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CHIEF COMPLAINT: descending thoracic aortic aneurysm PRESENT ILLNESS: The patient is a 64-year old male who has a penetrating aortic ulcer or a focal dissection that has become aneurysm which has increased in size. He was not a candidate for open surgery. He was admitted for descending thoracic aortic aneurysm repair. MEDICAL HISTORY: PMH: thoracic aortic aneurysm, history of pulmonary emboli (s/p IVC filter), h/o infected infrarenal aortic aneurysm/aortitis, bacterial meningitis (S. pneumoniae), anterior spinal artery infarct, colonic diverticulosis, diabetes mellitus, hypertension, hyperlipidemia, thoracic vertebral fracture MEDICATION ON ADMISSION: Amitryptiline 10 mg', Gabapentin 900 mg''', Glipizide 5 mg'', Metoprolol 50 mg'', Simvastatin 20 mg', Warfarin 4 mg', Zolpidem 5 mg', Docusate 100 mg', Ferrous gluconate 325 mg''', Senna 8.6 mg'' ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: VITALS: Afebrile, vitals signs stable. HEENT: Normocephalic, atraumatic. EOMI. PERRL. Nares clear. Mucous membranes moist. Neck supple without lymphadenopathy. CVS: Regular rate and rhythm, without murmurs, rubs or gallops. S1 and S2. No evidence of carotid bruits. RESP: Clear to auscultation bilaterally without adventitious sounds. No wheezing, rhonchi or crackles. ABD: soft, non-tender, non-distended, with normoactive bowel sounds. No masses or peritoneal signs. EXTR: The right lower extremity is warm well-perfused and is without erythema, drainage or edema. The left lower extremity is warm well-perfused and is without erythema, drainage or edema. Percutaneously closed groin incisions clean, dry and intact without hematoma or drainage. PULSE EXAM: weakly palpable DP pulses bilaterally FAMILY HISTORY: no history of premature coronary artery disease SOCIAL HISTORY: From the [**Country 13622**] Republic, lives alone but his daughter lives nearby; retired from work, ceased smoking 20-years prior, denies alcohol use

CHIEF COMPLAINT: Trauma - s/p assault PRESENT ILLNESS: This patient is a 85 year old male who complains of S/P ASSAULT. Afebrile male who was in bed at the nursing home when he was assaulted by his roommate, kicked in the head and abdomen, seen at L5 Hospital and transferred here for possible intracranial hemorrhage and questionable liver laceration. MEDICAL HISTORY: PMH: prostate ca, dementia, psychosis, HTN PSH: unknown MEDICATION ON ADMISSION: Atenolol 50 mg po daily, tylenol 650mg po Q8H, trazodone 25mg po qhs and 50mg po q 2 pm, depakote 500mg po q noon and 750 mg po q pm, MVI, Vit D 1,200 units po daily, ASA 81 mg po daily, colace 100 mg po daily, trazodone 25 mg po Q6H prn, prns: tylenol, MOM, bisacodyl, [**Name2 (NI) **] enema ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Constitutional: Calm HEENT: Pupils equal, round and reactive to light, Extraocular muscles intact; abrasion to face Oropharynx within normal limits Chest: Clear to auscultation Cardiovascular: Regular Rate and Rhythm, Normal first and second heart sounds Abdominal: Soft, Nontender, Nondistended Rectal: No gross blood Extr/Back: No cyanosis, clubbing or edema; no step-offs or deformities of the spine Skin: No rash, Warm and dry Neuro: awake, moving all extremities FAMILY HISTORY: NC SOCIAL HISTORY: dementia, lives in group home

CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: Mr. [**Known lastname **] is a 50 year old man who had four days of chest and left arm pain and was admitted to [**Hospital6 3105**] after a subsequent cardiac catheterization revealed multi-vessel coronary artery disease. He was transferred to [**Hospital1 18**] for surgical evaluation. MEDICAL HISTORY: Hypertension Diabetes Mellitus Depression Anxiety Benign prostatic hypertrophy Skin lesion removal of right infraorbital area s/p TURP MEDICATION ON ADMISSION: lisinopril 20mg daily, lantus 50 units at bedtime, aspirin 81mg daily, remeron 45mg daily, zocor 80mg daily, relafen 750mg [**Hospital1 **] PRN, colace 100mg [**Hospital1 **], metformin 1000mg [**Hospital1 **] ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse:50 Resp:16 O2 sat:100%RA B/P L:147/81 Height:5"3 Weight:151 lbs FAMILY HISTORY: No Premature coronary artery disease SOCIAL HISTORY: Race:hispanic Last Dental Exam:> 1 year Lives with:wife Contact: [**Name (NI) **] [**Last Name (NamePattern1) 91012**] Phone #([**Telephone/Fax (1) 92458**] Occupation:disability due to depression Cigarettes: Smoked no [x] yes [] last cigarette [**2172**] Hx: 1.5ppd times 25 years ETOH: < 1 drink/week [x] [**2-3**] drinks/week [] >8 drinks/week [] Illicit drug use - no

CHIEF COMPLAINT: altered mental status RLE pain PRESENT ILLNESS: 68-year-old female with h/o DM2, HTN, CAD, CHF and PVD s/p left AKA, angioplasty to R tibial artery in [**3-19**], chronic venous stasis ulcers s/p debridement one week PTA, also with death of son 10d PTA, who presents with several days of RLE pain and confusion. Patient unable to give history, spoke with her grandson at [**Telephone/Fax (1) 60469**] to gain some sense of story, though per his report his aunt will be calling in to provide more detail. From the grandson, the patient has had increasing RLE pain times several days, and from the limited info provided by the patient she ran out of the 60 tabs of Percocet also several days ago. It is unclear if the patient has been taking more of her MS Contin in the absence of Percocet. Per the grandson, the pt has been "in and out of reality" for these past few days, unable to sleep at night, poorly interactive during the day. The VNA saw the patient on the DOA and felt that she was somnolent, called 911. In the ED, the patient was confused and somnolent but in obvious pain, wailing out but unable to give a history. She repeated "cut it off" while holding her RLE. She received 2mg MSIR IV, then 2 Percocets. On the floor she was still in pain, received 1mg IV dilaudid. MEDICAL HISTORY: DM2, hypertension, coronary artery disease (h/o angina in past currently stable), history of congestive heart failure, severe PVD h/o GIB Left above-knee amputation, left common iliac stenting, IVC filter placement, hysterectomy, lumpectomy MEDICATION ON ADMISSION: Lasix 20 mg [**Hospital1 **] Protonix 40 mg daily Colace 100 mg b.i.d. Plavix 75 daily Aspirin 325 mg Losartan 100 mg daily Toprol XL 150 mg daily MS Contin 60mg [**Hospital1 **] Oxycodone/Acetaminophen (5/325) [**1-16**] tab q4h prn Nortriptyline 10 mg qhs Gabapentin 300mg tid Lipitor 10mg qd Combivent ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: Gen - lying in bed, breathing comfortably, NAD except upon manipulation of RLE wounds Heent - PERRL, EOMI, OP wnl, MMM Neck - supple, thick, JVP 8cm CV - RRR, nl s1/s2, [**2-20**] holosyst murmur loudest at apex Pulm - rhonchi throughout, likely transmitted from upper airway; scant bibasilar rales, L>R Abd - obese, soft, NT, NABS Ext - left AKA; R foot with non-pitting edema, venous stasis changes, 4 ulcerations s/p recent debridement appearing clean with no significant granulation yet, no evidence of cellulitis or superimposed infection Pulses - Rt: 1+fem/no [**Doctor Last Name **]/no DP or PT; Lt: 1+fem Neuro - A&Ox3, slighy ptosis on right, CNs otherwise intact, answers all questions appropriately, UE stregth intact, LE strength 3/5 in flexors/extensors FAMILY HISTORY: NC SOCIAL HISTORY: Pt lives at home with second son, first son recently deceased 3d PTA from unclear etiology, possibly liver disease vs. HIV per pt. Followed by VNA daily. wheelchair bound. She is a current smoker, ~half pack per day. Denies EtOH/IVDU.

CHIEF COMPLAINT: brain metastasis PRESENT ILLNESS: Patient is a 57-year-old male with Burkitt's type lymphoma originally diagnosed in [**12/2117**] s/p chemotherapy, allogenic stem cell transplant, and Ommaya shunt placement on [**2117-12-19**] who is currently admitted for chemotherapy for a solitary temporal lobe brain met. Pt initially c/o HA and reported this sx to oncologist. MRI was obtained and he was found to have an enhancing left temporal lobe mass. Pathological reports showed this lesion to be a recurrence of his Burkitt's lymphoma. He is now scheduled to get high dose methotrexate for the brain lesion. Pt also has a persistent groin seroma secondary to inguinal lymph node removal that has required draining x 4. Pt has been in good state of health recently. He reports no fever, nausea, vomiting, diarrhea, chest pain, SOB, and vision or hearing changes. MEDICAL HISTORY: 1. Irregular heart beat which was extensively worked-up with Holter monitors, and just felt to be secondary to occasional PVCs for which he takes atenolol. 2. Abdominal ventral hernia. 3. Pyloric stenosis as an infant. 4. Hypercholesterolemia. MEDICATION ON ADMISSION: 1. Lamivudine 100 mg Tablet qd 2. Ursodiol 300 mg po qd 3. Lopressor 25 mg po bid 6. Vancomycin HCl 1,000 mg IV bid 7. Protonix 40 mg po qd 8. Fluconazole 100 mg po qd 9. MVI 10. Epivir HBV 100 mg po qd 11. Procardia 30 mg po qd 12. Folate 4 mg po qd 13. Valgancyclovir 450 mg po qd 14. Decadron 4 mg tid 15. Levoquin 1 tab qd x 10 days ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 96.5 64 18 128/76 99% RA FAMILY HISTORY: No cancer history for colon, breast, ovarian or lung. No history of lymphomas or leukemias. SOCIAL HISTORY: He lives in [**Location 912**], [**State 350**]. He is a product developer at Fidelity. Tobacco - 20 pack year history, quit in [**2094**]. Alcohol - occasionally, [**3-15**] drinks per weekend. He has 3 children, 2 daughters, 1 son.

CHIEF COMPLAINT: chest pain, shortness of breath, back pain PRESENT ILLNESS: The patient is a 70-year-old female with history of HIV, end-stage renal disease, three vessel disease status post stent to left circumflex on [**2154-6-4**], history of congestive heart failure with ejection fraction of 25 percent who was recently discharged from the [**Hospital1 69**] status post non-ST elevation myocardial infarction, status post left circumflex stent, who experienced left sternal chest pain, back pain and dyspnea at 6:00 a.m. on the day of presentation while getting out of bed to go to the bathroom. The patient remained symptomatic and was taken to the [**Hospital1 190**] by EMS where she was found to have a systolic blood pressure of 210. She was given aspirin, Lopressor 5 IV times three, Lasix 40 IV times one and was started on intravenous nitroglycerin drip with resolution of all symptoms. The patient also has undergone a CT angiogram that showed no evidence of dissection. The patient had a chest x- ray that showed right costophrenic angle opacity. The patient's CT showed signs of left ventricular strain. By the time she was seen by the Coronary Care Unit team, her systolic blood pressure was in the 180's and she was symptom free. MEDICAL HISTORY: Coronary artery disease, three vessel disease status post non-ST elevation myocardial infarction in [**2154-6-4**], status post taxis down to left circumflex in [**2154-6-4**]. Congestive heart failure. Ejection fraction 25-30 percent. History of malignant hypertension. Status post intubation for flush pulmonary edema on [**2154-6-3**], complicated by laryngeal edema. History of human immunodeficiency virus, CD4 count 74, viral load less than 60 on [**2154-3-4**], on HAART therapy. End-stage renal disease on hemodialysis, HIV nephropathy. Type 2 diabetes, diet controlled. Spinal tuberculosis. Hypercholesterolemia. Hepatitis C viral infection. Gout. Anemia. MEDICATION ON ADMISSION: ALLERGIES: Colchicine, allopurinol, ethambutol. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: No smoking, no alcohol, no drug use.

CHIEF COMPLAINT: headache, nausea, vomiting, lethargy PRESENT ILLNESS: 49 y/o with a hx of diverticulitis who is transferred from an OSH with a L sided intraparenchymal hemorrhage. Fiance reports that pt. was in his USOH, skiing with his family the weekend of presentation. On Saturday he skiied a whole day and socialized with friends in the evening and had no complaints. On Sunday morning he woke up at 8AM and went skiing. He came back at 10 AM and complained of a severe, bifrontal, pounding headache. He seemed tired, and took 2 ibuprofen and layed down for 2 hours. He woke up at lunchtime and seemed his normal self, although he still had a headache (improved but still present). He went back out onto the slopes. His fiance was called to the first aid room at 2:30. She reports that he looked very fatigued and pale as a ghost, and had vomited once. She is not sure if he fell on the slopes. She was advised by the staff there to take him to the doctor when they got home. They got in the car to drive back to [**Location (un) 86**] around 3-3:30. He sat in the front seat slumped forward, in an "unnatural position" per his fiance, and slept for about 2 hours. She did not try to arouse him or talk to him because she thought that he was under the weather and needed to rest. She did not notice any facial droop or any obvious weakness. At around 4:30-5 he woke up somewhat, but seemed very confused, and was saying things that didn't make sense, and talking like he was "in a dream." She decided to take him to the closest hospital. He was seen there and Head CT was performed (~7P), and showed a large L intraparenchymal hemorrhage with intraventricular extension and mild hydrocephalus. He was transported to [**Hospital1 18**] for further evaluation. When he arrived here Head CT was repeated (~9:30) and appeared stable. He was evaluated by Neurosurgery who did not feel that he needed acute drainage of [**Last Name (LF) 71966**], [**First Name3 (LF) **] Neurology was consulted. Pt. is very unclear on the events of the day. He is unable to tell me where he is or why he is here. He does remember having a headache earlier today, but feels it is not present now. Has no complaints at present, denies weakness, numbness, dysarthria, dysphagia. MEDICAL HISTORY: Diverticulitis No Hx of HTN MEDICATION ON ADMISSION: Multivitamin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- 97.5 BP- 126/70 HR- 72 RR- 18 O2Sat- 98% on RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck: No tenderness to palpation, normal ROM, supple, no carotid bruit CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: no family hx of stroke or HTN SOCIAL HISTORY: lives with fiance, has 3 kids, works as a computer programmer, occ social EtOH, no tobacco

CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: Mrs. [**Known lastname **]. [**Known lastname **] is a -52-year-old female with hepatitis C and child A cirrhosis who was known to have peripheral vascular disease and underwent cardiac catheterization for anginal symptoms that showed severe 3-vessel disease, presenting for coronary revascularization. I decided to perform the operation off-pump on a beating heart given early cirrhosis to try and avoid causing further liver decompensation from cardiopulmonary bypass. MEDICAL HISTORY: CAD s/p CABGx4 Hepatitis C Diabetes mellitus Type II HTN Asthma GERD Depression/Anxiety Rheumatic Fever MEDICATION ON ADMISSION: Prevacid (no substitute) 15mg daily Zestril (no substitute:sun sensitive with Lisinopril) 20mg daily Prozac 40mg and 60mg alternating daily doses Aspirin 81mg daily Lorazepam PRN as needed for anxiety ALLERGIES: Codeine PHYSICAL EXAM: Ht: 5 feet inches Wt: 150 lbs GENERAL: Alert and well, no acute distress. HEENT: Sclera anicteric, oropharynx clear. NECK: Supple, no thyromegaly. CVS: S1-S2, no added sounds, murmurs or thrills. CHEST: Lungs clear to auscultation and percussion bilaterally. ABDOMEN: RUQ and LLQ tender on deep palpation, no guarding. No hepato- or splenomegaly. BS normal. LYMPH NODES: No cervical, supraclavicular, axillary, epitrochlear, or inguinal lymphadenopathy. NEURO: grossly intact. EXTREMITIES: No edema, clubbing or cyanosis. Peripheries well perfused. SKIN: Dry and intact. No jaundice or pallor. No rashes noted. FAMILY HISTORY: Mother with CAD in her 30's. SOCIAL HISTORY: Unemployed on disability. Occassional ETOH. Never smoked. Lives with significant other.

CHIEF COMPLAINT: adenocarcinoma of the descending colon. PRESENT ILLNESS: Mr. [**Name14 (STitle) 101858**] is a 69-year-old gentleman with multiple medical comorbidities who presents for resection of adenocarcinoma of the descending colon. Due to comorbidities to include obesity, type II diabetes, diastolic heart failure,hypertension, untreated sleep apnea with secondary pulmonary hypertension, and chronic renal insufficiency, the patient was admitted for pre-op evaluation and administration of contrast by mouth. He reports being in his usual state of health. No recent fevers are reported. Of note, he was hospitalized for a postive stress test and cardiac cath last month. Results included identification of 1. Single vessel coronary artery disease. 2. Mild to moderate aortic stenosis. 3. Marked biventricular diastolic dysfunction. 4. Severe pulmonary hypertension. MEDICAL HISTORY: 1. Obesity. 2. Type 2 diabetes mellitus on insulin. 3. Hypertension. 4. Diastolic congestive heart failure with preserved EF. 5. Obstructive sleep apnea and secondary moderate pulmonary hypertension. He has been asked to use a CPAP machine, but is reluctant to do so. 6. Degenerative joint disease. 7. Chronic renal insufficiency with a baseline creatinine in the 2-2.3 range. 8. Right acoustic neuroma status post gamma knife radiation therapy with resultant hearing loss. 9. Mild aortic stenosis and mild aortic regurgitation 10. gout. MEDICATION ON ADMISSION: Humalog insulin Sliding Scale, NPH 45 AM and 45 PM, Metoprolol 150 AM, Nifedical XL 30', Lisinopril 40', Triamterene/HCTZ 37.5/25', Avapro 150", Simvastatin 80', Lasix 120 AM, 80 afternoon, 80 PM, KDur 30 AM and 20 PM, Colchicine 0.6", Allopurinol 200', Hectorol 1 AM and 0.5 PM, Omeprazole 40', Alprazolam PRN ALLERGIES: Phenergan PHYSICAL EXAM: At Discharge: Vitals stable GEN: A/Ox3, NAD CV: RRR, no m/r/g RESP: CTAB, no w/r/r ABD: soft, obese, appropriately TTP, +flatus, +BM Incision: midline abdominal OTA with staples, distal erythema improved. Extrem: no c/c/e FAMILY HISTORY: Father had [**Name2 (NI) 101859**] and peripheral vascular disease, DVTs, and stroke. Mother is alive. Sister with CHF. SOCIAL HISTORY: Married and lives with wife. [**Name (NI) **] four daughters, ten grandchildren. Was laid off from Polaroid around the time the company went bankrupt, is now retired. Is of Italian background, grew up in the [**Hospital3 **]. --Smoked < 5 py, quit 45 y prior --No current EtOH

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 79M with h/o CAD s/p CABG in [**2106**] c/b longstanding sternal wound infection transferred from [**Hospital6 **] for inferior STEMI. He reports that he was in his USOH until last night ~ 11 PM. He was lying down to go to sleep and had the acute onset of SSCP - described as pressure, [**2125-7-23**], no diaphoresis/nausea, radiated to L shoulder and up L neck. He denies having pain like this since his last MI in [**2106**]. He called 911 and went to [**Hospital **]. At [**Hospital3 15402**], EKG showed 2mm STE in II, III, and aVF and subtle ST depressions in V1. He was Plavix loaded with 600 mg, received ASA 325 mg, was started on heparin bolus and gtt and nitro gtt. Of note, he was hypertensive to 200/116 at OSH. He also received morphine IV x 2, which relieved the pain. CP resolved at [**Hospital3 **]. . At [**Hospital1 18**] ED, initial VS 98.2 77 181/118 18 97% on 2L. EKG showed NSR 82, LAD, Q-waves in II, III, aVF and subtle depressions in V2. Labs showed Cr 0.8, Hct 35.7, PTT 76.3, Trop 0.05. CXR was performed and showed mild pulmonary vascular congestion, prior sternotomy and CABG clips (my read), no infiltrate. BP trended down to 110s-120s/70s-80s - nitro gtt on at 1.5 mcg/kg/min. Heparin gtt was continued. . Currently, the patient denies CP though does endorse pain in his L shoulder and L neck. He had mild SOB on presentation to [**Hospital **] but denies this at present. He denies any history of HTN. He also mentions increased swelling in his bilateral feet for the past 2-3 days - has never had this in the past. He is active at baseline and has not noticed any chest discomfort until last night. Finally, the patient has a 1-cm open wound on his chest with some superficial purulence - he states that his CABG incision has remained open since his surgery in [**2106**]. He was initially treated for a sternal wound infection but never followed-up when the infection recurred a few months later. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. MEDICAL HISTORY: . CARDIAC RISK FACTORS: -Diabetes, ? Dyslipidemia, - Hypertension per patient 2. CARDIAC HISTORY: - CABG: [**2106**] - [**Hospital6 **], c/b sternal wound infection that was initially treated post-op, but recurred several months later - has not followed up for this 3. OTHER PAST MEDICAL HISTORY: None per patient MEDICATION ON ADMISSION: ASA 81 mg qday ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam VS: 98.2 83 117/74 22 97% on 2L GENERAL: NAD. Oriented x3. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Lives in [**Location 21487**], MA with his wife. Had 7 children (1 passed away from rheumatic fever as child) - several live near him. Worked as a fisherman and then dockside repairman - now retired. Still active painting houses. Walks without a cane. - Tobacco history: 40 pack-year smoking history - quit in [**2106**] - ETOH: no history of heavy drinking, no current EtOh - Illicit drugs: none

CHIEF COMPLAINT: Chest Pain PRESENT ILLNESS: 43 y/o Caucasian man s/p stent [**2105**] presented to [**Hospital1 5979**] ED c/o jaw pain beginning 40 minutes prior to presenting to OSH. Pt reports having 2 alcoholic beverages and later had burning in his chest which felt like "heart burn". Pt reports burning in jaw bilaterally and mild diaphoresis. He denied CP, arm pain, or shortness of breath. Pt denies anginal episodes or CP since intervention in [**2105**]. In [**Hospital3 **] ED an EKG show ST elevation in the anterior leads, V1-V5 and ST depression in II, III, and aVF. Pt went into Vfib arrest, shocked (200J, 300J, 360J) and started on amiodarone gtt, integrillin gtt and transferred to [**Hospital1 18**] cath [**Hospital1 **]. MEDICAL HISTORY: CAD s/p PCI [**2105**] MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam (on admission) VS T97.1 P76 BP124/69 RR20 O2Sat88%4LNC->93% on face tent GENERAL: NAD, lying flat in bed w/ face tent, speaking in complete sentences. HEENT: PERRL, EOMI, MMM NECK: Supple, JVP 7cm, CARDIOVASCULAR: S1, S2, Reg, no murmurs LUNGS: CTAB by anterior exam only due to sheath in place ABDOMEN: Active bowel sounds, obese, soft, NT, ND, no HSM. EXTREMITIES: DP/PT 2+ bilat. Cool feet bilat. Otherwise, UE warm, well-perfused. NEURO: A/OX3, strength and sensation grossly intact FAMILY HISTORY: Mother w/ CAD SOCIAL HISTORY: Tobacco: 0.5 pack X 15 years EtOH: 1qwk Limited exercise Publisher of a magazine, lives in [**Location 5028**] with wife

CHIEF COMPLAINT: CC:[**CC Contact Info 63379**] Major Surgical or Invasive Procedure: Intubation Upper Endoscopy PRESENT ILLNESS: HPI: 38 yo male with hx of suicide attempts initially presented to [**Hospital1 18**] after a suicide attempt with ? 12 clonazepam and endorsing suicidal ideation. While in the ED, he revealed that he had ingested broken glass. Of note, the patient was recently discharged from [**Hospital1 2177**] on [**10-5**] after ingesting broken glass and [**10-1**] for ingesting razor blades. He has a history of swallowing glass and razor blades. He had an EGD here in [**2196**] after he swallowed multiple razor blades. Denied hematemesis or LGIB. Denied any lightheadedness. He does note diffuse abdominal pain. Denies nausea, vomiting. . In the ED: -urine tox- positive for cocaine - 2mg IV morphine for abdominal pain -portable CXR, abdomen negative for free air, or glass -PA and lat - no free air, no glass seen, no widened mediastinum - GI saw patient and will scope tonight - admitted to MICU for upper endoscopy MEDICAL HISTORY: - suicide attempt - swallowing glass and razor blades - bipolar - depression - splenectomy MEDICATION ON ADMISSION: protonix 40mg daily seroquel 300mg qhs and 25mg [**Hospital1 **] depakote 1000mg QDay Inderal 20mg daily ALLERGIES: Haldol PHYSICAL EXAM: VS: T: 96.7 BP: 102/66 HR: 66 RR: 12 O2: 99% on RA HEENT: normocephalic, anicteric, PERRLA, EOMI, no pharyngeal injection, exudate, neck supple, dentition fair, no LAD, no thyromegaly CV: +s1+s2 RRR PULM: CTA B/L No RRW ABD: EXT: no clubbing, no edema FAMILY HISTORY: father [**Name (NI) 63380**] sister with depression and psychiatric hospitalizations SOCIAL HISTORY: The patient reports that he was born in the [**Location (un) 86**] area and the youngest of 3, he has 2 older sisters. His father was an abusive alcoholic and his mother was extremely abusive to the children. He said "she burned my hands and all kind of things." His mother placed all her children in a catholic institution when he was 3 where he was sexually abused by a priest. [**Name (NI) **] sued the Archdiocesan and was awarded $350,000 which he says is in a trust. He was adopted at age 12 and was abused by his adoptive mother. At one point he went to [**State 4565**] to live with his biological mother and graduated from High School in [**Location (un) 11177**] after attending 3 high schools. He has worked in banks,retail, as a model, a stripper , selling cars but is now on disability. He is close with a family in [**Hospital1 **] who he refers to as his godparents and also to one of his sisters. [**Name (NI) **] currently lives alone in [**Location (un) 4310**], never married and no children. . - smokes [**1-30**] PPD, recreational cocaine and marijuana use; occasional EtOH use

CHIEF COMPLAINT: SEPSIS, HX NEC FASC PRESENT ILLNESS: 62 yo man w/DM, HTN, recent admission for necrotizing fasciitis, now readmitted with sepsis. During recent admission from [**11-18**] to [**2139-12-15**], pt had operative debridement of necrotizing fasciitis of the LLE and groin on [**11-18**], as well as f/u bedside debridements. He initially was started on zosyn, vanco, clinda, and flagyl. [**11-18**] Intra-op tissue cultures grew coag neg staph and pan-[**Last Name (un) 36**] E. Coli, and ABx narrowed to vanco & [**Last Name (un) 2830**]. Due to cytopenias, switched to dapto & [**Last Name (un) 2830**], and completed total 21 day course. [**12-1**] cath tip grew C. albicans. o/w multiple blood Cx all negative. Hospital course c/b bilat PE resulting in intubation, pt discharged on warfarin. Pt discharged to rehab on [**12-15**] on VAC, with PICC in place, and off antibiotics. He was originally scheduled for STSG surgery on [**2140-1-5**]. On [**1-3**], at rehab, pt developed temp 101.2, BP 80/55, w/foul smell from VAC (last changed 2 days ago), and erythema around VAC site. Pt presented to OSH, T 101, hypotensive despite 2L IVF, 36% bands on manual diff, Rec'd vanco, clinda, levoflox, started on pressors and transferred to [**Hospital1 18**]. CTA there neg for PE for w/u of SOB. Per pt, had no pain on LLE, but redness that has progressed over past 2 weeks. On arrival here, T 97.3, still on pressors. Exam at that time notable for foul odor, beefy soft tissue in wound, and light crepitus over L med thigh. CT showed no gas or fluid collection. Started empirically on meropenem, vancomycin, flagyl, and fluconazole. Overnight, IJ CVL and R art line inserted. This AM, weaned off pressors. MEDICAL HISTORY: PAST MEDICAL/SURGICAL HISTORY: *Nec fasc as above *Diabetes mellitus type 2 *Asthma *Bronchitis *Hypertension *Hyperlipidemia *Obesity *s/p knee surgery MEDICATION ON ADMISSION: Lovastatin 20', Lisinopril 20', Metoprolol 25'', ISDN 30', Albuterol, Ipatropium, Combivent, Glyburide 5AM, 2.5HS, Omeprazole 40', Advair 250/50'', [**Doctor First Name **] 60'', Ibuprofen 800'', Nicotine Patch ALLERGIES: All drug allergies previously recorded have been deleted PHYSICAL EXAM: Tmax: 100.4 P: 95 R: 19 BP: 115/57 off pressors, O2Sat 100% 2L NC General: obese man in NAD, speech fluent HEENT: NCAT, PERRL, OP clear without exudates/lesions, lower lip with crusted eschar ("cut myself shaving") Neck: no LAD/JVD, R IJ CVL c/d/i Lungs: CTA B Heart: RRR, no m/r/g Abdom: +BS, NT, ND, soft Extrem: *LLE edematous, warm, non-tender, diffuse erythema sparing knee only, extending from toes to L flank. *Ant thigh & groin wound with good granulation tissue, no pus, good margins. *RUE PICC no erythema GU: Foley intact, groin with erythema Neuro: MAE, PERRL Skin: no other rash. FAMILY HISTORY: NC SOCIAL HISTORY: Arrived from rehab. Formerly lived alone. On disability. Tob: quit 3 months ago after 54 yrs of smoking. EtOH: quit 3 mo. ago

