Datasets:

sh190128

/

MP_IN_adm

like 0

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: 83 yo M with afib on coumadin, hypertension, HL and hypothyroidism sent in from PCP to the [**Name9 (PRE) **] today for an INR elevated to 10.7. He has newly found metastatic disease with bony lesions on hip MRI. Planned to see oncology soon with likely biopsy, but was brought in due to INR. He has had hip and groin pain for a couple months. Imaging was obtained by PCP recently showing multiple bony lesions. . In the ED inital vitals were, 98.0 100 100/75 16 94% RA. He was given 10mg PO vitamin K. CXR showed large left sided pleural effusion suspicious for lung mass. Bedside cardiac echo shows no pericardial effusion but large left pleural effusion. Given levaquin for question of pneumonia. Given a 500cc bolus for SBP 79. On transfer, SBP85 HR102 RR16 O2 95% on 4L. . On arrival to the ICU, he is comfortable and feeling well. He has no complaints. . 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: 1. Anxiety 2. Depression 3. Osteoarthritis 4. Sciatica 5. Hypothyroidism 6. Hypertension 7. Hypercholesterolemia 8. Question of atrial fibrillation - The patient is on Coumadin but is unclear why. This is managed through the [**Hospital **] Hospital. MEDICATION ON ADMISSION: CITALOPRAM - 40 mg Tablet - 1 Tablet(s) by mouth daily FINASTERIDE - 5 mg Tablet - 1 Tablet(s) by mouth daily LEVOTHYROXINE - 25 mcg Tablet - 1 Tablet(s) by mouth daily METOPROLOL TARTRATE - 25 mg Tablet - 0.5 (One half) Tablet(s) by mouth twice a day SIMVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth daily WARFARIN [COUMADIN] - 5 mg Tablet - 1 tab Fridays, [**11-16**] tab other days ACETAMINOPHEN - 500 mg Tablet - 1000 mg by mouth three times a day CALCIUM CARBONATE-VITAMIN D3 [CALCIUM 600 + D(3)] - 600 mg-400 unit Tablet - 1 Tablet(s) by mouth twice a day OMEGA-3 FATTY ACIDS-VITAMIN E [FISH OIL] - (OTC) - Dosage uncertain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucus membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: minimal lung sounds on left, clear lungs on right CV: Irregularly irregular no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ edema bilaterally Skin: warm and dry FAMILY HISTORY: sister - unknown cancer SOCIAL HISTORY: The patient is a widower. He moved from [**State 108**] [**Street Address(1) 87028**] [**Hospital3 **] to be near his sons. [**Name (NI) **] has one son in [**Name (NI) 620**] and another in [**Location (un) 3844**]. He walks one mile daily for exercise. - Tobacco: smoked 1PPD for 30 years, quit 30+ years ago. Significant second hand smoke from wife - Alcohol: None - Illicits: None

CHIEF COMPLAINT: Respiratory Failure PRESENT ILLNESS: Ms. [**Known lastname 46**] is a 79 year od female with chronic respiratory failure, h/o GBS in [**2101**], vented, s/p trach x 1 year. Frequent hospitalization for trach exchanges and stent placements. Admitted initially to thoracix surgery service with respiratory failure. Last month, the patient was admitted for worsening respiratory distress and gastrointestinal bleeding (diverticulosis and hemrrhoids). During that admission, bronchoscopy was performed, she was found to have severe tracheobronchomalacia for which she underwent a Y silicone stent placement. In addition, she had some component of tracheal stenosis, and her trach was changed to a Portex #7, which was telescoped through the Y-stent. She was also diagnosed with pneumonia based on peak WBC 23, right perihilar and left retrocardiac infiltrates and positive sputum cultures. Cultures grew acinetobacter and stenotrophomonas for which she received a 14 day course of Bactrim and Unasyn. She recovered and was transfered to rehab. . She presented to pulmonary clinic on [**9-11**] for routine follow up appointment, and was found to be in respiratory distress, tachypneic, hypoxic to 80%. Was placed on mechanical ventilation, CXR was unchanged from earlier when daignosed with PNA. Was bronched with 50% lumenal stenosis at stent site with overgrowth of granulation tissue. BAL grew acinetobacter sensitive to unasyn. She was started back on bactrim/unasyn She was planned for OR removal of stent in setting of stenosis but this was deferred due to pt's persistently high Fi02 requirement. CTA was performed which showed no PE but multifocal PNA, unclear if this is resolving infection from recent PNA or new process. S/p repeat bronch with BAL yesterday which showed the tracheostomy in place/y-stent in place, scant mucous in airways, no evidence of clear obstruction, moderate distal granulation tissue. Pt transfered to MICU team for further work up and management of her hypoxia. . Upon transfer to MICU, patient was found to be hypertensive to 200/100 with decreasing 02 sats to mid to high 80s, she was visibly agitated with audible wheezing. Pt given regularly scheduled hydral and prn ativan. [**Name8 (MD) **] rn notes patient frequently becomes anxious and hypertensive, responds to ativan. + anasarca, elevated BNP, pt appeared total body volume overloaded with elevated BNP. Treated for likely flash pulmonary edema with nitro gtt, lasix IV gtt. MEDICAL HISTORY: 1)Ventillator dependence since [**1-5**] s/p trach (perhaps due to GBS), successfully decanulated in [**10-7**], however readmitted [**Date range (1) 76415**] for evaluation of small tracheal mass and desaturated in the setting of bronchoscopy and trach was replaced. AC 0.6/500/12/5, recently admitted and treated for PNA on 2)Hypertension 3)CHF 4)DMII c/b neuropathy 5)Anemia 6)CAD, s/p PEA/cardiac arrest [**2103**] 7)Syncope 8)hyperlipidemia 9)COPD 10)Atrial fibrillation 11) Colon Ca MEDICATION ON ADMISSION: Lovenox 40 mg SC DAILY Lidocaine 5% Patch 1 PTCH TD DAILY Oxycodone-Acetaminophen 1 TAB PO Q6H:PRN pain Nexium 40 mg PO Q24H Albuterol-Ipratropium 4 PUFF IH Q6H:PRN SOB, wheeze, Quetiapine Fumarate 50 mg PO TID Citalopram Hydrobromide 20 mg PO DAILY Senna 1 TAB PO BID:PRN Docusate Sodium 100 mg PO BID HydrALAzine 10 mg PO Q8H [**Name (NI) **] - unclear amount TP [**Name (NI) 76418**] Lopressor 37.5 mg PO Q8H Hydrochlorothiazide 12.5 mg PO DAILY Norvasc 10 mg PO DAILY Lantus 28 units SC QHS . Meds at time of transfer: Albuterol nebs Duonebs Amlodipine 10mg daily Unasyn day [**5-14**] 3G IV Q6 Ca Gluconate SS Chlorhexidine Citalopram 20mg daily Clonidine 0.2mg [**Hospital1 **] Colace 100mg [**Hospital1 **] Hep SC TID Hydralazine 25mg PO Q8 ISS Lansoprazole 30mg daily Prn lorazpam Metoprolol tartrate 37.5mg [**Hospital1 **] Bactrim DS TID day [**5-14**] ALLERGIES: Aspirin PHYSICAL EXAM: Vitals: T: BP: 200/106 P: 63 R:30 SaO2: 84-95% 60% Fi02 General: Obese, chronically ill appearing woman, in distress. Reaching out, trying to communicate. Denying pain. HEENT: NCAT, PERRL, EOMI, no scleral icterus, poor dentition Neck: thick, unable to appreciate JVP. tracheostomy in place Pulmonary: ascultated anteriorly with coarse, rhoncorous bs b/l, no crackles, expiratory wheezes centrally. Cardiac: distant Abdomen: tympanitic, non-tender, no rebound or guarding. ++ anasarca Extremities: marked anasarca, cool extremities with pitting edema. right PICC c/d/i Skin: pale, diaphoretic Neurologic: Awake, attempting to communicate. Very anxious. EOMI. Some lip smacking. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives in [**Location 86**] area. Former smoker, quit 20 years ago. No current alcohol or IVDA. NH resident

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 55-year-old woman transferred from [**Hospital3 15174**] with the worst headache of her life. She started having headaches on the day prior to admission; however, it became worse overnight. She saw her primary care physician on the day of admission and was given Imitrex. She had nausea, and vomiting, and photophobia. MEDICAL HISTORY: (Past Medical History includes) 1. Hypertension. 2. Hypothyroidism. 3. Migraine headaches. 4. Palpitations. MEDICATION ON ADMISSION: ALLERGIES: She has an allergy to TETRACYCLINE and IBUPROFEN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: The patient is a 70 year old patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 56051**], referred to [**Hospital1 188**] for an outpatient catheterization which was done on [**2168-7-22**], at which time he was found to have two vessel disease and normal left ventricular function. CT surgery was consulted and the patient was accepted for coronary artery bypass grafting. PRESENT ILLNESS: This is a 70 year old man with many years of chest pain, exertional relieved by rest and antacids at times and at other times no relief with rest, progressively worsening with increasing shortness of breath along with substernal chest pain. No orthopnea or paroxysmal nocturnal dyspnea. No palpitations, cough, hemoptysis. Exercise tolerance on [**2168-7-15**], was positive and he was referred for catheterization on [**2168-7-22**]. MEDICAL HISTORY: Hypertension. Hypercholesterolemia. Tobacco use. Transient ischemic attacks with bilateral carotid endarterectomy five years ago. No transient ischemic attacks since. Peripheral vascular disease. MEDICATION ON ADMISSION: 1. Aspirin 81 mg once daily. 2. Atenolol 50 mg once daily. 3. Lipitor 20 mg once daily. 4. Vitamins and Flaxseed Oil. The patient's catheterization done on [**2168-7-22**], showed an ejection fraction of 65 percent and a left ventricular end diastolic pressure of 14, 100 percent right coronary artery, 90 percent proximal left anterior descending coronary artery, 70 percent distal left anterior descending coronary artery, and 30 percent circumflex. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Wife and two daughters are well. He lives at home with his wife. Remote tobacco history. Occasional ETOH use.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 28-year-old female patient with a history of ALL status post chemotherapy, radiation therapy, and BMT, pancreatitis secondary to gallstones, status post cervical esophageal patch after esophageal perforation from dilation of a stricture, Barrett's esophagus, esophageal dysmotility, GERD, history of aspiration pneumonia, diabetes mellitus, hypertension, hypothyroidism, who presents with hypoxia and a new oxygen requirement after endoscopy. The patient was scheduled for an upper endoscopy under general anesthesia because of a history of an apneic episode during attempted procedure in [**2168-11-17**] which was determined to be secondary to aspiration pneumonia. During the procedure, the patient had notable bronchospasm and before the esophagus was intubated, the scope was pulled for desaturation and hypotension considered secondary to inadequate sedation. The patient's hypoxia and hypotension resolved and sedation was increased by anesthesia. The patient then underwent an uncomplicated EGD but postprocedure had noted decreased breath sounds and a chest x-ray which was significant for a right main stem bronchus intubation. Given a low oxygen saturation and rhonchorous breath sounds, the patient was transferred to the MICU for observation after extubation. MEDICAL HISTORY: 1. ALL, status post chemotherapy, radiation therapy, and a bone marrow transplant as a young child. 2. Pancreatitis. 3. Status post cholecystectomy. 4. Esophageal dilation for stricture complicated by perforation, status post esophageal patch. 5. Barrett's esophagus. 6. Esophageal dysmotility. 7. GERD. 8. Aspiration pneumonia. 9. Pneumococcal pneumonia. 10. Diabetes mellitus. 11. Hypothyroidism. 12. Hypertension. 13. Depression. 14. Gout. 15. Neuropathy. 16. Asthma. 17. Obstructive/restrictive lung disease. 18. Left apical nodule noted on chest CT at [**Hospital6 8866**]. MEDICATION ON ADMISSION: ALLERGIES: Morphine, erythromycin, and Compazine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Respiratory Distress PRESENT ILLNESS: The patient is a 70yo man with diabetes mellitus type 2, CAD, 140 pack year smoking history, who was transferred at the request of his PCP from the [**Hospital6 33**] ICU to the [**Hospital1 18**] MICU Friday [**2149-8-29**] for continued treatment of respiratory distress requiring supplemental O2, labile blood sugars, and a new lung mass found on CT. One week prior to admission to [**Hospital3 **] he developped a non-productive cough, fevers, and increased fatigue. He had a 10 pound unintentional weight loss over the past 1-2 months. On Monday [**2149-8-25**] he was found unresponsive at home with a FSBG of 21. He was working in his yard when he felt dyspneic and fatigued and sat down. He lost consciousness and awoke on the ground. He called a friend and EMS arrived shortly. . In the [**Hospital6 33**] ED he received glucagon and his glucose increased to 70. CXR revealed eosinophilic v. atypical PNA v. inflammation from COPD exacerbation, so he was started on Levaquin and Solumedrol and admitted. His BNP was elevated to 9248 and he was diuresed with Lasix 40 mg IV BID. On [**2149-8-27**] a chest CT demonstrated a 4 cm spiculated mass in the LLL and hilar and mediastinal lymphadenopathy. While on steroids, he became hyperglycemic and he was transferred to the MICU for insulin gtt. In the MICU he became hypoxic and was placed on a NRB. CXR demonstrated bilateral airspace disease, pulmonary edema, and possible atypical PNA. On transfer to the [**Hospital1 18**] MICU on [**8-29**], his SOB was slightly improved, but he felt fatigued. MEDICAL HISTORY: -CAD, s/p CABG in [**2131**], (LIMA to LAD, SVG to RCA, SVG to OM1, SVG to D1) -PCI in [**2142**] with stenting of SVG to RCA and PDA -Diabetes requiring insulin, complicated by peripheral neuropathy, retinopathy -Hypertension -Hyperlipidemia -Peripheral vascular disease -Insomnia -GI bleed secondary to peptic ulcer disease -Chronic gastritis -Depression -Status post AAA repair in [**2131**] -Status post aorto-popliteal bypass MEDICATION ON ADMISSION: Medications at home: [**Known lastname **] 80 mg daily Coreg 12.5 mg [**Hospital1 **] Cymbalta 30 mg daily Lisinopril 5 mg daily, Neurontin 600 mg three times daily Zoloft 75 mg daily Aspirin 81 daily. . Medications on transfer from OSH: Dextrose 50% 25 mL prn Glucagon 1 mg prn Zolpidem 5 mg qhs prn Albuterol 2.5 mg nebulization q6h Aspiring 81 mg daily Atorvastatin 80 mg daily Carvedilol 25 mg [**Hospital1 **] Enoxaparin 40 mg daily (prophylactic dose) Furosemide 40 mg IV BID Gavapentin 600 mg TID Lispro Insulin SS Ipratropium nebulization q6h Levofloxacin 500 mg IV daily Methylprednisolone IV 60 mg q8h Pantoprazole 40 mg daily Sertraline 75 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: V/S: HR: BP: RR:18 02sat: 95% on 2 L/min)2 General: Awake and alert, lying in bed, pleasant, in no acute distress HEENT: Normocephalic and atraumtic, sclera anicteric, oral and nasal mucosa pink and without exudates Neck: full range of motion, no lymphadenopathy, no JVP seen with head of bed elevated to 30 degrees, no thyromegaly or thyroid nodules Lungs: Diffuse rales bilaterally to halfway up lung fields, no expiratory wheezes, no rhonchi, no friction rubs, no squeaks CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Midline scar, non-distended, normoactive bowel sounds, soft, non-tender, no guarding, no organomegaly GU: not examined Ext: No edema, warm, well perfused, radial and dorsalis pedis arteries have 2+ pulses bilaterally, + clubbing of fingernails, no edema of lower extremities Neuro: CN 2-12 intact, decreased sensation to light touch below knees, ... FAMILY HISTORY: Father died of asbestosis (worked in shipyards). Mother died of COPD. CAD strong in family. SOCIAL HISTORY: Married for 20 years. Worked as a machinist for [**Company 2318**], served in the NAVY. Now retired. Reports exposure to asbestosis working for [**Company 2318**] on a daily basis for 10 years. Never used mask or ventilator. Tobacco: 140 pack year history, smoked 3.5 ppd, quit 14 years ago. History of alcohol abuse, sober for 37 years.

CHIEF COMPLAINT: in graft stenosis PRESENT ILLNESS: This is an 81-year-old man with severe peripheral arterial disease. He is status post a right common femoral to dorsalis pedis artery vein graft bypass. He has since had 2 percutaneous interventions for distal anastomotic stricture. On surveillance duplex he was found to have a distal anastomotic stricture once more. In addition, he has developed an ulcer in the medial aspect of his first toe. Given these findings the patient was consented for a leg angiogram possible angioplasty for limb salvage. MEDICAL HISTORY: *Gout * MRSA/Enterococcal (not VRE) UTI [**7-8**] * DM type 2 complicated by neuropathy & retinopathy, Hgb A1c 6.8% in [**9-8**] * CAD s/p 4v CABG ([**2119**]) * PVD s/p bypass grafting (s/p L popliteal to DP bypass w/ R arm vein ([**8-3**]) ; failed - s/p revision ([**3-4**]); RLE claudication - s/p R SFA to DP saphenous vein bypass ([**5-5**]) ; stenosed distal graft - s/p atherectomy ([**9-5**])) * 2nd & 3rd degree AV block s/p pacemaker in [**2123**] * hypertension * s/p L carotid endarterectomy in [**2128**] * hyperlipidemia * known infrarenal aortic aneurysm s/p graft repair ([**12/2119**]) * anxiety/depression * osteoarthritis * chronic back pain * cataracts * chronic renal insufficiency (recent creatinine values 1.3-2.1) * H/o intermittent slurred speech with CVA diagnosed in [**9-/2129**] * H/o vertigo, uses meclizine occasionally as outpatient MEDICATION ON ADMISSION: Allopurinol 100", plavix 75' METOPROLOL 25", lasix 40mg'', Diovan 160', simvistatin 80', HUMULIN N 45 u in am and 40 units in pm procrit, Doxercalciferol 2.5 mcg QOD, Tramadol 50 TID, Trazadone 50 HS ALLERGIES: Tetanus,Diphther Toxoid Adult / Aggrenox PHYSICAL EXAM: Physical Exam: Vitals: T: 96.4 P:71 R: 16 BP:141/53 SaO2: 98 General: Awake, cooperative, NAD. Obese man, pleasant, slighlty anxious. 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 Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds Extremities: Dressing in Right groin from angio, mulitple scars on legs from vascular procedures. Covered wound on base of R great toe. Skin: no rashes or lesions noted. FAMILY HISTORY: Mother with CAD,HTN and stroke. 2 brothers with CAD s/p CABG. SOCIAL HISTORY: Patient is a retired carpenter who lives with his wife. [**Name (NI) **] has a 30-pack-year smoking history, but quit about 30 years ago. He does not drink alcohol. He denies h/o illicit drug use. He uses a walker to ambulate due to leg pain. He receives home VNA.

CHIEF COMPLAINT: s/p fall with significant right sided subdural hemorrhage PRESENT ILLNESS: 7M on coumadin for an embolic stroke in [**2190**] and fell at 0500 on [**3-21**] while he was getting out of bed. This fall was unwitnessed, however his wife heard him fall and went immediately to the bedroom to his side. He was brought to [**Hospital 28941**] ED and then was transferred to [**Hospital1 18**] for further evaluation. Upon arrival to the ED his INR was 5.6 he was reversed with Vitamin K, profiline, and FFP. MEDICAL HISTORY: embolic stroke [**2190**], HTN MEDICATION ON ADMISSION: diovan, tramadol, coumadin, ceplex, tylenol ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: en: lethargic, but arousable, comfortable, NAD. HEENT: Pupils:3-2.5 on right and 2.5 to 2 on the left EOMs pt not cooperative with exam. Neuro: Mental status: Awake to voice-lethargic, inconsistently following simple commands only Orientation: Oriented to person, place "rehab", and date is correct with prompting. Recall:unable to perform at this time. Language: slow to respond, answers with one word after much prompting. FAMILY HISTORY: non-contributory SOCIAL HISTORY: resides at home with wife.

CHIEF COMPLAINT: Drop in HCT at rehab, Guiaic positive stools PRESENT ILLNESS: Briefly, patient is an 87 year-old gentleman with a history of multiple myeloma, essential thrombocytosis, diabetes mellitus (presumed Type II), who was recently started on [**First Name3 (LF) **] for his essential thrombocytosis who presented from [**Hospital3 2558**] with decreased Hct (27 --> 23). Stool was noted to be guiaic positive on admission. He denied abdominal pain, nausea, vomiting, or diaphoresis. No symptoms of anemia including lightheadedness, dizziness, shortness of breath, or chest pain were experienced. In the ED, he was hemodynamically stable but was noted to have maroon stools and clots per rectum. NG lavage was negative. GI was consulted, tagged red cell scan was done as part of w/u, which was negative. Patient was transfused total of 3 units, and Hct has subsequently remained stable. Plan is for colonoscopy on Monday. While in MICU, patient had large hematuria; he was evaluated by GU, and hematuria was thought to be secondary to both UTI and foley trauma with underlying BPH. After drainage, urine clarity has improved, and Hct has remained stable. Patient will need cystoscopy as outpatient. . Patient also noted to be hyperkalemic on [**2138-2-7**], EKG had questionable T-wave peaking, and he was given Ca Gluconate, D50 and insulin, kayexelate. MEDICAL HISTORY: 1. CAD - large reversible defect per MIBI [**11-9**], for medical management 2. CHF - LVEF of 45% by echo [**2137-6-21**]. 3. Atrial fib - Pt was anticoagulated in the past on coumadin but this was discontinued in [**4-/2137**] following a GI bleed. 4. Essential thrombocytosis - This was diagnosed in [**2129**]. The pt is followed by Dr. [**First Name (STitle) **]. Previously treated with hydroxyurea which was discontinued in [**12/2137**] when pt developed pancytopenia and low Hct requiring multiple transfusions. 5. IgA multiple myeloma - This was diagnosed in 10/[**2137**]. Pt is followed by Dr. [**First Name (STitle) **]. 6. HTN 7. Type 2 diabetes mellitus 8. H/O Dieulafoy's lesion and UGIB requiring ICU stay [**6-/2137**] 9. Hypercholesterolemia 10. PVD s/p L fem-[**Doctor Last Name **] bypass surgery [**2137-12-19**] MEDICATION ON ADMISSION: 1. Atorvastatin 40 2. Folic Acid 1 3. Pantoprazole 40 mg 4. Docusate Sodium 100 mg [**Hospital1 **] 5. Bisacodyl [**Hospital1 **] 6. Tamsulosin 0.4mg qhs 7. Heparin 5000 SC TID 8. Aspirin 325 mg 9. Acetaminophen 1000 TID 10. MVI 11. Lisinopril 5 mg 12. Ferrous Sulfate 325 13. Spironolactone 50 mg 14. Metoprolol Succinate 100 mg PO qd 15. Senna 8.6 mg [**Hospital1 **] 16. Lasix 80 mg Tablet PO qd ALLERGIES: Penicillins PHYSICAL EXAM: VS T 97.0; BP 121/40; HR 63; RR 12; O2 Sat 100% RA GEN: NAD, comfortable, slightly impaired speech HEENT: MMM. PERRL. EOMI. anicteric sclerae CV: S1S2 RRR with occasional ectopy. No appreciable M/R/G LUNGS: Basilar crackles, otherwise CTA ABD: soft, NT/ND. +BS. No organomegaly EXT: Diminished DPs, LLE dressing C/D/I. Extremities warm FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Pt lives at [**Hospital3 2558**] ([**Telephone/Fax (1) 7233**]) on [**Location (un) **]. Served in [**Country 2559**] and [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 480**] during WWII. Following this, he worked as a touring tap dancer for over 30 years. Pt is a former smoker who quit 1 year ago.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 46 -year-old female with severe symptomatic mitral regurgitation presenting for mitral valve repair. MEDICAL HISTORY: Includes arthritis of the hands. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: chest pain, wide complex tachycardia PRESENT ILLNESS: 78 y/o gentleman with chronic AF, known CAD--NSTEMI in [**8-28**] (3 x 13 mm Cypher to RPLV and 2.25 x 18 mm Cypher to LCx/OM; also found to have 3-% LMCA, 70% mLAD with an 80% D1 and 90% D2), repeat PCI in [**10-29**] with BMS to mid-LAD for 70% stenotic lesion, possible ISR in [**2174**] with DES to LAD ([**Hospital1 3278**]), AS with most recent estimate of [**Location (un) 109**] of 1.07 cm2, presents from [**Hospital1 **] ED where he was found to have an irregular wide-complex tachycardia associated with chest pain. . The patient has a history of chronic stable angina, class II Canadian Classification, able to walk about 1 mile or 1 flight of stairs before angina and SOB. Was in USOH when at 8PM tonight noted anginal equivalent only increased in intensity (SSCP radiating to L arm). Took 3 SL NTG without relief. Taken to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] where found to have Wide-complex tachycardia. Given Morphine IV, metoprolol IV 5mg x 2, Amiodarone 150mg IV x 1, and started on a diltiazem bolus 20 mg and 5mg/hr gtt. Rhythm appeared to convert to sinus when he was loaded on stretcher for EMS and symptoms resolved. Since then has had no further episodes of AF and no further CP or SOB. Of note, he stopped Plavix 6 months ago at the advice of his cardiologist. . In [**Hospital1 18**] ED his vitals were T 98.6 HR 61 BP 97/40 RR 25 87% RA-> 100 % in NRB. Patient recieved 600 mg plavix x 1. His BP occasionally dropes to SBP of 80s which improved to 110s with 500cc of NS. . On arrival to CCU, patient was asymptomatic. . ROS was negative for fever, chills, abdominal pain, recent BRBPR, melena, dysuria, hematuri. Cough recently which patient attributes to allergies. On cardiac review of symptoms, in addition to above, patient notes stable 2 pillow orthopnea, no PND or claudication. Occasional RLE edema. All other review systems were negative. . MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: -> CAD: NSTEMI [**2172**] PCI- DES of the r-PLV and LCx/OM, [**10-29**] PCI- BMS to LAD; [**2174**]- PCI ([**Hospital1 3278**]) [**Name Prefix (Prefixes) **]-[**Last Name (Prefixes) **] for possible ISR -> Aortic Stenosis ([**Location (un) 109**] 1.07, mean Grad 21 mmHg), EF 50% on ETT [**2172**] -> Atrial Fibrillation 3. OTHER PAST MEDICAL HISTORY: [**2172**]- CVA with residual speech difficulties Anemia GIB Anxiety Appendectomy Right Inguinal hernia MEDICATION ON ADMISSION: Aspirin 325mg daily Metoprolol tartrate 75 mg [**Hospital1 **] Simvastatin 80 mg qdaily Warfarin 2mg for 2 days, then 1 mg next day, then repeat Isosorbide dinitrate 10 mg tid Lisinopril 5 mg qdaily Nitroglycerin 0.4 SL prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: Pleasant, in NAD, able to follow commands HEENT: No conjunctival pallor. No icterus. MMM. OP clear. NECK: Supple, No LAD. JVP 12 cm. Normal carotid upstroke without bruits. CV: Soft S1S2, Irregluarlary irregular. II/VI systolic murmur best at USB. Early diastolic murmur. LUNGS: Bibasilar crackles. ABD: Soft, NT, ND. No HSM. Abdominal aorta was not enlarged by palpation. Abdominal bruit is present. EXT: 1+ edema BL. Full distal pulses bilaterally. SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Grossly intact, no focal deficits. FAMILY HISTORY: Father died of a myocardial infarction in his early 70's. His sister underwent a CABG and died from a CVA at the age of 78. His brother died of a myocardial infarction at the age of 39. SOCIAL HISTORY: Married with 1 adult son. [**Name (NI) **] is retired. Prior to retiring he was a construction worker. Quit smoking 30 years ago. Prior to quitting he smoked <1ppd for approximately 20-25 years. Denies drinking alcoholic beverages or recreational drug use.

CHIEF COMPLAINT: Left Lower Back and Buttock Pain PRESENT ILLNESS: 76 yof who was seen in the ED on [**2192-8-31**] for atraumatic left buttock pain. The pain started just over one week ago as a tingling sensation in her left buttock/lower back. It progressively got worse and is now a constant ache in left lower back, worse with movement and ambulation. Denies any numbness/tingling/weakness. Was discharged from the ED on [**2192-8-31**] with a walker and home VNA. The patient did not take very much of the pain medication and returned due to uncontrolled pain. The pain worsened after an ice pack was applied to the area. She denies any fevers/chills, no headache, no nausea/vomiting/diarrhea. Denies any urinary or bowel incontinence. . In the ED, initial vs were: T: 98.6 HR: 92 BP: 199/113 RR: 20 O2: 98%. Patient was given vicodin and percocet with some relief. . On the floor, the patient continues to be in pain, difficulty with moving the leg, trouble standing up. . Review of sytems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. MEDICAL HISTORY: COPD ([**Date Range 1570**]'s in [**2184**] with 38% predicted FEV1, 72%predicted FEV1/FEV) Hx of SBO Hypertension Headaches Duodenal and stomach ulcers (duodenal ulcer hemorrhage- was hospitalized for 7 mos, intubated, trached) s/p partial gastrectomy Aortic aneurysm AMI - possible history of some cardiac ischemia years ago, had stress MIBI in [**7-26**] that was negative Cataracts Pulmonary Nodule and Fibroid Uterus - per pt's PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] (discussed with him on [**2192-9-3**]) pt. has declined workup of these issues. MEDICATION ON ADMISSION: She was discharged from her last admission with the following medications: 1. Nortriptyline 25 mg Capsule Sig: Four (4) Capsule PO HS (at bedtime). 2. Triamcinolone Acetonide 0.1 % Cream Sig: One (1) Appl Topical QID (4 times a day). 3. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation TID (3 times a day). 5. Budesonide 0.5 mg/2 mL Suspension for Nebulization Sig: One (1) neb Inhalation three times a day. 6. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Aspirin 81 mg Tablet Sig: Two (2) Tablet PO once a day. 9. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**1-20**] puff Inhalation four times a day as needed for shortness of breath or wheezing. 10. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual under the tongue as needed for chest pain, every 5 minutes to max of 3 tablets. 11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 12. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 13. Home oxygen Home oxygen at 2 Liters per minute as needed to maintain oxygen saturation above 90%. ALLERGIES: Penicillins / Citalopram PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION TO THE FLOOR: Physical Exam: Vitals: T:98.4 BP:178/100 P:77 R:20 O2: 98% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation slightly decreased b/l, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, protuberant, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, rectal tone is wnl Ext: Warm, well perfused, 2+ pulses, TTP above left buttock, near sacroiliac joint. No radiation - sensation intact, plantar/dorsiflexion [**5-22**], has pain with hip flexion and extention Skin: warm, dry, intact Neuro: alert, oriented, CB II-XII grossly intact, strength 5/5 BUE, LLE limited due to pain, unable to ambulate currently due to pain. FAMILY HISTORY: DM, CAD, HTN, colon cancer (sister) SOCIAL HISTORY: Lives alone in senior housing, husband died at 31 yr of aneurysm, 2 sons, 9 grandchildren. Originally from NC. Smoked 1-1.5 ppd for most of her life, quit 7 yrs ago. No ETOH, no drugs

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 19833**] is a 57 year-old male with known coronary artery disease status post percutaneous transluminal coronary angioplasty in [**2102**], [**2108**] and in [**2109**] who has had increasing dyspnea on exertion with occasional chest discomfort over the past few months. He was catheterized on the day of admission and that revealed an occlusion of the left anterior descending coronary artery and right coronary artery with instent stenosis and moderate obtuse marginal disease. MEDICAL HISTORY: Coronary artery disease status post myocardial infarction in [**2109**]. Hypertension, hypercholesterolemia, chronic back pain, question of a transient ischemic attack versus a cerebrovascular accident at the time of his angioplasty in [**2102**] with no residual deficit. Degenerative joint disease. Status post total hip replacement on the left. MEDICATION ON ADMISSION: ALLERGIES: Zestril to which he gets a cough. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: suprapubic pain, dysuria PRESENT ILLNESS: Mr. [**Known lastname 96829**] is a 55 yo M w/long history of autonomic dysfunction complicated by urinary retention and suprapubic catheter placement who has multiple hospitalizations for recurrent UTI, most recently 2/[**2133**]. Of note, the pt's last UTI was positive for ESBL Klebsiella resistant to most abx except for meropenem/imipenem. Pt lives in a [**Hospital1 1501**] and reports 5 days pta noted onset of shaking chills, suprapubic pain/cramping, burning in the penis/urethra, and clouding of his urine. Pt also noted crusting material surrounding the catheter. He was not noted to be febrile at his [**Hospital1 1501**]. He denies abdominal pain, back pain, n/v/d. He does note intermittent chest pain x 1 wk. It is sharp, left sided and lasts seconds to minutes. It is not exertional, positional or pleuritic. Pt states it is different from his MI pain. He denies SOB. He does c/o productive cough over past few weeks, related to an episode 1 wk prior where he "stopped breathing, felt like I was choking." Pt unable to give color of sputum. <BR> Pt was taken from [**Hospital1 1501**] to the ED where a UA was positive. Pt was given one dose of meropenem and admitted to medicine. In the ED, a WBC was 8.5, lactate 1.2, temp was 99.4 MEDICAL HISTORY: - autonomic dysfunction c/b urinary retention requiring indwelling Foley catheter, with recurrent UTIs - CAD: s/p MI [**2107**], tx with angioplasty - diffuse interstitial pneumonitis - anemia - autoimmune hepatitis - autoimmune thyroiditis - autoimmune peripheral neuropathy - intradural t10 mass - s/p cholecystectomy - chronic pain - depression MEDICATION ON ADMISSION: --levothyroxine 50 mcg po daily --midodrine 20 mg po at 6 am, 20 mg at noon, 10 mg at 2 pm, 10 mg at 5pm --trazodone 150 mg po HS --requip 0.5 mg po HS --demerol 50 mg po PRN pain ALLERGIES: Darvon / Percocet / Codeine / E-Mycin / Percodan / Darvocet-N 100 / Penicillins / Amoxicillin / Ampicillin PHYSICAL EXAM: GEN: A&Ox3 HEENT: NCAT, PERRL, EOMI, OP clear, no LAD CV: RRR PULM: CTAB ABD: Soft, diffusely ttp w/o rebound or guarding. SP catheter site with mild erythema, crusting. +tenderness w/manipulation. EXT: No c/c/e NEURO: non-focal FAMILY HISTORY: father had MI at 72; Sister had [**Location (un) 96830**] after vaccine SOCIAL HISTORY: Pt lived with wife and 30-year-old daughter prior to prolonged hospital/[**Hospital1 1501**] stay; disabled, but formerly a truck driver; uses wheelchair at home w/ bedside commode [**1-8**] autonomic dysfunction; Previosly smoked 1ppd x 20years, then quit for ~10 yr, restarted and now quit since [**10-12**]; no alcohol or IVDU.

