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CHIEF COMPLAINT: Hyponatremia. PRESENT ILLNESS: 84 year-old female PMH DM, HTN, hyperlipidemia brought to the ED by her children for difficulty urinating. History mainly done through her son. [**Name (NI) **] reports she complained of fatigue since yesterday then this morning difficulty urinating. She described the sensation as needing to urinate but unable. Her daughter reported hematuria - however on further questioning this was on the toilet paper only so unclear whether urinary or GI related. Otherwise patient has been her usual state of health. She has had a chronic non-productive cough for the past month but not increased recently in severity. Denies fevers and chills. Denies sick contacts. Denies shortness of breath or chest pain. Denies abdominal pain, nausea and vomiting. Reports having regular BM (today and yesterday). Does describe a decreased appetite in the last week. No lower extremity edema, orthopnea or PND. . In the ED, initial VS T 97.9, HR 77, BP 175/85, RR 18, O2 Sat 93%. Patient then triggered for hypoxia with O2 sat 83% RA which improved with nasal canula. Abdominal exam notable for distention - when foley was placed 200cc urine returned and patient felt better. Patient was guaiac negative with no stool in the vault. CT Ab/pelvis was done which demonstrated cholelithiasis, small amount of free fluid in the pelvis but otherwise unremarkable. CT chest demonstrated moderate bilateral pleural effusions, bilateral basilar consolidations L > R concerning for aspiration versus pneumonia. Patient was treated with Levo/Flagyl, 1 L NS. Bedside ECHO demonstrated enlarged right ventricle and due to high BNP in setting of hypoxia CTA was done which was negative for PE. Labs notable for Na 111, lactate 1.3, WBC 12.5 (N 80, L 10.2), HCT 30.5. Mental status reported as agitated. Patient hypertensive throughout her stay. VS on transfer BP 138/94, HR 94, RR 24, O2 96% 4 L. . MEDICAL HISTORY: 1. DM. Dx'd ~[**2157**]. Followed by Dr. [**Name (NI) 31889**] of endocrine. 2. HTN. Dx'd ~[**2157**]. 3. High chol. 4. Pulmonary TB in [**2165**]. Treated w/ ethambutal, rifampin, pyrazinamide, and INH. 5. Osteoporosis. Unsure when last BMD was. 6. A Fib - per OMR - family unaware MEDICATION ON ADMISSION: Confirmed with PCP and cardiologist: Atenolol 50 mg Tablet one Tablet(s) by mouth every night at bedtime Lipitor 20 mg qhs Plavix 75 mg qd Glyburide 3 mg [**Hospital1 **] Lisinopril 30 mg qd Diltiazem CD 120 mg Diazepam 5 prn ALLERGIES: Penicillins PHYSICAL EXAM: On Admission: Vitals: T: 97 BP: 135/58 HR: 105 RR: 16 O2Sat: 98% 4L GEN: Eldery female in no acute distress HEENT: Dry mucus membranes, EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, OP Clear NECK: No JVD COR: Irregular rhythm, no M/G/R PULM: Decreased breath sounds at bases, diffuse wheezes ABD: Soft, mildly distended, decreased bowel sounds, no HSM, no masses. EXT: No C/C/E, no palpable cords NEURO: alert, according to family oriented to person, place, and time. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . At discharge: FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives alone, son and daughter live close by and check in regularly. Born and raised in [**Country 3992**]. Came to US in [**2147**]. Has 5 children. Used to work running a department store in [**Country 3992**].

CHIEF COMPLAINT: EtOH intoxication, hypertension. PRESENT ILLNESS: Please see admission note for full details. Briefly, 37yoM w/ h/o severe alcoholism with multiple admissions for withdrawal, HBV, HCV, who was found passed out on [**6-14**] after drinking more vodka that his usual amount. He also reported a recent h/o fighting with a friend, resulting in R hand and substernal chest pain. He was admitted to the MICU after being found to be in acute withdrawal with HTN (SBP to 200s) and HR>100. MEDICAL HISTORY: 1. polysubstance abuse: ETOH, listerine, heroin, IVDU, benzodiazepines 2. ethanol abuse, hx DTs and withdrawal seizures, intubated in past 3. hepatitis C 4. hepatitis B 4. compartment syndrome RLE, [**2171**] 5. OCD and anxiety 6. depression with hx suicidal ideations and attempts 8. chronic bilateral hand swelling 9. severe peripheral neuropathy MEDICATION ON ADMISSION: (not taking any, but supposed to be on the following) Prozac (pt thinks 40 mg daily) Klonopin 1 mg TID Trileptal (dose uncertain) Remeron (dose uncertain) ALLERGIES: Penicillins PHYSICAL EXAM: VITALS: T: 97.7 BP 97/63 HR 68 RR 18 SpO2 97/RA GENERAL: lying comfortably in bed, wearing cap, sheets pulled tight over body, no obvious tremors PSYCH: Combative Pt refused all other components of PE FAMILY HISTORY: Father with depression and alcoholism. Mother died of DM complications. He reports his father had depression, alcoholism and questionable OCD. SOCIAL HISTORY: He reports drinking [**2-8**] gallon vodka and listerine daily. History of heroin, IVDU, benzodiazepine abuse, alcohol withdrawal seizures and delerium tremens. States he does not speak to any family members, never married, no children. He is currently homeless and states he does not like shelters because he gets "nervous around all the people".

CHIEF COMPLAINT: Admit for surgery PRESENT ILLNESS: 75M who presented with painless jaundice. Subsequent ERCP and workup revealed a malignant stricture at the distal CBD, suggestive of IPMT. Although scheduled to see Dr [**Last Name (STitle) 468**] in clinic, he was admitted emergently for high fevers and likely acute cholangitis. He was stabilized on fluids and antibiotics, and discharged home on oral antibiotics to return for an interval hepatobiliary bypass surgery. MEDICAL HISTORY: Colon CA s/p chemo COPD Asthma MEDICATION ON ADMISSION: Prednisone FLovent Albuterol Atrovent Levofloxacin (prescribed on recent prior admission) ALLERGIES: Aspirin / Bactrim Ds PHYSICAL EXAM: Physical exam on discharge: FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Non-contributory

CHIEF COMPLAINT: progressive leg weakness, inability to urinate or defecate PRESENT ILLNESS: 57M w/ hx lung cancer and metastatic disease to T2 presents with 2 days of progressive leg weakness, inability to urinate or defecate. Not on XRT or chemo for his lung cancer, patient has been told he has a poor prognosis. He feels pins and needles throughout his trunk ankd lower extremities and has L > R lower extremity weakness. MEDICAL HISTORY: lung CA with mets to T2, hereditary hypercoaguability (Lupus anticoagulant according to patient). He has had PE before MEDICATION ON ADMISSION: albuterol, lovenox 80 mg(for hereditary hypercoaguability), ergocalciferol, loratadine, morphine solution 10mg prn, omeprazole 20 mg qday, sulfasalazine 500 mg po, tramadol 50 mg qid prn, ambien ALLERGIES: Taxol / Zocor PHYSICAL EXAM: General: NAD CV: Pulse RRR Resp: mildly labored breathing Abd: Soft, NT FAMILY HISTORY: non-contrib SOCIAL HISTORY: 1ppd, no etoh

CHIEF COMPLAINT: right leg pain PRESENT ILLNESS: 65M with bipolar disorder with 2 days of increasing RLE pain, swelling, erythema extending to his inner right thigh. He reports that the pain started two days ago. At that time he was unable to walk because of the pain in his leg. He reports that his "associates" [**Last Name (NamePattern1) 95241**] were concerned about him being "sick" so they brought him into the ED. He denies trauma to the leg. He denies any other skin infections currently or in the past. He denies fever, chills, chest pain, shortness of breath. He reports he has felt nasal congestion, cough, and nasal drainage for the same amount of time. He reports his PO intake has been good over the same amount of time. . In the ED his initial vital signs were T 103.0, BP 85/51, HR 132, RR 18, O2 96% on RA. Labs were drawn and the lactate was found to be 4.9. He also was found to have a WBC count of 12, Crn of 2.1 and BUN of 41. He had a RIJ placed and was given fluids. He was started on Unasyn/Vancomycin for suspected cellulitis. His lactate responded appropriately to fluids and came down to 1.7. MEDICAL HISTORY: Bipolar disorder SBO with colostomy and reversal in [**2162**] HTN MEDICATION ON ADMISSION: Geodon 60mg [**Hospital1 **] Ativan 0.5mg QD Flomax 0.4mg QD Norvasc 5mg QD Vit E 400 [**Hospital1 **] ALLERGIES: Haldol PHYSICAL EXAM: GENERAL: NAD SKIN: warm and well perfused, RLE erythema and swelling with ulceration of the lateral aspect, evidence of lymphangetic spread HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent nares, MMM, good dentition, nontender supple neck, no LAD, no JVD CARDIAC: tachycardic, irregularly irregular rhythm, S1/S2, no mrg LUNG: CTAB ABDOMEN: distended abdomen, midline scar, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly M/S: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities PULSES: 2+ DP pulses bilaterally NEURO: CN II-XII intact FAMILY HISTORY: noncontributory SOCIAL HISTORY: Living alone with services from JCJF. Case manager [**Last Name (un) 34793**] [**Last Name (un) 81033**] [**Telephone/Fax (1) 95242**], familiar with all medical care. Retired. Active in theater. No smoking, EtOH, or IVDU.

CHIEF COMPLAINT: Black stool/lightheadedness PRESENT ILLNESS: HPI: 75yo man with extensive past medical history including CAD, ischemic cardiomyopathy with EF of 10%, ICD/pacemaker, and h/o SVC thrombosis now on anticoagulation presented on [**2-25**] after 2 episodes of symptomatic melena, now attributed to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tears seen on EGD. His melena began 3 days after a day of nausea with several episodes of vomiting that the patient characterizes as a brief gastroenteritis. After the second episode of melena he felt lightheaded and his wife called his PCP, [**Name10 (NameIs) 1023**] instructed them to go the emergency department at an outside hospital. At no point did he have any F/C/S, CP, SOB, abdominal pain, LOC, or focal neuro sx. He initially presented to an outside hospital and was found to have a Hct of 24 and an INR of 4. There, he was given 5mg vit K. . In [**Hospital1 18**] ED, his initial vital signs were 97.7, 76, 122/63, 20, 100% on RA. He had an NG lavage which demonstrated dark blood with clots. This did not clear after 500cc of lavage. He had guaiac positive black stool on rectal exam. He remained hemodynamically stable with BP consistently in (110s to 120s/50s to 60s). His Hct was 24. INR was 4.1. He was treated with protonix 40mg IV. In [**Hospital1 18**] MICU, he was transfused with 4 U PRBC's and 4 U FFP to bring his Hct to 31.6. On [**2-26**] he had an EGD which showed [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tears at the GE junction which were cauterized and clipped. He has been hemodynamically [**Last Name (un) 2677**] since then. . He has not had any F/C/S, dizziness, CP, SOB, abdominal pain, or LOC since arriving at [**Hospital1 18**]. He has not had a bowel movement since he arrived here. He denies any recent EtOH abuse, tobacco, NSAID use. He reports that his appetite is currently good. MEDICAL HISTORY: 1. CAD s/p 2 MIs ([**2094**]; [**2101**] w/ VF arrest, coma, and neurological sequelae) and AICD/pacemaker placement. Cath [**10-9**] w/ LCX occlusion distal to OM1, which was widely patent. 2. Ischemic cardiomyopathy: echo [**2113-6-19**] w/ global LV hypokinesis (LVEF [**10-27**] percent) w/ akinesis of the inferior, posterior, and lateral walls; 3+ MR; 2+ TR; moderate PA systolic hypertension. 3. Hypertension 4. Hyperlipidemia 5. Valvular heart disease: moderate MR [**First Name (Titles) **] [**Last Name (Titles) **] 6. chronic kidney dz: baseline creat 1.3-1.4 since [**2112**] 7. anemia: baseline HCT 37-38 8. h/o SVC thrombosis (dx [**2-/2105**]); on warfarin since 9. h/o nephrolithiasis 10. s/p tonsillectomy 11. s/p appendectomy 12. s/p bilateral inguinal hernia repairs x 2 MEDICATION ON ADMISSION: 1. Aspirin 81 mg 2. Atorvastatin 80 mg 3. Mexiletine 150 mg [**Hospital1 **] 4. Warfarin 5mg HS 5. Lisinopril 2.5mg qD 6. Magnesium Oxide 400 mg [**Hospital1 **] 7. Digoxin 125 mcg Tablet Sig: 0.5 Tablet PO EVERY OTHER DAY(Monday, Wednesday, Friday and Sunday) 8. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Tuesday, Thursday and Saturday) 9. Carvedilol 3.125mg [**Hospital1 **] 10. lasix 10mg qD ALLERGIES: Penicillins / Amiodarone PHYSICAL EXAM: Physical exam: . vs: 98.9, 94, 117/49, 20, 99% RA . FAMILY HISTORY: - CAD: sister - prostate CA: father SOCIAL HISTORY: The patient lives in [**Location (un) 100183**] with his wife. They are both retired (he is a retired banker). He goes to cardiac rehab 2 times per week. He walks with a walker at home. They are independent and have no in-home health services. He denies ever smoking or using illicit drugs. He drank in the past but not for several years.

CHIEF COMPLAINT: Elevated WBC, ESR PRESENT ILLNESS: [**Age over 90 **] year old male with h/o diastolic heart failure and recent admission for endocarditis c/b heart block and bradycardia s/p temporary pacer placement who presented to the ED at the request of his ID physician due to elevated WBC and ESR. . He was admitted [**Date range (3) 50936**] with group B strep endocarditis (probable mitral valve). He was initially treated with vancomycin and was then desensitized to penicillin with plan for 6 weeks of treatment. Course was complicated by type I second degree AV block and temporary pacer was placed with plans to eventually internalize pacer. He was discharged to [**Hospital **] rehab. He was treated with IV penicillin for 7-8 weeks until [**9-10**] when he was changed to oral suppressive clindamycin (150mg po q12h) and his PICC line was pulled. . He had an ID OPAT visit yesterday. Labs showed a WBC 18.5 and ESR 125 despite treatment. Therefore, he was referred to [**Hospital1 18**] for admission from [**Hospital **] Rehab in [**Hospital1 **]. There were plans to internalize his pacemaker in the near future (some reports say tomorrow). . He complains of cough productive of clear sputum. Denies fevers but does have night chills occasionally. Denies CP or SOB. No abdominal pain or diarrhea. Denies urinary symptoms but comes with indwelling foley. . In the ED, initial vitals were 98.2 75 90/50 16 98%RA. UA was grossly positive. ECG was unchanged from prior. Physical exam showed a 3/6 systolic murmur heard best at the base. Repeat CBC showed WBC 9.9 with creatinine 1.4 from baseline 1.0. Blood and urine cx sent. CXR unremarkable. He was given vancomycin and ceftriaxone. Has 18g IV. . ROS: Denies headache, vision changes, rhinorrhea, congestion, sore throat, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria. MEDICAL HISTORY: Dyslipidemia Hypertension Atrial fibrillation on coumadin Moderate to severe mitral reguritation Moderate tricuspid reguritation Moderate pulmonary HTN Mild aortic reguritation Diastolic congestive heart failure Restrictive lung disease Hypothyroidism CKD stage III baseline Cr 1.5 to 1.6 MEDICATION ON ADMISSION: -Levothyroxine 37.5mcg po daily -Docusate 100mg po bid -Senna 8.6mg po bid prn constipation -Tamsulosin 0.4mg po qhs -Clindamycin 150mg po q12h -Tramadol 25mg po q6h prn pain -Warfarin 5mg po daily -Torsemide 20mg po daily -Lisinopril 10mg po daily -Guaifenesin 10ml po q6h prn -Clotrimazole 1 application q12h -MVI with minerals -Acetaminophen 650mg po q6h prn pain, fever ALLERGIES: Penicillins PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: 98.5 95/48 73 20 100%RA GENERAL: Elderly frail male in NAD, comfortable, appropriate. HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MM slightly dry, OP clear. NECK: Supple, no thyromegaly, JVD not elevated. HEART: Regular rhythm with marked ectopy, III/VI systolic murmur mostly at apex, quiet diastolic murmur at LSB LUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding. EXTREMITIES: WWP, no c/c/e, faintly palpable peripheral pulses. SKIN: No rashes or lesions. LYMPH: No cervical LAD. NEURO: Awake, A&Ox3. . DISCHARGE PHYSICAL EXAM: VS 97.7/95.5 HR 58, flutter (55-66) BP 117/58 (101-117/45-61) RR 16 Sat 100% RA I/O's 8: 0/200; 24: 1000/1100 Wt 52.2 GEN: well appearing, lying flat and comfortable in bed PULM: crackles bilaterally at the bases CVS: irregularly irregular, III/VI systolic murmur heard at the apex, S2 split with respiration ABD: soft, NTND, +BS, no bladder tenderness or enlargement palpated EXT: no cyanosis, no LE edema, erythematous plaque of scaly, dry skin on left antecubital fossa FAMILY HISTORY: Mother died of old age. Father died in 40's, patient not sure why SOCIAL HISTORY: Denies smoking, alcohol, or other drug use. Currently lives at [**Hospital1 **], was at home prior to recent admission with 24 hour caregiver. [**Name (NI) 6934**] with cane/walker but essentially bedbound lately

CHIEF COMPLAINT: Hypotension after elective right cardiac stent placement. PRESENT ILLNESS: This is a 73-year-old male with a past medical history significant for CAD, status post a five vessel CABG in [**2157-10-26**], hypertension, type 2 diabetes, hypercholesterolemia, whose cardiologist, Dr. [**Last Name (STitle) **], noted a carotid bruit on a routine physical in [**2162-11-26**]. An ultrasound in [**2162-12-26**] right ventricular significant right carotid plaque with 80-99% stenosis and a left moderate carotid plaque with 60-69% stenosis. However, based on high-grade contralateral lesion and low ratio, these values may have been artificially elevated. Then, an MRI in [**2163-3-26**] revealed greater than 80% stenosis of the right internal carotid and approximately 60% stenosis of the left internal carotid. An MRA of the head was within normal limits. The patient underwent elective carotid catheterization today which revealed a 90% critical stenosis after the bifurcation of the right ICA at the bulb. It was this area that was stented. During the catheterization, he had blood pressures up to 214/93 but then a vagal episode where his heart rate and blood pressure dropped with the systolic blood pressures down to the 80s to 90s. He received Atropine, IV Neo, and was transiently on a dopamine drip. He came to the CCU on IV Neo drip. MEDICAL HISTORY: 1. CAD, status post five vessel CABG in [**2157-10-26**], SVG to PDA, SEQ to RPTL, SVG to D2, SVG to D1, SEQ to OM. 2. Hypertension. 3. Noninsulin-dependent diabetes mellitus. 4. Hypercholesterolemia. 5. Status post hernia repair. MEDICATION ON ADMISSION: ALLERGIES: Shellfish. PHYSICAL EXAM: FAMILY HISTORY: Father with angina in his 60s. SOCIAL HISTORY: He is married. He has two children. He currently lives in [**Location **], [**State 350**]. He quit smoking four to five years ago. He is a salesman for an importer/distributing company. He watches his weight and runs on the treadmill three times per week. He drinks alcohol once per week.

CHIEF COMPLAINT: Incarcerated ventral hernia atrial fibrillation with rapid ventricular response chronic obstruction pulmonary disease obstructive sleep apnea diabetes mellitus pulmonary artery hypertension PRESENT ILLNESS: 53F transfer from OSH for an incarcerated ventral hernia. Patient reports a history of a ventral hernia repair in [**2144**] that recurred 1 month after the initial surgery but was always reducible until 2 days ago, when she was no longer able to manually reduce it. It has since become increasingly painful and she is experiencing worsening nausea, no vomiting. Her last BM was 3 days ago and she has not passed flatus since. Patient reports a complicated post-operative course after her initial hernia operation at [**Hospital3 **] requiring an ICU stay for "breathing problems". She says this is why she was referred to [**Hospital1 18**] for repair of her hernia. MEDICAL HISTORY: PMH: Paroxysmal Afib (onset after ablation therapy for aflutter dx [**10/2146**]), on coumadin 6 mg daily with q2 week INR checks Hyperlipidemia Hypertension Diabetes Mellitus Type II COPD OSA Pulmonary artery hypertension MEDICATION ON ADMISSION: Levelmir 94 units Qam Insulin sliding scale. Metformin XR 750mg [**Hospital1 **] Metoprolol Tartrate 50mg [**Hospital1 **] ASA 81mg daily Coumadin 6mg daily prevachol 80mg daily glimepiride 4mg PO daily Propafenone 225mg PO BID Spireva ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PE on transfer to the cardiology floor: PHYSICAL EXAMINATION: VS: VS: 99.3 130/62 81 19 95%4L GEN: NAD, comfortable HEENT: PERRL, OP clear NECK: Supple, JVD 6cm, no LAD CARDIAC: Irregularly irregular, nlS1S2, no m/r/g LUNGS: Resp unlabored, bilateral basilar crackles, good air movement ABDOMEN: Soft, NTND, no rebound/guarding, 6cm horizontal incision w staples mild surounding erythema EXTREMITIES: No c/c/e. 2+ DP/PT/radial pulses Has healing abdominal incision c/w recent surgery. No erythema or drainage SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Has healing abdominal incision c/w recent surgery. No erythema or drainage PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: Family hx of CAD SOCIAL HISTORY: quit smoking [**2147-2-17**], denies alcohol, illicit drugs

CHIEF COMPLAINT: Transfer for hypercapneic respiratory failure. PRESENT ILLNESS: The patient is a morbidly obese 31 year old female with a history of asthma (recent admission to outside hospital, no history of intubations), who was in her usual state of health until approximately two weeks prior to admission when she began experiencing increasing shortness of breath at home, not improving with her outpatient asthma medications. She began using her father's home oxygen. She was admitted to [**Hospital3 1443**] Hospital on [**2114-2-8**]. Arterial blood gases on admission revealed pH 7.19, pCO2 of 108 and pO2 of 119. Her bicarbonate level at that time was 37. She was treated with BIPAP, [**Last Name (un) **]-Dur, Solu-Medrol which was switched to Prednisone. Chest x-ray reportedly was unremarkable at that time. She improved with treatment and was transferred to [**Hospital1 34648**]. Admitted to [**Hospital1 34648**] on [**2114-2-14**], with arterial blood gases of pH of 7.41, pCO2 of 86 and pO2 of 84 on 40% FIO2 face mask. She was aggressively diuresed and plan was for rehabilitation with subsequent follow-up at [**Hospital 34649**] Clinic. She began to do poorly, however, with increasing shortness of breath and occasional nonproductive cough. Arterial blood gases showed pH of 7.31, pCO2 of 131 and pO2 of 63 on 90%. She was placed on BIPAP and unable to be weaned off. Over that time, she denied fever, chills, chest pain, light-headedness, confusion, calf pain. She was treated with Enoxaparin prophylactically. She did describe some nasal stuffiness. She was started on Augmentin for suspected sinusitis and Levaquin was added on [**2114-2-23**], for possible pneumonia when her chest x-ray showed white out of the right lung. She was transferred to [**Hospital1 188**] at that time for likely tracheostomy. MEDICAL HISTORY: 1. Morbid obesity. 2. Asthma. 3. Anxiety/depression. 4. Question history of thyroid nodule. 5. Echocardiogram in 05/00, shows left atrial enlargement with an ejection fraction of 60%. MEDICATION ON ADMISSION: ALLERGIES: Vicodin and Percocet. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She lives with her parents. No history of tobacco or alcohol use.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 37 year old female with a past medical history of anxiety, depression and C5-C6 disc herniation, status post appendectomy, status post right fallopian tube removal and laser eye surgery who is admitted status post a left supraclinoid carotid aneurysm clipping. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 76-year-old woman with a history of diabetes mellitus, hypertension and elevated cholesterol who, on an evaluation as an outpatient, was found to be anemic and a colonoscopy revealed a right colon cancer in [**2183-12-18**]. The patient was then scheduled for elective right colectomy. MEDICAL HISTORY: As above. MEDICATION ON ADMISSION: Procardia 60 mg p.o. q.d. Captopril 50 mg p.o. t.i.d. Lipitor 10 mg p.o. q.d. Insulin 409 units of NPH q.a.m. ALLERGIES: The patient had an allergy to penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 85 year old male transferred to [**Hospital1 69**] from [**Hospital **] Rehabilitation secondary to acute onset of shortness of breath. At baseline, the patient is essentially nonverbal and is totally dependent for his activities of daily living. He had been living at home with his daughter until [**2180-11-26**], when he was admitted to [**Hospital6 1129**] secondary to increased right thigh swelling. There he was found to have bilateral femur fractures which were thought to be secondary to a new [**Female First Name (un) 36902**] lift at home. Orthopedics evaluated the patient in house and felt that the best course of action would be healing without surgery with observation for three to six weeks and they planned to reevaluate for surgery if this conservative management failed. He was therefore transferred to [**Hospital **] Rehabilitation on [**2180-11-29**]. His hospital course at [**Hospital6 1129**] was also notable for hyponatremia which resolved with free water; anemia with heme positive stools and iron deficiency (started on supplemental iron); and pyuria thought to be secondary to chronic indwelling Foley. On [**2180-11-30**], in the morning, he was found to have increased shortness of breath, increased to moderate amount of thick yellow secretions. He was given nebulizers with minimal effect. His vital signs at that time were a blood pressure of 150/75, pulse 120, respiratory rate 32, temperature 100.5, oxygen saturation 88% on two liters oxygen. He was transferred to our Emergency Department for further evaluation. In our Emergency Department, the patient was found to be in severe respiratory distress, GCS 3, hypoxic with an oxygen saturation in the 70s and a respiratory rate of 40. He was subsequently intubated in the Emergency Department. He was treated with Levofloxacin and Flagyl and received two liters of normal saline. He was subsequently transferred to the Medical Intensive Care Unit. MEDICAL HISTORY: 1. Right femoral fracture with prosthesis in [**2174**], secondary to a mechanical fall. 2. Gastroesophageal reflux disease with hiatal hernia . 3. Peripheral vascular disease. 4. History of aspiration pneumonia. 5. Depression. 6. Ventral hernia. 7. Status post percutaneous endoscopic gastrostomy placement. 8. Contractures secondary to immobility. 9. Dementia of questionable etiology. MEDICATION ON ADMISSION: 1. Fragmon 2500 units b.i.d. 2. Reglan 10 mg p.o. t.i.d. 3. Iron 325 mg p.o. t.i.d. 4. Colace 100 mg p.o. t.i.d. 5. Senna two tablets p.o. b.i.d. 6. Lopressor 12.5 mg p.o. t.i.d. 7. Prevacid 15 mg p.o. q.d. 8. Vicodin p.o. p.r.n. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient came from rehabilitation. Previously he lived in [**Location 4628**], [**State 350**] with VNA and home health aids. He is a former electronics technician and has no history of alcohol or tobacco use. He is a widower times eight years. His daughter is health care proxy and he also has one son in [**Name (NI) 8449**]. The patient is a full code.

CHIEF COMPLAINT: hypotension PRESENT ILLNESS: Mr. [**Known lastname **] is a 53yo quadriplegic male ([**3-13**] motorcycle accident 6 years ago) with h/o frequent UTIs who presented to the ED after his VNA found him hypotensive this morning with BP 50/30. He stated he was in his usual state of health (other than a recent UTI for which he took 10 days of bactrim, ending 5 days prior to this admission) until a few days ago. He reported feeling general fatigue/malaise/nausea, with mild abdominal and back pain (difficult to discuss ascertain given altered sensation). He also reported mild dizziness when he got out of bed on the morning of admission. As above, Mr. [**Known lastname **] is dependent on intermittent urinary catheterization due to his paralysis and has had frequent UTIs ([**6-14**] in the past year; the last being [**3-13**] klebsiella pneumoniae resistant to bactrim, cipro, nitrofurantoin). In the ED his initial BP was 60's/40's with HR of 64, improving with IVF to 70's/30's, and finally 80's after 4L IVF bolus. In the ED a Precept catheter was placed, he was given empiric ceftriaxone and vancomycin and was started on Levophed after his CVP>8. SVO2 70 MEDICAL HISTORY: - quadriplegia and TBI [**3-13**] MVA several years ago - h/o DVT's (1 year ago) - autonomic dysfunction: frequent swings of blood pressure associated with not having BMs - urinary retnsion requiring straight cath: frequent UTI's (most recent due to Klebsiella resistant to ciproflox and nitrofurantoin) - chronic cystitis (?cystoscopy at [**Hospital1 2025**] with bladder irritation) MEDICATION ON ADMISSION: 1. Ascorbic Acid 500 mg po bid 2. Baclofen 20mg po QAM, 30mg po Q noon, 20mg po Q 4pm, 30mg po Q 8pm 3. Bupropion SR 200mg PO QAM 4. Bupropion 100 mg SR po Q 4PM 5. Diazepam 10 mg PO QAM ?prn 6. Ditropan XL 20 mg po q AM, 10mg po Q 4pm. 7. Dulcolax 10 mg PR once a day. 8. oxycontin 15mg po q4-6hrs prn pain. 9. Omeprazole 20 mg po daily. 10. Pantoprazole 40 mg po daily. 11. Senna 2 tabs po qhs. 12. Tamsulosin 0.4 mg PO HS 13. Nitroglycerin 2 % Ointment Sig: One (1) application Transdermal once a day as needed for dysreflexia. 14. Furosemide 40 mg po daily 15. Paroxetine HCl 50 mg PO DAILY 16. Coumadin 5mg ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 100.6 BP 116/67 HR 83 CVP6 RR 22 95% on RA Gen: quadriplegic male, non-toxic appearing, no distress CV: RRR no m/r/g Pulm: Lungs CTAB Abd: S/ND/NT +BS Flank: no flank TTP Extremities: mild edema FAMILY HISTORY: mother with cancer, grandmother with [**Name2 (NI) **] SOCIAL HISTORY: Former computer and real-estate executive. Retired wealthy at age 42 and traveled the country riding his motorcycle and unfortunately had his accident while on a trip to [**State **]. Has 4 children; now lives with his wife and 2 of his kids at home with daily VNA. He drinks 5+ shots of gin per day (no h/o withdrawal); no smoking.

CHIEF COMPLAINT: Constipation PRESENT ILLNESS: 35 yo male with mental retaration and chronic consipation (does not verbalize, Mother takes care with him.), p/w 3 weeks history of constipation and recent dystonic reaction to Haldol treated with Ativan. Two weeks prior to visit, pt was oozing fecal matter per rectum according to mother. sx of restlessness, generalized pain, rubbing head and ears, stomach is distended, pt having trouble walking, Pt is retarded and can not verbalize his symptoms. Referred back to [**Hospital1 18**] ER. Pt has a history of severe constipation, only fully dissolved with fecla disimpaction. Patient recently returned from [**State 1727**]. Mother reports BM T this am, Wed, [**Name (NI) 5929**]. Giaiac Neg in ED. MEDICAL HISTORY: mental retardation, seizure disorder(Grand mal seizure [**Month (only) 205**] l993. He has been on Dilantin since and has had no further seizure activity) hypertension, history of sinusitis [**Last Name (un) 6226**]-[**Last Name (un) 6227**] disease history of developmental delay MEDICATION ON ADMISSION: dilantin 100 qd, Hctx 25 po qd, golytel po prn, ibuprofen 600 po prn, moexpril 7.5 po qd, senokot 3 tab po tid ALLERGIES: Phenobarbital / Valium / Haldol PHYSICAL EXAM: VSS T 100.4 @12am attempted to retake temp in AM but pt is agitated BP 112/70-90 P 85-105 O2 100 RA R 12 Gen: MMM, NC/AT, OP clear Neck: Supple CV: RRR Chest: CTAB Abd: S, NT/ND, +BS Ext: WWP, no edema Neuro: agitated. FAMILY HISTORY: n/c SOCIAL HISTORY: mentally retarded and lives w/ family

CHIEF COMPLAINT: (Per patient) Mitral valve regurgitation noted on yearly physical examination. PRESENT ILLNESS: Mr. [**Known lastname 3203**] is a 63 year old male, otherwise healthy who was found to have a systolic workup. Workup revealed mitral regurgitation approximately two years ago. He had been followed serially with electrocardiograms and was noted to have worsening valvular dysfunction recently. He had a cardiac catheterization in [**2139-7-6**], which showed normal coronaries, ejection fraction was 66%, he had 4+ mitral regurgitation. Cardiac echocardiogram in [**2139-5-18**] stated the report was unavailable at the time of his preoperative surgical evaluation. MEDICAL HISTORY: MEDICATION ON ADMISSION: Lisinopril 30 mg q. day; Aspirin 81 mg q. day. ALLERGIES: Penicillin causes hives. PHYSICAL EXAM: FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Occupation - He is an electrician. Lives at home with his wife and son. [**Name (NI) **] quit tobacco several years ago. No significant alcohol history.

