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CHIEF COMPLAINT: Left sided brain mass PRESENT ILLNESS: 26F with a history of Schwanommatosis, status post surgical resection of posterior fossa brain mass, right medial nerve, and sacral mass recsection. Presents for an elective admission for left craniotomy for tumor resection of a left brain mass. MEDICAL HISTORY: Schwannomatosis Multiple surgeries since birth anemia, chronic constipation, cesarean section MEDICATION ON ADMISSION: valium, percocet, oxycontin, gabapentin, ibuprofen ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pre-op Exam: alert and oriented to person, place , and time. full strength and sensation. independently ambulates. [**2197-5-14**]: On the Day of discharge: The patient was alert and oriented to person , place and time. The patient exhibited full strength and sensation. no pronator drift. There were no complaints of nausea, vomiting, hearing loss, or visual disturbace. The patient was ambulating independently with a steady gait. EOM were intact. pupils equal and reactive FAMILY HISTORY: Family history of schwannomatosis (Mother) SOCIAL HISTORY: Resides at home in [**Location 34697**] with fiance, and young daughter.

CHIEF COMPLAINT: hip pain PRESENT ILLNESS: This is a 72 year-old male with PMH of diastolic heart failure with an EF=65%, AS s/p mechanical AVR, AF on coumadin, CAD s/p CABG, pulmonary hypertension, 3rd degree heart block s/p PPM, and severe COPD who was discharged to LTAC yesterday after a month-long hospitalization for MRSA bacteremia secondary to a PICC line complicated by left prostethic hip seeding requiring OR washout and prolonged intubation after the procedure who now presents with worsening left hip pain and evidence of dislocation on an X-ray taken at his LTAC. The patient was delirious at time of discharge and unable to effectively communicate that he was having pain in his left hip. According to the patient's son, his mental status quickly cleared at the LTAC and he was able to report severe pain in his left hip. This provoked the LTAC to obtain X-rays of the hip which showed dislocation necessitating transfer back to [**Hospital1 18**] for ortho evaluation. He remains on vanco for MRSA bacteremia to complete a 6 week course per ID recommendations and still has his midline in place. . In the emergency department initial vital signs were 99.2, 83, 108/56, 16, 99% 2L NC. He was later noted to have a fever of 102, but his son says that he did not feel as though the patient had a fever because he did not feel warm and his temperature resolved quickly to 99, although he was given 1gm of Tylenol. He received 500cc of IVFs for SBP in the 90s and his SBP climbed to 110s. He also received Zosyn 4.5gms as a CXR in the ED could not r/o PNA and his vanco level was checked at 16.7. An EKG showed atrial fibrillation and no changes from his prior. Orthopedics was consulted and his hip was reduced under conscious sedation with propofol. Repeat films after the hip manipulation showed successful relocation of the hip. He was admitted for documented fever on vanco in the setting of low SBP to the 90s. . On arrival in the ICU the patient was alert, pleasant, and conversational. The son notes that the patient's mental status improved dramatically after his hip was put back into place by ortho and postulates that his delirium was likely related to pain. Otherwise, the patient has no complaints and did not feel febrile in the ED. He feels as though he is improved from the time he was discharged. MEDICAL HISTORY: -CAD s/p 2V CABG -HTN -HLD -Severe diastolic CHF (EF >60% [**2129-2-7**]) -Pulmonary Hypertension -A fib on coumadin -Hx of 3rd degree block s/p PPM, currently V-paced -Hx of AS s/p AVR with [**First Name8 (NamePattern2) **] [**Male First Name (un) 1525**] Mechanical Valve ([**2116**]) -COPD -Hx of CVA c/b seizure DO, on lamictal -Diet-controlled DM -Chronic Kidney Injury -Chronic lethargy and confusion with concern for Dementia -Focal disection of abd aorta - noted CT abdomen [**2126-10-16**]- unchanged from [**2124**] -BPH (no difficulty voiding) -s/p L ORIF and THR [**9-/2128**] MEDICATION ON ADMISSION: vancomycin 500 mg QOD, goal 15-20 (cont through ID appnt [**11-29**]) sildenafil 20 mg tab 2 PO TID aspirin 81 mg tab daily furosemide 80 mg IV BID warfarin 1 mg tab PO Q4PM heparin drip: 800U/hr adjust PTT 50-70 bisacodyl 5 mg tab 2 tabs prn docusate sodium 100 mg 1 [**Hospital1 **] folic acid 1 mg tab PO daily latanoprost 0.005 % gtt QHS lamotrigine 150 mg PO BID dorzolamide 2 % gtt [**Hospital1 **] acetaminophen 325 mg 1 Q6H prn senna 8.6 mg tab [**Hospital1 **] prn polyethylene glycol 3350 17 gram/dose prn albuterol sulfate 2.5 mg /3 mL (0.083 %) neb Q6H prn famotidine 20 mg tab PO Q24H quetiapine 50 mg tab QHS prn insomnia, agitation humalog insulin sliding scale Flovent HFA 220 mcg/Actuation Aerosol 1 [**Hospital1 **] Vitamin D-3 400 unit Tablet 2 PO daily tiotropium bromide 18 mcg inh daily multivitamin 1 PO daily ipratropium bromide 17 mcg/Actuation HFA 1 inh QID prn Calcium 500 mg (1,250 mg) 1 PO BID simvastatin 20 mg 1 tab PO daily ALLERGIES: Penicillins / Tegretol / Spironolactone PHYSICAL EXAM: VS: T=97, HR=87, BP=126/56, RR=21, POx=100% on NC GEN: comfortable, pleasant HEENT: dry MM, EOMI, PERRL NECK: supple PULM: CTAB with crackles noted at the bases CARD: Irregularly irregular ABD: soft, NT/ND, BS+ EXT: no clubbing or edema SKIN: Multiple ecchymoses and wounds unchanged from previous admission NEURO: A+Ox1-2, diminished range of motion of left shoulder and elbow, left hip range of motion not assessed given recent ortho manipulation to reset hip in socket FAMILY HISTORY: There is a family history of CAD. All sisters and brothers are deceased. SOCIAL HISTORY: He currently lives with wife and son in a two story home. He is a retired newpaper journalist; He moved to the U.S.A. in [**2098**], but returned to [**Country 11150**] to work. He returned here permanently in [**2120**]. He does not currently smoke, but quit 10 years ago with an 80 pack year history.

CHIEF COMPLAINT: Abdominal Pain Fever Jaundice Change in mental status PRESENT ILLNESS: This is a [**Age over 90 **] year old male with A-fib, DMS, Parkinson's, now with fever, jaundice, mental status change. He was sent from [**Hospital 100**] rehab with 2-3 days fo these symptoms. His drain was removed on [**2136-9-3**] after cystic duct shown to be patent on cholangiography. MEDICAL HISTORY: Parkinson's, CRI, DVT s/p filter, afib, hip fracture, IBS, DM2, lobectomy for PNA, PEG MEDICATION ON ADMISSION: tylenol, calcitonin, sinemet, vit D, colace, lovenox, famotidine, finasteride, fluticasone, folate, lasix, gabapentin, levoxyl, PPI, flomax ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 101.2, 116, 97/57, 22, 92% RA NAD, A+O x 3 NCAT, no LAD or masses Irreg, systolic click distendeed, hypo BS, soft, mildly diffuse tenderness. No [**Doctor Last Name **], dullness to percussion Guaiac negative, no masses 1+ peripheral edema FAMILY HISTORY: nc SOCIAL HISTORY: Resides at [**Hospital 100**] Rehab

CHIEF COMPLAINT: right facial pain, hypotension PRESENT ILLNESS: Mr. [**Known lastname 87151**] is an 81 year old gentleman with a history notable for CAD, hypertension, afib off coumadin, PVD s/p left and right carotid end arterectomy, and type II DM who came to the ED on [**2157-9-21**] with a chief complaint of right sided facial pain and hypotension. . #Problem 1, Trigeminal Neuralgia: The patient has had pain from right sided trigeminal neuralgia for the past several years. He began experiencing this pain in [**2150**] after he underwent right and left sided CEA. The pain occurred in the morning, though it would not wake him up from sleep and would not be elicited by chewing. Over the past year, the pain has increased in frequency to approximately once per day occurring in primarily the morning. The pain is in the high right upper jaw near the TM joint in a V3 distribution. The pain is 'shooting' and he rates it as [**2161-8-28**]. . Mr. [**Known lastname 87151**] and his PCP report that his pain has become much worse over the last month in terms of the frequency in that they began occurring every few minutes. I spoke with the patient's PCP who says that he began ramping up the patient's tegretol up to the most recent dose of 400 mg of tegretol SR. The patient's pain improved with more tegretol, but he began experiencing gait instability attributed to the tegretol as well as several falls. The PCP discontinued the patient's coumadin (for afib) as a result of these falls. Despite initial improvement with tegretol, the patient's right facial pain again worsened. This led to his recent hospitalization at [**Hospital3 **]. He was discharged on Monday ([**2157-9-19**]) from NWH on 400 mg tegretol SR [**Hospital1 **] as well as a neurontin 200 mg PO TID. . The patient reports that since returning home on Monday the pain has been occurring every few minutes. The patient has not been taking in good PO's as a result and has been extremely uncomfortable. In addition to the neurontin, he has been taking percocet Q2-4 hours to manage his pain. . #Problem #2, Hypotension: Mr. [**Known lastname 87151**] was at home yesterday when his VNA nurse came in and woke him up. The patient had taken percocet that morning. He felt dizzy and 'dopey'. The nurse felt that the patient was not himself and was concerned enough to call EMS. At that time, the patient had no chest pain, SOB, visual changes, palpitations, or headache. EMS found him to hypotensive with SBP of 70. . #ED Course: In ED, Mr. [**Known lastname 87151**] was hypotensive with vital signs of 96.2 HR 55 BP 77/33 and lethargic. After 2L IVF bolus his BP improved to SBP 92, and another 2L NS of fluid were given and bp stabilized at 128. A bedside ultrasound performed did not show evidence of effusion or tamponade. In addition, an EKG was performed initially thought to be 2 AVB, but in review with cardiology, it was interpreted at afib and the recommendation was made to rule out Mr. [**Known lastname 87151**] for MI. He otherwise had a negative head CT for ICH, and became more orientated during his ED course, but he continued to complain of his right sided facial pain. His cardiac enzymes were negative times 2. . Review of Systems: No n/v/f/d, no weight loss, no abdominal pain, no hematochezia, no hematuria, no visual changes. MEDICAL HISTORY: Coronary artery disease with angina PVD s/p bilateral CEA with residual right-sided facial numbness Type 2 DM Arthritis bilaterally in his hands Hypertension Carpal tunnel syndrome status post release s/p TURP for benign prostatic hypertrophy s/p knee surgery for cartilage tear. MEDICATION ON ADMISSION: Aspirin 325 mg QD Isosorbide Mononitrate 20 mg [**Hospital1 **] Hydrochlorothiazide 25 mg QD Metoprolol Succinate 100 mg QD Pravastatin Sodium 20 mg QD Amlodipine Besylate 5 mg QD Metformin 500 mg QD Glyburide 2.5 mg QD Lisinopril 5 mg QD Tegretol SR 400 [**Hospital1 **] Percocet ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS 97 136/68 96 20 96/2L GEN: In Bed, NAD. HEENT: PERRL, EOMI, no LAD, MMM, no JVD CV: irreg irreg no m/r/g CHEST: CTA b/l no w/r/r ABD: Normoactive BS, soft, NT/ND, no organomegaly, per ED guaiac neg. EXT: 1+ lower extremity edema NEURO: AAOx3, No focal Deficits, Motor [**4-22**] throughout, Sensation intact FAMILY HISTORY: Mother with CAD, sister with DM, and niece with ovarian cancer SOCIAL HISTORY: Widowed 10 years ago, the patient lives alone. Positive tobacco times 10 years, but quit 41 years ago, and has approximately one glass of wine per week.

CHIEF COMPLAINT: esophageal caracinoma PRESENT ILLNESS: 61yM with T3 adenoCA esoph s/p neoadjuvant tx now s/p lap esophagectomy. Initially presented in [**2-2**] with dysphagia, anemia, fatigue. Found to have a GE junction tumor that was biopsied. Had J tube placed prior to neoadjuvant therapy. Now s/p laparoscopic esophagectomy. MEDICAL HISTORY: PMH:DM2, HTN, CRI (1.5), obesity, low back pain, depression/anxiety, gout, splenomegaly, reflux. . PSH: spinal fusion, s/p orchidectomy for torsion, R medial meniscus repair, lap j-tube MEDICATION ON ADMISSION: coreg 25', diovan 160', lasix 20', prilosec 20', morphine & klonapin prn, zoloft 100', allopurinol 300' ALLERGIES: Penicillins / Adhesive Tape PHYSICAL EXAM: AFVSS Gen: NAD, A+OX3, conversive with somewhat hoarse voice, pleasant HEENT: EOMI, PERRL, thyroid not enlarged/tender, no supraclavicular/axillary nodes palpable, neck JP in place with clear drainage (small) CV: RRR, 2+ radial and femoral pulses Resp: CTAB Abd: soft, NT/ND, no periumbilical LAD, no fluid wave Ext: 1+ edema to b/l LE FAMILY HISTORY: FHx: Mother had breast CA, Father had leukemia, Grandmother had throat CA SOCIAL HISTORY: Denies etoh/drug use, ex-smoker of 5 years, works as a medical assistant at St. [**Hospital 11042**] hospital

CHIEF COMPLAINT: MVC PRESENT ILLNESS: The patient is a 40 year old female who complains of MVC. severe mechanisms. right open tib fib fracture, right wrist injury. clsoed head injury. MEDICAL HISTORY: PMHx: MS [**First Name (Titles) **] [**Last Name (Titles) 90094**] disease w/ monthly episodes requiring steroids, vision impairment (? legally blind in R eye), MEDICATION ON ADMISSION: Oxycontin 40 mg TID Percocet 30 mg PRN Lamictal 100 mg daily Celexa 60 mg daily Gabatril (unknown dose) Nortriptylene (unknown dose) ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Demerol / Ultram PHYSICAL EXAM: GCS 14 T:96.7 BP:104/65 HR: 116 R20 O2Sats 94 FM Gen: WD/WN, comfortable, NAD. HEENT: Pupils:Bilaterally reaective to light. Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. No C/C/E. FAMILY HISTORY: non contributory SOCIAL HISTORY: Married with child. + tobacco, No ETOH

CHIEF COMPLAINT: Hypoxia PRESENT ILLNESS: Mrs [**Known firstname 2411**] [**Known lastname 16232**] is a 55 yo F w no significant PMH, who was on azthromycin for outpatient treatment of LLL pneumonia for 5 days and who p/w worsening cough, fever, malaise and dyspnea on exertion. The patient sx started two weeks ago when she felt she had caught a cold or a sinus infection. She had a dry cough, and fullness in her head.-- of note the patient is the director of a nursery home and many children and parents have been sick recently. On [**9-17**], she was started on a course of azythromycin and diagnosed with LLL pneumonia later that week. 5 days later, her sx had worsened, the pt was complaining of productive cough, DOE and pleuritic chest pain and temperature of 101.5 taken orally. On a follow up appt on [**9-21**], the pt was found to be tachy in the 130s and sating 85% on RA. She was advised to go to the ED. The pt did not complain of bloody sputum, N/V, HA, neck stiffness, bloody stool or dysuria. MEDICAL HISTORY: # Headache # Sinusitis # TMJ # Raynauds - takes nifedipine in the wintertime # s/p partial thyroidectomy for nodules, on levothyroxine MEDICATION ON ADMISSION: ALLERGIES: Ceclor / E-Mycin / Penicillins PHYSICAL EXAM: VS: 100.8 HR111 BP 127/61 RR32 95% 5LNC GEN: pleasant middle aged female in NAD, comfortable. HEENT: NC/AT. MMM. O/P erythematous, no exudates, + submandibular LAD. NECK: supple. No JVD. CV: regular tachycardia, nlS1, S2, [**1-31**] HSM throughout precordium. RESP: bronchial BS with inspiratory crackles in LLL, RML, and occasianl scattered rhonchi which clear with coughing. No accessory muscle use. Egophony E-->A LL, LM lobe and RML. Dullness to percussion L middle and base and R middle. ABD: S/NT/ND, + BS EXT: WWP, no c/c/e NEURO: AOx3. Non focal. FAMILY HISTORY: [**Name (NI) 20238**], father. Asthma-mother. Father died for renal failure. SOCIAL HISTORY: The patient lives in [**Location **] with her husband and two daughters. She is a nursery school director and is regularly in contact with many young children.

CHIEF COMPLAINT: Gangrenous left lower extremity ulcerations. PRESENT ILLNESS: This is an 85-year-old Cuban gentleman who presents with neurodegenerative disorder, CVA with right residual hemiparesis, diabetes, who was found to have a cool mottled left foot after a dressing was removed for the skin ulcers and bullous lesions. The patient himself is a poor historian secondary to language and dementia. The patient himself admits that he has no feeling in the leg or foot. The patient was transferred here for further evaluation and treatment. Initially, he was seen in the emergency room and was begun on IV heparinization, and vancomycin and Unasyn were given. He is now admitted to the vascular service for definitive care. MEDICAL HISTORY: Cervical spondylolisthesis; type 2 diabetes, noninsulin dependent, controlled; chronic anemia; history of seizure disorder on Dilantin; history of schizo- affective disorder; history of deep vein thrombosis; history of hypothyroidism on supplement. MEDICATION ON ADMISSION: Include Tylenol 1000 mg daily, Prozac 20 mg daily, levothyroxine 0.5 mg daily, Prilosec 20 mg daily, Remeron 7.5 mg at bedtime, Ativan p.r.n., Ultram 25 mg daily, Neurontin 600 mg daily, trazodone 100 mg daily, Dilantin 200 mg q.i.d., Colace p.r.n. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is a nursing home resident and is not ambulating.

CHIEF COMPLAINT: Right hip failed hardware PRESENT ILLNESS: Mr. [**Known lastname **] is an 85 year old man who suffered a right hip fracture [**2111-9-1**]. Unfortunately this went on to cut out and he presented to the [**Hospital1 **] [**Location (un) 620**] for evaluation. Due to his vascular history he was transferred to the [**Hospital1 18**] for further care and surgery. MEDICAL HISTORY: History of alcoholism type 2 diabetes with neuropathy colonic polyps hypertension BPH s/p TURP GERD coronary artery disease GI bleed in [**12-10**] diverticulosis High cholesterol Right hip fx [**8-11**] MRSA skin ulcer [**10-11**] R femoral artery bypass to dorsalis pedalis [**7-11**] c/b stenosis in setting of R hip ORIF s/p revision bypass by Dr. [**Last Name (STitle) 1391**] in [**9-11**] MEDICATION ON ADMISSION: lisinopril 20mg daily gabapentin 300mg daily Prilosec 20mg daily ASA 81mg daily Toprol XL 25mg daily Vit B12 100 mcg daily glipizide metformin 500mg [**Hospital1 **] oxycodone, docusate, valium prn Regular insulin sliding scale ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon discharge: Alert and oriented, NAD 99 130/72 74 18 97% RA RRR no m/r/g split S2 vs S3? CTAB soft NT/ND + BS right thigh incision c/d/i unable to palpate DP b/l pt is unable to flex at his R ankle no sensation at webspace R, medial R foot left foot sensation intact, able to flex/extend ankle FAMILY HISTORY: n/a SOCIAL HISTORY: EtOH abuse Tob - 40 pack year history d/c'ed in [**2088**] Lives alone; his wife died approximately one year ago Used to be an airline pilot, has flown all over the world

CHIEF COMPLAINT: pancreatitis with pseudocysts PRESENT ILLNESS: This is a 59 year old female with no significant PMH who presented to PCP with [**Name Initial (PRE) **] few days of RUQ pain, nausea and vomiting after meals. She was admitted from the office and underwent a laparoscopic cholecystectomy on [**2193-10-22**] for acute cholecystitis. Intraoperative cholangiogram was not done. The pt was discharged home on POD2 with an uncomplicated hospital stay. On POD8, the pt returned to the office with repeat episodes of acute RUQ pain, elevated LFTs, amylase and lipase; an abdominal ultrasound demonstrated a normal caliber CBD. On [**2193-10-30**] an ERCP with sphincterotomy, stent placement, stone extraction was done. Again the pt was discharged home. On [**2193-11-7**], however, she returned with acute onset epigastric pain, radiating to the back. The pt was again admitted and CT demonstrated a new pancreatic pseudocyst. She was started on antibiotics. A PICC was placed, and she was started on TPN. This hospitalization was complicated by a pulmonary embolus on [**11-13**], at which time a heparin drip was started. Repeat CT demonstrated multiple pancreatic pseudocysts. Diagnostic tap on [**11-13**] demonstrated budding yeast and the patient was started on antifungals per ID. The pt was transfered to [**Hospital1 18**] for further management. At the time of transfer the pt was on TPN, heparin drip, and vancomycin, meropenem, ciprofloxacin, fluconazole. MEDICAL HISTORY: PE ([**2193-11-13**]) PSH: s/p ERCP ([**2193-10-30**]), s/p lap chole ([**2193-10-22**]), s/p L breast lumpectomy ([**2188**]), s/p B tubal ligation ([**2185**]), c-section x2 ([**2167**], [**2169**]) MEDICATION ON ADMISSION: None ALLERGIES: Chlorhexidine Gluconate / Honey Bee Venom / Yellow Jacket Venom / Yellow Hornet Venom / Wasp Venom PHYSICAL EXAM: T 98.5 P 101 BP 154/62 RR 24 89% on RA WT: 97.7kg NCAT, EOM full, PERRL, anicteric Neck supple Chest decreased BS on left, otherwise clear Heart reg rate, tachycardic, no MRG Abd soft and round, diffusely tender to palpation, radiating to back, no rebound, minimal guarding, hypoactive bowel sounds LE 2+DP pulses, min edema at ankles FAMILY HISTORY: SOCIAL HISTORY: no Etoh Lives in [**State 1727**] with husband and son [**Name (NI) 4906**] a [**Name2 (NI) **]

CHIEF COMPLAINT: hypoglycemia PRESENT ILLNESS: 34 year-old man with hx brittle DM1 c/b HD-dependent ESRD now admitted with sympomatic early-monrning hypoglycemia, BS 15. . Patient reports taking usual dose of lantus (10 units) at 11pm on the night prior to admission and then he next remembers being put in an ambulance. His girlfriend gave him glucose tablets and called 911 because he he was "talking funny" and seemed confused early that morning. He doesn't remember any of this. EMS found the patient unresponsive with a FS of 15 - glucagon and IV dextrose were administered. . In the ED the patient was hypertensive but otherwise had stable VS. Initial FS was 179 & on repeat fell to 44. He was started on D10W gtt. [**Last Name (un) **] was consulted in the ED and the patient was admitted to the MICU for BS monitoring. Pt reports that he had been taking his current insulin regimen for ~1 months without hypoglycemia. Describes normal PO intake on the day prior to admission (eats several small meals throughout the day to prevent gastroparesis), perhaps less protein than usual. Denied alcohol or drug use. No unusual exercise. . Of note, the patient was recently admitted from [**Date range (1) 1396**] for CHF exacerbation that was notable for flash pulm edema due to hypertension & required intubation for worsening mental status. Patient also briefly required nitro drip and IV labetalol as well as dialysis for blood pressure control. On that admission, a bronchoscopy was concerning for alveolar hemorrhage, but [**Doctor First Name **], ANCA and anti-GBM were negative and patient had no further episodes of bleeding. Repeat echo on that admission showed an improved EF of 55%. That hospital course was c/b initial hyperglycemia then subsequent hypoglycemia requiring D20 gtt. On the floor the patient was again hyperglycemic requiring high doses of insulin prompting transfer bact to the MICU for insulin gtt. [**Last Name (un) **] was consulted on that admission and recommended increasing Lantus dose to 14units qAM and 12 units qPM. Patient ultimately signed out AMA on [**3-2**]. MEDICAL HISTORY: - DM type I since age 19, followed at [**Last Name (un) **]. Complicated by nephropathy, neuropathy, gastroparesis, retinopathy. Multiple prior hospitalizations with DKA, nausea/vomiting [**2-9**] gastroparesis - ESRD on HD T/Th/S via right arm fistula @ [**Location (un) **] [**Location (un) **], dry weight 73kg - Hypoglycemia - Hyperglycemia/DKA: requiring insulin gtt - Hypertension - Nonischemic cardiomyopathy with EF 30-35% - Anemia: [**2-9**] iron deficiency and advanced CKD - Depression - Pulmonary hypertension - Migraines MEDICATION ON ADMISSION: amlodipine 10 mg Tablet [**Name9 (PRE) **]: One (1) Tablet PO once a day. aspirin 81 mg Tablet, Chewable [**Name9 (PRE) **]: One (1) Tablet, Chewable PO DAILY (Daily). [**Name9 (PRE) 40899**] 0.3 mg/24 hr Patch Weekly [**Name9 (PRE) **]: One (1) Patch Weekly Transdermal QMON (every [**Name9 (PRE) 766**]) - every friday per patient. insulin glargine 100 unit/mL Solution [**Name9 (PRE) **]: Fourteen (14) units Subcutaneous In the morning. insulin lispro 100 unit/mL Solution [**Name9 (PRE) **]: Sliding scale units Subcutaneous With meals and at bedtime: home sliding scale. B complex-vitamin C-folic acid 1 mg Capsule [**Name9 (PRE) **]: One (1) Cap PO DAILY (Daily). lisinopril 40 mg Tablet [**Name9 (PRE) **]: One (1) Tablet PO once a day. sevelamer carbonate 800 mg Tablet [**Name9 (PRE) **]: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). sertraline 100 mg Tablet [**Name9 (PRE) **]: One (1) Tablet PO once a day. hydromorphone 4 mg Tablet [**Name9 (PRE) **]: One (1) Tablet PO every twelve (12) hours as needed for pain. ondansetron 4 mg Tablet, Rapid Dissolve [**Name9 (PRE) **]: One (1) Tablet, Rapid Dissolve PO every eight (8) hours as needed for nausea. labetalol per patient 600mg [**Hospital1 **], 300mg qhs ALLERGIES: Penicillins / Watermelon / Almond Oil / Hydralazine / cefepime PHYSICAL EXAM: MICU ADMISSION EXAM General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact, no SI . DISCHARGE EXAM VS 98.1 138/95 76 18 97/RA FS 104 GEN: well-appearing young man walking around comfortably, fully dressed, NAD HEENT: NCAT, MMM, oropharynx clear, EOMI, PERRL, no JVD CV: RRR, normal S1/S2, no mrg Lungs: good aeration throughout, no w/r/r Abdomen: soft NT ND NABS Ext: WWP, thin legs, 2+ palpable pulses no edema Neuro: AOX3, CNII-XII intact, 5/5 strength throughout, gait stable FAMILY HISTORY: Paternal grandfather had DM2. [**Name2 (NI) **] FH DM1. Hypertension in a few family members. [**Name (NI) 6419**] [**Name2 (NI) **] and several siblings alive and healthy, without known medical problems. SOCIAL HISTORY: Lives with girlfriend. Mother also local. College degree in marketing, worked at [**Company 2475**] previously. Tobacco: trying to quit; relapsed and smokes ~1 pack per week EtOH: previously drank heavily (30-40 drinks/week) but has not used alcohol since [**2144-11-14**] Denies other drugs.

