comfortable being seated upright with nebulizer treatments .
An angiogram was done which disclosed possible subsegmental pulmonary emboli of the upper lobes as well as infiltrates consistent with aspiration pneumonia .
The patient was placed on Flagyl and Levaquin for treatment of pneumonia .
He was continued on heparin for treatment of the pulmonary emboli .
While in the Intensive Care Unit , the patient was noted to have increasing abdominal distention .
On 05-03 the patient underwent an abdominal ultrasound with paracentesis , and 5 liters of fluid were removed .
On 05-04 , the patient was transferred back to the O-CMED CSRU
Service .
Due to persistent gastric secretions , an nasogastric tube was placed for decompression .
The patient was noted to have a functional ileus .
Octreotide was initiated in an attempt to decrease the gastric secretions .
On 05-13 , the patient 's respiratory status declined further .
He was noted not have an increasing left-sided pleural effusion .
A thoracentesis was done with removal of 1.5 liters of fluid .
A paracentesis was repeated with removal of 2.5 liters of fluid .
On the night of 05-13 , the patient continued to decline .
The family decided to pursue comfort measures .
Morphine was administered to insure patient 's comfort .
The patient expired at 6 p.m. on 05-14 . | [
{
"text": "2012-04-30",
"start_char": 18,
"end_char": 28,
"id": "T0",
"type": "DATE",
"val": "2012-04-30",
"mod": "NA"
},
{
"text": "05-03",
"start_char": 1863,
"end_char": 1868,
"id": "T3",
"type": "DATE",
"val": "2012-05-03",
"mod": "NA"
},
{
"te... | null | null | null |
471 | ADMISSION DATE :
06-06-93
DISCHARGE DATE :
06-07-93
HISTORY OF PRESENT ILLNESS :
The patient is a 68 year old male status post three and a half cycles of adjuvant EAP chemotherapy .
He had a good response to preoperative therapy and negative nodes , and is admitted for the final portion of his postoperative cycles .
His chemotherapy the week before was decreased because the white blood count dropped to 2.8 .
In the interim , the white blood count rose again to 4.2 with a hematocrit of 30.5 , platelet count of 196 thousand .
HOSPITAL COURSE :
The patient was treated with Adriamycin 25 mg , Cis-platinum 40 mg , preceded by Mannitol 12.5 grams intravenous bolus , and Zofran 11 mg on two occasions given as an antiemetic .
The chemotherapy was well tolerated . | [
{
"text": "06-06-93",
"start_char": 18,
"end_char": 26,
"id": "T0",
"type": "DATE",
"val": "1993-06-06",
"mod": "NA"
},
{
"text": "the week before",
"start_char": 336,
"end_char": 351,
"id": "T2",
"type": "DURATION",
"val": "",
"mod": "NA"
},
{
"te... | null | null | null |
511 | Admission Date :
Report Status :
Discharge Date :
01/23/2003
HISTORY OF PRESENT ILLNESS :
The patient is a 50-year-old female with history of low back pain radiating to both legs .
She had increasing symptoms overtime , not controlled by conservative management .
She therefore elected to undergo surgical treatment .
HOSPITAL COURSE :
She was taken to the operating room on 01/16/2003 for decompression at L2 , L5 and laminectomy with posterior instrumented fusion at L3 to L5 .
She tolerated the surgery well .
She was transferred to recovery room in stable condition .
She received blood transfusions intraoperatively and postoperatively in addition to autologous blood .
Her hematocrit was stable postoperatively .
Her neurologic exam was stable postoperatively with 5/5 bilaterally , tibial , EHL , FHL , gastroc soleus , and intact quadriceps .
She has intact sensation L3 to S1 and bilateral lower extremities .
She was fitted for Verholl Aet over leg brace and mobilized out of the bed in the brace with physical therapy .
Her wounds were stable without any erythema or drainage .
She reported nausea on pain medications .
Her pain medications were changed around until an acceptable regime was accomplished .
She is stable for discharge to rehab . | [
{
"text": "01/16/2003",
"start_char": 376,
"end_char": 386,
"id": "T1",
"type": "DATE",
"val": "2003-01-16",
"mod": "NA"
},
{
"text": "01/23/2003",
"start_char": 51,
"end_char": 61,
"id": "T0",
"type": "DATE",
"val": "2003-01-23",
"mod": "NA"
}
] | null | null | null |
707 | Admission Date :
2012-09-26
Discharge Date :
2012-10-01
Service :
NEONATOLOGY
HISTORY OF PRESENT ILLNESS :
This is a 5235 - gram full-term male infant of a diabetic mother born by repeat cesarean section to a 29-year-old gravida 1 , para 2 , woman .