CHIEF COMPLAINT: Seizure PRESENT ILLNESS: 73 yo woman with no significant [**Hospital **] transferred from OSH after a seizure earlier this am. History is provided per the OSH records and the patient's husband and son. By routine, she woke up around 3am, checked on the house. However, the patient did not return to bed for 15 to 20 minutes, and her concerned husband went to look for her. She was found on the floor of the kitchen, unresponsive. He called EMS and did not note any seizure activity while awaiting their arrival. EMS found her to be having a "full seizure grand mal" for ~30 seconds,associated with "snoring respirations, unresponsive." She had left eye deviation and a left facial droop. She was brought to [**Doctor Last Name 38554**] Hospital, still noted as unresponsive, with left gaze deviation but no facial droop, moving the right arm and leg. At ~ 4 am, she was given ativan 2mg, then pavulon 10mg IV, thiamine, and cerebyx 1gm. She had a head CT, which showed bilateral frontal intracerebral hemorrhages. She was given an additional 10mg pavulon IV and then transferred here. She was given an additional 2mg IV fentanyl prior to neurology consult. Somehat more irritable in recent days after attending funeral; otherwise no complaints and at normal functioning baseline. MEDICAL HISTORY: No significant past medical history per family. Patient visited physician for regular [**Name9 (PRE) 73962**]. MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Afebrile , BP 110-170/60-80, RR 12, SaO2 96-99%/vent General: elderly thin female, NAD HEENT: orally intubated, sedated Neck: C-collar in place CV: RRR, nl S1, S2, no m/r/g Chest: ventilated breath sounds Abd: soft, NTND, BS+ Ext: warm and dry Neurologic examination (paralytics given several hrs prior): Mental status: unresponsive to all stimuli, eyes closed Cranial nerves: pupils symmetric and reactive, 2->1mm; unable to check Doll's eyes due to c-collar, absent corneals, nasal tickle, and gag Motor: no movement to stim Sensory: no movements of extremities to noxious stimuli DTRs: absent, toes down FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Active woman who lived at home with her husband.

CHIEF COMPLAINT: respiratory distress PRESENT ILLNESS: Mr. [**Known lastname **] is a 44y/o gentleman with paranoid schizophrenia, HTN, and recent treatment for pneumonia last week who was found by his VNA to be short of breath and is now intubated. Per EMS records, VNA found him to be extremely agitated, speaking in "choppy" sentences. He reported 30 minutes of sudden shortness of breath, wheezing, difficulty speaking, and non-productive cough. On the scene, initial VS were BP 140/80, HR 120, RR 38, 62%RA - 88% on 6L NC. He was given nebs with minimal relief and was brought to the [**Hospital1 18**] ED. . In the ED, he was given Levofloxacin and Methylprednisolone. He was put on a NRB and continued to be somnolent, lethargic with bilateral rhonchorous breath sounds. He was intubated (mallampati 3), started on Norepinephrine, and was initially sedated w/ propofol but BP dropped so he switched to Fentanyl and Versed. Right IJ central line was placed. He was started on empiric Vancomycin + Levofloxacin. He was then transferred to MICU for his respiratory distress. . On arrival to the MICU, he was intubated and sedated. His Pinspiratory and plateau pressures were elevated, with an elevated differential. Nebs, steroids, and diuresis were initiated. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: DM2 Schizophrenia h/o pneumonia MEDICATION ON ADMISSION: Lisinopril 5mg QAM Omeprazole 20mg daily Haldol 10mg PO QID Benztropine 1mg PO TID PRN EPS Risperidone 2mg QAM, 4mg QHS Metformin 850mg [**Hospital1 **] Albuterol HFA 2 puffs QID PRN Fluticasone 440mcg inh [**Hospital1 **] Nicotine patch ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM Vitals: T 100.7, O2 sat 98% on 100% FiO2, HR 80, BP 120/70, RR 20 Gen: Morbidly obese black male, sedated Cardiac: Nl s1,S2 RRR, no murmurs appreciable, JVP not appreciably elevated Resp: mild wheezes bilaterally, mild crackles at bases Abd: obese abdomen, soft, nondistended Ext: 1+ lower extremity edema, pulses present bilaterally, warm DISCHARGE EXAM Physical Exam: Vitals: 98.3 136-160/80-95 19-22 86-93%RA Gen: Morbidly obese black male, A&Ox3, pleasant and cooperative Cardiac: Nl s1,S2 RRR, no murmurs appreciable, JVP not appreciably elevated Resp: mild wheezes bilaterally, no crackles Abd: obese abdomen, soft, nondistended Ext: no lower extremity edema, pulses present bilaterally, warm FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Raised by grandmother from age 10, at which time both parents died (father from [**Name (NI) **], mother "choked on her own vomit). Currently lives in a studio in [**Location (un) 4398**]. He has a VNA that goes to his home three times per day. He spends days going to grandmother's house and they run errands together.

CHIEF COMPLAINT: + Stress Test, referred for Cardiac Cath PRESENT ILLNESS: 81-yo-woman w/ DM2, HTN, hyperlipidemia, and PVD was admitted to the CMI service yesterday after 2 months of worsening dyspnea on exertion. She describes shortness of breath after climbing 1 flight of stairs, assoc w/ a "band" of chest "heaviness" across the upper sternum. This sensation occured reliably w/ climbing stairs, and always resolved within a few minutes after resting. There were no assoc palpitations, cough, diaphoresis, nausea, or vomiting. . She had presented to her PCP with the above symptoms and was evaluated w/ an adenosine ETT on [**6-12**], demonstrating reproducible symptoms w/ ST depressions in the inferolateral leads. She was admitted to the [**Hospital1 18**] yesterday for cardiac cath, which revealed extensive CAD including left main and 3 vessel disease. She is now transferred to the [**Hospital Unit Name 196**] service to begin prepartion for CABG. . Currently, she feels well. Denies any dyspnea or chest heaviness since admission to the hospital. ROS reveals no fever, abd pain, dysuria, melena, or hematochezia. MEDICAL HISTORY: - Diabetes mellitus type 2: complicated by neuropathy of her feet - HTN - Hyperlipidemia SVT - Peripheral vascular disease - Hypothyroidism - Urinary incontinence - Cervical cancer: dx [**2173**], s/p hysterectomy - s/p cholecystectomy - s/p appendectomy MEDICATION ON ADMISSION: Aspirin 81mg daily Atenolol 25mg daily Lipitor 80mg daily WelChol 625mg twice a day Isosorbide 10mg daily HCTZ 25mg daily Avandia 4mg daily Prandin 1mg with each meal Levothyroxine 50mcg daily Lotrel 10/20mg capsule daily Evista 60mg daily Cilostazol 100mg daily Folic acid 2mg [**Hospital1 **] Vitamin C 250mg daily Vitamin E 400 IU daily Occutabs one daily ALLERGIES: Sulfa (Sulfonamides) / Niacin Preparations PHYSICAL EXAM: Admission VS - 98.4, 142-173/41-52, 63-72, 16-18, 91-95% RA HEENT - OP clear, JVP 3 cm above sternal angle LUNGS - CTA HEART - RRR, S1, S2, no rmg ABD - soft, NT, ND, BS+ EXT - wwp, no cce; multiple varicosities. 2+ DP pulse R leg, no bruit, hematoma at R groin. Discharge VS 98.6, 140/80, 70, 18, 99%/2LNP Neuro- A&O, nonfocal Pulm- CTA bilat CV- irreg-irreg, sternum stable, incision intact Abdm- Soft, NT/ND/NABS Ext- no edema FAMILY HISTORY: CAD: maternal grandmother died at age 78 from an MI; paternal grandmother died "very young" from MI SOCIAL HISTORY: retired high school teacher; lives alone in a town house apartment; functionally independent at baseline; never smoked; no alcohol use.

CHIEF COMPLAINT: overdose PRESENT ILLNESS: He presented to the ED reported that he was s/p ingestion (right prior to coming into the ED) of 12 400mg seroquels and 11 900mg pills of trileptals. However the patient only had 600mg trileptal pills available to him and none on his person despite bringing in a bag of his meds. . In the ED, vital signs on arrival were 96.0 116 149/94 16 98%. In the ED the patient was originally asking questions appropriately but became increasingly somnolent. The patient was vomiting large amounts in the ED. He was given etomidate 20mg and succ 120mg and intubated. He received was then put on propofol. CXR showed low lung volume, ET tube terminates at 4.9 cm above carina, NG tube terminating at appropriate location, mild pulm vasc congestion, bibasilar opacities likely infection vs aspiration. He received 2.5L of NS and zofran 4mg IV x1 in the ED. . The pt's exam was notable for mydriasis with pupils dilated to 5mm, roving eye movements, diaphoretic, slurred speech, [**5-6**] beats of clonus, psychomotor depression, wheezy after intubation, mottling of the hands, poor cap refill. There was no evidence rigidity or fevers. His EKG at 18:20 was notable for sinus tachycardia to 117 and Qtc of 387 with QRS of 80 and then repeat EKG at 18:50 was sinus tachycardia to 104 and Qtc of 331 with QRS 86. FS was normal at 134. CBC was unremarkable. Electrolytes were normal. Serum tox screen was pending at the time of transfer. Unable to place foley to get urine tox. Vitals prior to transfer were Hr 93, BP 135/84 RR 15 100%. . On arrival to the ICU were 100% on AC TV 550 RR14 PEEP 5 Fio2 100%, HR 94 BP 154/96. He was awake on 60mcg/kg/min and responding to commands. EKG was concerning for 1mm ST elevations in v5, v6, old ST elevation in II, old j point elevation in v2/v3. His QRS remained narrow and his QTC was 383. MEDICAL HISTORY: Past Psych Hx: - dx of bipolar II with psychotic features in the past- symptoms unclear that led to that diagnosis at this time. - cognitive d/o NOS by neuropsychological testing [**12-9**] (prior to TBI) - h/o prior psychiatric hospitalizations, with "8 or 9" suicide attempts by overdose - h/o assaultive behavior: stabbed a friend with a penknife many years ago (in secondary school) MEDICATION ON ADMISSION: Sertraline 100mg 2.5 tabs qam lexapro 20 mg daily abilify 5mg [**Hospital1 **] trazodone 100mg qhs nifedipine 60mg daily naltrexone 50mg daily lisinopril 20mg daily lipitor 10mg daily seroqeul 25mg 1 tab TID prn agitation seroquel 300mg qhs protonix 40mg daily ducosate 100mg [**Hospital1 **] calcium + vit D -trileptal (had in med list but no bottle here) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: VS: T96.4 BP 154/96 RR18 95% on AC TV 550 RR14 PEEP 5 Fio2 100% FAMILY HISTORY: His father and two aunts (paternal and maternal) have a history of depression. This maternal aunt also has a history of alcohol abuse. SOCIAL HISTORY: Per OMR: Mr. [**Known lastname 67595**] reported in previous psych notes that he has h/o etoh abiue. Between the ages of 19 and 21 he reported drinking 2 pints of scotch or vodka per day. [**2193-10-1**] 3 to 6 times per week, drinking a six pack of beer at each use." He also reported a history of marijuana use. The period of heaviest usage was between the ages of 19 and 21. He stopped using marijuana because of its side effects such as paranoia. [**Year (4 digits) **] h/o of IVDU and cocain in past notes but urine and serum tox positive for methadone in [**11-9**]. H/o stabbing friend with [**Name2 (NI) **]. After graduating high school, he worked for one year as a prep cook, he then works at a farm, and later at [**Company 25282**] pharmacy. .

CHIEF COMPLAINT: 15 foot fall out of tree PRESENT ILLNESS: 68 yo male with PMH of HTN presents after fall from 15 feet. Patient fell off ladder and fell onto his back. Denies EtOH, RDU. Taken to [**Hospital3 **] where he was found to rib fractures and vertebral fractures. He was then transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: HTN, hypothyroidism, HLD MEDICATION ON ADMISSION: ezetibime 10', Allopurinol 300', Meclizine 12.5 prn vertigo, Triamterene-Hydrochlorothiazide 1 cap daily, gemfibrozil 600", levothyroxine 50' ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: T97.8 HR89 BP160/95 RR18 97% A&O x 3 , NAD Cor:RRR Pulm:CTAB CN II-XII grossly intact PERRL Head is AT/NC Cervical Spine: non-tender, no stepoff Thoracic and Lumbar Spine: non-tender, no stepoff Pelvis: Stable to AP/Lateral Compression General: NAD Mental Status: AOx3 Back: No step offs or TTP, skin intact, no rash/ecchymosis FAMILY HISTORY: NON CONTRIBUTORY SOCIAL HISTORY: (-)Tobacco /(+)EtOH, retired [**Company 2892**] division manager

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 74-year-old man with cardiac risk factors including hypercholesterolemia, hypertension, and a previous myocardial infarction who was referred to [**Hospital6 2018**] for CABG following catheterization done on the day of admission at [**Hospital **] Hospital. The patient's workup was initiated after the patient developed exertional angina and presented with chest heaviness after mowing his lawn. MEDICAL HISTORY: The past medical history is significant for hypertension, hypercholesterolemia, coronary artery disease status post myocardial infarction in [**2124**], AML status post x-ray therapy in [**2126**]--whole body radiation done at [**Hospital6 1708**], status post colonic polyp removal in [**2146**], and status post melanoma with an excision from his chest wall five years ago. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. Catheterization done at [**Hospital **] Hospital showed a right dominant circulation with 50% left main stenosis, 90% LAD stenosis, normal circumflex, and an RCA with severe diffuse disease of the entire vessel. His ejection fraction was estimated to be 45%. An echocardiogram done on [**2147-11-14**] was stopped because of ST depressions in the lateral leads. It showed hypokinesis of the basilar inferior septal region and anterior septal region, and borderline dilated aortic root. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient works as a quality assurance [**Doctor Last Name 360**]. He is married. He has a remote tobacco history, quit in [**2124**], and has rare alcohol use.

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Mr. [**Known lastname 9063**] is a 68 M with h/o CAD, MI, CVA, HTN who presents with 3 months history of dyspnea, cough, and leg swelling. His exercise tolerance has decreased dramatically over the last 3 months to the point where he cannot walk from room to room without getting SOB. His cough is occasionally productive of varying sputum quality and is sometimes associated with coughing fits that lead to vomiting. It is worse with laying down. Leg swelling has been present over the same time period with more recent reddening at the ankles. Patient is sleeping upright but states [**2-25**] cough and not feelings of orthopnea or PND. No CP, dizziness, abd pain, diarrhea, dysuria, fevers. Large EtOH history ([**1-25**] gallon whiskey per day). . Of note, the patient is at times a poor historian who has had little medical care in at least the previous 3 years. MEDICAL HISTORY: CAD; MI x 3, s/p RCA placement CVA x 2 with R sided weakness, reportedly resolved HTN Hypercholesterolemia Inguinal hernia repair Alcohol abuse MEDICATION ON ADMISSION: ASA ALLERGIES: Heparin Agents / Abciximab PHYSICAL EXAM: Admission: VS: 97.9,BP 146/88, HR 74, RR 18, O2 sat 94% RA General: Pleasant, slightly disheveled, NAD HEENT: NC, AT, sclera anicteric, PERRL. MMM, pharynx clear. Heart: RRR, S1, S2. No murmur appreciated Lungs: CTA bilat, slightly diminished. Abd: + BS. Distended, soft. Mild diffuse periumbilical tenderness. + hepatomegaly with spleen 5-6 cm below costal margin, ?splenomegaly also. No scrotal edema Extrem: 2+ pitting edema equal bilat to knees. Erythema and mild tenderness- skin over bilateral ankles. Not significant increased warmth. Neuro: Alert and oriented. CN II-XII intact, strength grossly normal. Normal pedal sensation. FAMILY HISTORY: Etoh abuse in father and brothers; mother with DM, brother with CAD SOCIAL HISTORY: Lives with wife (but separated currently). Retired construction worker. Denies smoking, illicit drug use. Heavy EtOH use as above. No h/o DTs.

CHIEF COMPLAINT: hypoxia PRESENT ILLNESS: 80 yo F with severe Alzheimer's dementia (non-verbal at baseline, bedridden x 10 yrs) and h/o multiple decubitus ulcers was noted to have shaking activity, moaning and in obvious respiratory distress with ronchorous breath sounds this morning. Her sats were 60% RA--> 70-80% 5L. She was given morphine 5 mg, albuterol neb, and EMTs were called. Per documentation had "tonic-clonic activity", but in speaking with RN on floor and EMTs who spoke w/ RN directly, may have had hypoxic myoclonus. She was thought to have aspirated. Pt's code status was discussed with daughter, who reversed the DNR status. . In ED, initial vitals T 99.6, HR 150, BP 104/50, RR 24, 100% on NRB. She was intubated for labored breathing and appearing as though she was tiring. She had a leukocytosis to 20 with left shift. She was given Vanco, Levo, Flagyl empirically for presumed aspiration pneumonia, and possible cellulitis given multiple pressure ulcers on the skin. . Of note, pt was d/c from [**Hospital1 18**] [**2155-5-28**] for likely aspiration PNA treated with vanc/levo/flagyl, and a 6 week course of vancomycin for a presumed osteomyelitis of the L lat malleolus which ended [**7-3**]. Her wbc were monitored as an outpt, and because of a rise to 18 on [**7-14**] and increased "gurgling" in the lungs, she was started on levo/flagyl on [**7-16**] for a presumed chronic repeated aspiration pneumonia, due to end on [**7-26**]. MEDICAL HISTORY: Severe Alzheimer's dementia x 10 years aspiration HTN GERD decubitus ulcers h/o GI bleeding secondary to aspirin chronic L lateral malleolus ulcer AF MEDICATION ON ADMISSION: Levoflox 500 qd, flagyl 500 q8h, colace, prevacid, mvi ALLERGIES: Aspirin / Cefazolin PHYSICAL EXAM: Physical exam on admission Vitals: T 98.7, BP 140/88, HR 134, RR 22, O2 sat 100% on AC 550/14/5/1. GEN: Elderly female lying in bed, tachypneic, unresponsive to voice or touch HEENT: Anicteric, OP dry mucous membrane. CV: Tachy, difficult to hear S1 S2, no m/r/g LUNG: Diffuse rhonchi bilat. ABD: Soft, NT/ND, +bs EXT: has multiple skin breakdown both in left elbow (covered), left lateral malleolus 2 cm, and sacrum with 7x7 cm ulceration which extends to bone FAMILY HISTORY: N/C SOCIAL HISTORY: Lives at nursing home, non-verbal and non-ambulatory at baseline. Has 2 PCAs who help care for her. H/o tobacco (quit 25 yrs ago, only few cigarettes/day before that), no EtOH.

CHIEF COMPLAINT: Mr. [**Known lastname 39868**] is a 77 year old male referred by Dr. [**Last Name (STitle) 2912**] for MVR, TVR, coronary artery bypass graft. PRESENT ILLNESS: The patient has been experiencing increasing shortness of breath and dyspnea on exertion times seven months. Told in [**Month (only) 404**] that he had a leaking valve that might require follow up. However, the patient became increasingly dyspneic over the next several months culminating in admission to [**Hospital6 **] on [**Month (only) 116**] of this month with congestive heart failure. He was diuresed at that time and an echocardiogram done during that admission showed dilated left ventricle, LA, and RA with aortic and mitral sclerosis with mild AS, trace aortic regurgitation, moderate to severe mitral regurgitation, and moderate to severe tricuspid regurgitation. Cardiac catheterization done on [**2103-7-18**] showed a normal left main, left anterior descending coronary artery with no disease, circumflex with total obstruction at the distal take of the posterior descending coronary artery. Right coronary artery with no significant disease. Severe mitral regurgitation, moderate pulmonary hypertension, an ejection fraction of 47 percent. MEDICAL HISTORY: The patient's past medical history is significant for coronary artery disease status post right coronary artery stent in [**2095**], hypertension, hypercholesterolemia, bilateral knee arthroscopies, partial gastrectomy, atrial fibrillation, congestive heart failure, right bundle branch block, asthma, hernia repair. The patient has been O2 dependent at home for the past year, mostly at night, however, since [**Month (only) 956**] has been home O2 dependent throughout the day as well. MEDICATION ON ADMISSION: His medications prior to admission include Aldactone 25 mg q d, Coreg 12.5 mg [**Hospital1 **], Captopril 50 mg tid, Coumadin 3 mg alternating with 4 mg - held since [**2103-7-19**], Lasix 40 mg [**Hospital1 **], Flovent two puffs [**Hospital1 **], Combivent two puffs qid, Verapamil 120 mg q d, Fergon one tab [**Hospital1 **], and Zoloft 25 mg q d. ALLERGIES: The patient states an allergy to sulfa which causes a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Married, lives with wife. Remote tobacco use. Quit 24 years ago. 150 pack years prior to quitting. Rare alcohol use.

CHIEF COMPLAINT: Primary Oncologist: [**Last Name (LF) 11309**], [**First Name3 (LF) 636**] . Primary Care Physician: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] . Chief Complaint: fatigue, weak without appetite PRESENT ILLNESS: 83F with history of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**], HTN, GERD, anxiety and depression referred in from oncology clinic due to elevated WBC. . The patient presented to clinic yesterday where she was noted to have an elevated WBC to 12.6 with left shift (89% polys). She was referred in for evaluation, however she declined because she was feeling well at the time. This AM however, she awoke feeling weak and without appetite. Her urine output was normal per report. She denies headaches, vomiting, fevers. She reports no dysuria, hematuria. No vomiting, diarrhea. No cough, SOB, chest pain. . In the ED, on exam, she was noted to be awake and cooperative. RRR, no murmur. Lung CTA b/l. Abd soft, NT, ND, no HSM or masses. A UA was done and was concerning for a UTI with elevated WBC and large leukesterase. WBC 12.9. Lactate 2.8. Her initial Vitals were 99.8 55 163/75 16 100% RA. However, later she spiked to 101.4 which she did not notice. Urology and Oncology was consulted and the decision was made to admit to OMED. Towards the end of the ED stay the nurse noted the patient to have 30 seconds bilateral upper extremity shaking, her eyes rolling back, a/w tachycardia. The episode was self-resolved and the patient had no post-ictal phase. After this episode the patient was noted to have a transient episode of increased PVCs/ectopy on tele. An EKG was done that reportedly showed SR at 59bpm, normal intervals, LAD, no STE. A noncontrast head CT was done and was unremarkable. The patient was given Ceftriaxone and Tylenol. . The patient currently reports feeling well and has no complaints. She recalls the event in the ED and states that she never lost consciousness. She never had a prior episode like this. She also specifically denies any dysuria or hematuria or pain. On ROS, she only endorses some dysphagia of pills since her surgery. She denies aspiration. She also denies blood in her stool or dark stools. MEDICAL HISTORY: Past Oncologic History: Recent diagnosis of high grade, large urothelial bladder cancer with invasion s/p resection [**2190-8-3**] . Other Past Medical History: HTN Anxiety Depression GERD MEDICATION ON ADMISSION: patient reports having stopped all meds because of dysphagia since her surgery ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Admission: 97.9 110/52 52 19 100RA GEN: AOx3, NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, supraclavicular LAD Cards: RR S1/S2 normal. [**1-31**] holosystolic murmur over precordium, no gallops/rubs. Pulm: No dullness to percussion, mild crackles L base Abd: BS+, soft, NT, no rebound/guarding, no HSM, no [**Doctor Last Name 515**] sign Extremities: wwp, no edema. DPs, PTs 2+. Skin: no rashes or bruising, dry skin Neuro: CNs II-XII intact. 5/5 strength in U/L extremities. Sensation grossly intact. No neck stiffness. FAMILY HISTORY: N/C SOCIAL HISTORY: lives alone, since surgery son was with her, widowed, no tobacco, occ ETOH denies tob 3 drinks daily

CHIEF COMPLAINT: IPH, SAH s/p fall PRESENT ILLNESS: 47M intoxicated and fell down approx 15 steps. At OSH he was found to have RR 8 intubated. ETOH 350. Was found to have R frontoparietal SDH with traumatic SAH. MEDICAL HISTORY: HTN, dyslipidemia MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: Gen: WD/WN, comfortable, NAD. HEENT:L side parietal lac. Pupils:5->2 EOMs UTA Neck: in c-collar Extrem: Warm and well-perfused. Neuro: Mental status: Intubated on propofol. Propofol held. Moves all extremities spont. Appears to attempt to follow commands. Face symmetric FAMILY HISTORY: unknown SOCIAL HISTORY: unknown

CHIEF COMPLAINT: ICD firing /occ. lightheadedness PRESENT ILLNESS: 73 year old male that presented to the ED [**7-14**] with complaints of ICD firing multiple times. He had recently been admitted for GAS bacteremia which he was started on ceftriaxone which was changed this admission due to concern of drug induced neutropenia. He continued to have ventricular tachycardia episodes in the hospital and underwent attempted ablations for Ventricular tachycardia on [**7-17**] and [**7-20**] with EP - that were not successful. He completed a course of antibiotics on [**7-26**] and PICC was removed after tPA injection in the ICU on [**7-27**]. RUE DVT noted. Bridged with lovenox and coumadin restarted. Presents today for further planning for surgery.Now off abx for 13 days. Reports no fevers. He has been at [**Hospital 9188**] Rehab since discharge from [**Hospital1 18**] with planned discharge to home in a few days. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: -Diabetes, -Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: - PACING/ICD: VVI [**Company 1543**] pacer/AICD, placed in [**2168**] - Non-ischemic cardiomyopathy with EF of 20% -Endocardial ablation, failed Epicardial ablation [**3-8**] adhesions - Rheumatic Heart Disease (in childhood) s/p bioprosthetic AVR [**68**] years ago in FL - paroxysmal atrial fibrilation on Coumadin (confirmed by phone by his [**State 108**] cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 99581**] (Holywood, [**Numeric Identifier 99582**]) - Ventricular tachycardia 3. OTHER PAST MEDICAL HISTORY: - Gout - Hypothyroidism - Traumatic injury to his left arm 30 years ago - GAS bacteremia - Neutropenia thought to be [**3-8**] CEftriaxone - Suspected Sleep Apnea MEDICATION ON ADMISSION: Coumadin 5 mg daily (adjusted based on INR - for afib) amiodarone 200 mg daily Calcium 500 mg/ Vit D 400 units daily Lasix 40 mg daily Levothyroxine 25 mcg daily Ropinirole 1 mg QHS Carvedilol 12.5 mg [**Hospital1 **] Lisinopril 2.5 mg daily Klor-con 20 mEq daily Digoxin 125 mcg daily Colchicine 0.6 mg daily Aspirin 81 mg daily Multivitamin daily lorazepam 1 mg daily prn anxiety oxycodone 5 mg prn chronic hip pain ALLERGIES: morphine PHYSICAL EXAM: On Admission: Skin: Dry [x] intact [x] scar on back, left arm multiple scars from previous trauma, midline surgical scar healed, right knee surgical scar healed Chest: Lungs clear bilaterally except for faint basilar rales; healed sternotomy and L ant. chest pacer scars Heart: RRR [x] Irregular [] Murmur - none Extremities: Warm [x] Edema - none Varicosities: None [x] venous stasis changes bilateral lower extremities Neuro: Alert and oriented x3 slight limitation ROM left arm due to trauma gait unsteady strength r=l [**6-8**] FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: The patient lives in [**State 108**] but recently moved to [**Location (un) 86**] to live with his daughter. [**Name (NI) **] is a lifelong nonsmoker and does not drink alcohol. He denies any illicit drug use. He has a girlfriend who lives in [**Name (NI) 108**].

CHIEF COMPLAINT: Abdominal pain PRESENT ILLNESS: 80yo female s/p ERCP @ [**Hospital3 **] which was unsuccessful for presumed choledocholithiasis found on MRCP last Tuesday after RUQ u/s was done prior to that for RUQ pain was equivocal. Pt has had intermittent fevers, but was not given abx. Also had rigors at that time but all resolved. Denies postprandial pain. Notes had "attacks" x 3 beginning early [**Month (only) 404**]. Tolerating POs, but c/o +N/V yesterday and today. MEDICAL HISTORY: MedHx: HTN, GERD, hyperlipidemia, goiter, hiatal hernia, diverticulitis SurgHx: Total thyroidectomy, TAH, appendectomy MEDICATION ON ADMISSION: Synthroid, atenolol, Nexium, celebrex, glucosamine ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS 101.6 86 149/69 18 96% on 2L NC NAD, AAOx3, uncomfortable PERRLA, EOMI RRR Abd soft, distended/tympanic, TTP RUQ. +[**Doctor Last Name 515**] sign. No rebound/guarding Ext w/o C/C/E FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Denies tobacco/drug use. Infrequent EtOH.

