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CHIEF COMPLAINT: PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 98538**] is an 84-year-old gentleman with a history of hypertrophic cardiomyopathy with an ejection fraction of 40%, sinus node dysfunction (status post pacemaker placement), left upper extremity deep venous thrombosis, paroxysmal atrial fibrillation, and known abdominal aortic aneurysm who presented to the Emergency Department with a 1-day history of shortness of breath and decreased mental acuity. The patient says that he developed a sudden spasm of shortness of breath on the morning prior to admission which had been progressively worsening over the past 24 hours. He denied pleuritic pain, fevers, coughing, chest pain, palpitations, or lightheadedness. He does not report orthopnea since these symptoms began. The patient also reports a low-grade back pain which began yesterday after leaning over. Review of systems was otherwise positive for blood in his stools with straining and occasional lightheadedness and dizziness. It is also positive for abdominal pain and dysuria. MEDICAL HISTORY: 1. Paroxysmal atrial fibrillation. 2. Sinus node dysfunction; status post dual-chamber pacemaker placement in [**2108-8-22**]. 3. Hypertension. 4. Abdominal aortic aneurysm; which has recently grown from 5.5 cm in [**2109-7-22**] to 7.2 cm on the day of admission on [**2110-9-17**]. The patient had previously declined elective surgery and currently declining elective surgery for his abdominal aortic aneurysm. 5. Hypertrophic cardiomyopathy with an ejection fraction of 40%. 6. History of a left upper extremity deep venous thrombosis in the left subclavian vein. 7. Gastroesophageal reflux disease. 8. Degenerative joint disease. 9. Status post left hip arthroplasty. 10. Left ventricular hypertrophy. 11. Mild aortic regurgitation. 12. Moderate mitral regurgitation. 13. Status post hemorrhoidectomy. MEDICATION ON ADMISSION: 1. Atenolol 25 mg by mouth twice per day 2. Amiodarone 200 mg by mouth once per day. 3. Multivitamin one tablet by mouth once per day. 4. Ginkgo biloba. 5. Lutein. 6. Bilberry. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives with his wife and performs all of her activities of daily living. He smoked one to two packs per day times 15 years but quit in [**2067**]. He denies alcohol use and denies intravenous drug use. The patient states that he is a full-time care taker for his wife, who he says needs constant care but did not want to elaborate as to why his wife needed constant care.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 61-year-old white woman with a history of coronary artery disease, status post coronary artery bypass graft, multiple sclerosis, and hypercholesterolemia who presents with lethargy and purulent discharge from her vagina. The patient was brought by her husband to the Emergency Room at [**Hospital6 33**] because of the lethargy and drainage. She was evaluated at the [**Hospital6 33**] at which time there was a high suspicion for necrotizing fasciitis in her right lower lobe. The patient was subsequently transferred to the [**Hospital1 69**] for further management. The patient's husband reports that the patient headache a dilatation and curettage one month ago, and for the last 10 days the patient has had poor oral intake and worsening lethargy. At [**Hospital6 33**] the patient was resuscitated with intravenous fluids and given vancomycin, ceftazidime, and clindamycin. The patient was then transferred to the [**Hospital1 1444**] for further care. MEDICAL HISTORY: (The patient's past medical history is significant for) 1. Multiple sclerosis. 2. Coronary artery disease. 3. Hypercholesterolemia. MEDICATION ON ADMISSION: Her home medications were Pravachol and digoxin. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Her social history is unknown.

CHIEF COMPLAINT: dyspnea PRESENT ILLNESS: The patient reports being in usual state of health developing daily hemoptysis in [**2168-6-19**]. He was subsequently found to have NSCLC with metastases to the adrenals.He was admitted to the MICU on [**2168-8-15**] and required angiography w/ embolization for a lung parenchyma bleed. He had a course of radiation therapy finishing on [**2168-9-6**] and 4 cycles of chemotherapy finishing on [**2168-12-1**]. He notes having morning recurrent hemoptys in the for the last few month. 4 days prior to presentation, he noted having dependent ankle swelling associated productive cough, orthopnea and increased dyspnea. He has slept in a chair on occasion. This am, during an outpatient imaging appointment for his leg, he was noted to be dyspnic and he was sent to the ED. MEDICAL HISTORY: HTN Hyperlipidemia PTSD MEDICATION ON ADMISSION: BENZONATATE - 200 mg Capsule - 1 Capsule(s) by mouth three times a day as needed for cough CODEINE-GUAIFENESIN - 200 mg-10 mg/5 mL Liquid - 10 ml by mouth every 4 hours as needed for cough FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose Disk with Device - 1 puff INH twice a day OMEPRAZOLE - (Prescribed by Other Provider) - 20 mg Capsule, Delayed Release(E.C.) - 2 Capsule(s) by mouth DAILY (Daily) ONDANSETRON HCL - 8 mg Tablet - 1 Tablet(s) by mouth every 8 hours as needed for nausea, vomiting OXYCODONE - 10 mg Tablet - 1 Tablet(s) by mouth every 3-4 hours as needed for pain POLYETHYLENE GLYCOL 3350 - 17 gram Powder in Packet - 17 grams by mouth daily as needed for constipation PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth every 6 h ours as needed for nausea SERTRALINE - (Prescribed by Other Provider) - 50 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily) TRAZODONE - (Prescribed by Other Provider) - 50 mg Tablet - 1 Tablet(s) by mouth HS (at bedtime) as needed for Insomnia ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: T:96.8 BP:132/79 P:106 R:30 18 O2:97 on 6 L nc General: Alert, oriented, no acute distress, appears cachetic HEENT: Sclera anicteric, tongue with white plaque Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation on left side,no breath sounds and increased dullness to percussion on the right until middle of lung. no wheezes, rales, ronchi CV: tachy, Regular rate and rhythm, systolic murmur no 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, 1+ edema in LE, no clubbing, cyanosis FAMILY HISTORY: Father with NHL, died age 47 SOCIAL HISTORY: Lifetime cigarette non-smoker, rare cigar use; [**2-22**] drinks per day (last drink day prior to admission). No current drug use. No previous exposure to asbestos, but + [**Doctor Last Name 360**] [**Location (un) 2452**] in [**Country 3992**] and + hydrofluoric acid at chemical plant (19 years) where previously employed. Currently a hockey coach. Engaged to [**Doctor First Name **], who previously had cancer and treatment.

CHIEF COMPLAINT: Intentional overdose of tizanidine PRESENT ILLNESS: HPI: Per MICU, psychiatry and outside chart notes, and brief history from pt, this is a 19 yo F with PMH of chronic back pain presents after overdose. She reportedly took 45-60 Tabs (each 4mg) of tizanidine (approx. 160 mg) around 11 am on [**2127-10-19**] after a breakup with her boyfriend. . She was prescribed tizanidine earlier this year for back pain and biofeedback was recommended, which she evidently has not been impressed with, feeling that her pain has a physiologic origin. To the original admitting team, she stated that she deals with chronic pain for years and wanted all her pain to go away. She also told the ED team she might do it again. She said that she took the pills and then called her mother to say goodbye. She says she did not want help, she just wanted to say goodbye. . Per prior notes, in the ED, her vitals initially were T96.2, BP 140/88, HR 56, RR 16, O2sat 97% RA. She was given charcoal in the ED (no vomiting afterwards). She was also given 0.4mg narcan with no effect, and then given 2mg narcan which brought her HR up from 50 to 88 and her BP down from systolic 140 to 110s. Toxicology was consulted in the ED and said she would be at risk for bradycardia, hypertension and AV block along with respiratory depression. She was admitted to the MICU for close monitoring. Overnight there were no events, and she is transferred to the medicine floor pending admission to [**Hospital1 **] 4 for inpatient psychiatric treatment. . On our exam in the MICU prior to transfer to the medicine floor, she was minimally communicative, but said she simply felt "stupid." She did not affirm any type of discomfort or pain or other symptoms. She denied current suicidal ideation and said that she had not had suicide attempts prior, though she did have prior feelings of "wanting it all to go away." Besides her back pain she denied any other significant medical history. MEDICAL HISTORY: asthma -exercise induced seasonal allergies lactose intolerance ovarian cysts being worked up for ? arthritis . MEDICATION ON ADMISSION: Excedrin prn Trivora OCP albuterol prn [**Doctor First Name **] prn tizanidine for back pain ALLERGIES: Morphine PHYSICAL EXAM: On admission to MICU: vitals: afebrile, BP 114/66, HR 68, RR 20, O2sat 100% on RA general: depressed affect, lying in bed fetal position HEENT: PERRL, EOMI, MMM, anicteric sclera, non-injected conjunctiva CV: RRR no m/r/g Lungs: CTAB no w/r/r Abdomen: +BS, soft, NDNT, navel ring Ext: no e/c/c Neuro: alert and oriented to person, place and time. Depressed affect. CN III-XII in tact, strength full throughout, sensation intact . On transfer to medical floor [**10-20**]: vitals: afebrile, BP 133/67, HR 78, RR 18, O2sat 98% on RA general: sitting up in bed, talking to sitter when we arrived; on our exam avoided eye contact, very flat affect, slow and quiet speech with minimal responses. HEENT: PERRL, EOMI, MMM, anicteric sclera, non-injected conjunctiva CV: RRR no m/r/g Lungs: CTAB no w/r/r Abdomen: +BS, soft, NDNT, navel ring in place without erythema Ext: no edema, WWP Derm: no rashes; no cuts or scars appreciated in limited exam Neuro: Alert and oriented grossly. Depressed affect. . FAMILY HISTORY: father with emphysema, grandfather with CAD and MI SOCIAL HISTORY: She is a student of nutrition at [**University/College **], a nonsmoker, rare drinker. She has a boyfriend of four years, who she told psych service has been her "best friend"; they have had recent problems. She is a high academic achiever relative to her family.

CHIEF COMPLAINT: Respiratory failure PRESENT ILLNESS: The patient presented to OSH ED yesterday w/neck pain since the 17th. Per the OSH, she was somnolent and found to be acidotic on ABG; she was then intubated and R triple lumen femoral placed. Discussion with family per OSH records indicates that she was found down for an undetermined amount of time. CXR initially showed extensive right-sided PNA and the next day (day of transfer) was notable for left upper lobe infiltrate. Exam was notable for fresh track marks. Pt was treated with vancomycin, gatifloxicin and Unasyn per OSH ID consult. Utox + for cocaine and opiates, BZ. By report, responded to Narcan (awoke). Head CT was negative for acute intracranial abnormality. 2 sets of blood cultures were + for gram + cocci; echo (TTE) negative for vegetations and EF was 70%. * The patient was transferred to [**Hospital1 18**] per her son's request. She was on Levophed and dopamine prior to transfer, and transferred on dopamine and bicarb gtts. She received 6 liters of IVFs by report to resident over the phone. She has been ordered 1 U PRBC, but needs to come from Red Cross, so they're trying to get the blood sent directly here. Her last abg was 7.37/40/287 on AC 500, Peep 8, rr 22, FiO2 100%. She had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test but no results are available yet. MEDICAL HISTORY: Hepatitis C (liver biopsy in [**2116**] as showing stage III fibrosis) Waldenstrom's macroglobulinemia/lymphoma history of IVDU depression sialolithiasis fine tremor peripheral neuropathy s/p prolonged ICU stay for heroin and benzodiazepine overdose multi-lobar pneumonia (M. cattharalis) MEDICATION ON ADMISSION: Meds at home: AMOXICILLIN 500MG--One tablet three times a day x 10 days EFFEXOR XR 37.5MG--3 by mouth every day FLONASE 50MCG--One spray each nostril every day GABAPENTIN 300MG--Take one tablet at bedtime IBUPROFEN 600 MG--One tablet by mouth q 6 hours as needed NAPROSYN 500MG--Take two pills by mouth every morning and one pill by mouth every evening as needed for for pain with food PEGYLATED INTERFERON --As directed by gi SEROQUEL 25MG--3 by mouth at bedtime . Meds on transfer: Tequin, Pepcid, Vancomycin, unasyn, Hydrocort, Fluorinef, MSO4 ALLERGIES: Codeine PHYSICAL EXAM: PE: AF 37.2C/ 105/65// 88// 100% Vented and on dopamine Acutely-ill female, looks younger than stated age. Flushed, awake, uncomfortable in appearance. HEENT: EOMI, perrl, conjunctiva injected, tan exudate right eye, MM dry. Neck: supple, no LAD Heart: rr, no m/g/r nl s1s2 Lungs: Diffusely rhonchorous, r>l, reduced BS at left base, no rales Abd: Distended, diffusely tender, no BS audible, no organomegaly Ext: Warm, well-perfused, no lower extremity edema, track marks in left antecub, no splinter hemorrhages. 2+ DPs b/l FAMILY HISTORY: Noncontributory SOCIAL HISTORY: hx for polysubstance abuse, lives with her son

