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CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: This is a [**Age over 90 **] year old female with hypertension, diastolic CHF, DM, and CKD who was hospitalized two weeks ago with flash pulmonary edema in the setting of hypertension. Apparently, she did well for a week after hospitalization and then over the past week has developed worsening shortness of breath and weakness. She vomited once yesterday but had no associated nausea. Today, she presented to the ED with worsening shortness of breath and was notably dyspeneic with vitals of T 98.2, HR 85, BP 201/64, RR 22, O2 Sat 99% on 4L NC (86% on RA). CXR revealed volume overload and basilar density c/w more likely atelectasis less likely PNA. She received nitro paste and nitro SL before being put on a nitroglycerine drip. She received 60 mg IV furosemide, 180 mg Nifedipine CR, 200 mg labetalol, and was tried on CPAP but had difficulty tolerating it. She also received IV ceftriaxone and azithromycin for the question of pneumonia on CXR. Of note she denied chest pain, fevers, or chills. On arrival to the ICU the patient was notably dyspneic and unable to speak in complete sentences. Audible gurgling. Crackles at bases to auscultation. REVIEW OF SYSTEMS: Unobtainable due to distress. MEDICAL HISTORY: -Chronic Diastolic CHF -Diabetes type 2 -Dyslipidemia -HTN -Stage IV CKD -recurrent right breast CA -glaucoma, blind -hypercholesterolemia MEDICATION ON ADMISSION: 1. furosemide 20 mg PO DAILY 2. multivitamin PO DAILY 3. dorzolamide-timolol 2-0.5 % one drop daily. 4. Anastrozole 1 mg once a day. 5. Isosorbide Mononitrate 60 mg QHS 6. Nifedipine ER 180 mg PO daily 7. Labetalol 200 mg PO twice a day ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 96.2, P 86, BP 194/70, RR 22, O2 94% on 4L GEN: appears distressed, gurgling breath sounds HEENT: anicteric, bluish discoloration of lenses, MMM, op without lesions, JVD difficult to assess due to CPAP but JVP visible above the clavicle with patient at nearly 90 degrees suggesting JVD RESP: Loud crackles over both lung fields, pt unable to speak in complete sentences CV: RRR, S1 and S2 grossly normal (though difficult exam due to loud breath sounds) ABD: Soft, NT, ND, no organomegaly or masses EXT: no C/C/E; 1+ DP and PT pulses bilaterally SKIN: no rashes/no jaundice/no splinters NEURO: couldn't fully assess orientation but responding correctly if briefly given dyspnea, moving all extremities FAMILY HISTORY: Sister with Breast CA. +DM, unclear for the remainder. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Lives in [**Location 669**] with daughter. 17 stairs in house between bedroom and kitchen. Spends significant time in bed. Denies hx of bedsores. Meds dispensed by daughter. [**Name (NI) 1139**]: remote hx Etoh: denies Drugs: denies

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 37-year-old man with HIV who presents with the chief complaint of abdominal pain. He has had a history of hepatitis-B and a history of upper GI bleed, who complains of two weeks of nausea, vomiting, abdominal pain, fevers, and chills. He has not had any PO intake for the last two weeks. He states that "there is a brick in his stomach," and severe abdominal pain. On the day of admission, he noted dark stools. No bright red blood per rectum. He states that he had clear [**Location (un) 2452**] colored urine, uncertain whether it is bilirubin, for also about two weeks. Otherwise, he denies any shortness of breath or chest pain. He is a poor historian. He had coffee grounds on his saline lavage in the Emergency Department. MEDICAL HISTORY: HIV since [**2094**], off HAART. Last CD-4 count in [**1-14**] was 446 with a viral load of greater than 100,000 in [**2-14**]. He has a history of Barrett's esophagus with esophagitis and upper GI bleed, hepatitis-C, neuropathy, depression, anal condylomas, and oral thrush. MEDICATION ON ADMISSION: ALLERGIES: Combivir and Crixivan, he gets a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He had a history of heavy alcohol use in the past, but now only drinks socially. He recently quit smoking, but had a 16 year tobacco history. No IV drug use.

CHIEF COMPLAINT: Fever, headache, nausea, vomiting, blurry vision PRESENT ILLNESS: This is a 24 year old woman with history of SLE and ESRD on dialysis MWF who presents with fever and mild headache after dialysis yesterday. . She underwent scheduled dialysis procedure yesterday and several hours later developed subjective fever and mild headache. She presented to the ED 12 hrs post dialysis where she was note to be hypotensive and tachycardic. She has had similar symptoms post dialysis in the past and was hospitalized at [**Hospital1 **] twice over last month. She could not qualify her headache, i.e. denied it being dull or sharp or squizing, but disclosed that it felt like lightheadedness. There is no neck stiffness, weakness or confusion. She also complains of nausea and vomiting x3 (no blood). No recent travel or sick contacts. She denies any other localizing symtoms for her fever, i.e. denies any abdominal pain, diarrhea, shortness of breath, chest pain, rashes, she has had no urine output in the past and she denies worsenig of her arthritis. Denies night sweats or chills. No heat or cold intolerance. . Initially was dialyzed through an AV fistula but this was complicated by pseudoaneurysm and thereafter his fistula was replaced with a tunneled LIJ (placed [**2119-6-30**]). On [**2119-7-10**] she was admitted to [**Hospital1 **] with post dialysis fevers and this was attributed to thrombosis in AVF. Transplant surgery attempted a thrombectomy, but was unsuccessful. On that admission it was felt that there was no evidence of infection in or around the thrombus and felt that her fevers were likely related to her significant clot burden. No other source of infection was identified. . SLE diagnosed in '[**15**] after noted to have anasarca, pericardial effusion, leukopenia, arthritis and positive [**Doctor First Name **], Ro, and P-ANCA. Was on prednisone until [**4-8**] and plaquenyl until [**10-7**]. . She was diagnosed with ESRL in '[**15**] and biopsy was nonspecific althought despite this there remains strong suspicion that her ESRD is secodary to SLE. She has been evaluated for, and is on a list for transplantation. She is hepatitis B surface antigen, surface antibody, and core antibody negative. At last check, hepatitis C antibody negative and HIV negative. . In the ED, initial vs were: 100.6 131 80/41 16 100%. CXR negative. ECG sinus tach. Patient was given 2 Lt IVF as well as gentamycin and daptomycin. She has extensive abx allergies. This was the same abx regimen that she was treated for similar admission recently. Was also given acetaminophen in ED. Prior to transfer her vitals were 100.1, 106, 94/40, 16, 100RA. Baseline BP 100/60. . In the MICU, patient received total og 5L IVF and SBP 100s. She was started on Daptomycin/Gent for emperic coverage given extensive ABX allergies. She has had multiple line infxns in the past. She was also started on 20mg po prednisone. CXR negative. Blood cultures no growth to date. UE ultrasound showed stable clot. TTE ordered, but not yet done. Tunnelled line was kept in and patient was dialyzed today (Monday). Rheumatology was consulted for concern of lupus flare, see recs below and recommended continuing current prednisone dose with start of taper. MEDICAL HISTORY: 1. Lupus (diagnosed [**2115**]) c/b Lupus nephritis and ESRD on HD. Outpt nephrologist is Dr. [**First Name (STitle) 805**]. Goes to [**Location (un) **] on MWF. No longer on any BP meds given borderline low BPs. 2. Hypertension in the past. 3. Diagnosis of Sjogren's. 4. She has a swollen gland that was removed by ENT last year 5. BOOP 6. Inflammatory arthropathy 7. Hx of myositis 8. History of pericarditis and pericardial effusion 9. Numerous line infections 10.Genital herpes 11. Depression 12. History of thrombosed AV fistula- L tunneled catheter placed on [**2119-6-30**] MEDICATION ON ADMISSION: 1. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Sevelamer HCl 400 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain, fever: do not take more than 3500mg per day. ALLERGIES: Sulfamethizole / Zosyn / Penicillins / Sulfa (Sulfonamides) / Iodine / Vancomycin PHYSICAL EXAM: V/S: T: 98.4, BP: 110/80, P: 91, RR: 18, O2sat: 97% RA General: Alert, oriented, no acute distress. sitting in bed eating. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: Supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Tachycardic, regular rhythm, no murmurs, rubs, gallops. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. Neuro: CN 2-12 intact, Kernigs and Brudzinski negative. Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. R hand digits are mildly swollen. Skin: HD line intact without erythrema or exudate, AVF thrombectomy site clean. FAMILY HISTORY: Sister has SLE. Mother: DM. Father: no diagnosed medical issues. Maternal grandmother: asthma and HTN. SOCIAL HISTORY: Lives in [**Location 686**], moving to [**Location (un) 583**] in 1 week. College student at Baypath College. Lives with mother, grandmother. [**Name2 (NI) **] smoking history. Denies alcohol consumption. No illicit drug use. Sexually active with boyfriend in stable relationship.

CHIEF COMPLAINT: s/ Fall PRESENT ILLNESS: [**Age over 90 **] yo female with h/o of previous falls (5 in the past year) s/p fall while walking up a [**Doctor Last Name **], fell forward, hit head on the ground. She does not recall tripping and states she probably lost her balance; denies any pre-fall symptoms and denies LOC, vision changes and dizziness. She recalls all events. She was helped by passer-bys and ambulance was called. Taken to an area hospital where found to have a small right SAH and was then transferred to [**Hospital1 18**] for further care. MEDICAL HISTORY: HTN, Lipids, DM, Urinary frequency, pacemaker 4 yrs ago, ?COPD . MEDICATION ON ADMISSION: Levoxyl 100', Toprol 200', Lisinopril 20', Caduet', Glimepiride 2'', Ditropan 5', Furosemide 20', ASA 81' ALLERGIES: Penicillins / Aspirin PHYSICAL EXAM: Upon admission: O: T 97 HR 80 BP 120/80 RR 14 O2Sats 93% on RA Gen: WD/WN, comfortable, NAD HEENT: R forehead abrasion w/ ecchymosis, Pupils: R 2 to 3, L 3 to 4; EOMI Neck: Supple. Lungs: CTA bilaterally. Cardiac: Regular Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Noncontributory SOCIAL HISTORY:

CHIEF COMPLAINT: Abdominal aortic aneurysm. PRESENT ILLNESS: The patient is known with abdominal aortic aneurysm initially repaired in [**2119**], returns now for re-do repair electively. MEDICAL HISTORY: Allergies: No known drug allergies. Medications on admission included hydrochlorothiazide, Lipitor and Nifedical 60 mg q.d. Illnesses include abdominal aortic repair in [**2119**] which was found incidentally on physical examination, hypertension, chronic obstructive pulmonary disease. MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: s/p fall, vertigo PRESENT ILLNESS: Ms [**Known lastname **] is 85 y/o female this morning in her apartment after returning to the bathroom. She states she became suddenly dizzy and fell. She was able to bring herself to her couch and call her daughter who called EMS. She was transported to [**Hospital3 80253**] with a main complaint of left hip pain. As part of her dizziness work up she was found to have right cerebellar mass on CT. An initial hip xray did not see a fracture the patient is exquistely tender so a further work up is being completed at this writing of her hip. Ms [**Known lastname **] reports 3 months of dizziness with intermittent falls. She was recently referred to a neurologist but has not been seen as of yet. She states she has occasional headache but not more than usual. She denies any visual problems. MEDICAL HISTORY: Questionable Ear tumor (unable to provide type states no treatment was done) Glucoma, Diabetes Type 2, COPD, MEDICATION ON ADMISSION: Benicar- Unknown Strength,Crestor 20mg QD, Norvasc 5mg [**Last Name (LF) 244**], [**First Name3 (LF) **] 81mg QD,Metformin ER 500 mmg 2 QD,Januvia 100mg QD,Glimepiride 4 mg QD, Dorzolamide 2 % 1 drop [**Hospital1 **] OU ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam on admission: O: T: BP:140/88 HR:78 R16 O2Sats: 94% Gen: WD/WN, comfortable, NAD. HEENT: Pupils: surgical EOMs full Neck: Supple. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives alone, has daughter who lives close by. Former smoker, stopped 18 years ago with a 40+ year history. No alcohol used.

CHIEF COMPLAINT: seizure/overdose PRESENT ILLNESS: Pt is a 30 yo f w/ history of depression and opiod dependence p/w a seizure in setting of intentional overdose on tramadol. Patient initially presented to the ED with an unclear complaint but was tearful. She stated that she had had a seizure while in the taxi cab on the way over to the ED but it was unclear why she was coming to the hospital in the first place; pt would not provide a complete history. It was eventually determined that she had taken 60 pills of Ultram earlier in the evening shortly after finding out that her boyfriend had cheated on her; pt endorsed this was an intentional suicide attempt. No other details of the history were available at that time as the patient was intubated in ED and no collateral sources were available. . On arrival at the [**Hospital1 18**] ED she was alert and oriented but noted to be agitated and labile. She was tachycardic to 160s and hypertensive to 158/105. On exam she was noted to have small but reactive pupils (3 -> 2 mm) and persistent clonus in her right lower extremity, as well as 8-10 beats of clonus in her left lower extremity. She also exhibited hyperreflexia bilaterally in her lower extremities. She was able to respond to questions. An EKG showed sinus tach with normal QTc ~430. Ativan was about to be initiated when the pt had another 30 second tonic clonic seizure in ED witnessed by ED physicians.Pt had no apnea but remained post-ictal for 10-15 minutes and was slow to arouse. . Toxicology was consulted who felt that her findings overall were potentially concerning for serotonin syndrome, although it was more likely that her symptoms were limited to medication-induced seizures. Treatment with supportive measures initiated, however given her repeated seizures it was felt that an elective intubation was warranted. This was discussed with the patient who agreed, and she was intubated with etomodate and succinate and started on a propafol gtt for sedation. Her vital signs at the time of transfer to the unit were 105 118/69 100%/FiO2. She remained afebrile. . In the MICU, pt was stablized and was able to be quickly extubated w/out difficulty ([**2116-11-27**]). Pt did not have additional seizures. However, code purple was called for agitation/hostility towards staff/wanting to leave hospital; pt pulled out all iv lines, refusing labs. Psych was consulted and pt was sectioned (Section 12; can't leave AMA). Per toxicology, needed to monitor for seizures for at least 24 hours; use benzos not haldol for agitation, and held of restarting cymbalta. On [**2116-11-28**], Lorazepam 2 mg PO/NG Q4H:PRN agitation ordered, b/c pt almost code purpled again for smoking and lighting match after a bowel movement. On [**2116-11-29**] pt called out to the floor . Tox said to monitor lower extremity clonus. Eventually pt will be transferred to inpt psych when bed available; currently sectioned 12 so not ok to leave AMA. psych will continue to follow her while inpatient. . Per most recent Psych note; "Pt. is frustrated by continued stay in the hospital. She is irritable and vaguely threatening, suggesting that she could hang herself in the ICU if she wished but denying active SI or intent. "I think about it all the time". She is disappointed about missing a job interview postponed to tommorrow morning. Denies recent stress. Says taking 12 ultram was "nothing for a heroin addict like me" Reports sober for 2 years. Seen crying in her rooom before evaluation. She denies this during evaluation "Everything is fine". Denies opiate withdrawal symptoms. Received lorazepam 2 mg twice overnight for anxiety. Nonerequired during the day per nursing staff." . On transfer VS were stable 97.8 afebrile, 132/78 (117-132/68-78) 84 (84-92) 97%RA. When asked about pain pt stated she always has pain. Wanted to know when she would be leaving. . Review of systems: By report of the patient's family from the toxicology team she has not endorsed any recent SI or HI. The patient has never been hospitalized for psychiatric reasons before(according to family). Review of systems otherwise unable to obtain. . MEDICAL HISTORY: multiple wrist surgeries (after being pushed down the stairs by ex-boyfriend) RSD s/p spinal stimulator Hepatitis C reports head trauma from MVA with brief LOC years ago denies h/o seizures depression h/o IVDU h/o alcoholism ? kidney disease (per boyfriend, unclear details) chronic pain MEDICATION ON ADMISSION: (not able to confirm at time of admission) celexa neurontin ultram ALLERGIES: Shellfish Derived PHYSICAL EXAM: Vitals: hr 101 bp 117/68 rr 16 O2 sat 100% Vent Settings: CMV FiO2 100% VT 500 Peep 5 f 16 General: nonresponsive HEENT: MMM Neck: supple, JVP not elevated, no LAD Lungs: coarse breath sounds bilaterally CV: RRR no R/G/M appreciated Abdomen: soft, mildly obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: +foley, +rash on genitalia Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: mother's twin has bipolar disorder, brother has depression and is addicted to heroin. No family h/o suicide attempts. SOCIAL HISTORY: Lives with boyfriend in [**Name (NI) **]. Recently laid off job in advertising agency. Spent 4 months in jail for drug possession about 2 years ago. H/o physical abuse by boyfriends. Finished high school, no college. Parents divorced, mother remarried. Did not meet her real dad or discover her step father was not her real father until the age of 10. Now all 3 parents are actively involved and supportive. -reports opiate addiction starting after wrist injury and being prescribed moriphine. Addicted to heroin (IV), morphine and oxycodone. States she has been sober for 2 years, denies methadone or suboxone maintenance. -denies alcohol use -smokes [**1-18**] ppd -denies marijuana or cocaine use -denies benzo use

CHIEF COMPLAINT: shortness of breath, chest tightness PRESENT ILLNESS: Ms. [**Known lastname **] is a 33 year old woman with a past medical history significant for asthma presents to the hospital complaining of SOB and chest tightness x 1 week. She states that her symptoms began approximately 2 days after moving into her grandmother??????s attic. She started to wake up in the middle of the night feeling SOB which was quickly relieved with her inhaler. The day before presentation to the hospital, she not only had symptoms at night, she also started to experience SOB, chest tightness and wheezing throughout the day. She used her inhaler approximately 10 times but experienced no relief, she then used her cousin??????s albuterol nebulizer because she was too weak to go through her un-packed moving boxes to find her own. She gave herself 2 treatments with no relief of symptoms. Her aunt, concerned about her lack of improvement called 911. At baseline, Ms. [**Known lastname **] uses her inhaler approximately twice per day and states that she normally does not have to use it at night. She states that for the past 3-4 years she feels that her asthma has been under control. She reports that she had to be intubated approximately 2-3 times and averages [**12-7**] emergency room visits a year. Her triggers include: cold, URIs, mental stress, cats, pollen, flowers, perfume and possibly exercise. In her new home she needs to go through a common hallway to get to her room. She has also been w/o her allergy pillows since the move. In the [**Name (NI) **] pt received IV Solumedrol and ATC albuterol nebs with improvement in her symptoms. She was changed to 60 mg of prednisone today. Currently she denies SOB. She continues to note minimal chest tightness. Denies N/V/D/belly pain/dysuria/F/C MEDICAL HISTORY: 1. Asthma -Diagnosis at 3-4 years old 2. Depression -Diagnosis at 26-27 years old -Two hospitalizations due to suicidal ideation. Patient feels that suicidal thoughts were due to family stressors in combination with her asthma exacerbations (she had to be intubated twice during her acute depressive episodes). 3. Eczema -Diagnosis at 3-4 years old -Well-controlled with Eucerin or hydrocortisone valerate 4. Allergic Sinusitis -Patient states that she has base-line post-nasal drip, cough and sneezing due to sinusitis -Well-controlled with [**Doctor First Name **] MEDICATION ON ADMISSION: [**Doctor First Name **] Adivir 500/50 one puff [**Hospital1 **] Albuterol neb PRN Ortho Evra birth control patch ALLERGIES: Erythromycin Base PHYSICAL EXAM: T 97.7, 118/67, 92, 22, 98% RA, I/O: 1340/625 General : Well developed, well nourished, pleasant woman lying down in bed, in no apparent respiratory distress HEENT: Normocephalic, atraumatic. Moist mucus membranes, good dentation, no sores appreciated in mouth, no lymphadenopathy. Ears and eyes were not assessed. Cardio: RRR, nl s1 and s2 with no extra heart sounds or murmurs. Dorsalis pedial pulses palpated bilaterally; brisk capillary refill Lungs: Decrease breathe sounds bilaterally, no wheezes or crackles appreciated ABD: Active bowel sounds; soft, non-tender, non-distended; no hepatospleenomegaly Musculoskeletal: no calf-pain, no lower extremity edema Neuro: A&Ox3; CNII-XII intact; 5/5 strength in both upper and lower extremities, gross sensory intact, reflexes not assessed FAMILY HISTORY: Mother and father are in their 50s and still alive. She has a sibling and cousin with asthma. No family history of CAD, DM or hypertension. SOCIAL HISTORY: Tobacco: A half a pack a day for the past 3-4 years. Patient states that she is trying to quit due to the urging her boyfriend. EtOH: Occasionally Cocaine, Heroine, Marijuana: Patient states that she has used marijuana, but not currently. She denies past or present cocaine or heroine use. Sexual History: Not assessed. Education level: Not assessed. Employment: Ms. [**Known lastname **] works as a conductor for the ??????T??????, Green line Ms. [**Known lastname **] has two children. She currently lives in [**Location 9137**] in grandmother??????s attic. She was recently granted custody of her brother and sister who also live with her.

CHIEF COMPLAINT: The patient is status post ventral hernia repair, panniculectomy and liposuction and this was complicated by acute renal failure, congestive heart failure and requirement of ventilatory support/slow vent wean/trach. PRESENT ILLNESS: This patient is a 49-year-old man with past medical history significant for idiopathic dilated cardiomyopathy who is status post a DDD pacer in '[**84**] which was replaced in the year [**2195**]. He also is status post a gastric bypass in [**2193**] for morbid obesity and his postoperative course at that time was complicated by a trach for ventilatory support. He has a history recently of atrial fibrillation since [**12-31**] followed by the EP service and his history of pulmonary hypertension and overall hypertension. His last echocardiogram was in [**2192**] with an ejection fraction of approximately 20%. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: He has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Distant history of tobacco and no significant alcohol or other drug usage.

CHIEF COMPLAINT: Respiratory distress, fall PRESENT ILLNESS: 78-year-old NH resident with COPD on 2L NC, DM, CAD s/p multiple PCI admitted after a mechanical fall. Was well until [**10-16**] when a RLL infiltrate was noted on CXR. Treated with levofloxacin 500 mg x 7 days as an outpatient without improvement. Admitted to [**Hospital1 18**] [**Date range (1) 17343**] for altered mental status and was treated with levofloxacin 750 mg x 10 days (ended [**10-27**]) for pneumonia and prednisone taper (ended [**11-7**]) for COPD exacerbation. Reports having had a mechanical fall on the morning of admission when he leaned forward on a folding food table that subsequently collapsed. He denies head trauma, loss of consciousness, or prodromal dizziness, lightheadedness, syncope, sweating, chest pain, palpitations, shortness of breath, or nausea. He denies having sustained any bodily injury. He endorses cough with brown sputum that is unchanged in quality but increased in quantity. He's had diarrhea that he cannot quantify or state when it began. No fever, chills, sweats, weight change, abdominal pain, vomiting, hematochezia, or melena. EMS records reflect episodes of desaturation to 87%on 2L NC but documented recent noncompliance with O2. In the ED, initial VS 97.3 87 153/87 32 84%RA (although also documented as 84%4L on triage notes). CXR showed an unchanged small R pleural effusion and increase in a patchy RLL patchy opacity compared with a study from [**10-24**]. Given vancomycin 1 g, levofloxacin 750 mg IV, ceftriaxone 1 g, solumedrol 125 mg IV, nebulized bronchodilators. BP 211/112 given SL NTG then SBP 86/50, given 500 cc with improvement in sbp 135 given another 500 cc bolus for a total of 1.5L in the ED. Vital signs prior to transfer T 98.2 HR 113 afib BP 117/52 RR 20-22 O2sat 92%4L NC. Upon arrival in the MICU, the patient is hungry but otherwise without complaints. MEDICAL HISTORY: 1. COPD on 2LO2 2. Multivessel CAD s/p BMS to the RCA and LCX [**4-30**], PTCA/BMSx2 to mid-LAD [**6-30**] 3. DMII 4. PAD s/p L SFA stent 5. Atrial fibrillation 6. Hypertension 7. Hyperlipidemia 8. [**Last Name (un) 309**] body dementia 9. Duodenal ulcer [**8-30**] EGD MEDICATION ON ADMISSION: Aspirin 81 mg PO DAILY Digoxin 125 mcg PO DAILY Furosemide 20 mg PO DAILY Multivitamin PO DAILY Paroxetine HCl 20 mg PO DAILY Clopidogrel 75 mg PO DAILY Thiamine HCl 100 mg PO DAILY Donepezil 10 mg PO once a day. Humulin N 30 units twice a day Novolog sliding scale Lisinopril 5 mg PO once a day Spiriva (1) capsule Inhalation once a day Metoprolol Tartrate 75 mg PO BID Divalproex SR 1250 mg PO at bedtime Mirtazapine 7.5 mg PO HS Simvastatin 40 mg PO at bedtime Albuterol Sulfate 0.63 mg/3 mL Solution for Nebulization Nitroglycerin 0.3 mg Tablet Sublingual PRN (as needed) as needed for chest pain. ALLERGIES: Zithromax / Erythromycin Base PHYSICAL EXAM: Vitals - T 97.8 BP 146/83 HR 109 RR 20 02sat 96%1L GENERAL: Well-appearing, resp non-labored HEENT: sclera anicteric dry MM NECK: supple no JVD no C-spine TTP CARDIAC: irreg irreg tachy no m/r/g LUNGS: crackles R base, diminished at L base scattered end-exp wheezes bilat no rhonchi ABDOMEN: soft NTND normoactive BS EXT: warm, dry diminished distal pulses NEURO: awake, alert, converses appropriately, oriented to person, place, month, year, president DERM: bilat ant LE chronic venous stasis changes, <1 cm ulcer on R heel with clean base and granulation tissue FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Currently lives in Stone [**Hospital3 **] home. He continues to smoke at least one pack of cigarettes a day (smoked for 60 years). Denies etoh use, h/o IVDU.

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: 61F with a recent cholecystectomy [**4-13**] found with RUQ pain and jaundice. She has no fevers or chills. She had nausea, vomiting, and retching on the day prior to admission, and is now anxious with left sided abdominal pain. OSH abdominal CT showed free air. She to the [**Hospital1 18**] emergency department via [**Location (un) **] from OSH on [**2161-6-28**] for further evaluation and treatment of her abdominal pain. MEDICAL HISTORY: s/p gastric bypass lap band [**1-14**] s/p cholecystectomy [**4-13**] s/p hysterectomy s/p R TKA s/p back surgery x2 s/p breast reduction anxiety hemorrhoids MEDICATION ON ADMISSION: prozac protonix trazodone ALLERGIES: Aspirin PHYSICAL EXAM: gen: A+Ox3, anxious, tearful, unconfortable heent: icteric sclera, dry mucosa cv: tachycardic, nl s1, s2 resp: ctab abd: soft, tender RUQ, obese, no rebound/guarding skin: warm, dry, jaundiced, no petechiae FAMILY HISTORY: noncontributory SOCIAL HISTORY: quick smoking 30 yrs ago, denies EtOH

CHIEF COMPLAINT: Change in mental status. PRESENT ILLNESS: The patient is a 51 year old white male with a history of type 2 diabetes mellitus, hypertension, quadriplegia secondary to cervical spine abscess and hepatitis C, who presents from [**Hospital3 4339**] after three days of change in mental status. The patient was transferred to the SICU for management of severe hyponatremia. Per outside records, the patient is a resident of a chronic care facility and at his baseline is very alert. Reportedly the patient has had decreasing serum sodium levels and had been placed on fluid restriction of 3000cc per day with which he has been very noncompliant. For the three days prior to admission, the staff had noticed a progressive change in mental status until the day of admission when he was found very confused and lethargic with a garbled speech. Laboratories revealed a sodium of 97. The patient was subsequently transferred to [**Hospital1 188**] Emergency Department where severe hyponatremia was verified. Urine osoms returned at 407. The patient was started on 3% sodium chloride at 42 cc/hour. The patient has no documented history of hypovolemia, diarrhea, syndrome of inappropriate diuretic hormone, hypothyroidism or adrenal insufficiency. His only new medication as Celexa which was started on [**2162-2-5**]. MEDICAL HISTORY: 1. Type 2 diabetes mellitus. 2. Quadriplegia secondary to cervical spine cyst/abscess. 3. Obesity. 4. History of polysubstance abuse. 5. Chronic obstructive pulmonary disease. 6. Hepatitis C. 7. Depression. 8. History of urinary tract infection. 9. Hypertension. MEDICATION ON ADMISSION: 1. Albuterol two puffs q8hours. 2. Baclofen. 3. Dulcolax 10 mg once daily. 4. Brimonidine Ophthalmic Solution. 5. Clonidine 0.1 mg once daily. 6. Diltiazem CD 180 mg once daily. 7. Enalapril 10 mg p.o. three times a day. 8. Flonezalide two puffs twice a day. 9. Ibuprofen 600 mg p.o. q6hours. 10. NPH 50 units q.a.m. and 45 units q.p.m. 11. Lantaprost eye drop solution. 12. Loratadine 10 mg p.o. twice a day. 13. Famotidine 20 mg p.o. once daily. 14. Losartan 50 mg p.o. twice a day. 15. Maalox p.r.n. 16. Flovent two puffs twice a day. 17. Opatadine Ophthalmic Solution. 18. Zinc. 19. Sodium Chloride tablets. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Father has type 2 diabetes mellitus. SOCIAL HISTORY: The patient smoked one pack per day times many years. He has no history of alcohol use. He is divorced. He is a resident of [**Hospital3 4339**].