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 68-year-old woman status post a fall down six stairs witnessed by her husband with positive loss of consciousness and positive ETOH on board. Patient was hemodynamically stable and transferred to [**Hospital6 256**] by ambulance. Her [**Location (un) 2611**] Coma Scale score was 14. She had no reports of seizure, loss of bowel or bladder function. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: admitted from [**Hospital 191**] clinic w/ 5 days worsening SOB, DOE PRESENT ILLNESS: Pt is a 63M w/ h/o metastatic carcinoid tumor, HTN, hyperlipidemia who reports increasing SOB and DOE starting about a month ago but worsening significantly within the last 5 days. It has recently gotten so bad he can barely get up out of a chair without getting short of breath. He reports orthopnea but no PND. In clinic today, he was using accessory muscles of respiration and was mildly diaphoretic, and his O2 sat on room air was 97%, dropping to 94% with ambulation. He reports no fever or chills, no URI symptoms, no recent travel, no changes in his medications. Pt also reports ~5 episodes of chest pain in the last few weeks which he describes as pressure on his mid-sternum and usually occurs during exertion. There is no associated nausea or vomiting. He says he takes a [**12-29**] tablet of Xanax when he gets this pain sometimes which seems to help. He cannot take nitroglycerin because of his Viagra. MEDICAL HISTORY: 1. metastatic carcinoid tumor, Dx'ed [**2123**] -was on a study drug for a year and a half (ended about a year ago) and was on octreotide for a few months earlier this year but stopped because of diarrhea 2. hypertension 3. hyperlipidemia 4. carotid endarterectomy [**2120**] 5. depression/anxiety 6. cellulitis 2 weeks ago, given Keflex IV at [**Hospital3 **], now resolved 7. DM2/prediabetic state: random blood sugar was high, was on glyburide for a brief time but made his sugars low so stopped 8. anxiety attack [**2110**] (collapsed), diagnosed in [**2120**] as MI 9. basal cell carcinoma (chest, low back, MOHS on cheek [**3-31**] and [**7-1**]) MEDICATION ON ADMISSION: ASA 81mg po qd Lipitor 20mg po qpm Norvasc 5mg po qd Paxil 30mg po qd ranitidine 150mg po bid Viagra 25mg po qd [**Doctor First Name **] 180mg po qd Xanax 0.25 mg po qd prn ALLERGIES: Nitroglycerin PHYSICAL EXAM: VS: T 97.7, HR 97, BP 140/52, RR 20, O2sat 97% on RA Gen: awake, alert, conversant, elderly man, mildly short of breath HEENT: PERRL, EOMI, MMM Neck: supple, JVP elevated (~8cm) Chest: fine cracles at left base, otherwise CTA CV: RRR, nl S1S2, no m/r/g, distant heart sounds Abd: S/ND, mildy tender to palpation in LLQ Ext: WWP, 1+ LE edema bilaterally, no c/c Neuro: nonfocal FAMILY HISTORY: early CAD SOCIAL HISTORY: Lives alone, has two daughters Distant tobacco use (25 pack-years, quit 30 years ago), distant EtOH use (quit 28 yrs ago), no drugs

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 50 year old female who was brought in by EMS after a syncopal episode leading to a head-on collision against a tree at approximately 30 mph. The patient was restrained and the airbag deployed. The patient was hemodynamically stable with a GCS of 15 in the Emergency Department. In the Emergency Department, she was complaining of left chest pain, shortness of breath, and in the field left crepitus was noted as well. In the trauma bay, the patient was hemodynamically stable with a GCS of 15, however, her oxygen saturation rate initially was between 80 and 90%. It was also noted at that time that her breath sounds on the left side were markedly decreased. A tube thoracostomy was then performed on the left side without complications. After the placement of the tube thoracostomy, the patient's oxygen saturation rate improved to 97%, her shortness of breath improved, and lung sounds improved on the left side as well. She remained hemodynamically stable throughout the procedure and tolerated it well. As far as her syncopal episode that led to the accident, the patient reports feeling lightheaded and then blacked out and woke up immediately after her motor vehicle collision without any confusion, no loss of continence, and denied symptoms of chest pain, palpitations, diaphoresis, or headache. She also notes the use of cocaine three days prior to the accident, and previously, one year ago without any sequelae at that time. She had one previous episode of syncope during pregnancy. There is no history of syncope in her family, but there is a significant history of myocardial infarction, both in her father and mother at an early age. MEDICAL HISTORY: Consistent bilateral pyelonephritis. MEDICATION ON ADMISSION: ALLERGIES: Codeine which causes nausea and vomiting. PHYSICAL EXAM: FAMILY HISTORY: Significant for her mother having a myocardial infarction around age 50 and her father dieing of a myocardial infarction in the [**2114**]'s. SOCIAL HISTORY: Consists of occasional alcohol as well as occasional cocaine ingestion, last was three days prior to the accident, and previously was one year ago.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 62-year-old right-handed gentleman who had a fall six to eight weeks prior to admission and was brought to [**Hospital3 35151**] where an MRI showed a cord compression at the C1-C2 level. The patient was transferred to [**Hospital1 190**], was evaluated by Dr. [**Last Name (STitle) 1327**], and was discharged to rehabilitation with follow up for surgery. The patient was admitted on [**2169-7-4**] for surgery on [**2169-7-5**]. The patient has a long-standing history of rheumatoid arthritis and cervical myelopathy secondary now to this periodontoid mass and pannus with CMJ compression. There was also an intrinsic cord signal abnormality of C1 and C2. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Pacemaker wound infection PRESENT ILLNESS: 87 year old female with past medical history of atrial fibrillation s/p PPM in approximately [**2116**], with recent generator replacement [**2134-5-26**]. She reports erosion of the skin overlying the pacer pocket on her left shoulder for approximately 1 month. Now noticing erythema and mild pain. She was brought to [**Hospital1 18**] ED by her daughter after being seen by her cardiologist. She does not report fever but notes possible chills a few weeks ago while in [**State 1727**] which she attributed to cold weather . In the ED, initial VS: 97.9 80 124/61 97%RA. EKG showed V paced rhythm with underlying afib/flutter. She was given 1 gm of vancomycin after blood cultures were drawn and admitted to cardiology for futher management. . On the floor, she has been comfortable. She denies chest pain, SOB, fever, chills, NVD, or abdominal pain. She has no other complaints. MEDICAL HISTORY: -Atrial fibrillation s/p PPM approximately [**2116**] -Skin cancer, BCC [**9-25**]; SCC10/06 -Cholelithiasis -Hysterectomy -Neuropathy -NPH with intracranial shunt -Urge incontinence -CLL/SLL, in remission. Currently on rituximab maintence q3 months, last dose [**2134-5-20**] -Polio dx [**2071**] -CHF -Gait disturbance -Fatigue -Osteoporosis MEDICATION ON ADMISSION: Coumadin 6 mg po qdaily Pilocarpine 1% eye drops tid glaucoma Detrol unsure dose Vitamin B12 alendronate 35 qwk monday Rituximab q 3month for CLL maintenance MVI ALLERGIES: Penicillins / Scopolamine / glaucoma drops / Strawberry / Demerol / Quinaglute Dura-Tabs PHYSICAL EXAM: FEX ON ADMISSION VS:95.2 144/85 81 18 100%RA GENERAL: Female in no acute distress HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. NECK: Supple, no JVD. HEART: RRR. 2/6 SEM noted over RUSB LUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Does not smoke, drink or use illicit drugs. Spends most of her summertime in [**State 1727**]. Married. Husband with severe Alzheimer's.

CHIEF COMPLAINT: acute shortness of breath and elevated INR s/p AVR(mechcanical)Ascending Aortic arch replacment on [**2-3**]. PRESENT ILLNESS: SOB onset about 5 days ago, increasing with any movement. Saw cardiologist yesterday had echo today with effusion. MEDICAL HISTORY: Complete Heart Block(PPM) Postop DVT in LUE [**2104-3-12**] following lead extraction Hyperlipidemia s/p Dual chamber pacemaker placement in [**2087**] s/p replacement of PM generator [**2096**] s/p Lead extraction and reimplantation of PPM [**3-/2104**] Hernia repair as child s/p AVR(mechcanical)Ascending Aortic arch replacment on [**2-3**]. MEDICATION ON ADMISSION: 1. Simvastatin 40' 2. Aspirin 81' 3. Acetaminophen 325-650/PRN 4. Hydromorphone 2-4 mg/Q4H/PRN 6. Warfarin 5QD: **dose will change daily for goal INR 2.5-3.5, 7. Potassium Chloride 20 Q12H (every 12 hours) x5 days. 8. Ranitidine HCl 150' 9. Docusate Sodium 100" 10. Metoprolol Tartrate 25" 11. Furosemide 40" ALLERGIES: Penicillins PHYSICAL EXAM: Physical Exam Temp 98.6 Pulse: 70 Vpaced Resp: 16 O2 sat: 96% 3LNP B/P Right: 109/70 Left: Height: Weight: FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) 1727**] Occupation: Production manager on ship yard Tobacco: Quit 1.5 years ago. 40 pack year history ETOH: [**12-14**] drinks per week

CHIEF COMPLAINT: Rigors PRESENT ILLNESS: 68yo male with Downs Syndrome, [**Last Name (NamePattern4) 862**] disorder (last [**Last Name (NamePattern4) 862**] [**4-/2145**]), urinary retention c/b CKD III due to urethral stricture and neurogenic bladder, recurrent UTIs and HOCM (LVOT gradient 100mmHg) who is presenting after being seen in urology clinic today, where [**Known lastname **] placement was unsuccessfully attempted for PVR >1L. In clinic he was noted to have a UTI, and was sent home with Cipro with plan for urethrotomy in the OR [**2146-1-28**]. However, he never filled his prescription and was noted to be febrile and rigoring at his group home. He was initially taken to [**Hospital1 3278**], where he received a dose of Vanc, but his HCP requested transfer to [**Hospital1 18**]. The patient's baseline state of function is very low; but sister accompanied him to [**Hospital1 18**]. He cannot walk due to b/l hip replacements and L hip osteomyelitis. . In the ED, initial VS were: T 100.2 HR 93 BP 106/89 RR 16 O2 Sat 99% 4L Nasal Cannula His BP was re-checked and found to be 88/49-->BP 58/66-->78/50. IV NS was started with open, a L IJ was placed and Levophed gtt was started. Blood and urine cultures were drawn (Vanc given at [**Hospital1 3278**]) and the pt was started on Vanc/Zosyn. His BPs continued to be low (65/35) and Dopamine was added, though he was not maxed out on Levophed. Urology was consulted and placed a suprapubic cathetar. Labs were notable for + UA, WBC 5.4 (20% bands), INR 1.8, Cr 2.3 (baseline 1.3-1.8), HCT 29 (baseline in low 30s) and Lactate 8.3. CXR showed no focal consolidation, EKG showed new ST depressions II, V4-V6 as well LVH, which is chronic. He received a total of 4L NS in the ED and was admitted to the MICU. . On arrival to the MICU, initial VS were: T 99.6 BP 104/34 HR 98 RR 21 O2 Sat 93% NC He was making urine (500cc in bag) and mentating near his baseline per sister, who accompanied him. An arterial line was placed and Dopamine, Levophed, Neosynephrine and Vasopression were required to keep MAP 65. SVO2 was 58, CVP was 5. NS was given wide open. VBG was 7.15/46/40. MEDICAL HISTORY: 1. Down syndrome 2. Mental retardation 3. NSETMI - recent DC on [**12-5**] 4. Hypercholesterolemia 5. s/p R hip replacement and no L hip 6. Osteoporosis 7. Seizures - generalized seizures 8. BPH 9. Hypothyroidism MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth HS (at bedtime) BISMUTH TRIBROM-PETROLATUM,WH [XEROFORM PETROLATUM DRESSING] - 2" X 2" Bandage - use as directed in affected area every 24 hours and as needed Dx: decubitus ulcer CICLOPIROX - 0.77 % Cream - Apply affected areas both feet twice a day as directed. CIPROFLOXACIN - 500 mg Tablet - 500 Tablet(s) by mouth twice a day DOUGHNUT CUSHION - - use as directed once a day FINASTERIDE - 5 mg Tablet - 1 Tablet(s) by mouth once a day LEVETIRACETAM - 500 mg Tablet - 2 Tablet(s) by mouth twice a day LEVOTHYROXINE - 137 mcg Tablet - 1 Tablet(s) by mouth qam NYSTATIN - 100,000 unit/gram Powder - apply to left foot twice a day NYSTATIN - 100,000 unit/gram Cream - apply to affected area on toes twice a day OVERLAY FOR MATTRESS - - use as directed once a day DX: Downs' syndrome, wheel chair bound and decubitui. PHENYTOIN SODIUM EXTENDED [DILANTIN KAPSEAL] - 100 mg Capsule - take 1 Capsule(s) by mouth twice a day Brand name only- medically necessary - No Substitution PHENYTOIN SODIUM EXTENDED [DILANTIN KAPSEAL] - 30 mg Capsule - take 1 Capsule(s) by mouth twice a day Brand name only- medically necessary - No Substitution TAMSULOSIN [FLOMAX] - 0.4 mg Capsule, Ext Release 24 hr - 1 (One) Capsule(s) by mouth at bedtime . Medications - OTC ACETAMINOPHEN - (Dose adjustment - no new Rx) - 325 mg Tablet - 2 Tablet(s) by mouth every 4 hours as needed for mild pain ALUM-MAG HYDROXIDE-SIMETH [MYLANTA] - (Prescribed by Other Provider) - Dosage uncertain ASPIRIN [ENTERIC COATED ASPIRIN] - 81 mg Tablet, Delayed Release (E.C.) - take 1 Tablet(s) by mouth once a day CALCIUM CARBONATE [CALCIUM 500] - 500 mg (1,250 mg) Tablet - 2 tablets by mouth daily at 4 pm; do not provide at the same time as his dilantin CHOLECALCIFEROL (VITAMIN D3) - 1,000 unit Capsule - 1 Capsule(s) by mouth daily (at 4 pm) MENTHOL-ZINC OXIDE [MEDICATED BODY POWDER] - 0.15 %-1 % Powder - apply topically once a day to mid thighs, and other irritated skin MULTIVITAMIN - Tablet - 1 (One) Tablet(s) by mouth once a day ; Multivitamin without calcium. Replaces rx dated [**2145-11-19**] NEOMYCIN-BACITRACNZN-POLYMYXIN [NEOSPORIN] - 3.5 mg-400 unit-[**Unit Number **],000 unit/gram Ointment - as directed PETROLATUM, WHITE-LANOLIN [VITAMIN A & D DIAPER RASH] - Ointment - apply to affected area on buttocks twice a day and as needed for moisture barrier protection ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: T 99.6 BP 104/34 HR 98 RR 21 O2 Sat 93% NC General: Alert, anxious appearing, moderate distress HEENT: Sclera anicteric, oropharynx clear, EOMI, PERRL Neck: JVP below the clavicle CV: Tachycardic, II/VI systolic murmur heard best at the apex, no rubs or gallops Lungs: Faint expiratory wheeze, otherwise CTAB, no increased WOB Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: suprapubic cathetar Ext: cool, 1+ distal pulses Skin: Mottling on the BLEs, BUEs and chest Neuro: Alert, responds to yes/no questions, follows commands, non verbal . Discharge Exam: FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Lives in a group home - wheelchair bound. [**First Name4 (NamePattern1) **] [**Known lastname 8389**] is the HCP ([**Telephone/Fax (1) 21968**]). No tobacco, EtOH or drug hx.

CHIEF COMPLAINT: Sepsis/UTI PRESENT ILLNESS: HPI: [**Age over 90 **]M with PMH notable for CAD, CHF (EF 20-25%) was brought to the ED this morning by his family with whom he lives. Prior to this morning, the pt was at his baseline, and had taken a number of day trips with his fmaily over the past 2 weeks. This morning, the pt's granddaughter went to his basement apt to look in on him (his son and son's famly live upstairs) and found that he was trembling and a bit confused. The pt's son then assessed his father, and gave him Benadryl (1 tab) for the shaking. He was sweating and clammy, but his temp later was >102 po The pt then took his usual am meds with Glucerna, but vomited a frothy emesis. He was then transported to the ED. . Per the pt's family, he had been feeling fine prior to this morning. he had not complained of cough or SOB, nor had he mentioned difficulty voiding or dysuria. His son empties a bedside commode in the am for him, and has identified past UTIs by malodorous urine, which he did not identify today. He had not complained of CP or SOB. No GI sx, no bowel changes, no previous fever/chills/malaise. He had not c/o HA or neck stiffness, or pain of any kind. Pt had no recent exotic travel or known sick contacts. . In the ED, the pt was initially stable but satting 84% RA. ON MD exam, sat improved (?on NC), but temp was 104 with HR 60s, BP 134/61. He was minimally responsive (s/p benadryl) and exam was notable for bibasilar rales. Because he was obtunded and had ememis in ED with ?aspiration, he was intubated for airway protection and quickly became hypotensive (BP min 105/50 prior to sedation). He received 5L NS boluses (levophed started after 3L), as well as 2 g CTX, 1 gm vanc, 500 mg metronidazole, 1 g tylenol, etomidate, succinylcholine, 10 mg dexamethasone, 2mg midazolam x 2, levophed gtt, propofol gtt. He was subsequently transferred to the [**Hospital Unit Name 153**] for further therapy and monitoring. MEDICAL HISTORY: CAD - s/p MI in [**2109**] tx with lytic therapy and rescue angioplasty CHF - EF 20-25% DM2 History of PAF S/p PPM Status post permanent pacemaker insertion. Hypertension Hypercholesterolemia L hip replacement [**2119**] c/b femur fx with "slipped prosthetic" [**2127**] Past UTIs, most recently with proteus mirabalis (ctx sensitive, fluoroquinolone resistant) S/p TURP MEDICATION ON ADMISSION: 1. Carbamazepine 200 mg Tablet Sig: 0.5 Tablet PO BID 2. Sotalol 80 mg Tablet Sig: One (1) Tablet PO BID 3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS prn 4. ? Nexium filled in [**7-19**]. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY 6. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID 7. Tolterodine 1 mg Tablet Sig: One (1) Tablet PO BID 8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY 9. Glipizide 10 mg Tablet Sig: One (1) Tablet PO BID 10. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (in d/c summary but never filled in pharmacy) 11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day. 12. Potassium 20 mEq po qd ALLERGIES: Erythromycin Base PHYSICAL EXAM: Upon arrival to [**Hospital Unit Name 153**]: Gen: Elderly man, sedated and unresponsive HEENT: B/l arcus, no scleral icterus, secretions around ETT Neck: Large, no LAD Heart: RR, no Lungs: Coarse breath sounds b/l, no rales appreciated Abd: Full with palpable spleen, not form or appreciably distended, scan BS, soft Ext: Thin, 1+ DPs, no c/c/e Skin: No jaundice, icthyosison feet b/l FAMILY HISTORY: non-contributory SOCIAL HISTORY: Pt is [**Age over 90 **] yo male who lives in basement of sons house. Wife passed away last year. Retired plumber who worked here at [**Hospital1 18**]. Had been ambulating with a walker since leaving rehab, participates in home PT few times a week.

CHIEF COMPLAINT: Diaphoresis, SOB, and hypoxia PRESENT ILLNESS: 79 year-old female with advanced dementia, PE with IVC filter placement ([**2116**]) and subsequent large bilateral LE DVT at rehabilitation facility for CONS endocarditis and right ankle osteomyelitis on daptomycin admitted with acute diaphoresis, SOB, and hypoxia concerning for PE. Prior to transfer from [**Hospital3 2558**], temperature 99.5, given Tylenol. Baseline oxygen saturation 93% RA. . Per discussion with son, as recently as [**Name (NI) 766**] patient was conversing (limited conversation at baseline). He noticed a decline over the week - increased pain in her right leg, increased crying. When he saw her the night preceding admission, she was "just not with it." He also noticed she was breathing fast. . [**Name (NI) **] son believes decline in her health began around [**2119-12-23**]. She was admitted to [**Hospital3 **] for lethargy, and was found to have serum sodium 182. She was hydrated and improved dramatically. A PEG tube was placed. . She was admitted [**1-12**] to [**2120-1-17**] with CONS bacteremia/endocarditis, Klebsiella UTI, and severe constipation. CONS bacteremia with suspected source right lateral malleolus stage III ulcer/osteomyelitis; TTE with MV vegetation and worsened MR; initially on vancomycin, then due to reaction switched to daptomycin. Surgical intervention for MR was not pursued at discretion of patient's son/HCP. . She was subsequently admitted [**1-19**] to [**2120-1-21**] with bilateral lower extremity DVT extending to previously placed IVC filter. Anticoagulation was initiated but not continued due to risk>benefit longterm. Per discussions with son, patient was made DNR/DNI with plan to transition to palliative care as an outpatient. . A new PEG placed was last week, [**2120-2-2**]. . In the ED, 98.6 110 157/94 34 95%. Triggered for tachypnea, 34. Tmax to 101. Physical examination notable for nonverbal, decreased breath sounds left base, benign abdominal examination. Laboratory data significant for creatinine 0.4, CBC within normal limits, troponin 0.08, lactate 1.3, and UA benign. EKG with sinus tachycardia, isolated TWI III, and without ischemic changes. CTA chest discussed with family; wished to proceed with imaging despite prior notes indicating patient is not candidate for anticoagulation. CTA chest with no PE or acute aortic syndrome and pneumatosis of hepatic flexure of colon. Subsequent CT abdomen/pelvis with contrast with pneumatosis of cecum (positioned up by the liver) and ileum - no free air or mesenteric/portal venous gas. Discussed with son; wished to proceed with surgical consultation prior to making a decision regarding surgical intervention. Surgery was consulted for pneumatosis - suspected etiology of pneumatosis benign and related to recent PEG placement given benign abdominal examination, normal lactate, and absence of leukocytosis; recommended NPO, IVF, repeat lactate, enemas for continued constipation with surgery continuing to follow. Received cipro/Flagyl, Tylenol. On transfer to MICU, 69, 101/51, 19, 99% 6L NC. . On the floor, patient is unable to participate in conversation. Says hello on reevaluation, but history otherwise limited. MEDICAL HISTORY: Hypernatremia, History of dehydation Dementia Aspiration pnumonia, Bipolar disorder. hip fracture with contraction fracture history of PE x 2 during the surgery Osteomyelitis and ferquent UTI MEDICATION ON ADMISSION: Daptomycin 500mg Q24 hours until [**2120-2-28**] x Glucerna 1.2 60ml/hour Remeron 30mg PO daily x Bactrim DS [**Hospital1 **] - d/c'ed Memantine 5mg PO BID x Vitamin C 250mg PO daily x Olanzapine 5mg PO daily x Vitamin D 50,000 units monthly x Donepezil 10mg PO QHS x Senna 8.6mg PO BID x Tylenol 650mg PO Q6hrs PRN x Docusate 50mg/5ml 10ml [**Hospital1 **] x ASA 81mg PO daily x Famotidine 20mg PO BID x Protein powder [**Hospital1 **] ?Roxanol 5mg Q6 hours Levofloxacin 500mg daily "indefinitely" x Ativan 0.25mg PH QHS PRN insomnia Miralax 17 gram PO daily PRN x Lactulose 30ml [**Hospital1 **] PRN x Hyoscyamine 0.125mg SL QID PRN secretions x ALLERGIES: Penicillins PHYSICAL EXAM: Admission Physical Exam: VS: Temp 98.8, HR 68, BP 126/49, RR 30, SpO2 100% 5L NC General: Sleeping; opens eyes to painful stimulation, now with verbal stimulation HEENT: Sclera anicteric, MMM Neck: Supple; prominent venous pulsation Lungs: Right lung CTA; severe kyphoscoliosis limits auscultation of left lung; no appreciable wheezes, rales, rhonchi CV: RRR; normal S1/S2; III/VI early systolic murmur best heard at LLSB Abdomen: PEG in place without surrounding erythema; hypoactive bowel sounds; soft, non-tender, not distended Ext: In waffleboots; warm, well-perfused, 2+ pulses; right ankle dressed; DP, radial pulses 2+ and symmetric Neuro: Limited examination; awakes to sternal rub, does not participate in physical examination FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Currently at rehab facility. Well-supported by son/HCP.

CHIEF COMPLAINT: Abnormal Stress Test PRESENT ILLNESS: Pleasant 46 y/o male who was under evaluation for possible renal transplant and during cardiac clearance pt had an abnormal ETT. He was then referred for cardiac catheterization which revealed 3 vessel disease. Pt. was then referred for cardiac surgery. MEDICAL HISTORY: End-Stage Renal Disease on Hemodialysis Renal Artery Stenosis s/p Right Renal Artery Stenting [**12-19**] Renal Osteodystrophy Cardiomyopathy Hypertension Hypercholesterolemia h/o Cellulitis left hip/LE MEDICATION ON ADMISSION: 1. [**Date Range **] 81mg qd 2. IC Renal 1 tablet qd 3. Toprol 100mg qd 4. Diovan 160mg qd 5. Lipitor 20mg qd 6. TUMS 5 tablets qd ALLERGIES: Ace Inhibitors PHYSICAL EXAM: VS: 189/91 90 20 36.5 66in 76kg General: WD/WN male in NAD Neuro: A&O x 3, non-focal HEENT: EOMI Neck: FROM, NC/AT Heart: RRR, -c/r/m/g Lungs: CTAB. -w/r/r Abd: Soft, NT/ND Ext: warm, -c/c/e FAMILY HISTORY: Brother died of an MI at age 37 SOCIAL HISTORY: Lives with significant other. Unemployed originally from [**Country **].

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Ms. [**Known lastname 108328**] is an 81 year old [**Known lastname 595**] speaking female with a history of anemia and thrombocytopenia, Crohn's disease on chronic steroids, PE, returned from rehabilitation for somnolence. Found to be hypoxic and somnolent in the emergency room (VS T 98, BP 132/53, HR 92, RR 24, 95% on NRB). New infiltrate on CXR in the left upper lobe, and ABG showed hypercarbia. She was admitted to the ICU and started on meropenem and vancomycin. She was given IV fluids for hypotension and responded appropriately. She was started on bipap in the ICU which improved her somnolence, and mental status returned to baseline. MEDICAL HISTORY: PAST MEDICAL HISTORY: -Anemia [**3-3**] CRI, chronic disease -MDS dx 3 yrs ago -Crohn's disease -CAD s/p NSTEMI '[**89**] -CRI w baseline Cr 1.5-1.8 -BL DVTs and saddle embolus in [**2190**], previously on warfarin now on Lovenox -Chronic BL LE edema -Breast cancer s/p lumpectomy & XRT -GERD -Intracranial bleed and fx after pedestrian vs car 20 yrs ago -Cataracts -Venous stasis dermatitis -Tinea pedis -?Arrhythmia unspecified which daughter says is tx with metoprolol -dHF with EF 60-70% . PAST SURGICAL HISTORY: -CCY 10 yrs ago -Lumpectomy 13 yrs ago MEDICATION ON ADMISSION: Acetaminophen prn pain Vitamin D 800 U q day Mesalamine 1200 [**Hospital1 **] Camphor-Menthol lotion prn Miconazole powder prn Atrovent q 6 hours Albuterol q2 prn Ciprofloxacin 250 mg [**Hospital1 **] Loperamide 2 mg PO QID Calcium Carbonate 1000 mg TID Timolol Maleate 0.5 drops daily Polyvinyl alochol-Povidone drops prn Predinosone 60 mg [**Hospital1 15123**] Lasix 10 mg daily ALLERGIES: Belladonna Alkaloids PHYSICAL EXAM: VS: T HR 84 BP 112/41 RR 15 O2 86% on 4L NC General: NAD, pleasant and interactive, NC in place [**Last Name (Titles) 4459**]: NCAT MMM anicteric pink conjunctiva Neck: no JVD appreciated, supple Lungs: crackles at LLL CV: RRR 2/6 SEM at LUSB, PMI nondisplaced Abd: soft, NT, ND, bowel sounds present, palpable non-moveable mass c/w ventral hernia Ext: + anasarca, LLE cellulitis - warm, erythematous, tender Skin: numerous ecchymoses and sites of skin breakdown over torso and extremities FAMILY HISTORY: non-contributory SOCIAL HISTORY: Married; lives with her husband who is demented, her daughter [**Name (NI) 108329**], [**Name2 (NI) 108330**] husband and 6 [**Name2 (NI) **] granddaughter. Presently in temporary housing while awaiting renovations on their [**Last Name (un) **] which was damaged during a fire last winter. [**Last Name (un) 108329**] is the caretaker for both of her parents. [**Last Name (un) 108329**] very stressed and overwhelmed. Her mother-in-law in [**Name (NI) 4565**] died this past month which required her husband to leave for [**Name (NI) 4565**]. She is in the midst of trying to place her father in nursing care facility and is quite guilty about this decision. Ms. [**Known lastname 108328**] [**Last Name (Titles) 108331**]y recieves near daily RN visits from Suburban Home Care. [**Last Name (Titles) 108329**] is reliant on "sitters" to bring her mother to appointments.