CHIEF COMPLAINT: PEGJ occlusion and respiratory failure PRESENT ILLNESS: 40 yo M with IPF, s/p double lung tx [**2128**], h/o recurrent pneumonia, chronic rejection and obliterative bronchiolitis, polymiositis, recent hospitalization for acute on chronic resp failure and multilobar pneumonia requiring chest tubes and PEJ placement by IR (discharged on [**2133-2-26**]) presenting from Radius [**Hospital 4094**] Rehab for PEGJ occlusion. He was transported from rehab to [**Hospital1 18**] ED using bag ventilation and was found to be lethargic and disoriented upon arrival to the ED. . In the ED his vitals were temp 101, HR 117, BP 210/105, RR 33, O2sat 89-95% and his ABG was 7.0/180/386. He was then placed on a ventilator in the ED and a repeat ABG was 7.24/89/71/40. His PEJ was repositioned by surgery in the ED without difficulty and is ready to use. He was brought to the MICU for resolution of his respiratory distress. A repeat ABG in the MICU was 7.24/94/70. His ventilator settings are TV300 RR20 PEEP8 FiO2 40. It appears that he is now at his baseline with regards to his ABG. . In the MICU his mental status is much improved. He is alert and oriented with no other complaints. He denies any fever, chills, nausea, vomiting, chest pain, or shortness of breath. He does not feel disoriented or that his breathing is impaired. He feels hungry. MEDICAL HISTORY: Chronic resp failure/ vent dependent since [**2132-2-3**] Chronic bronchitis Status post bilateral lung tranplant in [**2128**] [**3-6**] idiopathic pulmonary fibrosis complicated by chronic rejection and frequent aspiration pneumonia idiopathic pulmonary fibrosis since [**2122**] status post tracheostomy placement in [**2132-2-3**] esophageal dysmotility GERD HTN Paroxysmal atrial fibrillation hyperlipidemia DM II sacral decubitus ulcer now healed severe anxiety depression anemia of chronic disease pancreatitis chronic renal insufficiency MEDICATION ON ADMISSION: Lansoprazole 30 mg Tablet PO DAILY Ipratropium Bromide Trimethoprim-Sulfamethoxazole 40-200 PO DAILY Mycophenolate Mofetil 1000 mg TabletBID (2 times a day). Atorvastatin 10 mg PO DAILY Citalopram 40 mg Tablet PO DAILY Albuterol Bisacodyl 10 mg Tablet PO DAILY flagyl 500 TID Clonazepam 0.5 mg PO QHS Quetiapine 50 mg Tablet PO BID Prednisone 20 mg PO DAILY Docusate Sodium 100 mg PO BID Senna Zolpidem 5 mg PO HS Metoprolol Tartrate 100 mg PO TID Hydrochlorothiazide 25 mg PO DAILY Morphine Sulfate 2-6 mg IV Q3-4H:PRN abdominal pain Insulin sliding scale Tacrolimus 5 mg Capsule [**Month/Day (2) **]: One (1) Capsule PO BID (2 times a day): In total should receive tacrolmius 9 mg [**Hospital1 **]. Tacrolimus 1 mg Capsule [**Hospital1 **]: Four (4) Capsule PO twice a day: In total should receive Tarolimus 9 mg [**Hospital1 **] . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: well developed, well nourished, trach ventilation in tact HEENT: NC, AT, MMM, PERRL, EOMI CV: RRR nl S1, S2 Lungs: coarse insp and expir breath sounds, no focal area of consolidation, no wheezing Abd: soft NT ND + BS, PEJ tube site c/d/i Ext: 2+ pulses in all four, nl sensation, able to move all 4 extremities with 4/5 strength. Neuro: alert, oriented x 3, CN 2-12 intact FAMILY HISTORY: NC SOCIAL HISTORY: Lives at [**Hospital 671**] Rehab, wife is supportive. Has two sons. [**Name (NI) **] drinking, smoking, drug use.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 82-year-old female with a history of a large cell lymphoma status post CHOP as well as Chlorambucil off therapy for several years, lymphoma complicated by hypogammaglobulinemia for which the was seen in [**Hospital 191**] clinic with complaints of right arm and neck swelling and was referred to the Emergency Room for evaluation. The patient had right sided porta-cath in place for several years by report which has not been flushed in several months. In the Emergency Room a neck CT with contrast was performed revealing a right subclavian thrombus extending into the SVC around the patient's porta-cath. Per yesterday. The patient's main complaint is pain and swelling. She has had some shortness of breath with vigorous movement. She has not been doing any unusual activities, simply doing her usual housework. MEDICAL HISTORY: Carcinoma of the cecum, large cell lymphoma, zoster, gastroesophageal reflux disorder. MEDICATION ON ADMISSION: ALLERGIES: Include Morphine which causes nausea and vomiting. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Wake board accident with open skull fx PRESENT ILLNESS: 30M w/no sign PMH medlighted from OSH after wakeboarding accident on day of admission. Patient was being pulled by a speed boat when he went up in the air, lost control and landed at approx 25mph with impact of his skull on his wakeboard at apporximately 5pm. LOC for 5 minutes in water with life vest. Friends got him out of the water and transported him to shore which took 20minutes. GCS 12 at OSH opening eyes, able to follow commands with sluggish left pupil and decreased L sided grasp. Patient subsequently had decreased MS [**First Name (Titles) 6643**] [**Last Name (Titles) 59337**] medical paralysis (versed/fentanyl) and intubation for airway protection. Head CT at OSH showed R temporo-parietal depressed skull fracture with large right sided hematoma, R ventricular compression, midline shift and patent inferolateral basal cisterns. CXR, pelvis x-ray were negative. C-spine was also cleared. Patient remained HD stable throughout [**Location (un) **] transport and was bagged with gas 7.40/32/200 at 100%. VS P95 BP145/84 99%O2 sat. MEDICAL HISTORY: Seasonal allergies MEDICATION ON ADMISSION: Zyrtec ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O: T: AF BP: 150/75 HR: 96 bagged and vented Gen: sedated and paralyzed. HEENT: Pupils: 2mm nonreactive EOMs unable to assess. Large right frontal hematoma. Neck: in hard collar. Lungs: breath sounds bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+. Extrem: Warm and well-perfused. No C/C/E. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Location **], not married, oldest son of supportive family

CHIEF COMPLAINT: BRBPR PRESENT ILLNESS: 84 year old female with recent diagnosis of adeno CA of pancreatic biliary origin with pulm and liver mets, history of diverticulosis and colonic polyps, AF and recently d/c'd off coumadin, presents from [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] after having large amount of bleeding (500cc) with clots per rectum; son elected to send in; would want transfusion; DNR/DNI status per prior hospitalization. . In the ED, HCT 18 and passing large BRBPR (450cc), Right groin line placed. 1 Liter, and 1 u PRBC. BP 80's HR 120's. unknown UO. Mentation, speaking with son. EKG . After family meeting in [**Hospital Ward Name 332**] MICU today it was decided that she and the family would not want aggressive measures including excessive medications, endoscopy, lines, or surgery. Pt. transferred to floor with goals of care CMO. MEDICAL HISTORY: 1. Colon Polyps - s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**10-26**] --Sigmoid polyp, (biopsy): Adenoma. --Grade 1 internal hemorrhoids. --Diverticulosis of the entire colon. 2. Diverticulosis 3. Type 2 DM 4. S/P CVA - on coumadin 5. Tachybrady s/p pacer (EF >55%, [**11-24**]+ MR, 1+TR, mod pulm HTN - [**5-26**]) 6. Glaucoma 7. Cataracts 8. OSA 9. Anemia-source thought to be genitourinary MEDICATION ON ADMISSION: Lopressor 25mg po BID Colace 100mg po BID ASA 81mg po qd MOM [**Name (NI) 36524**] 15mg [**Name2 (NI) **] qd RISS Gabapentin 300mg TID Off Coumadin x 10days. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam: Deferred exam as pt. resting comfortably CMO, many family members at her bedside FAMILY HISTORY: Unknown if GI malignancy, no CAD/DM SOCIAL HISTORY: The patient lives alone. She has a caretaker overnight and goes to daycare during the day. She walks with a cane. She does not have a history of alcohol/tobacco use.

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 3315**] has a history of a non-Q wave myocardial infarction in [**2159**] and [**2160**]. He had a cardiac catheterization revealing left anterior descending and left circumflex disease. There is also 20% left main disease. At that time, he had an angioplasty of the left anterior descending and circumflex with a 30% stenosis residual in both at that time. He reports that he has done well for the past 15 years from a cardiac standpoint. He is status post cervical spine surgery in [**2175-9-25**], which was complicated by postoperative dysphagia. This dysphagia has persisted over the past year resulting in a 30 pound weight loss, weakness and activity intolerance. He denies chest pain but does report that over the past several weeks he has been getting dyspnea on exertion. He had a routine stress test on [**8-29**] of [**2175**]. He was able to exercise for seven minutes on [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] protocol. During exercise, there was 1 mm horizontal downsloping with ST depressions and T wave inversion in leads I and V2. In addition, there was 0.5 to 1.0 mm upsloping and ST elevation inferiorly and in the lateral precordial leads. Echocardiogram showed basilar inferior hypokinesis at rest. With exercise there was severe hypokinesis at the distal septum apex and inferior wall. Ejection fraction was estimated at 50%. The patient was referred for cardiac catheterization to evaluate coronary artery disease. The patient underwent a cardiac catheterization which showed significant left main disease of 70% and diffuse three vessel disease with an ejection fraction of 51%. Please see catheterization report for full details. MEDICAL HISTORY: 1. Cervical spine surgery. 2. Peripheral vascular disease. 3. Coronary artery disease. 4. Hypertension. 5. Diabetes mellitus. 6. Left lower extremity vascular surgery. MEDICATION ON ADMISSION: ALLERGIES: He is allergic to codeine which causes nausea. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Retired, married; lives with his wife.

CHIEF COMPLAINT: Non-healing R foot ulcers and severe hammer 2nd toe PRESENT ILLNESS: 76 y/o M with diabetes, hypertension, hyperlipidemia with non-healing diabetic R foot ulcer admitted for R TMA and tendo-achilles lengthening. Pt has history of a R third metatarsal head resection in [**Month (only) 404**] and additional debridement in [**2189-2-17**]. Pt underwent Clindamycin therapy from [**7-22**] until his present admission without improvement. MEDICAL HISTORY: Chronic systolic CHF Atrial fibrillation CAD Diabetes type II (allergy to insulin) on oral medications CHB s/p ppm ([**First Name8 (NamePattern2) **] [**Male First Name (un) 923**], [**2183**]) Left TMA in [**2187**] MEDICATION ON ADMISSION: Meds: Coumadin 2.5, toprol xl 100, digoxin 250, lisinopril 40, hctz 12.5, metformin 1000, glyburide 5, lovastatin ALLERGIES: Augmentin / Cipro / Keflex / Insulins PHYSICAL EXAM: General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no nuchal rigidity Respiratory: CTAB, no wheezes/rhonchi/rales - coarse upper airway sounds Cardiovascular: RRR Abdomen: Soft, NT/ND, + BS Extremities: No C/C/E bilaterally. Right foot is post-op without any noted discharge or blood on Skin: no rashes or lesions noted. FAMILY HISTORY: N/C SOCIAL HISTORY: Married, lives with wife. Retired police officer. Quit smoking 40 years ago (5 pack-year history), drinks wine occasionally

CHIEF COMPLAINT: status post fall PRESENT ILLNESS: This is a [**Age over 90 **] year old woman with a history of dementia who was found down at her nursing home. OSH CT showed Sub arrachnoid hemorhage/Sub Dural hemorhage and she was transferred to [**Hospital1 18**] for further care. Her daughter is her HCP and reports that she has fallen before. She needs assistance with most of her ADL's. MEDICAL HISTORY: htn, dementia, DM, cerebellar infarct, aortic stenosis, EF 45%, chol, anxiety, GERD, appy, depression MEDICATION ON ADMISSION: senna, Diovan, APAP ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]: 3 [**Doctor Last Name **]:[**1-31**] GCS E:1 V:5 Motor1 O: 13 98.7 68 115/67 15 99% Gen: Left periorbital edema and ecchymosis HEENT: Pupils: 2 MR FAMILY HISTORY: non contributory SOCIAL HISTORY: She resides in a Nursing home

CHIEF COMPLAINT: Acute renal failure. PRESENT ILLNESS: PCP: [**Name Initial (NameIs) 7274**]: [**Last Name (LF) **], [**First Name7 (NamePattern1) 449**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Hospital3 249**] [**Hospital1 **]/EAST Address: [**Location (un) **], E/CC-6, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 250**] Fax: [**Telephone/Fax (1) 3382**] Email: [**University/College 21961**] . Primary oncologist Name: [**Last Name (LF) **], [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD Location: [**Hospital1 18**]-DIVISION OF HEMATOLOGY/ONCOLOGY Address: [**Location (un) **] E/KS-121, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 3237**] Fax: [**Telephone/Fax (1) 21962**] Email: [**University/College 21963**] . Date seen [**2198-6-20**] Time [**2203**] 59 y/o M with PMHx of AFib, PE and Diffuse Large B Cell Lymphoma who was recently admitted with acute on chronic renal failure and was seen in renal clinic on [**6-19**] where he was found to have an acute rise in creatinine. Pt represented to [**Hospital 3242**] clinic and was given 2L IVF without significant improvement in creatinine. Pt did have 500cc of urine output and received a single unit of prbcs for hct of 21. Dr. [**Last Name (STitle) **] (primary nephrology) recommended admission for further work up of acute renal failure and possible renal biopsy. . In nephrology clinc yesterday urinalysis demonstrated : specific gravity of 1.020. Urine was positive for [**2-8**]+ protein (more than last time). Microscopy showed a fragment of granular cast and possibly a white cell cast . RECENT CHEMOTHERAPY ADMINISTRATION and CREATININE MONITORING He received Velcade/Doxil C1D1 on [**2198-6-1**]: velcade x 3 days and doxil x 1 day. He then received zofran 8mg IV, Decadron 20mg IV on [**2198-6-8**]. Pt then received the Velcade 2.6mg as an IVP over 3-5sec. His velcade was held on [**6-12**] secondary to TCP with PLT = 23. PLTS = 17 and received plt transfusion on [**2198-6-13**]. On [**6-15**] Cr = 1.7 and PLT = 20. He was given 1 U plts and 500 cc IVF. On [**6-18**] Cr = 3.0 and PLTs= 13. Pt received 1U PLTS and was referred to see his neprhologist on [**2198-6-19**]. . He also reports abdominal constriction and pain which resulted in difficulty eating. He felt bloated after eating and experienced early satiety. No emesis or nausea. No focal abdominal pain. His sx improved with defecation. . PAIN SCALE:0/10 ________________________________________________________________ REVIEW OF SYSTEMS: CONSTITUTIONAL: [] All Normal [ -] Fever T with chills was 97.9 and 98.1 [+ ] Chills [ ] Sweats [ ] Fatigue [ ] Malaise [ ]Anorexia [ ]Night sweats [ +] __11___ lbs. weight gain over 2 weeks per clinic sheets . HEENT: [X] All Normal [ ] Blurred vision [ ] Blindness [ ] Photophobia [ ] Decreased acuity [ ] Dry mouth [ ] Bleeding gums [ ] Oral ulcers [ ] Sore throat [ ] Epistaxis [ ] Tinnitus [ ] Decreased hearing [ ]Tinnitus [ ] Other: . RESPIRATORY: [X] All Normal [ ] SOB [ ] DOE [ ] Can't walk 2 flights [ ] Cough [ ] Wheeze [ ] Purulent sputum [ ] Hemoptysis [ ]Pleuritic pain [ ] Other: . CARDIAC: [] All Normal [ -] Angina [ -] Palpitations [ +] Edema intermittently since [**Month (only) 205**] as long as he has been getting the chemotherapy without acute worsening [ ] PND [ ] Orthopnea [ ] Chest Pain [ ] Other: . GI: [] All Normal [ ] Blood in stool [ ] Hematemesis [ ] Odynophagia [ ] Dysphagia: [ ] Solids [ ] Liquids [ ] Anorexia [-] Nausea [] Vomiting [ ] Reflux [ ] Diarrhea [+] Constipation- pebbly [] Abd pain [ ] Other: . GU: [] All Normal [ -] Dysuria [ -] Frequency [ -] Hematuria []Discharge []Menorrhagia . SKIN: [] All Normal [X] Recent rash on trunk now resolved [ ] Pruritus . MS: [] All Normal [+] knee pain x 2 weeks with swelling when he walks 0.5 miles [ ] Jt swelling [ ] Back pain [ ] Bony pain . NEURO: [] All Normal [+] Increased frequency and duration of HA but none now. On the weekend had one all day. It was not severe and he ranks it as [**3-15**] [- ] Visual changes [ ] Sensory change [ -]Confusion [ -]Numbness of extremities- chronic neuropathy from chemotherapy since [**Month (only) 205**] but nothing new [-] Seizures [ ] Weakness [ ] Dizziness/Lightheaded [ ]Vertigo [ ] Headache . ENDOCRINE: [X] All Normal [ ] Skin changes [ ] Hair changes [ ] Temp subjectivity . HEME/LYMPH: [X] All Normal [ ] Easy bruising [ ] Easy bleeding [ ] Adenopathy . PSYCH: [] All Normal [ ] Mood change []Suicidal Ideation [+] Other: He has occasional periods of depression but with meditation he is able to cope. . [X]all other systems negative except as noted above. MEDICAL HISTORY: Mr. [**Known lastname **] presented in early [**6-/2197**] with fever, weight loss, and muscle and joint aches. He was diagnosed with PMR and started on prednisone with improvement in his symptoms. During the preceding six months, he reported a history of shoulder, neck and quadriceps pain as well as fatigue, weakness and poor appetite. He reported periodic fevers, drenching night sweats and a 25-pound weight loss also over the same six months. With initiation of his prednisone at 20 mg daily, he noted marked improvement of both his musculoskeletal and constitutional symptoms. He then presented to the emergency room on [**2197-7-17**] with palpitations and dizziness and was found to be in atrial fibrillation. He had a history of PAF in the past. He was febrile to 101.6 with a heart rate of 126. CT scan of the chest, abdomen, and pelvis on [**2197-7-19**] showed multiple low-attenuation lesions within the liver, spleen, and kidneys. On [**2197-7-20**], MRI of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. A CT-guided biopsy of the spleen on [**2197-7-21**] was nondiagnostic. Mr. [**Known lastname **] [**Last Name (Titles) 1834**] bone marrow aspirate and biopsy on [**2197-7-26**], which showed extensive necrosis with focal involvement by high-grade B-cell lymphoma, diffuse large B-cell type. FISH translocation was notable for c-Myc and Bcl-2 indicating a "double hit" lymphoma characterized by a Burkitt's-like lymphoma. He then began chemotherapy. . TREATMENT HISTORY: -- Initiated treatment with Dose-adjusted [**Hospital1 **] chemotherapy on [**2197-7-29**] with two doses of Rituxan on [**2197-8-2**] and [**2197-8-3**]. Follow up CT imaging on [**2197-8-5**] showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. -- Rituxan 500 mg given on [**2197-8-10**] with a fever that evening and admission for neutropenia. During admission, noted for atrial fibrillation with RVR and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. -- Readmitted on [**2197-8-18**] for his second cycle of [**Hospital1 **] chemotherapy, which was delayed for two days due to hypotension and cough. A CT of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of Levaquin. -- On [**2197-8-30**], received Rituxan at 375 mg/m2. -- Follow up PET scan on [**2197-9-6**] showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. He [**Year (4 digits) 1834**] CT of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. -- Admitted on [**2197-9-7**] for initiation of anticoagulation with fondaparinux and began third cycle of treatment with [**Hospital1 **] on [**2197-9-8**](dose level 2). -- Received Rituxan 375 mg/m2 on [**2197-9-25**]. -- Admitted on [**2197-9-29**] for fourth cycle of treatment with [**Hospital1 **](dose level 3). -- Received Rituxan 375 mg/m2 on [**2197-10-17**]. -- Admitted on [**2197-10-20**] for fifth cycle of treatment with [**Hospital1 **](dose level 3 with Adriamycin at dose level 2. Received Rituxan on [**2197-11-7**]. -- FDG tumor imaging on [**2197-10-19**] showed no evidence for lymphoma with slight interval decrease in size in bilateral pulmonary infarcts. Focal uptake in the posterior left kidney appears parenchymal, but may be within the collecting system and projecting over the kidney due to misregistration. Focal FDG uptake in the left ischial tuberosity, without corresponding lytic or sclerotic lesion. Bone marrow biopsy showed no evidence for lymphoma and no cytogenetic abnormalities, particularly no c-Myc or Bcl2 translocation. Note was made of hypercellular marrow with maturing trilineage hematopoiesis. -- Admitted on [**2197-11-16**] with sudden onset of a dark cover in the lower half of the visual field in his right eye, which lasted 10-15 minutes, then self-resolved. He was evaluated by Neurology and Ophthalmology. TEE revealed thrombus at the tip of his right atrial catheter, with no PFO. Ophthalmology work up was negative and the episode was attributed to possible TIA. Discharged on [**2197-11-18**] to continue his fondaparinux. -- Admitted on [**2197-11-23**] for high dose Cytoxan for stem cell mobilization. -- Attempted stem cell collections with yield ~ 0.5 CD 34 cels after 4 collections with slow recovery of counts. Collections stopped. -- Repeat PET imaging on [**2197-12-19**] showed new focal mild FDG-avidities in the mediastinal region. Interval worsening of FDG-avidity in the soft tissue immediately medial to the left acetabulum. Persistent FDG-avidity in the left ischial tuberosity, without CT correlate. -- Repeat bone marrow biopsy on [**2197-12-20**] showed no evidence for lymphoma with some dyspoiesis noted. No cytogenetic abnormalities, specifically no evidence for MDS. -- Initiated 4 weeks of Rituxan on [**2197-12-26**]. -- Noted slight increase in LDH to ~ 260. Repeat CT of the torso on [**2198-1-3**] showed left pelvic soft tissue and expansion of the left piriformis muscle corresponding to the regions of FDG avidity for [**2197-12-19**] scan. Small internal mammary and left juxtaclavicular lymph nodes corresponding to foci of FDG avidity. Decreased size of lymphomatous renal lesions compared to [**2197-7-6**] with stable small retroperitoneal lymph nodes. Continued evolution of pulmonary infarcts. No definite bony lesions, though there is slightly lucency in the left acetabulum in a region of FDG avidity. . Other Past Medical History: s/p RLL lobectomy in [**2198-2-6**] secondary to PNA #. PAF diagnosed in [**2180**] with now chronic atrial fibrillation in the past several months. He had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in [**8-/2197**], currently receiving treatment with metoprolol and digoxin. #. Pulmonary embolism, fondaparinux on hold due to thrombocytopenia #. Polymyalgia rheumatica diagnosed in [**2197**] and managed by Dr. [**Last Name (STitle) **], although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not PMR. #. Remote history of syphilis, gonorrhea, and genital herpes in [**2160**]. #. Tonsillectomy and adenoidectomy in the [**2137**]. #. Myopia. #. Recent probable TIA with from thrombus on right atrial catheter tip MEDICATION ON ADMISSION: CONFIRMED WITH PATIENT ON ADMISSION ACYCLOVIR 400 mg Tablet - 1 Tablet(s) by mouth every twelve (12) hours ALLOPURINOL 100 mg by mouth DAILY (Daily) AMIODARONE 200 mg by mouth once a day FAMOTIDINE 20 mg Tablet by mouth once a day FILGRASTIM [NEUPOGEN] - 300 mcg/0.5 mL Syringe - 1 Syringe(s) once a day as directed- NOT CURRENTLY TAKING FONDAPARINUX [ARIXTRA] - (On Hold from [**2198-5-9**] to unknown per order of [**Last Name (LF) **], [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] for low platelets) - 7.5 mg/0.6 mL Syringe - 7.5 Syringe(s) once a day LORAZEPAM [ATIVAN] - 0.5 mg Tablet - 1 to 2 Tablet(s) by mouth every eight (8) hours as needed for nausea METOPROLOL SUCCINATE - (Prescribed by Other Provider) - 50 mg Tablet Extended Release 24 hr - 1 Tablet(s) by mouth once a day- TOPROL RECENTLY D/C'ED AT LAST D/C OXYCODONE - 5 mg Tablet - [**1-7**] Tablet(s) by mouth every four (4) hours as needed for pain PREDNISONE - 10 mg Tablet - 1.5 (One and a half) Tablet(s) by mouth daily for 2 days, then 1(One) Tablet daily. PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 (One) Tablet(s) by mouth every eight (8) hours prn nausea. Can causedrowsiness SULFAMETHOXAZOLE-TRIMETHOPRIM - 800 mg-160 mg Tablet - 1 Tablet(s) by mouth MWF ([**Month/Day (2) 766**]-Wednesday-Friday) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VITAL SIGNS: 98.6, 142/70, 74, 20, 100% on RA GLUCOSE: NA PAIN SCORE 0/10 GENERAL: Very pleasant male laying in bed. He is NAD. Nourishment: At risk. Grooming: good Mentation: good, he is a very good historian Eyes:NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted Ears/Nose/Mouth/Throat: MMM, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Respiratory: Lungs CTA bilaterally without R/R/W Cardiovascular: RRR, nl. S1S2, no M/R/G noted Gastrointestinal: soft, mildly distended/ND, normoactive bowel sounds, no masses or organomegaly noted. Genitourinary: deferred Skin: no rashes or lesions noted. No pressure ulcer Extremities: [**2-8**] + pitting edema present b/l Lymphatics/Heme/Immun: No cervical lymphadenopathy noted. Neurologic: -mental status: Alert, oriented x 3. Able to relate history without difficulty. -cranial nerves: II-XII intact -motor: normal bulk, strength and tone throughout. No abnormal movements noted. Psychiatric: Very thoughtful and contemplative. Appropriate ACCESS: [x]PIV []CVL site ______ FOLEY: []present [x]none TRACH: []present [X]none PEG:[]present [x]none [ ]site C/D/I COLOSTOMY: :[]present [X]none [ ]site C/D/I FAMILY HISTORY: Father had an MI in his 70s and his paternal grandfather had an MI in his 40s. His mother is status post aortic valve replacement. His younger brother had probable schizophrenia and died from suicide at age 18. There is no family history of cancer. SOCIAL HISTORY: Pt is married and lives in [**Location **]. Mr. [**Known lastname **] previously worked as a software engineer, but now works without pay from home contributing to open source software projects. They have two adult children, ages 21 and 28, but have minimal contact with them. Mr. [**Known lastname **] is a nonsmoker. He drinks alcohol on occasion. He denies any history of illicit drugs.