CHIEF COMPLAINT: Weakness on left, disorientation PRESENT ILLNESS: [**Known firstname **] [**Known lastname 50417**] is a 35yo M with a history of IHSS, chronic post nasal drip and GERD who is a chief surgical resident at the [**Hospital1 18**]. While performing his daily clinical duties on the [**Hospital Ward Name **], he noticed the acute onset of fall with inability to use his left hand. At that time he appeared confused. In discussion with his collegues, it appears that the patient had complained of a headache one day prior , however was acting normally on the day of presenation. Today, he describes a sensation of confusion and dysarthria at the time. A code stroke was called at 1340, and he was seen by the stroke fellow, on whose exam, he was found to be disoriented, not following commands, with a left sided neglect, significant left sided weakness and sensory loss and rightward gaze preference. MEDICAL HISTORY: Postnasal drip IHSS (history of being on toprol x 10 years, recently weaned off) GERD MEDICATION ON ADMISSION: None ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS T:afebrile HR:54 BP: 158/98 RR: 16 SaO2: 100% RA General: Awake, agitated. Head: NC/AT, no conjunctival icterus, no oropharyngeal lesions Neck: Supple, no nuchal rigidity, no bruits Cardiovascular: RRR, no M/R/G Pulmonary: Equal air entry bilaterally, no crackles or wheezes Abdomen: Soft, NT, ND, +BS, no guarding Extremities: Warm, no edema, palpable radial/dorsalis pedis pulses Skin: No rashes or lesions Psychiatric: Appears agitated. FAMILY HISTORY: NC SOCIAL HISTORY: The patient is a surgical resident. He lives at home with his wife.

CHIEF COMPLAINT: coffee ground emesis PRESENT ILLNESS: Mr. [**Known lastname 9499**] is a 79 year old man with h/o HIV/AIDS (Kaposi's sarcoma, last CD4 212 in [**10-9**], VL undetectable), DM, CKD, HTN, HLD, anemia, who presents with N/V x 2 days. . The patient was recently started on Vicodin for pain control of a ruptured lumbar disc. He notes 4-5days of constipation, and then developed 2 days of nausea/vomiting and abdominal discomfort. No h/o prior GIB in the past, no recent NSAID or steroid use, no prior scopes. . In the ED, initial VS: 98.2 102 142/91 18 100%. He had coffee ground emesis in the ED, as well as 1 episode of melena. Exam notable for grossly guaiac positive melanotic stool and Kaposi's lesions on b/l LE. Labs notable for HCT 28 (down from baseline mid30s), Cr 3 (up from baseline 2). NGL was negative (250cc, clear return). Patient was evaluated by GI, decided not to scope at that time. Given 2L IVF. Initially was going to be admitted to the floor, but repeat HCT down to 21, so transfused 2units pRBCs and admitted to the MICU for closer monitoring overnight. GI aware of further HCT drop, but will hold on scope unless patient becomes HD unstable overnight. Patient was given Protonix bolus and started on gtt. Also given Zofran. Vitals prior to transfer 98.2, 94, 142/59, 19, 100% RA, 2 PIVs in place. Ortho Vitals (Down BP128/49 HR 87) (up BP 127/55 HR103). . On the floor, patient currently c/o lower back pain. Some GI discomfort, but no pain. Mild nausea. 10-point ROS otherwise negative. MEDICAL HISTORY: HIV/AIDS (CD4 212 in [**10-9**], VL undectable, prior invasive Cryptococcal infection) Kaposi's sarcoma CKD, baseline Cr 2.0 DM (followed at [**Last Name (un) **]) HLD HTN Vitamin D deficiency MEDICATION ON ADMISSION: CITALOPRAM [CELEXA] - 40 mg Tablet - one Tablet(s) by mouth once a day CLOBETASOL - 0.05 % Ointment - apply to affected area on legs once daily apply at different time from Amlactin ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule - One Capsule(s) by mouth every 2 weeks. FLUCONAZOLE - 200 mg Tablet - Two Tablet(s) by mouth once daily. FLUTICASONE - 50 mcg Spray, Suspension - Two sprays ea nostril twice daily. GLYBURIDE - 5 mg Tablet - One Tablet(s) by mouth in the AM and 2 in the PM. HYDROCHLOROTHIAZIDE - 25 mg Tablet - One Tablet(s) by mouth once daily. KETOCONAZOLE [NIZORAL] - 2 % Shampoo - WASH HEAD WITH SHAMPOO EVERY 2-3 DAYS LAMIVUDINE [EPIVIR HBV] - 100 mg Tablet - One Tablet(s) by mouth once daily. NEVIRAPINE [VIRAMUNE] - 200 mg Tablet - 2 Tablet(s) by mouth once a day OXYCODONE-ACETAMINOPHEN [PERCOCET] - 5 mg-325 mg Tablet - [**1-30**] Tablet(s) by mouth every four (4) hours as needed for Pain RALTEGRAVIR [ISENTRESS] - 400 mg Tablet - One Tablet(s) by mouth [**Hospital1 **]. ROSUVASTATIN [CRESTOR] - 40 mg Tablet - One Tablet(s) by mouth once daily. SULFAMETHOXAZOLE-TRIMETHOPRIM [BACTRIM DS] - 800 mg-160 mg Tablet - One Tablet(s) by mouth daily. TAMSULOSIN [FLOMAX] - 0.4 mg Capsule, Ext Release 24 hr - Two Capsule(s) by mouth daily. VALSARTAN [DIOVAN] - 40 mg Tablet - One Tablet(s) by mouth daily. Medications - OTC AMMONIUM LACTATE [AMLACTIN] - 12 % Cream - apply to affected area on legs once daily apply at different time of day from clobetasol ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - One Tablet(s) by mouth once daily for cardiovascular prophylaxis. CYANOCOBALAMIN (VITAMIN B-12) - 1,000 mcg Tablet - One Tablet(s) by mouth once daily. Vitamin B12. NPH INSULIN HUMAN RECOMB [HUMULIN N] - 100 unit/mL Suspension - Up to 30 units every bedtime as directed by [**Hospital **] Clinic. OMEGA-3 FATTY ACIDS-VITAMIN E [FISH OIL] - 1,000 mg Capsule - 1 Capsule(s) by mouth twice per day. Prescribed by [**Hospital **] Clinic. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM VS: 97.8 85 152/60 17 100% Appearance: alert, NAD, obese Eyes: eomi, perrl, anicteric ENT: OP clear s lesions, mmm, no JVD, neck supple Cv: +s1, s2 -m/r/g, no peripheral edema, 2+ dp/pt bilaterally Pulm: clear bilaterally Abd: soft, nt, nd, +bs Msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing Neuro: cn 2-12 grossly intact, no focal deficits Skin: no rashes Psych: appropriate, pleasant Heme: no cervical [**Doctor First Name **] Rectal: heme positive on ED exam . DISCHARGE PHYSICAL EXAM VSS GEN: NAD, cachetic appearing HEART: RRR, no m/r/g LUNG: CTA BL ABD: soft, NT/ND, +BS EXT: hyperpigmented with ulceration and scap formation over bilateral shin FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives alone. Has 2 daughters, who help look after him. - Tobacco: none, quit 20 years ago - EtOH: glass of wine with dinner daily - Drugs: none

CHIEF COMPLAINT: PRESENT ILLNESS: Briefly, this is a 52-year-old female with a history of heart murmur who was found to have mild aortic stenosis in [**2125**], followed by serial echocardiograms and it was found that the aortic valve area was fully getting worse. She also had decreased exercise tolerance. The patient presented to Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] office for evaluation of aortic valve replacement. MEDICAL HISTORY: Significant for: 1. Aortic stenosis. 2. Anxiety. 3. Chronic anemia. 4. Left frozen shoulder. MEDICATION ON ADMISSION: 1. Celebrex 200 mg p.o. twice a day. 2. Ativan 0.25 mg p.o. p.r.n. 3. Aciphex 20 mg p.o. twice a day. 4. Multivitamin. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Fall PRESENT ILLNESS: History obtained from chart and nursing as pt very demented at baseline. Pt is an 81 F admitted from her [**Hospital3 **] facility after an unwitnessed fall while making her bed. Fall was heard by co-workers her found her on the floor laying on her right arm and bleeding from her lip. LOC unclear. At [**Location (un) 620**], her lip laceration was sutured, a head CT was negative for bleed, CT neck was abnormal prompting transfer for MRI c-spine and surgical evaluation. In [**Hospital1 **] [**Name (NI) **], pt was noted to have BL UE distal weakness, R worse than L. The MRI c-spine showed ? cervical cord compression. Neurology was consulted and exam was consistent with this. Pt was initially admitted to trauma surgery service for further care. MEDICAL HISTORY: Alzheimer's Dementia followed by [**First Name8 (NamePattern2) 26344**] [**Last Name (NamePattern1) 32878**] ([**Hospital1 **]) DM2 on po meds Hypothyroidism HTN OA on Motrin Neuropathy, unclear origin s/p L TKR x2 h/x falls MEDICATION ON ADMISSION: metformin 500', synthroid .075', lisinopril 5', lipitor 10', seroquel 12.5qhs, motrin 600'''', folate, b12. nemenda 10 mg Q AM AND PM. Ibuprofen 600 mg QID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 97.6 BP 148/65 HR 88 RR 21 O2 100% NRB Gen: elderly F - difficult to interpret speech at times. not oriented to place, year. HEENT: right pupil surgical. left pupil 3-4 mm reactive. Neck: + anterior neck wound with stereostrips over area. non tender CV: RRR. Nl S1, S2. no m/r/g. Lungs: some coarse breath sounds Abd: active BS. soft NT. ND. No HSM. No masses. Extr: trace edema. DP 2+ B/L. radial pulse 2+ B/l. facial muscles symmetric. sensation intact. Neuro: pt unable to cooperate with full neuro exam. DIfficulty with sitting upright and also standing - a combination of difficulty following commands and also weakness FAMILY HISTORY: unable to obtain. Per chart, 1 sister with MR/CP since birth, well-controlled sz d/o SOCIAL HISTORY: Single. Former elementary school teacher. No tob. etoh. drugs. Has 3 sisters, none married. No kids. Pt lives at the Falls [**Hospital3 400**] Facility [**Telephone/Fax (1) 62257**]. Per family, pt dresses herself and feeds herself, and walks well. Meals made by home. She is "disoriented" at baseline.

CHIEF COMPLAINT: ESLD PRESENT ILLNESS: 54 y.o. male with HCV cirrhosis and HCC with 2 lesions s/p RF ablation. Had previously been trialed on interferon and ribaviron without response. Chest CT and bone scan without evidence of metastasis. Has felt well in last month without any n/v/c/d illness or sick contacts. MEDICAL HISTORY: HCV, HCC, HTN, DM2 MEDICATION ON ADMISSION: ursodiol 300', colchicine 40', nadolol 40', Lantus 16qAM ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.1 71-148/83 18 94% RA, wt 95Kg, height 189.9cm NAD A&Ox3 neck -free range of motion, anicteric, no LAD,no thyromegaly, neck supple cor rrr lungs clear ext wwp FAMILY HISTORY: SOCIAL HISTORY: married with 2 children, high school teacher

CHIEF COMPLAINT: Change in Mental Status PRESENT ILLNESS: Pt is a 55y.o F trasferred from OSH with overdose of pain medication taken for post knee arthroscopy pain. Pt taking oxycodone, flexeril, and darvocet for pain relief post-op. Her family called EMS out of concern for altered mental status. She was given narcan by EMS with subsequent agitation. Urine tox at OSH was positive for benzos and opiates. She was given ativan, rocephine and vancomycin. Her OSH report, her family stated that she takes oxycodone 1,2 or 3 tablets every 4-6 hrs and that 8 tablets were missing from her bottle. She was increasing lethargic with a decrease in consciouness but arousable to stimulation. . On arrival to [**Hospital1 18**] ED, initial vitals T 98.9, HR 120, BP 90/56, RR 18, O2 sat 100% RA. The pt very confused, with waxing and [**Doctor Last Name 688**] coherence. She was found to be tachycardic with extremely dry MM, concerning for anticholinergic syndrome in setting of flexeril use. This am she dropped pressure to systolic of 60s which responded to a 500cc fluid bolus. She was given levaquin and flagyl. . On arrival to the MICU, the patient was agitated and tearful with conversation. She became increasingly frustrated when asked questions about her medication history. She states that she did not take any darvocet and took her oxycodone as prescribed. Denies flexeril use over past 24hrs but may have taken one tablet the day prior. She states she does not remember the events bringing her into the hospital. She states she had been with good energy over the last few months. She lost her job approx 3 months ago due to a harrassment claim but states her employer is being supportive in attempting to find her a new job. She has had excellent energy levels, increased from baseline with decreased need for sleep but she attempts to sleep 8 hours nightly. She has gained 15lbs due to increased appetite. Denies visual hallucinations but states she hears things that others do not but "only in my very deepest head" and when her "very good friend [**Name (NI) 717**] speaks to her." MEDICAL HISTORY: L knee arthroscopy Depression Hx of EtOH abuse - states sober for 14 years Abdominoplasty Migraine headache MRSA s/p Hysterectomy MEDICATION ON ADMISSION: Oxycodone 10mg 1-3 tabs Q4H/PRN Flexeril 3 mg qHS Darvocet N-100 1 tab q4-6H/PRN Topamax 100mg daily Effexor 375mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: V/S: T 98.2 HR 101 BP 104/52 RR 22 O2sat 99% RA GEN: Pleasant middle-aged woman converses appropriately, NAD HEENT: PERRL EOMI OP clear with dry MM NECK: supple w/o LAD or JVD CV: RRR nl S1S2 no m/r/g PULM: CTAB no w/r/r ABD: soft NTND normoactive BS EXT: warm, dry 2+ DP pulses; no c/c/e; erythema, warmth, and tenderness overlying anterior left knee with small effusion, no oozing or purulent drainage from stapled incision site FAMILY HISTORY: NC SOCIAL HISTORY: Married with 2 children, lives in [**Location **], MA. Husband also has h/o EtOH abuse and attends AA. Currently unemployed, lost job secondary to harrassment claim. Sober X 14 years, denies tobacco, denies IVDU.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mrs. [**Known lastname **] is an 85 yo woman with lymphoma s/p rituximab/Zevelin ~6 weeks ago (in nadir now) and recent admission to [**Hospital1 18**] with NSTEMI managed medically who presented to [**Hospital1 18**]-[**Location (un) 620**] on [**11-2**] with chest pain. There, her CKs were flat, and her chest pain resolved. She received a bag of platelets for thrombocytopenia and aspirin 81 mg was started. She also apparently had volume overload in the setting of a blood transfusion. She responded well to furosemide. An echocardiogram revealed globally depressed systolic function (LVEF 35-40%), which is worse than her echocardiogram during her last admission to [**Hospital1 18**]. In addition, a Foley catheter was placed for urinary frequency, and a urine culture grew out >100,000 Enterococcus. . She is being transferred for further management. . She reports that she awoke from sleep with 2 episodes of chest pain. She can not quantify the intensity. Seh reports that they lasted on the order of minutes to half an hour and radiated to [**Last Name (un) **] back. They were not associated with shortness of breath, nausea or diaphoresis. She called 911 and was taken to [**Hospital1 **]. . She currently denies chest pain or shortness of breath, and reports that she was chest pain-free at [**Hospital1 **]. She denies palpitations. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: HTN High Grade B cell NHL -Diagnoses [**6-/2146**] -s/p three cycles R-CHOP on [**8-3**], nadir 4-8 weeks -Now on rituximab or Zevalin (research protocol) Colon cancer in [**12/2143**] B12 deficiency . Cardiac Risk Factors: (-) Diabetes, (-) Dyslipidemia, (+) Hypertension . Cardiac History: s/p recent NSTEMI with planned medical management MEDICATION ON ADMISSION: Metoprolol 100 mg tid Furosemide 20 mg daily Vitamin B12 100 mcg daily Simvastatin 80 mg daily MVI 1 daily Omeprazole 20 mg daily Aspirin 81 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 94.2, 106/60, 64, 18 93% on RA Gen: Pleasant elderly woman lying in bed, NAD, appropriate HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva had mild pallor FAMILY HISTORY: Her brother died of leukemia. Her sister was diagnosed with uterine cancer and recently died. Her other brother is alive after having a nephrectomy for renal cancer. She also has family history of coronary artery disease in many of her seven siblings. SOCIAL HISTORY: She denies any tobacco or alcohol use. She used to work as a factory worker in an elastic factory. Currently lives next door to her son and daughter in law who provide most of her care.

CHIEF COMPLAINT: Generalized weakness PRESENT ILLNESS: 88 year old female with multiple medical problems including dementia, hypothyroidism, rheumatoid arthritis, and A.Fib on coumadin presents with one week of generalized weakness and not feeling well. Pt also c/o vague abdominal discomfort and, today, nausea and anorexia. In ED noted to have an inflamed wrist joint - this was tapped and there was no evidence of infection. Wrist films showed a wrist fracture and she was placed in a splint. On further history-taking the pt does recall falling on the right hand "a couple of weeks ago". She was also noted to have elevated LFTs and an abdominal CT and ultrasound showed choledocholitiasis without acute cholecystitis. The studies were not changed since [**2181-12-8**]. She received a dose of Zosyn in the ED as "empiric therapy for presumed intra-abdominal pathology". She was seen by Surgery in the ED, and no surgical problems were identified. GI Consultation was suggested. Was last admitted here from [**2182-7-5**] through [**2182-7-7**] for mental status changes, which were thought to be due to Ultram +/- Detrol (both were stopped) in the setting of probable [**Last Name (un) 309**] body dementia. MEDICAL HISTORY: Atrial fibrillation Hypothyroidism Hypertension H/o Diastolic Dysfunction Hypercholesterolemia Gastroesophageal reflux disease Arthritis - severe degenerative; ? RA - on low dose prednisone Status post hysterectomy Rheumatic fever Chronic renal insufficiency: baseline creat 1.4-1.6 Dementia - ? early [**Last Name (un) 309**] body type Hypothyroidism Menigioma MEDICATION ON ADMISSION: Atenolol 50 mg PO Daily, Furosemide 40mg PO Daily, Lovastatin 20 mg PO Daily, Omeprazole 20 mg PO Daily, Prednisone 5 mg PO Daily, Tramadol 50 mg PO prn pain, Synthroid 50 mcg PO Daily, Alendronate 35 mg PO Qweekly, Aspirin 81 mg PO Daily, Colace 100 mg PO BID, [**Doctor First Name **] 325 mg PO Daily, Warfarin 4 mg PO Daily except for Saturday and Sunday 5 mg PO. ALLERGIES: Nsaids PHYSICAL EXAM: T-96.0 BP-121/57 HR-70 RR-16 SaO2- 96 %RA Pleasant and cooperative. Morbidly obese. A & O x 3. HEENT-Negative. Neck-supple, non-tender, no JVD. Lungs-CTAB CV-RR, grade II/VI systolic murmur at apex, no rubs or gallops Abd-soft, obese, NT, ND, NABS, no HSM Extr-Right wrist in a splint. Fingers warm, sensation intact. No evidence of active joint inflammation elsewhere. No peripheral edema or calf tenderness. Neuro-Moves all 4 extremities equally against gravity (albeit with some difficulty in the LE). Sensation intact throughout. FAMILY HISTORY: Gastric CA - father at 83 [**Name2 (NI) **] SOCIAL HISTORY: Social History: lives [**Location 6409**] w/ her daughter and grandson. Retired [**Name2 (NI) **]. No tobacco or alcohol use. Has a PCA/HHA.

CHIEF COMPLAINT: Right Hip Pain PRESENT ILLNESS: Patient is a 52 yo F with a complex history of right hip problems. She had a total hip replacement performed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Hospital 1474**] hospital in [**2194-6-2**] through an anterior approach. Two weeks later she sustained a periprosthetic femur fracture which was treated with ORIF on [**2194-7-2**] at [**Hospital 1474**] Hospital. She then developed a deep MRSA infection and was transferred to [**Hospital1 18**]. She underwent a washout [**2194-7-13**] and a washout with hardware removal and antibiotic spacer placement on [**2194-7-15**]. She was discharged to [**Hospital 8971**] Rehab but returned to [**Hospital1 18**] on [**2194-7-23**] with increased drainage from the incision and underwent 9 further I&Ds with vac changes. She has had a spacer in situ and has been off antibiotics. A hip aspiration was negative. She reports her pain has been unchanged. She does not mobilize. She denies paresthesias or weakness. MEDICAL HISTORY: PMH: HTN, HL, Hx of EtOH abuse, Spinal stenosis, Mild COPD, Obesity MEDICATION ON ADMISSION: MEDS: Combivent inhaler, advair inhaler, dilaudid, tricor, atenolol, ambien, lorazepam, MVI, calcium, vitamin D ALLERGIES: Adhesive Tape PHYSICAL EXAM: Well appearing in no acute distress Afebrile with stable vital signs Pain well-controlled FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Current tobacco smoker, approximately one pack per day x 30 years. Reports occasional EtOH, denies illicits. Married.

CHIEF COMPLAINT: Hematemesis PRESENT ILLNESS: 62-year old man developed hematemesis and bright red blood per rectum earlier around 2pm that came on suddenly, accompanied with nausea, shortness of breath, and feeling severely unwell. He has a history of partial gastrectomy in [**2115**] for peptic ulcer disease and reportedly benign tumor where he had presented also with hematemesis, but no other episodes that he can recall. He called EMS and was brought to [**Hospital **] Hospital. He had EGD there that identified a bleeding ulcer that was injected with epinephrine, clipped, and cauderized. Was on protonix and octreotide drips. HCT was 41.6, received 2.5L. The patient was transferred to the [**Hospital1 18**] for further monitoring. If the patient developed recurrent GIB, then he would need angiographic intervention which [**Hospital **] Hospital did not have. Reportedly had fever spike per signout and does have leukocytosis though the patient denies fever or chills, aches, or nightsweats; He had taken ibuprofen earlier today for arthritic pains. . In the ED, initial VS: 97.4 75 143/97 16 98 Continued on PPI and octreotide drips. 97.3 67 128/80 10 100% on 2Lnc. . Currently, abdomen is non-tender. HCT is drifting downward, but he is without further episodes of rebleeding. . ROS: Denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath other than during acute bleeding episode, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, melena, dysuria, hematuria. MEDICAL HISTORY: s/p Billroth II MEDICATION ON ADMISSION: Takes no medications, prn ibuprofen ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GEN: Thin HEENT: PERRL, EOMI, MMM C/V: RRR, normal s1 and s2 PULM: CTAB ABDOMEN: Soft, non-tender, non-distended, bowel sounds present EXT: BLE no edema SKIN: Normal NEURO: CN 2-12 intact, sensory normal, strength 5/5 in upper and lower extremities, gait normal FAMILY HISTORY: No bleeding disorders or hereditary cancer syndromes SOCIAL HISTORY: Smokes pipe throughout the day x40 years. Lives at home with his wife [**Name (NI) 1154**], no children. Retired from stop and shop. Denies heavy EtOH use, reports only rare use.

CHIEF COMPLAINT: 1. Radiation-related ulcer, anterior aspect of right leg. 2. Status post resection and reresection of sarcoma, right leg, at the tibial level. PRESENT ILLNESS: 24 y.o. female s/p resection of synovial sarcoma and radiation to the right anterior tibial region. After the resection, a protective plate was placed on the tibia itself. The wound healing was [**Name (NI) 2480**], and although the initial grafts healed, some areas did not heal, and she developed a chronic, indolent wound. In order to avoid further problems, she was consented for free lat flap of the devascularized region. MEDICAL HISTORY: 1. Synovial sarcoma right anterior leg status post preoperative radiotherapy and excision [**2172-6-15**] with flap and split-thickness skin graft closure. MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: She looks well and is ambulating comfortably with crutches VS: 98.7 110/68 87 18 99% on RA HEENT: Unremarkable LUNGS: Clear to percussion and auscultation. Donor site overlying L latissimus dorsi wound c/d/i with one remaining JP. No exudate, no erythema. CARDIAC: RRR ABDOMEN: Soft and nontender, non-distended EXTREMITIES: The R lower ext is s/p free flap and skin graft, with some graft prominence and + doppler signals, no bleeding or drainage. L prox thigh skin graft donor site c/d/i, open to air NEUROLOGIC: Intact in the lower extremities B. FAMILY HISTORY: On her father's side, 2 relatives, possibly grandfather and siblings, had cancers involving lung, liver, and possibly skin, many were thought to be alcohol related. Otherwise, there is no family history of cancers. Her paternal aunt had some sort of bone [**Last Name 15482**] problem, which required a bone marrow transplant in the past, unclear what the nature of the illness was. There is a family history of hypercholesterolemia in the mother. She is one of 11 children; the remainder of her sibs are well, as are her three children. SOCIAL HISTORY: She is a housewife. Nonsmoker. Does not drink any alcohol. She has as noted 3 children, 5,2, and 3 months old. She is currently taking birth control pills.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 43-year-old gentleman who presented on [**5-21**] with a 2-day history of headache, nausea, vomiting, and paraphasic errors. The patient presented to the Emergency Department where a computed tomography scan showed multiple brain lesions confirmed by magnetic resonance imaging. Culture and sensitivity profile demonstrated an increased white blood cell count and red blood count with 98% polys. The Neurology staff was consulted and felt the picture was consistent with multiple septic brain emboli, and the patient was started on ceftriaxone and admitted to the Medical Intensive Care Unit. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: from [**Hospital1 **] with acute renal failure PRESENT ILLNESS: admitted [**Date range (1) 23271**] for ARF (2.3), supratherapeutic INR (3.2) after mechanical fall with R orbital fracture. Noted to have a.fib with RVR but rate controlled with b-blocker. Cardiology felt cardioversion not indicated. Baseline BP's noted to be 80-110 in legs and undetectable in arms. ACE-I and lasix held. Cr improved with gentle diuresis and d/c to rehab. * At rehab he was re-initiated on his lasix for increasing lower extremity edema and increasing evidence of CHF. The lasix was titrated to a dose of 80mg PO BID with good urine outpt but progressively increasing creatinine from 2.0 to 4.0. * Also, he had mutliple episodes of a.fib with RVR requiring large doses of lopressor. On [**2-6**] he was noted to be more lethargic and have gross hematuria. His coumadin was held for INR 6.1 and bladder irragation initiated. On [**2-7**] ABG 7.21/53/71 (2L NC) and started on BiPAP. Subseqent ABG 7.23/54/79 (3L NC) but not in significant respiratory distress at time of d/c per rehab notes and remained at 2-3L NC throughout rehab course. * In ED was given 1 unit FFP for INR 4.9 and initial CXR with right sided consolidation. Subsequently, he was noted to have mild resp distress and decrease in SBP to 80's which transiently responded to dopamine gtt. However, he developed a.fib c RVR at rate of 150s and dopamine weaned off after 1L NS bolus. However, resp distress continued with CXR showing CHF and intubated. His SBP's dropped again to 80's. Fem line placed and started on levophed. He was given decadron, vancomycin, levofloxacin. MEDICAL HISTORY: -End stage renal disease, status post living related kidney transplant [**2132-2-5**] -hypertension, -atrial fibrillation -peripheral vascular disease -hypothyroidism -OSA -DM2 with peripheral neuropathy -CHF EF mildly depressed (poor echo studies) echo [**2136-1-24**]: poor study, EF not documented but mildly depressed; PASP 52 and +2 TR. MEDICATION ON ADMISSION: coumadin (held since [**2-10**]) prednisone 5mg QDay tacrolimus 2 mg [**Hospital1 **] lopressor 100mg TID lasix 80mg [**Hospital1 **] bactrim DS MWF elavil 10mg QHS vit C 500mg [**Hospital1 **] synthroid 125mcg QDay prevacid 20 QDay zoloft 100mg QDay zinc 220mg QDay ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE 98.0 124/104 (on 1 mcg/kg/min levophed) HR 130 (irregular) A/C 650/16 PEEP 5 FiO2 100% PIP 28 SpO2 100% ABG: 7.22/50/188 Gen: intubated, sedated but responds to pain Heent: R orbital eccymosis, conjuncival and subscleral hematoma Neck: elevated JVD @20 degrees CV: tachy, irregular Pulm: decreased breath sounds and faint crackles at bases Abd: minor eccymosis, nd, soft, +bs Ext: dusky appearing hands and feet b/l; +2 DP on left foot, +1 DP on right foot, ulcerations on left shin and toes of left foot; +2 pitt edema to upper thighs b/l and dependent areas. FAMILY HISTORY: not-contributory SOCIAL HISTORY: SOCIAL HISTORY: The patient lives alone in an apartment in [**Location (un) **], but is close with his sister, who helps him out often. States he does his own shopping and cooking. Gets around in a motorized scooter. He is a lifetime nonsmoker and states he has not had any EtOh in 10 years. Before that had only occasional drinks. Priorly a machinest but now on disability.