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 80 year old female with a history of chronic obstructive pulmonary disease on home O2 and a cerebrovascular accident in [**10/2155**], with a residual right sided weakness, who presents to an outside hospital on [**2156-1-20**], because of a runny nose for six days. The patient complained of mild shortness of breath and hoarseness at that time. A chest x-ray at the outside hospital showed left lower lobe infiltrate, then Levaquin was started. A CT angiogram was done for increasing shortness of breath and showed no evidence of pulmonary embolism; however, CT scan of the chest did show a right hilar mass 1.3 cm nodule in the superior segment of the right lower lobe. On two occasions, was found to have an increasing troponin of 4.0 with a CK of around 100. Cardiac echocardiogram showed a very impaired left ventricular ejection fraction. She was then transferred to [**Hospital1 69**] for cardiac catheterization. The cardiac catheterization showed patent coronary arteries with an increased left ventricular end diastolic pressure of 28. After the procedure, the patient became tachypneic and hypoxemic due to acute heart failure with fluid overload and thus she was transferred to the Intensive Care Unit for further management. She was diuresed over two liters and oxygen demands decreased significantly. Cardiology considered the poor left ventricular function to be caused by viral myocarditis. They suggested no steroid or biopsy of the myocardium because of no benefits or no change in further management. They recommended low dose beta blockers, continuing ACE inhibitor and digoxin. After her condition was stable she was transferred to the Medical Floor for further treatment. MEDICAL HISTORY: 1. Cerebrovascular accident in [**10/2155**], with residual right sided weakness and residual word finding difficulties. 2. Chronic obstructive pulmonary disease with home O2. 3. Glaucoma. 4. Status post cholecystectomy. 5. Status post appendectomy. 6. Status post tonsillectomy. 7. Status post cataract surgery. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: One sister, one brother and two sons. One brother and father with asthma. SOCIAL HISTORY: The patient is a widow. Husband died of chronic renal failure and was on dialysis. The patient is an ex-smoker that quit greater than 15 years ago. The patient started smoking at age 18. The patient currently lives in an [**Hospital3 **] facility. The patient has no history or exposure to asbestos or chemicals. The patient denies any alcohol use.

CHIEF COMPLAINT: Headache PRESENT ILLNESS: Ms. [**Known lastname 51078**] is a 49 y/o woman known to the Neurosurgery service from a prior admission in [**2119-4-23**] after a SAH from two right MCA aneurysms, presents from drug rehab. She woke up early on the morning of presentation with a severe headache, nausea and vomiting and was seen ambulating in the halls dragging her left side. MEDICAL HISTORY: HIV,diagnosed 22 years ago, no HAART, last CD4 659, VL 21k [**8-31**] Hepatitis C Emphysema Sarcoid HTN Abnormal pap smears MEDICATION ON ADMISSION: The patient denies taking any medications at home. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Discharge: nonfocal FAMILY HISTORY: Her father had a history of lung cancer, and her mother had a history of throat cancer. SOCIAL HISTORY: Lives in [**Location 669**], works as medical tech at Community Health Center - Tobacco: 30 years x 1ppd, "in process of quitting" - EtOH: social - Illicits: denies current, + in past

CHIEF COMPLAINT: Fall PRESENT ILLNESS: This is a 87 year old female with ahistory of brain tumor s/p resected (gets treatment at [**Hospital1 2025**] with records pending). She was in rehab when she fell. At the time she was on coumadin for a-fib (with INR 1.3) She went to [**Hospital **] hospital and was found to be hyponatremic there (Na 114). Her family states Na runs low -120s - usually 123 per family but no records are currently available (ED/MICU staff trying to get from [**Hospital1 2025**].) A CT was done at the OSH and the pt was transferred here for neurosurg with question of possible punctate bleed. A repeat head CT was done in the ER and neurosugery felt that surgery was not indicated. However, she was admittted to the MICU for management of her hyponatremia. On presentation she was more obtunded on presentation initially - had gag reflex - not oriented, MEDICAL HISTORY: - Lt insular tumor, recently dx at [**Hospital1 2025**]; undergoing XRT; -HTN -Afib on coumadin - hyponatremia (chronic) MEDICATION ON ADMISSION: carbamazepime decadron gabapentin keppra levothyoxine imdur prilosec ALLERGIES: Levofloxacin / Metronidazole / Alendronate Sodium / Risedronate Sodium PHYSICAL EXAM: General Appearance: No acute distress, Thin Eyes / Conjunctiva: PERRL, No(t) Sclera edema, EOMI Head, Ears, Nose, Throat: Normocephalic, left forehead lac sutured Cardiovascular: (PMI Normal), (S1: Normal), (S2: Distant) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Present), (Left DP pulse: Present) Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Rhonchorous: ) Abdominal: Soft, Non-tender, Bowel sounds present, No(t) Distended Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t) Clubbing Skin: Not assessed Neurologic: Attentive, Follows simple commands, Responds to: Verbal stimuli, Oriented (to): person, season, Movement: Purposeful, Tone: Not assessed, mild right facial droop, intermittently able to follow commads, occ mumbles. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Not obtained

CHIEF COMPLAINT: Transfer from outside hospital. Shortness of breath. PRESENT ILLNESS: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction. 2. Congestive heart failure with ejection fraction of 45%. 3. Diabetes mellitus type II diagnosed 10 years ago. 4. Spinal stenosis. 5. Hypertension. 6. Hypercholesterolemia. 7. Nephrolithiasis. 8. Osteoarthritis. MEDICATION ON ADMISSION: ALLERGIES: He has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He quit smoking in [**2108**]. He denies any ETOH use. He is married and lives with his wife and son. [**Name (NI) **] was a pharmacist who retired in [**2102**].

CHIEF COMPLAINT: slurred speech, confusion, and hypotension PRESENT ILLNESS: 85 Russian-speaking only woman brought in from NH with confusion and slurred speech, and hypotension. Her niece called her at the nursing home this am and she did not answer; later, in the afternoon ([**5-19**]), she answered the phone but was slurring her speech and was somewhat disoriented. VNA visited and found she was disoriented and sent her to the ED, where she was found to be hypotensive at 65/43 on arrival. She described a night of nausea, vomiting, and diarrhea. Her slurred speech resolved and she was AAOx3 after receiving approximately 4 liters of IVF, at which time SBP 90s with MAP 50s; she also received levofloxacin and metronidazole empirically as well as dexamethasone 10mg. . . The family was not aware of any hematemesis or melena. There was no report of fevers and no localizing signs of infection. Pt was guaiac positive with brown stool in the ED, and so PRBCs hung, but stopped once Hct came back at 37, and protonix IV. EKG showed accelerated junctional rhythm with TWI anteriorly, cardiac enzymes were negative. MEDICAL HISTORY: "mini stroke" in [**2151-11-18**], for which she spent 2 weeks in rehab and was prescribed coumadin, which she does not take, according to her niece - inferior MI (non-Q wave) in [**2138-10-18**] Rx'd with balloon angioplasty of prox RCA - s/p R lobectomy - mitral regurgitation - dyslipidemia - HTN - s/p TAH MEDICATION ON ADMISSION: Medications at home--pt states she does not take, b/c medicines are "not good for her" trazodone 50mg qhs HCTZ 12.5mg daily lopressor 12.5mg [**Hospital1 **] simvastatin 80mg daily omeprazole 20mg daily docusate 100mg [**Hospital1 **] acetaminophen ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tmax: 35.6 ??????C (96 ??????F) Tcurrent: 35.6 ??????C (96 ??????F) HR: 80 (80 - 88) bpm BP: 91/50(61) {80/27(44) - 96/60(65)} mmHg RR: 22 (11 - 26) insp/min SpO2: 99% Height: 61 Inch FAMILY HISTORY: NC SOCIAL HISTORY: Lives alone, niece calls daily and VNA visits once/week. former smoker. No alcohol.

CHIEF COMPLAINT: diplopia, headache, dysarthria PRESENT ILLNESS: Ms. [**Known lastname 77354**] is a 36-year-old woman with a history of osteogenesis imperfecta who presents with acute headache and lethargy and was found on imaging at an OSH to have a midbrain and pontine hemorrhage. She was in her USOH at about 9 pm this evening, when she developed an acute onset headache. It was severe and she complained immediately to her husband by phone and to her son, who was present. Her son notes that she then became sleepy and her right eye turned in. He was able to wake her up, but again she became sleepy, and she began slurring her speech. EMS arrived and documented a GCS of 5. She was taken to [**Hospital3 21232**], where the hemorrhage was found. She was intubated for airway protection and transferred to [**Hospital1 18**]. Neurosurgery evaluated her in the [**Hospital1 18**] ED and felt there was no intervention needed at this time. MEDICAL HISTORY: Osteogenesis Imperfecta s/p torn R ACL surgically repaired Lumbar disc disease MEDICATION ON ADMISSION: None (stopped OCP's several months ago) ALLERGIES: Morphine And Related PHYSICAL EXAM: Physical Exam: Vitals: T: 98.8 P: 102 R: 16 BP: 130/68 SaO2: 100% AC 500x14 General: Intubated, unresponsive. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Skin: no rashes or lesions noted. FAMILY HISTORY: Adopted; FH not known. SOCIAL HISTORY: Drinks 15 beers/wk, no smoking, no illicits. Works as insurance customer service rep. Lives at home with husband and son.

CHIEF COMPLAINT: seizure PRESENT ILLNESS: 61yo man with metastatic melanoma, metastases to brain, and seizures related to this disorder presents with seizures at home. The history regarding his melanoma and seizures is listed below. Per the patient's family, he has had decline over past week - he has been talking less and less, when he does talk his voice is very soft and hoarse. He has had trouble swallowing his pills, and coughing when he drinks. He has persistent L arm and face weakness that has slowly worsened over time, though he can still walk around by himself (was walking the morning of admission). He had been having OCD-like symptoms on Keppra, which had been started for further seizure control as PHT had not been controlling the seizures. He saw Dr. [**Last Name (STitle) 4253**] the day prior to admission, where Lamictal was started and keppra was discontinued. The morning of admission, the pt woke up "very groggy." He took the first dose of Lamictal 25 mg and his other morning meds. At 1:30pm, his wife witnessed a prolonged seizure-like episode lasting 20-25 minutes - with R hand shaking and L leg shaking. After the event, he vomited and was very sleepy. His wife called EMS; it is unclear if benzos were given. He was taken to [**Hospital6 302**] where a head CT showed some "slightly" increased edema and hemorrhage at the site of a known hemorrhagic met in the R frontal [**Last Name (LF) 3630**], [**First Name3 (LF) **] he was transferred here. He has been sleepy and not saying much since the event; he has persistent L arm and face weakness. On ROS, his wife and sister do not think he has had fever; he has had HAs recently but did not think he had HA today; no coughing, no GI/GU complaints, no respiratory complaints except coughing when he eats or drinks sometimes. MEDICAL HISTORY: -Melanoma Hx: -- had moles removed few years ago, stage II melanoma, s/p resection with "clean margins" thought cured, no chemo -- presented this year with slight L facial droop, diagnosed with metastatic melanoma, mets to brain discovered -- s/p craniotomy with resection R frontal lesion, still had deeper, contralat lesions -- s/p gamma knife at RIH/Dr. [**Last Name (STitle) 39706**] for other lesions -- Hemorrhage in met [**8-27**] had p/w difficulty talking; hospitalized, had PNA and DVTs (wife denies PE, but Dr.[**Name (NI) 23016**] notes detail that he did have PE); s/p filter in each leg (one clotted off) -- Mesenteric mass [**10-19**] with bx consistent with melanoma -- Seizures started [**10-3**] - GTC 3-5 minutes, on PHT; subsequent sz associated with low PHT levels, several hospitalizations at [**Hospital3 15433**] for this; had been started on Keppra -- On decadron since [**11-27**] again after another seizure -- Was taken off Keppra [**11-2**] after obsessive-compulsive sx noted by family, saw Dr. [**Last Name (STitle) 4253**] for first time, Lamictal started MEDICATION ON ADMISSION: Toprol XL 12.5 mg qd HCTZ 25 mg qd Lasix 20 mg qam Iron 325 mg tid KCl 80 mEq [**Hospital1 **] Zoloft 150 mg qam Dilantin 300/200/300 OFF Keppra since last night (last dose) Lamictal 25 mg [**Hospital1 **] (FIRST DOSE THIS AM), with plans to incr over 4 wks Oxycontin 20 mg [**Hospital1 **] Colace Protonix ?40 mg [**Hospital1 **] Metoclopham 10 mg 4xd Procrit "prn" Miralax prn Decadron 6 mg tid Ativan 0.5 mg prn sz (took one dose this PM) ALLERGIES: Codeine PHYSICAL EXAM: Admission exam: T 99.9 HR 100 BP 119/75 RR 22 100%RA General appearance: lethargic, sweaty, white male HEENT: mildly dry mucus membranes Neck: supple, no bruits Heart: regular rate and rhythm, no obvious murmurs Lungs: diminished to auscultation bilaterally Abdomen: soft, nontender +bs Extremities: warm, well-perfused FAMILY HISTORY: Mother had [**Name2 (NI) 499**] ca; no other ca, no seizures, no neuro d/o's; father had MI. SOCIAL HISTORY: Lives with wife, taking medical leave from work - respiratory therapist at [**Hospital6 302**]. Quit tobacco this year, formerly smoked "whole life." No etoh, no drugs. Pt has no living will/advanced directive, has discussed with wife that he would not want to be on vent for long period of time, but is full code for now.

CHIEF COMPLAINT: Lower gastrointestinal bleed. PRESENT ILLNESS: The patient is a 75-year-old female with multiple medical problems including history of CVA with right hemiparesis and expressive aphasia, vascular dementia, atrial fibrillation, status post pacemaker implantation, and lower GI bleed in [**2151-11-24**] secondary to diverticuli who was sent from the [**Hospital3 1761**] Center of the Aged for bright red blood per rectum starting at about 7:00 p.m. tonight. While in the Emergency Department, the patient was initially found to be Guaiac positive with red stool in the vault. She initially had a blood pressure of 89/50 which improved to 102/49 with 2 liters of intravenous fluid. A lavage was performed through her PEG tube which was found to be Gastroccult negative. An anoscopy was performed as well which showed several large nonbleeding hemorrhoids. While still in the Emergency Department, Ms. [**Known lastname 18473**] had two very large episodes of greater than 1-2 liters of bright red blood mixed in with clots from her rectum. Her vital signs deteriorated and her systolic blood pressure dropped into the 60s. She was given 7 units of packed red blood cells as well as 7 liters of intravenous fluids and started on peripheral pressors. She was then transferred to the Medical Intensive Care Unit for further management of massive lower GI bleed. The patient was unable to provide any additional history secondary to altered mental status and baseline aphasia. MEDICAL HISTORY: 1. Cerebrovascular accident with right hemiparesis and expressive aphasia. 2. Vascular dementia. 3. Degenerative joint disease. 4. Hypertension. 5. Atrial fibrillation, status post pacemaker for sick sinus syndrome. 6. Chronic pain syndrome. 7. Lower gastrointestinal bleed in [**2151-11-24**] with diverticuli and external hemorrhoids. EGD in [**2154-7-23**] for dysphagia showed no evidence of ulcerations or varices. 8. Depression. 9. Hematuria with negative cystoscopy in [**2153-5-23**]. 10. History of syncopal event status post pacemaker placement. 11. Complex partial seizure disorder with an EEG on [**2154-6-24**], negative for epileptiform activity, positive for multifocal subcortical dysfunction related to cerebrovascular disease. 12. Positive PPD since [**2144**]. 13. Diastolic CHF with a transthoracic echocardiogram in [**2154-7-23**] showing an EF of 70%. MEDICATION ON ADMISSION: ALLERGIES: 1. Tetanus toxoid. 2. Penicillin. 3. Levaquin. 4. Bacitracin. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient is a permanent resident at the [**Hospital3 **]. She is dependent in all ADLs. She is DNR/DNI.

CHIEF COMPLAINT: Mitral Regurgitation PRESENT ILLNESS: 29 year old gentleman with a recently diagnosed heart murmur by his primary care physician [**Last Name (NamePattern4) **] [**3-17**]. Work-up was significant for [**4-13**]+ mitral regurgitation and an ejection fraction of 52%. Although he is currently asymptomatic, when pressed he will admit to chest discomfort with activity. MEDICAL HISTORY: Polysubstance Abuse Past Bronchitis ORIF left ankle MEDICATION ON ADMISSION: Multivitamin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse; 59 BP: (R) 120/70 (L) 117/69 Weight 210 GEN: No acute distress SKIN: Unremarkable HEENT: Benign NECK: Supple CHEST: Clear HEART: RRR, IV/VI systolic murmur ABD: Benign EXT: No edema. 2+ pulses throughout FAMILY HISTORY: Father with MI in his 50's. Aunt with valvular disease. SOCIAL HISTORY: Lives with roomates in recovery house. Smokes 1 pack per day currently. No drugs for past 9 months.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 57 year old female with a history of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 21344**] Lindau disease and metastatic renal cell carcinoma being admitted for cycle one, week one high dose IL2 therapy. Her oncologic history began in [**2130**], when she was diagnosed with bilateral renal masses consistent with renal cell carcinoma and underwent bilateral partial nephrectomy. She did well until [**2139-9-9**], when disease progression was noted in her right kidney and a liver lesion was noted. Needle biopsy of the liver lesion confirmed metastatic renal cell carcinoma. She received IL2 and Interferon phase III protocol with stable disease. She underwent resection of an isolated thyroid met in [**2141-12-9**], and had radiofrequency ablation of renal masses in [**2142**], [**2143**], and [**2144**]. Recent scans revealed progression of disease in her liver and an enlarging mass in her left kidney. She was planned for high dose IL2, but developed pyelonephritis/urosepsis and was hospitalized from [**2146-12-14**], through [**2146-12-19**], for intravenous fluids and intravenous antibiotics. She has recovered well and completed her last antibiotic dose this morning. Her MG has returned to 100 percent. She is now being admitted for cycle one, week one high dose IL2 therapy. MEDICAL HISTORY: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 21344**] Lindau disease. History of seizures. Recent urosepsis. History of hemangioma, status post cerebellar resection times two. Hypothyroidism. MEDICATION ON ADMISSION: 1. Levoxyl 50 mcg p.o. daily. 2. Phenobarbital 64.8 mg p.o. three times a day. 3. Fosamax 70 mg p.o. weekly. ALLERGIES: Levofloxacin causes a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: respiratory distress PRESENT ILLNESS: Blood count with differential revealed leukocytosis with blasts, indicating recurrence of her underlying disorder. According to the family's request comfort-oriented care was made a priority. On [**2174-8-16**], Ms. [**Known lastname 47828**] passed away secondary to underlying acute myelogenous leukemia MEDICAL HISTORY: AML dx [**3-9**] s/p 7+3 x 2 c/b typhlitis/appendicitis. MEDICATION ON ADMISSION: ALLERGIES: Vancomycin / Ambisome PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: This 61 year old female was seen originally by the Cardiac Surgery team on [**2165-11-1**], prior to her admission. She was status post myocardial infarction in [**2152**] with DCA of her left circumflex. She was recathed in [**2157**] which showed subtotal LAD occlusion. She was treated medically at that time. She now reports one year history of dyspnea, exertion. Stress test in [**2165-1-17**] showed an apical ischemia of EF of 67 percent. She has had ongoing symptoms and was referred for cath on [**2165-11-1**] which showed left vein 70 percent lesion, LAD 100 percent occluded, RCA 50 percent, ostium 70 percent mid lesion. She was referred to Dr. [**First Name (STitle) **] [**Name (STitle) **] for coronary artery bypass graft. She reports angina symptoms since [**2152**], worse lately with DOE and edema. She denies nausea, vomiting, diarrhea, or syncope. MEDICAL HISTORY: Myocardial infarction with coronary artery disease. Status post DCA of left circumflex. Insulin dependent diabetes mellitus. Hypertension. Hyperlipidemia. Gastroesophageal reflux disease. Obesity. Psoriasis. MEDICATION ON ADMISSION: ALLERGIES: Codeine which causes vomiting but stated that Percocet was OK to use. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives alone in [**Location (un) 4444**] with three children in the area. She works full time as a legal secretary. She quit smoking 13 years ago with a 30-year pack a day history. She has rare alcoholic drinks. Her mother had a coronary artery disease at age [**Age over 90 **]. The patient's weight was stable. She did have a history of psoriasis.

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: This gentleman has no history of cardiac risk factors and is described by his daughter as very healthy, though profoundly hearing impaired. He was extremely active, walking on a daily basis up until the end of last summer. At that point he began experiencing chest discomfort. The patient??????s daughter [**Name (NI) **] is unaware if her father reported his symptoms to his PCP but she knows he stopped walking at that point. She states that approximately two months ago he began to experience a choking sensation with exertion and developed a hoarse throat. He saw his PCP and was referred to Dr. [**Last Name (STitle) 7047**] for cardiac consultation. He underwent a nuclear stress test on [**2183-4-25**] where he was able to exercise 4.5 minutes of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] protocol to a peak heart rate of 137 bpm, representing 101% of his age predicted maximum, and stopping due to fatigue. He did not experience any chest discomfort and his EKG was uninterpretable due to baseline abnormalities though there were 1-2 mm of inferolateral ST depression. Nuclear imaging demonstrated a small area of inferior wall ischemia. His EF was 63% at rest and decreased to 54% with stress. Dr. [**Last Name (STitle) 7047**] reportedly started him on a beta blocker, statin, PPI and Imdur. His daughter reports he had no improvement in his symptoms. Apparently he was working in his yard on [**5-6**], when he once again, developed the sensation of "choking" in his chest and throat. This was followed by 3-4 days of feeling ill and remaining in bed. His daughter reports she have never seen her father so lethargic or ill and apparently her father described his chest and throat discomfort as his worse episode yet. He saw Dr. [**Last Name (STitle) 7047**] in follow up last week, was started on Plavix and ASA, and is now referred for cardiac catheterization. A [**6-9**] Cardiac cath revealed 3 VD. Dr.[**Last Name (STitle) **] was consulted for coronary revascularization. MEDICAL HISTORY: GERD,(recently diagnosed)HTN, borderline (recently diagnosed)Dyslipidemia (recently diagnosed), Mild arthritis, Bilateral hearing loss (patient denies) MEDICATION ON ADMISSION: Plavix 75(1)-started [**6-4**]-stopped [**6-9**], Isosorbide Mononitrate 30(1), Metoprolol Tartrate 25(2), NTG SL 0.4mg prn, Omeprazole 20(1), Simvastatin 20(1), ASA 325(1) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse:50 Resp:22 O2 sat: 98% RA B/P Right: Left: 139/56 Height: 71 inches Weight:173Lbs FAMILY HISTORY: Reports Brother died at age 73 +MI SOCIAL HISTORY: He is widower and lives with his [**Last Name (LF) 15560**], [**First Name3 (LF) **]. He does not smoke and drinks on social occasions. He is a retired machinist.

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: Ms. [**Known lastname 10528**] is a 65 year old woman with diabetes, hypertension, hyperlipidemia, and prior remote left circumflex MI transferred from OSH to our CCU for evaluation and treatment of CHF exacerbation. Two weeks ago she was admitted to OSH for treatment of DKA associated with significant nausea and vomiting and involving a 5 day ICU stay. On transfer to the floor, her family states she got lots of IV and PO fluids out of concern for dehydration and was discharged, by their thoughts, prematurely. According to her family, she entered the hospital weighing 160lbs and left weighing 180lbs. When at home she felt very short of breath and noticed significant lower extremity swelling. She returned to the hospital 3 days later in what was assessed as an acute CHF exacerbation. . She was initially admitted to the floor and was given IV furosemide. Cardiac biomarkers were cycled. Her troponin reached a high of 0.41. Her CK-MB reached a high of 8. Her renal function gradually climbed from 1.5 -> 2.6. UOP decreased and started on dobutamine with improved UOP. She also had a few episodes bradycardia to the 30's which required atropine. This occured in the setting of using the bedpan. On [**11-26**] she received two units of pRBC's without any diuretics for a drop in hematocrit from 25 to 21. There were no obvious areas of bleeding. She was on [**3-6**] L nasal cannula prior to her transfer. . On arrival to the CCU, she was on a non-rebreather. She had been transferred on a dobutamine and furosemide drip. She had 300 cc in her foley. She reported her breathing was slightly better than the past few days. . On review of systems, she reports some constipation. She denies any blood in her stools. She still has episodes of nausea. . Cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. MEDICAL HISTORY: CHF Hypertension Diabetes mellitus Chronic Kidney Disease (recent baseline 1-1.5) Episodes of Nausea and Vomiting Hyperlipidemia 1. Diabetes, Dyslipidemia, Hypertension 2. CARDIAC HISTORY: [**2178**] left circumflex angioplasty without stent - PERCUTANEOUS CORONARY INTERVENTIONS: MEDICATION ON ADMISSION: lisinopril 20 daily metoprolol xl 12.5 daily aspirin 81 mg colace 200 mg [**Hospital1 **] Lantus 15 units qAM and 25 units qPM insulin sliding scale novolog omeprazole 20 mg TID vitamin D 1000 units daily colestipol 1 gm daily 94 hours away from all other meds) erythromycin 250 mg TID ferrous sulfate 325 mg daily ? percocet prn pain ? torsemide 20 mg daily trazodone 50 mg QHS senna 2 tablets QHS ALLERGIES: Statins-Hmg-Coa Reductase Inhibitors / Reglan / Pravastatin PHYSICAL EXAM: ADMISSION EXAM GENERAL: appears slightly uncomfortable Oriented x3. HEENT: NCAT. Sclera anicteric. Pupils equal. NECK: Supple with JVP of to earlobes. CARDIAC: RRR, no murmurs, rubs, or gallops although difficult to assess given loud lung findings LUNGS: Respirations were unlabored, no accessory muscle use. Diffuse rales mixed with rhonchi in all lung fields. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: 1+ clubbing to mid shin SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: No tobacco or illicits.

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: Mr [**Name13 (STitle) 79**] is a 54 year-old with ulcerative colitis for past 40+ years, status post total colectomy and end ileostomy. He has done reasonably well since surgery [**53**] years ago, although recently underwent studies for iron deficiency anemia which revealed evidence of small bowel disease ([**5-14**] enteroscopy with small bowel ulceration/stricture 5cm proximal to stoma, [**7-13**] capsule study with distal small bowel inflammation). Small bowel follow-through study in [**3-15**] revealed likely stricture just proximal to stoma. The patient reports feeling well until Saturday [**2121-9-6**], when he began to have mild lower abdominal cramping and nausea which increased thoughout the day/night. He reported multiple episodes of abdominal pain and vomiting on Saturday night. He went to [**Hospital **] hospital on Sunday AM before being transferred to [**Hospital1 18**]. Ostomy output normal until the last 24 hrs-decreased and watery. He denied fevers, hematememsis/BRBPR, and decreased urine output. At [**Hospital **] Hospital, he presented pale with Hct=60, and in acute renal failure (Cr=2.2). A CT scan abdomen revealed dilated small bowel loops and portal venous air. He received 4L of intravenous fluid prior to transfer to [**Hospital1 18**]. MEDICAL HISTORY: PMH: IBD- UC vs. likely Crohn's Iron deficiency anemia Migraines GERD Hyperlipidemia Nephrolithiasis MEDICATION ON ADMISSION: NONE ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On discharge: FAMILY HISTORY: The patient has one cousin with [**Name (NI) 4522**] Disease SOCIAL HISTORY:

CHIEF COMPLAINT: seizure PRESENT ILLNESS: 81 year old female who presented to [**Hospital3 1280**] hospital initially and was transferred to [**Hospital1 18**] for further care after having a seziure. She was in her home when she was hearsd to fall and upon finding her a family member reports she was haveing a generalzied tonic clonic seziure. After her seizure she was post-ictal and found to have todds paralysis effecting her left side which has since resolved. She had imaging which showed that her previously known right sided meningioma which on serial scans shows growth. She was admitted to the neuro-oncology service and at their request we are seeing her for possible surgical resection of her Meningioma. Of note is she was previously seen by Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] here at [**Hospital1 18**] in neurosurgery and he is no longer working here. She deneies headache, nausea, vomiting, dizziness, difficulty ambulating, changes in vision hearing or speech, difficulty with bowel or bladder function. MEDICAL HISTORY: - Right frontal meningioma. - Probable lupus, with elevated ESR at 29, CRP at 15.1, [**Doctor First Name **] 1:640 with speckled pattern, and anti-SSB antibody was positive, while anti-dsDNA, anti-SSA, anti-centromere, anti-TPO, ANCA, and anti-[**Doctor Last Name **] antibodies were negative. - Peripheral polyneuropathy manifesting as pain in the feet and numbness in both feet and hands. - [**Hospital1 **]-frontal lobe dysfunction and neuropsychological testing showing decreased attention, language, and memory abilities concerning for [**Last Name (un) 309**] Body Disease. - Akathisias. - Hypoparathyroid. MEDICATION ON ADMISSION: calcitrol, lamictal, synthroid, metoprolol, zyprexa, zofran ALLERGIES: latex gloves PHYSICAL EXAM: On discharge the pt is awake alerto oriented x 3 PERRL [**4-18**] bilaterally CNII_XII intact no drift no facial asymmetry motor full ambulatory with assistance of walker incision is clean and dry FAMILY HISTORY: Non contributory SOCIAL HISTORY: Denies illicit drug use and ETOH. Has never abused prescription medications. Quit smoking 40 years ago after a <1ppd x 20 year history.