CHIEF COMPLAINT: Chest pain . HPI: Ms. [**Known lastname **] is a 64 yo female with history of an MI who presented to an OSH on [**9-7**] with 9/10 burning chest pain and right shoulder pain. Her EKG at the OSH showed bigeminy with a rate of 158, STE in aVR & V1, STD in I, II, F, V3 - V6. Troponin was elevated at 2.04. She was given SLNTG & morphine and was started on a nitro gtt and her pain improved. She underwent cardiac catheterization at [**Hospital3 **] which showed: RCA chronically occluded, Cx with tight disease, + LAD disease. She then went into atrial fibrillation (per outside report, no EKG available) which is new for her and was treated with IV Lopressor with successful conversion. . She was transferred to [**Hospital1 18**] for further evaluation for possible CABG for her 3VD. Since her admission, pt continues to have chest pain, similar to what she had at the OSH. She describes the pain as a burning sensation with some radiation to her right shoulder. Denies any associated SOB, PND, orthopnea, or dizziness. Her cardiac enzymes remain elevated. She had an episode of SVT on the floor with HR of 115. No new EKG changes at the time. She had a carotid ultrasound which showed bilateral stenosis, 60-69%. . She was transferred to the CCU for closer management. She is currently asymptomatic. . Medications: Heparin gtt Nitro gtt Lipitor 10mg PO daily ASA 325mg PO daily Metoprolol 50mg [**Hospital1 **] Prednisolone eye gtt Tobramycin eye gtt Cyclopentolate eye gtt . . Social History: She works in the post office and does a lot of heavy lifting. Significant tobacco use - at least a pack a day for 44 years. Occasional alcohol abuse. . Physical Exam: vitals T 98.7 BP 106/73 AR 54 RR 14 Gen: Pleasant female, NAD HEENT: PERRLA, MMM Heart: nl s1/s2, no s3/s4, no m,r,g Lungs: CTAB, no crackles Abdomen: soft, NT/ND, +BS, no organomegaly Extremities: no edema, 2+ DP/PT pulses . Laboratory results: see below . EKG: Sinus bradycardia at 57. Small Q in II, III, F. J point ele in V3 with no significant change compared with prior dated [**2155-9-8**] earlier today. EKGs at OSH showed vent bigeminy. . Relevant Imaging: . 1)Cardiac cath (OSH-[**9-8**]):100% RCA, 80 - 85% LCx, "Mod LAD", EF 55%. no formal report sent. . 2)Carotid U/S ([**9-9**]):60-69% stenosis in the proximal internal carotid arteries bilaterally. This is a baseline examination at the [**Hospital1 18**]. . 3)ECHO ([**9-9**]): 1. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. 2. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. 3. The mitral valve leaflets are mildly thickened . A/P: Ms. [**Known lastname **] is a 64 yo female with history of MI, 3VD on recent cardiac cath, bilateral carotid stenosis being transferred to the CCU for closer management as well as evaluation for CABG. . CARDIAC 1)3VD: Pt presented with chest pain at OSH and was found to have significant 3VD on cardiac catheterization. She was transferred to [**Hospital1 18**] for further evaluation and possible CABG. Pt being followed by CT surgery. - [**Hospital **] medical management w/statin, b-blocker, aspirin - Hold Plavix and Integrillin given possible surgery and that she unlikely does not have an unstable plaque, more likely demand ischemia in the setting of tachycardia. - ECHO, U/A, CXR, T+S as per CT surgery - Continue nitro gtt and titrate down as necessary - [**Hospital **] consult, as below; f/u reccs - F/u CT surgery reccs . 2)Rhythm: Pt in sinus rhythm on admission; she has episodes of tachycardia (with multiple APCs)associated with ST changes (not new), likely demand ischemia. - Ct with Metoprolol 50 [**Hospital1 **], titrate up as necessary . 2) LV Function: No history of CHF; appears to be normovolemic on clinical exam. - pre-op ECHO this afternoon . 3)Bilateral carotid stenosis: Ultrasound from today shows 60-69% carotid stenosis bilaterally. Currently asymptomatic. - [**Hospital1 **] surgery consult regarding surgical intervention (CEA vs. stent placement) and if this needs to be done prior to CABG. . 4)Retinal detachment: s/p bubble procedure, pt being followed by opthamology. Per opthamology, pt able to lye supine as well as receive high doses of heparin. Per optho, pt able to lye supine for surgery. - Ct with outpatient regimen: Alphagan, Pred Forte, Tobramycin, Cyclopent; the latter 2 can be stopped on [**9-11**]. - No nitrous oxide for anesthesia due to increased IOP. - F/u opthamology reccs . 5)FEN: Cardiac healthy diet, NPO after MN for likely CABG tommorow, replete electrolytes as necessary. . 6)Access: 1 PIV . 7)Code: Full . 8)Prophylaxis: Heparin IV for DVT prophylaxis, bowel regimen not necessary at this time. . 9)Communication: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 68948**], daughter: H [**Telephone/Fax (1) 68949**], C [**Telephone/Fax (1) 68950**], W [**Telephone/Fax (1) 68951**]. . 10)Dispo: Pending possible CABG and clinical improvement . PRESENT ILLNESS: 64 yo F presented to OSH with CP, +NSTEMI. Cath there showed 3VD, transferred to [**Hospital1 18**] for PCI v CABG. MEDICAL HISTORY: Past Medical History: 1) CAD: MI [**2142**] - no intervention. S/p PCI in [**2147**], no intervention at that time. 2) Retinal detachment s/p repair on [**9-4**]. 3) s/p Tonsillectomy 4) s/p Cataract surgery . MEDICATION ON ADMISSION: asa ALLERGIES: Nitrous Oxide PHYSICAL EXAM: vitals T 98.7 BP 106/73 AR 54 RR 14 Gen: Pleasant female, NAD HEENT: PERRLA, MMM Heart: nl s1/s2, no s3/s4, no m,r,g Lungs: CTAB, no crackles Abdomen: soft, NT/ND, +BS, no organomegaly Extremities: no edema, 2+ DP/PT pulses . Laboratory results: see below . EKG: Sinus bradycardia at 57. Small Q in II, III, F. J point ele in V3 with no significant change compared with prior dated [**2155-9-8**] earlier today. EKGs at OSH showed vent bigeminy. . Relevant Imaging: . 1)Cardiac cath (OSH-[**9-8**]):100% RCA, 80 - 85% LCx, "Mod LAD", EF 55%. no formal report sent. . 2)Carotid U/S ([**9-9**]):60-69% stenosis in the proximal internal carotid arteries bilaterally. This is a baseline examination at the [**Hospital1 18**]. . 3)ECHO ([**9-9**]): 1. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. 2. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. 3. The mitral valve leaflets are mildly thickened . A/P: Ms. [**Known lastname **] is a 64 yo female with history of MI, 3VD on recent cardiac cath, bilateral carotid stenosis being transferred to the CCU for closer management as well as evaluation for CABG. . CARDIAC 1)3VD: Pt presented with chest pain at OSH and was found to have significant 3VD on cardiac catheterization. She was transferred to [**Hospital1 18**] for further evaluation and possible CABG. Pt being followed by CT surgery. - [**Hospital **] medical management w/statin, b-blocker, aspirin - Hold Plavix and Integrillin given possible surgery and that she unlikely does not have an unstable plaque, more likely demand ischemia in the setting of tachycardia. - ECHO, U/A, CXR, T+S as per CT surgery - Continue nitro gtt and titrate down as necessary - [**Hospital **] consult, as below; f/u reccs - F/u CT surgery reccs . 2)Rhythm: Pt in sinus rhythm on admission; she has episodes of tachycardia (with multiple APCs)associated with ST changes (not new), likely demand ischemia. - Ct with Metoprolol 50 [**Hospital1 **], titrate up as necessary . 2) LV Function: No history of CHF; appears to be normovolemic on clinical exam. - pre-op ECHO this afternoon . 3)Bilateral carotid stenosis: Ultrasound from today shows 60-69% carotid stenosis bilaterally. Currently asymptomatic. - [**Hospital1 **] surgery consult regarding surgical intervention (CEA vs. stent placement) and if this needs to be done prior to CABG. . 4)Retinal detachment: s/p bubble procedure, pt being followed by opthamology. Per opthamology, pt able to lye supine as well as receive high doses of heparin. Per optho, pt able to lye supine for surgery. - Ct with outpatient regimen: Alphagan, Pred Forte, Tobramycin, Cyclopent; the latter 2 can be stopped on [**9-11**]. - No nitrous oxide for anesthesia due to increased IOP. - F/u opthamology reccs . 5)FEN: Cardiac healthy diet, NPO after MN for likely CABG tommorow, replete electrolytes as necessary. . 6)Access: 1 PIV . 7)Code: Full . 8)Prophylaxis: Heparin IV for DVT prophylaxis, bowel regimen not necessary at this time. . 9)Communication: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 68948**], daughter: H [**Telephone/Fax (1) 68949**], C [**Telephone/Fax (1) 68950**], W [**Telephone/Fax (1) 68951**]. . 10)Dispo: Pending possible CABG and clinical improvement . FAMILY HISTORY: Family History: There is a + family history of premature coronary artery disease - dad had MI in 40's, mom had "heart problems and [**Name (NI) 2320**]" SOCIAL HISTORY: She works in the post office and does a lot of heavy lifting. Significant tobacco use - at least a pack a day for 44 years. Occasional alcohol abuse. . Physical Exam: vitals T 98.7 BP 106/73 AR 54 RR 14 Gen: Pleasant female, NAD HEENT: PERRLA, MMM Heart: nl s1/s2, no s3/s4, no m,r,g Lungs: CTAB, no crackles Abdomen: soft, NT/ND, +BS, no organomegaly Extremities: no edema, 2+ DP/PT pulses . Laboratory results: see below . EKG: Sinus bradycardia at 57. Small Q in II, III, F. J point ele in V3 with no significant change compared with prior dated [**2155-9-8**] earlier today. EKGs at OSH showed vent bigeminy. . Relevant Imaging: . 1)Cardiac cath (OSH-[**9-8**]):100% RCA, 80 - 85% LCx, "Mod LAD", EF 55%. no formal report sent. . 2)Carotid U/S ([**9-9**]):60-69% stenosis in the proximal internal carotid arteries bilaterally. This is a baseline examination at the [**Hospital1 18**]. . 3)ECHO ([**9-9**]): 1. There is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF>55%). Regional left ventricular wall motion is normal. 2. The aortic valve leaflets (3) are mildly thickened. No aortic regurgitation is seen. 3. The mitral valve leaflets are mildly thickened . A/P: Ms. [**Known lastname **] is a 64 yo female with history of MI, 3VD on recent cardiac cath, bilateral carotid stenosis being transferred to the CCU for closer management as well as evaluation for CABG. . CARDIAC 1)3VD: Pt presented with chest pain at OSH and was found to have significant 3VD on cardiac catheterization. She was transferred to [**Hospital1 18**] for further evaluation and possible CABG. Pt being followed by CT surgery. - [**Hospital **] medical management w/statin, b-blocker, aspirin - Hold Plavix and Integrillin given possible surgery and that she unlikely does not have an unstable plaque, more likely demand ischemia in the setting of tachycardia. - ECHO, U/A, CXR, T+S as per CT surgery - Continue nitro gtt and titrate down as necessary - [**Hospital **] consult, as below; f/u reccs - F/u CT surgery reccs . 2)Rhythm: Pt in sinus rhythm on admission; she has episodes of tachycardia (with multiple APCs)associated with ST changes (not new), likely demand ischemia. - Ct with Metoprolol 50 [**Hospital1 **], titrate up as necessary . 2) LV Function: No history of CHF; appears to be normovolemic on clinical exam. - pre-op ECHO this afternoon . 3)Bilateral carotid stenosis: Ultrasound from today shows 60-69% carotid stenosis bilaterally. Currently asymptomatic. - [**Hospital1 **] surgery consult regarding surgical intervention (CEA vs. stent placement) and if this needs to be done prior to CABG. . 4)Retinal detachment: s/p bubble procedure, pt being followed by opthamology. Per opthamology, pt able to lye supine as well as receive high doses of heparin. Per optho, pt able to lye supine for surgery. - Ct with outpatient regimen: Alphagan, Pred Forte, Tobramycin, Cyclopent; the latter 2 can be stopped on [**9-11**]. - No nitrous oxide for anesthesia due to increased IOP. - F/u opthamology reccs . 5)FEN: Cardiac healthy diet, NPO after MN for likely CABG tommorow, replete electrolytes as necessary. . 6)Access: 1 PIV . 7)Code: Full . 8)Prophylaxis: Heparin IV for DVT prophylaxis, bowel regimen not necessary at this time. . 9)Communication: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 68948**], daughter: H [**Telephone/Fax (1) 68949**], C [**Telephone/Fax (1) 68950**], W [**Telephone/Fax (1) 68951**]. . 10)Dispo: Pending possible CABG and clinical improvement .

CHIEF COMPLAINT: Chest pain, shortness of breath PRESENT ILLNESS: This is a 60-year-old woman who has a past medical history of known CAD s/p MI in [**2153-3-10**] with a stent to her LAD at that time. She underwent a repeat catheterization in [**2153-8-10**] for recurrent chest discomfort and had two stents placed in her mid LCx. In [**2153-10-10**] she was admitted to [**Hospital 1514**] hospital for recurrent chest discomfort similar to her prior presentations. She ruled out for an MI and underwent a persantine stress test, which was positive for chest pain. Nuclear imaging demonstrated severe apical non-reversing defect consistent with a prior apical infarction, anteroseptal defect with minor reversibility and a moderate sized, mild intensity inferoposterior defect without significant reversibility. Subsequently she underwent another cardiac catheterization that revealed a 100% stenosis just after OM1 stent and a decrease in his EF to 31% (EF in [**3-/2152**] 50-56%). PCI was not attempted and adjustments were made to her medications. Since that time she continues to experiencing chest pain 3-4 times per week. It is non-radiating and is typically relieved with rest. She states that she gets extremely short of breath with minimal activity. She states that she is wearing her home O2 with increasing frequency. She further reports that she get lightheaded when going from a sitting to a standing position. She is now referred for a cardiac catheterization with possible revascularization. MEDICAL HISTORY: Coronary Artery Disease, Prior PCI, History of Myocardial Infarction, Obesity, Hypertension, Hypercholesterolemia, GERD, Depression, Tonsillectomy, Appendectomy, Cholecystectomy, Hysterectomy, Chronic Headaches, Chronic Knee Pain, History of MVA complicated by cerebral hematoma and coma, Prior Colon Surgery MEDICATION ON ADMISSION: Lisinopril 20 qd, Plavix 75 qd, lasix 40 qd, Oxycodone prn, Aspirin 325 qd, Ambien 10 qd, Lipitor 80 qd, Coreg 18.75 [**Hospital1 **] ALLERGIES: Compazine / Hydromorphone Hcl / Morphine PHYSICAL EXAM: Vitals: BP 160-170/82, HR 91, RR 18, SAT 92% on room air General: obese female in no acute distress HEENT: oropharynx benign, EOMI, PERRL Neck: supple, no JVD, Heart: regular rate, normal s1s2, no murmur or rub Lungs: clear bilaterally Abdomen: obese, some RLQ and LUQ tenderness, normoactive bowel sounds Ext: warm, no edema, Pulses: 1+ distally Neuro: nonfocal FAMILY HISTORY: Mother underwent CABG at age 78. Father and brother had hypertension. Father died from a pulmonary embolism. SOCIAL HISTORY: Quit tobacco 30 years ago. Admits to 10 pack year history. She denies ETOH and recreational drugs. She is divorced, no children. She is a retired chiropractor.

CHIEF COMPLAINT: Mental status change. PRESENT ILLNESS: The patient is a 74-year-old woman with the past medical history of ovarian cancer, status post total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and ileocecectomy in [**2131-9-29**], complicated by perforation of the anastomosis with peritonitis and abscess requiring exploratory laparotomy and resection of the anastomosis with ileostomy, perihepatic abscess MRSA, history of aspiration, diabetes mellitus, paranoid schizophrenia, depression, recent herpes zoster. The patient presented with several days of worsening mental status. Over the past few months, the patient has had multiple admissions related to ovarian cancer and complications, thereof. On [**5-13**], the patient was discharged from her rehabilitation placement. Over the ensuing days, the patient had increased lethargy and decreased responsiveness. The patient presented to the emergency department on [**2132-5-17**]. The patient was found to be in acute renal failure, hypokalemia, hyponatremia, leukocytosis of 12.3, purulent urine and a positive urinalysis. The patient was treated with Levofloxacin and Vancomycin. She became hypotensive despite hydration. She was transferred to the Intensive Care setting, where she received IV dopamine through a central venous line. Head CT was performed and negative. Abdominal CT was unremarkable. The patient's ICU course was significant for a 10 point hematocrit drop, which was thought to be dilutional. LP and chest x-ray were both negative. The patient was gradually weaned off dopamine. Mental status rapidly returned to baseline upon arrival to the ICU. MEDICAL HISTORY: 1. Ovarian cancer, diagnosed [**2131-9-29**], status post total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and ileocecectomy in [**2131-9-29**]. [**2131-12-29**], the patient was found to have perforation of her anastomosis with peritonitis and intraabdominal abscess. She under exploratory laparotomy and resection with ileostomy. Course was complicated by intubation, acute renal failure. 2. MRSA, perihepatic abscess. 3. History of aspiration. 4. Diabetes mellitus. 5. EF 45% to 50% with 2+ MR 6. Hyperlipidemia. 7. Paranoid schizophrenia. 8. Depression. 9. Recent herpes zoster virus infection. 10. Status post PEG placement. MEDICATION ON ADMISSION: ALLERGIES: The patient is allergic to PENICILLIN, WHICH CAUSES A RASH. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient is widowed.

CHIEF COMPLAINT: L dorsal wrist/hand defect from previous partial flap failure. PRESENT ILLNESS: [**Known firstname 40658**] is a familiar patient to our hand service. She, several months ago, had a subtotal incomplete amputation followed by revascularization of the entire wrist and hand, as well as open reduction of a very complex disarticulation injury. She recently had coverage of exposed plate on the dorsal aspect of the hand with a reversed dorsal interosseous tissue flap. A portion of this did not survive, namely the distal portion, and she comes back today for coverage of residual area of exposed plate and carpal bones. A free flap from the opposite forearm with primary closure of the opposite forearm was chosen. The recipient vessels were the radial artery in the mid forearm. Several days ago an angiogram had documented the patency. MEDICAL HISTORY: DM II, HTN, Hypercholesterolemia MEDICATION ON ADMISSION: Glyburide, norvasc, lipitor, advair ALLERGIES: Tape PHYSICAL EXAM: On Discharge Alert and Oriented RRR no murmurs Lungs clear to auscultation R forearm incision intact and without erythema. Steri strips in place. L doral wrist with STSG in place without evidence of necrosis. Splint in proper position. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives alone near [**Last Name (un) 17679**]. Works two jobs - factory in evening, housecleaning in daytime. Never smoked. Does not drink, no drug use.

CHIEF COMPLAINT: trach tube fell out PRESENT ILLNESS: This is a 65 year old female with a history of tracheomalacia, tracheal stenosis, DM2, HTN, schizoaffective disorder, s/p gastrostomy tube, who is here after her trach fell out. In [**Month (only) **] [**2104**], Ms [**Known lastname 174**] had respiratory failure and had tracheostomy tube placed however developed significant granulation tissue around the site. She had a procedure for debridement and an attempt to place a T tube failed; on [**8-19**] had T-tube reattempted but Ms [**Known lastname 174**] became short of breath and was noted to have a stenosis proximal to the T-tube; a trach was again placed and she was sent to a rehab. On the morning of this current admission, the nursing staff noted that the tracheostomy tube was out. She reported feeling a "brick in her throat and some SOB" and eating breakfast. These symptoms lasted 1 hour and were associated with some SOB. Dr [**Last Name (STitle) **] was notified and he requested she come to [**Hospital1 18**] for ICU monitoring and tracheostomy replacement. In the past, she had respiratory failure in the setting of tracheostomy tube displacement secondary to tight proximal stenosis with loss of airway. Upon arrival in the ED, Ms [**Known lastname 174**] was taken directly to the OR where a rigid bronchoscopy was performed. A significant amount of granulation tissue was noted. Percutaneous tracheostomy was performed without difficulty. Following the procedure, Ms [**Known lastname 174**] was admitted to the MICU for monitoring overnight. She was saturating normally near 100% on humidified trach mask, with HR of 62, normotensive, and afebrile. MEDICAL HISTORY: --diabetes mellitus --hypertension --tremors --cerebrovascular accident ~ 10 years ago --cataracts --schizoaffective disorder --s/p gastrostomy tube placement MEDICATION ON ADMISSION: 1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 2. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO QAM (once a day (in the morning)). 3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 8. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 9. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for anxiety. 10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 11. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q2H (every 2 hours) as needed for shortness of breath. 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 13. Labetalol 200 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day): Hold for sbp<100, hr<50. 14. Benztropine 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 15. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**12-6**] Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath. 16. Codeine Sulfate 30 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for cough. 17. Insulin Glargine 100 unit/mL Solution Sig: Fifty (50) u Subcutaneous at bedtime. 18. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime. 19. Vitamin D Oral 20. Insulin Aspart Subcutaneous 21. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. ALLERGIES: Penicillins / Keflex PHYSICAL EXAM: Discharge Physical Exam: Gen: Pleasant Caucasian female, trach mask in place in NAD HEENT: Anicteric Neck: Trach mask in place on humidified air Cardiac: Nl s1/s2, RRR Pulm: clear bilaterally with no wheezes or rales Abd: soft, nontender, nondistended Ext: No noted edema FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Prior to hospitalization for PNA, the patient lived alone in [**Location (un) 1294**]. After her hospitalization, she spent one month at [**Hospital **] rehab. The patient currently lives at [**Location 44563**], a nursing home/rehab facility. She retired as a school teacher over 30 years ago and supports herself with [**Social Security Number 86960**]social security. She smoked 2 ppd for 40 years but quit in [**Month (only) 958**]. She denied the use of EtOH or drugs. She currently walks with a walker, but is learning how to walk with only a cane.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: This is a 59 yo male with a history of hypertension who presented to [**Hospital1 18**] [**Location (un) 620**] with chest discomfort on evening of [**2105-12-28**]. He had 2 prior episodes of chest discomfort, 1 year ago and 3 days ago. The episode 3 days ago occurred while patient was in bed, and he doesn't know the duration because he went back to sleep. At 22:15 on [**12-28**] he had chest pain while lying in bed radiating to left arm, with no associated diaphoresis, nausea, or dyspnea. This episode was much worse compared to the previous [**Last Name (LF) 102931**], [**First Name3 (LF) **] patient's wife drove him to the [**Name (NI) **]. At [**Location (un) 620**], he was found to have ST elevations in inferior leads with reciprocal changes in I and aVL. Biomarkers were pending at the time of transfer. He received ASA325mg, SL NTG x 3 (pain free), clopidogrel 600mg, heparin 5000 units bolus with 1000/hr gtt, and eptifibatide 180mcg/kg bolus with 2mcg/kg/min gtt, and was transferred to [**Hospital1 18**]. Diagnostic catheterization showed occlusion of mid-LAD with distal filling via L-L collaterals, mid-RCA occlusion with L-R collaterals, and 80% OM1 with diffuse distal LCx disease. IABP was inserted and patient was transferred to CCU for further management, pain free. On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for absence of dyspnea on exertion, palpitations, syncope or presyncope. MEDICAL HISTORY: Hypertension prostate hypertrophy finger dislocation MEDICATION ON ADMISSION: Hydochlorothiazide 12.5mg daily Lisinopril 20mg daily ASA ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: BP: 132/74, HR:94, O2Sat:97% GENERAL: Middle-laged male, NAD HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: No family history of early MI, otherwise non-contributory SOCIAL HISTORY: -Occupation:Telecommunications sales -Married -Tobacco history: Quit smoking: in [**2084**] -ETOH: 2 drinks per week -Illicit drugs: None

CHIEF COMPLAINT: Gallstone pancreatitis and cholangitis PRESENT ILLNESS: The patient is a 54-years-old female with complicated psychiatric history. She has been under the care of Dr. [**Last Name (STitle) **] undergoing multiple ERCP and stent changes with a history of gallstone pancreatitis and cholangitis initially last spring. At that time, she had refused surgical intervention. She did state in [**2134-10-5**] that she would be interested in having her cholecystectomy, and she was then transferred to our service and prepared for surgery, but in the preoperative holding area again changed her mind, and thus was ultimately discharged home as she was no longer willing to undergo an ERCP either. In [**Month (only) 404**] [**2134**], patient returned back to Dr. [**First Name (STitle) **] office to discuss cholecystectomy again. All risks, benefits and possible outcomes were discussed with the patient, and she was scheduled for elective laparoscopic/open cholecystectomy on [**2135-1-11**]. MEDICAL HISTORY: Fibromyalgia Chronic fatigue syndrome Depression Schizophrenia Gallstone pancreatitis/cholangitis [**3-16**] Cholelithiasis/choledocholithiasis Possible sleep apnea MEDICATION ON ADMISSION: Clozaril 200qHS, Cal/Vit D 500-400', Dulcolax 5 PO prn, Senokot 2'' prn, Tylenol 650'''' prn, Zantac 150'prn ALLERGIES: Penicillins / Epinephrine / aspirin / Benadryl / grapes / red peppers PHYSICAL EXAM: On Discharge: VS: 97.6, 87, 136/80, 12, 95% 3L NC GEN: NAD, AAO x 3, somnolent CV: RRR, no m/r/g RESP: Diminished bilaterally on bases R > L ABD: Obese. Right subcostal incision OTA with staples and c/d/i. Right T-tube capped, insertion site with dry dressing and c/d/i. FAMILY HISTORY: NO family history of gallstone disease SOCIAL HISTORY: Social History: Lives alone, denies tobacco, EtOH, drugs

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 41 year old man who was recently admitted ([**2158-9-28**], to [**2158-10-3**]), status post a witnessed generalized seizure. His story was that he used 0.5 grams of Cocaine nasally. He went to work as a telephone technician. He was intoxicated while on the second step of the ladder and had a witnessed seizure. During the seizure, he fell and hit his head. He was brought to an outside hospital where he was noted to have an 8.0 millimeter middle cerebral artery aneurysm but no subarachnoid hemorrhage. He was transferred to [**Hospital1 190**] for [**Hospital1 2742**] of the aneurysm. MEDICAL HISTORY: 1. Middle cerebral artery aneurysm 8.0 millimeter. 2. Depression for three years. 3. Cocaine. MEDICATION ON ADMISSION: 1. Zoloft. 2. Nortriptyline. ALLERGIES: None. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He does use Cocaine and marijuana regularly. He drinks one beer per week. No tobacco. He was recently divorced.

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname **] is a 65-year-old man who was driving in his car when he hit a tree head-on. It is unknown whether a cardiac event had preceded the accident because a witness reported that the patient's eyes rolled back in his head prior to the accident. The patient was extracted from the vehicle with loss of pulse. He was defibrillated and found to be asystolic. While they were preparing to intubate the patient he regained consciousness and was transferred to BIMDC. While en route, he was intubated for airway protection. Abdominal and head CT showed multiple rib fractures. He also had sustained a laceration to his head. He was admitted to the Surgical Intensive Care Unit for further management. However, after it was noted that his surgical needs were not operable, he was transferred to Medicine. MEDICAL HISTORY: 1. History of CHF. 2. Type 2 diabetes mellitus. 3. Psoriasis. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lived alone in [**Location (un) 86**]. His brother, [**Name (NI) **] [**Name (NI) **], and [**Name (NI) 2013**] had been in to see the patient occasionally.

CHIEF COMPLAINT: Chief Complaint: diarrhea PRESENT ILLNESS: 67M w/ hx metastatic lung cancer, COPD, erosive gastritis p/w hypotension and diarrhea, possible blood per rectum. States for the past several days he felt faint, weak, and fatigued. Yesterday his symtoms worsened and he also experienced several episodes of ?bloody diarrhea. No N/V, no CP or abdominal pain. No fever, chills, dysuria. Complains of continued LLE pain c/w chronic pain. Also some ?SOB. [**Name (NI) 1094**] sister states that pt was on toilet and she caught him while he was trying to get up. Called [**Hospital1 **], SOB on the phone. Sister was with him and stated he was too weak to walk or get down stairs. She called 911. Patient presented to the [**Hospital1 18**] ED by ambulance. On arrival at [**Hospital1 18**] he was noted to be hypotensive and triggered. ED vitals: 97.2, 102, 70/40-->repeat 95/47, 16, 100%. He had heme postive, brown stool w/ no gross blood. Recent HCT 31.8 on [**2180-7-31**] (Atrius), and patient was found to have HCT of 19, ordered 2 units PRBCs, but did not yet get. Given 100mg hydrocortisone IV as stress-dose steroids because pt is on steroids. BPs have been mostly in the 100s-110s. Unclear if pt has had recent EGD or colonoscopy, none in our system, did have recent EGD for gallstone pancreatitis, but pt does reportedly have erosive gastritis, diverticulitosis, and has had rectal and colonic polyps. Also recent history of peri-anal zoster, now on Valtrex. Patient was given 2L NS in ED, bedside U/S NML, and had CT abdomen (oral, no IV contrast). GI paged and aware, but did not yet see patient. MEDICAL HISTORY: -Metastatic Lung Cancer (see below) -Chronic Obstructive Pulmonary Disease -Anemia (chemo and CKD) -Erosive Gastritis (secondary to NSAID use) -Psoriasis and Psoriatic Arthritis -Hypertension -Osteoarthritis -Peripheral Vascular Disease (s/p LE bypass) -Diverticulosis -Hypercholesterolemia -AAA repair in [**2171**] -Left total knee replacement in [**2173**] -Left L4/L5 spine surgery in [**2138**], reported as a discectomy; and severe lumbar DJD -Gallstone pancreatitis -Rectal and colonic polyps -ECHO [**4-/2179**]: L atrium mildly dilated; otherwise essentially NML w/ EF 60% -ECG [**4-/2179**]: normal sinus rhythm, Qwaves V1-V2 MEDICATION ON ADMISSION: - dexamethasone - folic acid? - lorazepam 1 mg as needed for insomnia or for nausea - omeprazole 20 mg capsule, delayed release(DR/EC) [**Hospital1 **] - ondansetron 8 mg tablet ODT every 8 hours as needed for nausea - oxycodone 5 mg tablet every 4 hours as needed for pain - prochlorperazine maleate 10 mg tablet every 6 hours as needed - simvastatin 80 mg daily (pravastatin?) - Alleve - Zometa - imatinib 100 mg daily - Tarceva (erlotinib) - Valtrex ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Vitals: T: 98.5, BP: 99/47, P: 93, R: 17, O2: 100% RA General: Alert, oriented, no acute distress, rash on face, arms FAMILY HISTORY: -Mother had some type of cancer. No family hx of pancreatitis. SOCIAL HISTORY: -Divorced, two children -Lives with sister, independent in ADLs -Tobacco: quit 8 years ago -ETOH: 1-2 drinks weekly at most, had 2 beers last night -Illicits: None

CHIEF COMPLAINT: cardiac arrest PRESENT ILLNESS: 82 M with h/o IPF (on chronic steroids), PVD, h/o VT (on dofetilide), and P.D. He was last seen at [**Hospital1 18**]-[**Location (un) 620**] cardiology clinic [**4-25**] (one month prior to admission). He was at home being cared for by his wife, daughter, and nurses and was noted to be "much improved" but using continual O2 and having increased SOB in the last few weeks. He denied chest discomfort or palpitations but did report occasional lightheadedness without falls. . On the evening of presentation, he was leaving a restaurant after father's day dinner. He sat down in the passenger seat, complained of fatigue, then became acutely SOB; changes in position did not help these sx. His family started to drive to the ED, but the patient passed out, turned blue, and his eyes rolled back in his head. He was promptly removed from the car and received CPR from his daughter who is [**Name8 (MD) **] RN until EMS arrived when he was noted to be in asystolic arrest. EMS administered epi, lido, and atropine and intubated the patient. He was brought to [**Location (un) 620**] ED where he was in SR w/NSVT. ECG demonstrated ST depression in V2-4. The patient was given amiodarone for his NSVT which decreased his HR to 100s. He was then trasferred to [**Hospital1 18**]. Labs pending at time of transfer demonstrated Na 141, K 4.3, Cl 103, CO2 22.9, Glucose 123, BUN 21, Creatinine 1.3, Ca 8.8, Mg 2.2, Albumin 3.7, Protein 6.8, TBili .66, AlkPhos 118, ALT 25, AST 27, CPK 42, INR 1.2, PTT 31, WBC 9.5, HCT 38.3, MCV 86.6, PLT 201, N59L34M7 and ABG of 7.3/33/155 on CMV550X2 40 5. ... MEDICATIONS: Sinemet 25/100 2 tabs at 9:00 a.m., 1.5 tabs 11:00 a.m., 1 tab 4:00 p.m. Prednisone 2.5. Quinaglute 325 q.12 hours. Omeprazole 20 q.a.m.. P.R.N. Colace, Senokot. ASA 81, MVI 1 daily. Zocor on hold. ... MEDICAL HISTORY: Past Medical History: 1. Orthostatic hypotension (? Shy-[**Last Name (un) **]). 2. Diastolic congestive heart failure. 3. RMVT (repetitive monomorphic VT presumably from RVOT origin). 4. Coronary artery disease/CA calcification. 5. Dyslipidemia. 6. Peripheral vascular disease (status amputation right first toe [**2168-11-23**]). 7. Pulmonary fibrosis. 8. Chronic obstructive pulmonary disease. 9. Parkinsonism with probable Shy-[**Last Name (un) **]. 10. Episodic gout. 11. Chronic respiratory failure. 12. Past hypermagnesemia. 13. Last echo [**2168-7-13**] w/EF 55-60% and 1+ MR MEDICATION ON ADMISSION: Sinemet 25/100 2 tabs at 8AM, 1.5 mg Q 1PM, 1 tab 4PM Prednisone 2.5 mg QD Quinidine 324 mg SA [**Hospital1 **] Simvastatin 20 mg QHS HCTZ/Spironolactone 25/25 Q MWF Omeprazole QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: NC SOCIAL HISTORY: lives at home with wife, who is HCP. Former [**Name2 (NI) 1818**], quit. Blueprint shop-->chemical exposures.