CHIEF COMPLAINT: T7-T8 osteomyelitis PRESENT ILLNESS: Unfortunate 61 y.o. male with several month history of shoulder pain who presented initially with fever, shoulder pain, shoulder infection, and mass over the sternum. He had two I&D by Dr. [**Last Name (STitle) 2719**] and because of the persistent pain, he had MRI of the spine and it showed T7 and T8 increased T2 signal c/w osteomyelitis. There is a small bulging disk at the T78 level that is not causing any neural impingement. He was treated with IV antibiotics and he has improved significantly and is able to ambulate. He is scheduled for ant/post fusion on [**3-5**] and [**2170-3-8**]. MEDICAL HISTORY: PMH: htn etoh abuse quit [**2169-12-19**] hypercholesterolemia pancreatitis [**2165**] depression epistaxis with recent cauterization [**2170-1-2**] MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.8 114/64 75 10 96% AO X 3 R/R/R CTA anteriorly Ext- mild edema b/l, N/V/I distally; He can flex forward and back without significant pain. Mild discomfort with palpation. Uses B LE well. His gait is wide. Joints at stable with good ROM of B LE. FAMILY HISTORY: fH: mother died 92 from emphysema; father died of "old age" 82 SOCIAL HISTORY: sh: employed, no smoking, etoh abuse-quit one mo ago, no hx of DTs, no IVDU, married 11 years, monogamous, denies hiv risk factors, 28 yo son

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is an 83-year-old female with a history of coronary artery disease status post MI and CABG in [**2186**], hypertension, hyperlipidemia, who was transferred from an outside hospital after she was found to have markedly elevated cardiac enzymes consistent with a non-ST segment elevation MI. EKG showed ST depressions in the lateral leads. According to the patient, she was in her usual state of health until two days prior to admission at which time she had onset of severe diaphoresis. There were no chest pains, but she does report palpitations and increasing dyspnea on exertion. She also notes that she has had increasing orthopnea over the last several weeks. Patient denies nausea, vomiting, or worsening lower extremity edema. She notes that she has been fatigued also lately. MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction in [**2186**] and subsequent CABG x4 at [**Hospital6 **] in [**2186**]. 2. Hypertension. 3. Hyperlipidemia. 4. Status post left carotid endarterectomy in [**2187-7-17**]. 5. History of paroxysmal atrial fibrillation. 6. History of a pancreatic cyst and left renal cyst. MEDICATION ON ADMISSION: 1. Aspirin 81 mg p.o. q.d. 2. Lisinopril 10 mg p.o. q.d. 3. Lopressor 50 mg p.o. b.i.d. 4. Lipitor 20 mg p.o. q.d. 5. Multivitamin q.d. 6. Celebrex. 7. Potassium chloride. 8. Lasix 40 mg p.o. q.d. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a 20 pack year smoking history, but she quit after her CABG. The patient recently resumed smoking half a pack per day for the past month. The patient denies alcohol use. She lives alone. She is widowed with two children.

CHIEF COMPLAINT: hematemesis PRESENT ILLNESS: 83 year-old male nursing home resident with DM, CRI, CHF, CAD and PVD on aspirin and Plavix, history of CVA, presents to [**Hospital1 18**] ED with 3-4 episodes of coffee ground emesis and possible aspiration with one of the episodes of vomiting. In the ED, temp 99.8. NG lavage positive for coffee ground, Cleared after 1L of lavage. Initially, briefly hypotensive to 80/40, but quickly resolved with IVF. Started on Levofloxacin, but developed a rash with infusion according to ED note. Infusion was stopped and patient was instead given Ceftriaxone, Azithromycin and Flagyl for community-acquired/aspiration pneumonia. Urine cloudy. MEDICAL HISTORY: PAST MEDICAL HISTORY: 1. Coronary artery disease s/p inferior MI in [**2196**] post-op of toe amputation, (taken to cardiac cath with PTCA c/b CVA) 2. ischemic cardiomyopathy (LVEF 35-40% on [**2197-6-24**] Echo) [**2197-6-24**] Echo showed hypokinetic mid anteroseptal, mid inferoseptal, basal inferior, mid inferior, anterior apex, septal apex, inferior apex, and apex. 3. CVA following cardiac catheterization in [**2196**] with residual right hemiparesis. 4. Diabetes type 2 with neuropathy. 6. Hypertension. 7. Hypercholesterolemia. 8. Chronic renal insufficiency (baseline creatinine 1.6-1.7). 9. Aspiration pneumonia in [**2196**]. 10. Benign prostatic hypertrophy. 11. MRSA. 12. Peripheral vascular disease. 13. Hypothyroidism. . PAST SURGICAL HISTORY: 1. Left BK [**Doctor Last Name **]-AT with reverse saphenous vein graft in [**2191**]. 2. Right [**Doctor Last Name **]-DP with nonreverse saphenous vein graft done in [**2194**]. 3. Amputation of right first toe in [**2194**], right second toe in [**2196**], left first and second toes in [**12-31**], left transmetatarsal amputation in [**3-1**]. 4. [**Date Range 24785**] of the left hip in [**2192**]. 5. Removal of hardware in the left hip in [**2196**] at [**Hospital6 11896**]. 6. G tube placement in [**2196**] post-CVA. 7. Right cataract surgery. 8. Laparoscopic cholecystectomy. MEDICATION ON ADMISSION: Insulin-sliding scale. Colace 100 mg p.o. q.p.m. Multivitamin one tablet p.o. q.d. trazadone 25mg PO QPM Levoxyl 25 mcg p.o. q.d. terazosin 1mg PO QD metoprolol 25mg p.o. b.i.d. Aspirin 325 mg p.o. q.d. Plavix 75 mg p.o. q.d. Lipitor 10 mg p.o. q.h.s. Lasix 20mg PO QD Lisinopril 5mg PO QD . [**Hospital1 **] Protonix started [**2198-12-20**] dulcolax started [**2198-12-20**] ALLERGIES: Levofloxacin PHYSICAL EXAM: T 95.6 HR 75 BP 116/43 RR18 98%RA Gen: comfortable, NAD HEENT: PERRL, anicteric, conjunctiva pink, mm dry, OP with blood posteriorly Neck: supple, no LAD CV: RRR, no mrg, 1+DP pulses (L>R) Resp: CTA apices, decreased breath sounds B bases Abd: obese, +BS, soft, NT, ND, no HSM, no masses Back: no CVA tenderness Ext: s/p L distal foot amputation, s/p R toe 1 and 2 amputation, no edema Skin: erythematous plaque in groin Neuro: A&O, CN II-XII intact, strength 4-/5 RUE, [**5-2**] LUE, 4+/5 RLE, [**5-2**] LLE, sensation intact grossly to fine touch but decreased distally FAMILY HISTORY: parents d. "old age" no known h/o DM, CVD, cancers SOCIAL HISTORY: Married but now lives [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] Nursing Home for two months Wheelchair bound at baseline Quit tob 25 years ago, previous 20 pack-yr hx No current EtOH use, but reports previously drinking 3 beers/day

CHIEF COMPLAINT: "My fistula wasn't flowing right." PRESENT ILLNESS: [**Age over 90 **]yom w/PMHx significant for CAD, CHF, CABG, HTN, Atrial fibrilliation, Ventricular Brady-paced, Hyperlipidemia renal CA, s/p left nephrectomy in ESRD, HD dependent who presented to the [**Hospital1 18**] 24hrs prior via his dialysis clinic. . Daughter reports weakness of the extremities over the weekend following Fri HD c/w previous episodes of hyperkalemia. He then presented this Mon for regularly scheduled HD per MWF schedule through left arm AV graft which was complicated my apparent clot of the graft. . Pt was then sent to the [**Hospital1 18**] for HD. On arrival at the [**Hospital1 18**] pt was noted to have hyperkalemia w/K of 8.1. He received calclium gluconate, insulin and bicarbonate for correction of hyperkalemia. Pt was admitted to the ICU and femoral access was obtained for HD and was subsequently dialysed via the femoral access. On hospital day two patient was taken to the interventional suite and clot lysis was attempted without apparent success. Pt was then evaluated by the vascular surgery team and planned for transfer to medicine. MEDICAL HISTORY: Past Medical History: #. P-MIBI ([**3-4**]): new fixed small severe defect in the PDA territory, new transient cavity dilation, and an old fixed small moderate defect in the distal LAD territory #. Cardiac catheterization [**5-4**] w/L main and 3 vessel dz w/ patent LIMA to LAD w/ 70% stenosis in distal LAD, patent SVG to diagnoal ramus w/ 50% stenosis in native diagonal branch, patent SVG to OM1/OM2 but occluded OM1 at touchdown. s/p unsuccessful PTCA of LM, Moderate right and left ventricular diastolic dysfunction #. CHF: Echo ([**6-4**]) EF 30-35%, [**12-1**]+ MR, 2+ TR, moderate pulmonary artery systolic HTN #. HTN #. Hypercholesterolemia #. Reportedly small ASD on a TEE #. ESRD, on HD (since [**2134**]) MWF evenings via left arm AV graft (evening shift at [**Location (un) 4265**], [**Location (un) **]) #. Chronic anemia associated w/ renal failure #. Renal cell carcinoma, s/p left nephrectomy #. Gout w/flairs 1-2x/mo #. s/p TURP for BPH #. Bilateral cataracts #. Left hydrocele w/ hydrocelectomy [**12/2130**] #. Multiple episodes of SOB . PSHx: #. Right common femoral artery thrombus s/p cath in [**5-4**] #. Pacemaker placement Trahy-Brady syndrome [**3-/2128**], w/replacement [**11-2**] #. CAD s/p 5-vessel CABG [**2124**] (LIMA-LAD, SVG-D1, SVG-RI, SVG-OM1, SVG-OM2) #. Left CEA [**2127**] (s/p TIA) #. Thrombectomy and revision of LUE AV graft [**2-1**] w/multiple interventions to graft in the past. MEDICATION ON ADMISSION: #. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY #. Pravastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY #. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet PO DAILY #. Pyridoxine 50 mg Tablet Sig: Two (2) Tablet PO BID #. Cyanocobalamin 100 mcg Tablet Sig: One (1) Tablet PO DAILY #. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY #. B-Complex with Vitamin C Tablet Sig: One (1) Tablet PO DAILY #. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY #. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO WITH BREAKFAST AND LUNCH #. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO WITH DINNER #. Warfarin 3 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). #. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO every other day. #. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation every four (4) hours as needed for shortness of breath or wheezing. #. Digoxin 50 mcg/mL Solution Sig: One (1) mL PO every other day. #. Colchicine prn gout flair ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T=96.1; HR=70; BP=90/48; RR=20; O2Sat=98% RA General: A/O x 3. NAD. HEENT: NC/AT, MMM, scar c/w previous CEA CV: S1=S2, with Grade II/VI soft systolic murmur heard best at apex, no rubs or gallops appreciated Pulm: CTA bilaterally, no rhonchi, wheezes or crackles Abd: Soft, NT/ND with normoactive BS. Ext: No cyanosis, 2+ DP bilat, left arm bleed/dressing over AV graft FAMILY HISTORY: Daughter with MI in mid-40s, had Type 1 DM, deceased 56y/o Brother w/heart disease, ?MI. + hypertension, + diabetes mellitus, Brother w/lymphoma, ? question liver ca SOCIAL HISTORY: He lives alone in [**Location (un) 745**]. Recently retired fully from selling furniture, pt had reduced from full time work to part time work over the past year. + tob: cigar/pipe smoking, daily x20-25 years w/cessation 20yrs prior - EtOH - Illicit/Recreational drug use

CHIEF COMPLAINT: Chief complaint of neutropenia, fever accompanied by volume responsive hypotension. PRESENT ILLNESS: This is a 38-year-old male with a recurrent B cell mediastinal lymphoma with known high grade SVC compression status post XRT and two autologous stem cell rescues (first in [**2167**] most recently 150 days ago), who had recently completed a five day course of Rituxan and E-CHOP starting [**6-6**]. Patient was well except for some post-chemo nausea and vomiting until three days prior to admission, the patient began to complain of temperatures to 101.0 F, but denied rigors, recent sick contacts, dysuria/frequency, cough, or diarrhea. Of note, the patient had a recent PICC line removal three days prior to admission placed for chemotherapy, but patient denied purulence at the insertion site, erythema, or tenderness. Patient had a problem with candidal esophagitis for the past 4-5 days and was started on fluconazole and has been compliant with his medications. Patient underwent EGD one day prior to admission without complication and fluconazole was increased to 400 mg p.o. q.d. at this time. Patient had almost no p.o. intake over the last 3-4 days secondary to nausea and vomiting from chemotherapy not controlled by his Ativan and Compazine. Patient also avoided p.o. secondary to dysphagia from esophagitis. Patient admits to lightheadedness with rising the past 2-3 days. Patient came to Hematology/[**Hospital **] Clinic on the day of admission for routine hematocrit check and systolic blood pressure was found to be in the 70s. Patient had two peripheral IVs placed, infused with 2 liters of normal saline with systolic blood pressure responsive to 117. Patient had blood cultures taken, urinalysis culture and sensitivity sent, and was given one dose of cefepime. Given his ANC of 250 for neutropenic fever. Transfer to MICU, where patient was sent for further care. Of note, there were no mental status changes with the decrease in blood pressure. MEDICAL HISTORY: 1. Recurrent B cell lymphoma as above (no SVC syndrome). 2. Graft-versus-host disease. 3. Knee arthroscopy. 4. Rhinoplasty. 5. EF of 30-40% at the last admission. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: No IV drug abuse, no smoking history. Drinks one six pack of beer per week.

CHIEF COMPLAINT: bradycardia . PRESENT ILLNESS: 59 F w/ recent L MCA CVA and resulting hemiplegia/aphasia presented to [**Hospital1 18**] w/ bradycardia to 30s. . Recently admitted to [**Hospital1 18**] [**2154-12-20**] to [**2155-2-14**] for large left-sided MCA stroke w/ severe hemiplegia/aphasia. Discharged to [**Hospital **] rehab on [**2-14**]. Admitted to [**Hospital 8**] Hospital [**Date range (1) 106409**], where BCxs showed enterococci, started on linezolid given hx of VRE. She also received metronidazole for presumed c diff. diarrhea. . At admission, [**2155-3-6**] Pt was noted to be in a junctional brady rhythm at 35 bpm, no clear p waves, rbbb (new), diffuse twf, twi in v1-5, Q III (old). Cr=2.2 from baseline Cr=0.8, K=5.2, lactate=3.3, u/a with > 50 wbcs, many bact, neg nitrite. Pt received vancomycin 1 gram IV X1, kayexalate 30 mg, asa 325 mgX1. Cards consulted and recommended no intervention. Patient was transferred to MICU. . Pt's bradycardia resolved with electrolyte balancing and IVFs. Ampicillin was added for amp-sensitive enterococcus coverage. TTE did not indicate endocarditis. Ciprofloxacin was added for U/A consistent w/ UTI. Metronidazole was discontinued, as C. Diff negative x2. Hydralazine was used for BP control, as A-V nodal blockers were avoided given bradycardia. MEDICAL HISTORY: --L sided MCA stroke with aphasia/hemiplegia --Type 1 Diabetes Mellitus w/ h/o DKA and poor compliance --HTN --asthma --dyslipidemia --fibroids --cataracts --adenomatous polyps MEDICATION ON ADMISSION: --Oxcarbazepine 600 mg [**Hospital1 **] --ASA 325 mg daily --Atorvastatin 40 mg daily --lansoprazole 30 mg [**Hospital1 **] --hctz 50 mg daily --lisinopril 20 mg daily --carvedilol 25 mg [**Hospital1 **] --irbesartan 80 mg daily --amlodipine 5 mg daily --linezolid 600 mg [**Hospital1 **] (started [**3-5**]) --flagyl 500 mg tid (started [**3-4**]) --lantus 10 U qhs --RISS --mvi --reglan 5 mg q6h --KCL --[**Name6 (MD) 106411**] [**Name8 (MD) 106412**] rn --albuterol prn --tylenol prn --atrovent prn --percocet prn --loperamide prn ALLERGIES: Milk / Dilantin PHYSICAL EXAM: T=98.7 BP= 130/70 P= 84 RR= 20 O2sat= 98% RA Gen - ill appearing AA female gazing at wall. HEENT - anicteric, mucous membranes moist, non elevated JVP Chest - Clear to auscultation bilaterally anteriorly, unable to lift CV - RRR no M/R/G Abd - Soft, nontender, nondistended, with normoactive bowel sounds, PEG in place, no discharge from PEG site Extr - 2+ DP pulses bilaterally, atrophic appearing. No E/C/C Neuro - turns eyes to voice, moved left arm if agitated Skin - No lesions noted. FAMILY HISTORY: aunt with type 2 diabetes. Her mom had a fatal MI at the age of 54. Her dad had ?COPD. SOCIAL HISTORY: lives at [**Hospital1 **]; per notes, prior to CVA, one 6 pk beer/wk, but no tob or illicits. .

CHIEF COMPLAINT: Shortness of breath, hypoxemia PRESENT ILLNESS: 53M with history of schizoprhenia on anti-psychotics and COPD, active smoker group home resident who began c/o wheezing and respiratory distress. Whe was given an albuterol treatment and EMS was called. While in EMS, c/o respiratory distress. When EMTs arrived his vitals were 130/85 115 28 90% on 3l NC, he had an end-tidal CO2 of 50. Per his sister he reports several days of feeling unwell with non-specific symptoms. . Per reports, he arrived at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with hypoxia and somnelence, a trial of bipap was initiated and he became acutely agitated. He was noted to have the following initial gas 7.30 76 55 and he was trialed on NRB however failed and was intubated. Bilateral breath sounds are documented but no CXR. Initial peak pressures appearr to have been 38, plateau 24, Compliance 33 on 14x600 with 5 of peep. He also received steroids and lasix. By report CXR showed edema. They had no ICU beds available and transferred him to the [**Hospital1 **] for further management. . In the ED inital vitals were not documented. He was evaluated with head CT and CTA. Preliminarily both studies are non-diagnostic though there is clear L>R atelectasis. He was noted to have coarse BS. ET tube was pulled back. Tox screen was negative. MEDICAL HISTORY: Schizoprhenia c/b psychosis Anxiety COPD Hyperlipidemia MEDICATION ON ADMISSION: Abilify 20 daily Klonopin 1mg [**Hospital1 **] Risperdal 6mg qHS Zyprexa 10qAm, 20qHS Ativan 1mg prn q2h PRN MVI daily Zocor 20mg qHS Combivent 2 puffs q4 prn ALLERGIES: Heparin,Porcine PHYSICAL EXAM: Vitals: T:97.3 BP:139/86 P:95 R: 18 O2: 95% 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 GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: None known SOCIAL HISTORY: Lives in a group home, sister is next of [**Doctor First Name **], smoker

CHIEF COMPLAINT: palpitations PRESENT ILLNESS: 59 year-old female with history of breast cancer, hypothyroidism, depression, presents with rapid heart rate at noon on the day of admission. She was at rest when the symptoms started. She recently experienced 5-6 days of symptoms consistent with an upper respiratory infection and laryngitis which was diagnosed by her PCP as [**Name Initial (PRE) **] viral infection. Temperature at home was 102F with increased cough over the last 1-2 days. She also reported right-sided pleuritic chest pain with weakness, but denied shortness of breath. REported diarrhea x1.5 day on Tues-Wed prior to adm. (loose stool with eating) In the ED on arrival, her temp was 99.0, she was tachycardic to 150 and hypotensive to 88/59, with a leukocytosis, bandemia, lactate of 4.1 and RLL pneumonia on CXR. She was given diltiazem IV and PO, 6L NS for volume resusitation, Ceftriazone, Azithromycin and admitted to MICU for sepsis protocol. MEDICAL HISTORY: 1) Hyperthyroidism s/p ablation, now hypothyroid 2) breast ca s/p XRT/chemo in [**2141**] 3) depression s/p ECT 4) squamous cell cancer resection from face in [**2151**] MEDICATION ON ADMISSION: Synthroid 0.1mg PO daily Prosom 1.5mg QHS (for insomnia) MVI Parmate 20mg PO BID (for depression) ALLERGIES: Propylthiouracil PHYSICAL EXAM: VS Tm 103/ Tc100.1 BP 136/67, HR 130, RR 27, O2 sat 96% on humidified shovel face mask FiO2=0.70 Gen: pleasant middle-aged female in NAD HEENT: MMM, no JVD Chest: egophany in bilateral bases. crackles in left middle lung zone. Heart: tachycardic, regular rhythm, pulsus [**7-20**] Abdomen: soft, nontender Extr: mild symmetric edema in bilateral arms. No edema in lower extremity. [**2-12**]+ DP and radial pulses. Neuro: alert and oriented X3. appropriate FAMILY HISTORY: mother with [**Name (NI) 5895**] SOCIAL HISTORY: denies tobacco, alcohol or drug use retired teacher

CHIEF COMPLAINT: Convulsive status epilepticus. PRESENT ILLNESS: A 71-year-old man with known metastatic brain cancer from non-small cell lung cancer, who now presents with convulsive status epilepticus. He was diagnosed with lung cancer on [**2131-2-1**] after he presented with cough and hemoptysis. CT of the chest still showed a left upper lobe mass and mediastinal lymphadenopathy. Fine needle biopsy of the left upper lobe mass on [**2131-2-16**] showed poorly differentiated non-small lung cancer. He was at Stage 3B. He then underwent neoadjuvant and carboplatin and Taxol with concurrent chest radiation. A restaging FDG-PET scan on [**2131-6-19**] showed decreased uptake at the left lobe, but his PET scan also staying the same of taking the right temporal brain. MRI on [**2131-6-24**] showed three brain mets, which include one with greater than 3 cm in diameter at the right posterior temporal lobe, one at the right insula, and the third one at the right singlet gyrus region. He was asymptomatic from the brain tumors. On [**2131-6-30**], he experienced nausea, fatigue, slurring of speech, confusion, and hiccups. He came to our Emergency Department at [**Hospital1 69**] on [**2131-6-30**]. His symptoms promptly resolved after starting Decadron. The posterior right temporal region was completely resected by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2131-7-3**]. The pathology was consistent with non-small cell lung cancer. He completed a course of Decadron uneventfully and is now scheduled for radiosurgery. Today, he appeared lethargic and apparently confused per family. At 5 p.m., he went to the bathroom and exited with his pants down and confused. Family called 911. By the time EMS arrived, he generalized, shaking left upper and lower extremities. He was brought to [**Hospital1 188**], where he arrived with eye deviation to the left and generalized tonic-clonic seizure. The seizure broke after 2 mg Ativan x1. He was loaded with Dilantin and the seizure stopped shortly thereafter. He is not in stable condition, although he is snoring with transmitted upper airway sounds. MEDICAL HISTORY: Lung cancer. Hypertension. MEDICATION ON ADMISSION: ALLERGIES: None. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: He lives with his wife, who is the healthcare proxy. According to his daughter, he stated he did not wish to be resuscitated.

CHIEF COMPLAINT: Broken left arm PRESENT ILLNESS: 64-year old male with pmhx of EtOH abuse, h/x alcoholic withdrawl seizures, HTN and [**Hospital 982**] transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital s/p mechanical fall while getting up from couch with a comminuted left proximal humerus fracture/dislocation. His last drink was this morning ([**2195-1-31**]). . He was admitted to the orthopedic service for semi urgent repair of this fracture. On pre op labs today was found to have a Hct drop from 32 at the OSH to 20. BUN noted to be 63. Type and crossed 2 units and transferred to the MICU. . On arrival to the MICU, 98 123/73 96 18 97 % RA. He endorses coughing up cofee ground material during this hosital stay, but denies any vomiting, nausea, dyspepsia, abdominal pain, diarrhea. He does not know the color of his stool. The patient has never recieved a EGD, last colonoscopy 5 years ago and was normal. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: H/o alcoholic seizures EtOH abuse Tobacco use Pulmonary nodules -followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1492**] Squamous cell carcinoma of piriform sinus, stage IV -s/p XRT and chemo Diabetes Mellitus (diet controlled) Vocal cord leukoplakia GERD BPH Prior tonsillectomy MEDICATION ON ADMISSION: Famotidine 20mg PO QD Doxazosin 4mg PO QHS Citalopram 60mg PO QD Mirtazapine 15mg PO QD Betamethasone 0.05% cream TP outer ear [**Hospital1 **] Vitamin B12 1 Tab PO QD Vitamin D3 1 Tab PO QD MVI ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam VS: 98 123/73 96 18 97 % RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact Rectal: brown stool,external hemorrhoids . Discharge exam notable for: -Anterior cervical stoma (trach site) clean and dry, with no surrounding erythema or tenderness -L shoulder + steristrips, surgical site c/d/i, nontender; L arm in sling -G-tube site well-appearing, no erythema, min surrounding tenderness FAMILY HISTORY: nc SOCIAL HISTORY: Lives with wife Occupation: Retired airplane mechanic Tobacco: 1 pack/week for many years EtOH: 1 pint of vodka daily

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 174**] is a 42-year-old male with a history of end-stage liver cirrhosis secondary to hepatitis C and ethanol abuse, who for a long time had been followed by Dr. [**First Name (STitle) **] at [**Hospital1 69**] for possible liver transplant. He presented to the [**Hospital 1474**] Hospital on [**2173-7-1**] with worsening confusion, lethargy, and increased fatigue. There was no evidence of bleeding or infection. It was thought that he would do better with being transferred to [**Hospital1 69**] and that this would expedite his chances for getting a new liver. The patient was transferred to [**Hospital1 188**] on [**2173-7-5**]. By the time of transfer, he was admitted with acute renal failure as well as encephalopathy. MEDICAL HISTORY: 1. Hepatitis C with cirrhosis. 2. Gastroesophageal reflux disease. 3. Bipolar-affective disorder. 4. History of pneumonia. MEDICATION ON ADMISSION: 1. Lamictal 200 mg po bid. 2. Protonix 400 mg po q day. 3. Ursodiol 300 mg po tid. 4. Nadolol 20 mg po q day. 5. Aldactone 25 mg po bid. 6. Seroquel 100 mg po q hs. 7. Lorazepam 0.5 mg po bid. 8. Levaquin 500 mg po q day x6 days. 9. Lasix 800 mg po q day. 10. Mycelex five pills a day. ALLERGIES: There are no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Occasional [**3-30**] cigarettes a day. He denies any alcohol use, and the patient is single with one son, never married, and he lives with his sister.

CHIEF COMPLAINT: intubated post-op PRESENT ILLNESS: Mr. [**Known lastname **] is a 48 year-old man who is being transferred to the [**Hospital Unit Name 153**] for monitoring after hip replacement surgery and hardware removal complicated by significant blood loss. The patient initially injured his hip after falling from a roof in [**2178**]. He suffered a right hip fracture at the time that was repaired with an IM nail. Recently, he developed R groin and hip pain, found to be due to AVN of the femoral head. Today he underwent a prolonged procedure involving removal of the IM nail and associated hardware followed by bipolar hip replacement. The procedure took over four hours. Pt had approximately 3L of blood loss. He received 1750cc of cell [**Doctor Last Name 10105**] blood in the OR, 2 units of pRBC, and 6L of colloid. He did require some neosynephrine during the procedure which was weaned prior to transfer. MEDICAL HISTORY: s/p R femur fracture with IM nailing in '[**78**] Hypertension (not on medication) MEDICATION ON ADMISSION: Percocet 5-325mg 1-2 tabs q6 prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: General: arousable, in no acute distress, AOx2 FAMILY HISTORY: Denies. SOCIAL HISTORY: Smokes 2 packs per day. Drinks 6 beers per day.