CHIEF COMPLAINT: Found down PRESENT ILLNESS: 38 y/o F with hx. ETOH cirrhosis, mult osh admissions for withdrawals and DTs (continues to drink 2 pints of Vodka daily) and mult osh dicharges 'ama' was found by police 'down' and intoxicated with multiple bruises. Brought to [**Hospital1 3793**], where she was noted to have an etoh level of 389 (at 1300h [**9-19**]), a bp of 75/44 (up to 124 sbp s/p 3 litres NS), LUL infiltrate and ? mediastinal pathology; Head CT: showing no acute pathology, brain atrophy, bilateral maxillary air fluid levels. Stated that she had not been eating or drinking for weeks (except vodka). The hospitalist there saw her, felt that she needed ERCP (due to a hypoechoic mass of the pancreas seen under his care there one month previously for a similar admission). They gave her CTX/Azithro, lactulose, 10 of KCl IV, and transferred her here "for ERCP". On arrival at our ED, she was noted to be diffusely rhonchorous, satting in the 80's, adamantly refusing foley, rectal exam. had "coffee ground emesis" on her shirt, but denied vomiting. She had mult bruises apparent. She was put on a NRB and was persistently tachy to the 130's (133 94/65 18 94% NRB). She then had a melanotic stool per the ED (approx 200 cc, guaiac pos), and protonix was started. She was intubated. An OGT was placed. GI was called per the ED resident, and suggestion was made to call the Liver team. Liver recommended Octreotide gtt, and this was started. She was given 4 mg ativan and ptopofol was up titrated for agitation/tremulousness to 40 mcg/kg/min and she was sent to CT for head and torso scans en route to the TSICU under the MICU Green service. MEDICAL HISTORY: ETOH abuse (ongoing) with hx. mult admissions, w/d Sz./DT Hypoechoic area on pancreas noted on abd. U/S at osh [**7-20**] - refused w/u Depression Asthma Tobacco use Thrombocytopenia attributed to alcoholism and liver disease in records from osh, but plts normal here ETOH hepatitis MEDICATION ON ADMISSION: (patient reported to be non-compliant) Advair Albuterol Dilantin Prozac ALLERGIES: Penicillins PHYSICAL EXAM: 100 114 112/67 21 100% on FiO2 of 1.0 Vent: AC 20X500 Peep 5 FiO2 1.0 Peak 37 plat 26 Sedated, but grimacing, writhing in bed, tremulous Sclerae jaundiced, pupils equally round, sluggishly reactive No JVD or LAD Skin dry Tachy, reg, no MRG Diffusely rhonchorous with wheezing Abdomen distended, hepatomegaly, bowel sounds present No edema or rash Moves all four estremities Foley in place 3 PIV's in UE's Discharge physical examination T 98 P90-110 BP150s/70s R12-20 PSV 14/5 FiO2 0.4 98-100% Gen- Up in chair, awake, alert HEENT- mild scleral icterus, PERRLA, EOMI, moist mucus membrane, trach site intact CV- regular, no r/m/g RESP- clear bilaterally ABDOMEN- soft, distended, nontender, normal bowel sounds, G tube site intact EXT- no edema FAMILY HISTORY: Unknown SOCIAL HISTORY: Has 3 kids, all minors No hx. IVDU per boyfriend Chronic ETOH, drinks 2 pints vodka daily

CHIEF COMPLAINT: SDH, S/P Fall PRESENT ILLNESS: [**Age over 90 **] y/o female who tripped and fell hitting the back of her head on a bookshelf on day of admission. There was no LOC per outside records. Patient was taken by EMS to [**Hospital3 10310**] hospital and evaluated there at approx. 2:10pm. CT imaging of the head revealed a right sided SDH and Cervical spine imaging revealed a C2 fracture. The patient was transferred to [**Hospital1 18**] for further care. MEDICAL HISTORY: Diverticulitis, GERD, GI bleed, hyponatremia, R breast mastectomy MEDICATION ON ADMISSION: Lisinopril, Metoprolol, Verapamil, ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: T: BP: 178/ 70 HR:82 O2Sats: 100% Gen: Lethargic, flat on back [**Last Name (un) **] with Aspen collar. Oral airway and Non-re breather mask HEENT: Pupils:R 3-2mm L irregular EOMs: u/a Neck: Collar Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Lethargic, oral airway, no eye opening to voice, not following commands. Cranial Nerves: I: Not tested II: Pupils right 3 to 2mm, left irregular. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives with her daughter

CHIEF COMPLAINT: cirrhosis. here for liver transplant PRESENT ILLNESS: 55-y.o. female with hep C, cirrhosis, and HCC, with h/o hepatic encephalopathy, who presents to receive liver transplant. Recently she sustained a fracture of the L little finger which was non-operative. Otherwise she has been in her USOH. Denies fever, chills, nausea, vomiting, and chest pain. No respiratory symptoms. Reports baseline abdominal cramps. MEDICAL HISTORY: 1.Hepatocellular carcinoma -s/p CT liver biopsy and RFA of segment VII liver [**4-9**] -path c/w well to moderately differentiated HCC -two new lesions on CT in [**5-9**] 2.Hepatitis C genotype 3 c/b cirrhosis and HCC -diagnosed with hepatitis C in the [**2076**] after a trip to the Caribbean -on interferon in the past -EGD [**5-9**] showed portal hypertensive gastropathy 3.Hepatic Encephalopathy 4.Shingles 5.ADHD 6.Disc disease 7.Fibromyalgia 8.PTSD 9.Depression 10.s/p C-section 11.s/p partial hysterectomy secondary to bleeding 12.s/p breast reduction 13.s/p appendectomy 14.s/p tonsillectomy 15. [**2116-9-13**] liver transplant MEDICATION ON ADMISSION: . Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day): Titrate to [**4-6**] BM per day. 2. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 3. Amphetamine-Dextroamphetamine 5 mg Tablet Sig: Two (2) Tablet PO bid (). 4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 6. Sertraline 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 7. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. Mycelex 10 mg Troche Sig: One (1) Mucous membrane five times a day. 11. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 12. Miralax 17 gram (100 %) Powder in Packet Sig: One (1) PO once a day. ALLERGIES: Lithium PHYSICAL EXAM: Vitals - T: 98.2 BP 121/52 HR 73 RR 18 94RA General: awake, alert, NAD. HEENT: anicteric. Heart: RRR, NMRG, nl S1/S2. Lungs: CTAB. Abdomen: soft, NT/ND, no hepatomegaly, liver edge palpated at costal margin. Extremities: WWP, brisk cap refill, no CCE. FAMILY HISTORY: Denies any known history of liver disease or liver cancer. Her mom did have coronary artery disease with a bypass graft as well as carotid endarterectomy. Her maternal grandfather did have an MI. Her dad is healthy. Her brothers and sisters are healthy. No other known significant family history. SOCIAL HISTORY: Single, She has 1 daughter age 22. Currently on disability, used to work as a real estate [**Doctor Last Name 360**]. She denies any significant alcohol intake, has not had any alcohol in over a year. She denies any smoking. She stopped tobacco about a year ago and prior to that she smoked intermittently only. She denies any history of IV drug use. She has other family that live out west.

CHIEF COMPLAINT: rectal bleeding PRESENT ILLNESS: Mr [**Known lastname **] is a 56M w HTN, HL, Lymphoplasmacytic Lymphoma (c/b GI bleed in [**2186**] s/p small bowel resection), Atrial Fibrillation on coumadin who presents from home with complaint of melena x 2 days. Patient states episode begain with one dark melanotic stool on friday night, no BRBPR. He then had 4 episodes on saturday and 3-4 episodes of very loose melanotic stools today. +intermittent RLQ pain, [**4-19**] which last for only seconds. Denies Nausea, Vomiting, fevers, chills, chest pain, cough, SOB. He does report two episodes of LH within the past two days when standing, no syncope. . In the ED, initial vs were: T 97.9, HR 90, BP 121/62, R 18 100% RA. Patient was given Vit K 10mg IV x 1, FFP x 1, 2L IVF, Pantoprazole 40mg IV x 1. 2 18g IVs placed and patient sent to the ICU for monitoring overnight with GI planning for scope in the AM. +black guaiac positive stool in the ED MEDICAL HISTORY: Atrial Fibrillation on Coumadin Hypertension Hypertriglyceridemia Cervical radiculitis Lymphoplasmacytic Lymphoma ? DM II Peripheral Neuropathy GI bleed [**2186**] s/p Small bowel resection MEDICATION ON ADMISSION: Warfarin 5mg M/W/F, 7.5mg Sun/T/Th/Sat Digoxin 375mcg daily Fenofibrate (Tricor) 145mg daily Losartan (Cozaar) 25mg daily Metoprolol succinate (Toprol XL) 200mg daily Pregabalin (Lyrica) 200mg TID Tizanidine (Zanaflex) 2mg 1-2tabs qHS PRN - muscle relaxant Viagra PRN Ambien 10mg qHS PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 98.4 BP: 143/62 P: 92 R: 14 96% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . FAMILY HISTORY: Denies hx of IBD. No history of colon Ca. SOCIAL HISTORY: Retired State Trooper. +EtOH 6-7 beers 4-5x/week. Denies tobacco or illicit drug use. Marrtied for 30years.

CHIEF COMPLAINT: 73-year-old male with known aortic stenosis, presenting with increased dyspnea on exertion. HI[**Last Name (STitle) 2710**]OF PRESENT ILLNESS: The patient is a 73-year-old male with a known history of aortic stenosis, who reports increased dyspnea on exertion since undergoing bilateral hip replacement in [**12-4**] and [**5-5**]. The patient reports that his dyspnea on exertion was such that, a few months ago, he could only walk 25 feet before experiencing the symptom. He can currently walk 50 to 75 feet before experiencing the symptom. The patient denies any chest pain. He does report some episodes of his head feeling "funny." The patient has not had any actual dizziness or syncope. The patient was admitted to [**Hospital 1474**] Hospital on [**2163-9-26**] with shortness of breath and lower extremity edema. He was found to be anemic, with a hematocrit of 27, and required transfusions. An echocardiogram was performed during that admission, which revealed aortic stenosis with a valve area of .6 cm.sq., peak gradient of 6 mm Hg, and a mean gradient of 40 mm Hg. The study also showed inferior hypokinesis, consistent with a prior infarct, and an ejection fraction of 50%. The patient underwent an endoscopy to evaluate his anemia, and this identified erosions in the stomach, duodenum, and esophagus, which were thought to account for his low blood count. The patient was subsequently treated with Prevacid and iron, with an improvement in his hematocrit. The patient was later discharged home, and diuresed well on lasix. A repeat echocardiogram was performed on [**10-27**] here at [**Hospital1 346**], which revealed his aortic valve area to be .9 cm.sq., peak gradient 50 mm Hg, and a mean gradient of 30 mm Hg. The patient was seen by Dr. [**Last Name (Prefixes) 411**] and scheduled for an aortic valve replacement on [**2163-11-8**]. PRESENT ILLNESS: The patient is a 73-year-old male with a known history of aortic stenosis, who reports increased dyspnea on exertion since undergoing bilateral hip replacement in [**12-4**] and [**5-5**]. The patient reports that his dyspnea on exertion was such that, a few months ago, he could only walk 25 feet before experiencing the symptom. He can currently walk 50 to 75 feet before experiencing the symptom. The patient denies any chest pain. He does report some episodes of his head feeling "funny." The patient has not had any actual dizziness or syncope. The patient was admitted to [**Hospital 1474**] Hospital on [**2163-9-26**] with shortness of breath and lower extremity edema. He was found to be anemic, with a hematocrit of 27, and required transfusions. An echocardiogram was performed during that admission, which revealed aortic stenosis with a valve area of .6 cm.sq., peak gradient of 6 mm Hg, and a mean gradient of 40 mm Hg. The study also showed inferior hypokinesis, consistent with a prior infarct, and an ejection fraction of 50%. The patient underwent an endoscopy to evaluate his anemia, and this identified erosions in the stomach, duodenum, and esophagus, which were thought to account for his low blood count. The patient was subsequently treated with Prevacid and iron, with an improvement in his hematocrit. The patient was later discharged home, and diuresed well on lasix. A repeat echocardiogram was performed on [**10-27**] here at [**Hospital1 346**], which revealed his aortic valve area to be .9 cm.sq., peak gradient 50 mm Hg, and a mean gradient of 30 mm Hg. The patient was seen by Dr. [**Last Name (Prefixes) 411**] and scheduled for an aortic valve replacement on [**2163-11-8**]. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease 2. Aortic stenosis 3. Colonic polyps 4. Osteoarthritis 5. Hypercholesterolemia 6. Hypertension MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: s/p Trauma- struck by motor vehicle PRESENT ILLNESS: Ms. [**Known lastname 74651**] is a 66 year-old woman who was transferred via [**Location (un) 7622**] from [**Hospital **] Hospital and being struck by a pick-up truck at low speed while crossing the street. She was reportedly pinned under the truck for five minutes. She did have loss of consciousness. MEDICAL HISTORY: Hypertension Depression RCT Past Surgical History- s/p vaginal hysterectomy, s/p appendectomy, s/p Left total hip replacment MEDICATION ON ADMISSION: Lisinopril 20 mg daily Aspirin 175mg daily Evista 60 Celexa 80mg daily HCTZ 12.5 mg daily Fosamax 70 MVI Calcium and Vitamin D ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam on Admission: FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at home alone. Reports occasional ethanol use.

CHIEF COMPLAINT: Chest tightness PRESENT ILLNESS: This is a 57-year-old gentleman with progressive exertional chest pain and shortness of breath that started several months ago and has been occurring with more frequency over the past few weeks. He was admitted to [**Hospital3 **] in [**2171-11-6**] with angina and ruled out for myocardial infarction. Subsequent nuclear stress test suggested the possibility of distal LAD distribution ischemia. Recent cardiac catheterization showed single vessel coronary disease. He now has been referred for CABG. MEDICAL HISTORY: Borderline Hypertension Elevated Triglycerides Gastroesophageal reflux disease Obesity Colonic polyps MEDICATION ON ADMISSION: Atenolol 25 daily Crestor 40 daily Omeprazole 20 daily Aspirin 325 daily Lisinopril 5 daily Nitro prn ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam FAMILY HISTORY: No family history of premature CAD SOCIAL HISTORY: Lives with: Girlfriend Occupation: AC/Heating Profession, works in management Tobacco: Denies ETOH: He drinks 18 to 22 drinks over Thursday, Friday, and Saturday and he never drinks between Sunday and Wednesday; typically, he uses [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] bourbon or scotch and occasionally beer. Other: He smoked pot and some cocaine, but quit age 27.

CHIEF COMPLAINT: nausea and vomitting PRESENT ILLNESS: Pt is a 46yoM with pmh sig for IDDM diagnosed at age 8, complicated by CAD, neuropathy, nephropathy, presenting with 2 days of nausea, vomitting, and weakness, with elevated fingerstick blood glucose readings at home. Pt states that 3 days prior to presentation he went out with friends and had three beers and "greasy" bar food. He normally has only one to two drinks per year. The following morning he began vomitting, had a fsbg in the 200s. Over the course of the day he vomitted approximately 20+ times. He never had diarrhea. He did have abdominal and chest diffuse "soreness" which worsening with retching during vomitting. He adjusted his insulin boluses per his insulin pump over the course of the day, but did not change the basal rate. Pt had a MI in the past and states that the soreness he feels today is nothing like the pain he felt at that time. . In the ED FSBG 415, labs pertinent for anion gap acidosis. He was given 2L NS and started on insulin drip, given ASA 325 mg po, and Zofran for nausea. . ROS: No dysuria/sob/cough/rhinorrhea/sinus tenderness/fever/chills MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. Type 1 diabetes - diagnosed age 8, followed by Dr. [**Last Name (STitle) 10088**] at the [**Hospital **] Clinic - on an insulin pump - history of neuropathy, nephropathy, and retinopathy, status post multiple laser surgeries - last hospitalized for DKA approximately five years ago. - hemoglobin A1c was 7.6 in [**2198-11-7**] 2. Coronary artery disease, followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - inferior myocardial infection in [**2183**] and status post CABG in [**2184**]. Last catheterization in [**2190**] with patent grafts. Last stress in [**2198-11-7**] showing moderate-to-severe inferior fixed wall motion abnormalities and an EF in 35%-40% range. 3. Hyperlipidemia - managed on Zocor. 4. Hypertension, currently managed on Cardizem, Cozaar, and metoprolol. 5. Chronic renal failure secondary to diabetic nephropathy 6. History of NSVT. 7. History of hematuria with normal renal ultrasound in [**2191-11-7**] per OMR. 8. History of seizures secondary to hypoglycemia. 9. History of gastroparesis. 10. History of left shoulder pain, diabetic cheiroarthropathy. MEDICATION ON ADMISSION: ALLERGIES: Vasotec PHYSICAL EXAM: PE: 98.4 103 162/72 16 100RA NAD Skin warm No carotid bruits No JVD Tachy, RRR nl s1s2, no mrg Lungs clear Abd soft nt nd nabs Ext wwp, No CCE Neuro AAOx3, CN 2-12 intact, strength 5/5 throughout, reflexed 2+ throughout FAMILY HISTORY: Father with CABG in his 70s, Mother with type 2 diabetes. SOCIAL HISTORY: H/o tobacco with a 30-pack-year history reformed for 15 years. Notes very rare alcohol use. Denies any drug use. Rarely exercises. He is married and wife [**Name (NI) 2048**] is HCP. On disability.

CHIEF COMPLAINT: hemoptysis PRESENT ILLNESS: 68M ex-smoker diagnosed with non-small cell lung cancer diagnosed in [**2165-9-21**] and underwent chemotherapy x5 and radiation treatment x16 so far. The patient suddenly had several episodes of coughing up bright red blood which totaled about [**11-22**] cups two days ago. He presented to the [**Hospital 8641**] hospital ED with a hematocrit of 31.7. Hematocrit was serially followed and was found to be stable and was saturating well on room air. His hemoptysis subsided to some extent prior to transfer. A chest CT showed no evidence of pulmonary embolism, however showed left hilar region mass with encroachment on left proximal pulmonary artery as well as proximal upper lobe bronchi. Pulmonology was consulted and he felt that the hemoptysis was most likely secondary to his lung cancer or possibly related to radiation induced bleeding. He was concerned about erosion into the pulmonary artery with potential for serious bleeding and was transferred to [**Hospital1 18**] for further care. On admission, patient is breathing comfortably, with stable vitals. Patient reports small amount of dark blood tinged sputum. Denies fever, chills, chest pain and SOB. MEDICAL HISTORY: Non-small cell lung cancer, treated with chemotherapy and radiation, HTN, COPD, Depression, Anxiety MEDICATION ON ADMISSION: Tylenol 650"""PRN, senna', colace 100", robitussin-DM 10ml""PRN, lisinopril 20', ambien qhs, ativan 0.5"', celexa 20', xopenex 1.25"""PRN, advair 250-50", omeprazole 20", zithromax 250'(2days), ceftriaxone 1' ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T: 98.6 HR: 85 SR BP: 140/72 Sats: 94% RA General: NAD Card: RRR Resp: clear lung sounds GI: benign Extr: warm Neuro: non-focal FAMILY HISTORY: Mother - osteomyelitis Father - angina Siblings - Brother - prostate cancer SOCIAL HISTORY: married, lives with family, ex-smoker 40-60pack year quit 8yrs ago,

CHIEF COMPLAINT: PRESENT ILLNESS: Fifty-five year old with male with end-stage renal disease who is hemodialysis dependent, who at dialysis session aborted midway on [**Last Name (LF) 2974**], [**2154-7-12**] because he developed chest pain midway through dialysis. Per his wife, he has had very frequent episodes of chest pain more than 10 during dialysis since he was started on hemodialysis in [**2153-8-16**]. He went to a hospital in [**Hospital1 392**], where he was started on nitrodrip. His chest pain resolved and has not returned since, and he went home the next day. His wife noted that the workup for his chest pain has been negative in the past including a cardiac catheterization done in [**2153-9-16**] which showed normal coronary arteries. Since the night prior to admission, he has had cough. No fevers, no chills. He missed dialysis today, [**7-15**] because he was sent to the Emergency Department from home shortly before he was scheduled for his 5 pm dialysis. He denies any changes in his diet or noncompliance with dietary restrictions. He has been unable to lie flat this past day due to shortness of breath. This is new compared with his baseline. He does not complain of shortness of breath at rest currently, and says that he is able to work, but that his exercise tolerance is markedly decreased compared with his baseline. In the Emergency Department, his oxygen saturation on room air is 80%, so he was begun on a nonrebreather mask. MEDICAL HISTORY: 1. Type 2 diabetes mellitus for the past 21 years complicated by retinopathy and nephropathy. 2. Hypertension. 3. End-stage renal disease on hemodialysis since [**2153-6-16**]. The patient has an A-V fistula placed at outside hospital with subsequent revisions on two occasions. The patient undergoes dialysis Monday, Wednesday, [**Year (4 digits) 2974**] at South Suburban in [**Hospital1 392**]. 4. History of Clostridium difficile colitis. 5. Diverticulosis. 6. Status post cholecystectomy. 7. Hepatitis C. 8. History of questionable congestive heart failure likely secondary to volume overload from an infected dialysis. 9. Prior cardiovascular evaluation, echocardiogram in [**2154-1-16**] was a limited study and showed an ejection fraction of greater than 55%, mild symmetric left ventricular hypertrophy, no known wall motion abnormalities or valvular disease. 10. Parathyroid adenoma in the left lower pole of the thyroid. He is scheduled for surgery on [**2154-8-2**]. 11. Status post right great toe amputation [**2154-6-12**]. 12. Status post right popliteal to posterior tibial artery bypass [**2154-5-15**]. 13. History of multiple pneumonias and recurrent pneumonia. 14. Patient is scheduled to see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of Vascular Surgery for a right carotid artery pseudoaneurysm repair. MEDICATION ON ADMISSION: 1. Hydralazine 50 mg qid. 2. Clonidine patch 0.2 mg/hour one patch q Monday. 3. Combivent inhaler two puffs qid. 4. Cozaar 100 mg po q day. 5. Heparin IV with dialysis. 6. Lopressor 150 mg po bid. 7. Multivitamin tablet one tablet po q day. 8. Norvasc 10 mg one tablet po q day. 9. Percocet 1-2 tablets po q4h prn pain. 10. Protonix 40 mg po q day. 11. Zocor 20 mg po bid. 12. Folic acid one tablet po q day. 13. Renagel two tablets po tid with meals. 14. ASA 325 mg po q day. 15. Insulin NPH 7 units subcutaneous q am. ALLERGIES: Ciprofloxacin causes mouth swelling, but no difficulty breathing. PHYSICAL EXAM: FAMILY HISTORY: Mother and father have a history of diabetes. SOCIAL HISTORY: Patient used to work for the State Lottery System, currently is unemployed. Lives in [**Location 38**] with his wife and two children ages 17 and 20. He has never smoked. Denies alcohol use.

CHIEF COMPLAINT: s/p fall, ICH PRESENT ILLNESS: HPI: 89yF found by construction workers at home at the bottom of stairs. Apparently fell down ~10 stairs and hit head on concrete below. BIBA, arrived HDS, non-verbal/non-responsive (unclear if speaks/understands English), moving all four extremities spontaneously, PERRL. C-collar in place. NCHCT in ED found extracranial hematoma over Left parietal region, several intracranial foci of hemorrhage SDH bilat/parafalcine, SAH, IPH (R-frontal), bifrontal contusions, occipital Fx, and fluid in T-bone and other sinuses possibly implying Fx there too. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: Unknown ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Temp:97.2 HR:97 BP:158/p Resp:21 O(2)Sat:100% normal FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Unknown at this time, other than she apparently lives at home with her husband, who is a physician/pulmonologist at [**Hospital3 5097**] hospital.

CHIEF COMPLAINT: Bright red blood per rectum. PRESENT ILLNESS: The patient is a 77 year old white female with a history of atrial fibrillation, St. [**Male First Name (un) 1525**] aortic valve replacement, on Coumadin, who presented with one to two weeks of progressive left lower quadrant pain. The pain was described as continuous, with intermittent periods of worsening. Four days prior to admission, she noted a bloody bowel movement. On the day prior to admission, she had bright red blood per rectum times one. She reports one episode of emesis two days prior to admission, which was non-bilious and non-bloody. She also, per her daughter, has been more confused than normal. She has been on Coumadin for her atrial fibrillation and aortic valve replacement. The dose was recently adjusted, although the patient is unclear about the dose. Reportedly, her primary care physician has been following her INR via her visiting nurse. In the Emergency Room, the patient received one liter of normal saline with 20 mEq of potassium. Her hematocrit was noted to be 36.5 with a white blood cell count of 11.6 and her INR was 31. She received four units of fresh frozen plasma and a head CT scan was performed, which was read as negative for an acute intracranial hemorrhage. An abdominal CT scan was performed which revealed diverticula and a thickened proximal sigmoid and descending colon within significant stranding and calcified vascular structures. She received ceftriaxone and Flagyl times one at the time of CT scan. On physical examination, the patient had moderate left lower quadrant tenderness without rebound or guarding. Her rectal examination revealed maroon guaiac positive stool. She was afebrile and hemodynamically stable. She was admitted to the medicine service for further evaluation and management of her lower gastrointestinal bleed. MEDICAL HISTORY: 1. History of diverticula in the sigmoid colon on a colonoscopy in [**2144-7-2**]. 2. Chronic obstructive pulmonary disease. 3. St. [**Male First Name (un) 1525**] aortic valve replacement in [**2136**]. 4. Hypertension. 5. Noninsulin dependent diabetes mellitus. 6. Chronic atrial fibrillation. 7. Coronary artery disease. 8. Congestive heart failure, no echocardiogram available. 9. Status post appendectomy. 10. Status post left oophorectomy. 11. Status post partial thyroidectomy. MEDICATION ON ADMISSION: Coumadin 2.5 mg p.o.q.d., Lipitor 10 mg p.o.q.d., glyburide 10 mg p.o.b.i.d., Glucophage 500 mg p.o.b.i.d., Lopressor 37.5 mg p.o.b.i.d., Serevent two puffs b.i.d., Flovent two puffs b.i.d., Combivent two puffs q.i.d., Captopril 25 mg p.o.t.i.d., digoxin 0.125 mg p.o.q.d., Lasix 40 mg p.o.b.i.d. ALLERGIES: Penicillin (rash). PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient is independent and lives alone, with a daughter in the area. She has a 20 pack year history of smoking, quit several years ago, and denies alcohol use.

CHIEF COMPLAINT: PRESENT ILLNESS: This 59 year old right handed man was initially found to have a left parasagittal frontoparietal glioma in [**2124**]. He had right leg weakness developing back in [**2120**]. By the time he was operated on he had recurrent focal seizures and was having severe right virtually no fine motor control at the ankle or foot. His right upper extremity was affected as well, but to a much lesser extent. He had moderate fine movement in the right hand. He underwent surgical excision and there was malignant alteration with increased cellularity and single cell necrosis and extensive multifocal tissue necrosis with large diffusely infiltrating histologic benign component typical of required reoperation. At that time he had radiation therapy carried out near his home at [**Hospital3 44339**] Hospital in [**Location (un) 45098**], [**State 2748**]. He did well again until [**2139**] when he was found to have a small recurrence in the posterior margin of the removal cavity. He underwent focal radiation at [**Hospital3 28333**] [**Hospital3 **]. The area of gadolinium enhancement on MR scan cleared and he did well until the summer of [**2141**] when he started having focal partial seizures involving the right hand. Repeat MRI scan showed recurrence of a gadolinium enhanced tumor again in the posterior margin of the removal cavity in the parietal region posteriorly. Repeat SPECT scan with thallium was consistent with tumor recurrence. This was compared with a prior thallium scan in [**2139**] prior to his high energy beam radiation to that site. The overall recommendation of radiation therapy was to reoperate and remove this area rather than consider any further high energy beam radiation at this time. It was thought that the risks outweighed the benefits and that since the area was one which could be approached surgically without high risk to function, removal of as much active tumor as possible was the best course of treatment. MEDICAL HISTORY: He has known esophageal reflux. He did not use tobacco or alcohol. He had L5-S1 lumbar fusion many years before in the [**2110**] for spondylolisthesis of L-5 on S-1. He had the prior left parietal craniotomies in [**2124**] and [**2128**]. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 72 year old female with no past medical history presented [**9-4**] to OSH with shortness of breath. She states she went about her usual routine, and was walking to start doing laundry, when her legs felt "rubbery," she became more short of breath, and she presented to [**Hospital3 3583**] emergency room. She notes she remembers little after the ride to the OSH ED. In the ED, she was found to have respiratory distress, CXR with pulmonary edema, and she was intubated and transferred to the CCU. Initial troponin was 0.16, which trended to 1.79 peak. Her initial EKG showed nonspecific ST-T wave changes, with new ST depressions in V3-V5 while in the ICU. No ST elevations. Overnight, the patient had hypotension (thought to be in setting of getting propofol) requiring dopamine. Initially covered with broad spectrum abx for presumed pna, later stopped. She had a TTE showing 30% EF with moderate Ao insufficiency, small pericardial effusion, aneurysmal sounding of apex and akinesis of anterior wall and adjacent septum. On [**9-5**], she was weaned of dobutamine, extubated, transferred to [**Hospital1 18**] for further workup. She is now being referred to cardiac surgery for revascularization and repair of ascending aorta aneurysm/ +/-AVR. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: - s/p 4 pregnancies with 3 vaginal deliveries and 1 emergent c-section and subsequent hysterectomy MEDICATION ON ADMISSION: None ALLERGIES: Penicillins PHYSICAL EXAM: Adm PE: VS: T=99.4BP=139/70HR=88RR=14O2 sat= 100% 2L GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Mother alive at 96, has pacemaker for syncope, pt is unsure of diagnosis. No family history of early MI, cardiomyopathies, or sudden cardiac death; otherwise non-contributory SOCIAL HISTORY: married, lives with her husband. Former nurse [**First Name (Titles) **] [**Last Name (Titles) 3325**]. -Tobacco history: 30 pack-year smoking history, [**1-27**] PPD. -ETOH: denies -Illicit drugs: denies

CHIEF COMPLAINT: Chief Complaint: Lower extremity swelling . Reason for MICU transfer: Dyspnea, hypoxia PRESENT ILLNESS: Mr. [**Known lastname 3646**] is a 52 year-old gentleman with history of hypertension, HLD, presenting with bilateral peripheral edema for three days. Patient was walking more over the weekend and noted b/l lower extremity edema and erythema. He attributed the worsened peripheral edema to increased ambulation. Today he had two teeth extracted. He was concerned about the edema and came to the emergency department. Patient denies fever and chills. No chest pain or shortness of breath. Pt endorses cough productive of white sputum. No recent immobilization, long car/plane rides. Of note, he was hospitalized from [**6-5**] - [**6-7**] at [**Hospital1 2025**] for pneumonia. He was sent home with a 8 day course of levofloxacin (although he ended up getting 16 days filled at pharmacy and is still taking it). He has felt better since being discharged from hospital and had not had ongoing fevers or chills. MEDICAL HISTORY: Hypertension Chronic lower back pain Tobacco use Diabetes not on insulin Peripheral neuropathy Hypertriglyceridemia Hyperlipidemia Anxiety Genital herpes MEDICATION ON ADMISSION: Losartan 50 MG PO daily Simvastatin 20 MG PO daily Docusate Sodium 100 MG PO BID Famotidine 20 MG PO daily Omeprazole 20 MG PO daily Glipizide 2.5 MG PO daily Pregabalin 300 MG PO BID Sertraline 100 MG PO daily Morphine Controlled Release 30 MG PO BID Oxycodone 15-30 MG PO Q4H prn Valacyclovir 500 MG PO BID Levofloxacin (Levaquin ) 500 MG PO daily (this was ordered for 8 days, but patient received 16 days from pharmacy, still taking) clonidine 0.1 mg [**Hospital1 **] (?) ALLERGIES: Sulfa(Sulfonamide Antibiotics) PHYSICAL EXAM: Admission exam: General: Alert, oriented, appears slightly diaphoretic, but comfortable HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Distant heart sounds, regular rate and rhythm, normal S1 + S2, no murmurs appreciated Lungs: Bibasilar crackles Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, 2- 3+ peripheral edema, diffuse patchy erythema, very tender to palpation b/l, few areas of skin breakdown on LE Neuro: CNII-XII intact, moving all extremities FAMILY HISTORY: Grandmother with CHF. SOCIAL HISTORY: Patient lost his job recently, has been homeless for the past month, staying at a shelter for veterans. Smokes 1 pack cigarettes per day. No alcohol or drugs.