Prenatal screens benign .
Group B strep status negative .
Pregnancy complicated by insulin-dependent gestational diabetes .
Apgar scores were 8 at 1 minute and 9 at 5 minutes .
The infant admitted to the Neonatal Intensive Care Unit for a dextrose stick of 20 in the delivery room .
SUMMARY OF HOSPITAL COURSE BY ISSUES-SYSTEM :
RESPIRATORY :
The infant has remained on room air throughout his hospitalization with oxygen saturations of greater than 95 percent .
Respiratory rates have been 40 s to 60 s.
The infant has had two spontaneous desaturations which quickly self-resolved on day of life one .
No other issues .
No apnea or bradycardia .
CARDIOVASCULAR :
The infant has remained hemodynamically stable with heart rates in the 120 s to 140 s and mean blood pressures of 57 to 60 .
FLUIDS , ELECTROLYTES AND NUTRITION :
The infant was admitted to the Neonatal Intensive Care Unit for treatment of hypoglycemia .
The infant was started on enteral feedings of Enfamil 20 calories per ounce by mouth ad lib and maintained glucoses in the middle to high 40 s taking by mouth feedings every two to three hours by mouth ad lib .
On day of life one , the infant had a dextrose stick of 34 .
At that time , an intravenous of D-10-W was started at 80 cc / kilogram per day .
On day of life two , the infant began to wean off intravenous fluids , and this was completed by day of life four .
Calories were increased to Similac 24 calories per ounce .
Before discharge to the Newborn Nursery , the infant was taking Similac 22 calories per ounce by mouth ad lib and maintaining dextrose sticks in the 60 s.
Weight on discharge was 5200 grams .
GASTROINTESTINAL :
No issues .
HEMATOLOGY :
No issues .
NEUROLOGY :
Normal neurologic examination .
SCREENS :
A hearing screen was performed with automated auditory brain stem responses and the infant passed on both ears .
PSYCHOSOCIAL :
The parents are involved . | [
{
"text": "ad lib",
"start_char": 1255,
"end_char": 1261,
"id": "T0",
"type": "FREQUENCY",
"val": "R",
"mod": "NA"
},
{
"text": "every two to three hours",
"start_char": 1338,
"end_char": 1362,
"id": "T6",
"type": "FREQUENCY",
"val": "RPT2.5H",
"mod": "APP... | null | null | null |
458 | Admission Date :
01/17/1993
Discharge Date :
01/21/1993
HISTORY OF PRESENT ILLNESS :
The patient is a 42 year old gentleman who suffered lower back pain during an accident at work in 1990 .
This gradually increased until June 1992 where he had recurrent severe right sided sciatica .
In September 1992 CT myelogram showed a lateral L-1 S-1 disc bulge and small L-4-4 bulge .
He has had no change in pain in the last few months .
HOSPITAL COURSE :
He was admitted , taken to the operating room where he underwent L5-S1 right hemilaminectomy and discectomy .
He tolerated the procedure well , was taken to the floor in stable condition .
Over the next three days he increased his activity gradually , was able to do stairs with Physical Therapy and had pain which could be controlled with oral analgesics . | [
{
"text": "01/17/1993",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "1993-01-17",
"mod": "NA"
},
{
"text": "1990",
"start_char": 184,
"end_char": 188,
"id": "T0",
"type": "DATE",
"val": "1990",
"mod": "NA"
},
{
"text": "Jun... | null | null | null |
316 | ADMISSION DATE :
03/07/2002
DISCHARGE DATE :
03/13/2002
HISTORY OF PRESENT ILLNESS :
The patient is a 79-year-old man status postradical cystoprostatectomy with ileal loop for locally invasive prostate cancer .
This operation was performed 2/11/02 by Dr. Doje Para .
The postoperative course was complicated by atrial fibrillation with transfer to the Cardiac Step-Down Unit .
This transfer occurred around postoperative day 8 for anticoagulation and amiodarone load .
The anticoagulation was stopped due to concern for postoperative bleeding .
The patient complained of fevers .
The patient presented to the emergency room on 3/7/02 , complaining of fevers since Monday 3/2/02 .