CHIEF COMPLAINT: fevers, chills PRESENT ILLNESS: 56 yo F with bronchiectasis, chronic sinusitis, asthma, acquired immunodeficiency, presents with fevers, chills, cough and new RLL pneumonia. The patient was on cipro for chronic sinusitis for 3 months with improvement in her symptoms until [**4-2**] when she developed recurrence of right sinus symptoms. Her sinus cultures grew MRSA, but was not started on abx because it was thought to be colonization and not an acute infection. She was seen by ENT, Dr. [**Last Name (STitle) **], yesterday and found to have sinusitis with cultures taken. She was given a ex for gentamicin rinses, but had not started the treatment. Overnight the patient developed fevers, chills, and worsening productive cough. She presented to her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1683**], today and found to have a temperature of 102.2, HR: 125 130/75 and 98% on room air. Her peak flow was 350 (baseline >400). A CXR was performed that showed a RLL pneumonia. A sputum cx was taken as well as legionella. She was sent to the ED for further treatment. . In the ED, initial vs were: T101.5 P110 BP109/65 R16 O2 sat 97%RA. Patient was given Vanco/CTX on direction from outpatient team. CXR read as RLL pneumonia. Patient planned for admission to floor but became hypotensive in the ED with SBP in the 80's. Patient was given 2L NS, and was redirected to the ICU for further care. Prior to transfer she dropped BP's to 70's, and had R-ij placed. Received 4 additional liters of fluid with SBP remaining low. Started on leveophed for BP support. Abx broadened with levofloxacin. . Last VS were SBP 91/56, HR 90's, O2 97% 2LNC. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: -Chronic Bronchiectasis -Asthma -Immunodeficiency (IgG) -Osteopenia -Depression -GERD and NSAID induced gastritis -Nephrolithiasis -Etoh abuse in past - now abstains completely -s/p TAH/BSO for endometriosis MEDICATION ON ADMISSION: Recent antibiotics: avelox [**Date range (1) 13493**] augmentin [**Date range (1) 6958**] bactrim [**Date range (1) 13494**] doxycycline [**Date range (1) 13495**] avelox [**Date range (1) 13496**] avelox [**Date range (1) 13497**] cipro [**Date range (3) 13498**]) ALLERGIES: Nsaids / Bactrim Ds PHYSICAL EXAM: 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 GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: NIDDM, and CAD SOCIAL HISTORY: - Tobacco: h/o tobacco use - Alcohol: abstains, h/o etoh abuse - Illicits: denies

CHIEF COMPLAINT: Increasing dyspnea on exertion PRESENT ILLNESS: 75yo man seen in [**2127**] after CHF exacerbation requiring intubation. During that stay patient had acute delerium and was deemed porr surgical candidate at that time. He ultimately was discharged to rehab where after period of recovery he returned home where he lives alone. He has been in relatively good health since that time but recently has been experiencing increasing dyspnea on exertion. He had repeat echo and underwent cardiac catheterization today. He is now referred to re evaluate surgical candidacy. MEDICAL HISTORY: Mitral Regurgitation Paroxysmal Atrial Fibrillation Hypertension Hypercholesterolemia Congestive heart failure Chronic Obstructive Pulmonary Disease ?CVA Obesity Past Surgical History: s/p left knee replacement s/p right knee surgery MEDICATION ON ADMISSION: Coumadin 7 alt 6 daily ASA 81 mg daily Lisinopril 2 mg [**Hospital1 **] KCl 10 mg daily Metoprolol 5 mg [**Hospital1 **] Lasix 40A/20P Amlopidine 10 mg daily Amiodarone 200 mg daily Vit D 1000 mg daily Vit C ALLERGIES: Penicillins / Olanzapine PHYSICAL EXAM: Pulse: 54 Resp: 16 O2 sat: 96%-RA B/P Right: 159/86 Left: Height: 72 inches Weight: 243lbs FAMILY HISTORY: non contributory SOCIAL HISTORY: Race: caucasian Last Dental Exam: Lives with: alone, wife deceased Occupation: former truck driver Tobacco: quit 40 years ago ETOH: no Illicit drugs: no

CHIEF COMPLAINT: Jaw pain PRESENT ILLNESS: Mr. [**Known lastname 8671**] is a 63 yo M tranferred from MWMC for CABG. Pt was shoveling snow in mid [**Month (only) **] when he experienced jaw pain. On [**12-27**] had pain at rest, went to ED where he was found to have EKG changes, and subsequent cardiac cath showed 3 vessel disease, and angioplasty of RCA was performed. He ruled in for an acute inferior wall MI at that time. MEDICAL HISTORY: Coronary Artery Disease Acute Inferior Wall MI Recent PTCA of RCA Hyperlipidemia Abnormal Fasting Blood Sugars Psoriatic Arthritis Appendectomy MEDICATION ON ADMISSION: lopressor 25, zocor 80, celex 20, protonix 40, trazadione 100 qhs, colace 100", Lovenox 40, feldene 120, embril 150 q weds sc ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: Afebrile, VSS General: WDWN male in NAD HEENT: Oropharynx benign, EOMI Neck: Supple, no JVD Lungs: CTA bilaterally Heart: Regular rate and rhythm Abdomen: Soft, nontender with normoactive bowel sounds Ext: Warm, no edema Pulses: 2+ distally Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal deficits noted FAMILY HISTORY: Brother with CABG SOCIAL HISTORY: No tobacco for the last 10 years. Admits to [**3-30**] ETOH per week. Employed as commercial printer.

CHIEF COMPLAINT: Neck Swelling PRESENT ILLNESS: Patient is a 33 year - old female with a past medical history of Crohn's Disease s/p ileostomy and infliximab therapy, history of DVT in left neck, history of 8 prior portacaths who presented to [**Hospital3 **] this morning with increasing abdominal, SOB, and increased ostomy output that started two days ago. Of note, on presentation, her face was swollen, she was tachypneic and tachycardic. Her labs were notable for a WBC of 4.4, hemoglobin 8.4, and hematocrit of 25. She was given IV morphine for her abdominal pain, when she subseuqently broke out in a rash, which diminshed with benadryl. Ct abd/pelvis showed no acute process and she was admitted to the medicine service for treatment of a Crohn's flare. For her SOB, she was initially treated with IV levofloxacin. On arrival to the medicine floor, her porta cath was not drawing back and there was concern for clot in the SVC with subsequent SVC syndrome causing her facial swelling. Due to her tachycardia and tachypnea, there was concern for PE. They could not get a peripheral IV on her, and given possible pathology in her neck, a groin femoral line was placed. Because they could not protocol the contrast for a CTPA with a groin line, a V/Q scan was done, which was low probability for PE. She was emperically started on a heparin gtt and is being transferred her for concern of porta-cath clot, SVC syndrome, and CTPA. On arrival to the MICU, patient was complaining of sever abdominal pain. She had apparently received zofran en route by EMS. While she was writhing in pain, she did state that the pain is consistent with her prior Crohn's disease flares, the last of which was six months ago. She is passing liquidy green stool through her ostomy with some gas. MEDICAL HISTORY: Crohn's Disease - Had previously been on inflixamab, but could not afford the medication. No prior workup could be obtained as there was no record of patient in prior hopsitals which she said she was admitted to PE - about 5-6 months ago DVT - in neck likely related to access issues MEDICATION ON ADMISSION: Coumadin 6 mg once a day, moxifloxacin eye drops ALLERGIES: Humira / Toradol / Certolizumab Pegol / Meperidine PHYSICAL EXAM: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact FAMILY HISTORY: No significant GI or heme history SOCIAL HISTORY: Lives with husband, moved from [**Name (NI) 15158**] 5-6 months ago. The patient didnt have any insurance even though she was in Mass since few months. Her husband also has insurance which she was not on board on.

CHIEF COMPLAINT: Transferred for respiratory failure. PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old woman recently admitted to the [**Hospital1 188**] ([**2186-11-11**] through [**2186-11-27**]) with left sided pneumonia requiring intubation for airway protection and bronchoscopy for aspiration of a mucus plug and re-expansion of a collapsed lobe. Her hospital course then was also complicated by myocardial infarction with a peak troponin of 0.83 and the development of hematuria while receiving Heparin. She also had acute renal failure during that hospital stay attributed to receiving intravenous dye as well as decompensation of her congestive heart failure requiring nesiritide and furosemide infusions. Finally, her hospital stay was complicated by MRSA urinary tract infection for which she had a percutaneous inserted central catheter and received a course of Vancomycin intravenously. The patient refused cardiac catheterization at that time decided to desire to avoid aggressive procedures. On discharge, the patient's code status was made DNR/DNI, however, on arrival to the outside hospital with complaints very similar to those listed above, specifically respiratory distress preceding two days of shortness of breath, she and her husband asked that her code status be reversed. She was emergently intubated in [**Hospital6 8283**], and transferred to the [**Hospital1 69**] for further care. Her blood gas in the Emergency Department of said hospital was 7.23, 57, 227 without documentation of ventilatory settings. The EMS documentation reports that she received a total of furosemide 80 mg, midazolam 2 mg, pancuronium, morphine sulfate 2 mg, and succinylcholine as well as nitro paste. In our Emergency Department, the patient received another 2 mg of Morphine, and was transferred to the Intensive Care Unit for further management. MEDICAL HISTORY: 1. Pneumonia with recent admission one month ago as well as one year ago. 2. Coronary artery disease status post myocardial infarction in [**2185-10-28**] initially when she refused intervention at that time, she was admitted to the Coronary Care Unit due to systolic congestive heart failure requiring intubation. See below for interval echocardiographic results. 3. Severe aortic insufficiency. 4. Acute on chronic renal failure. 5. Gout. 6. Status post total abdominal hysterectomy. 7. Thoracic aortic aneurysm. MEDICATION ON ADMISSION: ALLERGIES: She is allergic to penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient is married. Her husband is [**Age over 90 **] years old and is involved in her care as is their niece. She does not smoke tobacco or drink alcohol. There is a well-documented history of poor compliance with regimens of medications. Indeed her husband states in her presence that she does not taking hydralazine as prescribed every six hours, but takes it approximately every eight. She has not taken diuretics consistently in the past either. Her niece is [**Name (NI) **] [**Name (NI) 3075**], her number is [**Telephone/Fax (1) 8284**].

CHIEF COMPLAINT: chest pain, weakness, hypertension PRESENT ILLNESS: The patient is a 48y/o females with a past medical history HTN, iron deficiency anemia secondary to menorrhagia who was seen by her PCP today with complaints of lightheadedness and DOE of a several day duration. Her DOE occurs with 1 flight of stairs or walking a short distance. She also reported 2 episodes of chest pain, the first of which occurred last evening. She describes it ass a substernal pressure associated with SOB and diaphoresis lasting for 90 minutes. She had a second episode this am when walking to the subway station. She rested and her symptoms resolved. At [**Company 191**] she was found to have a BP of 190/108. ECG was done and showed no acute changes. EMS was called for transfer to the ED for treatment of hypertensive emergency. MEDICAL HISTORY: # Hypertension # Menorrhagia secondary to uterine fibroids. Baseline HCT 26-29 # Appendectomy # C-section X 4, bilateral tubal ligation # Sickle cell trait per the patient. MEDICATION ON ADMISSION: ALBUTEROL - 90 mcg Aerosol - two inhalations every 6 hours as needed AMLODIPINE - 10 mg Tablet - 1 Tablet(s) by mouth once a day ECONAZOLE - 1 % Cream - apply to left axilla twice a day LISINOPRIL-HYDROCHLOROTHIAZIDE - 20 mg-25 mg Tablet - 1 Tablet(s) by mouth daily METOPROLOL SUCCINATE - 100 mg Tablet Sustained Release 24 hr - 1 Tablet Sustained Release 24 hr(s) by mouth once a day OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day Medications - OTC IRON - 325(65)MG Tablet - ONE BY MOUTH TWICE A DAY . ALLERGIES: Compazine / Shellfish / Iodine; Iodine Containing PHYSICAL EXAM: General: Alert, oriented, no acute distress, resting comfortably in bed, aroused from sleep HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: fluent speech, lower extremities strength 5/5, sensation grossly intact, remainder of exam deferred to am . On Discharge: VSS L-sided weakness of L arm and leg which is fluctuating in severity and location. Soft voice. Exam otherwise unchanged from admission FAMILY HISTORY: +HTN in mom and DM in aunt. SOCIAL HISTORY: married, lives w/ husband and 7 children ([**11-1**]). Works at federal govt. appeals office. -Tobacco history: quit 20 years ago -ETOH: no -Illicit drugs: no

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 43433**] is a 45-year-old patient of Dr. [**Last Name (STitle) **] [**Name (STitle) **]. In [**2145-3-8**], the patient began experiencing dyspnea with minimal activities. Stress test was done in [**2145-6-7**] and positive for 2 to 3 mm inferolateral down sloping of the ST segment. Cardiac catheterization was performed. The results are as follows: LDEF 74%, No MR, diffusely narrowed left anterior descending, 6 beats of 70% stenosis at the circumflex, 6 beats of 70% proximal stenosis of the RCA and 80% stenosis of the distal RCA. He underwent percutaneous transluminal coronary angioplasty with stenting to the RCA at the [**Hospital1 **]. He has done well since. The patient was scheduled for endoscopy and required cardiac clearance. Prior to procedure, a cardiac catheterization was performed at an outside hospital on [**2145-12-8**] and the results are as followed: Left main diffusely narrowed, 50 to 60% stenosis at the mid circumflex, see report for full details. The patient was referred to the [**Hospital6 2018**] for cardiothoracic surgical consult. MEDICAL HISTORY: 1. Coronary artery disease. 2. Hypertension. 3. Gastroesophageal reflux disease. 4. Increased cholesterol. 5. Diverticulitis. 6. Status post head injury two years ago. 7. Intermittent left face and arm paresthesias. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Married with three children, works as a mortgage broker, smokes half pack of cigarettes a day and alcohol is about 5 drinks per week.

CHIEF COMPLAINT: bright red blood per rectum PRESENT ILLNESS: Ms. [**Known lastname 57871**] is an 84 year old woman with a past medical history significant for left femur fracture, repaired [**Date range (1) 57872**] and on coumadin until [**10-8**], found with bright red blood per rectum at [**Hospital3 **]. There was also a report of a ? vaginal bleeding. The patient denies presyncope or hematemesis. She refuses to participate in the rest of the interview because she is very nervous. Of note, in a conversation with her daughter, it appears that Ms. [**Known lastname 57871**] had a hysterectomy about 1 year ago. MEDICAL HISTORY: left femur fracture, repaired [**Date range (1) 57872**] and on coumadin until [**10-8**] HTN CAD DM-2 Parkinson's Hypothyroid Hyperlipidemia Pancreatitis h/o syncope h/o hysterectomy MEDICATION ON ADMISSION: Aspirin atenolol 12.5 QD iron levoxyl 150 QD senna zocor 80 mg mirapex 0.125 QD sinemet 25/100 QID lasix 60 QD glipizide XL 10 ALLERGIES: Penicillins / Valsartan / Ace Inhibitors PHYSICAL EXAM: Vitals: T 98.7 BP 119/70 HR 87 RR 18 O2 sat 100% on RA Gen: anxious appearing awake lying in bed HEENT: dry MM, EOMI, pupils reactive CV: RRR Pulm: CTAB no crackles Abd: soft NT ND + BS no guarding no rebound obese Ext: WWP DP 2+ bilaterally skin: ecchymosis throughout FAMILY HISTORY: noncontributory SOCIAL HISTORY: TOB-denies IVDA-denies ETOH-denies

CHIEF COMPLAINT: small cell lung cancer postobstructive pneumonia PRESENT ILLNESS: 56F with recurrent small cell lung ca, diagnosed 1 year ago, s/p chemo & radiation at OSH. She presents with a post-obstructive pneumonia. MEDICAL HISTORY: asthma COPD GERD cholelithiasis nephrolithiasis MEDICATION ON ADMISSION: vanc/zosyn ALLERGIES: Latex / Ivp Dye, Iodine Containing / Codeine / Darvon PHYSICAL EXAM: afebrile intubated & sedated cachectic decreased BS on left FAMILY HISTORY: noncontributory SOCIAL HISTORY: +cigs

CHIEF COMPLAINT: PRESENT ILLNESS: This 23 year old white female who has been healthy has had dizziness and shortness of breath on exertion for eight months. She had a history of a heart murmur as a child and has been followed by her primary care physician who referred her for an echocardiogram which revealed mitral valve prolapse at the age of 15 years. She denies ever having symptoms until last winter. She had an echocardiogram which revealed severe mitral valve prolapse with four plus mitral regurgitation. She is now referred for mitral valve repair. Cardiac echocardiogram on [**2129-7-21**], revealed an ejection fraction of 50 to 55%, myxomatous mitral leaflets, moderate to severe mitral valve prolapse and four plus mitral regurgitation. MEDICAL HISTORY: History of mitral valve prolapse. MEDICATION ON ADMISSION: ALLERGIES: She has no known allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for coronary artery disease. SOCIAL HISTORY: She has smoked one pack a day for ten years. She drinks five to ten beers per week. She works as a boat painter.

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: 66 yo M with PMH of DM2, CRI, recent subdural hematomas and bacteremia who presents from rehab with altered mental status. Per the report from the rehab, at baseline he desats with activity, requiring 3-6L O2 to maintain O2 sats 88-92% and is a chronic CO2 retainer. He was given IV Lasix and was refusing bipap. Given he was more disoriented he was brought to the ED. Of note, his wife says that he received a blood transfusion on [**2168-11-12**] and has been more confused since that time. . In addition, in [**8-12**] he was hospitalized for a fall and subsequent right subdural hematoma. This was complicated by a strep bovis endocarditis which was treated with 6 week of ceftriaxone. Shortly after stopping the antibiotics he developed line sepsis from the PICC which grew out MRSA and enteroccus. The tip was removed and he was treated with vancomycin given his penicillin allergy from [**2168-11-3**] until [**2168-11-14**]. . In the ED, his initial vital signs were T 98.1 HR 92 BP 118/78 RR28 94% 2L NC. Temp rose to 101.8. He was oriented x1 or 2 and complained of abdominal pain intermittently. Was given combivent neb and became more lethargic. Surgery was consulted for ? ischemic bowel given is abdominal tenderness. Lactate was normal though and CT scan was ordered. His blood pressure then dropped to systolic 64/48s and he was given 3L IVF, CVL was placed and levophed was started. He was intubated for airway protection given his altered mental status, but per report was not in any respiratory distress. He was given etomodate and succ, ativan. He had a CT torso looking for a source of infection. The only acute finding was a right pericardial effusion and right pleural effusion. He was given vancomycin and zosyn for empiric coverage. MEDICAL HISTORY: -Morbid obesity -DM type 2 poorly controlled with complications -Chronic renal insufficiency -HTN -reactive airways disease -asbestosis -GERD -Parkinson's disease -detrusor instability -gout -hypothyroidism -aortic stenosis, valve area 0.9cm2, peak gradient 24, median gradient 48 -Anemia -h/o nephrolithiasis -fall [**8-12**] w/ R subdural hematoma, s/p strep bovis bacteremia and 6 wks Ceftriaxone, developed bacteria after completion of tx with MRSA and enterococcus. line removed, tx with Vanco then d/c'd. Neg cx 3 consecutive days. [**11-4**] - febrile, blood cxs + enterococcus, [**Last Name (un) 36**] to PCN and Vanc. got Vancomycin due to PCN allergy. MEDICATION ON ADMISSION: Actos 15 mg daily calcitriol 0.25 mcg daily carbidopa-levodopa 50-200 5X/day cyanocobalamin [**2160**] mcg daily glipizide 5 mg qday prilosec 40 mg daily requip 3 mg qid synthroid 87.5 mcg daily Heparin SC TID Levofloxacin 250mg qday Arinesp 0.1 mg qTuesday Singular 10mg qday Zinc Sulfate 250mg PO qday Simethecone PRN Metoprolol 25mg PO BID Losartan 100mg PO qday KCL 20 meq qday Aspirin 325mg PO qday Iron 300mg PO BID Colace 100mg PO BID Senna 2 tabs daily Bisacodyl PRN Combivent MDI PRN Fluticasone 1 puff [**Hospital1 **] Duoneb PRN Tylenol PRN Regular insulin 151-200 give 2U, every 50 of blood sugar increase 2 U Miconazole powder daily ALLERGIES: Tagamet / Ditropan / Penicillins / Lisinopril PHYSICAL EXAM: vitals: afebrile BP 140/69, HR 83, 100% o2 sat. CVP 15, AC 650/18 peep 5, FIO2 0.5, FS 132 General: morbidly obese, intubated and sedated. Opens eyes to voice but does not follow commands HEENT: anicteric sclera, non-injected conjunctiva, pupils about 3mm and symmetric but sluggish, dry MM CV: RRR 3/6 SEM heard best at the USB Lungs: expiratory wheeze bilaterally, course breath sounds. mild crackles Abdomen: obese, umbilical hernia reducible. +BS, soft, seems non-tender Ext: trace bilateral edema, DP and PT pulses are strong and symmetric, bilateral upper extremity tremor with cogwheel rigidity Neuro: opens eyes to voice. not following commands. moving all extremities. toes are down going bilaterally FAMILY HISTORY: non-contributory SOCIAL HISTORY: no alcohol or tobacco use, currently resides at [**Hospital **] [**Hospital **] Rehabilitation Center, formerly owned pizzaria restuarants

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: This is 41 year old male with history of cirrhosis secondary to EtOH and hepatitis C virus, obstructive sleep apnea and hypothyroidism, with recurrent episodes of severe enceophalopathy and ascites. Mr. [**Known lastname 19420**] was re-admitted to [**Hospital1 18**] [**1-9**] for worsening encephalopathy. The patient has multiple admits for encephalopathy (5 since [**8-27**]). He has had 10 MICU admissions/floor transfers and at least 6 intubations since [**2147-10-21**] as a result of his encephalopathy. He was hospitalized from [**Date range (2) 77415**], during which time he had recurrent episodes of encephalopathy requiring MICU admissions, w/ one of them to be secondary to possible aspiration with poorly-fitting CPAP mask. He was most recently hospitalized again this month with discharge [**1-8**]. During this most recent admission, he likewise required MICU level care for encephalopathy and respiratory compromise when even a single Lactulose dose was delayed. He has demonstrated that he is exquisitely sensitive to any decrease in frequency of lactulose administration, and the results of delayed or missed doses lead to severe obtundation. MEDICAL HISTORY: - HCV and EtOH Cirrhosis with ascites and edema, biopsy diagnosed in [**2139**], last vl 32,600 copies; last MELD 24. - h/o SBP early [**7-27**] on cipro prophylaxis - Grade II esophageal varices - Recurrent hepatic encephalopathy of unclear precipitant - Pulmonary HTN - Hypothyroidism - Anxiety disorder - h/o EtOH abuse, IVDU - osteoperosis of hip and spine per pt - Anemia w/ hx of guaiac positive stool. - pulmonary HTN - echo [**2146-12-28**] unable to assess; EF > 55%, MR slightly increased MEDICATION ON ADMISSION: 1. Ciprofloxacin 250 mg PO Q24H 2. Lactulose Sixty (60) ML PO Q2H as needed for confusion. 3. Rifaximin 400 mg PO TID 4. Levothyroxine 88 mcg PO DAILY 5. Omeprazole 20 mg PO once a day. 6. CALCIUM 500+D 500 PO once a day. 7. Magnesium 400 mg PO once a day 8. Lactulose Forty Five (45) ML PO QID 9. Nadolol 20 mg PO DAILY 10. Home oxygen 2L continuous 11. CPAP 5 - 15 CM H2O 12. Iloprost 10 mcg/mL One (1) nebulizer treatment Inhalation 6x daily. 13. Lasix 20mg PO daily 14. Spironolactone 50mg PO BID 15. Clotrimazole Troche 10mg 5x/day ALLERGIES: Amoxicillin / Adhesive Bandage / Dicloxacillin PHYSICAL EXAM: EXAM PRIOR TO MICU TRANSFER ON [**2148-1-10**] Gen: Nonresponsive, eyes open, HEENT: dry MM, + scleral icterus Pulm: rhonchi BL, no wheezes or crackles CV: S1 & S2 regular without murmur Abd: Distended, tympanitic, + shifting dullness, firm. Unable to determine tenderness. Ext: 2+ edema bilteraly. Neuro: Non-responsive FAMILY HISTORY: Mother with DM and HTN. Father with rheumatic heart disease. SOCIAL HISTORY: Pt lives with his Mother. Pt quit smoking [**5-27**], was smoking 1/3ppd. Quit drinking etoh 11 years ago. Prior remote hx of IVDU as teen. No current drug use.

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: Mr. [**Known lastname 1124**] is a 73 year old gentleman with known coronary artery disease s/p PCI/stent to the LCX and presented to an outside hospital with dyspnea. He ruled in for a non-ST elevation MI. Therefore, he was transferred for pre-operative work-up for cardiac surgery. MEDICAL HISTORY: Aortic stenosis mitral regurgitation coronary artery disease s/p coronary artery stent noninsulin dependent diabetes mellitus hypercholesterolemia h/o prostate cancer depression degenerative joint disease s/p bilateral knee replacements s/p transurethral resection of prostate s/p femeral rodding MEDICATION ON ADMISSION: Metformin 1000", Lisinopril 20', Atorvastatin 80', HCTZ25', Cartia XR 300', Ambien 10-hs, Paxil 40', Lorazepam 0.5 TID/prn, MVI, Glucosamine, Oxycodone 5 Q3hr/prn, Enoxaparin 30", colace 100", Senna 8.6", CaCarbonate 500-tid, Vit D ALLERGIES: Heparin Agents PHYSICAL EXAM: Admission: Pulse: 82 SR Resp: 20 O2 sat: 96%-2LNP B/P Right: 140/83 Left: Height: 5'[**22**]" Weight: 129.3K FAMILY HISTORY: non-contributory SOCIAL HISTORY: Patient lives with daughter, son and grandaughter. He is retired. He is a non smoker.

CHIEF COMPLAINT: intraabdominal sepsis, multiple intraabdominal abscesses, pleural effusions, respiratory failure complication related to a Right Colectomy [**2159-7-13**] @ OSH PRESENT ILLNESS: This is a 70 year old male transfer from OSH for continued management s/p elective R hemicolectomy [**7-13**] for polyp, with subsequent resp failure, intubation on POD 3 and s/p trach [**7-26**] (POD 10), s/p small bowel feeding tube placed [**7-27**], incr abd pain [**7-28**]-CT showed anastomotic leak, s/p IR drainage [**7-28**], s/p anastamosis resection, diverting loop ileostomy and placement of 2 chest tubes for pleural effusions [**7-29**], fecal drainage in JP-leakage from small bowel [**7-31**], s/p small bowel resection proximal to ileal loop [**8-1**], s/p perc drainage abd fluid [**8-7**] MEDICAL HISTORY: laryngeal CA s/p radiation, GERD, multiple rectal polyps, COPD, hx of smoking, SCC, h/o melanoma, hiatal hernia, cholecystectomy MEDICATION ON ADMISSION: none ALLERGIES: Codeine PHYSICAL EXAM: VS: 99.3, 79, 143/61, 25, 99% Vent Gen: NAD CV: RRR, No M/R/G Lungs: Vent, trach Abd: soft, Nontender, mildly distended, incision C/d/I. JP drains in place. Ext: B/L LE erythematous ankles and knees. Warm, blanching. Smaller pathces of erythema to knees and groin. No erythema to feet. 2+ edema to mid calf and hands. FAMILY HISTORY: SOCIAL HISTORY: Married, lives with wife. 9 grandchildren Daughter is a clincal nurse specialist at [**Hospital1 18**].