CHIEF COMPLAINT: Brain Mass PRESENT ILLNESS: 69-year-old right-handed woman, with left facial spasms since [**2163**], who is here in the Brain [**Hospital 341**] Clinic for an evalaution of her enlarging left cerebellopontine angle meningioma. This hemi-facial spasm developed slowly over time. There is no pain. She has vertex headache, mild nasuea but no vomiting, and mild vertiginous sensation. She has lost hearing in the left ear. She has numbness on the left side of her face. She had a gadolinium-enhanced head MRI on [**2164-2-17**] at [**Hospital 3278**] Medical Center that showed a left cerebellopontine angle mass abutting the exiting zone of the left 7th and 8th nerves. After that MRI, she went back to [**Country 651**] and she came back to [**Location (un) 86**] in the fall of [**2165**]. Her head MRI was repeated on [**2165-11-5**] and it showed slight enlargement. She does not have imbalance, seizure, loss of consciousness, or fall. She was electively admitted for a craniotomy. MEDICAL HISTORY: Hypertension and hypercholesterolemia. MEDICATION ON ADMISSION: carbemezepine (for facial spasms), amlodipine, simvastatin, calcium, vit D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION EXAM: Physical Examination: Temperature is 98.0 F. Her blood pressure is 140/72. Heart rate is 64. Respiratory rate is 20. Her skin has full turgor. HEENT examination is unremarkable. Neck is supple. Cardiac examination reveals regular rate and rhythms. Her lungs are clear. Her abdomen is soft with good bowel sounds. Her extremities do not show clubbing, cyanosis, or edema. FAMILY HISTORY: Her parents died of old age. She has 5 siblings and they are all healthy. She has 2 children and they are all healthy. SOCIAL HISTORY: She does not smoke cigarettes or drink alcohol

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: Ms. [**Known lastname **] is a [**Age over 90 **] y/o woman with a history of Type 2 DM, atrial fibrillations, hypertension and congestive heart failure who presented to [**Hospital1 18**] from [**Hospital1 100**] Senior Life with a chief complaint of dyspnea. Per report, patient reports feeling unwell x 2 weeks. She has been treated with lasix over the past few days for hypoxia and a left pleural effusion. Today, O2 sats in the 80s on 4L NC. Noted by CXR in ED to have a left pleural effusion. Pt was admitted to MICU for CPAP. Did not tolerate mask well and was switch to non-rebreather mask. with diuresis on Lasix, her resp status improved. Thoracentesis was deferred in the MICU because she was supratherapeutic on coumadin with INR 5.5. MEDICAL HISTORY: Type II Diabetes Mellitus Atrial Fibrillation ? TIA Macular degeneration/Mild diabetic retinopathy Cognitive impairment S/P arterial thrombectomy Hypertension Congestive Heart Failure Stenosis of vocal cords Peripheral embolectomy Back pain MEDICATION ON ADMISSION: Norvasc 10 mg po qd Vitamin B12 100 mcg q56d Colace 200 mg po qd Insulin 16 units qam and 3 units qpm Lisinopril 30mg po qam Detrol LA 4 mg po qd Coumadin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 99.8 145/50 80 20-28 94%RA 100%CPAP Gen: Mildly uncomfortable on CPAP, desats when taken off HEENT: ATNC, on CPAP Chest: Bilat rales Cor: irregularly irregular, normal S1/S2 Abd: Soft, obese, nt/nd, Ext: WWP, trace peripheral edema Neuro: unable to cooperate FAMILY HISTORY: NC SOCIAL HISTORY: Lives at [**Hospital 100**] rehab.

CHIEF COMPLAINT: fever, abdominal pain PRESENT ILLNESS: Briefly, Mrs. [**Known lastname 9037**] is a 62 year old female with a past medical history significant for ESRD on MWF HD, DM 2, HTN, COPD, carotid stenosis s/p PCI and PVD admitted for fever and found to have MSSA bacteremia from an infected AV graft s/p AVG revision. The patient underwent "jump graft" procedure on [**2163-9-26**] that was complicated by edema and bleeding. In addition, her hospital course has been complicated by a new O2 requirement felt to be atelectasis versus volume overload. MEDICAL HISTORY: -ESRD, secondary to HTN and DM, on HD M/W/F via left upper arm AV graft created [**2162-11-30**], considering transplant with extended criteria donor -Type 2 DM, c/b nephropathy and retinopathy -HTN -Anemia -PVD, s/p left extremity arteriography, left superficial femoral artery, popliteal and anterior tibial angioplasty -Hyperlipidemia -COPD -s/p PCI of carotid stenosis with stent to L ICA, on ASA and plavix -s/p cholecystectomy -s/p C-section -s/p surgery for retinopathy, cataracts MEDICATION ON ADMISSION: ASA 325 mg daily atorvastatin 80 mg daily calcitriol .25 mg MWF Ca Acetate 6667 TIDac clopidogrel 75 mg qd humalog 75/25 12 units [**Hospital1 **] ipratropium-albuterol nebs prn SOB labetalol 200 mg [**Hospital1 **] lisionpril 20 mg [**Hospital1 **] (hold AM dose prior to HD) loperamine 2 mg qid prn diarrhea tramadol 50 mg [**Hospital1 **] prn B complex-vit C-folate 1 cap daily docusate, senna amlodipine 10 mg daily ALLERGIES: Hydralazine Hcl / Iodine; Iodine Containing PHYSICAL EXAM: VS: Tc 98.5, Tm 99.3, 142/44, 80, 18, 97%1L GA: awake, NAD HEENT: EOMI, PERRL, minimally reactive pupils, b/l lens transplant, MMM, oropharynx clear without erythema or exudate, no LAD, no JVD, neck supple, no conjunctival hemorrhage CV: RRR, nl S1+S2, no M/R/G Lung: CTAB, no wheezes, rales or rhonchi Abd: soft, NT, ND, +BS, no rebound or guarding, no HSM Extremities: W/WP, no C/C/E, 2+ DP/PT pulses bilaterally, LUE with dressing w/serous drainage in place over AVG revision Skin: warm, dry and intact with no rashes. L knee with hypopigmented area from fall Neuro/Psych: A+Ox3. CN II-XII grossly intact with no focal deficit. Moving all extremities. Strength, sensation and movement symmetric. Gait not observed. FAMILY HISTORY: Significant DM, heart disease. Sister on HD. SOCIAL HISTORY: Ms. [**Known lastname 9037**] is married and lives with her husband and daughter. She is independent in ADLs and ambulatory with a cane. She denies tobacco, alcohol, or illicit drugs.

CHIEF COMPLAINT: "I fell" PRESENT ILLNESS: 60 year old white male s/p fall for SAH. Pt, wife and family friend give report. His wife states that they were leaving a friends house and that he went to start the car. Her and the friend came out approx 10 minutes later to find him lying on the ground. He had LOC for ? approx 10 minutes. He thinks that he most likely tripped and fell [**3-12**] to working the last three nights. As well he admits to two glasses of wine. He was not immediately aware of the events at the time. He does not recall how he fell. He [**Month/Day (2) **] that he had a syncopal event. He recalls the ambulance ride and OSH eval. Currently he admits to pain above his left eye and fracturing some of his teeth. He also admits to nausea without emesis from narcotic administration at OSH. He does not think that he swallowed any of them. He [**Month/Day (2) **] CP, SOB, visual changes, neck pain or pain in other parts of his body. They deny any seizure activity or incontinence. MEDICAL HISTORY: meniscectomy / right knee high cholesterol MEDICATION ON ADMISSION: SA 325 mg daily / last dose this am simvastatin 40 mg po daily ALLERGIES: Kiwi (Actinidia Chinensis) PHYSICAL EXAM: PHYSICAL EXAM: O: T: AF BP: 138/ 90 HR:90 R 18 O2Sats99 Gen: WD/WN, comfortable, NAD. HEENT: Left peri-orbital ecchymosis / inferior linear chin laceration (no sutures at OSH), abrasion to left frontal region, scalp without laceration or bony step off / Pupils: [**4-9**] bilaterally/ No battles or raccoon sign / no CSF rhinorrhea/otorrhea / no hemotympanum. EOMI / no obvious entrapment Neck: Supple. / no tenderness to palpation Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**4-10**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: non contributory SOCIAL HISTORY: lives at home with wife, employed/ physician, [**Name10 (NameIs) **] tobacco, occasional alcohol use, no drug use.

CHIEF COMPLAINT: Lethargy PRESENT ILLNESS: 84 year old with h/o CAD s/p CABG, ESRD on hemodialysis presenting with three days of increasing lethargy, fever, decreased PO intake, and LLQ pain. Patient went to HD today and since complained of severe abdominal and back pain and he decided to come to the ED. He is a poor historian and states he cannot describe this pain further but does state it was gradual in onset started a couple of days prior to presentation. He denies chest pain, sob, fevers, chills, N/V, change in bowels, black, tarry, bloody stools, or dysuria. . In the ED, initial VS: 101.2 70 107/53 18 99% RA. He notably became tachycardic to the 120s and question of atrial fibrillation. Reportedly makes urine, however no urine on straight cath. Labs notable for lactate of 3.9 that decreased to 1.7 after 3 liters IVFs. WBC 20.1 with 5% bands. Trop elevated to 0.21 with flat CKs. CXR showed left peri-hilar opacity c/f PNA. Patient became hypotensive to the 70s while in ED and a triple lumen subclavian was placed and levophed started. Currently at 0.09. He was given vancomycin and zosyn for presumed PNA. Due to LLQ pain, a CT abdomen/pelvis was performed and para-cholecystic inflammation can't rule out cholecystitis, sigmoid diverticulitis. Transplant surgery was consulted and did not feel any surgical intervention was needed. VS prior to transfer: 76 8 97% 3L 130/65 on 0.09 mcs/kg/min of levophed. Prior to transfer, small amount of hemoptysis was noted. . Upon arrival to the MICU, patient feels well without abdominal pain. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: PAST MEDICAL HISTORY: Recent GI bleed earlier this month -> upper endoscopy showed only a hiatal hernia and colonoscopy showed extensive diverticulosis but no source of bleeding was identified Peripheral vascular disease Type II diabetes mellitus ESRD with hemodialysis Hyperlipidemia MI ([**2130**] and [**2138**]) TIA MRSA (+) (nares, [**2149-5-14**]) Enterobacteriaceae, Stenotrophomonas maltophilia, and Enterococcus faecalis bacteremia secondary to HD line infection [**2149-9-9**] . PAST SURGICAL HISTORY: [**9-/2136**] Right Fem-BK [**Doctor Last Name **] [**1-/2138**] CABG x 4 [**2-/2138**] PEG (later removed) [**2139**] Partial colectomy [**7-/2140**] Left CEA [**8-/2140**] Right CEA [**1-9**] Aortobifem and ventral hernia repair [**6-9**] Right toe amputations [**11-9**] Right inguinal hernia repair [**4-16**] Left UE AV graft (thrombectomy of graft [**4-17**] and [**1-18**]) [**2-17**] Left toe amputation [**2-17**] Right toe amputation [**8-17**] PEG (removed [**12-17**]) [**3-18**] Left CFA to AK-[**Doctor Last Name **] bypass with 8mm PTFE [**3-19**] Right hemiarthroplasty & ORIF MEDICATION ON ADMISSION: docusate sodium 100 mg [**Hospital1 **] senna 8.6 mgqhs polyethylene glycol daily calcium carbonate 200 mg TID aspirin 81 mg daily acetaminophen 325 mg QID pantoprazole 40 mg q12 simvastatin 80 mg daily zinc sulfate 220 mg daily calcitriol 0.25 mcg daily B complex-vitamin C-folic acid 1 mg daily sevelamer carbonate 800 mg TID trazodone 50 mg qhs oxycodone 5 mg q4:prn multivitamin daily insulin lispro sliding scale metoprolol tartrate 25 mg twice a day. Nephrocaps ALLERGIES: Neurontin PHYSICAL EXAM: ADMISSION: General: Alert, oriented, no acute distress, cachectic appearing FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Married, retired police officer, smokes [**3-12**] cigarettes/day when home; denies EtOH and other drug use.

CHIEF COMPLAINT: PRESENT ILLNESS: She is an 87-year-old woman found down by her daughter at home last seen well 24 hours prior. Patient had bilateral movement of her extremities at the scene, blood on her face. Found face down on the floor apparently moving all extremities equally at the scene, but intubated for airway protection. Was taken to [**Hospital6 3426**] where head CT showed a small subdural hematoma on the right. Patient was given Ativan 2 mg and then loaded with IV Dilantin. Past medical history of hypertension, asthma, ankle fracture in [**2198-12-15**]. On exam, her temperature was 98.9, heart rate 77, BP 131- 181/60-111. Patient was vented. She was intubated and sedated. HEENT: She had racoon eyes. Neck: She was in a C. collar. Cardiovascular: Irregular rhythm. Pulmonary: Breath sounds clear throughout. Abdomen: Soft, nontender, nondistended. Extremities: No clubbing, cyanosis, or edema. Neurologically: Sedated, not alert. Pupils: 2 mm and briskly reactive. She has positive corneals, positive gag. Face is symmetric. Minimal withdraw to noxious stimulation in all four extremities. Head CT shows right frontoparietal subdural 9 mm at its maximum thickness along the surface of the right frontal area. No midline shift and no mass effect. Patient was admitted to the ICU for close neurologic observation. Blood pressure was kept less than 140, and she was q.1h. neuro checks. INR less than 1.3. In speaking with the family on [**2199-4-23**], it was the family's wish that the patient become made DNR/DNI. On [**4-24**], the patient was extubated, and successfully and verbally following commands. Platelet count was low at 81, and she was transfused with platelets. Patient was evaluated by cardiology for her Afib. They recommended rate control, a surface echocardiogram, keeping her electrolytes within normal limits, keeping her heart rate in the 60 range. EEG was done, which just showed encephalopathy. The patient had repeat head CT which was stable. On [**2199-4-25**], she was transferred to the step-down unit. She remained awake, alert, following commands, and moving all extremities. On [**2199-4-26**], the patient had episode of nonsustained V-tach. Patient ruled out for a MI. Cardiology was notified. She continued to have some episodes of respiratory distress requiring some Lasix for CHF and also increasing heart rate with episodes of rapid Afib. Cardiology was reconsulted, and her Lopressor was increased. She was loaded with digoxin. She was seen by cardiology for possible cardioversion if rate control was not obtained. She remained neurologically opening her eyes briefly, following commands intermittently, verbalizing her name. Patient was seen by speech and swallow for possible PEG, although patient did not respond well to swallow testing. They did feel that with a couple of more days, before mental status improves, she may be able to generate a swallow without aspiration. Currently, she is at high aspiration risk and requires a feeding tube in place. Her vital signs have remained stable. She has been afebrile. She did have an induced sputum sent on [**2199-4-24**] that showed gram-negative rods. Although she has an allergy to penicillin, sensitivities on the sputum were performed. Currently, Bactrim sensitivity is still pending. The patient's vital signs have remained stable, and she is currently afebrile, and she was transferred to the medical service on [**2199-4-29**]. [**Name6 (MD) **] [**Name8 (MD) 739**], MD [**MD Number(2) 2930**] MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Right lung cancer PRESENT ILLNESS: This patient is an 83 year old female with small cell lung cancer who was accepted in transfer from [**Hospital 1562**] Hospital. Patient is with known right small cell lung cancer undergoing chemotherapy/radiation therapy at [**Hospital3 1563**] [**Hospital3 **]. She now presents with acute respiratory falure and is status-post intubation. The reports from the outside hospital indicate extrinsic compression from right mainstem bronchus obstructing the proximal airway now with complete collapse of the right hemithorax with partial collapse of the left hemithroax. CT scans from [**Hospital1 1562**] indicate a large volume tumor encasing the right lung. The patient's family was advised of her dismal prognosis, and the patient was admitted for the possibility of a meaningful intervention with the goal of palliative therapy. MEDICAL HISTORY: End stage small cell lung canger with known brain metastasis Now s/p chemo/radiation therapy Breast cancer X-Ray therapy pneumonitis COPD Osteoporosis MEDICATION ON ADMISSION: IV morphine Midazolam prn Hydrocortisone 25mg IV BID Azithro 500mg IV Q24h Protonix 40mg IV Q24h Zosyn 2.25g IV q6h Albuterol/atrovent nebulizer Lovenox 40qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.4 HR 86 BP 108/45 RR 22 SpO2 95% on AC 0.45/450/14/PEEP5 Intubated, sedated RRR CTA on the left, minimal breath sounds on the right Abdomen soft, NT/ND Extremeties with 1+ edema, no cyanosis FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Pericardial effusion s/p SVT ablation PRESENT ILLNESS: 66-year-old lady with history of breast and bladder cancers was admitted for elective EPS with ablation for SVT. She first noted palpitations approximately 16 years ago in the setting of high emotional distress when her son was killed while in the service. Since then, she has had palpitations in the setting of chemotherapy, and over the past years has had no more than [**3-2**] episodes per year. However, on the day of her most recent cystoscopy on [**3-5**] at [**Hospital1 69**], she experienced a tachycardia, which was terminated after she received intravenous Lopressor. The same tachycardia occurred on [**3-9**] for which she presented to [**Hospital6 17032**] Emergency Room, where the tachycardia was terminated with intravenous adenosine. The tracings of the tachycardia were reviewed by her Electrophysiologist, Dr.[**Last Name (STitle) 1911**], and thought be a narrow complex tachycardia at 150 beats/minute with an RP interval of 100-120 msec. However, immediately post adenosine, there was evidence of sinus rhythm with a fully pre-excited QRS complex consistent with a left lateral bypass tract. Since the Emergency Room visit, she has been on low-dose atenolol without further recurrences of the arrhythmia. Dr.[**Last Name (STitle) 26676**] recommended EPS with ablation and the patient was admitted today for the procedure. . During the procedure she developed hypotension to SBP of 77 mm HG. This responded to IVF and dopamine infusion to SBP of 130s. Patient was mentating appropriately. Focal views of TTE showed noncircumferential pericardial effusion with mild RA collapse without RV collapse. Her heparin was reversed with protamine. PA catheterization showed preserved CO, no equalization of filling pressures, and preserved Y descent on RA tracing. This suggested nonhemodynamically significant effusion. Patient was admitted to CCU with PA catheter for close hemodynamic monitoring. . On arrival patient complained of stable pleuritic chest pain which she had since the cath lab. She denied any shortness of breath. No other complaints. . MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: -CABG: N/A -PERCUTANEOUS CORONARY INTERVENTIONS: N/A -PACING/ICD: N/A 3. OTHER PAST MEDICAL HISTORY: - Total abdominal hysterectomy and salpingoophrectomy [**2164**] r/t endometriosis - Left breast cancer diagnosed [**2180**] s/p Left lumpectomy and radiation therapy - Papillary bladder cancer diagnosed [**2180**] s/p multiple resections and chemotherapy, finished [**2190-4-28**] - [**2190-3-5**] s/p right ureteral stent, ? transitional cell cancer of the right ureteral orifice - Anxiety . MEDICATION ON ADMISSION: Atenolol 25mg daily, last dose [**2190-10-3**] Lunesta 2mg qhs Alprazolam 0.25mg daily in the am, [**1-29**] tablet at noon, 1 tablet at night PRN Simvastatin 30mg daily MVI daily Vitamin D daily Vitamin B12 500mcg daily Calcium, magnesium daily Fish oil 1000mg daily Asa 81mg daily . ALLERGIES: Paxil / Benadryl / Buspar / Levaquin / Adhesive Tape PHYSICAL EXAM: VS: T=96 BP=103/58 HR=97 RR=17O2 sat= 98% 2LNC GENERAL: Pleasant lady, in NAD. Lying down flat, Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Unable to assess JVP appropriately given the patient's position. CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: Resp were unlabored, no accessory muscle use. CTAB in anterior lung fields, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis. PULSES: Right: DP 2+ Left: DP 2+ . FAMILY HISTORY: Unremarkable for any cardiac disease . SOCIAL HISTORY: Lives with: husband Occupation: retired ETOH: no Tobacco: 35 years/ 1ppd, quit in [**2180**] Contact person upon discharge: Husband and son: [**Telephone/Fax (1) 29176**] Home Services: NO .

CHIEF COMPLAINT: chest and back pain PRESENT ILLNESS: s/p MVC from likely syncopal episode, hit another car & water hydrant. Does not recall events of accident but all events prior to and afterwards. GCS 15 from [**Hospital **] Hospital and on arrival here. He has multiple traumatic injuries including hemoperitoneum w/ liver lac of L lobe & active extravasation and widening of the anterior C2/3 and C3/4 intervertebral space w/ posterior osteophyte C4/5, causing mild-to-moderate canal narrowing. He is on Coumadin for atrial fibrillation and CVA and his INR was 2.7 at [**Hospital **] Hospital. He was treated with Vitamin K 10 mg and 1 unit of FFP. His hematocrit was 36 and he was transferred to [**Hospital1 18**]. MEDICAL HISTORY: PMH 1. Atrial fibrillation ( on Coumadin) 2. Hypertension 3. S/P CVA '[**34**] 4. 5 cm infrarenal AAA (chronic) 5. Left renal artery stenosis MEDICATION ON ADMISSION: 1. Coumadin 2.5 mg PO Daily 2. Toprol XL 100 mg PO Daily 3. Vitamin D 400 mg PO Daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O:Temp: 100.0 Pulse: 80 BP: 146/76 RR: 16 O2sat: 98% 2LNC Gen: WD/WN, comfortable, NAD. HEENT:Multiple facial abrasions Pupils:PERRL EOMs full Neck: with C-collar Supple. Extrem: Cool with multiple abrasions, hands wrapped in guaze, + skin discoloration, no edema, non-tender, no ulcers. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Non contributory SOCIAL HISTORY: Lives alone Tobacco none ETOH none

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 58 year old female with two month history of pain between shoulders blades with exertion. Denies dyspnea and lightheadedness. She underwent nuclear stress which showed large anterior reversible ischemia, she was then referred for cardiac catherization. Cardiac catherization revealed left main and coronary artery disease MEDICAL HISTORY: Coronary artery disease s/p RCA stent (BMS) [**2188**] Diabetes Mellitus type 2 Hypertension Hypercholesterolemia Past coronary artery stenting and angioplasty MEDICATION ON ADMISSION: Toprol XL 100 mg daily Norvasc 5 mg daily Simvastatin 80 mg daily Aspirin 325 mg daily Lisinopril 5 mg daily Glyburide 5 mg twice a day Metformin 1000 mg qam, [**2186**] mg qpm ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: no acute distress Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] anterior Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [] bowel sounds + [x] obese Extremities: Warm [x], well-perfused [x] Edema trace Varicosities: None [x] Neuro: Grossly intact non focal oriented x3 Pulses: Femoral Right: IABP Left: +2 DP Right: +2 Left: +2 PT [**Name (NI) 167**]: +2 Left: +2 Radial Right: +2 Left: +2 FAMILY HISTORY: Father MI [**26**] years age, father stroke at age 50 Occupation: paralegal unemployed Lives with: mother who has dementia Tobacco: quit 15 years ago ETOH: denies SOCIAL HISTORY: Family History: Father MI [**26**] years age, father stroke at age 50 Occupation: paralegal unemployed Lives with: mother who has dementia Tobacco: quit 15 years ago ETOH: denies

CHIEF COMPLAINT: Ventricular Tachycardia PRESENT ILLNESS: 86 y/o man w/ hitory of CAD s/p 4vessel CABG [**2096**], CHF EF 35%, Atrial Flutter (not anticoagulated) and chronic renal insufficiency who was sent to the [**Location (un) **] ED when an outpatient stress test revealed inssesant non-sustained ventricular tachycardia. He was asymptomatic and hemodynamically stable. He was given a dose of lidocaine and transfered to the [**Hospital1 18**] ED. . @ [**Hospital1 18**] ED he was started on lidocaine drip and seen by EP. Preliminary plans are for a possible EP study and VT ablation. ROS is posative for dyspnea on excertion which has been stable, with no history of synope or presyncope. MEDICAL HISTORY: CAD s/p CABG [**2096**] with 4v disease CRI severe COPD ([**9-24**] FEV1 0.91, FVC 1.76, decreased TLC, nl DLCO) HTN Hyperlipidemia subclavian stenosis aflutter on sotalol prostate CA MEDICATION ON ADMISSION: sotalol 80 mg [**Hospital1 **] lasix 20 mg daily lipitor 10 mg daily univasc 15 mg daily advair 250/50 1 puff [**Hospital1 **] flonase ALLERGIES: Demerol PHYSICAL EXAM: VS - 96.6 129/86 86 20 Gen: WDWN elderly male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Family: no family history of premature heart disease SOCIAL HISTORY: Social: Patient lives with son, non-[**Name2 (NI) 1818**], no etoh or illicits. Ballroom dancing a few times per week.

CHIEF COMPLAINT: Hypotension. PRESENT ILLNESS: The patient is an 82-year-old woman with a history of non-Hodgkin's lymphoma, status post splenectomy; history of colon cancer, status post hemicolectomy, who presented to the Emergency Department with five days of fever, cough, and shortness of breath. In [**2104-12-28**], the patient presented to Dr.[**Name (NI) 10804**] office with a nonproductive cough. Chest x-ray showed no infiltrates, chronic layered densities of the left lung base and a fine reticular pattern at the right lung base were also appreciated. She received a five day course of azithromycin with improvement. Approximately five days prior to admission she developed a cough productive of yellow sputum, fevers to 101 degrees, night sweats and chills. She also had decreased p.o. intake, postural lightheadedness, and dizziness. She was nauseous. She had no vomiting or abdominal pain. Her last bowel movement was three days prior to admission. She denied dysuria or increased urinary frequency. She had not traveled recently. MEDICAL HISTORY: 1. CLL non-Hodgkin's lymphoma in [**2094**]. She underwent melphalan/prednisone therapy from [**2096-6-27**] to [**2097-6-27**] and then in [**2097-2-27**] pulmonary nodules were appreciated and treated with CHOP chemotherapy. She had a recurrence of lymphoma in [**2097**]-[**2098**] in the jaw and orbit, status post [**Hospital1 **] protocol. 2. History of hypogammaglobulinemia (required monthly infusions, the last one was one year ago, however). 3. Status post hemicolectomy in [**2105-3-28**] for T3, N1, M0 colon cancer. No chemotherapy was done at that time. 4. Status post splenectomy in [**2086**] with indications unclear. [**Name2 (NI) **] last Pneumovax was in [**2095-4-28**]. 5. History of Hemophilus influenzae bronchitis. 6. Interstitial pneumonitis with underlying lymphomatous lung infiltration. 7. History of SVC clot in [**2104-3-28**], likely related to her Port-A-Cath. MEDICATION ON ADMISSION: Alendronate 70 mg p.o. q.d., Protonix 40 mg p.o. q.d. ALLERGIES: MORPHINE WHICH CAUSES NAUSEA AND VOMITING. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She lives with her daughter. [**Name (NI) **] two grandsons are involved with her care. She immigrated from [**Country **] in [**2090**]. She does not smoke. Of note, the patient has never been married, and her daughter is adopted. She has a very large family through this adoption who are all very involved with her care. In the Emergency Department, the patient was given Vancomycin 1 g IV and Levofloxacin 500 mg IV. Blood gas on 4 L nasal cannula was 7.33, 37 and 75.

CHIEF COMPLAINT: Elective Surgery PRESENT ILLNESS: 52 year old female with h/o multiple drug allergies, complex pelvic mass now s/p TAH-BSO for excision and staging. . Patient initally presented to PCP [**Name Initial (PRE) **] abdominal pain and anorexia several weeks prior to this admission. Pelvic ultrasound positive for a 7cm cystic mass posterior to the uterus. MRI showed a 9cm cystic mass arising from the right ovary with <1.5cm nodes in the perirectal areas and some nodes anterior to the IVC. CA-125 was 46. Notably, she also has complete duplication of her lower gynecologic tract including a vertical vaginal septum and a didelphic uterus/cervix. She presented for surgery. MEDICAL HISTORY: Asthma, mild Hypertension GERD s/p Nissen Seasonal allergies Back pain Carpal tunnel surgery Ulnar neurosurgery Achilles tendon repair Nissen fundoplication Cholecystectomy Lithotripsy MEDICATION ON ADMISSION: Vitamin D Asmanex Triamterene/HCTZ 37.5/25mg po daily Protonix 40mg po daily Claritin Singulair 10mg po daily Xopenex - hasn't used in months ALLERGIES: Shellfish / Percocet / Codeine / Sulfa (Sulfonamide Antibiotics) / Ceclor / Darvocet-N 100 / Flexeril / Dilaudid / Valium / Zithromax / Ace Inhibitors / doxicycline / Cardizem / Toprol XL / Verapamil / Catapres / Atacand / Norvasc / Levaquin / Cipro / Floxin / Prednisone / Adhesive / Latex PHYSICAL EXAM: Exam upon admission to ICU: Vitals: afebrile, 88 87/49 99% on Assist Control (500/5/16bpm/50%O2) General: intubated, spontaneously moving all extremities HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear Neck: Supple, no JVD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: RRR, normal S1 + S2, no murmurs, rubs, gallops Abdomen: midline incision w bandage c/d/i, soft, non-distended, quiet bowel sounds, no guarding GU: +foley Ext: cool, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Breast cancer in paternal aunt and grandmother. Ovarian cancer, none. Uterine or cervical cancer in her sister. SOCIAL HISTORY: She smoked, but quit 15 years ago. Denies alcohol or drug abuse. She works in the Police Department.

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: This patient is a 68 year old male patient with a history of HTN, TIAs and carotid stenosis who presents after developing sudden onset of at 230pm today while he was the passenger in a car. He was at rest, not exerting himself. He developed shortness of breath and nausea, and the pain spread down left arm with some numbness in his fingers. The pain lasted several hours. EMS was called and he was taken to the [**Hospital1 46**] ER where he was found to have 2mm ST elevation 2, 3, AVF and left bundle branch block. . He was transferred to [**Hospital1 18**] cath lab for emergent cath with BMS to the RCA. He has transient bradycardia following line wire placement. On admission to CCU he was without chest pain, SOB, palpatations. . At baseline, patient denies ever having chest pain in the past, denies palpatations, shortness of breath, is able to climb stairs and exert himself without shortness of breath. . ROS: patient has hx of multiple TIAs with no residual losses. denies hx of stroke DVT, PE, cough, bloody [**Last Name (un) 74934**]. Patient comlains of numbness in fingers occassionally, both left and right. MEDICAL HISTORY: HTN: patient treated, but med dc/ed due to frequent episodes of Hypotension Nephrolithiasis, s/p lithotripsy Hernia repair in the 60s Carotid stenosis, unknown degree Recurrent TIAs, initially on Aspirin, recurrent, then started on Coumadin; last in [**Month (only) 547**] this year; no residual neurological deficit MEDICATION ON ADMISSION: Home meds: Coumadin 2.5/5 every other day ASA . Transfer MEDICATIONS: plavix 300 mg Bolus Plavix 75 mg PO daily s/p Heparin bolus 1555 heparin gtt at 1000/hr (turned off prior to cath) zofran 8mg at morphine 4mg asa 325mg in ER integrillin being started by [**Location (un) **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97.0, BP 114/66, HR 76, RR 14, O2 97 % on 4L Gen: middle aged male in NAD. Oriented x3. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, MM dry. adentulous Neck: Supple with non elevated JVP. No bruits auscultated CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. Chest: unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Some coarse sounds at base. Abd: Obese, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits bl. Groin with 4inch hematoma. Left arm swollen from shoulder to wrist. small demarcated area of erythema on antecubital fossa at site of previous IV. pulses palpable, warm. pulses Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: - Father died of "cancer" in his 80s, Mother with heart problems, died at age 70, first MI in 60s, no h/o sudden death SOCIAL HISTORY: - 40 pack years tobacco use. 1ppd x 40 years. quit last week. - admits to binge drinking occasionally (?1/week), and 1-2 beers every night, has never had seizures. - at baseline ambulatory, able to ambulate 2 flights of stairs without problems, independent in ADLs

CHIEF COMPLAINT: Altered mental status PRESENT ILLNESS: This is a [**Age over 90 **] year-old male with a history of dementia, CAD s/p CABG and atrial fibrillation who presents with altered mental status from nursing home. Pt recently with ? VRE UTI versus VRE colonization was treated with nitrofurantoin from [**Date range (1) 13926**]. Per wife, pt with new cough, since 1 week ago. Pt at baseline minimally communicative, she felt that yesterday, he was more lethargic than his baseline. Per discussion with physician at [**Name (NI) **], pt briefly "CMO" then yesterday decision made by family to bring him into the hospital. Wife is currently concerned about pt's lack of PO intake. Until a few days ago, pt ate with assitance. He now refuses to eat. Wife would also like pt's pacer interrogated. In the ED, VS T 98 BP 137/75 HR 68 RR 20 96% on NRB. Found to have bilateral lower lobe infiltrate and positive U/A, was given vanco 1 gm, CTX 1 gm, azithromycin 500. Found to have Na 162 and started on D5W 250 cc/h. MEDICAL HISTORY: 1. Memory loss, most likely Alzheimer's dementia. He has been taking Aricept 10 mg once daily. 2. Syncope with orthostatic hypotension. 3. Coronary artery disease, status post bypass surgery many years ago. 4. Atrial fibrillation status post pacemaker placement five years ago for possible sick sinus syndrome. 5. Gait disturbance. 6. Frequent falls. 7. Depression. He is on Celexa 10 mg once daily. 8. H/o Urinary frequency and Nocturia MEDICATION ON ADMISSION: Medications: ASA 81 Plavix 75 Lipitor 10 mg qhs Norvasc 5 mg daily Lasix 20 daily Trazodone 25 QHS Risperidol 0.25 [**Hospital1 **] CaCO3 500 [**Hospital1 **] Omeprazole 20 daily Nemenda 5 mg Proscar 5 QD Vit D [**Numeric Identifier 1871**] units Q monthly Remeron 15 qhs Fludrocortisone 0.1 daily Levsin drops 0.125 Ativan 0.5 q4h prn Colace Senna ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 96.9 BP: 140/60 HR: 81 RR: 25 O2Sat: 97% 2L GEN: At times agitated, confused, non-verbal, unable to follow commands HEENT: MM dry, PERRL, sclera anicteric, no epistaxis or rhinorrhea, OP Clear NECK: No JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Diffuse crackles bilaterally with expiratory wheezing ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: Difficult exam as pt unable to cooperate, CN grossly in tact, moving all extremities freely SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. FAMILY HISTORY: His first wife, child, siblings and parents were all killed in the Holocaust and so he does not know his family history of medical illness. SOCIAL HISTORY: He immigrated from Poland many years ago. Former smoker, quit many years ago. Denies alcohol.