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 57-year-old male with Burkitt's type lymphoma originally diagnosed in [**12/2117**] following a six week history of fatigue, night sweats, and adenopathy, and testicular enlargement. He underwent an inguinal node biopsy on [**2117-12-16**]. Pathology revealed diffuse replacement of the nodal architecture with extranodal invasion of the surrounding fat consistent with a high-grade lymphoid neoplasia. A lumbar puncture was performed which showed cerebrospinal fluid involvement and an Ommaya shunt was placed on [**2117-12-19**]. CODOX was started [**2117-12-17**] and Methotrexate started on [**2117-12-19**] via the Ommaya shunt. He is status post hospitalization for IVAC therapy from [**2118-1-4**] to [**2118-1-8**] status post intrathecal ara-C on [**2118-1-21**], and again on [**2118-2-25**]; status post CODOX and Rituxan cycle on [**2118-1-24**] to12/19/[**2117**]. Status post admission for high-dose methotrexate from [**2118-2-3**] to [**2118-2-9**]; status post admission for IVAC cycle number four but discontinued prematurely for pneumonia in [**2-/2118**]; status post IVAC without Ifosfamide in 01/[**2118**]. From [**2118-5-5**] patient underwent R-[**Hospital1 **] chemotherapy with Velcade and most recently prior to admission treated with the Gemcitabine, Rituxan, cisplatin, and currently being admitted for TVI high-dose Cytoxan followed by allogenic bone marrow transplant. MEDICAL HISTORY: As per History of Present Illness, pyloric stenosis, ventricular hypertrophy, history of ventricular ectopy and hypercholesterolemia. MEDICATION ON ADMISSION: 1. Tylenol 25 a day 2. Compazine 10 mg q. 6 hours p.r.n. nausea. 3. Zofran p.r.n. nausea 4. Acyclovir 400 b.i.d. 5. Diflucan 200 q. day 6. Fentanyl patch 25 mcg q. day 7. Colace. 8. Vitamin B6. 9. Potassium chloride pills. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: hypotension at HD PRESENT ILLNESS: 55F with ESRD on HD, PVD s/p R AKA, HTN, DM, presents with hypotension at HD. Pt was feeling in her usual state of health until she went to HD this morning. At HD, her BP was found to be 56/12. EMS was called and BP per the EMTs was 58/41. She was brought to the [**Hospital1 18**] ED. . On arrival to the ED, vitals were T 97.6, BP 62/34, HR 72, RR 17, SaO2 98% 2L. SBP initially maintained in the 60s but improved to 110s with manipulation on exam and attempts at IV access. She was initially very lethargic, and then became agitated, yelling out in pain. At best, she was answering yes/no questions. CXR negative. CT abd/pelvis showed mild increase in R pleural effusion but no acute intraabdominal process. Received vanco, zosyn, and 200cc IVF. Admitted to the MICU for close monitoring. MEDICAL HISTORY: - Peripheral Vascular Disease s/p L SFA-DP bypass for L gangrenous heel in [**2187**]; s/p R proximal SF-proximal AT bypass in [**4-4**]; s/p multiple debridements of b/l LE for infected/non-healing wounds; s/p L BKA [**12-6**], L AKA for non-healing BKA ulcer (prior MRSA, VRE and MDR Klebsiella) [**1-6**] - Likely left AKA stump osteomyelitis requiring admission in [**3-/2192**], on IV antibiotics, VAC dressing in place - ESRD on HD. Last HD yesterday. Usually MWF schedule. - HTN - Diabetes Mellitus - Renal Cell Carcinoma s/p right nephrectomy - Obesity - Depression - s/p CCY - Gastric Ulcer - Obstructive Sleep Apnea. The patient reports that she used to use a CPAP however her machine broke and she no longer uses it. - Gastroparesis - COPD on 3-4L NC baseline - h/o ischemic colitis - left adrenal adenoma MEDICATION ON ADMISSION: [**Month (only) **] 325mg PO daily Plavix 75mg PO daily Simvastatin 80mg PO daily Rifampin 300mg PO q12 Doxy 100mg PO q12 Regular insulin sliding scale Protonix 40mg PO daily Reglan 5mg PO QIDACHS Lanthanum 500mg PO PO TID w/meals Cinacalcet 60mg PO daily Nephrocaps 1mg PO daily Sevelamer 2400mg PO TID with meals Percocet 5-325mg 1-2 tabs q4-6h prn Gabapentin 300mg PO qHD [**Month (only) 95641**] Mirtazapine 15mg PO qHS Tramadol 50mg PO BID Colace prn Senna prn ALLERGIES: Lisinopril PHYSICAL EXAM: T 98.1, BP 120/doppler, HR 75, RR 75, SaO2 95% 2L General: obese female, alert and interactive. Neck: obese, unable to determine JVP Heart: RRR, distant HS [**12-31**] body habitus Chest: L subclavian tunneled HD line without surrounding erythema, CTAB anteriorly but difficult to auscultate Abdomen: +BS, obese, soft, non-tender with stethescope exam. Extrem: L upper arm incision with sutures in place, no erythema, s/p L BKA (stump is mildly edematous but no erythema or drainage), dopplerable R DP pulse, 1+ RLE edema, +anasarca Back: sacral decub ulcers by report Neuro: A+Ox2 (name and place), she believes this is [**2191**] and is unable to repeat date when told. CN2-12 grossly intact. FAMILY HISTORY: Mother died of stomach cancer in her 40s. Father had an unknown cancer in his 70s. Stated that diabetes, high cholesterol, and high blood pressure run in her family. SOCIAL HISTORY: Admitted from rehab. Has two sisters, one daughter. [**Name (NI) **] is a former smoker with a 30 pack year history, quit 20 years ago.

CHIEF COMPLAINT: Abdominal pain. PRESENT ILLNESS: This 68 year-old gentleman with abdominal pain x 6 weeks with sudden onset associated with eating, occurs 15 minutes post eating and lasts several hours. Partially relieved with Darvocet. The patient had a diagnostic work-up at an outside hospital for mesenteric ischemia which was positive. MEDICAL HISTORY: Peripheral vascular disease, status post angioplasty and stenting of the right lower extremity in [**2143**]. Vessel angioplastied is now known. History of hypertension, controlled. MEDICATION ON ADMISSION: Atenolol 100 mg daily, hydrochlorothiazide 25 mg daily. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Positive in the father for liver disease. Mother myocardial infarction and breast cancer. SOCIAL HISTORY: The patient is a 12 pack per week beer drinker. History of copious alcohol use previously. One and 1/2 packs per day times 55 years smoking, which is current.

CHIEF COMPLAINT: Chief complaint: acute renal failure, hyperkalemia Reason for ICU admission: Hypotension not responsive to 4L NS . PRESENT ILLNESS: Mr. [**Known lastname 1356**] is a 53 year old male with CAD s/p MI, HTN, type 2 DM, PVD, who [**Known lastname 1834**] right groin exploration and femoral patch redo last week who presented to clinic today with fatigue for one week. He denies fevers, chills, nausea, vomiting, shortness of breath, diarrhea, constipation, abdominal pain. He does report significant surgical incision pain at right groin without significant drainage. In addition, he reported one hour of chest pressure several days ago while at rest which resolved and has not recurred. . In the ED, vitals were T 98.1, 74/47, 69, 18, 100% on RA. He was given 4LNS with only transient improvements of his blood pressure. In the ED, his blood pressure 70s-90s/ 50s-60s. A fast exam was performed in the ED and was negative. His bedside echo was unremarkable. He was not given antibiotics. . Upon arrival to the MICU, patient denied chest pain, lightheadedness, thirst, fevers, chills, dysuria, cough, shortness of breath, diarrhea, or any other concerning symptoms. MEDICAL HISTORY: CAD s/p MI HTN DM, Type 2 Hyperlipidemia Peripheral Vascular Disease s/p L SFA stent/angioplasty [**8-26**] Arthritis Spinal spenosis Chronic back pain Bilateral knee surgery S/p liver orthotopic liver [**Month/Year (2) **] for ETOH cirrhosis MEDICATION ON ADMISSION: Fosamax 70 mg weekly Atenolol 50 mg daily Lipitor 40 mg daily Cilostazol 50 mb [**Hospital1 **] Cipro 500 q 12 hours Nexium 40 mg daily Tricor 145 mg daily Lasix 20 mg every other daily Hydromorphone 2-4 mg q 4-6 hours NPH 48 q am, 28 qpm with HISS Lisinopril 5 mg daily Cellcept [**Pager number **] mg [**Hospital1 **] Nifedipine 30 mg daily Viagra prn Tacrolimus 4 mg [**Hospital1 **] Detrol LA 4 mg [**Hospital1 **] Trazodone 100 mg prn insomnia Bactrim [**Hospital1 **] Aspirin 325 daily Calcium Carbonate 1500 [**Hospital1 **] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: HR 68, BP 118/60, RR 19, 96% on RA Gen: NAD, well appearing HEENT: EOMI, moist mucous membranes CV: RRR, no m/r/g, distant heart sounds Pulm: CTA b/l, no crackles, wheezes Abd: obese, soft, NT, ND Ext: severe right groin tenderness along the upper aspect of the surgical incision, +warm, but no visible drainage, right sided 2+pitting edema Neuro: AxOx3, moving all extremities FAMILY HISTORY: Father died 42 years old from MI. SOCIAL HISTORY: Patient is a retired cook. He smoked 2 PPD for 40 years, but has since quit. He is a former alcoholic, but has been sober for 6 years

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 20-year-old woman who felt well until the morning of admission when she awoke with a "belly ache." She states that the pain was primarily hypogastric and was not radiating or associated with any precipitating factors. She stated that she checked a fingerstick glucose on the morning of admission, and it was 145; so "I didn't think anything of" the pain. The patient states that she did not have anything to eat; however, she did not take her morning Humalog sliding-scale insulin. At about 11 o'clock on the morning of admission, the patient states that she became nauseous and vomited "clear fluid." This fluid was nonbilious, nonbloody, and did not have a coffee-grounds appearance. She states that she vomited a total of four times on the day of admission; the last time was at 2:30 in the afternoon. At approximately 1 p.m., she began having diarrhea that was neither bright red nor jet black, but it was "dark." She last had diarrhea at approximately 3:15 on the afternoon of admission. Her abdominal pain persisted, however, and at 4:30 p.m. she called for an ambulance. Of note, the patient states that she was admitted to [**Hospital3 1810**] two weeks prior to this admission with hypoglycemia. On the day of this admission, the patient states that she took her regular nighttime insulin dose, but then did not eat "as soon as I should have, so I blacked out." The patient's fingerstick glucose was 45 at that time. At [**Hospital3 1810**], she had ketonuria and was treated for "dehydration" and released. She denies subsequent ketonuria. She states that she has otherwise felt well recently; and she denies recent upper respiratory symptoms, cough, fevers, chills, sweats, dysuria, frequency, hematuria, unusual vaginal discharge, chest pain, shortness of breath, headache, lightheadedness, dizziness, neck stiffness, photophobia, rash, sick contacts, recent travel (although the patient did return from [**Country 6171**] on [**8-14**]), raw fish or unusual foods, fresh-water swimming, or other complaints. Her last menstrual period was two weeks prior to admission. She states that she is completely compliant with her medications. During an interview in the Emergency Department, the patient stated that she had more right upper quadrant than hypogastric pain. She also complained of thirst. MEDICAL HISTORY: Type 1 diabetes diagnosed at the age of nine. MEDICATION ON ADMISSION: 1. Insulin Glargine 30 units q.h.s. 2. Humalog insulin sliding-scale. ALLERGIES: CEFACLOR. PHYSICAL EXAM: FAMILY HISTORY: The patient's mother has a history of gallstones. SOCIAL HISTORY: The patient denies tobacco, alcohol, or recreational or intravenous drug abuse. She is a senior at [**University/College 4700**]. She denies current sexual activity. She has no history of unprotected sexual intercourse; although, she admits to protected intercourse twice in the past.

CHIEF COMPLAINT: PRESENT ILLNESS: This 71 year-old diabetic female with a history of exertional angina and a positive stress test referred to [**Hospital1 69**] for cardiac catheterization. The patient reports chest tightness and shortness of breath after climbing one flight of stairs. MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Noninsulin dependent diabetes mellitus. 4. Status post hysterectomy. 5. Status post spinal fusion. 6. Status post cervical disc surgery. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: inferior STEMI PRESENT ILLNESS: [**Age over 90 **]F with PMH of hypertension and aortic stenosis presents to OSH with severe epigastric pain, found by EKG to have inferior [**Hospital **] transferred to [**Hospital1 18**] for cath lab. Patient was last seen well by family yesterday morning and was at baseline. Family became concerned when they did not hear from her later in the day and went to check on her at 6:30pm and found her doubled over in severe abdominal pain and with altered mental status. She had not picked up her morning paper, so acute event likely occurred in AM. . At OSH, she was found by EKG to have an inferior STEMI. Labs showed WBC 15.9, Hct 40.9, Platelets 309. INR 1.8, BUN 28, Cr 2.3, Sodium 140, K 4.4, Cl 98. CK 516, troponin 1.58. She was transferred to [**Hospital1 18**] for further management of STEMI and cath lab. . At [**Hospital1 18**] ED, she was initially hemodynamically stable on arrival. On her way to radiology, sbp dropped to 50s and she was started on dopamine, after which her sbp came up to 100s-130s. A head CT was also obtained due to AMS, and was negative for acute intracranial abnormalities. She was transferred to the cardiac cath lab. . In the cath lab, patient was found to have elevated RA pressure 20/24/21, PCWB 16/15/16, LV 186/20, aortic valve gradient 30 (consistent with severe AS), O2 sats - no evidence of shunts, [**MD Number(3) 91869**] venous sat - 70, IVC sat lower than SVC 60 vs 81 (possibly indicates an inflammatory process in lower torso). LV gram showed hyperdynamic LV. Systemic vascular resistance is elevated at 1149. Coronary perfusion shows LMCA ostial 90% lesion, proximal LAD 70% stenosis. The RCA is proximally totally occluded, however, this was not thought to be acute because LV EF was good and LV wall motion was hyperdynamic. Curiously, however, no collateral vessels were seen, which would be expected if RCA lesion was thought to be chronic. The patient was judged to not necessarily benefit from stenting, so an intra-aortic balloon pump was put in for supportive measures. . Patient is intubated and unable to complete a review of systems, but per family, she does not have hx of prior stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She has had no recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension 2. CARDIAC HISTORY: moderate aortic stenosis 3. OTHER PAST MEDICAL HISTORY: - anxiety - s/p carotid endarterectomy - divertulitis - s/p hysterectomy MEDICATION ON ADMISSION: diltiazem lisinopril buspirone simvastatin (recently stopped) aspirin (recently stopped) ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: T= [**Age over 90 **]F (rectal) BP=126/91 HR=92 RR=14 O2 sat= 95% (CMV ventilation with TV 450, RR 14, FiO2 50%, PEEP 5) GENERAL: intubated, sedated, no acute distress HEENT: NCAT. Sclera anicteric. PERRL 3mm to 2mm. CARDIAC: bradycardic, somewhat irregular, normal S1, S2. systolic murmur best heard at LUSB radiating to left carotid> right carotid. LUNGS: No chest wall deformities, scoliosis or kyphosis. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: hypoactive bowel sounds, soft, nondistended. No HSM or tenderness. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: multiple sebhorreic [**Last Name (LF) 91870**], [**First Name3 (LF) **] stasis dermatitis, ulcers, scars, or xanthomas. FAMILY HISTORY: Son with CAD. Brother has valve replacement and pacemaker. SOCIAL HISTORY: Lives alone, independent and walks with cane, has dementia and is sometimes confused.

CHIEF COMPLAINT: aphasia PRESENT ILLNESS: Ms. [**Known lastname 90885**] is a 65 year-old right-handed woman with a history including tobacco use, arrhthymia s/p cardioversion, and left MCA stroke ([**6-/2111**]) with residual subtle comprehension deficits and paraphasic errors who initially presented to [**Hospital3 **] with a global aphasia and was transferred to the [**Hospital1 18**] following the administration of t-PA. . The patient suffered a left MCA stroke in [**2111-6-17**] (presenting syndrome included language deficits but is otherwise unclear). [**Name2 (NI) **] daughter states that she since regained the ability to speak in fluent, grammatical sentences. However, she continues to demonstrate paraphasic errors. Her daughter thinks Ms. [**Known lastname 90886**] comprehension is largely intact. She can watch television and engage meaningfully in conversations. However, the patient has trouble identifying the date and her birthdate at baseline. She has no residual weakness. Although she has been living with her daughter, she is reportedly getting ready to move into independent housing. She is independent in activities of daily living. . She was in her usual state of health until about 11 am on the day of evaluation. At around 11:05 am, the patient went downstairs to find one of her relatives. At that time, she could no longer speak fluently; rather, she was "mumbling." She seemed to be able to understand to some degree and communicated a desire for coffee. Her family member took her to get coffee. She was able to walk independently with no incoordination. No facial droop or non-language deficits were noted. When the language impairments did not improve, she was taken to [**Hospital3 **] for evaluation. There an NIHSS score of 8 was given. After a telemedicine evaluation, she was given t-PA at about 1406. She was then transferred to the [**Hospital1 18**] for further evaluation and care. . A code stroke was called at the time of the patient's arrival. NIHSS score following thrombolysis was 7 (for inability to answer loc questions 2, failure to follow some loc commands 1, slight right facial palsy 1, severe aphasia 2, and slight dysarthria 1), although her baseline is estimated to be about 3 (inability to answer loc questions, slight aphasia). A non-contrast CT of the head performed at [**Hospital3 **] reveals a prior left MCA stroke without clear evidence of new ischemic lesions; major territorial vessels appear patent without signifcant stenoses. The patient's daughter thinks the patient's ability to produce speech has improved since the t-PA was administered. . NEUROLOGICAL, GENERAL REVIEW OF SYSTEMS: - Positive for: headaches (baseline), recent flu shot and cold symptoms per her daughter - otherwise unobtainable MEDICAL HISTORY: - left MCA stroke as above ([**6-/2111**]) - hypothyroidism - depression - headache - "arrhythmia" s/p what sounds like cardioversion MEDICATION ON ADMISSION: - proAir Inh 2 puffs inh q6h prn SOB - amitriptyline 25 mg po qhs (older rx) - topamax 25 mg po bid - levothyroxine 137 mcg po daily - pravastatin 40 mg po qhs - sertraline 100 mg po bid - asa 325 mg po daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: PHYSICAL EXAM: VS: 97.7, 148/64, 53, 17, 97%RA GEN: elderly woman lying in bed, struggling to communicate HEENT: OP clear PULM: CTA-B anteriorly CV: RRR ABD: soft, NT, ND EXT: no peripheral edema . NEURO EXAM: MS - able to follow some commands (show L thumb, squeeze hand, let go of hand), but no more than 1-step commands, able to count fingers, but unable to always answer appropriately, most answers are "I dunno" or "no", which are intermittently appropriate responses. She nodded her head when asked if she was in a hospital. CN - PERRL, EOMI, mild R facial droop, decreased blink to threat in R eye MOTOR - effort/comprehension dependent exam, pt unable to cooperate with distal LE's delt bic tric WrExt WrFlex IP Quads Ham L 5 5 5 5 5 5 4+ 4+ R 4- 5 5 5- 4+ 4 4+ 4 DTRs - 2 and symmetrical throughout, upgoing toe on R SENSORY - intact to light touch throughout COORDINATION - deferred GAIT - deferred FAMILY HISTORY: - positive for stroke (sister), migraine (daughter, etc), CAD SOCIAL HISTORY: lives with daughter, previously worked in a factory, had a 6th grade education, likes gambling, smokes [**2-19**] cigarettes/day but previously [**1-18**] ppd for "most of her life", her daughter denies alcohol or drug use.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 76 year old female with a history of CAD s/p MI [**12-29**] with stenting x 5 (likely RCA) c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] on HD, DM, HTN, CVA [**2167**] presented this afternoon to [**Hospital1 18**] [**Location (un) 620**] with Chest Pain. The patient reports that at 5 pm, while she was at rest and lying down, she began to experience sharp, non-radiating, substernal pain. The patient also became diaphoretic. When she asked for some ginger ale, the patient noticed that she was nauseated. The patient had never experience this constellation of symptoms before. By 10pm, the pain had significantly worsened, and an ambulance was called. She was given ASA and NTG en route. On arrival at [**Location (un) 620**], her EKG demonstrated NSR with STD in V5, V6, STE in V1, aVR. She was initially placed on a NTG drip, but this was discontinued once it was noted that the patient has a history of AS. She was transferred to [**Hospital1 18**] [**Location (un) 86**] for urgent cardiac catheterization. . On cath, a 70% stenosis of the left main was treated with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 2. An 80% lesion of the LAD was treated with one DES. A 90% stenosis was nboted in the RCA, but intervention was deferred. She was chest pain free after the procedure and transferred to the CCU for further management. . The patient recently had a fall that resulted in damage to her knee. During her previous catheterization at [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 108**] hospital, she experienced kindey failure witha creatinine that peaked at 8. On review of systems, the patient endorses regular diarrhea with occasional bouts of constipation. She also reports that she often feels diaphoretic and hot at night. The patient reports easy bruising, but has been told it is a sequela to her ASA therapy. The patient denies any changes to eyesight, sinus congestion, dysphagia, cough. The patient also denies dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Hyperlipidemia, Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: None -PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: # H/o CVA [**2157**] # Visceral stenosis (70% stenosis of the celiac, SMA, and [**Female First Name (un) 899**] followed by [**Doctor Last Name **]) # PVD # DM II - not on insulin, most recent A1c 7.1 in [**6-25**] # Hypertension # Migraine headaches # Gastritis - no peptic ulcer disease history. # Depression x30 years, initially reactive. MEDICATION ON ADMISSION: confirmed with Daughter [**Name (NI) **] AMLODIPINE [NORVASC] 5 mg PO qhs ATORVASTATIN [LIPITOR] 80 mg PO daily METOPROLOL Succs 25 mg PO daily CLOPIDOGREL [[**Name (NI) **]] - 75 mg Tablet PO daily ISOSORBIDE MONONITRATE - 60 mg PO daily METFORMIN - 500 mg PO daily OLMESARTAN [BENICAR] - 20mg PO daily OMEPRAZOLE - 20 mg Capsule PO daily prn TRAZODONE - 75mg PO daily ASPIRIN - 325 mg PO daily ALLERGIES: Penicillins / Univasc PHYSICAL EXAM: Gen:alert, talkative, NAD lying in bed HEENT: supple, no JVD CV: RRR, 3/6 systolic murmur at RUSB RESP: [**Month (only) **] BS left side, no crackles, ABD: soft, NT EXTR: no peripheral edema, pulses palp NEURO: alert, oriented x2, denies hallucinations or Extremeties: Groin Pulses: Right: DP 1+ PT 1+ Left: DP 2+ PT 1+ Skin: stage 1 ulcer on coccyx, chronic per pt. FAMILY HISTORY: Mother had CAD and MI. Father died at a young age of MI. SOCIAL HISTORY: Widowed, daughter lives with her. Previously independent. The patient denies tobacco history. EtOH: Will have one drink when she goes out to dinner. Has long history of depression and bipolar disorder, on multiple meds in the past

CHIEF COMPLAINT: Neutropenic fever / epigastric pain PRESENT ILLNESS: 38 y/o female with history of ALL, diagnosed [**9-23**], status post complete remission induced by five cycles of chemotherapy but with recent relapse by bone marrow biopsy [**2135-6-13**] status post admission for reinduction chemotherapy [**Date range (1) 18555**] who presented to the ED from home with epigastric pain and fevers. . Her admission was prompted first by a call to the [**Date range (1) 3242**] floor at approx 9pm on [**6-29**] with concerns that she was not feeling well. She noted epigastric pain for approximately three days associated with diarrhea and nausea. She was directed to call the [**Month/Year (2) 3242**] fellow on call, and when she mentioned fever to 100.2 associated with chills and rigors, she was directed to the ED for evaluation. . In the ED her vitals with T 99.1 orally, HR 109, BP 128/87, RR 16, and satting 100% on RA. She received 2gm cefepime, IV dilaudid, and was pan-cultured. CXR was without evidence for pneumonia. She was guiac negative. No CT scan was performed. . On review of systems, she denies cough, shortness of breath, or diaphoresis. Her diarrhea has resolved, but her abdominal pain continues. She notes it has been occurring since tuesday, is worse with eating, and is constant all day and evening. MEDICAL HISTORY: PAST ONCOLOGIC HISTORY: # Her ALL was diagnosed in [**9-23**], [**Location (un) 5622**] chromosome negative. She underwent 4 cycles of part A and part B hyperCVAD and 1 cycle of maintenance therapy. As above, she had a recent relapse of her disease by bone marrow biopsy on [**2135-6-13**] and had re-induction chemotherapy on [**6-17**] with plans to undergo matched un-related allogeneic stem cell transplantation if a donor becomes available. Her treatment course has been complicated by -F+N, low back pain, C diff, -surgical debridement and extraction of a tooth on [**2135-2-11**] due to dentoalveolar abscess to bone -vaginal Herpes outbreak while in hospital [**Date range (1) 18555**]. . OTHER PAST MEDICAL HISTORY: # DMII # HTN # s/p tonsillectomy # s/p cholecystectomy # s/p tooth #12 flap, fistulectomy and debridement [**2134-12-26**] # s/p upper left tooth extraction on [**2135-2-11**] # vaginal herpes MEDICATION ON ADMISSION: Metoprolol 37.5mg po qday Acyclovir 400mg po Q 8 hours Glimepiride 2mg po BID Lantus/Humalog sliding scale ALLERGIES: Penicillins / Aspirin / Amoxicillin / Omeprazole PHYSICAL EXAM: On admission FAMILY HISTORY: ? sickle cell train in sister. + for HTN in parents and for DM in both sets of grandparents. SOCIAL HISTORY: Lives alone in [**Location (un) 669**]. Originally from [**Country 3515**]. Previously worked as a financial aid officer in a bank. No EtOH, no tobacco.