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: [**Age over 90 **] yo male with pmhx significant for Type 2 Diabetes Mellitus and coronary artery disease was admitted from the ED for [**2-14**] days of shortness of breath. Patient is a poor historian but reports that he has a [**2-14**] day history of shortness of breath, "wobbly on my feet," and generally "wasn't feeling good." He then called his PCP who recommended that patient call EMS to be taken to the hospital. On ROS, patient notes that he sleeps in a chair but denies leg swelling, PND, or palpitations. Patient reports that he takes his medications regularly but does occasionally "cheat" with his diabetic diet. On additional ROS, patient reports diffuse abdominal pain for 2-3 days, decreased appetite for several days, and URI 5 days ago which has improved. Patient otherwise denies dysuria, hematuria, diarrhea, constipation, fevers, chills, or night sweats. . Patient was brought to the ED by EMS where he was given 3x NTG and 180mg lasix IV. In the ED, VS were HR 120s / BP 125/72 / RR 28 / 98% on NRB / 1900 total UOP. Patient was initially placed on BiPap and then lowered to 4.5L NC. Received aspirin 325mg and was admitted. . Of note, patient was previously admitted to the hospital in [**2155-11-12**] with a similar episode of shortness of breath with dry cough. At that time, he was thought to have a CHF exacerbation secondary to medication noncompliance and underwent diuresis with improvement in SOB. Patient was discharged with outpatient cardiology follow-up but did not follow-up. MEDICAL HISTORY: 1. Adult-onset diabetes mellitus. 2. Coronary Artery Disease - MI per report 3. Prostate cancer, [**Doctor Last Name **] 6 out of 10, diagnosed in [**Month (only) **] [**2141**], no metastases, status post XRT. 4. Hiatal hernia. 5. External hemorrhoids. MEDICATION ON ADMISSION: Aspirin 81mg PO daily Atorvastatin 20mg PO daily Lisinopril 20mg PO daily Clopidogrel 75mg PO daily Toprol XL 25mg PO daily Lasix 40mg PO daily Diazepam 5mg PO qhs Ferrous Sulfate 325mg PO daily Nitroglycerin .4mg SL prn Lantus 22U SC qhs ALLERGIES: Aspirin PHYSICAL EXAM: PE: T 95.8 / HR 126 / BP 132/78 / RR 28 / PO2 96% on 4L Gen: lying comfortably in bed, no acute distress HEENT: Clear OP, MMM NECK: Supple; shoddy, nontender cervical LAD; JVP to jaw CV: tachycardic but regular rate. NL S1, S2. No murmurs, rubs or gallops LUNGS: bibasilar crackles with increased crackles on the left ABD: Soft, NT, ND. NL BS. No HSM EXT: No edema. 2+ DP/PT pulses BL SKIN: No lesions NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. alert and oriented x 3; hard of hearing with somewhat better hearing on the right side; slowed speech with difficulty with word-finding FAMILY HISTORY: n/c SOCIAL HISTORY: No hx of drugs or EtOH. Did recently take codeine.

CHIEF COMPLAINT: Lethargy, sleepiness, urinary incontinence PRESENT ILLNESS: Ms [**Known lastname 26812**] is a 66yo W with a history of longstanding tobacco abuse, EtOH Abuse (3 drinks/night per family), lower back pain s/p placement of thecal morphine pump, recent history of recurrent pneumonia/bronchitis, HTN, HLD, GERD, anemia who was brought to the [**Hospital1 18**] ED for complaints of altered mental status and urinary incontinence. Her history started two weeks ago approximately when she developed her third pneumonia of the year and she was hospitalized at [**Hospital **] Hospital for the same, treated with IV antibiotics and discharged to rehab. During her short rehab stint, she developed an episode of "shakiness", high blood pressures to the 200s systolic, and visual disturbances characterized as flashes of light in the peripheral visual fields, odd shadows/contours around objects in her field as well as patchy areas of blindness. During this episode, she was confused. They improved her blood pressure and 12 hours after the onset of symptoms her visual disturbance improved. She received CT imaging (which "ruled out" stroke), as well as carotid US imaging which showed the presence of a right sided 70% stenosis of the carotid artery. She was once again discharged to rehab. Over the past two days prior to her ED presentation this time, she was noted to be once again shaky, confused, lethargic and displaying urinary incontinence. She was noted to be quite perseverative and repeating herself, but was comprehending well and the language that she used ultimately made sense. For these complaints, the patient's family insisted that she brought to the [**Hospital1 18**]. MEDICAL HISTORY: Chronic pain (has morphine pump) failed back syndrome HTN HLD Failed back/ chronic pain on morphine pump depression GERD Anemia GI bleed ETOH abuse (last drink 2 weeks ago) Right hydronephrosis R carotid stenosis 70% MEDICATION ON ADMISSION: hydrochlorothiazide 12.5 mg Capsule [**Date Range **]: One (1) Capsule PO DAILY (Daily). baclofen 10 mg Tablet [**Date Range **]: Two (2) Tablet PO TID (3 times a day). rosuvastatin 20 mg Tablet [**Date Range **]: One (1) Tablet PO DAILY (Daily). amlodipine 5 mg Tablet [**Date Range **]: One (1) Tablet PO DAILY (Daily). lisinopril 20 mg Tablet [**Date Range **]: One (1) Tablet PO DAILY (Daily). lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On Admission: Vitals: T: 98.1 P: 88 R: 16 BP:140/98 SaO2:93% on 2l General: Awake,NAD. HEENT: NC/AT. Neck: No nuchal rigidity Pulmonary: + Wheezing, + rales Cardiac: RRR. Abdomen: soft, NT/ND. Extremities: No edema . FAMILY HISTORY: No history of seizures, strokes. SOCIAL HISTORY: Patient has a long history of alcohol abuse ([**1-19**] drinks/night). Current long standing smoker. Prior to her recent hospitalizations, she was living at home.

CHIEF COMPLAINT: The patient is a 72 year old lady with a history of insulin dependent diabetes mellitus, hypertension, hyperlipidemia, cerebrovascular accident and carotid stenosis, who presents with a history of angina for one year. Cardiac catheterization was performed, which was consistent with three vessel disease. Echocardiogram results also showed aortic stenosis. Given this information, the patient was evaluated for coronary artery bypass grafting and aortic valve repair on an elective basis. PRESENT ILLNESS: MEDICAL HISTORY: 1. Basal ganglia cerebrovascular accident with residual left hemiparesis. 2. Insulin dependent diabetes mellitus. 3. Hypertension. 4. Hyperlipidemia. 5. Carotid stenosis. 6. Chronic renal failure. 7. Osteoarthritis. 8. Status post left nephrectomy for tuberculosis. 9. Status post hysterectomy. 10. Status post cholecystectomy. 11. Status post cesarean section. MEDICATION ON ADMISSION: Prinivil 10 mg p.o.q.d., Norvasc 5 mg p.o.q.d., Xanax 0.25 mg p.o.b.i.d., Protonix 40 mg p.o.q.d., Aggrenox one p.o.b.i.d., Novolin 70/30 3 units q.a.m. and 25 units q.p.m. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Family history is cancer and diabetes mellitus. SOCIAL HISTORY: The patient lives alone. She has three living children.

CHIEF COMPLAINT: Left flank mass PRESENT ILLNESS: 58F transferred to medical service from OSH [**2187-9-12**] for W/[**Location 69532**] 10X15cm L renal mass. She presented to [**Hospital **] Hospital [**9-10**] c/o B LE swelling, pruritis, dry cough, and urinary retention. The LE swelling began approximately 1 month ago. W/U at OSH included CT A/P, demonstrating 10X15cm L renal mass and multiple small pulmonary nodules. HCT 21, so given PRBC transfusion. OSH oncologist recommended transfer to [**Hospital1 18**]. MEDICAL HISTORY: HTN New renal mass, likely metastatic renal cell carcinoma, with associated liver dysfunction CHF, EF 40-55% by report Factor [**Hospital1 **] deficiency MEDICATION ON ADMISSION: furosemide 40a, hydroxyzine 25 mg Q4-6 prn itching, acetaminophen 325 mg Q4-6 prn, zolpidem 5hs PRN insomnia, percocet prn pain, lisinopril 10 qd, spironolactone 25 qd, ferrous sulfate 325 mg qd, phytonadione 10 qd, digoxin 0.25 qd ALLERGIES: Codeine PHYSICAL EXAM: FAMILY HISTORY: Father d. 59 with brain tumor. Mother died of CVA. Sister with cervical cancer. Brother with CAD. SOCIAL HISTORY: Lives at home in [**Location (un) **], MA with husband and son. [**Name (NI) **] two other children. Smoked <1ppd x 10 years, quit 30 years ago. Denies exposures to dyes, chemicals. Occasional alcohol use. No illicit drugs.

CHIEF COMPLAINT: Nausea, vomiting, hypertension. PRESENT ILLNESS: The patient is a 33-year-old man last discharged from the MICU on [**2182-4-11**], after a 6-day stay for the same complaints. He has had approximately six admissions over the last six months with similar complaints. He presented on the day of admission with complaints of two days of nausea and vomiting and light-headedness. He also stated he was shivering, but has had no fevers, headache, photophobia, dysuria or diarrhea. In the Emergency Department, he was found to have a systolic of blood pressure of 230 mmHg and a glucose of 369 mg/dl, as well as laboratory values that were consistent with prerenal azotemia. In the Emergency Department, he received 4 L normal saline, regular Insulin intravenously, and was then switched to D5 normal saline with 125 ml/hr and continuation of the Insulin drip until the fingerstick was less than 200. He also received Zofran 4 mg IV once, Labetalol 40 mg IV once, 2 in of Nitroglycerin paste, baby Aspirin, 2 mg of Ativan, 20 mg of Hydralazine intravenously, 325 mg of Aspirin, and was then started on a Nitroprusside drip. During the evaluation by the MICU Team in the Emergency Department, he had a bout of emesis producing 50-75 ml of occult blood positive coffee-grounds. No nasogastric lavage was performed after the case was discussed with the Gastroenterology. The patient has known gastritis. MEDICAL HISTORY: 1. Diabetes mellitus type 1 for 12 years with triopathy. 2. Autonomic dysfunction. 3. Gastroparesis awaiting elective gastric pacer. 4. Coronary artery disease with catheterization in [**2181-7-14**] showing a 50% D1 disease. Echocardiogram in [**2181-12-14**] showed an ejection fraction of 50-55%, left atrial abnormality, and left ventricular hypertrophy. 5. Status post jejunostomy placement and then subsequent removal secondary to infection in [**2181-3-16**] (this was a penultimate admission). He has completed a course of antibiotics for the infection. 6. Depression diagnosed last admission. MEDICATION ON ADMISSION: ALLERGIES: NO KNOWN DRUG ALLERGIES. PHYSICAL EXAM: FAMILY HISTORY: Significant for diabetes mellitus type 2. SOCIAL HISTORY: He is engaged to be married. He is currently unemployed. He was a truck driver. He does not smoke tobacco or consume alcohol.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 69-year-old male with an approximately ten month history of worsening dyspnea on exertion, fatigue, and chest tightness with exertion. The patient had an echocardiogram done prior to admission which was consistent with inferior wall ischemia. There was an ejection fraction of approximately 60%, hypokinesis of the inferior wall, mildly thickened AV and mitral valve, trace MR and trace TR. The patient did have a cardiac catheterization on [**2109-12-13**] which showed 65% stenosis of the distal left main, LAD approximately 20%, left coronaries 65%, OM 65%. The patient now presents for semielective coronary artery bypass. MEDICAL HISTORY: 1. Arthritis. 2. Insulin-dependent diabetes. 3. Myocardial infarction (non-Q wave) in [**2100**]. 4. Status post PTCA of the LAD. 5. Hypertension. 6. Increased cholesterol. 7. Status post laminectomy. 8. Status post left leg vein stripping. 9. Status post left rotator cuff repair. 10. Excision of melanoma of the back. 11. Question of reflux. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 46-year-old female with past medical history of depression, who presented on [**2196-8-11**] after approximately 24 hours of tongue numbness on the right side, which progressed to right facial, both upper and lower teeth, and loss of taste, and progressive weakness of the right side of the face with difficulty closing the right eye with a right lower facial droop. Patient also complained of dizziness and lightheadedness, and weakness and numbness in her arms and legs. The patient at that time denied headache, visual changes, or speech changes. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: SOB PRESENT ILLNESS: 77M with tracheal malasia MEDICAL HISTORY: COPD, home O2, TBM, OA, diverticulosis, nephrolithiasis, MRSA, asbestosis, GERD MEDICATION ON ADMISSION: Capsaicin Dilt Colace Nexium [**Doctor First Name **] Advair Xopenex Levofloxacin Lopressor Prednisone Spiriva Tylenol Codeine Guaifenesin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: AVSS Course with wheezes FAMILY HISTORY: none SOCIAL HISTORY: sormer insulation (asbestos) worker minimal smoking history

CHIEF COMPLAINT: epigastric pain, vomiting PRESENT ILLNESS: 47 year old female with no known history of diabetes, presented to [**Hospital1 18**] ED with several days of lower abdominal pain and vomiting which began the night before. She also reported poor appetite for several weeks, with increased thirst and increased urine output. She has no history of diabetes personally, but has a strong history of diabetes in her family. She has not measured any fevers at home, but reports feeling subjectively feverish occasionally for the past several days. Denies any loss of consciousness, she was brought into the ED by her family today. She also reports a month-long history of severe pain in her lower back and legs - started suddenly in early [**Month (only) 216**], with no known trauma or inciting injury. She first noticed pain in her left hip and lower back, which has worsened to include the rest of her left leg and her right hip and leg as well. Her PCP has been working up this issue and has ordered an MRI which the patient reports was normal. She also underwent cortisone shot and possibly epidural injection about 3 weeks ago to her lower lumbar spine. She reports that the back pain intensified after getting these injections. She reports walking now with a cane. She is only able to ambulate short distances. . In the ED, initial vs were: T=98 P=119 BP=139/82 R=20 O2=100% The patient was given regular insulin 10 units IV, and started on an insulin drip, 7 units per hour. Mental status remained stable. After 3 hours her glucose had decreased from 826 to 440. Overall she received 1.6 liters of NS in the ED. . In the ICU she reports feeling quite fatigued. She remains quite thirsty. Reports back pain and achy pains throughout her lower extremities, especially with palpation. . . Review of systems: (+) Per HPI, +mild nausea Denies weight loss or gain. No chest pain or shortness of breath. Does report worsening vision over the past 2 months. MEDICAL HISTORY: ** Nephrolithiasis, s/p ESWL procedure ** asthma - never hospitalized ** diverticulitis MEDICATION ON ADMISSION: none ALLERGIES: IV Dye, Iodine Containing PHYSICAL EXAM: Vitals: T:98.6 BP:141/92 P:106 R:19 O2:99% on 1LNC General: Sleepy appearing, but alert and oriented, conversant. HEENT: Sclera anicteric, mucous membranes dry, oropharynx clear FAMILY HISTORY: Multiple family members with diabetes, including her mother whom she reports died from diabetes. SOCIAL HISTORY: Married, lives with husband. [**Name (NI) 1403**] as a bus driver for the [**Company 2318**], though she has not worked for the past month due to severe back/leg pain. Does not smoke, denies alcohol or drug use.