CHIEF COMPLAINT: Found down PRESENT ILLNESS: 55 yo man found unresponsive by EMS (Pro Ambulance). Per discussion with ambulance company and [**Hospital1 8**] police, the patient's elderly father called the [**Name (NI) 8**] police after not having heard from the patient for several days. The [**Hospital1 8**] police called EMS. Per OSH ED notes, the pt was found in an unclean apartment lying on left side with dried emesis in mouth and hair. Pt's FSBG was HI per glucometer. Pt was noted to have left sided flaccidity with skin breakdown and necrotic ulcer to sacrum. Pt was unable to communicate, but was moving right hand. At [**Name (NI) 8**] Hosp, pt received Insulin 10u IVx1, folic acid 1mg IV, thiamine 100mg IV, MVI, lidocaine 100mg IV x1, propofol 40mg IV x1, vecuronium 6mg IV x1, propofol gtt, banana bag, labetalol 10mg IV x1 and was intubated and transferred. CT head showed an intraparenchymal bleed. On transfer was hypertensive to 150's. His transfer vital signs were: T95.7, 73, 175/113, 18, 100% intubated. On exam in the ED, pupils were sluggish, rectal was guaiac positive, and pt was noted to have dark stools with "oozing." The patient was continued on a propofol gtt, CTA was done to look for aneurysm and pt was started on dilantin. A type and screen were sent and the pt was crossmatched for 2 units. Vanco and Zosyn were started for hypothermia, leukocytosis. UA, CXR were negative. Pt was given 1u of platelets and 8u insulin. Vitals on transfer were: P75, 123/85, 500/18/100%/5 MEDICAL HISTORY: ? head injury per father MEDICATION ON ADMISSION: none known ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: T: 96.8 BP: 130/62 P: 85 RR: 10 O2Sat: 96% RA Gen: gaspint breaths HEENT: blown left pupil, right minimally responsive NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops LUNGS: CTA, BS BL, No W/R/C ABD: Soft, NT, ND. NL BS. No HSM EXT: ungoing toes on babinski SKIN: Several 8cm eschars/ulcers on back, coccyx, heels NEURO: ungoing toes on babinski. does not withdraw to pain. FAMILY HISTORY: Father is 90 and in very poor health with severe diabetes, obesity, and macular degeneration to the point of almost total blindness SOCIAL HISTORY: Live alone, never married, father and brother involved.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 82 year old man with a history of nonHodgkin's lymphoma and delirium transferred from [**Hospital3 672**] Hospital with febrile neutropenia and worsening dementia. The [**Hospital 228**] medical history begins in [**2105-10-11**] when the patient was in a car accident. He was in [**Hospital3 **] for several days and was determined to only have soft tissue damage. He recovered physically completely, but he showed his first signs of depression and began to experience nightmares. In [**2105-1-10**], the patient experienced substantial vomiting. He was worked up at [**Hospital6 **] Medical Center. A right lung tumor was found on workup and was biopsied. The gastroenterologist at [**Hospital1 **] told the patient he had lung cancer. The patient's father had died of lung cancer, so this diagnosis put him into a severe depression. In [**2105-2-10**], the patient experienced syncopal episodes at home, he went to [**Hospital6 **] Medical Center and ended up staying in a hospital 57 days. He was worked up with Oncology and was finally diagnosed with nonHodgkin's lymphoma, after an exploratory laparotomy. The patient had his first deep vein thrombosis during that admission in his right leg. He was anticoagulated with heparin and subsequently had a massive gastrointestinal bleed which sent him to the Intensive Care Unit. The patient received 5 units of packed red blood cells while in the Intensive Care Unit. The bleed was not found on colonoscopy, although the procedure ended prematurely when the patient showed electrocardiogram changes. He subsequently ruled out for myocardial infarction. An inferior vena cava filter was placed and the patient was stabilized and transferred to the floor. At this time his nutrition suffered severely due to requirement of NPO for many of the days of this hospitalization. A gastrostomy tube was placed and initially did not function. The patient was put on total parenteral nutrition for two weeks at which point his follow up turned around. At this point he experienced a deep vein thrombosis in his left leg which was treated conservatively with Ace wraps. When the leg turned purple the team decided to give the patient the smallest amount of Lovenox. He did subsequently bleed again. During this hospitalization the patient was treated with Haldol and Ativan and the patient's daughter [**Name (NI) **] describes the patient "[**Last Name (un) 34693**]" severely sensitively to these medications. In addition, the patient demonstrated parkinsonian symptoms, although he was never formerly diagnosed with parkinsonism. In [**2105-3-13**] the patient received one chemotherapy treatment with Cytoxan and Vincristine. He allegedly received a very small dose. The patient also subsequently received two Rituxan treatment. In [**2105-4-10**] the patient was transferred to [**Hospital1 **] Transitional Care where he stayed for ten days and was discharged home with [**Hospital6 407**]. As soon as he got home, the patient was "off the wall and hyperactive" according to the daughter. The patient would not sleep. He was seen by Neuropsychiatry who determined the patient was in delirium. The patient was started on Trazodone and Risperdal which calmed him down. The patient did very well but was persistently depressed. It was at this time that the patient got his second treatment of Rituxan as an outpatient. In [**2105-5-11**], the patient was readmitted to [**Hospital6 2911**] Medical Center for recurrent vomiting. He received a computerized tomography scan which "looked great" according to the patient's doctors and the patient's daughter states, it demonstrated the cancer had diminished. One week later, the patient experienced high fever and was diagnosed with biliary sepsis. He was treated conservatively. He was scheduled for endoscopic retrograde cholangiopancreatography but syncopized the day it was scheduled and never underwent the procedure. He was transferred to [**Hospital6 **] and there was found to have a hematocrit of 29 while being severely dehydrated. It was at this time that he first showed evidence of hypercalcemia and change in mental status. He was treated with Pamidronate. The patient showed cardiac instability with hypertension and low heartrate. He was stabilized and sent home with [**Hospital6 407**]. At home he was mentally depressed and has not been back to baseline since this time. He was highly agitated according to the daughter. In [**2105-7-11**], the patient was admitted to the Psychiatric Inpatient Unit at [**Hospital1 392**] Heights because the family could not handle him at home. He had a fall in the Psychiatric Unit, experienced a frontal laceration and broke his nose. He was transferred to [**Hospital3 **] and was diagnosed with atrial fibrillation and a calcium up to 13. There he had the Haldol and Ativan and again demonstrated a sensitivity to those medications. He also showed signs of parkinsonism with increased rigidity. Discontinuing the Risperdal resolved these signs. The patient's high calcium was persistent despite Pamidronate treatment. He was tried on a Decadron treatment by Oncology to lower his calcium but this greatly worsened his mental status. In [**2105-8-10**], the patient was transferred to [**Hospital3 672**] Hospital where he was diagnosed with multi-infarct dementia. He was maintained on Seroquel and Remeron. On the day of admission, the patient was found to have febrile neutropenia as well as hypercalcemia and was transferred to [**Hospital6 649**] for management. MEDICAL HISTORY: 1. Multi-infarct dementia; 2. NHL; 3. Coronary artery disease, status post myocardial infarction, status post coronary artery bypass graft; 4. Hypertension; 5. Type 2 diabetes; 6. History of deep vein thrombosis; 7. History of gastrointestinal bleed on anticoagulation; 8. Status post inferior vena cava filter; 9. Spinal stenosis; 10. Gastroesophageal reflux disease; 11. Barrett's esophagus; 12. Hiatal hernia; 13. Major depression disorder with psychotic features; 14. History of biliary sepsis, [**2105-5-11**]. MEDICATION ON ADMISSION: 1. Pericolace 25 cc per gastrostomy tube b.i.d.; 2. Iron 325 mg p.o. b.i.d.; 3. Protonix 40 mg p.o. q.d.; 4. Seroquel 12.5 mg p.o. t.i.d.; 5. Nystatin, oral; 6. Epogen 30,000 units subcutaneously q. week; 7. Norvasc 10 mg p.o. q.d.; 8. Glipizide 5 mg p.o. q.d.; 9. Flomax 0.4 mg p.o. q.d.; 10. Trazodone 25 mg p.o. q.d.; 11. Tylenol; 12. Multivitamin. ALLERGIES: Haldol, Ativan, Ambien, Reglan, Coumadin and Heparin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: fall PRESENT ILLNESS: This is a 77 year old woman who was found down outside home approximately 10 minuts after had been seen in usual state of health going outside to walk the dog. She was brought to the ED and was intubated. A CT head was performed. This showed L frontal acute SDH and R temp/parietal SAH/IPH. Neurosurgery was consulted. MEDICAL HISTORY: HTN, inc cholesterol MEDICATION ON ADMISSION: atenolol, celexa, Oxybutynin ALLERGIES: Penicillins PHYSICAL EXAM: On Admiddion: O: T:97.5 BP: 156/85 HR: 65 R 20 O2Sats100 intub Gen: intubated examined in ED HEENT: Pupils:5mm surgical bilat R ecchymosis/edema upper lid Neck: in hard collar FAMILY HISTORY: NC SOCIAL HISTORY: She lives with daughter in own apt in same home.

CHIEF COMPLAINT: acute onset chest tightening, dizziness, diaphoresis, and shortness of breath PRESENT ILLNESS: 81 y old male with hx of dyslipidemia, HTN, CAD s/p NQWMI in '[**32**] s/p bare metal stenting of proximal and mid LAD as well as OM1 presented to ED by ambulance with acute onset chest tightening, dizziness, diaphoresis, and shortness of breath, was found to have STE >5mm in II, III, aVF, V4-V6 along with 3-4mm ST depression in I and aVL. Hr was in the 40s. Code STEMI was called, pt was given ASA 325mg, plavix 600mg (although takes plavix at home), Heparin 5000 units x 1, Integrillin 17mg IVx1 and then transferred to cath lab. In cath lab pt had successfull bare metal stenting to proximal RCA and was also found to have new diffuse aneurysmla dilatation of his vessels. Pt became bardycardic intermittently in the cath lab and required atropine x2. Temporary pacer placed prior to the transfer to the floor. When pt seen on on the floor he denied any chets pain, sob, diaphoresis, nausea. States onset of chest pain was in the setting of the culmination of a 16 day editing project he had as a composer. Pt quickly realized the urgency of the situation as the sx's very similar to his prior MI and therefore asked his friend to [**Name2 (NI) **] 911. Of note, pt states he was on ASA 325mg up until about 2 years ago when he was noted to have "blood from below". Per pt he was told to stop taking the ASA and never had a GI w/u for the bleeding as he states "it was assumed that the bleeding was due to apirin". His last colonoscopy was 7-8 years ago and was normal. he has never had an EGD. At home pt exercises by "speed-walking" on a treadmill for 30 minutes almost every day and never experiences any anginal sx's or SOB. He has never smoked, drinks occasionally and tries to adhere to a fairly low fat diet. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, recent black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems when seen on the floor is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: # CAD s/p NQWMI in '[**32**] s/p bare metal stenting of proximal and mid LAD as well as OM1 # HTN # Dyslipidemia # Hx of ulcers on feet bilaterally # R eye blind after traumatic injury at age 11 MEDICATION ON ADMISSION: Altace (ramipril) 5mg qday Toprol XL 25 mg qday Isosorbide Mononitrate 30 mg qday Lipitor 10mg qday Plavix 75 mg qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 96.4, BP 98/69, HR 62, RR 19, SaO2 100% on 2L Gen: male appearing younger than stated age in NAD. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: No JVD CV: RR, normal S1, S2. No S4, no S3. Chest: Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: Both feet with toes in dorsiflexion appearing like contractures. Also with superficila fungal infections of toes and nails. Both legs with brown discoloration of feet up to mid-calf. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Femoral 2+ without bruit bil; 1+ DP bil. FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Social history is significant for the absence of tobacco use. Occasional alcohol.

CHIEF COMPLAINT: Sepsis PRESENT ILLNESS: 89 y/o M h/o end stage parkinson's, dysphagia, GERD presented to ED after episode of choking in the afternoon. Of note he has had recent FTT and there was discussion with Dr. [**Last Name (STitle) 665**], his PCP of placing [**Name Initial (PRE) **] PEG tube. He had recently done better tolerating meals over the past few months, past few days he has had episodes of choking with meals with likely aspiration. Daughter gave him a few nebulizer treatments and his respiratory distress did not improve so she called EMS. . In the ED, respiratory difficulty throughout day, daughter gave nebs, EMS tachypneic, 90% room air, 40s RR, tired out, lots of secretions, mental status diminished, intubated in that setting for airway protection. Right IJ in place, lactate 4.1, CXR with infiltrates. U/A clean. ECG unchanged. 2 liters fluid given, HR decreased from 130s to 80s after fluids. CVP not transduced, apparently good UOP. Received levofloxacin 750mg, metronidazole 500mg, ceftriaxone 1g, vancomycin 1 g MEDICAL HISTORY: 1. Parkinson's disease diagnosed in [**2146**]. 2. Macular degeneration. 3. Gastroesophageal reflux. 4. Coccygeal skin breakdown. 5. BPH. 6. Cataract. 7. Carpal tunnel. 8. Cervical stenosis. 9. Gait instability with a history of falls. He has a history of right leg buckling under him, and he wears a knee brace for this purpose. He is being followed by Physical Therapy at home 10. Zoster [**2154**] MEDICATION ON ADMISSION: OUTPATIENT MEDICATIONS: Adefovir 10 mg daily Albuterol 2 puffs up to QID prn Alprazolam 1 mg q6 hours prn anxiety Dicyclomine 10 mg TID Fluticasone 50 mcg [**2-11**] sprays in nostrils prn Advair Diskus 500-50, one inhalation [**Hospital1 **] HCTZ 25 mg daily Mirtazapine 15 mg qhs Omeprazole 20 mg daily Oxazepam 15 po qhs prn Zoloft 150 mg daily Tiotropium bromide 18 mcg capsule INH daily Trazadone 50 mg daily (?) Oxygen 1 L/min at rest and 2 L/min during sleep and exertion, for resting Sat of 88% on r.a which drops to 78% with exertion. Keeping his Sat> or = to 90% ALLERGIES: Tape PHYSICAL EXAM: Vitals: T: BP: HR: RR: O2Sat: GEN: Well-appearing, well-nourished, no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear NECK: No JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength 5/5 in upper and lower extremities. Patellar DTR +1. Plantar reflex downgoing. No gait disturbance. No cerebellar dysfunction. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Lives in [**Location 1268**] with daughter. Chinese immigrant, retired pharmacist. Used to smoke cigarettes, but last smoked in the 70s; no alcohol. He is widowed and has 5 children. He walks with a walker or uses a wheelchair. He lives at home and is attended to by his daughter (a dentist) during the evening and overnight; and he has a home health aid who sees him during the day while his daughter is at work.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 52-year-old male transferred with a past medical history of diabetes on insulin since [**51**]-years-old. The patient presented for an ETT. Denied any recent history of fatigue, chest pain, or shortness of breath. The patient had an ETT for screening purposes which showed an asymptomatic [**Street Address(2) 1766**] elevation at the aVL and 2.5-3.[**Street Address(2) 45681**] at the inferolateral leads. MEDICAL HISTORY: 1. Type 1 diabetes. 2. Childhood asthma. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: cough, respiratory distress PRESENT ILLNESS: 53 yo M w/ h/o Down's syndrome, non-verbal at baseline, hypothyroidism, cataracts, dysphagia s/p G-tube, h/o aspiration pna's, hypoNa on 4Lnc QHS who presents w/ cough and hypoxia from group home. . Per report, patient with acute on chronic cough found to desat to 88% on RA this AM. Looked as if he were in respiratory distress. Per OMR had been empirically treated for pna back in [**6-/2118**] w/ multiple notes documenting cough. . In the ED, initial VS were: 98.2 74 92/50 28 100% nrb. Tmax 100.2. On exam +crackles L>R. Labs notable for Na 127, K 7.4, Cl 90, HCO3 29, BUN 11, Cr 0.7, Glu 121, Lactate 1.7, repeat K 4.4, UA neg leuk/nitr/3wbc/neg bact/epis O, wbc 6, h/h 15/43.4, plt 297. CXR: gastric distention, bibasilar atelectasis. He received zosyn and levo, vanc, 1LNS. Has a 20gauge piv. MEDICAL HISTORY: Down's syndrome, non-verbal at baseline -B12 deficiency -hypothyroidism -cataracts, legally blind -dysphagia s/p G-tube -h/o aspiration pna's -h/o DVT -h/o cdiff MEDICATION ON ADMISSION: 1. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 2. levetiracetam 100 mg/mL Solution Sig: 7.5 mL PO BID (2 times a day). 3. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 2 days. Disp:*2 Tablet(s)* Refills:*0* 4. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 5. therapeutic multivitamin Liquid Sig: Five (5) ML PO DAILY (Daily). 6. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Dulcolax 10 mg Suppository Sig: One (1) suppository Rectal once a day as needed for constipation. 8. Kaopectate (bismuth subsalicy) 262 mg/15 mL Suspension Sig: Fifteen (15) mL PO once a day as needed for diarrhea. 9. Fleet Enema 19-7 gram/118 mL Enema Sig: One (1) enema Rectal once a day as needed for constipation. 10. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for fever or pain. 11. simethicone 40 mg Strip Sig: One (1) tab PO every four (4) hours. 12. NeutraPhos Sig: One (1) packet twice a day. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission exam: General: Arousable, alert, non-communicative HEENT: Sclera anicteric, oropharynx clear Neck: supple, JVP not elevated, no LAD CV: RR, no mrg Lungs: +Rhonchi Abdomen: PEG placed, soft, NTND GU: + foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives in group home, siblings very involved in his care.

CHIEF COMPLAINT: shortness of breath and fever PRESENT ILLNESS: 52M with HIV CD4 401 VL 74, Burkitt's like NHL treated with 2 cycles of chemo [**9-12**] (Cytoxan, Etoposide, Vincristine, Bleomycin, MTX, leucovorin, prednisone, doxorubiucin) in remission admitted from clinic with night sweats, fever to 103, SOB, myalgias, fatigue. Reports night sweats x 6-7 days (3 episodes per night). Night sweats improved with one episode per night when he noted new onset chills last 2 nights, rigors today, with fever to 103.5 last night and 103 this am and progressively worsening SOB, chest tightness and DOE last [**2-6**] days with SOb with minimal activuty (speaking, walking across room). Denies cough or hemotypsis. Associated symptoms include intermittent diarrhea with loose stools 3 days ago and again today but no N/V or abd pain. Has mild HA and neck/back stiffness but no photophobia. + h/o weight loss 8 pounds last 1-2 weeks. Denies sick contacts or travel. 3 days ago, was not having any respiratory symptoms and able to work in garden, walk up stairs with no difficulty. has been using servent and combivent inhaler last 2-3 days. Denies CP, dysuria, recent abx use, recent steroids use last 6 months. Hx positive for tick bite yesterday which he noticed while gardening which was removed and area squeezed and washed with rubbing alcohol. Denies [**Last Name (LF) **], [**Known lastname **], rhinorrhea, nasal congestion, enlarged or painful LNs, melena, hematochezia, visual chages, numbness, weakness, joint aches/stiffness. MEDICAL HISTORY: PAST ONCOLOGIC HISTORY: ====================== Burkitt's lymphoma on [**2110-8-13**] after having a lymph node biopsy of the right axilla. He presented with 2 weeks of a rapidly growing mass in the right axilla that he says grew to the size of a plum. Was also having constitutional symptoms at presentation. FISH was performed and it was positive for a rearrangement involving MYC. He had a bone marrow biopsy performed on [**2110-8-28**] and this revealed a hypercellular bone marrow with trilineage hematopoiesis, no histomorphologic evidence of leukemia, or lymphoproliferative disorder was seen. Tx: 2 cycles of chemotherapy using the Vanderbilt protocol. This involved Cytoxan on day 1 and 2 and then etoposide on days 1, 2, and 3; followed by vincristine on day 8 and day 22; bleomycin on day 8 and day 22; methotrexate on day 15; and leucovorin on day 15; and prednisone on days 1 through 7. On cycle 2, he had Cytoxan on day 1 only; etoposide on days 1, 2, and 3; doxorubicin on days 1 and 2; vincristine on days 8 and 22; bleomycin on days 29, 8, and 22; methotrexate and leucovorin on day 15; and prednisone on days 1 through 7. He does report that he did have intrathecal chemotherapy twice. . PAST MEDICAL HISTORY: ==================== 1) HIV/AIDS CD4 401 VL 74. Nadir Cd4 51. He was diagnosed with HIV in [**2101**], when he seroconverted and had an acute [**Year (4 digits) 18617**] illness. He was started on a trial of an intensive anti-retroviral regimen at diagnosis, but ultimately had to stop these medications due to elevated amylase. He denies any history of opportunistic infections and did not have low CD4 until chemo initiation. HIV/AIDS. He reports a history of hepatitis A and is a hepatitis B carrier. 2) history of asthma:Moderate-to-severe bilateral paraseptal and central lobular emphysematous changes predominantly in the upper lobes. 3) depression, anxiety 4) anal herpes 5) low testosterone state 6) h/o left shoulder fracture in a scooter incident 7) anal fistula repair ([**2109**]) MEDICATION ON ADMISSION: ATAZANAVIR 300 mg daily WELLBUTRIN XL 300 mg daily EMTRICITABINE-TENOFOVIR [TRUVADA] 200 mg/300 mg daily FEXOFENADINE 180 mg daily FINASTERIDE 5 mg daily IPRATROPIUM-ALBUTEROL 2puffs q6prn LORAZEPAM 1 mg daily MONTELUKAST 10 mg daily OXYCODONE-ACETAMINOPHEN - 5 mg-325 mg Tablet - 1-2 Tabs q4-6prn QUETIAPINE 25 mg daily RITONAVIR 100 mg daily SALMETEROL 50 mcg [**Hospital1 **] TADALAFIL 10 mg prn TESTOSTERONE [ANDROGEL] 50 mg/5 gram (1 %) Gel 2pkt daily TRIAMCINOLONE ACETONIDE 0.1 % Ointment top [**Hospital1 **] VALACYCLOVIR 500 mg daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: PHYSICAL EXAM: ============= Vitals - T:99.5 BP:118/57 HR:93 RR:22 02 sat:94%RA GENERAL: Ill appearing man laying in bed, shaking, blankets pulled up to chin, diaphoretic, speaking in partial sentences SKIN: warm to touch and diaphoretic, 1 x 1 cm area of induration at left upper chest where he reports he pulled off tick, Erythematous sunburn like blanching [**Year (4 digits) **] which he reports is normal for him. HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent nares, MM dry, good dentition, nontender supple neck, no LAD, JVP flat, no meningismus CARDIAC: Distant heart sounds. RRR, S1/S2, no mrg LUNG: Inspiratory and exp wheezes bilaterally, no focal crackles or rhonchi. Decreased air movement throughout. Using abdominal and SCM accessory muscles ABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatomegaly, mild spelnomegaly just belwo costal margin. M/S: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities PULSES: 2+ DP pulses bilaterally NEURO: CN II-XII intact FAMILY HISTORY: FAMILY HISTORY: not obtained SOCIAL HISTORY: SOCIAL HISTORY: Lives with family in [**Last Name (un) 79914**] right now. Lived in [**Location 21601**] - apartment currently sublet. Was working in beauty marketing until he had to stop because of illness. 1 dog. No travel in past several years. Last trip abroad to [**Country 5881**]/[**Country **] in [**2105**]. MSM, not currently sexually active. Former smoker, quit 11 years ago.

CHIEF COMPLAINT: Chest and epigastric burning. PRESENT ILLNESS: This is a [**Age over 90 **]-year-old Italian-speaking male with a history of coronary artery who presented as an outside hospital transfer from burning which awoke him from sleep; but with no associated symptoms of shortness of breath, diaphoresis, lightheadedness, nausea, vomiting, radiating pain. He arrived pain free with an electrocardiogram taken. He was noted to have wide complex tachycardia, monomorphic. He converted spontaneously to atrial fibrillation but reverted back to ventricular tachycardia. Amiodarone was loaded on tachycardia acceleration from 120s to 170s which decreased after amiodarone was stopped. He spontaneously converted back to atrial fibrillation with ventricular rates in the 70s to 80s. MEDICAL HISTORY: (Past Medical History includes) 1. Coronary artery disease; status post inferior myocardial infarction in [**2163**]. 2. Congestive heart failure. 3. Atrial fibrillation. 4. Hypertension. 5. Adrenal insufficiency. 6. Chronic renal insufficiency. 7. Status post cerebrovascular accident. 8. Chronic obstructive pulmonary disease versus asthma. 9. Status post right ureteral stent. MEDICATION ON ADMISSION: Lasix 40 mg p.o. b.i.d., Coumadin, Monopril 20 mg p.o. q.d., Aldactone 25 mg p.o. q.d., glyburide, diltiazem 240 mg p.o. q.d., Hydrocort, Florinef, digoxin 0.125 mg. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is a nonsmoker. He lives with his family and is minimally ambulatory.

CHIEF COMPLAINT: Pelvic mass PRESENT ILLNESS: Ms. [**Known lastname 35274**] is a 42 yo woman who initially presented in [**Month (only) 205**] with LUQ discomfort. Due to her h/o nephrolithiasis, a CT urogram was done on [**8-11**] which showed non-obstructing stones and a bulky heterogenous uterus consistent with fibroids. Pt then had gradual onset of pelvic discomfort, constipation, and bloating. Pelvic ultrasound on [**10-16**] showed a large complex vascular left adnexal mass. MEDICAL HISTORY: PMH: Brain aneurysm, nephrolithiasis PSH: Coiling of brain aneurysm in [**2170**], lithotripsy [**2173**] OB HISTORY: Vaginal delivery x1. GYN HISTORY: Last Pap smear and mammogram were both recently normal. MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL APPEARANCE: Well developed, well nourished. HEENT: Sclerae anicteric. LYMPHATICS: Lymph node survey was negative. LUNGS: Clear to auscultation. HEART: Regular without murmurs. BREASTS: Without masses. ABDOMEN: Soft and distended with a palpable mass extending from the left lower quadrant to the left upper quadrant. This mass was nontender. It felt quite firm. There was also a palpable mass in the mid lower abdomen, which was also quite firm. EXTREMITIES: Without edema. PELVIC: The vulva and vagina were normal. The cervix was not visualized. Bimanual and rectovaginal examination revealed that the cervix was small and displaced anteriorly. There was a large smooth mass that was palpable both through the anterior vaginal wall and through the posterior fornix. By rectal examination, the posterior mass was filling the cul-de-sac. The rectal was intrinsically normal. Bimanual examination revealed that the mass seemed to be contiguous with the mass in the left upper quadrant. There was no parametrial disease. FAMILY HISTORY: Significant for mother with liver cancer. SOCIAL HISTORY: The patient does not smoke or drink. She is an accountant.

CHIEF COMPLAINT: positive exercise stress test, admission for elective cardiac catheterization PRESENT ILLNESS: This is a 73 year old female with a history of HTN, HC, hyperthyroidism who presented to the ED following a positive exercise stress test. The patient reports that she has had teeth pain especially with exertion for several months, but she did not attribute this to a cardiac issues. She describes over past 2-3 weeks 3 episodes of chest heaviness with pain radiating to her jaw/teeth. The first episode occured while pushing her grandchildren uphill in a stroller. She also reports mild dyspnea with this episode. Her pain was relieved by rest. A second episode occurred post-prandial with similar characteristics lasting about 1 hour while the patient was cleaning dishes and relieved by falling asleep. The patient's husband was very concerned by these episodes and encouraged his wife to seek care. An ECG last week prompted an admission to the [**Hospital3 2358**]. Serum CKs were negative and the highest troponin was 0.42 (lab normal 0.40). Work-up including dobutamine echo stress test on [**2101-7-14**] indicated old, but no new defects. The patient increased her atenolol to 75 mg daily. The patient was referred for ETT, but put it off by one week, during which time she had an additional episode of exertional angina relieved with rest without jaw pain. This additional episode of pain prompted the patient to have her ETT done today which was grossly abnormal and highly suggestive for ischemia. Patient has had no nausea, diaphoresis, PND, orthopnea, presyncope, syncope, or palpitations. MEDICAL HISTORY: Dyslipidemia Hypertension Hyperthyroidism Osteoarthritis s/p femur fracture s/p hysterectomy s/p bladder suspension s/p tonsillectomy MEDICATION ON ADMISSION: ATENOLOL 75 mg daily ATORVASTATIN 40 mg daily ASA 81 mg daily MULTIVITAMIN daily ALLERGIES: Augmentin / Morphine Sulfate PHYSICAL EXAM: VS - 97.9, bp 134/71, hr 56, rr 18, o2sat: 100% 2LNC Gen: WDWN middle aged female in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Father sudden death at 51 SOCIAL HISTORY: Her social history is significant for the absence of current tobacco use, remote 15 pack yr smoking history. There is no history of alcohol abuse. Lives with spouse

CHIEF COMPLAINT: AMS and slurred speech PRESENT ILLNESS: 94RHM PMH of resected colon cancer in [**2125**] s/p chemo with multiple SBO's, HTN, dementia, partial epilepsy, chronic L common femoral vein thrombosis and IVC thrombosis s/p IVC filter placement, depression and leukocytosis JAK2 positive presents with increasing confusion, fatigue, hallucinations and agitation now with intermittent unresponsiveness and mouth movements/right sided twitching and slurred speech. Patient transferred from nursing home with little documentation but apparently has been having increasing confusion over the past 1 week with associated fatigue and more agitated today prompting presentation. He has apparently otherwise been well systemically. On speaking with his daughter stated he has been talking about dead family members over the past 1 week and has been hallucinating. When daughter came to see patient today however, patient was seemingly having episodes when his eyes would roll back and be unresponsive and this is the first time his daughter has seen him like this. Daughter also feels his speech is slurred which is not his baseline and patient during a lucid moment had complained that his right arm was heavy but not specifically weak. While in the ED, patient was given IV metronidazole (given bowel pathology concerns) and IV levofloxacin 750mg (had been on in community) and initially patient was apparently singing in Creole and not responding to questioning and since then nursing staff and family have noted fluctuating level of consciousness with him speaking albeit confused with eyes open intermixed with episodes of unresponsiveness, eyes rolling and associated with blowing out cheeks motions of mouth (? similar to previous semiology per documentation) and twitching of his right face, both shoulders and right arm and possibly leg. This was associated with tachycardia to 130s and following lorazepam HR dropped to 90s-100s. Per records last seizure was in [**2138-2-12**] when he had twitching on right side of his face and arm and prior semiologies have included EPC admission in [**2136**] with abnormal tongue movements. He has been treated exclusively with Keppra. Of note patient has been treated with levofloxacin 500mg qd as above since [**6-6**] which can lower seizure threshold. Patient was recently admitted under surgery and discharged [**2138-5-23**] after abdominal pain with chronic constipation issues and stenosis of distal sigmoid colon and improved with laxatives with a CT on admission did not show any acute process. Unable to perform full neuro ROS due to patient's mental status but speech is dysarthric and had noted right arm heaviness and has been having intermittent unresponsiveness intermixed as above with confused at best speech. Patient had not noted any nausea or vomiting, diarrhea or cough/sputum or SOB. MEDICAL HISTORY: - HTN - Dementia - Depression - Partial epilepsy followed by Dr [**Last Name (STitle) 623**] previous right face and arm twitching on keppra - History of epilepsia partialis continua consisting of rhythmic mouth movements diagnosed in [**2136-5-12**] and has since been maintained on Keppra monotherapy. EEG at the time showed periodic beta frequency rhythmic spike activity in the frontocentral regions that correlated with rhythmic movements of the mouth consistent with myoclonus. MRI of the head that showed chronic small vessel ischemic changes, but no acute pathological abnormality. - Leukocytosis: Unclear [**Name2 (NI) 10810**] but after hem c/s was noted to have JAK2 V617F MUTATION positive (other mutations negative) and he has been suggested to have underlying hematologic process and recommended evaluation with hem as an outpatient which appears still not to have been done. - Right hemicolectomy in [**2123**] for colon cancer-s/p chemo with multiple SBO's ([**3-19**], [**4-19**], [**5-19**], [**7-19**]), then LOA [**9-19**], complicated by peritonitis s/p Abx - Chronic L common femoral vein thrombosis and IVC thrombosis s/p IVC filter placement - Osteoporosis - Cholecystectomy - B/l small inguinal hernias MEDICATION ON ADMISSION: CITALOPRAM - (Prescribed by Other Provider) - 10 mg Tablet - 1 Tablet(s) by mouth daily LEVETIRACETAM - 1,000 mg Tablet - One Tablet(s) by mouth twice daily - there is s discrepancy between reports - on [**Last Name (un) 1188**] house sheet states 2x500mg tablets [**Hospital1 **] and when ED nurse spoke to NH stated only getting 1x500mg tablets however when I called states getting correct dose. MIRTAZAPINE - (Prescribed by Other Provider) - 15 mg Tablet - One Tablet(s) by mouth once daily. RISPERIDONE - (Prescribed by Other Provider) - 0.5 mg Tablet - 1 Tablet(s) by mouth daily at 6 pm TAMSULOSIN - 0.4 mg Capsule, Ext Release 24 hr - 1 Capsule(s) by mouth daily 1/2 hour after a meal Medications - OTC ACETAMINOPHEN - (Prescribed by Other Provider) - 325 mg Tablet - 2 Tablet(s) by mouth three times a day not to exceed 4 GM in 24 hours ACETAMINOPHEN [MAPAP EXTRA STRENGTH] - (Prescribed by Other Provider) - 500 mg Tablet - 1 Tablet(s) by mouth three times a day as needed for pain, not to exceed 4GM in 24 hrs ** ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - One Tablet(s) by mouth once daily for cardiovascular prophylaxis. - NO DOCUMENTATION THAT HE WAS RECEIVING THIS AT HIS NURSING FACILITY BISACODYL - (Prescribed by Other Provider) - 10 mg Suppository - 1 supp rectally every other day CALCIUM CARBONATE - (Prescribed by Other Provider) - 500 mg (1,250 mg) Tablet, Chewable - 1 Tablet(s) by mouth three times a day CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D3] - 400 unit Capsule - Two Capsule(s) by mouth once daily. DEXTRAN 70-HYPROMELLOSE [ARTIFICIAL TEARS] - (Prescribed by Other Provider: [**Name Initial (NameIs) 3390**]) - Drops - Two drops OU three times per day. DOCUSATE SODIUM - 100 mg Capsule - One Capsule(s) by mouth twice per day. MAGNESIUM HYDROXIDE [MILK OF MAGNESIA] - (Prescribed by Other Provider) - 400 mg/5 mL Suspension - 30 mls by mouth at bedtime MULTIVITAMIN - Tablet - One Tablet(s) by mouth once daily. Docusate 200mg [**Hospital1 **] SENNOSIDES [SENNA] - (Prescribed by Other Provider) - 8.6 mg Tablet - 1 Tablet(s) by mouth at bedtime SODIUM PHOSPHATES [FLEET ENEMA] - (Prescribed by Other Provider) - 19 gram-7 gram/118 mL Enema - 1 Enema(s) rectally as needed for daily for constipation 2 hrs after Ducolax supp if no BM ALLERGIES: Vancomycin PHYSICAL EXAM: Vitals: T:98.6 P:92 R:17 BP:121/63 SaO2:99% 3L NC General: Drowsy, initially unresponsive with chewing/blowing motions of the mouth. Relatives and nursing staff reporteed intermittent brief right sided twitching and eyes [**Last Name (un) 8433**] although I did not see this. Evengually would open eyes and speak and when was speaking, speech was very dysarthric then was obtunded again. HEENT: NC/AT, no scleral icterus noted, MMM. Neck: Supple, no carotid bruits appreciated. No nuchal rigidity. Pulmonary: Decreased breath sounds both bases. Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Calves SNT bilaterally. Skin: no rashes or lesions noted. FAMILY HISTORY: Daughter is unsure of his parents' health problems but has 3 sisters who [**Name2 (NI) 18466**] well without MI, stroke or cancer. Children - 5 well one with DM. SOCIAL HISTORY: He is [**Location 7972**] speaking. Widowed with 5 children, 4 of whom live in area. The patient lives at [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] nursing home. Baseline is limited + mobility but can normally talk fluently, can read and comprehend well and feeds himself. Mobility: Generally wheelchair bound but can use walker for limited distances. Smoking: never Alcohol: rare perhaps 1 drink/week. Illicits: family denies.