CHIEF COMPLAINT: Shortness of breath and chest pain PRESENT ILLNESS: [**Age over 90 **]yo woman s/p PPM on [**2133-12-19**] returned to emergency room c/o shortness of breath and chest pain, found to have large right hemothorax. Subsequent echocardiogram revealed large pericardial effusion with tamponade physiology MEDICAL HISTORY: Afib/SSS s/p PPM placed [**12-17**] HTN HOH pulmonary fibrosis ^chol MEDICATION ON ADMISSION: univasc 15' Norvasc 10' Lipitor 20' Amiodarone 100' Plavix 75' Celebrex 100' MVI [**Doctor First Name **]-prn Tylenol-prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS T HR 40's BP 40-50/30 RR 12 O2sat 100%NRB Gen NAD HEENT EOMI, neck supple Chest diminished BS right CV RRR. c/ chest pain Abdm soft NT/ND Ext warm, no c/e/e Discharge VS T 98.2 HR 79 BP 105/61 RR 18 O2sat 95%-RA Gen NAD Neuro Alert, non-focal exam Pulm diminshed at bases but clear CV RRR, Rt anterior chest wound-no erythema/CDI Abdm soft, NT/+BS Ext warm, trace edema FAMILY HISTORY: nc SOCIAL HISTORY: widowed lives in [**Hospital3 **] no tobacco occais ETOH

CHIEF COMPLAINT: Nausea, vomiting, and acute pancreatitis. PRESENT ILLNESS: A 38-year-old gentleman with history of hypothyroidism and acid reflux who presented with acute abdominal pain, nausea, and vomiting times one day. Pain began a day prior to admission after eating tuna fish and having a glass of wine. He described the pain as severe and crampy with nausea and vomiting, it is bilious. No hematemesis or diarrhea. Denies heavy alcohol use or gallstones or diuretic use. Also denies hypertriglyceridemia. Of note, had recent URI with symptoms of sinusitis and bronchitis and sent home on Advair and Augmentin. On arrival to the emergency room, the patient was afebrile, hypertensive at 160/96 with severe abdominal pain. Labs notable for white count of 19, 79 percent neutrophils, 5 percent bands, and lipase of 1291. All other lab values within normal limits. CT of the abdomen revealed pancreatitis with stranding and abrupt tapering of major papillae, but no visible stones. The patient received Zofran, morphine, levofloxacin, and Flagyl in the emergency room as well as IV fluids. MEDICAL HISTORY: Hypothyroidism. Acid reflux. Recent history of bronchitis. Sinusitis. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: No significant past family medical history. SOCIAL HISTORY: Denies heavy alcohol use, drinks occasionally. Denies tobacco use. Married. Lives in [**State 16269**].

CHIEF COMPLAINT: Nausea/Vomiting PRESENT ILLNESS: This is an 82 yo F transfered for workup of a stomach mass. She was admitted to OSH on [**10-26**] with 5 weeks of nausea and foreful brownish/blackish emesis, appx 1 pint/day. She associated this with recently starting warfarin, but symptoms returned even after stopping warfarin. She had no prior issues with nausea or vomiting. Also with 8-10# wt loss over this time. At OSH, noted to be in rapid afib. HR improved with IVF and dilt drip (now in 80s-90s). Warfarin was held and she was continued on enoxaparin. Underwent EGD which showed gastric mass. Biopsy performed with pathology "inconclusive". NG tube was refused (pt does not recall this). Surgery was consulted and recommended CT scan, with results below. She did require blood transfusions for anemia, as well. She was also on levofloxacin, then bactrim, for pansens E coli UTI. Sent to [**Hospital1 18**] for possible EUS with bx, and likely surgical intervention. Vitals from transfer call-in: T: AF BP: 132/91 HR: 80s-90s RR: 20 O2 Sat: 99% 2 L/min O2. . On the floor, patient notes that she has been on a regular diet, but not eating much solid. Her nausea is bad in the am, with spitting up phlegm, but abates after ~1pm. . . MEDICAL HISTORY: Diabetes Hypertension Coronary artery disease s/p MI, 3 stents Osteoporosis Emphysema Atrial fibrillation Chronic back pain - spinal stenosis CHF? Anemia Hx of pancratitis Hx bilateral knee replacement and L shoulder replacement from OA MEDICATION ON ADMISSION: Home meds: ASA 81mg daily Glyburide 5mg daily Lipitor 10mg daily Lisinopril 10mg daily Atenolol 50mg daily Methadone 15mg qam, 10mg qnoon, 10mg qpm Combivent 2 puffs QID Advair 2 puffs daily Oxycodone APAP 5/325 prn . Medications (from [**Hospital3 26615**]): Atenolol 50mg [**Hospital1 **] Lisinopril 2.5mg daily Diltiazem CD 120mg daily Atorvastatin 10mg daily Lovenox 40 units daily Ferrous sulfate 325mg [**Hospital1 **] Insulin SS Methadone 15mg qam, 10mg qnoon, 10mg at 2200 Reglan 5mg IV TIDAC Zofran 8mg IV TIDAC Oxycodone APAP 1-2 tabs q6h prn pain Protonix 40mg daily Bactrim 1 tab [**Hospital1 **] Salmeterol Fluticasone 1 inh [**Hospital1 **] ALLERGIES: Erythromycin / Tramadol / Simvastatin PHYSICAL EXAM: Vitals: T: 96.0 BP: 120/82 P: 101 R: 18 O2: 96,2L Glc: 142 General: Alert, no acute distress HEENT: MMM Neck: SCMs tight, no LAD Lungs: Crackles throughout left lung (patient lying with left lung down), otherwise clear CV: Irregularly irregular, no murmurs, rubs, gallops Abdomen: soft, mild LUQ and R mid abd TTP without rebound or guarding, mildly distended with tympany, bowel sounds present Ext: Warm, well perfused, no edema FAMILY HISTORY: Father with [**Name2 (NI) 499**] cancer resected in his 80s; daughter diagnosed with breast cancer at age 48 SOCIAL HISTORY: Lives alone in [**Location (un) 5028**]. Former secretary. No tobacco, no etoh, no illicit drug use

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 53 year old woman with metastatic renal cell cancer status post radical nephrectomy, high dose chemotherapy and biliary obstruction, who presents with nausea and poor p.o. intake. Her last chemotherapy prior to admission was in [**2156-8-29**] with five cycles of CC1-779. The patient had a neck mass resection in [**3-29**] which was harvested for dendritic cell vaccine. The patient received her first dose of dendritic cell vaccine in [**4-29**]. She had disease progression in [**2157-6-29**] with biliary obstruction status post failed ERCP with subsequent PTC internalization of the stent. Since her last discharge from [**Hospital1 18**], the patient continued to have fatigue, poor p.o. intake and nausea. She denies fever, chills, vomiting, diarrhea, melena, bright red blood per rectum. The patient was admitted for hydration and further management of biliary obstruction. MEDICAL HISTORY: Renal cell CA metastatic to cervical and paracaval nodes, status post right nephrectomy in 5/98, status post IL2 in 7/98, status post CC1-779 in 10/00, status post dendritic cell vaccine in [**4-29**]. Hypertension. Biliary obstruction status post failed ERCP, PTC with internalization of stent. MEDICATION ON ADMISSION: Atenolol 25 p.o. q.d., Reglan 10 q.i.d., Prilosec 20 q.d., Benadryl p.r.n., Compazine p.r.n., Dilaudid p.r.n. ALLERGIES: Morphine and Demerol. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Dyspnea on Exertion PRESENT ILLNESS: Splendid 84 y/o female with a long standing h/o AS and heart murmur who has been experiencing progressive DOE. Admitted recently with CHB and TIA. Echo revealed significantly worsening AS with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of o.7. A cardaic cath revealed an occluded RCA. A PPM was placed and she was referred for surgical evaluation. MEDICAL HISTORY: Severe aortic stenosis Hypertension Hyperlipidemia Hypothyroidism TIA Asthma Gout Polymyalgia rheumatica Discoid [**Location (un) 11168**] h/o CHB s/p PPM [**2126-12-9**] h/o pulmonary embolus [**2122**] s/p coumadin h/o Left DVT s/p Right total knee replacement [**4-12**] s/p Left total hip replacement [**11-10**] s/p R Mastoidectomy MEDICATION ON ADMISSION: Fosamax 70mg qwk Lipitor 40mg qd Synthroid 100mcg qd Allopurinol 100mg bis Prednisone 1mg qd ASA 325mg qd Toprol XL 50mg qd Lisinopril 40mg qd Calcium ALLERGIES: Hydrochlorothiazide / Procardia / Verapamil PHYSICAL EXAM: VS: 82 14 138/86 62" 145# General: WDWN female in NAD, Appears stated age Skin: Warm, Dry. +Bruising arms and R groin HEENT: NC/AT, PERRL, EOMI, Anicteric sclera, OP benign Neck: Supple, -JVD, +R Bruit Chest: CTAB -w/r/r Heart: RRR, +S1S2, 3/6 SEM Abd: Soft, NT/ND +BS Ext: Warm, well-perfused, well-healed knee/hip scars, + Ant varicosities Neuro: A&O x 3, Gait cautious but [**Last Name (LF) 4374**], [**First Name3 (LF) 2995**], non-focal FAMILY HISTORY: sister-TIAs brother with CAD died at age 45 nephews with CAD at age <40 MS [**First Name (Titles) **] [**Last Name (Titles) 11168**] also in the family SOCIAL HISTORY: married x 60 years. 4 kids. Worked as an office manager at local newspaper. No tobacco, alcohol, drug use. ambulates on own.

CHIEF COMPLAINT: atrial fibrillation with RVR PRESENT ILLNESS: 78M w hx of PE, lupus anticoagulant, GERD, GI bleed, recent d/c from [**Hospital1 18**] for eval of CP (s/p stents to OM1 and D1) p/w Atrial fibrillation with RVR and CP. Pt was d/c'd yesterday to rehab. Did well overnight. This morning, awoke to bathroom then acutely became SOB with 8/10 CP. substerna, heavy, nonradiating. c/o nausea, diaphoresis, dizziness. BP 89/50 HR 120s. Given ntg x3 with some relief. Went to [**Hospital **] Hosp. Found to be in afib with RVR to 150s with old RBBB. Received dilt 20mg IV x1 then dilt gtt up to 10.h. given amio 150 x1 then 1mg/m. Remained in afib but rate improved to 100-110. Transferred to [**Hospital1 18**]. en route, converted to sinus. . Currently, c/o [**6-1**] CP. no SOB. c/o stable lower back pain. no edema, cough, fever, neck pain, dizziness, confusion. denies any palpitaitons at all today. MEDICAL HISTORY: -CAD: recent ST elevations in inferior leads and s/p c cath at the [**Hospital1 18**] [**2200-5-23**]: Multiple balloon inflations and deployment of 4 stents were performed: two to the OM1 branch of the LAD, and two to the D1 branch of the LCx. -GERD -R thigh hematoma from lovenox -R CEA--[**2190**], pt had presented with "forgetfulness", and underwent CEA at [**Hospital1 112**] -Anemia -Back surgery -Lupus anticoagulant -Femur fracture [**2196**], surgical repair -GIB, pt does not recall in past. Never had EGD/Colonoscopy per him -TB, lung surgery x3 ([**2152**], R and L resections at [**Hospital 912**] hospital) -Recurrent DVT/PE, on lovenox, has IVC filter--history of DVT on coumadin Cardiac Risk Factors: Dyslipidemia MEDICATION ON ADMISSION: ALLERGIES: NKDA . CURRENT MEDICATIONS atorvastatin 80 daily imdur 30 daily senna [**Hospital1 **] tylenol prn lovenox 80 [**Hospital1 **] ambien 5 qhs percoect prn MOM dulcolax [**Name2 (NI) 72956**] XL 75 daily plavix 75 daily prilosec 20 daily asa 325 daily colace 100 [**Hospital1 **] neurontin 300 [**Hospital1 **] then 900 qhs ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 99.3 83 NSR 17 105/51 Gen: Elderly man in NAD. Oriented x3. Mood, affect appropriate. FAMILY HISTORY: NC SOCIAL HISTORY: Retired custodian. Former heavy smoker (2PPD x 30+ years), quit in [**2152**]. Former heavy ETOH, quit in [**2177**]. Limited activity by back pain. lives at rehab s/p discharge.

CHIEF COMPLAINT: Abdominal pain, vaginal bleeding PRESENT ILLNESS: 82 yo F with a past medical history of DM, CAD, CHF, CKD and Parkinson's presents with 2 weeks of vaginal bleeding. At time of initial assessment husband reported that patient was experiencing intermittent episodes of vaginal bleeding vs hematuria over the last 2 weeks, as well as headaches and chills. In the ER patient was reported having 1 tablespoon per day of vaginal bleeding, but was not wearing pads. Also reported generalized weakness and intermittent chest pain/dyspnea over the last 3 days, with occasional headaches. Denies recent cough, diarrhea, and hemoptysis. Does report chronic urinary frequency of about 10-15 times per day, which is unchanged from baseline. In the ED patient was noted to be wheezing at the bases and was guaiac positive. Vaginal exam was noteable for gross blood without masses and a normal cervix. Patient was TTP in the RLQ, but could not further classify this pain. CXR showed an enlarged cardiac silhouete, but no obvious consolidation. EKG was noted to be at baseline. Pelvic u/s was negative. CT abdomomen and pelvis was unremarkable. Cardiac enzymes were negative. FS was noted to be 33 with the patient relatively asymptomatic, and patient was given an amp of D50 x1. FS improved to 65. Mental status started to worsen as patient became progressive more agitation. Patient received another amp of D50 but mental status appeared to worsen. Head CT was ordered and patient was given ativan 1 mg IV x1 for this procedure. She was also given Zofran 4 mg IV x1 and Morphine 4 mg IV x1. CT head was unremarkable. Thereafter she was lethargic but arousable. She was started on a D10 W drip at 125 cc/hr and transferred to the ICU. Patient was transferred to the MICU, VS were 90, 13, 162/78, 100% RA. In the ICU, patient remained lethargic and became disoriented. On [**5-27**] mental status deteriation, deemed secondary to morphine and ativan adminstration/component of hypoglycemia, continued to deteriate and patient became hypercapneic and was intubated. On [**5-28**] patient was started on CTX and azithromycin due to concern for PNA, sputum positive for gram possitive cocci, culture grew rare Asperigillos; Urine culture + for Garnderella and patient started on Flagyl. On [**5-29**] patient self extubated and was transitioned with bipap. saturting in the high 90s. Passed speech and swallow eval. Mental status continued to improve and patient was transferred to the floor. On the floor patient feeling much better. Continues to report pelvic pain and vaginal bleeding. Reports occassional chills, SOB and cough productive of clear sputum. Denies chest pain. MEDICAL HISTORY: 1. Diabetes mellitus, type 2, poorly controlled, last HbA1c 9.0 [**1-15**] 2. Atrial fibrillation, on coumadin 3. Coronary artery disease s/p stent to the RCA 09/[**2191**]. 4. Congestive heart failure, EF 70% [**12/2198**] 5. Hypertension. 6. Hypercholesterolemia. 7. Seizures 8. Parkinson's disease 9. Hx. PUD and gastritis 10. Hx. abnormal pap smears 11. Status post bilateral total knee replacement. 12. Low back pain 13. Chronic kidney disease with baseline creatinine 1.3-1.9 MEDICATION ON ADMISSION: # Psyllium Oral Powder - 1 teaspoon daily # Keppra 500 mg po BID # Tylenol #3 Q8H Prn # Novolin 20 U QHS, 50 U QAM # Clonidine 0.2 mg TID # Atenolol 50 mg daily # Proair 1-2 puffs Q4-6H prn # Furosemide 40 mg [**Hospital1 **] # Lisinopril 20 mg dalu # Simvastatin 40 mg daily # Glyburide 10 mg Q am, 5 mg Q pm # Clotrimazole 1 % Topical Cream apply to affected areas twice a day # Colace 100 mg [**Hospital1 **] # Ferrous Sulfate 325 mg daily # Warfarin 5 mg Tab QMoWeSatSu, 2.5 mg QTuThFr # Sinemet 25 mg-100 mg Tab - 1 tab TID # Asmanex Twisthaler 110 mcg (30 doses)1 puff daily # Ranitidine 150 mg [**Hospital1 **] ALLERGIES: Aspirin / Nitroglycerin PHYSICAL EXAM: On admission - Vitals: T: 98.0 BP: 134/78 P: 91 R: 24 O2: 96% RA General: Lethargic, arousable to sternal rub and loud verbal stimuli, nonverbal HEENT: Sclera anicteric, MMM, oropharynx clear, pupils minimally reactive Neck: supple, JVP not elevated, no LAD Lungs: Loud bilateral expiratory wheeze, with I:E ratio less than 1:2 CV: distant HS, irregular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema On discharge Vitals: T: 98.9 BP: 132/92 P: 65 R: 23 O2: 93% 4L General: Alert, pleasant, spanish speaking only HEENT: Sclera anicteric, MMM, oropharynx clear, pupils minimally reactive Neck: supple, JVP not elevated, no LAD Lungs: soft b/l expiratory wheeze, no crackles no rhonchi CV: irregular, irregular, no murmurs, rubs, gallops, trace b/l edema on feet Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis FAMILY HISTORY: Brother with DM. No CAD or COPD. SOCIAL HISTORY: Patient lives with her husband in [**Location (un) 686**], daughter lives nearby. Patient is a former smoker, but none in recent years. No alcohol. She walks with the aid of a cane. She was born in [**Male First Name (un) 1056**]. She is spanish speaking only. Grandson, [**Name (NI) **], is primary communicator for the family.

CHIEF COMPLAINT: Status post pneumonia. PRESENT ILLNESS: This is a 35 year-old Hispanic female who was a transfer from an outside hospital on [**2194-2-25**] after a [**2194**]0 to 30 feet after snorting heroine. The patient was reportedly trying to escape from police after which she had a fall. She was taken to an outside hospital and stabilized. At that time she was transferred to [**Hospital1 1444**] for further evaluation. On arrival she was found to have an acutely ischemic right hand without motor function. She was also found to have an open fracture of the distal humerus on the right side that was reduced. She was also noted to have a comminuted left sided fracture, right acetabular fracture. Moreover she was noted to have right iliac base fracture, right rib fractures in ribs 8 and 9, left transverse process of L5 vertebra fracture. On admission she was brought to the Trauma Intensive Care Unit. On [**2194-2-25**] the patient underwent right external fixation of the right humerus, incision and drainage of the right humerus fracture, right volar forearm fasciotomy and right carpal tunnel release. For her brachial artery avulsion she had right brachial artery to brachial artery bypass with reverse saphenous vein graft of the right lower extremity. At that time she was returned to the Trauma Intensive Care Unit for further evaluation. The patient initially required pressure support with Levophed. She was started empirically on Cefazolin, Ampicillin and Gentamycin. She required multiple blood products including packed red blood cells and fresh frozen platelets. Further hospital course will be described below. MEDICAL HISTORY: 1. Asthma. 2. Intravenous drug abuse with heroine. 3. Question of hepatitis C. 4. HIV with negative 1.5 years prior to admission. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient had reported three to four drinks of alcohol per day. She had smoked two packs per day for 18 years. She had been a heroine user since [**2174**].

CHIEF COMPLAINT: Respiratory failure PRESENT ILLNESS: 82M PMH CAD, PAD, RAS, CHF (EF 20%), recently admitted [**Date range (3) 106247**] with new diagnosis metastatic SCLC s/p radiation x 4 sessions, Cycle 1 Carboplatin and Etoposide, Pleurx catheter placement now p/w septic shock. Patient transferred from [**Hospital **] Rehab the day of admission with increased work of breathing and respiratory distress. . In the ED, T: 105.0 BP: 85/50 HR: 140 (atrial fibrillation) RR: 16 SaO2: 100% NRB. Patient in respiratory distress. - Chest x-ray showed multifocal PNA - Difficult intubation - Vancomycin/zosyn/azithromycin administered - Dexamethasone 10 mg IV x 1 - 18g x 2, 22g PIV - no central line placed for thrombocytopenia - NS x 6 L - Peripheral neosynephrine/levophed - Platelets 2 units MEDICAL HISTORY: - Small cell lung cancer, recently diagnosed [**4-/2142**] s/p Cycle 1 Carboplatin and Etoposide and radiation therapy x 4 sessions - Hypertension - Hyperlipidemia - Coronary artery disease with occlusion of RCA, LCx, and noncritical disease of the LAD - Hypertensive/ischemic cardiomyopathy with ejection fraction of 15%-20% in [**1-/2141**] - Peripheral vascular arterial disease status post an abdominal aortic aneurysm with aortobifemoral bypass with acute occlusion in the right common RCA status post PTCA initially by Dr. [**Last Name (STitle) **] and status post right PTCA by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], good result - Status post right total hip arthroplasty - Status post right carotid endarterectomy - Status post right total hip arthroplasty - Status post cholecystectomy as noted - Chronic renal failure (baseline creatinine 1.4-1.7) - Status post cataract surgery MEDICATION ON ADMISSION: Latanoprost 0.005 % 1 drop OD QHS Lipitor 40 mg DAILY Senna 8.6 mg [**Hospital1 **]:PRN constipation Aspirin 325 mg DAILY Allopurinol 300 mg DAILY Tylenol 325-650 mg Q6H:PRN pain Megestrol 400 mg DAILY Metoprolol 25 mg [**Hospital1 **] Colace 100 mg TID Bisacodyl 10 mg DAILY:PRN constipation Albuterol 90 mcg INH Ipratropium Bromide 0.02 % INH ALLERGIES: Iodine; Iodine Containing PHYSICAL EXAM: VS: T: 101.7 HR: 121 BP: 107/60 RR: 34 SaO2: 89% on PS 20/10 100%FiO2 GEN: Respiratory distress HEENT: PERRLA, ETT in place CV: Tachycardic, regular, nl s1, s2, no m/r/g PULM: Coarse breath sounds anteriorly ABD: Soft, NT, ND, + BS, no HSM EXT: Mottled, Dopplerable pulses NEURO: Sedated, non-specific movements, does not follow commands FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Transferred from [**Hospital **] Rehab. Married. History of EtOH and tobacco abuse per records.

CHIEF COMPLAINT: Altered Mental Status PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 84380**] is a 42 year old male with a history of alcoholic cirrhosis who presents with somnolence and left leg discomfort. Patient was scheduled to re-establish care with Dr. [**Name (NI) **] in the liver center today. Upon arriving to the clinic, there was concern about the patient's mental status and his left leg infection. The patient was instructed to go the ED for evaluation. In the ED, he was A and O x 3, but somnolent. His initial VS were 97.5 BP 96/36, HR 59, 99% RA. Given concern for evolving sepsis, he received NS 2.5 liters. LENI was (-) for DVT in left leg. RUQ was also obtained without dopplers, and was equivocal, with possible non-occlusive portal vein thrombosis. Blood and urine cultures were obtained, and the patient was given vancomycin. He apparently had a reaction to vanc, unclear if it was red man's syndrome, but received Solumedrol 125 mg IV x 1 and benadryl 25 mg IV x 1. He then received clindamycin IV. He was then transferred to the unit for management of presumed sepsis in the setting of altered mental status. . Upon arrival to the unit, the patient was somnolent but easily arousable. He endorsed abdmoninal pain, denied n/v/d. He also denied melena, BRBPR, or hematochezia. He denied chest pain of shortness of breath. Remainder of ROS as noted below. He does state that the swelling in his legs is new over the past few days. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. MEDICAL HISTORY: - Etoh Cirrhosis c/b grade I varices with h/o UGIB, hemorrhoids, ascites, and hepatic encephalopathy - h/o Alcoholic hepatitis - not treated with steroids given UGIB. - Alcohol dependence - hypertension - cholelithiasis - gout - obesity - depression MEDICATION ON ADMISSION: 1. Atenolol 50 mg daily 2. Furosemide 60 mg daily 3. MVI 4. Magnesium oxide 400 mg [**Hospital1 **] 5. Folic acid 1 mg daily 6. Lactulose 30 grams [**Hospital1 **] 7. Vicodin 5/500 1 tab daily PRN ALLERGIES: Penicillins / Vancomycin PHYSICAL EXAM: ON ADMISSION: VS: 113/60, 54, 16, 96% RA GA: AOx3, NAD, somnolent, arousable HEENT: PERRLA. mild scleral icterus. MMM. no LAD. no JVD. neck supple. Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard. no murmurs/gallops/rubs. Pulm: CTAB no crackles or wheezes Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign. Extremities: wwp, no edema. DPs, PTs 2+. Skin: Mildly icteric, LLE erythema, warmth on anterior shin with serosanguinous drainage Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities. DTRs 3+ BL (biceps, achilles, patellar). sensation intact to LT, pain, temperature, vibration, proprioception. cerebellar fxn intact (FTN, HTS). gait not assessed. (+) asterixis. . ON DISCHARGE: VS: 97.4, 120/73, 79, 18, 99% on RA General: WD/WN, pleasant, comfortable HEENT: NC/AT, mild scleral icterus, MMM Neck: No LAD, no JVD, neck supple Heart: RRR, nml S1/S2, 3/6 SEM, no rubs or [**Last Name (un) 549**] Pulm: CTAB Abd: Soft, obese, NT, no fluid palpated, liver and spleen not palpated Extremities: WWP, 2+ radial/DP pulses, 2+ edema bilaterally to the knees Skin: LLE warm with erythematous rash demarcated by marker, decreasead in size from yesterday, small amount of serosanguinous drainaga Neuro: A&Ox3, no asterixis, CNs II-XII intact, motor and sensory function grossly intact FAMILY HISTORY: NC SOCIAL HISTORY: Lives alone, divorced x2, has three children. Denies tobacco or other IV drug use. Last drink was [**2168-7-28**].