CHIEF COMPLAINT: BRBPR, anemia PRESENT ILLNESS: Mr. [**Known lastname **] is a 49-year-old male with history of anemia and GI bleeds who presents with bright red blood per rectum and hematemesis x1. He has had extensive workup done both here in [**Location (un) 86**] as well some [**State 2690**] including endoscopy, colonoscopy, capsule study, tagged red blood cell scan. On tagged red blood cell scan apparently there was an area that showed possible source of the patient's anemia however he does not have records and does not remember exactly. . The patient yesterday evening went to [**Hospital3 **] to be further eval for his palpitations and bloody stool. Currently he says he has not had a bloody bowel movement for the past 8-12 hours. Last episode was yesterday evening. Otherwise the patient denies any hematemesis or coffee-ground emesis. The patient denies any chest pain, shortness of breath, nausea, vomiting, and diarrhea. He does not have any fevers or chills currently. He also does not have any abdominal pain. . In the ED, initial VS: 97.5, 103, 114/70, 20, 99%. His initial hematocrit was 18.6, repeat the same. They attempted to contact the [**Hospital 2690**] hospital where tagged rbc scan was done however medical records was closed, number is ([**Telephone/Fax (1) 87738**]. He also recieved 1st unit PRBC, needs 2nd unit still. Pt asymptomatic currently, guiac neg. Guiaic trace positive without frank blood in vault. . On arrival to the MICU, he is feeling much better. His anemia symptoms (SOB, dizziness, weakness) have resolved with 1 U pRBCs. He also has not had anymore bleeding today. Has never had pain with his bloody bowel movements but does get nausea. Never had hematemesis. MEDICAL HISTORY: -Hx of GI bleeds x 2. Most recent bleed in [**10-1**], found to have duodenal ulcer at [**Hospital 87735**] Hospital, which was clipped vs cauterized -Hyperlipidemia -S/p motorcycle accident [**2162**], with bowel resection, ileostomy and reversal. MEDICATION ON ADMISSION: Simvastatin 40 mg qhs Protonix 40 mg b.i.d. iron 325 mg b.i.d. alendronate qweekly nortriptyline 50 mg qhs ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Admission: Vitals: T: 96.8, BP:137/65, P:101, R:18, O2: 100% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP 12-14 cm, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: mildly firm but non-tender, non-distended, bowel sounds present, no organomegaly, well healed midline scar GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred FAMILY HISTORY: Mother: MI at age 70. Father: MI at age 64. Three children (two sons and one daughter) are healthy. No known GI disease in the family. SOCIAL HISTORY: Lives at home with wife and children. Remote smoker (quit >20 years ago). Denies illicits or etoh intake.

CHIEF COMPLAINT: Trauma: fall PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS This patient is a 43 year old male who presents after being found under bridge, half submerged in water. Initially unresponsive, but now improved. ? seizure. ? [**2185**]5-20 feet. ? ETOH. Thought that patient lying in water at least half hour. Pt has h/o seizures, and now states that he thinks he might have seized. MEDICAL HISTORY: PSYCHIATRIC HISTORY: Inpatient detox 3 times (2 at [**Doctor First Name 1191**] in [**2182**], 1 at [**Hospital1 **] in [**2182**] or [**2183**]). Never taken meds, never seen a psychiatrist. AA did not help him much, did not attend. MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: celexa, depakote, neurontin ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAMINATION upon admission: [**8-14**] FAMILY HISTORY: Father - ETOH SOCIAL HISTORY: From [**Location (un) 3786**], 1 sister, 2 brothers (1 in [**State 2690**], 1 he does not keep in touch with 2/2 abuse). States was in the USMC from 87-89, d/c'ed for crystal meth in urine. Has 1 son, 20, was not involved but tried contacting recently via facebook, upsetting son. Lives under the [**Last Name (un) 88305**] bridge, [**Street Address(1) **] Inn helps with blankets and food. Works as a bike courier fulltime. No close friends, few acquaintances, never a long term relationship (dates but women are not intereseted [**2-9**] alcoholism

CHIEF COMPLAINT: NSTEMI/Transfer for cath PRESENT ILLNESS: 88 year old male with past history of DM, CHF, PVD s/p stents on both lower extremities, multiple amputations of his toes transferred from [**Hospital6 5016**] for cardiac catheterization after presenting with NSTEMI. Mr. [**Known lastname **] reports 2 episodes of chest pain over the past week, responsive to sublingual nitroglycerin. On morning of admission, he experienced chest pain for 15 minutes that also responded to nitroglycerin, he spoke with his PCP, [**Name10 (NameIs) 1023**] instructed him to call the ambulance. He recieved 243 mg aspirin in the ambulance. He was seen in [**Hospital6 5016**] ED, initial vitals 148/68 55 16 97.4 100% on 2L. He recieved nitro paste x 1. EKG showed normal sinus rhythm at 55 with TWI in v3-v6 with no ST elevation or depression. Troponin was 3.3 and he was transferred to [**Hospital1 18**] for catheterization. In the cath lab, he was noted to have a totally occluded RCA, 99% stenosis of mid-LAD, 30% eccentric plaque in LMCA, and 60-70% proximal disease of left circumflex. Performed PTCA and stenting using 3 overlapping DES to the prox-mid LAD. Good angiographic result. Severe HTN during the procedure (250mmHg systolic) treated w/ IV NTG, IA nicardipine. He is transferred to the CCU for further management of his BP. On arrival to the CCU, initial vitals were T 96.3 HR 58 BP 148/48 RR 18 O2Sat 98%RA. He is complaining of chronic lower back pain, otherwise no pain at site of cardiac cath (left groin). MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, - Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: - Congestive Heart Failure (EF unkown) 3. OTHER PAST MEDICAL HISTORY: - Diabetes Type 2 - Peripheral Vascular Disease s/p stents to bilateral lower extremities and multiple amputations of toes - GERD - Anxiety MEDICATION ON ADMISSION: Glyburide 5 mg qday for BS > 140 Plavix 75 mg qday Isosorbide Mononitrate 30 mg qday Xanax 0.25 mg qday Atenolol 25 mg qday diltiazem 180 mg qday NTG SL 0.4 prn Omeprazole 20 mg qday Lasix 40 mg qday Digiter ([**1-17**] pill) Ecotrin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T= 96.3 BP=148/48 HR=58 RR=18 O2 sat=98%RA FAMILY HISTORY: NC SOCIAL HISTORY: - Tobacco history: 40 year smoking history, quit many years ago. - ETOH: occasional alcohol use - Illicit drugs: Denies

CHIEF COMPLAINT: R foot TMA ulcer PRESENT ILLNESS: Pt is 66 y/o M with h/o ESRD on HD and peripheral [**First Name3 (LF) 1106**] disease s/p right transmetatarsal amputation one month ago for gangrene who presents with right TMA site ulcer. Patient has a history of occlusion of his popliteal artery and embolus to his distal vessels, which caused the grangrene for which required the TMA. He is s/p angioplasty and stenting of his R popliteal artery. Howver, he still developed necrosis of his TMA site. He currently denies pain, redness, or drainage from TMA site. No fevers, chills, chest pain, shortness of breath, abd pain, or nausea/vomiting. He will undergo debridement of his R foot TMA site on [**5-11**]. MEDICAL HISTORY: PMH: 1) Atrial Fibrillation - s/p cardioversion in [**10-13**]. Was maintained on coumadin for 6 months. Currently not anticoagulated due to fall risk. 2) Pericardial effusion - s/p drainage, unclear etiology 3) ESRD from ATN in setting of acute gastroenteritis, s/p failed cadaveric kidney transplant in [**2109**]. Dialyzed at [**Location (un) **] Tues, Thurs, Sat. 4) Abdominal wall hernia - s/p repair after transplant 5) Multiple knee surgeries 20 years ago 6) Poor access, Right Tunnelled line 7) Baseline SBP's in 90s 9) Hypercapnia due to obesity hypoventilation syndrome 10) non-melanoma skin cancer 11) septic knee MEDICATION ON ADMISSION: Albuterol Plavix 75mg PO daily Metoprolol 50mg PO TID Prilosec 20mg PO daily Prednisone 5mg PO daily Sevelamer 2400mg PO TID with meals Simvastatin 10mg PO daily Nephro-vite 1 capsule PO daily Vit A [**Numeric Identifier 961**] units PO daily ALLERGIES: Neupogen / Neurontin / Dilaudid PHYSICAL EXAM: VS: T 99.5, HR 88, BP 96/62, RR 18, 96% RA GEN: NAD, A&O x 3 LUNGS: Decreased BS B/L CV: irregularly irregular Abd: soft, NT, ND EXT: R TMA site with 4 x 6 cm black eschar, no active purulent drainage, slight surrounding erythema VASC: 1+ fem B/L, dopp [**Doctor Last Name **] B/L, dopp PT B/L, dopp DP B/L FAMILY HISTORY: History of CAD (mother died at age 70), cancer SOCIAL HISTORY: Denies any history of Tobacco use, no EtOh use for [**Last Name (un) **] than 20 years, no drug use. Lives with his wife, now on disability. Used to work as a spray painter. Has 3 children and multiple grandchildren.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 52-year-old gentleman who transferred to [**Hospital1 188**] from an outside hospital after presenting to the Emergency Department with a large evolving anterolateral wall myocardial infarction. The patient reports a 4-day history of substernal chest pain increasing over the hours prior to admission to the hospital. The chest pain was associated with radiation to his jaw and shoulders as well as nausea and vomiting. In the Emergency Department at the outside hospital the patient was placed on intravenous nitroglycerin, Aggrastat, and heparin. The patient was given Lopressor, morphine, and Plavix and transferred to [**Hospital1 188**] for cardiac catheterization. Cardiac catheterization revealed an ejection fraction of 15%, a 100% left anterior descending artery occlusion, a 100% right coronary artery occlusion, a 50% left circumflex occlusion, 2+ mitral regurgitation, elevated filling pressures. Intra-aortic balloon pump was placed, and the patient was transferred to the Intensive Care Unit. MEDICAL HISTORY: 1. Osteoarthritis in the right hip. 2. History of polio as a child with shortened right leg. MEDICATION ON ADMISSION: Preoperative medications included aspirin as needed. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient reports 6 to 10 beers per night. Positive tobacco use with greater than a 50-pack-year history.

CHIEF COMPLAINT: Dysuria, back pain. PRESENT ILLNESS: Ms. [**Known lastname **] is a 30 year old female with no significant past medical history who presented to the [**Hospital1 18**] with fevers, and dysuria. She is transferred to the MICU after developing septic shock in the ED. She first started feeling ill about three days prior to admission when she had fevers/chills, dysuria, increased urinary frequency, nausea, and some vomiting. She also had difficulty tolerating PO's. She came to the ED and her VS were T 102.9 HR 120 BP 108/72 RR 16 Sat 94% RA. She was started on levaquin and was given several liters of normal saline. Her BP bottomed out with SBP in the 70's so a sepsis line was placed. Ultimately she received 7 liters of normal saline. Her urine output remained good and put out a total of 1600cc in the ED. She is transferred to the MICU for further management. MEDICAL HISTORY: None MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Tm 102.9 Tc 99.3 BP 95/56 HR 100 RR 25 Sat 96% RA CVP 12 GEN: Pleasant well-nourished, well developed woman in no apparent distress. HEENT: Dry MM, sclerae anicteric. CV: Normal s1/s2, RRR PUL: CTA bilaterally. Chest: CVL in L scl ABD: Soft, NT EXT: No edema, FROM NEURO: A&Ox3 FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Smokes about 3 cigarettes per day, former drug use. She is engaged to an HIV + man and has never been tested. Uses an IUD, does not use condoms. She has two children.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 44-year-old female with AIDS, hepatitis C, pancytopenia, recent acute renal failure, who was transferred from [**Hospital3 3583**] after developed perfuse epistaxis. Briefly, the patient says that she has had increased fatigue for approximately one month and for the past two months (seven times), she has had epistaxis that stops with packing of the nose with cotton and lasts for approximately two hours without any preceding trauma and occurs in either nostril. The night prior to admission, she may have blown her nose and then developed perfuse epistaxis with clots that would not stop despite nasal packing. She called EMS and was taken to [**Hospital3 3583**] where per report, the right nostril had a large clot. Initial vital signs were 100/80 with a heart rate of 100. At [**Hospital3 3583**] she received one liter of normal saline, Zofran 8 mg and had packing placed. Initial hematocrit at that hospital was 24.4 with a platelet count of 18. She was transferred to [**Hospital1 **] where she received a six pack of platelets and was transfused two units of packed red blood cells for an initial platelet count of 13 and a hematocrit of 19. Of note, she also received clindamycin for nasal packing prophylaxis. MEDICAL HISTORY: 1. HIV. Last CD4 count 41 with a viral load of greater than 100,000 on [**2183-3-5**]. She was diagnosed in [**2165**]. She was initially treated with high dose AZT in [**2166**] complicated by bone marrow suppression. She then received combination therapy and despite this her CD4 count has never been greater than 400 and since having been on triple drug regimens, she has never had complete viral suppression. Most of the more recent regimens were discontinued because of gastrointestinal side effects. Her opportunistic infections include Cryptosporidium and candidal esophagitis, Salmonella and herpes labialis. Her risk factors include intravenous drug use. 2. Hepatitis C cirrhosis followed by Dr. [**Last Name (STitle) **]. On [**2183-3-7**] the HCV viral load was negative. Genotype 111. She is HCV arthropathy and has received interferon once a week. 3. Open cholecystectomy. 4. Pancytopenia on Neupogen twice per week. 5. Acute renal failure of unknown cause since [**2183-2-10**]. 6. Depression. 7. Gastroesophageal reflux disease. 8. Mitral valve prolapse since childhood. 9. Seizure disorder. Most recently grand mal seizure five years ago. 10. Gastroparesis. MEDICATION ON ADMISSION: ALLERGIES: Kaletra causes diarrhea and nausea and Prinivil causes fatigue. Nelfinavir causes fatigue and Denavir causes arthritis. T20 causes serum sickness. DDI causes peripheral neuropathy. Abacavir causes nausea. Tenofovir causes headache and disorientation. PHYSICAL EXAM: FAMILY HISTORY: Significant for a brother with myocardial infarction at age 45. Primary care doctor is Dr. [**Last Name (STitle) 4390**]. SOCIAL HISTORY: Lives with husband on disability. Smokes one pack of cigarettes per day. No intravenous drug use for 15 years. No alcohol use.

CHIEF COMPLAINT: Melena and Hematemesis PRESENT ILLNESS: 64 y/o M w/ h/o HIV, Hepatitis B and cirrhosis who presented to [**Hospital3 26615**] Hospital with melena and hematemesis. Patient was admitted to this OSH approximately 2 weeks ago with a variceal bleed that was banded on [**2200-2-21**]. At that time patient had frank hematemesis. Following that returned to work and was in his usual state of health until day of admission. Said his friends thought he looked [**Doctor Last Name 352**] and the patient described feeling bloated. He started to pass dark black stools so presented to OSH ED. . On arrival to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], patient reported mild epigastric discomfort. BP was stable at 150/84, HR in the 80's. HGb was 8.8 on arrival (down from 11 previously). Patient taken for endoscopy which reportedly showed varices (report not available) that were banded. Reportedly there were stigmata of recent bleeding. Also showed gastric varices in the antra and cardia w/o stigmata of bleeding. . On the floor, VS T 97.8, HR 70, BP 126/76, RR 21, O2 92% RA. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. MEDICAL HISTORY: - Cirrhosis with varices, ascites in past. No encephalopathy. Two recent variceal bleeds - Hepatitis B -> reportedly cleared, cause for cirrhosis unclear as per patient -> had CMV viral inclusions on biopsy. - HIV (CD4 253, VL UD [**12-8**]) + on HAART - HTN - Hyperlipidemia - Anemia - GERD - h/o liver biopsy in [**2186**] showing lobular hepatitis, CMV positive - Hemorrhoids MEDICATION ON ADMISSION: Medications: (On transfer) octreotide drip at 50 mcg per hour protonix 40 po daily epivir 150 [**Hospital1 **] dapsone 100mg daily prezista 400mg PO BID norvir 100mg PO daily levaquin 500mg IV q24 tylenol prn norvasc 5mg daily dulcolax prn colace prn ferrous sulfate 325mg daily reglan prn zofran prn pravachol 10mg daily ambien 5mg PO qhs prn . Home medications - Omeprazole 20mg daily - Famotidine 20 daily - Dapsone 50mg daily - Prezista 400mg daily - Epivir 150mg [**Hospital1 **] ? - amlodipine 2.5mg daily - pravastatin 10mg qhs - norvir 100mg [**Hospital1 **] ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Penicillins PHYSICAL EXAM: 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 GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Non-Contributary SOCIAL HISTORY: Lives alone. Works in carnival business. Has VNA 1x per week. - Tobacco: denies - Alcohol: denies - Illicits: denies

CHIEF COMPLAINT: Chest Pain/NSTEMI PRESENT ILLNESS: This is a 22yoM with a history of hepatitis C and polysubstance abuse, who was transferred from [**Hospital3 **] for further management of a NSTEMI thought to be secondary to aortic valve vegetation embolism. He first presented on [**2148-10-26**] with fevers and lightheadedness. He was found to have strep viridans endocartiditis with large vegetation on his noncoronary cusp, as well as posterior root seen on TEE. He was treated with penicillin and Gentamicin and transferred to [**Hospital1 **] State on [**11-14**], at which point he was transitioned to high dose ceftriaxone. He completed four weeks of antibiotics on [**2148-11-23**], and has been without fevers, chills, malaise, weakness, sensory deficits, vision abnormalities since that time. He presented to [**Hospital6 3105**] 3 days ago with anterior chest pain radiating to the left side, which started on [**11-30**]. Troponin was found to be elevated at 2.09, and though there were no acute EKG changes per report, he was treated for NSTEMI with Lovenox and Plavix (ASA allergy). A TTE demonstrated persistentce of a large aortic valve vegetation, along with moderate-severe aortic regurgitation. An embolic vegetation is suspected as the source of the NSTEMI. . MEDICAL HISTORY: Viridans strep aortic valve endocarditis NSTEMI Depression IV drug use (heroin) hepatitis C marijuana use migraines MEDICATION ON ADMISSION: Methadone 75mg daily lorazepam 0.5mg daily/PRN tylenol colace omeprazole 20mg daily senna simethicone bisacodyl ALLERGIES: Aspirin PHYSICAL EXAM: Admission Physical Exam: VS: T= 98 BP= 100/58 HR= 93 RR= 18 O2 sat= 100RA GENERAL: 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. NECK: Supple with JVP flat, positive carotid thrill CARDIAC: RRR, III/VI pan-diastolic murmur loudest at RUSB LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. No [**Last Name (un) **] lesions or splinter hemorrhages. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Multiple tatoos. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ NEURO: Walking w/o difficulty, normal gait, CNII-XII intact, strength 5/5 throughout FAMILY HISTORY: Mom had 2CVA with hemiparesis. Dad with DM2, four living siblings are healthy, one murdered. SOCIAL HISTORY: Lives w/ his wife in [**Name (NI) 487**]. Has four kids 12, 8,6,2. 1PPD for 7 years, quit Hx of polysubstance abuse, particularly heroin, but claims to be clean since d/c from [**Hospital1 **] state hospital, utox was + for MJ at admission to LGH. Had tried cocaine 5 times in the months prior to initial admission [**10-26**], but none since. Not currently working, applying for SSI.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 74-year-old female, recently diagnosed with a right femur osteosarcoma, status post 1 cycle of neoadjuvant chemotherapy with adriamycin and cisplatinum on [**2-28**], and a history of ulcerative colitis, status post total colectomy and ileostomy in the past, who presented to the Emergency Room with acute sharp abdominal pain, nausea and vomiting. MEDICAL HISTORY: 1. Melanoma, right lower extremity, in [**2097**]. 2. Hyperthyroidism. 3. Migraines. 4. Proctocolectomy. 5. Total abdominal hysterectomy. 6. Cholecystectomy. 7. Hemithyroidectomy. 8. Appendectomy. 9. Ulcerative colitis. 10.Hypertension. MEDICATION ON ADMISSION: ALLERGIES: No known allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Significant for 1-pack of cigarettes per day. No alcohol.

CHIEF COMPLAINT: Fever PRESENT ILLNESS: 62 yo male with MDS, pancytopenia who presented from clinic with fever in setting of platelet transfusion and hypotension. He only complained of productive cough, no dysuria, no headache, neck stiffness. In ED received 3 L NS, gvien cefepime, vanco, gentamicin and flagyl for febile neutropenia. Code sepsis called. MEDICAL HISTORY: 1. Myelodysplastic anemia diagnosed eight years; treated with monthly blood transfusions. 2. Hypertension. 3. perinephric hematoma 4. h/o RLE cellulitis MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 101.1, 102, 85/44, 30, 97%RA GENL: NAD HEENT: pupils 1- 2 mm, reactive, anicteric, OP clear, dry MM, supple neck CV: tachy, 3/6 systolic murmur Lungs: dry crackles at bases Abd: soft, nt, nd, +bx Ext: 2+ pedal pulses Skin: numerous erythematous plaques with scale over torso FAMILY HISTORY: NC SOCIAL HISTORY: The patient lives his brother and son-in-[**Name2 (NI) 108895**] home and works in maintenance at [**University/College 5130**] [**Location (un) **].The patient reports social alcohol use of one to two drinksper week. The patient denies tobacco use.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 51 year old female with post polio syndrome, Crohn's disease and breast cancer. The patient was admitted to [**Doctor Last Name 15594**] [**Hospital 107**] Hospital on [**2101-12-5**] to [**2102-1-5**] with pneumonia. Hospital course was complicated by intubation secondary to respiratory failure. She failed to wean from the ventilator and underwent tracheostomy and percutaneous endoscopic gastrostomy placement. Also, she had a pleural effusion drained. She was transferred to U-Ville on [**2102-1-5**]. The patient has been experiencing increasing shortness of breath and cough over the past week. She underwent bronchoscopy on [**2102-2-3**] and was noted to have irregularities of the left middle main stem bronchi, electively admitted to the Medical Intensive Care Unit for further evaluation of this abnormality. MEDICAL HISTORY: Significant for tracheostomy placed in [**11-21**]. Percutaneous endoscopic gastrostomy tube placed [**11-21**]. History of post polio syndrome. History of Crohn's disease. History of breast cancer, [**2095**]. Status post lumpectomy and XRT on Tamoxifen. History of low back pain. MEDICATION ON ADMISSION: Combivent. Alprazolam 3 mls q h.s. Ferrous sulfate 325 mg p.o. q. day. Folic acid one q. day. Floxetene 20 mg q. day. Heparin 5,000 units twice a day subcutaneous. Loperamide 4 mg three times a day. Magnesium oxide 800 mg three times a day. Ranitidine 150 mg twice a day. Tamoxifen 20 mg q h.s. Trazodone 300 mg q h.s. Tylenol. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: An aunt with breast cancer. Parent with colon cancer. SOCIAL HISTORY: She lives with her husband and daughter. [**Name (NI) 269**]. [**Name2 (NI) **] tobacco, no alcohol.

CHIEF COMPLAINT: Evaluation for failure to wean from vent. Possible pneumonia PRESENT ILLNESS: 78 M with complicated past medical history presented from [**Hospital3 105**] for rigid bronchoscopy and possible tracheal stenting. Patient spirometry consistent with COPD and asthma. In [**2161-1-21**] he underwent a tracheostomy for prolonged intubation and has failed weaning since. Recent symptoms include shortness of breath while on tracheostomy [**Last Name (un) **] and increasing secretions. Prior to admission to [**Hospital1 18**], sputum cultures were consistent with stenotrophomonas and pseudomonas bacteria as well as enterobacter. Recent urine culture from [**2161-9-14**] was consistent with MRSA and proteus. - MEDICAL HISTORY: COPD, HTN, diverticulosis, c.diff colitis in past, prostate CA s/p resection, peripheral vascular disease, CHF with diastolic dysfunction, non ST elevation MI in [**2158**], chronic pain (L2 compression fracture, 9th rib fracture), hyperlipidemia, chronic anemia. MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: No acute distress. Sclerae anicteric. PERRL. Neck supple, no lymphadenopathy. Tracheostomy in place. Clean, dry. Regular rate and rhythm. S1 S2 normal. No rubs, gallops Mild end-expiratory wheezes. Abdomen with PEG tube in place. Clean and dry. Bowel sounds diminished but present. Extremities cool but well perfused. Limited movement of extremities. No edema. FAMILY HISTORY: SOCIAL HISTORY: Married. 50 pack-year history, quit 20 years ago. Married. Denies alcohol use.