CHIEF COMPLAINT: shortness of breath and hemoptysis PRESENT ILLNESS: This a [**Age over 90 **]y/o female with a history of COPD, hypertension, gastroespohageal reflux who presented with shortness of breath and dyspnea on exertion X 3 days. Per nursing home records, the patient was reported to have had 10cc of hemoptysis. O2 sat was 92%. Patient reports substernal chest pain radiating to the back, lasting seconds. By history the pain is pleuritic, because coughing makes it worse. . On presentation peak flow was 140; improved to 240 after 1st neb in the ED. Chest X-ray showed multilobular consolidation. CT-A showed no PE or obstructive bronchial lesion, but central bilateral consolidation secondary to pneumonia and CHF was noted. An EKG showed TWI in I and avL, and in V4-V6, unchanged from previous. Trop was 0.10 in the setting of renal insufficiency. MEDICAL HISTORY: COPD Rash back of neck GERD HTN MEDICATION ON ADMISSION: Acetaminophen Aluminum Hydroxide Suspension Albuterol 0.083% Neb Soln Amlodipine Bicitra Calcium Carbonate Cyanocobalamin Fexofenadine Fluticasone-Salmeterol (250/50) Furosemide Hydrocortisone Cream 1% Hyoscyamine Ipratropium Bromide Neb Isosorbide Dinitrate Pantoprazole Prednisone Simethicone Sorbitol ALLERGIES: Nsaids / Ace Inhibitors PHYSICAL EXAM: VS t98.8, hr82, bp, r26, 99%on2lNC Gen elderly petite Caucasian female sitting upright in stretcher, in mod distress, using accessory muscles to breath HEENT MMM, OP, -JVD, bruits Heart nl rate, S1S2, unable to assess due to breathing Lungs coarse, rhonchorous breath sounds Abdomen round, soft, nt, nd, +bs Extremities [**1-2**]+pitting edema, posterior aspect of legs bilaterally Neuro: A&O X3, II-XII grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Hospital 100**] Rehab Denies alcohol and ciggarette smokine

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 82 year-old male patient with a one year history of presyncope with recent increase in symptoms three to four weeks prior to admission. This has also been accompanied by chest discomfort for approximately two weeks prior to admission. The patient underwent cardiac catheterization at an outside hospital on [**2104-1-3**], which revealed left main coronary artery disease as well significant three vessel disease. The patient transferred to [**Hospital1 69**] on the evening of [**2104-1-3**] with a plan to undergo coronary artery bypass graft by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. MEDICAL HISTORY: Atrial fibrillation, hypertension, congestive heart failure, status post right above the knee amputation, status post repair of an incarcerated umbilical hernia. The patient is a former cigarette smoker. Denies alcohol intake. Also, peripheral vascular disease. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 53-year-old gentleman who began experiencing pain in his limbs while walking on the beach in cold weather this past winter. He had noticed this pain with exertion, or with climbing stairs. The patient underwent an exercise treadmill test in [**2168-2-6**] during which he complained of chest pain with 1-[**Street Address(2) 1766**] depression, and was shown to have a large inferior and apical reperfusing defection with an ejection fraction of 50%. He was admitted to [**Hospital6 256**] for cardiac catheterization, and subsequently referred for cardiac surgery. MEDICAL HISTORY: 1) Hypercholesterolemia, 2) Status post shoulder surgery in his teens, 3) History of back injury to L5 requiring sleeping with a pillow under his knees. MEDICATION ON ADMISSION: ALLERGIES: NKDA. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Admited to [**Hospital Unit Name 153**] after cardiac arrest PRESENT ILLNESS: MEDICAL HISTORY: h/o afib TAH 2 week post partum c-section [**2127-2-27**] MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Has 2 month old baby

CHIEF COMPLAINT: Near Drowning/diving injury PRESENT ILLNESS: 23 y.o. male with no PMH presents after near drowning event in warm, fresh water. Patient was reportedly up at a [**Doctor Last Name **] and dove from standing into the water. He was reportedly submerged for up to 8 minutes, and friends/bystanders believed that he was playing around. After they realized that the patient was not moving, he was taken from the water and found to be pulseless and apneic. CPR was initiated for 15 minutes with return of vitals and patient was intubated in the field and flown by helicopter to [**Hospital1 18**]. Here, the patient was found to have priapism and some decorticate posturing. No purposeful movements, and no movements of the lower extremities. He was hypothermic at approximately 33 degrees celcius upon arrival. In the ED, he underwent CT scans of his head, C-spine, and torso. MEDICAL HISTORY: PTSD Unknown back surgery for bullet MEDICATION ON ADMISSION: PMH: none PSH: ?? back surgery for bullet/shrapnel ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 34 C on arrival, then 33.5 (prior to active cooling) BP: 130s/70s HR: 80s R: CMV 100% O2Sats Gen: Healthy appearing man s/p trauma. Comatose. Sand in ears. HEENT: Normocephalic without evident skull fracture Neck: In collar. Lungs: Clear with some reduced sounds inferolaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Cool poorly-perfused. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Diver for marines

CHIEF COMPLAINT: PRESENT ILLNESS: Ms. [**Known lastname **] is a 75-year-old woman with a history of a thoracic aortic aneurysm repair in [**2169-1-10**], which was complicated by a prolonged ventilator-dependent respiratory failure and atrial fibrillation. She had been intubated for approximately 2 weeks prior to a trache placement at her prior admission for trache. She was discharged to rehab after a prolonged hospital stay and her trache was removed on [**2169-2-13**]. At rehab, she was noted to be complaining of stridor as well as dyspnea on exertion, and was found to have a bilateral vocal cord paralysis. She was admitted for an awake trache. MEDICAL HISTORY: Thoracic aortic aneurysm. Abdominal aortic aneurysm. Clostridium difficile positivity. VRE positivity. Postoperative atrial fibrillation requiring cardioversion. Hypertension. Type 2 diabetes. Osteoarthritis. Lower back pain. Hypercholesterolemia. Left [**Last Name (un) **]. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: tachypnea and mental status changes PRESENT ILLNESS: 65 yo man with CHF, DVT, ESRD on HD, metastatic poorly differentiated CA, likely NSLCA recently discharged [**4-5**] after hospitalization for cauda equina syndrome treated with XRT. This afternoon, noted to be very tachycardic and tachypnic en route to [**Hospital3 2558**] after HD, so EMS brought pt to ED. . In the ED, he was given 750mg iv levofloxacin for possible LLL airspace disease, though progression of metastatic malignancy more likely and CT chest did not show consolidation. MEDICAL HISTORY: #. Onc HX: [**12-11**] pre-renal transplant CT scan chest noted enlarged RML nodule, w/ subcentimeter FDG avid scattered lymph nodes. Developed neck pain and found to have C2 pathological fracture, [**11-22**] cytology demonstrated poorly differentiated carcinoma. Likely non-small cell lung carcinoma, with RML mass and metastasis to the cervical and sacral spine. The only manifestation of his disease currently is cervical neck pain, s/p pathologic fracture and posterior cervical arthrodesis C1-C3 and palliative XRT. #. Left Common Femoral DVT: small non-occlusive, possibly chronic DVT and started on coumadin for a goal INR [**1-7**] in [**1-/2198**] #. CAD s/p angioplasty D1 [**7-10**] and stents to OM2/3 in [**3-11**] #. ESRD secondary to FSGS on HD (MWF) #. Hypertension #. LLE peroneal nerve palsy [**1-6**] GSW to L leg #. Thalassemia trait #. h/o Substance abuse (heroin/cocaine); reports none since [**2163**] #. CHF w/ EF 35% in [**11-11**], EF 25-30% on [**Date Range 113**] [**2198-1-23**] #. MR - 2+ on [**Month/Day/Year 113**] in [**11-11**]; now found to be 3+ MR [**First Name (Titles) **] [**Last Name (Titles) 113**] #. Pathological C2 Fx s/p C1-3 Fusion #. Parotiditis - [**12-12**] (levo/flagyl) #. CDiff - [**12-12**] #. HCV - grade 1 inflammation and stage 0 fibrosis on bx [**2-9**] MEDICATION ON ADMISSION: Clopidogrel 75 mg PO DAILY Simvastatin 20 mg PO DAILY Gabapentin 300 mg PO QHD B Complex-Vitamin C-Folic Acid 1 mg PO DAILY Sevelamer HCl 1600 mg PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Acetaminophen 500 mg PO Q6H 7Docusate Sodium 100 mg PO BID Lisinopril 10 mg PO DAILY Fentanyl 50 mcg/hr Patch 72 hr Transdermal Q72H Polyethylene Glycol 3350 17 gram (100 %) PO once a day. Aspirin 162 mg PO DAILY Metoprolol Succinate 12.5 mg PO DAILY Omeprazole 20 mg PO once a day. Fentanyl Citrate (PF) 50 mcg/mL Solution Sig: Twenty Five (25) mcg Injection q2 hours as needed for pain. Dexamethasone 0.5 mg Tablet Sig: Taper as follows PO every six (6) hours: 2mg PO q6hr for 3 days, then 1mg PO q6hr for 3 days, then 0.5mg PO q6hr for 3 days, and then discontinue. ALLERGIES: Penicillins / Adhesive Tape PHYSICAL EXAM: GEN: obese, lethargic male HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, anicteric, OP clear, MMM, Neck supple, no LAD, no carotid bruits FAMILY HISTORY: Brother with CAD, and kidney disease requiring hemodialysis SOCIAL HISTORY: He lives with his partner but they are not legally married, has 2 sons. Used to work in construction, + smoker 1 PPD for many years quit recently, rare ETOH, no drugs. Recently has been living in rehab.

CHIEF COMPLAINT: non responsive PRESENT ILLNESS: 55 y/o M with hx of hep C, s/p transplant in [**Location (un) **] 15 years ago, now with decompensated cirrhosis. On the transplant list here. Pt found unresponsive today. Initially went to OSH where he was found to have coffee ground lavage and guiac positive stools, with questionable GI bleed. In fulminant hepatic failure. Intubated and started on pressors at OSH and tranferred to [**Hospital1 18**] ED. In the ED, patient was requiring four pressor support and had low saturations in the 60s on 100% FiO2 intubation. Was given vanco and zosyn and 1 u FFP and 1 u PRBCs. Bedside echo was done. Eval was consistent with sepsis. . Of note, last week he had a cardiac catheterization at an OSH to work up a cardiomyopathy. Was noted to have a growing hematoma in his thighs per wife's history. Then the last three days started feeling unwell. Was unresponsive at home this morning. . Upon arrival to the floor, the patient is intubated and sedated. He had saturations in the 50s. Had bruising on both legs. Hands and feet were cool with difficult to palpate but dopplerable pulses. His BP was in the 60s on max levo, vasopressin, neo. MEDICAL HISTORY: Graft Cirrhosis Hepatitis C s/p liver transplant 15 years ago Diabetes Cardiomyopahty MEDICATION ON ADMISSION: Lasix 40 mg daily Lactulose 15 ml daily Methadone 55 mg daily Metoclopramide 5 mg tid w/ meals Interferon alpha 2-B injection weekly Ribavirin 400 mg [**Hospital1 **] Rifaximin 600 mg [**Hospital1 **] Spironolactone 50 mg daily Tacrolimus (prograf0 1 mg qAM, 2 mg qPM ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals - afebrile, BP 70/30s, HR 100s, RR 28, O2 50s-60s Gen - intubated, sedated, coffee ground emesis in OG tube, frothy pink sputum coming up from ET tube CV - RRR, no m,r,g Lungs - coarse, diffuse, rhonchorous sounds Abd - soft, NT, ND, no bowel sounds Ext - cool, molted, ecchymotic with bullae Neuro - unresponsive FAMILY HISTORY: non contributory SOCIAL HISTORY: Pt lives with wife, independent of ADLS, hx of smoking and quit approximately 3 years ago; hx of IVDU quit in [**2138**], no hx of etoh

CHIEF COMPLAINT: Alcohol intoxication, orbital fracture PRESENT ILLNESS: 38 y/o male with a h/o ETOH abuse, HTN reportedly since childhood but not on medication, and depression/anxiety p/w facial injuries following a fight while intoxicated. He was reportedly punched in the left eye and left jaw; he had no LOC or fall. On arrival to the ED, he was found to have BP 200/120's on triage; he complained of eye pain and difficulty breathing through his nose. Head and spine CT's were negative. Sinus CT's showed a nasal bone and superiomedial orbital wall fracture. He was seen by ophtho in the ED who felt there was no damage to the globe itself and no compartment syndrome; plastic surgery also saw him and felt there was no need for acute surgical intervention. . In the ED, VS were HR 112, BP 221/130, RR 16, 98% RA. He was given lopressor 5 mg IV x 2, a combivent neb, a banana bag, and valium 5 mg IV x 5 and ativan 2 mg IV x 4 for CIWA > 10. It is unclear whether he was wheezy before or after the lopressor was given. He is a poor historian. MEDICAL HISTORY: ETOH abuse HTN, reportedly since childhood, not on medication longstanding decr. vision in left eye reported h/o asthma anxiety d/o psychotic depression - past hospitalization at [**Hospital 1191**] Hospital PTSD The patient reports receiving psychiatric care in the past from [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Health Center in [**Location (un) 14307**] ([**Telephone/Fax (1) 50305**]), who informed us that the patient was also seen by a social worker at [**Name (NI) 112**] named [**Name (NI) **] [**Name (NI) 79297**] ([**Telephone/Fax (1) 79298**]) MEDICATION ON ADMISSION: none ALLERGIES: Aspirin PHYSICAL EXAM: VS: T 98.7 HR 83 BP 179/117 RR 17 O2sat 95% RA Gen: Awake, intoxicated, NAD HEENT: limited fundoscopic exam WNL, PERRL, EOMI, bilateral periorbital ecchyomoses, L>R, no scleral injection CV: RRR nl S1S2 no m/r/g Lungs: CTAB no w/r/r Abd: obese, soft, NTND +BS Ext: warm, dry, +PP no edema Neuro: visual fields full, 2+ DTR FAMILY HISTORY: NC SOCIAL HISTORY: ETOH abuse; uses marijuana, no other illicits

CHIEF COMPLAINT: RIGHT face weakness and inability to speak PRESENT ILLNESS: 84 yo RHM with multiple vascular risk factors including coumadin-na ve atrial fibrillation presents with rapid-onset of RIGHT facial weakness and mutism between 10:30-12PM today. He was seen this morning by his wife who [**Name2 (NI) 102582**] that he was at his baseline, talkative, without focal wekanes, able to move all extremities, and able to walk. She left the house at about 10am and then received a call from his HHA at approximately 12pm reporting the above symptoms to her. They immediately called 911 and brought the pt to [**Hospital1 18**]. He underwent a head CT which was negative for intracranial hemorrhage. An MRI was performed. The pt was seen by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **] of Neurology and an NIH Stroke Scale of 12 was determined. The pt received 0.9mg/kg of t- PA intravenously. The patient was transferred to the ICU for close post-procedure monitoring. MEDICAL HISTORY: 1) chronic atrial fibrillation 2) CAD - s/p cath in [**2178**] which revealed LAD occlusion, good collateral flow. 3) pleural pericarditis - Pleural effusion since [**2178**]. In [**2178**], the patient underwent a procedure to examine the pleural fluid as well as a lung biopsy, both of which did not reveal a clear etiology to the source of the patient's effusion. The patient at that time also had a pericardial window procedure performed for a pericardial effusion. 4) hypertension 5) type 2 diabetes 6) chronic mitral regurgitation 7) chronic obstructive pulmonary disease 8) depression 9) hyperlipidemia 10) mild renal insufficiency 11) hard of hearing 12) Hemorrhoids 13) Chronic urinary retention/BPH MEDICATION ON ADMISSION: Glipizide 2.5 mg daily Metoprolol 100mg daily Spironolactone 25 mg daily Zoloft 25 mg daily ALLERGIES: Erythromycin Base / Penicillins / Tetracyclines / Iodine Containing Agents Classifier PHYSICAL EXAM: T 97.7 HR 98 RR22 BP 108/78 Pox 94% 2L NC Gen NAD CV: Irregularly irregular rate, no m/r/g Distal pulses palpable at radius equally, no JVD Resp Mild crackles at RLL GI: soft, NT, ND, +BS GU: Foley in place, I/O 1180/1660 EXT: Bilateral pitting edema to lower legs bilaterally, with some interval improvement since admission NEURO: AA&O to person and place. Eyes open spontaneously. Pt. follows commands. His speech is markedly slurred, hypophonic and dysarthric however fluent. Repetition and naming are intact. CN: I--not tested; II,III-PERRLA [**1-25**] b/l, VFF by confrontation; III,IV,VI-EOMI w/o nystagmus, no ptosis; V--sensation intact to LT/PP, masseters strong symmetrically; VII-there is dense RIGHT facial weakness sparing the forehead; IX,X--voice nasal, palate elevates symmetrically, uvula midline, gag weakly intact; [**Doctor First Name 81**]-- SCM/trapezii [**3-31**]; XII--tongue protrudes midline, no atrophy or fasciculation. Motor: normal bulk and tone, no tremor, rigidity or bradykinesia, no pronator drift. Strength: Tri [**Hospital1 **] FE WE IP R 4+ 5 5 5 5 L 5 5 5 5 5 FAMILY HISTORY: Family History: Remarkable for colon cancer in a brother. [**Name (NI) **] reported history of neurological disease. SOCIAL HISTORY: The patient retired from his medical practice about five years ago and has not taken up any new activities since that time. He denies any interest in [**Location (un) 1131**], movies, or other entertainment. He rarely goes out. He does have two sons and several grandchildren whom he enjoys. He denies alcohol and stopped smoking in [**2140**].

CHIEF COMPLAINT: CC:[**CC Contact Info 70015**] Major Surgical or Invasive Procedure: tracheal stent(removed) tracheostomy PRESENT ILLNESS: 80yom with recent mitral valve repair and one vessel cabg [**2134-8-18**], course complicated by polymicrobial empyema (e. coli, enterococcus, actinomyces), cardiogenci shock, respiratory failure, with prolonged vent weant and renal failure and was subsequently transferred to [**Hospital 70016**] rehab hospital. Was initially taken to [**Hospital 1727**] Medical Center on [**2134-11-20**] after being found down, intubated enroute. Initially hypotensive in the ED, afebrile, thought sepsis of unclear source started on dopamine and vasopressin also given linezolid and zosyn. [**Last Name (un) **] stim with inadequte response and he was given fludricort/hydrocort. Patient also with positive troponin thought to be NSTEMI in setting of demand ischemia. . Following day patient noted to be doing better and was extubated and later reintubated after CT report with tracheal stenosis. Patient also taekn off linezolid after no source identified. TEE done at OSH negative for vegetation, EF 20% per report. Patient is now being transferred for w/u tracheal stenosis. . On transfer, Pt denies any complaints. MEDICAL HISTORY: s/p CABG X 1 vessel and mitral valve repair s/p annuloplasty. course complicated by empyema, cardiogenic shock and renal insufficiency, difficult to wean and had trach/peg [**8-25**]. Anemia Post operative Atrial fibrillation h/o GI bleed hperlipidemia GERD MEDICATION ON ADMISSION: famotidine 20 mg iv each day fludricortisone tablet 0.1mg, [**12-21**] tab daily hydrocortisone 50 mg q6 hours ipratropium inhaler 2 puffs q6h megesterol suspension 40 mg/ml 400 mg [**Hospital1 **] metoprolol 5 mg iv qhours zosyn 2.25 grams every 6 hours zoloft 75mg each day heparin gtt ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 97.9 BP 112/69 HR 86 RR 14 O2sat 100% Vent settings: AC 600X 12, P5, Fio2 40%. . General: Elderly male lying in bed. HEENT: PERRL, no scleral icterus noted, MMM Neck: supple Pulmonary: Lungs CTAB Cardiac: RRR, nl. S1S2, +Systolic mumor at apex Abdomen: soft, NT/ND, PEG and ostomy site clean Extremities: No C/C/E bilaterally Skin: stage III decub Neurologic: able to follow commands. Moves all extremities. FAMILY HISTORY: n/c SOCIAL HISTORY: retired stock broker, widowed, smoking history unknon, etoh unknown.

CHIEF COMPLAINT: COPD flair, hypercarbic respiratory failure PRESENT ILLNESS: 77 year old woman with a history of COPD (FEV1 0.4/FVC 1.2 in [**2131-9-13**]), on chronic home O2 at 3L, nocturnal BiPAP at night for hypercarbia, who was directly admitted to MICU from the clinic by Dr. [**First Name (STitle) **] for management of COPD with mental status changes and ABG of 7.29/96/101. . Ms. [**Known lastname **] has been in her usual state of health until several months ago when whe started to complain of HAs which were attributed to her hypercarbia. Her nocturnal BiPAP settings were changed from [**10-17**] to 13/5, however, the patient did not do well on these new settings and developed abdominal distension that made her dyspnea worse. In the last few weeks she completed two courses of Levaquin and Prednisone for COPD exacerbation. She did have cough productive of yellow sputum and increased shortness of breath. She completed last course of prednisone taper last Firday, 4 days prior to this admission. Prior to her current admission, she has had increased confusion and was noted to be more lethargic and somnolent at home. The patient was seen in the ED complaining of subacute progressive episodes of confusion and forgetrullness, on [**2131-11-2**], where her ABG was 7.36/77/63. HCO3 39. Head CT was done and was negative for intracranial hemorrhage but did show suprasellar mass. She then was discharged home. Over the weekend, she reports that she did not feel well. On [**11-5**], the day of admission, she saw her pulmonologist, and an ABG showed 7.29/96/101. Following these labs, she was admitted to the MICU. . She denies fevers, chills, nightsweats. She does complain of nausea, no vomiting, and diminished appetite while on prednisone. She denies urinary urgency, frequency or incontinence. No chest pain. MEDICAL HISTORY: 1. COPD. PFTs on [**2131-9-28**] showed FEV1 0.4, FVC 1.2. On O2 chronically, 4L when active, 2L at rest. One prior intubation at time of diagnosis in [**2118**]. Followed by Dr [**First Name (STitle) **] 2. Hypertension 3. Hypercholesterolemia 4. Lung mass (lingula), enlarging, on Chest CT, presumed neoplasm, 10 mm in [**2130**]. 5. Sellar mass ?????? noted on head CT [**10-17**], thought to be benign pituitary adenoma, prolactin nl, TSH slightly elevated at 4.9 6. Anxiety/depression 7. Impaired glucose tolerance ?????? 2hr glucose of 197, hgba1c of 6.2 [**10-17**]. No polyuria, polydipsia, visual changes 8. Bilateral cataract surgery MEDICATION ON ADMISSION: Ativan 0.5mg po bid prn anxiety Albuterol 90mcg ih 2puffs qid prn O2 4L when active, 2L at rest Lipitor 20 mg po qd Lisinopril 5 mg po qd Servent diskus 50 mcg/dose 1 puff [**Hospital1 **] ASA ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals 98.6 117/52 122 25 92% on 3L NC Gen: Elderly woman lying in bed, no apparent distress, able to speak in full sentences HEENT: NCAT, mucous membranes dry, oropharynx clear, EOMI. +dentures. Surgical pupils. Neck: Supple, no bruits, no masses, no LAD. JVD non-elevated. CV: nl S1, S2. No murmurs, rubs, gallops. Pulm: Soft crackles bilaterally, decreased air movement, no wheezes Back: No CVA tenderness, no spinal tenderness Abd: NABS, soft, NT, ND, no organomegaly Ext: Warm, well-perfused. No clubbing, cyanosis, or edema. DP 1+ bilaterally Skin: No exanthems Neuro: Alert and oriented x 3. Confused at times, but answers questions appropriately. CNII-XII intact. Motor: good tone, [**5-17**] strength in upper and lower extremities; Sensation: intact to light touch and vibration sense in upper and lower extremities bilaterally. Reflexes: 1+ in UE and LE Bilaterally. FAMILY HISTORY: Father died at 80 of lung cancer (smoker). Mother at 79 from ??????diabetes??????. Four sisters in good health, one died from ??????alcohol??????. Five children. One son with [**Name2 (NI) 499**] cancer at age 50. SOCIAL HISTORY: ~70pack years. No EtOH. Lives in [**Location **] ([**Location (un) **]) with 2 sons, 3 other children live nearby. Husband died a couple of decades ago. Not formerly employed.

CHIEF COMPLAINT: headache, nausea, vomiting PRESENT ILLNESS: Ms. [**Known lastname **] is an 88-year-old woman with a history of HTN, prior strokes and MI who presents with dizziness, vomiting, found to have cerebellar ICH at OSH. She was on a day-trip with her daughter and son-in-law from their home in [**State 792**]to [**Location (un) 28318**]. At 12:30, she was normal. Then she suddenly said she needed to go to the bathroom badly, and said she felt "dizzy." They pulled off the highway into a restaurant's parking lot. When they tried to get her out of the car, they noticed she was leaning to the left. They thought she had a right facial droop, as well. They brought her into the bathroom, discovering that she had had fecal incontinence - this she has at baseline to some extent, but this was worse. She also vomited. Because of these concerns, 911 was called. She was brought to [**Doctor Last Name 38554**] hospital at 1:30 pm, where initial BP was 205/83. A head CT showed an 18-mm cerebellar ICH. She began vomiting again, and received 12.5 mg Phenergan and 4 mg Zofran at 2:30 pm. Although her GCS was consistenly 14, they decided to intubate for airway protection. She was given Etomidate and succinycholine at 3 pm, and Versed at 3 and at 5 pm. She was transported to [**Hospital1 18**] ED for further eval. ROS is not possible at this time. Per her family, she had not complained of any other symptoms prior to this MEDICAL HISTORY: Prior strokes - [**2147**] caused significant language impairment and she had other "small" strokes in late [**2143**], but she had no residual symptoms. CAD s/p MI and 3-V CABG [**2147**] DM2, diet controlled HTN Rectal Prolapse Osteoarthritis MEDICATION ON ADMISSION: ASA 325 daily Metoprolol (pt cannot recall full list) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 99.8 PR P: 81 R: 14 BP: 172/91 SaO2: 100% AC 450x14 FiO2 100 General: Intubated, unresponsive, having received Zofran, Phenergan, Versed, Etomidate, Succinylcholine, and Propofol. HEENT: NC/AT, no scleral icterus noted, MMM 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, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Surgical scars over knees. Skin: no rashes or lesions noted. FAMILY HISTORY: NC SOCIAL HISTORY: Lives in [**State 792**]with daughter and son-in-law; they were on a day-trip to [**Location (un) 28318**] at the time of the event. Drinks one glass of wine per day. No tobacco history. Independent in ADLs.

CHIEF COMPLAINT: PRESENT ILLNESS: This 76-year-old white female reports several years of progressive dyspnea on exertion. She gets short of breath walking five minutes on a level surface and also had significant dyspnea when carrying heavy bundles. She had a stress test on [**2136-5-23**] which went for 2 minutes, 20 seconds, stopped due to shortness of breath and it revealed a fixed anteroseptal defect, ischemia of the anterolateral inferior and inferior posterolateral regions. She had an echocardiogram on [**2137-6-25**] which revealed a 55% EF, LVH, moderate MR [**First Name (Titles) **] [**Last Name (Titles) **], biatrial enlargement, pulmonary hypertension with pulmonary artery pressure of 30-40 mmHg. On [**2137-8-16**], she had a Myoview stress test which went for three minutes and was stopped due to dyspnea. Nuclear imaging revealed significant anterior and inferior reversible defects. She is now admitted for cardiac catheterization. MEDICAL HISTORY: 1. History of hypertension. 2. History of hypercholesterolemia. 3. History of anemia. 4. History of paroxysmal atrial fibrillation. 5. History of a left bundle branch block. 6. History of osteoporosis. 7. Status post hysterectomy. 8. Status post negative breast biopsies. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She does not drink alcohol. She does not smoke cigarettes. She lives with her son.