CHIEF COMPLAINT: Lower gastrointestinal bleeding PRESENT ILLNESS: 83 year old woman with a history of recently diagnosed diverticulosis, hypertension, chronic kidney disease, and temporal arteritis who presents from OSH with brisk bleeding from rectum since 8:30 PM [**2173-7-20**]. Her last normal BM was that morning, and her last meal was 7:00pm that day. Reportedly passed ~1L BRBPR. Associated syncopal episode at [**Hospital 2725**] hospital. She has also had LLQ pain for the past several weeks that prompted a CT 4 weeks ago that reportedly revealed the diverticulosis. At the OSH ED, her BP was initially 100/50 P in 60's.. Hematocrit 31 (at 10pm on [**2173-7-20**]). She received 2 units pRBC. Because she continued to have brisk bleeding from her rectum, she was transferred to [**Hospital1 18**] ED for further management while the second unit was running. In ED at [**Hospital1 18**], BP intially 192/70, though was as high as 235/79--both in setting of nausea, P 76 but became bradycardic -- she was noted to have continued BRBPR and hematocrit returned at 24.5. An NG lavage was attempted but the patient became bradycardic & vomitted (brown emesis, no frank blood) during this procedure. P returned to [**Location 213**] spontaneously. Through the ED course she continued to have brisk bleeding Her BP ranged downward to the 100-110 range, P unchanged. Pt passed total of 800cc of BRBPR, 2 additional pRBC were given. She was also given 4 units of platelets because she was reported to be on plavix. It was decided to send the patient to IR urgently for embolization. . On further questioning, the patient reports she has never had BRBPR. She does not recall ever having a colonoscopy. . MEDICAL HISTORY: (from ED & OSH records and daughter) 1) Diverticulosis seen on [**6-/2173**] CT scan 2) Hypertension (Baseline SBP 130s) 3) Anemia (Baseline ~35) on procrit 4) Chronic kidney disease, secondary to one non-functioning kidney and hypertension (baseline & cause of CRI unclear) 5) Temporal arteritis on steroids 6) Hypercholesterolemia 7) PVD w/ h/o R foot pain and faint pulses 8) Status post surgery for ovarian cancer with peritoneal seeding in [**2160**]--likely TAHBSO and peritoneal surgery. 9) Status post appendectomy 10) S/p cataract surgery [**77**]) Spinal stenosis surgery in [**2166**]. MEDICATION ON ADMISSION: 1) Procrit 2) Plavix 75mg daily 3) Vytorin QPM 4) Clonidine 2mg QAM & 3QPM 5) Atenolol 12.5mg daily 6) Norvasc 10mg daily 7) Cozaar 100mg daily 8) Prednisone 5mg daily 9) Nephrocaps 1tab daily 10 Advair PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 98 P 82 BP 187/99 RR 18 O2 97 on RA Gen: WD/WN African American woman, fully oriented Eyes: Anicteric, PERRL Mouth: No lesions. Neck: Supple Lungs: CTA anteriorly Cor: RRR, 3/6 systolic, [**2-13**] diastolic murmur, no gallops/rubs Abd: S/NT/ND; +BS Ext: No C/C/E; 2+ rad pulses b/l; 2+ PT pulse in L foot, not palpable on R foot; LE warm b/l FAMILY HISTORY: Mother with HTN SOCIAL HISTORY: Lives alone in Senior Development Apartment, independent of ADL's and active. Former manager of a free health care clinic. Former smoker, 30 pack years, quit 15 years ago. Does not use alcohol. Has son and daughter.

CHIEF COMPLAINT: Hematemesis PRESENT ILLNESS: Pt is a 57 yo lady w/ HCV, presumed cirrhosis, grade I-II esophageal varices, recently treated with IFN/ribavirin complicated by FUO [**2-3**] with discontinuance of therapy at 6 months, who was admitted to MICU with hematemesis on [**2197-3-31**]. She reported feeling nauseated followed by few episodes of emesis with "blood clots in the bowl" with associated dizziness. She was hemodynamically stable in the ER but then had another episode of large volume emesis w/ blood clots after NG tube placement attempts for which she was admitted to the MICU. The patient has no prior history of GI bleeds (never had variceal bleed). She denies any episodes of BRBPR ormelena. The patient was seen by the liver service in the MICU with recommendation that she be started on octreotide overnight. An EGD was performed which showed an ulcer in fundus of stomach with clot covering it but no active bleeding. The patient has had serial Hcts with nadir of 24.6 ([**3-31**] 5 am) from 30 on [**3-30**], coags stable at INR 1.3. The patient received vitamin K on admission and she received only one unit of PRBCs since admission. The patient has had no repeat episodes of hematemsis and is now ready for transfer to the floor. . Currently, patient denies any discomfort or bleeding. She denies any further episodes of emesis and reports no abdominal pain. She denies dizziness, lightheadedness, chest pain, or dyspnea. MEDICAL HISTORY: # HCV genotype I w/presumed cirrhosis, followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] --s/p Peg IFN/ribavirin x 6 mos, stopped for FUO-- last VL undetectable [**2197-3-21**] # admits for FUO [**2-3**], [**3-6**] w/ extensive, unrevealing workup, treated for pneumonia -eval for FUO included bone marrow biopsy, CT torso, extensive ID work up, [**3-27**] gallium scan (No abnormal areas of increased tracer uptake concerning for inflammation). Still ?lymphoma w/ enlarged left inguinal lymph node. # pleural/pericardial effusion # Grade I-II esophageal varices, no h/o bleeds # presumed cirrhosis # S/p TAH # Hepatitis A in [**2161**]'s # ECHO [**2-3**]: nl EF, 1+ MR, no wall motion abnl or veggies # Anemia of chronic inflammation MEDICATION ON ADMISSION: Pantoprazole 40 mg IV Acetaminophen 325-650 mg PO Q6H:PRN Estrogens Conjugated 0.9 mg PO DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: T 99.1 BP 142/80 R 80 R 18 99%RA Gen: sleeping, easily arousable, conversant HEENT: MM moist, OP clear CHEST: CTA CV: RRR w/ [**2-3**] early systolic murmur at LUSB ABD: non tender, no HSM, nabs, no ascites. SKIN: warm, well perfused EXTRM: no edema, no rashes, strong peripheral radial and DP pulses NEURO: totally intact, conversant, oriented x 3, normal extrm exam; full exam not completed at this time FAMILY HISTORY: sister w/ CABG age 61, father passed away of MI age 64, mother passed away w/ complications of biliary surgery. SOCIAL HISTORY: Per report, the patient was never a heavy alcohol drinker. She now drinks approximately one glass of wine or one vodka and tonic a week. She is a nonsmoker. She works in Customer Service for U.S. Airways. She also runs her own business, designing notepaper. She currently lives alone. She is currently divorced and has a son living in [**Name (NI) **] and a daughter in [**Name (NI) 531**]. Denies IVDU.

CHIEF COMPLAINT: Right sided weakness PRESENT ILLNESS: 88 year old woman with history of Afib for which she is on Coumadin who this past monday realized that she felt her right arm was weak and that she was leaning toward the right. She currently resides at a nursing home and today her nurse felt she should be evaluated so she was sent to an OSH. While there a head CT showed a 2cm x 2.5 cm right cerebellar hemorrhage. Her INR was 3.4 the day prior to admission, and approximately 2 at the OSH. Per report, she was reversed with FFP, vitamin K and factor IX complex. . She was transferred to [**Hospital1 18**] for further management. Her INR was 2.0 for which she received FFP, Vitamin K, and Propylene IX in the emergency department. She denies headache, is blind in her right eye secondary to macular degeneration but has good vision with her left eye. She is listing to her right when entering the room. She is interactive. MEDICAL HISTORY: Atrial fibrillation/flutter on warfarin Hypertension Type 2 DM Dyslipidemia Right eye blindness secondary to macular degeneration Glaucoma Cataracts Uterine prolapse with urinary incontinence, prior hx of pesary Spinal stenosis with radiculopathy Osteoporosis Depression MEDICATION ON ADMISSION: Acetaminophen 1g [**Hospital1 **] Lacri-lube gtt qhs Alphagan 0.2% daily Tums 3 tabs daily Diltiazem 360mg daily Cosopt 2-0.5% [**Hospital1 **] Vitamin D2 50,000 units daily Gabapentin 300mg qhs Heparin flush Xalatan 0.005% eye drops qhs Metoprolol succinate 112.5 mg daily Remeron 15mg tab qhs KCl 20 meq daily Senna 2 tabs qhs Tramadol 25mg [**Hospital1 **] Trazodone 25mg qhs ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O: T:98.1 BP: 180/111 HR:88 R 18 O2Sats 95% Gen: WD/WN, comfortable, NAD. HEENT: NCAT Pupils: R blind/clouded over, L 3mm/2mm EOMs full without nystagmus Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to self and hospital Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. . Cranial Nerves: I: Not tested II: Pupils Right blind/clouded over secondary to cataracts and macular degeneration. Left 3mm to 2mm. Visual fields are full to confrontation with left eye III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. . Motor: Right pronator drift, RUE is not weak but is uncoordinated. Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**4-20**] throughout. . Sensation: Intact to light touch and proprioception bilaterally . Toes downgoing bilaterally . Coordination: Finger to nose uncoordinated with Right, good with left, normal heel to shin FAMILY HISTORY: Brother with diabetes and eye problems. Denies cardiac or pulmonary disease. SOCIAL HISTORY: Smoked <[**12-18**] ppd x 10 yrs, quit in [**2125**] Denies EtOH and recreational drugs Lives at nursing home. Living brother and sister [**Name (NI) 382**] and two nieces are very involved in her care. Widowed for 7 years, has a daughter in [**Name (NI) 108**] who is not involved. She previously worked as an xray technician and helped physicians do house calls in the [**Location (un) 34538**] area.

CHIEF COMPLAINT: Carcinoma of the distal esophagus PRESENT ILLNESS: Mr. [**Known lastname **] is a 69-year-old gentleman with multiple prior abdominal procedures including Nissen fundoplication and open cholecystectomy, who presents with biopsy-proven adenocarcinoma of the distal esophagus. Preoperative staging suggested a T2 N0 lesion and given his good performance status he was recommended for primary resection with a decision regarding adjuvant therapy based on true pathologic stage. He agreed to proceed. Dr. [**Last Name (STitle) **] discussed a transhiatal approach given the distal nature of this lesion. His preoperative workup did show that he had a prior Nissen fundoplication which had slipped up into the chest. MEDICAL HISTORY: 1. Invasive CA of GE junction, Barrett's esoph s/p remote fundoplication (20 yrs ago @[**Hospital1 **]) 2. Open CCK 3. Diverticulitis 4. Benign colon polyps 5. B/L cataracts MEDICATION ON ADMISSION: omeprazole, lisinopril, amitriptyline, zocor, ASA, MVI ALLERGIES: Ativan PHYSICAL EXAM: general: well appearing man in NAD HEENT: unremarkable Cor: RRR S1, S@ ABD: Extrem: no C/C/E neuro: no focal deficits FAMILY HISTORY: non contributory SOCIAL HISTORY:

CHIEF COMPLAINT: Abdominal pain. PRESENT ILLNESS: Briefly, this is a 40 yo M with a hx of ulcerative colitis with ileoanal pouch then diverting ileostomy with multiple hospital admissions for abdominal pain, diarrhea, and BRBPR which have been dx'ed as UC flares, chronic pouchitis, small bowel obstructions, C. difficile colitis. The pt now presents with his usual sx of abd pain, BRBPR and n/v. He was recently treated at admitted to [**Hospital3 **] for 8 days for similar symptoms including nausea, large stool output, and BRBPR, he was treated with supportive care and pain control, and then discharged home. The pt returned to [**Hospital1 18**] on the following day for recurrent symptoms. In the past, the pt has recieved large doses of IV dilaudid, up to 6mg IV q4, as per records in POE to treat his abd pain, the pt remains very insistent that 6 mg of IV dilaudid is the only treatment that really works to treat his pain. . In ED, central line placed. Given dilaudid 4mg, flagyl 500mg, and promethazine. Continued to complain of pain. Pt was transferred to [**Hospital Unit Name 153**] with tachycardia to 170's, hypertension, and hypoxia. ABG revealed 7.38/54/57/lactate 3.8 on 10L Face Mask. He was given Narcan for somulence without a change in his vitals. He was A&Ox3; answering questions appropriately. He denies CP, change in baseline abdominal pain, N/V, cough, weakness, or numbness. He notes chills and mild dyspnea. He had received a dose of IV dilaudid for pain in addition to his standing regimen of Oxycontin 80 tid and SC dilaudid 6 mg q 3 prn. MEDICAL HISTORY: 1. Proctocolectomy with ileal pouch - anal anastamosis: 10/03 [**2114-1-16**]: LOA for small bowel obstruction. At this time the ileostomy was closed, with end to end anastomosis of small intestine to resume flow through intestines through to the ileal pouch and rectum. [**2114-8-20**]: Ileostomy replaced because of recurrent symtoms which "quite frankly were never clearly delineated" per Op note. Symtoms were thought to be possibly relating to flow through ileoanal pouch. 3. Inflammatory bowel disease - dx 22 years ago 4. Grand mal seizure disorder s/p motorcycle accident in [**2095**] 5. Chronic back pain with c-spine fx s/p MVA 4. Iron Deficiency Anemia 5. Narcotic Dependence 6. Recurrent C. difficile enteritis 7. Anxiety 8. GERD 9. Postoperative multifocal aspiration pneumonia with parapneumonic effusion 10. Lysis of adhesions and ileostomy take-down: [**1-4**] MEDICATION ON ADMISSION: Pantoprazole40 mg PO Q24H Levetiracetam 1000 mg PO BID Oxcarbazepine 300 mg PO BID Mesalamine 400mg DR [**Last Name (STitle) **] [**Name (STitle) **] Alprazolam 2 mg PO [**Name (STitle) **] Oxycodone 80 mg Sustained Release PO Q8H Clonazepam 2 mg PO BID Phenergan PRN Canasa 500 mg Suppository twice a day ALLERGIES: Morphine / Compazine / Penicillins / Codeine PHYSICAL EXAM: Physical Exam: T 97.7 BP 144/80 HR 94 RR 20 Sat 98% RA Gen: appears uncomfortable, NAD HENNT: MMM, anicteric, MMM Neck: No LAD, JVD CV: RRR, no m/r/g Lungs: CTAB Abd: Soft, tender to palpation diffusely, no rebound/guarding. BS+. ileostomy site without surrounding erythema, c/d/i. ileostomy bag with tan-colored stool. Ext: No edema, strong DP/PT pulses bilaterally FAMILY HISTORY: His mother had "Crohn's disease" and died at the age of 63 from colon cancer. His father is still alive, at age 79, without any known health problems. His 5 brothers and one sister are all alive and healthy. SOCIAL HISTORY: Married x 25 years. Lives with his wife and children on the water in [**Name (NI) 392**]. Used to work in law enforcement. + marijuana about 3 times per week, no IVDU. No tob or EtOH in last 20 yrs

CHIEF COMPLAINT: DOE, palpitations PRESENT ILLNESS: 78-year-old male with history of hypertension, hyperlipidemia, diabetes and persistent atrial fibrillation s/p PVI [**11/2107**] on fleicanide. He has not been feeling well for the last 3wks. He states he has shortness of breath that comes and goes and that he can feel his heart and it feels like it is working very hard and fast. He denies shortness of breath when he is laying flat, but does have difficulty when standing up and has difficulty walking due to palpitations and shortness of breath. He says this feeling is similar to an episode he had in [**2105**] when he developed a. fib. He states that when he eats then he also has some pain in his chest. He denies cough at present. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension 2. CARDIAC HISTORY: -CABG: -PERCUTANEOUS CORONARY INTERVENTIONS: -PACING/ICD: 3. OTHER PAST MEDICAL HISTORY: atrial fibrillation s/p pulmonary vein ablation ([**2106**]) hypertension chronic lung disease likely [**1-7**] smoking MEDICATION ON ADMISSION: MEDICATIONS: confirmed with Sutherland Pharmacy [**2110-11-5**] atorvastatin 10 mg daily fenofibrate 48 mg daily flecainide 100 mg [**Hospital1 **] glipizide 2.5 mg TID isosorbide sustained release 30 mg daily lisinopril 40 mg daily metformin 500 mg TID metoprolol succinate 50 mg daily in and and [**12-7**] tablet in the evening warfarin 5 mg daily Ambien 10 mg at HS ASA 81 mg daily Vitamin D 50,000 units daily Nasonex 2 sprays daily Nitrostat 0.4 mg tab under tongue as directed. ALLERGIES: Penicillins / Streptomycin PHYSICAL EXAM: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: -Tobacco history: smoked for a long time, quit in [**2101**] -ETOH: "and who doesn't drink alcohol"? drinks occasionally on weekends, did not drink preceding onset of afib -Illicit drugs: none

CHIEF COMPLAINT: Endobronchial mass PRESENT ILLNESS: 76M with hx of LUL resection for NSCLC 30 years ago who presented to [**Hospital **] Hospital with massive hemoptysis on [**2160-9-5**]. At that time, he was intubated for airway protection and on bronchoscopy, he was found to have an obstruction lesion of the right mainstem due to a RUL tumor. At that time, he was transferred to [**Hospital1 18**] on [**2160-9-9**] for a rigid and flexible bronchscopy where they found that the right mainstem was approximately 80-90% obstructed by a tumor mass coming from the right upper lobe. They found foreign bodies which appeared to be suture material and perhaps a fingernail in that area which was sent to pathology as well, prompting a possible diagnosis of foreign body granuloma. They performed multiple biopsies of the friable mass. Following the biopsies, the tumor was destroyed with electrocautery and argon plasma coagulation. However, they were not able to achieve patency of the right upper lobe bronchus. The right mainstem was completely patent at the end of the procedure. He was then sent to the SICU where he was extubated without event. He had a video swallow which showed no evidence of aspiration. . Of note, he originally presented to PCP with [**Name Initial (PRE) **] month of cough and shortness of breath. He was treated emperically with abx with no resolution of the mass on cxr, which prompted the bronchoscopy at [**Location (un) **]. . At baseline, he can walk 4 blocks without getting SOB. MEDICAL HISTORY: NSCLC LUL resection 30 years ago HTN CAD s/p angioplasty/stent [**2148**] MEDICATION ON ADMISSION: Medication at home: Levalbuterol Atrovent Asmacort Spiriva Metoprolol ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 97.1 84 159/99 119 25 95%-4LNC Gen: A+Ox3, NAD, comfortable, pleasant HEENT: MMM, OP clear NECK: No JVD, no LAD CV: RRR, no m/g/r Pulm: CTAB, no w/r/r, resonant to percussion Abd: soft, nd, nt, positive bs Ext: no c/e/c Neuro: mobilizes all extremities, sensation grossly intact FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives with family and worked 25 years as a plumber. Has a 50 pack year history of smoking and has been exposed to asbestos in the past. He socially drinks alcohol.

CHIEF COMPLAINT: ST elevation Myocardial Infarction (post-trauma to the chest by soft ball) PRESENT ILLNESS: 31 y/o female transferred for STEMI post struck by softball in chest. PMH only significant for anxiety and asthma (no episodes of intubation but multiple ED visits) Patient reports one week of L subscapular pain as well as h/o suggestive of orthopnea and DOE. Seen by ED, and sent home with prednisone taper, bronchodilator, and amoxicillin for ? pneumonia on CXR. Continued having intermittent episodes of subscapular pain and orthopnea as well as chest tightness until on day of admission - patient was struck in left breast with softball. Presented to OSH where she was noted to have ST elevations in II, III, F, and ST depressions in V1, V2. Patient was transferred to [**Hospital1 18**] for emergent cath and ?dissection. MEDICAL HISTORY: Asthma Anxiety MEDICATION ON ADMISSION: Prozac 60 Xanax 4 Prednisone Albuterol Amoxicillin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS T98.2, HR86, BP129/79,R12, O2100% on RA Gen: NAD, lying in bed HEENT: OP clear, MMM, neck supple, no JVD, no LAD Heart: nl rate, S1S2, no G/M/R Lungs: CTA-anteriorly Abdomen: benign Extremities: no c/c/e Skin: ecchymosis over right breat Lines: R groin site tend to palp, no hematoma, no bruits, site: slight oozing FAMILY HISTORY: Father died of sudden cardiac death age 49. SOCIAL HISTORY: Social History: Last drink 1 year ago. 20pack year tobacco. No cocaine, heroin, crack. Smokes marijuana.

CHIEF COMPLAINT: transferred from OSH with ICH and IVH PRESENT ILLNESS: Mr. [**Known lastname 16008**] is a 70 y/o male with a history of mental disability per the coordinator at the [**Hospital3 **] center where he lives. Neighbors at the center heard a loud sound in his room and found him unresponsive. It was assumed he sustained a groud level fall. He was taken to an OSH where he received etomidate, vecuronium, and versed approximately 90 minutes ago. A head CT without contrast revealed acute intraventricular hemorrhage in all 4 ventricles with associated cerebellar hemispheres intraparenchymal hemorrhages (left>right) and small amount of interhemispheric fissure subarachnoid hemorrhage. He was transferred to [**Hospital1 18**] ED for neurosurgical evaluation. MEDICAL HISTORY: Friedreichs ataxia HTN MEDICATION ON ADMISSION: omeprazole 20 mg po qd metoprolol 25 mg po qd lamisil ALLERGIES: Cefadroxil PHYSICAL EXAM: Upon admission: T: 98.9 BP: 144/74 HR:89 R12 O2Sats 100% Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 2.5 mm bilaterally and sluggish EOMs no eye movement Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: comatose Orientation: none Recall: none Language: intubated FAMILY HISTORY: has 2 brothers with Friedreichs ataxia SOCIAL HISTORY: lives in group home, has legal guardian, sister is also very involved

CHIEF COMPLAINT: ESRD PRESENT ILLNESS: Mr. [**Known lastname 5108**] is an 81-year-old gentleman who is on the cadaveric kidney transplant list. An ECD/ DCD kidney became available. The risks and benefits of this ECD/DCD kidney were explained in detail to the patient and he elected to go ahead with the procedure. Of note, the donor was a 58-year-old man with a history of hypertension and a total creatinine of 1.0. MEDICAL HISTORY: 1. End-stage renal disease on hemodialysis for approximately four years. 2. Hypertension. 3. Coronary artery disease with history of cardiac catheterization on [**2178-2-5**] and is status post angioplasty and stent x3 in the right coronary artery. 4. Hyperlipidemia. 5. Right upper arm AV fistula. 6. Heme-positive stools status post EGD and colonoscopy in [**2179-7-23**] that showed [**Female First Name (un) 564**] esophagitis and tubular adenoma of the colon. 7. Left eye blindness and is scheduled to undergo a corneal transplant. 8. Bone mineral density test in [**2179-6-22**] showing osteoporosis. MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: The patient was verified to be asystolic on ECG monitoring and had no arterial waveform or blood pressure on arterial line tracing. He had no spontaneous respiration. Based on these findings, he was declared at 14:45 FAMILY HISTORY: Non Contributory SOCIAL HISTORY:

CHIEF COMPLAINT: hypoxia, intubation PRESENT ILLNESS: This is a 84 year-old female with a history of hypothyroidism, ? cholecystitis, HTN, frequent UTIs who presented to [**Hospital3 2568**] with elevated LFTs and epigastric pain. She was transferred here for ERCP. She was found to have 2 pigmented gallstones and sludge. She had sphincterotomy and good drainage. Prior to the procedure, while undergoing induction anesthesia, she became hyoxic to the to the low 80s, and eventually went intubation which was difficult per anesthesia. The anesthesiolgist states there was no aspiration event, but the story is not quite clear. She was transferred to the ICU intubated in stable position. . ROS: unable to obtain MEDICAL HISTORY: ? h/o Cholecystitis Hypothyroidism Hypertension chronic UTIs GERD Hyperlidemia MEDICATION ON ADMISSION: Avapro 75 mg daily KCL 40 meq daily Lasix 40 mg daily Bumetanide 20 mg daily Tapazole 10 mg daily Caltrate with Vit D Simvastatin 20 mg daily Zantac 150 mg daily Nitrofurantoin 100 mg TID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GEN: Well-appearing, well-nourished, no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear NECK: No JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline COR: RRR, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength 5/5 in upper and lower extremities. Patellar DTR +1. Plantar reflex downgoing. No gait disturbance. No cerebellar dysfunction. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. FAMILY HISTORY: SOCIAL HISTORY: Lives at home with son. [**Name (NI) **] tobacco or ETOH