He developed erythema around the wound on Wednesday and was seen by Dr. Para , who started Keflex and obtained a CT scan which demonstrated a fluid collection at the site of erythema .
The fevers continued as high as 102.5 degrees F with chills on the morning of admission .
He was draining pus from the wound site with subsequent relief of discomfort at the site .
HOSPITAL COURSE :
The patient was admitted to Urology .
After the wound was further opened , he was started on ampicillin , Gentamicin , and Flagyl antibiotics and he was placed on a bid dressing change and packing .
On hospital day 2 , the patient had no complaints .
He was afebrile with stable vital signs and good urine output .
The wound erythema was improving and the wound was packed twice a day .
Wound cultures remained negative at that time .
We continued his ampicillin , Gentamicin , and Flagyl .
By hospital day 4 , he remained afebrile throughout his hospital course .
The wound cultures demonstrated gram-positive cocci in clusters and gram-negative rods .
Blood cultures remained negative .
The patient was continued on antibiotics and we obtained a CT scan to check for an enterocutaneous fistula .
We discontinued his Flagyl on that day .
We contacted the patient 's primary care physician , Dr. Aslinke ______ , regarding his cardiac medication management .
We agreed that he should resume his atenolol .
He was started on 2.5 mg PO qd .
He was continued on his dressing changes .
We changed the dressings tid instead of bid for continued drainage .
The CT scan that was obtained on 3/10/02 demonstrated no connection between bowel and the wound .
The drainage had been decreasing and the patient continued to be afebrile .
On the following day , 3/11/02 , a fistulogram was obtained which was negative for a fistula from the bowel to the wound .
The patient was continued on ampicillin and Gentamicin .
Her remained afebrile with stable vital signs .
He was comfortable and erythema continued to decrease with improvemeent in the appearance of the wound .
In consultation with Infectious Disease , it was agreed to discharge the patient on Augmentin for coverage .
We obtained sensitivities of his wound bacteria .
His intravenous antibiotics were discontinued .
He remaineda febrile with daily improvement in the appearance of his wound .
On hospital day 7 , the patient remained afebrile with stable vital signs .
His wound demonstrated no erythema with moderate dark drainage .
The patient will be discharged with WH and continued dressing changes bid . | [
{
"text": "hospital day 2",
"start_char": 1267,
"end_char": 1281,
"id": "T6",
"type": "DATE",
"val": "2002-03-08",
"mod": "NA"
},
{
"text": "twice a day",
"start_char": 1438,
"end_char": 1449,
"id": "T7",
"type": "FREQUENCY",
"val": "RP12H",
"mod": "NA"
... | null | null | null |
302 | Admission Date :
2010-02-05
Discharge Date :
2010-02-06
Service :
TRAUMA
HISTORY OF PRESENT ILLNESS :
The patient is a 23 year old female , status post fall from standing position after slipping on ice .
She had no loss of consciousness .
She recalled the entire event .
She was found by family and friends to be somewhat confused and was therefore taken to Newton-Wellesley Hospital thereafter .
Workup at the outside hospital included a CT scan of the head revealing a possible parietal subdural bleed on the right side .
The patient 's GCS was 15 .
She was hemodynamically stable .
She was thereafter transferred to Beverly Hospital for further evaluation and management . | [
{
"text": "2010-02-05",
"start_char": 18,
"end_char": 28,
"id": "T1",
"type": "DATE",
"val": "2010-02-05",
"mod": "NA"
},
{
"text": "2010-02-06",
"start_char": 46,
"end_char": 56,
"id": "T2",
"type": "DATE",
"val": "2010-02-06",
"mod": "NA"
}
] | null | null | null |
666 | ADMISSION DATE :
09/15/2000
DISCHARGE DATE :
The patient was admitted to the hospital on July 12th for a chole with a principle diagnosis of recurrent biliary colic .
HISTORY OF PRESENT ILLNESS :
The patient is a 42 year old with recurrent biliary colic .
She has had ultrasound proven gallstones for ten years , seen on an earlier obstetric ultrasound .
The patient has had no symptoms until approximately two years ago when she began having classic biliary colic pain with right upper quadrant epigastric pain radiating to midback with nausea , but without vomiting .
Onset was an hour to 1 hour after meals , worse with greasy meals , lasting five minutes to two hours .
Episodes have been increasing in frequency over the last few months .