CHIEF COMPLAINT: S/p whole lung lavage in OR for Pulmonary Alveolar Proteinosis PRESENT ILLNESS: 25 y/o M w/ history of hyperlipidemia and obesity, with the diagnosis of pulmonary alveolar proteinosis, as determined by wedge biopsy following a two-month workup for dyspnea. He was admitted to an outside hospital in [**Month (only) 404**], where CT revealed bilateral infiltrates. He eventually underwent lung biospy, which was c/w pulmonary alveolar proteinosis. He was discharged and set up with pulm follow up. On day of admission he was scheduled for a bronch but was hypoxic on room air and dyspnic. He was admitted for CT and possible bronch. The patient went to the [**Hospital1 18**] OR on [**4-7**] for whole right lung lavage, where he had 10 L of normal saline infusion, with all 10 liters successfully lavaged. He tolerated the procedure well, but reportedly had no subjective improvement of his dyspnea. Studies of the BAL were negative for infection. On [**4-9**], he returned to the OR for whole lung lavage of the left lung, where he had 2.5 liters instilled but only 1.25 liters lavaged out. He was hypoxic to the mid-80's during the procedure, and the procedure was aborted. His ETT was changed from a double lumen to single lumen, with position confirmed by fiberoptic bronchoscopy. Post CXR revealed no pneumothorax but significant left-sided pulmonary edema. . He was transferred to the MICU intubated. In the MICU he did spike a fever to 101.3, defervesed with tylenol. Blood cultures are still pending. He was extubated on [**4-11**] and was noted to have stridor, which resolved with racemic epinephrine. A CXR on [**4-12**] revealed unchanged minimal bibasilar opacities, with no evidence of new opacities. MEDICAL HISTORY: -Hyperlipidemia -Obesity MEDICATION ON ADMISSION: -Zocor 20mg daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: On admission to MICU: T:98.8 BP:128/74 P:87 R:18 O2: General: Sedated, intubated, moving upper extremities without clear purpose HEENT: Sclera anicteric, MMM Neck: supple, obese, JVP not elevated Lungs: Diminished sounds over entire left lung CV: RRR, normal S1 + S2, no murmurs, rubs, gallops, no thrills or heaves Abdomen: obese, soft, NT/ND, +BS x4, no rebound tenderness or guarding, no organomegaly or pulsatile masses GU: Foley catheter in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: NC SOCIAL HISTORY: No tob, Occasional EtOH, No IVDA, Lives with parents, has only had temporary/short term jobs.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 23-year-old male with a past medical history of Crohn's, status post small bowel resection x 3, last in [**2113**], who was recently admitted to [**Hospital3 1280**], an outside hospital, on [**9-26**], where he presented with 12 hours of severe abdominal pain. He was noted to have severe abdominal pain the night prior to admission to the outside hospital, followed by nausea and vomiting. He is now transferred to the [**Hospital1 190**] after he developed septic parameters at the outside hospital. MEDICAL HISTORY: Significant for Crohn's disease. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: low back pain PRESENT ILLNESS: 34 y/o M with hx of AVR after IVDU associated endocarditis in [**2140**] has presented several times over the past month for multiple complaints. Past admissions include: . [**Date range (1) 35164**] - in the ED for chest pain after drug use, d/c'ed. [**Date range (1) 35165**] - admitted for SI, d/c'ed to [**Hospital 1680**] rehab [**Date range (1) 35166**] - admitted to ICU for ? etoh withdrawl seizure, left AMA the same day [**Date range (1) 35167**] - admitted for back pain, possible pyelonephritis or UTI and increased creatinine, left AMA [**Date range (1) 35168**] - admitted for back pain and LOC after using inhalants, again left AMA . Then after leaving AMA that day, he went home, drank approx a half pint of vodka at 10am on [**10-27**], used some inhalants, and then returned to the ED with complaints of chest pain, low back pain and the hope to get into rehab. . This morning, the patient denies any chest pain, shortness of breath, headache, changes in his vision. He only complains of low back pain and denies having chest pain yesterday. His back pain is low back, bilaterally paraspinally with slight midline tenderness. He had no numbness or tingling or weakness in his legs. No fevers, chills, weight changes or other problems. MEDICAL HISTORY: 1) s/p aortic mechanical valve replacement in [**2139**] for endocarditis secondary to IVDU. - Patient has a cardiologist at [**Hospital1 2177**], but he infrequently follows care; INR range is supposed to be between 2.5-3.5 but patient is noncompliant with coumadin. In the past, he has been a patient of the [**Hospital1 2177**] coumadin clinic. 2) +Hepatitis B and C 3) H/o EtOH withdrawal seizures - Says he's never had seizures out of the context of alcohol withdrawal. 4) history of suicide attempt [**6-5**] while in Police custody, admitted to the Trauma service, intubated x days, ultimately recovered and went to inpatient Psych service on [**Hospital1 **]-4 x 3 days where he was determined to have no evidence for depression. He was discharged at that time to Police custody. MEDICATION ON ADMISSION: coumadin 7.5 mg daily (not taking since leaving hospital on [**10-27**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE the morning of admission: Vitals - Tm 98.3, BP 146/96, P 76, R 20, 100% on RA Gen - in bed, slightly anxious, but with good attention and calm and cooperative, NAD HEENT - abrasions on top of L forehead, moist mucous membranes, supple neck, no LAD of JVD CV - RRR, mechanical systolic click, no other murmurs appreciated Lungs - CTA B Back - tender to palpation paraspinally above gluteus muscle, no midline tenderness to palpation Abd - soft, NT, ND, no hsm, hyperactive bowel sounds Ext - warm, well perfused, blisters on R palm Neuro - CN intact, no nystagums, mild intention tremor with hands outstretched, cerebellar functions intact, strength 5/5 throughout, reflexes 2+ throughout except R patellar which was 1+, [**Last Name (un) 36**] and motor grossly intact . Pt [**Doctor Last Name **] btw [**7-8**] on CIWA scales for sweating, anxiety, tremors. FAMILY HISTORY: DM in mom and sister. Denies CAD, stroke. Grandparents died of lung CA. Patient denies family medical history of mental illness. SOCIAL HISTORY: Smokes cigarettes-recently only [**3-3**] cigs/day -Etoh - onset of problem drinking 15 y/o, ~10 detox, h/o w/d seizures, denies h/o DTs, longest periods of sobriety were 6 months in '[**31**] (? if in jail during this time) and also reports recently sober X 8 months earlier this year, last drink yesterday - Marijuana - none recently. - Cocaine - "a couple of times/week", smoked or IV, last use was 1 month ago. - Heroin - last used approx 4 wks ago - inhales Dust-Off on a regular basis (done yesterday) - Denies any other illicit substance use or prescription med misuse. - Homeless - Formerly lived with his parents. Has a teenage son. Mr. [**Known lastname 35160**] parents and the boy's other grandparents reportedly share custody of him.

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: 86 year old female with history of Type II DM on insulin, ESRD on [**First Name3 (LF) **] [**Last Name (LF) 12075**], [**First Name3 (LF) **]/CVA, CAD, Anemia, MGUS, hypercholesterolemia, and hypertension recently discharged (see d/c summary [**2124-10-3**]) after treatment for lower back pain and pneumonia with Azithromycin and Ceftriaxone, which ended [**2124-10-8**]. She returned to the ED on [**2124-10-8**] with nausea, vomiting, and abdominal pain. The SICU/transplant team obtained history from her son and chart as pt was unable to give detailed history. Per report, she had lower abdominal pain and vomiting. Pt had stated she has been unable to tolerate POs and denied recent diarrhea but had normal bowel habits. Denied fever. MEDICAL HISTORY: ESRD on HD [**Date Range 12075**] via R AV fistula Hypertension Type II diabetes mellitus on insulin Cerebrovascular accident/[**Date Range **] (on coumadin) Coronary artery disease Chronic anemia with a baseline of 30-35 Hyperlipidemia cataracts MGUS CHF MEDICATION ON ADMISSION: Home meds: Atorvastatin 10mg daily Amlodipine 5mg daily Metoprolol 50mg [**Hospital1 **] Hydralazine 50mg QID Lidocaine 5 %(700 mg/patch) - apply to affected area; 12h on/12h off Isosorbide Mononitrate 60mg daily Docusate 100mg [**Hospital1 **] acetaminophen 1g q8H lactulose 10g/15mL syrup, 30mL PO q8H: PRN constipation Senna 8.6mg PO BID: PRN constipation Sevelamer HCl 800mg TID Oxycodone 5mg PO BID: PRN pain NPH Insulin 10u qAM Fluticasone 50mg Warfarin 4mg daily . Medications on transfer from SICU to floor [**2124-10-12**]: Lidocaine 5% Patch 1 PTCH TD Q24H; 12h on, 12h off HydrALAzine 50 mg PO Q6H NPH 10units at breakfast ISS Sevelamer 800mg PO TID w/ meals Metoprolol Tartrate 50 mg PO TID Atorvastatin 10 mg PO DAILY Amlodipine 5 mg PO DAILY Ampicillin-Sulbactam 1.5 g IV Q24H; Day 1= [**2124-10-12**] (on augmentin day 1= [**2124-10-11**]) MetRONIDAZOLE (FLagyl) 500 mg IV Q12H; Day 1 = [**2124-10-8**] Vancomycin Oral Liquid 125 mg PO Q6H; Day 1 = [**2124-10-8**] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: Afebrile, P80 SBP 108 R20-22 96%RA Gen: pleasant, lying in bed HEENT: sclera anicteric, MMM Neck: supple Cor: irregularly irregular, no m/r/g Pulm: CTA b/l Abd: soft, distended, tender in RUQ, suprapubic tenderness, hypoactive BS Extrem/back: Warm, well perfused, 1+ DP b/l, no c/c/e, R AV fistula with palpable thrill, no CVA tenderness Neuro: AOx1 (first name only), Knows [**Last Name (un) **] is president . Physical exam on discharge [**2124-10-18**]: VS: Afebrile P70-80 SBP 120s 100% RA Gen: AOx3, pleasant, lying in bed, some difficulty with movement HEENT: sclera anicteric, MMM Neck: supple Cor: irregularly irregular, no m/r/g Pulm: CTA b/l Abd: soft, non distended, non-tender, NABS Extrem/back: Warm, well perfused, 1+ DP b/l, no c/c/e, R AV fistula with palpable thrill, no CVA tenderness Neuro: AOx3 Skin: excoriations under breasts without surrounding erythema or induration, no drainage FAMILY HISTORY: Per prior d/c summary: As above, she has ten children. She has a strong family history of diabetes and hypertension. No known history of coronary disease. SOCIAL HISTORY: per prior d/c summary: She currently lives alone in [**Location (un) 686**] in a [**Location (un) 1773**] apartment. She has great difficulty getting up the stairs. She walks with a walker at baseline. She has ten children. She has never smoked. She does not drink alcohol.

CHIEF COMPLAINT: esophageal cancer PRESENT ILLNESS: The patient is a 67-year-old gentleman with a T2 esophageal cancer who underwent neoadjuvant chemotherapy and radiation and presents for resection. He underwent a lap jejunostomy and port placement on [**2163-11-15**] that went well without complication. Since that time patient was on tube feeds to help maintain his nutrition and increase his weight. He was seen in clinic by Dr. [**Last Name (STitle) **] on [**2164-3-1**]. At that time patietn had already completed his neoadjuvant therapy. His weight was stable, and his mood had improved. PET scan was negative for metastatic disease. It was determined that patient was no suitable for resection of his cancer. MEDICAL HISTORY: PMH: hypertension, prostate cancer, depression, and anxiety. MEDICATION ON ADMISSION: ATENOLOL 25', COLCHICINE 0.6', LORAZEPAM 1mg Q6PRN, MOEXIPRIL 15', COLACE 100 UD, SENNA 2 UD ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Discharge: AVSS GEN: NAD, resting comfortably NECK: Incision CDI, dry guaze over JP site CV: RRR Lungs: No respiratory distress ABD: Soft, appropriately tender around incisions. Wound sites are clean, dry, intact. EXT: warm, well perfused FAMILY HISTORY: Family history is notable for a father with renal insufficiency and a mother who died of a myocardial infarction at the age of 88. SOCIAL HISTORY: The patient drinks occasionally. He has never smoked. He is retired.

CHIEF COMPLAINT: Hypoxic respiratory distress PRESENT ILLNESS: 76 yo F w/ h/o emphysema initially admitted to ICU [**2178-11-11**] for hypoxic respiratory failure due to CAP w/ mucous plugging causing acute desat that led to urgent intubation. MEDICAL HISTORY: emphysema macular degeneration EF 75-80%, mod pulm htn, 2+ TR MEDICATION ON ADMISSION: unknown eye drops ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On initial MICU admission: Afebrile, normotensive with normal pulse. Gen: well appearing elderly woman sitting upright in chair, conversing comfortably. Alert and oriented. HEENT: Pupils reactive, irregular. + cataract over right eye. CV: RRR. Nl S1, S2. S4 present. No murmurs or rubs. Lungs: Diminished breath sounds throughout. Exp wheezing in upper lobes. Prolonged expiratory phase. Abd: Soft. NT. ND. Normoactive bowel sounds. Ext: Warm. Trace pitting edema. Thin extremities. DP 2+ b/l. Neuro: Moves extremities well. Rectal: Deferred but guaiac positive at OSH. FAMILY HISTORY: CAD father and brother 50s. Mother with cardiac history. SOCIAL HISTORY: Alcohol: 2 drinks/night. Tobacco: 50 pack-years. Currently still smoking. Drugs: Denies. Currently retired. Lives alone without assistance. Daughters in the area. Used to work as a secretary at a lumber mill.

CHIEF COMPLAINT: Nausea and vomiting, one episode of coffee ground emesis PRESENT ILLNESS: History of Present Illness: Ms. [**Known lastname **] is a 27yo F with history of DM type 1, known grade 1 esophageal varices, status post exploratory laparoscopy from trauma presenting with frequent emesis with episode of coffee grounds and abdominal pain. . In the ER, initial vitals were 141, 133/96, 16, 99% 3L. Patient was profusing vomiting and R femoral CVL was placed for access. She had a very tender abdomen on exam and CT showed signs of pneumobilia. Surgery was consulted who recommended admission to medicine with serial abdominal exams. GI and liver were also consulted. She was started on PPI and octreotide drips, and also received dilaudid, zofran, insulin (home dose), zosyn, metoclopramide and metoprolol. Her initial labs showed an anion gap which later closed and small amount of ketones. Hct was stable since prior on [**5-29**]. NG lavage cleared after 20 cc flush and guaiac was negative. Vitals on transfer were 98.0 85 125/88 12 100% RA. FSBS 132. . In the MICU, patient is initially coughing/retching up clear liquid. Soon after receiving IV dilaudid and reglan, she appears comfortable and is fixing her hair. She reports being in her usual state of health yesterday but awoke with a FSBS in the 60s and has been vomiting throughout the day. The vomitus looked like coffee grounds at one point so she came to the ER. Her abdominal pain resolved in the ER but she continued to have n/v. She has been unable to eat today. MEDICAL HISTORY: - Diabetes mellitus type I: diagnosed age 16 in [**2120**] after her first pregnancy. - Severe anxiety/panic attacks - Previous admissions for nausea/vomiting with h/o esophagitis and with concern for diabetic gastroparesis on metoclopramide - Esophagitis / H. Pylori [**6-/2128**] and again [**8-/2130**] - Stage I diabetic nephropathy - Grade I esophageal varices seen on scope in [**2132-1-1**], negative liver ultrasound, normal LFTs, hep panel negative - Anxiety/panic attacks - Depression - Hyperlipidemia - S/P MVA [**5-3**] - lower back pain since then. - S/P MVA [**2130**], ex-lap - G2P1Ab1, s/p miscarriage in 06/00 3rd trimester, s/p C-section in [**2122**], not menstruating secondary to being on Depo-Provera - Genital Herpes - H pylori, s/p 2-week triple therapy on [**2132-1-24**] MEDICATION ON ADMISSION: 1. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for nausea. 3. Lantus 100 unit/mL Solution Sig: Seventeen (17) units Subcutaneous at bedtime. 4. Humalog 100 unit/mL Solution Sig: 1-10 units Subcutaneous with meals: as directed by your sliding scale. 5. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). Disp:*120 Tablet(s)* Refills:*2* 6. gabapentin 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): may increase slowly up to 2 Capsules twice daily if tolerated. Disp:*100 Capsule(s)* Refills:*2* 7. insulin lispro 100 unit/mL Solution Sig: One (1) Subcutaneous three times a day: per sliding scale. ALLERGIES: Morphine / Prochlorperazine / Tramadol PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: General: Alert, oriented, initially retching but later NAD and comfortable appearing [**Location (un) 4459**]: NC/AT, sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, midline well healed scar, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Grandmother with type 1 diabetes, no history of CAD, hypertension, celiac disease, IBD. SOCIAL HISTORY: She was born and raised in [**Location (un) 669**] but currently lives in her own apartment with her son. She is currently unemployed and received disability. Her mother and sisters live nearby. She had to drop out of school for becoming a medical assistant due to her multiple hospitalizations. She does not smoke and reports rare alcohol use on holidays. She denies drug use.

CHIEF COMPLAINT: Bilateral hip and calf claudication. PRESENT ILLNESS: This is a 41 year old diabetic with multiple risk factors and known coronary artery disease referred for peripheral vascular angiography due to severe bilateral leg claudication. He complains that his calf and thighs "ache 24 hours a day" over the past six months. He has had progression in his symptoms. He describes bilateral severe cramping behind both knees extending down to the feet. This occurred after walking only 20 feet. The patient does not admit to rest pain. The patient underwent PVRs which demonstrated distal superficial femoral artery, proximal popliteal disease with bilateral tibial disease. The patient is admitted for elective diagnostic angiography. MEDICAL HISTORY: Hypertension , hypercholesterolemia, diabetes, hypothyroidism, left shoulder bursitis and peripheral vascular disease. MEDICATION ON ADMISSION: 1. Aspirin 325 mg daily 2. Lipitor 80 mg daily 3. Tricor 67 mg daily 4. Toprol XL 250 mg daily 5. Plavix 75 mg daily 6. Levoxyl .15 mg daily 7. Zestril 40 mg daily 8. Norvasc 20 mg daily 9. Prevacid 30 mg daily 10. Imdur 60 mg q.d. 11. Lente insulin 17 units q AM and 8 units at supper 12. Regular insulin sliding scale before meals 13. Mirapex .125 mg at h.s. ALLERGIES: Vancomycin. Negative to shellfish and dye. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He is divorced, former smoker, 1.5 packs per day times 28 years.

CHIEF COMPLAINT: Insulin overdose PRESENT ILLNESS: Ms. [**Known firstname **] [**Known lastname **] is a 57 year old woman with a history of locally advanced pancreatic cancer s/p whipple and XRT c/b radiation enteritis and biliary strictures s/p PBD, diabetes mellitus, malnutrition, and pancreatic insufficiency. She reports waking up this morning and calculating that she needed 6 units of Humalog. She accidentally used her Lantus and her Lantus syringe and injected "6 units" which in her 100 unit syringe is actually 60 units of Lantus. She recognized that she used the wrong insulin and the wrong dose and informed her partner who called [**Name (NI) **]. The [**Last Name (un) **] physician instructed her to report to the Emergency Department. . In ED VS were T 98.4 HR 100 BP 145/54 RR 18 SpO2 100. Serial finger sticks in ED were 234, 258, 240, 241. She was given 1 L NS IV and zofran 4 mg IV prior to transfer to the MICU for glucose monitoring overnight. . On presentation to the ICU she denies any specific complaints. She admits to a history of depression but denies any intent of self harm. She denies any history of suicidal or homicidal ideation. MEDICAL HISTORY: 1. locally advanced pancreatic cancer - s/p Whipple procedure [**9-2**] with positive margins - s/p cyberknife radiation [**1-4**] - s/p adjuvant chemotherapy with EB-XRT with chemosensitization with capecitabine and adjuvant Gemcitabine c/b radiation enteritis and gastric outlet obstruction due to adhesions, s/p laparotomy [**12/2193**] - biliary stricture [**12-30**] radiation s/p biliary drain in setting of biliary obstruction with biliary tube replacement in [**4-16**] 2. Malnutrition s/p Nasojeojunal Tube placement [**11-5**] 3. pancreatic insufficiency 4. gallstone pancreatitis [**2189**] 5. depression 6. diabetes mellitus 7. anemia MEDICATION ON ADMISSION: 1. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Month/Day/Year **]: One (1) Tablet PO TID (3 times a day). 2. Ursodiol 300 mg Capsule [**Month/Day/Year **]: One (1) Capsule PO BID (2 times a day). 3. Prochlorperazine Maleate 10 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO every eight (8) hours as needed for nausea. 4. Fluoxetine 10 mg Capsule [**Month/Day/Year **]: Three (3) Capsule PO DAILY (Daily). 5. Calcium Carbonate 500 mg Tablet, Chewable [**Month/Day/Year **]: One (1) Tablet, Chewable PO TID (3 times a day). 6. Bupropion HCl 150 mg Tablet Sustained Release [**Month/Day/Year **]: One (1) Tablet Sustained Release PO DAILY (Daily). 7. Clonazepam 0.5 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO BID (2 times a day). 8. Metoclopramide 10 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO four times a day as needed for nausea. 9. Lantus 100 unit/mL Solution [**Month/Day/Year **]: Ten (10) Units Subcutaneous QAM. 10. Omeprazole 40 mg Capsule, Delayed Release(E.C.) [**Month/Day/Year **]: One (1) Capsule, Delayed Release(E.C.) PO once a day. 11. Trazodone 50 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 12. Morphine 15 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO every four (4) hours as needed for pain. 13. Docusate Sodium 100 mg Capsule [**Month/Day/Year **]: One (1) Capsule PO BID (2 times a day). 14. Ondansetron 4 mg Tablet, Rapid Dissolve [**Month/Day/Year **]: One (1) Tablet, Rapid Dissolve PO every eight (8) hours as needed for nausea. 15. Humalog sliding scale qid 16. Senna [**Hospital1 **] prn ALLERGIES: Penicillins PHYSICAL EXAM: GA: oriented to day of the week, location, and self not oriented to date, cachectic, fatigued HEENT: PERRLA. icteric sclera, dry MM. no LAD. no JVD. neck supple. Cards: RRR, 1/6 systolic murmur Pulm: CTAB no crackles or wheezes Abd: distended, soft, +BS. no rebound,guarding, dressing on RUQ c/d/i, biliary drain in place and capped Extremities: warm, 2+ distal pulses Skin: mildly icteric, dry, Neuro/Psych: CNs II-XII intact. Mild asterixis. Conversant, follows commands. Moves all four extremities FAMILY HISTORY: Significant for mother with uterine cancer. SOCIAL HISTORY: Currently lives with her partner [**Name (NI) **] who is well-informed and involved in all of her medical care. Used to work as a self-employed house cleaner. She has a 20-pack-year history of smoking and quit in [**2194-8-28**]. She used to drink alcohol occasionally but none since her cancer diagnosis. She denies use of herbal medications or illicit drugs. She is able to ambulate short distances without assistance but often is aided by her partner [**Name (NI) **].

CHIEF COMPLAINT: Altered mental status PRESENT ILLNESS: 83 M w/ pmh of ESRD on HD, Afib s/p AVN ablation and dual-chamber PM, systolic CHF (EF 25%, 2+AS, 3+MR) transferred from nursing home, w/ MS change. His son who accompanies him says that he has noticed an increase in his RR over the past few days and a decrease in his energy level. When he went to visit him this morning, he was very sleepy and not coherent which is a change so they called the ambulance. BP and O2 sats there noted to be low. He did not eat breakfast this morning which is very unusual for him. . In the emergency department, initial vitals: 19:00 U 97.1 74 98/63 22. 97% on 5L NC. Arrived hypotensive in 70s, MS A+Ox3 here (but per son, not at baseline), BP unresponsive to 2L NS so left femoral central line placed under U/S guidance (as INR 13) and levo started. Moving arms but legs weaker. 2 U FFP, 10 vit K IV. Cxr w/ increased CHF. Head CT NEG. Could not pass foley X 2, now w/ small amt of blood. Given vanco 1g IV, levo 750 mg IV, flagyl 500 mg IV. Cool hands/feet, dopplerable PT but not DP, vasc called and will see on the floor. Guaiac + brown stool. . On arrival to the ICU, his son states he is more alert now but not back to baseline. . Review of systems: Pt. states he feels short of breath but cannot clarify further. MEDICAL HISTORY: On 2-3L O2 at NH for unclear reason - PVD (Followed by [**Name (NI) 3407**]) w/ chronic LUE and bilateral LE ischemis - Chronic renal failure on HD x 4 years (thought to be due to obstructive uropathy, kidney stones, BPH) - Systolic heart failure w/ EF 25% on ECHO [**6-26**] - Moderate aortic valve stenosis (area 1.0-1.2cm2). Moderate (2+) aortic regurgitation is seen. Moderate to severe (3+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. ([**6-26**]) - Hx atrial fibrillation and paroxysmal atrial tachycardia - s/p AV nodal ablation and implantation of a dual chamber pacemaker - Baseline AV conduction delay - Hypertension - Coronary artery disease with old posterior MI on EKG and pMIBI in [**6-/2130**] with EF44%, global hypokinesis, no reversible defects. - Hx Left 4-9th rib fx, Left hemothorax - R kidney stone s/p Lithotripsy ([**6-23**], complicated by ESBL Klebsiella UTI) - s/p stroke (cerebellar), found on MRI, sxs of gait instability - hx gait d/o, hand paresthesias, polyneuropathy, C3/C4 spinal cord compression [**12-21**] cerival spondylosis, L median nerve injury - Anemia - Benign prostatic hypertrophy - [**Month/Day (2) 98041**] headaches - Hx of positive PPD, never treated - Hx squamous cell and basal cell ca - HSV keratouveitis - ventral hernia - s/p open cholecystectomy [**2130-4-21**] - s/p small bowel resection (80-90%) for mesenteric ischemia - s/p umbilical hernia repair - s/p cystocele repair - s/p laminectomy - c/b osteomyelitis - s/p TURP [**9-24**] MEDICATION ON ADMISSION: (per med sheets) Coumadin 3 mg daily Dialysis at [**Location (un) **] dialysis MWF Acetaminophen ASA 325 mg daily calcium acetate 667 mg 2 tabs tid dextroamphetamine 2.5 mg daily docusate folate 1 mg daily lotemax 0.5% eye drops mucinex 600 mg [**Hospital1 **] mucomyst nebs [**Hospital1 **] nephrocaps pantoprazole 40 mg daily sensipar 30 mg [**Hospital1 **] spiriva daily tobramycin 0.3% eye drops Valtrex 500 mg daily lactulose lorazepam 0.5 mg [**Hospital1 **] percocet 5/325 [**Hospital1 **] dexadrine 5 mg daily Albuterol vit B12 1000 mg daily nepro 235 daily albumin w/ dialysis darbapoetin w/ dialysis ALLERGIES: Horse/Equine Product Derivatives / Calcium Channel Blocking Agents-Benzothiazepines / Metoprolol PHYSICAL EXAM: VITAL SIGNS: T 95.9 BP 96/61 HR... RR... O2 GENERAL: Awake but confused, NAD. Answers do not make sense. HEENT: Normocephalic, atraumatic. No conjunctival pallor. No scleral icterus. PERRLA/EOMI. dry MM. OP w/ poor dentition. Neck Supple. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, rubs or [**Last Name (un) 549**] but very distant heart sounds. LUNGS: Occasional crackles anteriorly and posteriorly w/ poor inspiratory effort. ABDOMEN: NABS. Soft, midline scar. No HSM EXTREMITIES: anasarca, palp radial pulses, dopperable PT/DP bilaterally. L hand w/ purple fingertips on fingers 2, 3 and 4. FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Patient has been at a NH and has not gotten home since hospitalization in [**Month (only) 958**]. His wife lives in [**Name (NI) 8**]. He is a retired psychiatrist. Social history is significant for the remote tobacco use, 3ppd x 40 years, quit 20 years ago. He drinks alcohol occasionally, denies illicit drug use.