CHIEF COMPLAINT: Reason for Transfer: Sepsis PRESENT ILLNESS: Ms. [**Known lastname **] is a 84 year old female transferred from [**Hospital1 112**] on the day of admission after presenting to their ED with vomiting and poor po intake for 2 days. She also complained abdominal pain with associated diarrhea. Per patient and family, she had been vomiting for 2 day, which was clear, nonbloody and occasionally resemble what she ait. She thinks this is [**3-4**] cabbage ingestion. The day of admission, she had [**2-1**] bowel of cereal and toast, which she immedicately vomited. She confirms hunger. Also with loose stool for two days, but only one BM daily. No BRBPR, no melena. She's felt warm, but states this is baseline and has not taken her temperature. Did have a insect bite 2 days ago, that developed a pustule that has since resolved. Has had cough for several weeks, minimally productive. Son confirms intermittent aspiration of fluids. No family members with illness, no renct travel, unclean water sources or eating raw meat. No recent antibiotics. Generally has one BM daily. No history of bowel obstruction though is s/p appy and ccy. No pain currently. Family states FS usually run 120-170, but were 300 this morning. . She was given 500cc NS and IV zofran. UA was reportedly negative though not in the BICS system on sign-out. Did have mild cough that was not productive. . Review of systems is positive for recent nausea, cough that started approx 2 week ago. Additionally she has had orthopnea and constipation at baseline. Her cough is mild and without phlegm. She has vomited a few times in the last few days. Negative for dizziness, syncope, presyncope, disorientation, hematuria, fever, chills, dysuria, sorethroat or palpitations. Reporst SOB that is improved with SL NTG at home. MEDICAL HISTORY: 1. CAD s/p MI in '[**03**] 2. CHF with EF of 20-25%, severe global HK 3. DMII Insulin dependent 4. HTN 5. Hypercholesterolemia 6. PVD 7. PAF ?post op? not on anticoagulation 8. Anemia (Fe deficiency per report) 9. h/o CVA [**15**]. h/o cataracts 11. h/o fatty liver 12. s/p CCY 13. s/p ureteroscopy with stent '[**02**] 14. s/p appy 15. Nephrolithiasis . PAST SURGICAL HISTORY: 1. Cholecystectomy, remote. 2. Right ureteral stenting 3. Appendectomy, remote. 4. Bilateral cataract surgeries, remote. 5. Right axillary bifemoral bypass on [**2108-3-27**]. 6. Left AKA MEDICATION ON ADMISSION: Medications upon Admission 1. Digoxin 125 mcg DAILY 2. Furosemide 60 mg PO DAILY - hold for now given diarrhea 3. Aspirin 81 mg Tablet PO once a day. 4. Metoprolol Succinate 75 mg PO DAILY 5. Rosuvastatin 10 mg PO DAILY 6. Isosorbide Mononitrate 30 mg Tablet PO DAILY 7. Lisinopril 12.5 mg PO DAILY 8. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: as directed units Subcutaneous twice a day: Take 23 units every morning and 7 units at dinner time. 9. Pantoprazole 20 mg Tablet daily 10. Spironolactone 25mg daily 11. Nitroglycerin 0.3 mg Tablet PRN as needed for chest pain / SOB 12. Humalog 100 unit/mL Solution Sig: as directed units Subcutaneous four times a day: Please follow sliding scale. ALLERGIES: Morphine PHYSICAL EXAM: Physical Exam: VS 97.1, 170/80, 86, 18, 96/RA Gen - Elderly woman, mildly diaphoretic, appears fatigued, in no acute distress HEENT - OP clear, mmm, arcus senilis, pupils reactive but somewhat sluggish Neck: no thyromegaly, JVP approx 8-10 cm CV - regular rate, rhythm, soft systolic murmur at LLSB Lungs - occasional crackles at bases, poor air movement Abd - soft, nt, nd, + bs Back - no tenderness Ext - RLE no edema, no statis dermatitis Neuro - intact sensation RLE Skin - no rashes FAMILY HISTORY: Family History: Diabetes in son, mother had TB SOCIAL HISTORY: Social History: Tobacco: 1ppd x many years quit [**2093**] EtOH: Used to drink heavily, has quit for over 25+ years Illicit drugs: None .

CHIEF COMPLAINT: transfer from OSH for right intraparenchymal hemorrhage PRESENT ILLNESS: [**Known firstname 13842**] [**Known lastname **] is an 83 year-old right handed woman who was transferred by [**Location (un) **] from [**Hospital6 3105**] after she had an acute change in mental status this morning. According to her husband [**Last Name (un) **] [**Telephone/Fax (1) 110140**]) who was reached by phone, he said that over the past month she has not been herself. He says that she has been leaving faucets on and even the gas stove on occassion. She will stare blankly at him while he is speaking and then not remember anything that he said. He was unsure what was the cause of this, but thought it might be dementia. He felt that most of this change was in the past month. On the morning of [**2185-3-22**] he was in his car and was backing up into the garage. He states that she is never in the garage and he did not know what she was doing there. He was driving in reverse and then heard her scream. Initially he thought he had hit her, and he found her on the ground. She was able to stand up and walked into the kitchen where she was holding her head and trying to speak but husband reports that her words were not making any sense. They brought her over to [**Hospital6 3105**] where initially it was thought that she had trauma. There was no outward sign of trauma and no fractures seen on films. She had a CT head performed and was then intubated given concern for respiratory compromise. Initial BPs at LGH were 224/163. She was transferred to [**Hospital1 18**] and started on nicardopine, propofol, midazolam and fentanyl and BPs came down to 150s-190s systolic. MEDICAL HISTORY: Diabetes Hypertension MEDICATION ON ADMISSION: Lisinopril - unknown dose HCTZ - unknown dose oral diabetes medication - unknown by husband ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: ADMISSION EXAM Vitals: initial afebrile BP 224/163 P 136 R 34 SpO2 99% General: intubated, sedated HEENT: NC/AT Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: CTABL Cardiac: tachycardic, no murmurs Abdomen: soft, nontender, nondistended Extremities: slight abrasion noted on right knee, no edema Skin: no rashes noted. FAMILY HISTORY: No history of stroke in family, otherwise unknown by husband SOCIAL HISTORY: Lives with husband in [**Name (NI) 12595**], MA. Was independent until 1 month ago. No assistive devices required. prior smoker years ago. Has an occassional glass of port

CHIEF COMPLAINT: dyspnea on exertion, chest pain PRESENT ILLNESS: This patient is a 74 year old white male with a history of coronary disease, s/p stents to the RCA and LCx in [**2124-11-2**]. He continues to have dyspnea on exertion and chest pain, despite the intervention. The patient underwent cardiac catheterization and coronary angiography at [**Hospital1 **] Heart Center which revealed multi-vessel disease. He is transferred to [**Hospital1 18**] for surgical evaluation. MEDICAL HISTORY: coronary artery disease s/p stents [**November 2124**] (RCA-1, Cx-2) hypertension narcolepsy obstructive sleep apnea (uses CPAP) peripheral neuropathy skin cancer (basal and squamous cell) spinal stenosis MEDICATION ON ADMISSION: allopurinol 300', plavix 75', cozaar 100', toprol xl 25', provigil 400', colchicine 0.6', doxazosin 2'', nifedipine ER 90', gabapentin 400', simvastatin 40', asa 325', vit D 1000'' ALLERGIES: Rofecoxib / Celebrex PHYSICAL EXAM: Admission: FAMILY HISTORY: father had coronary artery disease died at 66 years of age SOCIAL HISTORY: Lives with: wife Occupation: retired biology professor Tobacco: 15 pack years, quit in [**2085**] ETOH: 1 glass of wine per night

CHIEF COMPLAINT: Lower GI bleed PRESENT ILLNESS: This is a [**Age over 90 **] year-old woman with history of stroke seven weeks ago, atrial fibrillation, hypertention, CAD s/p MI, and BRBPR in [**2182-1-15**] with colonscopy at [**Hospital6 2561**] revealing extensive diverticulosis and internal hemorrhoids who presents with copious BRBPR at home on [**2184-8-18**]. The patient noted a large amount BRB in her undergarments with large clots and BRB noted on the toilet seat. No melena was noted. In addition to starting aspirin and aggrenox seven weeks ago, she was also taking celebrex. She was prescribed Fosamax at the time as well, but had refused to take it since her stroke. She had BRBPR in [**2182**] while on celebrex and fosamax. MEDICAL HISTORY: 1. [**6-18**]: small acute lacunar infarct: right periventricular white matter, started on ASA and aggrenox 2. Diverticulosis/int hemorrhoids seen on colonscopy in [**2182**] and abdominal CT [**2181**] Colonscopy [**Hospital3 **] [**1-16**] for guiac postive stool/LGIB: -- Two right colon polyps, excised. -- Extensive diverticulosis of the distal colon. -- No blood encountered. -- Internal hemorrhoids. 3. AFIB- not on coumadin as fall risk 4. HTN 5. CAD s/p MI 6. Depression 7. GERD/HH 8. Hip surgery [**2178**] and [**2179**] 9. s/p shoulder fracture and surgery in [**2182**] 10. glaucoma s/p eye surgery [**91**]. Lumbar stenosis 12. BPPV 13. 7-beat run of asymptomatic ventricular tachycardia on Holter monitor in [**2182**]. MEDICATION ON ADMISSION: ASA 81mg po qd Aggrenox 1 tab [**Hospital1 **] Protonix 40mg po qd Megace 40mg po qd Celebrex 100mg po qd Paxil 30mg po qd Lopressor 25mg po bid Trazodone 50mg po qhs Lipitor 10mg po qd Vitamin D 400 IU po qd Calcium 500mg po qd ALLERGIES: Penicillins PHYSICAL EXAM: PE on admission: T98 BP 96/53 --> 70/p --> 100/75 HR 101-118 RR18-22 O2sat 94-97% RA gen- elderly frail woman in NAD HEENT-L surgical pupil, R pinpoin but reactive, OP moist NECK- supple, no LAD CHEST- bibasilar crackles - very poor effort/cooperation with exam (Bowel sounds at left base) CV- irreg irreg no m/r/g ABD- hyperactive BS, soft, NT/ND, frank gross blood noted in ED EXT- no c/c/e, 2+ DP b/l, warm Neuro- alert, follows some commands, oriented x 1 (self), moving all extremities, ? right facial drop FAMILY HISTORY: Sister w/ breast CA, urinary CA Parents with PVD SOCIAL HISTORY: Widowed and lives alone on [**Location (un) 453**] of 2-family apartment. Daughter lives above. Two sons (one in [**Name (NI) **], one in CT) also involved. Retired bookkeeper. Distant history of tobacco and rare ETOH.

CHIEF COMPLAINT: transferred for ICU level care of sepsis in febrile neutropenia PRESENT ILLNESS: 63M CLL dx'd [**12-4**] with last chemo a month ago p/w febrile neutropenia (T102.3), shortness of breath, and hyponatremia on [**4-27**] to NEBH. Levoflox started as outpt 1d PTA at NEBH for low grade fevers and shaking chills. He was transferred to the ICU on [**4-28**] for increasing shortness of breath and for initiation of hypertonic saline. Work up (UCx and Bld Cx neg, stool neg for Cdiff, CMV antigen neg, EBV IgG pos but IgM neg, HepB immune, HepC neg) isolated only C albicans in stool and he was empirically broadened to flagyl/cefepime. Pleural effusion on HD3, got some lasix--BNP was normal, though. V/Q scan intermed prob on HD4. No CTA [**1-30**] ARF. . By [**4-29**], anemia had worsened, Na down to 122 . Morning of [**2168-5-2**], 7.25/34/61, 88%, on face mask + 5 liters. No improvement after lasix 80mg IV and so intubated with size 8 ETT and became hypotensive to 60s. Started peripheral neo and propofol and transferred to [**Hospital1 18**]. Prior to departure from OSH, on vent: 800x16, PEEP 5, FiO2 85% at 1:30 7.17/47/104; given 1 amp NaHCO3 prior to departure. En route had temperature to 103.5. MEDICAL HISTORY: CLL dx'd [**12-4**] with massive HSM and WBC 500,000. treated with chemo, last in [**3-5**] was fludarabine, prednisone, cytoxan. Splenomegaly Anemia Neutropenia/Leukopenia Gout h/o GI bleed; guaiac pos at OSH, but no GI work-up chronic laryngeal spasm HSV MEDICATION ON ADMISSION: allopurinol iron supplements, multivitamin ALLERGIES: Rituxan / Shellfish Derived PHYSICAL EXAM: General Appearance: Well nourished, Diaphoretic Eyes / Conjunctiva: PERRL, pupils 3->2 Head, Ears, Nose, Throat: Endotracheal tube Lymphatic: Cervical WNL Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), No(t) S3, No(t) S4, No(t) Rub, (Murmur: No(t) Systolic) Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse: Present), (Right DP pulse: Absent), (Left DP pulse: Present), L radial a-line Respiratory / Chest: (Expansion: Symmetric), (Percussion: Resonant : ), (Breath Sounds: Bronchial: , Diminished: R base) Abdominal: No(t) Bowel sounds present, massive liver and spleen enlargement Extremities: Right: 2+, Left: 2+ Skin: Warm, petechiae over shins Neurologic: Responds to: Not assessed, Movement: Not assessed, Sedated, Tone: Not assessed FAMILY HISTORY: NC SOCIAL HISTORY: quit smoking 5 months ago, occ/social alcohol. works as heating company manager.