She has had no fevers , chills , respiratory symptoms , diarrhea , bright red blood per rectum or melena .
She has not found any relieve with any over the counter medications .
She has no family history of gallbladder or pancreatic disease .
She has had no significant weight loss .
No anorexia .
An ultrasound on 1/25/00 showed six gallstones without cholecystitis .
She has no history of liver disease , hepatitis .
The patient is from 45 Sidewonly Blvd , Fresa Loharanleah , Maryland .
Has lived in 896 Lokatspur Pkwy , Ingrich Vepobuffh , Indiana for 25 years and works as a teaching assistant in a second grade in Satlnonew Rollglend Pabridrham .
HOSPITAL COURSE :
The patient was admitted for the lap coli with an intraoperative cholangiogram by Dr. Sterp under general anesthesia .
A separate operative note has been dictated .
Operative course and recovery were without complication .
The patient was admitted to floor .
The patient was afebrile , vital signs were stable .
She is taking po 's .
She is ambulatory .
The patient will be discharged to home in stable condition with a follow up appointment with Dr. Sterp . | [
{
"text": "1/25/00",
"start_char": 1059,
"end_char": 1066,
"id": "T2",
"type": "DATE",
"val": "2000-01-25",
"mod": "NA"
},
{
"text": "25 years",
"start_char": 1300,
"end_char": 1308,
"id": "T8",
"type": "DURATION",
"val": "P25Y",
"mod": "NA"
},
{
"... | null | null | null |
116 | Admission Date :
11/30/1993
Discharge Date :
12/07/1993
HISTORY OF PRESENT ILLNESS :
The patient is a 40 year old woman with end stage renal disease , on hemodialysis since 12/91 .
This was secondary to polycystic kidneydisease , which was noted since age 12 .
She is status post cadaveric renal allograft in 03/93 , and she subsequently underwent an early postoperative transplant nephrectomy secondary to rupture .
He has been having difficult access problems and now has a left upper arm PTFE .
She had been placed on emergency transplant for this difficult access problem .
Otherwise , she has been healthy and her last hemodialysis was the day prior to transplant .
HOSPITAL COURSE :
She was taken to the Operating Room on 11/30/93 where Dr. Tiveloydherdes performed a cadaveric renal allograft to the left iliac fossa which she tolerated well .
Postoperative course was unremarkable .
She was started on her immunosuppressive agents as per protocol .
Her creatinine fell to the normal range early .
Over several days she continued to make good amounts or urine .
She was gradually advanced to a regular diet .
Her prednisone was tapered to a stable dose . | [
{
"text": "several days",
"start_char": 1011,
"end_char": 1023,
"id": "T6",
"type": "DURATION",
"val": "P6D",
"mod": "APPROX"
},
{
"text": "several days",
"start_char": 1011,
"end_char": 1023,
"id": "T8",
"type": "DURATION",
"val": "P5D",
"mod": "APPROX"
... | null | null | null |
472 | Admission Date :
2017-06-16
Discharge Date :
2017-07-27
Service :
MEDICINE
History of Present Illness :
Patient is a 58 year old male with a recent admission for abdominal pain s/p negative exploratory laparotomy for suspected intussuception now returns on day of discharge with fever and tachycardia .
Patient has a history for terrible vasculopathy s/p recent right BKA with dry gangrene of the distal stump .
Patient 's last admission was significant for a negative ex-lap .
Post-operatively , his course was complicated by respiratory distress necessitating an urgent return to the ICU and was intubated .
After multuple failed attempts at extubation , the patient was trached .
Patient then did well on a trach mask and was transferred to rehab on the day of admission but now returns with tachycardia to the 120 's , and fever to 102 degrees F .
Brief Hospital Course :
The patient was re-admitted to the surgical service and taken to the CMED .
A chest x-ray on admission showed effusions consistent with CHF along with overlying pnumonia .
Urine cultures were significant for Klebsiella UTI and sputum cultures were significant for MRSA .
He was placed on vancomycin , levofloxacin and fluconazole .
He underwent PICC line placement on 06-18 .
A trach collar was placed on 06-19 .
GI was consulted for colonoscopy .
Patient was transferred to the floor on 06-20 .
He was seen by respiratory therapy and suctioned continually throughout his hospital course .
His respiratory status improved .
He tolerated his trach collar , and tube feeds at goal .
The fluconazole was discontinued .
On 06-21 the patient was seen by physical therapy .
A nutrition consult was obtained on 06-22 .