CHIEF COMPLAINT: Shortness of Breath PRESENT ILLNESS: 73 y/o female with shortness of breath/dyspnea on exertion who had a positive stress test. She then underwent a cardiac cath which revealed severe 3 vessel disease with normal LV function. MEDICAL HISTORY: Hypertension Hypercholesterolemia Diabetes Mellitus Migraines Back Pain Eczema s/p T&A s/p Right ankle ([**Doctor Last Name **]-[**Doctor Last Name 49**]) procedure s/p Appendectomy s/p Cholecystectomy s/p Bladder resuspension and removal of right ovary and tubal ligation MEDICATION ON ADMISSION: ASA 325 mg, Glyburide 10/5mg am/pm, Norvasc 5mg qd, Ambien prn, Actonel, MVI, Betamethasone ALLERGIES: Metformin PHYSICAL EXAM: VS: 72 23 160/ 99% RA 5'5" General: WDWN, NAD lying flat in bed Skin: Eczema BLE HEENT: PERRL, EOMI, NC/AT OP Benign Neck: Supple, FROM, -JVD, -Carotid Bruits Chest: CTAB -w/r/r Heart: RRR +S1S2 -c/r/m/g Abd: Soft, NT/ND +BS Ext: Warm, well-perfused, -edema, -varicosities, -pulses Neuro: Grossly intact, MAE, Non-focal, A&O x 3 FAMILY HISTORY: Father died of MI at 70. Uncle died of CAD at 49. Cousin had CABG in 40's. SOCIAL HISTORY: Nurse

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: 58 yo m hep C, EtOH cirrhosis, p/w diffuse abdominal pain x 2 days. He noted that the pain was at times sharp, and more on right side than left. He had no N/V, but was unable to tolerate PO's. He denied any fever, chill. He had daily BMs which were very watery and at times BRBPR. In ED, Temp 100.6. lactate 1.0, guaiac + brown stool. Abd CT revealed SMV thrombosis and bowel ischemia. Patient was evaluated by transplant surgical fellow who asked patient to be admitted to medicine. Patient was started on levo/flagyl and HD stable. On floor, patient was complaining of excruciating abd pain. Last BM was in AM. no N/V, chest pain, SOB. MEDICAL HISTORY: hep C: genotype 2B; treated w/ ribaviron and interferon for 6 mo ended [**4-23**] EtOH cirrhosis: followed at [**Hospital1 2025**] by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. - Liver bx [**1-20**]: complete cirrhosis, hepatic activity indec [**9-5**], fibrosis stage 6/6 - Liver MRI [**11-24**]: no evidence of mass lesion gastric varices portal hypertensive gastropathy EtOH abuse IVDU OSA on CPAP anxiety DJD osteoporosis scoliosis macular degeneration MEDICATION ON ADMISSION: (Based on [**Hospital1 2025**] note on [**2133-5-14**]) Propranolol ER 60 daily lactulose [**Hospital1 **] ASA 81 Lasix 20 TID Celexa 40 QD albuterol IH Fluticasone 44 mcg Spiriva IH prilosec 4O Daily ALLERGIES: Penicillins / Codeine PHYSICAL EXAM: PE: 96.3 118/73 71 20 97%4L O2 Sats Gen: clearly in severe pain; holding quite still on bed HEENT: Clear OP, MMM CV: RR, NL rate. No murmurs, rubs or [**Last Name (un) 549**] LUNGS: CTA ant and lat ABD: Soft, diffusely tender throughout R>L; voluntary guarding, no rebound; pain out of proportion to exam EXT: No edema. 2+ DP pulses BL SKIN: No lesions FAMILY HISTORY: Father: CAD [**Name (NI) **] fam hx colon, liver, GI disease SOCIAL HISTORY: Smoking: started age 14, now 1.5 ppd EtOH: long history of abuse, last drink in [**3-25**] Divorced, lives alone, no children. Does not work and on disability.

CHIEF COMPLAINT: Fever and chills, sepsis, history of orthotopic liver transplant. PRESENT ILLNESS: Mr. [**Known lastname 19672**] is a 51-year-old male with a history of hepatitis C and alcohol abuse with cirrhosis, who underwent a liver transplant in [**2176-3-9**]. His transplant was complicated by a biliary leak and a septic knee with orthopedic washout. Mr. [**Known lastname 19672**] had been discharged just a few days prior to his presentation. He had been discharged to a rehabilitation facility after an extended stay after his liver transplant here. In his previous stay, he had been treated with multiple ERCPs as well as stents. He also had a drain placed and a washout of his knee as noted above. He now presents with two days after his discharge to rehabilitation with fevers and chills to 101.9. He denies any abdominal pain. No nausea or vomiting. No dysuria, no cough, and no diarrhea. He denies no changes in his baseline left knee pain. MEDICAL HISTORY: 1. Hepatitis C and alcoholic cirrhosis, Childs Class C. 2. Status post orthotopic liver transplant in [**2176-3-9**]. 3. Status post septic left knee joint washout. 4. Portal gastropathy. 5. Grade II varices. 6. Ascites. 7. Multiple episodes of spontaneous bacterial peritonitis. 8. Multiple episodes of encephalopathy. 9. Type 1 diabetes. 10. Gastroparesis. 11. Chronic renal insufficiency. 12. Osteoporosis. 13. Diverticulitis. 14. Status post hemicolectomy secondary to diverticulitis. MEDICATION ON ADMISSION: 1. Neoral 150 mg po bid. 2. Insulin-sliding scale as well as 18 units of NPH am and 18 units NPH pm. 3. Lasix 40 mg po bid. 4. Prednisone 50 mg po q day. 5. CellCept 1,000 mg po bid. 6. Nystatin swish and swallow 5 mg po qid. 7. Vicodin prn. 8. Fluconazole 400 mg po q day. 9. Trazodone 7.5 mg po q hs. 10. Actigall 300 mg po tid. 11. Valcyte 450 mg po q day. 12. Protonix 40 mg po q day. 13. Bactrim one tablet one q day. ALLERGIES: Ceftriaxone and questionable Heparin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 7111**] is a 76 year-old male with multiple medical problems including diabetes type 2, hypertension, hypercholesterolemia, PMR, prostate cancer with a chronic indwelling Foley, anemia, nephrolithiasis, gout who presents with slurred speech, right arm weakness and edema. History was difficult to obtain in the Emergency Department. Apparently this slurred speech and ________ was worked up at the [**Hospital6 1708**] four days ago. He had return of these symptoms. He is status post prostate cancer with radiation therapy. He has had a chronic indwelling Foley for obstruction and is followed by [**Hospital6 **] Urology. His friend states that the patient's Foley stopped draining urine four days ago and had immediate onset of symptoms. He denies fever, cough, shortness of breath, abdominal pain. In the Emergency Department the Foley was draining brown opaque questionably feculent urine material irrigated by urology with a clot removal and hematuria. The patient had a blood pressure drop to 84/41 and received 4 liters of intravenous fluids and found to have a hematocrit of 20. He was transferred to the Intensive Care Unit and received 4 units of packed red blood cells and was on Vasopressin for one day. MEDICAL HISTORY: 1. Type 2 diabetes. 2. Hypertension. 3. Hypercholesterolemia. 4. PMR. 5. Prostate cancer in [**2164**] status post radiation therapy. 6. ETOH abuse distant. 7. Anemia iron deficient. 8. Gout. 9. Nephrolithiasis with acute renal failure. 10. Chronic indwelling Foley secondary to the prostate cancer. MEDICATION ON ADMISSION: ALLERGIES: He is intolerant to ace inhibitors, which causes a cough. MEDICATIONS ON [**10-30**] VIA PRIMARY CARE PHYSICIAN: 1. Lopressor 100 b.i.d. 2. Thiazide 50 b.i.d. 3. Diovan 320 q.d. 4. Aspirin. 5. B-12. 6. Iron sulfate. At the [**Hospital6 1708**] on the discharge summary he was also noted to take Allopurinol 300 q.d., Colchicine .6 q.d., NPH 50 units in the morning and 7 units in the evening, insulin sliding scale, Lisinopril 5 q.d., Toprol XL 100 q.d., Zocor 20 q day. Prednisone taper, which was off. PHYSICAL EXAMINATION AT [**Hospital6 **] AS PER THE CHART: Temperature 97.7. Heart rate 86. Blood pressure 81/44 increased to 104/52 with 4 lites of intravenous fluid, breathing at 22, 100% on room air. He is in no acute distress. He is pale, cachectic. Pupils are equal, round, and reactive to light and accommodation. Extraocular movements intact. Mouth was without lesions. He had distant heart sounds, regular rate and rhythm. 1 out of 2 systolic murmur at the apex radiating to the axilla. Regular rate and rhythm. Distant heart sounds. Clear to auscultation bilaterally. No rales, wheezes or rhonchi. Abdomen soft, nondistended. Erythematous skin in his penis with the Foley in place draining clear yellow urine with clot. He had no clubbing, cyanosis or edema. 2+ dorsalis pedis pulses bilaterally. Skin he had large complex nevi on the left cheek. Neurological cranial nerves II through XII were intact. His speech was slow, somewhat slurred and cephalopathic like. 5 out of 5 lower extremity and upper extremity strength with 5- out of 5 on the right upper extremity. LABORATORIES ON [**Hospital6 **]: White blood cell count 23.2. Hematocrit 28.7 and went down to 21.5 with 4 liters of intravenous fluid. Platelets 333, MCV 89, 133/44, 95/16, 122/5.6, glucose 179, anion gap 22, ALT 10, AST 25, alkaline phosphatase 90, lipase 40, amylase 44, total bilirubin .4, albumin 2.7. Calcium 8.9, magnesium 2.1, phosphorus 8.3, INR 2.4, PTT 36.7. Arterial blood gas done in the Emergency Department 7.35/22/122, lactate 3.5. He had a urinalysis with brown cloudy urine with 50, moderate leuks, positive nitrate, protein 100, many bacteria and this ended up growing out VRE. The patient was treated with Linezolid for a full course for this VRE. The patient had a head CT without contrast, which showed no mass effect or hemorrhage in acute setting. It did show subacute risks of chronic infarcts. CT of the abdomen and pelvis showed atelectasis and dependent lung zone, gallbladder was distended, bilateral hydronephrosis and hydroureter, bilateral fat stranding surrounding the kidneys, marked bladder wall thickening with possible diverticula. Three large stones were seen in the urinary bladder 1.5 by 1.2 cm. The sigmoid colon directly abutted the thickened urinary bladder wall. The follow up that was recommended was a CT cystogram or fluoroscopic examination for possible rectovesicular fistula. Chest x-ray was negative for pneumonia or congestive heart failure. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: Mr. [**Known lastname 18252**] is an 84 year old man with hx of COPD, Afib, PE on warfarin, s/p remote cholecystectomy, presented to OSH with one day of worsening sharp epigastric pain and nausea, found to have transaminitis and stones in CBD by imaging at [**Hospital **] transfered to [**Hospital1 18**] for ERCP, now also with hypoxia. Patient recalls epigastric pain starting at 9am yesterday morning. He does not recall the severity or quality of the pain at this time and how it progressed, but daughter states that he was able to attend a church function yesterday during day prior to presenting to ED. [**First Name4 (NamePattern1) 392**] [**Last Name (NamePattern1) **] reports that patient has had this pain before, usually subsiding with gingerale or simethicone, but no relief on night of presentation. He was taken to OSH by ambulance around midnight. Abdominal pain localizes to epigastrum, RUQ and LUQ, radiates to back, was [**10-7**] at its worst. He endorsed nausea, no vomiting. He denies any association with food. Denies fevers/chills. Had one episode of loose brown stool yesterday. . At OSH ED, he was given 1mg dilaudid to which he became difficult to arouse, so he was given narcan. He was noted to otherwise be pleasant, alert and oriented. Rhythm in Afib, rate 90s, stable blood pressures in 110s-120s, remained afebrile and hemodynamically stable, saturating well on room air. He did have several episodes of desaturation secondary to pain, improved with deep breath and pain relief. TBili initially noted to be 1.5, increased on recheck to 3.9 with direct bili 3.5; ast/alt 233/133; wbc 6; INR 5.8. ABG at OSH reportedly 7.18/79/89/29.5 after somnolent from dilaudid. CT revealed pneumobilia and choledocholithiasis, moderate to severe bilateral intrahepatic duct dilatation; CBD 16 mm; abrupt cutoff at distal CBD. Decision was made to transfer to [**Hospital1 18**] for ERCP. At [**Hospital1 392**], he was given D5_1/2NS with 20meq K at 100cc/hr, 10u subq vitamin K, 4 bags total of FFP. He was also given 4mg of IV morphine prior to transfer. OSH ED notes listed antibiotics in plan, but no record of whether patient received antibiotics. . . On arrival to the ICU, patient appeared comfortable in bed, wearing 50% venti mask. Reports pain has subsided somewhat and is tolerable. Abdominal pain located in entire epigastrum, radiates right to left and to the back; it is worsened with deep breaths. Reports some mild dyspnea on exertion and shortness of breath at baseline but nothing increased recently. Last bowel movement yesterday. Reports coughing up sputum today x 1 and swallowing it afterwards; has chronic morning cough, sometimes mildly productive, does not appear to be changed from baseline. Shortness of breath also at baseline, does not feel that it has increased. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies new cough. Denies chest pain, chest pressure, palpitations, or weakness. Denies vomiting, constipation. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: COPD Afib/Aflutter Right bundle branch block PE s/p IVC filter (on warfarin) thoracic aortic aneurysm s/p AAA repair Diverticulosis hx TIA - yr [**2164**] Headaches - ?migraine Bilateral inguial hernia (with omental fat) Hiatal hernia GERD Squamous Cell Carcinoma (localized) . Past Surgical History s/p Aortic graft [**2155**] s/p Right lobectomy (?partial) [**2155**] s/p cholecystectomy [**2133**] s/p sphincterotomy [**11/2173**] s/p tonsillectomy [**2096**] s/p left inguinal hernia repair [**2167**] s/p R meniscus repair [**2160**] circumcision [**2162**] s/p left cataract surgery [**2172**] oral papilloma removed [**2163**] Left sinus drainage window [**2149**] Septum Resection [**2155**] MEDICATION ON ADMISSION: atenolol 25mg daily HCTZ 25mg daily warfarin - 5mg Sun/Tue/Wed/[**Last Name (un) **]/Sat ; 2.5mg Mon/Fri hydroxyzine Hcl (Atarax) ?25mg vs ?10mg [**Hospital1 **] pepcid AC 20mg daily calcium 600mg daily MVI 1 tab daily vitamin C 500mg daily docusate 100mg latanoprost both eyes QHS fioricet prn benfotiamine 150mg lamisil cream - feet ALLERGIES: Latex PHYSICAL EXAM: On Admission: Vitals: T: 97.6F BP: 108/72 P: 94 R: 21 O2: 94% on 50% FiO2 by face mask (88% on 2L) General: tired, but alert when speaking to him, oriented, no acute distress HEENT: Sclera mildly icteric, pink conjunctiva, dry mucus membranes wearing face mask, oropharynx clear Neck: Lungs: limited air movement, rales bilateral bases, right>left CV: irregular rhythm rate 90s Abdomen: soft, moderately distended, decreased bowel sounds, + tenderness over epigastrum/RUQ/LUQ, mild tenderness diffusely elsewhere, no rebound tenderness ; well healed midline scar and right costochondral scar GU: + foley Ext: warm, well perfused, palpable DP pulses, no peripheral edema Skin: does not appear to be jaundiced FAMILY HISTORY: NC SOCIAL HISTORY: Lives alone in [**Location (un) 38**]. Daughter [**Name (NI) **] HCP lives in [**Name (NI) 3320**]. - Tobacco: Smoked for about 30-40 yrs, and quit about 35 yrs ago. Smoked at most up to 1.5ppd, switched to mini cigars for a few years before he quit. - ETOH: quit when he started taking warfarin. - No illicits.

CHIEF COMPLAINT: Hyperglycemia PRESENT ILLNESS: 27 y/o male with approximately one month of polyuria and polydipsia who was sent in from clinic with glucose and ketones in his urine with concern for new-onset diabetes. Patient also reported blurred vision. Otherwise has been healthy in the past with only history of mild dyslipidemia (by report). Denied any abdominal pain, nausea, vomiting, or diarrhea. Further denied any fevers, chills, dysuria, or hematuria. No neurological symptoms including numbness or tingling. . In the ED, the patient was found to have ketotic breath on arrival. Initial vitals were T:96.5, HR:109, BP:160/84, RR:17, SO2:100%. He was found to have a serum glucose of 485, an anion gap metabolic acidosis (AG = 24) and a serum potassium of 3.3. UA with Gluc 1000 and Ketones of 150. The patient was started on an inuslin drip at 8 Units/hr and received Potassium 40 mEq IV and 40 mEq PO. The drip was subsequently decreased to 5 Units/hr and then to 2 Units/hr when the blood glucose reached 259. The patient received a total of 3 liters of fluids (NS + D5 1/2 NS) in the ED. . MEDICAL HISTORY: Hyperlipidemia MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam: VS: T:98.5, BP:107/63, HR:71, RR:19, SO2:99%RA GEN: Comfortable-appearing, NAD HEENT: Moist mucus membranes, flat neck veins, no TM RESP: Unlabored respirations, CTAB CV: RRR, normal S1 and S2, no m/r/g ABD: S/NT/ND, BS+ EXT: No clubbing, cyanosis or edema SKIN: No rashes/no jaundice/no splinters NEURO: AAOx3, CN II-XII intact, strength 5/5 throughout, sensation intact to light touch FAMILY HISTORY: Grandmother and uncle with diabetes. Mother with ? hemochromatosis. SOCIAL HISTORY: Occassional smoker, social drinker (no alcohol in over two months), and no other substances.

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: [**Age over 90 **]yo F with h/o CAD, dCHF, symptomatic bradycardia s/p PPM, severe pulmonary hypertension admitted from [**Hospital **] rehab with cough, SOB and hypotension today. Per records and signout from [**Hospital **] rehab patient initially had ST and cough on [**7-5**]. Was afebrile and treated with robutussin [**7-6**]. Then overnight on [**7-7**] noted to be hypotensive (89/59 ->80/50) with )2sat 70% on RA->88% on 2LNC. Patient was placed on NRB and BP dropped precipitously to 69/30 so she was given 500mL bolus at [**Hospital **] rehab but was not responsive (BP 70/37, HR 77 RR 24, [**Last Name (un) **] 100% NRB) and was subjectively more SOB so sent to ED. In the ED, initial vs were: T 98.6 85 120/34 28 100 on NRB. Then had fever to 100.8. CXR showed RLL PNA and patient was given vanc and levoquin as well as 1L NS however BP continued to "dwindle" and patient was more and more dyspneic so she was given succinylcoline, etomidate, versed, and fentanyl and then intubated and a CVL was placed in left IJ. EKg was reportedly with inferior STD thought [**12-30**] demand from increased work of breathing. Started on levophed drip for persistent hypotension and thoguht sepsis vs chf. . Review of systems: unable as intubated/sedated MEDICAL HISTORY: - Severe pulmonary HTN, severe TR, RV dysfunction and normal LV function - Symptomatic bradycardia s/p pacemaker implantation - HTN - Renal insufficiency - Chronic venous stasis - Recurrent leg cellulitis - Gout - Morbid obesity - s/p TAHBSO - OA MEDICATION ON ADMISSION: Oxycodone 2.5mg [**Hospital1 **] Ativan 0.5mg daily at night and Q6H PRN anxiety APAP 650mg daily Sorbitol 15mL daily Calcium 1300mg daily colace 100mg daily Omeprazole 20mg daily Nitro 0.3mg PRN Aspirin 81mg daily Metolazone 2.5mg 3 x weekly (M/W/F) Allopurinol 100mg QOD Mag hydroxide 30ml daily PRN Lasix 40mg M/W/F Ergocalciferol 5000units Q21days guiafensin PRN ALLERGIES: Keflex PHYSICAL EXAM: Vitals: T: 98.7 BP:108/38 P:89 R: 18 O2:100 on TV 400 X 14 FIo2 60 peep 8 General: intubated/sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP to earlobe Lungs: crackles bilateral bases CV: Regular rate and rhythm, normal S1 + S2 Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ edema FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death SOCIAL HISTORY: lives at [**Hospital **] rehab. demented but reportedly A+OX 3 in ED last night. wheelchair to ambulate. unmarried. denies tobacco or EtOH use.

CHIEF COMPLAINT: Inability to decannulate trach PRESENT ILLNESS: Ms. [**Known lastname 78098**] presents for evaluation of tracheobronchomalacia and possible decannulation of tracheostomy tube. MEDICAL HISTORY: s/p trach (7 years ago, failed to extubate p hip surgery), COPD, DJD, MRSA PNA ([**10-11**]), Vtach ([**7-/2174**]), s/p multiple hip surgeries, GERD, DMII, atrial stenosis, +Ab for transfusions MEDICATION ON ADMISSION: Meds at Home: OxyContin 30", Protonix 40', Duragesic 100mcg q72h, Lasix 60', Coumadin 2', Robaxin 500' x 10d, glimepiride 4", Duoneb q6, KLor 20", Klonopin 1', Percocet prn, Combivent prn, Mylanta prn, albuterol prn, Proventil prn, ferrous sulfate 325', Cardizem 360' Meds on Transfer: Compazine prn, Lopressor 50", prednisone 20", Lovenox 130", Lasix 60', Neurontin 300", Ativan prn, OxyContin 30", ferrous sulfate 325', Cardizem 360', clonazepam 1', Xopenex prn, Atrovent prn, NG 0.4 prn, Lantus 20U qhs, clinda 600''' ([**1-18**]), ceftaz 1''' ([**1-18**]), prochlorperazine prn, ISS, Duragesic 100mcg q72h, Protonix 40', KLor 20" ALLERGIES: Cephalosporins / Vancomycin / Quinolones / Sulfa (Sulfonamides) / Latex / Adhesive Tape / Vantin / Cefpodoxime PHYSICAL EXAM: 97.1, HR 107, BP 107/60, RR17, 02 100% with trach mask General: 57 year-old female trached in no apparent distress HEENT; normocephalic Neck: trach in place site clean dry intact, no erythema or discharge Card: A-fib/A-flutter Resp: breathing comforbably with trach GI: obese, bowel sounds positive, abdomen soft NT/ND Extr - severe edema BLE, R leg open wound w/d dressing s/p hematoma evacuation Incision: RLE Neuro: non-focal FAMILY HISTORY: non-contributory SOCIAL HISTORY: Married lives with family Tobacco: 30 pack-year quit [**2174**]

CHIEF COMPLAINT: wound drainaige and dehiscence PRESENT ILLNESS: 58F with complicated PMH s/p open procedure [**6-13**] for L2 fracture-dislocation. Presented on [**7-5**] with 2 days of "wetness" on her back, +chills, no fevers, no new weakness or paresthesias. MEDICAL HISTORY: -afib -DM2 -peripheral neuropathy -lumbosacral radiculopathy -breast cancer [**2088**], s/p XRT/chemo -cervical cancer [**2084**] -thrombocytopenia, treated with Rituxin [**2092**] at [**Hospital1 2025**] (Dr. [**Last Name (STitle) **] -anemia -anxiety and depression -s/p CCY -s/p splenectomy MEDICATION ON ADMISSION: albuterol inhaler Fosamax Xanax 2 mg QHS and 0.5 mg PRN Cymbalta 30 mg daily Advair diskus [**Hospital1 **] lidocaine patch folate synthroid 25 mcg daily lisinopril 2.5 mg daily Topamax 600 mg [**Hospital1 **] Requip 0.5 mg QHS reglan 10 mg daily metoprolol tartate 25 mg TID omeprazole 20 mg daily oxycodone ER 40 mg [**Hospital1 **] and IR 5 mg q4 prn pain HISS Lovenox ppx bowel regimen ALLERGIES: Ampicillin / Indocin / adhesive tape / Penicillins / Tetracycline / Levaquin / Prednisone / Neurontin PHYSICAL EXAM: PE: 96.4 62 112/45 16 98% NAD, AOx3 Inferior posterior lumbar wound dehissence with erythema without crepitus or induration, staples removed, sutures in fascia exposed, yellow discharge. Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] L 5 5 5 5 5 5 5 3* 5 5 5 5 5 R 5 5 5 5 5 5 5 3* 5 4+ 5 5 5 hip adduction 5- bilaterally but with *giveway weakness/pain, hip abduction 5 bilaterally FAMILY HISTORY: mother died of lung cancer, father died of DM and renal failure SOCIAL HISTORY: widowed, lives alone but has not lived at home since [**Month (only) 958**], has been at [**Hospital3 **]. Quit smoking [**2101-3-10**]. No EtOH or illicits.

CHIEF COMPLAINT: Right pleural effusion. For complete history and physical, please refer to the notes written by Dr. [**Last Name (STitle) **] on [**2153-11-25**]. In brief, the patient is a 63-year-old woman who has undergone a combined liver, kidney transplant who has had recurrent right pleural effusions that had been managed by repeat thoracenteses. She is currently in the hospital for management for urinary tract infection and has planned to undergo an umbilical hernia repair by the transplant service. They have asked if we would consider performing a talc pleurodesis in the same setting. I discussed with the patient the anticipated procedure. We reviewed the possibility that lung may not expand and a decortication may be required. We also discussed the possibility that the effusion may recur despite pleurodesis. We also discussed other risks of the operation and include bleeding, infection, pneumonia, and death. She is willing to proceed and we will schedule for surgery for tomorrow [**2153-11-28**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(2) 32450**] PRESENT ILLNESS: 63F s/p liver/kidney transplant [**7-17**] requiring multiple courses of plasmapheresis for desensitization, c/b splenic venous thrombus, recurrent MDR UTI (ESBL Klebsiella) s/p course of ertapenem, right pleural effusion requiring thoracentesis. Now p/w 3 day history of dysuria, 1 day history of abdominal and flank pain, nausea, vomiting and chills. She denies diarrhea, states she has been eating normally, and states her urine output has decreased over the last several days. She also complains of a worsening cough. MEDICAL HISTORY: PMH: NASH, esophageal varices, ascites, aenmia, thrombocytopenia, ESRD, T2DM, CDiff, seizures, meningioma, HTN, GERD, OSA, ?RLS, nekc DJD, dermoid cyst, R adrenal mass MEDICATION ON ADMISSION: Medications - Prescription AMLODIPINE - (Dose adjustment - no new Rx; recording) - 5 mg Tablet - 2 Tablet(s) by mouth once a day CITALOPRAM - 20 mg Tablet - 3 Tablet(s) by mouth daily FUROSEMIDE - 40 mg Tablet - 2 Tablet(s) by mouth once a day HYDROCODONE-ACETAMINOPHEN - (discharge med) - 5 mg-500 mg Tablet - [**2-9**] Tablet(s) by mouth every four (4) hours as needed for abdominal pain given # 20 on [**11-10**] LEVETIRACETAM - 500 mg Tablet - 1 Tablet(s) by mouth twice a day LORAZEPAM - (discharge med) - 0.5 mg Tablet - 1 Tablet(s) by mouth HS (at bedtime) as needed for anxiety METOPROLOL TARTRATE - (Dose adjustment - no new Rx; discharge med) - 50 mg Tablet - 1 Tablet(s) by mouth twice a day MYCOPHENOLATE MOFETIL - 250 mg Capsule - 1 Capsule(s) by mouth twice a day OMEPRAZOLE - 40 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth once a day PREDNISONE - 5 mg Tablet - 1.5 Tablet(s) by mouth DAILY (Daily) TACROLIMUS [PROGRAF] - (Dose adjustment - no new Rx; d/c meds) - 1 mg Capsule - 3 Capsule(s) by mouth twice a day TRAZODONE - 50 mg Tablet - 0.5 Tablet(s) by mouth twice a day as needed for anxiety TRIMETHOPRIM-SULFAMETHOXAZOLE - 400 mg-80 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily) WARFARIN - (Prescribed by Other Provider) - 3 mg Tablet - 1 Tablet(s) by mouth daily Medications - OTC DOCUSATE SODIUM - (d/c med) - 100 mg Capsule - 1 Capsule(s) by mouth twice a day INSULIN REGULAR HUMAN [NOVOLIN R] - 100 unit/mL Solution - per sliding scale four times a day NPH INSULIN HUMAN RECOMB [NOVOLIN N] - (Dose adjustment - no new Rx; d/c meds) - 100 unit/mL Suspension - 30 units at 7am once a day ALLERGIES: Erythromycin Base / Indomethacin / Actonel / Reglan PHYSICAL EXAM: 98.1 72 169/62 24 98 (T 101.1 on arrival) uncomfortable RRR, diminished R sided lung sounds scattered left basal crackles, abdomen + RUQ tenderness and tenderness over graft site, incisions c/d/i, non peritoneal, reducible abdominal hernia, 1+ edema bilateral lower extremities. FAMILY HISTORY: NC SOCIAL HISTORY: SOCIAL HISTORY: Widowed, lived in [**Hospital3 2065**] although most recently has been at rehab. Has 4 children, several in MA. Smoking: None; EtOH: Never; Illicits: None

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 54-year-old white male who has a past medical history of coronary artery disease. He presented to an outside hospital with complaints of chest pain for four hours and associated shortness of breath, nausea, vomiting, and diaphoresis. He was referred to [**Hospital1 1444**] for a cardiac catheterization. MEDICAL HISTORY: Significant for a history of hypertension, history of hypercholesterolemia, history of obesity, status post tonsillectomy, and status post hernia repair. MEDICATION ON ADMISSION: Atenolol 100 mg by mouth once daily, Lipitor 20 mg by mouth once daily, Tums as needed, Prozac (which he is currently not taking), and Ambien at bedtime. ALLERGIES: He has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for coronary artery disease. SOCIAL HISTORY: He lives with a roommate and is unemployed. Currently taking a work employment retraining course. He does not smoke cigarettes. He does not drink alcohol.