CHIEF COMPLAINT: multiple PE PRESENT ILLNESS: 56M w/diffuse Bcell lymphoma stage IV C2D12 of daEPOCH with recent line associated RUE DVT on fondaparinux presenting with palpatations and dyspnea found to have multiple PEs on CTA. . Patient recently admitted from [**10-9**] - [**10-14**] for cycle #2 [**Hospital1 **]-R with hospital course complicated by rapid Afib and provoked RUE DVT at PICC site. Patient discharged on metoprolol and fondaparinoux. . Per patient had been in USOH after return home when 3days prior to admission developed gradual onset fatigue, palpitations, constant mild chest discomfort, and shortness of breath. Patient spoke with heme who initially instructed him to downtitrate his BB. However symptoms persisted with worsening palpitations and new onset wheezing. He contact[**Name (NI) **] his primary heme who recommended presentation to the ED. . In the emergency dept, Initial Vitals/Trigger: 98.0 100 112/67 16 100% RA. CTA demonstrated acute pulmonary emboli involving the right middle and lower lobar arteries,extending to at least segmental and probably subsegmental level. Also involving to a lesser extent, the right upper lobar artery. Pulmonary emboli also involving the left lower lobar arteries. No evidence of right heart strain, pulmonary infarct, or pleural effusion. Heparin bolused and gtt begun in ED as pt has missed AM fondux. No bedside TTE performed. Per heme, ?lysis therefore decision made to transfer to the MICU. . On the floor, patient with persistent "laborious breathing" and mild chest discomfort but otherwise without complaint. . Review of systems: (+) Per HPI; non-productive cough (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies 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: # Past Oncologic History: DLBCL stage IVEB on R-[**Hospital1 **] - [**5-/2194**] Developed new back pain - [**7-/2194**] Developed low grade fever of 99s and symptomatic - [**8-/2194**] Developed nightly drenching night sweats - [**2194-8-27**] Seen for above symptoms. Initial work up notable for transaminase elevations with AST/ALT of 72/88, CRP 209.4, new anemia to H/H 11.1/34.8. Serologies for Lymes, Ehrlichiosis, CMV, Babesiosis, HAV, HBV, and HCV were negative. SPEP and UPEP were unremarkable but quantitative Igs are not done. - [**8-29**] and [**2194-9-4**] MRI showed increased signal intensity in the marrow spaces in the spine as well as scattered enhancing lesions in several vertebrae. - [**2194-9-8**] CT torso without obvious adenopathy, thoracic, abdominal, or pelvic pathology. - [**2194-9-8**] Evaluated in [**Hospital 17130**] Clinic. Found to have worsening anemia to H/H of 10.7/31.6, low reticulocyte count, new thrombocytosis to 632, elevated ferritin to 2067, rising transaminases to AST/ALT of 86/141 with an alk phos up to 174, an LDH of 588, and normal B12 and folate. - [**2194-9-8**] Bone marrow biopsy with fibrosis and organizing bone, indeterminate. Dry tap. - [**2194-9-12**] LDH up to 1664, Ca up to 10.5, ferritin 3805, CRP above assay, more anemic. Repeat BMBx showed large atypical cells which co-express B-cell marker CD20 along with CD10 and bcl-2 C-MYC negative c/w DLBCL. Admitted at that time. - [**2194-9-18**] C1D1 R-da-[**Hospital1 **] (rituximab 375 mg/m2, etoposide 50 mg/m2, doxorubicin 10 mg/m2, vincristine 0.5 mg, cyclophosphamide 750 mg/m2, Prednisone 100 mg) c/b afib w RVR. - [**2194-10-9**] C2 R-da-[**Hospital1 **] with 20% increase of etoposide, doxorubicin, and cyclophosphamide for good ANC in C1 (rituximab 375 mg/m2, etoposide 60 mg/m2, doxorubicin 12 mg/m2, vincristine 0.5 mg, cyclophosphamide 900 mg/m2, prednisone 100 mg). Planning for HDMtx on C2D15 if patient agrees. . OTHER PMHx: - Obstructive sleep apnea, not on CPAP. - Idiopathic DVT in his 30s. - Remote h/o provoked DVT of LE after a long plane ride MEDICATION ON ADMISSION: # fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1) Subcutaneous once a day for 30 days. # acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). # metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. # lorazepam 1 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for Nausea, anxiety, insomnia. # ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: [**2-2**] Tablet, Rapid Dissolves PO every eight (8) hours as needed for nausea. # oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for Pain. (no longer taking) # docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. # senna 8.6 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for Constipation. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO three times weekly on Monday, Wednesday, Friday. # Neupogen 480 mcg/0.8 mL Syringe Sig: One (1) syringe Injection once a day: daily starting the evning of [**2194-10-15**]. Disp:*14 syringes* Refills:*2* ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission: FAMILY HISTORY: - Mother: Died suddenly in her 50 of a ruptured brain aneurysm. - Father: Hyperlipidemia. - Adopted sister: SLE. - Cousin: Osteosarcoma. SOCIAL HISTORY: - Tobacco: Rare cigars in his youth. - Alcohol: 1-2 drinks per night, less so now. - Illicits: Denies. - Occupation: Computers [**Street Address(1) 17131**] Bank. - Exposures: Worked for a landscaping company years ago and used pesticides. Formerly in the Navy. - Living situation: Lives in [**Location 932**] with his wife, 3 daughters. - Travel: Within the last year to [**Hospital3 **], [**State 5887**], and NY. - Diet: No raw meats or unpasteurized dairy, no game. - Pets: 2 dogs, sometimes they have ticks.

CHIEF COMPLAINT: hypotension, neutropenic fever PRESENT ILLNESS: Ms. [**Known lastname 107792**] is a 57-year-old woman with relapsed AML following a matched unrelated donor bone marrow transplant in [**7-/2154**] for therapy related AML, now s/p DLI on [**2154-11-23**]. Subsequently, she had increasing numbers of blast in both the peripheral blood and the marrow and just finished a course of decitabine last week with ANC 340. . She had been at home in good health and was actually seen in clinic by Dr. [**Last Name (STitle) 410**] on [**2155-4-11**]. His note at that time reported "She has no new complaints. She has had to receive platelets on occasion and may need somered cells but otherwise does not really have any significant dyspnea on exertion, shortness of breath, and certainly no bleeding. She has been able to walk around the [**Doctor Last Name **] at [**University/College 107793**]with her husband without any significant problems. She has had no evidence of infection, no fevers, no night sweats, no weight loss, no cough, dyspnea on exertion, or shortness of breath. No chest pain. She is having no bowel problems. She feels the rash on her face and arms that is stable, not any worse, not any better. She is now on 4 mg of Medrol every day because of her elevations in liver function studies and her skin rash, all felt to be secondary to some GVH after her DLI." . On the day of admission, she woke up feeling lethargic. She also had one presyncopal episode with LHD, diaphoresis, but no LOC. She did subsequently have emesis (non-bloody, non-bilious X1) after breakfast. She took her temp at home and was 101 and came to ED. Per patient, no sick contacts, travel to FLA 1 month ago. She just went down on medrol from 6mg to 4mg last Wednesday (3 days prior to admission). ROS otherwise negtaive. NO HA, vision changes, cough, rhinnorhea, sore throat, N, abd pain, diarrhea, dysuria, new rash, CP, SOB. . In ED, 101.2; HR 155; BP 73/64; RR 16; 97% RA. She received 3LNS, blood cx drawn from line and peripheral, Vanc X 1, Zosyn X 1. Upon discussion with BMT team and given low plts, no CVL was placed. Patient was mentating well the won a game of scrabble throughout all of this. . Upon arrival to [**Hospital Unit Name 153**], she is feeling at baseline with no complaints. T100.9; dynomap BP 85/64 (but on manual repeat 96/70); HR 125; RR 22; 98%RA. . During her [**Hospital Unit Name 153**] stay, pt received additional 4L fluid with no significant increase in her SBP; pt, however, remained asymptomatic. Pt was noted to have a fever of 102.2 and was cultured. MEDICAL HISTORY: AML s/p unrelated donor BMT on [**2154-11-23**] Possible graft vs host skin reaction S/p breast CA in [**2151**] Positive PPD in the past, mother worked in TB sanitarium and s/p INH treatment in the 70's. MEDICATION ON ADMISSION: Acyclovir - 400 mg Q8H Fluconazole - 100 mg daily Folic Acid - 1 mg daily Hydroxyurea [Hydrea] 1 gram daily Lorazepam PRN Methylprednisolone 4mg daily Sertraline - 75 mg daily Bactrim DS - 800 mg-160 mg Tu/Th/Sat . ALLERGIES: Cefepime ALLERGIES: Cefepime PHYSICAL EXAM: PE: 100.9 125 96/70 22 98% RAO2 Sats Gen: well appearing, frail, but in good spirits HEENT: dried brownish crust on tongue, MMM NECK: Supple, No LAD, No JVD CV: RR, NL rate. NL S1, S2. No murmurs, rubs or [**Last Name (un) 549**] LUNGS: CTA, BS BL, No W/R/C ABD: Soft, NT, ND. NL BS. No HSM EXT: No edema. 2+ DP pulses BL SKIN: skin hypopigmentation over face (old per patient) NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. [**1-8**]+ reflexes, equal BL. Normal coordination. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: Father died of unknown cause. Mother alive at [**Age over 90 **] years of age - recently had diagnosis of "heart disease." SOCIAL HISTORY: Denies EtOH, tobacco or drug use. Lives with her husband. [**Name (NI) **] 2 children. Mother with "heart disease" at an elderly age.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 73-year-old white male patient who is admitted to [**Hospital **] Hospital on [**5-22**] with an upper gastrointestinal bleed. Endoscopy at that time revealed duodenal ulcer which was injected with epinephrine and he also had two AVM's which were cauterized. H. Pylori at that time was reportedly positive. While he was being treated at [**Hospital **] Hospital in the Intensive Care Unit, he experienced some vague abdominal pain which radiated to his chest and his neck and ultimately was found to have suffered an anteroseptal myocardial infarction. Cardiac catheterization revealed a tight left main stenosis as well as three vessel coronary artery disease and he was transferred to [**Hospital1 69**] on [**2111-5-28**] for coronary artery bypass graft. MEDICAL HISTORY: Significant for hypertension, hypercholesterolemia, coronary artery disease, status post remote myocardial infarction by electrocardiogram, positive claudication, peripheral vascular disease, gastroesophageal reflux disease, chronic obstructive pulmonary disease, syncope, history of prostate cancer, status post radiation treatments. He is a two pack a day smoker and question of a left carotid artery stenosis. The patient is widowed, retired and lives alone. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 54 yo male with history of coronary artery disease status post coronary artery bypass grafting in [**2145**] to 4 vessels. Past medial history significant for hypertension, hyperlipidemia and a strong family history. He has been having intermittent chest pain for the past year, accelerating over the past 2 weeks and developed [**10-2**] substernal chst pain at rest yesterday morning relieved with 2 sublingual nitroglycerin. The chest pain recurred every 1 hr and he took 2 sublingual nitroglycerin tablets everytime until 4am until he finally took 6 tablets with no relief thus prompting a visit to an outside emergency department. He reports that his chest pain is pressure like, [**10-2**] with radiation to both arms, his neck and his back. He notes diaphoresis, dyspnea, paroxysmal nocturnal dyspnea, orthopnea, but no palpitations. At baseline, he cannot walk up 1 flight of stairs. AT [**Hospital1 1474**]' emergency [**Hospital1 **], he became free of chest pain after intravenous nitroglycerin. An EKG there showed an intraventricular conduction delay and a left bundle branch block with 1mm concordant ST depression in V3-V6 as well as T-Wave inversions in leads I and aVL. He was then tranferred to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for cardiac catheterization. MEDICAL HISTORY: CAD HTN hyperlipidemia EtOH abuse but no withdrawl symptoms CABGx4 [**2145**] MEDICATION ON ADMISSION: Atenolol 100 mg once daily Imdur 30 mg once daily Nifedipine SL 30 mg once daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: AF 133/92 HR 79 RR 18 O2sat 100% RA GEN: NAD, nondiaphoretic HEENT: NC/AT, PERRL, EOMI, anicteric sclera, supple COR: RRR, S1, S2, no m/r/g, no JVD. LUNGS: diffuse wheezes bilaterally, no crackles. ABD: soft, NTND, no rebound EXT: 1+ femoral bilateral, no bruits, 1+DP bialterally, no edema NEURO: A+Ox3, CNII-XII intact. Nonfocal FAMILY HISTORY: Brother w/ MI at 25, Other brothere with MI at age 62 Father w/ multiple MI's and deceased at age 74; Mother deceased from MI at age 62. SOCIAL HISTORY: Works as [**Doctor Last Name 3456**], building brick walls, lives with his wife, smokes 2 packs/day x 40years, drinks a 6 pack of beer/day.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 62-year-old male who presented to outside hospital after shoveling snow a few day prior to admission when he developed intermittent chest pain, nausea, vomiting, diaphoresis, and lightheadedness. He described the pain as [**9-5**]. It was initially constant but then subsided and became intermittent on the day of admission. He was driving and became very lightheaded. He then went to [**Hospital3 3583**] and was found to have a systolic blood pressure of 69. He was also found to be in atrial fibrillation with a heart rate in the 130s. He also was noted to have 2-mm to 3-mm ST elevations in leads V2 to V6 and large Q waves. His pressure responded to intravenous hydration. He was also started on a low-dose esmolol drip for rate control, also on heparin and Aggrastat. He was transferred to [**Hospital1 69**] for catheterization which revealed a totally occluded proximal to medial left anterior descending artery with no collaterals. The left main was free of disease. The right coronary artery was with medial 50% stenosis and normal diastolic ventricular function. When the patient was initially hypotensive when arriving to the laboratory. The esmolol drip was discontinued. His blood pressure remained in the low 100s systolically, but later he required dopamine. MEDICAL HISTORY: None. MEDICATION ON ADMISSION: No medications on admission. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history significant for father who died of a myocardial infarction. SOCIAL HISTORY: Social history is positive for tobacco of one pack per day for 50 years. Positive for alcohol of approximately a few beers per week.

CHIEF COMPLAINT: Seizure PRESENT ILLNESS: Mr. [**Known lastname 31523**] is a 56 yo healthy man who presents after episode of stiffening and unresponsiveness concerning for tonic seizure. History was obtained from patient's partner. [**Name (NI) **] was in bed playing game on iPad, when he began saying "ok" repeatedly. He then raised his arms, internally rotated, and stiffened, and his legs were extended and stiff, there was some shaky movements but not vigorous rhythmic convulsions. He was not responsive during this, and he remains unresponsive after the movement resolved. His partner called 911, and is unclear about how long the event lasted, but states he thinks it was resolving about the time EMS arrived. The patient was intubated in the field for unresponsiveness, with etomodate/succ/versed. His fingerstick was normal. He arrived to [**Hospital1 18**] sedated and intubated. In ED head CT and labs were normal. He received 1 dose antibiotics (levaquin) for ?aspiration. The patient has never had a seizure before. He was at his baseline yesterday and has not been febrile or ill recently. He does not use drugs, and no EtOH for at least 1 week. MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: VS T (rectal) 99.4 HR 80 BP 152/87 RR 18 intubated 100%02sat Gen: intubated, sedated HEENT: NC/AT, sclera anicteric CV: RRR no m/r/g PULM: CTAB AB: NT/ND EXT: no edema. Has punctate scabs on arms and legs. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives with male partner, works as systems analyst. No tobacco, rare ETOH, no illicits, no exposures.

CHIEF COMPLAINT: Slurry speech, right arm weakness PRESENT ILLNESS: 76y/o RH lady with recent (8 days ago) Left frontal subcortical stroke (slurred speech and right facial), hx of renal cancer, lung mets, on chemotherapy (Nexavar), on Coumadine 2mg QD and Aggrenox (for port and recent stroke) presented with worsening in slurry speech and right arm weakness. She was admitted for a night to [**Hospital6 2910**] for above CVA. She had MRI, reportedly had "a stroke". She had drooped right face and slurriness at that time, but no limb weakness. The detail studies there is unknown at this point. She took Coumadine 1mg QD to avoid clotting at her port, which has been increased to 2mg QD since discharge. Last night, she might have some unsteadiness in her gait. But she was able to walk by herself. Otherwie, she has been doing well until this morning (woke up 8:15AM), when husband noticed some worsening in slurriness. At lunch time (around noon), her husband noticed that she was not able to lift her right arm to feed her. She finished her lunch at her left hand. EMT was called and brought her to [**Hospital1 18**] ED. MEDICAL HISTORY: CVA (left sided stroke) a week ago. s/p Right nephrectomy for renal cancer, had lung and brain metastasis, on chemo. MEDICATION ON ADMISSION: Coumadin 2mg QD, Aggrenox 1 tab [**Hospital1 **], Nexavar 400mg [**Hospital1 **] ALLERGIES: Food Extracts PHYSICAL EXAM: Vitals: T 98.2 HR 84, reg BP 14/58 RR 25 SO2 98% r/a Gen:NAD. HEENT:MMM. Sclera clear. OP clear. Extra ear canals, ear drums clear. Neck: No Carotid bruits CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally Abd: Soft, flat, no tenderness Ext: No arthralgia, no deformities, no edema FAMILY HISTORY: Unknown. SOCIAL HISTORY: Lives with husband

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 28 year old male with no apparent medical history who presented from the outside hospital with respiratory collapse and adult respiratory distress syndrome, sepsis of unknown etiology. The patient was feeling ill over the weekend with cough and upper respiratory infection symptoms, febrile to 102. The patient last took NyQuil and Ibuprofen. The patient's girlfriend was [**Name2 (NI) **] with the same symptoms. The patient last went to a local Emergency Department with a cough, hemoptysis, diarrhea, fatigue and chest x-ray showing right hilar fullness. The patient was diagnosed with bronchitis at that time and was given a metered dose inhaler and discontinued to home. Laboratory data at that time revealed white blood count 9.8, hematocrit 42.7, platelets 201 and white blood count had 25% bands, 57% polys. His creatinine at that time was 1.6. The patient presented again and felt very poorly today, felt very weak and continued to cough with hemoptysis, states he was staggering around his apartment. The patient also complained of severe chest pain, states relieved when the patient positioned himself prone on the floor. He returned to the outside hospital on the evening of [**12-23**] with chest x-ray now revealing diffuse left-sided air space infiltrate as well as right upper lobe infiltrate. Laboratory data were notable for white blood count of 1.0 with an ANC of 210, 16% bands, 5 polys, platelets of 92 and creatinine of 2.0. Creatinine kinase at that time was 2,852 with a troponin I of 0.07. The patient was intubated for respiratory distress and was transferred to [**Hospital6 1760**] via [**Location (un) **]. MEDICAL HISTORY: None. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Non-contributory, no sudden deaths. Further history from girlfriend and mother revealed the patient had a right thigh abscess incised and drained approximately two weeks ago. SOCIAL HISTORY: Patient smoked tobacco and used marijuana, occasional alcohol, denies any intravenous drug abuse. Denies any cocaine. The patient spent four years in jail and had negative human immunodeficiency virus test times four, yearly tests done in prison. The patient also had a PPD placed and worked as a mechanic.

CHIEF COMPLAINT: Respirtory Compromise s/p hanging PRESENT ILLNESS: Pt was found at home hanging from dogleash around neck, for undetermined amount of time, Pt was cut down from leash a fell down stairs hitting head on bookshelf. MEDICAL HISTORY: None MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: Neuro: Combative HEENT/Neck: Blood in oropharnyx/nares, C collar on Chest: CTA B Cardiac: Tachy, reg rythym Abd: distended, soft Rectal: guiac neg, normal tone Ext: No deformities FAMILY HISTORY: Adopted SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 110313**] is a 76 year old Caucasian male with a history of asbestosis and restrictive lung disease who was recently admitted to this hospital from [**12-7**] through [**12-14**] for right lung decortication and pleurectomy. He is now representing with complaints of increased shortness of breath since his prior discharge. During the previous hospitalization, his hospital course was complicated by exacerbation of his congestive heart failure requiring Natrecor. The patient also had two brief episodes of hypotension and syncope. In addition, the patient was discontinued home with a Foley catheter due to the fact that when the Foley catheter was removed prior to discharge the patient was unable to urinate. The patient was to have the Foley catheter removed by the [**Hospital6 407**] services at his home, however, before that has happened the patient is returning to the hospital today. With regards to his current symptoms, the patient states that right after returning home, however, before that as it happened the patient is returning to the hospital today. With regards to his current symptoms, the patient states that right after returning home from his prior discharge he started to develop gradually increasing shortness of breath and weakness. In particular, the symptoms have worsened over the last 48 hours. He also complains of decreased appetite and decreased p.o. intake. He also states that he had intermittent chest pain in a band like fashion across the chest which is worse with activity, however, he states that it is not pleuritic chest pain. He denies any cough, fevers or chills. He denies any nausea, vomiting, diarrhea or abdominal pain. The patient states he has chronic lower extremity edema and has not noticed any change in that in the recent days. With regards to his shortness of breath, the patient specifically notes that it is significantly worse when he is sitting up and therefore has spent most of the previous day lying supine. MEDICAL HISTORY: 1. Asbestosis and restrictive lung disease: The patient is status post recent right lung decortication and pleurectomy. 2. Dilated cardiomyopathy: The patient's ejection fraction is measured at 35%. 3. History of supraventricular tachycardia. 4. Pericarditis. 5. Fatty liver. 6. Alcoholic hepatitis. 7. Status post cholecystectomy. 8. Status post tonsillectomy. 9. History of positive PPD. MEDICATION ON ADMISSION: Digoxin .125 mg q. day; Aspirin 325 mg q. day; Protonix 40 mg q. day; Colace 100 mg b.i.d.; Dulcolax prn; Ambien prn; Percocet prn; Flomax .4 q. day; Lasix 40 mg b.i.d.; Diovan 160 mg q. day; Ciprofloxacin for a five day course. In addition, the patient was previously taking Coreg 6.25 mg b.i.d., however, this discharge he had been off of Coreg as it was not included in his discharge medications although he is not certain why. ALLERGIES: 1. Penicillin causes a rash; 2. Shellfish causes anaphylaxis. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has no recent alcohol abuse history and denies any tobacco use.

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: 76 y/o man with h/o CAD, s/p MI ([**2107**], [**2131**]), CHF EF 20%, DM, a. fib/flutter admitted to [**Hospital3 417**] hospital on [**2132-5-21**] for SOB. Of note, the pt had been admitted to [**Hospital3 417**] hospital on [**2132-4-26**] with the same complaints. At that time, he pt was found to be in respiratory distress and was intubated and diuresed (and extubated 1 day following intubation). His respiratory decompsensation on [**4-26**] was thought to be due CHF after missing 2 days of lasix. On [**5-21**], the pt's wife called 911 after the pt became acutely SOB at home. EMS intubated the pt en route to [**Hospital3 417**] hospital. Again, the pt was diuresed with rapid improvement, leading to extubation within days. There was question of PNA, for which he was tx'd with abx. Myoview stress testing during the admission was reportedly negative for ischemia. Echo on [**5-22**] showed EF = 10%. Pt found to be in AFR Creatinine w/ Crt peaking at 2 upon admission but came back to baseline (thought to be ~1.7). Additionally, during this admission to [**Hospital3 **], the pt was in afib. (The pt does not know when his afib started, and has never undergone electrocardioversion. He was started on coumadin in early [**Month (only) **].) On [**2132-5-29**], the pt was transferred to [**Hospital1 18**] to undergo EP evaluation and possible intervention. . Upon review of systems, the pt reported that he can walk the length of the hallway before getting short of breath. He denies lightheadedness, orthnopnea, PND, leg edema, or ascites. He had self-limited palpitations yesterday. No current SOB, and is comfortable and ambulatory on room air. MEDICAL HISTORY: 1. a-fib - [**2132-5-13**] INR 3.0 2. CHF EF 20% - [**2132-4-27**] Echo: EF 20-25% with global hypokinesis, Trace TR, mild pulmonary hypertension. - [**2132-5-22**] Echo: severe global hypokinesis and EF of 10% c/w ischemic cardiomyopathy, mild LA enlargement, RV systolic function mildly reduced, moderate MR, IVC dilated. 3. MI in [**2107**] 4. LBBB 5. COPD 6. diabetes 7. hyperlipidemia 8. CRI with baseline Cr of 1.7 on [**2132-5-5**] 9. Anemia MEDICATION ON ADMISSION: 1. digoxin 0.125mg qday 2. esomeprazole magnesium 40mg 3. salmeterol/fluticasone 250 1 puff [**Hospital1 **] 4. tiotropium bromide 18mcg qday 5. atorvastatin 20mg qday with supper 6. Mylanta 30mL q6h prn 7. aspirin 325 mg qday 8. furosemide 80mg qAM and 40mg qHS 9. glipizide 10mg [**Hospital1 **] 10. metoprolol 100mg [**Hospital1 **] 11. enoxaparin qday 12. acetaminophen 325-650mg q4-6h prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals T: 97.0oF HR: 88 BP: 110/50 RR: 16 O2sat: 96% RA Ht: 5??????9?????? Wt: 154lbs Glucose 465 Gen pleasant, NAD Derm skin normal coloration and texture for age, nails without clubbing or cyanosis. No rash. Hair of normal texture for age HEENT Anicteric. conjunctiva pink. PERRLA, EOMs normal, VFs full. Oropharynx clear. Mucous membranes moist. Trachea midline. Neck supple. No cervical LAD, no enlarged or tender thyroid. Pulm CTAB. No crackles or wheezes CV JVP 8 cm above the sternal angle at 45&#[**Numeric Identifier 18014**]; elevation. irregularly irregular pulse, pulsus alternans. normal S1, S2. No c/m/r/g. Pedal and radial pulses symmetrical and strong,. Abd Non-distended. No scars/herniae. +BS. No aortic/renal artery bruits. Hollow to percussion. S/NT/ND. Liver, spleen not palpable. Ext no c/c/e. Neuro MSE: alert, Ox3. Rest of MMSE not performed CN: II-XII intact to direct testing. Sensory: Light touch intact in UEs and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]. Motor: Good bulk and tone, ROM full and smooth. Strength 5/5 throughout. Coordination: Gait normal. FAMILY HISTORY: FH: No h/o CAD, no HTN. grandmother and brother with diabetes. Brother with laryngeal cancer, mom died of stomach cancer at 73, father died of aneurysm at 73. SOCIAL HISTORY: SH: retired, formerly worked as a carpenter. Has been married for 33 years with his second wife, has 7 children with his first wife. [**Name (NI) **] [**Name2 (NI) 1818**], 63 pack years. Rare alcohol use, no illicit drug abuse history.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 46-year-old female with a history of dilated cardiomyopathy and congestive heart failure with an ejection fraction of 15% who presents with chest pain and cough for a one month period. She was previously admitted to the Coronary Care Unit in [**2122-2-4**] for congestive heart failure secondary to medication noncompliance. Approximately one month ago, the patient says she began developing productive cough with no fevers or chills, and has been having intermittent chest pain controlled by Ultram. She only takes brand name medications due to a concern for allergies to generic medications. However, she is only able to take some of her prescribed medications due to the cost. She denies any lightheadedness or dizziness, and also denies any medication noncompliance or dietary indiscretion. On arrival in the Emergency Department, the patient's vital signs were a heart rate of 97, blood pressure of 120/60, respiratory rate 20, and oxygen saturation of 96% on room air. She had transient episodes of hypotension to the 70's over 40's and received 500 cc of normal saline. She was treated with aspirin, Levaquin and Zofran. MEDICAL HISTORY: 1. Postpartum cardiomyopathy with ejection fraction 15%. 2. Diabetes mellitus. 3. Chronic renal failure with creatinine baseline 2.0. 4. Hepatitis B. 5. Hepatitis C. 6. Elevated cholesterol. 7. Gout. 8. Asthma. 9. Status post cholecystectomy. MEDICATION ON ADMISSION: ALLERGIES: The patient is allergic to penicillin, Lasix and codeine. She claims allergies to all generic medications. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient discontinued tobacco use ten years ago, she has a history of crack cocaine usage.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 27-year-old male, status post gunshot wound to the head. Reportedly no loss of consciousness at the scene. Taken to an outside hospital hemodynamically stable. While he was in the ED, he was increasingly agitated, so was intubated for his own safety. At the outside hospital, head CT showed an occipital cortex trajectory of the bullet from left-to-right with swelling along the tract. The patient was transferred to [**Hospital6 1760**] via LifeFlight hemodynamically stable throughout the flight. MEDICAL HISTORY: Asthma. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Altered mental status PRESENT ILLNESS: (obtained from daughter, who is the only [**Name (NI) 43795**] family member): 49 year old Male with history of Stage IV gastric cancer with liver metastases, presenting with encephelopathy. By report, the patient experienced an episode of urinary incontinence the morning of admission. Shortly thereafter, the patient took a shower, and was subsequently found to be confused and responding inappropriately to questioning. Per family, these are the first such episodes the patient has ever had. Of note, the patient recently traveled to [**Country 651**], where he experienced an upper GI bleed. He reportedly vomited ~1 liter of blood, shortly after taking an unspecified Chinese herbal medicine. The patient spent eight days in a hospital, including the ICU. He returned to the US several days ago, and has had no further bleeding since his return. ROS (Per daughter): Patient has chronic nausea and back pain. He has not been experiencing any focal weakness, tingling, numbness, or difficulty with speech or gait. He has not had fevers, chills, or cough. No abdominal pain, nausea, or vomiting since his trip to [**Country 651**]. MEDICAL HISTORY: Past Oncologic History: The patient developed abdominal pain and bloating in 08/[**2133**]. EGD showed a gastric mass, which was biopsied to reveal carcinoma most consistent with gastric cancer. A CT scan of the torso on [**2134-7-16**] revealed no abnormal findings in the stomach but did show 2 hepatic lesions measuring up to 1.4 cm and retrocrural and retroperitoneal lymphadenopathy. MRI of the abdomen on [**2134-7-23**] revealed, in addition to the findings seen on CT, abnormal thickening in the fundus and proximal body of the stomach and celiac lymphadenopathy. Fine needle aspiration of a retroperitoneal lymph node on [**2134-7-29**] confirmed metastatic carcinoma. Initial CA [**44**]-9 was 156 (9/[**2133**]). Chemotherapy with epirubicin, cisplatin, and capecitabine (CX)was started on [**2134-8-9**]. He remains on treatment but with dose modifications and the use of Neulasta. Torso restaging scans performed on [**2135-7-20**] showed a stable appearance of disease. Starting with cycle 19 of his ECX, the scheduling of his chemotherapy regimen has been changed such that he is now receiving his chemotherapy every four weeks. He has currently s/p 22 cycles. MEDICATION ON ADMISSION: Medications (per [**3-26**] OMR Progress note): CHINESE HERBS ENOXAPARIN 80 mg SC daily LIDOCAINE-DIPHENHYD-[**Doctor Last Name **]-MAG-[**Doctor Last Name **] [FIRST-MOUTHWASH BLM] 1 tbsp swish and spit Q4 hrs PRN mouth pain/ ulcers LORAZEPAM - 0.5 mg PO Q8 PRN nausea/vomiting MEGESTROL - 400 mg/10 mL PO daily OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) PO daily ONDANSETRON - 8 mg PO Q8 PRN nausea OXYCONTIN - 20 mg PO Q12 hr OXYCODONE - 5-10 mg PO Q6 hrs PRN PROCHLORPERAZINE - 10 mg Tablet PO Q4-6 hrs PRN nausea/vomiting LOPERAMIDE-SIMETHICONE - Dosage uncertain SIMETHICONE - 80 mg PO Q6 hrs for Gas ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T:96.8 BP:113/88 P:102 R:17 O2:99% General: Cachectic Chinese male, appears older than stated age. Awake, alert, not oriented to name, place, or time. NAD. HEENT: +conjunctival injection. MM dry. Poor dentition. OP clear. Neck: supple, no appreciable JVD or LAD Lungs: CTAB, limited inspiratory effort. No wheezes, rales, rhonchi CV: Tachycardic, regular, normal S1 + S2, no S3/S4, murmurs, rubs Abdomen: Flat, soft, NT/ND, bowel sounds present, no rebound tenderness or guarding, no organomegaly or pulsatile masses GU: No foley Ext: Thin, WWP, symmetric 2+ radial/PT pulses, no edema Neuro: Mandarin-speaking only. Makes intermittent eye contact to voice and will track across room. FAMILY HISTORY: Mr. [**Known lastname **] moved to United States in [**2115**]. He has no tobacco history. He reports occasional alcohol use. SOCIAL HISTORY: Stomach cancer in 3 paternal uncles. [**Name (NI) **] has an older brother and [**Name2 (NI) 1685**] brother who have no history of cancer.