CHIEF COMPLAINT: Headache PRESENT ILLNESS: Mr [**Known lastname 9063**] is a 61 y/o male transferred from [**Hospital3 25357**] after presenting there on Thursday [**7-2**]. His symptoms began as he awoke on [**6-29**] with a severe headache occipital based going down his neck. He was able to go to work for the next day but then the headache became worse he became dizzy and felt to lack some coordination. He went to [**Hospital3 25354**] where a CT was negative for blood but an LP showed (traumatic per report) showed 5200 in tube 1 and 58,000 in tube 4 + for xanthrochromia. He had a CT of his neck and brain negative for anuersym. He also had an MRI of his whole spine that showed a flow void at T5. A repeat LP at [**Hospital3 **] which results are not available. He was transferred here for a diagnostic cerebral angiogram. MEDICAL HISTORY: Hypercholesterolemia, Hyperthroidism treated with radiation, HTN, stress test showing 2 vessal CAD MEDICATION ON ADMISSION: levothyroxine atorvastatin ofloxacin atenolol ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O: T:98.9 BP:154/80 HR: 64 R 20 O2Sats 97% Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 3mm min reactive EOMs full Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: [**2-1**] objects at 5 minutes. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: Has cousin who was treated for a brain aneursym, Father 86 with CAD, Mother 84 with osteoarthritis SOCIAL HISTORY: Married, works for the VA in [**Location (un) **], non smoker, social alcohol

CHIEF COMPLAINT: Occasional palpitations with no shortness of breath or dyspnea on exertion. PRESENT ILLNESS: The patient was diagnosed at the age of 30 with a murmur. The patient had been followed by echocardiogram and exercise tolerance test serially over the past decade. MEDICAL HISTORY: 1. Mitral regurgitation. 2. Hemorrhoids. 3. Old fracture of left wrist. MEDICATION ON ADMISSION: ALLERGIES: Aspirin which causes airway problems requiring epinephrine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Elective coronary angiography PRESENT ILLNESS: This is a 62 y/o male with a history of hypertension and hyperlipidemia, medically managed, who presented for an elective catherization. A proximal RCA lesion was noted. Attempt at crossing the lesion was difficult. Procedure was complicated by small aortic dissection of the aorta, visible with injection on contrast directly into the lesion. LVG revealed no wall motion abnormalities. . Patient tolerated procedure well and was chest pain free. [**5-16**] normal ETT EKG [**7-16**] ETT MIBI: EF 53%, normal perfusion MEDICAL HISTORY: Hypertension Hyperlipidemia Kidney stones Basal cell carcinoma of the nose Genital warts MEDICATION ON ADMISSION: ASA 81 Atenolol 25 Zocor 20 ALLERGIES: Lipitor PHYSICAL EXAM: VS: HR 47;BP 113/62; RR13 Gen: NAD HEENT: neck supple, no JVD Heart: nl rate, S1S2, no gallops/ murmurs/ rubs Lungs: CTA- bilaterally Abdomen: bengign R groin: 2+ femoral, no ecchymosis, no bruit, +DP Extremities: no c/c/e FAMILY HISTORY: Father died from sudden cardiac death following an myocardial infarction. SOCIAL HISTORY: Sales representative at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] alcohol or drug use

CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known lastname 46185**] is a 78-year-old man with a history of laryngeal squamous cell carcinoma status post x-ray therapy initially in [**2184**] with a subsequent left-sided partial laryngectomy due to local recurrence, ultimately receiving a total laryngectomy in [**2186-2-20**]. He did well from that point on prior to admission, and was seen by Dr. [**Last Name (STitle) **] his old laryngologist on [**2187-7-24**] for left neck pain believed to be due to TMJ, as well as a left external auditory canal insect bite. His stoma examination at that time was within normal limits. He recently, however, was found to have a mediastinal mass noted on chest x-ray that was 5 x 6 cm. This caused significant tracheal deviation to the right. A biopsy revealed poorly differentiated squamous cell carcinoma similar to the biopsy from [**2186-1-28**]. He presented on [**2187-8-22**] with increasing dyspnea and a 1- to 2-day history of throat tightness. MEDICAL HISTORY: Polycythemia. Squamous cell carcinoma of the larynx. History of DVT and PE. Forehead squamous cell carcinoma. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: This 89 year old white male who had a week of productive sputum, weakness and malaise and presented to the [**Hospital3 10494**] ED and was found to have elevated troponins and ST depressions on the lateral leads of his EKG. He had CHF on CXR and was admitted to the telemetry floor and was given 300 mg of Plavix and was also given IV Lasix and Lopressor. He underwent cardiac catheterization today which revealed 99%LM and 99%RCA lesions and he was transferred to [**Hospital1 18**] for further management. MEDICAL HISTORY: Past Medical History: HTN COPD dyslipidemia colon ca- s/p surgery and radiation prostate ca unsteady gait Past Surgical History: s/p colostomy and reversal MEDICATION ON ADMISSION: Simvistatin 20 mg PO daily Amlodipine 5 mg PO daily Spiriva 18 mcg 1 PO daily Levoxyl 137 mcg PO daily Doxazosin 2 mg PO daily ASA 81 mg PO daily ALLERGIES: Codeine PHYSICAL EXAM: Pulse:70 Resp.: 19 sat: 95% on RA B/P Right: 106/56 Left: Height: Weight: FAMILY HISTORY: unremarkable SOCIAL HISTORY: Race: Caucasian Last Dental Exam: 2 years ago Lives with: wife Occupation: retired insurance appraiser Tobacco: 40 pk year, 2 pppd x 20 years, quit 30 years ago ETOH: rare

CHIEF COMPLAINT: Respiratory distress PRESENT ILLNESS: The patient is a 65-yo woman with interstitial lung disease on chronic immunosuppression, and h/o left breast Ca s/p partial mastectomy + adjuvant chemo-XRT, who presented to the ED with dyspnea. Pt has been feeling unwell since Thursday of last week, when she initially developed symptoms of headache, dizziness, body aches, decreased appetite, and inability to get out of bed. These symptoms have continued since, and since Sunday she has had significant dyspnea as well. She has been using her home O2 continuously since Sunday (at baseline she only uses 2L NC as needed for dyspnea). She denies any associated cough or sputum production, but endorses mild wheeze, stating it feels like a bronchitis or pneumonia. Overnight last night she developed subjective chills and sweats, and this morning she found her temperature to be 101.7F, so she was brought to the ED for evaluation. In the ED, VS - Temp 98.0F, BP 128/57, HR 102, R 34, SaO2 78% on 2L NC. Labs were remarkable for an elevated WBC at 11.6 with 90% PMNs, and lactate 3.6, and negative UA. Blood Cx sent x2. CXR showed low lung volumes, increased interstitial markings c/w chronic fibrotic changes, and interstitial edema; an underlying atypical pneumonia cannot be ruled out. She was given Solumedrol 125mg IV x1, Levofloxacin 750mg IV x1, Vancomycin 1g IV x1, and 2L NS IVF for SBPs ~100. She seemed to improve and was changed from NRB to 3L NC, but desaturated to 85% on 3L so was restarted back on the NRB, with good response. CTA was done to r/o PE, which showed no PE or acute aortic syndrome; lung fibrotic changes, increased in left lung at site of radiation tx; and no underlying pneumonia. She is being admitted to the MICU for further care. On the floor, pt feels significantly improved. She has been on daily steroids and azathioprine for several months, with a recent decrease in her methylprednisolone dose and corresponding increase in her azathioprine dose on her last visit with Dr. [**Last Name (STitle) **] on [**2128-4-7**]. She also complains of mildly painful "pimples" on the sides of her tongue, which she relates to the increase in her azathioprine. She also endorses having stopped her Bactrim PCP [**Name9 (PRE) 5**], but was unsure as to when this was stopped. MEDICAL HISTORY: - Interstitial lung disease, followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], last seen [**4-/2128**], with increase in Azathioprine to 150mg daily and decrease in methylprednisolone to 16mg daily - Left breast carcinoma grade 3, T1c, N0, ER positive, PR negative, HER-2/neu negative, s/p partial mastectomy, sentinel node dissection, adjuvant chemotherapy and radiation therapy - Hypertension - Hypercholesterolemia - Depression - Gastritis - Arthritis - H/o low positive [**Doctor First Name **] MEDICATION ON ADMISSION: - Azathioprine 150mg PO daily - Chlorpheniramine-Hydrocodone 10mg-8mg/5ml [**12-6**] tsp PO Q12hr PRN severe cough - Celexa [dosage uncertain] - Methylprednisolone 16mg PO daily - Omeprazole 20mg PO daily - Simvastatin 20mg PO daily - Sulfamethoxazole-Trimethoprim 800mg-160mg PO 3x/week - pt states this was stopped - Tamoxifen 20mg PO daily - Acetaminophen 500mg PO PRN - Ergocalciferol [Vitamin D2] - Loratadine ALLERGIES: Iodine; Iodine Containing PHYSICAL EXAM: 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 GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: No family history of lung disease. No early CAD. Sister with breast cancer at 50. No other cancers in the family. SOCIAL HISTORY: Married, lives with husband and three children. Originally from El [**Country 19118**], Spanish-speaking only. No history of smoking or drinking.

CHIEF COMPLAINT: Fatigue, Fever, SOB PRESENT ILLNESS: Mr. [**Known lastname 80287**] is a 51 M with a medical history notable for multiple sclerosis requiring self bladder catheterization and recurrent urinary tract infections who presented with fatigue, fever and SOB starting at 2pm on the day of admission. He reported that he was in his usual state of health until 2pm when he ate meatballs. He then started to feel poorly and laid down to rest; when he woke he continued to feel very weak and called an ambulance. Of note, patient reports that he injured his urethra while catheterizing himself 2 days prior to admission; denies any purulent drainage, but did note hematuria. MEDICAL HISTORY: 1. MS- clinically definite since [**2167**]- secondary progressive type 2. Status post ADCF C5-C7 ([**2171-9-25**]) 3. History of depression [**2164**] to [**2166**] and currently. 4. History of alcoholism in the past (last drank 10 years ago) 6. Recurrent UTIs with multi-drug resistance urinary pathogens 7. Hyperlipidemia 8. Greater trochanteric ulcers MEDICATION ON ADMISSION: HOME MEDICATIONS: -Aspirin 325 mg po qd -Fluoxetine 40 mg po qd -Ezetimibe 10 mg po qd -Lidocaine HCl 2 % Gel Sig: One (1) Appl -Mucus membrane as needed for Self-cath -Oxybutynin Chloride 10 mg [**Hospital1 **] po -Methenamine Hippurate 1 gram Tablet Sig: One (1) Tablet PO BID To be restarted on [**7-30**] after course of antibiotics complete. -Vitamin C 1,000 mg po bid . Medications on transfer: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical exam on arrival to the floor: VS: afebrile, BP 138/77, HR 86, RR 95% RA GEN: NAD HEENT: EOMI, PERRL, moist mucous membranes, no OP lesions, no JVD, neck supple, right IJ in place, no cervical or supraclavicular LAD CV: RRR, NL S1S2 no MRG PULM: CTAB anteriorly and in axillae ABD: hypoactive BS+, soft, NTND, baclofen pump subcutaneously in LLQ, no HSM LIMBS: no LE edema, 2+ DP/PT pulses SKIN: very warm, macular, blanching rash on neck. Two ulcers on left trochanter. NEURO: Face symmetric, somewhat stiff face. Increased tone in lower extremities, able to move all extremities, some spasticitiy. Psych: flat affect. FAMILY HISTORY: No family history of MS. SOCIAL HISTORY: Single, lives alone, has 2 home health aides. Works Smokes: [**12-9**] ppd, 20 pk/yr history. Smokes marijuana once every 2 months.

CHIEF COMPLAINT: R sided weakness, N/V, aphasia PRESENT ILLNESS: Pt. is a 50 year old woman, listed in OSH records as having no PMH, who is transferred for further management of ICH. Husband reports that pt. had been in her USOH all day today. She did not complain of any headache, and she was not confused or lethargic, or not herself. Around 7:00 he was in the house and she came in from the back yard and said "I can't move my right arm. I think I'm having a stroke." She slumped down on a chair. He called EMS right away. By the time they got there he felt that she was slurring her speech somewhat. Per OSH records, pt. was brought in to their ED at 7:30. EMS described that they saw a R facial droop, R sided weakness, and aphasia on their exam. She vomited en route to the hospital. Ot the hospital CT scan showed a large L BG hemorrhage with midline shift. She was intubated at 8:30 (with etomidate, lidocaine, succ) and given 50 g Mannitol and 80 mg IV Lasix. Her exam is listed at pipoint pupils bilaterally, R facial droop, R hemiparesis, and aphasia. Her initial BP was 240/150 and she was given Labetalol 20 mg IV x 2, then started on a Labetalol gtt at 1 mg/min for BP control. She was transferred here for further management. MEDICAL HISTORY: None per husband, but [**Name2 (NI) 8298**]'t seen a doctor in 15 years MEDICATION ON ADMISSION: baby ASA, MVI ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T- BP- 186/101 HR- 67 RR- 12 O2Sat- 99% on vent Gen: Lying in bed, intubated HEENT: NC/AT, moist oral mucosa Neck: supple, no carotid or vertebral bruit CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender ext: no edema FAMILY HISTORY: NC SOCIAL HISTORY: Lives with husband (retired Ob/Gyn), not working, no tobacco, drinks 2-3 glasses of wine/night

CHIEF COMPLAINT: Mental status changes PRESENT ILLNESS: This 25 year old female with a history of Bipolar disorder, Cocaine use presented initially admitted to [**Hospital 1514**] hospital on Monday with jaundice/nausea and vomiting. She was diagnosed there with Hepatitis B and discharged the day of presentation. Shortly after discharge she experienced severe mental status changes. She presented to [**Hospital3 **] where she was found to be in fulminant liver failure. There she was having hallucinations, suicidal ideations and increased combativeness. There she was given Zofran and Ativan. She was also given Mucomyst. The patient is unable to answer questions at this time, according to the family it is not known if she had an overdose of any kind, however it is possible given that she has a long history of substance abuse. Her boyfriend was recently hospitalized for Hepatitis B as well. Of note she had a c-section 9 months ago followed by a D&C for retained placenta, she developed an infection in her uterus at the site of a stitch, she had a hysterectomy in [**Month (only) 205**]. MEDICAL HISTORY: 1. Cocaine/heroine use 2. Hepatitis B 3. Bipolar disorder 4. c-section 9 months ago 5. s/p retained placenta -> D&C 6. Hysterectomy MEDICATION ON ADMISSION: Percocet - s/p surgery ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals 98.8 (rectal), Pulse 89, BP 113/63, RR 16, 97% on RA Gen moaning, unresponsive to questions HEENT: sclera icteric, pupils 8mm, equal reactive, MMM, unable to assess OP due to poor cooperation Lungs: clear to auscultation bilaterally CV: RRR, nl S1S2 Abd: Soft, non-tender, non-distended, positive BS Ext: no edema Rectal: guiaic negative Skin: jaundice, no rashes, no spider angiomas Neuro: moaning, responsive to pain but not to voice, moving all extremities FAMILY HISTORY: no history of liver disease SOCIAL HISTORY: Lives with boyfriend and two children 9 months and 2 years, smokes, excessive drug use, rare EtOH

CHIEF COMPLAINT: Alcohol abuse, abdominal pain, delirium. PRESENT ILLNESS: The patient is a 46 year old homeless man with a past medical history significant for hepatitis C and alcoholic cirrhosis, who presented with two to three days of multiple complaints including abdominal pain, blurry vision, tremors and malaise. The patient reports that he has had vague epigastric abdominal pain for the past two to three days. This was associated with anorexia. No hematemesis, change in bowel habit, weight loss. nonproductive cough. He also admits to feeling depressed and hopeless and wishes to undergo alcohol detox and to speak with psychiatry re his depression and substance abuse. He apparently was delirious at one point and threatened to throw himself off a bridge. In ER, he received IVF, folic acid, thiamine and ativan. MEDICAL HISTORY: (COLLATERAL HISTORY FROM CHART) 1.) History of hepatitis A. 2.)History of hepatitis B. 3.) History of hepatitis C. 4.)History of alcohol abuse with a history of delirium tremens. 5.) Cirrhosis 6.) History of spontaneous bacterial peritonitis. 7.) History of incarcerated inguinal hernia MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse 74 BP 112/59 Afebrile RR 16. Alert, oriented, co-operative. Unkempt. Hands - no clubbing. No flap. No evidence peripheral stigmata of infectious endocarditis. HEENT - no jaundice. Eyes are bloodshot. Mucous membranes dry. No lymphadenopathy. JVP - not elevated. Cardiac- regular rate and rhythm. No murmur/rub/gallop Chest - R > L basal crackles. [**Last Name (un) **] - tender RUQ and RLq. No masses. No hepatomegaly. +BS Legs - no edema/swelling/erythema FAMILY HISTORY: Non-contributory SOCIAL HISTORY: The patient is homeless. He is originally from the Bronx. He previously worked as a musician, playing piano and drums. He has been divorced 4 times. He tells me he does not have any living relatives. [**Name (NI) **] reports significant alcohol intake. The patient reports smoking one pack of cigarettes per day. The patient admits to using crystal meth, cocaine and heroin IV. The patient has a history of multiple admissions for detoxification as well as multiple sign-outs against medical advice.

CHIEF COMPLAINT: Black Tarry Stools PRESENT ILLNESS: Ms. [**Known lastname 38758**] is a 86 y/o woman with recent history of low crit who had swallow study today with GI at [**Hospital3 **] presenting for melena and weakness. The patient reports she has been experiencing melena and weakness for the past 2 weeks in the setting of iron supplementation. The patient also notes experiencing substernal discomfort similar to heartburn which has been occurring for the past week which was different in nature from her baseline heartburn symptoms. She reports the pain occurred with laying down or on exertion, but states the pain was different in that it recurred intermittently in the past week which was different from baselien. The day of presentation, the patient had undergone a capsule endoscopy and got home, noticed 2 episodes of black, tarry stool without any red blood. She again noted weakness, lethargy, and nausea. She denies fevers, chills, vomiting, abd pain or SOB. She presented to the ED. Of note she had a large diverticular bleed in [**Month (only) **] of this year which required 4 transfusions at [**Hospital6 **]. Colonocopy at the time showed diverticuli and EGD showed mild antral gastritis and duodenitis. She had recently been undergoing an outpatient workup for worsening anemia and was due for initiation of aranesp shot tomorrow after having received IV Iron supplementation recently. She denies NSAID use and denies alcohol use. In the ED, initial VS were 98.4 103 125/63 20 100%. Workup was notable for a HCT of 21 (was 22.1 2 days prior, 26.2 one month prior). EKG showed new ST depressions in the inferolateral leads with Troponin of 0.06. Cardiology evaluated the patient and felt that this was likely demand ischemia in the setting of GI bleed. She was given Aspirin 325mg and and Nitroglycerin SL 0.4mg x1 with improvement of her heartburn-like pain. CXR showed possible mild pulm edema, focal calcification R lower lung, likely scarring/atelectasis. She was written for 2 units PRBC in addition to 500cc of a 1L NS bag, a GI cocktail, and Pantoprazole IV x1, and was admitted to the MICU for the management of GI Bleed. VS prior to transfer were 116/64, 107, 17, 98% 2L. On arrival to the MICU, the patient denied symptoms including abdominal pain, nausea/vomiting, chest pain, heartburn, or shortness of breath. MEDICAL HISTORY: Lower GI Bleed [**Month (only) **]/[**2179-3-9**] at [**Hospital **] Hospital. Thought to be Diverticulosis. Required 4 units of blood. Had colonoscopy with adenoma removed. Normocytic Anemia: thought to be due to CKD/iron def Iron Deficiency: S/P Ferraheme X 2 in [**2179-8-9**] stage 4 CKD thought to be due to hypertension and possibly diabetes. Hypertension hyperlipidemia right knee arthritis gastroesophageal reflux disease mild aortic stenosis mild mitral regurgitation ? mild type 2 diabetes (last A1C 6.2% not on any meds) MEDICATION ON ADMISSION: ATORVASTATIN 10mg PO Daily CITALOPRAM - 20 mg PO Daily FOLIC ACID 1mg PO Daily HYDROCHLOROTHIAZIDE - 25 mg PO Daily LOSARTAN - 100 mg PO Daily METOPROLOL TARTRATE - 50 mg PO BID PANTOPRAZOLE - 80 mg qAM and 40mg qPM ARANESP FERRAHEME FERROUS SULFATE - 325mg PO BID MULTIVITAMIN - PO Daily ALLERGIES: Penicillins / Lisinopril / Niacin / Meclizine / Ace Inhibitors / Paxil PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T: 96.7 BP: 122/66 P: 100 R: 22 PO2: 98% 2L NC General: Alert, oriented, no acute distress HEENT: Pupils equal and round, sclera anicteric, MMM Neck: supple CV: Regular rate and rhythm, normal S1/S2, GIII crescendo-decrescendo murmer at RUSB radiating across the precordium, GII holosystolic murmer at the apex, no rubs or gallops Lungs: End inspiratory crackles at bases b/l, no wheezes or ronchi Abdomen: Soft, non-tender, non-distended, bowel sounds present, no organomegaly Rectal: Guiac (+) with Black stool in ED Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . DISCHARGE PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Lives alone with sons very supportive. Uses Walker/Wheelchair - Tobacco: Previously smoked, quit over 60 years ago. - Alcohol: Denies

CHIEF COMPLAINT: fevers and relapsed AML PRESENT ILLNESS: 65 yo M with h/o AML D+119 s/p allo-SCT presents with febrile neutropenia and fatigue. He was seen in clinic on [**2125-6-1**] and was feeling well, his performace status was 100%. His peripheral blood showed 19% atypicals which later were read by pathology as blasts. There was concern for relapse. He was brought back to clinic on [**2125-6-5**] for a lab check and had 54% blasts. He reports that 5 days prior to admission he had a temp of 100.6 which quickly resolved. Then two days prior to admission he began to feel weak and have chills. This morning his daughter took his temperature and it was 101.2. He still complains of fatigue and weakness. He felt some lightheadedness, but no fainting or LOC. He denies CP, SOB, cough, diarrhea, dysuria, hematuria, no rectal pain. . In the clinic, he appeared weak and fatigued and given his temperature at home, it was decided that he should be admitted to the hospital. Blood cultures and urine cultures were taken. He was given cefepime and vancomycin. MEDICAL HISTORY: AML s/p allo SCT BPH renal stone MEDICATION ON ADMISSION: Terazosin HCl 5 mg PO HS PredniSONE 20 mg PO daily Acyclovir 400 mg PO Q8H Zolpidem Tartrate 5 mg PO HS:PRN Fluconazole 200 mg PO Q24H FoLIC Acid 1 mg PO DAILY Prilosec 20 mg Oral [**Hospital1 **] Sulfameth/Trimethoprim DS 1 TAB PO QMOWEFR Ursodiol 600 mg PO QPM Ursodiol 300 mg PO QAM Mycophenolate Mofetil 250 mg PO BID CycloSPORINE Modified (Neoral) 100 mg PO Q12H GlyBURIDE 2.5 mg PO BID Metoprolol 50 mg PO BID lorazepam 1mg qhs prn prednisolone eye gtts hydrea 500mg daily (started on [**2125-6-5**]) ALLERGIES: Morphine PHYSICAL EXAM: VS: T 99.9, BP 128/92, HR 80, RR 18 General: fatigued appearing male lying in bed; right chest port site is clean without erythema or edema HEENT: NCAT, anicteric, mildly injected conjunctiva, MMM, oral pharynx clear without erythema or exudate. No ulcers or lesions. CV: RRR, nl S1 S2, no m/r/g Lungs: CTAB no w/r/r Abd: +BS, soft, NTND Extremities: + 1 pitting edema bilaterally lower extremities with R slightly greater than left. No calf tenderness. No clubbing or cyanosis. 2+ DP pulses bilaterally. Neuro- A/O x3, bilateral hands with tremor (chronic), CN II-XII intact Skin: very warm skin. hyperpigmented LE. FAMILY HISTORY: Sister had breast Ca. Mother died at 89 and had alzheimers. Father died at 79 of CVA. SOCIAL HISTORY: Patient lives with wife and daughter. [**Name (NI) **] has 2 sons and 2 daughters. [**Name (NI) **] is a retired car salesman. He denies ever smoking and only occasionally drank etoh prior to his diagnosis.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 49 yo male with h/o IMI in '[**67**], HTN, hypercholesterolemia, former cocaine user, + tob user, s/p PTCA + stent of RCA which was shown in 4/00 to have mild restenosis, also with poor medication complicance (not taking BB or Plavix x2 years) presented to [**Hospital3 417**] Hospital on [**2-13**] with SSCP radiating to neck and arm, CE neg but persistent CP not relieved by [**Hospital 19298**] transfered to [**Hospital1 18**] [**2-15**] for PTCA. Last cath [**11-7**] with mild 1VD with 50% RCA stenosis just proximal to previous minimally restenosed stent. During hospitalization at [**Hospital1 18**] from [**2-15**] to [**2-18**], pt was taken to cath showing 70% mild RCA occlusion, but could not receive drug coated stent d/t aspirin allergy. Pt was supposed to stay for elective aspirin desensitization in the MICU prior to stent placement, but chose to leave AMA and follow up for future elective stenting. He presents now for aspirin desensitization and cardiac cath. . On interview, pt reports decrease in exercise tolerance x 3 weeks and numerous episodes of [**2178-8-15**] SSCP associated wtih SOB and radiation to he R arm at rest. No associated N/V/diaphoresis. CP episodes not more with activity. Denies PND, orthopnea, LE edema. CP episodes last 20-30 minutes, resolved wtih SLNTG. Denies recent cocaine use. MEDICAL HISTORY: CAD (IMI in 99 s/p RCA stent, angio of jailed PDA in '[**67**], No increasing CAD 00,00,02,02. HTN (on atenolol 100mg at home, not taking) h/o rheumatic Heart Dz in [**2142**] in [**Country 2784**] (after Strep throat) c/p pericarditis. Chronic cresendo angina (all started after his Pericarditis) Hyperlip. Not taking his lipitor Meniere's dx (deaf in Right ear) Laminectomy x 2 MEDICATION ON ADMISSION: Discharge Medications from previous admission several days prior: . 1. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ALLERGIES: Aspirin / Toradol PHYSICAL EXAM: 98.6 72 114/81 16 96%RA Well-app, sitting upright in chair, NAD No JVD appreciated No o/p erythema or lesions RRR, s1s2 nl, no murmurs, 1+ femoral pulses bilaterally without bruits, R pulse > L. DP 2+ bilaterally Lungs CTA B Legs without edema FAMILY HISTORY: SOCIAL HISTORY: The patient has a one half to two pack per day times 30 years. The patient drinks roughly 32 ounces of alcohol per day, on weekends, and sometimes drinks three to four bottles of wine or hard liquor. No intravenous drug abuse. Denies recent cocaine. The patient is married with children. He works for the postal office. Very noncompliant with meds (on no medications X 2 years).

CHIEF COMPLAINT: Dyspnea/Cough PRESENT ILLNESS: Otherwise healthy 29F, no sig PMH, history of smoking, developed dyspnea and cough 3 days ago, and went to [**Hospital3 4107**], where she was diagnosed with anxiety and a RML pneumonia on CXR and discharged on azithromycin. Pt states that her coughing has gotten worse over the past 3 days, and so she returned to the [**Hospital1 **] ER, where she was found to be dyspneic with an O2 sat in the low 80s. Pt had "low-grade" temp to 100F, with chills and body aches. Pt had no n/v/d, no sputum production. Pt did feel a subjective wheezing sensation. Pt was placed on BiPap, with improvement in O2 sat to high 90s. A CXR revealed worsening Right middle lobe infiltrate from prior study, with a questionable LLL infiltrate as well. ABG revealed PaO2 63. Pt received Azithro, ceftriazone, nebs, magnesium, solumedrol for wheezing and ?asthma exacerbation, as well as a heparin bolus and gtt. Given pt's hypoxia, pt was given a CTPE to r/o PE in addition to pneumonia. This was read by [**Hospital1 39933**] radiologists as showing b/l PEs, in addition to b/l multifocal pneumonia. Pt was transferred to [**Hospital1 **] for further management. . In the ED, initial VS were: 98.9 ??????F (37.2 ??????C), Pulse: 94, RR: 25, BP: 126/74, O2Sat: 91, O2Flow: 5. PT was given Tamiflu for concern for influenza, and the CT study was sent to radiology for a 2nd read. She was taken off bipap here and subsequently she satted 88% on 4L NC with RR 40s. She was switched to non-rebreather with RR high 30s, and then placed on BIPAP with RR 20s, FiO2 60, with O2 Sat high 90s. ABG was performed on BiPap with PaO2 86. Pt had a persistent air leak on bipap mask, and required multiple mask revisions. An informal bedside echo in the ED revealed no RV strain, and her EKG revealed no R heart strain. A Trop and BNP are pending (sent for prognosis of PE). PT has a Flu swab, blood cx at [**Hospital3 4107**] none here. Access:20 g and 18g IVF: 1L at OSH, nothing here Vitals: afebrile, HR 103, BP 120-130/82, RR 25 on BIPAP satting 95%. . On arrival to the MICU, pt is comfortable, satting 90% on 4L NC. She was conversational but breathing quickly, and complained of continuing dry cough and anxiety. PT also complained of a wheezing sensation, but otherwise stated that she felt "well." MEDICAL HISTORY: Anxiety, treated w/ gabapentin Uterine hemmhorage 1 yr ago s/p D&C, no anemia since weekly "migraine" headaches MEDICATION ON ADMISSION: Gabapentin 600mg TID Ibuprofen 400mg q8h prn pain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Exam: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: scattered inspiratory and expiratory wheezes and coarse crackles r>l, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact FAMILY HISTORY: No family history of lung disease, blood clots, pneumonia. SOCIAL HISTORY: - Tobacco: 1 ppy for 3 yrs - Alcohol: denies current use - Illicits: denies recently got a hamster as a pet

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 63 year-old male with a past medical history of hypertension and high cholesterol who had chest pressure radiated, which resolved spontaneously. Episodes are very frequent, however, they increased. He took sublingual nitro and beta blockers. He went to an outside hospital where he was evaluated. Chest pain continued and increased in frequency. The patient was diagnosed with acute myocardial infarction at that time. The patient was transferred to the hospital for cardiac catheterization and workup. MEDICAL HISTORY: Significant for hypertension, high cholesterol and prostate CA. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Small bright red blood in vomitus PRESENT ILLNESS: 52yoM with h/o HepC cirrhosis c/b varices presenting with hematemsis. Patient receives most of his care at [**Hospital1 2025**]. He is s/p TIPS with TIPS revision 6weeks ago. He was in his normal state of health until DOA when he developed nausea. At about 5:30pm that night he had a "small amount" of hematemesis, less than [**11-25**] cup. Hematemesis was associated with worsening of his chronic RUQ pain, prompting presenation to [**Hospital1 18**] ED. In the ED initial vitals T 99.5 HR 86 BP 130/65 RR 14 98%RA. Hct 30.7. He received 1L NS, 40mg iv Protonix, and octreotide gtt started. NG lavage was negative. In the ED his FS was 515 and 5units regular insulin given. Pt. admitted to MICU. MEDICAL HISTORY: diabetes, hepatitis C cirrhosis on transplant list, tips proc [**6-27**], chole [**9-27**], h/o nephrolithiasis, IV substance abuse MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T 98.0 HR 78 BP 118/60 RR 11 98%RA Gen: alert, cooperative, NAD HEENT: PERRL, anicteric, OP clear, MMM Neck: supple, no LAD, JVP flat CV: RRR, no mrg Resp: CTAB Abd: +BS, soft, ttp RUQ with guarding, no rebounding, no masses Ext: no edema, 2+ DPs Neuro: A&Ox3, CN II-XII intact, strength 5/5 throughout, no asterixis . FAMILY HISTORY: NC SOCIAL HISTORY: SHx: homeless x6mos, on disability Tob: 1/2ppd x 40yrs EtOH: none, h/o abuse, quit 3yrs ago Illicits: none, h/o abuse, ivdu last used [**2117**]

CHIEF COMPLAINT: PRESENT ILLNESS: An 84-year-old G3, P2-0-1-2 presents with a one to two week history of abdominal distention, nausea and diarrhea who was found to have ascites at [**Hospital6 2561**] that was tapped and was found to be positive for papillary adenocarcinoma. She was transferred from [**Hospital3 **] and was planned for surgery on [**3-22**]. She initially presented at [**Hospital3 **] on the 5th with bloating, decreased appetite in five days, without nausea or abdominal pain. She also noticed some discomfort and loose stools for about six days. There was no heme in the stool. She noted increased fatigue, leg swelling. No chest pain, shortness of breath. Initially at [**Hospital3 **], they noticed anemia, hyponatremia and elevated liver function tests as well as ascites. A CT revealed ascites with omental caking and bilateral probable ovarian masses. Paracentesis on [**2137-3-20**] revealed papillary adenocarcinoma. A gynecologic oncology consult was obtained as the patient complained of increased nausea and decreased bowel movement and was transferred to [**Hospital3 **] for an operative procedure due to her symptoms. MEDICAL HISTORY: 1. Mitral regurgitation 2. Hypertension 3. Paroxysmal atrial fibrillation 4. Left leg claudication 5. High cholesterol 6. History of Helicobacter pylori 7. Uterine prolapse MEDICATION ON ADMISSION: ALLERGIES: NONE PHYSICAL EXAM: VITAL SIGNS: Temperature 95.0??????, 122/60, 98, 20. HEAD, EARS, EYES, NOSE AND THROAT: Normal. Extraocular muscles are intact. No lymphadenopathy. GENERAL: In no apparent distress. HEART: Regular. LUNGS: Clear. ABDOMEN: Soft, distended, grossly uncomfortable, no localized tenderness. EXTREMITIES: Within normal limits. VAGINAL: Deferred. FAMILY HISTORY: SOCIAL HISTORY: She lives alone in [**Hospital3 4634**]. Denies drug use. She did smoke for about 10 years and she drinks about a glass of wine a day.

