Datasets:

sh190128

/

MP_IN_adm

like 0

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58-year-old white gentleman with multiple medical illnesses who was admitted to the Medical Intensive Care Unit on the date of admission with respiratory failure. He complained of progressive shortness of breath over one week with cough, fever, night sweats, and nausea. He had lethargy as well. It was a concern in the Emergency Room of the right lower lobe pneumonia. He has had several recent medical admissions including course of rehabilitation at [**Hospital **] Hospital for hypoxic respiratory failure. His past medical history is extensive and includes HIV infection, methadone maintenance, history of DVT/PE, chronic pancreatitis, end-stage renal disease on hemodialysis, chronic lung disease, hepatitis B and hepatitis C positive. History of pneumonia with methicillin-resistant Staphylococcus aureus and intubation, and obstructive-sleep apnea. His medications on admission included amiodarone 200 mg/day, Epivir 25 mg/day, Protonix 40 mg/day, Megace 400 mg po q day, MVI one po q day, Zoloft 50 mg po q day, Zerit 20 mg po q day, Warfarin 2.5 mg po q day, methadone 50 mg po q day. He used Bactrim double strength one tablet 3x a week and Roxicet, albuterol, zinc sulfate. He had allergies to Thorazine and intolerant to H2 blockers for thrombocytopenia. Also did not tolerate due to rash Haldol, clindamycin, Stelazine, and codeine. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He is a chronically ill gentleman who lives at home with his wife. [**Name (NI) **] is unemployed and disabled. Former heavy IVDU and tobacco user. Family history includes pneumonia.

CHIEF COMPLAINT: found down in her apartment s/p fall; mental status change PRESENT ILLNESS: 78 y/o w/pmh sig for tobacco, COPD and dyslipidemia, presents after being found face down at home s/p fall of unclear etiology, was brought to OSH and on ECG had ST elevations concerning for ACS. Also noted to have CK 20k, right shoulder injury from fall, dysarthia, mental status change. Brought to [**Hospital1 18**] for cath. MEDICAL HISTORY: tobacco COPD dyslipidemia multiple falls (4 in last year), with broken vertebra 1y PTA MEDICATION ON ADMISSION: amytriptyline ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: thin elderly woman, lying on stretcher, appearing frightened and fatigued Skin: pale, cool and dry, no rash HEENT: MMM CV: RRR nl s1 quiet s2 no mgr, +JVD Lungs: decreased breath sounds and crackles at bases b/l; poor inspiratory effort; poor air movement Abd: thin, soft NT/ND +BS Ext: LE edema, no c/c/e Neuro: disoriented, slurred speech, uncooperative FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Significant tobacco use, unquantified No etoh No drugs

CHIEF COMPLAINT: Post-op Bleed Dyspnea PRESENT ILLNESS: This is a 74 year old male s/p Lap appy by Dr [**Last Name (STitle) **] 8 days a go at the [**Last Name (un) 4068**]. He was discharged home pod #2 with an INR of 1.2 at discharge. His preop HCT was 36.6 and decreased to 30.2 immediately post op and to 27 just before discharge. He was transferred form the [**Hospital1 18**] [**Location (un) 620**] with shortness of breath and vomiting x1. INR measured at the [**Last Name (un) 4068**] was 10 and HCT 16. He was sent to [**Hospital1 18**] for further management. He received 3 units FFP, 10 mg Vit K IV, 1 U PRBC. MEDICAL HISTORY: 1. Hypertension. 2. Placement of DDD pacemaker secondary to AV block 3. Left ventricular Hypertrophy 4. CHF EF 50% last echo [**2184**] PSH: [**5-18**] Replacement of the arch ascending aorta and aortic valve with a valve conduit composite using a [**Street Address(2) 11688**]. [**Male First Name (un) 923**] mechanical prosthesis and a separate piece of 25 mm weave tube graft with profound hypothermia and circulatory arrest, and direct reimplantation of the coronary ostia. Lap appy [**3-24**] MEDICATION ON ADMISSION: Coumadin 7.5/5.0, Lopressor 25", Fentanyl patch, ASA 81 Cozaar 100' Colace 100', Norvasc 10' ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.3 80 147/68 28 98 2 l NC Appearance: tachypneic, diaphoretic, uncomfortable Lungs r side coarse left side Heart RRR ABD soft in the left side tense on the Right side. No rebound rectal No blood guaiac neg Ext no edema FAMILY HISTORY: SOCIAL HISTORY: The patient quit smoking 40 years ago. Married

CHIEF COMPLAINT: Fever, hypotension PRESENT ILLNESS: Mr. [**Known lastname 12130**] is a 69 year-old male with a history of prostate cancer, RA on prednisone, AAA, HTN frequent admits for LE ulcers, who has been admitted twice recently for fevers of unclear source. On his admission in early [**Month (only) **], he was treated for presumed cellutitis with 2 weeks of Nafcillin. On his last admission in mid-[**Month (only) **], he received 1 dose of vanco for fever in ED but afebrile thereafter and not c/w with RA, pneumonia, cellulitis, osteomyelitis by Xray. He presents from [**Hospital 38**] Rehab this time with intermittent fevers fever for one week, and fever to to 102.5 s/p right LE angiography yesterday. Patient reports that he was felt well after the procedure but was a little depressed because he was admitted for RLE angiogram for RLE ischemia and gangrene and no intervention was performed. Angiogram had demonstrated severely diseased right superficial femoral artery and occluded posterior tibial artery requiring a femoral to below-knee popliteal bypass graft in order to heal his RLE gangrene. However, he woke this morning feeling generally unwell, reporting nausea. He went to physical therapy but went back to his room shortly after as felt fatigued, had 4 bouts of emesis prior to falling asleep. He woke up with fevers and chills and was noted by Rehab to have had a rectal temp of 101.3, vomited once, and had drop in BP from 160/50 to 116/70 as well as desatted to 80% on RA, improved to 98% on 4LNC. . In the [**Name (NI) **], pt was awake but delirious with temp to 100.1. He was hypotensive to SBP high 70s which increased to 100-105 with 3L IVF. Lactate nl. He was hypoxic to 92% on RA, 98% on 2L. Pancultured and started on CTX, vanco, and azithromycin for concern for pneumonia (CXR read as no consolidation), and transferred to ICU. Of note, he had a systolic ejection murmur which had not been documented in prior notes. . ROS: No headaches recently, vision changes, jaw claudication. Poor dentition, no recent visit to dentist, no tooth pain. Intentional weight loss. Pt reports having had alternating diarrhea and constipation over the past several days, not bloody or black at that time. He last received antibiotics (1 day on vanco) during his last admission in mid-[**Month (only) **]. On his admission prior to that in early [**Month (only) **], he had been treated with 2 weeks of Nafcillin. Last colonoscopy 1 year ago with benign polyp per report. Reports clear rhinorrhea x 1 week; no h/o allergies, no shortness of breath, cough, or sinusitis. No dysuria. Lower extremity ulcers stable per pt. Chronic back pain. Of note, he has been on Solumedrol 8 mg daily x few years for RA, increased to 10 mg three weeks ago for RA flare. Upper extremity weakness 2/2 RA flare and still unable to flex fingers fully but improved. MEDICAL HISTORY: - S/p left AT and left popliteal angioplasty [**2130-10-2**] - S/p debridement of left lateral malleolus ulcer [**2130-10-16**] - S/p split-thickness skin graft to left lateral malleolar ulcer ([**2130-10-20**]) - Hypertension - Hyperlipidemia - Atrial fibrillation: S/p DC cardioversion, no recurrence. - Rheumatoid arthritis: As above - Prostate cancer: S/p chemotx and radiation tx (completed 40 tx) - Neuropathy - Lumbar spinal stenosis - Abdominal aortic aneurysm (4.7cm): being monitored - Rosacea - Ocular migraines MEDICATION ON ADMISSION: - ASA 81 mg daily - Toprol 100 mg daily - Lisinopril 40 mg daily - Simvastatin 10 mg daily - Methylprenisolone 10 mg daily - Pantoprazole 40 mg daily - Colace 100 mg [**Hospital1 **] - Oxycodone 5-10 mg q4h prn pain - Multivitamin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 97.7 BP: 98/78 HR: 81 RR: 17 O2Sat:100% RA GEN: Well-appearing, well-nourished, no acute distress, pale. HEENT: NCAT, no temporal tenderness, EOMI, PERRL, no conjunctival icterus or pallor, no epistaxis or rhinorrhea, poor dentition. NECK: No JVD, carotid pulses brisk, no bruits, no cervical or supraclavicular lymphadenopathy, trachea midline. BACK: No focal spine or CVA tenderness. COR: RRR, S1-S2+, 1/6 SEM loudest at USB, no r/g. PULM: Lungs CTAB, no W/R/R. ABD: Soft, NT, ND, +BS, no HSM, no masses, no CVA tenderness. EXT: Warm, no inguinal lymphadenopathy, no LE edema, no calf tenderness or palpable cords, DP pulses difficult to palpate, no palpable PT, no acute synovitis. RECTAL: Rectal tone intact, tender circumferentially on exam with bright red blood but no masses palpated. NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Decreased hand grip limited by RA. Patellar DTR +1. Plantar reflex downgoing. No gait disturbance. No cerebellar dysfunction. SKIN: No jaundice, cyanosis, or gross dermatitis. Left thigh and lateral malleolus skin graft sites and right 1st toe and right heel dark, necrotic ulcers not infected-appearing, no skin breaks. No [**Doctor Last Name **] spots. No [**Last Name (un) 1003**] lesions. FAMILY HISTORY: Parents both smokers and died of lung cancer, father at 57 [**Name2 (NI) **] and mother at [**Age over 90 **] [**Name2 (NI) **]. SOCIAL HISTORY: Currently coming from [**Hospital 38**] Rehab, lives alone at home. Retired security guard. H/o tobacco use 2 ppd x 40 years, quit 18 years ago. H/o heavy EtOH use (beer) for many years, stopped few months ago. Denies illicit drug use. Able to drive on his own, buys his own groceries. Has son and sister who are his support structure.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 74 year old with complaints of fatigue, shortness of breath and dyspnea on exertion which has increased over the past two years and especially over the past two weeks. He refused surgery two years ago for severe mitral regurgitation. MEDICAL HISTORY: Hypertension, bilateral knee replacement, colostomy and reversal, bilateral cataract surgery, severe pulmonary hypertension and atrial fibrillation. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Variceal Bleed PRESENT ILLNESS: 5 yo M w/ ETOH hepatitis & cirrhosis (last drink 11pm night PTA [**1-30**]) c/b ascites, PSE, portal HTN, esophageal varices, PUD, subacute pancreatitis, and HTN who was admitted [**1-31**] from [**Hospital3 **] where he p/w melena & BRBPR. Per report, patient had melena for the past few days. Last night he was sleeping and woke up in a "pool of bright red blood". He went to the bathroom, had LOC and awoke again in a pool of blood. EMS was called and he was taken to [**Hospital3 **]. At [**Hospital1 46**], patient was tachycardic and had HCT of 20, given 1u PRBC, started on octreotide gtt and x-fer to [**Hospital1 18**] where protonix gtt was added and pt received 2u PRBC before x-fer to MICU. Denies hx DTs/ w/d seizures. Still actively drinking. Had EGD in MICU on [**1-31**] which showed 3 cords of grade II varices, which were banded x2. He also had a hiatal hernia and findings c/w portal HTN-ive gastropathy and blood in the stomach body. He continued on octreotide and protonix ggts and was x-fer to [**Doctor Last Name 3271**]-[**Doctor Last Name 679**] in stable condition. MEDICAL HISTORY: PAST MEDICAL HISTORY: - ETOH hepatitis/cirrhosis, portal hypertension, esophageal varices - Subacute pancreatitis - Hypertension MEDICATION ON ADMISSION: lactulose 30ml TID nadolol 20mg daily omeprazole 40mg once daily spironolactone 50mg daily sucralfate 10ml [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T:100.4 BP:150/77 P:93-102 R: 15 O2:100% RA General: A & O x3. Mild tremor with outstreatched hands. HEENT: Sclera anicteric, dry mm, oropharynx clear. Lips slightly assymmetric but pt reports had severe accident to face previously. Nystagmus with poor accomodation of right eye. Neck: supple, no LAD Lungs: Clear to auscultation bilaterally anteriorly CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: + bs, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, ? very fluid shift <2cm on exam Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CN exam notable for Lips slightly assymmetric but pt reports had severe accident to face previously. Nystagmus with poor accomodation of right eye. Otherwise CN II-XII intact (did not check pupil reaction). UE reflexes +2. Sensation grossly intact. LE strength 5/5. . FAMILY HISTORY: CAD, father deceased at 64, grandfather deceased at 61, both from MI SOCIAL HISTORY: Heavy ETOH abuse with binge drinking episodes. He is single with no children, past smoker. Last drink was one week ago, previously drank one 6 pack per day, +/- whiskey. Now drinks 2 beers before bed, +/- shot. Livers with his mother. [**Name (NI) 1403**] as a grocery clerk.

CHIEF COMPLAINT: Hypoglycemia PRESENT ILLNESS: 83 yo W with PMH of Type II DM, HTN presents with hypoglycemia. Patient woke this morning and fell out of bed. She was unable to get up. She had no head trauma or loss of consciousness. Son found her and called EMS. In the field, her FS was in the 20's associated with altered mental status. She received oral glucose + juice and both mental status and FS's improved. She also reports epigastric/ substernal CP, nonradiating that lasted for several hours and improved on arrival to the ED without intervention. . On arrival to the ED, VS: T97.5 HR 76 BP 148/103 RR 17 100%RA. FS was 29. She received 1 amp of D50, 50 ucg of octreotide and was started on D5 infusion. There was a question of new infiltrate in R base and received Levaquin x 1. Labs notable for elevated CE's. Per notes, patient was seen by cards, but was refusing heparin or ASA at this time Pt was refusing treatment with heparin and ASA. MEDICAL HISTORY: DM type II Mild-moderate diabetic retinopathy HTN Arthritis Cataracts MEDICATION ON ADMISSION: Acetaminophen Amitryptiline 10mg PO qHS Cozaar 100 mg q daily glipizide 10mg PO bid metformin 500 mg [**Hospital1 **] pravastatin 40mg qHS Colace ALLERGIES: Ace Inhibitors PHYSICAL EXAM: Vitals Stable. GEN: elderly female, pleasant, NAD. HEENT: eomi, mmm. RESP: CTA B. No wrr. CV: RRR. No mrg. Abd: benign. Ext: No cee. FAMILY HISTORY: Son in good health. SOCIAL HISTORY: Patient was born in [**Country **]. Moved to the United States in [**2075**]. Currently living with her daughter. Previously worked as a housekeeper at [**Hospital 13128**]. Denies tobacco/EtOH.

CHIEF COMPLAINT: Low platelets PRESENT ILLNESS: HOSPITALIST ADMIT NOTE (transfer from ICU) Ms. [**Known lastname **] is a 71 year-old woman with gliobastoma multiforme and hypertension. Patient was diagnosed with gliobastoma multiforme on [**2147-7-3**]; she started radiation therapy and temodar on [**2147-8-1**] and is to complete therapy on [**2147-9-7**]. She was being treated with dexamethasone, which was recently decreased from 6 mg to 4 mg daily. She returned to the brain tumor clinic yesterday for a follow-up visit. She had no complaints during her visit except chronic left sided weakness. Blood draw showed platelet count of 7k and WBC of 0.7. She was sent to the ED for transfusion. . In the ED inital vitals were, T:98 P:91 BP:80/55 R:16 O2 sat 96%. Her lactate was noted to be 3.4. Blood cultures were sent and she was given cefepime, vancomycin and 10mg dexamthasone along with 4 bags of platelets and 1L NS. SBPs recovered into the 100's prior to transfer to the ICU. . In the ICU, she was given additional IVF, and her blood pressure stabilized. She did not require pressors. Platelet count increased to the 40s after transfusion. She had no complaints. Neuro-Oncology was consulted. Cefepime was continued, though she was afebrile, without localizing symptoms, and no notable findings on blood cultures, UA/urine culture, or CXR as of yet. Neupogen was started. Temodar was held. Upon transfer to the [**Hospital1 **] today, she still has no complaints. She denies recent fevers or chills. No recent shortness of breath, cough, sore throat, or URI symptoms. Denies headaches or myalgias. No abdominal pain, nausea, vomiting, or diarrhea. No dysuria. No blood in stool or in urine. Does note some mild bleeding of gums with brushing. Has had decreased po intake recently to attempt to decrease the amount she urinates due to difficulty getting on bedpan at rehab. . Review of systems: (+) Per HPI (-) Denies fever or chills. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. MEDICAL HISTORY: -GBM [**2147-5-19**]- Progressive left sided weakness [**2147-6-22**]- Brain CT showed right large heterogeneous nodular mass with peripheral enhancement and central necrosis [**2147-7-3**] CT guided brain stereostatic biopsy [**2147-7-3**] Pathology showed Gliobastoma Multiforme [**2147-8-1**] Started Radiation therapy (800 cGY of 6000 cGY) and temodar . -Hypertension -Dyslipidemia -hysterectomy, -tonsillectomy -appendicectomy. MEDICATION ON ADMISSION: DEXAMETHASONE - (Prescribed by Other Provider) - 4 mg Tablet - 1 (One) Tablet(s) by mouth 1 tab am, [**11-20**] tab pm start [**2147-8-23**] DEXAMETHASONE - 0.5 mg Tablet - 1 Tablet(s) by mouth see instructions Take 1 tab daily times 5 days, then 1 tab every other day times 5 days and stop. - No Substitution LEVETIRACETAM - (Prescribed by Other Provider) - 500 mg Tablet - 1 Tablet(s) by mouth twice a day NIFEDIPINE - (Prescribed by Other Provider) - 30 mg Tablet Extended Rel 24 hr - 1 Tablet(s) by mouth once a day OMEPRAZOLE - (Prescribed by Other Provider) - 20 mg Capsule, Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day PRAVASTATIN - (Prescribed by Other Provider) - 80 mg Tablet - 1 Tablet(s) by mouth once a day PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth daily x 3 days as needed for then as needed take one hour before chemotherapy TEMOZOLOMIDE [TEMODAR] - 100 mg Capsule - 1 Capsule(s) by mouth daily x 45 days patient takes total of 110 mg daily x 45 days TEMOZOLOMIDE [TEMODAR] - 5 mg Capsule - 2 Capsule(s) by mouth daily x 45 days patient takes total of 110 mg daily x 45 days . Medications - OTC MAGNESIUM HYDROXIDE [MILK OF MAGNESIA] - (Prescribed by Other Provider) - Dosage uncertain SENNOSIDES - (Prescribed by Other Provider) - 8.6 mg Tablet - 2 Tablet(s) by mouth at bedtime ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: Vitals: 98.0 68 118/73 68 16 97% RA General: Comfortable, pleasant, pale, appears chronically (but not acutely) ill HEENT: Sclera anicteric, pale conjunctivae, MMM, scattered white macules over buccal mucosa. No ulcers noted. Pupils equal. Neck: supple, no LAD Lungs: good air movement, no crackles or wheezes CV: Regular rate and rhythm, soft S1/S2, no murmur Abdomen: soft, non-tender, non-distended, bowel sounds present Ext: warm, 2+ DP pulses, no edema; wearing pneumatic boots Neuro: Alert, oriented x3 ("[**Hospital3 **]", "[**2147-9-6**]"). CNs [**12-31**] intact, except for diminished ability to elevate L shoulder. Motor: diminished strength in LUE and LLE as compared to RUE and RLE. Normal sensation to light touch. Normal finger-nose-finger with right arm (unable to do with left arm). FAMILY HISTORY: Her father had liver cancer, otherwise no history of cancer. SOCIAL HISTORY: has been in [**Hospital3 **] She used to live alone and independent with activities of daily living. She is currently in rehab. - Tobacco: Denies - Alcohol: Denies - Illicits: Denies

CHIEF COMPLAINT: Barrett's Esophagus PRESENT ILLNESS: Mrs. [**Known lastname 34578**] is a 73 year-old female who present with fatique and satiety related to iron deficiency anemia. An investigational EGD done at an OSH found an asymptomatic 2cm lesion at the junction of the esophagus and stomach consistent with Barrett's Esophagus. She is being admitted for a Transhiatal Esophagectomy with feeding J-tube placement. MEDICAL HISTORY: Hypothyroidism Anemia Thyroidectomy [**2110**] Appendectomy Right Breast lumpectomy [**2129**] MEDICATION ON ADMISSION: Levothyroxine 112mcg alternating with 100mcg Tamoxifen 10 mg once daily Simvastatin once daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: 73 year-old female in no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple Card: regular rate & rhythm, normal S1,S2, no murmur/gallop or rub Resp: decreased breath sounds GI: bowel sounds positive, abdomen soft non-tender/non-distended Extr; warm no edema Wound: mid abdominal clean dry intact with staples. J-tube site clean Esophageal incision clean, dry, intact with steri-strips Neuro: non-focal FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with husband. [**Name (NI) 75042**]: quit [**2104**] ETOH rarely

CHIEF COMPLAINT: Transfer from OSH after cystic duct leak. PRESENT ILLNESS: Mrs [**Known lastname 17926**] is a 84 female s/p Lap cholecystectomy ([**3-3**]) which was complicated by CHF exacerbation and cystic duct leak at an OSH. She also underwent unsuccessful ERCP prior to admission/transfer to [**Hospital1 18**] for further management of duct leak. MEDICAL HISTORY: HTN, CHF, DVT, PE, PVD, GERD, RA, CRI, A Fib, anemia, [**Doctor Last Name 105178**] PSH: s/p B hip replacement, s/p CCY, s/p hysterectomy MEDICATION ON ADMISSION: lasix, lopressor, prednisone, protonix, tylenol, coumadin ALLERGIES: Ciprofloxacin PHYSICAL EXAM: AF, HR in 80s, 160/80, 97 (RA) GEN: NAD HEENT: anicteric, No LAD, CV: RRR RESP: crackles at bilateral bases ABD: NABS, soft, RUQ TTP, mild guarding, EXT: edema, multiple bruises FAMILY HISTORY: NC SOCIAL HISTORY: No Tobacco/No EtOH

CHIEF COMPLAINT: Dizziness, diarrhea PRESENT ILLNESS: 55 year-old female with a history of ESRD secondary to hypertensive nephropathy, transitioning from HD to PD, SVC syndrome [**12-27**] clots on anticoagulation, recent line infection with E.cloacae on ceftazidime admitted with hypotension and diarrhea found to have C.diff colitis now somewhat improved on PO vanco and IV flagyl. The patient was admitted to the MICU on [**7-15**] [**12-27**] hypotension in the ED. In the MICU, the patient was fluid repleted, given peripheral dopamine, and ruled out for MI. Renal is following and managing her HD and PD. . Patient was recently hospitalized at [**Hospital1 18**] [**Date range (1) 17901**] enterobacter bacteremia, and began treatment with ceftazidime at HD and empirically in peritoneal diasylate with plans for 3 week course starting [**6-28**] (last day would be [**7-18**]). She states that she began having very frequent liquid diarrhea after discharge from the hospital with slight blood, mucous in stool. Reports dizziness and a presyncopal episode, especially with standing over past 2 weeks. Pt was seen by Dr. [**First Name (STitle) 805**] on [**7-8**] and had stool culture sent at that time that was negative, no c. diff was sent. . She has denied abd pain, SOB, chills, CP. States appetite has been normal, no N/V. Reported her dry weight at 78Kg, was 78Kg at HD prior to HD on Monday. Gets HD M and F at [**Location (un) **] in [**Location (un) **]. On other days does PD at home, reports using extra diasylate day prior to admission as she was concerned that she was retaining water because her face was "puffy." Reports her normal BPS 100-120s. Has noted her BPs have been low, has been holding her lisinopril and taking half dose of her atenolol. . MEDICAL HISTORY: -ESRD on HD: proliferative glomerulonephritis. ? hx of lupus On steroids several years ago. Diagnosed in [**2122-10-25**] ([**Doctor First Name **] 1:160) -Bilateral total knee replacement in [**2125-1-23**] -CAD -Rheumatic fever -HTN -Left shoulder OA -Left rotator cuff tear -Hyperparathyroidism -Iron deficiency anemia -Hypercholesterolemia -Hysterectomy; fibroids -Bilateral knee replacements [**1-28**] -Herpes Zoster prior history with resulting post-herpetic neuralgia right side MEDICATION ON ADMISSION: 1. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 2. Cinacalcet 30 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 5. Lanthanum 500 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 6. Sevelamer HCl 800 mg Tablet Sig: Three (3) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed for anxiety. 9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*1* 10. Paricalcitol Paricalcitol 6.5 mcg IV QHD 11. Ferric gluconate Ferric Gluconate 125 mg IV QWEEK AT HD 12. ceftazidime CeftazIDIME 1 g IV 3X/WEEK (MO,WE,FR) Duration: 3 Weeks with start date [**2128-6-28**] 13. Outpatient Lab Work Please check INR at next HD session 14. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 15. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 16. Ferric Gluconate 125 mg IV QWEEK AT HD 17. CPAP CPAP with 2L O2 Auto CPAP range 4-20 Diagnosis: OSA 18. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 96.7 BP:90/67 P:85 R:20 SaO2:94% on RA General: Awake, alert, NAD, pleasant, appropriate, cooperative. FAMILY HISTORY: Father myocardial infarction in his 40s. Uncle with a myocardial infarction in his 40s. Brother with a myocardial infarction in his 40s. There is no family history of connective tissue disease. Sister with [**Name (NI) **]. Uncle with prostate ca. SOCIAL HISTORY: Lives with housemates in [**Location (un) 669**]. Worked as social worker for DSS, currently not working. Smoked [**11-26**] pack per day x 30 years, now down to 1-2 cigarettes a day. Former cocaine user. Last drink 1/[**2127**]. Denies recent cocaine use. Denies IVDU.

CHIEF COMPLAINT: high speed MVA PRESENT ILLNESS: 59 y/o male, unrestrained driver, high speed MVC car vs. pole. GCS 5 in field, so patient intubated. Found to have bilateral small apical ptx, rib fx, pelvic fs, SAH/SDH, facial fx, depressed skull fx L parietal area. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: unknown ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: vitals in E.D. 97.2 (rectal temp), 82, 140/palp, 20, 95%(AC 40/33/124/22/2) HEENT: Bleeding laceration on left forhead, depressed Left skull fx (parietal region), L dilated pupil compared to right Chest: CTAB, no deformities CV: RRR ABD: soft, non-distended Extremities: cool, 2+ second capillary refill rectal tone: decreased (given vecuronium in field) spine: no step-offs or obvious deformities FAMILY HISTORY: unknown SOCIAL HISTORY: unknown

CHIEF COMPLAINT: SAH/ L MCA aneurysm PRESENT ILLNESS: 63 F transfer from [**Hospital3 **]after reportedly complaining of dizziness earlier this evening. Husband was at home with her and heard her fall when getting up to use the bathroom, and she was unresponsive at that time. She did have one episode of emesis prior to EMS arrival, and when EMS arrived on scene she was reportedly unresponsive with agonal breathing. She was bag-mask ventilated and taken to [**Hospital3 **]where she was intubated with RSI meds. At that time her exam was GCS 3T with reportedly equal nonreactive 2mm pupils. A CT scan demonstrated a large (2.5 x 3.5) left sided aneurysm at the ICA vs MCA with subarachnoid hemorrhage and moderate blood in lateral, 3rd and 4th ventricles as well as 8mm rightward midline shift. SBPs at [**Location (un) **] were in the 200s - 240s and she was started on a nipride drip which initially controlled SBPs to 140s. Heart rate was reported to be 50s. She was loaded with dilantin and mannitol and transferred to [**Hospital1 18**] for further care. On arrival to [**Hospital1 18**] she was found to have SBPs in 220s with nipride off, and nicardipine was started. She was also noted to have a newly blown right pupil with left pupil 2mm and fixed. GCS still 3T with absent cough and gag reflexes. Corneal reflex intact. A CTA again demonstrates a large L-sided anterior aneurysm with interval increase in the quantity of hemorrhage in lateral, 3rd and 4th ventricles with increase in midline shift to approximately 11mm. The patient's husband is reportedly en route from [**Hospital3 **]by car. All history is obtained via medical records from transfer and EMS reports. MEDICAL HISTORY: Hypertension MEDICATION ON ADMISSION: Unknown ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: PHYSICAL EXAM: GCS 3T O: T: 98 BP: 128/68 HR: 56 O2Sats 99% CMV Gen: intubated, no sedation on board, unresponsive HEENT: Pupils: R 6mm fixed and dilated, L 3mm fixed Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. No C/C/E. FAMILY HISTORY: Unknown SOCIAL HISTORY: Lives with husband.