CHIEF COMPLAINT: neck pain PRESENT ILLNESS: 61yo male psychiatrist with h/o bladder cancer (TCC) s/p radical cystoprostatectomy ([**4-23**]), now with increasing atraumatic neck pain for 1 week, has had 2 similar episodes but less severe. pain not controlled with aleve or percocet at home, so came to ER on [**9-10**] and was admitted to Medicine Service. some pain/tingling in both arms and both posterior thighs, especially with neck ROM and palpation around C7. some difficulty in past 2days with writing. MEDICAL HISTORY: PMH: Bladder cancer s/p radical cystoprostatectomy with ileal loop urostomy, Meniere, Lumbar laminectomy, Cervical myelopathy, Knee arthroscopy. MEDICATION ON ADMISSION: Adderall 30 mg po daily Aleve prn Claritin prn Clonazepam 3 mg qhs Fish Oil Nystatin (for stoma site) Prozac acyclovir Vitamin B-50 ALLERGIES: Demerol PHYSICAL EXAM: pleasantly conversant, NAD. c-collar on. ant/post incisions intact. about 3/5 strength at right elbow extension/wrist extension. otherwise [**5-20**] in BUE/BLE. FAMILY HISTORY: In [**2104**], his father died of bladder cancer after undergoing a cystectomy. His mother died at 53 of renal cell carcinoma. She, of note, had a hypertrophied right kidney, and he has a grandfather with prostate cancer. SOCIAL HISTORY: He is divorced. He rarely smokes. He works as a psychiatrist. His descent is eastern European Jew and he rarely drinks alcohol.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 76M with PMH significant for AFib, HTN, and prostate CA, who presented to [**Hospital 8125**] Hospital the night of admission after being woken up by sudden-onset [**7-8**] CP described as "horses running over his chest", radiating to both arms, with associated diaphoresis. He called EMS, and was taken to [**Hospital 8125**] hospital 45 minutes after the onset of his symptoms. On arrival, he was found to have 1mm STE in I, AVL, and ST depressions and TWI in V4-6 and III. He received ASA, plavix 300mg x 1, metoprolol, and NTG, and underwent thrombolysis with one dose of 10U IV reteplase, 90 minutes after the onset of his symptoms. Following this, he was started on IV heparin. No cardiac enzymes from OSH are currently available. He continued to c/o CP, and was transferred to [**Hospital1 **] for cardiac cath. On arrival to [**Hospital1 **], Mr. [**Known lastname **] was CP-free, and underwent diagnostic cath. Cath revealed R-dominant heart with likley culprit D1 lesion with 80% tubular obstruction, and TIMI-3 flow. Also noted was 80% terminal OM lesion with TIMI-3 flow, 90% distal AVG-LCx lesion, moderate diffuse RCA disease, with 60% tubular lesion and normal flow at origin of PDA. No interventions were made. RA 18, RV 62/32, PCWP 29, PA 62/35 (mean 45), CI 2.45. Received 20mg IV lasix in cath lab, and sent to CCU for further management. . Mr. [**Known lastname **] has not experienced this type of CP before, but notes [**1-2**] month h/o AM GERD symptoms, described as "bulge" under his sternum, occurring most mornings. He also admits 2-pillow orthopnea. No PND. Dyspnea after one flight stairs on occasion. MEDICAL HISTORY: 1) AF, not on coumadin 2) HTN 3) Prostate CA 4) Gout 5) h/o radiation proctitis, no bleeding since. MEDICATION ON ADMISSION: Nifedipine 90mg PO qD ASA 325mg PO qD Toprol XL 50mg PO qD HCTZ 50mg PO qD Terazosin 2mg PO qD Allopurinol 300mg PO qD Digoxin 0.25mg PO qD KCl 50mEq PO qid Ibuprofen 400mg PO tid Vitamin E 400IU [**Hospital1 **] Casodex 50mg PO qD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T: 96.1 BP 148/85 HR 73 RR 14 SaO2 100% 4L, 100kg Gen: Lying in bed comfortably, NAD HEENT: PERRL, MMM Neck: Supple, no LAD, JVP 8cm CV: [**Last Name (un) **] [**Last Name (un) 3526**], nl S1 and S2, no m/r/g Chest: CTA anteriorly, no w/r/r Abd: Soft, NT/ND, +BS, no HSM Extr: 1+ LE edema bilaterally, 1+ DPs, R groin sheath in place Neuro: A&Ox3, no focal deficits FAMILY HISTORY: Sister with [**Name (NI) 10322**] SOCIAL HISTORY: No tobacco, occ EtOH, no drugs. Married, lives with wife. Former policeman, still does occasional electrical work.

CHIEF COMPLAINT: respiratory distress PRESENT ILLNESS: 21 year-old developmentally-delayed male with restrictive lung disease (s/p placement of multiple pulmonary stents in [**2201**]) secondary to severe kyphoscoliosis presenting with worsening hypercarbic respiratory failure. His PCO2 is normally in the 60s (per OMR) but were worse on admission (103). Per caretaker, the patient has been having steadily increasing O2 requirements over the last 6 weeks and has not been able to perform his usual activities. He is normally on 2L Nasal O2 at home with O2 sats 98-100%. During the week before admission, he required 4L O2 to keep O2 sats above 90%. He was recently admitted to [**Hospital1 **] for multifocal PNA in [**6-19**]. . Per caretaker, the patient has been complaining of cough over the last week. The patient is mostly non-verbal. He can utter short phrases, but is NOT TO BE TAKEN at face value, i.e., when offered food, he may say he is not hungry even though he has not eaten that day. He is able to vocalize pain and discomfort with pointing. He is ambulatory (with assistance) at baseline and is normally incontinent of urine and stool. . He presented to the ED on [**2204-9-1**] with HR=120s, BP=140/70, RR=24, 96% on 2L. ABG showed pH=7.34, pC02=103, pO2=79. CTA showed worsening volume loss of right lung and left-sided pulmonary edema with possible multifocal infection. He was given ceftriaxone, azithromycin, and vancomycin. He was admitted directly to the ICU for further management. In the ICU, he had episodes of desaturation to the mid-50s; these improved rapidly with face mask and nebulizer treatment. He did not require intubation. His antibiotics were changed to levofloxacin and Unasyn for treatment of pneumonia. Repeat ABGs showed improvement in pC02 and p02, and he was transferred to the floor for further management. He was then transferred to the floor. . On the floor this morning at approximately 4:30 am, he was found to be acutely agitated, he had removed his oxygen and was desaturating into the teens - he became cyanotic and unresponsive. A gas shortly after this revealed a pco2 of 109 - up from his baseline of pCo2 of 60. On replacing his oxygen by face mask (100%), he recovered his sats, his color, and his responsiveness. He is transferred to the MICU for continual O2 monitoring. . PAST MEDICAL HISTORY: 1. Mitochondrial enzyme deficiency causing mental and developmental retardation. Specific deficiency not specified in prior notes. 2. Severe kyphoscoliosis, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] rods placement 3. Restrictive lung disease secondary to kyphoscoliosis (extrinsic/compression of bilateral bronchi). s/p R main stem stenting, + stents to bronchus intermedius and left main stem bronchus (stents placed in [**1-17**]; patent as of [**4-16**]) 3. Asthma 4. ? [**Location (un) 805**] vs Carpenter's syndrome 5. Hypertension. 6. Bilateral hydronephrosis, right greater than left. 7. Valvular heart disease by history (Mild AR, trace MR, normal ejection fraction). 8. Developmental delay, nonverbal, but communicative. 9. History of acute respiratory distress, hypoxia, requiring MICU stay, intubation, and pressors. 10. Postobstructive pneumonia. 11. Status post several surgeries to correct kyphoscoliosis. 12. Chronic resp acidosis with PCO2s in 60s . Allergies: NKDA . PREADMISSION MEDICATIONS ([**2201**]) 2. Enalapril 2.5 mg po bid. 3. Home O2 - 2 liters nasal cannula. 4. Xopenex 5. Omeprazole 40 qd . SOCIAL HISTORY: Lives with his [**Doctor Last Name **] parents (Mrs. [**First Name (STitle) **] is his health-care proxy and [**Name2 (NI) **] mother), brother, and other [**Doctor Last Name **] children. . Family History: 3 brothers with same mitochondrial disorder . PE: VS: AF, BP 125/90, HR 105, RR 18-20; 100% on 100% face mask Gen: young male, non-communicative, breathing with face mask HEENT: microcephalic, atraumatic, PERRLA, MMM, pink conjunctiva. MEDICAL HISTORY: 1. Mitochondrial enzyme deficiency causing mental and developmental retardation. Specific deficiency not specified in prior notes. 2. Severe kyphoscoliosis, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] rods placement 3. Restrictive lung disease secondary to kyphoscoliosis (extrinsic/compression of bilateral bronchi). s/p R main stem stenting, + stents to bronchus intermedius and left main stem bronchus (stents placed in [**1-17**]; patent as of [**4-16**]) 3. Asthma 4. ? [**Location (un) 805**] vs Carpenter's syndrome 5. Hypertension. 6. Bilateral hydronephrosis, right greater than left. 7. Valvular heart disease by history (Mild AR, trace MR, normal ejection fraction). 8. Developmental delay, nonverbal, but communicative. 9. History of acute respiratory distress, hypoxia, requiring MICU stay, intubation, and pressors. 10. Postobstructive pneumonia. 11. Status post several surgeries to correct kyphoscoliosis. 12. Chronic resp acidosis with PCO2s in 60s . Allergies: NKDA . PREADMISSION MEDICATIONS ([**2201**]) 2. Enalapril 2.5 mg po bid. 3. Home O2 - 2 liters nasal cannula. 4. Xopenex 5. Omeprazole 40 qd . SOCIAL HISTORY: Lives with his [**Doctor Last Name **] parents (Mrs. [**First Name (STitle) **] is his health-care proxy and [**Name2 (NI) **] mother), brother, and other [**Doctor Last Name **] children. . Family History: 3 brothers with same mitochondrial disorder . PE: VS: AF, BP 125/90, HR 105, RR 18-20; 100% on 100% face mask Gen: young male, non-communicative, breathing with face mask HEENT: microcephalic, atraumatic, PERRLA, MMM, pink conjunctiva. MEDICATION ON ADMISSION: Enalapril 2.5 mg po bid. 3. Home O2 - 2 liters nasal cannula. 4. Xopenex 5. Omeprazole 40 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: VS: AF, BP 125/90, HR 105, RR 18-20; 100% on 100% face mask Gen: young male, non-communicative, breathing with face mask HEENT: microcephalic, atraumatic, PERRLA, MMM, pink conjunctiva. FAMILY HISTORY: 3 brothers with same mitochondrial disorder . PE: VS: AF, BP 125/90, HR 105, RR 18-20; 100% on 100% face mask Gen: young male, non-communicative, breathing with face mask HEENT: microcephalic, atraumatic, PERRLA, MMM, pink conjunctiva. SOCIAL HISTORY: Lives with his [**Doctor Last Name **] parents (Mrs. [**First Name (STitle) **] is his health-care proxy and [**Name2 (NI) **] mother), brother, and other [**Doctor Last Name **] children. . Family History: 3 brothers with same mitochondrial disorder . PE: VS: AF, BP 125/90, HR 105, RR 18-20; 100% on 100% face mask Gen: young male, non-communicative, breathing with face mask HEENT: microcephalic, atraumatic, PERRLA, MMM, pink conjunctiva.

CHIEF COMPLAINT: right carotid stenosis, progressive,asymptomatic PRESENT ILLNESS: Patient with known carotid disease. Serial carotid ultrasounds done now with progressive stenosis. asymptomatic. admit for elective rt. carotid endartectomy. MEDICAL HISTORY: histroy of hypertension histroy of dyslipdemia histroy of DM2 histroy of carotid disease s/p Left CEA histroy of dysrythmia AF,PAF, anticoagulated histroyof coronary artery disease .s/p CABG's Lima-LAD,SVG-OM, s/p PTCA RCA xa '[**29**] myoview 112/07 fixed apical defect with possible focal ischemia of inferior wall. EF 60% history of arthritis s/p rt. hip prothesis history of obesity history of obstructive sleep apnea/CPAP MEDICATION ON ADMISSION: atenolol 50mgm [**Hospital1 **] glyset 25mgm tid plavix 75mgm daily gabapentin 300mgm tid asa 81mgm daily mirapex 0.125mgm daily vicodan 5/500 daily slo niacin 100mgm daily cardura 4mgm daily liptor 40mgm daily lisinoprinl 10mgm daily imdur 60mgm daily cosopt gtts OS [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital signs:P-77 B/P 159/84 O2 sat 98% HEENT: right carotid bruit Lungs: clear to auscultation Heart: regular irregular ABd: bengin Neuro: nonfocal exam FAMILY HISTORY: unknown SOCIAL HISTORY: married and lves with spouse

CHIEF COMPLAINT: S/p MVC unrestrained passenger car vs. pole PRESENT ILLNESS: 43 yo female unrestrained passsenger in MVC, car vs. pole with impact on passenger side. GCS 3 at scene with agonal braething. Intubated at outside hospital; transferred to [**Hospital1 18**] hemodynamically stable. MEDICAL HISTORY: Diverticulitis Panic attacks MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HEENT - PERRL, somewhat sluggish. Right frontal laceration Cervical spine - No stepoffs Chest - CTA bilaterally Cor - RRR, No M/R/G Abd - soft, non-tender, non-distended. FAST exam negative GU - Hematuria via Foley drainage bag Rectum - Normal tone Ext - Palpable bilateral DP/PT pulses; superficial lacerations right hand Neuro - Moves all four extremities spontaneously; not following commands FAMILY HISTORY: non-contibutory SOCIAL HISTORY: Separated from spouse; lives with her son [**Name (NI) 916**]; has 3 children

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 10678**] is a 56-year-old male with a past medical history significant for hypertension, hypercholesterolemia, and a positive family history for coronary artery disease, who presented with complaints of left chest wall numbness and tingling and pressure with radiation into the left arm for 24 hours. This was intermittent in nature, was non-exertional, had no associated symptoms of shortness of breath, palpitation, nausea or vomiting. This was different from what the patient usually experienced with his anginal equivalent, which was typically chest pain extending to the throat with shortness of breath and often with exertion and relieved by rest. Of note, recently on [**2123-11-26**], the patient had undergone a stress echocardiogram that was positive, showing inferolateral ST depressions with hypokinesis on echocardiogram with an ejection fraction estimated at 55%. Due to the patient's positive stress test and now his new onset symptoms, he was evaluated in the [**Hospital1 190**] Emergency Room on the [**9-9**] by the Cardiac Critical Care team. Ironically, the patient had previously agreed for an elective coronary artery catheterization to be done prior to the [**Holiday **] holiday, but now presents with new symptoms of chest pain. MEDICAL HISTORY: Gout, gastroesophageal reflux disease, symptomatic premature atrial contractions, hypertension, hypercholesterolemia. The hypertension is borderline. MEDICATION ON ADMISSION: Atenolol 37.5 mg by mouth once daily, Lipitor 10 mg by mouth once daily, Norvasc 5 mg by mouth once daily, a baby aspirin per day, and [**Name (NI) 6196**] 40 mg by mouth once daily, which the patient had recently stopped taking. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Positive for coronary artery disease. SOCIAL HISTORY: Remarkable for occasional ethanol, no tobacco history. Lives with his wife.

CHIEF COMPLAINT: s/p Motor Vehicle Crash PRESENT ILLNESS: 22 yo female rear passenger s/p T-bone motor vehicle collision. Patient taken to referring hospital where found to have pelvic fracture. She was transfewrred to [**Hospital1 18**] for continued trauma care. MEDICAL HISTORY: Asthma MEDICATION ON ADMISSION: Denies ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen-Alert/oriented, NAD VS-afebrile/vital signs stable CV-RRR Lungs-CTA bilat Abd-soft NT/ND Ext:+[**Last Name (un) 938**]/FHL/AT bilat, + sensation bilat, +DPP FAMILY HISTORY: Noncontributory SOCIAL HISTORY: SIngle Employed in a Research Department in a hospital

CHIEF COMPLAINT: Left sided chest pain (9 out of 10) PRESENT ILLNESS: 88 y/o woman with no h/o cardiac disease developed CP under her L breast 3 days ago that lasted for approx 1 hr. It passed on its own. Not related to exertion. Accompanied by nausea and diaphoresis. No SOB. Same pain returned the next night, again for ~1 hr and relieved by tea. She was then without pain the next day. Today, she had rapid onset of L back pain and L chest pain as before (9 out of 10). Again, she had nausea and diaphoresis, and the episode today was worse than the others, but no SOB. EMS was called and they took her to [**Hospital3 417**] Hospital. She was found to have ST elevation is V1 and V2 as well as I and avL, with recip. depressions in II, III, and avF. She refused ASA due to past bleeding ulcer. She was hypotensive to 56/36 after NTG and morphine. Rsolved with IVFs. She was also guiac + in ED at OSH. She was sent here for PCI. Here, she agreed to ASA, and had cath as summarized in results section, with heparin coated stent placed in proximal LAD. She was transferred to the CCU after cath with stable vitals and normal mentation. Now, no CP/SOB lying flat/N/V/D. No vision/hearing changes. No weakness/melena/dysuria/PND/LE edema/orthopnea/DOE. No HA. No abd pain. MEDICAL HISTORY: 1. h/o bleeding ulcer [**8-8**] 2. HTN 3. s/p hip surgery 4. s/p hysterectomy/appendectomy MEDICATION ON ADMISSION: 1.HCTZ 50 qd 2.Cozaar 100 qd 3.Prevacid 30 qd 4. Oxazepam 15 qd 5.Metoprolol ? dose ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T=95.8, HR=67, BP=136/76, O2 sat=100% on 4LNC. Gen: Lying flat, comfortable, speaking in full sentences, NAD HEENT/Neck: OP clear, no LAD. CV: No carotid bruits, RRR with nL S1,S2. No MRG. Pulm: CTA bilaterally anteriorly and laterally Abd: Soft, NT/ND, + BS, guiac + by report from OSH Skin: No rashes Ext: No edema, 1+ DP pulses bilaterally. Neuro: A&O x3. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives alone, but with many family members in area. Lives independently with some assistance. Scheduled to move to FL to be with other family members, but likely delayed after this episode. No tobacco, EtOH, or drugs.

CHIEF COMPLAINT: Shortness of breath, altered mental status Intubated PRESENT ILLNESS: 45yo male with history of IV drug use, endocarditis s/p MVR and PPM placement, and hepatitis C admitted to OSH with altered mental status. . The patient was admitted to [**Hospital **] Hospital on [**5-4**] requesting detoxification as he started using IV drugs again. He had not been compliant with his medications, including his coumadin. He was found to have a subclavian DVT and a left brachial arterial aneurysm, which was thought to be secondary to injection of IV drugs. Vascular evaluated the patient and recommended the patient be fully sober before any attempt at aneurysm repair. He was placed on a heparin gtt and transitioned to coumadin. He had an elevated WBC there and was febrile so he was started in azithromycin with improvement in both. However, on [**5-8**], he became agitated and left the hospital AMA. He returned to the ED on [**5-9**] and reported chest pain radiating to the left arm, headache, photophobia (no rigidity) and shortness of breath. He reported using cocaine since his discharge and denied use of EtOH. . While there, he was found to be febrile with increasing shortness of breath. TTE negative for vegetations and blood culture with no growth at the time of transfer. CXR with no clear consolidation and he was scheduled to undergo a TEE to rule out endocarditis but the patient started withdrawing right before the procedure. He was given suboxone. Later on during the hospitalization, he was found to have a dense aphasia and left hemiplegia. Neurology was consulted and felt this could be secondary to meningitis vs embolic events. CT scan demonstrated poor definition of perimesencephalic cisterns without asymmetry which was concerning for some increased intracranial pressure. There was evidence of treated AVM with no other signs of acute or evolving territorial infarct. Patient was started on a heparin gtt for presumed embolic event. . Given the concern for meningitis, he was also treated with vancomycin, ceftriaxone and gentamycin. His mental status remained altered. In addition, his respiratory status worsened requiring intubation on evening [**5-16**]. CXR did not reveal a clear consolidation and he had elevated A-a gradient so he underwent a CTA which did not reveal a PE. His mental status did not improve and his respiratory status worsened. He continued on a heparin drip. A CTA was negative for PE. He was intubated and transferred to [**Hospital1 18**] on [**5-17**] for further w/u. . On transfer to MICU [**Location (un) 2452**], vital signs were T- 98.2, BP- 127/76, HR- 62, RR- 23, SaO2- 96% (intubated). Patient was intubated and sedated. On day of admission a new right eye lateral deviation was noted on exam. Neurosurgery was urgently consulted. An stat head CT/CTA was obtained that showed SAH and likely PCA aneurysm. MEDICAL HISTORY: - Streptococcus salivarius mitral valve endocarditis [**9-1**] with course complicated by severe MR, multiple septic embolic to bilateral kidneys, spleen, L parietal hemorrhage with underlying mycotic aneurysm s/p onyx embolization s/p MVR [**2112-2-4**] - IVDU x 22 yrs (cocaine, oxycodone) - EtOH Abuse - hx inguinal hernia repair [**2105**] - HCV Ab + [**2108**], viral load negative - Hypertension - Depression, anxiety - Permanent pacemaker MEDICATION ON ADMISSION: Home: 1. Gabapentin 300mg TID 2. Metoprolol 25mg [**Hospital1 **] 3. Magnesium oxide 400mg PO daily 4. Abilify 5mg PO qHS 5. Celexa 20mg PO daily 6. Coumadin daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission Vitals: T- 98.2, BP- 127/76, HR- 62, RR- 23, SaO2- 96% (intubated). General: Intubated, sedated HEENT: Sclera anicteric, pupils reactive to light, non-pinpoint FAMILY HISTORY: No family history of coronary artery disease, CVA or malignancy SOCIAL HISTORY: The patient has a long history of IVDU with cocaine and oxycodone since the age of 21. He also has a past history of EtOH abuse. + Tobacco use. He worked as a land-scaper. Was most recently in rehab, previously lived with his girlfriend and her children. Pet cats in the home. HIV negative [**9-1**].

CHIEF COMPLAINT: Thrombocytopenia Nausea/Vomiting/diarrhea Hematuria Cough PRESENT ILLNESS: The patient is a 74 year old male with a history of CLL diagnosed five years ago, status post fludarabine times one year complicated by AIHA, then switched to chlorambucil plus prednisone with the former discontinued secondary to decreasing platelets in [**2116-6-13**]. The patient presented to [**Hospital6 8283**] emergency room on Wednesday with complaints of nausea and vomiting times one and diarrhea times three. No blood noted in emesis or stool. The patient reported bleeding from pimple on forehead, otherwise not noted to have any overt bleeding sources. At [**Hospital6 8283**] his hematocrit was 24, platelets [**2112**]. Coags were normal. D-dimer positive. Last CBC taken at that hospital on [**2116-7-6**], revealed hematocrit of 31 and platelets of 101,000. In the emergency room he was given intravenous fluids, Solu-Medrol 200 mg IV, suspecting ITP versus leukemic transformation and levofloxacin. He was transferred to [**Hospital1 190**] emergency room via ambulance for further management. In [**Hospital3 **] E.R. the patient was seen by the bone marrow transplant service. Peripheral blood smear revealed a single, normal appearing platelet without clumps or schistocytes. In the emergency room he had bright red blood per rectum times two and significant hematuria complicated by clot retention and difficult Foley placement necessitating urology consult. A 14 French coude was placed. Repeat labs confirmed hematocrit of 24 and platelets of [**2112**]. He was given one unit of packed red blood cells and a six pack of platelets as well as IVIG for presumed ITP and transferred to the Fennard ICU. The patient was hemodynamically stable throughout the E.R. course. MEDICAL HISTORY: CLL. Primary oncologist in [**Hospital3 **] is Dr. [**Last Name (STitle) 55734**]. BPH status post TURP. Hypercholesterolemia. MEDICATION ON ADMISSION: Prednisone 4 mg p.o. q.d., acyclovir 400 mg p.o. b.i.d., Lipitor, aspirin, Hytrin, Protonix 40 mg p.o. q.d., folate 3 mg p.o. q.d., Bactrim double strength one tab b.i.d. Monday, Wednesday, Friday. ALLERGIES: No known drug allergies. PHYSICAL EXAM: On admission temperature 98.6, t-max 99.1, heart rate 104, blood pressure 143/67, 100 percent on 2 liters. In general, he was a very pleasant man in no apparent distress. HEENT PERRL, sclerae anicteric, moist mucous membranes, no mucosal bleeding or petechiae. Neck no LAD, no JVD, no thyromegaly, no masses. Lungs clear to auscultation bilaterally. CV regular rate and rhythm, normal S1, S2, no murmurs, rubs or gallops appreciated. Abdomen soft, significantly distended, patient claimed baseline, moderately tympanitic, nontender, no hepatomegaly, hyperactive bowel sounds. Extremities trace pitting edema, warm, 1 plus distal pulses. Skin petechiae on upper and lower extremities and abdomen. EKG normal sinus rhythm, normal axis, first degree AV block, 3 with Q wave and inverted T wave. Chest x-ray from [**Hospital3 **], AP and lateral, appeared within normal limits, no infiltrates, cardiomegaly or lymphadenopathy. Labs on admission white count 10.8, hematocrit 23.7, platelets less than 5, MCV 103. INR 1.2. Creatinine 1.4. LFTs were within normal limits. Amylase and lipase were normal. D-dimer elevated at 10, fibrinogen 280. FAMILY HISTORY: No oncologic family history. SOCIAL HISTORY: Lives with wife on [**Hospital3 4298**]. Retired college administrator and [**Male First Name (un) **]. No children. Prior smoker 20 pack years, quit 20 years ago. Rare alcohol use.

CHIEF COMPLAINT: necrotizing fasciitis PRESENT ILLNESS: 32M with long history of steroid abuse leading to multiple joint replacements, including both hips and both knees. He was an inpatient at [**Hospital6 2910**] for 6 weeks prior to admission for septic left knee joint (cultured for MRSA & [**Female First Name (un) 564**]). He underwent I&D of the joint and developed MRSA and Citrobacter sepsis. ID at NEBH stsarted linezolid, Diflucan, and cipro. He developed fevers, chills, and significant right-sided abdominal and flank pain with extensive erythema and induration of the soft tissues. A CT scan revealed multiple peritoneal, retroperitoneal, intrahepatic, pseudopancreatic, and pelvic cysts. His WBC rose to 40. He was transferred to [**Hospital1 18**] for IR aspiration cytology of cysts and further management. MEDICAL HISTORY: PMH: -Seronegative arthritis, possibly ankylosing spondylitis, of hips, knees, wrist, on steroids/immunosuppressants since [**2190**](methotrexate, sulfasalazine, Enbrel, Humira, Remicade, prednisone) -anemia of chronic disease -MRSA infection -PUD -anabolic steroid abuse (16 months in early 20s) . PSH: -L TKR [**2-28**] c/b wound dehiscence & septic arthritis in [**3-1**] -R THR [**10-29**] -L THR [**1-25**] -R THR [**4-27**] -L tibial osteotomy -L4-L5 laminectomy [**2193**] (s/p MVA with traumatic disc herniation) MEDICATION ON ADMISSION: Meds at Home: MSIR, MScontin, prednisone, clonazepam, Percocet, Lasix, omeprazole, Indocin, Lovenox ALLERGIES: Clindamycin PHYSICAL EXAM: On admission: VS: T: 102.4 HR: 120-130 BP: 110s/50s RR: 25 Sat: 96% on 4L CVP ~18 Gen: slightly drowsy, answering all questions appropriately, slightly diaphoretic, somewhat uncomfortable appearing HEENT: NCAT, PERRL, sclera anicteric, OP with bari-cat covering mucosa (pt prepping for CT), dentition appears to be in good repair Neck: obese, JVD unable to be assessed CV: tachy, S1/S2, no m/r/g Pulm: CTA b/l Abd: obese, distended, striae present, skin is erythematous and weeping w/ serous fluid, particularly over RLQ, tender in RLQ & LLQ, BS+ Ext: Anasarca, 3+ LE pitting edema DP pulses are 2+ bilaterally FAMILY HISTORY: noncontributory SOCIAL HISTORY: Disabled, lives with mother in [**Name (NI) **], MA. Was a semiprofessional body builder in early 20s with h/o anabolic steroid abuse x 16 months. Tobacco 1 pack/day x 10 years. Denies alcohol use.