CHIEF COMPLAINT: hypothermia, lethargy PRESENT ILLNESS: The patient is a 71 yo man with h/o cognitive delay, IDDM, and seizure disorder, non-verbal at baseline, who presented from his nursing home with altered mental status. Per report, the patient was in his normal state of health until yesterday, when he was reported to be "under the weather." This afternoon, he became lethargic and did not open his eyes when spoken to. His nurse took his vital signs, and his rectal temperature was found to be 92. He was thus brought to the ED for further evaluation. . In the ED, his initial VS were T 86.2 (92 rectally), P 53, BP 122/96, R 24, O2:100% sat. On transfer from the stretcher to the bed, he had a very wet cough. His FSBG was 54, so he was given an amp of D50. He was found to be hyperkalemic, so he was given Albuterol, Insulin 10 U, and glucose, and his repeat glucose was 18. He was thus started on a D50 gtt. His CXR showed patchy infiltrates bilaterally, so he was given CTX/Vanc/Levaquin for presumed HAP. He was placed in a bear hugger and he was given warm fluids, and his repeat temperature was 35.3 and his pulse increased to 70. His VS at the time of transfer were BP 109/37, P 75, O2 99% on 3L NC. . On the floor, the patient is lethargic but opens his eyes on command. He was unable to express any acute concerns. MEDICAL HISTORY: Mental retardation, diabetes type 2 on insulin, seizure disorder, dementia, osteoporosis, dysphagia, aspirations, psychosis. MEDICATION ON ADMISSION: MVI daily Risperidone 1 mg PO QHS Cholecalciferol 400 U daily Calcium carbonate 500 mg PO daily Ferrous sulfate 300 mg daily Novolin 15 U qam ISS Levothyroxine 75 mcg daily Atrovent 17 mcg HFA inhaler daily Heparin SC Vitamin C 500 mg PO BID Senna 17.2 mg daily Duoneb q4h prn Dulcolax 5 mg daily Tylenol 650 mg q6h prn for pain Lorazepam 0.5 mg daily PRN Dilantin ER 250 mg PO qhs (reconciled with PCP) PeptoBismol prn q6h ALLERGIES: Azithromycin / Penicillins PHYSICAL EXAM: Admission Exam VS: Temp 35 BP 109/37, P 75, O2 99% on 3L NC General Appearance: Well nourished, No acute distress, not following commands Eyes / Conjunctiva: Left pupil 1mm < right pupil at 1.5 mm Head, Ears, Nose, Throat: Normocephalic, dry MM Cardiovascular: Difficult to ascertain secondary to rhoncorous chest exam Respiratory / Chest: Rhonchorous Abdominal: Soft, Bowel sounds present Extremities: No edema, warm and well perfused, 2+ DP pulses Neurologic: toes are upgoing on the left Discharge Exam VS: Tc 96, P: 54, BP: 116/60, RR: 16, 96% on RA GEN: chronicall ill appearing, non-verbal, appears comfortable CV: rrr, no m/r/g PULM: CTAB on anterior chest ABD: BS+, soft, NT, ND, no HSM EXT: no edema, some bruising over RUE NEURO: alert, follows commands FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives at group home. Does not smoke, does not drink alcohol. No drug history.

CHIEF COMPLAINT: Hypotension, respiratory failure PRESENT ILLNESS: 71 year old male with MMP including severe OSA, recent [**First Name3 (LF) **] [**Date range (1) 79292**] for large R MCA stroke with residual weakness, L hemineglect, bulbar dysfunction (dysphagia s/p PEG, slurred speech), bilateral PEs on coumadin, was readmitted from [**Hospital1 15454**] Hosp rehab to [**Hospital3 417**] Hospital on [**7-1**] with lethargy, depressed MS, fevers. Was febrile and hypotensive and intubated for lethargy/airway protection. subsequently transfered to [**Hospital1 18**] MICU. He was found to have septic shock [**1-4**] either central line (had old R subclavian central line since [**6-17**]) vs PNA. Got IVF reccussitation, short term pressor support. He has been on Vanc, cefepime, and flagyl, and has shown clinical improvement. Also as part of AMS w/u on [**Month/Year (2) **], he got CT head, which showed small area of hemmorhagic conversion. Given concern for expansion, his coumadin was stopped (INR reversed) and he underwent IVC filter since LE dopplers showed RLE DVT. The question now is whether the coumadin is safe to be resumed, and it is for this question that the patient transfered to medicine [**7-5**]. Neurology evaluated the patient and felt right MCA bleed does not explain decline in mental status, which is likely [**1-4**] infection/sepsis. MEDICAL HISTORY: 1. severe OSA - BiPAP at 16/8 at night 2. Asthma 3. GERD 4. BPH 5. CVA, LARGE R MCA stroke [**6-9**] (MRA with distal occlusion R MCA), residual weakness L sided, L hemineglect, bulbar dysfunction (dysphagia s/p g-tube [**2116-6-15**], slurred speech) 6. Anemia, unclear etiology 7. Bilateral PEs [**6-9**], initially on coumadin, now s/p IVC filter this [**Month/Year (2) **] for RLE DVT. 8. Recent aspiration Pneumonitis, requiring intubation [**2116-6-17**], then VAP s/p zosyn X 8 days, extubated [**6-23**] s/p L knee repair and replacement s/p ventral hernia repair s/p L hand surgery after fracture s/p L elbow surgery s/p G tube and J tube? MEDICATION ON ADMISSION: ALLERGIES: Celebrex PHYSICAL EXAM: Upon [**Location (un) **] to ICU, physical exam was as follows: FAMILY HISTORY: FH: Father died of CAD and mother died of stomach cancer. No FH of strokes, seizures and bleeding issues. SOCIAL HISTORY: SH: Quit smoking in [**2074**] and sober for 7 years. Works as full-time maintenance person at [**Hospital1 11485**] School in [**Location (un) 2624**]. Has three children and several grandchildren.

CHIEF COMPLAINT: Altered mental status and CT scan at outside hospital with colonic abcess, right renal artery embolus PRESENT ILLNESS: 74 y/o F with a h/o HTN, RA, hypercholesterolemia who presents from OSH for further w/u of R renal artery embolus and sigmoid diverticulosis with intramural abscess, and slurred speech. Pt. is delirious and is unable to relay a history; history is obtained from her daughter and EMS reports. . Per report she fell at home 3 days PTA. She does not remember the fall. She says that her friend found her beside the bed yesterday morning and called EMS. She reports L lower back pain since the fall. She reports that she has felt "generally down and punk" for several days, and that her speech has been "heavy, thick and boozy" for about 2 weeks. She denies numbness anywhere, has noticed generalized weakness but no focal weakness, denies dysphagia, word finding difficulties, bowel or bladder incontinence. She denies fevers, chills, N/V, abd pain, or dysuria at home. . Per EMS records they were called to pt's house on [**9-5**] at 18:00. Pt. was complaining of lower back pain and LUQ abd pain. Family reported to them that pt. fell 3 days ago, that she has been increasingly confused over the past few days, that her speech has been "slightly slurred," and that she has had generalized weakness for several days. . Pt. was brought to an OSH, where head CT showed age-related atrophy but no infarcts. CT abd performed and showed R renal artery embolus and diverticulosis with chronic-appearing intramural abscess. CEs negative x 1, WBC Ct 18. Pt. received Clindamycin, transferred here for further w/u. . In the ED she underwent evaluation by the neurology, vascular surgery, and general surgery teams. CXR showed a hilar mass. Vascular surgery recommended medical management of renal embolus due to new finding of hilar [**Hospital3 **] surgery recommended antibiotics and NPO status to manage diverticular abscess. She received 1 mg of ativan in the ED, mucomyst, ASA, and levo/flagyl. . ROS (per family): Pt is s/p fall 6 mos ago and experienced a vertebral fracture. Denies fever or chills. 10 pound weight loss over past 6 months. Denied headache, cough, chest pain. Denied nausea, vomiting, diarrhea, or abdominal pain. No dysuria. No rash. MEDICAL HISTORY: HTN Hypercholesterolemia Rheumatoid arthritis Vertebral fracture Multiple falls per pt., etiology unclear spont pneumothorax - [**2097**] MEDICATION ON ADMISSION: (not taking any of these medications) atenolol prednisone folic acid fosamax methotraxate ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 97.8 ax P: 86 BP: 120/60 RR: 18 SaO2: 95% on 2L O2 General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI, sclera anicteric. MMM, OP without lesions Neck: supple, no JVD or carotid bruits appreciated Pulm: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G appreciated Abdomen: soft, NT/ND, + BS, no masses or organomegaly noted. Ext: No clubbing cyanosis or edema. Skin: no rashes or lesions noted. Neurologic: -mental status: Alert & Oriented x [**2-10**] (occaisionally correctly identifies this as a hospital). -cranial nerves: intact except unable to protrude tongue. -motor: reduced bulk. Able to hold limbs against gravity but would not resist. So [**4-12**] throughout. Possibly confounded by effort. -sensory: No deficits to light touch detected. -cerebellar: dysarthric. -DTRs: 2+ biceps, triceps. FAMILY HISTORY: emphysema - mother glomerulonephritis - son SOCIAL HISTORY: lives alone in [**Location (un) 4047**] with home health asst several times a week. Tobacco: 1.5 PPD since age 16. No EtOH, no illicits.

CHIEF COMPLAINT: supratherapeutic INR, rigors, delirium PRESENT ILLNESS: Mr. [**Known lastname **] is a 78 year old man with h/o CAD s/p MI [**2095**], Afib on Coumadin, CMP EF 45%, s/p AAA repair, PVD s/p fem-[**Doctor Last Name **] bypass, cognitive impairment, HTN, HLD, biliary obstruction s/p biliary stent placement and revision in [**2126**], who was admitted to [**Hospital1 **] [**Location (un) 620**] with supratherapeutic INR, rigors, and confusion. The patient was seen in [**Hospital 197**] clinic and noted to have a supratherapeutic INR to 7. Also noted to have altered mental status and rigors, so was transferred to the [**Hospital1 **] [**Location (un) 620**] ED. Wife has noted increased confusion from baseline (typically mild cognitive impairment and confusion when he moves from [**State 108**] to [**State 350**]) x 1 week. At [**Hospital1 **] [**Location (un) 620**], the patient was admitted to the ICU for further workup of AMS, rigors, and low grade fevers (100.8). Initial concern for UTI given recent instrumentation of the bladder (bladder tear s/p repair in [**State 108**] recently) and dirty UA, but UCx was negative. Patient noted to have elevated AP, as well as biliary sludge on Abd U/S and ?obstruction on CT abdomen, concerning for cholangitis, started on Zosyn for empiric coverage. Patient had a biliary stent placed in the past for obstruction that migrated and was replaced in [**1-3**]. According to records, this was supposed to be removed in [**5-3**], but that was not done. ERCP team at [**Hospital1 18**] was notified and will evaluate his stent further. Hospital course at [**Hospital1 **] [**Location (un) 620**] was complicated by hypotension (SBP 90s), for which the patient was given some gentle IVF with improvement of pressures. He developed flash pulmonary edema and responded well to Lasix 20mg IV x1. Patient was also delirious/agitated, given Ativan and Haldol prn. MEDICAL HISTORY: CAD, s/p MI [**2095**] Cardiomyopathy, EF 45% Afib on Coumadin HTN HLD Mild cognitive impairment TIA - in the setting of low INR Biliary obstruction - s/p biliary stent in the past with migration, replaced by metal stent in [**1-3**], supposed to be re-evaluated/possibly removed [**5-3**] but was not done PVD s/p L fem-[**Doctor Last Name **] bypass [**2126**] s/p bladder repair for tear [**3-4**] s/p AAA repair [**8-2**] Prostate ca - s/p radiation Gout UTIs MEDICATION ON ADMISSION: Medications at home: Metoprolol 25mg PO BID Lisinopril 5mg PO daily Coumadin 2.5mg PO daily x 6 days, 5mg PO daily Mondays, currently held for supratherapeutic INR MVI 1tab PO daily Protonix 40mg PO daily Flomax 0.4mg PO qhs ASA - d/c'd in [**State 108**] recently ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: Vitals: T 97.4 P 96 BP 145/84 RR 33 O2sat 96% General: lethargic, arousable to voice, oriented x1, no acute distress, Cheynes-[**Doctor Last Name **] breathing pattern HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: irregular, tachycardic, S1 + S2, no murmurs, rubs, gallops Lungs: decreased breath sounds at bases, otherwise clear Abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding FAMILY HISTORY: Father with prostate problems. Mother died at age 89 after hip fracture, ?clot. SOCIAL HISTORY: Lives with his wife, also has a home in [**Name (NI) 108**]. History of tobacco use, but quit in [**2114**]. Does not drink alcohol.

CHIEF COMPLAINT: lethargy, fevers. PRESENT ILLNESS: Briefly, 79 yo M NH resident, h/o dementia, remote h/o saddle PE, MRSA, Afib not on coumadin presumable due to temporal lobe hemorrhage, urinary retention with recurrent UTIs who presents with urosepsis. Patient presented to [**Hospital1 **] [**Location (un) 620**] with lethargy, fevers to 102, HR 180s Afib, BP 100/90s. Treated with Zosyn, 2L IVF, and transferred to [**Hospital1 18**] for further management on [**2172-9-29**]. On arrival to [**Hospital1 18**] [**Name (NI) **], pt was rigoring and minimally interactive, VS 100.2, 80, 132/74, 38, 94% NRB and then became hypotensive to 70s. He was rescusitated with 6L IVF w/o improvement in BP. Neosynephrine was started after a R IJ was placed. Levophed was started due to persistent hypotension. In the MICU, patient treated with Zosyn ([**10-2**]), growing proteus in urine resistant to amp and fluoroquinolones and piperacillin based on culture data from [**Location (un) 620**], here sensitive to Zosyn and clinically improved. Blood culture growing [**2-23**] coag neg staph--sensitivities pending. Also started to have loose stool, C.Diff positive- started flagyl on [**10-4**]. NG tube placed for feeding. Pt developed ARF with Cr to 2.8 now resolved. Patient now back on diltiazem for HR control and SBP stable. Upon transfer to the floor, patient resting comfortably, denies pain, oriented to self and place. VSS. MEDICAL HISTORY: 1) Bilateral Saddle Pulmonary Emboli s/p IVC filter 2) Delirium 3) Alcohol Withdrawal 4) Dementia 5) Urinary retention 6) Complicated urinary tract infection 7) Thrombocytopenia NOS 8) Large Inguinal hernia 9) Macrocytic anemia 10) History of alcoholism 11) Hypertension 12) Lung nodules NOS 13) Schizotypal personality disorder with paranoid ideation 14) Does NOT report appendectomy MEDICATION ON ADMISSION: Cholecalciferol (Vit D3) 400mg po daily Hexavitamin daily Thiamine HCl 100mg PO daily Folic acid 1mg po daily Acetominophen 325mg prn Haloperidol 1mg PO BID Quetiapine 25mg two tabs po BID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS 97.1 122/62 90 24 96% RA Gen: cachectic male, NAD, lying flat in bed HEENT: OP clear, dry, anicteric Neck: supple, RIJ in place, C/c/i CV: nl s1/s2, irregularly irreg Lungs: CTA anteriorly Abd: soft, NT Ext: 2+ edema throughout. Large scrotal edema Neuro: oriented to self and place, follows simple commands, diminished strength throughout. FAMILY HISTORY: No h/o psychiatric illness per pt. Mom died of GI cancer, dad died of heart failure SOCIAL HISTORY: Graduated HS, taught machine shop, [**University/College 23925**] and [**University/College 5130**] [**Location (un) **], rec'd Bachelor's of Science. Was most recently teaching at [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 69987**] Occupational Center in [**Location (un) 669**] but quit in [**2153**] b/c "had enough money".