CHIEF COMPLAINT: Recurrent HTLV1 associated adult T-cell leukemia/lymphoma PRESENT ILLNESS: This is a 72 year old female with past medical history of hypertension, coronary artery disease, and hyperlipidemia who was newly diagnosed with the lymphomatous form of HTLV associated T-Cell lymphoma/leukemia in [**2147-5-30**]. She received fluids and bisphosphonate for hypercalcemia and CHOP*1 before being discharged on Zidovudine and Interferon alpha therapy. Interferon had to be discontinued due to cytopenias and AZT was continued through [**Month (only) 547**] of this year. She recieved an additional six cycles of CHOP coupled with Denileukin diftitox and was in complete remission at the cessation of cycle five (her fourth as an outpatient). Next, she received two additional cycles of CHOP + Denileukin diftitox consolidation before proceeding to maintenance therapy with Denileukin diftitox two doses Q14 days. Unfortunately, in [**2147-1-28**] the patient began to experience a hematologic relapse with a rise in her WBC to 9.4 and atypical lymphs on a CBC from [**2148-2-9**]. Her LDH had peaked in the 1300-1600 range and then she went on to receive CHOP w/ Denileukin diftitox on [**2148-2-26**]. This led to a response with her LDH dropping to 199 and cytopenias ensuing. She was admitted to NEBH from [**Date range (3) 79098**] with neutropenic fever and phayrngitis for which she was treated with levofloxacin. Since that admission, she reported dealing with recurrent lymphadenopathy with palpable cervical, preauricular, occipital, and axillary nodes. She had also developed fevers and night sweats over the past four days prior to admission. The highest fever she has had was 101.4 after a Denileukin diftitox dose two days prior to presentation. She had a repeat chest CT on [**2148-4-9**] that showed increased lymphadenopahthy. She was admitted again on [**4-18**] for [**Hospital1 **]. She had developed adriamycin induced cardiomyopathy (EF 25-30%) and had to stop [**Hospital1 **] 3 days into therapy. Since then her volume status has been difficult to manage on the floor, and she was alternatively being given IVFs and diuresed with Lasix. She had a brief stay in the Medical ICU ([**Hospital Ward Name 332**]) from respiratory distress, which was felt to be pulm edema and was treated with aggressive diuresis. She was then tried on ARA-G (last course was on [**5-15**]) but was running into problems with tumor lysis syndrome and the fluids necessary to treat/prevent this. She was also started on vanc/levofloxacin for suspected line infection and pneumonia on [**5-20**]. . MEDICAL HISTORY: -Angina w/ history of negative cardiac catheterization -Hypertension -Hyperlipidemia -Right rotator cuff injury -Hypertension -History of choelithiasis -History of presyncope -Status post right knee arthroscopy MEDICATION ON ADMISSION: -Trimethoprim/Sulfamethaxosole 1 DS tab PO 3*/wk -Mirtazapine 7.5 mg PO daily -Metoprolol 25 mg PO BID -Docusate and Senna PRN ALLERGIES: Codeine / Penicillins PHYSICAL EXAM: VS: T 99.0, BP 104/60, HR 80, RR 16, O2 Sat 98% on 2L Gen: Well appearing, NAD HEENT: Normocephalic, anicteric, PERRL, OP benign, MMM Neck: Supple, no thyroid nodules Lymphadenopathy: There are numerous 1-2 cm posterior cervical lymph nodes, one 1-2 cm right pre-auricular node, a one cm left sided occipital node, multiple supraclavicular nodes bilaterally, an approximately 2 cm right sided axillary node and a 1.5 cm left sided node, these are all mobile and rubbery, inguinal exam was deferred, no antecubital or popliteal lymphadenopathy appreciated CV: RRR, [**12-5**] PSM; mild jugular venous distension; no carotid bruits; DP, PT, Radial, and carotid pulses 2+ bilaterally Pulm: Expansion equal bilaterally, mild bilateral inspiratory crackles. Abd:Soft, NT, ND, BS+, no organomegaly or masses appreciated Extrem: Warm and well perfused, no C/C/E, there is some scarring around her left ankle related to a childhood injury per the patient Neuro: A and O*3, CNII-XII grossly intact, strength 5/5 in all extremities Psych: Pleasant, cooperative, thought process linear and goal-directe FAMILY HISTORY: Her mother died of CHF. Her great aunt died of an unclear GYN malignancy. SOCIAL HISTORY: She was born in [**Doctor Last Name 15076**] and immigrated to the United States in the early [**2108**]'s. She worked as a housekeeper until the end of [**2145**]. She lives with her husband and daughter with several other adult children in the area. Never smoker and very rare alcohol user.

CHIEF COMPLAINT: Melena PRESENT ILLNESS: 58 yo F otherwise healthy p/w black tarry stools one day prior to admission. At 1500 she had a bowel movement at work and noticed tarry stools. She felt fatigued and went home to sleep. She then awoke at 3 AM on the floor of her bathroom. She could not recall events prior to this. She called for her daughter who took her blood pressure which was 80/40. She was then taken to OSH. Initial BP 94/57 P 68. Reportedly Hct was 30.7 at the OSH. NG lavage reportedly w/900 cc of coffee grounds. She was started on octreotide gtt and given 80mg IV protonix. EGD was performed which showed a submucosal mass in body of stomach w/superficial ulcerat. It was clipped and injected w/epi. Received 1U PRBCs at OSH +1U PRBCs enroute to [**Hospital1 18**]. Octreotide gtt continued on transfer. . In ED VS 100.7 118/75 97 18 98% 2L. Second unit PRBCs was stopped out of concern for febrile reaction. EKG w/sinus tachycardia 103, no ischemic changes. Hct 30.6. VS prior to transfer: 99.6 96 117/67 20 97% 2L. . In the MICU, pt remained hemodynamically stable overnight w/stable hct and no further transfusion req'ts. Seen by GI and surgery, CT scan showed lg mass at L gastric body. Octreotide gtt dc'ed (no suspicion for varices.) Plan for endoscopic U/S guided FNA in am. On transfer to the floor, VS 111/53 95 20 96%RA. Pt w/o complaints; denies abdom pain, continued tarry stools or lightheadedness. MEDICAL HISTORY: Hysterectomy Bladder Suspension Has had two colonscopies at age 50 and 55 which were reportedly negative. MEDICATION ON ADMISSION: Estrogen patch ALLERGIES: Penicillins PHYSICAL EXAM: ADMISSION PHYSICAL (MICU resident) VS: 95 111/53 20 9% RA GA: NAD HEENT: PERRLA. MMM. no LAD. no JVD. neck supple. Cards: RRR normal S1/S2. no murmurs/gallops/rubs. Pulm: CTAB no crackles or wheezes Abd: soft, NT, +BS. no rebound tenderness or guarding. no HSM. Extremities: warm and well-perfused, no edema. DPs 2+. Skin: no rashes Neuro/Psych: A&Ox3, CNs II-XII grossly intact. no focal motor deficits. sensation intact throughout FAMILY HISTORY: Mother: H. pylori +, GERD/ulcers/esophageal strictures, Father: MI age 81. Died of colon cancer at 83. SOCIAL HISTORY: Denies h/o tobacco. Social drinker. Denies IVDU. Works as an accountant

CHIEF COMPLAINT: Mr. [**Known lastname 61807**] was found to have a 9.5cm ascending aortic aneurysm and was refered to Dr. [**Last Name (STitle) **] for operative treatement PRESENT ILLNESS: Mr. [**Known lastname 61807**] was found to have a 9.5 cm ascending aortic anneurysm on workup for abdominal pain. MEDICAL HISTORY: chronic atrial fibrillation renal insufficiency h/o bilat LE cellulitis chronic anemia dwarfism Paget's disease h/o MI s/p multiple dental extractions MEDICATION ON ADMISSION: digoxin 0.125 qd oxybutin 10mg qam, 5mg qpm lasix 40mg [**Hospital1 **] colace allopurinol 100mg qd protonix 40mg qd lisinopril 2.5mg qd toprol XL 25mg qd ALLERGIES: Aspirin / Bactrim PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone. He denies tobacco and admits to rare alcohol

CHIEF COMPLAINT: Abdominal pain, vomiting, abdominal distention. PRESENT ILLNESS: The patient is a 74 year-old female with a history of a radical hysterectomy, omentectomy, ileocecectomy on [**2131-10-18**] who presented on [**2132-1-19**] with a four day history of abdominal pain, one day history of vomiting, and increased abdominal distention. Chest x-ray showed free air under the diaphragm. MEDICAL HISTORY: Ovarian carcinoma status post radical hysterectomy, omentectomy, ileocecectomy on [**2131-10-18**]. Status post cholecystectomy, status post dilatation and curettage, status post C section, depression. MEDICATION ON ADMISSION: Risperdal, Glyburide 10 mg po q.d. ALLERGIES: Penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: She lives with her daughter.

CHIEF COMPLAINT: headache PRESENT ILLNESS: 56 yo F with a hx of ALL s/p whole brain RT, essential tremor, [**Doctor Last Name 9376**] syndrome, ocular myasthenia, various types of headaches, L sided ataxia, and a hx of episodes of near syncope, presented 2 days ago with a SAH. She describes the event as a very sudden worst headache of her life while changing out of her business clothes after dinner. She did not fall at that time either before or after the onset of the headache. She also denies any hx of head trauma in the preceding days. She called her husband to call 911 and was taken to [**Hospital6 3105**]. She recived a head CT showing SAH and was transferred to [**Hospital1 18**]. Here, she received a repeat confirmatory head CT and an angiogram which was negative for aneurysm. She has been treated with analgesics and antiemetics. This SAH has occurred in the context of an ongoing history of episodes of lightheadedness and headaches have been worked up by Drs. [**Last Name (STitle) 724**] and [**Name5 (PTitle) 10442**] of neurology. She states that these episodes have been going on for 8-9 years, ever since she had the whole brain RT. She states they occur roughly weekly, although she can go for longer periods without one. She states they were worse when she had been simultaneously on chemotherapy until [**2109**], and then presented sometimes as frank syncope. More recently however, she denies any frank syncopal episodoes. She states that sometimes these episodes are accompanied by a band-like headache around her head, she she states that if she gets that headache first, it is a cue for her to sit down. She states that these headaches are different that her migraines, which are preceded by an aura of funny smells and flashing lights. She received a brain MRI in [**2116-1-25**] after presenting to Dr. [**Last Name (STitle) 10442**] with a complaint of one of these spells, which was negative. In early summer of [**2115**] she also underwent tilt table testing at [**Hospital6 10443**], which was positive per her report. She does not have any history of seizures, and she denies any focal motor movements or loss of bowel/bladder continence during these episodes. She denies any other recent focal weakness, parasthesias, vertigo, or hearing changes. She does state that she has a history of intermittent diplopia c/w her ocular myasthenia. MEDICAL HISTORY: ALL s/p whole brain RT essential tremor [**Doctor Last Name 9376**] syndrome ocular myasthenia various types of headaches including migraine L sided ataxia hx of episodes of near-syncope MEDICATION ON ADMISSION: Celexa 20 mg PO Qday Imitrex PRN MVI Qday Fish Oil tab Qday Vitamin D Qday ALLERGIES: Penicillins / Iodine PHYSICAL EXAM: T- 98.5 F BP- 121/74 HR- 82 RR- 21 O2Sat 96%RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa, O/P clear Neck: No tenderness to palpation, normal ROM, able to touch chin to chest, but states that it is painful of she lingers in this position, 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: Father with CAD, Sister with [**Name (NI) 9376**] syndrome SOCIAL HISTORY: Married, works in corporate banking, no tobacco or drugs, rare EtOH

CHIEF COMPLAINT: Dyspnea/Hypoxemia PRESENT ILLNESS: Ms. [**Known lastname **] is a 52F with T1-T2 paraplegia s/p MVC, recurent UTI/PNA, and anxiety admitted with hypoxemia. She presented to [**Company 191**] waiting room for an appt with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**9-8**], and her routine O2 sat was 80%; BP 98/60 HR 105. At the time pt states she was not sob, no CP, and she was placed on 2L oxygen. At [**Company 191**] her O2 sat on 2L=95%, BP 118/67, HR=85 T=97.2. She typically uses 2l oxygen at night but does not usually need it during the day. Patient endorses a more "junky" cough since the week prior to admission, and now coughing up yellowish sputum but feeling well otherwise. CXR at [**Company 191**] was limited secondary to poor penetration showing left upper lung opacification improved with no new focal areas and persistent LLL opacity likely representing atelectasis/effusion but cannot exclude pneumonia. In clinic, her pOx was 93-94 on 2 L NC, with drops to 84 % without oxygen. She was sent to ED for hypoxia. . In the ED, she became hypotensive to SBP 70s, and a central line was placed. Levophed was started. Patient was given CeftriaXONE 1g for UTI, vancomycin, azithro for pneumonia, and oxycodone for pain. She was given 1500 cc NS. VS upon transfer to the MICU were T97.6 P 98 BP 88/55 --> 140/85 RR 22 O2 94%3L. MEDICAL HISTORY: #T1 to T2 paraplegia status post a motor vehicle accident. #Recurrent pneumonia (followed by pulm - Last [**2149-4-9**]) - Per pulm, recurrent pneumonia likely from pulmonary toilet issues secondary to neuromuscular disease with improvement with consistent and aggressive bronchopulmonary therapy. - Prior sputum cultures + for MRSA, pan-sensitive Klebsiella, and Pseudomonas. #Recurrent UTIs in the setting of urinary retention requiring straight catheterization #COPD #Hx Pres syndrome #hepatitis C #anxiety #DVT in [**2142**] -IVC filter placed in [**2142**] #Pulmonary nodules #Hypothyroidism #Chronic pain #Chronic gastritis #Anemia of chronic disease #S/p PEA arrest during hospitalization in [**2147-10-3**] MEDICATION ON ADMISSION: (from recent d/c summary) 1. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN dyspnea/hypoxia 2. Albuterol-Ipratropium [**2-2**] PUFF IH TID 3. Baclofen 10 mg PO/NG HS 4. Baclofen 10 mg PO/NG NOON 5. Baclofen 20 mg PO/NG BREAKFAST 6. Citalopram Hydrobromide 40 mg PO/NG DAILY 7. Clonazepam 1 mg PO/NG [**Hospital1 **] 8. Docusate Sodium 100 mg PO BID 9. Levothyroxine Sodium 75 mcg PO/NG DAILY 10. Lidocaine 5% Patch 1 PTCH TD DAILY 11. Methadone 5 mg PO/NG TID 12. Oxybutynin 5 mg PO NOON 13. Oxybutynin 10 mg PO BREAKFAST 14. Oxybutynin 10 mg PO HS 15. Polyethylene Glycol 17 g PO/NG DAILY 16. Pregabalin 150 mg PO/NG TID 17. Sucralfate 1 gm PO/NG QID 18. traZODONE 100 mg PO/NG HS 19. OxycoDONE (Immediate Release) 5 mg PO TID pain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission: Vital Signs: T 99.4 BP 137/69 HR 88 RR 13 O2 97% 3L NC CVP 10 Gen: Alert, oriented, sitting calmly in bed; patient with weak, wet prolonged productive cough HEENT: Mucous membranes dry, no lymphadenopathy or JVD Card: Normal S1, S2, no murmurs, rubs or gallops Resp: poor inspiratory effort; mild scattered rhonchi bilaterally Abd: obese, soft non-tender, non-distended Ext: 1+ pitting edema to low calf; no calf tenderness Skin: no rashes Neuro: CN II - XII grossly intact; UE strength grossly [**6-5**]; LE strength 0/5; feet slightly inverted but no evidence of lower extremity contracture/rigidity . Discharge: Unchanged from above except for the following: Vital Signs: T96.1 BP 116/70 HR 75 RR 20 O2 97% 2.5L NC GENERAL - NAD NECK - supple, no thyromegaly, no JVD, no carotid bruits, CVL in Left IJ clean and intact LUNGS - talking in full sentences, small rhonchi on R side but none on L, moderate air movement, resp unlabored, no accessory muscle use. NEURO - awake, A&Ox3. FAMILY HISTORY: Mother passed away with lung disease. SOCIAL HISTORY: Lives at home with husband and 2 adolescent children. - Tobacco: 35-pack-years, quit several months ago, relapsed recently. - Alcohol: Denies. - Illicits: Denies.

CHIEF COMPLAINT: pancreatitis, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear PRESENT ILLNESS: 56 year old male with a history of HCV ([**3-15**] IVDU; last biopsy [**5-/2196**] with portal fibrosis, no viral load or genotype on file), chronic pancreatitis, alcoholism, CAD, presented initially on [**12-24**] with abdominal pain, elevated lipase, consistent with acute exacerbation of his chronic pancreatitis, secondary to recent alcohol use. Of note, on admission, he reported one episode sometime the week prior to admission of hematemesis (coffee-grounds, dark brown). On day prior to admission, had non-bilious, non-bloody vomitus x1, one episode of yellowish diarrhea, no melena or hematochezia. He admitted to [**6-16**] drinks day prior to admission, last drink at 6 PM on day prior to admission. CT abdomen [**12-24**] demonstrated new 31 x 23mm soft tissue density peripherally enhancing mass extending superiorally off the pancreatic tail; Mild surrounding soft tissue stranding c/w recurrent or residual pancreatitis; cholelithiasis; fatty liver. He was placed on bowel rest, pain control, CIWA scale for alcohol withdrawal. On day after admission, had an episode of hematemesis (bright red blood and clots), remained hemodynamically stable throughout, but was transferred to MICU for emergent EGD, which demonstrated [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear with stigmata of recent bleed (clot). Hematocrit remained stable at 35-40 throughout. The area of erythema and bleeding was injected with epinephrine without residual bleed. Subsequently, remained stable without further episodes of hematemesis or fall in hematocrit. Per GI, will follow-up with repeat abdominal CT on [**1-1**] for re-evaluation of suspected pancreatic pseudocyst. MEDICAL HISTORY: 1.)ETOH abuse 2.)HCV 3.)Frequent episodes of pancreatitis related to etoh abuse 4.)CAD with [**2195**] MIBI showing mod partially reversible defect in LAD region 5.)Osteoarthritis 6.)s/p colectomy for ?SBO/bowel perforation, done at [**Hospital1 112**] MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 98.1 P: 73 BP: 162/73 R: 16 O2 sat 98% on RA Gen: fatigued male in NAD, NGT in place HEENT: pink conjunctiva, sclerae anicteric, MM dry Neck: no jvd CV: RRR S1 S2. Pulm: CTAB, crackles at bases that cleared with repeat respirations. Abd: +bs. Soft. TTP in epigastric region with mild voluntary guarding, no rebound . Non-distended. Liver edge palpable at 3cm below costal margin. Ext: WWP. No edema. 2+ DP/PT pulses bilaterally Neuro: A&Ox3 FAMILY HISTORY: Dad with ETOH cirrhosis, uncle with Diabetes, Mom with MI at 72. SOCIAL HISTORY: ETOH: 5 beers and 3 shots every night, Tob: 1/2ppd since age 16, Drugs: +ivdu, none since [**60**], +cocaine and marijuana but none since 7 months.

CHIEF COMPLAINT: AAA / claudication PRESENT ILLNESS: [**Known firstname **] [**Known lastname 75562**] is a 76-year-old woman who presents for prehydration for an elective thoracic aortic stent graft. Thoracic aneurysm was an incidental finding on CT for chest cold MEDICAL HISTORY: Past medical history: 1. 7-8 cm right renal mass with possible invasion into the collecting system and perinephric fat 2. 7 cm left adrenal mass appears separate from the surrounding organs and from the left kidney. 3. Constipation 4. Hypertension 5. Type 2 diabetes x3 years. 6. Hip replacement [**2105**] 7. Cardiac stent [**2096**] MEDICATION ON ADMISSION: Meds: HCTZ 25', amlodipine 5', Atenolol 100', Glyburide 2.5', ASA 81, Vytorin 10/40', Senekot 1 tab' ALLERGIES: Epinephrine PHYSICAL EXAM: a/o nad supple / farom neg lymphandopathy neg supraclavicular nodes cta rrr abd benign sugical inc c/d/i Pulses: dopplerable DP/PT b/l FAMILY HISTORY: Family History: Mother lived to be 87. Father died at 52 of stroke. No history of kidney problems or cancer. SOCIAL HISTORY: Social History: The patient is a retired receptionist, is currently active, working around the house, and no change in daily activities. She has a 90-pack-year history of smoking. She quit 10 years ago. No significant alcohol or drug use

CHIEF COMPLAINT: Pedestrian struck PRESENT ILLNESS: 53F brought to [**Hospital1 18**] ED via ambulance as pedestrian struck by a car, +EtOH, +LOC. Upon arrival to [**Hospital1 18**] ED, the patient was found to be extremetly agitated and combative. She did not give a history and did not endorse any particular pain. She did complain of shortness of breath. MEDICAL HISTORY: Alcohol abuse MEDICATION ON ADMISSION: Denies ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Patient reports to be homeless, living mostly [**Location (un) 84022**]. She has a significant history of alcohol abuse, for which she has been cared for at [**Hospital1 18**] on multiple occasions for detox and other related issues.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 39-year-old male who presented with leukemia and disseminated intravascular coagulopathy. He was transferred to [**Hospital1 69**] from [**Hospital3 1280**] Hospital Emergency Room for management of nausea, vomiting, headaches, and a cerebellar hemorrhage. He was intubated on arrival at [**Hospital1 188**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Right Upper Quadrant Abdominal Pain PRESENT ILLNESS: The patient is a 49 year old male with history of long standing alcohol abuse with resultant alcoholic cirrhosis who presented initially to [**Hospital3 4107**] on [**2183-12-15**] with symptoms of 2 days of epigastric and right upper quadrant pain. The patient reports his ain is sharp, stabbing, [**10-10**] at it's worst, and radiates to his back. He reports associated symptoms of nausea and vomiting of non-bloody, non-bilious fluid with associated chills. The patient denies hematemsis, BRBPR, melena, chest pain. He does report some shortness of breath which he attributes to difficulty taking deep breaths because of his abdominal pain. At [**Hospital3 4107**] the patient had labs pertinent for Cr 1.4, Alb 3,9, Tb 4.1, Db 1.2, Alk Phos 102, ALT 68 and AST 77, WBC 15.2 (2% Bands), HCt 44.2, and platelet 129. Per D/C summary, the patient had an abdominal ultrasound which revealed gallstones and CBD of 6mm, no ascites. A CT Abd/Pelvis was subsequently performed which is reported to have revealed cholelithiases with a 7mm stone in the distal CBD as well as gallstones in the neck of the gallbladder (CT report not accompanying). No intrahepatic lesions of dilated intrahepatic ducts were noted. The liver was with irregular contour suggestive of cirrhosis. Given report of stone present in the CBD, the patient is now being transferred to [**Hospital1 18**] with plan for ERCP. In anticipation of the need for eventual cholecystectomy, a surgical consult is requested by the hospitalist today. On arrival to the medical floor patient confirms history as above. The patient reports he has history of relapsiing alcoholism, however, he reports his alst drink was now 3 weeks ago. He reports history of tremors and has undergone detox, denies history of seizures or DTs. The patient reports ongoing abdominal pain. On review of systems he reports some difficulty taking deep breaths secondary to his abdominal pain, mild sensation of associated air hunger. Remainder of ROS negative. MEDICAL HISTORY: #. History of Alcohol abuse - history of tremors and blackouts. Has been in detox - no DTs, no seizures #. Alcholic Cirrhosis - denies history of variceal bleed although history of GI bleed NOS previously - denies history of ascites - history of encephalopathy documented #. Thrombocytopenia #. History of GI Bleeding #. Gastritis/Duodenitis #. Cholelithiasis #. Pancreatitis #. Hypothyroidism MEDICATION ON ADMISSION: Levothyroxine - dose unknown Iron tab daily Potassium Chloride daily Prilosec 20mg daily ALLERGIES: Shellfish Derived PHYSICAL EXAM: Vitals on admission: 100.4, 112/80, 118, 16, 95% RA General: Patient is a middle aged male, appears to be in pain, no acute distress. Appropriate, oriented x 3. No asterixis HEENT: NCAT, EOMI, sclera mildly icteric, conjunctiva WNL OP: MMM, no lesions Neck: Supple, no LAD, no JVD Chest: Generally clear anterior. Small crackles at both bases, poor air movement in general, + splinting. + spider angioma Cor: Tachycardic, regular, no M/R/G Abdomen: Mildly distended, hypoactive BS. Mod tenderness throughout, severe tenderness in RUQ and epigastrium with voluntary guarding, no rebound. Rectal: empty rectal vault, guaiac negative fluid Ext: No edema Skin/Nails: + spider angioma Neuro: Oriented x3, no asterixis, appropriate FAMILY HISTORY: Noncontributory SOCIAL HISTORY: The patient lives in [**Hospital1 **] with his sister. [**Name (NI) **] was previously employed insecurity at a hotel, now going to start new job as security in a hotel. ETOH: No use x 3 weeks, previous 18 beers daily or 2 pints of vodka daily Tobacco: None Illicits: None

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 34589**] is a 45-year-old male with a past medical history remarkable for chronic relapsing pericarditis secondary to severe variant rheumatoid arthritis. The patient has been experiencing severe pleuritic chest pain which had been controlled on 10 mg of prednisone; however, this had recently increased to 20 mg to control these recurrent flares. Since the symptoms stemming from the relapsing pericarditis has required the use of prednisone while other symptoms such as aching in the hands and feet have been well controlled on colchicine and methotrexate, the Cardiothoracic Surgery Service was consulted to evaluate this patient for pericardiectomy. MEDICAL HISTORY: 1. Severe variant rheumatoid arthritis. 2. Gastritis. 3. History of Helicobacter pylori. 4. Status post back surgery. MEDICATION ON ADMISSION: (Medications at home included) 1. Prednisone 7.5 mg p.o. once per day. 2. Methotrexate 15 mg p.o. every week. 3. Colchicine 0.6 mg p.o. twice per day 4. Duragesic patch 50 as needed. 5. OxyContin 40 mg p.o. four times per day as needed (for pain). 6. Centrum. 7. Nexium. 8. Stool softeners. ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION: Pertinent laboratories as of [**2180-5-5**] revealed white blood cell count was 10.5, hematocrit was 30.8, and platelets were 175. Sodium was 143, potassium was 4.4, chloride was 107, bicarbonate was 27, blood urea nitrogen was 11, creatinine was 0.7, and blood glucose was 120. Magnesium was 2.3. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Patient status post high speed motor vehicle accident PRESENT ILLNESS: 21 year old female unrestrained rear seat passanger in a taxi that was ejected from the vehicle. Asisted by EMS and transfer to the Emergency Department at the [**Hospital1 1170**]. MEDICAL HISTORY: None MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Patient was brought to eh ER by EMS after MVA responsive. She became unresponsive and was placed on Endotracheal Entubation. Gen: unresponsive. Neck: cervical collar. Chest: clear to auscultation bilaterally. Abdomen: soft, non tender, non distended. FAST ultrasound exam with fluid in [**Location (un) 6813**] pouch. Extremeties: good pulses, no deformities. FAMILY HISTORY: Patient is one of six children, family very close. SOCIAL HISTORY: Swim coach.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname **] is a 72 year old male s/p CABG in [**2114**], graft failure [**2115-4-11**] undergoing cypher(DES) stenting of LAD and LCx, and three prior Vision (BMS) placed in mid and proximal LAD and one to the proximal circumflex arteries. He recently presented to [**Hospital6 **] with precordial chest "heaviness" [**9-20**], on [**2116-5-5**]. He concomitantly had shortness of breath with chest pain but denied nausea, vomiting, diaphoresis, and presyncope. No radiation of pain. He was noted to have new 2mm ST depressions v4-v6, TWI v3-v6. He received IV morphine, NTG x3, and was started on weight based enoxaparin regimen. He was already on Plavix. Pain was controlled to point where he was chest pain free in ED. He ruled in for a NSTEMI. Initial neg trop 0.04, that rose to 1.26, then 1.34. CK peak at OSH was 94. He was stablized on medical therapy and was transferred to [**Hospital1 18**] after diagnosis of NSTEMI so that he could be managed by his primary cardiologist Dr. [**First Name (STitle) **]. On arrival to [**Hospital1 18**], patient was chest pain free. Pt had ECG w/ new 1-2mm ST elevation in V1-V2, and 2mm ST depression v4-v6, TWI v3-v6. 1mm ST depression and TWI in I & avl are old. Pt was started on Heparin and Integrillin on arrival to [**Hospital1 18**]. MEDICAL HISTORY: Coronary Artery Disease, History of CABG [**2114**] (LIMA to LAD, SVG to RCA, sequential SVG to D1 and OM1) Recent NSTEMI [**2116-4-11**] Ischemic Cardiomyopathy/Chronic Systolic Heart Failure Hypertension Elevated Cholesterol Type II Diabetes Mellitus History of renal cancer status post left nephrectomy in [**2105**]. History of bilateral cataracts with repair. MEDICATION ON ADMISSION: -Aspirin 325 mg once daily -Imdur 30 once daily -Plavix 75 once daily -Zocor 40 once daily -Diovan 80 mg daily -Toprol 150 mg daily -Feosol 65 mg daily -insulin per protocol -Colace 100 mg daily -senna 2 mg daily -sublingual nitroglycerin 0.03 mg p.r.n. ALLERGIES: Lisinopril PHYSICAL EXAM: PREOP EXAM: VS - T 96.7, BP 109/49, HR 63, RR 16, 97% RA. Gen: Indian male, No chest pain, resting comfortably. HEENT: NCAT. PERRL, EOMI. Conjunctiva were pink, good dental hygeine Neck: Supple with JVP of 12 cm. CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Chest: Crackles at the bases bilaterally. poor air movement. No rhonchi. Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: No edema. Nontender, 1+ weak DP/PT bilat. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+ Discharge VS T98.4 HR 104ST BP 109/57 RR 18 O2sat 96% 2LNP Gen NAD Neuro Alert, orientedx3, non focal exam Pulm CTA bilat CV RRR-tachy, sternum stable, incision CDI Abdm soft NT/+BS Ext warm well perfused. 1+ pedal edema bilat FAMILY HISTORY: Family history is significant for a brother with a CABG at the age of 65. Parents died of old age. SOCIAL HISTORY: Patient is originally from [**Country 11150**], where he worked in agriculture. He denies ever smoking, drinking etoh or using illicit drugs. He came to the US in [**2094**], but returns frequently to [**Country 11150**]. Last trip to [**2116-3-13**]. Pt lives with son and wife in [**State 350**].