CHIEF COMPLAINT: S/P VFib arrest PRESENT ILLNESS: 87 y/o F with PMH significant for CAD s/p CABG ([**2129**]), HTN,HL, afib (on coumadin and dofetilide initially) presents from the MICU for increasing Cr (ARF) and supratherapeutic INR. Pt. initially p/w a [**1-9**] day headache to the ED triage where she went into V-fib arrest. Her SBP was in the 200s. She was defibrillated 200 J once, went into a junctional rhythm for 1 minute and then into sinus rhythm. She did not require chest compressions. She was intubated without sedation but was started on propofol shortly afterwards dur to agitation. Head CT was done which showed no acute intracranial process and neurology ruled out seizures and cooling was not needed. . Post-defib EKGs with normal sinus rhythm was neg for ischemia and echo was nl. She was given 2g Mg and cardiology thought her v-fib was a primary arrythmatic event [**1-8**] dofetilide rather than ischemia. Also, she continued to be hypertensive w/ SBPs in the 200s post arrest on 80mcg of propofol with other notable lab values being K 5.3, INR 3.6, Lactate 5.0. She was then transfered to the MICU on ventilation with the settings: 100% 400 x 18 PEEP 5. . In the MICU, her hypertension w/ SPB 200s persisted so was started on nipride gtt which dropped SBP to 40-50s hence propofol and nipride gtt was stopped. She was bolused 1L and SBP rose to >190-200. She was then placed on nimodipine and then switched to her home hypertensives: valsartan 80 mg [**Hospital1 **], Amlodipine 10 mg QD, metoprolol 25mg [**Hospital1 **] and maintained at SBP goal of 140s. . In the MICU, she was given IV Mg 1g Q6H and transitioned to amiodarone and plavix for her afib. Her course complicated by MSSA VAP with lots of respiratory distress for which she got nafcillin/vanc/cefepime, improved and was extubated and placed on Bipap for 2 days. She was made DNR/DNI (daughter is health care proxy). Respiratory distress improved with abx and was weaned from Bipap to breathing room air. . On arrival to the floor pt. has been afebrile, breathing 100% on 4L O2, comfortable. Denies fevers/chills/night sweats, SOB/chest pain, nausea/vomiting, diarrhea/constipation/melena/hematochezia, dysuria, headache, fatigue, myalgias, light-headedness. MEDICAL HISTORY: HTN HLD CAD s/p PCI in [**2129**] with stents to [**Female First Name (un) **] and x3 to RCA AF on coumadin Anemia MEDICATION ON ADMISSION: 1. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 3. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day. ALLERGIES: Ace Inhibitors PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Tmax: 37.1 ??????C (98.7 ??????F) Tcurrent: 36.8 ??????C (98.2 ??????F) HR: 67 (51 - 67) bpm BP: 178/63(98) {178/63(-6) - 202/80(114)} mmHg RR: 18 (15 - 19) insp/min SpO2: 100% Heart rhythm: SR (Sinus Rhythm) O2 Delivery Device: Endotracheal tube Ventilator mode: CMV/ASSIST/AutoFlow Vt (Set): 400 (400 - 400) mL RR (Set): 18 RR (Spontaneous): 0 PEEP: 5 cmH2O FiO2: 100% . Physical Examination: General: Intubated, sedated 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 Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: PEERLA, unresponsive while sedated, withdraws to pain FAMILY HISTORY: Maternal: mother- Cardiac disease, sister-breast cancer at 87yrs SOCIAL HISTORY: Pt. lives alone in [**Location (un) 86**] and her boyfriend/companion lives next door. Daughter lives in [**Location 3146**] and is very involved with her care. However, daughter reports pt. is very indepedent. Although pt. moved to the US from [**Country 532**] 20 years ago, pt speaks very little English- has been trying to learn. Denies EtOH and tobacco, illicits.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 84 yo M with HTN, hyperlipidemia, PVD, CAD s/p MI [**2120**]'s, h/o L nephrectomy admitted with inferior STEMI s/p Cath and BMS x2 to RCA. Pt reports that he awoke at 4 AM on the morning of admission and noted that he had substernal aching in his chest. In addition he noted that he had L sided jaw ache, diaphoresis, nausea and vomiting. He took NTG x3 with no relief in pain. The aching in his chest continued until 7 AM when he called his son and was taken to [**Name (NI) 2025**]. He reports that he was told that he lost consciousness several times since coming to the hospital. Nothing relieved his pain, which was finally relieved during cardiac cath. Chest pain free on arrival to the CCU. . In ED given ASA 325, NTG gtt, Plavix 600mg po x1, Heparin gtt, Integrilin gtt and transferred to ED. He was noted to be bradycardic and vomiting with HR in 30's , hypotensive SBP 70's. Transferred to cath lab. . Cardiac cath with mid occlusion of RCA with no collaterals, s/p BMS x2 to RCA. . He had been in his usual state of health prior to this am. He has had no chest pain in the past, even with his prior MI and has never had to use his NTG prior to this AM. He has been taking all of his medications except for his ASA which he stopped 1 1/2 weeks ago as he ran out of his pills. He has not had any decrease in exercise tolerance and has been able to go up 13 steps and walk around his neighborhood without any shortness of breath. He denies orthopnea, PND, lower extremity edema, palpitations, dyspnea on exertion. He does report occasional left buttock pain with exercise relieved with rest. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. All of the other review of systems were negative. MEDICAL HISTORY: Past Medical History: 1. Coronary artery disease; a myocardial infarction in [**2126**]. A normal stress echocardiogram in [**2142-11-9**] with left ventricular ejection fraction of 55% and trace aortic regurgitation. Cardiac cath,[**1-13**] stress: negative, LV normal wall motion ,small fixed distal anterior wall defect per OMR. 2. History of hypertension. 3. Peptic ulcer disease. 4. Abdominal aortic aneurysm; status post repair. 5. Renal cell carcinoma; status post left nephrectomy. 6. Hyperlipdemia 7. Syncope in [**2143**] attributed to vasovagal reaction vs orthostatic hypotension * Past Surgical History 1) Poplitial aneurym excised/bypass [**9-13**] 2) Left iliac aa [**2-13**] 3) AAA repair w bilat iliac aa repair [**11/2135**], 4) Lt. thorocoabdominal Nephrectomy [**2-/2139**], 5) Angio [**2-13**] with embolization of left hypogastric artery 6) Left inguinal hernia repari 7) Vasectomy MEDICATION ON ADMISSION: Lopressor 50mg [**Hospital1 **] Zocor 40mg daily ASA 325mg daily (hasn't taken for past 1.5wks) HCTZ 25mg daily NTG (took for first time on morning of admission) Saw [**Location (un) **] (and two other herbals for BPH) Coenzyme Q-10 Omega 3 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97.8 BP 142/86 HR 72 RR 17 96%2L Gen: alert, lying flat, appears comfortable, answers questions appropriately HEENT: JVP around 7-8cm CV: distant heart sounds, RRR no murmur auscultated Lungs: unable to assess posterior lung fields as he is lying flat with sheaths still in place, anterior lung fields CTAB Abd: obese, soft, nontender BS+ Ext: no pedal edema, DP's 2+ bilaterally, Sheaths in place in R femoral A and V, oozing around site . FAMILY HISTORY: non contributary SOCIAL HISTORY: Retired, worked in chemical compnay mixing compounds. Widowed 9 years ago, but has 5 children, 4 of whom live locally, and 16 grandchildren. Pt was a smoker, but quit in [**2126**]. Never drank much alcohol and currently drinks none. Was a singer/son[**Name (NI) 110963**] in his freetime.

CHIEF COMPLAINT: facial pain and numbness PRESENT ILLNESS: Pt reports right sided facial pain, began approx. 13 years ago. Pain subsided for several years, and returned 3 years ago. Pain has been progressively worsening last 2-3 weeks, affecting pts sleep. Pt reports pain [**6-17**] currently in V2, V3 distribution. Occasionally pain extends to V1 and in eyes. Pt reports intermittent facial itching, denies numbness. Reports bilateral eye redness, lacrimation & rhinnorhea x2-3 weeks. Denies hx of herpetic lesion or head trauma. MEDICAL HISTORY: Diabetes, hypercholesterolemia, hypertension MEDICATION ON ADMISSION: Oxcarbazepine, oxycodone ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD. HEENT: Pupils: [**4-9**] bilaterally, conjunctiva injected bilaterally FAMILY HISTORY: NC SOCIAL HISTORY: Lives with wife, works [**Name2 (NI) 84406**] as construction laborer. Smokes few cigarettes/day, no ETOH abuse.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 47-year-old woman with known mitral regurgitation followed by electrocardiogram. Cardiac catheterization done showed 3 to 4+ mitral regurgitation with normal coronaries and an ejection fraction of 67%. Cardiac echocardiogram done in [**Month (only) 404**] of this year showed an ejection fraction of 60% with mildly enlarged left atrium. No aortic insufficiency. There was 3+ mitral regurgitation. MEDICAL HISTORY: 1. Mitral valve prolapse. 2. Hypothyroidism. 3. Varicosities of the lower extremities (left greater than right). MEDICATION ON ADMISSION: Levoxyl 50 mcg by mouth once per day. ALLERGIES: The patient states no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Her mother is alive. Her father is alive, status post mitral valve repair. SOCIAL HISTORY: She lives with her husband and two children. Occupation as a writer. She denies tobacco use. Occasional alcohol use. Denies any other drug use.

CHIEF COMPLAINT: fall from standing - neck pain PRESENT ILLNESS: [**Age over 90 **]F s/p fall at noon today. Fell backwards on head, unsure of why she fell. Denies LOC. Originally presented to [**Hospital **] hospital where head CT was negative and c-spine CT showed a fracture of C2 through the dens with bilateral involvement of the transverse processes. MEDICAL HISTORY: PMH: "Liver" ca - pt did not want treatment HTN CAD Back pain DNR MEDICATION ON ADMISSION: Diazide, Gabapentin, naproxen, tylenol, zantac ALLERGIES: Penicillins / Sulfa (Sulfonamides) PHYSICAL EXAM: PE 97.2 92 147/59 20 96% RA AAOx3 NAD RRR CTAB Soft NT/ND no edema or peripheral injury, extrem warm CII-CXII intact, motor 5+ Upper and lower extrem B/L, pat reflexes intact, no clonus sensation upper and lower extremities bilaterally FAMILY HISTORY: not obtained SOCIAL HISTORY: no EtOH, non smoker

CHIEF COMPLAINT: Dyspnea, fever PRESENT ILLNESS: Mr. [**Known lastname **] is a 45yo M with HIV (well controlled on ART with CD4 542 [**1-6**] and VL<75) and pulmonary fibrosis presenting with a day of high fevers, chills, cough and post-tussive emesis. . Of note, the patient had a similar presentation in [**2138-3-27**] and was briefly in the ICU for hypotension with similar presenting symptoms. Diagnostic studies at that time were unremarkable and he was diagnosed with respiratory viral illness. . In the ED, initial VS were 105.9, 130, 126/107, 18, 98%RA. He received tylenol 1g, motrin 600mg, ceftazadime 1g, azithro 500mg, bactrim DS 1 tab, tamiflu 75mg. Patient got 3L of IVF and had normal lactate of 1.3. CXR showed known fibrosis and CT head was unremarkable. Vitals prior to transfer were 110, 109/74, 23, 94% RA. . On the floor, he reports feeling well the day prior to admission but developing rapid onset of fevers, chills, sweats and worsening productive cough today. Patient endorses coughing fits and then has post-tussive n/v. He has some SOB and mild headache during the coughing fit but no SOB or HA at rest. No chest pain, constant headache, neck stiffness, visual changes, dysuria or hematuria. No diarrhea or constipation. No known sick contacts but he is a bus driver. No recent travel or unusual foods. MEDICAL HISTORY: HIV (dx at least 7 years years ago). Currently on HAART and PCP [**Name Initial (PRE) **]. Hypothyroidism. Pulmonary fibrosis. MGUS. Systemic sclerosis. Raynaud's phenomenon. Previous hospitalizations for viral pneumonias. MEDICATION ON ADMISSION: PERCOCET 5-325 MG TABS 1 - 2 po Q AM and 1 po QHS prn GABAPENTIN 300 MG CAPS 1 - 2 caps po at bedtime, prn extremity pain LEVOTHYROXINE SODIUM 200 MCG TABS 1 tab po daily CALTRATE 600+D 600-400 MG-UNIT TABS ON HOLD (per pt) LEVOTHYROXINE SODIUM 25 MCG TABS 1 tab po daily (with 200mcg tab) ALBUTEROL AERS via nebulizer REYATAZ 300 MG CAPS 1 cap po daily VIAGRA 25 MG TABS outside MD NORVIR 100 MG CAPS 1 po daily ALLOPURINOL 100 MG TABS 2 tabs po daily EPZICOM 600-300 MG TABS 1 tab po daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission physical exam: VS: 99.5, 116/70, 120, 18, 95% RA GENERAL: Well-appearing man in NAD, comfortable, appropriate. HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. NECK: Supple without stiffness, FROM HEART: RRR, no MRG, nl S1-S2. LUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. FAMILY HISTORY: Brother has scleroderma. Otherwise NC SOCIAL HISTORY: Lives in [**Location 686**], MA with brother. [**Name (NI) 1403**] with juvenile delinquents in a detention center. Occasionally uses marijuana. No smoking or alcohol use. Not currently sexually active. Contracted HIV from homosexual partner.

CHIEF COMPLAINT: Transfer for tracheostomy & PEG tube placement PRESENT ILLNESS: Mr. [**Known lastname **] is a 22yo male with PMH significant for mediastinal germ cell tumor with airway obstruction s/p cycle 3 of cisplatin & etoposide ([**Date range (1) 32684**])who presents for elective tracheostomy & PEG tube placement. Patient was recently discharged from [**Hospital1 18**] on [**9-20**] after undergoing stent placement in the left mainstem bronchus and Y stent placement in the trachea. . Patient initially presented to OSH in respiratory distress and was found to have an anterior mediastinal mass on CXR, confirmed by CT. Patient continued to desat from 80s to low 50s and was eventually intubated. Patient was transfered to [**Hospital1 2177**] on [**2171-7-22**] per request of family. According to family, patient was in his usual state of health until he started to have generalized symptoms 6 months prior to presentation to OSH including sore throat, cough, and respiratory symptoms. Patient had been treated for 2 weeks for bronchitis without resolution. . At [**Hospital1 2177**], patient was intially intubated with double lumen ETT for acute respiratory distress. Patient had multiple episodes of desaturation requiring intervention with bronchoscopy for better ETT positioning. On bronchoscopy, the anterior mass was noticed to cause tracheal narrowing and obstruction of the mainstem bronchi bilaterally. Patient's double lumen ETT was changed to a single lumen on [**7-26**] for better ventilation. Course complicated by bilateral pneumothoraces requiring bilateral chest tube placement which were d/c'ed on [**8-24**] and [**8-25**]. Patient was extubated on [**8-23**] but reintubation on [**8-30**] due to hypercarbic respiratory failure. He was transferred at this time to [**Hospital1 18**] for Y stent placement and then transferred back to [**Hospital1 2177**]. He was extubated on [**9-21**] and initially did well but could not adequately handle the secretions so he was taken to the OR on [**9-27**] for tracheostomy by ENT. The procedure was technically difficult since the Y stent was too high. He was reintubated (nasotracheal tube) in OR with bronchoscopy to remove mucous plugging in right middle and lower lobes. . He underwent an ultrasound guided biopsy of his anterior mediastinal mass on [**7-23**]. Given elevated AFP (4093 on [**7-23**]) and biopsy of undifferentiated carcinoma, patient was treated for germ cell tumor with neoadjuvant cisplatin and etoposide from [**Date range (1) 73635**]. Patient prophylaxed for TLS with alopurinol, dexamethasone, and IV fluids. Chemotherapy complicated by pancytopenia and neutropenic fever, requiring PRBC transfusions on Neupogen. Cycle 2 of chemotherapy delayed due to development of Pseudomonas sepsis and ARF. However, with stabilization, patient underwent cycle 2 of carboplatinum and etoposide on [**8-4**]. At the time of transfer, patient is reportedly at his chemo-induced neutropenic nadir. However, Hct and platelets have been stable. . From an ID perspective, following cycle 1 of chemotherapy, patient was diagnosed with a VAP on [**7-28**] and was started on vancomycin and cefepime. Both were continued with the addition of fluconazole for neutropenic precautions following chemotherapy. Cefepime was changed to Zosyn when patient's sputum culture was (+) for Achromobacter on [**8-7**]. Patient then developed an abscess in his R groin at the site of a prior line which was I&Ded by surgery on [**8-16**] and was also the source of the above mentioned MDR pseudomonas sepsis. Patient had pseudomonas in blood, urine, and R groin abscess cultures. He completed a 15 day course of gentamicin and cefepime, despite nephrotoxicity as pseudomonas in wound culture was only sensitive to Gentamicin. Patient was then started on Vancomycin due to MRSA from R quinton tip culture. Also started on Amikacin for Pseudomonas in sputum and urine. Diarrhea started on [**8-17**]. C diff was negative x 3 and was thought to be secondary to chemotherapy. He was placed on empiric Flagyl at this time. A CT scan was obtained on [**9-15**] showing ileocecal thickening and ? typhlitis (necrotizing enterocolitis) as well as some ? intusseception fo ascending colon, although there was no evidence of obstruction. Patient then had temp spike through above broad antibiotic coverage and empiric caspofungin started on [**9-15**]. With persisting fevers patient was continued on Cefepime, Amikacin, for pseudomonas in sputum and urine. . [**Hospital **] hospital course was also complicated by ARF thought to be secondary to pseudomonas sepsis and hypotension on [**8-8**]. Patient developed poor UOP and lasix gtt started with poor response. Patient eventually required CVVH for volume overload on [**8-11**] with 6L removal, and on [**8-15**] with 4L removal. R Quinton placed in R IJ and patient was started on HD on [**8-17**]. Quinton eventually clotted on [**8-25**] and he recent emergent dialysis through a newly placed left femoral line. He then went to IR for possible L quinton placement for HD, but was discovered to have bilat DVTs in IJs which prevented placement. He eventually responded to 140 mg IV lasix with good UOP on [**8-29**] and the L femoral line was d/c'ed to prevent further infection. ARF eventually resolved with normal Cr and good UOP. MEDICAL HISTORY: # Germ cell tumor in mediastinum - s/p 2 rounds of chemotherapy # pancytopenia [**3-15**] chemotherapy MEDICATION ON ADMISSION: Ipratropium Bromide MDI 4 PUFF IH QID Acetaminophen 650 mg PO Q6H:PRN Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY Albuterol 10 PUFF IH Q4H Lorazepam 1-3 mg IV Q1H:PRN anxiety Albuterol 10 PUFF IH Q2H:PRN Metoprolol 12.5 mg PO TID Amikacin 1100 mg IV Q36H Methadone HCl 20mg PO Q8H CefePIME 2gm IV Q8H Miconazole Powder 2% 1 Appl TP TID Diazepam 10mg PO BID Nephrocaps 1 CAP PO DAILY Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION Nystatin Oral Suspension 5 ml PO QID Haloperidol 5 mg IM Q4H:PRN agitation Olanzapine 5 mg PO DAILY Promethazine HCl 6.25 mg IV Q6H:PRN Insulin SC Sliding Scale Vancomycin 1.25gm IV Q 12H . Allergies: NKDA ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: vitals T 99.4 BP 181/107 AR 127 RR 21 vent AC FIO2 0.40 TV 400 RR 12 Peep 5 Gen: Patient awake, responsive to commands HEENT: Nasopharyngeal tube in place Heart: distant heart sounds, no audible m,r,g Lungs: Abdomen: soft, distended, NT/ND, decreased BSs Extremities: No edema, 2+ DP/PT pulses bilaterally FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Patient was a student at [**State 1558**] in accounting. He was a non smoker, no alcohol or tobacco use.

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 89 year old female with history CHF(EF 40%), MI([**12-18**]- medically managed), chronic hyponatremia who presents from nursing home with hypotension, hypoxia, and progressive cough x 2 weeks. No clear history of aspiration, but pt eats pureed food. No fever/chills, 88% on RA at nursing home, 89% on RA on arrival to ED, 99% on 3L NC. In ED afebrile, BP initially 99/60, dropped to 79/50, improved to 106/70 with 2L NS bolus. Patient CXR was consitent with pulmonary edema. She was given dose of levofloxacin, cefepime, and clinda for possible aspiration PNA. She uderwent CTA chest in the ED which showed multiple segmental and subsegmental pulmonary emboli in the bilateral lower lobes and patient was started on IV heparin and admitted to the ICU. Also in the ED patient was noted to be hyponatremic with Na of 122, her Na on previous admission has been ranged from 122-128. Cortisol was sent in the ED. . ROS: Denies any HA, chest pain, currently no SOB, denies any abdominal pain. Patient states she feels weak. Admits to recent weight loss. States her heels hurt her. MEDICAL HISTORY: Hypertension S/P hysterectomy Iron deficiency anemia Basal cell carcinomas (largest on scalp; patient refuses to have treated per PCP) Recent MI [**12-18**] medically managed CHF most recent echo with LVEF 40% Critical AS: Peak velocity 4.0 and valve area of 0.5 Rectal mass (no workup) MEDICATION ON ADMISSION: Docusate Sodium 100 mg PO BID Aspirin 325 mg PO DAILY Lisinopril 5 mg PO DAILY Senna 8.6 mg PO BID Bisacodyl 5 mg PO DAILY prn Furosemide 40 mg PO DAILY Atenolol 25 mg PO DAILY Omeprazole 20mg MVI Zinc sulfate Vit C KCL 20meq daily ALLERGIES: Erythromycin Base / Metoprolol Tartrate / Keflex PHYSICAL EXAM: Docusate Sodium 100 mg PO BID Aspirin 325 mg PO DAILY Lisinopril 5 mg PO DAILY Senna 8.6 mg PO BID Bisacodyl 5 mg PO DAILY prn Furosemide 40 mg PO DAILY Atenolol 25 mg PO DAILY Omeprazole 20mg daily MVI Zinc sulfate Vit C KCL 20meq daily FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Pt previously lived alone but most recently from rehab. Nephew is HCP. She does not smoke or drink alcohol. She previously [**First Name8 (NamePattern2) 98190**] [**Last Name (NamePattern1) 23081**]. The patient does not have any family; her nephew does not see her often. She has no children.

CHIEF COMPLAINT: Fevers PRESENT ILLNESS: In brief this is a 60 yo female with muliple complications from uterine CA s/p XRT including radiation cystitis/colitis with multiple enteric and vessicular fistulas requiring bowel resections and chronic colostomy and nephrostomy who presents with 2 days of bladder spasm, and fever to 101.5. Most recently admitted in [**Month (only) **] with line infection (MRSA, VRE in urine), treated for 2 weeks with dapto. During that admission she was noted to have EF 20-30% with global hypokinesis. Seen in office yesterday ([**9-13**])with low grade fever, bladder spasm. Urine/blood cultures taken and based on previous cx, vanco/levo started. B/l urine cx from nephrostomys now growing >100,000 GNRs. Tonight she calls and says that she has a fever to 101.8 and also that she had a twinge of chest pain. Referred to ED for eval. She was started on vanco and levo since yesterday. In the ED, initial vital signs were T 101.8, HR 121, BP 123/66, RR16, O2 96%RA. Urine cultures from [**2157-9-13**] came back growing GNR's. Her blood pressure dropped to 83/60 and she received 500cc NS. She received a total of 1.5L NS and her SBP remained in the mid 70's. She refused a central line, but was started on levophed through her central line. She received zosyn 4.5mg IV x 1. MEDICAL HISTORY: 1. Endometrial/cervical cancer 2. S/p TAH in [**2153**] (due to uterine cancer) 3. Chylous ascites 4. Colectomy, cholecystectomy, and ileostomy ([**11-16**], likely related to radiation bowel damage.) and chronically draining fistula 5. Small bowel removal and ileostomy ([**6-17**]) c/b chronic skin infection 6. S/p ventral hernia w/ repair 7. PE s/p IVC filter 8. Anxiety 9. Nephrostomy tube replacements, multiple 10. Hyperbilirubinemia and hyper alkaline phosphatemia thought to be [**1-14**] TPN induced chronic cholestasis. 11. Anemia of chronic disease 12. VRE 13. Basal cell of face MEDICATION ON ADMISSION: Mirtazapine 15 mg Tablet QHS Ativan 0.5 mg Tablet 1-2 Tabs PO Q8hrs Epoetin Alfa 4,000 unit/mL Solution Sig: 20000u qtuesday Loperamide Two Capsule PO QID prn Fludrocortisone 0.1 mg daily Opium Tincture 10 mg/mL Tincture qid Diphenoxylate-Atropine 2.5-0.025 mg q6h ALLERGIES: Meperidine / Heparin Agents / Bactrim PHYSICAL EXAM: Vitals - T99.4, HR94, BP 118/55, RR19, O2 98% Gen - NAD, appears chronically ill, somnolent, but arousable HEENT - PERRL, MMM, no elev JVP Heart - RRR, no murmur appreicates Lungs - clear to [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] - soft, mild diffuse discomfort, no rebound/guarding. small amount of discharge from fistula. Extrem - [**1-15**]+ pitting edema bilaterally Neuro - CNII-XII intact, [**4-16**] UE and LE strength Skin - multiple echymosis, no rashes FAMILY HISTORY: Father 83 (deceased, CVA, MI); Mother (deceased, 92, CVA); Brother (79, esophageal cancer); Sister (60s, colon cancer, lung mass, afib) SOCIAL HISTORY: Lives with her husband and has 2 children. Denies current alcohol use. Had been banking executive prior to development of health issues. Smokes + [**12-14**] PPD for 19 years.

CHIEF COMPLAINT: Bladder Cancer PRESENT ILLNESS: Large bladder ca found. Causes difficulty with voiding. MEDICAL HISTORY: A-fib Chronic renal insufficiency Anemia Indwelling foley Pacemaker MEDICATION ON ADMISSION: Digoxin 0.0625' Midodrine 5' Protonix 40' Coreg 3.125" Betoptic 0.25% OU" Alphagan 0.15 OU TID FeSO4 325''' Lipitor 10 QHS Xalatan 0.005% OD QHS ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: AAOx3 NAD CV: S1 S2 RRR CHest: CTA B/L Abd: pos BS, soft NT/ND, midline incision C/D/I, JP incision C/D/I Extrem: no edema FAMILY HISTORY: NC SOCIAL HISTORY: 3 pack/day smoker, quit [**2118**]

CHIEF COMPLAINT: Weakness and myalgias x 2 days PRESENT ILLNESS: Ms. [**Known lastname **] is a 64yo woman with multiple myeloma, s/p allogeneic transplant [**2143**] with recurrent disease and with systemic amyloidosis(cardiac), on hemodialysis for ESRD who represents for malaise, weakness, and generalized body aching x 2 days. She was admitted last week [**Date range (1) 19274**]/08 with hypercalcemia and treated with pamidronate 30mg, calcitonin, and dialysis. Hospital course was complicated by an episode of hypotension following dialysis on [**2153-1-12**]. She also began treatment for myeloma and amyloidosis last week with Revlimid. Besides generalized pain worst in back, legs, and jaw and weakness, she also notes intermittent SOB x 2 days(at home is on 2-3LNC). Denies cough, fever, chills, chest pain or palpitations. She was dialyzed yesterday to dry weight of 60kg. She and her husband note poor po intake for the past several weeks. . In the ED, initial vs were: T 98.7 P 68 BP 83/43 R 22 O2 sat 99% on NRB. Her lowest systolic 60s improved to the systolic in the 80s. She was transiently on peripheral dopamine w/improvement of systolic to mid 90s. Restarted levophed around 0900 because tachycardia due to dopamine. Labs were notable for calcium 14.2, INR of 7.2. CXR showed a worsening pleural effusion and CTA chest was performed which demonstrated stable chronic changes and no PE. TTE in the ED was w/o evidence of large pericardial effusion. Patient was given cefepime and vancomycin. CVL was attempted, but reportedly clotted. . Review of sytems: (+) Per HPI (-) Denied night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. No nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. Does not make urine. She denies lightheadedness/dizzyness. MEDICAL HISTORY: Multiple Myeloma: (Per Problem [**Name (NI) **] [**Name2 (NI) **], reconfirmed with patient) "1. Initial treatment with melphalan and prednisone, [**2142-2-28**] followed by VAD [**Month (only) **], [**2142-9-25**] with autologous stem cell transplant in 01/[**2143**]. With relapse of her myeloma, she received thalidomide from [**Month (only) **] to [**2143-10-25**]. 2. Nonmyeloablative allogeneic stem cell transplant from a sibling donor in 11/[**2143**]. 3. Noted for recurrent disease in the summer of [**2145**] and received a donor lymphocyte infusion in [**8-/2145**] with relatively a stable disease after this. 4. Noted for slow progression of her disease in the fall of [**2150**] and status post a second donor lymphocyte infusion on [**2151-2-5**] given at a dose of one x10 to the seventh T-cell/kg. 5. Admitted on [**2151-9-13**] due to worsening renal insufficiency with creatinine of 3.4 and new lung mass causing right lower lobe collapse. The lung mass was biopsied and thought consistent with amyloid. 6. Following [**Year (4 digits) **], she was started on thalidomide for a short period of time, but was readmitted on [**2151-9-28**] due to left lower edema and new DVTs. 7. Received Cytoxan [**2151-9-30**] with Decadron 20mg X 4 days with no change in disease. 8. Received Velcade 1.3mg/m2 D1 and D4, but then admitted due to worsening lower extremity edema and increased creatinine. 9. Received Cycle 1 Velcade/Cytoxan/Decadron on [**2151-10-22**]. Cycle 2 started on [**2151-11-12**]. Cycle 3 on [**2151-12-3**] with D11 Velcade held. C 4 started on [**2151-12-24**] but admitted following morning due to dyspnea. C5 started on [**2152-1-31**] with D8 Cytoxan held and D11 Velcade held due to low counts. Also on dialysis for renal failure. 10. Thalidomide to start on [**2152-2-18**]. Coumadin is anticoagulation. 11. Another admission on [**2152-3-9**] due to increasing shortness of breath and worsening/recurrent pneumothoraces on the left side. She underwent pleurodesis and although had a reaction to the talc procedure, she was discharged home after only about a one-week stay in the hospital. She resumed her thalidomide at 50 mg daily, and she has slowly increased this to 150 mg daily as of [**2152-4-17**]. She was restarted on Coumadin which is being adjusted to keep INR at 2-3. 13. Status post DLI on [**2152-4-24**]." Other Pertinent Past Medical History - Per [**Year (4 digits) **] and Confirmed with Pt - s/p 3 episodes of epiglottitis/supraglottitis requiring intubation in [**2145**], [**2149**], [**2151**] - Amyloidosis - involvement of lungs, tongue, bladder, heart - CKD - thought secondary to amyloid disease progression - Diastolic dysfunction - likely secondary amyloid - Multiple DVT's (L IJ, L popliteal, L sup femoral)-IVC filter, due to R sided DVT propagation; on coumadin intermittently (due to fluctuating platelet counts on Velcade) - Pulmonary emboli in the past associated with DVT's - Osteopenia s/p Zometa infusions - HTN - s/p tonsillectomy - Hx of disseminated herpes in [**2146**] - Urge incontinence - Subdural hemorrhages in [**2-/2151**] in the setting of elevated INR MEDICATION ON ADMISSION: Sevelamer HCl 800 mg PO TID W/MEALS Pantoprazole 40 mg PO Q24H Trimethoprim-Sulfamethoxazole 160-800 mg PO 3X/WEEK (MO,WE,FR) Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for Nausea. Docusate Sodium 100 mg PO BID Senna 8.6 mg PO BID as needed B Complex-Vitamin C-Folic Acid 1 mg PO DAILY Lenalidomide 5 mg PO Three times weekly the day of dialysis. Warfarin 4 mg PO DAYS([**Doctor First Name **],MO,TU,WE,TH,FR,SA) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 97 BP: 94/49 on 0.06 levophed P: 73 R: 13 O2: sat 96% on NRB General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: bronchial BS and crackles at left base; decreased BS on left, no wheezes, 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 Rectal: guaiac (-) Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema; +edema on right wrist, no tenderness w/passive motion Neuro: A&O x 3, CN 2-12 in tact, [**5-29**] upper and lower extremity strength Skin: No rash, warm and dry. FAMILY HISTORY: Notable for hypertension. No family history of malignancies or premature cardiac death SOCIAL HISTORY: Married and lives in [**Location 3786**]. She has two adult children and one grandson. She uses alcohol occasionally. She denies ever using tobacco or illicit drugs.