CHIEF COMPLAINT: DKA PRESENT ILLNESS: 79 y/o female with PMHx of HTN, hypothyroidism, DM, CHF (LVEF 20-25%) who has been having intermittent nausea and vomiting for the past 1 month, however no abdominal pain, fever or chills. She was found to have acute renal failure from outpatient visit and sent to the ED. In the ED patient was found to be in DKA with urine positive for ketones, anion gap of 18, and blood sugar > 600. She was also noted to have a WBC of 45 with a U/A suggestive of UTI. She had a CXR in the ED which did not show any infiltrate. She took 8U of lantus and 8U of humalog at home prior to arrival in the ED. In the ED she was started on isulin gtt and given 1L NS. Her Hct was noted to be low in the ED at 29 however she was guiac negative in the ED. Per OMR note patient daughter states patient has not been feeling well for over a month and has had weight loss (3lbs). Patient denies any dysuria or frequency. . On HD1, blood and urine cultures grew pansensitive e.coli. and the patient was switched to IV ceftriaxone. . Patient currently states that she feels well. Denies cp/sob/abd pain/n/v/d. Eating w/o difficulty. MEDICAL HISTORY: HTN Hypothyroidism DM type II CHF LVEF 20-25% in [**2119**] Coronary artery disease, status post non Q wave myocardial infarction in [**2120-6-3**]. S/p appy Eczema MEDICATION ON ADMISSION: Aspirin 81mg daily Ferrous Sulfate 325mg daily Fosamax 70mg qweek Diovan 80mg daily Hydroxyzine 10mg daily Lasix 20mg daily Lantus Levoxyl 50mcg Lisinopril 2.5mg daily Toprol XL 25mg daily Zocar 40mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: t 98.5, bp 140/90, hr 108, rr 18, 96% ra Well appearing NAD PERRL. anicteric OP clr. MMM 7cm JVP. Thyroid benign. Regular S1,S2. No m/r/g LCA b/l. Notable Kyphosis. +bs. soft. nt. nd No le edema No rashes. FAMILY HISTORY: non-contributory SOCIAL HISTORY: Patient lives with her husband and son. Is able to ambulate at baseline. Patient denies any smoking or etoh use

CHIEF COMPLAINT: hypoxia PRESENT ILLNESS: 71M with MMP including CHF, afib, CAD, and COPD and multiple admissions to [**Hospital1 18**] (recently D/C'd [**2-15**] from [**Hospital Unit Name 196**]/MICU for admission for CHF/chest pain) found at HebReb to have change in MS and O2 sat 76-80% RA. In [**Name (NI) **], pt initially placed on 3L O2: 91% then dropped to 86%. ABG initially 7.3/44/66, pt placed on bipap: 7.24/50/90. Per previous DC summaries, pts base ABG is nl (no hypercarbia). She was noted to have thick yellow sputum. At some pt in ED, BP dropped and ED team unable to find pulse. LIJ attempted, but unsuccessful. R groin line placed and pt started on dopamine and levophed. Lactate in ED 1.5. UA positive and pt started on empiric coverage with Vanc, Levo, flagyl. CXR showed CHF. Cr elevated at 2.9 from baseline 0.8-1.2. Pt was transferred to the [**Hospital Unit Name 153**] on [**2-25**], where she was treated for her hypotension with pressors and IVF (7 L). She was also continued on vanc/levo/flagyl for emperic treatment of sepsis while cultures were pending. Pt was off pressors on [**2-28**] and transferred to medical floor. During medical evaluation pt revealed that she may have had diarrhea for 2 weeks prior to admission, however, [**Hospital **] rehab was unable to corroberate since no evidence that pt had diarrhea there. During this hospitalization, pt was found to be c. difficile toxin positive. MEDICAL HISTORY: 1. CHF diastolic dysfunction (EF 65% 1/05 MIBI normal) DRY WEIGHT 194 lbs 2. DM 2 on insulin 3. Atrial Fibrillation 4. Anemia 5. CAD s/p PTCA x 3 (RCA '[**09**], LCx '[**10**], RCA '[**13**]) 6. Pulmonary HTN 7. Hypercholesterolemia 8. COPD/[**Year (2 digits) 105496**] on home O2 (sometimes on home O2) 9. Thyroid CA s/p resection/now hypothryoid 10. Myoclonic tremors 11. H/O PE 12. OSA on CPAP (started last admission) 13. Depression/Anxiety 14. h/o MRSA/VRE. ICU admit x 2 for MRSA aortic valve endocarditis and pseudomonal sepsis (secondary to wound infection), status post intubation x 2. 15. S/p laproscopic cholecystectomy [**34**]. s/p right throcoscopy and decortication. Right lung bx. 17. s/p right hip ORIF 18. s/p right ankle ORIF MEDICATION ON ADMISSION: Meds on admission: 1. Aspirin 325 mg PO qD 2. Amiodarone HCl 200 mg PO qD 3. Simvastatin 20 mg PO qD 4. Gabapentin 900 mg Capsule PO BID 5. Ferrous Sulfate 325 (65) mg PO qd 6. Lansoprazole 30 mg PO qD 7. Citalopram Hydrobromide 60 mg PO qD 8. Multivitamin Capsule qD 9. Topiramate 25 mg PO qD 10. Methylphenidate HCl 10 mg PO qAM 11. Methylphenidate HCl 5 mg PO qnoon 12. Levothyroxine Sodium 200 mcg PO qD 13. Warfarin Sodium 3.5 mg PO qHS 14. Lisinopril 5 mg PO qD 15. Furosemide 40 mg PO qD 16. Miconazole Nitrate 2 % Powder TP [**Hospital1 **] 17. Metoprolol Tartrate 25 mg PO TID 18. Oxycodone HCl 5-10 mg PO Q4-6H prn 19. Albuterol INH q6 prn 20. Ipratropium Bromide INH q6 prn 21. Fentanyl 25 mp patch q 72h 22. Insulin Glargine 15U qHS 23. Insulin Lispro SS ALLERGIES: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn PHYSICAL EXAM: Physical exam upon transfer to medical floor: WEIGHT 204 V/S Tm 99.7 BP 109-169/50-70 P 95-120 RR 24 O2 sat 88-99%, at time of transfer 91% on 4L Gen: awake, alert, oriented x 3, REJ in place Lungs: scattered wheezing in all lung fields Heart: irregularly irregular Abd: obese, soft, +bs, mild tenderness in all quadrants ext: bilateral hyperpigmentation of LE, 1+ pitting edema, L 1st toe ulcer, L heel ulcer, RLE shin ulcer FAMILY HISTORY: F: Died at 47 of MI; M: Colon ca; brother with DM SOCIAL HISTORY: Pt is divorced with three children. Former CPA. Quit smoking in [**2104**] after a history of 1 ppd x 15 years. No etoh. No drugs.

CHIEF COMPLAINT: cold right foot PRESENT ILLNESS: A 71-year-old man with history of CAD, HTN, hyperlipidemia, and diabetes who presents to [**Hospital1 18**] with complaints of a 5 day history of severe bilateral lower extremity pain, now greater in the right as compared to the left. He presented to his PCP the following day, and, given numbness and pain in his bilateral lower extremities, suggested an MRI to evaluate the patient's spine. As the patient was to undergo MRI testing today, he complained of severe RLE calf pain and asked to be transferred to the ED. The patient's bilateral lower extremity pain was of sudden onset and started while walking in the yard. It started as a 'jolt', shooting down from his buttocks to his calves bilaterally. He sat down, which made the pain better. Since that time, however, he has been unable to walk secondary to severe calf pain. The patient now states that his pain is worse on his right leg compared to his left. He also complains of intermittent numbness, greater in his right leg as compared to his left. The ED has consulted Vascular Surgery because his distal RLE was cool to the touch. The patient continues to complain of severe RLE calf pain. He is unable to walk on it now. He denies any history of claudication. He has no history of a-fib. The pain is not any better when he hangs his leg over the side of the bed. He complains that his right foot feels 'numb' subjectively. He denies any pain in his feet bilaterally. MEDICAL HISTORY: PMH: obesity, CAD, hypertension, hyperlipidemia, gout, abnormal LFTs, diabetes, anxiety, BPH, colon polyps, lung nodule, diabetic nephropathy, and obstructive sleep apnea MEDICATION ON ADMISSION: AMLODIPINE - 5 mg Tablet - 1 Tablet(s) by mouth once a day COLCHICINE - 0.6 mg Tablet - 1 Tablet(s) by mouth twice a day EZETIMIBE-SIMVASTATIN [VYTORIN [**9-/2150**]] - 10-80 mg Tablet - 1 Tablet(s) by mouth once a day GLIPIZIDE [GLUCOTROL] - (Dose adjustment - no new Rx) - 10 mg Tablet - 1 Tablet(s) by mouth twice a day HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg Tablet - [**12-24**] Tablet(s) by mouth at bedtime as needed for pain ISOSORBIDE MONONITRATE - 30 mg Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth once a day LISINOPRIL - 40 mg Tablet - 1 Tablet(s)(s) by mouth once a day METHYLPREDNISOLONE - 4 mg Tablets, Dose Pack - taper Tablets(s) by mouth as directed METOPROLOL SUCCINATE [TOPROL XL] - 100 mg Tablet Sustained Release 24 hr - one tablet once a day PIOGLITAZONE [ACTOS] - 30 mg Tablet - 1 Tablet(s) by mouth once a day for diabetes ASPIRIN - 325 MG Tablet, Delayed Release (E.C.) - ONE BY MOUTH EVERY DAY ALLERGIES: Allopurinol PHYSICAL EXAM: VS: T 98.2 P 74 BP 120/101 20 98 RA GENERAL: AAOx3, lying in bed, NAD Chest: CTAB CV: RRR Abd: obese, soft, NT/ND, well healed surgical scars RLE: 2+ Femoral, Biphasic Popliteal, unable to doppler DP, Biphasic PT. Right cooler compared to LLE, but no evidence of mottling. RLE soft throughout. Lateral and medial fasciotomies with beefy wound bed. Right groin wound with bright red wound base. Patient complains of pain when asked to move toes, but denies any pain with toe passive extension/flexion. Sensation normal to light palpation throughout. Pulses LLE: RLE: 2+ Femoral, Popliteal, DP, PT. Denies any pain/numbness. WWP. FAMILY HISTORY: Non contributory SOCIAL HISTORY: Non smoker, no ETOH lives with sister

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 86 year old male with brittle TIDM, aortic insufficiency, and CKD presents with chest pain. The pain woke the patient from sleep last night. He felt a tightness in his anterior chest that wrapped around his chest like someone was tightening a towel around him. It lasted till the morning, and he can't recall when it stopped. His wife reports that he felt like food was caught in his stomach at dinner and he had a need to vomit. He also developed the hiccups and a headache, both rare for him. He denies exertional pain, denies diaphoresis, nausea, or associated shortness of breath. He denies any fever, chills, cough, nausea, vomiting. He never had significant chest pain before. The patient has been compliant with a new, more conservative insulin regimen since his last admission [**2195-7-10**], but recently lost control. He reports feeling thirsty the past few days, and developing suprapubic pain from not voiding. He otherwise denies fatigue, nausea, abdominal pain, chills, or headache over the past few days. He recently traveled to [**Hospital3 **], has not had recent antibiotics. In the emergency room, initial vitals were T 97.4 HR 96 BP 157/40 RR 22 O2 100%. EKG showed 1st degree block, RBBB, no ST elevation, T-wave flattening in III and AVF, T-wave inversions V1-V3. Initial labs in ED were notable for trop of 0.20, Na was 119, K 5.8, bicarb 6 with AG of 24, BUN/Cr 82/3.7, baseline ~ 60/2.5. CBC shows leukocytosis of 21.7, with left shift 90.9%N. H/H 10.5/33.9, platelets 403. Rectal exam was heme negative. A CXR showed a heart of normal size, opacity behind heart cosistent with hiatal hernia, rotated lungs are clear, no effusions. His pain responded to nitroglycerin and he was bolused with 5000 units heparin and started on a heparin drip. He was given 81mg ASA, cardiology saw him and agreed. He was bolused 10U insulin and started 8 units/hr. Access with two peripherals 20 guage. MEDICAL HISTORY: Endocarditis, [**2184**] strep Ao valve, gets f/up echos 1-2x yr w/cardiologist Dr [**Last Name (STitle) **] Aortic insufficiency, moderate (latest echo in [**11-15**], normal LV size and function, ejection fraction greater than 70%, asymptomatic, requires abx prophylaxis) Hyperlipidemia -his last cholesterol was 210, but his HDL 56, LDL 104. Hypertension Type I Diabetes, latest hemoglobin A1c 10.7 on [**2193-5-7**] Chronic kidney disease (stage III, stable, baseline creat 1.6, K 4.5) Hypothyroidism GERD Partial knee replacements, L knee in [**2190**], R knee [**6-/2192**] BPH/Recurrent UTIs (TURP [**5-/2173**]) (Followed by Dr [**Last Name (STitle) **] Tinnitus (decreased hearing by audiogram. Thought [**1-8**] sound trauma or gentamycin) Benign colonic polyps and diverticulosis Macular degeneration Abnormal Chest CT- needs follow-up Chest CT [**2193-10-7**] to re-evaluate nodules on chest CT performed for abnormal pulm exam MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientFamily/Caregiver[**Name (NI) 581**]. 1. Pravastatin 80 mg PO DAILY 2. Calcitriol 0.25 mcg PO DAILY 3. Felodipine 10 mg PO DAILY 4. Furosemide 40 mg PO DAILY 5. HydrALAzine 25 mg PO BID 6. 70/30 28 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 7. Levothyroxine Sodium 150 mcg PO DAILY 8. Lisinopril 40 mg PO BID 9. Vitamin D 1000 unit PO DAILY 10. Ferrous Sulfate 325 mg PO DAILY 11. Multivitamins W/minerals 1 TAB PO DAILY ALLERGIES: All allergies / adverse drug reactions previously recorded have been deleted PHYSICAL EXAM: ADMISSION Physical Exam: Vitals: T: 97.2 BP: 130/39 P: 59 R: 17 O2: 99% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry mucous membranes, oropharynx clear, EOMI, pupils 2mm, round, reactive to light Neck: supple, JVP 8 cm, no LAD CV: Systolic crescendo/decrescendo murmur best heard at RUSB, radiating to carotids, regular rate and rhythm, normal S1 + S2, heartbeat palpable Lungs: Clear to auscultation bilaterally, good air movement, no crackles, wheezes, ronchi Abdomen: Distended, soft, non-tender, hypoactive bowel sounds, no organomegaly Back: No CVA tenderness bilaterally GU: Foley in place Ext: warm, well perfused, 2+ pulses bilateral radial and dorsalis pedis, no clubbing, cyanosis or edema. Neuro: CNII-XII grossly intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilateral brachial and patellar, gait deferred FAMILY HISTORY: No cardiac history. SOCIAL HISTORY: Lives with his wife. [**Name (NI) **] smoking hx of 1/2pk for 30yrs, quit many years ago. Ocassional alcohol. Denies past or present hx of IVDU or other recreational drugs.

CHIEF COMPLAINT: Bicuspid aortic valve and aortic stenosis. PRESENT ILLNESS: 59M c h/o AS/AI/bicuspid AV, now with decreasing [**Location (un) 109**], from 1.5 to 0.7 cm. Has been followed with serial echos. Most recent echo showed [**Location (un) 109**] 0.7 cm, dilated Ao root 3.6 cm, and asc Ao 4.3-4.5 cm. Recent cardiac cath showed EF 45%, AS, clean coronaries. MEDICAL HISTORY: 1. Aortic stenosis 2. Aortic insufficiency 3. Bicuspid aortic valve 4. Hypertension MEDICATION ON ADMISSION: 1. Lisinopril 10 mg PO QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Afebrile, VSS NAD, alert Neck: no bruits, no JVD Heart: RRR, 4/6 SEM c radiation to carotids Lungs: CTAB Abd: soft, NT, ND, + BS Ext: no edema FAMILY HISTORY: Father: CAD and MI SOCIAL HISTORY: + EtOH, ? amount No tobacco No IVDU

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 76 year old male with a past medical history of a right-sided cerebrovascular accident, coronary artery disease, status post coronary artery bypass graft, hypertension, lower gastrointestinal bleed on Coumadin who was sent to [**Hospital6 649**] from [**Hospital1 **] for right upper quadrant pain, nausea, vomiting and change in mental status. The patient denies any fevers, chills, chest pain, or shortness of breath. He was recently discharged from [**Hospital6 1760**]. He was here from [**4-9**] to [**4-14**], for a right hemisphere watershed stroke. He had diarrhea that was nonbloody during that admission while he was on Coumadin. Previously the patient has had projectile vomiting and bloody diarrhea at the rehabilitation facility while on Coumadin, so the Coumadin was discontinued at [**Hospital6 1760**]. The patient in the Emergency Room had systolic blood pressures in the 200s and elevated liver function tests and lipase. A gallbladder ultrasound showed acute cholecystitis. His troponin was also elevated at 0.[**Street Address(2) 53869**] elevation son his electrocardiogram. Surgery was consulted. The patient was made NPO and given Levofloxacin and Flagyl intravenously, intravenous fluids and admitted to Medicine for further care. MEDICAL HISTORY: 1. Cerebrovascular accident. He had a right hemisphere watershed infarct on [**2172-4-9**]. He had a right carotid artery total occlusion, and he had a 79% left internal carotid artery stenosis. 2. Lower gastrointestinal bleed on Coumadin. 3. Hypertension. 4. Patent foramen ovale by echocardiogram in [**2171-11-18**]. There was an ejection fraction of 40 to 45%. He had apical akinesis, 1+ aortic regurgitation, 1+ tricuspid regurgitation. 5. Coronary artery disease, status post coronary artery bypass graft 26 years ago. 6. Chronic obstructive pulmonary disease. 7. He had had a left groin hematoma. MEDICATION ON ADMISSION: 1. Ativan 2 mg p.o. q.i.d. 2. Aspirin 325 q.d. 3. Aggrenox 1 tablet b.i.d. 4. Coumadin had been discontinued on [**2172-4-9**]. 5. Lisinopril 30 q.d. 6. Lipitor 40 q.d. 7. Protonix 40 q.d. 8. Iron tablets. 9. Neurontin 300 b.i.d. 10. Tylenol prn. ALLERGIES: Penicillin causes a rash. PHYSICAL EXAM: FAMILY HISTORY: He has a sister with [**Name (NI) 2481**] disease. SOCIAL HISTORY: He lives with his wife in clinic. He has a 100 pack year tobacco history. He quit in [**2171-11-18**]. He is a retired homicide detective.

CHIEF COMPLAINT: Dyspnea. PRESENT ILLNESS: The patient is a 63 year old female with a past medical history significant for end stage chronic obstructive pulmonary disease on four liters of home O2 with O2 saturations in the low 90s, multiple intubations in the past, on chronic steroids, who is admitted for dyspnea. The patient was recently seen at the [**Hospital1 346**] in [**2137-11-16**] for dyspnea and cough. She was treated with steroids and nebulizers and she was discharged to Pulmonary Rehabilitation. The patient was discharged to Pulmonary Rehabilitation and then was only at home for two days and experienced dyspnea and was readmitted on [**2138-1-22**], this admission. The patient states that she has worsening dyspnea on exertion. She has a cough which has been productive of white sputum for approximately one month. She denies any nausea, vomiting or abdominal pain; she has stable two pillow orthopnea. She denies any paroxysmal nocturnal dyspnea. She denies any lower extremity edema. In the Emergency Department, she was given Solu-Medrol nebulizer, Ceftriaxone, Azithromycin. She had a chest x-ray done which showed enlarging right pulmonary mass. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease; four liters of nasal cannula oxygen at home; on chronic steroids , Prednisone 20 q. day. She had pulmonary function tests in [**2134**] which showed FEV1/FVC ratio of 48% predicted. 2. Hypertension. 3. Diverticulosis. 4. Status post appendectomy and cholecystectomy. 5. Non-insulin dependent diabetes mellitus secondary to steroid use. 6. Multifocal atrial tachycardia. 7. Depression. MEDICATION ON ADMISSION: 1. Flonase. 2. Glipizide. 3. Lisinopril. 4. Calcium carbonate. 5. Fosamax. 7. Magnesium. 8. Multivitamin. 9. Paxil. 10. Protonix. 11, Verapamil. 12. Vitamin C. 13. Nifedipine. 14. Prednisone. 15. Ativan. 16. Atrovent. 17. Lipitor. ALLERGIES: She has an allergy to percocet which causes GI upset. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Respiratory distress PRESENT ILLNESS: 61 year old male with severe CAD, unrevascularizable, s/p cardiac arrest with anoxic brain injury [**5-/2171**], chornic bronchitis, osteomyelitis, trached and peged, living in extended care, admitted to the MICU after presenting to the ED with respiratory distress. Was reportedyl in USOH when had episode of hypoxia, fevers to 101 and tachycardia. Was placed on NRB and sating 90-100% on transfer to ED. . In ED - was able to be weaned to trach mask with good saturations nad no respiratory distress. Got 1gm Vancomycin and tylenol. Was per call-in reportedly was on Zosyn for pseudomonas colonization. When on floor, BP noted to be 70s systolic, responded well to IV fluid bolus. . Of note: recently admitted [**8-14**], discharge [**8-21**] for fevers, tachycardia, tachypnea. Was discharged on a 5 week course of vancomycin for osteo that was newly diagnosed on MRI imaging of the hip, located @ ischial tuberosity and coccyx. - no biopsy or debrediment performed. MEDICAL HISTORY: # CAD - 3VD s/p cardiac arrest w/anoxic brain injury as above. Arrest was in setting of left hip fracture and repair. has 3VD not revascularizable # ischemic cardiomyopathy (EF 25%) # Osteomyelitis - recently diagnosed ([**7-/2171**]) during above admission. # Sensorimotor demyelinating polyneuropathy, confirmed by EMG per the pt's brother. Pt. has resultant paraparesis # suspected colonization of airway with pseudomonas (pan sensative) # UTIs # chronic renal insufficiency, known horseshoe kidney # chronic sacral and ischial decubitus ulcers # H/O chronic indwelling foley # h/o afib (currently not anticoagulated, not rate controlled, and not in afib # Hyperlipoidemia # h/o AAA # Schizophrenia # prior strokes seen on CT head # h/o dementia MEDICATION ON ADMISSION: colace 100 mg po bid bisacodyl suppositories prn for constipation heparin 5,000 u sq q8hr reglan 5 mg po tid miconazole nitrate one application [**Hospital1 **] amantadine 50 mg po bid ascorbic acid 90 mcg [**Hospital1 **] albuterol mdi q2hr prn glycerine suppositories pr prn constipation lactulose 30 ml qday prn constipation senna 2 tabs [**Hospital1 **] pern constipaton scopolamine patch 1.5 mg q2hr simvastatin 10 mg po daily zinc sulfate 220 mg po daily tylenol 650 mg q6hr prn pain asa 81 mg po daily ALLERGIES: Beta-Adrenergic Blocking Agents / Zosyn PHYSICAL EXAM: Admit exam: 98.5 109 109/70 22 99-100%RA on trach mask GEN: ill appearing, non responsive HEENT: no rashes, CV: rrr s1 s2, no M/G/R RESP: CTA ant ABD: soft, NT/ND EXT: no edema or excoriations NEURO: deffered . Discharge exam: (notable findings) T 96.9 Tm 99.2 BP 95/74 HR 88-100 RR 20 94% trach mask 35% General: minimally responsive elderly male with trach, NAD Neuro: tracks people with eyes (EOMI PERRL), needs glasses on to see, does not respond in meaningful way to questions, does follow some commands (squeeze finger, spread fingers, blinks, moves limbs spontaneously, L arm lightly contracted but able to move passively, does not wiggle toes. Some days he waves hello and some days he mouths words though unclear what he is trying to say. Respiratory: trach w/35% trach mask, white-light yellow sputum requiring frequent suctioning, rhonchi heard throughout CV: RRR no m/r/g, distant heart sounds Abd: soft, NT/ND, PEG c/d/i, functioning well Limbs/extremities: old excoriations on L arm, no edema, brown mottling/discoloration of dorsal feet b/l, dopplerable pulses FAMILY HISTORY: NC SOCIAL HISTORY: The pt. is a resident of a skilled nursing facility. There is no history of alcohol use. The pt. quit smoking tobacco 2 years ago after approximately 20 years of use. He is a former electrical engineer. His Brother [**Name (NI) 11312**] [**Name (NI) 14714**] is actively involved in his care.