CHIEF COMPLAINT: Intrahepatic cholangio carcinoma PRESENT ILLNESS: 72 y/o femaile who was found to have a right lobe liver mass on Abdominal CT. MRI was done showing in [**Month (only) 404**] a 7.1 x 6.4 x 7.2-cm mass in the right lobe of the liver suggestive of malignancy. The main portal vein was patent. The left hepatic vein was normal. The middle hepatic vein was displaced by the mass and the right hepatic vein was encased but did enhance near the IVC. CT guided biopsy in [**Month (only) 956**] demonstrated poorly- differentiated adenocarcinoma. Morphology and immunohistochemical staining pattern did not support a primary site. A negative stain for HepR1, AFP and polyclonal CEA mitigated against a primary hepatocellular carcinoma. A PET CT scan on [**2-20**] demonstrated intense activity in the lesion of the liver with an SUV of 10 but no other areas of FDG avidity were noted. Tumor markers included a normal CA- 125 at 6.3, a CA19-9 elevated mildly at 79, a CA27.29 mildly elevated at 50.3 and a CEA to 0.6. No pulmonary metastases were demonstrated on chest CT. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: 2 Cypher [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**] here [**2164**] -PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: Hypertension Hyperlipidemia L ankle repair [**2149**] Osteoarthritis MEDICATION ON ADMISSION: ASA 325' (held), plavix 75' (held), lisinopril 20', nitro prn, crestor 40', trazodone 25 hs prn, vitC, glucosamine, MVI ALLERGIES: Prochlorperazine PHYSICAL EXAM: VS: 98.7, 70, 160/74, 12, 100% General: Pain initially not well controlled, but improved with adjustments Card: RRR, no M/R/G Lungs: CTA bilaterally Abd: JP in place, initially bilious in appearance, improved over time to serous, incision C/D/I, non-tender, non-distended Extr: warm, no edema, R shoulder has lipoma Skin warm and dry Neuro: Oriented but forgetful FAMILY HISTORY: Mother died when young, cause unknown. Father passed away after suicide. SOCIAL HISTORY: Retired, lives alone -Tobacco history: None -ETOH: 0 weekly -Illicit drugs: Denies

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 87 year-old female with history of hiatal hernia/GERD, AF, history of recent aspiration pneumonia presents with progressive SOB. She was recently admitted to [**Hospital1 18**] for pneumonia and treated wtih Levofloxacin for 14 days. She completed her antibiotics and presented to her PCPs office where a CXR was performed. The CXR was unchanged so she had a CT which showed multifocal infiltrates, ? aspiration versus infectious. She was told to eat smaller meals and avoid eating quickly. For the last week, she has had increased shortness of breath. Five days prior to admission she was having lots of coughing and shortness of breath. 911 was called but didn't bring her to the ED. On Sunday, she was at the [**Last Name (un) 4068**] because she swallowed a hearing aid. A CXR was performed but no further intervention was performed. Over the past week, she notes increasing fatigue and shortness of breath. she endorses a mild non-productive cough, worse at night. No fever/chills. No orthopnea, PND, or edema. In the ED, a CXR showed new multifocal infiltrates. A chest CT was subsequently obtained, which showed worsening consolidations, especially in RML with RML collapse, with ? RML abscess. She was given Ceftriaxone, Atithromycin and Flagyl. MEDICAL HISTORY: 1. Hiatal hernia with gastroesophageal reflux disease 2. Paroxysmal atrial fibrillation, on Coumadin 3. Iron deficiency anemia. 4. Recurrent UTIs. 5. Hyperthyroidism attributed to Amiodarone toxicity 6. History of iatrogenic pneumothorax following line placement in 02/[**2112**]. 7. Colonic polyps 8. s/p Appendectomy. 9. Impaired visual acuity MEDICATION ON ADMISSION: Senna 8.6 mg [**Hospital1 **] Pantoprazole 40 mg daily Amiodarone 100 mg daily Hydralazine 25 mg QID Methimazole 5 mg daily Psyllium 1.7 g daily Fluticasone 110 mcg/Actuation Aerosol 2 puffs [**Hospital1 **] Warfarin 5 mg daily Lisinopril 5 mg daily Combivent 103-18 mcg/Actuation Aerosol 1 inh QID ALLERGIES: Ranitidine PHYSICAL EXAM: Physical examination on admission: VS: T 98.8, Pulse 66, BP 116/76, RR 17, 95% on RA Gen: Alert, oriented, cooperative female in NAD HEENT: EOMI, anicteric, mildly dry MM Neck: Supple, -LAD, JVP not elevated Lungs: Distant lung sounds (difficult exam as in [**Doctor Last Name **] in noisy ED), no rhales appreciated Heart: RRR, nl S1S2, no murmers Abd: Soft, obese, mild distension, NT +BS Ext: 2+ edema bilaterally, ecchymoses at left calf, slight tenderness on anterior palpation of shin bilaterally Neuro: A&OX3, responding to all ?'s, moving all ext FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: She does not smoke or drink. She walks with a cane at baseline. She lives in [**Location (un) **] with a young woman who helps with her care.

CHIEF COMPLAINT: STEMI PRESENT ILLNESS: This is a 64 year-old male with history of HTN who presents to CCU from cath lab after STEMI. He experienced pleuritic chest pain [**7-27**] starting at 2 AM. His pain was worse with inspiration. The patient took 6 ASA (325 mg tabs) at home prior to going to the hospital. In the morning, he walked 2 miles on his treadmill, attempting to "work it out", but then decided to go to the ED once the pain continued. At OSH ([**Hospital1 46**]), he received nitro gtt and was hypotensive to SBP 90s. They also started the patient on morphine, fentanyl, lopressor 2.5 mg IV x 2, plavix 600 mg, and he was started on heparin gtt and integrillin gtt. The patient also had brown, heme positive stool at OSH. He then got transferred to [**Hospital1 18**] for cardiac cath and continued to have CP. . During cath, he was found to have mid to distal LAD, has very small left cx disease, and diffuse RCA disease. LAD showed 90-95% stenosis, mid to distal LAD. The patient had balloon angioplasty to the distal LAD, complicated by disection distal LAD. His CP remained stable and improved on nitro gtt with morphine PRN. The patient was started on integrillin, but was stopped once he reached the CCU. The patient also had mild acidosis on admission with pCO2=42. His BP was in the 130/80s post cath. . On review of symptoms, he started [**First Name8 (NamePattern2) **] [**Doctor Last Name 1729**] diet 3 weeks ago. He denies tinnitus, any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. He walks approximately 2 miles without difficulty. All of the other review of systems were negative. . Cardiac review of systems is notable for chest pain as noted above, but negative for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: Hypertension Hiatal hernia Sciatica MEDICATION ON ADMISSION: Lisinopril/HCTZ 20/12.5 mg daily ASA 81 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97.6, BP 122/74, HR 96, RR 19, O2 96% on 6LNC Wt: 86 kg. FAMILY HISTORY: No family history of premature coronary artery disease or sudden death, but his father and mother both had MIs at age>70 yrs. Also his mother had diabetes. SOCIAL HISTORY: Prior 15 year h/o tobacco use, but he is currently a non-smoker. He drinks ETOH occasionally.

CHIEF COMPLAINT: 68F with recent R ICA stenting on [**2108-5-18**], 80-90% [**Doctor First Name 3098**] stenosis, now with L stroke symptoms s/p L CAS PRESENT ILLNESS: This is a woman with left hemispheric TIA who has an extensive history of coronary artery disease, status post MI in need for CABG. She previously had right carotid stenting and then developed left hemispheric symptoms, and was shown by CTA to have severe, greater than 80% stenosis of the left carotid. MEDICAL HISTORY: [**Doctor First Name **] HISTORY: Stent Placement, : R carotid [**2108-5-18**]. MEDICATION ON ADMISSION: Synthroid 75', Atorvastatin 80', Plavix 75', Zonisamide 400'', ASA 325', Lopressor 25', MVI, colace, ranitidine 150', miralax ALLERGIES: Lamotrigine PHYSICAL EXAM: PHYSICAL EXAM Vital Signs: Temp: 97.6 RR: 18 Pulse: 68 BP: 102/64 Neuro/Psych: Oriented x3, Affect Normal, NAD. Neck: No masses, Trachea midline, Thyroid normal size, non-tender, no masses or nodules, abnormal: B/l carotid bruits. Nodes: No clavicular/cervical adenopathy, No inguinal adenopathy. FAMILY HISTORY: There is no family history of stroke or epilepsy. Her father passed away from a ruptured aortic aneurysm. He had insulin-dependent diabetes. Her mother passed away from an MI at age 49. SOCIAL HISTORY: She is a widow. Her husband passed away from esophageal cancer in [**2102**]. She does not have any children. She had 5 miscarriages. She used to work in a factory that made smoke detectors. That is where she met her longtime friend who looks after her and is present during this HPI.

CHIEF COMPLAINT: Hemoptysis PRESENT ILLNESS: This is a 72 year-old male with a history of Afib on coumadin, HTN and recent bronchitis who was transferred from OSH ED with several episodes of hemoptysis (frank blood and large clots) for pulmonary evaluation. . Pt was in USOH until today when he noticed an episode of hemoptysis this afternoon at home. He went to [**Hospital3 **] ED for evaluation and continued to have multiple episodes of frank hemoptysis and clots. He was HD stable. CXR did not show any acute finding. INR was 2.4 and Hct was 49. Pt was transferred to [**Hospital1 18**] for pulmonary evaluation. . Of note, pt had severe bronchitis about three weeks ago that resolved on its own. No h/o cancer or smoking. Also denies BRBPR, tarry stools or vomiting. Also no changes in his coumadin dose. No sick contacts. [**Name (NI) **] [**Name2 (NI) **] bleeds. . In the ED, his VS were T97.7, 115, 148/79, 18, 100%RA. Lung exam with b/l rales. He was guaiac negative. EKG with Afib, no acute changes. CXR without acute process. INR was 2.7. Hct stable at 44.3. WBC 16.9 with left shift but no bands. Pt coughed up a total of approximately 50-75cc of blood (frank blood and clots) which eventually subsided after one large clot. 2 large bore IVs were placed. Interventional Pulmonary was contact[**Name (NI) **] who decided to reverse his INR and perform bronchoscopy in AM. Pt received 10mg IV of Vitamin K and 2U of FFP and was admitted to the ICU for further monitoring. . ROS: The patient denies any [**Name (NI) **] bleeds, fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, melena, hematochezia, chest pain, shortness of breath or dysuria. MEDICAL HISTORY: - Atrial fibrillation x 20 yrs, on coumadin - HTN - PPM (per pt, for difficult to control Afib; no h/o heart block); placed 9 yrs ago at [**Hospital3 **] - Anxiety - Depression MEDICATION ON ADMISSION: Atenolol 50 daily Digoxin 250 mcg daily Nortryptiline 25 daily Coumadin 10 mg total per week (2 Mo, 2 Tue, none Wed, 2 [**Last Name (un) **], none Fri, 2 Sat, 2 Sun) ASA 81 daily Nifedipine SR 30 daily Klonopin 0.5 tid . ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 97.6 BP: 138/75 HR: 107 RR: 20 O2Sat: 95% RA GEN: WDWN male in no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis, dry MM, OP Clear, dry blood around lips NECK: No JVD, supple COR: irregularly irregular, no M/G/R, normal S1 S2 PULM: coarse BS b/l, dry inspiratory crackles at bases b/l ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, good pulses NEURO: alert, oriented x3. Moves all 4 extremities. SKIN: No jaundice, cyanosis or ecchymoses. Maculopapular rash with hives over chest and left temporal area on his head. FAMILY HISTORY: No lung diseases. SOCIAL HISTORY: Lives at home with wife. Denies any EtOH, cigarette smoking or IVDU.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 39 yo male with known murmur was hospitalized in early [**Month (only) 116**] for angina. Murmur noted, pain resolved, and subsequent ETT/echo scheduled. ETT was stopped for fatigue and was non-diagnostic for ischemia. Echo revealed moderate to severe MR. MEDICAL HISTORY: Mitral Regurgitation Atrial Fibrillation with DCCV [**2168-4-20**] MEDICATION ON ADMISSION: Xanax prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 76 reg Resp: O2 sat: B/P Right:136/86 Left: 138/82 Height: 72" Weight: 185# FAMILY HISTORY: non-contributory SOCIAL HISTORY: Occupation: biotechnician Last Dental Exam: dental clearance obtained [**5-3**] Lives with wife [**Name (NI) **]: Caucasian Tobacco: active [**11-27**] ppd, reduced on chantix ETOH: social occasions

CHIEF COMPLAINT: hemiparesis, confusion, dysarthria followed by headache PRESENT ILLNESS: Patient is a 39 yo man with PMH of hypercholesterolemia and recent diagnosis of complex migraines who presents with his third episode in 3 days of hemiparesis/confusion/dysarthria followed by a throbbing headache. He has never had migraines or similar symptoms prior to this and generally does not suffer from headaches very much. Was in his baseline state of health until monday night at 10 PM when he noted right foot numbness/weakness which advanced up to his right arm and face over a period of minutes. 2-3 hours later he had confusion and dysarthria. He went to [**Hospital **] Hospital where he was worked up for stroke. He had a negative MRI and MRA, negative cardiac echo, and his symptoms had all resolved after about 4 hours. As his deficits resolved a bitemporal throbbing headache set in for a period of hours. He has never had these types of headaches in the past. He was discharged from [**Hospital1 **] yesterday AM with a diagnosis of complex migraines and instructions to start ASA and Zocor. After being home a few hours he was cleaning and around 6pm noted onset of right foot numbness and weakness again in the right foot. The numbness and weakness advanced up to the right hand over 5 minutes. He became confused and dysarthic at some point after that but cannot say exactly when. Deficits lastted 1.5-2 hours and throbbing headache recurred as his deficits abated. Was taken to [**Hospital6 **] where he was given compazine and ASA but did not have any imaging. They reviewed his old records and told him again complex migraine and sent him home last night. His throbbing headache never actually resolved and continued until today. This morning around 0930 he noted numbness and weakness in his left foot (prior 2 episodes were right) which spread up to the back of his head and arm over period of minutes. Again followed by confusion and dysarthria. Deficits lasted period of hours and HA has continued since yesterday. The headache is throbbing pressure bitemporally without lateralizing predominance. The throbbing sensation is accompanied by a "whooshing" sound in each ear. Has moderate photophobia and phonophobia as well as N/V. No neck stiffness or pain. His wife describes the hemiparesis as he was unable to use that side and could not move the foot to get his sock on it. She also said that the weak side of the body correlated with a droop on that side ((on both occasions she was witness to). His confusion manifested as not being able to recall the names of co-workers who visited at the OSH [**Name (NI) **] although he said he recognized them. He was also dysarthric and would often just say "um...um....um.....". He could not name any animals on timed test at OSH. MEDICAL HISTORY: prior to 4 days ago had no PMH. MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- 99.0 BP- 130/79 HR- 89 RR- 16 O2Sat 100 RA Gen: Lying in bed, NAD, sleeping HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit Back: No point tenderness or erythema CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: Mother had migraines from age 15-20, but never with symptoms such as this. Father and brother do not have migraines. No strokes, DVT or PE. Mother has some CAD. GF had MI and stroke at 47. GM had stroke at 62. SOCIAL HISTORY: Works as a corrections officer. Drinks occasional alchohol. Occasional cigars and remote cigarrettes. No drugs. Drinks 1 cup coffee a day. Started drinking "red Bulls" about 2 months ago, but not the last few days. No dietary supplements.

CHIEF COMPLAINT: Coronary artery disease. PRESENT ILLNESS: The patient is a 65 year old male with hypertension, diabetes mellitus, hypercholesterolemia and a past smoker, who had recent onset of chest pain and a positive stress test. He was admitted to the Cardiac Medicine service on [**2142-5-23**], for catheterization. MEDICAL HISTORY: 1. Coronary artery disease. 2. Diabetes mellitus. 3. Renal insufficiency. 4. Sleep apnea. 5. Hypercholesterolemia. MEDICATION ON ADMISSION: 1. Cartia 120 mg p.o. q.d. 2. Lipitor 10 mg q.d. 3. Univasc 15 mg p.o. q.d. 4. Atenolol 25 mg q.d. 5. Diovan 160 mg q.d. 6. Humulin N 30 units q.a.m. and 30 units q.p.m. 7. Humulin R 14 units q.a.m. and 8 units q.p.m. ALLERGIES: Penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: R anterior tibia fx from clinic PRESENT ILLNESS: 84 year-old female with advanced dementia, osteoporosis, hypothyroidism (not on replacement) who experienced an unwitnessed mechanical fall on [**2170-7-11**] at her nursing facility (lives at memory unit of [**Hospital3 4103**] on the [**Doctor Last Name **]) causing a right angulated tibial-fibula fracture s/p ORIF ([**2170-7-14**]). MEDICAL HISTORY: - dementia - hypothyroidism - osteoporosis - chronic constipation - rectal prolapse - cataracts - hyperlipidemia - anxiety - ventral hernia MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from nursing home records. 1. Lidocaine 5% Patch 1 PTCH TD DAILY 2. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain 3. Risperidone 1 mg PO HS 4. Milk of Magnesia 30 mL PO DAILY constipation 5. Lactulose 30 mL PO BID 6. Sertraline 150 mg PO DAILY 7. Mirtazapine 15 mg PO HS 8. Guaifenesin 5 mL PO Q4H:PRN cough 9. Vitamin D 50,000 UNIT PO Q21DAYS 10. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH [**Hospital1 **] 11. Acetaminophen 650 mg PO DAILY 12. Calcium Carbonate 1250 mg PO QPM 13. Sodium Chloride Nasal 1 SPRY NU [**Hospital1 **]:PRN congestion ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VITALS: Temp: 99.3 HR: 90 BP: 125/71 Resp: 18 O(2)Sat: 95 Normal GEN: NAD, pleasant, A&Ox1 HEENT: Normocephalic, atraumatic Chest: Normal Cardiovascular: Normal Abdominal: Normal RLE: In splint, moving toes, DP 1+, cap refill < 1 sec; splint was applied in office, left in place. FROM at hip, knee, no knee tenderness or swelling, no jointline tenderness. SILT on palpable skin on RLE Neuro: Moving all extremities Heme/[**Last Name (un) **]/[**Last Name (un) **]: Normal FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives in the Memory Unit at Newbridge on the [**Doctor Last Name **]. No alcohol, tobacco, or drugs.

CHIEF COMPLAINT: Recent pancreatitis and ascending cholangitis s/p ERCP, found to have increasing abdominal pain PRESENT ILLNESS: 75 yo F with COPD on 3-4L of oxygen at home and h/o pancreatitis of unknown etiology who initially presented to OSH with a presumed diagnosis of ascending cholangitis and was treated with abx, but left AMA, presented here for outpatient ERCP [**2176-1-31**]. . The patient was a poor historian but said that she was symptom free prior to her ERCP and developed epigastric abdominal pain post-procedure. She said the pain was similar to prior episodes of pancreatitis, denied radiation or alleviating or exacerbating factors. She also said that she was somewhat SOB, more so than her baseline. . ROS was otherwise negative MEDICAL HISTORY: -COPD on 3-4L on oxygen at home -h/o pancreatitis, etiology unknown -h/o cholecytitis and possible ascending cholangitis -GERD -Hypercholesterolemia -DM -HTN -Echo > 70% -Rectocele -cataracts -Afib with RVR -Fracture dist radius MEDICATION ON ADMISSION: prednisone 10 po qd prilosec 20 po qd toprol xl 100 qd pravastain 20 po qd asa 81 po QD lasix 20 qd trazadone 50 qpm albuterol prn oxygen 3-4L at home ALLERGIES: Penicillins / Sulfa(Sulfonamide Antibiotics) / Cephalosporins / Codeine / morphine / Codeine / morphine PHYSICAL EXAM: Admission PE 96.5 148/65 74 15-16 94-95 on 3L NC General: AAOX3, in NAD, somewhat of a poor historian and has eyes closed during most of PE HEENT: CN 2-12 grossly intact, MMM CV: RRR, no rmg Lungs: distant BS, decreased BS at bases, posterior end expiratory wheeze and anterior rhonchi Abdomen: soft, ND, TTP in epigastrum-moderate and mild TTP in RUQ and LUQ, no rebound, no hsm Extremities: WWP, pulses 2+ and equal Neuro: CN and MS wnl, sensation and strength wnl Derm: no obvious rashes Psych: mood and affect wnl FAMILY HISTORY: -was adopted, unsure of family hx SOCIAL HISTORY: -lives with sister, drinks three times a week when well (Scotch reportedly [**2-4**] drinks per week), is retired, has a living will which indicates DNR/DNI status. -quit smoking 2 months ago, has a ~60 py history

CHIEF COMPLAINT: chest tightness with exertion PRESENT ILLNESS: 57 y/o Cantonese speaking F with known 3V CAD, medically managed with recent 2 day episode of exertional angina. Underwent cardiac cath which again revealed severe three vessel coronary artery disease. Referred for surgical revascularization. MEDICAL HISTORY: Coronary Artery Disease s/p Myocardial Infarction [**8-9**], Hypertension, Hypercholesterolemia, Diabetes, melodysplastic syndrome, Peripheral Vawscular Disease s/p R com Fem to [**Doctor Last Name **] BPG, Retinopathy, GERD, Chronic Renal Insufficiency(1.3-1.8) MEDICATION ON ADMISSION: Aspirin 81mg qd, Norvasc 5mg qd, Lipitor 80mg qd, Plavix 75mg qd, Iron, Folic Acid, Glyburide 5mg [**Hospital1 **], Lisinopril 10mg, MVI, Pyridoxine25mg qd, Zantac 150mg qd, Toprol XL 100mg qd, Lantus ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HR 66 RR 16 BP 177/92 WDWN Asian F in NAD Lungs CTAB Heart RRR no Murmur Abdomen benign Extrem warm, no edema FAMILY HISTORY: n/c SOCIAL HISTORY: no alcohol non smoker

CHIEF COMPLAINT: Chief Complaint: Shortness of Breath PRESENT ILLNESS: 71-year-old woman with a past medical history of known metastatic breast cancer and a known chronic pleural effusion (has bilateral drains, gets drained QOD). Over past two weeks she has had increased drainage. She presented to [**Hospital3 **] hospital with worsening shortness of breath. Sat initially 75%. She was scheduled for pleuredesis here in the future. Pt states increasing SOB and increased drain output x 2 weeks, but acutely worse this week, with the output from the R-sided drain appearing more bloody. No fevers, chills, diarrhea, vomiting, abd pain. Does note LE edema bilaterally, as well as productive cough for the past week. Denies recent sick contacts. She is undergoing chemo for breast CA (last session Wednesday). MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes - , Dyslipidemia - , Hypertension - 2. OTHER PAST MEDICAL HISTORY: Bilateral stage I lobular carcinoma (see below) goiter, which is being followed Basal cell cancer ten years ago . PSH: Tonsillectomy at age 14 and a cholecystectomy at age 25, rotator cuff surgery at 64 and knee surgery at age 55. . ONCOLOGIC HISTORY: 1. [**5-/2108**]: Multiple suspicious areas on breast MRI. Bilateral breast biopsy demonstrated invasive lobular carcinoma. 2. [**6-/2108**]: Underwent bilateral mastectomy for what appeared to be multifocal disease in both breasts and had negative sentinel lymph node biopsy. The right breast had a lesion staged as T1b and was grade II, ER positive, PR negative, HER-2 negative, grade II. The left breast lesion was T1C M0, ER/PR positive, HER-2/neu negative without lymphovascular invasion and grade II. BRCA [**2-15**] testing negative. 3. [**7-/2108**]: Oncotype DX assay revealed a recurrence score of 21, which was in the intermediate risk group. The patient declined enrollment in the TAILORx trial because she did not want chemotherapy. Started on Arimidex. The last bone mineral density scan in [**7-/2108**] revealed osteopenia at the left femoral neck MEDICATION ON ADMISSION: Medications - Prescription AMIODARONE - 200 mg Tablet - 1 (One) Tablet(s) by mouth Once daily ANASTROZOLE - 1 mg Tablet - 1 Tablet(s) by mouth daily ENOXAPARIN - 60 mg/0.6 mL Syringe - injection subcutaneously twice a day (every twelve hours) LIDOCAINE - 5 % (700 mg/patch) Adhesive Patch, Medicated - apply at 8pm Up to twice daily Patch may remain in place for up to 12 hours. Remove at 8am. MORPHINE - 15 mg Tablet Extended Release - 1 Tablet(s) by mouth Every 12 hours ONDANSETRON HCL - 4 mg Tablet - 1 (One) Tablet(s) by mouth every eight (8) hours as needed for nausea OXYCODONE - 5 mg Tablet - 1 Tablet(s) by mouth Every 6 hours PANTOPRAZOLE [PROTONIX] - 20 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day as needed for may repeat once - No Substitution SERTRALINE - 25 mg Tablet - 1 Tablet(s) by mouth daily Medications - OTC DOCUSATE SODIUM - (OTC) - 100 mg Capsule - Capsule(s) by mouth Twice daily GLUCOSAMINE &CHONDROIT-MV-MIN3 - (Prescribed by Other Provider; OTC) - Dosage uncertain MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain POLYETHYLENE GLYCOL 3350 - (OTC) - 17 gram/dose Powder - by mouth ALLERGIES: Codeine / OxyContin / Ativan PHYSICAL EXAM: Admission Physical Exam: Vitals: T 98.1 HR 95 BP 107/44 RR 27 O2 93% NRB General: Alert, oriented, no acute distress, can speak in full sentences HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops. Pulsus measured at about [**7-21**]. Lungs: Clear to auscultation b/l in upper lung fields; decreased air movement halfway up lung fields, dullness to percussion, bronchial breath sounds, rubs, and coarse ronchi in b/l lower lung fields. Abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding. B/l chest tube sites with clean dressings. GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Discharge exam - FAMILY HISTORY: A brother who was diagnosed with breast cancer at age 59, metastatic disease at age 60. She has a sister who was diagnosed with breast cancer at age 49 and died at age 51 from metastatic disease. She has another sister recently diagnosed with breast cancer in [**2109**]. Genetic testing for BRCA 1 or 2 mutations was performed and was negative. SOCIAL HISTORY: Lives with husband. [**Name (NI) **] 4 kids. Occupation retired school teacher. Smoking history 20 pack-year smoking hx; quit 33 years ago. Alcohol denies.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 53 year old woman with a history of Hodgkin's lymphoma diagnosed approximately twenty-five years ago and treated with chemotherapy/radiation. The patient has also had a pulmonary embolism approximately fifteen years ago. She was admitted to [**Hospital3 35813**] Center on [**2141-1-18**], for increased shortness of breath, chest tightness, nonproductive cough associated with tachycardia. Deep vein thrombosis and pulmonary embolus workup was negative. Spiral chest CT did, however, reveal a thickened pericardium with pericardial effusion. Follow-up echocardiogram confirmed a markedly thickened pericardium, moderate effusion with right atrial collapse, septal dyskinesis. There were marked respiratory variations of mitral valve flow. The patient further underwent cardiac catheterization demonstrating an ejection fraction of greater than 65% and no evidence of any coronary artery disease. The patient was then transferred to [**Hospital1 1444**] for pericardectomy. MEDICAL HISTORY: 1. Hodgkin's lymphoma. 2. Status post chemotherapy/radiation. 3. History of pulmonary embolus. 4. Hypothyroidism. MEDICATION ON ADMISSION: 1. Synthroid 75 mcg once daily. 2. Solu-Cortef 100 mg q6hours. 3. Indomethacin 25 mg p.o. three times a day. 4. Lorazepam 0.5 mg three times a day. 5. Lasix 20 mg p.o. once daily. 6. Zosyn. 7. Zithromax. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Post-operative hypotension Right hip heterotopic ossification PRESENT ILLNESS: 45 year old male with history of T4 paraplegia,admitted for R hip girdlestone resection arthroplasty to improve mobility. MEDICAL HISTORY: -T4 paraplegia from MVA age 28, [**2137**] -IBD -VRE, MRSA ([**2153**]), polymicrobial infections; followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ID fellow bb12672 (clinic number [**Telephone/Fax (1) 39041**]) at [**Hospital1 756**] -h/o urosepsis and chronic indwelling foley with multiple false passages of urethra; foley changes require urology involvement -h/o osteomyelitis on chronic suppressive abx -Stage IV sacral ulcer decubiti and bilateral ischial ulcers and -left trochanteric ulcers s/p debridement [**2154-6-21**] -Chronic pain on narcotics -Iron deficiency anemia -Peripheral neuropathy (ulnar) -GERD -GIB secondary to hemorrhoids Past Surgical History (as summarized in ortho note) -[**2155-4-23**], Surgical preparations of very large sacral and left trochanteric wounds with STSG and VAC placement -[**2155-1-28**], developed wound breakdown posterior thoracic spine surgery area, at which time he had a complex wound exploration with debridement and removal of posterior thoracic instrumentation with a wound washout and complex closure by plastic surgery in combination with neurosurgery. I&D of the paraspinal abscess and placement of a large VAC sponge was completed. - [**9-/2154**] s/p surgical preparation of left trochanteric and ischial ulcers and local tissue rearrangement and advancement with coverage of trochanteric and ischial ulcers exceeding 160 cm2 - [**8-/2154**] s/p thoracic wound revision with a washout and removal of hardware for postoperative cervical, thoracic wound infection with failure of instrumentation from progressive osteomyelitis -[**2154-8-14**] s/p lateral extracavitary transpedicular T9-T10 corpectomy for debridement of spinal abscess and bony infection with a T6-L1 posterior spinal instrumentation fusion - [**5-/2154**] s/p debridement decubitus ulcers - [**2146**] s/p Girdlestone procedure L hip [**2146**] at [**Hospital1 756**] [**2136**]?3 s/p tracheostomy at time of MVA [**2136**]?3 s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 931**] rods placement MEDICATION ON ADMISSION: Home Medications Confirmed with patient: Doxycycline 100mg PO BID BACLOFEN 10 mg PO daily prn OXYCONTIN 40 mg Tablet Sustained Release 12 hr PO q8 hours OXYCODONE-ACETAMINOPHEN [ENDOCET] - 5 mg-325 mg Tablet - [**1-1**] Tablet(s) by mouth four or five times a day as needed for breakthrough pain to not take tylenol in addition. ASCORBIC ACID - 500 mg Tablet - 1 Tablet(s) by mouth twice a day FERROUS SULFATE - 325 mg PO q day-[**Hospital1 **] MULTIVITAMIN - 1 Tablet(s) by mouth once a day . ALLERGIES: Gentamicin PHYSICAL EXAM: On iCU Admission: General: Alert, oriented, speaking in full sentences, interactive, appears in mild discomfort HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, unable to appreciate JVP, no LAD Lungs: Clear to auscultation bilaterally anteriorly, no wheezes, rales, ronchi CV. Regular 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: Foley draining clear yellow urine Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. Contracted. DP/PT 1+ B/L. R hip with dsg C/D/I. FAMILY HISTORY: Mom with HTN, DM, heart failure SOCIAL HISTORY: He lives alone in [**Location (un) 2268**], uses VNA services, has a son, requires a personal care attendant four hours a day. On disability. States he is anxious and claustrophobic by limited mobility at home. - Tobacco: denies - Alcohol: denies - Illicits: denies