CHIEF COMPLAINT: throat swelling PRESENT ILLNESS: 78 year old female with history of acute myelofibrosis with panmyelosis (a rare form of acute leukemia), neutropenic, recent admission for mild pancreatitis as well as neutropenic fever after experimental chemotherapy cycle (C1D1 [**2198-4-5**], now C1D26), now transfered from [**Hospital1 1474**] ED with tongue and anterior neck swelling. Patient reports having aphthous ulcers in her mouth for several days secondary to chemotherapy, and had begun using glycerin (FIRST) mouthwash, after which she noted tongue and anterior neck swelling this morning. She has used this product in the past, but not for at least a year. She noticed soon after using that the bottle was expired. Patient is also on lisinopril for hypertension, which she has been on long-term. She was started on allopurinol two weeks ago. Patient noted no chest or abdominal pain, rashes or pruritus. She did note some dyspnea at the time, but no specific sensation of throat closing. She did notice some symptoms of drooling. She also had some nausea, but did not vomit. She had not eaten anything that morning. This type of reaction and symptomatology has never occurred before. She presented initially to [**Hospital1 1474**] ED where she was given benadryl, famotidine, IV methylprednisolone, and an epinephrine pen injection, after which symptoms of dyspnea dramatically improved, per patient report. She was then transfered to [**Hospital1 18**] for further management. Her tongue was still noted to be swollen on arrival, though she has not had any throat tightness or stridor symptoms. . In the ED, initial VS were: T 98.2 P 72 BP 164/72 R 16 Sat 98% 2L. Patient was given no further medications in the [**Hospital1 18**] ED. Patient's hematologist/oncologist Dr. [**Last Name (STitle) **] was contact[**Name (NI) **] in the [**Name (NI) **] and requests Allergy consult for patient on arrival to [**Hospital Unit Name 153**]. . On the floor, patient reports that her tongue swelling has decreased considerably. She reports no dyspnea, throat tightness or current drooling. She has no nausea at this time. . Review of systems: (+) nausea and dry heaves (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough. Denied chest pain or tightness, palpitations. Denied vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. . MEDICAL HISTORY: ONCOLOGIC HISTORY: Acute myelofibrosis with panmyelosis: - [**12/2195**]: presented with pancytopenia. Bone marrow biopsy at OSH showed >40% blasts. Subsequent bone marrow biopsy done at [**Hospital1 18**] showed acute myelofibrosis with panmyelosis, a rare form of acute leukemia, versus acute megakaryoblastic leukemia with acute myelofibrosis. The patholgy report favors the former given CD34 positive expression on blast cells. - [**2196-1-12**]: started on decitabine - [**2197-6-19**]: repeat bone marrow biopsy showed ~50% cellularity (previously 20%), 5% blasts by CD4 staining, grade [**1-26**] fibrosis (fibrosis essentially unchanged from previous), with normal-appearing megakaryocytes. Her chemo cycle duration was increased from every 28 days to 42 days. - [**10-1**]: acute cholecystitis sp ERCP with cocnurrent klebsiella bacteremia, had lap chole on [**11-1**]. - [**2197-12-30**]: restarted decitabine after prolonged discontinuation secondary to cholecystectomy (completed 9 total cycles) - [**3-19**]: admitted for febrile neutropenia with no source identified. - [**2198-4-5**] RAD001 5 mg po - [**2198-4-6**] Start PKC412 50 mg po bid . OTHER PMH: 1. Acute cholecystitis s/p ERCP with concurrent Klebsiella bacteremia [**10-1**] treated with perc cholecystostomy placement. 2. laparoscopic cholecystectomy [**2197-11-1**] 3. CoNS BSI [**9-1**] - treated with daptomycin for 10 day course 4. History of endometrial cancer s/p TAH-BSO - [**2168**] 5. Hypertension [**2156**]'s 6. L knee replacement -[**2186**] 7. R knee replacement - [**2187**] 8. R eye macular degenerative disease - [**2192**] 9. L eye cataract - [**2195**] 10. Bilateral knee replacements MEDICATION ON ADMISSION: Lisinopril 10 mg PO daily Metoprolol tartrate 50 mg PO BID Allopurinol 200 mg PO daily Omeprazole 20 mg PO BID Valacyclovir 500 mg PO daily Prochlorperazine 5 mg PO Q6h PRN nausea Levofloxacin 500 mg PO daily Lorazepam 0.5 mg PO Q8h PRN nausea, anxiety Acetaminophen 325-650 mg PO PRN headache ALLERGIES: Morphine Sulfate / Codeine / Shellfish Derived / Vancomycin / Zosyn / lisinopril PHYSICAL EXAM: Physical Exam Admission: General: Alert, oriented, no acute distress, appears comfortable, pleasant HEENT: Sclera anicteric, tongue mildly swollen, uvula is visible without tongue depression, MMM, punctate hemorrhagic lesions over underside of tongue Neck: supple, JVP not elevated, no LAD in cervical or supraclavicular chains, no inspiratory or expiratory stridor Lungs: Clear to auscultation bilaterally, with no wheezes, rales, rhonchi 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 GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . Physical Exam Discharge: HEENT: Sclera anicteric, tongue not swollen, uvula is visible without tongue depression, MMM, punctate hemorrhagic lesions over underside of tongue FAMILY HISTORY: Daughter is s/p lumpectomy (?breast cancer). Father died at 41 & brother died at 50, both from bone cancer. SOCIAL HISTORY: Lives in [**Hospital1 1474**] by herself. Works for her daughter doing "computer work". Tobacco: none EtOH: social, occasional glass of wine IVDU: none .

CHIEF COMPLAINT: Non-Q wave myocardial infarction. PRESENT ILLNESS: The patient is a 71-year-old male with a history of diabetes, hypertension, hypercholesterolemia, peripheral vascular disease, CHF, chronic renal insufficiency, and CAD, who was transferred to the [**Hospital1 18**] from the [**Hospital3 15174**] on [**2139-11-16**] after being ruled in for a non-Q wave MI. The patient was admitted to the [**Hospital3 15174**] on the evening of [**2139-11-14**] following the acute onset of chest pain and shortness of breath while at a church dinner. He was ruled in for an MI with a troponin peak of 1.07. He was started on heparin, IV nitroglycerin, and Aggrastat. His symptoms resolved. An echocardiogram performed while there showed an ejection fraction of 30% with basilar inferior hypokinesis and anterior severe hypokinesis to akinesis. The patient was, therefore, transferred to the [**Hospital1 18**] for a cardiac catheterization. The patient had previously had a cardiac catheterization at [**Hospital1 18**] in [**2139-3-13**], during which the patient received a stenting of the LAD and PTCA of the diagonal branch. He was reported to have done well following the [**Month (only) 958**] procedure, returning to work five days a week and able to walk several miles without any chest pain or shortness of breath. MEDICAL HISTORY: 1. Hypertension. 2. Diabetes times 30 years (on insulin for four years). 3. Chronic renal insufficiency. 4. Peripheral vascular disease. 5. Silent MI. 6. Status post right renal artery stenting. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is a married [**Country 3992**] and Korean War veteran with possible post-traumatic stress disorder. The patient works at [**Company 2486**] five mornings a week. The patient quit smoking 30 years ago after a 40 pack year history.

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 81 year old male transferred from Bronkton for ST segment depression on stress test and drop in his blood pressure. He was transferred to the Medical Service and underwent a cardiac catheterization which showed 30 percent ostial disease, 40 percent proximal left anterior descending coronary artery and an right coronary artery disease. His past medical history is significant for hypertension, coronary artery disease, angina and high cholesterol. MEDICAL HISTORY: MEDICATION ON ADMISSION: Aspirin, Flomax, Plavix, Pepcid, Lovenox and Atenolol. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Hypoxia, Altered Mental Status PRESENT ILLNESS: 66 y/o male with schizophrenia, COPD, previous episodes of aspiration pneumonia and chronic rhabdomyolysis who was admitted for altered mental status with recurrent falls and an increasing oxygen requirement. At admission he had been on Azithromycin for three days for a bronchial infection but no improvement had been noted and his oxygen requirement was gradually increasing. His oxygen saturations were 83% on room air on admission and required 4-5 liters to maintain saturations of 95-96%. There was high concern for another aspiration event and he was started on Levofloxacin and Flagyl. He had been febrile to the low 100s prior to admission but was afebrile on presentation to [**Hospital1 18**]. He was initially admitted to medicine but on the morning after admission, the patient was found to be hypoxic to 82% on 5L NC. A CXR from the prior night was concerning for volume overload. Lasix were given and the patient was placed on a NRB with subsequent improvement in O2 saturation to 100%. He was transferred to the MICU for presumed impending respiratory failure. The patient improved on Levofloxacin and Flagyl and was able to be weaned down to low flow oxygen by nasal canula. He was then transferred back out to the medicine floor. MEDICAL HISTORY: Paranoid schizophrenia COPD History of psychogenic polydipsia Anemia Aspiration pneumonias Rhabdomyolysis (? Chronic) MEDICATION ON ADMISSION: 1. Clozapine 100 mg daily 2. Clozapine 500 mg QHS 3. Divaloprex 500 mg [**Hospital1 **] 4. Ferrous sulfate 325 mg daily 5. Multivitamin daily 6. Thiamine HCl 100 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 96.3, BP: 152/78, P: 85, R: 18 O2: 98% RA General: restless at times, NAD HEENT: NCAT, sclera non-icteric, no TM, no cervical LAD Lungs: frequent coughing, minimal diffuse wheezing, +/- decreased breath sounds at right lung base CV: no JVD, regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Psych: patient actively hallucinating, frequently delivering lectures religious in nature, patient able to be redirected Neuro: CN II-XII grossly intact, sensation grossly intact, requires assistance to ambulate FAMILY HISTORY: Deferred. Not addressed during this admission. SOCIAL HISTORY: Ordained as a rabbi, no longer engaged in rabbi[**Name (NI) **] work. Lived in his current [**Hospital3 **] apartment for approximately 10 years. Smokes 1.25-2 ppd but no other substance. Brother [**Name (NI) 5045**] is his guardian. [**Name (NI) **] immediate family in the [**Location (un) 86**] area.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 78 year old male transferred from the [**Hospital3 2558**] Nursing Home. He was transferred for reported desaturations without improvement after being given nebulizers. The patient was transferred to [**Hospital6 256**] Emergency Room for shortness of breath and tachypnea to a respiratory rate of approximately 42 per minute with vital signs at the nursing home of a temperature of 99.8, heart rate of 100 to 110, blood pressure 220/90 and 78 percent oxygen saturation on room air. Reportedly this patient was previously being treated for a perihilar bilateral pneumonia and given Levaquin 250 mg p.o. for ten days and then Flagyl 500 mg. There was a reported episode of vomiting on the day prior to admission with desaturation of his oxygen during those times. There was also annotation of low-grade temperatures prior to admission. On presentation to the [**Hospital6 256**] Emergency Department, the patient was entered in the MUST sepsis protocol for suspected source of infection with a fever, tachycardia, tachypnea as well as an elevated lactate which on presentation was 5.7. In the Emergency Department, a right internal jugular central line was placed. The patient was given Zosyn and Vancomycin for antibiotics and fluid resuscitation and admitted to the Medical Intensive Care Unit. MEDICAL HISTORY: 1. Cerebrovascular accident leading to dementia, aphasia and noncommunication at baseline. 2. Dysphagia resulting from the cerebrovascular accident, now status post G-tube placement. 3. Hypernatremia. 4. Depression. 5. Hypertension. 6. Atypical psychosis. 7. History of Proteus back abscess, status post incision and drainage. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives at [**Hospital3 2558**]. His wife is his health care proxy. The patient is nonverbal at baseline.

CHIEF COMPLAINT: transfer for management of possible sepsis and hypercarbic respiratory failure PRESENT ILLNESS: 52 year old female with HTN, T2DM, COPD, and sleep apnea who was transferred from an OSH for further management and evaluation of hypotension and respiratory failure. She presented on [**1-13**] with fever to 104 and WBC 19,000 and was found to have b/l LE cellulitis. She was initially treated with vancomycin. She was treated with Zyvoxx. She was noted to be lethargic the night of admission and ABG revealed 7.17/70/70. She was placed on BiPAP and transferred to the ICU. She also became hypotensive and was started on dopamine. Her respiratory status did not improve on BiPAP and she was intubated. . Of note, pt was admitted from [**2154-7-27**] to [**2154-8-1**] for community acquired pneumonia, sepsis, respiratory Failure, laryngeal edema secondary to endotracheal intubation, asymptomatic sinus bradycardia NOS, and mild aortic valve stenosis (area 1.2-1.9cm2). She was initially transferred to [**Hospital1 18**] for evaluation of laryngeal edema after she was unable to be extubated. She was seen by pulmonary, they treated her with steroids, and then successfully extubated her without complications. Her course was complicated by asymptomatic bradycardia; cardiology did not feel that this required further evaluation, but recommended echocardiography to rule out structural heart disease. This showed mild aortic stenosis, but was otherwise normal. . Admitted again to [**Hospital3 **] for chest pain in [**10-5**]. P-MIBI was negative at the time. . ROS: Cannot obtain. MEDICAL HISTORY: COPD Mild aortic valve stenosis (area 1.2-1.9cm2) Hypertension Morbid Obesity Obstructive sleep apnea Schizophrenia Recurrent lower extremetiy cellulitis and lymphedema Diabetes mellitus type II Hyperlipidemia. s/p CCY MEDICATION ON ADMISSION: Home Medications: Atorvastatin 20 mg PO daily Valsartan 320 mg PO daily Aspirin 81 mg PO daily Furosemide 20 mg PO BID Montelukast 10 mg PO daily Lyrica 100 mg PO TID Fluphenazine HCl 5 mg PO QHS Docusate Sodium 100 mg PO BID Budesonide 0.5 mg/2 mL two IH [**Hospital1 **] Albuterol Nebs PRN Ipratropium Bromide Nebs PRN Insulin Norvasc 2.5 mg PO daily Advair CPAP/supplemental oxygen Please use a pressure of 12 in-line humidification and a ramp of 30. . Medications on transfer: Amlodipine 2.5 mg PO daily ISS Linezolid 600 mg IV Q12H Dopamine 5 mcg/kg/min Albuterol Nebs Atropine Nebs Lovenox 40 mg PO daily Heparin SQ [**Hospital1 **] Fluphenazine 5 mg PO QHS Tylenol PRN Lorazepam 2 mg IV Q2H PRN Zofran PRN Oxycodone PRN . ALLERGIES: Penicillins / Cephalosporins PHYSICAL EXAM: On Presentation: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Disabled. Nonsmoker. Nondrinker. Widowed with three children. She lives with a family member.

CHIEF COMPLAINT: atrial flutter for scheduled ablation PRESENT ILLNESS: 70 M with DM, HTN, hyperlipid, DM2, CRF, stroke x 3 s/p R CEA, SAH s/p LMCA aneurysm clip, CAD, LV dysfxn who had p/w CHF, atrial flutter and found on TEE 6 weeks ago to have left atrial appendage thrombus since rate controlled with metoprolol and anticoagulated with warfarin, now returning for flutter ablation. . The atrial flutter was diagnosed when the patient reported palpitations to his visiting nurse. [**First Name (Titles) **] [**Last Name (Titles) 28085**], EKG documented atrial flutter and TEE documented clot in a left atrium appendage. . The patient was recently hospitalized for TIA and had non-invasive carotid studies showing 40% stenosis of [**Country **] and significant plaque in the distal [**Doctor First Name 3098**]. He has reported some persistent numbness in the thighs, incidentally. . He has had primary symptoms of fatigue and dyspnea. He was started on replacement therapy for iron-deficiency anemia. He was diuresed with lasix for lower extremity edema and has had improved symptoms but a rising creatinine, such that on [**2161-3-30**], his was 5.3 (baseline ~mid-3's). He was instructed to hold his lasix, permitting his weight to go increase, and then resume lasix at 60 mg daily. Off lasix3 days later, however, his BP increased to approx 180/110, HR was about 110 and weight up to 180 lbs by remote monitoring, although he denied SOB or CP. He did respond well to lasix 60 mg daily with BP down to 170/74, HR 108, improved symptoms with residual bibasilar crackles. . On presentation, the patient denies dyspnea or chest pain and notes that his exercise capacity is limited more by claudication symptoms in the quadriceps than by DOE. Denies orthopnea or PND. Occasional palpitations but no lightheadedness, dizziness, or vertigo. +Constipation without n/v. +Insomnia only partially explained per patient by nocturia. No pruritis, sleep-wake reversal. MEDICAL HISTORY: 1. Stroke in [**2145**], ? new stroke in [**5-25**] with decreased word finding ability, Repeat CT stable, EEG nl. [**8-25**] carotid U/S-->80-99% rt carotid stenosis, 50% on left. [**10-25**] right CEA. 2. Subarachnoid hemorrhage in [**2137**] status post middle cerebral artery aneurysm clipping with residual large area of infarct and encephalomalacia 3. Coronary artery disease -[**2130**] MI.[**2143**] CABG at [**Hospital1 2025**], details unavailable followed by [**Name (NI) **] PTCA. [**2149**] cath-->occlusion of all grafts. Repeat CABG NEDH, SVG-->OM1, SVG-->D1, SVG-->RCA. [**2-20**] rest pain, cath-->occluded native RCA and LAD, grafts patent. [**Month/Year (2) 8714**] stented. [**9-25**] routine ETT/[**Doctor Last Name **]--LAD and PDA distribution ischemia on [**Doctor Last Name **]. Cath-->stent of SVG to PDA. -[**1-24**] TTE with EF 30-40% (see below) 4. Hypercholesterolemia 5. Type 2. Diabetes mellitus - no neurologic/opthalmalogic complications. 6. Chronic renal insufficiency - [**4-22**] incr creat 2.4. D/c Univasc, repeat labs-->creat 2.6. Renal U/S nl. [**6-22**] eval Dr. [**Last Name (STitle) 1366**] felt c/w microvascular disease +/- atheroembolic complications post cath. SPEP, UPEP nl. Began Diovan. [**12-27**] incr creat 3.2 persists post cath despite d/c Diovan. 7. Gastroesophageal reflux disease 8. Status post bilateral cataract surgery 9. Hearing loss 10. Peripheral vascular disease with claudication 11. Carpal tunnel syndrome MEDICATION ON ADMISSION: MEDS AT HOME: AMARYL 2MG--2 qam, one every evening AMBIEN 5MG--One by mouth at bedtime as needed ASPIRIN 325MG--One every day EPOETIN ALFA 2,000 unit/mL--1 cc ([**2155**] u) sc three times weekly HYDRALAZINE HCL 25 mg--1 tablet(s) by mouth three times a day ISOSORBIDE DINITRATE 30 mg--1 three times a day LASIX 40 mg--2 tablet(s) by mouth once a day LIPITOR 10MG--One by mouth every day NIFEREX 60 mg--1 capsule(s) by mouth once a day METROPOLOL 100mg TID WARFARIN SODIUM 3 mg--as directed (held 3 days prior to admission) WARFARIN SODIUM 5 mg--as directed (held 3 days prior to admission) Milk of magnesium Colace Senna ALLERGIES: Univasc PHYSICAL EXAM: T: 96.7F, BP: R-168/90 L-148/90, P: 68, R: 20, SaO2:96%,RA NAD, nondiaphoretic Edentulous, no OP lesions, no scleral/sublingual icterus. No LAD, Carotids 2+ without bruits, JVP 8cm H20 Chest with rales confined to bases. Heart with irregularly irregular rate. No S3,S4 heard consistently. No M/R. +BS, quite distended but nontender. No HSM by percussion or palpation. 2+ left femoral and dp. 1+ right femoral and dp. Trace left and 1+ right leg edema. 1-second capillary refill. Neuro A/Ox3 with word-finding difficulties, occasionally stuttering, motor with 5/5 throughout except 4+/5 RLE and [**3-26**] LLE. (+)R Babinski sign. (-)L Babinski sign. FAMILY HISTORY: Father with strokes. Brother with coronary artery disease. SOCIAL HISTORY: Married, lives with wife. Former accountant, retired in [**2145**]. Former tobacco smoker, quit in [**2144**]. Social alcohol use. Denies drug use.

CHIEF COMPLAINT: chest, lower back and hip pain, s/p crush injury PRESENT ILLNESS: Mr. [**Known lastname 88968**] is a 30 year old man with untreated hypertension who suffered a crush injury to his chest (tractor loaded with weight rolled onto his chest) requiring extraction with a fork lift. He denied any LOC; VS were stable during [**Location (un) **]. Upon ED presentation, he c/o hip and low back pain, yet denied chest pain, dyspnea, abdominal pain, headache or neck pain. Cardiology was consulted given concern for contusion, cardiac injury. He was noted to have a new RBBB on ECG with TWI. The patient has a CPK of 1464 and TnT<0.01. MB 5. Pt's chest pain improved with narcotics. He also denied dyspnea, although it hurts to take a deep breath. He stopped taking anti-hypertensives because lack of insurance. He had atypical chest pains in the past and was evaluated at [**Hospital1 **] with an ECG. Denies any exertional chest symptoms. No orthopnea or PND. Remaining ROS positive for back pain and pain in the hips. All other ROS are negative. MEDICAL HISTORY: HTN (not currently treated) MEDICATION ON ADMISSION: none ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: HEENT: Pupils equal, round and reactive to light, Extraocular muscles intact Oropharynx within normal limits Chest: Clear to auscultation Cardiovascular: Regular Rate and Rhythm Abdominal: Soft, Nontender GU/Flank: No costovertebral angle tenderness Extr/Back: No cyanosis, clubbing or edema Neuro: Speech fluent FAMILY HISTORY: No premature CAD. SOCIAL HISTORY: Married (wife, [**Name (NI) **] [**Name (NI) 88969**], [**Telephone/Fax (1) 88970**] is emergency contact). Non-smoker, no alcohol. No illicits.

CHIEF COMPLAINT: Hepatic adenomas, segments 3 and 4 PRESENT ILLNESS: I had the pleasure of seeing, Mr. [**Known lastname 1637**], in the Hepatobiliary Surgery Clinic today, [**2187-8-30**]. As you recall, he is a 30-year-old man with a history of ruptured hepatic adenomas that turned out to [**Hospital1 **] some hepatocellular carcinoma. He is scheduled for reexcision of two adenomas that we intentionally left behind at his prior incision. He reports he has actually been feeling quite well and that his weight has been stable. He has had no problems with the incision itself. He denies any nausea, vomiting, fevers, chills, chest pain, or shortness of breath. He is moving his bowels regularly. Medications were reviewed today and include cholestyramine, which he says he has not actually started taking as well as his scopolamine patch for his preop nausea control. On examination today, his temperature is 98.4, heart rate 83, blood pressure 125/85. His weight is 87.8 kilos. He is anicteric and in no acute distress. His lungs are clear to auscultation bilaterally. His heart is regular. His abdomen is soft and nondistended. His incision has healed nicely without evidence of hernia. He has no peripheral edema. Laboratory studies from today are notable for white count of 5, hematocrit 46, and platelets of 178,000. His INR is 1.0. His renal function panel is entirely within normal limits with a creatinine of 0.9. His liver function tests remain mildly elevated with an ALT of 161, AST 116, alkaline phosphatase 169, and total bilirubin of 0.6. In summary, Mr. [**Known lastname 1637**] is a 30-year-old man with multiple hepatic adenomas, likely due to steroid ingestion. He is scheduled for reexcision of a segment IV adenoma as well as a segment II/III adenoma. We are hopeful that these do not [**Hospital1 **] any cancer, although as he was found to have carcinoma in his prior specimens, we feel strongly that these should be removed. He knows that there are still remaining several small adenomas, but we are hopeful that as he is off steroids, these may regress. Alternatively, if he does [**Hospital1 **] more cancer, we will have to talk about the potential need for liver transplantation. We did not discuss this in detail, but he knows that this is a possibility going forward. MEDICAL HISTORY: ARF s/p ingestion of nautral diuretic product MEDICATION ON ADMISSION: None ALLERGIES: Dilaudid PHYSICAL EXAM: Pre-Op examination His temperature is 98.4, heart rate 83, blood pressure 125/85. His weight is 87.8 kilos. He is anicteric and in no acute distress. His lungs are clear to auscultation bilaterally. His heart is regular. His abdomen is soft and nondistended. His incision has healed nicely without evidence of hernia. He has no peripheral edema. FAMILY HISTORY: No family history of liver disease/cancer/masses SOCIAL HISTORY: Bodybuilder. In school. Denies T/E/D.

CHIEF COMPLAINT: Leukocytosis PRESENT ILLNESS: 65 M w recent dx lymphoboplasmacytic lymphoma now in remission s/p 4 cycles R-C-medrol [**2140**], who was recently hospitalized at [**Hospital1 18**] ([**2142-3-7**] - [**2142-4-16**]) for a saccular aneurysm of the lateral aspect of the aortic arch that was emergenctly intervened upon under deep hypothermic circulatory arrest on [**2142-3-11**] (descending aorta was replaced with 28 mm Gelweave graft). . The patient had a prolonged and complicated hospital course. He failed extubation on POD 2 and multiple times thereafter. . He had persistent leukocytosis, fevers, and diarrhea during hospitalization and was empirically treated for C. Diff with a 10-day course of vancomycin & flagyl (despite 7 negative C. Diff toxin tests). . His thoracotomy wound developed erythema and blistering and he had an incision & drainage of [**2142-3-21**] (fluid culture returned without growth). He becam septic on [**2142-4-8**] and, in addition to persisent leukocytosis & fevers, he also became hypotensive and required pressors. He was treated with broad spectrum antibiotics per ID recommendations. He was found to have a graft infection (noted on CT) requiring IR drainage on [**2142-4-8**]. All OR swabs were without growth. . The patient had a tracheostomy & PEG tube placed on [**2142-4-1**] for multile failed attempts at extubation. . Ultimately, his sputum was showed enterobacter; the patient was started on meropenem. He was transferred to [**Hospital1 49145**] on [**2142-4-16**] on meropenem (course to end on [**2142-4-22**]). . On [**2142-4-24**], the patient presented to the [**Hospital3 **] from NESH with hypoxic respiratory failure with hypotension & fever to 101.3. At that time, according to the OSH notes, he was still on meropenem and this was initially continued. In he ED he was found to have a PNA which was ultimately determined to be due to Enterobacter resistant to all tested antibiotics except tigecycline. He initially required ventilatory support, but transitioned to trach mask on [**2142-4-30**]. He has since been stable from a hemodynamic & respiratory standpoint. . A CT chest with contrast performed (& read) at OSH demonstrated a 7 x 3.4 x 1.7 cm loculated pleural fluid collection at the lateral posterior aspect of the L lung base. . Serial chest x-rays during his admission at [**Hospital3 **] demonstrated development of a a R lower lobe PNA. . The patient has had an intermittent leukocytosis with bandemia at the [**Hospital3 **]. A tagged WBC scan was performed on [**4-30**] in an attempt to identify an infectious source. The scan demonstrated increased update in the L chest adjacent to the aortic arch which was suspicious for a periarotic infection. According to notes, he has been afebrile for several days but developed WBC 12.3 with 13% bands [**Last Name (un) **]. As such, the patient is being transfered to [**Hospital1 18**] for further evaluation and treatment. . REVIEW OF SYSTEMS: Unable to obtain. MEDICAL HISTORY: - Descending Aortic Aneurysm s/p emergent repair ----> s/p replacement with 28 mm graft [**2142-3-11**] ----> c/b graft infection requiring IR draining [**2142-4-8**] - Respiratory Failure ----> VAP (Enterobacter) - Tracheostomy placement - PEG placement - Lymphoplasmacytic lymphoma (dx in [**4-7**]) - see onc history below - Hypertension - Gout - Anemia: B12 & iron deficiency - Hx/o EtOH overuse - Hx/o esophageal stricture - Diverticulitis - Inflammatory arthritis (on chronic prednisone) - CVA - GERD - Laparoscopic cholecystectomy - s/p vein stripping on left leg MEDICATION ON ADMISSION: - Tigecycline (completed on [**2141-5-1**]) - Lopressor 100 mg [**Hospital1 **] - Hydralazine 10 mg TID - Pepcid 20 mg QD - RISS - 300 cc free water for tube feds Q4H - Allopurinol 200 mg QD - Isosorbide dinitrate 20 mg TID - Dilaudid 0.5 mg IV Q2H PRN pain - Zyprexa 5 mg QHS - Albuterol nebs Q2H PRN - Tylenol 650 mg Q4H PRN - Heparin 5000 units SC Q8H - Celexa 20 mg QD - Miconazole powder topically - Ativan 2 mg IV Q2H PRN agitation ALLERGIES: vancomycin / Ace Inhibitors PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: 71 102/51 99% on 40% FM GEN: Appears slightly agitated. Follows basic commands. Frail. HEENT: PERRL. OP clear. NECK: Trached. PULM: Faint breath sounds throughout both lung fields, diminished at bases. Intermittent transmission of upper respiratory sounds [**Last Name (un) **]: +NABS. PEG in place. Soft, NTND EXT: Trace LE. No rashes. GU: Excoriated rash on buttocks. NEURO: Follows basic commands. MAEE. FAMILY HISTORY: Father with EtOH abuse and liver cancer, hypertension. SOCIAL HISTORY: Prior to [**Hospital1 18**] hospitalization, he lived with his wife - [**Name (NI) **] children - Was most recently in rehab - Contact = wife: [**Telephone/Fax (1) 96773**] - Retired [**Company 2318**] inspector - Tobacco: Quit smoking in [**2122**] (previously 2-3 packs/day x 30 years) - EtOH: none in 2 years (-pack or more a last week)

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 79-year-old woman with a history of moderate to severe chronic obstructive pulmonary disease who presented with a five day history of chills and shortness of breath. She saw her primary care physician [**2134-6-1**], at which time she was started on a Prednisone taper, starting dose 60 mg q d, and Singulair. No improvement in shortness of breath and progressed to having a productive cough. Denied hemoptysis. Started Robitussin AC on [**6-2**]. Shortness of breath worsened so she went to the Emergency Room. Has increased wheezing which was exacerbated with exertion. She denied chest pain, palpitations, fevers. She did not sleep the night prior to admission, work up sweating, had a poor appetite. Wheezing present at baseline, worsens with walking, baseline non productive cough every day. No history of intubation. She states "no tubes, no machines". Patient is DNR, DNI, has a living will. MEDICAL HISTORY: COPD, macular degeneration, she is legally blind, hyperlipidemia. MEDICATION ON ADMISSION: ALLERGIES: Sulfa - hives. No Aspirin or blood thinning products due to her macular degeneration. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Subglottic stenosis Tracheoesophageal fistula PRESENT ILLNESS: The patient is a delightful 26-year-old healthy male who developed a subarachnoid bleed in the basilar section of his brain while in [**Country 6171**]. He had prolonged hospital course, during which he developed a subglottic stenosis and tracheoesophageal fistula either from traumatic intubation or percutaneous tracheostomy tube placement. He was referred for operative repair. A preoperative rigid bronchoscopy and flexible esophagoscopy evaluating the lesion demonstrated tracheal stenosis measuring approximately 3 cm and spanning the distance from just below the cricoid to 3 cm distally on the airway. The remainder of the airway was free of disease. There was a small fistula approximately 2 cm distal to the carina. MEDICAL HISTORY: s/p ICH unknown etiology, cerebellar in location s/p trach and PEG MEDICATION ON ADMISSION: 1. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol [**Date Range **]: [**1-6**] Puffs Inhalation Q6H (every 6 hours) as needed. Disp:*1 inhaler* Refills:*5* 2. Guaifenesin 100 mg/5 mL Syrup [**Month/Day (2) **]: 5-10 MLs PO Q6H (every 6 hours) as needed. Disp:*1000 ML(s)* Refills:*2* 3. Acetaminophen 325 mg Tablet [**Month/Day (2) **]: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for headache. 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR PO BID (2 times a day). Disp:*60 Tablet,Rapid Dissolve, DR(s)* Refills:*2* 5. Codeine Sulfate 30 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO Q4-6H (every 4 to 6 hours) as needed for cough. Disp:*30 Tablet(s)* Refills:*0* ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.3 HR 85 BP 117/70 RR 20 SpO2 95%RA Awake and alert. Coughing repeatedly with belching. Able to speak in short sentences. RRR CTA b/l Abdomen soft, NT/ND Extremeties warm. No clubbing or edema. FAMILY HISTORY: SOCIAL HISTORY: Patient was previously in the army, was working as a body guard in [**Country 6171**]. Currently living with his parents, who take care of him.

CHIEF COMPLAINT: Admit for planned surgery PRESENT ILLNESS: 51-year-old female with sigmoid lesion discovered during surveillance colonoscopy for reassessment of sessile polyp. Family history of colon cancer, biopsy proven hyperplasia, plastic polyp at 50 cm with 270 degree growing sessile lesions at approximately 35 cm. Pt underwent sigmoid colectomy in [**2147**], and presented recently with new-onset L leg weakness. Evaluation revelaed a large mass from the L colon invading the psoas muscle. She is admitted for subtotal colectomy and possible colostomy. MEDICAL HISTORY: 1. Colon CA s/p sigmoid colectomy in '[**47**]. No chemo or rad tx. 2. Report of multiple episodes of bleeding; hematologic workup and two workups for vWF have been normal. 3. Uterine CA s/p TAH BSO [**2144**] 4. HTN 5. Anxiety/depression 7. Cervical neuropathy 8. Hep C 9. OA 10. Asthma 11. H/o EtOH abuse 12. CCY [**2148**] 13. Appendectomy 14. Tonsillectomy 15. Ventral hernia repair MEDICATION ON ADMISSION: 1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q6H (every 6 hours) as needed. 2. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR Transdermal DAILY (Daily). 3. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 4. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 5. Venlafaxine HCl 75 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO DAILY (Daily). ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical exam on discharge: FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Quit tob and EtOH last month. EtOH: [**1-25**] pint of rum 2-3x/week. On nicotine patch. No IVDU. On disability. Lives with daughter, granddaughter, and ex-husband.