He underwent a failed bedside swallow study .
Based on a chest x-ray that showed a small hydro-pneumothorax on the left lower lobe of the lung , a thoracic surgery consult was obtained , though no specific interventions were warranted at the time .
On 06-23 the patient 's tube feed were changed from Respalor to Deliver 2.0 to give increased calories .
On 06-25 , urine cultures grew out VRE , and a C diff was negative .
He experienced low grade fevers .
He was pan-cultured on 06-26 for continued fevers .
On 06-27 , his nutrition regimen was changed to Deliver 2.0 at 70 cc / hr with 15 g ProMod .
On 06-28 , the patient experienced PVC 's .
An EKG showed ST segment depression along the lateral pre-cordial leads .
Serial enzymes showed mild elevation of troponins .
A cardiology consult was obtained .
The cardiology service simply recommended increasing the beta-blockade and maximizing the patient 's electrolyte status .
On 06-29 , the patient was transferred to the medical service .
Pt 's vancomycin was stopped after 14 days of treatment .
HIV test was found to be negative .
MRI head was obtained to further w/u patient 's apparent cognitive decline .
MRI showed prominent sulci and enlarged ventricles abnormal for the patient 's age .
Due to concerns for dementia , neurology consult was obtained .
Neurology felt that the patient 's cognitive symptoms were consistent w/ metabolic encephalopathy due to his multiple medical problems .
They felt that his mental status would improve as his health improved .
Underlying dementia was possible but difficult to assess with an overlying delerium .
The patient continued to pull out his doboff tube .
Pt had EGD performed to evaluate his poor nutritional status .
He was found to have a large gastric ulcer and high dose PPI was started .
The gastric biopsy and the serology were both negative for H. pylori .
PEG placement was unsuccessful by GI due to the patient 's anantomy .
07-05 the patient had a J tube placed in interventional radiology for nutritional support .
He was re-started on tube feeds .
07-06 patient failed a repeat swallow evaluation due to discoordinated swallow .
07-07 the patient was taken for colonoscopy and found to have a normal colon to cecum .
07-12 the patient was found to be C diff positive and was started on 14 day course of Flagyl .
On 07-18 , as his mental status improved , he did well at the bed side swall evaluation .
On 07-19 , he underwent video swallow evaluation and was able to tolerate ground consistent food and thin liquids .
His meds should be crushed and mixed with puree thick liquid .
He has gained 30 lb since the tubefeed was initiated ( 70 lb to 100 lb ) during this admission .
He will still need to be on tubefeed to support his nutrition until he is cleared by a nutritionist .
In terms of his mental status , he continued to improve steadily over the last few weeks of his hospital stay .
He was more alert and engaged with activity .
He did much better with PT and OT at the end after his mental status improved .
As noted above , his mental status change was likely toxic-metabolic from acute infection .
He started to develop more pain around the right stump since 07-17 .
He was seen by the vascular surgery who felt that he is too medically sick and malnourished to have surgery at this time .
He will follow up with Dr. Javier as outpatient .
Initially , his pain was controlled with titrating up the Oxycontin .
However , it was titrated too quickly from 10 mg bid to 30 mg bid .
He then developed urinary retention requiring foley placement .
After he passed the video swallowing , he was tolerating ground consistent solids .
On 07-24 , he had an emesis x 1 , and had aspiration pneumonia ( + interstital markings on the left on CXR , fever , leukocytosis ) .
His Flagyl course was extended , and Vanc / Levo were added .
His sputum showed many GPC which later grew Staph aureus .
Given his recent MRSA pneumonia , he will be treated with 2 week course of Vanc / Levo / Flagyl .
He was seen by the pain service who recommended to discontinue Oxycontin , and start Neurontin , MSIR , and lidocaine patch in addition to the standing Tylenol .
On 07-25 , his J-tube was noted to be obstructed but was able to be flushed by IR on 07-26 .
Tubefeed was resumed without any difficulty since .
Since oxycontin was discontinued , the foley was removed on 07-27 and was able to void without any difficulty . | [
{
"text": "06-18",
"start_char": 1245,
"end_char": 1250,
"id": "T5",
"type": "DATE",
"val": "2017-06-18",
"mod": "NA"
},
{
"text": "06-19",
"start_char": 1282,
"end_char": 1287,
"id": "T6",
"type": "DATE",
"val": "2017-06-19",
"mod": "NA"
},
{
"tex... | null | null | null |
512 | Admission Date :
2019-02-28
Discharge Date :
2019-03-26
Service :
CARDIOTHORACIC
History of Present Illness :
Mr. Pizano is a 75 y/o man who has a PMHx significant for Enterococcus mitral valve endocarditis which has been treated since 09-19 .