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 83-year-old Caucasian female with history of dementia, hypertension, chronic renal insufficiency, who was initially admitted to [**Hospital1 346**] on [**1-5**] for acute mental metabolic toxic encephalopathy from acute and chronic renal failure, questionable Tylenol overdose with transaminitis, and an untreated urinary tract infection superimposed on her underlying dementia. On the night of admission, the patient acutely decompensated with an increased heart rate, increased respiratory rate, requiring an immediate transfer to the Intensive Care Unit. There she was found to have multiple pulmonary emboli, and was started on a Heparin drip for adequate anticoagulation. Unfortunately, this resulted in a massive intracranial hemorrhage within the occipital horns and the patient has had severe cognitive decline ever since to the point of unresponsiveness. Her hospital course has been marked by worsening renal and hepatic dysfunction associated with multiple metabolic derangements requiring intubation, blood loss anemia requiring multiple transfusions, a renal mass suspicious for malignancy, and an acute myocardial infarction, event associated pneumonia. Since the patient was without friends or family, a legal guardian was appointed by the state and the patient's code status was changed to DNR/DNI. The patient was transferred out of the Intensive Care Unit on [**1-17**] once her code status was finalized, and passed away the next day ([**1-18**]) at 12:45 pm. An autopsy was granted by her guardian, Ms. [**First Name4 (NamePattern1) 8214**] [**Last Name (NamePattern1) **]. [**First Name11 (Name Pattern1) 2671**] [**Last Name (NamePattern4) 2672**], M.D. [**MD Number(1) 2673**] MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 55 year-old male with a history of atrial fibrillation, depression, alcohol abuse, hypertension and hyperlipidemia who was transferred from an outside hospital with increasing hepatic failure, renal failure, tremors, change in mental status and possible sepsis in the setting of an elevated white count with bandemia and mild respiratory distress. The patient had presented to [**Hospital 1558**] Medical Center on [**2167-6-17**] after injuring his knee from a fall at work. He was found to have a right patellar fracture and was transferred to [**Hospital6 **], closer to his home, where his hospital course there was significant for atrial flutter that developed on the day of his admission. The patient was then monitored on telemetry. During his hospital stay he had increasing respiratory distress and was eventually intubated on [**2167-6-20**]. The patient was suspected to be in delirium tremens and was also diagnosis with a Staphylococcus aureus pneumonia. On [**2167-6-27**] he was diagnosed with an Alpha Strep bacteremia by positive blood culture. A lumbar puncture done on [**2167-6-28**] ruled out meningitis. Bronchial washings done on [**2167-7-5**] were significant for growth of [**Female First Name (un) 564**] Albicans and also the catheter tip culture grew coagulation negative Staph, two bottles, from a blood culture also on [**2167-7-5**]. During his hospital course his hematocrit dropped from 38 to 25. His liver function also worsened, AST changing from 105 to 133, ALT from 77 to 113 and total bilirubin from 1.9 to 17.5. Renal failure also worsened throughout his hospital stay. BUN changed from 17 to 57 and creatinine from 0.8 to 2.9. In addition, a stage two decubitus ulcer developed in his perianal area. MEDICAL HISTORY: Atrial fibrillation treated with Propanthenone for approximately five years. History of hyperlipidemia, depression, hypertension, history of alcohol abuse, gout. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history is significant for both parents with a history of cirrhosis without A-B hepatitis diagnosis. SOCIAL HISTORY: Married but separated from his wife. Denies recent smoking. The patient has a long history of alcohol abuse. The patient works as a construction supervisor.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 75-year-old female with a history of metastatic breast cancer who was originally admitted to [**Hospital3 3834**] [**Hospital3 **] on [**5-3**] with complaints of diarrhea and fevers. Of note, she had recently completed (in [**2138-3-24**]) a course of Xeloda for right axillary breast cancer recurrence. At the outside hospital she was initially treated with IV fluids. On [**5-10**] CT scan was done which showed dilated large and small bowel with thickened colon wall. She was started on a course of Cipro and Flagyl on [**5-12**]. She was also started at this time on a course of Vancomycin for empiric coverage of a right middle lobe pneumonia that was seen on that CT scan. On [**5-14**] the patient started to spike temperatures and had increased somnolence as well as increased diarrhea. On [**5-17**] the patient was desaturating to 60-70% and was subsequently intubated. She then became hypotensive requiring pressors. Culture data from the outside hospital was notable for MRSA in stool and sputum. The patient was transferred to the [**Hospital1 1444**] MICU on [**2138-5-17**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Transfer from Nursing home for fever and elevated white count PRESENT ILLNESS: 87 yo M with PMH of DM, CAD, ESRD on HD who was transferred from [**Hospital 26563**] Rehab to ED for eval of Fever. . Per referal note, patient 2 days ago developed increase leukocytosis and delirim. Apparently, he was started on iv vancomycin, Flagyl and Ceftazidime for PNA. On day of admission patient developed a fever to 101.2, pulse 76 BP 102/68R 18 and sat 92%. Blood Cx and Urine Cx were drawn. . Of note he was recently operated on by vascular [**Doctor First Name **] for a R sup femoral and [**Doctor Last Name **] angioplasty and stenting along with Left femoral patch angioplasty with bovine patch. He was discharged home on Levoflox for probable RLL PNA . In the ED, VS 100.8 HR 85 BP 81/28 RR 20 Sats 95%. A femoral line was placed and he was given 1000 cc NS. Given pooor response, and after CVP measure 12, patient was started on levophed and transfer to [**Hospital Unit Name 153**]. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. ESRD secondary to hypertensive nephrosclerosis s/p right upper extremity AV graft 9'[**56**]'[**33**] in preparation for dialysis. Graft placement was complicated by cellulitis, for which he was treated with keflex 2. DM, on glyburide and glipizide at home 3. HTN, on clonidine, lisinopril, nifedipine 4. PVD s/p aortic bypass 5. CVA, with residual weakness of his left side 6. R CEA 7. Secondary hyperparathyroidism 8. Chronic anemia on procrit injections 9. Prostate CA on Lupron 10. Gout MEDICATION ON ADMISSION: 1. Clopidogrel 75 mg qday 2. Docusate Sodium 100 mg [**Hospital1 **] 3. Epoetin Alfa Injection 4. Sertraline 100 mg daily 5. Fexofenadine 60 mg [**Hospital1 **] 6. Amiodarone 200 mg qd 7. Aspirin 325 mg qday 8. Insulin Glargine 10u/hs. 9. Lisinopril 5 mg day 10. Multivitamin daily. 11. Oxycodone 5 mg q4h-6h 12. Pantoprazole 40 mg /day 13. Senna 8.6 mg [**Hospital1 **] 14. Levothyroxine 50 mcg /daily 15. Metoprolol Succinate 25 mg sustain release 16. Simvastatin 40 mg /daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 99.7 BP 114/60 Hr 78 RR Sats 98% 4 L NC General: Patient in mild apparent distress, alert, responding to questions HEENT: dry oral mucose, no LAD, JVD Lungs: crackles bilaterally CV: Regular heart sounds, soft holosystolic murmur RLSB Back: sacral ulcers Abdomen: BS +, soft, non tender non distended Extremities: cold, distal pulses decreased, heel ulcers bilaterally, necrotic. 3-4th underneath nail toe right foot black. RU extremiti AVF , no trhill, no erythema. Left upper extremity- picc line Right femoral line in place Neuro: patient alert, oriented to person, movilizing grossly all extremities. FAMILY HISTORY: NC SOCIAL HISTORY: Denies past or present Tob, EtOH, or Illicit drug use. Was living at a senior facility in [**Location (un) 745**] with his wife prior to last admission. Now at [**Hospital 100**] Rehab.

CHIEF COMPLAINT: Lacerated axillary artery PRESENT ILLNESS: 66 F emergent transfer from OSH for axillary artery hemorrhage. Patient fell down at 3:00 p.m. today and developed a hematoma of her left chest but had no shoulder dislocation. Due to neurologic symptoms in her left hand, the patient was taken urgently to the operating room despite no active extravasation of contrast on the chest CT. In the operating room from OSH, the surgeon's exposed the artery but found massive bleeding and decided to transport the patient to [**Hospital1 69**] by med flight. The surgeon came in the helicopter with manual pressure being held on the artery and the patient was brought emergently to the endovascular room. At this point, the patient had artery had already lost 2 liters of blood and received 4 units of packed red blood cells and 2 units of FFP. She arrived intubated and hemodynamically stable. MEDICAL HISTORY: L shoulder dislocation 2 months ago Vaginal hysterectomy in [**2102**] MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tmax 97, Tc 97, HR 91, BP 117/76, RR 19, SaO2 100%, CMV/AC (FiO2 0.5, Peep 5, TV 500, RR 18), Neo 1.3, Prop 20 Gen: intubated, sedated CV: RRR Pulm: CTA BS Abd: soft, NT, ND, act BS L ext - dopplerable ulnar, radial, brachial R ext - dopplerable ulnar, radial Ext: no clubbing, cyanosis, gross edema FAMILY HISTORY: mother with arthritis, father with brain tumor (unclear pathology) SOCIAL HISTORY: Drinks socially Denies tobacco and IVDU

CHIEF COMPLAINT: :"My neck and my back" / "the spasms in my upper back" PRESENT ILLNESS: HPI:Asked to eval this 57 year old white female with extensive PMH for ? osteo in cervical spine. Note: pt has husband at bedside / both give conflicting stories of PMH and hospitalizations. Pt and husband describe that pt was hospitalized at [**Last Name (un) 1724**] in [**Month (only) 205**] of this yr for "perforated" vs "tear" in esophagus. Hospitalization lasted approx 5.5 wks at which time she was transferred to [**Hospital **] rehab for an additional 5.5 weeks. While at [**Hospital1 **] she had a PICC line placed for vancomycin x 4 weeks that was treating "gastric abscess and PNA". She was discharged to home with PICC line (but not on abx) and spent about 6 days at home. She then went back to [**Last Name (un) 1724**] for "fever and another esophageal tear". They removed the PICC line as possible fever source. The PICC cx was positive for MRSA. Note during that second hospitalization she was intubated in the ED and spent "[**3-30**]" days in the ICU on ventilatory support. She did not have surgery at any time for the esophageal tears. She describes coffee ground emesis during that time and was taken off of her Coumadin (which she was taking for a supraclavicular clot" that was ultimately treated by a "balloon breaking it up"). Her husband recalls an admission date of [**11-8**] because he had to miss [**First Name (Titles) **] [**Last Name (Titles) 648**] and says she was complaining of neck pain a "few days after". She was ultimately released to home with PT. About 2 weeks after being discharged her neck pain was worse and she went to [**Last Name (un) 1724**] ED - had xrays and was sent home. She called her PCP and was prescribed Robaxin for muscle spasm which was increased from QD to TID. The pain was continuing and she states the PT refused to perform any further treatment b/c she was getting progressively weaker without explanation. She describes that PT called PCP and OSH MRI was ordered. She received this imaging on [**12-29**] and the radiologist wheeled her to the ER where she was placed in a collar and seen by Neurosurgery. She was sent here for further eval. Images are being uploaded to the system at this time. She admits to numbness and tingling to all finger tips and palms of both hands. She also admits to pain to dorsal and ventral surfaces of arms as well as pain down anterior thighs and legs. She denies MI, CVA, falls or hyperesthesias or bowel or bladder issues. MEDICAL HISTORY: Past medical history: -Gastroparesis (likely narcotic induced vs idiopathic): History of TPN -Childhood constipation -History eating disorder -Narcotic induced ileus -History of laxative abuse and ? eating disorder -Supraclavicular clot -Chronic pain -History meningioma -Peripheral neuropathy -GERD -C. difficile colitis -Mild esophagitis -Cholecystitis -Hysterectomy for uterine cancer -Migraine headaches -Staph aureus bacteremia in setting of TPN MEDICATION ON ADMISSION: Medications prior to admission: Fentanyl 100mcg q 72 hrs senna two tabs po bid colace 200mg po bid scopolamine patch 1.5mg q 72 hours dicyclomine 20 mg q 6 hrs for stomach spasm Ativan 1 mg q 4 hours Nexium 40mg [**Hospital1 **] (liquid) promethazine suppository 50mg q 4 hours reglan 40 mg daily hydromorphone 2mg po q 4 hours vivonex T.E.N. packet 20 ml / hr 8pm to 8am daily Coumadin 2mg (stopped last hospitalization to [**Last Name (un) 1724**]) potassium chloride 20meq [**Hospital1 **] (powder) lactulose 15ml qd NTG fiorocet 1-2 tabs q 6 hours ALLERGIES: Codeine / Ciprofloxacin / Morphine PHYSICAL EXAM: PHYSICAL EXAM: O: T: 98.7 BP: 110/ 62 HR:108 R 18 95 O2Sats Gen: Pale small framed female, comfortable, NAD at rest HEENT: NCAT Neck: Tender from occiput to upper thoracic region/ paraspinal regions bilaterally as well as to shoulders and ears. Abd: Soft, G-J tube noted with broth/ brown drainage noted / no coffee grounds Extrem: Warm and well-perfused./ no edema - note: husband feels that R hand is very swollen still "from clot" / no edema is appreciated by this examiner Neuro: Mental status: Awake and alert, attempts to cooperate with exam. FAMILY HISTORY: Her father had diabetes and her mother died of colon cancer. SOCIAL HISTORY: She lives with her husband. History of tobacco abuse but quit 30-40 years ago after smoking [**1-24**] pack per day prior to that. Occasional alcohol. No illicit drugs. Has been on disability for years secondary to her chronic abdominal symptoms.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 78-year-old right-handed male with a history of left frontal ischemic infarction in [**2142-10-11**], for which he was given t-PA complicated by hemorrhagic transformation. His right-sided weakness and word-finding difficulties after that stroke have since resolved. He then had another left corona radiata stroke in [**2144-10-10**] with similar right-sided weakness and word-finding difficulties that also resolved. He had a carotid ultrasound with less than 50% occlusion. Transesophageal echocardiogram showed significant plaque in the aortic arch. He was continued on aspirin and Plavix. His most recent note from his Neurology appointment in [**Month (only) 956**] notes complete resolution of his right hemiparesis. He was in his usual state of health until the day of admission at 8:30 p.m. He took a brief nap after dinner. He woke up and was "confused" and was having right-sided weakness, so he was immediately brought to the Emergency Department within 45 minutes of symptom onset. He is currently not able answer review of systems questions due to his aphasia. His wife said he was fine until before his nap. MEDICAL HISTORY: 1. Left frontal stroke in [**2142-10-11**], status post t-PA with hemorrhagic transformation. 2. Left corona radiata infarction in [**2144-6-9**]. 3. Lung cancer, status post resection. 4. Rising prostate-specific antigen; likely benign prostatic hypertrophy. 5. Hypertension. MEDICATION ON ADMISSION: Aspirin, prednisone, Plavix, Pravachol, folate, and Altace. ALLERGIES: PENICILLIN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is married. Remote tobacco and wine before the event, retired. Wife also aphasic from stroke.

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 71M with dilated CMY, EF20% (hospitalized in [**2127**] for CHF thought to be due to medication noncompliance), no significant CAD on cath in [**2123**], CKD (baseline Cr 1.8), HTN, gout, who has had a chronic cough since [**2131-7-11**] that was treated with increased Lasix and PPI. As per OMR notes, his cough abated with the PPI and his Lasix dose was decreased to 80 [**Hospital1 **]. As per patient's wife, he's had a chronic progressive cough since [**Month (only) 216**], associated with PND and orthopnea, and yesterday had increased SOB and DOE, palpitation and chills. She reports that he hasn't been having CP, abdominal pain, or fevers. She also denies him reporting hematochezia or melena. In Dr.[**Name (NI) 10697**] clinic note yesterday, the patient had apparently been taking Lisinopril, which was supposed to be stopped on account of renal failure, and there is a question as to whether he was taking his carvedilol. . She does report that last week he had some right hand swelling that was thought to be due to gout. . In the ED he was intubated for SOB, SBP to 70 mmHg, and bradycardia to 17bpm (as per cardiology note) responsive to atropine. He was started on Norepinephrine and Dopamine for cardiogenic shock, and given Levofloxacin for concern for pneumonia related sepsis. . He also had a potassium of 7.6 for which he received calcium, insulin, bicarbonate. Repeat K pending. BNP [**Numeric Identifier 10698**]. Uric Acid 14. . He had a CXR that showed no overt failure and correct placement of a RIJ central line. He also had a noncontrast Chest CT that was negative for aneursym or focal consolidation. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, ankle edema, syncope or presyncope MEDICAL HISTORY: 1. dilated cardiomyopathy: LVEF 23% ([**12/2123**]) 2. Hypertension 3. chronic renal failure (baseline Cr 1.7) . Cardiac Risk Factors: -Diabetes, -Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: Carvedilol 25 [**Hospital1 **] ASA 325 Furosemide 80 [**Hospital1 **] Omeprazole 40 qd Cyclobenzaprine 10 daily Colchicine 0.6 [**Hospital1 **] Lisinopril 5 daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97, BP 118/73, HR 88, 02 95% VENT SETTINGS: AC 550x16 FiO250% PEEP5 . Gen: WDWN middle aged intubated and sedated, family at bedside HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple without obvious JVD CV: PMI located in 5th intercostal space, slightly lateral from midclavicular line, [**2-14**] holosystolic murmur at apex. RR, normal S1, S2. No S4, no S3. Chest: No chest wall deformities, scoliosis or kyphosis. Assisted respirations were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Femoral 2+ without bruit; 2+ DP, 2+ PT [**Name (NI) 2325**]: Femoral 2+ without bruit; 2+ DP, 2+ PT MEDICAL DECISION MAKING . FAMILY HISTORY: Brother with MI at age 75. SOCIAL HISTORY: Lives at home with his wife. Denies tobacco use, IVDU. Drinks 3 drinks/week.

CHIEF COMPLAINT: s/p Fall PRESENT ILLNESS: 71M s/p fall down stairs with +EtOH with right temporal SAH/SDH, right clavicle & scapular fractures, right rib fractures [**1-28**]. He was initially taken to the an area hospital and transferred to [**Hospital1 18**] for further management of these injuries. MEDICAL HISTORY: - HLD - Hypothyroid (since iodine treatment, remote) - anxiety - vitiligo - HTN - "neck discs" MEDICATION ON ADMISSION: amlodipine 10', synthroid 0.125', lorazepam 1'prn, doxazosn 4', simvastatin 20', ibuprofen prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: T: 98.3 BP: 137/70 HR: 76 R 18 O2Sats 96% 2L NC Gen: WD/WN, comfortable, NAD. HEENT: Pupils: PERRL EOMs intact Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. 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. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Married; + EtOH

CHIEF COMPLAINT: Admitted for potential kidney transplant. PRESENT ILLNESS: Patient is a 42-year-old female with end-stage renal disease secondary to P-ANCA glomerulonephritis currently getting hemodialysis on Monday, Wednesday, and Friday via right upper extremity AV fistula. She had a previous kidney transplant in [**2109**] which failed approximately 1.5 years posttransplant. She does not void and has high sensitization. MEDICAL HISTORY: Vasculitis secondary to P-ANCA, status post partial parathyroidectomy in [**2103**] at [**Hospital6 **], history of pericarditis, perirectal abscess, GI bleed, Afib resolved, chronic renal failure x15 years, AV fistula graft. MEDICATION ON ADMISSION: refer to previous note ALLERGIES: PCN and amoxicillin, codeine. PHYSICAL EXAM: see previous note FAMILY HISTORY: The patient denies family history of diabetes, coronary artery disease, hypertension, cancer, or kidney disease. SOCIAL HISTORY: The patient is unmarried with no children. She has no immediate family in [**Location (un) 86**]. Her mother lives in [**Name (NI) 5170**]. She works at the train station as a collector. She has no IVDA, no drug use, and no significant alcohol abuse. She has been abstinent of smoking for greater than 10 years.

CHIEF COMPLAINT: Headache PRESENT ILLNESS: 28 year old Somalian female with a history of PRES, HTN, CRI, seizures and small infarcts related to hypertension and visual changes at baseline presents with headache and worsening visual changes and CT findings concerning for worsening PRES. Patient has had left frontal headache for one week and worsening. Headache is diffuse worse in the occipital area on the left side. She has a hard time qualifying her headache. This headache is different from her usual migraine headache. She does not experience photophobia or phonophobia. Patient has noticed blurry vision in bilateral eyes in the last two days. Her right sided vision is worse the the left side. She has had two episoded of chest pain and shortness of breath in the middle of the night lasting two minutes in the last three days. Chest pain is located in bilateral sternal area. She denies any fever, chills, nightsweats, nausea, vomitting, abdominal pain, diarrhea, constipation, dysuria, neck stiffness. She has experienced urgency in the last few days. Two days ago she had left jaw and eye pain which has now resolved. . In [**Hospital1 18**] ED her vitals were T 97.9 BP 116/76 HR 80 RR 16 100% on RA. Patient was also found to be in renal failure with Cr 3.6 (last known Cr from [**Hospital1 112**] was 1.8). MEDICAL HISTORY: - Hypertension, including hypertensive emergencies, workup in the past include nl TSH/cortisol/[**Male First Name (un) 2083**]/catecholamines. Abd MRI/A in [**2112**] showed nl kidneys, adrenals, no evidence of RAS. Small bilat arteries arising inf to main renal arteries, likely lumbar arteries but cannot exclude small accessory renal arteries. - h/o CVA in [**1-8**] secondary to uncontrolled HTN, tiny infarcts including cortical and subcortical areas of ACA, MCA PCA and watershed areas - h/o generalized tonic-clonic seizure in the setting of uncontrolled - [**4-8**] PRES in the setting of hypertensive emergency - Moderate LVH with EF 65-70% - Migraine headaches - Vitamin B12 deficiency - Chronic renal insufficiency with baseline Cr 1.8. - Previous hypercoag work-up negative except for B2 glycoprotein, also negative sicle celltrait. MEDICATION ON ADMISSION: Lisinopril 25 mg daily Ferrous sulfate 325 mg daily Aldactazide 25/25 mg daily Vitamin B12 injections? ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: alert and awake, in NAD, pleasant lady following commands HEENT: PERRL, MMM, OP clear Heart: S1S2 with II/VII SEM Lungs: CTAB Abdomen: soft NTND, left CVA tenderness Neuro: CN III-XII intact, right visual fields defecits, strength [**5-5**] bilat, sensation is intact FAMILY HISTORY: 2 maternal uncles who died of MI in 20's - 30's. Multiple family members with HTN. SOCIAL HISTORY: She is originally from Smolia, moved to the US 12 years ago. She lives with her sister in [**Name (NI) 669**]. She is unemployed. Denies tobacco, ETOH, street drugs.

CHIEF COMPLAINT: s/p Fall off truck PRESENT ILLNESS: 46 yo man s/p fall off top of truck onto head with large scalp hematoma, small left frontal ICH, C7 spinous process fracture and T3 anterior body fracture. MEDICAL HISTORY: low back pain, anger management(on zoloft), cocaine use, smoking MEDICATION ON ADMISSION: Percocet, zoloft ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Married

CHIEF COMPLAINT: lower extremity weakness & numbness (right>left) PRESENT ILLNESS: HPI: 33 yo male with a history of alcohol dependence and peripheral neuropathy who presents with two days of bilateral lower extremity weakness and numbness. Mr. [**Name14 (STitle) 79121**] was in his usual state of health until two days ago when he woke up with numbness and pain in both of his legs (R>L), starting at the feet and tracking upward. Though he has had peripheral neuropathy in his legs in the past, the current episode of pain was by far the most severe of his life, and in fact he was unable to walk or even bear weight. He was seen at [**Hospital 47**] Hospital where MRI of the thoracic spine revealed a mass at the level of T10, initially thought to be consistent with an epidural abscess. He was transferred to [**Hospital1 18**] for surgical consideration. The mass was reomoved and found to be consistent with a cyst. It was not felt that this mass could explain the presenting symptoms, and in fact Mr. [**Known lastname 6483**] reports little or no improvement since surgery. Currently, he reports numbness and pain in both legs (R>L)most intense at the foot and extending up to the ankle. MEDICAL HISTORY: alcohol dependence with h/o withdrawal (shakes, DTs) and seizure peripheral neuropathy lower extremities reportedly ascribed to alcohol abuse asthma psoriasis MEDICATION ON ADMISSION: albuertol inhaler prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - Temp 99.9F, BP 128/73, HR 94, R 20, O2-sat 97% RA GENERAL - young man lying in bed on his back, complains of pain HEENT - NC/AT, PERRL, EOMI, sclerae anicteric, MMM NECK - supple, no LAD or thyromegaly LUNGS - CTA bilat, no r/rh/wh HEART - RRR, no MRG, nl S1-S2 ABDOMEN - +BS, soft/NT/ND, liver not palpated EXTREMITIES - WWP, no c/c/e, 2+ DPs SKIN - no jaundice or stigmata of chronic liver disease NEURO - Awake, A&Ox3, attentive, + calculations, average fund of knowledge CN II-XII intact Motor Normal bulk and tone. No fasciculations. [**5-30**] BUE throughout; 4+/5 left thigh extension, 2-3/5 plantar flexion b/l, [**3-1**] dorsiflexion, otherwise [**5-30**] throughout BLE Sensation to soft touch, temperature decreased in both feet to the level of the ankle. Normal BUE and face. ? deficit or proprioception in both feet, but intact BUE. Reflexes: 2 patellar b/l, 0 ankle b/l, babinski down on left, mute on right Cerebellar signs: No deficit of finger-to-nose, rapid alternating movements. Gait: deferred FAMILY HISTORY: Parents, children healthy. SOCIAL HISTORY: Lives in [**Location 1110**] with parents, recently separated from wife and 2 [**Name2 (NI) 25400**] (6,8). Works as a [**Hospital1 **] carpenter. Alcohol: [**1-27**] gallon/day vodka daily or almost daily for 16 years. Has experienced periods of sobriety for up to 2 months. Expresses desire to cut down. Tobacco: [**1-29**] PPD x years Drugs: Denies past or present use, inclduing IVDU.