CHIEF COMPLAINT: fevers, chills, night sweats PRESENT ILLNESS: 55M comes to the ED with chronic large scrotal and perineal collections with persistent fevers, chills and night sweats. He has a long-standing history of urethral strictures treated with urethroplasties at [**Hospital6 1129**] which subsequently failed and developed into urethral and pelvic fistulae. Under the care of Dr. [**Last Name (STitle) 770**], the pt underwent a diverting ileal conduit but continued to have drainage from his native bladder. He then underwent a cystoprostatectomy. Despite having no urinary source for a persistent fistula, he continues to have drainage of fluid from a pinpoint opening at the bottom of his scrotum and out of his hip and buttocks. . Currently, he notes that he has severe fevers (as high as 103) when he sits for too long on his collections. In association with his high fevers, he has chills, sweats, nausea and vomiting. He has not had n/v for one week however. He had a normal BM today and is passing flatus. He notes that one of the abscess collections "burst" a month ago and continues to drain. These drainage sites are tender/painful MEDICAL HISTORY: PAST MEDICAL HISTORY: History of methicillin resistant Staphylococcus aureus urinary tract infection. History of ampicillin sensitive enterococci urinary tract infection, diabetes mellitus type 2 on oral hypoglycemic, hepatitis C virus status post blood transfusion at the time of his motor vehicle accident approximately 27 years ago, T12 paraplegic status post motor vehicle accident approximately 27 years ago with chronic inguinal and scrotal abscesses status post urethra and bladder surgery. Coronary artery disease, history of one stent placed at [**Hospital1 2025**] in the past on aspirin and Toprol, status post back surgery due to motor vehicle accident. At the time of his motor vehicle accident 27 years ago, the patient had a urethral disruption and needed a surgery. Approximately five years ago is when the scrotal abscess occurred. History of fluoroquinolone resistant and fluoroquinolone sensitive pseudomonas of osteomyelitis of bilateral tibias. History of osteomyelitis of the right ischium, pelvic ramus and sacrum decubitus. MEDICATION ON ADMISSION: glucophage 1500 qam/1000 qpm, glyburide 5 [**Hospital1 **], lipitor 20 qd, toprol XL 25 qd, lantus 50, [**Last Name (LF) **], [**First Name3 (LF) **] 81, protonix 40, MVI, vitC ALLERGIES: Sulfa (Sulfonamides) / Bactrim PHYSICAL EXAM: PE: 98.9 100 134/63 16 98RA NAD, lying in bed CTAB RRR, no CVAT, well-healed scar over spine Soft, nontender, protuberant abd with reducible parastomal hernia Stoma is pink and functioning well. Phallus uncirc scrotum erythematous and tender bilaterally, purulent drainage tract in right hemi-scrotum and right perineum R hip with drainage tract DRE: flat fossa, minimally tender, poor rectal tone No sacral breakdown Ext wnl FAMILY HISTORY: nc SOCIAL HISTORY: SOCIAL HISTORY: The patient was born in [**Country 4194**] and has lived in the United States for ten plus years. He is wheelchair bound at baseline. He has a history of tobacco use, but does not smoke currently. He denies alcohol use. He denies any IV drug use. He lives in [**Location 583**] with his wife.

CHIEF COMPLAINT: SOB, "Sweating" PRESENT ILLNESS: The patient woke up this morning severely dyspneic and diaphoretic. She called EMS, and on arrival, she was pale and in distress due to her SOB. SHe was taken to the ED, had a decreased O2 sat in the 70s due to pulmonary edema, and was intubated. An EKG showed acute ST elevations in V2-V4, and she was taken directly to the cath lab. She was found to have diffuse multivessel disease, with the most [**Last Name **] problem in her LAD. She had several stents placed throughout this artery. She had several episodes of hypotension in the cath lab and a balloon pump was placed. She was sent to the CCU with balloon pump and PA catheter in place. MEDICAL HISTORY: 1.DMII 2.Hypertension 3.Hyperlipidemia 4.Chronic LBP 5.h/o SVT 6.h/o herpes zoster 7.Diabetic neuropathy 8.h/o allergies MEDICATION ON ADMISSION: Ambien 10 qhs prn Atenolol 25 qd Glyburide 10 [**Hospital1 **] Lisinopril 40 qd MVI [**Doctor First Name **] 60 [**Hospital1 **] prn ASA 81 qd Atorvastatin 20 qd Lasix 40 qd Metformin 1 g [**Hospital1 **] Neurontin 300 tid ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T=94.9, HR=98, BP=97/63, RR=18(on vent), O2 sat=100% on vent Gen: Sedated, on vent HEENT:No JVD, ventilated, ET tube in place CV:RRR without MRG. Nl S1, S2, no S3 Pulm: CTA bilaterally anteriorly and bilaterally Abd:Soft, NT/ND, +BS Ext.: Mild pretibial edema bilat., Good pulses on L, Good p.t. on R. Cold bilat. Neuro: Sedated, but appropriate when addressed. FAMILY HISTORY: Unknown, non-contributory SOCIAL HISTORY: Social worker for the elderly. No EtOH or tobacco use

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 73 year old male with a history of coronary artery disease and aortic stenosis who has had a jaw tightness with walking short distances. He has been followed by his cardiologist given his history of coronary artery disease and was discovered to have aortic stenosis. This aortic stenosis is followed by echocardiogram. The patient's coronary history is significant for percutaneous transluminal coronary angioplasty with stent to obtuse marginal one. This percutaneous transluminal coronary angioplasty was complicated by formation of a right femoral AV fistula and pseudoaneurysm which eventually required surgical repair. Cardiac catheterization in [**2196-12-7**], showed 80 percent in-stent restenosis of the obtuse marginal one which was treated with roto. Cardiac catheterization in [**2198-1-6**], showed 30 percent in-stent restenosis of obtuse marginal one. Also at that time, the patient was discovered to have a moderate to severe aortic stenosis with a mean gradient of 26 mmHg. Ejection fraction was 61 percent at the time. The patient was followed by echocardiogram and echocardiogram in [**2199-11-6**], showed progression of the aortic stenosis with a mean gradient at 64 mmHg. The aortic valve area was calculated to be 0.9 with preserved left ventricular function. Cardiac catheterization done [**2200-6-18**], showed a worsening of the aortic stenosis. Although the mean gradient was calculated to be 48 mmHg, the calculated valve area was 0.8 centimeter square. At this time, the coronary angiography showed the left main to be normal. The left anterior descending coronary artery showed mildly diffuse disease with discrete 40 to 50 percent midstenosis. The left circumflex had mild diffuse disease at 40 percent in-stent stenosis and right coronary artery had no angiographically significant obstruction. Left ventricular function was preserved at 65 percent with no regional wall motion abnormality. Given these findings, the patient was seen by cardiac surgery for surgical intervention. Based on the findings, the patient agreed to undergo aortic valve replacement and coronary artery bypass graft at the same time. MEDICAL HISTORY: 1. Coronary artery disease, status post percutaneous transluminal coronary angioplasty with multiple in-stent restenoses complicated by right femoral pseudoaneurysm requiring surgical repair, worsening aortic stenosis. 2. History of hypertension. 3. History of diabetes mellitus. 4. History of hypercholesterolemia. MEDICATION ON ADMISSION: 1. Aspirin 81 mg p.o. once daily. 2. Lipitor 10 mg p.o. once daily. 3. Lisinopril 40 mg p.o. once daily. 4. Atenolol 50 mg p.o. once daily. 5. Glipizide 10 mg p.o. once daily. ALLERGIES: The patient denies any allergies to medications. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient denies any smoking and reports occasional alcohol use.

CHIEF COMPLAINT: Bright red blood in bowel movement PRESENT ILLNESS: This is an 83yo female with a past medical history of CAD/CVA, DM2, hypertension, hypercholesterolemia, chronic pain on hospice for pain control, with abd pain x 2 days, BRBPR x 1. Initially constipated for 1 day, then took dulcolax and now with brbpr in stool on the day of admission. She apparently fainted while having bm, no fall, and then vomited x 1. Denied f/c/sob. . In ED, + BRBPR in vault, + TTP LLQ/RLQ. CT abd performed with results suggestive of proctocolitis, differential including ischemic bowel vs. less likely, infectious etiology. Surgery was consulted for possible bowel ischemia, who recommended IVF, Hct trending and possible OR if abdominal exams worsen. . MEDICAL HISTORY: - CAD: s/p CABG '[**15**] (reportedly had 2 vein grafts, but unclear anatomy) and cath at [**Name (NI) 336**] in [**3-22**] revealed severe triple vessel disease, patent SVG to RCA, SVG to OM, SVG to D1, SVG to D2, SVG to OM1. - h/o multiple CVA's: residual L sided weakness. Severely limited activity at home, with daughter providing help with all [**Name (NI) 5669**]. - h/o seizures (last sz reportedly 1 yr ago, on keppra at home) - DM2 x 20 yrs - HTN - hyperlipidemia - hypothyroidism (on synthroid) - arthritis - spinal stenosis w/ chronic leg and hand pain MEDICATION ON ADMISSION: Colace sodium 100 mg 1 cap(s) [**Hospital1 **] Synthroid 75 mcg (0.075 mg) 1 tab(s) once a day atenolol 25 mg 1 tab(s) once a day aspirin 325 mg 1 tab(s) qd roxanol 20 mg/mL .25 ml Q4H benadryl 25 mg 1 tab(s) TID Sarna 0.5%-0.5% as directed TID Claritin 10 mg 1 tab(s) once a day lactulose 10 g/15 mL 15 mL [**Hospital1 **] Protonix 40 mg 1 tab(s) once a day metformin 500 mg 1 tab(s) [**Hospital1 **] Zetia 10 mg 1 tab(s) once a day Aspirin Low Strength 81 mg 1 tab(s) once a day Keppra 250 mg 2 tab(s) [**Hospital1 **] simvastatin 40 mg 1 tab(s) once a day (at bedtime) lisinopril 10 mg 1 tab(s) once a day Morphine IR 15 mg 1 tab(s) q 12 hrs morphine 5 mg sl q2hrs . Medications on transfer: 1. DiphenhydrAMINE 25 mg PO Q6H:PRN 2. Insulin SC (per Insulin Flowsheet) 3. Levofloxacin 750 mg IV Q48H 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Levetiracetam 500 mg PO BID 6. MetRONIDAZOLE (FLagyl) 500 mg IV Q8H 7. Morphine Sulfate 2-4 mg IV Q6H:PRN pain in abd, legs 8. Pantoprazole 40 mg IV Q24H 9. Simvastatin 40 mg PO DAILY 10. Vancomycin 1000 mg IV Q24H ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PHYSICAL EXAM: Vitals: Tm 99.0 P 64 BP 154/72 R [**12-7**] 100%ra I/O- 1.6/1.5 General: Anxious appearing, but NAD HEENT: AT/NC, PERRL, EOMI, anicteric. OP clear, MM dry. Neck: no LAD. JVP at 5cm. Neck supple. EJ in place, c/d/i Lungs: CTAB no w/r/r Heart: RRR no m/r/g +S3 Abd: soft, ND, mild ttp LLQ, no rebound/guarding Ext: no e/c/c. warm and well perfused. 2+ DP pulses. Neuro: CN II-XII in tact bilaterally. Mild [**3-22**] LUE weakness, hip flexors LLE [**3-22**], plantarflexion on L [**4-21**]. Right [**4-21**]. FAMILY HISTORY: Mother died of stomach CA. Brother and sister with "heart problems." SOCIAL HISTORY: Lives at home with elderly partner. Daughter helps with most ADL. No tobacco, EtOH or illicit drugs. Retired professional singer

CHIEF COMPLAINT: s/p presumed assault PRESENT ILLNESS: This is a 43 year old female who was found lying in the street by police near her home. When approached she ran into her home where she was found with numerous pills scattered about the floor with the home in disarray per reports of EMS. The patient was taken to [**Hospital3 26615**] Hospital where she was wake but drowsy with a 2cm laceration at the occiput. A head CT was performed that was consistent with [**Hospital1 **] frontal SDH, SAH, and occipital bone fracture. The Urine toxicology screen was positive for cocaine, methadone, oxycodone. The patient was intubated for airway protection and transported here for further evaluation. There is a toxicology significant other in the waiting room that is unable to provide reliable history. He states that he can not remember exactly, but thinks that he last saw the patient at approximately 1145 pm [**7-25**]. He also states that the diamond from her engagement ring is missing. He is unsure what her medical history is or what her current medications are. MEDICAL HISTORY: cholecystectomy- other unknown, possibly depression MEDICATION ON ADMISSION: unknown ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: O: BP: 119/78 HR:88 R:19 O2Sats:100% Gen: Intubated,+ gag/cough/corneals GCS 10 T, No raccoon/battle sign, no hemotympanum or otorrhea or rhinorrhea HEENT:1.5 cm laceration on the occiput present Pupils:[**2-10**] EOMs grossly intact Neck: hard collar in place GU/GI: rectal and vaginal blood present Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation:GCS off propofol 15 mins- 10 T Recall/Language: intubated but follows commands off sedation FAMILY HISTORY: unknown SOCIAL HISTORY: unknown

CHIEF COMPLAINT: progressive dyspnea PRESENT ILLNESS: Mrs. [**Known lastname 111334**] is a 56 year old woman with a history of severe dilated cardiomyopathy with an EF of [**10-24**]% (?viral vs post-partum) s/p ICD placement who was admitted on [**2112-2-23**] for severe shortness of breath and PND, presumably due to worsening congestive heart failure. Given the lack of edema or hypoxia, the patient was continued on her home regimen fo torsemide 30mg PO QAM and 10mg PO QPM. Notable findings during her stay included a BNP >4000 (baseline of 1000), trigger for severe dyspnea/orthopnea, and an echo that showed profoundly worsened EF now down to 5% from 10-15%, with severe dilation of the LV. At the behest of her cardiologist, Dr. [**First Name (STitle) 437**], she underwent a right heart cath with plans for a trial of milrinone therapy. RHC revealed markedly elevated left and right heart filling pressures that significantly improved with milrinone infusion. If this milrinone trial fails, she would likely be transferred to [**Hospital1 3278**] for a heart transplant evaluation. . On arrival to the CCU, the patient subjectively felt much better after milrinone infusion. She had by that point made nearly 700cc of urine. . REVIEW OF SYSTEMS On review of systems, she 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. She denies recent fevers, chills or rigors. She 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, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: - Idiopathic vs post partum cardiomyopathy atleast since [**2092**], EF of [**10-24**]% - 64 year old female with post-partum dilated cardiomyopathy s/p abdominal ICD implantation for NSVT and inducible VT in EP study in [**2092**]. She had an abdominal ICD generator change on [**2096-2-8**]. In [**4-/2098**] she had abdominal ICD explantation and lead capping due to discomfort. She had first transvenous ICD implant on [**2098-5-29**] in the L pectoral region and had a device change [**2103-3-7**]. Implantation of a [**Company 1543**] Secura VR Single Chamber ICD in [**2108-9-14**]. 3. OTHER PAST MEDICAL HISTORY: - Incidental finding noted on chest CT scan of a 6 mm nodule, mild restriction on PFTs - status post cholecystectomy, status post appendectomy, two C-sections - remote asthma and multiple allergies - anxiety - ovarian cysts - Lyme disease seeing specialists in [**State 531**]. MEDICATION ON ADMISSION: Active Medication list as of [**2112-2-23**]: Medications - Prescription CLONAZEPAM - (Prescribed by Other Provider; Dose adjustment - no new Rx) - 1 mg Tablet - 1/2-1 Tablet(s) by mouth three times a day as needed IPRATROPIUM BROMIDE [ATROVENT HFA] - 17 mcg/Actuation HFA Aerosol Inhaler - 1-2 puffs inhaled twice a day for wheezing LOSARTAN [COZAAR] - 25 mg Tablet - one Tablet(s) by mouth twice a day METOPROLOL TARTRATE - 25 mg Tablet - 1 Tablet(s) by mouth two times a day NATTOKINASE - (Prescribed by Other Provider) - - one capsule twice a day NYSTATIN - 100,000 unit/gram Powder - apply to inflammed area twice a day TERCONAZOLE [TERAZOL 7] - 0.4 % Cream - insert in vagina once a day TORSEMIDE - 20 mg Tablet - 1.5 Tablet(s) by mouth every morning, 0.5 tablets by mouth every evening Medications - OTC ASPIRIN - (Prescribed by Other Provider; OTC) (Not Taking as Prescribed: forgets) - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day (not taking because she forgets) CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D] - (Prescribed by Other Provider) - 2,000 unit Capsule - 1 Capsule(s) by mouth COENZYME Q10 [CO Q-10] - (Prescribed by Other Provider; OTC; Dose adjustment - no new Rx) - 300 mg Capsule - 1 Capsule(s) by mouth twice a day ALLERGIES: Morphine Sulfate / Pronestyl / Quinidine-Quinine Analogues / Mexiletine / Captopril / Sulfa (Sulfonamide Antibiotics) / Latex / Nitrofurantoin PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: T 97.8 HR 90 BP 95/63 RR 25 O2 95%RA GENERAL: Chronically ill appearing woman in NAD, AOx3 and appropriate but mildly drowsy HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Father died suddenly at age 74. She reports he may have had a heart attack and had diabetes near the end of his life. Mother is alive and fairly healthy. SOCIAL HISTORY: [**Known firstname **] is married, lives with her husband and has two daughters. She smoked cigarettes in her 20s and has not smoked tobacco since. Occasional wine.

CHIEF COMPLAINT: fever PRESENT ILLNESS: 46 year-old gentleman with history of pancreas divisum and recurrent pancreatitis presents for his Whipple operation today. However, he was found to be febrile in the pre-op area to 101.4. The patient has not checked his fevers in the past few days and has not noticed any chills. However, he reports that he completed a course of antibiotics for a scalp wound infection 3 weeks ago. Futhermore, he has a PICC line in place since [**9-9**] for TPN. His PICC line was pulled back 4 days ago, and he has had pain with infusions since then. The patient feels well otherwise - he reports no nausea or vomiting and is able to tolerate a low fat diet. Because the patient is febrile without a clear etiology, his Whipple has been postponed. He will be admitted to Dr.[**Name (NI) 60612**] service for fever workup. MEDICAL HISTORY: PMHx: Recurrent pancreatitis with known divisum s/p EUS with non-diagnostic FNA by Dr. [**Last Name (STitle) **] of pancreatic head "fullness", peptic ulcer disease, PTSD from war, Fe-def anemia, chronic back pain . PSHx: Cervical fusion 5yrs ago, left inguinal hernia treated remotely, EUS with biopsy MEDICATION ON ADMISSION: Iron 325 mg qd, Nexium 40 mg qd, Zoloft 100 mg [**Hospital1 **], Vit C 500 mg qday ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Tm 101.4, Tc 100.8, 82, 132/74, RR 18, 100% RA GEN: NAD, A&O x 3 HEENT: scalp wounds healing - no active drainage LUNGS: Clear B/L CV: RRR, nl S1 and S2 ABD: Soft, NT, ND EXT: L arm with PICC - slight erythema at PICC insertion site; no clubbing/cyanosis/edema of LE B/L FAMILY HISTORY: Father with stomach, lung, throat CA. Mother died of MI and had DM2. SOCIAL HISTORY: Married, lives with wife. [**Name (NI) 1403**] as supervisor for Army Corps of Engineers. Non-smoker, recovering alcoholic with no current alcohol x 7months, denies illicit substance use.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 63 year old male with a history of hypertension, hypercholesterolemia, who had new onset of exertional shortness of breath and was shoveling snow this past [**Month (only) 1096**]. The patient saw his primary care physician who referred the patient for exercise treadmill test which was done on [**2159-2-28**], and showed ejection fraction of 47%, minimal left ventricular reversible dilatation and moderately severe inferolateral reversible defect and inferolateral hypokinesis. The patient was then referred for cardiac catheterization. His catheterization was done on [**2159-3-16**], and showed an ejection fraction of approximately 50%, left internal mammary artery of approximately 50% distal and left anterior descending of approximately 80% distal stenosis and 80% stenosis at D1, 50% at mid diagonal, left circumflex total occlusion, 60% before left posterior descending artery and right coronary artery 70% ostial and total occlusion of mid. The patient was then evaluated for coronary artery bypass graft. MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Status post brain abscess, on prophylaxis with Tegretol secondary to lung infection. 4. Status post gastrointestinal bleed and partial gastric resection. 5. Status post right hernia repair. MEDICATION ON ADMISSION: 1. Aspirin 325 mg p.o. once daily. 2. Tegretol 200 mg p.o. twice a day. 3. Procardia XL 40 mg p.o. once daily. 4. Zoloft 150 mg p.o. q.a.m. 5. Toprol XL 25 mg p.o. once daily. 6. Lipitor 10 mg p.o. once daily. 7. Zestril 2.5 mg p.o. once daily. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient works at [**Company 52516**], married, smoked cigars. The patient quit approximately four years ago. He drinks two beers a day.

CHIEF COMPLAINT: shortness of breath, BRBPR PRESENT ILLNESS: 73M with multiple medical problems including HIV (CD4 76, VL 48 on [**5-/2112**]) on HAART, atrial fibrillation (not on coumadin), GERD, distant history of peptic ulcer disease presents with shortness of breath, coming BRBPR, abdominal pain. Patient has a history of chronic abdominal pain (eval by Dr. [**Last Name (STitle) 2161**] but no episodes of bleeding in past. Reports several episodes of bloody bowel movements starting yesterday when went to urinate. Last episode earlier today. Denies dizziness, syncope. Also reports that yesterday started to feel short of breath at rest (at baseline walks with walker with dyspnea on exertion for several months) associated with new non-productive cough. Denies fever but feels colder than usual. Wife says has been in bed most of the time for past couple of days, minimal PO intake. . In the ED, initial vs were: 98.1 110 114/66 24 97. Triggered for respiratory distress, breathing at 35, put on NRB. Rectal with gross blood and clots, had large episode BRBPR. Type and cross for 2 units. Has 2PIV, started protonix GTT with bolus. No NGT lavage given respiratory status. Plan for CT abdomen given abdominal pain but unable to lie flat without SOB. CXR notable for right lower lobar consolidation. He was given vancomycin, zosyn, and levoquin for PNA. Given insulin, calcium, dextrose for hyperkalemia. Got 3L of fluid, lactate of 3.3 down to 2.2. Current vitals: AFIB 113 125/87 20 99% NRB. Access: 2 18G PIV. MEDICAL HISTORY: # HIV disease, dx [**9-15**] likely secondary to heterosexual transmission. ATRIPLA started [**12-18**]. Self-d/c meds due to side effects. Last CD4 count last month 76 ([**5-19**]). # Chronic kidney disease (baseline cr 1.0) # Atrial fibrillation - off coumadin due to GI bleed # Prostate cancer - Diagnosed 15 yrs ago, in remission s/p hormonal and radiation therapy # COPD, long ex-tobacco history, severe emphysema on radiography # 2mm LUL lung nodule detected on CT chest [**9-15**] # GERD # PUD, Had 'surgery' 40 yrs ago, likely a Billroth # Anemia # Lumbar radiculopathy, spinal stenosis # Left shoulder rotator cuff tear with repair in [**10/2105**] # Trichomonas # Gout # Hx of esophageal candidiasis # Chronic left-sided abdominal pain, follows with GI here, extensive negative workup as an outpatient # Infrarenal abdominal aneurysm, measuring 3.6 cm on [**2111-12-31**] # pulmonary nodule MEDICATION ON ADMISSION: -abacavir-lamivudine 600-300mg 1 tablet QHS -albuterol 2 puff Q4PRN -atazanavir 400mg QHS -diltiazem 180mg daily -fluconazole 100mg daily -fluoxetine 40mg daily - mirtazapine 30mg daily - nystatin 5ml Q6hrs - oxycodone 10mg Q4PRN - oxycontin 30mg [**Hospital1 **] - prochlorperazine maleate 10mg [**Hospital1 **] - raltegravir 400mg [**Hospital1 **] - ranitidine 150mg daily - bactrim 800-160 daily - tiotropium 1 capsule daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION EXAM: Vitals: T: 98 103/53 107 99%4L General: Africal American Male sitting 45 degrees in bed NAD HEENT: Sclera anicteric, dry membranes, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: unlabored respirations, decreaseed BS left base CV: S1, S2 irregular rhythm, borderline fast rate Abdomen: soft, tenderness diffusely most prominent RUQ, no guarding GU: foley with straw colored urine Ext: warm, distal pulses palpable, bruising left leg above ankle FAMILY HISTORY: No history of lung disease, cancer or CAD. SOCIAL HISTORY: He lives with his wife in [**Location (un) 686**]. He is retired. He smokes 1 ppd (smoking since age 7). Denies alcohol or drug use. Uses a walker recently, but using a cane before that.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 67-year-old male with diabetes, history of PVD, left CVA in [**2098**] and bilateral calf claudication. The patient reported no discomfort or shortness of breath on admission. On [**2103-8-28**] the patient underwent ETT which showed a moderate inferior defect and reversible anterior wall defect. Ejection fraction at the time was 34%. MEDICAL HISTORY: Hypertension, hypercholesterolemia, insulin dependent diabetes, PVD, diabetes retinopathy, chronic renal insufficiency, benign prostatic hypertrophy, chronic bronchiectasis, lower extremity claudication, carotid disease status post CEA, left colon polypectomy. MEDICATION ON ADMISSION: ALLERGIES: 1. Sulfa. 2. Calcium channel blockers. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Pt s/p fall PRESENT ILLNESS: HPI: 57 yo male with heavy EtOH use who presents after fall from standing and seizure activity to OSH. Pt with 1 quart vodka intake 1day. pt was in detox X 5 days until thursday and when he got out, he was drinking heavily (wife does not know quantity) night prior to fall. he was at baseline (post inebriated state) ~2pm when he was walking to bedroom - began mumbling and then fell and hit head on door and had generalized convulsions with urinary incontinence - convulsions X 3-4 minutes. Pt brought to OSH where was intubated for airway protection. CT head done with L SDH and 3mm shift. pt transferred to ED where repeat CT demonstrated similar amount of ML shift and 1.1 cm in greatest diamter of acute SD blood. pt with chronic subdurals as well bilaterally. MEDICAL HISTORY: PAST MEDICAL HISTORY: GERD depression ETOHism MEDICATION ON ADMISSION: MEDICATIONS: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: EXAM VS: T 98 HR 90 BP 121/77 Sat 100% intubated PE: General, intubated HEENT AT/NC, MMM no lesions Neck Supple, no bruits Chest CTA B CVS RRR, no m/r/g ABD soft, NTND, + BS EXT no C/C/E, no rashes or petechiae NEUROLOGICAL MS: General: alert, responds to voice, spontaneous eye opening not following commands consistently FAMILY HISTORY: no seizures SOCIAL HISTORY: 1 cig/day heavy ETOH use - 1 quart vodka/daily lives with wife [**Telephone/Fax (1) 77153**] ([**Doctor Last Name 1356**])

CHIEF COMPLAINT: headaches PRESENT ILLNESS: Mr. [**Known lastname 32661**] is a 55-year-old male with a history of headaches and a family history of three members who died from subarachnoid hemorrhage. He underwent routine screening MRA and was found to have a right middle cerebral artery aneurysm. He had a cererbal angiogram bu tthe aneursym was not able to be successfully coiled. He presented electively for a open craniotomy/clipping MEDICAL HISTORY: HTN, arthritis, cocaine use, appendectomy MEDICATION ON ADMISSION: AMLODIPINE - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day PRAVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day SELENIUM SULFIDE - 2.25 % Shampoo - lather, apply to skin, shower off 10 minutes later q d x 1 week, then biweekly - No Substitution SILDENAFIL [VIAGRA] - 50 mg Tablet - 1 Tablet(s) by mouth 1 hour prior to intercourse ASPIRIN [ASPIR-81] - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day CAMPHOR-MENTHOL [DERMASARRA] - 0.5 %-0.5 % Lotion - affected area twice a day ALLERGIES: OxyContin PHYSICAL EXAM: On Discharge: intact FAMILY HISTORY: three members who died from subarachnoid hemorrhage. SOCIAL HISTORY: +tobacco, +cocaine use

CHIEF COMPLAINT: balance difficulty and confusion PRESENT ILLNESS: This is a 70 yr old gentlman who has flown in from [**Male First Name (un) 36290**] this afternoon and was directly transported to [**Hospital1 18**] for assessment of progressive LE weakness. The patient was last seen by his daughter in [**Month (only) 359**] who has found him bedridden, weak, and incontinent of urine. This is a change from [**2124-1-29**]. It is not known when the progression of weakness occurred. The patient has a prior EtOH abuse history; his last drink was 5 months ago. CT head in the ED was consistent with massive hydrocephalus. MEDICAL HISTORY: EtOH abuse, ? gastric ulcer MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam upon admission: T: 97.8 BP: 189/84 HR: 106 R 18 O2Sats ?82 %RA Gen: WD/WN, NAD. Spanish-speaking. HEENT: Pupils: 6mm, non-reactive EOMIs 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. Initially the patient was somnolent, yet easily arousable. After his daughter arrived, he was more conversational, awake, and alert. Orientation: Oriented to person, place, only. Language: Spanish-speaking. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives in [**Male First Name (un) 1056**], has 6 children, prior EtOH abuse, 1ppd tobacco, no drugs

CHIEF COMPLAINT: PRESENT ILLNESS: MEDICAL HISTORY: Pedestrian struck by motor vehicle on [**2144-11-12**], subsequent hospital course was as follows. Status post exploratory laparotomy with a splenectomy and diaphragmatic rupture repair. The patient had a right internal capsule and right frontal lobe intracranial bleed. On [**2144-11-13**], he went to the operating room for external fixation of his left tib-fib fracture. Subsequently he was noted to have a right MCA embolic stroke with a patent foramen ovale. He had an IVC filter placed. On [**2144-11-19**], he went back to the operating room and had an ORIF performed of his left tib-fib fracture. On [**2144-11-21**], status post exploratory laparotomy, appendectomy for perforated gangrenous appendicitis, status post tracheostomy, status post percutaneous cholecystostomy on [**2144-11-27**], secondary to acalculous cholecystitis, an episode of rapid atrial fibrillation, and underwent a left lung decortication on [**2145-1-1**]. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Left foot gangrene. The information was obtained from hospital records and the daughter. The patient is Portugese speaking. PRESENT ILLNESS: This is a 72-year-old Portugese speaking male with a history of left foot ulceration and cellulitis. Cultures have grown out MRSA and Morganella which was treated without changes. Noninvasive studies demonstrated severe femoral-tibial disease and left forefoot flow deficit. Right ABI was 0.4, resting, and left ABI was not measured. The patient was evaluated at [**Hospital6 **] from [**2178-5-12**], to [**2178-6-7**], by Vascular Surgery, and felt that the patient was not a viable candidate for revascularization, and the patient's daughter referred the patient to Dr. [**Last Name (STitle) **], who was seen in the office on the day of admission. He is now admitted for intravenous antibiotics, open TMA, then with potential bypassing graft depending on wound response. MEDICAL HISTORY: Daily Insulin dependent. Atrial fibrillation. Sick sinus syndrome. Hypercholesterolemia. History of alcohol abuse. History of congestive heart failure. History of dehydration with orthostasis. History of mild chronic renal insufficiency, 3.5-2.0. Chronic anemia. Negative upper GI on barium enema. Hematocrit was 24, transferrin 17, total IBC 206, ferratin 4.5. Obstructive sleep apnea, blood gases on room air of 7.48, 42, 93, 97%. T12 compression fracture. Left foot infection of MRSA Morganella morganii which was sensitive to Gentamicin, Bactrim, Unasyn, Ceftriaxone, Ceftazidime, ................, and Cipro, and ................ Gallstones by ultrasound, asymptomatic. Cataract, left eye. MEDICATION ON ADMISSION: Atenolol 25 mg q.d., Avandia 4 mg b.i.d., .................. 2.5 mg q.Thursday, Potassium Chloride 20 mEq q.d., Ativan 4 mg b.i.d., Protonix 40 mg bedtime, Spironolactone 50 mg t.i.d., Flomax 0.4 mg h.s., Lasix 80 mg q.a.m. and 40 mg q.p.m., Neurontin 100 mg t.i.d., ................... 5 mg t.i.d., Nephrocaps 1 daily, Simethicone 80 mg t.i.d., Insulin 75/25 20 U q.a.m. ALLERGIES: NO KNOWN DRUG ALLERGIES. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He is retired, barely inactive. He is a non-smoker. He drinks 3-4 glasses of wine; he previously drank 1 gallon per day. He has not any alcohol over the last two months.