CHIEF COMPLAINT: Disorientation, incontinence PRESENT ILLNESS: 54 yo F with hx of SLE c/b nephritis, pericarditis and peritonitis, HTN, EtOH and substance abuse who was brought in for report of disorientation and incontinence. Per EMS, a man called from her house to report that she had incontinence. Patient does not recall the exact events leading up to her admission, she remembers losing urine continence and does not believe she had LOC. Says she was sleeping all day and then developed abdominal pain, but is not able to relay any other events from earlier today. She reports 3 week history of abdominal pain with 1 episode of diarrhea this AM, nausea and vomiting for 3 days, poor PO intake and a reported loss of 50lbs in 3 months. She reports a [**11-4**] headache since this AM with blurry vision for 2 days. Also has had non-productive cough for indeterminate amount of days, no sore throat. No chest pain or SOB. She has no BRBPR or melena, no hematemesis, no fevers/chills. No history of seizures, no recent EtOH or drug use per patient. . When EMS arrived at pt's house, pt was awake and oriented, but combative. FS was 102 in the field. She reported abdominal pain. On arrival to the ED, her T 97.2, BP was 220/135 and HR 130s, 99% RA, and she was triggered. Given total of 40mg IV hydralazine with improvement in BP to 180/105. She was complaining of severe abdominal pain and was tender diffusely on exam. She had 1 episode of coffee ground emesis, but refused NG lavage. Stool was guaiac negative. Per report, patient had possible recent crack use though pt denied any illicit drug use, only EtOH. . ECG in the ED showed ST with HR 125, LAD with STD in V4-6. CT head was limited by artifact but showed "tiny" SAH at the left parietal vertex with no other abnormalities. CT abdomen showed diffuse small bowel wall thickening, also involving sigmoid and rectum with moderate volume ascites. Surgery was consulted and felt that radiographic findings could be vasculitic in nature and related to pt's SLE, less likely ischemic given normal lactate and WBC. She had prior similar CT findings though now worse, no surgical intervention was felt to be needed. Recommended serial lactates, rheumatology c/s, empiric anitbiotic coverage with levo and flagyl, which was started, and to consider steroids. . On the floor, patient was somnolent but arousable. Reported [**11-4**] headache with blurry vision, mild chest pressure which when asked to localize, pointed to RUQ. MEDICAL HISTORY: Lupus, c/b nephritis, pericarditis, and peritonitis, currently refusing treatment (previously on steroids and Plaquenil) Hypertension Alcoholism Polysubstance abuse (cocaine, amphetamines, opiates, benzodiazepines and tobacco), on narcotics contract Neuropathy due to alcoholism and poor nutrition, seen by Dr. [**First Name8 (NamePattern2) 5627**] [**Last Name (NamePattern1) **] in Neurology Remote right basal ganglia infarction on head CT Migraine Headaches Hypothyroidism Depression/Anxiety Remote history of a gunshot wound to the abdomen with subsequent PTSD Anemia GIB secondary to PUD s/p cholecystectomy s/p hernia repair s/p total abdominal hysterectomy, bilateral salpingo-oophorectomy History of pelvic inflammatory disease with prior disseminated infection MEDICATION ON ADMISSION: -Fioricet 1 tab [**Hospital1 **] prn headache -Gabapentin 900mg TID -Levothyroxine 25mcg daily -Lisinopril 5mg daily -Nadolol 10mg daily -Omeprazole 20mg daily -Paroxetine 60mg daily -Tramadol 50mg TID prn pain -Trazodone 50mg qhs prn insomnia -Tylenol 500mg TID prn pain ALLERGIES: Ibuprofen / Aspirin PHYSICAL EXAM: Vitals: 98, 120, 168/101, 100% 2L General: AOx2, cachectic, somnolent but arousable, in mild distress HEENT: EOMI, PERRLA, mild papilledema, dry oral mucosa and tongue, hyperpigmented buccal/oropharyngeal lesions, hypopigmentation in lips Neck: supple, JVP not elevated, no cervical LAD Lungs: decreased breath sounds in RLL, no rales or wheezing CV: Tachycardic, regular rhythm, nl S1/S2, no m/r/g Abdomen: distended, soft, tender to deep palpation diffusely, mild voluntary guarding in epigastric and RUQ region with no rebound, BS sluggish GU: foley Ext: warm, 2+ distal pulses, diffuse muscle wasting of extremities FAMILY HISTORY: Father died of renal failure 1 year ago at age 75 no FH of aneurysms. Reports mother and 2 sisters with lupus. [**Name (NI) **] sister died from "steroids and lupus" and older sister wheelchair bound from lupus. SOCIAL HISTORY: Social History: Lives alone with 1 dog - on disability. Smokes 1 PPD for 30~40 years but would like to quit. Also has been sober for close to 1 year and denies any current illicit drug use.

CHIEF COMPLAINT: Multiple rib fractures, s/p fall PRESENT ILLNESS: [**Age over 90 **] yo female found after an unwitnessed fall; on Coumadin with an INR of 10.2; found to have multiple rib fractures and a hemothorax on evaluation. Takne to [**Hospital1 18**] for continued care. MEDICAL HISTORY: DM, DVT [**5-12**] on coumadin, OSA (home CPAP, but denies using it), depression, CHF (echo [**2174**] with preserved EF), hx GI bleed and gastritis [**5-12**], HTN, angina, chronic low back pain MEDICATION ON ADMISSION: Coumadin 5 Norvasc 10 Lasix 80 Lisinopril 40 Lopressor 12.5 Bactrim DS Lexapro 10 Omeprazole Colace Senna Dulcolax ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission: T:97.9 HR:69 BP:150/50 RR:21 O2Sat:96% 2L N/C FAMILY HISTORY: Non-contributory SOCIAL HISTORY: No EtoH, Tob, IVDA

CHIEF COMPLAINT: admitted from OSH s/p fall with subdural hematoma for management and evaluation PRESENT ILLNESS: 89 y/o M with PMH of afib, DMII, hypercholesterolemia transferered to [**Hospital1 18**] on [**7-14**] for evaluation of subdural hematoma. The patient initially presented to [**Hospital3 **] ED after having a syncopal episode on the morning of [**2132-7-14**]. Pt states that he went to his bathroom at 8 am to take a bath and was standing, turning on the fawcet and the next thing he remembers is finding himself lying on his back in the tub. [**Hospital3 **] notes state that patient felt lightheaded prior to fall but patient later denied this. He denied any HA, CP or palpitations, shortness of breath, diaphoresis, dizziness/LH prior to fall. His daughter then called him at 9 am to help take him to an opthalmology appt, but pt did not answer phone. Ten minutes later daughter called him again and his father sounded "breathy, winded" and that he did not need to go to the doctor's office today and then his voice trailed off. The daughter then arrived at his apartment and found his father asleep in bed but with lacerations on both of his feet, specifically left toes. In bathroom, shower curtain rod was down on floor. Patient did not appear confused but seemed "out of it", no dysarthria, answered questions appropriately, no numbness/weakness in extremities, unclear if stool incontinence (soiled underwear in bathroom but often happens at baseline). Per daughters, patient has not taken his meds in 3 days, unclear if change in PO intake. MEDICAL HISTORY: PMH (full records not available): 1) Atrial fibrillation on coumadin dxed [**2119**] 2) DMII 3) hypercholesterolemia 4) CAD 5) CHF with EF 30% by echo [**2128**] 6) Chronic renal insufficiency with baseline creat 2.0 7) h/o Zoster 8) Thrombocytopenia with plt count as low as 125 in [**2128**] MEDICATION ON ADMISSION: 1. Lasix 80 mg daily 2. Coumadin 4.5 mg daily 3. Digitek 0.125 mg daily 4. Namenda 10 mg daily 5. Avandia 4 mg daily 6. Mobic 15 mg daily 7. Aricept 10 mg daily 8. Lipitor 20 mg daily 9. Aldactone 25 mg daily 10. Flomax SA 0.4 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 96.6 BP 140/44 P 67 R 14 Sat 93-95% RA Gen: A+O x 3, lying comfortably, NAD, speech clear, answering ?'s appropriately HEENT: R surgical pupil and left pupil 1mm minimally reactive, EOMI, OP clear with MM slightly dry, OP clear CV: irreglarly irregular, no m/r/g Pulm: CTA anteriorly Abd: + BS, soft, NT, ND Ext: no LE edema to knees, +2 DP pulses bilaterally; R LE with purple discoloration over lateral aspect Neuro: CN 2-12 intact, strength 4+/5 equal and symmetric bilaterally, DTRs 2+ throughout flexors and extensors, neg Babinski, no pronator drift Skin: Abrasions on LEs. Left foot with dressing c/d/i. FAMILY HISTORY: NC SOCIAL HISTORY: Lives home alone. Wife passed away from cancer. Denies tob and EtOH. Independent with all ADLs and IADLs. Children in town.

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mr. [**Known lastname **] is a 64 year old male with recent diagnosis of CAD (non-intervenable 3VD) who was discharged from [**Hospital1 18**] on [**2196-1-1**] after 4 day hospitalization for chest pain who presented to OSH after 7-10 minutes of shortness of breath this morning, now transferred to [**Hospital1 18**] for further evaluation and management. Mr. [**Known lastname **] first presented to [**Hospital1 18**] on [**2195-12-28**] on transfer from OSH for catheterization after experiencing several episodes chest pain over the prevoius 4-5 days. He had multiple episodes of chest pain, at rest, felt like weight on his chest, accompanied by shortness of breath and dizziness. Denied palpitations, nausea, vomitting. During his previous [**Hospital1 18**] admission, he had cardiac catheterization which showed 3VD with totally occluded LAD and RCA and EF 30% that was not ameniable to intervention. He was medically maximized and discharged home for planned CABG on Thursday [**2196-1-7**]. Of note, there was Code Stroke called for new left facial droop on [**12-29**], CT and MRI head negative. Droop resolved. The morning after discharge, he was walking around his house and experienced 7 minutes of shortness of breath with mild chest pressure. The shortness of breath recurred later in the morning and he went to [**Hospital3 **] for evaluation. He states the chest pain is different than prior, however he did experience SOB before previous admission. At [**Hospital3 **], Troponin 0.02, chest pain free since admitted, started on heparin gtt and loaded with 600 mg plavix at 1537. On review of systems, he denies history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for dyspnea on exertion with 3 blocks of ambulation (worsening over months) and paroxysmal nocturnal dyspnea; denies orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: no-Diabetes, no-Dyslipidemia, no-Hypertension 2. CARDIAC HISTORY: Denies 3. OTHER PAST MEDICAL HISTORY: Denies MEDICATION ON ADMISSION: MEDICATIONS (home): Aspirin 325 mg qday Atorvastatin 80 mg qday Nicotine 21 mg patch q24h Isosorbide Mononitrate 30 mg qday Omeprazole 20 mg qday Metoprolol tartrate 37/5 mg [**Hospital1 **] MEDICATIONS IN OSH ED (prior to transfer): Heparin bolus and gtt Clopidogrel 600 mg x 1 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS: T= 97.6 BP= 124/73 HR= 68 RR= 18 O2 sat= 96RA GENERAL: Elderly male in NAD, lying in bed on 1 pillow with HOB elevated 30 degrees. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. NECK: Supple with JVP of 8 cm. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: decreased BS at right posterior base, occasional bibasilar crackle, otherwise CTA bilaterally with no wheezes or rhonchi. Resp were unlabored, no accessory muscle use. ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits. FAMILY HISTORY: 2 brothers with Coronary artery disease SOCIAL HISTORY: Splits time between MA and NY, is originally from [**Country 3399**]. Lives with wife. -Tobacco history: 15 cig/day x 30-35 years -ETOH: denies -Illicit drugs: denies