CHIEF COMPLAINT: Respiratory Distress PRESENT ILLNESS: 64 y/o F, with a PMHx significant for oxygen dependent COPD, diastolic CHF, [**First Name3 (LF) 1291**] (St. [**Male First Name (un) 923**]) on coumadin, s/p MRSA sternotomy wound infxn, DM2, and a fib, who presented to [**Hospital 1474**] Hospital on [**2130-10-24**] with hypoxia, dyspnea and symtpoms c/w with similar episodes of CHF. She was initially treated with BiPap, but failed and therefore required ET-intubation. She also had fevers with Tmax of 103, hypotension with SBP in 80's treated with agressive fluid resucitation. On [**10-25**] blood cultures, [**4-23**] were positive for GPC. Urine Culture + for staph. The bacteria was further identified as MRSA. She was started on Vanc/Gatiflox/Flayl and stress dose steroids (solumedrol 125mg IV TID). It was suspected the patient may have been developing possible DIC. At this time she was transferred to [**Hospital1 18**] for further care beginning on [**2130-10-26**]. She did not require any pressors during her transfer. MEDICAL HISTORY: decompensated diastolic heart failure Acute on chronic renal failure aortic valve replacement paroxysmal a fib Thrombocytopenia Coagulopathy COPD (Prior ET intubation 5 years ago) MRSA + sternotomy wound infxn ~2year ago. Treated with ~1years of IV Vanc at [**Hospital1 2177**] (per daughter) MEDICATION ON ADMISSION: Meds on Transfer: Dig, pepcid, prop, asa, vanc, gatiflox, flagyl, solumedrol. ALLERGIES: Keflex / Erythromycin Base PHYSICAL EXAM: At the time of discharge: FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives with husband, has multiple children who are very involved in her care

CHIEF COMPLAINT: Diarrhea, fall PRESENT ILLNESS: 85 yo M with PMH of CAD s/p recent STEMI on [**8-19**] with BMS to RCA presents with diarrhea, vomiting and weakness. Also with nonproductive cough and chills. He has been SOB since prior to his STEMI last week. Pt denies abdominal pain, fever, chest pain, back pain, BRBPR. Per niece, patient has been unsteady since leaving hospital. Also with poor po intake and dizziness. He has fallen at home without head trauma. MEDICAL HISTORY: Emphysema gastric ulcers h/o bilateral inguinal hernia repair recent STEMI as outlined above MEDICATION ON ADMISSION: 1. Aspirin 325 mg Tablet PO DAILY 2. Clopidogrel 75 mg Tablet PO DAILY 3. Atorvastatin 80 mg Tablet PO DAILY 4. Lisinopril 5 mg Tablet PO DAILY 5. Metoprolol Succinate 25 mg PO once a day ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS:HR 69, BP 135/70, 92% on RA GEN: Elderly in NAD, Sitting up in bed HEENT: EOMI, PERRL, anicteric NECK: Supple, no JVD CHEST: CTABL, distant BS throughout, no w/r/r CV: RRR, S1S2, no m/r/g ABD:Soft, NT, ND, +BS, no organomegaly EXT: warm, no c/c/e SKIN: ecchymoses on bilateral hands, LUE, L flank NEURO: AAOx 3(place: hospital- [**Location (un) **]), CN ii-xii intact; strength and sensation grossly intact FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Past history of heavy 2ppd tobacco use for 30 plus years, quit 12-15 years ago per his niece; no recent etoh use, no drugs. Lives at home alone. His wife died in [**2125**] , had been caring for her by himself, she had bad dementia. He has a wood stove at home that he uses every day. He is a retired carpenter and was in the army in WWII.

CHIEF COMPLAINT: Recurrent falls PRESENT ILLNESS: Ms. [**Known lastname **] is an 82 yo female with PMH significant for HTN and HLD who initially presented from OSH on [**5-20**] with 3 week history of multiple falls, approximately once per week. She had an MRI which showed 4 enhancing cerebellar lesions, thought to be consistent with metastatic cancer. She was transferred to the oncology service for further work-up. She underwent a CT scan chest at OSH (read by our radiologists)which showed a RUL lung mass with mediastinal lymphadenopathy. She was started on Decadron and Keppra. She was transferred to the IP service for further work-up. on [**5-24**] and underwent a transbronchial nodal biopsy. She acutely became hypertensive and tachycardic causing her to go into flash pulmonary edema. Initial EKG showed ST depressions inferiorly and laterally. She received Nitropaste, Lasix, and was started on a Labetalol gtt. She was taken to SICU and placed on BIPAP with little improvement in her respiratory status. Repeat ECG showed ST elevations in V2 and V3 and post-procedure cxray showed moderate R sided pneumothorax. Chest tube was placed and she was intubated. During her stay in the MICU her hypoxia slowly improved with diuresis. Cardiology was consulted and did not feel that she was having an ACS. ST elevations resolved and she was transferred back to the oncology service. MEDICAL HISTORY: 1)Hypertension 2)COPD 3)Hyperlipidemia MEDICATION ON ADMISSION: Ipratropium Bromide Neb 1 NEB IH Q4H Lactulose 30 ml PO Q6H:PRN Acetaminophen 325-650 mg PO Q4-6H:PRN Lansoprazole Oral Disintegrating Tab 30mg PO DAILY Amlodipine 5 mg PO DAILY Levetiracetam 1000 mg IV Q12H Aspirin 325 mg PO DAILY Atorvastatin 40 mg PO DAILY Metoprolol 125 mg PO Q 8H Bisacodyl 10 mg PO/PR DAILY Nystatin Oral Suspension 5 ml PO QID Captopril 100 mg PO TID Olanzapine (Disintegrating Tablet) 2.5 mg PO QHS:PRN Dexamethasone 4 mg PO Q12H OxycoDONE 5 mg PO Q4-6H:PRN Docusate Sodium 100 mg PO BID Fluticasone-Salmeterol (100/50) 1 INH IH [**Hospital1 **] Heparin 5000 UNIT SC TID Xopenex *NF* 0.63 mg IH Q6-8H:PRN HydrALAzine 10 mg IV Q6H ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: vitals T 98.1 BP 110/50 AR 74 RR 22 O2 sat 97% on 5L Gen: Patient lying in bed, does not appear distressed HEENT: dry MM Heart: nl s1/s2, no s3/s4, no m,r,g Lungs: +bibasilar crackles Abdomen: soft, NT/ND, +BS Extremities: 1+ bilateral edema, 2+ DP/PT pulses bilaterally FAMILY HISTORY: NC SOCIAL HISTORY: Patient has daughter and son. Lives at [**Hospital1 1501**]. No tobacco, alcohol, or IVDA.

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: Per MICU Admit note: 60F nonsmoker with HTN and hypothryriodism who presents with ~24 hours of DOe and tachypnea. She reports dyspnea with minimal activity. She denies and CP, lightheadedness, pleuritic pain, fevers, or chills. She did have bilateral calf pain L>R, that has since resolved. She did recently take a long bus trip to [**State **] recently (~6 hours each way) over [**Location (un) 10684**] day weekend. She denies and hx of malignancy or family hx of clotting disorders. She went to her PCP on day of admission and was referred to the ED where she was found to be tachycardic and hypoxic: P103 BP130/98 RR27 O2:97 4L 89RA CTA revealed bilateral multiple pulmonary emboli. She was started on heparin gtt and transferred to the MICU in stable condition. MEDICAL HISTORY: Hypertension Hypothyroidism Neck Radiculopathy MEDICATION ON ADMISSION: Aspirin 81 Lisinopril 2.5 Unithyroid 50 mcg (confirmed dose with patient and son) Neurontin 300 qhs ALLERGIES: Hydrochlorothiazide PHYSICAL EXAM: Per MICU admit note General Appearance: Well nourished, No acute distress Eyes / Conjunctiva: PERRL, No(t) Conjunctiva pale Head, Ears, Nose, Throat: Normocephalic, No(t) Poor dentition Lymphatic: Cervical WNL, Supraclavicular WNL, Cervical adenopathy Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), No(t) S3, No(t) S4, No(t) Rub Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: No(t) Symmetric), (Percussion: Resonant : ), (Breath Sounds: Clear : , No(t) Crackles : , No(t) Bronchial: , No(t) Wheezes : , No(t) Diminished: , No(t) Absent : , No(t) Rhonchorous: ) Abdominal: Soft, Non-tender, Bowel sounds present, No(t) Distended, No(t) Tender: Extremities: Right: Absent, Left: Absent Skin: Not assessed Neurologic: Attentive, Follows simple commands, Responds to: Not assessed, Oriented (to): person, place, and time, Movement: Not assessed, Tone: Not assessed FAMILY HISTORY: No family history of malignancy or clotting disorder. Reports brother died of heart attack in Phillipines, though she does not know the details. SOCIAL HISTORY: Nonsmoker, nondrinker, no illicits. Lives at home with husband. Originally from the Phillipines

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 82-year-old woman with a history of chronic obstructive pulmonary disease, congestive heart failure and hypertension, who was admitted to the medical intensive care unit on [**2130-10-18**]. She initially presented to [**Last Name (un) 36412**] mental status; the patient was extremely confused, with slurred speech and diaphoresis. She had gone to her primary care physician earlier in the day secondary to a headache with possible subacute confusion, i.e. not feeling herself, for several days prior. At [**Hospital 26200**] Hospital, the patient was intubated on protection. She was transferred to [**Hospital1 190**] for medical intensive care unit care. Workup included an unremarkable CT scan of the head, MRI, lumbar puncture and electroencephalogram. The [**Hospital 26200**] Hospital course was notable for a blood pressure of 210/100 as well. On the day of admission after a visit to her primary care physician's office, the patient went into the bathroom and had a bowel movement. She needed her husband to help her walk and sit down when coming out of the bathroom. She then seemed confused, not knowing family names, repeating "Who is that?". She was on the phone when there was no one on the other end. Her husband commented that her speech seemed slurred and was not making sense, but there were no clear word substitutions. The patient also appeared diaphoretic at that time. By the time that the EMS arrived, the patient had lost consciousness. Her subsequent course was as noted above. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease. 2. Congestive heart failure. 3. Hypertension. 4. Question of history of hallucinations. MEDICATION ON ADMISSION: ALLERGIES: There were no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient had a history of tobacco use, quitting five years ago.

CHIEF COMPLAINT: s/p fall and dyspnea/hypoxia PRESENT ILLNESS: This is an 88 yo female w/ hx of AS, Afib, HTN, and dementia who was transferred from the MICU after presenting to the ED the day before with SOB secondary to CHF and s/p unwitnessed fall. On the day of ED presentation, pt was found down by son at [**Hospital 4382**] home; pt was reportedly diaphoretic, increasingly confused, and in respiratory distress. There was no associated fever, chills, or cough. There was no LOC evident. The son, who is the primary historian and HCP, reported that the pt had increasing mental status changes in the last week, secondary to changing medications, and was noted to have increasing falls by ALH staff. Last hospitalization for CVA was [**4-26**], in which medications were titrated. . In the [**Name (NI) **], pt had 02 sats in 70s on RA, which improved to 99 on NRB, rectal T of 102 w/ lactate of 2.9. A foley catheter was placed and pt received levaquin 500 mg IV, ceftaz 1 g IV, 10 mg Decadron, and 20 IV lasix IV x2. She was subsequently admitted to the MICU. MEDICAL HISTORY: DM A fib, w/ coumadin, rate controlled with BB and ditalizem Osteoperosis HTN AS, no hx of syncope Dementia, s/p CVA [**4-26**] Temporal Arteritis Recurrent falls MEDICATION ON ADMISSION: Medications: Diltiazem XR 180 QD Metoprolol 100 [**Hospital1 **] Mag ox 400 qd Ranitidine 150mg QD Prednisone 1mg QD Trazadone 50 mg Qd Lasix 20mg QD Metformin 500 qd Lipitor 10mg qd Coumadin 4mg qhs Fosamax 40mg Qweek Brimonidine 0.2% ou [**Hospital1 **] Travatan one drop ou qd ALLERGIES: Ampicillin / Aldactone / Percocet / Simvastatin / Codeine / Motrin PHYSICAL EXAM: Physical Exam: VS: Temp: 96.5 BP: 130/72 HR: 119 RR: 22 O2sat: 93% on 3L NC GEN: elderly woman in NAD HEENT: MMM, neck supple RESP: diffuse crackles but good air movement CV: irregular, [**1-24**] sys murmur at RUSB, late peaking ABD: soft, NT, ND, + BS EXT: trace edema to shin BL, 2+ DP pulses, erythema over bilateral knees with abrasions FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Pt. lives at [**Hospital3 **] community after CVA [**4-26**]. Son is HCP and makes major decisions for mother.

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Name14 (STitle) 44169**] is a 56-year-old male with past medical history significant for hypertension who originally presented to outside hospital the day prior to admission with complaint of substernal chest pain. He was treated with Nitroglycerin and continued to drop his blood pressure. He also complained of lower extremity tingling and had decreased femoral pulses bilaterally. A chest x-ray at the time showed widened mediastinum. The patient was intubated and transferred to [**Hospital1 188**] for further management. Emergent transesophageal echocardiogram was performed which demonstrated Type A aortic dissection with a pleural/pericardial effusion and low normal left ventricular function. Cardiothoracic surgery was consulted. The patient was consequently taken to the operating room for an emergent ascending aortic dissection repair. MEDICAL HISTORY: 1. Hypertension. 2. Elbow fracture. 3. Lower gastrointestinal bleed in [**2175**]. 4. History of back spasm. MEDICATION ON ADMISSION: ALLERGIES: Penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Works as manager. Has no history of tobacco use.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 49 year-old gentelman who has a many year history of a heart murmur who was found to have mitral valve disease by echocardiogram with a recent onset of chest discomfort and diaphoresis with exertion. Echocardiogram in [**2134-12-6**] showed a moderately dilated left atria, mildly dilated left ventricle, ejection fraction of 60 to 70%, mildly thickened mitral valve leaflets, mild mitral valve prolapse, partial mitral leaflet flail with 3+ mitral regurgitation, 1+ tricuspid regurgitation and mild pulmonary hypertension. The patient underwent cardiac catheterization on [**2135-3-7**], which showed an ejection fraction of 60% with 2+ mitral regurgitation and no coronary disease. The patient was referred to Dr. [**Last Name (Prefixes) 411**] for mitral valve repair. MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Mitral valve prolapse. 4. Depression. 5. Psoriasis. 6. Status post tonsillectomy. 7. Status post right knee arthroscopy. 8. Multiple orthopedic injuries. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Melena PRESENT ILLNESS: 64yo male with history of chronic back pain, Aflutter on coumadin presenting with complaints of melena x 2 episodes (Saturday and yesterday), associated with lightheadedness and shortness of breath which worsened today. Patietn also complains of nausea but denies vomiting, abdominal pain, or bright red blood per rectum. He presented to his PCP today with complaints of general malaise, found to be guaic + and sent to the ED for further evaluation. He reports taking more ibuprofen 800mg twice daily for a couple of weeks for his chronic back pain, though reports having stopped the NSAIDs about 2-3 weeks ago in the setting of abdominal discomfort. . In the ED, initial vitals were as follows: 100.2 64 105/66 18 100%. Denied symptoms of orthostasis. 500ccs NS placed on NG lavage, but only 100cc on return, clear in appearance. Rectal vault was empty and guaiac negative. His hematocrit was noted to be 25 (last Hct in OMR was 41 in [**2127**]). Pt was transfused 1u pRBCs, 1 bag FFP, and started on pantoprazole gtt. . On the floor, patient feels overall well. Denies lightheadedness currently. No abdominal pain, shortness of breath. States that his stools frequently change in color or consistency after gastric bypass surgery several years ago. MEDICAL HISTORY: Asymptomatic atrial flutter status post ablation, on warfarin Right bundle-branch block Hypertension Nephrolithiasis Osteoarthritis s/p Gastric Bypass (Roux-en-y) surgery about 8 yrs ago s/p spinal surgery s/p Right inguinal hernia repair s/p cataract surgery - complicated by retinal detachment and blindness of right eye - at which time they sent sample of vitrious fluid, concerning for B cell lymphoma, so he has been followed for this and had two LPs in last few years, no signs of B cell lymphoma so far s/p tonsillectomy MEDICATION ON ADMISSION: BUPROPION HCL - 150 mg Tablet Extended Release 24 hr daily CLINDAMYCIN PHOSPHATE - 1 % Solution - [**Hospital1 **] PRN to folliculitis DOXAZOSIN - 2 mg Tablet daily HYDROCODONE-ACETAMINOPHEN - 10 mg-500 mg Tablet - [**1-11**] Tablet(s) by mouth q 6 hrs prn LISINOPRIL - 40 mg Tablet daily METOPROLOL SUCCINATE - 50 mg Tablet Extended Release 24 hr daily MUPIROCIN - 2 % Ointment - apply [**Hospital1 **] to affected area for 7-14 days as needed then stop topical antibiotic POTASSIUM CHLORIDE [KLOR-CON 10] - 10 mEq Tablet Extended Release - 2 Tablet(s) by mouth once a day POTASSIUM CITRATE - (Prescribed by Other Provider) - 10 mEq (1,080 mg) Tablet Extended Release - [**Hospital1 **] TRIAMTERENE-HYDROCHLOROTHIAZID - 37.5 mg-25 mg Capsule - daily WARFARIN - 1 mg Tablet - [**1-14**] Tablet(s) by mouth qd as directed by physician [**Name Initial (PRE) **] - 4 mg Tablet - 1 Tablet(s) by mouth qd as directed by physician [**Name Initial (PRE) **] - 5 mg Tablet - 1 Tablet(s) by mouth qd as directed by physician . Medications - OTC ASPIRIN [ADULT ASPIRIN EC LOW STRENGTH] - 81 mg Tablet daily CYANOCOBALAMIN (VITAMIN B-12) [VITAMIN B-12] - (Prescribed by Other Provider; OTC) - 1,000 mcg Tablet - 1 Tablet(s) by mouth weekly GLUCOSAMINE-CHONDROITIN - (Prescribed by Other Provider) - 750 mg-600 mg Tablet - 2 Tablet(s) by mouth twice a day IRON-VITAMIN C - (Prescribed by Other Provider; OTC) - Dosage uncertain MULTIVITAMIN WITH IRON-MINERAL - (Prescribed by Other Provider; OTC) - Tablet - 1 Tablet(s) by mouth twice daily PHENYLEPHRINE HCL [HEMORRHOIDAL SUPPOSITORY] - (Prescribed by Other Provider) - 0.25 % Suppository - 1 Suppository(s) rectally [**1-11**] daily as needed ALLERGIES: Nsaids / Ambien PHYSICAL EXAM: ADMISSION: Vitals: T: 98.3 BP: 109/90 P: 64 R: 17 O2: 98%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, mildly dry mucous membranes, 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, mild suprapubic tenderness, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: No CAD SOCIAL HISTORY: Lives with wife. Daughter and son-in-law live nearby. Tobacco: quit in [**2087**], smoked for about 10 yrs x2ppd. ETOH: Drinks socially, usually 2 drinks at a time but infrequently. Illicits: none Works as a software engineer, programmer. .

CHIEF COMPLAINT: seizures & mental status change PRESENT ILLNESS: 77 y/o male with a PMH significant for prostate cancer s/p XRT, L1 & L4 compression fractures s/p vertebroplasty & migraines who p/w MS changes and seizures. The patient was accompanied to the ED by his wife who provided a majority of the history to the neuro resident and ED resident. Per patient's wife, he was feeling fine day prior to admission when after breakfast, when he felt nauseous and went to the bathroom. There, he had a bout of emesis. No hematemesis. Per the pt's wife, the pt was not making sense when he spoke, reciting random words. Thus, she called 911. Pt seized in the ambulance & in the ED. In the ED, he seized x 2 and broke with ativan. Neuro was consulted and saw patient in ED. He was given Cipro 400 mg x 1 and tylenol 650 mg x 1. Pt denies a history of prior seizures. No recent sick contacts, recent travel, or consumption of raw/undercooked foods. Per patient, he has chronic, diffuse abdominal pain and problems with [**Name2 (NI) **] intake and early satiety for several months. He has lost approx 10 pounds over one year. The pt's wife states that the patient has had some personality changes over the last several months and recently saw a psychiatrist last week and was given seroquel for "mania". Currently, pt denies any f/c/s. He does have dizziness and slight lightheadedness upon moving. No URI sx, chest pain, dyspnea, palpitations. Has chronic trouble turning his head to the right [**1-26**] neck pain. No n/v. +diffuse abdominal pain. +dysuria but per pt it is chronic. No diarrhea, has normal BM's. No hematochezia/melena/BRBPR. Reports constant swelling of his extremities, particularly left LE. No weakness/loss of sensation. MEDICAL HISTORY: 1.Depression 2.Anemia 3.H. Pylori 4.GERD 5.Hiatal Hernia s/p surgical repair 6.Liver disease 7.Degenerative Joint Disease 8.H/o Renal calculi 9.Ostopenia 10. Prostate CA s/p radiation therapy MEDICATION ON ADMISSION: ALLERGIES - Reglan (dystonia) . MEDS - 1. Ditropan 2. Lorazepam 2 mg qhs 3. Seroquel 25 mg qhs 4. Calcium 5. MVI qd 6. Tonazepam 7. Tylenol w/codeine ALLERGIES: Reglan PHYSICAL EXAM: VS: Tc 97.7, BP 116/58, HR 96, RR 18, SaO2 96%/2L NC General: Cachectic-appearing elderly male, laying on his left side in bed, AO x 3 in NAD, appears very fatigued HEENT: NC/AT, PERRL, EOMI. Anicteric sclerae. MM dry, OP clear Neck: cervical dystonia to the right, no LAD or JVP Lymph: No cervical, axillary, epitrochlear, inguinal LAD Chest: CTA-B, no w/w/r CV: RRR s1 s2 normal, no m/g/r Abd: soft, scaphoid, diffuse TTP, no peritoneal signs, soft BS, no HSM GU: left inguinal hernia, reducible and NT, no erythema Ext: [**12-26**]+ non-pitting edema of LLE, RLE normal, pulses 1+ b/l Neuro: AO x 3, CN II-XII intact grossly. MS [**3-29**] throughout, sensation to LT/PP intact. DTR's 2+ in all four extremities, FNT intact. Downgoing babinski's. FAMILY HISTORY: His father died of arterial sclerosis. His mother died of a cerebrovascular accident SOCIAL HISTORY: Lives at home with his wife. Uses a walker and a stroller to ambulate. Quit smoking at age 65. Rare ETOH.

CHIEF COMPLAINT: Recurrent TTP PRESENT ILLNESS: Patient is a 25 y/o woman with history of recurrent TTP who now presents with signs/symptoms suggestive of TTP. Her symptoms began about 2 weeks ago when she noticed increased bruising. She sought evaluation and blood work revealed hematocrit of 36% and platelet count lower than her baseline at 190K. She then developed increased petechiae and ecchymoses and reevaluation revealed a hematocrit of 33% and thrombocytopenia of 90K/uL. She was thus referred to ED for urgent plasmapharesis. She has been undergoing therapy with Clindamycin for a dental infection for the past 3 weeks and is due to have a tooth extracted on [**7-19**]. Currently she denies fevers, chills, nausea, vomiting, diarrhea, headaches, dysuria, decreased urine output. She does report some mild mental status changes which her mother confirms. These were present during her prior TTP as well. She would forget her place while speaking. Very subtle changes. . She was diagnosed originally in [**5-30**], had ADAMTS 13 inhibitor documented and required plasmapheresis. She had recurrent TTP in [**8-30**] again requiring plasmapheresis. Her previous pheresis sessions have been complicated by allergic reactions with diffuse hives as well as anaphylaxis on one occassion requiring epinephrine. She now undergoes pre-treatment with hydrocortisone 200mg IV, benadryl 50 mg iv Q 6 and Famotidine prior to pheresis. MEDICAL HISTORY: TTP requiring plasmapheresis diagnosed [**5-30**] Asthma Eczema s/p appendectomy Allergic Rhinitis MEDICATION ON ADMISSION: Clindamycin 300 mg po 4 times daily Advair Albuterol Flonase Claritin or Allavert (loratidine) ALLERGIES: Morphine / Codeine / Penicillins PHYSICAL EXAM: VS: T 99.4, HR 100, BP 154/68, RR 24, 99% RA GEN: young female, overweight, NAD HEENT: PERRL, anicteric, poor dentition, no obvious erthyema, purulence or other drainage. Neck: Supple CV: RRR no m/r/g Lungs: CTAB ABD: soft, NT, Nd, +BS EXT: no edema, 2+ pt pulses Skin: multiple ecchymoses, no petechiae Neuro: A/A Ox3 FAMILY HISTORY: 1. Diabetes Mellitus in maternal and paternal grandparents 2. SLE in maternal aunt 3. no family history of TTP, coagulopathy, thrombocytopenia. SOCIAL HISTORY: Lives with her cousin and another roommate. She cares for her nephew and her cousin??????s daughter. Recently quit smoking following 10 year history of smoking. Rare ETOH use. Denies recreational drug use.

CHIEF COMPLAINT: Head trauma s/p MCA PRESENT ILLNESS: 57M presents with head trauma s/p motorcycle accident during which his skull cap fell off. Unknown whether accident was witnessed. Per EMS report, BP 160/90 HR 80, GCS 3, pupils 3mm, +purposeful movements in UE only. Patient was intubated by rapid sequence and medflighted to [**Hospital1 18**] where GCS 3, 101.2 rectal, 147/90, 62 100% on vent. On exam in ED, patient localizes with left UE, withdraws to right UE and bilateral legs. Does not open eyes spontaneously or to voice. Does not follow commands. Positive gag and corneals. Head CT showed b/l SDH R>L. Large amounts of SAH. Hemorrhagic contusions in R frontal and temporal lobes. Effacement of perimesencephalic cisterns and right uncal herniation. Nondisplaced fractures through the left occipital bone and the left temporal bone, extending down to the anterior middle cranial fossa. Patient was taken emergently to OR for bolt and craniotomy. MEDICAL HISTORY: Unknown MEDICATION ON ADMISSION: Combivent INH 2 puffs QID Naproxen 500mg [**Hospital1 **] Lisinopril 10mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 101.2 rectal 147/90 62 100% on vent sedated and intubated lacerations to scalp, blood oozing from left external meatus and nostrils breath sounds bilaterally soft abdomen extremities warm, well perfused, nonedematous FAMILY HISTORY: NC SOCIAL HISTORY: Has a son [**Name (NI) **] [**Name (NI) 60531**] [**Telephone/Fax (1) 67504**].