CHIEF COMPLAINT: This is a [**Age over 90 **]-year-old female admitted with atrial fibrillation with a rapid ventricular response, hypertension and electrocardiogram changes at Dialysis. PRESENT ILLNESS: On the day of admission, the patient was at Dialysis and received two hours of treatment when she became hypertensive and confused. She has a history of similar complaints on an admission on [**2101-1-24**]. She was brought to the Emergency Department. Heart rate was in the 140s. Systolic blood pressure was 40. She was found to be in irregular narrow complex rhythm and was given two liters of normal saline. Attempts at cardioversion at 100, 200 and 360 joules failed to convert her to sinus rhythm. Her blood pressure slowly rose to 95/50s with fluids and the patient became increasingly response and interactive. An attempt at a left subclavian line failed in the Emergency Department. She was given 5 mg Lopressor intravenous for persistent tachycardia without any change. Her blood pressure became 70s/50s. She was given another liter of normal saline for a total of 3 and transferred to the Medical Intensive Care Unit. MEDICAL HISTORY: 1. End stage renal disease from nephrolithiasis with obstruction. She is receiving hemodialysis at [**Location (un) 4265**] and has a right AV fistula. She is dialyzed Tuesday, Thursday and Saturday. 2. Ulcerative colitis status post colectomy with ileostomy, remote. 3. Paget's disease. 4. Peptic ulcer disease, status post hemigastrectomy. 5. History of cholecystectomy. 6. Osteoporosis. 7. Admitted [**2101-1-24**] for atrial fibrillation with rapid response and lateral ST depressions with troponin leak attributed to demand ischemia and renal failure. Echocardiogram was done and was normal except for delayed relaxation. She had no stress test or cardiac catheterization because patient and family did not desire revascularization. She was started on aspirin at that time. 8. Severe memory deficit and dementia. 9. Recent fall, [**2102-3-3**] with staples to forehead laceration. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: The patient lives at home and has full time [**Last Name (LF) 13222**], [**First Name3 (LF) **], who provides 24 hour care. She has a distant tobacco history. She drinks one vodka tonic every afternoon. Her cardiologist is [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Patient had a son nearby but he died within the last several years. Patient's proxy is her [**Last Name (LF) 802**], [**Name (NI) 5627**] [**Name (NI) **], and she is closely involved in her aunts care and transport.

CHIEF COMPLAINT: Shortness of breath, palpitations, chest pressure and worsening fatigue PRESENT ILLNESS: 70 year old woman with history of shortness of breath, palpitations, chest pressure and worsening fatigue who was worked up by her PCP for dysphagia. As part of workup, she had a transesophageal echocardiogram that showed an atrial septal defect with normal pulmomary veins. Cardiac catheterization showed normal coronary arteries. MEDICAL HISTORY: Dyslipidemia Thyroid cancer s/p ablation with radioactive iodine Hiatal hernia Enterogastric ulcers Migraines Skin cancer s/p c-section x3 s/p right femoral hernia repair s/p TAH MEDICATION ON ADMISSION: Levoxyl 75 mcg po daily Ambien 5mg po QHS PRN Fiorinal MVI daily Protonix 40 mg po daily ASA 325 mg po daily ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Fentanyl / Lipitor PHYSICAL EXAM: Admission: HR 72 Right BP 142/76 Left BP 122/64 Height 5'5" Weight 66KG General: no acute distress Neck: supple with full range of motion, no JVD Chest: lungs clear to auscultation bilaterally COR: regular rate and rhythm. III/VI systolic ejection murmur. Abdomen: soft and nontender without rebound or guarding Extremities: warm without edema. 2+ peripheral pulses Neuro: grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Retired and lives with her husband in [**Name (NI) 17566**]. She never smoked and consumes alcohol rarely.

CHIEF COMPLAINT: Dyspnea (although patient non-verbal) PRESENT ILLNESS: 80 YO nonverbal M with end-stage Alzheimer's and a well-documented h/o chronic aspiration p/w increased breath sounds. The patient's CC from the ED was initially dyspnea, but, per MICU resident discussions with the family, they were concerned about increased airway sounds described as "gurgling." The patient has failed a s/s eval in the past with frank aspiration. The family decided not to pursue a g-tube in the past despite documented aspiration given lack of likely benefit for the patient. The family normally will feed him yougerts at home and reports that he coughs with all PO intake. As the patient is non-verbal and only tracks to voice, please refer to the MICU history obtained from the family. . The patient was briefly admitted to the MICU due to persistent tachycardia despite having been given 3L of fluids in the ED. Upon review of prior EKGs, it appears the patient has been persistently tachycardic. A d-dimer was checked and was elevated so a CTA was ordered; the read is pending at this time. He has not been noted to be hypoxic while awake although sats did drop to the high 80s while sleeping. He did respond to 1L NC. In addition, the patient was reportedly suctioned by MICU nursing staff who produced whole pieces of food from his airways. MEDICAL HISTORY: Recent hospitalization ([**Date range (2) 43948**]) with resp failure and resultant intubation requiring intubation Alzheimer's dementia- nonverbal at baseline h/o pneumonia requiring intubation 2 years ago h/o SBO [**1-29**] HTN MEDICATION ON ADMISSION: Viatmin E 800units [**Hospital1 **] Albuter MDI 2 puffs PRN Zocor 20mg daily Ambien 5mg HS PRN Bisacodyl PR PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals - T: afebrile BP: 105/65 HR: 116 (low 100s to 120s) RR: 22 02: 93% on 1L while sleeping GENERAL: opens eyes, non verbal, tracks HEENT: NCAT, edentulous, PERRL CARDIAC: tachy, no MRG LUNG: diffuse rhonchi ABDOMEN: soft, NT/ND, NBS EXT: no CCE FAMILY HISTORY: non-contributory SOCIAL HISTORY: Lives at home with wife and son. [**Name (NI) **] is his primary caregiver. [**Name (NI) **] is dependent for all ADLs. Pt is originally from [**Country 3587**]. He lived in [**Country 6257**] for 40 years, moved to US in [**2151**]. Formerly worked in construction, building maintenance. History of sniffing tobacco, but none for greater than 10 years. No history of smoking or EtOH use.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 70 year old woman with a history of breast cancer, chronic obstructive pulmonary disease, severe refractory hypertension, type 2 diabetes mellitus, and chronic renal insufficiency who presents from [**Hospital 103101**] Rehabilitation, followed there by the Pulmonary Interventional Fellow, [**Name (NI) **] [**Name8 (MD) **], M.D., with a desquamating rash, serum eosinophilia as well as recent acute renal failure. The patient was discharged to this rehabilitation from [**Hospital1 69**] in [**2177-7-10**]. Prior to the admission to [**Hospital1 346**] Medical Intensive Care Unit from [**7-3**] until [**2177-8-1**], she was also here in early [**Month (only) **] as well. In the first admission, she was admitted for a chronic obstructive pulmonary disease flare and was noted to have bilateral pleural effusions and pericardial effusions with tamponade physiology. This was tapped under ultrasound guidance and found to be exudative with negative cytology and [**First Name8 (NamePattern2) **] [**Doctor First Name **] of 1.160. She was then readmitted nine days later with shortness of breath again, thought to be a chronic obstructive pulmonary disease flare and was treated with nebulizers, Lasix and Solu-Medrol. She was found to have tamponade physiology on a transthoracic echocardiogram, underwent balloon pericardiotomy and intubated for airway protection. An ultrasound guided thoracentesis on [**7-4**] for a left pleural effusion which was found to be transudative was performed and the patient was extubated successfully. Five days later, both the pleural effusion and the pericardial effusions reaccumulated requiring re-intubation on [**7-9**]. The patient went to the Operating Room for a pericardial window, a left chest tube and a left pleurodesis. After this, she was unable to extubate and was then returned to the Medical Intensive Care Unit. Failure to wean in the Medical Intensive Care Unit was secondary to diaphragmatic weakness and she was noted to have critical care polyneuropathy/myopathy per EMG on [**2177-7-24**]. She underwent tracheotomy on [**2177-7-17**]. The cause of the pleural and pericardial effusions are unknown. The work-up was basically negative; there were no malignant cells found in either of the fluids and the pericardial window biopsy was negative. Also, Rheumatology evaluated her and thought it was not secondary to a rheumatological cause because her admission [**Doctor First Name **] on [**7-6**] was negative (however, she had positive [**Doctor First Name **] on [**2177-7-25**] times two). Her Pulmonary status improved and the effusions remained stable so she was discharged to Vent-Core on [**2177-8-1**]. She did well at the rehabilitation and her course there was actually unknown to us at this point, however, we do know that she was unable to be weaned off of her ventilator. She was currently on CMV with a total volume of 500, respiratory rate of 12 and an FIO2 of 40% and had recently failed a PS trial secondary to tachypnea and low volume. MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease: Restrictive lung disease with reactive airway disease. 2. Status post tracheostomy on [**7-17**] and PEG placement on [**2177-7-28**]. Her tube feeds are at a goal of 35 cc per hour. She has been unable to be weaned off her ventilator at Vent-Core. 3. Pericardial effusion / tamponade that was found to be exudative with negative cytologies. Status post window placement on [**2177-7-9**]. 4. Bilateral pleural effusions, transudative, status post left pleurodesis on [**2177-7-9**]. 5. Breast cancer (DCIF), status post total mastectomy, ER-pos, Stage 2, no radiation, N0 M0, and currently off tamoxifen. 6. Severe hypertension, on five medications. 7. Type 2 diabetes mellitus, previously on oral hypoglycemics and now requiring insulin. 8. Chronic renal insufficiency secondary to diabetes mellitus with nephrotic range proteinuria. 9. Acute renal failure secondary to intravenous dye in [**2177-7-10**]. Also had a history of elevated creatinine secondary to ACE inhibitors. 10. Thalassemia trait. 11. Questionable history of osteogenesis imperfecta. 12. Legal blindness; she has a left eye prosthesis as well. 13. Urinary incontinence. 14. Echocardiogram results from [**2177-6-9**] revealed a right ventricular wall clot/tumor with an ejection fraction of 58%. Her latest echocardiogram at [**Hospital1 188**] on [**2177-7-22**], revealed an ejection fraction of greater than 65%, mild LAE, mild symmetrical left ventricular hypertrophy with normal cavity size and regular wall motion; mild thickened atrial valve and mitral valve leaflets; moderate pulmonary hypertension; small to moderate pericardial effusion predominantly over the right ventricle. No change when compared to the prior study of [**2177-7-17**]. 15. Noted to have Vancomycin resistant enterococcus in her urine on [**7-23**]. 16. Left ocular paresthesia. 17. Anemia; it appears that her baseline hematocrit is usually in the high 20s. 18. SPAP with 2% gamma band, likely consistent with MGUS. UPAP revealed multiple protein bands without even predominating. 19. Urine positive for Pseudomonas according to the RN at Vent-Core. 20. History of Methicillin resistant Staphylococcus aureus - question in her sputum. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. MEDICATIONS ON TRANSFER TO [**Hospital1 **]: 1. Amlodipine 10 mg q. day p.o., recently began on [**11-22**], after the rash had appeared. 2. Hydralazine 100 mg four times a day; she has been on this medication for a while. Please note that the Vent-Core sheets report that she began this medicine on [**11-21**], however, this was only a renewal according to Dr. [**Last Name (STitle) **]. 3. Lasix 40 mg twice a day. 4. NPH 20 units twice a day. 5. H2O 125 cc three times a day. 6. Benadryl 25 mg q. eight hours. 7. Subcutaneous heparin 5000 twice a day. 8. Prednisone 5 mg q. day. 9. Protein soy supplement, two scoops in the feeding tube q. eight hours. 10. Nepro 3/4 strength tube feeds 35 cc per hour. 11. Clonidine 0.3 three times a day. 12. Bisacodyl 10 mg q. day p.r.n. 13. Regular insulin sliding scale with Humulin. 14. Lopressor 100 mg four times a day. 15. Labetalol 200 mg four times a day. 16. Isosorbide dinitrate 40 mg q. eight hours. 17. Sublingual Nitroglycerin p.r.n. 18. Protonix 40 q. day. 19. Epogen 40,000 units subcutaneously weekly. 20. Brimonidine 0.2% solution, one drop bilaterally q. eight hours. 21. Ditolamide one drop solution to each eye three times a day. 22. Ativan 1 mg q. eight hours. 23. Calcium carbonate 500 mg q. eight hours. 24. Ipratropium and Albuterol MDI four puffs q. four hours p.r.n. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Remote history of tobacco use. No current alcohol use. She has a sister who is demented. She previously had lived with her son and her son whose name is [**Name (NI) **] [**Name (NI) 16093**] is her primary contact, [**Telephone/Fax (1) 103102**]. He also has a brother, [**Name (NI) **] [**Name (NI) **], who is a second contact, whose phone number is [**Telephone/Fax (1) 103103**].

CHIEF COMPLAINT: This is an 81 year old woman with no significant past medical history or cardiac risk factors, transferred from an outside hospital with anterior myocardial infarction. PRESENT ILLNESS: The patient was in her usual state of health until the Friday before admission when she felt short of breath after walking up a [**Doctor Last Name **] near her home. She normally walks this route without difficulty. The shortness of breath was not associated with chest pain, nausea, vomiting or diaphoresis and resolved quickly. On the Saturday prior to admission, she experienced similar isolated shortness of breath while on a shopping trip. The same evening she noted the onset of vague nonradiating epigastric discomfort that made it difficult for her to sleep. This was associated with intermittent nausea but no vomiting. She denied frank chest pain or shortness of breath at this point. She denies history of paroxysmal nocturnal dyspnea or orthopnea. She has no cardiac risk factors. The discomfort was constant and progressive throughout the day on Sunday. On Sunday evening, she was again unable to sleep due to epigastric discomfort and nausea prompting her family to take her to [**Hospital3 68**]. At [**Hospital3 68**], she was found to have ST segment elevations and a CK of 211. She was treated with Aspirin, Heparin, Lopressor and Nitroglycerin prior to being transferred to [**Hospital1 69**] for emergent catheterization. The Nitroglycerin therapy was discontinued prior to transfer due to one episode of low blood pressure. At [**Hospital1 69**], she was taken to emergent catheterization and found to have a proximal Left anterior descending occlusion with dual ostia that was angioplastied and stented. Her pulmonary capillary wedge pressure was 23. Cardiac index was 1.6. Cardiac output was 2.7. The procedure was complicated by a fifteen second ventricular fibrillation arrest that was treated immediately and successfully with 200 joules. MEDICAL HISTORY: 1. Meniere's disease. 2. Total hip replacement with redo. MEDICATION ON ADMISSION: Meclizine. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient denies tobacco or alcohol use. The patient lives at home with her husband and daughter in [**Name (NI) **]. PHYSICAL EXAMINATION On admission, vital signs revealed temperature 97.2, blood pressure 139/77, heart rate 100, respiratory rate 22, oxygen saturation 94% on two liters. In general, the patient was alert and oriented times three in no apparent distress. Head, eyes, ears, nose and throat examination was anicteric. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Neck revealed no lymphadenopathy, no carotid bruit bilaterally. Chest - good aeration, inspiratory crackles bilaterally to the apices and end expiratory wheeze. Cardiovascular examination - regular rate and rhythm, normal S1 and S2, no murmurs, rubs or gallops noted. Abdominal examination was benign. Extremities were warm, pulses 2+ and extremities were not edematous bilaterally. Neurologically, cranial nerves II through XII are intact, no gross motor deficits noted.

CHIEF COMPLAINT: ascending thoracic aortic dissection PRESENT ILLNESS: Patient is a 49 year old male who is transferred to [**Hospital1 18**] with abdominal pain concern is for aortic dissection. The pain began at 9 am this morning. Patient underwent the CT scan of the abdomen which showed a dissection of abdominal aorta. Patient was subsequently transferred here. The blood pressure on admission was in 200s systolic. Patient was hemodynamically stable. At the time of presentation to the [**Hospital1 18**] patient continued to be hemodynamically stable with sbp in 110 - 150s and hr in the 90s - 100s, saturating well on room air. Patient denies any pain. He underwent an emergent CTA of the aorta with run offs which showed Type A aortic dissection. MEDICAL HISTORY: HTN (untreated) MEDICATION ON ADMISSION: none ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: PE: on admission VS: 98 87 135/76 18 99% RA gen: alert and oriented, appropriate, seemed comfortable CV: RRR pulm: CTA b/l abd: mildly softly distended, minimally diffusely tender, + BS extemities: pulses all palpable . At the last examination his heart was motionless (the chest was open), there were no pulses, the pupils were fixed and dilated bilaterally, there were no breath sounds. FAMILY HISTORY: non-contributory SOCIAL HISTORY: smoked 1.5 pack a day for at least 20 years, quit [**3-/2176**]

CHIEF COMPLAINT: sepsis PRESENT ILLNESS: Ms. [**Known lastname **] is a 71 year old female with previous medical history significant for DM2, HTN/HL, and diverticulosis. She initially presented to [**Hospital6 19155**] on [**12-27**] with 3 weeks of crampy abdominal pain. Initial pain control with Dilaudid and nausea control with Zofran + Reglan. CT abdomen showed ?diverticular abscess and he was started on Levaquin/Flagyl initially. She had a leukocytosis to 25 and hypotension requiring neosyneprhine. Given her worsening picture, she was brought to the OR for an exploratory laparotomy. . A necrotic uterus was found and Ob-Gyn was called in for a sub-total hysterectomy and bilateral salpingo-oopherectomy and omentectomy were performed. They found a pocket of pus/abscess adjacent to uterus (walled off). No fistula, no diverticulitis. Omentectomy done "just in case it was cancer". They closed the fascia, placed a JP, left SQ tissue open. She was given FFP and 10mg vitamin K IV intra-op for an INR of 1.6-->1.4. Peri-operative EBL~500cc and follow-up hematocrit went from 26 to 24. She no longer required pressors post-operatively, but remained intubated due desaturation to 85% on 4L, corrected to 100% on NRB presumably secondary to pulmonary edema (confirmed by CXR) so she was given lasix 100mg IV with 1650cc output. Prior to transfer, she was reportedly given 1 unit pRBCs followed by Lasix. Antibiotic coverage broadened with Zosyn/Flagyl/Levaquin with blood cultures growing GNRs and GPCs in [**4-17**] bottles and GNRs in urine culture. An arterial line is in place with a right double-lumen PICC. She was sedated on propofol. She has a partially open abdomen, packed with betadine/gauze and with a JP drain in place (drained 20cc of serosanguinous fluid to date). . On arrival to the MICU, she was breathing spontaneously on pressure support and ABG showed 7.37/37/152. She was in significant pain, so she was bolused with Fentanyl for comfort and started back on AC for rest. . Review of systems: Unable to perform secondary to sedation MEDICAL HISTORY: type 2 diabetes mellitus - HTN (diagnosed in [**2164**]) - HL - diverticulosis - right hydronephrosis on CT abdomen in [**2164**], ?etiology - s/p carpal tunnel release - "disc surgery" - tubal ligation MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Lisinopril 10', Glyburide 5 qAM, 2.5mg qPM, Metformin 1000'', Fish Oil 300'', Glucosamine-chondroitin 1', Simvastatin 40' ALLERGIES: epinephrine PHYSICAL EXAM: Admission PE: Vitals: T: 97.7, BP: 93/50, P: 93/50, R: 15 O2: 86% on PS [**10-23**] General: opens eyes to voice, sleepy HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Relatively clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: protuberant, soft, diffusely tender with vertically-sutured wound packed with gauze and abdominal binder in place. Bowel sounds quiet, no organomegaly appreciated GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, [**1-15**]+ edema Neuro: opens eyes to voice, painful to palpation of abdomen FAMILY HISTORY: No reported history of cancers, blood disorders, or GU issues. Mother had breast "lump". One of her daughter had a hysterectomy for unknown reasons. SOCIAL HISTORY: Lives independently in [**Location (un) **] - Tobacco: none - Alcohol: none - Illicits: none

CHIEF COMPLAINT: Melena times one week. PRESENT ILLNESS: Patient is a 75-year-old female who presents with melena times one week. Today she vomited blood and it appeared to obtain coffee ground. She also complains of abdominal pain and nausea. In the Emergency Department, nasogastric lavage revealed coffee ground material but no active bleeding or bright red blood. Shortly thereafter, she vomited large amount of bright red blood and became transiently hypotensive along with bradycardic. Intravenous fluid, normal saline was given wide open through two large-bore IVs. Patient transferred to Surgical Intensive Care Unit for esophagogastroduodenoscopy. Patient was given three units of packed red cells and two bags of FFP. MEDICAL HISTORY: Hypertension, glaucoma, history of congestive heart failure, history of thrombocytopenia, history of arteriosclerotic disease, history of transaminitis 15 years ago, no diagnosis made. MEDICATION ON ADMISSION: ALLERGIES: Question Tylenol. PHYSICAL EXAM: FAMILY HISTORY: Negative for liver disease of any kind, negative for lupus. SOCIAL HISTORY: No tobacco, no alcohol. No history of transfusions. The patient lives with one of her two daughters. [**Name (NI) **] has worked in the past as a hairdresser.

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 87 yo female with PMH CAD, HTN, hyperlipidemia, DM admitted to [**Hospital 1474**] hospital with complaints of intermittent chest pain for several days preceding admission. Six months ago, she had chest pain and was admitted to the [**Hospital3 417**] Hospital where she said she was exercised and was told she should have a cardiac cath but refused it at her age. This time, pt complained of severe chest pain at lower substernal area with SOB, lightheadedness, and n/v when doing housework 6 days ago. Unable to determine pain rate. Chest pain radiated to left arm, lasted more than 30 minutes. Did not take medicine, diminished by resting. Denied palpitations, orthopnea, or edema. She called her grandson who suggesting going to the hospital. She called an ambulance and was taken to [**Hospital **] hospital where they found anterolateral ST elevation and +trop 2.9 consistent with anterior ST elevation MI. Pt was initially medically managed. Was started on lovenox and transferred here for cardiac cath. MEDICAL HISTORY: CAD s/p MI, refused cardiac cath in the past HTN hyperlipidemia NIDDM GERD Barrett's esophagus diverticular disease hiatus hernia with [**Doctor First Name **] skin ca with [**Doctor First Name **] s/p cytectomy s/p colectomy TAH bilateral salphingo-oopherectomy right cataract surgery MVA in [**4-24**] MEDICATION ON ADMISSION: Metoprolol 50mg [**Hospital1 **] ASA 81 mg qd Lipitor 80mg qd Plavix 75mg qd Lovenox 50mg sc bid Imdur 60mg po qd ALLERGIES: Sulfa (Sulfonamides) / Amoxicillin / Latex / Shellfish PHYSICAL EXAM: VS: t91.1 (oral), p111, 90/37, rr20, 92% on AC FiO2 1, TV 500, RR28 Gen: sedated and intubated CVS: RRR, nl s1 s2, no murmurs appreciated Lungs: course breath sounds bilaterally Abd: soft, NT, ND, +BS Groin: no hematoma or bruit Ext: no edema bilaterally FAMILY HISTORY: mother died at 81 due to MI SOCIAL HISTORY: Denies tobacco, ETOH lives alone, able to perform ADL

CHIEF COMPLAINT: SOB/orthopnea PRESENT ILLNESS: 85 yo F with known AS & SOB. Hospitalized in [**3-23**] after suffering CVA post cardiac catheterization. MEDICAL HISTORY: AS CVA ?COPD CHF OA transient global amnesia basal cell skin ca - nose esophagitis HTN GERD/hiatal hernia Right THR Right knee arthroscopy bilat rotator cuff surgery Bilat cataract surgery Bilat carpal tunnel repair MEDICATION ON ADMISSION: relafen asa protonix oscal mvi lidocaine patch ALLERGIES: Latex Exam Gloves / Penicillins / Demerol / Tequin / Tetracycline Analogues / Horse/Equine Product Derivatives PHYSICAL EXAM: WD/WN F in NAD Skin unremarkable HEENT PERRL/EOMI OP Benign Non-icteric sclera Neck No JVD, LAD Chest Kyphotic, lungs CTAB Heart 3/6 SEM Abd benign Extrem warm, trace edema Varicosities R> L Neuro Grossly intact, mild L sided weakness, MAE Pulses 2+ femoral, radial bilat., 1+ DP/PT bilat No carotid bruits FAMILY HISTORY: sister with valve replacement in her 70's Mother deceased from MI at age [**Age over 90 **] SOCIAL HISTORY: - tob - etoh

CHIEF COMPLAINT: ETOH intoxication PRESENT ILLNESS: 46M who was BIBEMS to the ER intoxicated. By report, he was drinking whiskey, and his friends [**Name (NI) 47129**]'t get him to wake up while sleeping in his car, so they called EMS. . In the ED, initial vs were: T 97 P 85 BP 102/88 R 12 O2 sat 98%. FSG 136. Nonfocal basic neuro exam, but patient was intubated for airway protection as he didn't react to nasal trumpet. Nasotracheal intubation was attempted but was unsuccessful, and then the pt vomited 1L of gastric contents. He was then intubated i the standard fashion. Propofol caused mild hypotension to 95. Initial ABG 7.28/47/128, so increased TV and rate in ED. Also got 1L NS. No signs of trauma but got head CT and C-spine CT just to be sure, which show no acute process. EKG without acute process. Has 2 PIVs for access. Arrived to the ICU with no sign-out and no holding orders. . He currently appears intubated and sedated, does not respond to verbal commands or withdraw from painful stimuli. . Review of systems: unable to be obtained. MEDICAL HISTORY: None MEDICATION ON ADMISSION: Chinese herbal supplements ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 95.5 BP: 110/70 P: 90 R: 18 O2: 100% General: intubated, sedated, unresponsive HEENT: NC/AT. Pupils equal at 5mm, reactive, slightly disconjugate gaze. Sclera anicteric 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 Skin: no lesions or rashes FAMILY HISTORY: Unknown SOCIAL HISTORY: Going through a divorce. Not usually a drinker.

CHIEF COMPLAINT: severe aortic stenosis PRESENT ILLNESS: 76yo well developed male with history of Parkinson's disease seeking deep brain stimulator device. Elective procedure on hold due to severe aortic stenosis elevating risk. Past medical history of CAD s/pCABG x 3 ([**2137**]), hyperlipidedmia. Patient admits to noticing increasing fatigue over the last year, now requiring daily naps. Reports lightheadedness when getting out of bed in the morning, and dizziness after 2-3 minutes of pulling weeds. He can climb a flight of stairs but must pace himself, ambulates 2 blocks before needing to stop due to shortness of breath. He denies chest pain or syncope. Echocardiogram reveals aortic valve area 0.8cm2, peak gradient 66mmhg, EF>60%. NYHA Class: II MEDICAL HISTORY: -aortic stenosis -CAD, s/p CABG x 3 ([**2137**]) -hyperlipidemia -sick sinus syndrome -Parkinson's (rt hand tremors, RLE weakness, speech hesitancy) -[**Year (4 digits) 499**] Ca s/p [**Year (4 digits) 499**] resection - exlap for twisted bowel -vein ligation -vertebral fracture T5-6-7 secondary to fall, s/p fusion -right arm fracture -tonsillectomy -left ankle fracture -varicella zoster rt torso [**6-2**] MEDICATION ON ADMISSION: CARBIDOPA-LEVODOPA - 25 mg-100 mg tablet - two Tablet(s) by mouth 4 times per day CITALOPRAM - 20 mg tablet - one Tablet(s) by mouth once at night RAMIPRIL [ALTACE] - (Prescribed by Other Provider) - Dosage uncertain SIMVASTATIN - (Prescribed by Other Provider) - Dosage uncertain TAMSULOSIN - 0.4 mg capsule,extended release 24hr - one Capsule(s) by mouth once per day ZONISAMIDE - 25 mg capsule - 1 Capsule(s) by mouth twice a day ZONISAMIDE - 50 mg capsule - 1 Capsule(s) by mouth twice per day increase to twice a day after 1 week Medications - OTC ASPIRIN - (Prescribed by Other Provider) - Dosage uncertain ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission FAMILY HISTORY: Father deceased age 70's, stomach Ca. Mother deceased age [**Age over 90 **], CAD/CVA. Two brothers deceased, [**Name2 (NI) 499**] Ca. Brother 82yo alive. Widowed, 3 adopted children. SOCIAL HISTORY: Retired to [**State 1727**]. Supportive friends. Usually walks the neighbors labrador several times a week, none recent. contact: [**Name (NI) **] [**Name (NI) 91288**] (brother) [**Telephone/Fax (1) 91289**]