CHIEF COMPLAINT: Dyspnea on exertion PRESENT ILLNESS: 75yo woman with past medical history of cardiomyopathy and know mitral regurgitation admiited for heparinization bridge for history of Afib. Pre-op MVR MEDICAL HISTORY: Past Medical History: Atrial Fibrillation s/p AV node ablation Breast CA s/p bilat mastectomy Cardiomyopathy (EF 40-50%) Hypertension Mitral Regurgitation Sarcoid - negative myocardial biopsy [**2116**] Past Surgical History: PPM [**2117-11-16**] ([**First Name8 (NamePattern2) **] [**Male First Name (un) 923**]) MEDICATION ON ADMISSION: Actonel 35 QWk ASA 81 QD Calcium 600 qd Coreg 3.125 [**Hospital1 **] Coumadin 1mg QMon and Fri/2mg rest of week- LAST DOSE [**2121-4-2**] Digoxin .125 qd Fish Oil 1000 qd Lasix 40 QD Lisinopril 5 QD MAg Oxide 400 qd MVI Potassium Chloride 10mEq qd Proteinex 40 Zocor 10 QD ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse: 75 VP Resp: 16 O2 sat: 100%-RA B/P Right: 128/76 Left: Height: 5'0" Weight: 64.2 FAMILY HISTORY: non contributory SOCIAL HISTORY: Last Dental Exam: 1 wk ago Lives with:very involved daughters Occupation: retired Tobacco: Quit 45pack year history ETOH:

CHIEF COMPLAINT: increasing abdominal pain, nausea and vomiting PRESENT ILLNESS: 49M s/p ECD renal transplant [**7-27**] presents with hct of 16.7 24 hours post liver bx and peritoneal tap by IR. These were performed because of pt's idiopathic jaundice and recent LFT elevation. Pt reports diarrhea since the procedure and increasing abdominal discomfort, nausea and dizziness. Diagnostic paracentesis was attempted in the ED with return of frank blood. MEDICAL HISTORY: -End-stage renal disease on HD T/T/S secondary to diabetic nephropathy-started on dialysis [**2163-7-19**] -diabetes for at least 20 years with retinopathy and neuropathy with footdrop -coronary artery disease with history of ST elevation MI [**7-24**] c/b pericardial tamponade requiring pericardiocentesis -three-vessel disease with stents in the RCA and left circumflex -hypertension -depression -hyperlipidemia MEDICATION ON ADMISSION: Norvasc 10', Procrit 10,000 qwk, Lasix 120'', Gabapentin 100', insulin lantus 6 qam, ISS, Ativan 2mg hs, Lopressor 100'', Cellcept [**Pager number **]'', Omeprazole 20 prn, Kayexalate prn, Tacro 1'', Bactrim ss', Valcyte [**Age over 90 **] M/[**Last Name (LF) **], [**First Name3 (LF) **] 325', Benadryl 50 HS ALLERGIES: Motrin / Lisinopril / Rapamune PHYSICAL EXAM: On admission: 97.5 76 117/46 14 96 Gen: Uncomfortable appearing HEENT: +scleral icterus Skin: visible jaundice CV: RRR Resp: Clear to auscultation Abd: Distended, +fluid wave, diffuse moderate tenderness, no rebound or guarding FAMILY HISTORY: Significant for myocardial infarction in his father at the age of 49. Multiple family members with diabetes. SOCIAL HISTORY: The patient does not smoke and he does not drink alcohol. He lives with his wife, [**Name (NI) **]. From [**Male First Name (un) 1056**] originally. Has multiple family members in the area including 4 children, one of which works in BMT on the [**Hospital Ward Name 516**].

CHIEF COMPLAINT: Nausea, vomiting, and abdominal pain. PRESENT ILLNESS: A 79-year-old female with 36 hours of abdominal pain, nausea, and emesis. She is noted to have recurring abdominal pain over the past three months with 36 hours of severe, unremitting, colicky band like upper abdominal pain, but at times is sharp that is associated with nausea and emesis of more than 10x, nonbloody, nonbilious, brownish in color, no fevers, no chills, although she has felt shaky after multiple bouts of emesis today. She does not have any dysuria. Last bowel movement was today, normal caliber and color. Normal color of urine. No change in her usual problems with shortness of breath and chest pain which improves with sublingual nitroglycerin tablets. There has been weight loss over the past few months and she feels eating can precipitate her abdominal pain. She avoids fatty foods because of her history of coronary artery disease and peripheral vascular disease. She has also had no bloody bowel movements. MEDICAL HISTORY: 1. Coronary artery disease as described above. 2. Peripheral vascular disease as described above. 3. Carotid stenosis. 4. Diverticulosis. 5. Hypercholesterolemia. 6. Esophagitis status post EGD in [**10-9**] showing mild esophagitis, antral ulcers, and duodenitis. Colonoscopy shows grade 2 small internal hemorrhoids, diverticulosis, and the patient had an echocardiogram with an EF of 35%, 3+ mitral regurgitation. MEDICATION ON ADMISSION: 1. Lisinopril 5 a day. 2. Toprol 12.5 q.d. 3. Lipitor 40 q.d. 4. Protonix 40 q.d. 5. Hydrochlorothiazide/triamterene 37.5/2.5 [**2-8**] tablet Monday, Wednesday, Friday. 6. Desipramine 10 mg with meals. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: fever, somnolence PRESENT ILLNESS: 57 yo F c PBC c/b cirrhosis, HCC s/p segmentectomies x 2 ([**2-14**], [**6-17**]) and recurrence s/p TACE of R, L hepatic arteries ([**7-19**], [**8-19**]) c/b biliary ischemia and hepatic abscesses growing separate pansensitive and ciprofloxacin-resistant <i>Pseudomonas aeruginosa</i> s/p surgical drain placement in [**2122-11-10**] and indefinite inititation of home IV meropenem. Interval imaging showed decrease in abscess size in [**Month (only) 404**]; her last imaging was a CT scan on [**2123-1-18**] and showed no change in abscess size since [**Month (only) 404**] and showed intrahepatic biliary dilatation, as well as ill-defined opacity in caudate lobe worrisome for tumor recurrence. Her AFP was documented as 4.2 at that time and she was scheduled for ERCP for stent placement. ERCP was performed [**2123-1-26**] and revealed no evidence of extrahepatic biliary stricturing, diffuse stenosis of intrahepatic ducts with no lesion appropriate for stent placement. . Since the ERCP, patient has noted increased somnolence and fatigue; she has been falling asleep during conversations and has trouble going up and down stairs. On day prior to admission, she was noted to have temperature on VNA assessment of 100.0 and was noted to have WBC count of 2.5 on lab draw. Patient said that her skin felt warm but she denied feeling feverish, chills, or night sweats. Patient endorses increased abdominal distention and LE edema over last two weeks; she is unclear as to whether she has gained weight recently. Stable, chronic, non-radiating RUQ pain well controlled with oxycodone prn. Patient was admitted from clinic today after detailing these complaints for management of suspected infection and possible hepatic encephalopathy. . Currently, patient is resting comfortably in the hospital bed and is lucid, oriented x 3, and without acute complaints. . ROS: See HPI. Patient complains of mild HA, nasal congestion x 2 days with no associated sinus congestion or SOB. Mild cough x 2 days slightly productive of sputum. Altered taste and poor appetite. Denies CP, N/V/D/C, dysuria. MEDICAL HISTORY: ONCOLOGIC HISTORY 1. [**2-14**]: Resection of segment VII HCC 2. [**6-17**]: Resection of segment VI HCC 3. [**6-18**]: Multifocal HCC in both the left lobe and remainder of right lobe. Underwent TACE of the right hepatic lobe on [**2122-7-30**] 4. [**2122-9-8**]: TACE of the left hepatic lobe . PAST MEDICAL HISTORY: 1. Primary biliary cirrhosis diagnosed in [**2096**]. EGD on [**2122-4-10**] demonstrated normal esophagus without esophageal or gastric varices. 2. Ulcerative colitis x10 years. 3. Frequent urinary tract infections. 4. HCC s/p segmentectomy MEDICATION ON ADMISSION: calcitonin 200u spray 1 hs questran 4g qday folic acid 1 mg qd lasix 40 mg qd meropenem 1g IV q8h mesalamine 1.2g tid mesalamine enema qd oxycodone 5-10 mg q8-12h prn pain compazine 5mg q12-24h prn nausea spironolactone 100 mg qd ursodiol 500 mg [**Hospital1 **] Vit C 500 qd-tid Ca/Vit D 500/200 [**Hospital1 **] MVI cranberry extract 500 qd ALLERGIES: Codeine / Demerol / Penicillins / Erythromycin Base PHYSICAL EXAM: Vitals - T: 97.1 BP: 90/60 HR: 101 RR: 16 02 sat: 99% RA Wt: 61.7 kg GENERAL: NAD, AAOx3 HEENT: NCAT, OP clear, MM dry CARDIAC: RRR s mrg LUNG: CTA with diminished BS at bases bilaterally ABDOMEN: mildly distended, S, mild TTP R side > L side without rebound, guarding, or rigidity, no appreciable fluid wave or shifting dullness EXT: WWP, [**12-12**]+ pitting edema to knees bilaterally, 2+ pulses NEURO: DERM: Spider angiomata on trunk. PSYCH: Appropriate affect, intact thought processes and content. FAMILY HISTORY: Significant for primary biliary cirrhosis in one of her sisters. SOCIAL HISTORY: She is a dentist who works with her husband in a mutually owned dental practice in [**Location (un) 686**]. She smoked tobacco between the ages 12 and 19 and does not drink alcohol.

CHIEF COMPLAINT: Fever PRESENT ILLNESS: -- per admitting hospitalist -- 74 year-old man presents with fatigue, chills, and poor PO intake over one month. Patient reports that two months ago, he was able to walk 30 minutes/day with weights, but over the few weeks prior to admission, he has felt fatigued and is more easily fatigued. He has daytime somnolence and night insomnia. He denies any localizing symptoms. He denies nausea, vomiting, anorexia, abdominal pain, melena, BRBPR, new lymphadenopathy, meningismus. Patient denies weight loss, but on review of the records, patient has lost 10 pounds over one month. He reports lightheadedness and dizziness with standing for several weeks. Of note, he presented to his PCP [**Last Name (NamePattern4) **] [**2184-2-12**] with fatigue and weakness. He was found to have a low normal TSH (0.46) and low free T4 (0.9). He was referred to endocrinology for evaluation of central hypothyroidism. He was also found to be anemia to Hct of 30 with his last checked Hct 41.6 six years prior with anemia labs consistent with anemia of chronic disease. In [**Hospital1 18**] ED, his vitals were T 103.5, HR 125, BP 96/ 52, RR 18, 98% on RA. He was found to be markedly dehydrated. A right groin line was placed and he was given 7L of IVF. He remained hypotensive at 81/46, so he was started on Levophed 0.2. He was given Vancomycin, Ceftriaxone, and Decadron as he was initially alert and oriented x3 but tangential in thought for concern for meningitis. His mental status improved with hydration therefore LP was not pursued. MEDICAL HISTORY: Coronary artery disease s/p cardiac cath in [**2175**] Hypertension Chronic renal insufficiency Hyperlipidemia Benign prostatic hyperplasia Insomnia MEDICATION ON ADMISSION: Atorvastatin 20 mg daily Nitroglycerin 0.3 SL prn chest pain Toprol 25 mg XL daily Zestril 10 mg daily Zolpidem 10 mg qhs Aspirin 325 mg daily ALLERGIES: Zocor PHYSICAL EXAM: VS: T: 97.9, BP 122/84, RR 15, 98% on 2LNC GEN: No acute distress HEENT: EOMI, Sclera anicteric, MMM, oropharynx clear NECK: supple, JVP not elevated, no LAD CHEST: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops ABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly SKIN: No rash EXT: Warm, well perfused, 2+ pulses, trace pedal edema NEURO: Alert and oriented x3, CN 2-12 intact, strength 5/5 BUE/BLE, sensory intact, fluent speech PSYCH: Calm, appropriate FAMILY HISTORY: Mother died at 95 secondary to CAD. Father died at 85 secondary to pancreatic cancer and had known colon cancer. He is married with three children. SOCIAL HISTORY: Patient is a former smoker, quit at age 42. Used to drink beer or wine twice daily but has not drank for a month due to fatigue.

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 18-year-old female who arrived to [**Hospital1 69**] via Med-Flight who had been found near her home on the side of the rode next to her bicycle, unresponsive, with a small laceration to her right temple. The patient was had stable vital signs at the scene; however, she was unresponsive with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 3 to 5; documentation unclear. Per Emergency Medical Service, the patient evacuated by helicopter to [**Hospital1 69**] Emergency Department. In transit, she vomited and was subsequently intubated to protect her airway given her mental status. On arrival to the Emergency Department at [**Hospital1 346**], the patient was intubated status post sedation. MEDICAL HISTORY: The patient has no significant past medical history (per subsequent interview when the patient was awake). MEDICATION ON ADMISSION: The patient takes no medications on a daily basis. ALLERGIES: The patient has no known drug allergies PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives with her family at home and is planning on going to veterinarian school. No ethanol or recreational drug use.

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: This is a 61 year old Chinese male with a one month history of shortness of breath and orthopnea. In early [**2108-8-3**], he experienced new onset congestive heart failure. He was admitted to [**Hospital1 336**] and underwent further evaluation. Echocardiogram was notable for an LVEF of 15% with 2-3+ aortic insufficiency. SPECT study found a severe inferior defect consistent with no significant viability. There was also a moderate-severe anteroapical defect that had some viability. Subsequent cardiac catheterization revealed severe three vessel coronary artery disease with severely depressed left ventricular function. Coronary angiography showed total occlusion of the left anterior descending and right coronary arteries while the circumflex had a 60% lesion. Ventriculogram revealed an LVEF of 20% with 2+ mitral regurgitation. Based on the above results, he was referred for cardiac surgical intervention. MEDICAL HISTORY: Congestive heart failure, Ischemic cardiomyopathy, Hypertension, Mitral regurgitation, History of cholelithiasis - s/p cholecystectomy MEDICATION ON ADMISSION: Lisinopril 10 qd, Coreg 3.125 [**Hospital1 **], ASA 325 qd, Lipitor 10 qd, Iron 325 qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: BP - 122/74, Pulse 57/min, Resp 14/min Wt - 133 lbs General - well developed, well nourished male in no acute distress Skin - no rashes or lesions, good turgor HEENT - orpharynx benign Neck - supple, no JVD Chest - mostly clear, soft bibasilar rales noted Heart - regular rate, normal s1s2, soft diastolic murmur noted Abd - benign Ext - warm, no edema Varicosities - none Neuro - alert and oriented, cranial nerves grossly intact, FROM, 5/5 strength in all extremities, normal gait, good balance, no focal deficits noted Pulses - 1+ distally Bruit - no carotid or femoral bruits noted FAMILY HISTORY: No premature coronary artery disease SOCIAL HISTORY: Quit tobacco over 30 years ago. Denies ETOH. Lives with wife and son. [**Name (NI) 1403**] at a chinese restaurant.

CHIEF COMPLAINT: increasing OSB, CP PRESENT ILLNESS: 72 yo M F who presented to [**Hospital3 417**] on [**6-1**] with SOB and was found to have pulmonary edema. She was transferred to [**Hospital1 18**] where cardiac catheterization showed 3VD and she was referred for CABG. MEDICAL HISTORY: hyperlipidemia hypertension Diabetes CAD, s/p PCI to RCA in [**2092**], s/p PCI to LCx in [**2103**] S/P pulmonary embolism [**11-4**] Asthma Degenerative joint disease of the back COPD MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], lipitor 80', lisinopril 20'', zetia 10', imdur 60', colace 100'', vicodin PRN, KCL 20', toprol 100', advair'', lyrica 50'', serax 15', spiriva 18', lasix 80', humulin 70/30 60uQA/40uQP, coumadin 4'(PE) ALLERGIES: Penicillins / Codeine PHYSICAL EXAM: HR 78 RR 18 BP 128/53 NAD Lungs with scattered crackles Heart RRR Abdomen Benign Extrem warm Superficial varicosities FAMILY HISTORY: Brother with MI at 42, Other brothers with CAD in 60s. SOCIAL HISTORY: Has 10 children, doesn't work, No smoking, No Etoh, No IVDU

CHIEF COMPLAINT: Intubated status post ventricular fibrillation arrest. PRESENT ILLNESS: This is a 50-year-old male with known coronary artery disease who collapsed suddenly in the park while standing with his wife by their car. His wife started CPR immediately. EMS was called at 8:56 and arrived at 9:02. The patient was found to be unconscious without pulses or spontaneous breathing. He was shocked immediately at 200 joules and 300 joules for ventricular fibrillation and went into to asystole. CPR was restarted and patient was intubated. He was shocked again at 360 joules for ventricular fibrillation at 9:08 and went in to idioventricular rate which then converted to sinus rate. He received Amiodarone, heparin and Nitroglycerin drip. During his ambulance ride to the [**Hospital6 33**], he went back into ventricular tachycardia again and lost pulses. He was again shocked at 360 joules for two times and went back into sinus and stayed in sinus since 9:32. On his arrival to the [**Hospital3 **] Emergency Room his heart rate was 80, blood pressure 157/70. He received 2 mg Versed, 100 mcg Fentanyl and an 8 mg Pavulon. His blood pressure dropped to 60/30 for which he was given IV fluids and Dopamine. His EKG showed ST elevation in leads III, aVF and ST depression in I, aVL and V1 through V5 which was suggested of inferior MI. He was given aspirin, Lopressor and started on a heparin drip. He was transferred to [**Hospital1 188**] for PTCA. On his arrival to the Cath lab, he was on Amiodarone and Dopamine drip. In the Cath lab no acute changes were identified compared to his last cath done in [**2190-6-9**], therefore no intervention has been performed. He tolerated the procedure well and was weaned off Dopamine. He remained on Amiodarone drip upon his arrival to the CCU. MEDICAL HISTORY: Coronary artery disease status post silent myocardial infarction. Last cath [**2190-6-9**] at outside hospital in [**State **]. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Father had his first MI at age 54. SOCIAL HISTORY: Former smoker with 30 pack year history, stopped [**2188-6-9**]. Alcohol, one beer per night.

CHIEF COMPLAINT: 35F with 6 months of headaches and intermittent dizziness who was found to have a 2.4cm left cerebellar brain mass PRESENT ILLNESS: 35 year old female presents with approximately 6 months of headaches and intermittent dizziness. She reports no visual changes, no new gait disturbances, no numbness, or tingling. Her PCP referred her to Dr. [**Last Name (STitle) **] who ordered an MRI of the brain. She had this in [**2119-1-10**] and the study revealed a brain mass in the left cerebellum measuring 2.4 cm at the greatest diameter. Dr. [**Last Name (STitle) **] then referred her to Dr. [**Last Name (STitle) **] for neurosurgical consultation. MEDICAL HISTORY: sarcoidosis (affecting liver and kidneys) - dx in [**2115**], multiple ear infections s/p multiple surgeries, s/p lymph node biopsy, s/p kidney biopsy, s/p cyst removal, HTN (secondary to sarcoidosis in kidneys), hypercholesterolemia MEDICATION ON ADMISSION: CeleXA 20mg',Jolessa 0.15mg/30mcg',Valsartan 160mg', Lorazepam prn spasm,Diazepam 5mg"',Omeprazole 40mg' ALLERGIES: Latex / Erythromycin Base / Percocet / Vicodin / Sulfa (Sulfonamides) / Penicillins / Alcohol / Egg PHYSICAL EXAM: On Discharge: Neurologically intact. Scalp incision clean, dry, intact. Rash to FA significantly improved, with only trace red pigmentation and non-pruritic. FAMILY HISTORY: mother:died from metastatic breast CA, maternal grandmother and [**Name2 (NI) 5358**] aunt both had non-[**Name (NI) 4278**] Lymphoma, maternal grandfather had leukemia SOCIAL HISTORY: lives alone, works as Nanny part time

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 61 yo male with a PMH for Acid reflux, TIIDM, HTN, s/p nephrectomy following RCC diagnosis, ESRD with dialysis 3x/week, and s/p cadaveric kidney transplant after lone kidney became dialysis dependent and stopped functioning well, who comes in complaining of CP. He was last well 3 days PTA when lifting heavy trash right after lunch at work when he felt acute chest pain that was burning in nature in his sternum that radiated to his back. It was severe in nature and was relieved with rest after 30 minutes. He did feel some SOB with this episode and does not remember how long it lasted for. He had no pain the following day and then 1 day PTA the same pain returned while watching TV and after eating spicy food. This time the pain lasted for 30 minutes and was relieved by burping and drinking gingerale and milk. The pain retuned this morning without eating and was again relieved by drinking milk. The pain this morning was not as severe as times before. Of note, he states that he does not experience any exercise chest pain and is on his feet and walking all day without problem. If he walks uphill he does get short of breath but otherwise does not feel limited by his lung capacity. . In the ED, initial vs were: T 98 P 85 BP171/83 R 16 O2 97 sat.on RA Patient had an EKG that showed no change from previous EKGs and a normal chest x-ray. . Review of sytems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea, dysphagia or congestion. Denies cough, chest tightness, or palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. MEDICAL HISTORY: DM2 ESRD s/p cadaveric renal transplant in [**8-8**] renal transplant artery stenosis s/p dilatation/stent in [**8-8**] hemolysis with unknown etiology ([**1-11**]) ciguatera intoxication ([**4-9**]) Barrett's esophagus ([**12-7**]) asthma RCC s/p L nephrectomy ('[**93**]) obstructive sleep apnea s/p AV graft on LUE and AV fistula RLE hypercalcemia MEDICATION ON ADMISSION: Minoxidil 10mg 1TAB 2xday Prednisone 5mg 1TAB daily Clonidine 0.1mg 1TAB 2x daily Calcitriol 0.25mcg 1capdaily Furosemide 3TAB 2xday Mycophenolate 500mg 1TAB 2xday Lisinopril 10mg 1TAB QHS Labetalol 200mg 3TAB 2xday ASA 81 mg Humalin NPH 20 units AM and 15 in PM ALLERGIES: Vancomycin PHYSICAL EXAM: Vitals: T:96.1 BP:146/54 P:82 R:18 O2:98RA General: Alert and oreinted obese African American male in no acute distress HEENT: Scar in right eye from childhood injury, sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: CTAB, no wheezes, rales, ronchi CV: RRR, crescendo-decrescendo murmur heard best in the aortic valve distribution Abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding Ext: Warm, well perfused, 2+ pulses, non pitting mild edema bilaterally in feet, no C/E Skin: W+M, no rash, petichiae, or echymosis Neuro:CN II-XII grossly intact motor: [**5-10**] throughout Sensation: Intact to light touch throughout DTR: 2+ biceps bilaterally Coordination: Intact to rapid alternating movements and finger-to-nose FAMILY HISTORY: Mother and 3 uncles died of "kidney disease." Otherwise all 8 of his siblings are healthy. SOCIAL HISTORY: Married with 7 children. Originally born in [**Country **] and moved to the U.S. in [**2078**]. Currently works as a cook at [**Hospital1 18**] and is planning on retiring over the next couple of years. Last travel was in [**Month (only) 1096**] to [**Country **]. Former smoker-quit 20 yrs ago. Denies alcohol or IVDU.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 20-year-old male who fell 45 feet off a roof. He states that he stepped back and slipped and fell landing on his back. He complains of severe lower back pain and left ankle pain. He had no loss of consciousness. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Episodes of recurrent Ventricular tachycardia PRESENT ILLNESS: 75 y.o. male transferred from [**Hospital6 **] with V-Tach, BiV ICD firing several times per day. Loaded with amiodarone in the ED. Recently admitted in [**Month (only) 956**] for Left lead revision. . He reports a history of recurrent ICD firing since it was placed approximately 3 years ago but has not had an incident since [**Month (only) 956**] when his leads were revised. ~4am on [**4-12**] his ICD fired while he was sleeping. He was scheduled to have a colonoscopy today so went through a bowel prep throughout the day but did take his medications. His ICD fired again early this morning. He was instructed not to take his medications and remain NPO for his colonoscopy, but when his gastroenterologist found out that his ICD had fired again, he cancelled the procedure. The patient then took his usual morning medications at ~1pm. His ICD fired 2 more times, and as he was close to his cardiologist's office, he stopped in. His ICD was interrogated, verified that it did fire, and he was sent by ambulance to [**Hospital6 33**] ED. There, he was loaded with IV amio (15 mg/min for 150mg, then 1mg/min) and transferred to [**Hospital1 18**] for further care. The patient reports a fluttering-type of sensation and "funny feeling" before his ICD fired each time, similar to the past, but he never syncopized, had chest pain, or had shortness of breath. Currently he feels at his baseline with no complaints. . ROS: No orthopnea, PND, chest discomfort, lower-extremity swelling, N/V/D/C/abdominal pain, fevers, chills. MEDICAL HISTORY: -Ischemic cardiomyopathy, EF documented as low as 15% -CHF -Prior MI -[**2102**] CABG at [**Hospital6 **] --Cath report from [**Hospital1 112**] [**2121-3-28**]: ---Right-dominant system ---50% LMCA ostial lesion ---50% tubular stenosis at bifurcation of LAD and LCx ---proximal LAD-> D1 stent placed on [**2-/2121**] patent ---LIMA->LAD patent, known occlusion of RCA. --- Pressures, Aortic - 127/65, RA 16-17, RV 64/8, PA 61/26, PCWP 27 -Ventricular tachycardia, s/p ablation -Prior ICD implant with upgrade to BiV ICD in [**6-22**] -Atrial flutter, s/p ablation -Chronic renal insufficiency (baseline creatinine 2.0) -Peripheral vascular disease -Facial melanoma -Bladder cancer Pacemaker/ICD, BiV ICD in [**6-22**], revised in [**2-24**]. MEDICATION ON ADMISSION: Aspirin 81 mg daily Digoxin .125 mg daily Lasix 120 qAM, 80 mg qPM Mexiletine 200 mg [**Hospital1 **] Hydralazine 10 mg three times a day Protonix 40 mg [**Hospital1 **] Lisinopril 2.5 mg qd Metoprolol 100 mg q AM, 50 mg qPM Folic acid 1 mg qd Niferex 150 mg daily colace 100 mg [**Hospital1 **] Plavix 75 mg daily Flomax 0.4 mg daily MVI 1 qd Lipitor 80 mg daily Amiodarone 200 mg daily Imdur 60 mg qd Advair 250/1 puff [**Hospital1 **] ALLERGIES: Penicillins PHYSICAL EXAM: Blood pressure was 117/56 while supine. Pulse was 63 beats/min and regular, respiratory rate was 14 breaths/min. GEN: well developed, well nourished and well groomed. Oriented to person, place and time. Mood and affect appropriate. HEENT: no xanthalesma, no conjunctiva pallor, mucous membranes moist NECK: supple with JVP of 10cm with +HJR. carotid pulses +1. There was no thyromegaly. left-sided carotid bruit PULM: No chest wall deformities, scoliosis or kyphosis. Respirations unlabored, no accessory muscle use. lungs CTAB, no W/R/R COR: PMI diffuse, laterally displaced to anterior axillary line. There were no thrills, lifts or palpable S3 or S4. Normal S1, loud P2. [**1-23**] early systolic murmur at LLSB radiating to apex. ABD: No pulsatile masses, no hepatosplenomegaly or tenderness, NT, ND, +BS. No abdominal or femoral bruits. EXT: No pallor, cyanosis, clubbing or edema. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. . Pulses: Right: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+ Left: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+ FAMILY HISTORY: No family history of premature CAD or SCD. SOCIAL HISTORY: No EtOH or tobacco use.