CHIEF COMPLAINT: GI bleed PRESENT ILLNESS: Mr. [**Known lastname 732**] is a very pleasant 77-year-old man who had an ERCP on [**11-19**] at [**Hospital6 4287**] for cholangitis attributed to gallstone pancreatitis complicated by post-sphincteromy bleeding. He underwent a second ERCP with vessel clipping on [**11-22**]. During that admission, his Hct decreased to 20, requiring 5 Units of PRBCs as well as FFP. He was discharged on [**11-25**] with Hct 24. He reports he was feeling fairly well and completed his course of levofloxacin and metronidazole on Wednesday. Since discharge he reports dark stools almost every day. On [**11-28**] he became Lightheaded with transient syncope while at work, no LOC, chest pain, palpitations, focal weakness, numbness, tingling. EMS activated and SBP 80 in the field per EMS--> [**Hospital3 **] ED. On arrival to [**Hospital3 **] ED, BP 107/43 with HR 67. Hct 29.4 --> 28.4 over 5 hrs in their ED. CE neg x 1. ECG with incomplete RBBB and LAD, LAFB with no acute ischmic changes. In the ED there, reportedly had hematochezia and recurrent episode of lightheadedness. Rx'd 1 L NS bolus and started on NS 150 cc/hr. Patient was conversant throughout. He was transferred to [**Hospital1 18**] for further management, and admitted to the [**Hospital Ward Name 332**] ICU. . On arrival to the [**Hospital Unit Name 153**], patient was clinically stable, conversational with SBP in the 130s-150s. . ROS: The patient denies any fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, chest pain, shortness of breath, orthopnea, PND, lower extremity oedema, cough, urinary frequency, urgency, dysuria, focal weakness, vision changes, headache, rash or skin changes. MEDICAL HISTORY: DM2 HTN CAD s/p in LAD in [**2186**] Diverticulosis Bilateral inguinal hernia repair Recurrent E. coli UTI Thoracic aortic aneurysm MEDICATION ON ADMISSION: ASA 81 mg qday pioglitazone 30 mg qday doxazosin 2 mg qday Fe sulfate 325 mg [**Hospital1 **] metronidazole 500 mg tid - recently completed folate 1 mg qday furosemide 60 mg qday levoflox 750 mg qday - recently completed glyburide 1.25 mg qday ? [**Hospital1 **] amlodipine 10 mg qday lisinopril 40 mg qday metoprolol XL 200 mg qday Vicodin prn simvastatin 80 mg qhs ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GEN: Well-appearing, well-nourished elderly man, no acute distress, pleasantly conversational HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear NECK: No JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline COR: regular rhythm, normal rate, normal S1/S2, 2/6 systolic murmur, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength 5/5 in upper and lower extremities. Patellar DTR +1. Plantar reflex downgoing. No gait disturbance. No cerebellar dysfunction. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. FAMILY HISTORY: Mother died of an aneurysm in her 30's, when patient was 10 yrs old. He's the only child. Father died in his 70's from a heart condition. SOCIAL HISTORY: No smoking, drinking, or drug use. Lives with wife. [**Name (NI) **] works full-time at his farm - he owns [**Known lastname 732**] Farms, a large operation in [**Location (un) **] and southern [**Location (un) 3844**]. He and his sons work together in the family business.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 72 year old woman with a history of coronary artery disease who reported increasing shortness of breath and chest discomfort times several months, refused a stress test, which was ultimately done on the morning of admission and was positive for ischemic changes. She was then sent to the cardiac catheterization laboratory, which showed three vessel disease and was ultimately referred for coronary artery bypass grafting. As stated, the catheterization showed proximal right coronary artery with 100 percent lesion, the mid left anterior descending coronary artery with a 90 percent lesion, the first diagonal with an 80 percent lesion and obtuse marginal one with a 90 percent lesion with an ejection fraction of 52 percent. MEDICAL HISTORY: Diabetes mellitus. Hypertension. Hypercholesterolemia. MEDICATION ON ADMISSION: 1. Diovan 80 mg daily. 2. Glyburide 5 mg daily. 3. Methocarbamol 750 as needed. 4. Atenolol 25 mg daily. 5. Oxycodone as needed. 6. Hydrochlorothiazide 12.5 mg daily. 7. Lipitor 10 mg daily. 8. Ritalin daily, no dose provided. ALLERGIES: The patient states an allergy to Lisinopril which causes a cough. PHYSICAL EXAM: FAMILY HISTORY: Significant for brother with coronary artery disease who had a coronary artery bypass graft at 65 years of age. SOCIAL HISTORY: The patient is [**Name8 (MD) **] RN who continues to work as a Hospice nurse. She lives in [**Location 32651**] with a roommate. She has a remote tobacco history, quit two years ago after 45 years of smoking. No alcohol use.

CHIEF COMPLAINT: confusion PRESENT ILLNESS: 62 yo female with a history of metastatic melanoma to liver and lungs with unknown primary on weekly taxol(last dose 11/8) who presented with nausea and vomiting for the past 6 days and increasing confusion for the past 2 days per her husband. Pt complained of severe frontal headache as well as some mild neck stiffness w/o photophobia. She also complained of diffuse abdominal pain which she said had been present since last [**Month (only) 547**]. She reported fatigue for the past week with more confusion over the past 2 days. Husband was concerned about her talking nonsense and with possible delusions, so he called [**Hospital **] clinic and she was referred to the ED. Per her husband she had no recent, cough, SOB,fever, chills, dysuria, diarrhea. In the ED she was given Ativan for nausea, and morphine for pain. CT head was negative and MRI showed question of leptomeningeal enhancement. LP performed for hx concerning for meningitis which revealed xanthocromia with fourth tube with 35 wbc(2 neuts, 45 lymphs, 6 monos, 33% atypicals), and 356 RBC's with protein >583 and glucose 28. Pt started on Acyclovir for herpes encephalitis, but leptomeningeal spread of melanoma was higher on the differential. Pt transferred to [**Hospital Unit Name 153**] with hydrocephalus, as demonstrated by LP and CT/MRI, secondary to leptomeningeal spread of her metastatic melanoma. Pt seen by neurosurgery for placement of ventricular drain at bed side for a communicating hydrocephalus with functional obstruction by atypical cells. MEDICAL HISTORY: 1. Melanoma- dx on [**11-24**] due to elvated LFT with bx consistent w/melanoma began biochemotherapy [**2149-5-12**] but not tolerated due to nausea, vomiting, diarrhea, changed to cisplatin, vinblastine, and dacarbazine started recently on weekly taxol 2. Hypothyroidism 3. RA 4. Pilonidal cyst 5. HTN 6. diverticulitis 7. tubal ligation MEDICATION ON ADMISSION: Medications on Transferr: 1. Acetaminophen 2. Acyclovir 350mg IV Q8 hours 3. Atenolol 25mg PO once daily 4. Bisacodyl 10mg PO QHS 5. Dolasetron Mesylate 12.5mg IV Q8 hours PRN 6. Docusate 100mg PO BID 7. Levothyroxine 75mcg PO once dialy 8. Lorazepam 0.5mg IV Q4 hours PRN 9. Metoclopramide 5mg PO IV QIDACHS 10. Morphine sulfate 2-4mg IV/SC Q4hours PRN pain 11. Senna 1 tab PO BID PRN ALLERGIES: Iodine PHYSICAL EXAM: VS: HR: 61 BP: 118/43 RR: 12 SaO2: 95% Pain: 0/10 -Gen: pt is a well nutritioned pale women with significant alopecia. She is not particularly communicative, but does responds to questions with nodding and gesturing and is otherwise cooperative (s/p olanzapine and ativan prior to imaging this evening). -HEENT: pupils are 2mm bilaterally and due to their small size, difficult to assess for reactivitiy -CV: RRR, S1, S2, no murmurs, rubs, gallops -Chest: CTA bilaterally -Abd: soft, NT, ND, BS+ (s/p morphine prior to CT scan) -Ext: warm, well perfused, no clubbing, cyanosis, edema . FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Dizziness. PRESENT ILLNESS: 62 year old F with a PMH of type 1 diabetes (complicated by retinopathy, neuropathy, and nephropathy), HTN, and chronic anemia. She presented to the ED since she was feeling ??????dizzy and lightheaded?????? over the past two days, and noted that her blood sugars were elevated. She reports polydipsia and polyuria, but notes a decrease in her appetite. She denies any recent fevers, chills, cough, dysuria, chest pain, palpitations, diaphoresis, abdominal pain, diarrhea, constipation, or flank pain. She had one episode of non-bloody emesis in the Emergency Department. She reports compliance with her insulin regimen, but states she forgot to take her nighttime Lantus 1 day PTA. She records her blood sugars daily in a log book. Pts log book shows that the patient has had persistent hyperglycemia over recent weeks, as high as 500+. Pt states that 1 day PTA her glucometer read ??????HI.?????? In the [**Name (NI) **], pt was noted to have a glucose of 974, an anion gap of 30, and urinary ketones. Lab data was also notable for a potassium of 7.1 and the EKG had peaked T waves. Pt was treated with fluids, insulin drip, bicarb, Ca gluconate, and Kayexalate and was transferred to the MICU for further management of DKA. In the MICU MEDICAL HISTORY: 1. Type I diabetes mellitus x 35 years. The patient has had previous admissions for DKA and hypoglycemic episodes. Her DM is complicated by peripheral neuropathy, proliferative retinopathy (she is blind in left eye due to neovascular glaucoma, also has small cataract in right eye), and nephropathy. She is s/p amputation of the toes on her L foot. She also has a history of a 1.5x1cm ulcer on her L foot. She also has a podiatrist, Dr. [**Last Name (STitle) **]. She is followed by Dr. [**Last Name (STitle) **] at the [**Last Name (un) **], and last saw her on [**8-13**]. At that time, her Novolog sliding scale was increased. Hemoglobin A1C in [**11-21**] was 10.1%. Urine microalbumin in [**11-21**] was 280. 2. Osteomyelitis. The patient is s/p amputations of 2 toes on her L foot in the '[**46**]'s. 3. Hypertension. 4. Herpes zoster of L chest in [**2163**]. 5. Bezoar. Disclosed on UGI series [**7-/2166**]. 6. S/p metatarsal fractures of R mid foot. The patient??????s foot was placed in a Cam walker. 7. Nuclear stress test [**4-21**]: The patient exercised for 4 min and achieved 62% of her maximal HR. Imaging disclosed no fixed or reversible defects. Normal wall motion. Ejection fraction measured 61%. MEDICATION ON ADMISSION: novolog Insulin SS Nifedipine 60 po qd ASA 325 qd Atenolol 25 po lantus 21 qhs diovan 80 mg qd HCTZ 50 mg qd ALLERGIES: Gantrisin PHYSICAL EXAM: General: in NAD. VS: 99.4 165/63 84 15 98% RA HEENT: NC/AT. Blind in L eye, small cataract in R eye. MM moist and clear. Patient has upper dentures - lowers are missing. Neck: Supple. Flat neck veins. No cervical lymphadenopathy. CVS: RRR. S1, S2. No m/r/g. Lungs: CTAB. Abd: Soft, NT, ND, +BS. Extr: trace edema, LLE. Warm. Brace in place on L foot, [**Doctor Last Name **] brace on R. Skin: No rashes or lesions. No sacral decubitus ulcer. Neuro: AxOx3. CN II-XII grossly intact. Strength 5/5 in all extremities. Sensation significantly decreased to LT in B LE. Monofilament 0/10. FAMILY HISTORY: She notes that her mother had DM. Her father had Alzheimer??????s disease. Her sister has DM and recently diagnosed breast cancer. SOCIAL HISTORY: The patient lives at home with her son. She receives assistance from visiting nurses. She does not work. She is a former smoker, and reports that she smoked 1 ppd x 2 years. She no longer drinks alcohol. She denies use of illicit drugs.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 77-year-old woman with a history of prior cerebrovascular accident in [**2163-10-22**] and atrial fibrillation in [**2165-6-21**] (on Plavix and Coumadin) who was in her usual state of health until yesterday evening on the day prior to admission when she began experiencing a sensation of abdominal discomfort and fullness followed by multiple bouts or normal colored diarrhea. She had diarrhea every 15 to 30 minutes with associated chills, abdominal discomfort, bloating, and diaphoresis. After sleeping through for hours last evening prior to admission, she felt constipated this morning, and after mild straining she passed one to two large coal-black stools. Negative for bright red blood per rectum. No nausea or vomiting. Positive weakness. Positive shortness of breath. Mild lightheadedness. The patient presented at [**Hospital **] Hospital where her hematocrit was 38 and then dropped 32. She was transferred to [**Hospital1 69**] for further care. In the Emergency Department, the patient with a blood pressure of 120s/40s. A nasogastric tube with return of 30 cc to 40 cc of dark red blood not cleared by lavage, greater than 1 liter. INR on admission was 3.3. Also in the Emergency Department, the patient received 10 mg of vitamin K subcutaneously times one, and 22 units of fresh frozen plasma, 40 mg of intravenous Protonix, and 250 mg of erythromycin intravenously times one. The patient was seen by Gastroenterology in the Emergency Department. MEDICAL HISTORY: (Past Medical History includes) 1. History of cerebrovascular accident in [**2163-10-22**]. 2. Atrial fibrillation in [**2165-6-21**]. 3. Status post appendectomy. 4. Status post total abdominal hysterectomy. 5. Status post cholecystectomy. 6. Hypertension. 7. Transient ischemic attacks. 8. Amaurosis fugax. 9. She has one kidney. 10. History of dementia. 11. History of carotid stenosis. 12. History of osteopenia. MEDICATION ON ADMISSION: Medications on admission were Coumadin, atenolol, Lipitor, Aricept, Atrovent, Tylenol, quinine, albuterol, and Plavix. ALLERGIES: Allergies to CODEINE, SULFA, BENADRYL, ASPIRIN, and IBUPROFEN. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Social history was negative for tobacco now with a previous 40-pack-year history. No alcohol.

CHIEF COMPLAINT: Small-bowel obstruction secondary to internal hernia. Ischemic bowel. PRESENT ILLNESS: Young patient 11 months status post gastric bypass with the retrocolic Roux-Y anastomosis presented with a bowel obstruction present. MEDICAL HISTORY: hypercholesterolemia, hypothyroidism, hypertension, mitral valve prolapse, migraine headaches bilateral carpal tunnel syndrome, chronic low back pain, history of pneumonia and urinary tract infection and gallbladder disease. MEDICATION ON ADMISSION: albuterol, betamethasone valerate, synthroid, nystatin, biotin, calcium citrate, vit D, vit B12, iron, claritin, multivitamin ALLERGIES: Shellfish / Aspartame / Cipro / Nsaids PHYSICAL EXAM: FAMILY HISTORY: Her family history is noted for father living age 59 with diabetes and obesity; mother living age 55 with heart disease, hyperlipidemia, obesity, asthma and arthritis; sister living age 32 with hyperlipidemia, thyroid disease and obesity; grandmother deceased age [**Age over 90 **] with heart disease and grandfather deceased age 75 with stroke. SOCIAL HISTORY: She used to smoke 5 to 10 cigarettes a day for 7 years stopped two years ago, denies recreational drugs or alcohol usage, no carbonated beverages. She is employed as a business analyst for a technology company. She lives with her partner age 28 and her 9 month-old daughter.

CHIEF COMPLAINT: s/p stabbing PRESENT ILLNESS: 50M transferred from OSH after obtaining a self-inflicted wound to his epigastric region. He was stable in the ED but FAST was positive for trace pericardial effusion and free fluid in hepatorenal gutter. 3 cm stab wound w/ visible. He was admitted to the TSICU after his operation. MEDICAL HISTORY: HTN, DM (diet-controlled), depression MEDICATION ON ADMISSION: lisinopril 40 mg daily neurontin 300 mg TID Nortriptyline 75 mg QHS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: Physical Exam: Vitals: T 99.2 P 80-110 BP 107/74 RR 16 O2 100%RA GEN: A&O, NAD HEENT: No scleral icterus, mucus membranes moist CV: RRR, No M/G/R PULM: Clear to auscultation b/l, No W/R/R ABD: Soft, mild distention, diffusely tender to mild palpation with rebound and guarding Ext: No LE edema, LE warm and well perfused FAMILY HISTORY: Pt was adopted but did find his biological parents. No known psychiatric illness in blood relatives. Medical history non-contributory. SOCIAL HISTORY: Divorced for 13 years; pays alimony. Has two teenage children. Has degrees in accounting and business, but has not worked in this capacity for many years. Has been living with and caring for this man for about 4 years.

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 30814**] is a 62 year-old man who had several episodes of chest pain in the spring of this year. He had a stress test done at that time that showed inferolateral ischemia with an ejection fraction of 60%. At that time it was decided that he would be treated medically and he did well until the past two weeks when he experienced angina again. Electrocardiogram done in his primary care physician's office at that time revealed biphasic T waves in V4 through 6 and the patient was sent to [**Hospital1 346**] for cardiac catheterization, which was done on [**2102-8-18**]. Please see the catheterization report for full details. In summary, the catheterization showed that the patient had 90% left anterior descending coronary artery, 80% left circumflex and long subtotal occlusion of the right coronary artery with an ejection fraction of 55%. Following his cardiac catheterization the cardiothoracic surgery was consulted and the patient was scheduled to return to the hospital for coronary artery bypass grafting. MEDICAL HISTORY: Significant only for coronary artery disease. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: No tobacco use. Rare alcohol use.

CHIEF COMPLAINT: Chest Pain<h3>[**Known lastname 103687**],[**Known firstname 103688**] J. [**Numeric Identifier 103689**] . PRESENT ILLNESS: Pt was eating dinner this evening, then developed SSCP, no radiation, lasted about 1hr. + diaphoresis, no palpitations, no n/v, no dizziness, no lightheadedness. Thinking it was indigestion, pt took 2 tylenol, alka-seltzer and peptobismol. When this produced no relief, famiy took pt to OSH, chest pain improved on the way to OSH. At OSH, given ASA, NTG w/improvement of sx. EKG changes persisted (STE's in V2-V4) and pt was xferred to [**Hospital1 18**] for cath. Pt was given a bolus of integrillin, bivalirudin, but no heparin, given h/o HIT. He was given a total of 180cc's of optiray dye. MEDICAL HISTORY: MEDICATION ON ADMISSION: 1. Flomax 0.4mg daily 2. Trazodone 50mg qhs 3. Atenolol 50mg daily 4. Norvasc 10mg daily 5. Avodart 0.5mg qd 6. Clonidine 0.2mg [**Hospital1 **] 7. Xalatan 1 gtt qhs 8. Hydralazine 100mg daily 9. Protonix 40mg daily 10. Tylenol prn 11. Nicotine patch 14 mg daily for two weeks, then 7mg daily x 2wks, then d/c ALLERGIES: Heparin Agents PHYSICAL EXAM: PE: Vitals: T96.8 HR 72 BP 127/67 RR 14 O2sat 97% on 4L NC . Gen: elderly male, in bed, NAD HEENT: OP clear, no lesions, PERRLA, EOMI, flat JVP. no carotid bruits Pulm: barrel chested. diffuse wheezes throughout. no rales/rhonchi CV: distant heart sounds. S1, S2 RRR. no M,R,G Abd: +BS. soft, NT, ND, no HSM Groin: arterial and venous sheaths in R groin. slight ooze. no bruits Ext: warm, dry, no lesions. + onychomycosis Neuro: A&Ox3. hard of hearing. FAMILY HISTORY: brother died of CAD in his 80's SOCIAL HISTORY: lives with wife at daughter in law's house. Pt has smoked 2ppd x 65yrs. now smokes 1ppd. No EtOH

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: Mr. [**Known lastname 1399**] is a 55 year old male with nonocclusive right femoral and popliteal DVT, obstructive sleep apnea and obesity who was doing well until two days ago. He reports waking up with left groin pain. He went for lunch and then noticed acute onset of shortness of breath with minimal exertion leading him to present to [**First Name8 (NamePattern2) 1495**] [**Hospital 122**] Hospital. At OSH ED, his inital vitals were 134/83 107 95%3LNC and breathing 24-26. Due to creatinine of 1.6, he got a V/Q scan to evaluate for pulmonary embolism which showed high probability for pulmonary embolism. LENIS showed DVT. CTA confirmed saddle pulmonary embolism. He was given fundoparinaux 10 mg and transferred to ICU. TTE showed right ventricular strain with paradoxic motion of the septum, right ventricular dilatation ands severe pulmonary hypertension. He was offered TPA vs OSH transfer for thrombectomy. He opted for OSH transfer for thrombectomy and thus [**Hospital1 18**] ICU transfer. At [**Hospital1 18**] MICU, he reports 20% improvement in his shortness of breath at rest though no chest pain or dizziness. MEDICAL HISTORY: Multiple right lower extremity DVTs approximately two years ago. He was treated with Coumadin for six months and has been off of the Coumadin for over a year. He saw a hematologist who could not find any cause for the multiple DVTs. Hypercoagulable workup did not reveal any causes High triglycerides Obstructive sleep apnea, uses CPAP at home Obesity Past Surgical History Bilateral knee surgery for torn meniscus three years ago Ruptured appendix s/p emergent lapraroscpic appendectomy MEDICATION ON ADMISSION: 1. Aspirin 325 mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Tricor 48 mg po qdaily ALLERGIES: Penicillins PHYSICAL EXAM: Admission Exam 76 114/72 96% 2LNC General: The patient is a middle-aged obese male, in no acute distress. Neuro: Alert and oriented x3, pleasant, and cooperative. HEENT: Head is atraumatic and normocephalic. Trachea is midline. Neck: Supple. No carotid bruits noted. Lungs: Increase work of breathing. Clear to auscultation bilaterally. Heart: Regular rate and rhythm. S3 present. Abdomen: Soft, obese, and nontender. No masses noted. He has an umbilical hernia. Extremities: He has [**1-29**]+ right lower extremity edema. 2+ left lower extremity edema. He has a palpable posterior tibial pulse bilaterally. Discharge Exam VS 98-98.3 66-75 136/91-98 18 96%RA GEN Alert, oriented, no acute distress, breathing comfortably HEENT NCAT MMM EOMI sclera anicteric, OP clear NECK supple, no JVD, no LAD PULM Good aeration, CTAB no wheezes, rales, ronchi CV RRR normal S1/S2, no mrg ABD soft NT ND normoactive bowel sounds, no r/g EXT WWP 2+ pulses palpable bilaterally, 2+ pitting edema b/l R>L. No calf tenderness. NEURO CNs2-12 intact, motor function grossly normal SKIN no ulcers or lesions FAMILY HISTORY: Significant for coronary artery disease or myocardial infarction. He denies a family history of blood clots or bleeding disorders. SOCIAL HISTORY: Occupation: He is a safety director. Tobacco: never Alcohol: None Recreational Drugs: None

CHIEF COMPLAINT: Jaundice and unintentional weight loss PRESENT ILLNESS: 76 M with no known liver disease, now here with unintentional wt loss x 4 weeks and elevated bili/jaundice. Patient reports a decreased appetite and some intermittent nausea over this 4 week period, but denies dysphagia, vomiting, diarrhea, fevers/chills or night sweats. He complains of frequent urination at night, which he reports to be dark in color, but otherwise, no hematuria/dysuria. No occult blood. MEDICAL HISTORY: stable CAD - ETT MIBI [**8-31**] demonstrating a severe fixed defect in the inferior and lateral wall from apex to base with global HK and an LVEF of 18%. s/p CABG [**2150**] ED h/o pancreatitis Afib CHF - ischemic - EF 18%, class II - III, refused anticoagulation and ICD/BiV pacer hypertension dyslipidemia h/o obesity MEDICATION ON ADMISSION: Lasix 40 mg QAM K supplement Aldactone 50 QD ASA 325 Lipitor 20 - stopped [**1-31**] transaminitis Bactrim DS x 7 days up to [**8-19**] BiDil 20-37.5 mg PO TID Calcitriol 0.25 3x/week Diovan 80 mg QD Toprol XL 100 QD ALLERGIES: Ace Inhibitors PHYSICAL EXAM: VITAL SIGNS: Wt181 ([**4-4**]) -> 178 ([**5-4**]) -> 163 ([**2165-8-8**]) -> 123 ([**2165-8-20**]) GENERAL: Awake, alert, cachectic, NAD HEENT: NC/AT, PERRLA, EOMI, scleral icterus, OP non-erythematous NECK: Supple. No lymphadenopathy HEART: RRR, S1, S2 nl, II/VI systolic murmur at RUSB CHEST: CTAB ABDOMEN: Soft, NT, ND, +BS, no rebounding, but guarding, denies pain EXTREMITIES: No c/c/e FAMILY HISTORY: NC SOCIAL HISTORY: He lives with his wife. [**Name (NI) **] reports that family helps both of them with ADLs since wife has also been ill with strokes. No current or former smoking or alcohol.

CHIEF COMPLAINT: vistaril overdose PRESENT ILLNESS: Ms. [**Known lastname 1637**] is a 25 yo F with HX of bipolar disorder, anxiety, severe persistent asthma with multiple prior intubations, IVDA, septic arthritis presenting with drug overdose.She came from [**Hospital3 **] where she had presented for her 5th detox from IV heroine on [**1-7**], endorsing depression at which point she had a positive tox screen for benzodiazepines, tricyclics and opiates. She was receiving vistaril as part of detox, but also had own supply. She stated on presentation to [**Hospital1 18**] ED that she had been taking extra visteril as was not getting seroquel, doxepin for anxiety. She had received 35mg methadone this am for detox. She was estimated to have taken over 76 visteril in 48 hours she was noted to have become progressively sedated with waxing and [**Doctor Last Name 688**] mental status. . In the ED her VS were: T:97 HR: 122 BP 121/62 RR:14 sating 94% on RA. She was not noted to be agitated, but would climb out of bed thus restraints were placed. She was noted to have roving eye motions, and sinus tachycardia on EKG although she has a history of this. She was without clonus, agitation, fever, dryness. A urine/serum tox screen was positive for methadone. She was seen by the toxicology team in the ED who felt that her presentation was consistent with central anticholinergic. She was also noted to have wheezing on respiratory exam. On CXR, she was noted to have a RLL infiltrate with leukocytosis to 12.5.She received levofloxain for PNA. She was last discharged [**2142-10-11**] for septic arthritis with group A bacteremia and resultant septic shock, with left knee replacement. . On arrival to the floor her vital signs were stable and she complained of [**9-3**] pain L knee pain. . MEDICAL HISTORY: Severe persistent asthma - multiple intubations chronic sinusitis opiod dependence s/p bilateral knee replacements for osteonecrosis [**2-26**] long term prednisione use (R knee [**9-1**], left knee [**1-1**]) hypogammaglobulinemia hepatitis c tobacco abuse -spontaneous PTX in [**5-2**] -s/p R VATS/bleb resection and pleurectomy at [**Hospital 8**] Hospital in [**2141-6-25**] osteopenia by xray MEDICATION ON ADMISSION: Fluticasone-Salmeterol 250-50 mcg/Dose Disk [**Hospital1 **] 2. Montelukast 10 mg Tablet once daily 3. Omeprazole 20mg E.R once daily. 4. Nystatin Five (5) ML PO QID PRN mouth pain. 5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) q4hr prn 6. Tiotropium Bromide 18 mcg Capsule once daily 7. Quetiapine 100 mg Tablet qHS. 8. Ferrous Sulfate 325 mg daily 9. Senna 8.6 mg Tablet [**Hospital1 **] 10. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 11. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q3H (every 3 hours) as needed for pain: should be weaned over 6 weeks. 12. Penicillin G Potassium 20,000,000 unit Recon Soln Sig: Four (4) Million units Injection Q4H (every 4 hours) for 5 weeks: do not stop medication until instructed by [**Hospital **] clinic at [**Hospital1 18**]. 13. Clonazepam 0.5 mg Tablet Sig [**Hospital1 **] PRN anxiety. ALLERGIES: Magnesium / Latex / Salicylate / Benzocaine PHYSICAL EXAM: Vitals: T: 95.6 BP: 104/52 P: 118 R:16 O2:97% 2L General: waxes and wanes, arousable. HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear. Bilateral eccymoses below eyelids. Neck: supple, JVP not elevated, no LAD Lungs: bilateral expiratory wheezes CV: sinus tachycardic(before nebs), normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: left knee with surgical scar. No erythema, no TTP, no effusion. CXR: Wet read: Multifocal areas of opacity at R lung base and perihilar diffuse opacity. Could be infection, drug reaction, versus cardiogenic in nature. Labs: see below. FAMILY HISTORY: Mother - breast cancer [**Name (NI) **] - asthma and hyperthyroidism SOCIAL HISTORY: She endorses recent injection of heroin in the past week and reports that prior to this she had been clean for about two years. She does have history of injection drug use and cocaine use in the past. Tobacco: She endorses smoking [**1-26**] PPD currently and has been smoking for the past 10 years.