He has had 2 6 week courses of antibiotics with recurrent bacteremia .
He had a TEE on 2019-01-22 which revealed thickened mitral leaflets with small vegetations on both anterior and posterior leaflets with moderate to severe mitral regurgitation .
He has preserved LV systolic function with mild TR and AR and LAE without abscess .
He had a repeat TEE on 02-19 which revealed 4 + MR .
Thomasine was tranferred from MWMC ( where he was admitted on 02-15 with fevers and positive blood cultures ) to IDMC for further treatment and possibly MVR .
Brief Hospital Course :
As mentioned in the HPI , Mr. Mcculley was transferred from MWMC to Nantucket Cottage Hospital for ongoing care ( ? MVR ).
And Infectious disease consult was immediately made .
IV Daptomycin was continued via PICC line which was inserted on 02-20 at MWMC .
Mr Stutts had an extensive preop evaluation including cardiology , infectious diseases , orthopedics , psychiatry and ethics services .
He ultimately was brought to the operating room on 03-19 .
At that time he had a Mitral Valve replacement , aortoomy , and left atrial appendage resection .
His bypass time was 103 minutes / crossclamp 89 mins .
Please see OR report for full details .
He tolerated the surgery well and was transferred from the OR to the CSRU on Epinephrinne and Propofol infusions .
He did well in immediate postoperative period .
Following surgery his anesthesia was reversed , he was weaned from ventilator and successfully extubated .
His iv medications were also weaned to off .
On POD1 His PA line and chest tubes were removed , he was also started on Beta blockers and diuretics .
On POD2 the patient remained hemodynamically stable and was transferred from the ICU to F2 for continued postop care .
Over the next several days with the assisstance of the nursing staff and physical therapy the patients activity level was advanced , he was transitioned to all oral medications with the exception of his antibiotics .
On POD7 it was decided that the pt was stable and ready for discharge to rehabilitation .
It should be noted that the patient did have episodes of postoperative atrial fibrillation , he was seen by the
Electrophysiology service , started on Procainamide and Coumadin . | [
{
"text": "02-20",
"start_char": 1055,
"end_char": 1060,
"id": "T7",
"type": "DATE",
"val": "2019-02-20",
"mod": "NA"
},
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"start_char": 1258,
"end_char": 1263,
"id": "T8",
"type": "DATE",
"val": "2019-03-19",
"mod": "NA"
},
{
"tex... | null | null | null |
248 | Admission Date :
2016-04-05
Discharge Date :
2016-04-11
Service :
Cardiothoracic Surgery
HISTORY OF PRESENT ILLNESS :
This is a 67 - year-old male with a history of high cholesterol who was in his usual state of health until 2016-04-03 .
He was raking leaves on 04-02 and then developed episodes of mid chest pain and burning which radiated to the left arm .
That night he reportedly stopped breathing and was unresponsive .
His wife gave him mouth-to-mouth resuscitation and he regained consciousness .
He presented to an outside hospital with an acute inferior myocardial infarction and was treated with thrombolytic therapy .
His troponin was 20 and he had EKG changes .
He underwent catheterization on 2016-04-05 which revealed a left ventricular ejection fraction of 50% , no mitral regurgitation , insufficiency or hypokinesis .
Left main coronary artery was narrowed 50-60% , left anterior descending coronary artery 70% proximally , right coronary artery dominant diseased up to 90% proximally in the midportion , 70% distally .
The left circumflex coronary artery was 50% proximally , 90% obtuse marginal #3 .
HOSPITAL COURSE :
The patient was admitted to the hospital and on 2016-04-06 the patient underwent coronary artery bypass grafting x 4 with left internal mammary artery to the left anterior descending coronary artery , saphenous vein graft to the diagonal , saphenous vein graft to obtuse marginal , saphenous vein graft to right coronary artery , posterior descending coronary artery .
The patient appeared to have tolerated the procedure and was transferred to the cardiac intensive care unit for postoperative management .
He was started on beta blockers .
The patient had pacing wires and chest tubes in place , both of which over the course of his stay were removed successfully .