CHIEF COMPLAINT: 20 M s/p GSW to R chest. PRESENT ILLNESS: 20 M s/p GSW to R chest. MEDICAL HISTORY: GSW to R leg, s/p IM rod MEDICATION ON ADMISSION: ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Lungs Clear to auscultation Heart regular Abd soft non tender Ext symetric strength FAMILY HISTORY: unknown SOCIAL HISTORY: GSW to R leg, s/p IM rod

CHIEF COMPLAINT: Dyspnea, hemoptysis PRESENT ILLNESS: 79 yo M with known metastatic nonsmall cell lung CA (mets to T-spine) p/w episodes every 2 hours of coughing up blood starting last night at 2300. Associated with dyspnea over the past 2 days to the extent that he was unable to get out of bed yesterday. Also, he had nausea and one episode of post-tussive emesis. He felt feverish and had chills last night, but did not take his temperature. He denies chest pain or abdominal pain. Denies trauma. . In the ED, initial vs were: T 94.6F P afib 113 BP 92/50 R 20 O2 sat 90% on 2L NC. Patient was given Levaquin 750mg IV x1 for CXR showing LLL infiltrate and effusion. The EKG showed afib with ventricular rate of 113, NA, NI with no STE or changes from previous tracing. CTA chest negative for PE, but showed tumor burden in L hilum with likely post-obstructive pneumonia in the setting of a left-sided pleural effusion. . On the floor, the patient had no complaints and was speaking in full sentences. . MEDICAL HISTORY: # stage IV adenocarcinoma of the lung dx [**2177-10-21**] by bronchoscopy, MRI [**10-26**] with bony mets to T11, 50-75% narrowing of spinal canal and mild to moderate spinal cord compression. TREATMENT: 1. Status post palliative thoracic spine radiation to T9-T12 thoracic spine. Total of 800 cGy (1 dose) completed [**2177-10-28**]. 2. Status post cycle 1 of carboplatin 6 AUC, paclitaxel 200 mg/m2 and anamorelin vs placebo as part of DFHCC 07-369. C1D1 given on [**2177-11-11**]. 3. Status post cycle 2 of carboplatin 4.5 AUC, paclitaxel 180 mg/m2 and anamorelin vs placebo as part of DFHCC 07-369. C2D1 given on [**2177-12-2**]. # DM2 # Atrial fibrillation # HTN # chronic renal failure # Anemia # Hyperlipidemia # COPD MEDICATION ON ADMISSION: ALBUTEROL - 90 mcg Aerosol - 2 puffs qday DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth twice a day day before chemotherapy, and for 2 days following chemotherapy. DIGOXIN - 125 mcg Tablet - daily FENTANYL - 25 mcg/hour Patch 72 hr FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose Disk with Device - 1 puff intraoral twice a day FOLIC ACID - 1 mg Tablet - daily HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg Tablet - [**1-16**] Tablet(s) by mouth every 6 hours as needed for pain for cancer-related pain LORAZEPAM - 1 mg Tablet - 1 Tablet(s)(s) by mouth every 12 hours chemotherapy-induced nausea or anxiety METOPROLOL TARTRATE - 100 mg Tablet - twice a day SIMVASTATIN - 20 mg - daily TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule, w/Inhalation Device - 1 capsule orally daily . Medications - OTC ASPIRIN - 325 mg Tablet - daily BLOOD SUGAR DIAGNOSTIC [SURESTEP TEST] check fs qid as needed for DM LANCETS [LIFESCAN FINEPOINT LANCETS] - Misc - check once a day NUT.TX.GLUC.INTOL,LAC-FREE,SOY [GLUCERNA] - Liquid - 2 bottles by mouth twice a day ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 97 BP: 123/51 P: 113 R: 21 18 O2: 99/4L NC General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, trace dried blood on lower lip Neck: supple, JVP not elevated, no LAD Lungs: Diminish BS L>R, scattered rales and rhonchi heard throughout CV: [**Last Name (un) **] [**Last Name (un) 3526**], normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, protuberant, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema ===================== Discharge Examination: Vitals: Tc 96 Tm 96.7 BP 110/66 HR 104 RR 20 O2 Sat 96% on 2L Gen: well appearing, NAD Heart: irregularly irregular, s1/s2 present, -mrg Lungs: diminished breath sounds at bases, scattered wheezes Abd: +bs, soft, non-tender, non-distended Ext: [**1-16**]+ LE edema FAMILY HISTORY: No family history of lung cancer SOCIAL HISTORY: -Tob: quit in [**2166**], approx 150 pk yrs, + asbestos exposure -EtOH: quit in [**2166**] -Illicits: None -Occupation: used to be a [**Doctor Last Name 9808**] operator

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: Ms. [**Known lastname 28003**] is a 44 year old female with Factor V Leiden and multiple prior pulmonary emboli who was transferred from [**Hospital1 **] to [**Hospital1 18**] ED for evaluation of pleuritic chest pain radiating to the back and dyspnea. Per the record she also had two days of flank pain radiating to the groin, and dysuria. She was transferred for a study to rule out pulmonary embolism. She is anticoagulated on coumadin, currently with an INR of 2.2. Vitals at [**Hospital1 **]: bp 149/96, p 72, rr 18, sat 98%, t 98.4 . Her initial [**Hospital1 18**] ED vitals were: 98.1 76 184/83 16 98%. Based on her symptomotology, aortic dissection became a concern. In the ED she was electively intubated because she is clautrophobic and needed the MRI. An MRA was contraindicated due to the risk for gadolinium induced nephrogenic systemic sclerosis. A TEE was considered; however, this would not interrogate the entire aorta and there is report that the patient also had two days of flank pain. Transfer vitals: 136/84, p 74, bp 136/84, rr 16, o2 sat 99% on cmv/ac . On arrival to the MICU, she was intubated and sedated. MEDICAL HISTORY: 1. Factor V Leiden gene mutation 2. Pulmonary emboli 3. IDDM 4. Hypertension 5. ESRD on HD via left subclavian HD line, schedule unknown 6. Hypothyroidism 7. Atrial myxoma s/p resention 8. atrial fibrillation 9. Reflex sympathetic dystrophy/chronic regional pain syndrone 10. Fasciotomy of right forearm [**2180-5-16**], left forearm [**2194-4-15**] 11. Permanent IVF filter placed on [**2186-7-10**] MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. HYDROmorphone (Dilaudid) 20 mg PO Q3H pain 2. Nephro-Vite *NF* (B complex-vitamin C-folic acid) 0.8 mg Oral daily 3. Lisinopril 40 mg PO BID 4. Digoxin 0.125 mg PO MWF 5. sevelamer CARBONATE 1600 mg PO TID W/MEALS 6. Levothyroxine Sodium 125 mcg PO DAILY 7. Propranolol LA 120 mg PO DAILY 8. Montelukast Sodium 10 mg PO DAILY 9. Aciphex *NF* (RABEprazole) 20 mg Oral daily 10. Lantus Solostar *NF* (insulin glargine) 30 units Subcutaneous HS 11. NovoLOG *NF* (insulin aspart) sliding scale Subcutaneous slidinc scale 12. Doxazosin 2 mg PO HS 13. Lorazepam 1 mg PO Q6H:PRN anxiety 14. Promethazine 25 mg PO Q6H:PRN nausea 15. Ondansetron 8 mg PO BID:PRN nausea 16. Frova *NF* (frovatriptan) 2.5 mg Oral PRN migraines 17. Xopenex Neb *NF* 1.25 mg/0.5 mL Inhalation Q4H PRN 18. Ferrous Sulfate 325 mg PO DAILY 19. DiphenhydrAMINE 50 mg PO Q4H:PRN itching 20. Docusate Sodium 100 mg PO BID 21. Denavir *NF* (penciclovir) 1 % Topical q6h rash 22. Warfarin Dose is Unknown PO DAILY16 Based on INR 23. Metoprolol Succinate XL 25 mg PO DAILY ALLERGIES: multiple / Amoxicillin / baclofen / Cephalexin / doxycycline / Erythromycin Base / Hydralazine / Meperidine / Polystyrene Sulfonate / povidone-iodine / valproic acid / Verapamil / Nifedipine / cefuroxime / Labetalol / ciprofloxacin / omeprazole / loratadine / loratadine / amlodipine / metformin / sumatriptan / fexofenadine / bee venom (honey bee) / esomeprazole / Penicillins / Sulfa(Sulfonamide Antibiotics) / IV Dye, Iodine Containing Contrast Media PHYSICAL EXAM: ADMISSION EXAM: General: Alert, oriented, no acute distress 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 Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE EXAM: General: NAD AOx3 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 Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, +CVA tenderness on left that is stable x4 days GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation FAMILY HISTORY: She denies a family history of kidney disease. Father had MI and CABG in his 50's. No FH of premature CAD, SCD, or arrhythmia. SOCIAL HISTORY: Patient is from [**Location (un) 15739**], NY. She is currently on disability. Lifelong nonsmoker. Denies EtOH or illicits

CHIEF COMPLAINT: Tremors, chest pain PRESENT ILLNESS: 77 yo M w/ h/o DM type 2, HTN, dyslidemia, NASH cirrhosis/HCC s/p liver [**First Name3 (LF) **] who presents w/ tremors and chest pain. Pt reports was in usual state of health until around 11:30pm night prior to presentation. At that time noted "rope-like" pain around his chest while watching TV on the couch. Pain lessened and he was able to go upstairs and go to sleep. He awoke 1 hour later w/ tremors and shaking of his "entire body" and worsened chest discomfort of the same quality, now [**2180-7-24**] in severity. Reported shallow breathing but denied SOB, nausea, diaphoresis, vomiting, sweats. Felt cold and was shivering. Wife saw husband shaking and called 911 and was transported to [**Hospital1 18**]. In the ED, initial vitals were 98.1 95 112/55 14 99% RA. Pt initially reported tremors and chest pain w/ onset in ED, but on further questioning noted that CP may have started at home. EKG was done which showed ST elevations in I, aVL, and V2 w/ infero-lateral ST depressions. Patient was given aspirin 325, heparin bolus, and nitroglycerin and immediately transported to the cath lab for STEMI. Labs were notable negative troponin and creatinine of 2.0. In the cath lab, patient recieved 600 mg of plavix and 5 mg of lopressor. Cath was notable for right dominant system w/ 100% occlusion of mid LAD which was stented w/ a BMS. Also showed 70% LCx lesion and diffuse disease of the RCA- 50-60%. Pt tolerated the procedure well and was transported to the CVICU. On arrival to the floor, patient appeared comfortable and denied any symptoms of CP, SOB, abd pain, nausea or vomiting. Reported a little bit of "acid taste" in his mouth. MEDICAL HISTORY: -cirrhosis [**1-17**] NASH -HCC s/p liver [**Month/Day (2) **] [**4-19**] -post-operative course complicated by bile duct ischemia, strictures, requiring bilateral biliary percutaneous drains, left drain removed [**2179-1-18**] due to leak -re-placed on liver [**Year (4 digits) **] list -cardiac tamponade, required pericardiocentesis in [**8-/2178**] -DM2 > 10 years -HTN -parathyroid adenoma s/p parathyroidectomy [**8-21**] -CRI, recent baseline cr 1.6-1.9, from DM and HTN -Squamous cell carcinoma in situ of face MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. cilostazol *NF* 100 mg Oral [**Hospital1 **] 2. Ezetimibe 10 mg PO DAILY 3. Felodipine 10 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Lantus *NF* (insulin glargine) 32 Units Subcutaneous QHS 6. insulin lispro *NF* 15 Units Subcutaneous QID Titrate to meal time FS 7. Metoprolol Tartrate 50 mg PO BID 8. Omeprazole 20 mg PO DAILY 9. Potassium Chloride 20 mEq PO DAILY Duration: 24 Hours Hold for K >5.0 10. Rifampin 300 mg PO Q12H 11. Simvastatin 10 mg PO DAILY 12. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 13. Tacrolimus 7 mg PO Q12H 14. Terazosin 10 mg PO HS 15. testosterone propionate *NF* 1 % Transdermal DAILY apply as directed to upper back and shoulders 16. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY 17. Ursodiol 600 mg PO QAM 18. Valsartan 320 mg PO DAILY 19. Vitamin D [**2169**] UNIT PO DAILY 20. Multivitamins 1 TAB PO DAILY 21. naltrexone *NF* 50 mg Oral DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: VS: T= afebrile BP= 120/65 HR= 89 RR= 17 O2 sat= 97% on 2L GENERAL: overweight, pleasant gentleman in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera icteric. dry MM. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple; unable to appreciate JVP 2/2 habitus. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, somewhat distended w/ mild TTP in [**Name (NI) 5283**]; enlarged liver; + BS; no rebound or guarding. EXTREMITIES: R groin site w/ dressing c/d/i. No hematoma or bruit. No c/c/e. SKIN: + [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] scar of abdomen, well healed; No stasis dermatitis, ulcers, spider angiomas, or xanthomas. PULSES: Right: Dopplerable DP & PT [**Name (NI) 2325**]: Dopplerable DP & PT FAMILY HISTORY: Father - [**Name (NI) **] CA Mother- CVAs Brother - DM, HTN No family history for liver disease or colon CA. SOCIAL HISTORY: Very rare Alcohol use, stopped smoking [**2148**]. Retired, was previously director of Health Services for the Prison Service. He has three children, and is married

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 77-year-old male with diabetes, angina, fatigue, left leg claudication, hypertension and hypercholesterolemia. He had a cardiac catheterization that showed a left ventricular ejection fraction of 45-50%, a left main coronary artery that was moderately calcified, a left anterior descending artery that was 90% proximally occluded, a left circumflex coronary artery that was 90% occluded, a second obtuse marginal artery that was 90% occluded and a right coronary artery that 80-90% lesions. MEDICAL HISTORY: The past medical history was significant for noninsulin dependent diabetes, hypertension, prostate carcinoma and hypercholesterolemia. MEDICATION ON ADMISSION: Aspirin 81 mg p.o. q.d. Glyburide 2.5 mg p.o. q.d. Diltiazem 240 mg p.o. q.d. Casodex 50 mg p.o. q.d. Vitamins. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: CC:[**CC Contact Info 80944**] PRESENT ILLNESS: HPI: Patient is a 47 yo woman with no PMH who had a dull occipital HA starting 2 weeks ago. Intermittent and lasting 2-6 minutes each time. Then developed URI sxs about 1 week ago and HA continued to worsen. Was significantly worse last night so went to OSH ED where hyperintensity in right BG identified as possibly being hemorrhage or other. Patient denies any neurological deficits such as weakness, paresthesias, vision change, confusion, language changes, clumsiness. MEDICAL HISTORY: PMHx: none MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission FAMILY HISTORY: Family Hx: no ICH. Breast CA. SOCIAL HISTORY: Social Hx: quit tob recently. Occasional ETOH.

CHIEF COMPLAINT: hypotension PRESENT ILLNESS: This 69 white male presented to [**Hospital3 3583**] on [**2108-10-16**] with severe back and flank pain. He became hypotensive and hypoxic and was life flighted to [**Hospital1 18**]. He was transferred to the MICU intubated and a CTA of the torso showed a 7 cm infrarenal AAA without evidence of leak or rupture. He ruled in for an MI with a troponin of 2.68 and a CK of 1099. Cardiac cath on [**10-16**] revealed 90% LMCA lesion, occluded LCX, and 80% RCA. His EF is 35-40%. Cardiac surgery was consulted. Vascular surgery took Mr.[**Known lastname 84604**] for exploration of below-knee popliteal artery with popliteal and tibial thrombectomies, repair of thrombosed popliteal aneurysm with reversed saphenous vein graft, and angioscopy and valve lysis.Once recovered from this procedure, Cardiac surgery prepared him for surgical coronary artery revascularization and Aortic Valve Replacement. MEDICAL HISTORY: 1.Aortic stenosis. 2. Severe 3-vessel coronary artery disease. 3. Status post recent myocardial infarction. 4. History of ruptured abdominal aortic aneurysm in the setting of an acute myocardial infarction. 5. Status post Endo AAA repair 6. Chronic obstructive pulmonary disease 7. HTN 8. hyperlipidemia 9. A Fib MEDICATION ON ADMISSION: MEDICATIONS (obtained from [**Company 4916**] Pharmacy): Simvastatin 20 mg daily Captopril 100 mg po bid Amlodipine 5 mg daily ALLERGIES: Benzodiazepines PHYSICAL EXAM: Pulse: 80 Resp: 16 O2 sat: 95% B/P Right: 123/75 Left: Height: 5'[**09**]" Weight: 92 kg FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Race: Caucasian Last Dental Exam: years Lives with: alone Occupation: retired Tobacco: never ETOH: none

CHIEF COMPLAINT: End stage liver disease PRESENT ILLNESS: ESLD status post hepatitis C infection and cirrhosis with a 3x 4 lesion in segment II treated with ablation on final path was 1.2 cm hepatocellular carcinoma in pathology specimen, recovery was prolonged by persistent ascites MEDICAL HISTORY: ESLD, Hep C, HCC, Psoriasis, Grade I varices, Left sciatic pain, arthritis, H/O lyme disease, diverticulosis, B/L inguinal hernia repair, r cataract surgery, discectomy L-[**4-5**] MEDICATION ON ADMISSION: Protonix 40, clotrimozole cream, oxycodone 5, potasium, Eye drops ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: AXO X3, CN 2-12 intact, MAE no defecits [**5-5**], reflexes symmetric [**Last Name (un) **], PERRL, NC, At, no LAD, anicteric, EOM-I, no JVD, no bruit, no thyroidmegaly CTA-B/L S1, S2, trace SEM LLSB no R/G S-Nt-ND, no masses no RT no guarding + fem B/L, + DP b/L FAMILY HISTORY: NC SOCIAL HISTORY: PPD for 25 years quit [**8-4**], H/O cocaine, denied IVDA, H/O heavy drinking, disabled carpenter, married one son

CHIEF COMPLAINT: Abdominal pain, shortness of breath. PRESENT ILLNESS: Briefly, this is a 88 M with CAD s/p IMI and stenting, Afib, admitted with progressive SOB. In ED, noted to be in AF with RVR at rate of 130s. Was rate controlled on 15 mg IV dilt. Pt then received 120 PO dilt. Given concern for PE, D-dimer sent and returned at 516. CTA not performed given renal insufficiency, and pt given 60 mg SQ lovenox for empiric treatment of PE . On initial floor eval by primary team, noted to be tachypneic, with basilar crackles, HR ~100. Given IV lasix. Then as pt was straining to have BM, became bradycardic and hypotensive. Stools guaiac negative. ABG 7.25/47/79 with lactate 6.1. On further exam, was also noted to have lower abdominal pain. . Per daughter, pt functional at baseline. Lives alone, no assistance with ADLs. Walks up to a mile to market without exertional symptoms. Daughter takes [**Name2 (NI) **] weekly. Had been regular up until this past Saturday when she noted it to be irregular. Pt had otherwise been in USOH until this weekend when had worsening SOB. MEDICAL HISTORY: - Atrial fibrillation s/p cardioversion [**2190**] - Hx upper GI bleed - MI s/p stent [**2187**] - HTN - Hypercholesterolemia - BPH MEDICATION ON ADMISSION: ASA daily Previously on amio, but stopped several months ago ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 96.0, BP 94/79, HR 48, RR 28, O2 sat 96% 2L NC, wt 78 kg Gen - somewhat uncomfortable, but NAD, speaking in full sentences HEENT - NCAT, PERRL, OP clr, MMM, no LAD CV - [**Location 64063**] [**Last Name (LF) 64063**], [**First Name3 (LF) **], no mur Lungs - dependent R-sided crackles (pt laying on R side) Abdomen - NABS, distended, tender in lower abdomen with voluntary guarding, no rebound tenderness, no CVA tenderness Back - no back tenderness Ext - 1+ bilat edema, WWP, distal pulses 2+ Neuro - A&Ox3 Skin - Pink, warm, no rashes FAMILY HISTORY: Many family members with CAD. SOCIAL HISTORY: Moved from [**Country 5881**] 50 years ago; he is widowed, lives alone and is independent in all ADLs. He quit smoking 35 years ago, and smoked 1ppd for "many years." Occasional alcohol use. Has 2 children. Daughter lives in [**Location 86**] and is active in his care. He used to work at a raincoat factory.

CHIEF COMPLAINT: Fall down stairs PRESENT ILLNESS: 53-year-old male who fell down 15 steps by report while intoxicated. He was brought to an area hospital and subsequently transferred to the [**Hospital1 1444**] for full trauma evaluation. On his arrival he was found to exhibit flaccid paralysis of bilateral upper extremities, but demonstrated some sacral sensory sparing and distal lower extremity strength 3/5 in the gastrocnemius soleus complex, [**Last Name (un) 938**], tibialis anterior. He underwent imaging including fine-cut CT and MRI of his entire spine. This identified an undisplaced fracture of the C2 pars into the body, involving the foramen transversarium without vertebral injury as well as a C3 spinous process fracture, evidence of previous C4 and C5 spinal process fractures, severe subaxial spondylosis with ligamentum flavum buckling causing severe central as well as foraminal subaxial stenosis and a non-displaced C4 injury with increased STIR signal. Thoracic imaging identified T3 spinous process fracture with posterior ligamentous complex disruption, a T4 burst fracture with retropulsion, and a minimally displaced T7 compression fracture with increased STIR signal. MEDICAL HISTORY: HTN Back surgery MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: 98.4, 63, 136/57, 16, 100% on FIO2 0.35. TV 700, PEEP 5, PS 10. GENERAL APPEARANCE: The patient is a thin man, intubated and sedated. NECK: A cervical spinal collar is in place. LUNGS: Clear to auscultation bilaterally anteriorly. HEART: S1, S2, regular, without murmurs. ABDOMEN: Soft, without palpable masses or splenomegaly. EXTREMITIES: No peripheral edema. NEUROLOGIC: The patient is sedated and does not respond to voice or withdraw to pain. He has hyperreflexia of upper extremities and 2+ patellar reflexes. SKIN: There are no petechiae or ecchymoses and no visible oozing from IV lines. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: +EtOH Supportive family

CHIEF COMPLAINT: Increasing Abdominal Pain, Decreased PO Intake PRESENT ILLNESS: This is a [**Age over 90 **] year old male with PMH of Alzheimer's disease, bilateral inguinal hernias, BPH, constipation, bilateral heel ulcers, s/p 3 documented falls since [**2195-2-13**] presenting with increasing abdominal pain and decreased PO intake over the past week. The patient started developing abdominal pain 6 days ago. The pain has become increasingly severe and is diffuse in nature. He stopped taking solid foods PO 5 days prior to presentation and stopped taking fluids 3 days prior to presentation. Prior to this past week he was described as having a robust appetite. He saw his PCP yesterday and was started on enemas and magnesium citrate PO as well as cipro/flagyl to empirically cover for a GI source of infection. According to the patient's family he has been having bowel movements as they report that the nursing home has been changing his undergarments. . The patient has been in severe pain from his bilateral heel ulcers and is on an aggressive opiate pain regimen with a minimal bowel regimen. He is seen by a wound specialist and gets debrided once weekly with dressing changes of his wounds twice daily. He has fallen three times in [**2195**] and has a residual hematoma on his left forehead from one of his falls. . In the ED, initial vs were: T=98.4, P=97, BP=130/70, R=18 O2 sat=94% RA. He was noted to have a rigid abdomen and non-reducible >6 cm, hard bilateral inguinal hernias with concern for strangulation in the right scrotum. He also had a leukocytosis to 26.4 and a Cr=1.9. CXR and KUB showed no evidence of free air under diaphragm. Non contract CT of abdomen and pelvis preliminariy showed fecal loading, large inguinal hernias without evidence of obstruction or strangulation or volvulus. Surgery was consulted and recommended no surgical intervention. A Foley was placed and drained 1.5L of urine. Blood cultures were drawn. Patient was given ciprofloxacin and flagyl, 2L of NS boluses, and morphine 4mg IV. . On the floor, the patient was somnolent, but briefly arousable. He would not answer questions appropriately but was noted to be in severe pain secondary to his heels and his abdomen. . Review of sytems: Unable to obtain as patient is too somnolent MEDICAL HISTORY: -Bradycardia - never worked up; asymptomatic per son. Noted on physical exam -BPH -constipation -post-herpetic neuralgia -he denies CAD, DM, cancer MEDICATION ON ADMISSION: (Per Nursing Home Records) - Ciprofloxacin 500mg PO BID (started [**6-19**]) - Flagyl 500mg PO TID (started [**6-19**]) - Oxycodone IR 2.5mg-10mg PO q4 PRN pain - Oxycodone IR 2.5mg daily at 7AM - Morphine 4mg PO hourly PRN - Lorazepam 0.5mg PO q4 PRN - Artificial tears 1gtt OU [**Hospital1 **] - Milk of Magnesia 30cc PO daily PRN - Bisacodyl 10mg PR PRN - Doxazosin 2mg PO HS - Simethicone 40mg TID PRN - EMLA cream PRN to heels prior to debridement - Hyoscyamine sulfate 0.25mg q6 PRN - Prochlorperazine 25mg PR q12 PRN - Senna 17.2mg PO HS - Lactulose 10gm daily ALLERGIES: Penicillins PHYSICAL EXAM: Admission Exam: Vitals: T: 98 BP: 139/46 P: 110s-130s R: 18 O2: 94% RA General: Elderly male, somnolent, but will respond to his name HEENT: Sclera anicteric, dry MM, oropharynx clear, hematoma noted on the left side of his forehead Neck: supple, JVP flat Lungs: Clear to auscultation anteriorly CV: Irregularly irregular, tachycardic Abdomen: firm, diffusely tender, distended, hypoactive bowel sounds, no rebound tenderness or guarding GU: Foley in place Ext: warm, well perfused; Dopplerable pulses; no clubbing, cyanosis or edema; bilateral necrotic heel ulcers noted FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at [**Location 19168**] on the [**Doctor Last Name **]. Denies history of tobacco use. Occassional alcohol use.

CHIEF COMPLAINT: A 58-year-old woman with a history of severe asthma requiring many past hospitalizations. No Intensive Care Unit stays and has never been intubated who presents with worsening shortness of breath over the past several hours, not relieved by inhalers. PRESENT ILLNESS: Ms. [**Known lastname 38086**] was in her usual state of health until three days prior to admission when she began to have fevers, nonproductive cough, worsening shortness of breath, and dyspnea on exertion. On the day of admission, these symptoms became worse, and they were not relieved by her rescue albuterol inhaler. She then found that her peak flow was down to 90 from a baseline of 200 to 250. Therefore, she went to the [**Hospital1 346**] Emergency Department. On presentation to the Emergency Department, her vital signs were a temperature of 99.2, blood pressure of 153/73, heart rate in the 130s, respiratory rate of 22, and an oxygen saturation of 97% on room air. Her peak flow was measured to be in the 90s in the Emergency Department, with her baseline at home noted to be 200. A chest x-ray showed hyperinflated lungs with no infiltrate. She was requiring albuterol nebulizers every hour and was not showing improvement while in the Emergency Department. Therefore, she was admitted to the Intensive Care Unit. While in the medical Intensive Care Unit an arterial blood gas was obtained, from which she was found to have a pH of 7.28, a PCO2 of 29, and a PO2 of 76, with a lactate level of 6.6. Urinalysis showed a pH of 5, trace ketones, and a glucose of greater than 1000. At 5:30 p.m. arterial blood gas showed a lactate level peaking at 10.2, with a pH of 7.29, and a bicarbonate level of 11. With this presentation, bowel ischemia was considered. An abdominal CT was performed which was negative for ischemia or abnormalities. She then had an episode of chest pain which occurred on the way to the CT scan which she regarded as anxiety. A 12-lead electrocardiogram at that time was negative for ischemia. She was subsequently ruled out by enzymes with creatine kinases being negative times four, and troponin I being negative times three q.6h. She was started on intravenous Solu-Medrol at 60 mg t.i.d., and on admission to the floor was switched over to prednisone 60 mg p.o. q.d. MEDICAL HISTORY: (Her past medical history includes) 1. Asthma times five years. 2. Hypertension. 3. Hyperlipidemia. MEDICATION ON ADMISSION: Medications at (preadmission) included Pulmicort, Serevent, Flovent, albuterol, Combivent, Zocor, Glucophage, glyburide, Avapro, Premarin, Accolate, and cyclobenzaprine. ALLERGIES: She has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history was positive for diabetes. Mother recently died of chronic renal failure related to her diabetes. SOCIAL HISTORY: The patient lives with her husband. [**Name (NI) 1403**] as a manager of a house for the care of mentally disabled people. No recent travel. No change of residence. No pets. No tobacco. Husband smokes infrequently. The patient reports having had house renovated a couple of weeks ago.

CHIEF COMPLAINT: PRESENT ILLNESS: This patient was transferred to our service from the medical Intensive Care Unit. Briefly, 63-year-old female with end stage renal disease, status post cadaveric kidney transplant who was recently discharged from arrived at rehabilitation facility and was found unresponsive. She was not reacting to deep sternal rub, and appeared to be in respiratory arrest. Upon arrival in the MICU, the patient remained unresponsive. She had mild reaction and to Narcan. There was also no evidence to suggest that she receive any narcotics. As previously said, patient remained unresponsive for the first 8-12 hours in the MICU regained consciousness and became conversant. Her arterial blood gases in the MICU revealed hypercapnia and acidosis. In addition pt with worsening renal failure. Pt put on bipap for OSA and obesity hypoventilation syndrome c/b hypercarbia. Pt remianed lethargic but improved over presentation. Her ABGs remained abnormal with PH which was 7.13 and 7.18 and PCO2 between 50 and 80. Her other medical systems were stable and she was transferred to our floor. MEDICAL HISTORY: 1) End stage renal disease. Had a cadaveric transplant in [**2115**] 2) Sleep apnea. The patient has refused to go for sleep apnea study but has presumptive diagnosis of obstructive sleep apnea. 3) Obesity, hypoventilation syndrome. 4). HTN 5). DM 6) recurrent respiratory failure requiring intubation X3 over past month presumed due to OSA/Obesity hypoventilation. 7) SVC syndrome due to clots from repeated IV access lines and possible uinderlying hypercoaguable state. 8) recent hematoma in right groin due to femoral line requiring transfusion. SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**], has 6 children who are all very close to her and see her fairly frequently. The baseline patient was able to ambulate and ride an exercise bike in [**Month (only) 547**] although reportedly had increasing daytime somnolence for several months prior to admit. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient lives alone in [**Hospital1 1474**], has 6 children who are all very close to her and see her fairly frequently. The baseline patient was able to ambulate and ride an exercise bike in [**Month (only) 547**] although reportedly had increasing daytime somnolence for several months prior to admit.