CHIEF COMPLAINT: s/p MVC PRESENT ILLNESS: 25 y.o. male transferred from OSH s/p MVC with hypotension and tachycardia. Patient reportedly was involved in MVC with ejection. GCS in the field was 3 and SBP was 90/p. He arrived at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital and was intubated for airway protection. He was found to be hypotensive with SBP 78, and was transfused a total of 5 units pRBCs at OSH. He was transferred to [**Hospital1 18**], and received an additional 2 units of pRBCs in route. Upon arrival to [**Hospital1 18**], he was found to have ABG 7.12/57/108, a positive FAST exam, and RLE exam concerning for right open knee fracture. He was expeditiously taken to the OR due to his hypotension and positive FAST. MEDICAL HISTORY: depression MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.4 HR 102 BP 114/60 RR 20 Sat 97% RA Gen: A and O x 3, NAD Card: RRR no MRGC Pulm: CTA B Abd: soft, nontender, nondistended. incision c/d/i healing well. ext: no edema. FAMILY HISTORY: NC SOCIAL HISTORY: +ETOH

CHIEF COMPLAINT: Syncope, Bradycardia PRESENT ILLNESS: 84yoM with DM, DLP who initially presented to [**Hospital3 **] after a syncopal event. The patient reported he was backing out his car when he became lightheaded and blacked out, lost consciousness, and ran his car over a curb into a 3 foot boulder at a low speed. He was restrained by a seat belt and had moderate damage to the vehicle. Following the MVA, he awoke, was extracted from his car, and transported to [**Hospital3 **]. Per EMS report, he was in NSR at the time of transport with occasional PVCs, and HR was 92, BP 130/58. On transport he denied any symptoms of chest pain, shortness of breath, palpitations, or dyspnea. At [**Hospital3 4107**], he was found to be bradycardic to the 30's. He received atropine 1mg x2 without improvement. EKG showed what was thought to be type II heart block (no EKG in the record). The patient had a 6 second pause recorded in OSH records where he was transiently unresponsive. He subsequently awoke and was alert and oriented. BP was stable at the OSH and the patient was transferred to [**Hospital1 18**] for further management. . In the [**Hospital1 18**] ED, initial VS were: afebrile 98.3, HR 35, BP 124/66, R18, PO2 100%. The patient denied chest pain, lightheadedness. EKG showed complete heart block. He did complain of back pain since the MVC and underwent a trauma workup with a CT abdomen/pelvis wet read that showed a fracture at L1. CXR was negative for pneumothorax or acute cardiopulmonary process. While in the ED he had multiple episodes of asystole, for which CPR was performed with chest compressions and atropine and epi. At 1:30 he again became asystolic CPR was performed for 5 mins, 1mg atropine was give, he regained pulses and transcutaneous pacing was placed and subsequently failed (machine incorrectly connected). He was intubated and a R cortis was placed. Once again pulses were lost and CPR was performed for 10 mins, 1mg of atropine and 1mg epi were given. A transvenous temporary paced was placed. He was put on a propofol drip and bolused with versed. At the procedures end, the temporary pacer was capturing at 80, and put at a threshold of 12. 1 gm ancef was given for acute pacer placement. He was admitted to the CCU for further management. . On review of systems, he denied chest pain, shortness of breath, dyspnea, palitations en route to [**Hospital1 18**]. . On the floor, he was intubated and sedated with a transvenous pacer placed. He was capturing with a setting of 12mamps on the pacer. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, HTN 2. CARDIAC HISTORY: None. 3. OTHER PAST MEDICAL HISTORY: - followed by Dr. [**First Name (STitle) **] (Endocrinology) at [**Hospital1 **]-[**Location (un) 620**] MEDICATION ON ADMISSION: Metformin 500mg PO BID Glipizide 10mg PO Daily Pioglitazone 45mg PO Daily Enalapril 5mg daily Lipitor 10mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T= BP=92/52, HR=80, RR=17, O2 sat=100% GENERAL: Older gentleman intubated andsedated with a transvenous pacer in place HEENT: NCAT. PERRL. NECK: Supple with JVP that was flat. CARDIAC: Normal rate, regular rhythm, normal S1, S2. No m/r/g. No thrills, lifts. LUNGS: Anterior breath sounds were coarse, ventilated breath sounds, no crackles or wheezes. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No lesions. PULSES: Right: Carotid 2+ Radial 2+ Left: Carotid 2+ Radial 2+ FAMILY HISTORY: NC SOCIAL HISTORY: -Tobacco history: No current smoking history (unsure of past) -ETOH: Rare use -Illicit drugs: None

CHIEF COMPLAINT: cardiac arrest PRESENT ILLNESS: 58 yo M with h/o MI no intervention and AFib on coumadin, presented after cardiac arrest that occurred while at gym this morning. Witnesses reported that he slumped over and had labored breathing. CPR was initiated and AED placed on patient and he received shock for "wide complex tachycardia." He was combative with EMS on the scene and received valium. . Patient presented to the ED with VS: 100.6 156/97 87 20 100%. His EKG was notable for AFib with rate in 80s, PVCs, LVH with T wave inversions in aVL and V3-V5. He was emergently taken to the cath lab, where he was loaded with plavix and ASA. He received a BMS for 70% stenosis of his LAD. . On presentation to the CCU, he denied having chest pain or shortness of breath. His vitals were stable and he was in AFib with normal rate. He was given statin and started on a beta-blocker. . Review of systems positive for h/o upper GI bleed in [**2168**]. On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, or hemoptysis. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. Patient had syncopal event as described in HPI. MEDICAL HISTORY: Outpatient Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] . - HTN - question of MI in past based on [**Last Name (NamePattern1) **] results, no intervention done - atrial fibrillation, on coumadin - GI bleed-[**2168**], received 4 units PRBCs; EGD showed gastritis/esophagitis; repeat EGD in [**2173**] showed Barrett's esophagus but no gastritis - Zenker's diverticulum s/p Cricopharyngeal myotomy and diverticulopexy - hiatal hernia - L tibial fracture from MVA [**2173**] - nephrolithiasis - Raynaud's phenomenon . Cardiac Risk Factors: +Hypertension, +Dyslipidemia (LDL 125, HDL 34 in [**2166**]) . Cardiac History: no CABG, no pacemaker/ICD, no PCI in past MEDICATION ON ADMISSION: Coumadin Lopressor--pt admits he has not been taking this HCTZ Lipitor Viagra . ALLERGIES: Demerol--nausea, vomiting ALLERGIES: Demerol PHYSICAL EXAM: VS: T 97.1, BP 146/85, HR 71, RR 10, O2 100% on 2L NC Gen: Healthy-appearing middle-aged man, wearing C-spine collar in NAD, resp or otherwise. Oriented to place and time, but repeating questions and statements multiple times, unable to recount events of today. HEENT: No obvious trauma to head. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple; difficult to assess JVP with collar in place CV: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. No S4, no S3. No murmur. Chest: No chest wall deformities. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. No hematoma at R groin (cath site) Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. Mother died of "old age," father of asbestosis and carcinoma. Siblings with HTN. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse; he reports he drinks on social occasions. Ex-policeman; reports he is now in construction. Works out every day and can bench press 380 pounds.

CHIEF COMPLAINT: Fever, chills, lethargy PRESENT ILLNESS: Mr. [**Known lastname 80287**] is a 51 year old man with history of multiple sclerosis necessitating self bladder catheterization complicated by recurrent UTI's with resistant organisms, who was brought by EMS to the ED after being found lethargic at home. He stated that he was in his usual state of health until the morning of [**7-19**] when he awoke feeling thirsty and unwell. He went back to bed and when he woke up in the afternoon he couldn't move and was having chills. He called to his tenant, who found him to be very lethargic and called EMS. There was no dysuria, frequency or urgency. Of note, he does not remember self cathing on the day of admission but did so yesterday. MEDICAL HISTORY: 1. MS- clinically definite since [**2167**]- secondary progressive type 2. Status post ADCF C5-C7 ([**2171-9-25**]) 3. History of depression [**2164**] to [**2166**] and currently. 4. History of alcoholism in the past (last drank 10 years ago) 6. Recurrent UTIs with multi-drug resistance urinary pathogens 7. Hyperlipidemia MEDICATION ON ADMISSION: 1. Aspirin 325 mg Daily 2. Oxybutynin Chloride 5 mg [**Hospital1 **] 3. Ascorbic Acid 1000 mg [**Hospital1 **] 4. Baclofen intraabdominal pump 5. Fluoxetine 20 mg Daily 6. Ezetimibe 10 mg Daily 7. Methenamine Hippurate 1 g [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 98.5 BP: 114/70 P: 61 RR: 17 O2: 97% RA General: Thin, AO3, NAD HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. Baclofen pump is felt on the LLQ. Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Skin: 3 x 3 cm non-painful, L hip ulcer with 2 cm area of surrounding erythema and central eschar Neuro: CNII-XII intact, strength and sensation intact distal UE and LE. Lower extremity tone very high. FAMILY HISTORY: No family history of MS. Father: [**Name (NI) 2320**] Mother: Melanoma SOCIAL HISTORY: Single, lives alone, has a VNA. Works for [**Company 107279**] during tax season; Smokes: [**12-9**] ppd, 20 pk/yr history. Smokes marijuana once every 2 months. Rents a three family house.

CHIEF COMPLAINT: Dyspnea PRESENT ILLNESS: 84 y/o M w/hx of DM, ESRD approaching HD, HTN, presented to the ED with 2 days of increasing dyspnea. Per admitting team, "states he woke up in the middle of the night with SOB. Denied CP. Has been having worsening DOE over the past few months, now would be dyspneic if he walked up a flight of stairs. Also has had worsening LE edema over the past few months. Has never had CP with this. Did have stress in [**2169**] that was normal. In terms of renal disease, had AVF placed [**1-21**] in anticipation of HD but has not required it as of yet. . In the ED, was initially hypertensive in the 200s. Was hypoxic to 96% on 4L. CXR showed moderate to severe pulmonary edema, so he was placed on bipap. He received lasix 80 mg IV x1, and put out 80 cc. He was placed on a nitro gtt. EKG showed ST elevations in V2-V3 which were worse from prior. His troponin was 0.18 with a CK of 1135 (although MB negative) so he was given aspirin and placed on a heparin gtt. He was seen by cardiology who performed a bedside echo; it did not show any wall motion abnormalities, so they felt this was not a cardiac problem and recommended admission to the MICU. Renal saw him in the ED and recommended lasix 160 mg IV with diuril 500 mg IV, to which he put out 60 cc." MEDICAL HISTORY: - ESRD felt [**2-16**] DM and HTN, had AVF placed [**1-21**] in anticipation of needing HD soon -Hypertension -DM -Hyperlipidemia -Severe DJD of the cervical spine with resultant gait disturbance -Gout -Known thyroid cancer (Patient declined resection) -Probable renal cell cancer (noted by MRI, not biopsied) MEDICATION ON ADMISSION: allopurinol 300 mg daily amlodipine 10 mg daily aranesp 60 mcg/0.3 ml q week atenolol 100 mg [**Hospital1 **] calcitriol 0.25 micrograms daily candesartan 32 mg daily clonidine 0.3 mg/24 hr, 2 patches weekly ferrous sulfate 325 mg daily flomax 0.4 mg qhs lasix 120 mg [**Hospital1 **] glipizide 5 mg [**Hospital1 **] lipitor 80 mg daily lisinopril 40 mg daily nifedipine 60 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 98.2, 60, 157/64, 20, 92%RA --> 98% 4L NC Gen: middle aged male in very mild respiratory distress. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Arcus senilis. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. II/VI systolic murmur at apex. No thrills, lifts. No S3 or S4. Chest: No chest wall deformities, scoliosis or kyphosis. Minimal abdominal breathing, no other respiratory muscle use. Mild-mod rales bilateral bases Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Neuro: CN II-XII intact, 5/5 strength, NL sensation all ext . FAMILY HISTORY: Heart problems, HTN, stroke SOCIAL HISTORY: Lives with wife, worked in social work supervising children with drug problems. [**Name (NI) **] tobacco, EtOH, drugs

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 64 year old woman who was recently diagnosed with Wegener's granulomatosis in [**2137-9-16**], who was readmitted in late [**2137-10-17**], for dialysis graft clog and increased lethargy and malnourishment. The patient was discharged to short term rehabilitation after workup for lethargy which included MR of her head, lumbar puncture and electroencephalogram were nondiagnostic. She also had the dialysis catheter removed as renal felt it was no longer necessary. On presentation on [**2137-11-19**], the patient was noted to have had three days of increased lethargy, confusion and abdominal pain, nausea, vomiting. Apparently the patient also had not eaten at home. Tube feeding had been proposed but the patient refused. She complained of occasional nausea, no vomiting, no melena or bright red blood per rectum. She did complain of pain in multiple areas of her body especially in her abdomen. In the Emergency Department, the patient received one liter of normal saline, Droperidol and Levofloxacin and Flagyl intravenous for question of intra-abdominal processes. MEDICAL HISTORY: 1. Wegener's granulomatosis. 2. Acute renal failure. 3. Peripheral neuropathy. 4. Bilateral otitis media. 5. Basal cell carcinoma of the face. MEDICATION ON ADMISSION: 1. Zoloft 50 mg q.d. 2. Nystatin swish and swallow 5 cc q.i.d. 3. Calcium Carbonate 1500 mg t.i.d. 4. Neutra-Phos one packet t.i.d. 5. Cytoxan 75 mg q.d. 6. Prednisone 40 mg q.d. 7. Epogen 6000 units subcutaneous each week. 8. Potassium Chloride 40 meq q.d. 9. Lasix 80 mg q.d. 10. Multivitamin q.d. 11. Iron 325 mg q.d. 12. Bactrim DS q.o.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Short term rehabilitation. Also significant for death of husband approximately one year ago.

CHIEF COMPLAINT: Found down PRESENT ILLNESS: 70 yo ho Hep C, DM2, CAD s/p CABG, PPM, hyperchol, HTN and polysubstance abuse including etoh and narcotics brought in by EMS after being found at home confused with a clonidine patch on by his VNA. Neurology was consulted upon presentation to the ED and their exam at that time was notable for severe inattention and word finding difficulty with phonemic paraphrasias but exam was otherwise nonfocal and there were no signs of aphasia. Additional assessment of patient's mental status was confounded by his severe inattention. There was no ophthalmoplegia to suggest a Wernicke's encephalopathy however patient did seem to confabulate at times suggesting possible Korsakoff's syndrome. He was noted to have bilateral dysmetria likely associated with chronic alcohol use. Neuro impression at that time was that deficits were most c/w a delirium related to a toxic metabolic infectious etiology, but could not exclude seizure activity or post-ictal confusion. . CT was obtained in the ED on [**10-11**] which showed no bleed nor edema, but neuro felt that, given his vascular risk factors, it would be reasonable to evaluate for interval change after 3 days with a noncontrast head CT. . Because of severe agitation, he required 4 point leather restraints he received 6mg ativan and 15mg of Haldol in ED and was transferred to the MICU. MEDICAL HISTORY: -Coronary artery disease status post coronary artery bypass graft [**12/2091**], status post failed percutaneous transluminal coronary angioplasty in [**2098-6-2**] secondary to tortuous vessels-->1. Native two vessel coronary artery disease. 2. Unsuccessful attempt at intervention on mid-RCA stenosis. -Status post pacer placement for bradycardia [**2097-7-3**] -Status post atrial flutter ablation in [**2097-6-2**] -Hypertension. -Hyperlipidemia. -Anemia. -Dyspepsia. -Syncope. -Cirrhosis with a positive Hepatitis C virus. -Type II diabetes mellitus. -80% vertebral artery stenosis. -Severe restless legs. -Depression and bipolar disorder. -Hypothyroidism. MEDICATION ON ADMISSION: 1. ASPIRIN 325MG PO daily 2. ATENOLOL 50 MG daily 3. Catapres-TTS-3 0.3 mg/24hr; 1patch transdermal one time per week 4. ENALAPRIL 20MG PO bid 5. HYDROCHLOROTHIAZIDE 25 mg daily 6. [**Name (NI) 8472**] unclear amount of units 7. Humalog sliding scale 60-65 units per OMR and [**Last Name (un) **] Note 8. LOTRIMIN 1% 1 application [**Hospital1 **] as needed for prn itching 9. MIRTAZAPINE 60 mg Po daily 10. NEURONTIN 600 mg tid-qid PRN:pain (total nte 2400 mg/day) 11. VERAPAMIL 80 MG PO daily 12. DESIPRAMINE 20 PO QHS 13. LEVOTHYROXINE 25 micrograms po daily 14. Tramadol 50mg po q 8hrs 15. Lunesta 25po q day 16. Uroxatral 10mg po daily 17. Actaplus MET 15mg/850 [**Hospital1 **] ALLERGIES: Oxycodone / Opioid Analgesics PHYSICAL EXAM: T-95.4 BP-97/40 HR-62 RR- O2Sat 95%RA Gen: Elderly gentleman in NAD, requesting sleeping pill. Alert and oriented to person, place and date [**2103-10-4**] although thinks it's the 5th. HEENT: EOMI, no nystagmus appreciated, moist oral mucosa, PERRL FAMILY HISTORY: [**Name (NI) **] father died at age 69 from a myocardial infarction and patient's mother died at age 86 and did have cardiac arrhythmias. SOCIAL HISTORY: Lives [**Location 6409**] in a senior housing project. Long h/o EtOH dependence but sober for "many years" after AA, although endorses occasional beer, last drink he reports a few months ago. Has experienced one withdrawal seizure in past. Heavy use of amphetamines in [**2055**]. H/o abusing morphone, dissolved it and injected it. Off narcotics after several detoxs. Quit tob in [**2085**].

CHIEF COMPLAINT: Coffee ground emesis. PRESENT ILLNESS: Ms. [**Known lastname **] is a pleasant 69 year old female with past medical history of cirrhosis and scleroderma who presents with coffee ground emesis. On 6/23PM, she vomited 500cc dark brown material with several clots on a car ride from [**Location (un) 86**]. She denies wrenching and bright red blood. . Prior to this event, she denies any recent history of nausea/vomiting, dysphagia or GERD. She denies NSAID use and other anticoagulation medications. She does report melanotic stools the past week and occasional BRBPR which she attributes to her external hemorrhoids. She denies any episodes of syncope or dizziness. She has felt weak the last few weeks, but attributed this to her worsening scleroderma and cirrhosis (unknown etiology). . Of note, her symptoms of ascites began in [**2187-2-5**]. Since [**2187-3-8**], she has had two paracentesis since for removal of fluid. Per her report, neither have demonstrated evidence of infection. Her most recent paracentesis was roughly two weeks ago, at which time her daughter reports 5 liters were removed. She reports worsening lower extremity edema. She was seen in liver clinic [**5-30**] by Dr. [**Last Name (STitle) **]. . She presented to [**Hospital3 **] Hospital, where she was initiated on octreotide and pantoprazole drips. During her time there, reported to be hypotensive (unknown how low BP was), for which she received 2 liters of IVF. She was then transferred to [**Hospital1 18**] for further management. . In the [**Hospital1 18**] ED, initial vtial signs were: temperature of 97.6, blood pressure 111/86, heart rate 10, respiratory rate of 16, and oxygen saturation of 100%. NG lavage was completed and notable for dark coffee ground material that did not clear; there was no bright red blood. Pantoprazole and octreotide drips were continued. . She was transfered to the MICU where she received 2U pRBC (Hct 22.9-currently stable at 35.1) and started on ciprofloxacin. She was evaluated for upper GI bleed via NGL and EGD. On EGD showed no signs of active bleeding, 2 cords of non-bleeding grade I varices, gastritis, and severe esophagitis. She was started on sucralafate. RUQ ultrasound showed evidence of cholelithiasis with no evidence of cholecystitis, but no portal vein thrombosis. She was note to have a leukocytosis to 23 which was attributed to steriods, stress response, and possible infection. CXR showed no consolidations and diagnostic paracentesis showed no signs of infection. . On the floor, she appears comfortable, although complains of sharp lower extremity and lower back pain. Of note, her bed sheets are soaked around her abdomen which could be due to recent paracentesis. She denies any recent episodes of vomiting, diarrhea, (has been NPO), dysuria. . Review of systems: (+) Per HPI. + Abdominal distension, + lower extremity and back pain (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies constipation, abdominal pain, dysphagia. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: - Scleroderma - Cirrhosis of unknown etiology: Status-post two paracentesis, last one several weeks ago, with 5L fluid withdrawal. No episodes of SBP, encephalopathy, or bleeding. She saw Dr. [**Last Name (STitle) **] [**5-30**] for the first time. Liver biopsy has not been completed. History of positive [**Doctor First Name **] 1:640 - Hypothyroidism - Anemia of chronic disease - Coagulopathy - Cellulitis (multiple infections in lower extremities) - Sinus tachycardia - Mitral regurgitation (patient unaware) - External hemorrhoids - 'Heart burn' but no diagnosis of GERD . MEDICATION ON ADMISSION: - Calcium with vitamin D - Nyastatin swish and swallow [**Hospital1 **] (currently not taking) - Acetaminophen 500 mg [**Hospital1 **] - Calan SR 60 mg daily (Verapamil) - Levothyroxine 50 mcg daily - Fluconazole 200 mg Q72 hr (currently not taking) - Acidophilus 500 million cell [**Hospital1 **] - Millipred 10 mg daily (prednisolone)- Stopped [**5-30**] - Hydrocodone 1 tab q6-8 hours - Lactulose -- prescribed [**5-30**] - Spironolactone 50 mg -- prescribed [**5-30**] - Furosemide -- prescribed [**5-30**] ALLERGIES: Aspirin / Motrin / Advil / Penicillins / Amoxicillin PHYSICAL EXAM: General: Alert, oriented, pleasant, no acute distress, cachectic. HEENT: Sclera anicteric, PERRL, EOMI. MMM and oropharnyx clear, Neck: Flat neck veins. No lymphadenopathy. Lungs: scant bibasilar inspiratory crackles, no wheeze. CV: Tachycardic. RR. Normal S1 + S2. No murmurs, rubs, or gallops, Abdomen: Soft, distended, no fluid wave. tympanic to percussion in LLQ, non-tender w/o rebound or guarding. Ext: Warm, well perfused, 2+ pulses. 2+ pitting edema to upper shin. NEURO: CN II-XII intact. Upper and lower extremity sensation intact bilaterally SKIN: Per nurses report, patient has two 1-2cm lesions on gluteus FAMILY HISTORY: No family history of liver disease, auto-immune disease. Lung cancer history related to smoking, grandmother with type two diabetes mellitus. SOCIAL HISTORY: Retired, lives with 84 yo husband in [**Name (NI) **] [**Hospital3 **]. Husband disabled with dementia. VNA and PT visits 1-2 times per week. Daughter and son provide additional care. Feels safe at home, but overwhelmed by husband's health and own health problems. - [**Name2 (NI) 1139**]: Never - Alcohol: Very rarely, none in the last few years. - Illicits: Denies

CHIEF COMPLAINT: Respiratory Distress PRESENT ILLNESS: This is a 61 year old female with PMHx of COPD requiring home oxygen, diastolic congestive heart failure, pulmonary artery hypertension, morbid obesity, asthma, remote hx of DVT p/w shortness of breath, refractory to nebulizers requiring intubation in the field by the EMS. The patient was transferred to [**Hospital 4199**] hospital and finally to [**Hospital1 18**]. THe patient reports that she was in her USOH until 5 days PTA when she suddenly developed SOB without warning and was able to call for help before she vaugely recalls any events thereafter. She remembers her daughter and others helping place her down somewhere and intermittent people talking but otherwise cannot recall any specific events of her intubation and transfer to the hospital. She has no idea what might have caused her to have this arrest but suspects that it was due to her asthma. She does report a mild fever for which she did not check her temperature, mild cough, and not feeling well within 3 days of this event. She denies any recent allergic response to pollens or pets, recent travel, exposure to ill people, physical exertion at the time, nausea, or vomiting. She says her compliance with medications was good and had not eaten anything that was abnormal. Of note the patient reports mild abdominal discomfort along with recent loose stools since being in the ICU. . In the ED VS T 98.4 HR 91 Bp 172/140 RR 18 Sats 99% Intubated- Patient received 40 mg lasix, proppofol, Methylprednisolone 125 IV, albuterol inhaler, ipratropium bromide and midazolam. ABG PH 7.23/107/143- on AC 500 x12, FIO2 50% PEEP 6. . Laboratory Data on arrival to the ED 142 95 10 150 AGap=11 ------------- 4.6 41 0.7 MEDICAL HISTORY: PMH: 1. severe asthma: baseline peak flow 320, PFT in [**2188**]: FEV1 50%, FEV1/FVC 84%; intubated 7 years ago, on home O2 (3L) for years and CPAP, (since childhood. PFTs: restrict & obsruct, intubated in 2/96. CO2 retention. Followed by Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 2146**] (pulm). Mult. admissions spring & [**2188**] Cx (+) for pseud, trying outpt abx and steroid tapers 2. Echo [**9-8**]: biventricular hypertrophy, thickening of mitral, tricuspid, valves, AS, EF >55% 3. Morbid obesity (as high as >400, down to 297 ([**9-/2183**]) on inpt obesity program. Has tried outpt and programs (deal-a-meal, wt watchers). Currently resistant to outpt nutrition programs (limited transportation - [**9-/2186**]). ([**6-/2187**]): referred to surgical obestiy management clinic 4. Deep venous thrombosis, in [**2188**]-unclear Dx, coumadin d/c'ed b/c GIB 5. h/o upper GI bleed, while on coumadin and vioxx 6. GERD 7. Hypertension 8. Congestive heart failure [**1-7**] 9. OSA on CPAP at night 10. Osteoarthritis 11. Anemia, baseline hct 30-31 12. Hypocalcemia 13. Chronic lower extremity venostasis 14. Stress incontinence 15. Menopause 16. Low back pain (DJD due to obesity) 17. Cardiac ([**4-/2183**] ROMI, upper ext ETT (-) at low workload. ? short run of NSVT while on tele-> Holter (-). [**11/2184**]:Echo w/ pulm HTN, nl RV/LV fxn. [**7-/2186**]: Worse pulm HTN, MR, RV overload) MEDICATION ON ADMISSION: Lasix 40mg PO bid Calcium qd Stool Softener Singulair 10mg qd Loratidine 10mg qd Potassium (K-dur) 20mg qd Lisinopril 5mg qd Protonix 40mg qd Combivent 2 puffs x4 per day Advair 1 puff x3 per day ALLERGIES: Bactrim PHYSICAL EXAM: Vitals: 98.9 140-190/50-80 80-100 95% on 4L General: patient is morbidly obese, alert, talkative, noticeably short of breath in talking, HEENT: no lymphadenopathies, NO JVD appreciated Pulmonary: Lungs with diffuse wheezes throughout with a predominance in the lower bases bilaterally, Cardiac: RRR, s1-s2 normal, holo systolic eyection murmur at the sternum and bases, minor neck radiation Abdomen: obese, soft, NT/ND, +BS, no masses or organomegaly noted. Extremities: obese legs, significant discoloration and venostasis present on lower extremities bilaterally, no visible ulcers, +1 edema, unable to appreciate pedal pulses Skin: marked dryness throughout Neurologic: AOx3 FAMILY HISTORY: sister with asthma SOCIAL HISTORY: She is an ex-smoker; quit in [**2171**]. Occasionally drinks alcohol. Denies any drugs. She lives in the [**Location (un) 448**] with her significant other and her son. [**Name (NI) **] sister, who is a nurse, lives on her [**Location (un) 1773**]. She also has a daughter who is [**Name (NI) **], lives nearby. She walks around in her home with a walker. She uses a wheelchair when she comes out.

CHIEF COMPLAINT: 47 M presents after possible assault in jail and reported seizure. Intubated at OSH for airway protection. It is not clear if seizure was secondary to assault or EtOH withdrawl. PRESENT ILLNESS: Pt is a 47yo M transf'd from OSH s/p unknown trauma. Per EMS, pt was arrested on Saturday [**2151-7-16**] for DUI. Possible MVC associated w/ arrest, but pt was not taken to hospital. Pt was withdrawing in jail and was found having a seizure. There is a vague report he may have been assaulted while in jail, but this has not been confirmed. He was brought to the OSH, intubated and transf'd to [**Hospital1 18**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: Erythromycin Base PHYSICAL EXAM: VS 98.2 128/74 116 20 98% RA pupils equal RRR Chest chear Abdomen soft FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Nose bleed PRESENT ILLNESS: Mr. [**Known lastname 77816**] is an 84 yoM from a NH on coumadin for a AFib, who presents with profound hypotension and altered MS. [**Name13 (STitle) **] was seen in the [**Hospital1 **] [**Location (un) **] ED three days ago for epistaxis at whihch time his nose was packed; per his son, he later pulled thatout, thugh unclear when. Reportedly he has "not been himself" since the visit (increased confusion and anorexia). This morning, he had an "explosive" black bowel movement and was noted to be hypotensive. SBP was 67 when EMS arrived; he received IVF in the ambulance with improvement in BP. MEDICAL HISTORY: Alzheimer's dementia Depression Restless leg syndrome Atrial fibrillation Lung mass-- right, paratracheal; picked up incidentally on chest CT in [**Month (only) 547**]; bx deferred ? CHF HTN Syncope BPH Anemia Dysphagia ? Necrotizing Enterocolitis Abd surgeries for ulcer disease 25 & 55 years ago Pulmonary embolism-- unclear circumstances; happened years ago per son MEDICATION ON ADMISSION: Iron sulfate 325 mg Omeprazole 20 mg QD Proscar 5 mg QD Amlodipine 10 mg QD Lexapro 15 mg QD Vitamin B12 100 mg QD Folic acid 1 mg QD MVI Toprol XL 12.5 mg QD Ensure TID Requip 0.25 mg [**Hospital1 **] Tylenol 1000 mg [**Hospital1 **] + PRN Seroquel 200 mg TID Aricept 10 mg QD Senna Warfarin 2 mg QHS Depakote 125 mg x 2 QAM; 125 mg Q1pm + Q5pm ALLERGIES: Penicillins PHYSICAL EXAM: VS: afebrile, BP stable General: elderly male, pale, frail appearing; NAD HEENT: PERRL; dry mucous membranes; dried blood around mouth and nares b/l; poor dentition; LUNGS: crackles at bases anteriorly, unable to sit up for posterior exam due to fem line CARDIO: 0occasional tachycardic, no m.r.g. appreciated ABD: midline abd scar EXTREMITIES: right fem Cordis line; 1+ pedal pulses SKIN: scattered ecchymoses on arms/hands, legs; generalized xerosis; chronic venous stasis; no other rashes NEURO: oriented to self, no focal gross neurological deficits. FAMILY HISTORY: NC SOCIAL HISTORY: Lives [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 583**] Gardens of [**Location (un) 1411**]

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: The patient is a 61-year-old male who originally presented to an outside hospital with complaint of increasing abdominal and back pain with CT scan performed at an outside hospital demonstrating an 8.2-cm ruptured infrarenal abdominal aortic aneurysm with retroperitoneal containment. He was transferred to [**Hospital1 1444**] emergently for emergent operative repair of ruptured aortic aneurysm. MEDICAL HISTORY: CAD s/p PCI with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 2 ('[**80**],'[**82**] @ [**Hospital1 112**]) HTN Hyperlipidemia Disc compression Right knee surgery Adenoidectomy MEDICATION ON ADMISSION: simvastatin ?, asa 325, plavix 150', metoprolol ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: discharge: gen - wdwn obese male in nad, alert and oriented x 3 card - rrr, no m/r/g lungs - cta bilat abd - soft +bs, no m/t/o; midline incision c/d/i extremities - mild edema bilat groin - puncture sites c/d/i, no hematoma FAMILY HISTORY: denies CAD, aortic aneurysms SOCIAL HISTORY: Tobacco: prior smoker, denies current use ETOH: occasional Ilicit: denies Lives w/ wife in [**Name (NI) **]. No medical insurance at this time - pays cash for all doctors [**Name5 (PTitle) 2176**].