CHIEF COMPLAINT: Upper GI bleed PRESENT ILLNESS: 64yo man with advanced colon cancer on chemo/radiation (dx 1.5 yrs ago), s/p repeat surgery 6 months ago, presented to the ED with one week of progressive N/V/D, weakness, coffee ground emesis and black stools. He has been unable to tolerate POs for 1 week and has been getting IV fluids at home. Also with weakness, exertional dyspnea, intermittent chest pain approximately 2 days ago, which has since resolved. The patient states that he has a tumor pushing on his stomach and another on his abdominal wall. His most recent EGD in [**Month (only) 116**] showed esophagitis, semi-solid food material, and extrinsic compression of antrum. His previous colonoscopy in [**Month (only) 958**] showed noduar mucosa at anastamosis, and a biopsy showed adenoCa. He underwent a laporotomy in [**Month (only) 116**] with diffuse metastatic disease, Bx of abdominal wall mass showed metastatic adenoCa. In the ED, he was tachycardic with HR 100 to 110s, hypotensive BP 90s/70s, which responded to SBP 120 with IV fluids. Exam was notable for a frail patient with dry MM, abdominal tenderness at scar on abdomen, bilateral edema. Labs were significant for Hct 27.9 (baseline mid-20 to mid 30s), WBC 20.0 (91% PMNs), BUN 34, Cr 1.0, HCO3 42, K 2.3, lactate 2.9, normal LFTs, positive UA. He was admitted to the OMED medicine service, where he had a drop in hematocrit from 27.9 to 23.8. Plt 365. He threw up 400cc of maroon colored / coffee ground emesis. GI assessed, and recommended transfer to the [**Hospital Unit Name 153**] for EGD in the AM. The patient received 2 units pRBCs before transfer to the [**Hospital Unit Name 153**]. Upon transfer to the [**Hospital Unit Name 153**], his vitals were T 97.3, BP 119/86, HR 07, RR 18, O2 95% /RA MEDICAL HISTORY: PAST ONCOLOGIC HISTORY: - [**6-/2169**] developed nausea, vomiting diarrhea - saw GI and decided on watchful waiting - [**8-/2169**] developed worsening abdominal pain, N/V intermittently - [**9-/2169**] KUB consistent with SBO, CT scan showing poa[**Name (NI) 28210**] large bowel obstruction with concern for mass - [**2169-10-2**] exploratory laparotomy with right hemicolectomy and ileocolic anastomosis. Tumor in proximal transverse colon with no intra-abdominal findings to suggest metastatic disease; pathology showed that tumor invaded through muscularis propria Specifically, the tumor was invading through into the subserosa or the non-peritonealized pericolic or perirectal soft tissues and so it was pathologically stage T3. 21 lymph nodes were examined and 2 out of the 21 were positive for malignancy and so he had a pathologic N1B disease. - Received 3 cycles of FOLFOX that was changed to 5FU/LEUCOVORIN due to allergic reaction to the oxaliplatin. Complete 6 cycles of chemotherapy on [**4-24**]. Last cycle was incomplete. - [**3-/2171**]: CT: disease recurrence at prior surgical site - [**2171-5-20**]: operation:unresectable tumor, peritoneal spread and carcinomatosis - [**2171-6-19**]: start on irinotecan 125mg/m2 3 wks on/1 wk off MEDICATION ON ADMISSION: - AZELAIC ACID [FINACEA] 15% Gel apply to face twice a day. - CITALOPRAM 10 mg - DOXYCYCLINE 100 mg twice a day - ERGOCALCIFEROL (VITAMIN D2) - 50,000 unit capsule - weekly - LORAZEPAM - 0.5 mg tablet - [**1-14**] Tablet(s) Q4H PRN - OMEPRAZOLE - 20 mg capsule daily - ONDANSETRON HCL - 4 mg tablet daily - POTASSIUM CHLORIDE - 20 mEq tablet daily - PROCHLORPERAZINE MALEATE - 10 mg tablet Q6H PRN nausea - TADALAFIL [CIALIS] - 20 mg tablet Q36H hours prn - TRETINOIN [ATRALIN] - 0.05 % Gel - Pea sized amount at bedtime ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Vitals: T 97.3, BP 119/86, HR 07, RR 18, O2 95% /RA General: Alert, oriented, pleasant man, appears chronically ill but in in NAD. HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Tachycardic, normal S1 + S2, 3/6 systolic murmur heard best over RUSB Lungs: Appears nonlabored on RA. Good air movement with coarse expiratory rhonci which clear with cough. Abdomen: soft, non-distended, tender irregular mass palapated just right of midline in epigastrum. bowel sounds present, no organomegaly, no rebound or guarding GU: no foley Ext: Warm, well perfused, left leg markedly more swollen than right. Neuro: AAOx3. CNII-XII intact, moving all extremities with equal strength against gravity, grossly normal sensation. FAMILY HISTORY: Denies history of malignancy or bleeding diathesis SOCIAL HISTORY: Retired school teacher. Former smoker, quit in [**2169**]. Also quit EtOH in [**2170**]. Denies illicits. Two grown children in the area. Wife is his HCP.

CHIEF COMPLAINT: ascites PRESENT ILLNESS: 63 M with cryptogeneic cirrhoiss with complications of hepatic encephalopathy, varicies, CAD, DM 2, who presents with 3-4 weeks of increasing abd girth. He has had 2 prior taps, one with 8 L removed another 3 weeks ago with 6 L removed. Three days prior he fell on his back with no LOC, some LBP. He denies jaundice, confusion, tremor or change in bowel habits. Mild nausea this morning but no vomiting. No F/C/SOB/CP. In past, he has had SOB when ascites was even greater. No LE edema or cough. Frustrated by poor medical options given his liver disease and concominant heart disease. Came from home for further evaluation and possible TIPS procedure. Of note, his liver disease was found after he had bloody emesis in [**2117**]. MEDICAL HISTORY: 1. Cryptogenic Cirrhosis (from Dr.[**Initials (NamePattern4) 1369**] [**Last Name (NamePattern4) **] note [**1-2**]) [**10/2118**] liver bx: portal and periportal PMN inflammation grade 2, periportal and portal fibrosis stage 3 [**3-30**] liver bx: grad 2 portal and periportal PMN,, mildly predominant macrovasc. statosis and inc in portal and focal periportal fibrosis (stage 2-3) [**6-1**] EGD: recurrent espoh. varicies, 4 bands placed, portal gastropathy [**11-1**] MRI: mod cirrhosis with splenomegaly and splenic varicies, perihep/splenic fluid, nonoccl thrombus in med [**Last Name (un) **] of left portal and ant branches of right protal vein, 4mm arterial ehancement in right liver lobe [**12-1**] CT abd: espohageal, gastrohepatic, [**Last Name (un) 22392**]. varicies, cirrhosis, splenomegaly, min ascites, cholelithiasis, simple right kidney cortical cyst 2. DM 2 with neuropathy 3. Sinusitis 4. Depression 5. CAD: at [**Hospital3 **] had positive stress test, cath showed 3 VD, no intervention MEDICATION ON ADMISSION: effexor 75 mg qd/37.5 mg prn, flagyl 250 mg [**Hospital1 **], ambien 10 mg [**Last Name (LF) **], [**First Name3 (LF) **], zetia 10 mg qd, provigel 100 mg qd, prevacid 30 mg [**Hospital1 **], lactulose 60 cc qd, NPH 46 u qam/44 u qhs, SS humalog; aldactone and lasix d/c ([**11-26**]) ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: Temp 97 4 BP 100/60 Pulse 79 Resp 18 O2 sat 100% RA Gen - Alert, no acute distress, tired HEENT - PERRL, extraocular motions intact, anicteric, mucous membranes moist Neck - JVP 7 cm, no cervical lymphadenopathy Chest - Clear to auscultation bilaterally CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops Abd - + BS, distanded abd, + fluid wave, NT, uable to feel liver or spleen on exam, marked "X" for tap Back - No costovertebral angle tendernes, non tender spine, no ecchymosis Extr - No clubbing, cyanosis, trace ankle edema. 2+ DP pulses bilaterally Neuro - Alert and oriented x 3, cranial nerves [**2-10**] intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact, no asterixis Skin - No rash FAMILY HISTORY: NC SOCIAL HISTORY: College educated with degree in chemistry. Worked as a plant manager for many years, short term jobs since then for 10 yrs, now on full time disability, 3 children, sons 37, 24; daughter 32; married for 37 years to current wife

CHIEF COMPLAINT: hypotension, abdominal pain transfere from OSH PRESENT ILLNESS: 39 yo woman with h/o AML s/p related allo-PSCT [**2118**], chronic GVHD, on prednisone, cellcept, h/o CAD s/p MI and stents, h/o R brachiocephalic DVT who was in her USOH until about 1300 today when she developed acute onset of mid abdominal pain after eating a few bites of her meal. She described her abdominal pain as sharp and crampy at the same time, non-radiating. Immediately following the onset of abdominal pain, she became diaphoretic, felt weak, and complained of tingling in bilateral lower extremities. She then developed shortness of breath with associated chest pain. Her husband [**Name (NI) 47658**] her down and called the ambulance which brought her to the [**Hospital 8**] hospital. On presentation to the OSH VS 97.0; HR 57; BP 60/palp; RR 24; O2 sat 86% on RA (96% on NRB). ABG 7.23/46/22. Labs notable for Lactate of 11. BUN 17. Creat 0.8. Glucose was 558. AG 15. Urine ketones and urine gucose negative. Right femoral central venous catheter was placed. At the OSH, she received IVF, Hydrocortisone 100 mg IV once, Ertapenem 1 gm IV, had a KUB, CT chest and abdomen. She was also started on Insulin gtt. Bedside echo EF 55%, limited study, but no effusion noted or flow abnormalites detected. CT chest showed PE. Surgery was consulted and recommended conservative management with serial exams. The patient was started on heparin gtt with a bolus and transfered to [**Hospital1 18**]. . Upon arrival to [**Hospital1 18**] ED initial VS HR 87; BP 108/70; O2 SAT 99% on 100 % NRB. Lactate down to 3.9. K low 2.5. Glucose 280. The patient was given Morpine 2 gm IV, D51/2 NS c 40 mEq KCL. Blood cultures were drawn. Insulin and heparin gtt were stopped (PTT >150). General surgery was consulted given findings of GB wall thickening on CT from the OSH. They did not feel that she had an acute abdomen. . Currently, the patient c/o mid abdominal pain about [**5-21**], non-radiating. She denies any chest pain, shortness of breath, dizziness, lightheadedness, diaphoses, nausea or vomiting. She had loose BM today after CT scan contrast at the OSH, but otherwise denies diarrhea, melena, or hematochezia. . MEDICAL HISTORY: 1. AML: diagnosed [**4-14**] s/p allo-HSCT in [**10-14**] (sister was donor) Cytoxan/MTX/TBI 2. CAD s/p STEMI [**11-16**] with 2VD s/p DES in LAD, POBA D1 with BMS to mid D1. 3. GVHD: skin, gut (now controlled), mouth,liver- left hand digit amps x4, chronic immune suppression cellcept, entocort, prednisone, rituxan (last [**2121-8-22**]) . Chronic left upper extremity brachiocephalic DVT . ankle fracture in left ankle ~2.5 months ago. . asthma . eczema . migraine headaches . history of oral HSV MEDICATION ON ADMISSION: 1. Prednisone 20 mg po qd 2. Mycophenolate Mofetil 500 mg po qid 3. Acyclovir 400 mg po q 8hrs 4. Fluconazole 200 mg po bid 5. Lipitor 80 mg po qd 6. Folic Acid 1 mg po qd 7. Nexium 40 mg po qd 8. Clopidogrel 75 mg po qd 9. Aspirin 325 mg po qd 10. Atovaquone 750 mg/5 mL po bid 11. Lasix 20 mg po bid 12. Verapamil 180 mg Tablet po bid 13. Metoprolol Tartrate 100 mg po bid 14. Budesonide 3 mg po tid 15. Insulin Glargine 36 units qam 16. Humalog per sliding scale. 17. Nexium 40 mg po qd 18. MagOx 400 mg po bid 19. Potassium Chloride 20 mEq po qd . Allergy: Amoxicillin, Sulfa, Bactrim, Iodine ALLERGIES: Amoxicillin / Sulfa (Sulfonamides) / Bactrim / Iodine; Iodine Containing PHYSICAL EXAM: Upon presentation to the ICU: afebrile, 120 100/60 24 100% on NRB Gen: pleasant woman, + Cushingoid, lying in bed, NAD, breathing comfortably, speaking in full sentences HEENT: PERRL, no scleral icterus, mm dry, no lesions Neck: supple, no LAD, unable to assess JVD due to body habitus CV: regualar, nl S1S2, no murmur/rub/gallop Pulm: CTA bilaterally, ? pleural rub RLL Abd: + BS, soft, diffusely tender to palpation (L >R), ND Ext: bilateral 2+ LE edema, LE's warm, LEU with digits amputated. Neuro: alert and oriented x3, appropriate, moving all 4 extremities Skin: changes c/w GVH, hyperpigmentation of face, thick/tightened arm skin Rectal (per surgery note): trace guaiac + FAMILY HISTORY: no cad, mother died of cancer SOCIAL HISTORY: lives with husband and two sons (12yo, 14yo) mother-in-law on [**Location (un) 1773**]. no drink. smoking down to 2-3 cig per day. no illicit

CHIEF COMPLAINT: Shortness of breath. PRESENT ILLNESS: This is an 88-year-old female with severe chronic obstructive pulmonary disease with an FEV1 measured at 0.6 liters, on home oxygen, who was admitted to the hospital for chronic obstructive pulmonary disease flare. The patient has had recent multiple admissions over the past nine months for similar symptoms, requiring Intensive Care Unit stays. The patient now presents following several days of lethargy and upper respiratory infection symptoms accompanied by increasing shortness of breath and declining mental status to the point of somnolence with respiratory rate of 40. She was intubated in the field and brought to the Emergency Department where initial presenting gases were 7.24/119/161 with unknown ventilator parameters. She initially had a blood pressure of 99/48 with a pulse of 93 and then was noted to be hypotensive with pressure of 57/33 and a pulse of 63 and was given two liters of normal saline, one amp of Narcan, 125 mg of Solu-Medrol, 1 gram of ceftriaxone and started on a Dopamine 10 mcg/kg/minute drip with an increase in her blood pressure to 78/43 and a pulse of 83. While in the Emergency Department, a left subclavian triple lumen was placed, and a right radial arterial line. When the arterial line was placed, the blood pressure was noticed to be 120/64 with a pulse of 88, and the dopamine was weaned off in the next ten minutes. A transthoracic echocardiogram at the bedside showed normal left ventricular systolic function and no effusion. Chest x-ray showed emphysema and no infiltrate. MEDICAL HISTORY: Her past medical history is significant for chronic obstructive pulmonary disease with FEV1 of 0.66 and FVC of 1.36, ratio measured 78 percent of predicted. She is on three liters of oxygen at home via nasal cannula. She has a history of colon cancer, Duke stage A, status post low anterior resection in [**4-/2098**], status post seizure in [**2097**] from hyponatremia, syndrome of inappropriate diuretic hormone, osteoarthritis, lower back pain, osteoporosis, old lacunar infarct in the right corona radiata. Transthoracic echocardiogram in [**9-/2102**] showed ejection fraction of 60 percent with normal valves. MEDICATION ON ADMISSION: ALLERGIES: The patient is allergic to doxycycline. PHYSICAL EXAM: FAMILY HISTORY: Family history is positive for tuberculosis and lung cancer. SOCIAL HISTORY: The patient lives with her children. She has a history of smoking one pack per day for 20 years. She stopped 30 years ago. She has no occupational exposures. She is followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 216**]. Her pulmonologist is Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 217**].

CHIEF COMPLAINT: rectal cancer PRESENT ILLNESS: The patient is a 65yo male with a rectal mass that had appearance of a sizeable rectal cancer. His biopsy showed just an adenoma. His previous biopsy was complicated by significant bleeding. We did check the CEA, which was slightly elevated at 4.9. We did an MRI of the pelvis which most of the time tend to be one of the best studies which we can get, however, in his case because of absence of any fat in his body, it was really not diagnostic. He underwent an ultrasound today which was also very difficult, but showed may be a T2 lesion at best but some areas cannot be really well evaluated. He is complaining of some phlegm and some coughing that has been persistent and he is going to get an x-ray at your office tomorrow. Otherwise, he has been in the same health. He has occasional abdominal cramping and he is having some diarrhea. He occasionally passes some blood. He has been trying to eat, but unable to gain much weight. He presents for surgical staging with TEM. MEDICAL HISTORY: Past Medical History: HTN, COPD, PVD, 'abnormal heart beat' MEDICATION ON ADMISSION: 1. atorvastatin 20 daily 2. aspirin 325 daily 3. docusate sodium 4. oxycodone 5 prn 5. Daliresp 500 mcg daily 6. Symbicort 80-4.5 mcg [**Hospital1 **] 7. ProAir HFA 90 mcg 1-2 per day 8. Plavix 75 mg daily 9. atenolol 50 [**Hospital1 **] 10. lisinopril 20 daily 11. omeprazole 40 daily 12. nicotine 14 mg/24 hr Patch 24 hr daily 13. calcium carbonate 200 mg calcium TID prn 14. thiamine HCl 100 daily 15. acetaminophen prn ALLERGIES: Haldol / Penicillins PHYSICAL EXAM: At time of discharge 97.7 62 136/67 16 95RA NAD RRR breathing easily Abd soft, ND, NT, no R/G Ext no edema, R LE in multipodus boot FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives with daughter and her family. Heavy smoker 1.5 pack/day for 50 years, EtOH 4 beers/day, denies drugs

CHIEF COMPLAINT: Peripheral vascular disease and left foot two toe gangrene PRESENT ILLNESS: 84yF with known bilateral lower extremity vascular disease, seen as an outpatient and scheduled for angiogram and angioplasty. She was unable to make it into the hospital on her scheduled day secondary to inclement weather. She was noted to have a fever at her nursing home, and was sent to an outside hospital for evaluation. They then transferred her from the outside hospital to [**Hospital1 18**] for evaluation. MEDICAL HISTORY: MEDICATION ON ADMISSION: new: augmentin 500mgm tid x 7 days percocet tab 5/325mgm [**12-15**] q4-6h prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital signs: 97.6-100-24 97/46 oxygen saturation room air 97% General: no acute distress HEENT: no caroitd bruits Lungs: clear to auscultation bilaterally Heart: irregular irregular rythmn ABd: begnin PV: left ist and 2nd toe witrh ulcerations on dorasl aspect of toes with erythema to mid leg. Pulses: radial and femoral pulses 1+ bilaterally, distal [**Last Name (un) **] monophasic dopperable signal only bilaterally. Neuro: grossly intact FAMILY HISTORY: unknown SOCIAL HISTORY: Resident of [**Hospital6 59521**] Home nonsmoker or drinker

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 60-year-old female status post emergent coronary artery bypass graft on [**2189-6-18**] with left internal mammary artery to left anterior descending, saphenous vein graft to OM, saphenous vein graft to posterior descending artery with postoperative course complicated by pneumonia. Of note, mitral regurgitation noted in echocardiogram but no mitral valve replacement at the time of surgery. States USOH until today when patient noted left shoulder pain and acute shortness of breath. Patient came to the Emergency Department with saturations in the 80s on room air. Patient was placed on nonrebreather, then BiPAP, 100% with blood pressures 80-60 which change to 40-20. A right subclavian was placed in the Emergency Department and patient was placed on a dopamine drip. Patient was also started on a Levophed drip. Patient was intubated in the Emergency Department. Patient's electrocardiogram with ST depressions in V1 through V4 with T wave inversions. Patient was taken to the catheterization laboratory. At catheterization, there was found a left iliac artery which was found to be occluded, was stented. Then, all the coronary grafts were found to be occluded. Blood pressure, heart rates dropped to the 20s with a transvenous pacer and an IABP placed. Patient was maxed out on dopamine and Levophed. Epinephrine drip and dobutamine were started. Patient's arterial blood gas at that time was 6.99, 5197 and a bicarbonate drip was started. Patient was transferred to the Coronary Care Unit unresponsive. MEDICAL HISTORY: 1. Coronary artery disease, status post coronary artery bypass graft [**2189-5-24**]. 2. Hypertension. 3. History of congestive heart failure. Ejection fraction 40%, 3+ mitral regurgitation. MEDICATION ON ADMISSION: ALLERGIES: Questionable drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Ex tobacco user, no alcohol. Lived alone.

CHIEF COMPLAINT: PRESENT ILLNESS: This 47 year old obese male with a history of end stage renal disease of unclear etiology on hemodialysis since [**2194-3-20**] complains of shortness of breath and chills during hemodialysis on the day of admission. The patient was in his normal state of health which was poor at baseline until the day of admission. At hemodialysis the patient was found to have a increased white blood cell count of 17 and temperature of approximately 101. He was transferred from his outpatient dialysis unit to transplant surgery team at [**Hospital6 256**] for evaluation of his arteriovenous graft. During the month prior to admission the patient had positive cultures from his catheter at his hemodialysis for Methicillin-resistant Staphylococcus aureus. Initially the patient had a subclavian tunnel catheter that was found positive for Methicillin-resistant Staphylococcus aureus in [**2194-9-20**]. That line was discontinued and a left upper extremity arteriovenous graft was placed [**2194-10-10**]. The arteriovenous graft was used prior to maturation. On [**10-26**], the patient's left upper extremity arteriovenous graft was noted to have some purulent discharge, the patient had shakes and chills, however, was afebrile and had a normal white blood cell count. At that time the graft was cultured and Methicillin-resistant Staphylococcus aureus grew out on culture. The patient was started on Vancomycin and Gentamicin a few days later. He completed a 34 day course of Vancomycin and a 31 day course of Gentamicin prior to his admission at [**Hospital6 256**]. In addition, over the weeks prior to admission the patient had multiple blood cultures drawn for unclear reasons at hemodialysis that were positive for Vancomycin-resistant Enterococcus that were sensitive to Ampicillin and Penicillin. The patient was not treated for this Vancomycin-resistant Enterococcus. The blood cultures will mostly be drawn from the left upper extremity arteriovenous graft. On admission the patient also complained of increasing low back pain over the last three days. The patient has chronic low back pain at baseline. He has a history of a lumbar abscess/osteomyelitis that required surgical drainage and [**Location (un) 931**] rod placement in the thoracic through the lumbar spine to help with spinal stability in [**2184**]. The patient received a left upper extremity ultrasound which revealed a patent graft with some inflammatory changes but no fluid collection, however, there was a small thrombus outside of the graft itself. Blood cultures were drawn and a transesophageal echocardiogram was performed. The transesophageal echocardiogram showed a 2 by 1.2 cm pedunculated vegetation on the atrial side of the posterior leaflet of the mitral valve with moderate points for regurgitation and a mild stream of mitral regurgitation at the leaflet base indicating a small perforation. At that time, the patient was transferred to the General Medicine Team. Of note, the patient was seen at the dentist the day prior to presentation. The only procedure was done was that his dentures were put into place. There was no surgery performed. On admission the patient had severe asterixes and myoclonus. After approximately one and a half weeks of hospitalization with multiple dialysis treatments the symptoms seemed to resolve. Unclear of etiology, however, probably related to uremia. MEDICAL HISTORY: 1. The patient was in a good state of health until approximately ten years ago. Over the past ten years the patient has had recurrent pneumonias with multiple admissions that required intubation. His last admission with intubation was [**2195-2-19**]. 2. History of "pus around his heart." The patient was sent home from the hospital with a Hickman catheter and antibiotics. Two weeks after he discontinued for pericardial infection the patient developed spinal abscess. 3. Spinal abscess that required surgical drainage and rehabilitation (to learn to walk again) at [**Hospital3 4419**] Center. 4. Spinal instability requiring two [**Location (un) 931**] rod placements in [**2184**] after spinal abscess removed. 5. Kidney failure, the patient was told that his end stage renal disease was secondary to nephrolithiasis. At the time of this dictation, unable to obtain medical records to clarify the etiology. Five years ago the patient was extremely fatigued and was diagnosed with calcinosis in his skin. At that time he started on dialysis for a few months. He was doing well off of dialysis until last year at which time he was restarted on hemodialysis on [**2194-3-20**]. 6. End stage renal disease on hemodialysis, the patient commonly has low blood pressure, shakiness and chills after hemodialysis. 7. History over the past year of multiple clots in his dialysis line according to his mother. 8. Paroxysmal atrial fibrillation, unclear of length and duration of time but the patient is on Coumadin on admission. The patient thought that his Coumadin was to prevent catheter clot. 9. Gastroesophageal reflux disease. 10. Obstructive sleep apnea, this is apparent in old note, however, the patient has never been officially diagnosed as he is not on a CPAP machine. 11. History of hepatitis B. 12. Chronic low back pain. 13. Anxiety. 14. Nephrolithiasis. MEDICATION ON ADMISSION: Medications include Epogen, Nitropaste, Nephrocaps, Iron, Renagel, TUMS, Coumadin, Lasix, Aspirin, Xanax, Vicodin, Milk of Magnesia, Reglan, Colace and Protonix. ALLERGIES: Questionable Latex allergy. Rash to Ampicillin with discrete red bumps on his chest, the last time he had Ampicillin. PHYSICAL EXAM: FAMILY HISTORY: Maternal grandmother died of a cerebrovascular accident. Maternal grandfather had a nephrectomy of unknown reasons. Mother with cystitis and multiple urinary tract infections. Brother died at 16 from Hodgkin's disease. Father died from a motor vehicle accident in [**2194-3-20**], (around the time the patient became sick and was restarted on dialysis). SOCIAL HISTORY: The patient is a chef, divorced in his 20s and he has a daughter who lives in [**Name (NI) 8449**] with his ex-wife. [**Name (NI) **] lives with his girlfriend of 15 years and her daughter in the upstairs floor of his mother's house. (It is not a separate apartment.) The patient is able to walk up stairs at baseline but does get short of breath. In his 20s, the patient became involved with drugs but denies intravenous drug use (his mother believes he may have experimented with intravenous drugs.) He has been in drug rehabilitation two times in the past. The patient says that he had an negative human immunodeficiency virus test over the past year. He denies cigarette use but has a history of pipe smoking. In the past the patient drank six beers a day but has not drank in over a year and prior to ten years ago the patient was extremely active and he played football, he was semi-pro hockey player and was a competitive runner.

CHIEF COMPLAINT: GI bleeding PRESENT ILLNESS: 54 year old female with hx GIB from Upper GI AVM's (stomach, duodenum, jejunum), on coumadin for extensive DVT s/p IVC filter, DM, asthma, and OSA who presents with 2 days of dark stools and lightheadedness. The patient reports that she has had dark, non-bloody stools for two days associated with lower quadrant cramping. She also reports lightheadeness on standing for the past week, no syncope. She denies any vomiting, nausea or hematemasis. She went to her PCP today who recommended that she go the ED. At her PCP's office, she was found to have a BP 110/60 sitting, tenderness in abd in lower midline, hemoccult + stools. At her PCP's office, labs were done which showed a Hb 7.3 and INR 2.5. Of note, she had a ferillicit infusion on [**11-14**] for chronic anemia likely [**2-21**] slow GIB. MEDICAL HISTORY: -GI Hx as of [**7-/2185**]: nine upper endoscopies, two small bowel enteroscopies, five colonoscopies and one sigmoidoscopy over the last six years. Multiple AVMs have been found and treated in her duodenum and jejunum. Her most recent scopes were last [**Month (only) 547**], when 2 angioectasias in the stomach, one in the jejunum, one in the descending colon were found. -Poorly controlled DMII -hypertension -asthma -anemia - profound iron deficiency [**2-21**] gastric and duodenal AV malformations as above, transfusion dependent, Hct baseline around 22-29 -depression -migraines -obesity -chronic abdominal pain -delayed gastric emptying -diverticulosis -extensive DVT [**2-27**] s/p thrombectomy, IVC filter placement, common and external iliac vein stenting on coumadin/plavix -OSA, on home BiPAP vs CPAP -? Meningioma (lesion identified by CT on [**6-27**] in left perimesencephalic region, being followed) -S/p appendectomy -S/p bilateral oophorectomy and hysterectomy -gout MEDICATION ON ADMISSION: ALBUTEROL SULFATE - 90 mcg HFA Aerosol Inhaler - 2 puffs every 4-6 hours as needed BUTALBITAL-ACETAMINOPHEN-CAFF [FIORICET] - 50 mg-325 mg-40 mg Tablet - 1 (One) Tablet(s) by mouth every six (6) hours as needed for headache DULOXETINE [CYMBALTA] - 30 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth once a day FABRICATE - NEW CHANNELS IN NEW SHOES FOR EXISTING KLENZAK BRACE - - use as directed as needed FLUTICASONE [FLONASE] - 50 mcg Spray, Suspension - 2 sprays in each nostril twice a day FLUTICASONE [FLOVENT HFA] - 110 mcg/Actuation Aerosol - 2 puffs twice a day FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth once a day if gain 2 pounds or more in one day. If you gain over 4 pounds in a day call the health center GABAPENTIN - 800 mg Tablet - 1 Tablet(s) by mouth three times a day HYDROCORTISONE ACETATE [ANUSOL-HC] - 25 mg Suppository - 1 per rectum rectally once per day after BM as needed INSULIN GLARGINE [LANTUS] - 100 unit/mL Cartridge - 75 units at noon and at bedtime sq daily INSULIN LISPRO [HUMALOG] - 100 unit/mL Solution - according to sliding scale administer twice a day - No Substitution INSULIN SYRINGES - ULTRA COMFORT 28 - - USE AS DIRECTED ISOSORBIDE MONONITRATE - 30 mg Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth four times a day before meals and at bedtime METOPROLOL TARTRATE - 100 mg Tablet - take one Tablet by mouth twice a day MUPIROCIN CALCIUM [BACTROBAN] - 2 % Cream - apply to each naris with cotton swab twice a day OLOPATADINE [PATANOL] - 0.1 % Drops - 1 gtt OU twice a day OXYCODONE [OXYCONTIN] - 15 mg Tablet Sustained Release 12 hr - 1 Tablet(s) by mouth twice a day OXYCODONE-ACETAMINOPHEN [PERCOCET] - 5 mg-325 mg Tablet - 1 to 2 Tablet(s) by mouth q 6 h PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth twice a day Pt would like it delivered to her at her daughter's house at [**State 12857**]. Apt#3, [**Location (un) 686**]. SIMVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day UREA [CARMOL 40] - 40 % Cream - apply to both feet twice a day as needed for thickened and dry skin WARFARIN - 5 mg Tablet - 1 Tablet(s) by mouth once a day except on Thursday and Sunday, take 1 1/2 tablets by mouth ZOLPIDEM [AMBIEN] - 10 mg Tablet - 1 Tablet(s) by mouth at bedtime as needed DOCUSATE SODIUM [COLACE] - 100 mg Capsule - 1 Capsule(s) by mouth twice a day LORATADINE - 10 mg Tablet - 1 Tablet(s) by mouth once a day NICOTINE - 7 mg/24 hour Patch 24 hr - apply 1 patch once a day SENNA - 8.6 mg Tablet - 1 Tablet(s) by mouth twice a day ALLERGIES: Penicillins / Aspirin / Lipitor / Glucophage PHYSICAL EXAM: Vitals: T: 98.7 P: 70 BP: 142/90 R: 11 SaO2: 100% 2L NC General: obese AAF in NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted, no lesions noted in OP but dry MM. Neck: supple, obese, difficult to assess JVP Pulmonary: Lungs CTA bilaterally Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: obese, surgiclaly scarred, diffusely TTP, no peritoneal signs. Extremities: WWP. No C/C/E bilaterally, 2+ DP pulses b/l. Skin: no rashes or lesions noted FAMILY HISTORY: Colon Ca in Mother and Grandmother both in 70s, HTN in Mother, Diabetes in grandfather. [**Name (NI) **] family hx of thrombophilia. Son has recurrent epistaxis. SOCIAL HISTORY: Negative for EtOH, very remote marijuana use (30 yrs ago). Positive tobacco use. Currently smokes 3 cigarettes/ day, 20 pack-year history. Formerly worked as a special needs counselor. Currently lives alone in an apartment in the [**Location (un) 12859**] in the [**Location (un) 4398**]. Has a son and grandchildren she sees frequently.