The patient did well postoperatively and was transported to the regular cardiac surgery floor where he tolerated a regular diet , ambulated well , did well with his activities of daily living .
He was seen by physical therapy and cleared .
They requested that he follow up in three to five weeks for endurance training , however then physical therapy followed him a number of times afterward and decided that he was in good condition and did not need further physical therapy .
On 2016-04-11 the patient was in good condition and he is being discharged on a regular heart-healthy diet .
He may observe regular activity although he should avoid strenuous activity and should not drive while on pain medications .
He should follow up with Dr. Dushaj in four weeks .
He should follow up with his cardiologist in two to three weeks and he should follow up with his primary care physician in one to two weeks . | [
{
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"type": "DATE",
"val": "2016-04-06",
"mod": "NA"
},
{
"text": "x 4",
"start_char": 1251,
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"id": "T8",
"type": "FREQUENCY",
"val": "r4",
"mod": "NA"
},
{
"tex... | null | null | null |
711 | ADMISSION DATE :
10-03-94
DISCHARGE DATE :
10-06-94
HISTORY OF PRESENT ILLNESS :
This 85 year old man was admitted because of the new onset of focal left-sided seizure and unresponsiveness .
He had a past history of ischemic cardiomyopathy with an ejection fraction of 10 , mild aortic stenosis and a right middle cerebral artery territory stroke in 07/94 .
He was at Orlak on the day of admission and was found unresponsive with left tonic-clonic movements , greater in the arms than in the legs .
He was transferred to Fairm of Ijordcompmac Hospital , where seizures were stopped with 2 mg of Ativan .
He was loaded with IV Dilantin .
He remained unresponsive with poor airway protection .
HOSPITAL COURSE :
By the patient and his family 's prior wishes , the patient was extubated .
An electroencephalogram revealed generalized slowing without ictal events .
He had no carotid bruits .
He had stertorous breathing , positional tremors of the left upper extremity , a spastic left hemiparesis in flexion .
He withdrew both legs to painful stimuli .
The right upper extremity was flaccid and paresthetic .
Again , comfort measures only were undertaken as per the patient 's previous wishes and the family 's current insistence .
At 1:15 PM on 10/06/94 , the patient was found unresponsive with no heart sounds , carotid pulse , respiratory excursions , or pupillary reactions .
His family was notified .
Consent for autopsy was denied . | [
{
"text": "1:15 PM on 10/06/94",
"start_char": 1249,
"end_char": 1268,
"id": "T4",
"type": "TIME",
"val": "1994-10-06t13:15",
"mod": "NA"
},
{
"text": "10-03-94",
"start_char": 18,
"end_char": 26,
"id": "T1",
"type": "DATE",
"val": "1994-10-03",
"mod": "NA... | null | null | null |
301 | ADMISSION DATE :
03/30/97
DISCHARGE DATE :
04/01/97
HISTORY OF PRESENT ILLNESS AND REASON FOR HOSPITALIZATION :
The patient was a 108-year-old nursing home resident , who was admitted with a two-day history of increased respiratory secretions and a 24-hour history of elevated fever .
Despite Augmentin , the patient 's delirium worsened in the 24 hours prior to admission , and her temperature was up to 102 .
She was refusing to take p.o.'s .
HOSPITAL COURSE AND TREATMENT :
The patient was admitted for treatment of a presumed aspiration pneumonia and for rehydration .
She was started on Clindamycin and Ofloxacin at renal dose to cover the aspiration pneumonia and positive urine culture , which subsequently came back .
She had some wheezing , which responded well to Albuterol nebulizers .
She was generally doing well with resolution of her temperature until 4/1/97 at 9:20 P.M. , when she was noted to be unresponsive with fixed dilated pupils .
She was certified dead at 9:20 P.M.
MI CUCHSLI , M.D.
TR :
vgo
DD :
05/11/97
TD :
05/15/97 8:26
Acc :
MI CUCHSLI , M.D.
cc :
Nursing Director Pcaer,ter Medical Center Sco , Ohio | [
{
"text": "03/30/97",
"start_char": 18,
"end_char": 26,
"id": "T0",
"type": "DATE",
"val": "1997-03-30",
"mod": "NA"
},
{
"text": "a two-day",
"start_char": 190,
"end_char": 199,
"id": "T2",
"type": "DURATION",
"val": "p2d",
"mod": "NA"
},
{
"text"... | null | null | null |
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