CHIEF COMPLAINT: Exertional chest pain PRESENT ILLNESS: This is a 70 year old male with exertional chest pain and abnormal stress test. He recently underwent cardiac catheterization which revealed two vessel coronary artery disease. He was therefore referred for surgical revascularization. Prior to this admission, he underwent full preoperative evaluation and was cleared for surgery. MEDICAL HISTORY: Coronary Artery Disease Hypercholesterolemia Parkinsons Disease GERD History of Detached Retina History of Hydrocele Low Back Pain Prior Hernia Repair Prior Cataract Surgery Prior Tonsillectomy MEDICATION ON ADMISSION: Crestor 5 qd Omeprazole 20 qd Mirapex 0.25 qd Aspirin 325 qd Sudafed prn ALLERGIES: Sulfa (Sulfonamides) / Zocor PHYSICAL EXAM: Vitals: T - afebrile, BP 130-140/70-80, HR 60, RR 20 General: elderly male in no acute distress HEENT: oropharynx benign, Neck: supple, no JVD, no carotid bruit Heart: regular rate, normal s1s2, no murmur or rub Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds Ext: warm, no edema, no varicosities Pulses: 2+ distally Neuro: tremors noted, otherwise nonfocal FAMILY HISTORY: Denies premature coronary artery disease. SOCIAL HISTORY: Denies history of tobacco. Admits to occasional ETOH. He is retired.

CHIEF COMPLAINT: PRESENT ILLNESS: 1. This gentleman has a long history of cardiac disease with a diagnosis of tetralogy of Fallot. 2. In [**2134**] he had a classic right Blalock-Taussig shunt. 3. In [**2139**] he had a complete repair. 4. In [**2166-12-28**] he had right ventricular outflow tract construction with a 24-mm aortic homograft. At that time, he was found to have anomalous left coronary artery off the right coronary artery which was sacrificed and complicated by emergent coronary artery bypass grafting with a vein graft to the LAD and circumflex with augmentation of the right ventricular outflow tract for right ventricular outflow tract outflow postoperatively. 5. In [**2170**] he had a history of ventricular tachycardia by Holter. He had a negative electrophysiology study, and no inducible ventricular tachycardia. 6. Atrial fibrillation. 7. Cerebrovascular accident in [**2139**] with left hemiparesis. 8. Obstructive sleep apnea. 9. Chronic obstructive pulmonary disease with mild restrictive and obstructive disease by pulmonary function tests. 10. Obesity. 11. Hypercholesterolemia. 12. Hypertension. MEDICAL HISTORY: MEDICATION ON ADMISSION: Enalapril 5 mg p.o. twice daily, digoxin 0.25 mg p.o. once daily, Lasix 20 mg p.o. once daily, atenolol 25 mg p.o. once daily, Lipitor 10 mg p.o. once daily, Coumadin (dosing usually 5 mg but this varied), trazodone (unknown dose), and baclofen as needed. ALLERGIES: He has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives with his wife and two children (ages 15 and 20). He has no tobacco history. No alcohol history.

CHIEF COMPLAINT: Coronary artery disease. PRESENT ILLNESS: Mr. [**Known lastname **] is a 56 year-old man who presents for coronary artery bypass graft. He has had symptoms of coronary artery disease for about the last seven years. He had an left anterior descending coronary artery stenting back in [**2109**]. He did well until [**2116-1-23**] when he had a positive exercise treadmill test. He subsequently had angiography with percutaneous transluminal coronary angioplasty, roto rooting and stenting of the proximal circumflex and percutaneous transluminal coronary angioplasty roto rooting of both poles of the obtuse marginal one. In [**Month (only) **] he subsequently had another positive stress test and at that time was found to have restenosis of the circumflex. It then appears that he had further percutaneous transluminal coronary angioplasty and brachytherapy. Now he presents with symptoms of fatigue and more recently the feeling of complete exhaustion. He never experienced any chest pain or shortness of breath with this and now denies claudication, orthopnea, edema or paroxysmal nocturnal dyspnea. In his prior cardiac workup his catheterizations have occurred, because of routine stress testing. In [**Month (only) 116**] of this year he had a stress test that demonstrated 2 to 3 mm ST segment depressions in the inferior and lateral leads and he had a small mild reversible inferolateral defect with an ejection fraction of 59%. MEDICAL HISTORY: 1. High cholesterol. 2. Tobacco use. 3. Coronary artery disease. 4. Anxiety and depression. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: He has a positive family history with four half brothers that all died prematurely of coronary artery disease. SOCIAL HISTORY:

CHIEF COMPLAINT: 63 y/o male s/p CABG on [**2168-7-26**], d/c'd to rehab on [**8-3**]. Re-admitted on [**8-16**] with sternal wound drainage. PRESENT ILLNESS: s/p cabg, discharged to rehab, began to have sternal wound drainage, managed w/antibiotics, did not improve. re-admitted for IV antibiotics and wound debridement MEDICAL HISTORY: CAD: [**2158**]- stent to prox RCA; [**2161**]-MI with 2 RCA stents; [**2164**] - MI with PTCA and stent to 90% mid LAD lesion and PTCA to D2; [**2-25**] - PTCA and brachytherapy to mid-LAD; stents to diag and OM1 branch; [**2166**] - at [**Hospital3 **] - 60% LAD stenosis, no stent placed. HTN morbid obesity CVA (right MCA) [**2154**] s/p RCEA NIDDM COPD OSA on CPAP MEDICATION ON ADMISSION: Protonix ASA Lipitor Seroquel Zetia Albuiterol Atrovent Iron Vitamins Carvedilol Lasix Insulin Tylenol Levaquin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Sternal wound with erythema, small area of dehiscence, 2+ peripheral edema, exam otherwise unremarkable FAMILY HISTORY: non-contributory SOCIAL HISTORY: Previous Hospitalization: none Suicide attempts: in [**2155**] after having a stroke, he placed a shotgun at his chin, pointing upwards, and pulled the trigger, but the safety was still on, for which he was later grateful. Assaultive behavior: none Current treaters: none in mental health Medication trials: none prior to zoloft

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 54 year-old woman who presented with complaint of increased shortness of breath with exertion, fatigue and transient vision loss. The patient was approximately ten months status post repair of an aortic dissection with a hematoma. The patient returned complaining of increased shortness of breath recently as well as fatigue and transient vision loss. The patient underwent a cardiac catheterization on [**2196-11-17**], which revealed a pseudoaneurysm at the proximal end of the graft and a stenosis as well as a mobile density in the ascending aorta with a false lumen flow. She also had 1 to 2+ aortic insufficiency. A cardiac echocardiogram performed on the same day revealed she had an ejection fraction of greater then 55%. MEDICAL HISTORY: Hypothyroidism, hypercholesterolemia, gastroesophageal reflux disease, transient ischemic attack, hypertension, osteoarthritis of the spine, obesity. MEDICATION ON ADMISSION: ALLERGIES: Morphine causes nausea and vomiting. PHYSICAL EXAM: FAMILY HISTORY: Father died at age 67 of a possible aneurysm or myocardial infarction. Mother is deceased and had colon cancer, coronary artery disease, and coronary artery bypass graft. SOCIAL HISTORY: The patient is a retired meeting planner who lives with her husband. She quit smoking in [**1-1**]. She occasionally drinks.

CHIEF COMPLAINT: found down PRESENT ILLNESS: Mr [**Known lastname **] is a 53 yo M with PMH sig for long-standing DM I c/b insulin autoimmune syndrome in recent years, systolic CHF, and CRI who was found unresponsive at home with fs 29. . He later reported that there were no symptoms/warning signs that his blood sugar was low. He had spent the morning doing normal activities without complaint. He last remembers coming in from walking his dog. . Of note, the patient has been admitted to [**Hospital1 18**] several times in the past with the same symptoms, most recently from [**Date range (1) 20177**]; he was also admitted to [**Hospital1 2177**] with same [**7-26**]. MEDICAL HISTORY: #DIABETES MELITUS-TYPE I -x 37 yrs -frequent hypoglycemic episodes -high level of anti-insulin Ab -followed by Dr.[**Doctor Last Name 4849**] of [**Last Name (un) **] -complicated by nephropathy -complicated by retinopathy (s/p right eye laser surgery, repeated [**8-3**]) #END STAGE RENAL DISEASE SECONDARY TO DIABETIC NEPHROPATHY #HYPERTENSION #ANEMIA, LIKELY DUE TO END STAGE RENAL DISEASE #HYPERURICEMIA #GRAVES' DISEASE #HYPERLIPIDEMIA #DIASTOLIC CONGESTIVE HEART FAILURE WITH LEFT VENTRICULAR HYPERTROPHY MEDICATION ON ADMISSION: 1. Calcitriol 0.25 mcg PO once a day. 2. Clonidine 0.3 mg/ One (1) Patch Weekly QFRI 3. Toprol XL 150 mg PO once a day. 4. Allopurinol 100 mg PO Every other day. 5. Diltiazem HCl 180 mg PO twice a day. 6. Furosemide 40 mg PO BID 7. Doxazosin 4 mg PO HS 8. Levothyroxine 75 mcg PO DAILY 9. Minoxidil 5 mg PO DAILY 10. Ferrous Sulfate 325 mg 11. Insulin Glargine 3 units [**Hospital1 **] 12. Humalog Sliding scale 200-250 1 unit [**Unit Number **]-300 2 units 300-350 3 units 350-400 4 units 13. Glucagon Emergency 1 mg Kit Sig: One (1) Injection kit: Use as needed for hypoglycemia. 14. Rosuvastatin 20 mg PO DAILY 15. Calcium Carbonate 500 mg PO TID W/MEALS 17. Nephrocaps 1 PO DAILY 18. Amlodipine 10mg PO once a day. ALLERGIES: Tapazole PHYSICAL EXAM: Vitals: 96.5, 172/93, 66, 12, 100% 2LNC General: NAD, awake, alert, pleasant. HEENT: PERRL, EOMI, OP clear +halitosis Neck: no LAD, supple Heart: RRR no m/r/g Lungs: CTAB, rare rhonchi, clears w. cough. Abd: +BS, NT, softly distended Ext: trace edema b/l; small skin tear on RLE [**Month/Year (2) **]: appropriate Neuro: CN 2-12 intact. strength 5/5 x4. sensation grossly wnl. FTN intact. FAMILY HISTORY: Mother has DM2 and RA. Maternal Aunt also c DM2. Nephew c DM1 SOCIAL HISTORY: Lives with parents. Works in construction. No alcohol, drugs, or tobacco.

CHIEF COMPLAINT: mitral regurgitation, coronary artery disease PRESENT ILLNESS: This 69 year old white male was recently admitted with congestive heart failure. Work up revealed 3+ mitral regurgitation. He has known coronary disease having undergone stenting to the RCA in [**2195-7-5**]. he was admitted now for surgical intervention. MEDICAL HISTORY: insulin dependent diabetes mellitus Hyperlipidemia Depression s/p cardiac stent MEDICATION ON ADMISSION: ASA 325mg/D Plavix 75mg/D Lipitor 40mg/D Folic acid, Vit D, VitC and cyannocobolamine supplements Lasix 20mg/D Lantus 40U/D Starlix prn Lisinopril 10mg/D Lopressor 12.5mg [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission: FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: He is married with two grown children. He does not smoke and stopped drinking 4 months ago due to his diabetes. He is a retired salesman.

CHIEF COMPLAINT: s/p fall PRESENT ILLNESS: 86yF s/p unwitnessed fall at nursing home this am, tx fr OSH for intercranial hemorrhage. Intubated enroute for declining mental. Went into rapid AFib, given dilt w/good effect. INR OSH was 2.3, pt received 2units of FFP. MEDICAL HISTORY: AFib, anemia, schizophrenia, dementia MEDICATION ON ADMISSION: Diltiazem, digoxin, ativan, depakote, KCL, bumex, remeron, lasix, coumadin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: on presentation: O: T: 97.6 BP: 114/73 HR:98 R 18 O2Sats 100% Gen: intubated, no eye opening, no verbal. Large ecchymosis of left thigh. HEENT: Pupils: round and minimally reactive to light Neck: intubated, on hard collar Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, BS+ Extrem: Warm and well-perfused. Mental status: intubated, no eye opening, no verbal. Pupils equally round at 2.5mm and minimally reactive to light bilaterally. FAMILY HISTORY: . SOCIAL HISTORY: living in nursing home.

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname **] was originally seen in Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] office on [**2142-2-1**]. He has had increasing dyspnea on exertion for the past 2 months. He is a 49 year old male with known coronary artery disease, status post coronary artery bypass graft x4 in [**2140**], now with dyspnea on exertion and palpitations. Murmur was noted on examination and he was referred for echocardiogram which revealed mitral regurgitation. MEDICAL HISTORY: Mitral regurgitation. Status post coronary artery bypass graft x4 at [**Hospital6 2121**] in [**2140**]. Previous PCI to the right coronary artery. Inferior myocardial infarction in [**2132**]. Question of asthma on no medications. Hypercholesterolemia. Paroxysmal atrial fibrillation in [**2139**], and 11-12 years ago. Left arm fistula in [**2141-5-27**]. LDL plasmapheresis every 2 weeks at [**Location (un) 5450**] Kidney Center. Episodic dizziness for which a neurology workup was negative, question whether this was due to statins. MEDICATION ON ADMISSION: When he was seen initially were: 1. Coreg 12.5 mg p.o. twice a day. 2. Aspirin 325 mg p.o. once a day. ALLERGIES: He is allergic to Lipitor and Mevacor, both of which give him muscle aches. Albumin causes profound hypotension with bradykinin response. PHYSICAL EXAM: FAMILY HISTORY: He had a positive family history of coronary artery disease. SOCIAL HISTORY: He lives with his wife as a mortgage salesman. He had a 20 pack year history of smoking and quit 20 years ago. He had [**3-1**] drinks every weekend of beer and wine. He does exercise regularly.

CHIEF COMPLAINT: lip swelling PRESENT ILLNESS: 89yM with HTN on ramipril and hx of laryngeal cancer s/p tracheostomy presents with lower lip and facial swelling in context of recent bactrim use. Patient awoke today and noticed lower lips swelling. Throughout the morning and afternoon swelling increased to include upper lip, cheeks, and around neck. No tongue swelling, no dysphagia (able to eat lunch), no associated shortness of breath or wheeze. No pruritis, no rash. No prior history of angioedema or allergic reactions. No new contact with animals, latex, different foods, insect stings. . Patient has been on bactrim twice a day for presumed respiratory infection and has been having increased secretions from tracheostomy and congestion. No fevers, shakes, chills. . In ED, vitals afebrile HR 70, BP 131/57, RR 19, 98% on RA. Given benadryl 50mg IV, Methylprednisolone 125mg IV, and famotidine 20mg. Facial edema decreased significantly. . On floor, vitals 98.9, HR 78, BP 138/80, 20, 96% RA. Pt remains comfortable. . Review of systems: neg for headache, changes in vision, chest pain, wheezing, shortness of breath, trache secretions as above, abdominal pain, diarrhea, constipation, nausea, melenotic stools, extremity edema, dysuria. MEDICAL HISTORY: Laryngeal Cancer s/p laryngectomy [**2141**] HTN HL Hypothyroidism PUD s/p perforated gastric ulcer requiring surgery at age 22 MEDICATION ON ADMISSION: Synthroid 0.1 Pravastatin 40mg Qhs Ramipril 10mg QD Metoprolol XR 25mg Qhs Bactrim ALLERGIES: Bactrim / Ramipril PHYSICAL EXAM: General: Awake, alert, appropriate. Pleasant. HEENT: NCAT. PERRL. Minimal swelling around cheeks, under eyelids, gums. No tongue swelling. No throat inflammation or erythema. Neck: no posterior cervical, anterior cervical, or submental adenopathy. Tracheostomy site clean without secretions or erythema. Thyroid not palpated. CV: Regular rate and rhythm. Soft I/VI systolic murmur heard best at RUSB. Lungs: Coarse, bronchial breath sounds at right mid lung zone. Bibasilar crackles. No wheezing. Abdomen: Soft, nontender, nondistended. Bowel sounds present. Midline surgical scar from prior gastrectomy. Extremities: Warm, well-perfused. No edema, clubbing, or cyanosis. 2+ radial and DP pulses bilaterally. Skin: No rashes, urticaria FAMILY HISTORY: No family history of angioedema. SOCIAL HISTORY: Former smoker (quit decades ago), drinks 1 glass wine/day, retired factory worker/electroplater with chemical exposures. Lives with wife downstairs from daughter. Wife is currently hospitalized at [**Hospital1 18**] for colonic volvulus.

CHIEF COMPLAINT: s/p Gunshot wound to abdomen PRESENT ILLNESS: 33 yo male who sustained 32 caliber gunshot wound from ~10ft away to his abdomen. GCS 15 at scene. He was taken to an area hospital and becasue of his injuries was medflighted to [**Hospital1 18**] for further management. MEDICAL HISTORY: Chronic low back pain Panic attacks MEDICATION ON ADMISSION: Oxycontin 120mg tid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Married, lives with wife h/o cocaine use

CHIEF COMPLAINT: polytrauma PRESENT ILLNESS: 47M transfer from [**Hospital 8641**] Hospital after high speed MVC ~50mph. head-on motor vehicle collision reportedly intoxicated with alcohol. At OSH patient initially complained of SOB and bilateral chest pain and later developed worsening SOB/agitation and was intubated. Imaging was significant for the below MEDICAL HISTORY: none (per OSH note) PSH: unknown MEDICATION ON ADMISSION: unknown ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Discharge Physical T 98.1 P 93 BP 150/85 RR 18 O2 94 NAD rrr ctab R hip incision covered, c/d/i. R knee lac covered c/d/i. ambulatory w/ touch down weight bearing on R no LE edema or calf swelling FAMILY HISTORY: NC SOCIAL HISTORY: unknown

CHIEF COMPLAINT: Altered Mental Status PRESENT ILLNESS: Ms. [**Known firstname **] [**Known lastname 10935**] is a 30 yo woman who was found wandering the streets with altered mental status. She was brought to the hospital by EMS who reported persistently low blood pressures and waxing and [**Doctor Last Name 688**] mental status. She was able to tell EMS her name and that she has a history of HIV, Hepatitis C, and substance abuse. . In the ED, initial VS: 100.1 BP 108/69 HR 114 RR 16 SpO2 97%. She received a total of 8 L NS for her hypotension (SBP in the 80s)with little response. The decision was made to undergo elective intubation to protect her airway given her poor mental status. She was started on fentanyl/versed for sedation. After intubation her blood pressures normalized. NG tube was placed, suction yeilded 500 cc yellow bilious fluid. Given her fever, altered mental status and HIV status she underwent CT head followed by LP. Head CT showed no acute lesions or bleeds. LP showed mildly elevated WBC count with significant lymphocytic predominance. She was started on empiric meningitis therapy with decadron, ceftriaxone, vancomycin, ampicillin, and acyclovir. Patient's lung exam and mental status were concerning for aspiration and she was started on flagyl. She received 1 gram of acetaminophen for fever. . On arrival to the ICU patient is hemodynamically stable, she is intubated but becoming more alert. Her belongings were searched and several recent prescription medications were indentified. MEDICAL HISTORY: 1) HIV: no history of being on HAART; reports she is monitored at [**Hospital1 2177**], last CD4 > 1000 2) HCV: No history of treatment; considering starting IFN 3) Polysubstance Abuse MEDICATION ON ADMISSION: Gabapentin 800 mg po tid Clonidine 0.1 mg po tid Promethazine 50 mg po daily Suboxone (unknown dose) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals - T: BP: 121/76 HR: 63 RR: 16 02 sat: 100% GENERAL: intubated, sedated HEENT: mmm, PERRL, pupils 4mm, anicteric sclera, no conjunctival pallor CARDIAC: RRR, no MRG LUNG: CTA anteriorly ABDOMEN: soft, obese, + bs, ntnd, no HSM EXT: warm, dry, 2+ distal pulses NEURO: unable to assess DERM: No rashes, no track marks FAMILY HISTORY: Unable to assess SOCIAL HISTORY: Unable to assess. Patient told ED staff that her mother was watching her children.

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 30 year old female with h/o asthma who presented with respiratory distress. She reported one to two weeks of rhinorrhea and cough productive of clear sputum, as well as increased wheezing. She needed an increase in frequency of nebs at home and was using them every 4 hours. . This morning, she presented to her PCP's office with SOB after waking up feeling acutely worse. She was found to have an O2 sat of 89%RA and tachycardia to 110. She was given a set of nebs and EMS was called. EMS gave her 125mg IV solumedrol and 2 more nebs. . In our ED, initial vitals were HR 104 RR 29 O2 Sat 97%NRB. She was reportedly diaphoretic and tripoding with prolonged I/E ratio with significant wheezing. She was given continuous duonebs, 2g IV mag, and Zofran (for nausea). She was put on BiPap and felt symptomatically improved with FiO2 100% with pressure support of 3. ABG was done while on BiPap which showed 7.15/65/579/24. She was subsequently intubated due to fatigue. Also given epinephrine x 1. Vitals on transfer T 95.0 HR 117 BP 135/84 RR 22 O2 100% on BiPap. She has 2 PIVs for access. . Notably, she had an admission to [**Hospital1 112**] in [**2159**] for similar symptoms. At that time she was intubated and was difficult to ventilate in spite of continuous nebulizers and high-dose steroids. She was paralyzed on Nimbex and started on heliox. She had a bronch that revealed sputum positive for staph and treated with nafcillin. She also developed pneuomediastinum and pneuoperitoneum felt to be [**1-6**] high ventilatory pressures. She had a normal esophagogram and her ABGs improved. She was extubated 8 days after admission. She also had sinus tachycardia with T wave inversions in V5-V6 that were new and EF showed concentric LVH with EF 40-45% felt to be due to her high ventilatory pressures and severe asthma exacerbation. MEDICAL HISTORY: Severe Asthma s/p recent intubation [**12/2159**] at [**Hospital1 112**] similar to this admission, also with intubation at age 18 Depression MEDICATION ON ADMISSION: Singulair 10mg po daily Albuterol 2.5mg/3ml nebs q4-6h prn Sronyx 01.mg-20mcg po daily (OCP) Albuterol 90mcg inh q4-6h prn Citalopram 40mg po daily Advair 500mcg-50mcg [**Hospital1 **] (fluticasone) ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: On admission VS: T 96.4 HR 99 BP 153/90 O2 Sat 98% on AC TV 380 RR 16 PEEP 5 FiO2 100% GEN: Intubated, but agitated at times, gasping breaths of air despite being on ventilator HEENT: Small but equal and reactive pupils, EOMI, anicteric, MMM, op without lesions, significant nasal flaring with respirations RESP: Significant wheezing throughout, bilateral breath sounds with moderate air movement on ventilator CV: Tachycardia with regular rhythm ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: no c/c/e SKIN: no rashes/no jaundice/no splinters . At Discharge PHYSICAL EXAM: Vitals - Tc:97.5 BP:129/82 (129-176/86-104)HR:80(71-90) RR:16 02 sat:99% RA GENERAL: young female appearing alert no acute distress HEENT: Mild pain on active rotation, flexion and extension at neck, no pain on passive movement. Pain improved with palpation. PERRLA, mucous membs moist, no lymphadenopathy CHEST: CTABL, no crackles, no ronchi CV: S1 S2 Normal in quality and intensity RRR no murmurs rubs or gallops ABD: Non-distended, BS normoactive, Soft, non-tender, no organomegaly EXT: warm, well perfused, no edema. Dorsalis pedis pulses 2+ BL. FAMILY HISTORY: Father has asthma Both parents with cerebralpalsy SOCIAL HISTORY: Lives with boyfriend in [**Name (NI) 86**]. Per family, does not smoke or use other drugs. Report of previous marijuana use (unconfirmed with patient). Used EtOH in college. Has cat at home.

CHIEF COMPLAINT: respiratory failure s/p ingestion PRESENT ILLNESS: 30 y/o M with PMHx of Polysubstance abuse and Rheumatoid Arthritis who was found down in his apartment after polysubstance ingestion. Pt was last seen at 10pm on Sat evening and today, his girlfriend found him unresponsive on the floor of her apartment. When EMS arrived, pt was lethargic and breathing with RR of 4, BS of 41 and received 1 amp D50. He was noted to have pinpoint pupils for which he received Narcan x 3 without any improvement in MS. EMS attempted to place an oral airway and pt was being bagged on arrival to the ED. . In the ED, initial documented vs were: P 59 BP 187/118 R 16 O2 sat 97% with oral airway. There were multiple traumatic intubation attempts which were unsuccessful and he ultimately underwent a nasal intubation by anesthesia. The ABG was obtained during the attempted intubations and revealed a severe respiratory acidosis. While in the ED, he underwent a CT C-spine and CT head that were negative and was given a total of 3L of NS IVF. Tox screen was positive for benzos and ETOH level of 12. Tox was consulted but has not seen the patient yet. Pt was notably hypertensive on propofol and therefore did not have a central line placed. . On arrival to the MICU, pt was intubated and sedated. Additional history was obtained from mother and girlfriend who had found him on the floor of her apartment earlier this evening. The girlfriend reported that he was unresponsive and surronding my bottles of alcohol, crack pipes, herbal internet sleeping [**Doctor Last Name 360**] and possible industrial cleaner. . Review of systems: unable to obtain MEDICAL HISTORY: Rheumatoid Arthritis s/p bilateral knee replacements h/o septic knee s/p washout and removal of hardware Seizures (in setting of substance abuse) Depression (no h/o suicide attempts or intentional overdose) MEDICATION ON ADMISSION: Neurontin Naltrexone Chinese Herbal Medications ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission to MICU General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Occasional rhonchi R>L 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; scarring from previous b/l knee arthroscopies On discharge from MICU General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, 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; scarring from previous b/l knee arthroscopies FAMILY HISTORY: NC SOCIAL HISTORY: Pt was living on his own until [**9-10**] when he moved back in with his mother. [**Name (NI) **] smokes 1 ppd and has a h/o polysubstance abuse including IVDU, cocaine and international internet purchased sedatives. He has a PhD and works at local college as a teacher. Pt has a h/o ETOH abuse and was actively participating in AA until 6mths ago.

CHIEF COMPLAINT: Left hand pain and numbness PRESENT ILLNESS: 57-year-old man w/ history of an MI in [**2112**] with clean coronaries and felt to be [**3-7**] emboli, mitral valve repair in [**2111**], a St. [**Male First Name (un) 923**] Identity pacemaker placed on the right side for complete heart block in [**2105**], and a recent BiV pacer replacement in [**2122-1-9**] for dilated cardiomyopathy. For this recent pacer change, he was off coumadin from [**1-4**] through [**1-14**]. INR yesterday 1.8 at Quest labs. On Monday, he began to notice left hand discomfort and swelling. He was [**Last Name (un) 104483**] to see his PCP until Wednesday, who noted swelling and referred him to Dr. [**Last Name (STitle) 1391**]. On the morning of admission, he saw Dr. [**Last Name (STitle) 1391**], who noted, no pulses in left radial and sent him for CT scan, which revealed large clot in left atria, left ventricle, and embolus to left brachial artery. In the ED,T98.0 BP 134/86; HR 82 O2Sat 99%RA. Dr. [**Last Name (STitle) 1391**] asked Dr. [**Last Name (STitle) **] to evaluate patient, and it was decided that medical management with no embolectomy at this time. He received heparin 5000 bolus, then 100/hour, no lysis. Coagulopathy w/up (ACL Ab, V leiden) initiated. Non-contrast abd CT to r/o thrombus showed no other emboli/infarcts. Patient was admitted to CCU for closer monitoring. Upon arrival to CCU, he is without complaints and feels at baseline except for a very mild [**2-12**] achiness in left chest, nonradiating, not associated with any movements, and different from previous MI pain. Cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Otherwise, on review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: # Hyperlipidemia # s/p embolic MI [**2112**] with no CAD noted on cath # Severe dilated cardiomyopathy # [**2122-1-9**]: [**Company 1543**] Concerto BiVentricular ICD: DDD mode, lower rate 50 beats per minute; treat rates greater than 188 beats per minute. # Congenital heart block, s/p right sided pacemaker placed in [**2105**] # Heart failure # Mitral regurgitation: s/p mitral valve repair [**2111**] at [**Hospital1 756**] and Women??????s # Hemorrhoids # Hernia repair [**2112**] MEDICATION ON ADMISSION: Coumadin 5mg MWF, 4mg Tu/Th/Sat/Sun last dose [**1-4**] Simvastatin 80mg daily Digoxin 0.125mg daily Captopril 6.25mg TID Metoprolol 12.5mg daily Zetia 10mg daily Coenzyme Q 10 100mg daily Nitrostat as needed [**Doctor First Name **] 60mg daily Celexa 10mg [**Hospital1 **] ([**2-4**] of 20mg tab) ALLERGIES: Percocet / Iodine; Iodine Containing PHYSICAL EXAM: VS: T 98.6 , BP 125/68 , HR 89, RR 18, 96%RA Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: no LAD, thyromegaly CV: RR, normal S1, S2. No S4, no S3; I/VI systolic murmur at RUSB Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. Ext: nailbed reperfusion <1sec, warm well perfused, no cyanosis Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; 2+ DP; 2+ PT; 2+ radial Left: Carotid 2+ without bruit; 2+ DP; dopplerable PT; dopplerable radial FAMILY HISTORY: [**Name (NI) **] brother: same congenital heart block and MV, died stroke age 34 Mother: stoke in 80's Father: AAA, currently still alive 2 Sisters: no known hx of miscarriages SOCIAL HISTORY: Pt works as a software writer and also plays [**Doctor Last Name **] piano. He is married. Quit smoking age 29. 1-2 drinks/week. No elicits.