CHIEF COMPLAINT: Asymptomatic PRESENT ILLNESS: 74-year-old gentleman with a several year history of asymptomatic, severe aortic stenosis which has been followed by serial echocardiograms. His echocardiograms have shown a progressively worsening valve area and gradients. He denies chest pain, dyspnea, orthopnea, PND, palpitations, syncope or presyncope. He is quite active working out with a personal trainer twice a week as well as walking and riding a bicycle without symptoms. There is a question as to whether the amount of exercise he is performing is adequate to "cause" symptoms. Therefore, he has been referred for surgery due to his most recent echo findings which suggest now critical aortic stenosis. He was admitted today for a diagnostic cardiac catheterization in preparation for an aortic valve replacement. Cardiac Catheterization: [**2197-12-1**] [**Hospital1 18**] Coronary angiography: right dominant LMCA: No angiographically-apparent CAD. LAD: proximal/mid vessel with 60% stenosis and 40% stenosis after D1. LCX: No angiographically-apparent CAD. RCA: Proximal 80% stenosis. Cardiac Echocardiogram [**2197-10-27**]: LVEF 60-65%, Severely thickened/deformed aortic valve leaflets. Critical AS (Area <0.8cm2, pk/mn 98/71), Trivial MR, 1+ TR MEDICAL HISTORY: - Aortic stenosis - Hypertension - Hyperlipidemia - Malignant melanoma excised from the left shoulder for which he follows up at the dermatology clinic at [**Hospital1 18**] - Prior history of empyema and pneumonia with decortication of the right lung in [**2189**] - History of colonic polyp - Congenital absence of the left kidney - Remote history of tonsillar radiation ( thyroid is monitored) - collagen injection L 4th finger - remote R leg fx as child Past Surgical History: Right VATS for empyema R 5th finger [**Doctor First Name **] L shoulder melanoma exc. MEDICATION ON ADMISSION: ATORVASTATIN 40 mg once a day NEBIVOLOL [BYSTOLIC] 5 mg once a day TADALAFIL [CIALIS] Dosage uncertain DIOVAN HCT 160 mg-25 mg Tablet - 1 Tablet once a day ASPIRIN 325 mg once a day DOCUSATE SODIUM 100 mg twice a day VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] 1 Tablet once a day ALLERGIES: adhesive tape PHYSICAL EXAM: Pulse:68 Resp:16 O2 sat:99% B/P Right:141/98 Left: 140/88 Height: 72" Weight: 215 lbs FAMILY HISTORY: +Premature coronary artery disease Father MI < 55 [X] died at 60 from MI/CVA Mother < 65 [] grandfather died MI @ 54 SOCIAL HISTORY: Race:Caucasian Last Dental Exam:3 weeks ago, Dental clearance in office Lives with: wife Contact:[**Name (NI) 17**] (wife) Phone #[**Telephone/Fax (1) 7317**] Occupation: Psychiatrist with his own practice in [**Hospital1 8**] Cigarettes: Smoked no [x] yes [] Other Tobacco use:no ETOH: < 1 drink/week [] [**3-6**] drinks/week [X] >8 drinks/week [] Illicit drug use: none

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 45-year-old male with a history of GERD, standing with substernal chest pain while working at a construction site, which he thought was his GERD, then worsened in a few hours. After about 2 hours, he went to the emergency department. The pain was radiating down both arms with his chest pressure. No nausea, diaphoresis or shortness of breath. In the emergency department, he was found to have lateral ST elevations in V4 through V6 and ST elevations in 2 equal to 3 and aVF. He went into ventricular fibrillation arrest. In the emergency department, he was shocked to normal sinus rhythm, given thrombolysis with TNK. At 4:52 a.m., he was transferred to [**Hospital1 18**] for emergent catheterization. At the catheterization, they found right ventricular pressure of 38/14, pulmonary capillary wedge mean pressure at 25, and 98 percent thrombotic occlusion in OM1. PTCA and stent with heparin- coated stent was placed. ST elevations resolved after catheterization and patient was pain free. Patient then developed automated idioventricular rhythm after TNK at outside hospital. On arrival after catheterization here, he was pain free with small right groin hematoma. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: She is a 68 year-old female with a history of coronary artery disease and a MI at age 40 who presented to the Good [**Hospital 5159**] Hospital after two to three weeks of intermittent chest discomfort, [**8-24**]. A catheterization was performed here which showed 95% ostial left main coronary artery disease and LAD left circumflex. She had a 70% proximal occlusion of serial high grade mid vessel stenosis with good left ventricular function. The patient had an intra-aortic balloon bump indicated because of a left main stem main lesion. She underwent a coronary artery bypass graft x4 on [**2134-12-9**] which she tolerated well. Postoperatively, she was transferred to the Intensive Care Unit where we weaned her intra-aortic balloon bump which was discontinued on [**12-11**], postoperative day #1 and the patient was transferred from the unit onto the floor on [**2134-12-12**] in good condition. Her chest tubes were discontinued on [**2134-12-13**]. Her wires were discontinued on [**2134-12-13**] and she did well. Her incision looked clear and dry without a click or evidence of any infection. Her leg was in good condition. She as ambulating well and was a level 5 at this point. PT cleared her and the patient was cleared for discharge. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: s/p motorcycle crash PRESENT ILLNESS: Mr [**Known lastname 58702**] is a 41 year old male who was involved in a motorcycle crash on [**2152-6-12**] MEDICAL HISTORY: none MEDICATION ON ADMISSION: ALLERGIES: Dicloxacillin PHYSICAL EXAM: Upon discharge: AVSS NAD A+O CTA b/l RRR S/NT/ND +BS spine: incisions c/d/i w/ steri strips [**Date Range **]: incisions c/d/i VAC working well +[**Last Name (un) 938**]/FHL/AT SILT brisk cap refill FAMILY HISTORY: Father and brother with hemachromatosis dz gene (awaiting records). No hx of early cardiac disease in the family. SOCIAL HISTORY: Occasional ETOH, no drugs, no tobacco. Has had unprotected heterosexual sex with multiple partners. Currently with one female partner for past one year. No rescent travel out of the country in the past 2 years. Has only travelled to Europe in the past. Mother and father are first cousins.

CHIEF COMPLAINT: dehydration, seizures PRESENT ILLNESS: 65yo M with EtOH cirrhosis, HCC, s/p RFA of segment 5 lesion s/p OLT [**2104-8-22**], presents with dehydration and seizure en route to [**Hospital1 18**]. He was in his USOH until the morning of presentation, when his wife noted the onset of confusion. They were going to get routine labs drawn at an outpatient lab, when she noted that he seemed not to know where he was going. He did recognize her, however. This confusion continued for a couple of hours (he again knew her but did not know how to find the bathroom from the garage), during which time they had called his transplant surgeon at [**Hospital1 18**] and made arrangements to come in for evaluation. However, before they were able to leave, he had the first of three seizures. His wife notes that she was in the other room when her friends (one of whom is a physician, [**Name10 (NameIs) **] other a nurse) called her in to witness the seizure. She reports that all four limbs were shaking, his jaw was clenched, his eyes rolled back, and his head was turned to the right. This lasted ~90 seconds and resolved spontaneously. They called EMS. En route to [**Hospital **] [**Hospital **] hospital, he is reported to have another seizure similar to the first, although specific details are not available at this time, as the wife was not there. Finally, shortly after arrival to the OSH, the wife witnessed a third seizure, similar in description to the first and again lasting only 1-2 minutes. A Head CT performed there was by report normal. The patient's wife denied that he had had headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denied difficulties producing or comprehending speech. Denied focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denied difficulty with gait. The pt's wife reported only soft, loose stool that he has had since starting tube feeds in [**Month (only) 547**]. She also noted that his BP was elevated at 165/100 when she first took it in the morning. She denied that he had recent fever or chills. No night sweats or recent weight loss or gain. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, constipation or abdominal pain. No dysuria. Denied arthralgias or myalgias. Denied rash. Following stabilization at [**Hospital3 **] Hospital, he was then transferred to the [**Hospital1 18**] SICU for further evaluation and management. MEDICAL HISTORY: liver transplant from 19 y.o. brain dead donor ([**2104-8-22**]) EtOH cirrhosis, diagnosed 06/[**2103**]. HCC Anemia Essential thrombocytosis Prior complications of ascites, malnutrition (now on tubefeeds), portal hypertension with grade 2 esophageal varices. Peritonitis [**7-17**], Duodenitis [**7-17**], Grade I rectal varices MEDICATION ON ADMISSION: Tacrolimus 3 mg PO Q12H Mycophenolate Mofetil 1000 mg PO BID (2 times a day). Pantoprazole 40 mg PO Q24H (every 24 hours). Fluconazole 400 mg PO Q24H Prednisone 20 mg PO DAILY Trimethoprim-Sulfamethoxazole 80-400 mg PO DAILY (Daily). Valganciclovir 450 mg PO DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: 98.4 F, P 117 BP 158/101, RR 31, Sat 100% 2L O2 via NC. Weight 45.7 kg(down from 48.6 [**9-2**]). Glucose 140. GEN: Very thin man with temporal wasting. Neuro: Attempts to open eyes to voice, moves all extremities. HEENT: Pupils equal, no scleral icterus, no thrush, PPFT in R nare No JVD, 2+carotids without bruits Lungs: Clear to auscultation bilaterally Cor: S1S2 nl, no murmurs Abd: Soft, nontender, nondistended, normoactive bowel sounds. His chevron incision is well-healed with staples in place. Ext: No peripheral edema Vasc: 2+ DPs Bilaterally FAMILY HISTORY: Non contributory SOCIAL HISTORY: The patient owns business in [**Hospital3 **]: a clothing store and a limousine business. Recently he started working from home due to his poor health. He lives with his wife, who is very supportive. He smokes. No drugs. Stopped EtOH in 6/[**2103**].

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 81-year-old female with history of pulmonary hypertension and severe kyphosis, who presents with increasing progressive shortness of breath and acute hypoxia at rehab. She desaturated to the 60s, but improved on BiPAP. She has a long history of restrictive lung disease with a FEV1 of 0.42 liters and secondary to her severe kyphoscoliosis also with mild pulmonary hypertension on echocardiogram in [**2136**]. She is on home oxygen. She fell on [**9-14**], and had a left hip fracture status post ORIF here and then went to [**Hospital3 **]. She has not been able to ambulate since that time, and with significant left lower extremity weakness. She is doing well on Coumadin with goal INR of 1.5 to 2, and getting PT at rehab. She then developed increasing shortness of breath for five days prior to admission. No complaints of fever, chills, cough with minimal sputum plus postnasal drip. No change in her lower extremity edema, no calf swelling, and no tenderness at rehab. She slowly progressed with shortness of breath with increased respiratory rate and desaturations at 79% on 2 liters and up to 86 to 91% on 6 liters. She was seen by Pulmonary and Cardiology with a gas of pH of 7.35, pO2 of 77, pCO2 of 60 on 4 liters. She had no EKG changes. She was tried on the BiPAP with better saturations at night as well as with increasing nebulizers. She was not felt to be a cardiac cause at [**Hospital1 **], and saturations during the day improved to 92% on 3 liters. She continued on her nightly BiPAP, but today had increasing dyspnea, which was gradual and more q.d. saturations of 64%, was very short of breath. BiPAP was started bringing saturations up to high 80s and transferred to [**Hospital1 69**]. Her saturations were 90% on BiPAP, given 20 mg of IV Lasix in the ED with good diuresis. Chest x-ray consistent with CHF on initial presentation. A CTA was obtained to rule out pulmonary embolism which was negative, and lungs were fairly clear with small bilateral pleural effusions with bibasilar atelectasis after diuresis without signs of pulmonary edema or consolidation. She was admitted to the MICU on BiPAP for further workup. MEDICAL HISTORY: 1. Severe restrictive lung disease. Kyphoscoliosis. She is followed by Dr. [**Last Name (STitle) 217**] as her primary pulmonologist. 2. Status post spinal fusion for scoliosis as a child. Recent pulmonary function tests on [**12-5**] with FVC of 0.68 liters, FEV1 of 0.48 liters. 3. Pulmonary hypertension on [**2-6**] liters of home oxygen. 4. SVT during admit for left hip ORIF on [**2141-9-4**], which is controlled with a beta blocker. 5. Hypertension. 6. Osteoporosis. 7. Left femur fracture status post ORIF in [**2141-9-4**]. She was discharged on Coumadin with a goal INR of 1.5-2 for six weeks at [**Hospital3 **]. 8. Left ankle fracture in [**2135**] status post pins and resolved edema after a MVA. 9. Bilateral mild femur fracture requiring nonoperative treatment. 10. Congenital [**Last Name (un) 21356**]. 11. Cataracts. MEDICATION ON ADMISSION: 1. Combivent. 2. Fosamax. 3. Diltiazem. 4. [**Doctor First Name **]. 5. Aspirin. 6. Os-Cal. 7. Protonix. 8. Lasix. 9. Multivitamin. 10. Coumadin. 11. Metoprolol. 12. Beconase. ALLERGIES: 1. Amoxicillin causing a rash. 2. Morphine which causes mental status changes. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Health care proxy is [**Name (NI) **] [**Name (NI) 21357**], who is a nurse here and a niece. Her extension is [**Numeric Identifier 21358**]. Code status is DNR/DNI, but does want noninvasive vents. She was currently at rehab before fracture and could ambulate about two feet with a walker, but no tobacco history.

CHIEF COMPLAINT: Esophageal cancer. PRESENT ILLNESS: Mrs. [**Known lastname 2643**] is a 77-year-old woman with a squamous cell carcinoma involving the distal thoracic esophagus. Her preoperative staging disclosed a T2, N0 esophageal cancer. Her distant metastatic workup was negative. She is being admitted for [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy. MEDICAL HISTORY: Stage 3B colon cancer (surgical tx & 5-FU/leucovorin) Enteritis (following administration of chemo - was on TPN for 3 wks) Hypothyroidism CAD, MR [**First Name (Titles) **] [**Last Name (Titles) **], bypass in [**2089**], Chronic ITP, no treatment and no history of bleeding SURGICAL HISTORY Colon resection for CA ([**2090**]) CABG [**2089**] MEDICATION ON ADMISSION: Liquid Vicodin 7.5 mg-500 mg/15 mL Sln 0.5-1 Tbspn qid prn Levothyroxine 50 mcg Tablet qday Lisinopril 5 mg qday Lorazepam - 0.5 - 1.0 mg [**Hospital1 **] prn Metoprolol 50 mg [**Hospital1 **] MVI 1 tab qday Simvastatin 80 mg qhs Calcium Carbonate 2 tabs [**Hospital1 **] ALLERGIES: Toradol / Codeine PHYSICAL EXAM: T: 96.9 HR: 83 SR BP 112/56 Sats: 93% RA General: 77 year-old female in no apparent distress HEENT: nomocephalic, mucus membranes moist Neck: supple, no lymphadenopathy Card: RRR, normal S1, S2 no murmur/gallop or rub Resp: decreased breath sounds on right with faint basilar crackles GI: bowel sounds positive, J-tube in place Incision: Right thorascopic site clean dry intact Neuro: non-focal FAMILY HISTORY: Mother: [**Name (NI) 2481**] Father: CAD SOCIAL HISTORY: Lives alone. Has 6 adult children. Tobacco: 50 pack-year. ETOH: occasional drink

CHIEF COMPLAINT: Inferior MI PRESENT ILLNESS: 39 yo male with history of GERD woke up w/ SOB and LUE discomfort 1 day PTA. He presented to [**Hospital1 1474**] where he was ruled out for MI by enzymes. He underwent stress test the following day at [**Hospital1 1474**]. He developed SOB and shoulder pain during the test. The stress test was discontinued and he reportedly had STE inferiorly and w/ inf WMA on echo. He was transferred to [**Hospital1 18**] for cath. At cath, he had 90% prox RCA & 80-90% mid-distal RCA lesions s/p 4 TAXUS stents w/ PCWP 17, hemodynamically stable throughout. . Post-procedure he was doing well, no SOB, no CP on arm discomfort and admitted to the CCU for monitoring. MEDICAL HISTORY: GERD MEDICATION ON ADMISSION: Outpt Meds: aciphex Meds on transfer: ASA, plavix, lopressor, aggrastat ALLERGIES: Percocet PHYSICAL EXAM: 97.1 123/78 12 100% 2L NC Gen: cauc M lying in bed flat in NAD, alert, Ox3. HEENT: anicteric Neck: thick neck, no masses Heart: RRR, S1, S2, no m/r/g Lungs: CTBLA, no rales, no wheezing Abd: NABS/S/NT/ND/no masses, no HSM Ext: no edema FAMILY HISTORY: father w/ MI's in 60's, + DMII; SOCIAL HISTORY: Works as police officer, lives alone, never married, no children; + tobacco 1p/week x 5 yrs, quit yesterday, occ EtOH last drink 4 days ago, no IVDU;

CHIEF COMPLAINT: Status post transfer from [**Hospital3 1280**] for possible cardiac catheterization. PRESENT ILLNESS: The patient is a 73 year old white male with a past medical history significant for previous myocardial infarction and coronary artery bypass grafting in [**2182**], who awoke on the day of admission with chest pressure and shortness of breath at 4:30 a.m., which was better with sitting up. Review of systems at that time was negative for nausea, vomiting and positive for lightheadedness and palpitations which had been present at baseline. Symptoms improved with getting up but returned after the patient went back to bed. At that time, 911 was activated and the patient was taken to [**Hospital3 1280**] Hospital for further evaluation. At that time, arterial blood gases showed a pH of 7.15, pCO2 68, pO2 68 with a CPK of 45 and troponin less than 0.3. At that time, the patient's blood pressure was noted to be 209/129. He was acutely dyspneic and thus intubated, given nitroglycerin paste, intravenous Lasix 200 mg, intravenous morphine 2 mg and Versed. Post intubated arterial blood gases showed a pH of 7.31, pCO2 45 and pO2 106. At that point, he developed a mottled allergic rash and hypotension to 57/36. It was thought to be an allergic reaction to morphine. He was started on a Dopamine for maintenance of his blood pressure. The maximum Dopamine dose was 4 mcg/kg/minute and he was weaned off gradually. Prior to transfer, the patient experienced a one time ICD shock, presumably because of atrial fibrillation. Of note, urine output was 1,300 cc from the intravenous Lasix. The patient was started on intravenous nitroglycerin and transferred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for further evaluation. Ventilator settings on transfer were an assist control of 700 by 14 with a PEEP of 5. Outside laboratory data were significant for an AST of 39, ALT 53, alkaline phosphatase 217, total bilirubin 0.9, white blood cell count 11.1, hematocrit 45, platelet count 283,000, sodium 146, potassium 3.6, bicarbonate 23, chloride 105, BUN 24, creatinine 1.7 and blood sugar 251. In the [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] Emergency Room, nitroglycerin was continued. The patient was awake and alert, and was gradually extubated. His Emergency Room stay was notable for a urine output of 800 cc. MEDICAL HISTORY: 1. History of coronary artery disease, status post myocardial infarction at age 50, again in [**2195-5-22**], status post coronary artery bypass grafting in [**2182**] with left internal mammary artery to left anterior descending artery, saphenous vein graft to obtuse marginal one, saphenous vein graft to right coronary artery; most recent cardiac catheterization in [**2195-5-22**] showed 100% proximal left anterior descending artery lesion, 50% mid- left anterior descending artery lesion, 70% first marginal lesion, 100% proximal right coronary artery lesion with collaterals coming from the circumflex to the right coronary artery, left ventricular ejection fraction 25% with mild mitral regurgitation; right heart catheterization showed elevated right sided pressures including a right atrial pressure of 24, right ventricular pressure 50, pulmonary artery pressure 52/20 and wedge of 33, cardiac output 6.05 and cardiac index 2.79. 2. Hypertension. 3. Dyslipidemia. 4. Peripheral vascular disease, status post left femoral to anterior tibial bypass in [**2194-2-19**] with jump graft in [**2195-5-22**] and status post TPA several months later. 5. Deep vein thrombosis. 6. Status post AICD placement on [**2195-5-27**]; patient had been transferred from [**Hospital3 1280**] to [**Hospital6 8866**] after developing chest pain and shortness of breath; he was found hypotensive and in respiratory failure, requiring intubation; he became tachycardiac and went into pulseless ventricular tachycardia and required shock; he ruled in at [**Hospital3 1280**] with a high CK and, at [**Hospital6 8866**] workup included cardiac catheterization, echocardiogram and exercise tolerance test; ICD placement was also at that time; the device is known to be a Guident device, the details of which will be included in a discharge addendum. MEDICATION ON ADMISSION: Aspirin 325 mg p.o.q.d., Lasix 40 mg p.o.q.d., Zestril 20 mg p.o.q.d., Norvasc 5 mg p.o.q.d., Lipitor 20 mg p.o.q.d., Coumadin 5 mg p.o.q.d., atenolol 50 mg p.o.q.d. ALLERGIES: Morphine. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient lives with his wife. [**Name (NI) **] quit tobacco approximately 30 years ago. He has one to two drinks per day.

CHIEF COMPLAINT: Dyspnea on exertion/AF PRESENT ILLNESS: 67 year old male hospitalized for rapid A Fib earlier this year with dyspnea on exertion. He was cardioverted to SR and echo showed severe mitral regurgitation. Of note, he has history of mitral valve prolpase x 15 years. Presents today for pre-op cath, which reveals normal coronaries. MEDICAL HISTORY: Mitral Regurgitation Atrial Fibrillation PMH: Hyperlipidemia Hypertension Diabetes mellitus type II Osteoarthritis Abdominal aortic aneurysm (2.4-3.2cm) Prostate Cancer (watchful waiting) Bilateral knee patellofemoral syndrome Past Surgical History: Lap cholecystectomy Bilateral hernia repair MEDICATION ON ADMISSION: Coumadin 3mg daily Lipitor 40mg daily Avodart 0.5mg daily Losartan 50mg daily Metformin 500mg twice daily Metoprolol succinate 50mg daily Sotalol 80mg daily Flomax 0.4mg daily Aspirin 81mg daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) / scallops only PHYSICAL EXAM: Pulse: 52 Resp: 18 O2 sat: 98% B/P Right: 133/69 Left: Height: 5'8" Weight: 170 lbs FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) 745**], MA Occupation: Retired CPA Tobacco: Denies ETOH: several/wk

CHIEF COMPLAINT: Doxycycline desensitization PRESENT ILLNESS: [**Known firstname **] [**Known lastname 94828**] is a 43 yo female with a history of multiple drug allergies who presented to her PCP's office on [**5-9**] with diffuse joint aches and a history of a recent bull's eye rash. She reported that she had a rash on her left anterior shin for about 6 days prior to her visit with her PCP. [**Name10 (NameIs) **] took a picture of a rash and it was consistent with erythema migrans. She had had some exposure to the [**Doctor Last Name 6641**] prior to the rash developing, but does not recall a tick bite. Her PCP has not started treatment due to concern about her doxycycline allergy. She consulted with the patient's allergist at [**Hospital1 112**] who recommended doxycycline desensitization and outlined a protocol. The patient's treatment has been delayed by lack of ICU beds. She reports mild joint aches in her knees and elbows. Her joint pain was quite severe earlier but has lessened over the past week. She describes some low-grade fevers, but no chills. Denies joint swelling. Of note, the patient recently was treated for pyelonephritis with gentamycin. . Review of sytems: (+) Per HPI and for night sweats r/t menopausal sx, intermittent headache and chronic constipation. (-) Denies fever, chills, recent weight loss or gain. Denies sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. MEDICAL HISTORY: # Multiple drug allergies including likely [**Initials (NamePattern4) 22721**] [**Last Name (NamePattern4) **] Syndrome associated with fluconazole desensitization. Also, severe phlebitis with PICCs, milder phlebitis with conventional IV catheters if left indwelling # CVID - monthly IVIG # History of recurrent pyelonephritis # autonomic neuropathy - on IVIG primarily for neuropathy but also CVID. # esophageal dysmotility # oral/genital ulcers ? Behcet's # colonic inertia s/p subtotal colectomy at [**Hospital3 14659**] in [**2093**] # atrophic vaginitis with recurrent yeast infections # sleep disorder characterized by non-REM narcolepsy, restless leg syndrome, and periodic leg movements MEDICATION ON ADMISSION: # Epinephrine [EpiPen] 0.3 mg/0.3 mL (1:1,000) Pen Injector # Esomeprazole Magnesium [Nexium] 40 mg PO BID # Ferumoxytol [Feraheme] 510 mg/17 mL (30 mg/mL) Solution Infuse over one minute weekly for 2 weeks Have patient stay in observation for 30 minutes after first dose - none recently # Fexofenadine 60 mg Tablet PO TID - not using currently # Lorazepam [Ativan] 0.5 mg Tablet PO Q6hr PRN anxiety # Methylphenidate [Concerta] 18 mg Tablet Extended Rel 24 hr 2 Tab(s) by mouth once a day [**2101-4-25**] # Sucralfate 1 gram Tablet crushed and used topically four times a day compound and diluted to 4% into an ointment please make dye and fragrance free PRN. ALLERGIES: Penicillins / Amoxicillin / E-Mycin / Latex / Ondansetron / Vancomycin / Levofloxacin / Zofran / Phenergan / Dilaudid / Ceftriaxone / Sulfamethoxazole/Trimethoprim / Voriconazole / Fluconazole / Caspofungin / Doxycycline / Propranolol / Neurontin / Azithromycin / Xopenex Hfa / Optiray 300 / Ketorolac PHYSICAL EXAM: General: Alert, oriented, no acute distress, very pleasant. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, + midline abdominal scar, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, no joint erythema or swelling. Skin: no rashes FAMILY HISTORY: Mother with ovarian cancer and history of DVT. SOCIAL HISTORY: The patient was [**Name Initial (MD) **] GI NP at [**Hospital1 18**]. She has been on disability for 2 years. She lives alone in the [**Hospital3 4414**]. No tobacoo, alcohol and illict drugs.

CHIEF COMPLAINT: Status post mitral valvuloplasty PRESENT ILLNESS: Mr [**Known lastname 1968**] is a 73 year old man with complicated past medical history including large B cell non-hodgkins lymphoma, mitral stenosis, Afib, seizure disorder, electively admitted for valvuloplasty, transferred to CCU for close monitoring. . Briefly, patient was admitted on [**10-14**] with SOB and DOE and was evaluated for valvuloplasty, however at that time was found to have a clot in the right atrium and procedure was deferred. He remained anticoagulated and repeat TEE yesterday revealed persistent left atrial appendage clot with smoke. Became hypotensive during the procedure and was given 2L IV fluids, thought to be multifactorial from poor PO intake, sedation, and afib with RVR. Today, he underwent planned mitral vavuloplasty uneventfully with improvement in mitral valve area from 1.2 to 3.7 cm2 (gradient decreased from 10 to 2 mmHg); cardiac index was 2.5 L/min/m2; mean PCWP 17 mmHg with LVEDP 9 mmHg. He currently has no complaints. . On review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, 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. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, - Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: 3. OTHER PAST MEDICAL HISTORY: -AAA 4cm -CVA: Cerebellar artery infarct on MRI -TIA [**2179**] -Large B cell non hodgkin's lymphoma treated with diverting colostomy, chemo, radiation -Moderate to severe Mitral stenosis wtih MVA of 1cm2 -Chronic atrial fibrillation -Seizure disorder-last seizure 1.5 yrs ago -Depressive disorder -Osteopenia -Pulmonary hypertension -? dementia per wife -Hx Cholecystectomy -Hard of hearing MEDICATION ON ADMISSION: Depakote 500mg [**Hospital1 **] Lovastatin 40mg 2 tablets in the am Fluoxetine 40mg daily Warfarin 3mg last dose Sunday night Vitamin D 1000 IU daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission: VS: T=not recorded BP=127/71 HR=83 RR=19 O2 sat= 100% 2L GENERAL: Cachectic male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. MM dry. NECK: Supple with no JVD CARDIAC: PMI located in 5th intercostal space, midclavicular line. Irregular rhythm, normal S1, S2, ? S4 vs mid-systolic click. No m/r/g. No thrills, lifts. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, however poor air movement. ABDOMEN: Soft, NTND, decreased bowel sounds. Colostomy bag in place. No HSM or tenderness. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: 2+ radial pulses . On Discharge: VSS, decreased breath sounds in R base, lungs otherwise clear. Cardiac rhythm remains irregular with no mrg, mid-systolic click no longer present. FAMILY HISTORY: No siblings. Father died in his 80s from emphysema. Mother died in her early 50s from heart disease. SOCIAL HISTORY: Currently lives with his wife in an [**Hospital3 4634**] facility. He is a retired manager. He denies EtOH or drug use, smokes [**4-10**] cigs/day, has been smoking since age 25.