CHIEF COMPLAINT: incisional chest pain/sternal click PRESENT ILLNESS: This 74 year old male with severe COPD and extensive cardiac history in [**2171-10-5**]. Since surgery in [**2171-10-5**], patient has always complained of a sternal click and incisional discomfort. This finding was confirmed at his postoperative visit in [**2171-12-5**]. At that time, his incisional discomfort was described as mild and did not affect his routine ADL's. However over the last several weeks following another bout of pneumonia with significant coughing episodes, his sternal click and incisional discomfort have significantly worsened. Currently, he rates his pain 10 out of 10 and is no longer able to function. He denies fevers, chills,palpitations, orthopnea, PND, syncope and pedal edema. He has just completed a course of Prednisone and Levofloxacin for presumed pneumonia. The ACE inhibitor was also recently stopped due to persistent dry cough. He presents for surgical repair. MEDICAL HISTORY: Mitral Regurgitation s/p redo redo sternotomy and redo Mitral valve replacement chronic obstructive pulmonary disease Asthma Hypertension Hyperlipidemia paroxysmal Atrial fibrillation h/o peptic ulcer Descending aortic anuerysm 2.8cm (followed by Dr. [**Last Name (STitle) **] s/p removal of bladder cancer [**2166**] ) s/p coronary artery bypass s/p redo sternotomy, mitral valve replacement,MAZE MEDICATION ON ADMISSION: - verapamil 240 mg daily - lovastatin 40 mg daily - aspirin 81 mg daily - losartan 25 mg daily - albuterol MDI 2puffs prn - ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler: Two (2) Puff Inhalation QID (4 times a day). - tramadol 50 mg as needed for pain - fluticasone-salmeterol 250-50 mcg/dose Disk: One (1) Disk with Device Inhalation once a day - furosemide 20 mg every other day - iron 325 mg daily ALLERGIES: Codeine / lisinopril / Toprol XL PHYSICAL EXAM: VS: BP 152/77 HR 92 RR 18 SAT 97% room air gen: patient is somewhat anxious, and has obvious discomfort when moving and taking deep breaths CV: regular rate and rythm, [**1-10**] murmur appreciated pulm: [**Month/Day (4) 7968**] breath sounds at bases o/w clear abd: soft, nontender, nondistended with NABS extremities: minimal pedal edema inc: significant sternal non-[**Hospital1 **] with flail segments. extremely painful with palpation. incision is clean, dry and intact with no signs of infection. FAMILY HISTORY: Family history is significant for a mother who died in her 60s of cardiac causes, a father who died in his 40s of unknown (?cancer) causes, a sister who died in her 40s from an MVC (with known CAD) and a brother who has significant CAD SOCIAL HISTORY: -Tobacco history: quit 20 years ago, 65 pack year history -ETOH: occasional wine with dinner -Illicit drugs: no reported illicit drug use Retired UPS trailer driver (20 years), lives at home with wife. 3 children, 1 grandchild. Active lifestyle (rides bikes, motorcycles, golfs)

CHIEF COMPLAINT: PRESENT ILLNESS: This 73 year old gentleman is admitted with a sigmoid carcinoma. The patient had a colectomy in [**2200-5-23**], for a splenic flexure carcinoma. At that time, he required a stay in the Intensive Care Unit for what was thought to be perhaps alcohol withdrawal. At that time, he had a small polyp in his sigmoid which had not been resected. On follow-up colonoscopy, this area had degenerated into a carcinoma which was not amenable to endoscopic resection. He now presents for resection. MEDICAL HISTORY: 1. Diabetes mellitus. 2. Hypertension. 3. Above mentioned history of alcohol use. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Transfer from [**Hospital **] Rehab w/ SVC syndrome for planned IR intervention PRESENT ILLNESS: Mr. [**Known lastname **] is a 65 y/o man, long-time smoker, recently diagnosed w/ SCC of lung w/ SVC syndrome, who presents for scheduled SVC recannalization w/ IR. The patient was diagnosed w/ SCC in [**11-22**] at NWH, when he presented w/ SVC syndrome. CT chest revealed large R lung mass which is 6cm in maximal dimension & paratracheal/RUL/RML in location. The mass encases the patient's SVC. (CT chest also showed R main pulm artery narrowed by mass and R pleural effusion). The pt underwent bronchoscopy [**2162-12-1**], lesions in right and left lobe biopsied & established dx of SCC. Head MRI [**2162-12-2**] reportedly negative for mets. He was started on chemotx (Decadron, Taxotere, & Cisplatin) on [**2162-12-29**] plus radiation. He subsequently developed worsening SOB & on [**2163-1-4**] was admitted to ICU at NWH w/ post-obstructive PNA (sputum grew MRSA & Acinetobacter Baumannii, which was tx'd w/ tigecycline & doxycycline). He underwent R sided thoracentesis, results not available in paperwork w/ pt. He also had a bronchscopy, which showed significant airway edema above the vocal cords & complete obstruction of R bronchial tree due to edema & extrinsic compression. He was started on steroids for airway edema. In the setting of steroids, he was noted to have elevated Bld glucose & was started on Lantus & ISS. He had a bout of pre-renal [**Last Name (un) **] w/ crt peaking at 2.4 (BL reportedly 1.6-1.7). Echo done showed EF >65% w/ mild concentric LVH. Bilateral LENIs (done b/c of edema) were negative for thrombus as was RUE u/s. Pt was discharged to [**Hospital1 **] [**Hospital1 **] on [**2163-1-14**]. During rehab stay at [**Name (NI) **], pt noted increasing swelling of b/l arms, neck, face, & LEs. Pt also occasionally c/o SOB. (Of note, he has been on 02 via NC over the last month--likely b/c of CA, underlying COPD & pl effusion. He is currently requiring 2-3L O2 by NC.) He has been noted to have declining counts in all cell lines: WBC 2.8, plt 77, Hct 23 on [**2163-1-25**]. Per email from Dr. [**Name (NI) **], who spoke w/ MD at rehab, the pt's primary oncologist, Dr. [**Last Name (STitle) 23509**], does not think drop in cell counts is secondary to chemo at this point, and reportedly thought bone marrow suppression might be cause. ASA & Fragmin (DVT ppx) were stopped due to the thrombocytopenia. There were repotedly no signs of acute bleeding. Pt transfused 2 units PRBCs [**2163-1-25**] last night. He has reportedly had periods of hypernatremia (as high as 152 per notes). Additionally, his prednisone taper (for airway edema) ended [**2162-12-25**]; however, on [**2162-12-27**] he was given a dose of 40mg prednisone for unclear reasons. It appears that he has had persistent sinus tachycardia, possibly [**1-17**] decreased cardiac filling from SVC syndrome. His last chemo was [**12-29**] & XRT was [**12-31**]. On arrival to [**Hospital1 18**] wards, pt is w/o complaints. He says he is not SOB, unless he exerts himself. He gets SOB w/ ambulating a few feet. He denies all pain, including CP. MEDICAL HISTORY: -SCC dx'd [**11-22**], c/b SVC syndrome. Per pt, not metastatic. Brain MR reportedly w/o mets. -HTN -Hypercholesterolemia -COPD -- pt unaware of this as a dx, though he has been on spiriva as oupt -Shingles [**9-22**] -Right arm keratosis excision; -Benign laryngeal polyp excision [**2131**] MEDICATION ON ADMISSION: Acetaminophen 650 mg PO Q6H:PRN Allopurinol 150 mg PO DAILY Cyanocobalamin 100 mcg PO DAILY Furosemide 40 mg PO DAILY Guaifenesin HydrALAzine 10 mg PO Q8H Multivitamins 1 TAB PO DAILY Nicotine Patch 21 mg TD DAILY Nystatin 500,000 UNIT PO Q8H Paroxetine 20 mg PO DAILY Pantoprazole 40 mg PO Q24H PredniSONE 40 mg PO DAILY Simvastatin 80 mg PO DAILY Tamsulosin 0.4 mg PO HS ALLERGIES: Ace Inhibitors / Ambien PHYSICAL EXAM: VS: 98.2, 128, 138/80, 94% on 3L GEN: sitting up in bed, appears older than stated age, appears sl uncomfortable, though pt states that he is comfortable. Plethoric facies. A&0X3. HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP moist and without lesion NECK: swollen appearing b/l, JVP elevated above jaw, no masses felt CV: Distant hrt sounds. Tachy but Reg rate, normal S1, S2. No m/r/g. CHEST: Resp appeared labored, occas w/ purse mouth breathing. Some accessory muscle use. Scatter wheezes, rhonchi & crackles. Decreased Breath sounds about [**12-18**] way up R back.. ABD: Soft, NT, ND, no HSM. EXT: [**1-18**]+ dependent edema in UEs (R>L), 1+ dependent edema in LEs. Muscles are atrophied in LEs. SKIN: Skin tear on R hand, ecchymosis on abd ([**1-17**] insulin injx per pt). Reported stage II pressure ulcer on buttock. Neuro: CN 2-12 intact. Sensation intact to light touch throughout. 5/5 strength in upper & lower extremities except for hip & knee flex/ext which is ~5(-)/5. FAMILY HISTORY: Brother with cancer (unknown kind). NC SOCIAL HISTORY: Married, supportive spouse, who is [**Name8 (MD) **] RN. Worked for town of [**Hospital1 **] as "Parts Manager" until he was dx'd w/ CA. Quit smoking ~4mo ago, 80-100pack-year hx. No ETOH/ilicits.

CHIEF COMPLAINT: Pedestrian hit by car Left rib fractures [**3-13**], pneumomediastinum, Left pneumothorax L elbow laceration PRESENT ILLNESS: Patient is 34 year old female pedestrian hit by moving vehicle on L side at moderate speed (30mph) while crossing street. No loss of consciousness. Patient landed on [**Doctor Last Name **] of car. MEDICAL HISTORY: Asthma MEDICATION ON ADMISSION: None ALLERGIES: Penicillins PHYSICAL EXAM: afebrile, VS normal A&O x3, NAD RRR, B CTA Abd soft, NT/ND, BS + B LE WWP, no edema L elbow laceration no erythema FAMILY HISTORY: SOCIAL HISTORY: Smoker, occ. ETOH

CHIEF COMPLAINT: Malaise, weakness, reduced appetite . Reason for MICU transfer: cholangitis / pancreatitis / ARDS PRESENT ILLNESS: HPI gleaned from [**Hospital1 **] [**Location (un) 620**] notes and daugther since Pt is intubated. . Pt is a 86 year old female w/ PMH of hypertension, hyperlipidemia, and insulin-dependent diabetes mellitus who complains of generalized malaise and weakness. According to family she has had a six-month decline in her general function including mobility, ability to communicate and mental status. At baseline, she can transfer wheelchair to toilet with assistance and some walking at home with physical therapy, but is "quite confused". According to the family, 2 days ago she had an episode of hypoglycemia related to a insulin dose it was late in the evening administered by her husband. Shortly afterwards, she became combative and needed to be restrained by her son. They called 911 and EMS found her blood sugars to be in the 40s. Her mental status cleared after admin of D50 and glucagon. Since that episode, she has had increased lethargy and weakness. She has been refusing to get out of bed at all and she has been moaning. No vomiting, no diarrhea, no fever. She did have episode of incontinence however that was in the setting of not getting out of bed. She always is a poor eater reported to family however she's had much nothing to eat for the last 24 hours. Her husband states her blood sugars have been normal and has been giving her her insulin as usual the last couple of days. Pt was brought to [**Hospital1 **] [**Location (un) 620**] ED for evaluation by family for continued "moaning" and reduced responsiveness. At BIDN, initial vitals were Temp: 100.6 HR: 98 BP: 120/46 Resp: 20 O(2)Sat: 94. Pt complained of L chest pain and R wrist pain. Troponins were negative, no concerning ECG changes. Plain CXR did not show any fractures of the chest or R wrist. Pt's lipase was elevated to [**2122**] and Pt developed a fever to 102F. She had a CT abdomen w/ contrast, which showed a common bile duct dilated to 2.8 cm w/ multiple stones and a question of obstructing ampullary stone. Plan was made to transfer Pt to [**Hospital1 **] [**Location (un) 86**] for ERCP, and Pt received a dose of Zosyn. Before transport, the patient became unstable with SBP in 70's. She was given 2L IVF and her BP remained low, and she was started on peripheral levophed. [**Hospital1 **] [**Location (un) 620**] ED placed a R IJ without complications, however she developed hypoxia just afterwards and needed to be intubated for airway control. She was intubated on second attempt with a 7.0 ETT. Her ETT and CVL appear to be in correct position on CXR and [**Hospital1 **] [**Location (un) 620**] feels she may have developed ARDS. Pt was then transferred to [**Hospital1 **] [**Location (un) 86**] ED. . In the [**Hospital1 **] [**Name (NI) 86**] [**Name (NI) **], Pt was stable. CXR showed diffuse bilateral infiltrates R > L and blunting of R costophrenic angle, ?ARDS. Pt was on midaz/fent. On norepi 0.21. IJ + 2PIVs. Received a dose of Vanc. Vent settings on transfer were FiO2 50% TV 420 RR 20 PEEP 5. Vitals were 76, 107/49, 98%. Pt was finishing 6th liter of IVF. . On arrival to the ICU, Pt's vital signs were 37.2C, HR 73, BP 109/46, RR 17, Sat 100% on FiO2 50%, intubated and sedated. . Review of systems: Unable to confirm due to intubation. Per [**Hospital1 **] [**Location (un) 620**] records and daughter, Pt did not have fevers / chills. No nausea or vomiting. No diarrhea. Reports malaise and reduced appetite for several months, but especially so for the last two days. No urinary symptoms. MEDICAL HISTORY: insulin-dependent diabetes hypertension hyperlipidemia benign stricture of the pylorus and duodenum s/p dilation [**2187**] ampullary stenosis s/p sphincertotomy in [**2187**] peptic ulcer disease rheumatic heart dz Mixed aortic valve disease (mild) Mixed mitral valve disease (mild) History of breast cancer; status post bilateral mastectomy osteoporosis chronic hip and leg pain peripheral neuropathy R hip "plate" L carotid artery stenosis ? TIA MEDICATION ON ADMISSION: Atenolol 12.5 mg daily Aggrenox 1 tablet twice a day calcium 600 mg daily vitamin D 1000 units a day. Insulin - 70/30, 10 units before supper B12 1000mcg daily ALLERGIES: Scopolamine PHYSICAL EXAM: Vitals: 37.2C, HR 73, BP 109/46, RR 17, 100% on FiO2 50%. General: intubated elderly woman HEENT: pupils pinpoint, dry mucous membranes Neck: R IJ Lungs: Clear to auscultation bilaterally except for L base, no wheezes or ronchi CV: Regular rate and rhythm, normal S1 + S2, 3/6 systolic and diastolic murmurs, no rubs Abdomen: soft, non-distended, bowel sounds present, no organomegaly GU: foley present Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Alzheimer dementia in sisters SOCIAL HISTORY: Former smoker, quit decades ago. Denies EtOH. She lives with her husband in their home. Has visiting PT 2x weekly.

CHIEF COMPLAINT: hypotension, hyponatremia, anemia PRESENT ILLNESS: 46F with history of heavy alcohol usage and alcohol withdrawal seizures (last 5-6yrs ago) per patient presents with numerous falls recently. Though she denies ETOH in the past week, her serum ETOH is 243. She states, since stopping ETOH she has had numerous falls that concern her for seizures. She denies LOC. She presented to the ED for left arm pain s/p a fall/seizure. Also, states she's felt excessively dizzy and weak walking around which resulted in several falls. She's noticed large amounts of dark BMs over the last 3 days. She denies any abdominal pain, nausea, vomiting, hemetemesis or hematochezia. She states she has not had any fevers or chills. She denies any chest pain or cough, but does state she's been dizzy with shortness of breath recently. No dysuria or frequency. Of note patient was admitted in [**2186**] for GIB with hct drop to 11.8. [**Year (4 digits) **] and [**Last Name (un) **] was performed showing esophagitis, antral erosions, duodenitis, and tics. Patient was rescusitated but source of bleed was not identified. MEDICAL HISTORY: 1. Macrocytic Anemia. Attributed to ETOH 2. Anxiety. 3. Depression. 4. ETOH abuse. complicated by pancreatitis in [**12/2184**], associated LFT abnormalities. Possibly chronic pancreatitis also (evidence on CT scan today). 5. h/o Seizures. 6. Pancreatic mass. Poorly defined soft tissue density within the pancreatic body noted on MR in 12/[**2185**]. Pancreatic mass felt to be c/w chronic pancreatitis on [**Year (4 digits) **] [**3-6**]. 7. Benzodiazepine agreement. 8. Insomnia. 9. PCKD. Dx [**2185**] 10. Status post tonsillectomy. MEDICATION ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Cyanocobalamin 50 mcg PO DAILY 2. Lisinopril 40 mg PO DAILY 3. Zolpidem Tartrate 5 mg PO HS:PRN insomnia 4. Minoxidil Dose is Unknown PO Frequency is Unknown 5. Multivitamins 1 TAB PO DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: Vitals: 100.4, HR 108, BP 112/62, 20, 100%RA General: Alert, oriented x3, appears tachypneic, unkempt HEENT: Sclera anicteric, dry MM, oropharynx clear, EOMI, PERRL minimally Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm but slightly tachy, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi. Speaking full sentences but breathing fast Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley Skin: old and new ecchymoses diffusely on face, breasts, most notably large ecchymosis of left upper arm with tenderness to palpation proximally. Arm in sling. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact but pupils slow, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred FAMILY HISTORY: The patient's father and brother both have autosomal dominant polycystic kidney disease. The patient's father was first diagnosed in his 60s; he is currently 64, and he is told he is 3-4 years away from needing dialysis. There is no other recognized history of medical conditions that run in the family. GF - died of lung cancer at early age. No family hx of IBD or bleeding diathesis. SOCIAL HISTORY: The patient previously worked as a real estate [**Doctor Last Name 360**] for commercial properties. Currently, she is "sort of" working. EtOH: Actively drinking, with concerns for ETOH abuse Tob: approximately [**1-31**] cigarettes daily and has been smoking at this level for 20yrs. Ilicit drugs: H/o marijuana but denies other recreational drugs. Deos have [**Month/Day (1) **] contract She lives alone in JP alone.

CHIEF COMPLAINT: headache x 3 months PRESENT ILLNESS: HPI:67 y/o female with headache x 3 months was transferred from OSH with SDH. She denies any trauma or anticoagulation. She also denies any dizziness, nausea, vomiting, or instability. She was sent to [**Hospital3 44023**] for a head CT which showed a large L SDH and was transferred to [**Hospital1 18**] for further neurosurgical workup. MEDICAL HISTORY: PMHx:HTN MEDICATION ON ADMISSION: estradiol, Diovan ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Arrival PHYSICAL EXAM: T:96.7 BP:156/78 HR:96 R: 18 O2Sats:99% RA Gen: WD/WN, comfortable, NAD. HEENT: atraumatic, normocephalic Pupils: 4-2mm bilaterally EOMs: intact, L lateral nystagmus 2 beat Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**1-28**] objects at 5 minutes. Language: Speech- word finding difficulties slight dysarthria No paraphasic errors. FAMILY HISTORY: Family Hx:NC SOCIAL HISTORY: Social Hx:No tobacco or ETOH

CHIEF COMPLAINT: Nausea, vomiting and abdominal pain PRESENT ILLNESS: 41 y/o M with DM, ESRD with AV fistula placed last week not yet on hemodialysis, and HTN who p/w N/V X 3 days, scant hematemesis, severe [**11-25**] intermittent LLQ pain radiating to left flank x 1 day, and temp to 100.2. He is admitted to the MICU for DKA. . According to him, the nausea started 3 days ago. On AM of admission, he started vomiting "brownish liquid" multiple times. He also started experiencing [**11-25**] left flank pain which is burning in nature and does not radiate. He claims that he has had similar pain in [**8-19**] when he was hospitalized but he could not recall his diagnosis. He denies urinary symptoms, no h/o kidney stone, no trauma to left flank, no change in bowel movement, no melena. . In the ED, his vital signs were:P 140 BP 170/80 R16 patient refused NG lavage. He was guiac negative. CT abdomen was done without contrast but the ED radiologist confirmed that it is a good enough image to rule out abdominal pathology. . He was then found to be in diabetic ketoacidosis with approptiate respiratory compensation. His initial blood gas was 7.34/33/96, HCo3 16, Cr 7.0. Insulin drip and D5 with HCO3 were started. Renal team was made aware but felt that he has no emergent need to dialysis. Blood cultures and urine cultures were sent. CXR was negative. There was a concern for osteomyelitis and he was given one dose of vancomycin. . In the MICU patient was placed on insulin gtt until anion gap was closed. At this time he was transferred to a regular medical floor. Although anion gap had closed patient continued to have nausea, vomiting and abdominal pain. MEDICAL HISTORY: -Diabetes -End stage renal disease, not on HD yet -Hypertension -right foot ulcer operation one week prior to admission for ? ostemyelitis vs hammertoe MEDICATION ON ADMISSION: Aspirin Clonidine HCl SC Heparin HydrALAZINE HCl Insulin SS Metoprolol NIFEdipine Nephrocaps Pantoprazole Ambien ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T99.1 P112 BP 181/81 R12 100% on RA Gen- comfortable, alert, NAD HEENT- anicteric, MMM, neck supple CV- regular, tachycardic, no r/m/g resp- CTAB [**Last Name (un) 103**]- + bowel sound, non distended, left flank tender, diffuse mild TTP, no rebound, no guarding, no splenomegaly extremities- right toe in bandage, no edema, ulcer does not probe to bone, DP 1+ b/l FAMILY HISTORY: Diabetes in multiple relatives SOCIAL HISTORY: Denies smoking/tobacco history

CHIEF COMPLAINT: Hypotension. PRESENT ILLNESS: 63F w/ sudden-onset 6/10 chest pain yesterday. Had episode of sharp, intermittent substernal cp ~5hrs PTA while at rest. No relief w/2 SL NTG or mylanta. Also had throbbing L calf pain night prior to admission. ASA in ambulance to OSH. Went to [**Location (un) **] where she had a positive d-dimer. She was given Lovenox and transferred to [**Hospital1 18**]. . In the ED, initial vs were: T 97.3 P 60 BP 94/50 R 16 O2 sat 98%. Pt reports sporadic substernal chest "soreness." Got 5L of fluid. Lactate 1.4. However, patient remained bradycardic and hypotensive with SBPs to 70s and 80s, at times up to low 100s. She has a pacer which does capture if she is too brady. EKG showed SR 64 LAD TWI III, V3-V5, w/o old for comparison. Recent RCA dissection. Bedside FAST did not show pericardial effusion. Getting CT abdomen for mild abdominal pain, but w/o a second load of IV contrast. . On the floor, is having some mild low abdominal pain. No fevers, HA, cough, N/V, D/C or dysuria. Once had hypotension after RCA dissection at [**Hospital1 3278**], but otherwise is typically normotensive. Other ROS negative. +left ear fullness, no headaches, hx sycope, has hx of chest pain that is similar but usually resolves with NTG, + anorexia last three days MEDICAL HISTORY: 1.) PPM for syncope 2.) h/o 6 DVTs in LUE, RLE and LLE, 1st at 24yo while on OCPs, most recent after PPM in left arm. Was on coumadin for 2 years until one month ago. No h/o PEs. 3.) cardiac cath [**12-9**] at [**Hospital1 3278**] for failed stress test c/b RCA dissection. Placed 6 BMS. 4.) anxiety 5.) multiple personality disorder 6.) s/p bilateral TKRs 7.) s/p R hip replacement x3 - congenital hip alignment 8.) s/p appendectomy MEDICATION ON ADMISSION: home: - Plavix 75mg daily - SL NTG 0.4mg PRN - ASA 325mg daily - Metoprolol ER 25mg - Lasix 60mg daily - Ativan 1mg QHS - KCl 10mEq daily - Fluoxetine 60mg daily - Zantac 150mg daily . Allergies: NKDA ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Tmax: 36.4 ??????C (97.6 ??????F) Tcurrent: 36.4 ??????C (97.6 ??????F) HR: 74 (63 - 74) bpm BP: 113/56(68) {108/42(55) - 141/72(84)} mmHg RR: 16 (16 - 22) insp/min SpO2: 99% Heart rhythm: SR (Sinus Rhythm) Wgt (current): 104.6 kg (admission): 104 kg General Appearance: Well nourished, No acute distress Eyes / Conjunctiva: PERRL Cardiovascular: (S1: Normal), (S2: Normal) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Clear : ) Abdominal: Soft, Bowel sounds present, Mild RUQ tenderness Extremities: Right lower extremity edema: Trace, Left lower extremity edema: Trace Skin: Not assessed Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone: Not assessed FAMILY HISTORY: No family h/o thrombotic disorders, father with CABG in 50s. Mother died of pancreatic cancer. SOCIAL HISTORY: Lives with son in [**Name (NI) **], MA, where she swims regularly in a nearby [**Doctor Last Name **]. Not currently working. Walks with care assistance since BL total knee replacement surgeries. - Tobacco: Never smoker - Alcohol: 1 drink/week - Illicits: Denies

CHIEF COMPLAINT: Dyspnea and hypoxia following resection of left renal mass PRESENT ILLNESS: This is a 41 year old man with a PMH significant for Factor V Leiden mutation, who is now POD2 s/p resection of a left renal mass, who had episodes of oxygen desaturation on the floor and for whom a CT showed likely mucus plugging. He was transferred to the [**Hospital Unit Name 153**] for planned bronchoscopy by the interventional pulmonology service. . He originally presented with back pain and in the process of workup for this got an MRI which incidentally showed a 2 cm left renal mass. A CT scan confirmed the presence of the mass. He came to Dr. [**Last Name (STitle) **] for urological follow-up, who scheduled and, on [**4-22**], performed an open partial nephrectomy to resect the mass. This included chest tube placement in the left; the chest tube was pulled [**4-23**]. At midnight [**Date range (1) 62333**], he had a trigger on the floor for hypoxia and fever, with temp 102.2 and O2 saturation of 87% on 3.5L NC. This increased to 92% with 5L NC and use of an incentive spirometer. At that time, the covering MD noted that he was "asymptomatic" without SOB, CP, dyspnea, N/V, chills, or calf pain. An ABG at that time was 7.38/52/74 on 5L NC. . A PE protocol CT chest was ordered stat, and a provisional read showed "Small left pneumothorax... [and] obstructive atelecatsis of the left lower lobe and right middle and lower lobe due to fillings of the lower lobe bronchi, most likely mucous plug." . An EKG done around that time appears to show diffuse T-wave flattening compared to his earlier pre-op EKG but otherwise without diagnostic focal changes. . On the floor today, he continued to be febrile for much of the day, with Tmax of 102.8 at 1415; he continued to require oxygen support of 5L NC with 40% facemask for much of the day, with oxygen saturations in the mid 90s to this. He was also tachycardic to the 110s-120s for most of the day. MEDICAL HISTORY: Lower extremity DVT in [**2127**], diagnosed with heterozygous Factor V Leiden mutation; on coumadin, followed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2805**] Right leg vein stripping for varicose veins, [**2128**] Essential tremor MEDICATION ON ADMISSION: Home medications: Warfarin 5 mg daily Advil 600 mg prn ("occasionally") Propranolol 20mg, prn ("very occasional" per pre-op med list) for palpitations before presentations Fish oil MVI . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General Appearance: Well nourished, No acute distress FAMILY HISTORY: Mother and sister with factor V Leiden mutation; sister w past DVT SOCIAL HISTORY: Professor [**First Name (Titles) **] [**Last Name (Titles) 20367**] at [**University/College **]. Married. Quit smoking in [**2120**], was light smoker before then. 3 glasses of alcohol/month. Denies recreational or IV drug use.

CHIEF COMPLAINT: Upper GI Bleed PRESENT ILLNESS: 59 year old man with history of ESLD secondary to EtOH, hypertension who was referred to the hospital after having an elective EGD that showed significant amount of blood in the stomach. The patient noted that he was having black, loose stools and feeling dizzy when walking around for one week prior to presentation. He denied abdominal pain, chest pain, or headache. He had no nausea or vomiting prior the EGD. EGD showed a ? mass vs clotted blood in the antrum along the lesser curvature of the stomach and multiple lesions similar to a Dieulafoy's lesion. One cord of grade I varices was seen in the distal esophagus. Cold forceps biopsy was done of the mass. He was hypotensive to 80/45 following the endoscopy and again en route to the ED. . In the ED, vitals were: 98.7 106 99/64 18 100%2L. The patient's Hct was 20 and platelets were <5,000. He received 5 mg IV vitamin K and was transfered to the MICU where he required multiple transfusions. Additionally, on presentation his platelet count was <5K and hematology was consulted. . The patient was recently admitted to [**Hospital1 18**] from [**Date range (1) 109799**] for ascites control. During that admission he had a paracentesis for ~5 liters and started on spironolactone, lasix, and protonix. MEDICAL HISTORY: EtOH abuse HTN Hypercholesterolemia Peripheral neuropathy [**12-24**] EtOH use Transaminitis Anemia Dermatitis herpetiformis Celiac disease MSM MEDICATION ON ADMISSION: Gabapentin 600 mg Q8H Omeprazole 20 mg daily Thiamine HCl 100 mg DAILY Folic Acid 1 mg DAILY Miconazole Nitrate 2 % Powder Topical TID:prn Spironolactone 100 mg DAILY Furosemide 20 mg DAILY ALLERGIES: Gluten PHYSICAL EXAM: VS: 95.8 117 108/56 23 100%2L GEN: NAD, pale HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, anicteric, OP clear, MMM, Neck supple, no LAD, no carotid bruits FAMILY HISTORY: The patient's mother has [**Name (NI) 2481**] disease (she is 85 yo old); father died of prostate cancer at the age of 63; has one brother. SOCIAL HISTORY: He is a lifetime nonsmoker. Until recently, he worked from [**Month (only) 116**] to [**Month (only) **] as a marketing director for farmer's markets. In the winter months, he worked in an office as a computer analyst. He has recently retired from both jobs. He was drinking [**12-25**] cocktails per night (mostly vodka). MSM.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 76-year-old woman with a history of right upper extremity tremor. She had an MRI scan which showed a 7 mm right posterior communicating artery fetal PCA aneurysm. She was seen by Dr. [**Last Name (STitle) 1132**] and admitted for angio and possible coil embolization of this aneurysm. She was admitted status post arteriogram which showed evidence of this right PCA aneurysm which was not amenable to coiling; therefore, the patient was scheduled for clipping of this aneurysm. She remained in the hospital, was seen by cardiology and cleared for surgery. MEDICAL HISTORY: 1) Migraines, 2) Palpitations, 3) Hepatitis A. MEDICATION ON ADMISSION: ALLERGIES: 1) codeine, 2) sulfa, 3) penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: dysarthric speech & gait difficulties PRESENT ILLNESS: The patient is 80-year-old gentleman who was diagnosed with stage IV [**Doctor Last Name 10834**] level V melanoma of the right nasolabial fold in [**2108**]. He had a wide local excision completely excised with residual superficial spreading melanoma. His sentinel lymph nodes were negative. Routine chest x-ray in [**2112-2-6**] showed multiple bilateral nodular opacities measuring up to 1-2 cm. A left upper lobe wedge biopsy was consistent with metastatic melanoma. A CT scan also showed a 10.5 mm pericarinal lymph node and MRI of the head showed two metastatic lesions, one in the left frontal and one in the right inferior frontal. He received SRS to both on [**2112-4-6**]. He started on Temodar 75 mg per meters squared times six weeks and two weeks off on [**2112-4-18**]. One month followup MRI on [**5-2**], [**2112**], showed resolution of the right frontal met to 50% decrease of the left frontal met. Good response of lung mets on [**2112-6-6**], torso CT. His second cycle of Temodar was interrupted for diarrhea and then was restarted in the end of [**Month (only) **]. On [**2112-8-25**], torso CT showed some progression of the lung nodules. The abdominal and pelvic CT was negative for disease. He is here for his five month post-radiation MRI. The patient states that since last being seen, he has been having some difficulties with double vision, unsteady gait, and some incoordination. He denies any headaches, no nausea or vomiting. He states that he has not noticed if he is veering to one side more than the other. The diplopia has been for four days and his imbalance has been for two weeks. He also thinks he might have some slurred speech. MEDICAL HISTORY: 1. Atrial fibrillation, on anticoagulation. 2. Hypertension. MEDICATION ON ADMISSION: Decadron 4mg tid Keppra 250mg 5 tabs twice a day Coumadin 5mg daily Doxazocin 1mg daily Lipitor once daily, Digoxin half a tablet a day Metoprolol 50 mg twice daily. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAMINATION: VITAL SIGNS: His blood pressure is 126/74, pulse of 74, respirations of 16, and temperature of 97.6. GENERAL: He is alert, pleasant elderly gentleman, who looks younger than his stated age. CARDIOVASCULAR: The patient has a grade 2/6 systolic ejection murmur heard best at the right upper sternal border. LUNGS: Clear to auscultation bilaterally. FAMILY HISTORY: No melanoma in his family. His father died of a stroke. He believes his mother died of a stroke. His family history knowledge is limited as his family was [**Doctor First Name **] Scientist and did not seek medical attention. SOCIAL HISTORY: He never smoked. He drinks half a bottle of wine at night. He is married. He has five children. His son [**Name (NI) **] is present today: he is NP. He has seven grandchildren. He lives in [**Location 17927**]. He used to work in the insurance business. He is retired now.