CHIEF COMPLAINT: SOB PRESENT ILLNESS: 80 y/o with hx of HTN, anxiety, several herniated discs, polyarthralgia on prednisone who was hospitalized at [**Hospital1 **] for recent pna/sepsis with + blood for strep pneumo and is now transferred from [**Hospital1 39933**] ICU for further management of PE and pericardial effusion. Pt was admitted to [**Hospital3 **] on [**2120-1-20**] for pneumonia. She states that she had a head cold during the week of admission, she then developed severe chest pain "sharp/pressure like" on mid substernal and left side of chest. This was accompanied by nausea/vomiting and diaphoresis. It lasted ~ 2 hours before she called 911. At [**Hospital3 4107**], she had CT of chest W/o contrast that showed right upper lobe consolidation as per CT report and no pleural effusion. she was diagnosed with pna and sepsis from strep pneumo. Uncertain if workup was done to r/o MI. As per family, she was in the ICU for 3 days, but was never intubated. She was treated with ceftriaxone IV and Azitro for total of 7 days. She was discharge home on [**2120-1-26**] on Ceftin 500mg [**Hospital1 **]. As per family she developed LE edema R>L while hospitalized. This was thought to be due to fluid overload and she was given lasix. Since her discharge she had SOB with min exertion. She denies having any chest pain or discomfort. Her SOB seem worse yesterday and she became febrile up to 101 and went back to [**Hospital3 4107**]. She had a repeat CTA today that showed bibasilar atelectasis, mod-to-large pericardial effusion (new), bilateral pleural effusions, RUL PE. She was evaluated by cardiologists. A TTE was done and that was no tamponade. She was started on heparin drip for her PE and given concern for bleeding, she was tranfer here for further evaluation. As per report her SBP of 132 and she had no pulses, HR in 105-111 on time of transfer. She also had LENIs prior to transfer that were negative for DVT. . Of note, pt has been taking prednisone 10mg PO Qday for polyarthritic pain. She states that the prednisone was not helping and she stopped ~ 1 week ago. . She arrived in the MICU , except for increase in RR in the low 30s. Her HR is sinus tachy in low 110s-130s, with SBPs in 150s. Initial pulsus measured at 12. Sating 95-97% on 2L NC. Bedside echo was performed, which showed RV diastolic collapse and an echdense effusion. At this time, it was determined that she would be drained in the morning, as she was maintaining good pressures at the time. She was [**Hospital 71236**] transferred to the CCU for further management. . On review of systems, she states she did have a fever to 101 at home prior to presentation to [**Hospital3 4107**]. She denies any prior history of stroke, TIA, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. S/he denies recent fevers, chills or rigors. S/he denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for stable ankle edema and mid-shin ankle erythema. Notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Hypertension 2. CARDIAC HISTORY: No known . 3. OTHER PAST MEDICAL HISTORY: HTN Several disc herniations Kidney stones Anxiety Polyarthritis GERD Osteoporosis BCC on the Leg and SCC on the hand [**Last Name (un) **] during this recent admission in [**Month (only) **] with creatine up to 3.0 MEDICATION ON ADMISSION: Benicar 40mg daily Cefuroxime 500mg [**Hospital1 **] Diovan/HCTZ 12.5mg [**Doctor First Name **];y Lasix 20mg daily Lorazepam 0.5mg [**Hospital1 **] prn Prazosin 1mg daily Tramadol 60mh daily Ambien 10mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]: VS: T= 100.8 BP= 170/61 HR= 109 RR= 34 O2 sat= 95% 2L GENERAL: Anxious, mild respiratory distress. HEENT: Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 12 cm. CARDIAC: PMI located in 5th intercostal space, midclavicular line. Irreg Irreg, no m/r/g. LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: + erythema on kid shin bilaterally PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: SOCIAL HISTORY - Tobacco history: Denies - ETOH: Social - Illicit drugs: Denies

CHIEF COMPLAINT: DOE PRESENT ILLNESS: 57M w/ CAd, CHF presents with DOE and CP x 1 wk. Went to an OSH, ECG unchanged, given ASA, NTG. Pain free at that time. Tx'd to [**Hospital1 18**] for eval of unstable angina. Pt reports 17lbs weight gain over last 2 weeks and dietary indiscretion, eating Deli meats. Taking all meds as ordered. He also notes cough w/ green sputum. Has increase in orthopnea 2 pillow to 4 pillow. MEDICAL HISTORY: CHF, EF 18% CAD s/p CABG x 2 [**2180**] and [**2181**]. LIMA to LAD down, multiple SVGs down, radial artery conduit to RCA down. Only patent graft is radial artery conduit to LAD. CRF baseline Cr 1.4 PVD w/ multiple interventions in legs A. fib AICD/pacemaker h/o V. tach GERD Depression DM2 hypercholesterol HTN psoriasis MEDICATION ON ADMISSION: ASA 325 qd, Amio 400 qd, lisinopril 20 qd, neurontin 800 q am, 1600 qhs, plavix 75 qd, lipitor 120 [**Hospital1 **], Toprol XL 50 qd, Zoloft 200 qd, Iron 300 qd, NTG Sl prn, Glucotrol XL 10 qd, Insulin 75/25 25u q am, 32u q dinner, coumadin 2.5-5mg qd per PCP ALLERGIES: Glucophage PHYSICAL EXAM: 96.9, 77, 126/66, 18, 97%5LNC NAD HEENT: JVP to angle of jaw Chest: crackles 1/2 up bilat CVS: RRR Nl S1/S2, no S3/S4, + 1/6 systolic murmur at [**First Name9 (NamePattern2) **] [**Last Name (un) **]: + BS NT/ND ext: 2+ edema bilat, 2+ pulses DP on L, 1+ on R Neuro: A&O x 3 non-focal FAMILY HISTORY: Mother MI, CVA SOCIAL HISTORY: 45 pack yr h/o smoking, quit [**2180**]. No EtOH/drugs

CHIEF COMPLAINT: hypoxia PRESENT ILLNESS: 87yo male w/ ischemic cardiomyopathy with an EF of 45% s/p PPM/AICD placement in [**2113**] for AV block, HTN, and possible sarcoidosis who presents with two days of shortness of breath. Presents with worsening breathing since yesterday. Family reports a mechanical fall onto bottom yesterday. Has not been altered since. Just worse breathing over course of 24-48 hours. No fevers, chest pain or worsening pedal edema. Was at clinic for foley placement with urology for urinary retention and noted to be tachypneic, breathing in the 30s. Sent here for further eval. Has been off of metoprolol b/c of hypotension. . He has had multiple recent admissions. On admission from [**1-13**] to [**1-14**], patient presented with acute onset shortness of breath with [**Month/Year (2) **] productive of whitish sputum without fever or leukocytosis, felt to be consistent with bronchiectasis flare. Sxs resolved overnight so pt was discharged on ciprofloxacin to be completed on [**1-23**]. [**1-19**] to [**1-23**] he was admitted for hyopxia that improved while on BiPAP. That time he was found to have a DVT and was presumed to have a PE, started on lovenox bridge to coumadin. Treated for PNA with vanc/cefepime, then levofloxacin. . In the ED, initial VS were: 97.8 120 110/70 28 100% 10L. Crackles at L lung base, mild wheeze. Afebrile. Portable CXR looked okay. BNP up to 939. Pressures into 80s, responded to 500ccs of fluid. Tachycardic to 130s, down to 110 with fluid. UA negative. Down to venti mask, dipped down to 90 with nasal cannula. Ordered for vanc/Zosyn. Full code. Prior to transfer, patient became hypotensive to the 80s. A CVL was placed, given 1L NS and started on Levophed. CTA looked like aspiration pneumonia. . On arrival to the MICU, patient denies pain. Per his wife he is 'not himself'. He is exasperated with being in the hospital. MEDICAL HISTORY: bradycardia - with primary AV block s/p AICD and pacer placement Recurrent urethral strictures [**12-29**] childhood infection Mild systolic dysfunction - EF of 40-45% on Echo in [**2110**] Chronic [**Year (4 digits) **], congestion and hoarseness with referral forpossible sarcoidosis. Chronic sinusitis. Osteoarthritis. Right knee surgery. Repeated hypoxia episodes from ?bronchiectasis flares MEDICATION ON ADMISSION: 1. finasteride 5 mg daily 2. furosemide 40 mg daily 3. metoprolol tartrate 12.5mg [**Hospital1 **] 4. rosuvastatin 20 mg daily 5. potassium chloride 20 mEq Tablet QOD 6. sertraline 25 mg daily 7. tamsulosin 0.4 mg QHS 8. aspirin 81 mg Tablet daily 9. multivitamin daily 10. calcium carbonate 200 mg calcium (500 mg) [**Hospital1 **] 11. Aleve 220 mg [**Hospital1 **] PRN pain 12. terazosin 5 mg QHS 13. sodium chloride 0.65 % Aerosol, Spray Sig: [**11-28**] Sprays Nasal QID (4 times a day) as needed for nasal congestion. 14. ofloxacin 0.3 % Drops QID 15. fluticasone 50 mcg/actuation nasal spray daily 16. levofloxacin 750 mg until [**1-30**] 17. warfarin 4 mg as instructed 18. Lovenox 110mg daily until yesterday 20. albuterol sulfate 2.5 mg /3 mL (0.083 %) nebs Q6hrs 21. guaifenesin 50 mg/5 mL Q6hrs PRN [**Month/Year (2) **] ALLERGIES: sulfa or amoxicillin PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: General: Alert, oriented, no acute distress though mildly tachypneic HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear, EOMI, PERRL Neck: supple, JVP flat, no LAD CV: tachycardic but regular, normal S1 + S2, slight systolic murmur loudest at apex. No rubs, gallops Lungs: Diffusely rhonchurus with good air movement Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. 1+ pitting edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation . DISCHARGE PHYSICAL EXAM: Vitals: 98.1/98.1 132/60 [108-132/52-60] 61-109 20 96-99% 2L General: elderly M who appears short of breath, AAOx3 HEENT: PERRL, EOMI, dry MMs, eyes closed NECK: supple, no JVD CARDIAC: RRR S1 S2 no R/M/G LUNGS: CTAB. No C/W/R. [**Last Name (un) **]: SNTND +BS no HSM EXTREM: 2+ pulses BLE, no C/C/E SKIN: bruises on BUE FAMILY HISTORY: Father died of CVA; sister has [**Name (NI) 4278**]. SOCIAL HISTORY: Denies smoking, alcohol use, recreational drug use. Lives at home with wife.

CHIEF COMPLAINT: Transfered from OH for evaluation and management of ICH PRESENT ILLNESS: Ms [**Known lastname **] is a 63 year old woman with a hx of smoking, HTN, high cholesterol and family hx of intracranial aneurysm who presented to [**Hospital **] Hospital this morning complaining of back pain. According to her husband, she was in her usual state of health until last night, when she began to experience upper back pain. He rubbed her back and she felt slighltly better and went to bed. This morning, she told him that she slept well, but still had back pain. She decided to sit in a "massage chair" at her home (which has vibration and roller in the chair. At that point, the pain became excruciating and she told her husband to take her to the hospital. She did not have headache or weakness at that point. They drove to [**Hospital **] hospital where she arrived at 9:40AM. She walked into the hospital and was noted to be "visibly uncomfortable, clutching her chest" On presentation, her vitals were 97.8 HR 78, BP 207/94. Initially, telemetry/EKG revealed bigemeny which converted to NSR. She was given NS x 1Liter and 4mg IV morphine for pain (at 10:55AM). She began vomiting and was given Zofran. She then became more lethargic and was noted to have a "flaccid left arm and leg". She was taken for head CT where she was found to have a large right frontal hemorrhage. She was intubated for airway protection and transferred here for further management. On arrival to [**Hospital1 18**], BP was 214/108 HR 69. She was started on labetalol drip. Rpt head CT was without change and CT chest to evaluate for aortic aneurysm was negative. MEDICAL HISTORY: HTN High cholesterol Smoker MEDICATION ON ADMISSION: ASA 81mg Atenolol 50mg qd Lipitor (3x/week) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals - Afeb BP 180/78 HR 75 RR 18 O2 sat 100% FAMILY HISTORY: Father died of SAH due to intracranial aneurysm in 70's. Mother died in 60's from "bone cancer". Has 2 brothers and one sister who are generally healthy SOCIAL HISTORY: Lives in a 2 family home with her husband. [**Name (NI) **] son and his family also live in the same house. She recently began smoking again after having quit for 3 years (former 1.5ppd). Rare EtOH. No drugs. Recently retired in [**Month (only) **]

CHIEF COMPLAINT: L sphenoid [**Doctor First Name 362**] meningioma PRESENT ILLNESS: 55y/o female with h/o ALS presents to ED c/o worst headache of life. She reports that her headache was sudden onset upon awaking this morning and is located in her temporal areas bilaterally. She also reported n/v, photophobia and dizziness. She was brought to [**Hospital1 18**] by her sister. She denies any h/o headaches, migraines, or seizures. MRI was done in ED which showed L frontal mass. MEDICAL HISTORY: ALS, GERD, depression MEDICATION ON ADMISSION: celexa 20mg daily gabapentin 300mg hs lithium 300mg [**Hospital1 **] oxybutyn rilutek 50mg [**Hospital1 **] Tianozidine 2mg HS ALLERGIES: Erythromycin / Phenytoin PHYSICAL EXAM: On Admission: T:98.3 BP:118 / 83 HR:77 R 20 O2Sats:100% Gen: WD/WN, comfortable, NAD. HEENT: normocephalic, atraumatic Pupils: 3-2mm Bilaterally EOMs: intact Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**2-8**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Family Hx:no brain tumors in family SOCIAL HISTORY: Social Hx:[**12-10**] glass of wine/week, denies tobacco or illicit drug use.

CHIEF COMPLAINT: Bladder CA PRESENT ILLNESS: 69M invasive bladder CA elected to proceed w/ lap cystectomy per Dr. [**Last Name (STitle) 3748**] and open neobladder w/ Dr. [**First Name (STitle) **]. MEDICAL HISTORY: 1) Myocardial Infarction - 17 yrs ago, treated at [**Hospital **] Hospital. Patient reports receiving a "clot busting medication" ? tPA, hospitalized x 6 days and discharged. Did not take medications after discharge nor did he see a physician [**Name Initial (PRE) 14169**] . No history of other hospitalizations or illnesses . Patient does report multiple abrasions, minor lacerations etc that have occurred during his work as a self-employed contractor. MEDICATION ON ADMISSION: Simvastatin 10 Lopressor 100 [**Hospital1 **] Doxazosin 4 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: AVSS NAD S/NT/ND FAMILY HISTORY: Mother died at 92. Father died in early 70's from asbestosis SOCIAL HISTORY: Married, lives with wife in [**Name (NI) **]. 30+ pack year history of tobacco, quit 10+ years ago. Does not and never has drunk alcohol (confirmed with family). No history of illicit drugs. Works as construction worker.

CHIEF COMPLAINT: low blood sugar PRESENT ILLNESS: 70 year-old female with history of diabetes, HTN, MRSA foot infection, recent C. diff, who presents with hypoglycemia. She initially had viral symptoms of cough, decreased PO's, and found to have low BG's to 60's. She was given 1 amp D50 for BG 23--> 158 in the ED. Patient found by NF resident to have profound asymptomatic episodes of hypoglycemia, which were attributed to likely decreased clearance of glyburide. She was given an additional [**12-22**] amp D 50 +apple juice and toast at MN for a BG of 49 and two hours later a full amp of D 50 + juice and crackers for a BG of 45. At 4am she was found w/ persistent low BG of 25 and was started on D5 1/2 NS at 100cc/hr. At that time, she still had no symptoms and was mentating appropriately. At 6am her BG was 28, w/o symptoms, and was started on D10 gtt at 100/hr. At 7:30 am , resident was called for unresponsivess. Pt found to be unresponsive to sternal rub, BG of 26, so she was transfered to the medical ICU for closer monitoring. MEDICAL HISTORY: Right Femur Fx S/P ORIF ([**10/2165**]: Tripped Over Commode), HTN, Hyperlipidemia, DMII, Peripheral Neuropathy, Obesity, IBS (Chronic Constipation, Abdominal Pain and Intermittent Diarrhea), Crohn's Disease, Chronic LBP/Sciatica (Osteoporisis, DJD/OA, Spinal Stenosis), Depression/Anxiety, Panic Disorder, Parotid Gland Tumor S/P Resection, S/P Multiple Falls, H/O Herpes Zoster, S/P CCY, B/L Cataract Removal. * Pertinent Studies: pMIBI ([**2160**]): No ECG changes or anginal symptoms. IMPRESSION: Normal Persantine stress study with a small defect in the high anterior portion of the lateral wall, likely artifactual. EF of 65% MEDICATION ON ADMISSION: Oxycodone HCl 5 mg PO Q6H prn Gabapentin 300 mg PO BID Clonazepam 1 mg PO QHS Doxepin HCl 100mg QHS Tizanidine HCl 4 mg QHS Atorvastatin Calcium 20 mg PO DAILY Diphenhydramine HCl 25 mg PO HSprn Fluoxetine HCl 20 mg PO DAILY HCTZ 25 mg DAILY Pantoprazole 40 mg Q24H Mesalamine 800 mg Tablet PO TID Glyburide 10mg PO BID Bisacodyl 10 mg Tablet PO DAILY prn Elidel 1 % Cream 1 tsp Topical DAILY prn psoriasis Docusate 100 mg PO BID Clonazepam 0.5 mg PO TID prn Olanzapine 10 mg PO HS Aspirin 325 mg Tablet PO DAILY Lisinopril 2.5 mg daily Pioglitazone HCl 30 mg PO DAILY Cyanocobalamin 50 mcg DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: vitals- 96% on RA, T 99.4, BP 85/40, HR 77 NSR Gen- obese, lethargic, minimally responsive to sternal rub-->opens eyes heent- PERRLA. membranes moist pulm- clear to auscultation. occ wheezes cv- RRR. normal S1/S2. no m/r/g abd- soft, NT/ND ext- R foot heel ulcer, clean and dry. no pus or bleeding neuro- not able to follow commands. FAMILY HISTORY: Her mother had DM. She knows nothing of her father. [**Name (NI) **] sister died of [**Name (NI) **] at 60. SOCIAL HISTORY: She lives with her daughter, who is very involved with her care. She had 11 children, and one passed away. She was a homemaker. She quit smoking 20 years ago and had between [**4-29**] py. She uses ETOH rarely (<1x/month).

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: 82 yr old female w/hx of gout, CAD s/p PCTA of in-stent restenosis of prox LAD lesion [**2134-4-26**], diastolic dyfunction, AF s/p successful DCCV [**4-18**] on amidoronone, who has been admitted twice last month for CHF exac. At [**Hospital 100**] rehab, pt was noted to be short of breath with increased orthopnea. Initial story was that pt was given fluid bolus as well as signficant amount of fluid via heparin bolus, as precipitant for heart failure. [**Hospital 100**] rehab physician denies this. Transferred to [**Hospital1 18**] for eval. Also, was being bridged on heparin and coumadin for recent AF. PTT >200 and INR >10 at [**Hospital 100**] Rehab, so she was given PO and IV vit K. In the ED, given 2mg IV morphine, lasix 80mg IV X 1, and ntg gtt started. Given her resp distress she was also started on BiPAP 10/10. Pt's BP dropped from SBP 180's to 80's. She remained assymptomatic during this episode. Febrile to 101 on admission. NTG stopped, and BiPAP stopped. She was taken to the CCU. Of note, she c/o abd pain that lasted ~30 minutes, relieved with defecation. No bloody diarrhea or persistent belly pain. MEDICAL HISTORY: 1. Atrial fibrillation status post DCCV on [**2133-3-18**] and again on [**2134-3-23**] (still in AF) - chronically on coumadin. Successfully cardioverted [**4-18**]. Being bridged with hep and coumadin at [**Hospital 100**] Rehab. 2. Hypercholesterolemia/HTN 3. UTI: Klebsiella in past (pansensitive) 4. Diastolic congestive heart failure. Hemodynamic evaluation revealed moderately to severely elevated right-sided pressures (mean RA was 17 and RVEDP was 22 mmHg), severely elevated left-sided pressures (mean PCW was 29 and LVEDP was 31), and severely elevated pulmonary pressures (PA was 67/33 mmHg). There were prominent V waves on the PA tracing up to 50 mmHg, 2+MR. 5. CAD: s/p PCI of the proximal LAD on [**2130-2-23**], then had NSTEMI and in-stent restenosis treated with PTCA [**2134-4-26**] and PTCA of mid-LAD 70% lesion 6. Gout. 7. Obesity. 8. Obstructive sleep apnea on CPAP (setting of 12). 9. Status post cholecystectomy. 10. History of spinal stenosis MEDICATION ON ADMISSION: Allopurinol 100mg qd amiodarone 200mg qd asa 325mg qd atenolol 50mg qd plavix 75mg qd simvastatin 80mg qd Valsartan 40mg qd Trazodone prn warfarin 5mg qhs lasix 40mg qd ALLERGIES: Ciprofloxacin / Ambien PHYSICAL EXAM: Gen: NAD, obvious distress HEENT: MMM, no dentures, 11cm JVP CV: RRR, no m/r/g though distant HS Lungs: L>R crackles up 1/2 bilaterally Abd: + BS, soft, Nt, ND obese. No peritoneal signs. Skin shows mild breakdown and erythema. Ext: 1+ pedal edema to knees. Preserved peripheral pulses. Neuro: A&Ox3. non-focal FAMILY HISTORY: n/c SOCIAL HISTORY: Very functional, lives alone. She is able to shop, drive, all ADLS. She does not smoke or drink. Her daughter is her health care proxy. She has three children.

CHIEF COMPLAINT: SOB PRESENT ILLNESS: 58M with EtOH cirrhosis s/p TIPS placement, hx of R hydrothorax with last EtOH use in Winter [**2174**], who s/p day 7 for a thoracentesis and paracentis. Patient presents today with SOB. He feels most comfortable when he lies on his right side. He denies any chest pain or palpitations. He initially felt better after these interventions. However he has since noted increasing abdominal distention. He denies any n/v/f/c/abd pain. . In the ED, the patient's vitals were as follows: T98 BP 125/76 HR 102 R22 O2sat 97%RA. CXR showed a very large right-sided pleural effusion increased since the [**2175-5-6**] study. The liver fellow was contact[**Name (NI) **] who recommended admission and thoracentesis in the AM. MEDICAL HISTORY: 1. EtOH cirrhosis: decompensated with ascites and varices, on transplant list 2. Colonic adenoma: polypectomy in [**2171**] 3. Esophageal varices: grade 1 on last EGD in [**8-26**], s/p banding of grade II varices in [**10-25**], h/o hematemesis in the past 4. Cholelithiasis 5. Partial colectomy: at [**Hospital3 **] in [**2158**] [**2-24**] severe GI bleed after polypectomy 6. hernia repair MEDICATION ON ADMISSION: HydrOXYzine 25 mg PO DAILY:PRN BuPROPion (Sustained Release) 100 mg PO QAM Lactulose 30 ml PO TID FoLIC Acid 1 mg PO DAILY Furosemide 40 mg PO BID Spironolactone 100 mg PO DAILY Hexavitamin *NF* one cap Oral daily Ursodiol 300 mg PO BID ALLERGIES: Percocet PHYSICAL EXAM: VS: Tc 98, BP 125/76 HR 102, RR 22, SaO2 97%/RA General: chronically ill-appearing male in NAD, able to speak in full sentences, lying comfortably in BED HEENT: NC/AT, PERRL, EOMI, no scleral icterus,no LAD, MMM, OP clear Chest: decreased BS over right lung base, no RRW CV: nl rate, S1S2, II/VI HSM along LUSB Abd: soft, NT, distended, +fluid wave, no peritoneal signs Ext: no c/c/e, wwp Neuro: no asterixis, CN II-XII intact, no motor or sensory abnormality FAMILY HISTORY: no fam hx of cirrhosis/liver disease; 6 siblings, all healthy. parents both alive and healthy SOCIAL HISTORY: Catholic Priest. [**Name (NI) **] children. No tobacco. Currently no EtOH. Formerly a heavy drinker (cannot quantify). Currently living with parents.