CHIEF COMPLAINT: Sepsis PRESENT ILLNESS: 87 yo NH resident with h/o cervical ca and XRT, vescicovaginal/rectovesicle/rectovaginal fistulas, s/p bilateral percutaneous nephrostomy, and recurrent UTIs presents with fevers, rigors, fatigue, and decreased UOP. She presented to the hospital when her family noticed that she was not feeling well, acting lethargic, and producing less urine from her bilateral nephrostomy. The patient did not complain of chest pain, SOB, cough, or GI symptoms. These symptoms have been relatively new, as she had felt well in the week prior to admission. Her activity level is limited by her functional status, and has not traveled as a result. Her daughter also denies obvious sick contacts. . Of note, the patient has been admitted multiple to times for dislodged nephrostomy tubes, as well as recurrent UTIs. Her most recent UTI consisted of ESBL Klebsiella resulting in sepsis, central line placement, and treated with Meropenem and Flagyl x 2wks for question of C. diff infection. Previous UTIs have included VRE/MRSA bacteria, treated with linezolid and vancomycin. . In the ED, 97.0, 82, 102/50, 16, 97 % RA. She was noted to have rigors, and her BP decreased to 70's/40's. She was also tachycardic to the 110's. She was given IVF and sent to the MICU for close observation. While in the ED, the patient and her family refused central line placement. Pt recieved 5 L NS. . Admitted to [**Hospital Unit Name 153**] for sepsis. MEDICAL HISTORY: 1. Cervical Cancer 30 yrs ago, treated with XRT. Known vesicovaginal fistula, with recently discovered rectovaginal fistula, and rectovesical fistula. Per d/c summary, she is a poor surgical candidate for repair of this, but could consider a diverting colostomy done endoscopically, however patient did not want any further invasive procedures. Status post bilateral nephrostomy tubes which per notes were last placed [**2151-4-8**]. 2. Type 2 DM 3. Hypothyroidism 4. History of VRE, MRSA UTIs 5. Bipolar d/o 6. Anemia of chronic disease, baseline around 28. 7. delirium. 8. UTI's with Klebsiella, VRE/MRSA, s/p meropenem, vancomycin, and linezolid therapy. 9. Pressure sores- stage IV decubitus ulcer MEDICATION ON ADMISSION: Zyprexa, synthroid, gabapentin, oxycodone, iron, prilosec, MVI, megace ALLERGIES: Prochlorperazine / Metoclopramide / Cephalosporins / Penicillins PHYSICAL EXAM: VITALS: 76/33, 79, 16, 100% 5L NC (upon admission to [**Hospital Unit Name 153**]) GEN: Lying in bed, pale appearing, sleeping. HEENT: PERRL, anicteric sclera, dry MM, conjunctival pallor Neck: supple, no JVD appreciated Lung: Poor inspiratory effort, decreased BS on left Heart: Distant sounds, RRR, no m/r/g Abd: Soft, NT/ND Ext: warm, perfused, 1+ DP pulses, R PICC, bilat heels dressed Back: buttock dressing dry, intact Skin: pale apprearing, no ecchymosis or rashes noted Neuro: no focal deficits appreciated FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Living at [**Hospital3 2558**] currently. Daughter [**Name (NI) **] is HCP.

CHIEF COMPLAINT: Urinary tract infection PRESENT ILLNESS: Ms. [**Known lastname **] is an 87 woman with advanced alzheimer's dementia and recent hospitalization on [**2101-9-28**] for urosepsis, who presents for replacement of her nephrostomy tube on day of admission. Once her tube was placed, she started to rigor in the PACU and was found to have high lactate, tachycardia, and dirty UA. In the ED, ceftriaxone, vanco, flagyl were administered. She also got tylenol and motrin. Urine was sent from nephrostomy and clean catch in addition to blood cultures. MEDICAL HISTORY: 1. Alzheimers 2. Aspiration pneumonia 3. UTI 4. Uterosigmoid fistula 5. B/L obstructing renal stones s/p right nephrostomy tube 6. GERD 7. Osteoarthritis 8. Depression 9. vitamin B12 deficiency 10. hyperlipidemia 11. TB treated 50 years ago 12. DVTs in superficial veins [**5-10**] and [**6-9**] (superfical femoral and distal cephalic), on warfarin 13. apical cardiac thrombus 14. urinary tract infection with e.coli MEDICATION ON ADMISSION: dulcolax, loperamide, MOM, [**Name (NI) **], [**Name2 (NI) **], PPI, B12 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 102 HR 100 BP 74/34 RR 20 O2 sat 99% on 4L NC, Gen: somnolent, responds to painful stimuli, but otherwise not responding. HEENT: PERRL. Poor dentition Neck: supple. CV: regular and tachycardic with no m/r/g Lungs: clear bilaterally. Abd: soft, NT, ND active BS, no hepatosplenomegly, J tube in place, no drainage ext: warm and sweaty, with 2+ DP pulses, No clubbing, cyanosis or edema. Back: nephrostomy tube in place neuro: Does not follow commands. FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives at [**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **]. Former egyptologist and competitive speed skater. Daughter very involved in her care.

CHIEF COMPLAINT: Dyspnea, wheezing PRESENT ILLNESS: 61 y/o female with severe COPD and frequent flares who presents with dyspnea, admitted to MICU for respiratory distress. She is on 2L oxygen by nasal cannula at baseline and has required intubation 2 times for COPD exacerbations. She reports three days of dyspnea despite using her home nebulizer machine. She also notes productive cough with greenish sputum. No fever or chills. No coryza, congestion, sinus pain, headache. No sick contacts. [**Name (NI) **] chest pain, palpitations. MEDICAL HISTORY: PCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] 1. COPD, last PFTs [**8-4**] with FVC 1.72, FEV1 0.82, FEV1/FVC 66% (61% and 40% predicted respectively); intubated twice. on 2L home O2. 2. IgA deficiency, was on IV gamma globulin with Dr. [**Last Name (STitle) 2148**]. 3. CAD s/p MIs in [**2186**] (flu symptoms), [**2192**] (jaw pain), NSTEMI in [**2197**] (chest pain with left arm discomfort). Cath in [**2197**] with PTCA/stent to LCx. Cath in [**4-/2202**] with stent placement to RCA and LCx. 4. Hypertension 5. Hyperlipidemia 6. Gastritis, on PPI 7. Osteoporosis, with history of multiple compression and rib fractures from coughing 8. History of thrush/[**Female First Name (un) **] esophagitis [**12-29**] steroid therapy 9. Depression 10. Tremor MEDICATION ON ADMISSION: -Albuterol nebs/INH prn -Ipratropium Q4H prn -Simvastatin 20mg po qam -Clopidogrel 75 mg po daily -Omeprazole 20 mg po daily -Fentanyl 25 mcg/hr Patch 72HR -Oxycodone-Acetaminophen 5-325 mg 1-2 Tabs po Q4-6H prn -Nortriptyline 25 mg po qhs -Fluticasone-Salmeterol 500-50 mcg [**Hospital1 **] -Calcium 500 mg po daily -Docusate Sodium 100 mg po bid prn -Prednisone 10 mg daily -Singulair 10 mg QDay -MVI -KCl 20 mEq QDay -paroxetine 10 mg QDay -fluticasone nasal 2 sprays QDay ALLERGIES: Tetracyclines PHYSICAL EXAM: VS: 98.8 143/64 111 25 95% 4L 49kg GENERAL: thin female, sitting up in bed tremulous, in mild respiratory distress. Not using accessory muscles, able to speak in several word phrases. HEENT: MMM, OP clear, no exudates. non elevated JVP. HEART: tachycardic, regular rhythm. No murmur. CHEST/BACK: Kyphosis; ?pes excavatum LUNGS: Moving air reasonably well with increased expiratory phase. Decreased breath sounds bilaterally. Bilaterally expiratory wheeze. +rhonchi. ABDOMEN: Non-tender. + Distended. + BS. EXTREMETIES: Muscle wasting to LE, no edema. NEURO: 4+/5 strength in LE b/l SKIN: Warm, well perfused. FAMILY HISTORY: Mother with DM, father with pancreatic cancer. SOCIAL HISTORY: She lives with her daughter, [**Name (NI) 6177**], son-in-law and 3 grand-children. She is a widow. She is an ex-smoker, with about a 30-pack-year smoking history, quit in [**2200**]. No EtOH. Uses a cane and walker to ambulate.

CHIEF COMPLAINT: Fatigue Dyspnea on exertion Chest pain PRESENT ILLNESS: 78 yo female presents with several month h/o fatigue, dyspnea on exertion, and chest pain, alleviated by rest. Stress test ([**2141-2-20**]) showed ST depression. Cardiac cath ([**2141-2-22**]) showed 3-vessel disease. Referred for CABG. MEDICAL HISTORY: 1. Hyperlipidemia 2. Hypertension 3. Osteoporosis 4. s/p tubal ligation 5. s/p tonsillectomy MEDICATION ON ADMISSION: 1. ASA 325' 2. Toprol XL 50' 3. Lipitor 10' 4. Evista 60' ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Afebrile, VSS Neck: soft, supple, no JVD, no bruits Chest: RRR, no murmurs; CTAB, no R/R Abd: soft, NT, ND Ext: no edema, no varicosities FAMILY HISTORY: Father: CAD SOCIAL HISTORY: 10 pack-year tobacco (quit 40 y ago0 No EtOH

CHIEF COMPLAINT: Wound infection PRESENT ILLNESS: 57 M w/ diabetes, morbid obesity, with interstitial pulmonary fibrosis on steroids who recently was treated for MRSA osteomyelitis of the right ankle but then had his antibiotics stopped 3 weeks ago because of renal problems returns with pain, redness, swelling and open ulceration of R ankle. One week ago he fell, sustaining an injury to his r ankle and right shoulder. The ankle began to swell in the last few days become erythematous and a new wound developed over the side of his osteomyelitis of the ankle, draining cloudy yellow pus. The shoulder, which had not been assessed by a physician, [**Name10 (NameIs) **] been very painful with decreased range of motion since the fall. Pt had R ankle surgery in [**Month (only) 216**] for a fracture sustained from falling, which became infected one month later, requiring surgery to remove devices. Wound infection was identified as MRSA, and PT was diagnosed with osteomyelitis later in the year. Pt has dyspnea at baseline from his IPF, but states that he feels well-controlled of late. He has a home O2 requirement of 2L at baseline. . In the ED, the patient was admitted for what appears to be cellulitis and osteomyelitis of his right ankle. Per ED, he has no sign of necrotizing fascitis. He was seen by ortho who will follow closely. He received IV vancomycin (1g) for the infection and stress dose steroids (200mg hydrocortisone), as well as morphine and percocet for pain. MEDICAL HISTORY: 1) Interstitial lung disease on prednisone 20 daily 2) Diabetes II 3) Osteomyelitis of right ankle on daptomycin (s/p vanc failure) 4) HTN 5) HLP 6) PAF on coumadin 7) Provoked DVT in remote past 8) Obesity Hypoventilation syndrome on BIPAP MEDICATION ON ADMISSION: -carvedilol 25 mg Tab; 1 Tablet(s) by mouth twice a day -pantoprazole 40 mg Tab, Delayed Release, 1 Tablet(s) by mouth once a day -bumetanide 2 mg Tab, 1 Tablet(s) by mouth twice a day -warfarin 5 mg Tab, 1 Tablet(s) by mouth Once Daily at 4 PM -amlodipine 5 mg Tab, 2 Tablet(s) by mouth DAILY (Daily) -Lantus 100 unit/mL Sub-Q Subcutaneous, 75units in am Solution(s) 55units at dinner -Humalog 100 unit/mL Sub-Q Subcutaneous -prednisone -- 30mg Powder(s) Once Daily -gabapentin 100 mg Tab Oral, 1 Tablet(s) Three times daily -paroxetine 40 mg Tab Oral, 1 Tablet(s) Once Daily -nortriptyline 25 mg Cap Oral, 1 Capsule(s) Twice Daily -levothyroxine 100 mcg Tab Oral, 1 Tablet(s) Once Daily -tramadol 50 mg Tab Oral, [**2-9**] Tablet(s) Every 4-6 hrs, as needed -Omega 3-6-9 -- Unknown Strength, [**2-9**] Capsule(s) Once Daily -ferrous sulfate 300 mg (60 mg iron) Tab Oral, 1 Tablet(s) Once Daily -nortriptyline 25 mg Cap Oral, 1 Capsule(s) Twice Daily ALLERGIES: Penicillins PHYSICAL EXAM: on admission: VS - Temp 97.6F 164/74BP , 88HR , 22R , O2-sat 99% 3L GENERAL - conversational obese man in NAD, comfortable, appropriate HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear NECK - limited exam [**3-12**] obesity, very large panus over neck LUNGS - good air movement b/l, w/ scattered coarse breath sounds HEART - distant heart sounds, RRR, no MRG, nl S1-S2 ABDOMEN - Obese abdomen notable for pale striae, NABS, soft/NT EXTREMITIES - large pitting edema to b/l lower extremities, equal in girth above ankles. R ankle with patches of erythema extending from dorsum of foot/ankle to ~9cm superior. Ankle and foot are significantly swollen, with an open ulcer with yellow cloudy pus draining from lateral malleolus. Foot w/ intact sensation, pulses. Pt has limited range of motion to L shoulder and wrist, with strength limited by pain. No swelling, deformity, crepitus, or ecchymosis. SKIN - no rashes except as above LYMPH - no cervical, axillary, or inguinal LAD NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength [**6-12**] in extremities but deferred in RUE [**3-12**] pain and RLE below shin [**3-12**] infection. Sensation diminished to touch at feet b/l, DTRs 2+ and symmetric. FAMILY HISTORY: No family hx of lung disease. Mother with MI at age 48. SOCIAL HISTORY: Former businessman, on disability at present. Does not smoke, drink, or use drugs. Good social support from wife.

CHIEF COMPLAINT: SOB, respiratory distress PRESENT ILLNESS: 85 yo F who presented to PSH with SOB and respiratory distress, was intubated and transferred to [**Hospital1 18**] on [**2140-10-7**]. Echo here showed severe AS, 2+MR. MEDICAL HISTORY: H/o of mild AS: Aortic valve area is estimated to be 1.5 cm sq. Mean pressure gradient is 20 mmHg and maximum pressure gradient is 28 mmHg on ECHO in [**2136**]. ECHO from [**6-/2140**] AS with 0.7cm2, peak gradient 76 and mean 49 mmHg. Osteoporosis HTN Hypercholesterolemia DM 2 Paget's disease S/p PCM, DDD, for bradycardia Anemia, unclear baseline, Vit B12 def Breast cancer, s/p L mastectomy and chest radiation S/p R hip fracture and L knee fracture in the 60s and 70s MEDICATION ON ADMISSION: Aspirin 325', Lipitor 80', Metoprolol 12.5'', Glyburide 10'', Levothyroxine 150', Folic Acid 1' ALLERGIES: Diovan PHYSICAL EXAM: deferred on admission. FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. Mother had angina in her 60s and a stroke in her 70s. Son with DM2. SOCIAL HISTORY: Social history is significant for the absence of current or prior tobacco use. There is no history of alcohol abuse.

CHIEF COMPLAINT: chest pain, Afib with RVR PRESENT ILLNESS: Ms [**Known lastname 55542**] is a 62yoF with h/o PAF on coumadin, CVA, HTN, HLD, who presents with chest pain, afib with RVR, and elevated troponin. [**Known lastname 20036**] started on [**2133-1-29**], when she was riding in a car as passenger and suddenly developed [**6-26**] substernal chest pain with diaphoresis. Lasted 5 minutes then gradually resolved. NO SOB or palpitations. For the next day she felt some residual pressure feeling that was constant and did not vary with activity. Today she is pain free x24 hours. She waited to be seen because she was visiting on [**Location (un) **] at the time and returned today. She notes she has had this type of pain before when has developed afib. Pain was never this severe and never had diaphoresis previously. Denies SOB, n/v. Had been in NSR on [**2132-12-9**] at last cardiology appointment. . She initially presented to [**Hospital1 **] [**Location (un) 620**], where vitals were T97.9 HR: 147 BP: 134/99 Resp: 18 O(2)Sat: 100 Normal. INR 2.6, troponin(t) 0.746. D-dimer was checked and was negative. She was transferred to [**Hospital1 18**] for further care . In the ED, initial vitals were 98.3 110 114/86 16 99% Labs and imaging significant for CXR which showed clear lungs fields with some vascular fullness. Patient given metoprolol 15mg IV and 25mg PO, and ASA 325. . On arrival to the floor, 98.0, 116/85, 123, 16, 99%ra, 69.1kg. She feels well, and denies chest pain or discomfort, SOB, or palpitations. She overall feels well. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia, (+)Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: ATRIAL FIBRILLATION BASILAR ARTERY OCCLUSION/CVA residual numbness on the left side HYPERLIPIDEMIA HYPERTENSION OSTEOPENIA GERD MIGRAINES MEDICATION ON ADMISSION: ESOMEPRAZOLE MAGNESIUM [NEXIUM] - (Prescribed by Other Provider: [**Name Initial (NameIs) **]) - 40 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s) by mouth [**Hospital1 **] unclear of dose PROPRANOLOL - 80 mg Capsule,Extended Release 24 hr - 1 Capsule(s) by mouth once a day SIMVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily) SUCRALFATE - 1 gram Tablet - 1 Tablet(s) by mouth four times a day WARFARIN - (Prescribed by Other Provider) - 2 mg Tablet - 1.5 Tablet(s) by mouth qday Medications - OTC ACETAMINOPHEN [TYLENOL 8 HOUR] - (Prescribed by Other Provider) - Dosage uncertain CALCIUM CARBONATE-VITAMIN D3 [CALCIUM 500 + D] - (OTC) - Dosage uncertain MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: VS: T=98.0 BP=116/85 HR=123 RR=16 O2 sat=99%ra GENERAL: Elderly caucasian female, NAD, comfortable HEENT: NCAT. Sclera anicteric. PERRL, EOMI. NECK: Supple with JVP of 8cm. CARDIAC: tachycardic, irregularly irregular, no m/r/g LUNGS: CTAB, no w/r/r ABDOMEN: Soft, NTND. No HSM or tenderness. No HSM EXTREMITIES: warm, well perfused, 2+ pulses globally. No edema. FAMILY HISTORY: Brother has had a myocardial infarction at age 49. Otherwise, no family history of atrial fibrillation, although her mother did die of a stroke in her 70s. SOCIAL HISTORY: She has three children, 6 grand-children -Tobacco history: never -ETOH: 1 glass per day -Illicit drugs: none

CHIEF COMPLAINT: syncope PRESENT ILLNESS: 49yoM presents with syncopal episode. Pt states he does not remember exactly the details of the episode, but does remember he was pushing a cart at work. He states that the next thing he remembers he was waking up on the ground. He does not remember having any chest pain, palpitations, nausea, or sob. He had not been eating or drinking because he was so busy at work. He states that a similar episode happened several years prior, the cause was never determined. No family h/o heart disease or sudden death. MEDICAL HISTORY: none MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 98.3 BP 120/72 HR 72 RR 16 96%RA comfortable at rest, no apparent distress eomi, perrla neck supple, no jvd rrr, nl s1+s2, no m/r/g ctab, nl effort abd soft, non tender, nl bs no o/c/c cns [**2-4**] intact. nl strength and reflex in all four limbs. FAMILY HISTORY: no cardiac, valvular, or neurologic disease SOCIAL HISTORY: smokes 1ppd cigarettes, 2 beers every night, no IVDU, recently divorced and lives with his son

CHIEF COMPLAINT: s/p MVC PRESENT ILLNESS: 47 year old unrestrained driver, reported to cross the centerline, with head on collision with another vehicle. Broken windshield. Patient found on floor of passenger seat. + LOC + EtOH MEDICAL HISTORY: None. MEDICATION ON ADMISSION: None. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 99.0, 84, 144/63, 18, 99% RA. A&O x 3, GCS 15 HEENT: Airway intact, 3 cm laceration/abrasion on occiput, pupils 3-->2 mm bilaterally, TM clear, dentition intact. CV: RRR Chest: CTAB, equal chest excursion Abd: soft, diffusely non-tender, FAST negative Back: reported pain along entire thoracic spine Pelvis: stable Ext: R knee laceration/abrasion, minor R knee abrasions, equal DP pulses bilaterally FAMILY HISTORY: NC SOCIAL HISTORY: Per family patient has history of alcohol abuse

CHIEF COMPLAINT: palpitations PRESENT ILLNESS: This is a 56 year old woman with history of peptic ulcer disease status post an upper endoscopy in [**2141**] and [**2138**](?), rheumatoid arthritis and hypertension who presented with palpitations on day of admission. Patient was concerned because she had palpitations with her prior episodes of GI bleeding. In the ED, she was found to have melena and her Hct was 25 down from her baseline of 31-33. NG lavage was negative and she was given IV fluids. Her heart rate decreased from 130's to 100's. GI was consulted and recommended transfusion 2U PRBCs, PPI and admission to the unit for close monitoring. . Patient denied nausea, vomitting, constipation, chest pain, shortness of breath, abdominal pain. MEDICAL HISTORY: 1. rheumatoid arthritis 2. peptic ulder disease w/EGD in [**2141**] and [**2138**]? 3. hypertension MEDICATION ON ADMISSION: 1. prednisone 5 daily 2. methotrexate 10 mg q mon?? f/u with attg 3. leukovorin 4. enbrel 25 mg q mon + friday ALLERGIES: Gold Salts PHYSICAL EXAM: T97.8 HR 96 BP 108-122/68-72 O2Sat 100% RR 21 GEN pleasant, NAD, looking younger than actual age HEENT PERRL, mmm, OP clear, JVP 9cm CV RRR, nl s1 s2, no murmur/rubs/gallops LUNG CTA b/l at bases, no w/r/r ABD soft ntnd +bs no rebound/guarding EXT nonedematous, 2+ DP pulses, warm NEURO AOx3 nonfocal FAMILY HISTORY: NC SOCIAL HISTORY:

CHIEF COMPLAINT: Dyspnea on exertion PRESENT ILLNESS: 70y/o male c/o dyspnea on exertion and LE claudication who had an abnormal ETT. Referred for cardiac cath which revealed three vessel coronary artery disease. MEDICAL HISTORY: Hypertension, Hyperlipidemia, Diabetes Mellitus, Depression, Erectile Depression, Remote Duodenal Ulcer hx, s/p Tonsillectomy, s/p Vasectomy, s/p cataract [**Doctor First Name **], s/p left rotator cuff repair, s/p hemorrhoidectomy MEDICATION ON ADMISSION: HCTZ 25mg qd, Lisinopril 40mg qd, Nifedipine 90mg qd, Toprol XL 50mg qd, Simvastatin 80mg qd, Lexapro 15mg [**Last Name (LF) **], [**First Name3 (LF) **], Humulin N 30units qAM, 20qPM ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 50 132/59 5'7: 210# Gen: WDWN male in NAD lying supine in bad Skin: Unremarkable HEENT: EOMI, PERRL, NCAT Neck: Supple, FROM -JVD Chest: CTAB -w/r/r Heart: RRR -c/r/m/g Abd: Soft, NT/ND +BS Ext: Warm, well-perfused -edema, -varicosities Neuro: A&O x3, MAE, non-focal FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Current smoker of 1.5ppd x 53 yrs. Denies ETOH.

CHIEF COMPLAINT: s/p fall with isolated right C7 lamina fracture PRESENT ILLNESS: 54 year old male s/p fall down a flight of stairs while intoxicated. He apparently had loss of consciousness for approximately 4 hours. When he woke up, he called EMS. Upon arrival, EMS noted a GCS of 15 and the patient was brought to the hospital where he complained of RUE numbness. MEDICAL HISTORY: +EtOH abuse. History of DT's with prior hospitalizations. Depression, HTN MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tenderness over cervical spine. Bilateral Upper extremity 5-/5 in deltoids, biceps , triceps, brachioradialis and interossei Sensations intact in C4-T1 Reflexes 2+ in bilateral biceps, triceps and brachioradialis reflexes. Bilateral hip abductors, iliopsoas , quadriceps, hamstrings , [**Last Name (un) 938**], FHLand TA [**4-3**] SILT in L2-S1. Reflexes 2+ in knee and ankle jerks. Toes downgoing to plantar reflexes response. FAMILY HISTORY: non-contributary SOCIAL HISTORY: EtOH abuse - drinks about [**12-2**] gallon of vodka/day Denies tobacco or illicit/recreational drugs. Divorced with two children.

CHIEF COMPLAINT: Confusion, lethargy and hyperglycemia PRESENT ILLNESS: 78F h/o Atrial fibrillation (not on coumadin), dementia, and DM2 sent in from rehab for altered MS today. She is demented at baseline, AAOx person and place and able to report immediate medical complaints. She is a poor historian and oriented only to self. She is stating only that she does not feel well. Denies specific complaints when asked, including chest pain, SOB, cough, abdominal pain, N/V, diarrhea, and dysuria. Did not answer question about sick contacts. Daughter thinks she may not have been eating quite as well as usual, but otherwise has been in her usual state of health without any complaints. . In the ED, initial vitals 97.8, 91, 100/60, 16, 98% RA. Labs significant for glucose 1053, Hct 54, AG 25, Creatinine 1.7, lactate 8.1, K 4.0, Na 141, trop <0.01. U/A positive for 9 WBC, few bacteria, 1000 glucose, neg nitrite, 3 epi. CXR obtained which showed "Subtle streaky opacity at the right lung base." Pt given levofloxacin 750mg x 1. Got 10 units IV insulin in ED, then started on drip at 7 units per hour. Fingerstick still elevated; got another 10 units insulin and drip increased to 10 units per hour. Got 2 liters of fluid and 40 mEq potassium chloride. Lactate 7.4 on recheck. VS at time of transfer 97.7, 90, 16, 140/61, 99% RA. . On arrival to the MICU, VS 96.7, 108/57, 97, 19, 97% RA. She states she doesn't feel well but unable to specify how or why. AAO x person only. . Review of systems: Per HPI MEDICAL HISTORY: Atrial fibrillation, not on coumadin Diabetes Mellitus type 2 History of noncompliance with medical therapy dementia MEDICATION ON ADMISSION: multivitamin daily omeprazole 20mg [**Hospital1 **] metformin 1000mg [**Hospital1 **] ferrous sulfate 325mg [**Hospital1 **] lisinopril 10mg TID simvastatin 10mg qHS glipizide 2.5mg daily atenolol 100mg qAM citalopram HBr 20mg daily furosemide 80mg po daily acetaminophen 650mg q4h prn pain bisacodyl 10mg supp daily prn constipation milk of magnesia 30mL po daily prn constip fleet enema daily prn constip ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon Admission Vitals: T:96.7 BP:108/57 P:97 R:19 O2:96% RA General: AAOx person, not place or time. appears uncomfortable, but in NAD HEENT: Sclera anicteric, MM dry, EOMI, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, obese, bowel sounds present, appears uncomfortable to palpation but denies pain Ext: warm, well perfused, 2+ pulses, blue-tinged feet with dilated superficial veins/spider veins FAMILY HISTORY: NC SOCIAL HISTORY: Lives at rehab ([**Hospital3 1186**]). Denies smoking, ETOH, or illicit drugs

CHIEF COMPLAINT: seroquel overdose PRESENT ILLNESS: Ms. [**Known lastname 87256**] is a 18yo F with history of bipolar disorder and schizophrenia who presented to the ER after ingestion of 50 pills of 50mg Seroquel. She called her friend who showed her the empty bottle of seroquel. Her friend called 911. She also had other pill bottles with her, but she said she only took the seroquel. This was approximately at 3am. She denies SI/SA. No previous SA. Initially in the ED she was alert, but then developed some visual hallucinations. She was given 50g activated charcoal. Her QTc was 407 and QRS 70. . In the ER, initial vitals were 96.8, 111, 142/79, 18, 98%. Serum tox screen was negative for other ingestions. Toxicology was consulted given her ingestion and recommended monitoring her QTc (in ER QTc 407) and vitals given risk for anticholinergic toxicity. Psychiatry recommended 1:1 sitter for now and should be fully consulted once she reaches the floor. She received two liters of NS, 50g activated charcoal and 2mg of ativan while in the ER. Vitals on transfer were 126, 113/65, 11, 100%RA with most recent QTc 437. MEDICAL HISTORY: Depression/Biplar Schizophrenia MEDICATION ON ADMISSION: Celexa Risperdol Seroquel ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: FAMILY HISTORY: NC SOCIAL HISTORY: student, +tob

CHIEF COMPLAINT: BRBPR PRESENT ILLNESS: 49 y.o. M with no PMHx here with sudden GIB @ 5 pm today. Describes acute onset of stomach grumbling which progressed to gross blood per rectum. Episode resolved but then recurred second time so patient presented to [**Location (un) **] ED where he was having profuse LGIB. Denies any h/o previous GI bleeding, melena, recent sick contacts, aspirin use, personal or family history of IBD, abdominal pain, fevers or other complaints. Took couple days of motrin couple weeks ago for neck pain. . At [**Location (un) **], BP 180/109, HR 92. Hct 42 on presentation. Given 3 units PRBC's and additional 2L IVF's with repeat hct of 40. Course notable for transient non-responsiveness for 1-2 minutes in setting of bradycardia to 30's. This occurred while at rest 1-2 minutes after moving his bowels. Patient describes feeling nauseated and then light headed and then syncopized - aroused with sternal rub. Given atropine for bradycardia and improved accordingly. Not hypotensive at any point. Started on IV PPI. Transferred to [**Hospital1 18**] for management. . In ED 99.2, 95, BP 161/107, RR 25, O2 93% RA. Patient given one additional Liter NS. Anoscopy demonstrated blood in rectal vault, fresh clot, internal hemorrhoids but no active bleeding lesion. Admitted to ICU for management. . EKG nl, CXR normal, 3 PIV, PPI [**Hospital1 **] today (one at [**Location (un) **]). MEDICAL HISTORY: None MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vital Signs as of [**2103-4-5**] 02:35 AM FAMILY HISTORY: No family history of crohn's, UC, early colon cancer. SOCIAL HISTORY: Software engineer, no-tobacco, 2 glasses wine per day.