CHIEF COMPLAINT: palpitations PRESENT ILLNESS: Mr. [**Known lastname 11752**] is a 31 year old man with a history of a renal papillary tumor s/p nephrectomy. He reports feeling "flu-like sx" last Thursday. He developed nausea, chills, diarrhea, cough, and headache. These symptoms were treated with pepto-bismol and essentially resolved by the end of the weekend. He was driving to work at 10AM yesterday when noticing a discomfort in his mid chest area. He also reports SOB, DOE, lightheadedness, and some nausea. He states it occurred several times throughout the day. He describes the feeling as if his heart "shifts into overdrive." He felt faint at work and drove to the ED. . In the ED 98.1po 158/84 69 17 100%RA. He went into VT on telemetry. He was seen by the EP service. He was given 5 mg IV lopressor and 20 mg PO x1. He had no further episodes in the ED. EKG showed left BBB and wide complex, QTC 396. Chest xray unremarkable. Remained hemodynamically stable. Initial laboratory studies were negative for troponin and d-dimer. . He was initially admitted to [**Hospital Unit Name 196**] however he developed runs of Vtach around 0000 and was given 5mgIV lopressor x1 by NF with some improvement. His rhythm continued to be irregular with occasional VT and CCU was called to transfer and medically manage pt in the unit. Vitals on Fa3: 114/55 65 16 100/2L NC . In the CCU, he reports feeling comfortable although his runs of VT continued and were detectable by pt who reports feeling SOB, palpitations and some anxiety. This was accompanied by a fluttering sensation in his chest. He denies any pain. Denies usage of illicit drugs, inhaled catecholamines, known thyroid disease, or supplements/medications. Drinks 1 iced coffee daily. No recent EtOH. Vitals on transfer to CCU: 138/71 72 18 100RA. He was given 5mg IV lopressor and started lidocaine 100mg bolus plus IV drip at 2mg. . On review of systems, reports 1-2 episodes nocturia regularly, blurry vision, increased thirst, and 15lb intentional wt loss (diet, walking) since 7/[**2145**]. Denies numbness/tingling. s/he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, myalgias, joint pains, cough, hemoptysis, black stools or red stools. S/he denies recent fevers, chills or rigors. S/he denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: PMH:Papillary renal cell cancer, cholelithiasis PSH:Right partial nephrectomy and cholecstectomy [**3-22**], left leg ORIF MEDICATION ON ADMISSION: none ALLERGIES: Claritin / [**Doctor First Name **] PHYSICAL EXAM: Tc: 96.8 HR: 52 BP: 113/49 RR: 12 O2: 97% RA Gen: Obese, caucasian male. Sleeping. Pleasant appears comfortable. Oriented x3. HEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. Neck: No JVD. CV: RR. No m/r/g. No thrills, lifts. No S3 or S4. Chest: CTAB, no crackles, wheezes or rhonchi. Abd: Soft, NTND. Obese. No abdominal bruits. BS in all quadrants. Ext: 2+ pitting LE edema to midcalf, no evidence of venous stasis changes +TEDS in place Pulses: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ FAMILY HISTORY: Father has diabetes. He also had right kidney removed. Grandmother has diabetes. No h/o sudden death, MI, stroke. SOCIAL HISTORY: Works at city [**Doctor Last Name **]. Does not smoke. One glass of alcohol per week. No illicit drug use. Lives alone, parents live next door. No recent travel.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 62 year-old male with a past medical history of squamous cell lung cancer treated with right total pneumonectomy, chronic obstructive pulmonary disease on 2 to 3 liters of home oxygen with saturations in the low 90s at baseline, congestive heart failure, and diabetes mellitus type 2 who was recently admitted from [**7-15**] to [**2176-7-19**] for presumed bronchitis or bronchiectasis flare here with recurrent cough, shortness of breath and fevers. During his last admission two weeks ago he was treated for chronic obstructive pulmonary disease flare versus bronchitis with a ten day Prednisone taper and Augmentin for one week. He underwent bronchoscopy due to concern for possible endobronchial lesion, which was normal. Sputum sample was done at that time showed no growth. He was discharged at his baseline function on [**2176-7-19**]. The plan was to treat him for one week of Augmentin, skip one week followed by Bactrim for one week, skip one week and then on Augmentin for two weeks for pneumonia prophylaxis. The last dose of Augmentin was [**2176-7-22**] after being on Augmentin for only three days. He was doing well until approximately one week ago when he developed mild spasms in the afternoon that he thought was due to low potassium. Within the following days he complained of worsening cough productive of clear sputum. He had a low grade temperature, mild headache and worsening cough and presented to the Emergency Department. He denied any sinus pain, sore throat, chest pain, abdominal pain, diarrhea, dysuria or joint pain. In the Emergency Department he was febrile to 102 orally and had a heart rate of 160 and a blood pressure of 118/56. Respiratory rate 28. Sating 88 to 98% on 100% nonrebreather. Initially he was stable, but then had a gradual change in mental status with hypoxia, which resulted in his elective intubation. He received Lasix 100 mg intravenous twice, 1 mg of Bumex and 1 gram of Ceftriaxone as well as 125 mg of Solu-Medrol. He was also placed on a heparin drip for a subtherapeutic INR and given morphine and Ativan for sedation. Chest x-ray showed no focal pneumonia or evidence of heart failure. The patient then underwent a CT angiogram of the chest that showed no evidence of pulmonary embolism. MEDICAL HISTORY: 1. Stage three squamous cell lung cancer diagnosed in [**2175-2-26**], status post right pneumonectomy in [**2175-6-28**] treated with neoadjuvant radiation therapy and carboplatin and Taxol. 2. Chronic obstructive pulmonary disease. 3. Congestive heart failure, last echocardiogram [**2176-6-18**] with limited views showing grossly preserved left ventricular function and right ventricular function. 4. Atrial fibrillation in the postoperative period. 5. History of prostate cancer diagnosed in [**2172-2-26**], status post radical proctectomy with penile prosthesis in [**2172-8-27**]. 6. Diabetes mellitus type 2. 7. History of urosepsis. 8. History of pulmonary embolus postoperative in [**2175-6-28**]. 9. Myocardial infarction with a troponin of 4.1 in [**2175-6-28**]. Cardiac catheterization showed 30% right coronary lesion, normal left ventricular function with an ejection fraction of 50%. 10. Transient ischemic attack in [**2165**]. 11. Gout. 12. Gastroesophageal reflux disease. 13. Sleep apnea. 14. Colonic polyps discovered in [**2173-5-27**]. 15. Hypercholesterolemia. 16. Small pericardial effusion in [**2176-5-27**], which subsequently resolved. MEDICATION ON ADMISSION: Bactrim 800 mg/160 one tablet twice a day for one week skip one week and then Augmentin 500 mg three times a day. Potassium 40 milliequivalents twice a day. Protonix 40 mg once daily. Lasix 160 mg b.i.d., Uniphyl 200 mg q.d., Zestril 2.5 mg q.d., Serevent two puffs b.i.d., Flovent 110 micrograms four puffs twice a day. Combivent inhaler two puffs four times a day. Duo-neb solution four times a day as needed. Amiodarone 200 mg q.d., enteric coated aspirin 325 mg a day, Glyburide 5 mg once a day, Colace 100 mg twice a day, Senna prn, Coumadin 5 mg once a day except for 4 mg on Tuesday and Thursday, Neurontin 300 mg b.i.d., Oxycontin 20 mg t.i.d., Paxil 20 mg q.d., Lipitor 10 mg q.d., Ambien 15 mg q.h.s. and a regular insulin sliding scale. ALLERGIES: Doxepin causes delirium and Levaquin causes prolonged QTs. PHYSICAL EXAM: FAMILY HISTORY: The patient has a sister who died of cancer at the age of 39 and an older brother who had a coronary artery bypass graft. His father also had coronary artery disease and he had a sister with cardiac valvular disease. SOCIAL HISTORY: The patient quit smoking in [**2175-5-28**] following a forty year history of smoking three to four packs a day. He consumed two to three drinks alcoholic drinks per day and was a construction worker.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 58 M with h/o DM, hyperlipidemia, hypertension, neuropathy, tenosynovitis, and chronic headaches presents with sharp left-sided chest pain radiating to his left shoulder and scapula which started yesterday morning. The pain was slightly worsened by movement. He felt slightly lightheaded and short of breath. He has a history of capsulitis to which he initially attributed the pain to, however pain did not improve with Tylenol, so he presented to the ED. In the ED, pain slightly improved with SL NTG x3 and aspirin. EKG was without acute changes and cardiac enzymes have been negative. He was admitted to the observation unit where he had continued chest pain that again slightly improved with SL NTG and admitted to medicine. Patient describes the pain as a constant, sharp pain. Has never experienced this before. . On the medicine service, he continued to have chest pain. Cardiology was consulted and recommended cardiac catheterization given atypical chest pain that has persisted for over 24 hours. Pain was again slightly improved with SL NTG x3, IV morphine 2mg x3, and IV metoprolol 5 mg x1. EKG over the course of the day showed that he has progressively peaking T waves. Patient was started on a heparin drip for concern for ACS. He continued to have pain. Nitro drip was unable to be started on the floor to help in controlling pain and so patient was transferred to the CCU for further management. . Cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, or syncope MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: - DM - Hyperlipidemia - Hypertension - Hypothyroidism - Tenosynovitis - Tension Headaches - Peripheral Neuropathy - Palmar Contracture - Peptic Ulcer and GI bleed - last bleed in [**2097**] - h/o TIA x5 MEDICATION ON ADMISSION: Insulin pump Levothyroxine 125 mcg daily Lisinopril 5 mg daily Nortriptyline 25 mg daily Methotrexate (unknown dose) weekly (last taken on Friday) Folic Acid 1 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 98, L 140/79, R 140/80, 98, 18, 96% 2L Gen: WDWN male in NAD, AAOx3 Eyes: No conjunctival pallor. No icterus. ENT: MMM. OP clear. CV: JVP low. Normal carotid upstroke without bruits. PMI in 5th intercostal space, mid clavicular line. RRR. nl S1, S2. No murmurs, rubs, clicks, or gallops. Full distal pulses bilaterally. No femoral bruits. LUNGS: CTAB. No wheezes, rales, or rhonchi. ABD: NABS. Soft, NT, ND. No HSM. Abdominal aorta was not enlarged by palpation. No abdominal bruits. Heme/Lymph/Immune: No CCE, no cervical lymphadenopathy. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**2-1**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred. PSYCH: Mood and affect were appropriate. FAMILY HISTORY: Father with CAD (60s). No premature heart failure or sudden cardiac death. SOCIAL HISTORY: -Tobacco history: former smoker - quit [**2115**] -ETOH: denies -Illicit drugs: denies Former ENT physician in [**Country 532**]. Married.

CHIEF COMPLAINT: left thigh cellulitis, leukocytosis, thrombocytopenia, anemia, duodenal perforation PRESENT ILLNESS: The patient is a 79-year-old male with past medical history significant for HTN, hypercholesterolemia, coronary artery disease, atrial fibrillation, premature atrial tachycardia, CHF, anxiety/depression and prior squamous cell cancer of the anus (s/p resection, chemotherapy and radiation -[**2151**])who presents now as a transfer from [**Hospital6 17032**] with CBC and differential concerning for acute leukemia. The patient went to PCP earlier this week with main complaint of left thigh cellulitis. The patient was sent to ED after CBC labs were markedly abnormal. ED labs on [**2157-3-11**] showed a marked leukocytosis to 45.7, platelet count of 15, Hct 26.8, Hgb 9, MCV 93.7. Manual differential showed 34% blasts, 5% promyelocytes, 12% myelocytes, 14% metamyelocytes, 14% bands, 14% neutrophils, 1% lymphocytes, 5% monocytes, 2% eosinophils, 7% nucleated RBCs. . At OSH a hematology/oncology consult was called and team felt his presentation was that of possible CML with blast crisis given increased blasts on differential. He was given 1 Unit of irradiated platelets and platelets rose from 15 to 26. He also received Hydrea 500mg x 2 doses. No blood transfusions. He was started on allopurinol 100mg Po tid. DIC panel showed INR 1.5, fibrinogen 347.8, d-dimer 1422. He had no fever spikes throughout his brief course at OSH and blood cultures were negative to date at transfer time. . In terms of his left thigh sores, Mr. [**Known lastname 68754**] explains that he went to his PCP [**Name Initial (PRE) **] 3 days ago complaining of left thigh "painful boils and redness" that had developed slowly over about 1.5 weeks. He was placed on PO Keflex for a few days. Then at ED, infectious disease team was consulted at OSH and placed him on IV Vancomycin and IV Ancef which he has been getting for last day leading up to his transfer. . Oncologic history is significant for prior squamous cell cancer of the anus that was resected and treated with 5-FU and mitomycin with radiation. His treatment ended on [**2151-12-2**]. Staging T2NOMO. Per OSH records, the patient had been in [**4-/2156**] for a routine visit with his cardiologist and labs at that time (for comparison) showed WBC 4.5 with 62% neutrophils, 1% bands, 11% atypical lymph cells, 17% monocytes, and platelets of 149. Also of note, he explains having been exposed to multiple chemicals and fumes while he worked in autobody business for many years. . Upon arrival to [**Hospital1 18**] BMT Unit his vitals were: temp 98F, BP 116/80, HR 83, RR 20, O2 Sat 94% RA. He appeared to be in no apparent distress. He complained of some diarrhea he had been having x 4 days since starting antibiotics. . MEDICAL HISTORY: -Squamous Cell CA of anus ([**2150**], s/p chemotherapy and surgical resection) -Hypertension -Hypercholestrolemia -CHF -Atrial Fibrillation (cardioversions x 2) -taken off Coumadin last month for GI Bleed concerns -Premature Atrial Tachycardia -Colonic Polyps - s/p polypectomy [**3-/2156**] -Anxiety -Depression MEDICATION ON ADMISSION: HOME MEDICATIONS: -Fluoxetine 40mg daily -Lipitor 10mg daily -Verapamil SR 120mg daily -Flecanide 25mg daily -Lasix 20mg [**Hospital1 **] -Toprol 12.5mg daily -KCL -Keflex qid -Centrum Silver MVI once daily -Nystatin Swish and Swallow x 1 week for thrush (day [**7-10**] at time of admission to OSH) . MEDICATIONS ON TRANSFER: Nystatin Swish and Swallow tid Ancef 2g IV q8hrs Vancomycin 1.5g IV q12hrs Ca Carbonate 500mg PO bid Flagyl 500mg PO tid Allopurinol 100mg Po tid Fluoxetine 40mg PO daily Lipitor 10mg PO daily Verapamil SR 120mg PO daily Flecainide 25mg PO tid Toprol 12.5mg PO daily Centrum Silver MVI daily Zantac 150mg PO daily ALLERGIES: Penicillins PHYSICAL EXAM: VS: temp 98F, BP 116/80, HR 83, RR 20, O2 Sat 94% RA. GENERAL: No acute distress. Oriented to person, place and time, affect appropriate. HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Tongue erythematous/bright pink, no patchy thrush noted. NECK: Supple with JVP of 7cm. No cervical LAD LN: No head/neck lymphadenopathy, no groin/axillary/supraclavicular nodes noted CARDIAC: PMI nondisplaced. Irregular rhythm, S1/S2 appreciated, [**3-11**] holosystolic murmur at apex, no rubs/gallops. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Respirations were unlabored, no accessory muscle use. CTA bilaterally. No crackles, wheezes or rhonchi. ABDOMEN: large vertical 11" midline well healed scar, soft, NTND. No HSM or tenderness. Obese. Unable to palpate spleen but limited due to habitus. EXTREMITIES: 1+ bilateral pedal edema, 2+ pedal pulses bilaterally SKIN: Left thigh with outlined erythema of approximately 4x4x5" area and large central 2cm boil with pus at edges, no bleeding, no palpable masses but area edematous with scattered satellite boils and furuncles. No rashes. Stasis dermatitis at lower extremities. No petechiae. NEURO: CNs [**3-17**] grossly intact, no focal sensory or motor deficits, gait assessment deferred . At Discharge: FAMILY HISTORY: Patient states his mother died of CVA at 89yo, father died of MI at 69yo. He had an aunt who had cancer and died in 50s when he was young but he is uncertain of additional details and type of maliganncy. Patient denies any other known blood conditions or malignancies in family. SOCIAL HISTORY: The patient is married and lives on [**Location (un) **] with his wife and daughter. [**Name (NI) **] is a retired autobody worker. Of significance, he reports exposure to multiple fumes and paint chemicals over the years while he worked in auto industry. He smoked 1PPD x 20years and quit 35 years ago. He used to drink 24 beers/week but stopped drinking 10 years ago. No history of IVDU/ illicits. Patient states he was exposed to multiple fumes and chemicals while working in autobody business for many years. .

CHIEF COMPLAINT: Unresponsiveness PRESENT ILLNESS: In brief this is a 68yo M PMhx SBE c/b brain septic emboli, complex partial seizure d/o stable on neurontin (last seizure "many years ago"), AF on coumadin, a/w episode of unresponsiveness at rehab, initially treated in Neuro-ICU, including intubation for airway protection, now extubated but w continued lethargy and AMS, course complicated by aspiration PNA, now on broad spectrum abx (gent/aztreo/vanco) w improving respiratory status, stable mental status, being called out to medicine floor for continued management of PNA and discharge placement. MEDICAL HISTORY: -hx staph endocarditis in [**2137**] s/p valve replacement and L occipital bleed [**1-9**] mycotic aneurysm rupture -seizure disorder - prior notes report episodes of losing track of time, simple partial seizures manifested as loss of speech with right arm sensations and some confusion. other events with distorted auditory sensations. also occasionally with secondary generalization. -mild R-sided weakness at baseline -afib on coumadin -cognitive problems -depression -abdominal abscesses requiring splenectomy and duodenojejunostomy -cholecystecotomy -excision of R hepatic artery aneurysm and ligation of R hepatic artery -hepaticojejunostomy MEDICATION ON ADMISSION: -risperdal 0.5 mg [**Hospital1 **] -celexa 40 mg daily -folate 1 mg daily -trazadone 200 mg daily -vitamin B12 [**2153**] mcg daily -coumadin 4 mg daily -clonazepam 1 mg tid -neurontin 900 mg tid -digoxin 0.25 mcg daily ALLERGIES: Cephalosporins PHYSICAL EXAM: ON TRANSFER TO MEDICINE SERVICE VS: 99.1 75 117/70 95%3L GEN: Elderly male, NAD, comfortable HEENT: PERRL, EOMI, OP dry NECK: supple, no JVD, no LAD LUNGS: mildly ronchorus throughout CV: Irregularly irregular, II/VI systolic murmur at RUSB Abd: Soft, NT/ND, naBS, no [**Doctor Last Name **], no CVA tenderness Ext: 2+ DP/PT/radial pulses, no c/c/e Neuro: AOx2 (person+time), 5/5 strength x 4 ext, no pronator drift ON DISCHARGE VS: 96.6 104/54 61 16 92%RA GEN: Elderly male, NAD, comfortable HEENT: PERRL, EOMI, OP dry NECK: supple, no JVD, no LAD LUNGS: mildly ronchorus at bases, upper airway noises throughout CV: Irregularly irregular, II/VI systolic murmur at RUSB Abd: Soft, NT/ND, naBS, no [**Doctor Last Name **], no CVA tenderness Ext: 2+ DP/PT/radial pulses, no c/c/e Neuro: AOx3, 5/5 strength x 4 ext, no pronator drift FAMILY HISTORY: Mother had DVT, unknown cancer. Sister had ? breast CA. 2 brothers with ETOH. SOCIAL HISTORY: Does not smoke, drink or use illicit substances. At current baseline, can dress, toilet,bath, feed, cook, shop, take public transportation and is having problems managing his medications. He has not balanced his own checkbook or paid bills for a long time. He used to work in real estate, work as a part-time chaplain, and was a marathon runner. Has 2 brothers and a sister. [**Name (NI) **] been primarily living in [**Hospital3 **], but most recently has had increasing difficulty functioning on own, resulting in recent rehab stays

CHIEF COMPLAINT: referral for paraesophageal hernia repair contributing to GI bleed PRESENT ILLNESS: 61-year-old man who was referred from PCP to Dr. [**Last Name (STitle) 57300**] for surgical evaluation of a large hiatal hernia with ulcer and significant blood loss- microcytic anemia. Patient c/o of fatigue from blood loss. He obtained a barium swallow and a motility study to evaluate the anatomy and propulsive force and the decision to proceed to surgery was made with patient. MEDICAL HISTORY: His past medical history is notable for a history of cardiomyopathy and some mild congestive heart failure. He has had atrial fibrillation in the past and been cardioverted twice. He has been on Coumadin and amiodarone in the past, but has now been in sinus rhythm and is off both medications. There is some question history of a septal defect of the heart but has not had any surgery. His past surgeries include an appendectomy, several knee surgeries including five arthroscopic surgeries on the left knee. MEDICATION ON ADMISSION: Bupropion HCl [Wellbutrin XL] Dosage uncertain (Prescribed by Other Provider) [**2199-6-10**] Recorded Only DELORIE, [**Doctor Last Name **] nr Enalapril Maleate Dosage uncertain (Prescribed by Other Provider) [**2199-6-10**] Recorded Only DELORIE, [**Doctor Last Name **] nr Esomeprazole Magnesium [Nexium] Dosage uncertain (Prescribed by Other Provider) [**2199-6-10**] Recorded Only DELORIE, [**Doctor Last Name **] Allergy Alert nr Furosemide [Lasix] Dosage uncertain (Prescribed by Other Provider) [**2199-6-10**] Recorded Only DELORIE, [**Doctor Last Name **] nr Iron-B12-IF-FA-MV-Min-DSS [HEMAX] nr Metoprolol Succinate [Toprol XL] nr Modafinil [Provigil] nr Sucralfate [Carafate] Dosage uncertain nr Chlorpheniramine-Acetaminophen [Coricidin] Dosage uncertain nr Vitamin E Dosage uncertain ALLERGIES: Protonix / Cortisone / Motrin PHYSICAL EXAM: At time of discharge: Afebrile, VSS Alert, oriented x 3, NAD RRR CTAB Abdomen soft; steri strips in place over surgical incisions LE warm, some edema of L knee, 2+pulses FAMILY HISTORY: Family history is notable for diabetes in his mother and lung disease in his father. SOCIAL HISTORY: The patient drinks socially. He lives alone. He smoked three packs of cigarettes a day for approximately 10 years, but quit 40 years ago. He works as a social worker in a psychiatric [**Hospital1 **].

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname **] is an 84-year-old gentleman with medical history significant for atrial fibrillation treated with Coumadin and glaucoma. He presented to the [**Hospital1 69**] Emergency Room on [**8-12**] from [**Hospital3 4527**] Hospital for treatment of a subdural hematoma following a fall. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: SSCP DOE PRESENT ILLNESS: 64yo man with h/o CAD s/p multiple percutaneous interventions, HTN, hypercholesterolemia, who had SSCP 2wks PTA, was scheduled for ETT, had PND and palpitations on PM PTA, then NSVT on DOA during his ETT and was transferred to [**Hospital1 18**] for cath. Pt's CAD history consists of angioplasty of OM1, OM2 in [**2165**], a crown stent placed in his LAD in [**2172**], a relook in [**2173**], and a cath in [**7-/2174**] that showed EF 42%, OM1 99% stenosis, OM2 100% stenosis, RCA 20-30% stenosis, LVEDP 12 mmHg, moderate global hypokinesis with LVEF 42%. No intervention done at that time. Patient was in his USOH until 2 weeks PTA, when he had SSCP while jogging on a treadmill that ended on its own, no associated symptoms, no N/V, radiations, no diaphoresis, [**4-25**] pain at worst. He went in to his ETT on AM of admit, started exercising and was stopped by the tech for NSVT of 3 beats. [**Hospital 3390**] transfer to [**Hospital1 18**] for cath. In cath, pt was found to have right dominant system, single vessel coronary artery disease, LMCA clear, LAD patent stent, LCX with TO of OM2 branch, filling via collaterals, RCA tortuous mid vessel 50 to 60% stenoses, LVEDP 14 mm Hg, LVEF 53%, no MR. Pressure wire was placed in mid-RCA with FFR 0.6 (>0.75 indicating restricted flow); during attempts at stent placement dissection occurred, pt had [**8-25**] "elephant sitting on my chest" pain; one stent was placed proximal to the lesion, Fentanyl given, IABP started, pain relieved, pt sent to CCU. MEDICAL HISTORY: 1. Hypercholesterolemia 2. HTN 3. CAD as in HPI 4. GERD MEDICATION ON ADMISSION: Lipitor 10mg qd ASA 81mg qd Atenolol 25mg qd Diltiazem 60mg [**Hospital1 **] Protonix ALLERGIES: Lidocaine / Wheat Starch PHYSICAL EXAM: On admit: Vitals: HR 72 RR 18 BP 150/69 O2 sat 96%ra Gen: middle-aged man, pleasant, lying flat on bed with IABP Skin: warm and dry skin, no rash HEENT: nc/at, perrl, eomi, op clear, mmm CV: RRR, [**2-20**] syst murmur at apex, JVP flat Lungs: trace rales lower [**1-17**] bilaterally Abd: soft, nt, nd, no HSM Groin: R -- A + V sheaths in place; ecchymosis, tender; L -- A sheath with IABP in place; ecchymosis, tender; no bruits on either side Ext: no lower extremity edema, 2+ DP and PT pulses b/l, no clubbing, cyanosis or erythema Neuro: nonfocal exam, sensation intact FAMILY HISTORY: noncontributory SOCIAL HISTORY: etoh: social tob: quit [**2164**] drugs: none

CHIEF COMPLAINT: s/p fall down 8 steps PRESENT ILLNESS: 83M with CAD (MI [**09**] years ago, CABG #1 30 years ago at [**Last Name (un) 1724**], CABG #2 20 years ago at [**Last Name (un) 1724**]), ICD/PCM who was in his usual state of health until [**10-6**] when he fell while carrying a door up some stairs. He was taken to an OSH where he was awake but perseverating. He then started vomiting. He was paralyzed and intubated to protect his airway. He wastransferred to [**Hospital1 18**] where a Head CT showed SAH (massive SAH, bilat SDH. Downward transtentorial herniation. Effacement of the midbrain bilaterally, uncal herniation cannot be excluded. Occ fracture extending to the foramen magnum). . His course is complex and is summarized in the following follows. He was intubated in SICU on admission. On admission, he got 1 unit of platelets given. On [**10-7**], he was febrile with worsening head CT, however, he improved in respiratory status, was able to wean down from vent. Due to fever and concern for aspiration PNA, sputum cultures were sent, blood culture negative thus far. He was extubated on [**10-8**]. On [**10-9**], vanc/cefepime was started. He had a fall from bed. Subsequent CT head showed no significant change. He passed Speech and Swallow. The following day on [**10-10**], he was cleared from c-collar. Echo showed EF of 20-25% with LV thrombus calcified. He was restarted on home lasix. Renal function improving. ABX was dc'd as sputum showed 2+GPCpc/2+GPR/sparse yeast and no fever. He was cleared collar and tolerated POs. . Of note, CT Torso showed left upper lobe lung mass and subcarinal enlarged node is seen. Just below this there is a 3.8 cm mass, difficult to be certain whether this is in the left atrium or just extrinsic to it. There is also a calcified left ventricle aneurysm with thrombus. Multiple hypodensities in Splenic, left renal and left upper quadrant concerning for metastases. The is a left thyroid nodule, incompletely evaluated. . On transfer: VS at transfer: afebrile, 125/70, HR 90-100, RR 20-30, 90-100% on NC. MEDICAL HISTORY: CAD, V-paced, s/p CABG based on the scar Gout CAD CHF CRF MEDICATION ON ADMISSION: Allopurinol 100 mg daily Alprazolam 0.5mg TID ASA 81 mg daily Plavix 75 mg daily Digoxin 0.125 mg daily Lasix 40 mg [**Hospital1 **] Indomethacin 75 mg daily Imdur 60 mg daily Nazonex spray daily Potassium Chloride 20meq daily Ramipril 2.5mg Daily Ranitidine 150 mg daily Simvastatin 40mg qhs Sprionolactone 25mg daily Vitamine B daily Carvedilol 6.25mg [**Hospital1 **] ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: PHYSICAL EXAM: Gen: Intubated, sedated. Ext: cold to touch . Neuro: Off propofol: Pupils 3-2 mm, no corneals, no cough, no gag, not over breathing the vent. No movement to BUE except for some hand twitching to noxious. No movement with the BLE except for some twitching of his toes to noxious. . At the time of discharge the patient's neurologic exam was substantially improved. He was intermittently oriented x1-2 and responsive to basic commands. He was moving all extremities. FAMILY HISTORY: Family Hx: Unknown SOCIAL HISTORY: Social Hx: Quit smoking 30 years ago. Travels to [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **] (PCP in [**Name9 (PRE) 108**]). Travelled to [**Country 14635**] with the military. .

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: 80F with h/o MDS, HTN presented to OSH [**9-27**] with 2 days chills, cough productive of brown sputum, progressive SOB, DOE and orthopnea. No chest pain or pressure, + increased palpitations. Of note, hospitalized [**6-11**] for PNA and more recently was treated with abx for cough, completed course 2 weeks PTA. At OSH, AF, sat 79% RA, 90% 3L, crackles bilaterally, + LE edema, WBC 54.6(43.6 [**2191-9-13**]), Cr 1.6 (0.9 [**2191-6-19**]), BNP 1780, trop 0.02, UA 2+blood and protein. CXR showed cardiomegaly, diffuse bilateral alveolar infiltrates and bilateral blunting of costophrenic angle. EKG NSR @ 76, low voltage. EF 60% 4/12. Began Ceftriaxone and azithromycin, IV lasix 80mg [**Hospital1 **]. WBC peaked at 63.4 [**9-29**], Hgb 7.6-8, hct 22.1-23.1, plt 15-16, Cr 1.6-1.7, trop peak 0.07.ABG [**9-29**]: 7.46/45/64 FiO2 100%. TTE showed EF 55-60%, borderline LVH with LV dilatation, unable to r/o diastolic dysfunction, trace pericardial effusion, mild AI and MR. On arrival to the MICU, AF, 87-99% 5L facemask-> Venturi Mask 50%. Desats to 80s while talking. MEDICAL HISTORY: -MDS: Diagnosed~ [**2189**]. On Aranesp. WBC typically 40-50, transfusion parameters HGB <8, plt<10 or signs of bleeding. [**2191-9-21**] 2 units PRBC per OSH report. Also transfused PRBCs and plts while hospitalized for PNA per patient. Chronic bruising. -UTI: Reports frequent UTI requiring abx q 2-3 months, no h/o incontinence or retention. -PNA: as per HPI -HTN -Depression -Glaucoma -Insomnia MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Lisinopril 10 mg PO DAILY 2. Amlodipine 10 mg PO DAILY 3. Lunesta *NF* (eszopiclone) 3 mg Oral HS prn insomnia 4. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES [**Hospital1 **] 5. Dorzolamide 2% Ophth. Soln. 1 DROP BOTH EYES [**Hospital1 **] 6. Lumigan *NF* (bimatoprost) 0.03 % OU unknown 7. Escitalopram Oxalate 10 mg PO DAILY ALLERGIES: Sulfa / Belladona PHYSICAL EXAM: ADMISSION EXAM: Vitals:Tm 99.5 p71-75 BP 107-128/40-51 R17-28 87-99% 5L facemask-> Venturi Mask 50% General: Alert, oriented x 3, breathing comfortably without accessory muscle use HEENT: Sclera anicteric, MMM, oropharynx clear, PERRL Neck: supple, no LAD CV: Regular rate and rhythm, normal S1 + S2, 2/6 systolic murmur RSB Lungs: bilateral crackles to mid lung fields Abdomen: soft, non-distended, bowel sounds present, no organomegaly, +tenderness to palpation RUQ, no rebound or guarding GU: foley in place Ext: Warm, well perfused, 2+ pulses, + mild pitting edema to ankles Neuro: moves all 4 extremities, gait deferred. FAMILY HISTORY: Sister with leukemia age [**Age over 90 **]. Father died from MI age 74. Mother CVA age 90s. SOCIAL HISTORY: Husband died 5 years ago. Lives alone in house, no children, niece [**Name (NI) 2048**] [**Name (NI) 112224**] lives in [**Location 86**] area. 10 pack year smoking history, quit [**2162**]. No EtOH or illicits.