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Ms. [**Known lastname 12307**] is an 80 year-old Russian speaking woman with a history of DM, CAD s/p CABG, dCHF, and PAF who presents with dyspnea and is admitted to the MICU for respiratory distress. She was recently discharged on [**2122-2-26**] after presenting with [**Last Name (un) **] in the setting of increased lasix intake and ?AIN. She was doing well at [**Hospital 100**] Rehab until yesterday when she was noted to be dyspneic and lethargic with a diminshed appetite. Her symptoms of dyspnea worsened until this morning when she was was found to be satting 70% on room air. Lasix 40 iv was given, an ABG on 100%NRB was 7.48/37/239 at 4 p.m., and she was transferred to the [**Hospital1 18**] for further evaluation. MEDICAL HISTORY: 1. Coronary artery disease s/p CABG x 3 and mitral valve repair (bioprosthetic) - post-operative course complicated by prolonged mechanical ventilation requiring tracheostomy and PEG tube placement, C. diff colitis, and upper GI bleed 2. History of type B thrombosed aortic dissection (seen on chest CTA [**2122-2-23**]) 3. h/o Clostridium difficile colitis 4. h/o Upper GI Bleed 5. Gallstones diagnosed 30 years prior. 6. Type II diabetes, on oral agents. 7. Hypertension. 8. Status post hysterectomy. 9. History of benign mastitis and lumpectomy. 10. History of paroxysmal atrial fibrillation. 11. T11 Vertebral Compression fx ([**1-/2123**]) MEDICATION ON ADMISSION: MEDICATIONS AT HOME (per discharge summary): Levothyroxine 150mg qAM Furosemide 20mg [**Hospital1 **] Spironolactone 25mg qAM ASA 325mg daily Amiodarone 200mg qAM Vit B12 1,000mg qAM Omeprazole 20mg qAM Diltiazem 30mg TID Glipizide 25mg qAM Glipizide 12.5mg qHS Magnesium 400mg [**Hospital1 **] Simvastatin 40mg qHS . MEDICATIONS AT REHAB (per discharge summary): 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) 2. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg PO BID (2 times a day). 3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) dose Injection TID (3 times a day): Until ambulatory. 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) 5. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY 6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 8. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 9. Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray Sig: One (1) dose Nasal DAILY (Daily). 10. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for pain or fever. 11. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for nebulization Sig: One (1) inhalation Inhalation Q4H (every 4 hours) as needed for wheezing. 12. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 13. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for anxiety or insomnia 14. Furosemide 10 mg/mL Solution Sig: Ten (10) mg Injection DAILY 15. Insulin Regular Human 100 unit/mL Solution Sig: Insulin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 98 117/50 95 100%5L GEN: tachypneic but able to speak in full sentences SKIN: multiple ecchymoses over extremeties and abrasion on right forearm and left leg HEENT: unable to assess JVP. no cervical LAD CHEST: diminished breath sounds, limited exam [**3-16**] stethoscope CARDIAC: irreg, no murmurs ABDOMEN: distended, soft, nontender EXTREMITIES: 1+ LE edema NEUROLOGIC: Alert and appropriate x 3. CN II-XII grossly intact. BUE [**6-16**], and BLE [**6-16**] both proximally and distally. FAMILY HISTORY: No history of sudden cardiac death. SOCIAL HISTORY: Home: Russian-speaking only. Lives with husband. Had prolonged hospitalization and rehab course after CABG and MVR in [**4-20**]. At rehab after most recent discharge. Supportive family. Never smoked. Occupation: Retired physician [**Name Initial (PRE) **]: Denies Drugs: Denies

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 76 yo M w/ h/o DM, HTN, hypercholesterolemia, NSCLC s/p resection, progressive on multiple chemo regimen, presents to the ED with 3 days of worsening N/V/D, found to be fevebrile, hypotensive, hypoxemic. On [**6-8**] c1w2 of taxotere (3wks on 1wk off). Tolerated well until 3 days ago when he developed non-bloody diarrhea after he went out to eat at a restaurant. He called the fellow on call and was given imodium which he [**Last Name (un) **] w/o significant relief. Today, pt's wife called to inform Heme/Onc fellow that Mr. [**Known lastname **] is having n/v, and now unable to keep down PO fluids. He also c/o chills. Pt was referred to ED for further evaluation. He reports 4 episodes of non-bilious non-bloody vomiting today. He denies abdominal pain. + chills . In the ED, initial VS T 102.1, HR 102; BP 133/52; RR 20; 93% RA. He then became hypoxic to 88% (baseline 92%) and hypotensive with systolic BP in upper 80's/low 90's, blood gas concerning with 7.37/34/63. Lactate 1.2. Labs remarkable for K 5.6, pt was given kayexalate. WBC 3.9 (46% neutrophils), Hct 35.6 (down from 40.2 in [**4-1**]). U/A negative, BCx and UCx sent. CXR with interval progression of NSCLC in the right upper and left lower lobes with larger more dense masses. Otherwise, relatively stable. The patient was given Cefepime 2 gm IV once, Zofran, Tylenol, kayexalate, and given total of 5L NS. . The patient currently is asymptomatic. Denies any trouble breathing. Denies LH or dizziness. Reports normal urine output at home. MEDICAL HISTORY: - NSCLC: s/p right upper and middle lobectomy ([**11-27**]) and wedge resection of the left lower lobe([**3-30**]) lung nodule, recurrent [**2-27**], s/p protocol with Navelbine and Cetuximab, started [**5-30**], completed 6 cycles by [**10-30**]. Given dz progression started on tarceva d/c'd in [**12-31**] due to further dz progression. Subsequently had 2 cycles Alimta, oxaliplatin, and Avastin but again had dz progression on imaging. ECOG protocol 2501 with sorafenib started 03/[**2184**]. - Diabetes mellitus type 2 - Hypertension - Hyperlipidemia MEDICATION ON ADMISSION: glucophage 1000 mg po bid start [**2179**] Glipizide 10 mg po bid start [**2179**] Actos 30mg po daily(changed by his PCP in [**Month (only) **] from 15mg) Verapamil sr 240mg po daily start [**2173**] Lisinopril 40 mg po daily Lovastin 10mg po daily start [**2182**] Prilosec 20mg po daily Vitamin C 100u po daily start [**2173**] Multivitamin po daily start [**2173**] Hydrochlorothiazide 25mg po daily Reglan for nausea prn d/c'ed [**2186-2-22**] Immodium 1-2 tabs po, prn for diarrhea ended [**2186-3-27**] Gas-X 40 mg po every 6 hours, prn start [**2186-2-22**] ended [**2186-3-27**] Immodium with Gas-X 1-2 tabs po qid, prn start [**2186-3-28**] Naproxen 1-2 tabs po qid, prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97.2; BP 109/52; HR 89; RR 20: sat 89-91 % on 4L NC Gen - Alert, no acute distress, breathing comfortably HEENT - PERRL, extraocular motions intact, anicteric, mucous membranes slightly dry, no lesions Neck - no JVD, no cervical lymphadenopathy Chest - Coarse BS bilaterally, rhonchi, decreased BS LLB, + expiratory wheezes CV - regular, nl S1/S2, no murmurs, rubs, or gallops Abd - Soft, obese, nontender, nondistended, with normoactive bowel sounds Back - No costovertebral angle tendernes Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally Neuro - Alert and oriented x 3, cranial nerves [**2-6**] intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact Skin - No rash Rectal - brown; strongly guaiac positive FAMILY HISTORY: Unremarkable for malignancy but he has a significant history of cerebrovascular and coronary artery disease among his relatives. SOCIAL HISTORY: He is a retired automotive mechanic and has taught most recently automotive repair. He is married with one child. He is a 50-pack-year smoker but quit approximately 35 years ago. He uses alcohol on an irregular basis but has never drunken to excess.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 61-year-old Creole-speaking only man who presents with a seizure on the day of admission. Most of the history is obtained from his daughter and friend who are at the bedside translating. He was in his usual state of health until earlier in the day. He was playing cards with his friends and began to feel not so good. He had a headache and was later found on his bed with shaking of both of his arms forcefully with his eyes rolled back in his head. This lasted for about eight minutes. He then vomited one time. He had never had a similar episode in the past. He had some postepisode confusion. He does not see doctors and [**Name5 (PTitle) **] [**Name5 (PTitle) **] had any prior medical problems. Further history is difficult to obtain as he is not volunteering answers to his family. MEDICAL HISTORY: He has not sought medical attention for 40 years. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Negative per daughter. SOCIAL HISTORY: Denies tobacco, alcohol or drugs. He is Creole-speaking only, daughter and roommate are at bedside. He is unemployed with two children.

CHIEF COMPLAINT: Exertional chest pressure and dyspnea x 3-4 months PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old man with a history of hypertension, hyperlidemia who has complained of exertional chest pressure and dyspnea for the last 3-4 months. A stress test done [**2125-11-5**] was abnormal (results not available) and underwent elective cardiac catheterization [**2125-11-8**] with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (STitle) 1474**] Hospital. This was notable for a 40% left main lesion and a 95-99% stenosis in the distal right coronary artery. Based upon the above results, he was transferred to the [**Hospital1 18**] for further evaluation and treatment. MEDICAL HISTORY: Coronary artery disease Hypertension Hypercholesterolemia Chronic Obstructive Pulmonary Disease MEDICATION ON ADMISSION: asa 325 qd, HCTZ 25 qd, lipitor 10 qd, atenolol 50 qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: NAD 62 20 172/71 AAOx3 Lungs CTAB CV RRR Abdomen Obese, soft/NT. well healed [**Doctor First Name **]. Pulses Femoral DP PT Radial [**Name (NI) 167**] 1+ 1+ 1+ 2+ Left 2+ 2+ 2+ 2+ No carotid bruits FAMILY HISTORY: Brother deceased from MI at unknown age SOCIAL HISTORY: [**Doctor First Name **] tobacco. Admits to six beers per week. He is married and works as a part time limo driver.

CHIEF COMPLAINT: hyperglycemia PRESENT ILLNESS: Patient is a 25 yo M with PMHx sig. for microcephaly/cerebral palsy and is non-verbal and severely contracted at baseline who presents with lethargy and was found to be in DKA at OSH. Per his mother, he developed a fever to [**Age over 90 **] yesterday. His grandmother, who also cares for him, recently had a cough treated with 5 day course of antibiotics. However, the patient never developed a cough; he may have looked a little more short of breath today. Throughout the day today, he did became increasingly lethargic, though he completed eating his breakfast and lunch without problems. His mother felt that he was not responding as well to her voice, ie smiling or looking at her. His limbs were also more flaccid than at baseline. In addition, she noticed that his eyes were twitching, which has occurred in the past with fevers. They were also bloodshot. His mother noticed that he has been urinating more and drooling less. She denied any vomiting, diarrhea. He has had H1N1 already in [**Month (only) **]. He also had a cough, treated with amoxicillin, in [**Month (only) 1096**]. He usually gets over these episodes rather quickly. . He was taken to [**Hospital3 **], where VS were rectal temp of 100.5, SBP 95, hyperglycemia to 1392, Na 162, and Cr 2.2. He was given CTX there for UTI despite a U/A with neg nitrite, leuk est. He was not given insulin. CT head at OSH reports no acute pathology. . In the ED, vital signs were initially: 97.0, 98, 117/79, 18, 98%. Exam was sig. for slight rhonchi on the right. Labs were sig. for glucose of 1208, Na 170, Cl 128, creatinine 2.6, HCT of 61, lactate 3.1. U/A showed ketones. CXR showed no infiltrate. BCxs, UCx were obtained. He is receiving NS 100 cc/hr. He was not started on insulin gtt. VS on transfer: 99, 117/87, 16, 100% on 2L. MEDICAL HISTORY: Microcephaly/Cerebral Palsy Kyphosis s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 47817**] rod MEDICATION ON ADMISSION: Fexofenadine 30 mg daily Ranitidine 75 mg [**Hospital1 **] Diazepam 6 mg/4 mg/6 mg Baclofen 5 mg TID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Temp:97.0 HR:98 BP:117/79 Resp:18 O(2)Sat:98 GEN: The patient is in no distress and appears comfortable. NECK: Supple. No lymphadenopathy in cervical, posterior, or supraclavicular chains noted. HEENT: L pupil 2 mm larger than R, both reactive. Erratic nystagmus. MM dry. CHEST: Lungs are clear without wheeze, rales, or rhonchi. CARDIAC: Regular rhythm; no murmurs, rubs, or gallops. ABDOMEN: Normoactive BS, soft, NT, ND. EXTREMITIES: no peripheral edema, warm. NEUROLOGIC: Alert. Wrists, elbows bilaterally flexed. Increased tone in shoulder joint, less in elbow joint bilaterally. SKIN: There is a maculopapular rash on the back, which the mother states is his usual rash on dependent areas. Erythematous rash on R groin. FAMILY HISTORY: Both parents are healthy. No history of heart disease, DM. Aunt with epilepsy SOCIAL HISTORY: Pt lives with his parents. He goes to a day program from 9AM -3PM. His grandmother also cares for him. He is wheelchair bound. He is fed pureed foods and Ensure once a day.

CHIEF COMPLAINT: anaphylaxis PRESENT ILLNESS: 50yo F with a h/o CAD, severe PVD, s/p thoracic aorta replacement, COPD, and severe hyperlipidemia admitted to CCU after attempt at revascularization of femoral stent complicated by anaphylactic reaction. Visipaque dye was injected and shortly after pt developed anxiety, increased HR, facial edema, and erythema/flushing. Pt's sBP's when down to the 60's. She was given 1 amp of epinephrine with subsequent sBP's into the 200's and tachycardia. Propofol bolus and gtt and nitro gtt and sBP's decreased again. Nitro was stopped and propofol was decreased and neosynephrine was initiated with IVF. Pt also received solumedrol 125 IV , Benadryl 50, and Pepcid. She was transferred to the CCU for monitoring overnight. Pt underwent a peripheral catheterization on [**2149-12-5**] due to critical limb ischemia. This revealed total occlusion of the distal SFA, for which she received a stent: overlapping 5.0x30mm Precise and 7.0x100mm and 7.0x38mm Dynalink stents. This intervention followed a failed femoral popliteal bypass in [**2149**]. Her symptoms returned and she was referred for angiogram of this limb with likely revascularization. She reports bilateral leg pain, right greater than left for many years. The pain is predominantly in the back of her calves. The onset of the pain is after a half a block. She reports bilateral ankle swelling, right greater than left. MEDICAL HISTORY: 1. Severe peripheral [**Year (4 digits) 1106**] disease status post right femoral-popliteal bypass in [**2149-11-1**], now found to be occluded. 2. Status post thoracic aortic replacement. 3. COPD. 4. CAD with 90% RCA and 60% LAD lesions by recent catheterization. 5. Severe hyperlipidemia, cholesterol level of about 600 and triglycerides of approximately 3,000. 6. Insulin dependent diabetes. 7. Hypothyroidism. 8. Hypertension. 9. Pancreatitis. 10. Degenerative joint disease status post laminectomy. 11. Status post cholecystectomy. 12. Status post right femoral embolectomy. 13. Obesity. MEDICATION ON ADMISSION: Insulin Lantus 80u at HS Insulin humalog sliding scale Gemfibrozil 600mg twice daily Lipitor 80mg daily Folic Acid 1mg daily Neurontin 800mg twice daily Remeron 150mg twice daily Niaspan 500mg daily Lisinopril 10mg daily Atenolol 50mg daily Plavix 75mg daily ASA 81mg daily-pt does not take ALLERGIES: Penicillins / Percocet / Iodine; Iodine Containing PHYSICAL EXAM: HR 70, RR 15, BP 117/72, O2sats 98-99% Gen: sedated, intubated. HEENT: eyes slightly swollen. Lips with edema Neck: obese and slightly swollen, +erythema supraclavicular. Chest: CTA bilaterally on anterior auscultation. CV: RRR, no M?R?G Abd: soft, obese, no HSM appreciated. Ext: R DP 1+ with doppler, 0 PT. L DP 1+ with doppler, PT 2+ with doppler. Neuro: sedated, withdraws to stimulation. FAMILY HISTORY: not able to obtain. SOCIAL HISTORY: She admits to a 45 pack year history of tobacco. She is still smoking. Pt lives alone. She has 3 children.

CHIEF COMPLAINT: SOB PRESENT ILLNESS: This is a 71M who was initially referred to Dr. [**Last Name (STitle) **] following a thoracotomy demonstrating RUL adenocarcinoma invading the chest wall, followed by 3 months of carboplatin and Taxol with Avastin. He underwent a second thoracotomy with RUL lobectomy and en bloc R chest wall resection (ribs [**3-9**]) with [**Doctor Last Name 4726**] Tex chest wall reconstruction and decortication of the RML and RLL with Dr. [**Last Name (STitle) **] on [**2100-12-21**]. His postoperative course was complicated by a bronchopleural fistula and Serratia VAP for which he took cipro x 14 days. On [**2101-1-13**], he was re-admitted with R empyema and partial dehiscence of the chest wall patch. On [**1-18**], he underwent R VATS with drainage, decortication, and removal of patch. Postoperatively, his three chest tubes were converted to empyema tubes. He was discharged on vancomycin and fluconazole on [**2101-2-11**]. Since discharge, he has returned twice for desaturations. Both times, his vitals were stable and his CXR unchanged; he was thus sent home with regular follow up in clinic. On [**2101-2-23**], he began c/o SOB. In transit to [**Hospital1 18**], EMS noted HR 30 and apneic. He was intubated at [**Hospital 882**] Hospital then transferred directly to the TSICU. Thick purulent secretions were noted. He then underwent bronchoscopy which demonstrated thin secretions in the trachea and proximal b/l bronchi. MEDICAL HISTORY: PMH: Traumatic blindness (left eye) Hypertension Alcohol-induced gastric ulcers (alcohol-free x20yr) Lung CA, R chest wall ([**4-11**]), s/p carboplatin, taxol with avastin h/o serratia marascens VAP MEDICATION ON ADMISSION: atenolol 100', doxazosin, Lasix 20', lisinopril 20" . ALLERGIES: Penicillins PHYSICAL EXAM: 98.5 73 120/63 16 100% AC 0.6/450 x 14/5 Gen: intubated, arousable to voice CVS: RRR Pulm: coarse breath sounds diffusely, CTs with purulent output, incisions c/d/i Abd: soft, NT, ND, +BS Ext: no c/c/e FAMILY HISTORY: Notable for cerebral hemorrhage. Father with lung cancer. Brother with gastric cancer and another brother with emphysema. Sister with cystic fibrosis. SOCIAL HISTORY: Lives with wife EtOH: {x}N { }Y Quit Tobacco: {x}N { }Y Quit 20 years ago Drugs: {x}N { }Y Amount: Married: { } N {x}Y Occupations: Construction worker Exposures: Asbestos, chemical / construction materials Diabetes: N Immunodeficiency: N Cancer: Y

CHIEF COMPLAINT: Weakness PRESENT ILLNESS: Ms. [**Name13 (STitle) 12101**] is an 84 year old lady 6 weeks post CABG recently discharged home from Rehab returns to the ED with weakness, poor PO intake and R flank pain. MEDICAL HISTORY: Chronic Diastolic Congestive Heart Failure Hypercholesterolemia Hypertension Type II Diabetes Osteoporosis Glaucoma Osteoarthritis Perioperative Atrial fibrillation, not on coumadin left sided carpal tunnel syndrome with hand numbness s/p Left knee replacement s/p Partial hysterectomy s/p Tonsillectomy s/p Bladder suspension s/p Appy s/p Breast reduction MEDICATION ON ADMISSION: Alendronate 70mg PO QSunday Amiodarone 200 mg PO Daily Furosemide 30mg PO daily Gabapentin 300mg TID while awake Latanoprost 0.005 % Drops 1 drop OU QHS Lisinopril 20mg PO Daily Metoprolol Tartrate 25mg PO BID Simvastatin 80mg PO QHS Tramadol 50mg Q6h PRN Pain Acetaminophen 325-650mg PO Q4 PRN Pain Aspirin 81mg PO daily Calcium Carbonate-Vitamin D3 500 mg (1,250 mg)-400 unit Tablet PO BID Omeprazole 20mg PO Daily Compazine 5-10mg q4 hours PRN Nausea ALLERGIES: Amlodipine PHYSICAL EXAM: Vitals: T: BP: 114/94 P: 82 R: 20 O2: 91% Manually BP repeat 84/40 General: Generally tremulous, Alert, oriented to place, time and self with some coaching, mentions [**Hospital3 **], no acute distress; HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Lives alone, daughter visiting. Ambulates with cane currently. No history of smoking, no EtoH.

CHIEF COMPLAINT: 79 yo m with aplastic anemia, Fournier's gangrene and history of possible old TB exposure admitted [**1-1**] for a 5 day course of ATG and initition of CSA PRESENT ILLNESS: 79 year old male with untreated aplastic anemia is being admitted for ATG + cyclosporine treatment. Pt was found to have a hematopoietic disorder in [**4-19**] when he went to his PCP for [**Name Initial (PRE) **] follow up after experiencing lethargy. Patient's marrow was initially aplastic on [**2192-6-28**]. Since then, he has been tried on IVIG and prednisone without significant effect. His medical course has been complicated by line infection, perianal abscess, retinal bleed and the findings of pulmonary nodules and granulomatous disease. Hence, at this time he is finishing a 9 month course of INH. His CT Chest shows improved nodules allowing him to undergo ATG + Cyclosporine at this time. At home, he denies any fevers, chest pain, SOB or bodily pain. Denies any rashes, bleeding. MEDICAL HISTORY: 1) Aplastic anemia dx [**4-19**] by bone marrow biopsy. Given some questions about a history of TB, he was treated with INH for one month and then started on prednisone 60mg daily on [**2192-7-5**]. He requires platelet transfusions weekly, and blood transfusions every several weeks or so. Complicated by retinal hemorrhage. 2) Pt remembers living in a sanitorium from age [**2-24**]. This prompted an investigation for TB, with subsequent sputum and bone marrow negative for acid fast bacilli. However, given a concern for this in face of starting steroids, pt is being treated with Isoniazid and Pyridoxine since [**2192-5-29**]. Chest CT showed evidence of granulomatous disease in the past, but no active disease. 3) kyphoscoliosis 4) L inguinal hernia, reducible present for long time, not painful MEDICATION ON ADMISSION: Medications: 1. G-CSF 300 mcg/mL Q24H 2. Colace 100mg [**Hospital1 **] 3. Isoniazid 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Acetaminophen 325 mg PRN 5. Folic Acid 1 mg PO DAILY 6. Pyridoxine 50 mg PO DAILY 7. Pantoprazole 40 mg delayed release Q24. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: Thin elderly male in NAD HEENT: Oropharynx clear CV: +s1+s2 RRR No murmurs Resp: CTA B/L No crackles or wheezing Abd: R ostomy bag. GU: No perianal signs of abscess or skin degradation. Inguinal hernia present. Neuro: AAO x 3. CN 2-12 grossly intact. FAMILY HISTORY: There is no history of blood disorders. SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Has two grown daughters nearby. [**Name2 (NI) **] tobacco, quit 40 years ago Rare alcohol when he goes out

CHIEF COMPLAINT: Diarrhea - Transfer to MICU for Hypoxia PRESENT ILLNESS: Pt is an 80 year-old female with h/o Sjogren's syndrome, IBS, who presents with diarrhea and fever. Patietn starting having non-bloody, watery diarreha approximately three weeks ago. This has been persistent since that time. For the past several days, she has been experiencing crampy b/l lower quadrant abdominal pain and distension. Today she developed subjective fever and rigors at home. Denies nausea, vomiting, dysuria. Decreased appetite over same time course. In the ED, initial vs were: 98.5 125 111/63 22 100%. Patient AAOx3. Subsequently febrile to 101.0. Exam remarkable for mild discomfort to palpation in RLQ/LLQ. Labs notable for WBC 20.2 with 93.6% PMNs (no bands), Na 127, lactate 2.2, normal LFTs. UA showed 5 hyaline casts, no mucus/WBC/RBC etc. BCx and UCx drawn. CT [**Last Name (un) 103**]/pelvis with contrast showed pancolitis without perforation or obstruction, intrahepatic biliary duct dilatation and prominent CBD, right lung base consolidation. CXR showed bibasilar opacities +/- pulm edema and multiple dilated small bowel loops. Patient given 2L NS, 2L LR, IV Cipro, IV Flagyl and Tylenol. Patient was initially admitted to medicine floor, but developed hypoxia while in ED and had new 5L O2 requirement. She had a repeat CXR showing possible pneumonia vs. pulmonary edema. She received ceftriaxone for possible pneumonia and was transferred to MICU. . On arrival to the MICU, patient appears uncomfortable and is rigoring. She reports crampy abdominal pain in her lower abdomen, fevers, and rigors. She continues to have diarrhea, but no nausea or vomiting. Mild cough productive of white sputum. Of note, patient last received antibiotics in [**2186-11-19**] (azithromycin for CAP). . Review of systems: (+) Per HPI (-) Denies night sweats. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes MEDICAL HISTORY: Anemia Borderline cholesterol C. Diff Heart Murmur Hypertension Hypothyroidism Mitral Regurgitation Osteoporosis Pneumonia Sinusitis Sjogren MEDICATION ON ADMISSION: fluticasone 50 mcg 1 - 2 nasal sprays [**Hospital1 **] PRN allergies levothyroxine 50 mcg daily lisinopril 10 mg daily tiotropum bromide 18 mcg daily Calcium multivitamin omeprazole 20 mg daily acetaminophen PRN pain [**Hospital1 **] Medications: 1. fluticasone 50 mcg/actuation Spray, Suspension Sig: 1-2 puffs Nasal twice a day as needed for allergies. 2. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every four (4) hours as needed for pain. 4. polyvinyl alcohol 1.4 % Drops Sig: One (1) drop Ophthalmic every four (4) hours as needed for dry eyes. 5. heparin, porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML Intravenous PRN (as needed) as needed for line flush. 6. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection twice a day. 7. insulin lispro 100 unit/mL Solution Sig: sliding scale units Subcutaneous three times a day: Sliding scale: 150-200 - 2 units; 201-250 - 4 units; 251-300 - 6 units; 301-350 - 8 units; 351-400 - 10 units; over 400 - 10 units and [**Name8 (MD) 138**] MD. 8. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day) as needed for rash. 9. ondansetron HCl 2 mg/mL Solution Sig: Four (4) mg Intravenous every eight (8) hours as needed for nausea. 10. olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for anxiety/insomnia. 11. olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed for anxiety. 12. vancomycin 250 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) for 12 days: Continue through [**2187-5-1**]. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: General: Alert, oriented, rigoring, appears uncomfortable HEENT: Sclera anicteric, dry mucus membranes, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Tachy, S1, S2, II/VI holosystolic murmur at apex Lungs: Diffuse rhonchi, no wheezes Abdomen: +BP, Firm, distended, tender to palpation in right and left lower quadrant, no rebound/guarding GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, moving all extremities [**Year (4 digits) **] exam - unchanged from above, except as below: General: tired but arousable to voice, appropriate CV: RRR, 2/6 systolic murmur at the apex Lungs: Slightly decreased breath sounds at the lung bases, right pigtail catheter in place Abd: Hypoactive BS, soft, non-tender, mildly distended Extr: 2+ edema to the thigh bilaterally FAMILY HISTORY: Long history of hypertension in her family. She does report that her father's family has a history of multiple cancers. She has a grandfather with a history of stomach cancer and an uncle with a history of throat cancer. She denies any history of colon cancers. Father had stroke. No family h/o MI. Mother had a heart valve replaced (pt not sure which one). SOCIAL HISTORY: Widowed. Two children. Patient lives alone in an apartment and cares for herself. She is independent with her shopping, cleaning, and cooks her own meals. She does not use tobacco or alcohol.

CHIEF COMPLAINT: upper GI bleed PRESENT ILLNESS: 38yoM with h/o EtOH abuse, likely cirrhosis with grade I varices, and s/p gastric bypass c/b prior GI bleed, who presented to [**Hospital 8641**] Hospital ED today with complaint of 3days of progressive bloody emesis associated with rectal bleeding, RUQ abdominal pain, and dizziness. On presentation to OSH ED he was hypotensive with SBP 90, HR 140. BP normalized after 3LNS. Initial Hct was 18. EGD prior to this had showed 1+ varices and gastritis. EGD at OSH showed grade I varices, oozing cratered gastric ulcer with adherent clot at the anastomosis (30x30mm). This was injected with epinephrine for hemostasis. Diffuse moderately hemorrhagic mucosa without active bleeding but with stigmata of bleeding. He received octreotide infusion, iv pantoprazole, and sucralfate. He was transfused 5units PRBC prior to transfer. . Patient normally drinks 6beers/day, but will binge for Patriot's games. His last drink was two days ago. He denies having a history of withdrawals. On presentation now he complains of persistant RUQ pain. MEDICAL HISTORY: EtOH abuse h/o GI bleed after gastic bypass surgery ?cirrhosis, h/o alcoholic hepatitis s/p gastric bypass surgery [**2099**] polyneuropathy obstructive sleep apnea s/p septoplasty chronic pain syndrome hypertension s/p MVC [**9-/2103**] h/o C.diff colitis ([**2104-12-21**]) tobacco use legally blind following MCV [**2103**] MEDICATION ON ADMISSION: Meds on Admission to OSH: KCl 20mEq po daily Diltiazem XR 240mg daily Fentanyl patch 25mcg Q72hr Flagyl 250mg po QID Gabapentin 300mg [**Hospital1 **] Lasix 40mg daily Spironolactone 50mg daily MVI daily FeSO4 325mg TID Omeprazole 20mg daily . Meds on Transfer: Sucralfate 1g QID Nicotine TP morphine 2mg prn pain Zofran prn pain Ativan per CIWA Thiamine 100mg daily MVI daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Wt 86.7kg T 96.7 HR 114 BP 124/100 RR 15 97%RA GEN: comfortable, cooperative, NAD HEENT: PERRL, anicteric, MMM, OP clear Neck: supple, JVP nondistended, no LAD CV: tachy, regular, no mrg, PMI nondisplaced Resp: CTAB Abd: +BS, soft, ttp RUQ (non tender with distraction), no rebounding/guarding, liver edge palpable Ext: no edema, 2+ DPs Neuro: A&Ox3, CN II-XII intact, strength 5/5 throughout, sensation intact to touch Skin: tattoos on chest and arms, no rashes FAMILY HISTORY: mother w/ hypertension, COPD son has a heart condition SOCIAL HISTORY: lives alone, going through divorce with one seven year old son Disabled EtOH: 4-6beers/day, no h/o withdrawals Tob: 1/2ppd x 20yrs Illicits: denies