CHIEF COMPLAINT: Mental status changes and confusion. PRESENT ILLNESS: Mr. [**Known lastname **] is a 75-year-old right-handed man with CAD, CHF, h/o stroke, paroxysmal atrial fibrillation, and metastatic NSCLC cancer, s/p Cyberknife on [**2148-3-14**] to brain metastases who presents with progressive confusion over the past month. Patient is unable to provide any details of the events precipitating this admission; thus, history was obtained from his son [**Name (NI) 12041**] [**Name (NI) **]. He has had waxing and [**Doctor Last Name 688**] confusion for the past two weeks. His son states that he "seems to have lost his logic and common sense." He recognizes his family but has exhibited much confusion with performance of his ADL's. Son reports that he has only been putting on his left shoe and walking around the house with only one shoe on. Similarly he has had difficulty with putting on only one side of his pants. He has not been performing self-hygiene and has not been taking medications. Family has noticed changes in his balance, and patient reports that he has fallen twice in the past week. His son recently noticed scratches on his arms and legs, but a fall was never witnessed. He frequently complains of fatigue and has been sleeping more than usual. Patient has not reported any dizziness. He has had one episode of urinary incontinence approximately one month ago, but otherwise has been using the bathroom unassisted. He has not had any observed seizure-like activity or fecal incontinence. In the ED, vital signs were 97.6 F, heart rate 105, blood pressure 148/89, respiratory rate 18, and oxygen saturation was 96% on room air. He received Decadron 10 mg PO x 1. CT head was performed and he was evaluated by Neurology consult. He was admitted for further work-up to the Oncology Medicine service. MEDICAL HISTORY: 1) NSCLC w/brain metastases (see below) 1) CAD - s/p inferior STEMI [**11-15**], stent to left circumflex 2) CHF(EF 55% on [**4-16**]) 3) HTN 4) Paroxysmal afib 5) CVA 6) Left LE DVT on coumadin 7) s/p prostatectomy 8) s/p IVC filter MEDICATION ON ADMISSION: Not documented. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital Signs: Temperature 97.9 F, HR 98, BP 154/87, RR 18, SpO2 99% on RA GENERAL: elderly male, supine in bed, smiling HEENT: clear OP, MMM, sclera anicteric CARDIOVASCULAR: RRR, nl s1 S2, no m/r/g RESPIRATORY: Decreased breath sounds RUL ABDOMEN: soft nt/nd, +BS EXTREMITIES: warm, well-perfused, no clubbing/cyanosis/edema FAMILY HISTORY: Father and mother had CAD. SOCIAL HISTORY: Originally from [**Country 651**], cantonese speaking. Retired. Worked a variety of jobs, including in restaurants. Lives with wife and one of his sons. [**Name (NI) **] three kids. He is a non-smoker, occasional ETOH, AND no drugs.

CHIEF COMPLAINT: Direct admission for deep venous thrombosis from radiology. PRESENT ILLNESS: This is a 63 year-old male with extensive recent medical history began with coronary artery bypass graft for coronary artery disease in [**2187-1-18**], discharged and then readmitted on [**2187-2-27**] for shortness of breath. He was subsequently found to have a hemothorax, gastrointestinal bleed and acute renal failure. A chest tube was placed and esophagogastroduodenoscopy performed, which showed a duodenal nonbleeding ulcer. His Plavix was held and his aspirin was held as well and was started on a high dose PPI and transfused for a low hematocrit. During his hospitalization a right subclavian line was readmitted on [**3-5**] for right arm swelling with a subclavian deep venous thrombosis. He was started on heparin and again had an upper gastrointestinal bleed described as severe requiring multiple transfusions and a MICU stay. He was discharged on the [**2-11**] and followed up with Dr. [**Last Name (STitle) **] after this who felt that his right leg was a bit swollen suggested an ultrasound evaluation for deep venous thrombosis. On the day of admission the patient was at ultrasound and was diagnosed with a right lower extremity deep venous thrombosis and was told to go to the [**Hospital1 69**] for a direct admit. The patient reports that since his last discharge he has not been able to ambulate as well, because limited by shortness of breath, but not leg pain. He has not experienced any angina nor orthopnea or paroxysmal nocturnal dyspnea, but sits up and sleeps due to swelling in his upper and lower extremities. He has no history of coagulopathies or hypercoagulable studies. No recent travel. No extended sitting at home other then when he is resting for his leg swelling. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft in [**2187-1-18**]. 2. Cadaveric renal transplant. 3. Hypertension. 4. Diabetes. 5. Gastrointestinal bleed. 6. Deep venous thrombosis. 7. Anemia. 8. Depression. 9. Gout. 10. Appendectomy. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He lives at home with his wife.

CHIEF COMPLAINT: chest pain, shortness of breath PRESENT ILLNESS: 57F with history of dyspnea on exertion and nonexertional left arm numbness for the past several years who had new onset chest pressure and pain the morning of [**2144-3-19**] accompanied by left arm heaviness and pain radiating across the chest to the right arm. This was associated with nausea, diaphoresis, and shortness of breath. The pain/pressure was partially relieved few hours later after her husband came home from work and gave her aspirin. In the ambulance, the pain was fully relieved by SLNGx3; however, the pressure did not resolve until after getting IV morphine x3 at [**Hospital3 3583**]. CBC w/ WBL 10.8, hct 42, plt 311K, CHEM 7 WNL, creat 0.7, gluc 119. Initial ECG showed <1mm ST elevation in III and TWI in I, AVL. Remained CP free overnite. By the morning of [**2144-3-20**], the ST elevation had resolved and TWI now appeared in III along with ?Q wave development. She had less severe chest discomfort that resolved with 2'' nitropaste and morphine. CK was 53 and TnT<0.038 then CK 250/trop 1.57 in the 2nd set. At [**Hospital1 46**], she was also given zofran, nitropaste, plavix 75, metoprolol 12.5, and lipitor 10 for diagnosis of "myocardial infarction, calcified trileaflet aortic valve with mild aortic stenosis." . She was tx to [**Hospital1 18**] for emergent cardiac cath. Pt was found to have severe AS, area 0.7. She had distal total RCA occlusion for which PCI was unsuccessful. LMCA proximal 20%. Anatomy was right dominant. Elevated LV and RV filling pressures. MEDICAL HISTORY: chronic low back pain, no prior cardiac history, TAH [**2130**], Tonsillectomy age 10 MEDICATION ON ADMISSION: Home Meds: MVI, estrogen ring started about 3 mo ago. \ Meds on transfer: plavix 75 daily lopressor 12.5 [**Hospital1 **] lipitor 10 daily ECASA 325 daily tylenolol prn morphine prn nitro prn nitropaste 1 in q 6 hr magaldrata plus prn dyspepsia Methocarbamol 750 mg qhs Etodolac 400 mg [**Hospital1 **] ALLERGIES: Penicillins PHYSICAL EXAM: Gen:NAD, appropriate HEENT: PERRL, EOMI, MMMI, OPC CV: RRR, SEM w/ rad to neck III/VI, JVP 1cm above sternal angle FAMILY HISTORY: mother with CHF and heart murmur, no early MIs SOCIAL HISTORY: no tobacco, alcohol, illicit drugs. lives with husband; 2 children; recently returned from vacation in NH about 3 days ago.

CHIEF COMPLAINT: rectal bleeding PRESENT ILLNESS: Ms. [**Known lastname **] is an 83 y/o woman with PMH notable for type 2 DM, hypertension, and recent NSTEMI who presented to the ER after several episodes of bright red blood per rectum starting last evening. The patient states that she went to move her bowels and noted bright blood in the toilet; she has a history of hemorrhoids but this typically presents as red blood on toilet tissue. She noted several more stools filling the toilet bowl with bright red blood. She also noted some clots. She noted dizziness per ED notes but denies this to me. She also reports fatigue. . On arrival to the ED, the patient's initial VS were T 98.8, HR 84, BP 156/79, RR 16, 100% on RA. On exam, there was no evidence of obvious bleeding hemorrhoid but there was bright red blood on rectal exam. Two 18 g PIVs were placed. Hematocrit was found to decrease from recent 31 --> 26 and 23. GI was contact[**Name (NI) **] and their recommendations are pending. He is now admitted to the MICU for further workup. . On arrival to the MICU, the patient's first unit of PRBCs is hanging. She denies any abdominal pain, chest pain, difficulty breathing, or dizziness. She endorses some rectal pain, especially when moving her bowels last night. MEDICAL HISTORY: NSTEMI (diagnosed during admission [**9-1**]) * DM type II (recent admit for hypoglycemia, glipizide stopped) * Mild-moderate diabetic retinopathy * HTN * Arthritis * Cataracts MEDICATION ON ADMISSION: aspirin 325 mg daily * colace 100 [**Hospital1 **] prn * ibuprofen prn * losartan 100 mg daily * metformin 500 mg [**Hospital1 **] * toprol XL 25 mg daily * pravastatin 40 mg daily * tylenol prn * timolol 0.5% eye gtt twice daily to left eye * isopto hyoscine eye drops to left eye ALLERGIES: Ace Inhibitors PHYSICAL EXAM: PE: T: 98.5 BP: 172/70 HR: 83 RR: 18 O2 98% RA Gen: Pleasant elderly female in no distress, lying in bed HEENT: no scleral icterus, L pupil large but reactive, R pupil reactive NECK: supple, JVP at 7 cm, no lymphadenopathy CV: rrr, 2/6 systolic murmur at LUSB LUNGS: clear bilaterally, no wheezing or rhonchi ABD: soft, hypoactive bowel sounds, nontender throughout EXT: warm, trace pitting edema bilateral LE, dp pulses 1+ bilaterally SKIN: no rashes NEURO: alert & oriented to self, place not oriented to time, speech somewhat difficult to understand given dentures out & accent, face symmetric, moving all extremities . FAMILY HISTORY: Son in good health. SOCIAL HISTORY: Patient was born in [**Country **]. Moved to the United States in [**2075**]. Currently living with her daughter. Previously worked as a housekeeper at [**Hospital 13128**]. Denies tobacco/EtOH.

CHIEF COMPLAINT: 16' fall off ladder PRESENT ILLNESS: 66M fell off ladder, struck left side, with + LOC. MEDICAL HISTORY: hyperchol, HTN MEDICATION ON ADMISSION: lipitor 20, budeprion 150', lisinopril 20', fluoxetine 40' ALLERGIES: Codeine PHYSICAL EXAM: Gen: NAD Neuro: A&Ox3, ambulatory Chest: CTAB RRR Abd: S/NT/ND Ext: wnl FAMILY HISTORY: non-contributory SOCIAL HISTORY: non-contributory

CHIEF COMPLAINT: Transfer for Trach and PEG PRESENT ILLNESS: 70 y/o male with PMHx significant for recent MCA stroke, CHF (LVEF 15%) who was initially at [**Hospital1 18**] in [**2141-1-12**] for MCA stroke. Patient during that admission developed MRSA PNA and sent to [**Hospital **] rehab for completion of antibiotics. At [**Hospital1 **] got nosocomial PNA initially treated with vanc/zosyn as well as developed CHF exacerbation. He was intubated and then extubated for 72 hours and then needed to be re-intubated for hypoxic respiratory failure. He was extubated again and then reintubated after failing bipap for 24-48 hours. He was noted to have a persistant WBC count and underwent CXR which showed increased R pleural effusion. A thoracentesis was done which drained 600cc of exudative fluid that was cloudy (LDH 1200 and glucose 5). A chest tube was placed which drained approximately 2L and grew E. Coli from his sputum and chest tube drainage. At that time he was switched from zosyn to aztreonam based on sensitivities. His WBC count decreased and his clinical condition improved so he underwent another trail of extubation on [**4-24**]. He started to decompensate 24 hours later felt to be in heart failure so given Bipap and maxamized cardiac meds. He continue to fail and was re-intubated on [**4-26**] felt to be because patient too weak and unable to clear secreations. After discussion with patient's sister decision made to have patient undergo trach and PEG so transferred to [**Hospital1 18**]. MEDICAL HISTORY: - Hypertension - hypercholesterolemia - disc bulge L4-5 w/o herniation - hx of osteomyelitis T12-11 [**2136**] - screening carotid study '[**37**]: bilateral mild to moderate carotid stenosis - s/p laminectomy thoracic spine - Cardiomyopathy with LVEF 10-15% - Ischemic MCA CVA - Paroxymal Afib - History of GI bleed - Aspiration PNA (patient failed speech and swallow in past) - CRI with baseline Cre 1.8-2.2 . MEDICATION ON ADMISSION: Hydralazine 50mg q8 Lasix IV 40mg q12 Isosorbide dinitrate 30mg q8 Tylenol 1000mg q6 Fentanyl gtt Versed gtt Metoprolol 75mg q8 Aztreonam 1gm IV q8 Digoxin 0.125mg qod Protonix 40mg q24 Flagyl 250mg q6 Atrovent/albuterol INH MVI Ascorbic Acid Heparin SC Darbepoetin alpha 100mcg q7d RISS Ferrous sulfate 325mg daily ALLERGIES: Keflex PHYSICAL EXAM: PE: T 97.0 BP 119/65 HR 89 AC 450x14 PEEP 5 Fio2 100% O2Sat 100% 7.51/48/404 Gen: Large male, sedated left eye droop Heent: Intubated, OG tube in place Chest: CT tube sounds, diffuse ronchi; R chest tube in place Cardiac: RRR S1/S2 no murmurs appreciated Abdomen: obese, soft, active bowel sounds Ext: +2 edema in LE and UE b/l; heel ulcer, FAMILY HISTORY: Non contributory SOCIAL HISTORY: From [**Hospital **] rehab. No history of tobacco, history of heavy alcohol use (2 pint/day) but has been less recently. Retired biochemist.

CHIEF COMPLAINT: Shortness of breath, cough PRESENT ILLNESS: Mr. [**Known lastname **] is a 55 year old Creole speaking man with multiple myeloma on Velcade and Cytoxan and s/p failing renal transplant [**11-7**] on tacrolimus and currently on HD who presented to the ED on [**12-30**] with dyspnea and non-productive cough. He developed a "high fever" and chills with a nonproductive cough on [**12-29**] and came in to the ED after developing dyspnea [**12-30**]. He had chest discomfort with coughing, but no pleuritic pain and no hemoptysis. No known sick contacts or recent travel, denies h/o +PPD but not sure when this last was done. He had received in influenza vaccination [**11-7**]. Had been hospitalized [**Date range (1) 14048**]. . Review of systems negative for sweats, abdominal discomfort, nausea, vomiting, diarrhea, myaglias, arthralgias, rhinitis, sore throat, headache. . In the ED, vitals were T 102.4 P 105 Bp 185/91 RR 16 O2 94% on room air. His chest film showed a RLL opacity and he was started empirically on vancomycin, ceftazidime, and levofloxacin. Due to tachypnea 20-30[**Hospital **] transferred to [**Hospital Unit Name 153**] for close observation. Admission labs notable for WBC 2.1 (57% polys no bands) and lactate of 2.7. MEDICAL HISTORY: 1. Multiple myeloma diagnosed [**11-7**] - s/p cytoxan and high dose decadron end of [**11-7**] - currently on on velcade/cytoxan q2wks. last seen in clinic [**12-28**] cytoxan held for WBC 1.5, velcade given however 2. s/p DDRT [**2187-11-3**], graft failing now back on HD - on tacrolimus, cellcept held in setting of cyclophosphamide tx - still makes some urine 3. h/o ESRD secondary to HTN on HD from [**2183**]-[**2187**] thought at that time to be [**2-2**] HTN 4. s/p L AVF [**2-3**] 5. HTN 6. Hepatitis B 7. Hordeolum MEDICATION ON ADMISSION: Medications: per OMR Docusate Sodium 100 mg PO BID Amlodipine 10 mg PO DAILY Omeprazole 20 mg PO once a day Nystatin 500,000 unit/mL Suspension PO QID Oxycodone 5 mg Tablet PO Q6H as needed for pain. Acylovir 400 mg PO DAILY Toprol XL 75 mg [**Hospital1 **] (though conflicting note states pt is on lopressor 75 mg [**Hospital1 **]) Trimethoprim-Sulfamethoxazole 80-400 mg One Tablet PO DAILY Calcium Acetate 1334 mg PO TID W/MEALS MVI Tacrolimus 8 mg PO twice a day Doxazosin 2 mg PO HS Zofran prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam [**Location (un) 3242**] floor [**12-31**] Tmax 102.8 (4:30pm [**12-30**] in ED) T 99.6 P 96 BP 126/71 RR 22 O2 95% RA General: Appears older than stated age, coughing occasionally in mild respiratory distress HEENT: Sclera white, conjunctiva pale, moist mucus membranes, no thrush or other oral lesions. R eyelid slight swollen Neck: No cervical or supraclavicular adenopathy Pulm: Speaking in full sentences. No dullness to percussion, +rhonchi, +crackles L>R CV: Regular rate S1 S2 II/VI systolic murmur Abd: Soft, +bowel sounds, mild tender epigastrium and over allograft in LLQ Extrem: Warm, well perfused, tr ankle edema. Fistula L forearm with palpable thrill. Neuro: Alert, interactive, moving all extremities with no gross deficits Derm: Skin warm to touch, no rash FAMILY HISTORY: noncontributory SOCIAL HISTORY: 4 children, supportive in [**Location (un) 86**] area. He lives with a friend and does not work. He had been a preacher, last job was cab driver 4 years ago. He has never smoked, denies any alcohol usage. States he has never used illicts. Native language Haitian Creole. His son [**Name (NI) **] [**Name (NI) **] is his HCP. Immigrated to the US ~ [**2160**], lived in [**Location 2848**] ~5 months then but in [**Location (un) 86**] otherwise without residence elsewhere in US. No pets at home.

CHIEF COMPLAINT: syncope PRESENT ILLNESS: 66 year old man with CAD s/p CABG and mechanical AVR in [**2142**], with multiple medical problems who has been hospitalized frequently in the past year, presented to OSH with chest pain and SOB on [**3-19**]. He was diagnosed with PNA and ruled out for MI. He completed a course of azithro and CTX and was ready for rehab. . On [**3-27**], reports say that he was walking in the hallway when he had a vfib arrest. He was defibrillated and subsequently developed PEA arrest and bradycardia. Epi was given and he was intubated and sent to the CCU at OSH. Temporary pacing wires were placed. His vfib arrest may have been due to hyperkalemia (K=6.1) although he did not have any EKG changes prior to arrest. He was also on dopamine. . Neurology consult was called and they did not note any focal neurological deficits while he was intubated. Cardiology consult was called and they believed he may need an ICD for his vfib arrest. On [**3-31**], he was extubated and dopamine was stopped. He was transferred to [**Hospital1 18**] for cath and ICD placement. MEDICAL HISTORY: ) CAD, s/p CABG (in [**2142**]) 2) Status post AVRx2, (St. [**Male First Name (un) 1525**] Mechanical valve in [**2142**] revision) 3) CVA (complication of [**2142**] CABG/AVR) 4) Congestive heart failure, EF 45% 5) Paroxysmal atrial fibrillation 6) COPD 7) Multiple pneumonias, twice requiring intubation. 8) Diabetes type II 9) Bladder cancer 10) History of alcohol abuse 11) History of drug abuse 12) Gastroesophageal reflux disease 13) Depression/Anxiety . Cardiac History: CABG, in [**2142**] anatomy as follows: LIMA to LAD SVG to PDA MEDICATION ON ADMISSION: HOME MEDICATIONS: Albuterol nebs q6H Oxycodone 10 q4H Lisinopril 10 Aldactone 25 Coreg 6.25 [**Hospital1 **] Lipitor 20 Lasix 40 Protonix 40 Fentanyl patch 50 q72 Trazadone 50 QHS Depakote 500 Ativan q4 PRN Olanzapine 10 QHS Folic acid 1 coumadin 7.5 mg qhs . TRANSFER MEDICATIONS: Ceftriaxone 1 Vanc 1 q 12 Lasix 40 IV daily Protonix 40 albuterol Atropine 0.5 mg four times daily-- ???? Valproic acid 750 QHS Lipitor 20 Folic acid 1 Olanzipine 5 Regular insulin sliding scale Haldol PRN Ativan PRN Metoprolol IV PRN Morphine PRN Albuterol/atrovent nebs PRN Trazadone 50 PRN Riopan 10 four times daily PRN . ALLERGIES: NKDA ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 98.9, BP 105/48, HR 63, RR 18, O2 98% on 5LNC Gen: A+ox2, somnelent, follows simple commands and answers simple queastions HEENT: PERRL, Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with JVP of 10 cm. CV: Regular rate. S1 and mechanical S2. No M/G/R. Chest: Resp were unlabored, no accessory muscle use. Bibasilar crackles, left > right half way up. No wheezes or rhonchi. Abd: Soft, NTND, No HSM or tenderness. Ext: No c/c/e. Pulses: Right: 1+ DP, 2+ TP Left: 1+ DP, 2+ TP FAMILY HISTORY: non contributory SOCIAL HISTORY: Continues to smokes half a pack of cigarretts daily. No alcohol use. .

CHIEF COMPLAINT: PRESENT ILLNESS: Ms. [**Known firstname 72073**] [**Known lastname 93554**] is a 68-year-old woman with a history of rheumatic fever and mitral regurgitation, who had two valvuloplasties in the past in [**2105**] and [**2133**], referred from Dr. [**First Name (STitle) 2031**] to [**Hospital1 346**] for a potential mitral valve replacement. She had undergone a cardiac catheterization in [**2144-8-9**] that revealed normal coronaries, moderate mistral stenosis, and mild mitral regurgitation, as well as mild diastolic ventricular dysfunction, with moderate pulmonary hypertension. She is being admitted to [**Hospital1 190**] at this time for anticoagulation with heparin so that she can come off of her Coumadin in preparation for a mitral valve replacement by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. MEDICAL HISTORY: 1. Rheumatic fever. 2. Atrial fibrillation; status post permanent pacemaker. 3. Hypercholesterolemia. 4. Diabetes mellitus. MEDICATION ON ADMISSION: 1. Digoxin 0.25 once per day. 2. Coumadin 5 mg once per day (she stopped on [**3-3**]). 3. Neurontin 300 mg twice per day. 4. Potassium 20 mEq twice per day. 5. Lipitor 10 mg once per day. 6. Aldactone 25 mg once per day. 7. Glucophage 850 mg three times per day. 8. Glyburide 5 mg twice per day. 9. Lasix 120 mg once per day. 10. Ferrous sulfate 325 mg once per day. 11. Z-pack (which she finished on the day of admission). ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is married with three children. She lives with her husband. She denies tobacco use. Occasional ethanol use.

CHIEF COMPLAINT: Chest pain and fatigue PRESENT ILLNESS: 76 yo F with chest pain and fatigue x 1 week presented to OSH with MI. Transferred to [**Hospital1 18**] fo cath. MEDICAL HISTORY: DM2 HTN TAH MEDICATION ON ADMISSION: glipizide HCTZ MVI ALLERGIES: Bactrim / Amoxicillin / Floxin PHYSICAL EXAM: Admission exam unremarkable FAMILY HISTORY: Father deceased from MI at 58 Mother lived to old age, had heart disease SOCIAL HISTORY: lives alone, independent no tob, occ. etoh.

CHIEF COMPLAINT: Vertigo, gait disturbance, headaches and short term memory loss. PRESENT ILLNESS: HPI: Pt is a 57 y/o with one-two weeks of vertigo and ataxia. She is left handed and has had changes in her handwriting and her writing often doe snot make sense. She also has been damaging her car while driving. She has had short term memory problems as well as spatial orientation issues. She has had several falls. She has had daily headaches after waking from sleep. She has had associated nausea for several days. Her right arm "feels heavy". She presented to [**Hospital3 **] ED and underwent CT imaging with revealed a right occipital mass. She was given Decadron and transferred to [**Hospital1 18**]. MEDICAL HISTORY: DM, HTN, anxiety MEDICATION ON ADMISSION: Cozaar 100 mg po QD, Effexor 37.5 mg po QD, Actos 40mg po QHS, Protonix 30 mg po QD, Hydrocodone prn, Glipizide 10 po BID ALLERGIES: Penicillins / Morphine PHYSICAL EXAM: On Admission: O: T:99.3 BP: 174/96 HR 79: R 16 O2Sats 97% Gen: WD/WN, comfortable, NAD. Obese HEENT: Pupils: 3.5-3mm B EOMs Full Extremities: congenital shortening of 2-3rd digits B. Neuro: Mental status: Awake and alert, cooperative with exam Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: non-contributory SOCIAL HISTORY: Social Hx: she reports rare ETOH use. She stopped smoking 5 years ago and smoked 1-1.5 packs per day prior to this time. She is a part time chef. She is left handed.

CHIEF COMPLAINT: ETOH Withdrawal, Chest, Abdominal, Arm and Hand Pain PRESENT ILLNESS: 37yoM with hx of polysubstance abuse, frequent ICU admissions and ED evals returns with alcohol intoxication and withdrawal. Pt reports currently using ETOH, and presenting for pain from a reported trauma approx 4 days ago at which time the patient reports being hit by a SUV. He states he signed out AMA from the [**Hospital1 3278**] ICU after this accident. Pt with a hx of withdrawal seizures as well as Section 35/Section 12 for ETOH abuse. The patient reports being acutely intoxicated currently, and most recently, drinking Listerine this am. Today the patient was found lying next to [**Company 2486**] where EMS was called and we has brought to the ED. Since leaving [**Hospital1 3278**] he has spent the past few days at [**Location (un) 7073**] Station, drinking Vodka during the day and Listerine at night "to prevent seizures". He believes his last seizure occurred three weeks ago. He notes pain all over his body - esp in his hands, chest, abdomen and legs. . In the ED, initial VS 98.3 120/88 116 16 100%2L: In the E.D. he received Morphine 6mg, Valium 50mg, Gabapentin 600mg, Toradol 30mg, 1 banana bag and 2 additional L of NS. He was monitored, but noted to be progressively more tremulous, tachycardic and reporting visual hallucinations. . Of note the pt has had recent admissions for EtOh withdrawal on [**11-9**] but left AMA. He returned to the ED on [**11-13**] for intoxication and was noted to have elevated amylase, lipase concerning for acute pancreatitis. Again, pt signed out AMA. The pt was admitted on [**11-18**], again for acute EtOH withdrwal, and signed out AMA on [**11-20**]. . On arrival to [**Hospital Unit Name 153**]: Pt tremulous, anxious, tachy to 110s, with some visual hallucinations, however not hypertensive or febrile. Pt denies fever, + chills, headache. Admits to chronic abdominal pain of [**8-14**] months duration. Pt also admits to chest pain of one weeks duration since being hit by a car. Pt also noted recent episodes of epistaxis, although none within the past few days. . MEDICAL HISTORY: Polysubstance abuse: ETOH, heroin, IVDU, benzodiazepines Hepatitis C (Diagnosed around [**2163**], Never treated) Hepatitis B Compartment syndrome RLE, [**2171**] OCD and anxiety Depression with hx suicidal ideations and attempts Alcohol abuse, hx DTs and withdrawal seizures MEDICATION ON ADMISSION: None ALLERGIES: Penicillins PHYSICAL EXAM: VS: 98.7 113/77 89 98 3LNC GEN: Anxious, cooperative. Alert to date, name but not to location HEENT: PERRLA Dry MM, jvp flat; Poor dentition CV: Tachycardic, reg, no murmurs RESP: CTABL, no w/r/r ABD: Soft/non-distended; mild tenderness throughout, hypoactive BS Ext: 1+ Bilateral upper extremity edema. good pulses SKIN: No rashes Neuro: AOx2, (not location), CN II-XII intact, Motor [**6-11**] bilat, Tremulous bilateral upper ext FAMILY HISTORY: Father with depression and alcoholism. Mother died of DM complications. SOCIAL HISTORY: Homeless, lives on streets. Denies IVDU for >10yrs. Denies cigs for>10 yrs. Denies SI or HI. He has a history of polysubstance abuse: EtOH, heroin, IVDU, benzo, h/o alcohol withdrawal seizures and DT's, h/o section 35. h/o incarceration for ETOH, estranged from family, never married, no children, homeless. Last worked 17 years ago as a grocery shelf stocker.

CHIEF COMPLAINT: right sided weakness PRESENT ILLNESS: Ms [**Known lastname **] is a 61 year old LEFT handed female who presents from an OSH s/p tPA after sudden onset of right sided weakness. Patients husband states that she was driving to go shopping however returned home at 2:20 pm on [**7-9**]. He states she was complaining that the right side of her face felt 'warm and numb.' He sat her down and went to call an ambulance because he noticed her speech became slurred. At that point she became unresponsive and would not open her eyes. EMS arrived and she was taken to an OSH. No seizure activity was detected. Patient was brought to an outside hospital where she was found to be hypertensive to the 210s systolically. She also had a negative noncontrast CT. Med flight was called for transfer to [**Hospital1 18**] ED for further care and en route patient was started on TPA (Patient was given a bolus and then started on a drip on her right based on 70.9 kg) after discussion with the stroke fellow and patients family. MEDICAL HISTORY: HTN, GERD, diverticulitis, lymphocytic colitis MEDICATION ON ADMISSION: HCTZ 25 mg daily, omeprazole 20 mg daily ALLERGIES: Dilaudid (PF) / Zofran PHYSICAL EXAM: ADMISSION EXAM: Temp: 98 HR: 87 BP: 134/87 Resp: 16 O(2)Sat: 99 Normal General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, no masses or organomegaly noted. Extremities:warm and well perfused Skin: no rashes or lesions noted. Neurologic: FAMILY HISTORY: mother had stroke in her 60's SOCIAL HISTORY: Married, has 1 daughter. Smokes [**1-17**] PPD, [**2-16**] glasses of wine daily, denies drugs. Works as special needs teacher.

CHIEF COMPLAINT: Pregnancy Post-partum hemorrhage Blood loss anemia PRESENT ILLNESS: This is a 31 year old female presenting at 39 weeks gestation admitted for induction secondary to worsening gestational hypertension. She was induced with cytotec x 2 and given an epidural. She was noted to have fetal bradycardia and was taken for an urgent c-section. She had an uncomplicated c-section until about 1 hour following her c-section she was noted to be passing large clots. She was given cytotec, but continued to have bleeding and was then taken to the OR. In the OR she was given hemabate, methergine. pitocin, and cytotec. Her uterus was noted to be atonic and D&C was performed, but due to persistent atonic uterus, laparotomy and subsequent supracervical hysterectomy performed. Laparotomy revealed a hemoperitoneum and boggy, enlarged, atonic uterus. Her operative course was notable for IVF 4200, EBL 4 L with urine output 500 with 5 units pRBC, 4 units of FFP, 1 bag of platelet as well as 500 albumin. She required brief neosynephrine for SBP 60s, then was weaned off with subsequent elevated SBP to 150s-170s. She was also reportedly given vercuronium during the procedure. . She arrived to the [**Hospital Unit Name 153**] intubated and sedated on propofol. She had her 5th unit of pRBC hanging at time of transfer. MEDICAL HISTORY: Panic disorder with agoraphobia Migraine headaches MEDICATION ON ADMISSION: PNV ALLERGIES: Amoxicillin PHYSICAL EXAM: Upon admission to the [**Hospital Unit Name 153**]: VITALS T: 96.2 BP: 149/84 P: 116 R: 18 VENT CMV Fi O2 40%, TV 500, RR 15, PEEP 5 GENERAL Intubated/sedated, pale LUNGS Clear to auscultation anteriorly HEART RRR, no m/r/g ABDOMEN Soft, dressing c/d/i GU Foley in place, yellow urine in tubing, minimal VB on [**Male First Name (un) **] LOW EXT No edema bilaterally FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Married, works doing fund raising. Denies tob/EtOH, illicit substances