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58-year-old man with a longstanding history of alcohol abuse who presented for a liver transplant on [**2174-8-25**]. The patient has been abstaining from alcohol since [**2173**]. He first became significantly symptomatic from his liver disease about three to four years ago. His liver disease is complicated by intractable ascites, hepatic encephalopathy, malnutrition, and fatigue. His history is also significant for falling down last year which was complicated by a compartment syndrome in the right leg status post fasciotomy. On the day of admission, the patient had no specific complaints except for some tingling in the right foot. He denied any recent fevers, chills, nausea, vomiting, diarrhea, shortness of breath or chest pain. PAST MEDICAL HISTORY: 1. Alcoholic cirrhosis diagnosed in [**2170**], class C with ascites, edema, esophageal varices, low grade encephalopathy. 2. Alcohol abuse, abstinent since [**2173**] 3. Eczema 4. History of right clavicular fracture 5. History of Enterobacter bacteremia 6. History of guaiac positive stools 7. History of right leg fasciotomy, status post compartment syndrome MEDICAL HISTORY: 1. Alcoholic cirrhosis diagnosed in [**2170**], class C with ascites, edema, esophageal varices, low grade encephalopathy. 2. Alcohol abuse, abstinent since [**2173**] 3. Eczema 4. History of right clavicular fracture 5. History of Enterobacter bacteremia 6. History of guaiac positive stools 7. History of right leg fasciotomy, status post compartment syndrome MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 46-year-old male with past medical history significant for hepatitis C and alcoholic cirrhosis with a history of variceal bleed status post banding and recently admitted for hepatic encephalopathy, discharged [**2167-8-1**]. He had been doing well over the weekend, however, on the morning of the 21st, he was found by family to be unresponsive and incontinent of stool. The family called 911, and the patient was taken to [**Hospital3 417**], where he was found to be lethargic, but still arousable, but he was abusive and combative with the staff. At [**Hospital3 417**], his head CT scan was negative. His creatinine which is at a baseline at 1.3 was at 2.2. His ammonia level was 162, and he was given 1 mg of Ativan for his combativeness. The patient was transferred to [**Hospital3 **] Hospital. MEDICAL HISTORY: 1. Hepatitis C virus. 2. Cirrhosis. 3. Patient is on the transplant list. He failed interferon therapy. 4. Esophageal varices status post banding. 5. History of alcohol abuse. 6. Suspected hepatocellular carcinoma (HCC). 7. Recent admissions for fevers, mental status changes, and encephalopathy. 8. Chronic renal failure. MEDICATION ON ADMISSION: 1. Lactulose prn. 2. Nadolol 40 mg po q day. 3. Lasix 20 mg po q day. 4. Aldactone 50 mg [**Hospital1 **]. 5. Ursodiol 300 mg tid. 6. Protonix 40 mg q day. ALLERGIES: No allergies to any medicine. The patient lives with his wife. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a history of alcohol abuse. He quit one year ago. No smoking, no IV drug use.

CHIEF COMPLAINT: Colocutaneous fistula PRESENT ILLNESS: 55M with recent diagnosis of gastric cancer who underwent a total gastrectomy with J-tube placement on [**2169-4-5**]. His post-operative course was complicated by a splenic artery pseudoaneurysm (which was coiled) and an infected perisplenic hematoma which failed non-operative management (IR drained twice on [**4-16**] and [**4-30**]) and ultimately required open drainage in the OR on [**2169-5-8**]. He was discharged to rehab on [**2169-5-12**] with a wound vac over his left abdominal wound. He returns from rehab today as he was noted to have stool output through his wound vac. It was removed and replaced with an ostomy appliance and has been collecting stool. Of note, a possible fistula between the descending colon and the inferior portion of the fluid collection was seen on [**2169-5-5**] CT scan (prior to the open drainage procedure). A fistulogram was obtained to further assess but did not show evidence of communication with the fistula. MEDICAL HISTORY: PMH: BPH, hemorrhoids PSH: Total gastrectomy, feeding J tube [**2169-4-5**], drainage left flank abscess [**2169-5-8**] MEDICATION ON ADMISSION: Medications at rehabiliation: metoprolol 2.5Q6, zosyn, daptomycin, doxazosin 8', trazodone 25', tylenol, percocet, zofran ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon discharge: VS: 98.5, 90, 100/70, 12, 99% RA GEN: NAD CV: RRR RESP: Deminished bilaterally ABD: Midline abdominal incision open to air with steri strip and healed well. Stoma with appliances in RLQ, pink, 1 [**1-4**]" x 1 [**1-2**]" oval, proximal limb center, mucocutaneous junction intact, and peristomal skin intact. LLQ fistula site with minimal amount of yellow pasty stool, covered with DSD. Left to medial J-tube patent and site c/d/i. EXTR: RUE PICC line, dressing c/d/i FAMILY HISTORY: His family history is unrevealing for any history of carcinoma, he has 3 brothers and 1 sister all in good health. SOCIAL HISTORY: He has never smoked, and does not drink alcohol. He works as a cook, and lives in an extended family with his son. Was previously at rehab after recent hospitalization.

CHIEF COMPLAINT: Hypotension, rigors PRESENT ILLNESS: 82 yo M with history of multiple episodes of past syncope, CAD, hypopituitarism. He is not the most clear historian; however, he reports periods of uncontrollable shaking in his rehab facility prior to presenting to the [**Hospital6 12112**] ED the night of [**2125-11-13**]. He was assessed in triage there as having a BP of 59/36 with temp of 96 pulse of 53. At [**Last Name (un) 4199**] ED, he had a WBC count of 8.9, HCT of 32.9, and a lactate of 1.7. A head CT was performed and noted opacified left maxillary sinus, though no acute intracranial pathology. He reports a clear nasal drainage, though denies any facial pain or yellowish nasal drainage. He has had a scant cough, though denies a productive cough. He reports diarrhea in the last week. He was given 1.5 L of fluid, was started on dopamine and avelox and was then transferred to the [**Hospital1 18**] ED. He notes that he was treated at [**Hospital1 2025**] (records state that he was hospitalized from [**10-30**] to [**11-6**] for syncopal event and UTI) one week ago and was discharged to rehab, where he has remained in the last week. He was reported as ending a 14 day course of Cipro for complicated UTI on [**2125-11-13**]. His daughter notes that the patient has been admitted to several different hospitals in the area recently for urinary tract infections. Upon presentation to the [**Hospital1 18**] ED, vitals were: HR 74, BP 85/58, O2Sat 98%. Had a RIJ sepsis line place as well as a 20g IV. Got a total of 3 L NS in ED. Received 1 g Vancomycin and 4.45 g Zosyn. CVP was 6 at time of signout to the ICU. Receiving 0.09 of levophed prior to transfer to the ICU. Urinalysis was performed. Vitals prior to transfer to the unit were: T 97.3, HR 78, BP 115/51, RR 14, O2Sat 99% 3L NC. MEDICAL HISTORY: 1) Diabetes mellitus 2) Coronary artery disease with missed IMI in [**2105**] 3) COPD 4) Pituitary adenoma resection [**2106**] and [**2108**] with resulting hypopituitarism 5) OSA 6) Hypertension 7) Hyperlipidemia 8) Hypothyroidism 9) CKD baseline Cr in [**6-/2125**] was 1.4 10) Gout 11) Dementia 12) Syncope, recurrent since [**2101**] - Tilt table testing negative x 2 - Holter monitor from [**7-/2125**]: SR 41 to 92, mean 52, APBs with 6 beat run @ 102 - Nuclear exercise stress test [**7-/2124**]: [**Doctor First Name **] 2'[**51**]", 5 mets, HR 54 to 70, SBP 90 to 130, no CP, no EKG changes, EF 49% with inferior hypokinesis and moderate fixed inferior defect - Cardiac cath [**4-/2121**]: mild LCA, collateralized 100% RCA, calcified mild R fem stenosis - Interim IMI by EKG in [**2105**] MEDICATION ON ADMISSION: 1) Aspirin 81 mg daily 2) Donepezil 10 mg daily 3) Metoprolol succinate 12.5 mg daily 4) Lisinopril 10 mg daily 5) Prednisone 5 mg daily 6) Trazodone 50 mg PO QPM 7) Omeprazole 20 mg daily 8) Allopurinol 100 mg daily 9) Advair 250/50 1 INH [**Hospital1 **] 10) Calcium carbonate 1250 mg [**Hospital1 **] 11) Wellbutrin SR 200 mg [**Hospital1 **] 12) Tiotropium bromide 1 INH daily 13) Levothyroxine 25 mcg daily 14) Metoclopramide 10 mg QACHS 15) Simvastatin 80 mg PO QPM 16) Senna 2 tabs PO daily 17) Cipro 500 mg Q12H (course ended on [**2125-11-13**]) ALLERGIES: Diltiazem PHYSICAL EXAM: VS: T 98.3, HR 80, BP 140/61, RR 17, O2Sat 99% 3L NC. GENERAL: NAD, occasional shaking chill HEENT: PERRL, EOMI, oral mucosa slightly dry, NECK: Supple, no [**Doctor First Name **], no thyromegaly CARDIAC: RR, nl S1, nl S2, nl M/R/G LUNGS: CTAB anteriorly ABDOMEN: BS+, soft, NT, ND EXTREMITIES: Warm and well-perfused, no edema or calf pain SKIN: No rashes/lesions, ecchymoses. NEURO: Oriented only to self, difficult to understand his speech, BUE strength intact PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: NC SOCIAL HISTORY: He receives his primary care at [**Location 1268**] VA with Dr. [**Last Name (STitle) 29697**]. He receives cardiology care with Dr. [**Last Name (STitle) 84073**] at [**Hospital1 2025**]. Tobacco: previously smoked for 80 pack-year history, quit 12 years ago (later stated he quit only months ago) EtOH: Denies Illicits: Denies

CHIEF COMPLAINT: PRESENT ILLNESS: A 52-year-old male, with coronary artery disease, status post coronary artery bypass graft surgery, diabetes mellitus, hypertension, and chronic renal insufficiency, who presents with fevers, rigors, and a likely right arm cellulitis. The patient was recently discharged from [**Hospital1 2025**] 1 day prior to this admission for chest pain. The patient had a painful right antecubital IV site that was warm and erythematous. The patient stated that he had acute onset of fever starting the afternoon prior to admission and had "delirium," and vomited 3 times. He called EMS and was brought to [**Hospital6 256**]. In Emergency Room, he was found to have a temperature of 105, a lactate of 5.9, and a sepsis protocol was initiated. He was also recently discharged from [**Hospital6 649**] on [**3-22**] for another admission for noncardiogenic chest pain. MEDICAL HISTORY: 1. Coronary artery disease, status post coronary artery bypass graft surgery with multiple admissions, per the patient, for noncardiac chest pain to [**Hospital6 15291**], [**Hospital3 2576**] [**Hospital3 **], and [**Hospital6 1322**]. He had a sternal wound dehiscence. He had an SVG to OM stent performed in [**2148-1-21**]. He has native three-vessel disease, and has an SVG to PDA, and a patent LIMA to LAD. 2. Diabetes mellitus type 2. 3. Hypertension. 4. Hypercholesterolemia. 5. Anxiety disorder. 6. Narcissistic personality disorder. 7. Chronic renal insufficiency. 8. Neuropathy. MEDICATION ON ADMISSION: 1. Zantac 150 mg [**Hospital1 **]. 2. Aspirin 235 mg qd. 3. Plavix 75 mg qd. 4. Neurontin 900 mg tid. 5. Nitroglycerin sublingual prn. 6. Risperidone 0.25 mg [**Hospital1 **]. 7. Promethazine 25 mg q 6 h prn. 8. Ativan 1 mg q 6 h prn. 9. Ambien 10 mg q hs. 10.Isordil 10 mg tid. 11.Lopressor 25 mg [**Hospital1 **]. 12.Lisinopril 50 mg qd. 13.Tylenol prn. 14.Glipizide 20 mg qd. 15.MSSR 50 mg [**Hospital1 **]. 16.Elavil 25 mg q hs. 17.Lidocaine transdermal patch. 18.Lipitor 80 mg qd. 19.Percocet prn. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: The patient's mother had heart disease in her 70s. SOCIAL HISTORY: The patient lives in a hotel at his sister's expense. He has smoked 2 packs of cigarettes a day for 35 years. He quit 8 months ago. He denies alcohol use, drug use, or IV drug use. The patient states that he owns his own computer business.

CHIEF COMPLAINT: Fatigue PRESENT ILLNESS: (H&P obtained via interpreter) 64 year old Cantonese speaking male who recently was seen in preop testing for total right knee replacement that is scheduled for [**2186-9-28**] at NEBH. His EKG was notable for a possible old inferior infarct with T wave inversions in V4-V6. For this reason he was referred for stress testing with Dr. [**Last Name (STitle) **]. This was notable for bigeminy with exercise and possible RCA ischemia. He was referred for left heart catheterization. He was found to have coronary artery disease upon cardiac catheterization and is now being referred to cardiac surgery for revascularization. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia (diet controlled), Hypertension, prediabetes 2. OTHER PAST MEDICAL HISTORY: Prediabetic Gout Osteoarthritis, requiring right knee replacement [**2185-4-23**]: colon cancer s/p colectomy [**2184**] CVA versus TIA: dizziness, double vision ([**Hospital 8**] Hospital) - no specifics Environmental allergies Mildly hard of hearing MEDICATION ON ADMISSION: ALLOPURINOL 300MG Daily COLCHICINE [COLCRYS] 0.6 mg Daily VERAPAMIL 240 mg, 1 Tablet(s) by mouth every morning, may take one in evening if BP his high CETIRIZINE 10 mg, [**12-25**] Tablet(s) by mouth daily prn CHOLECALCIFEROL (VITAMIN D3) 2,000 unit Daily CYANOCOBALAMIN (VITAMIN B-12) Dosage uncertain ALLERGIES: Amoxicillin / Clindamycin / Cortisone PHYSICAL EXAM: Physical Exam FAMILY HISTORY: No family history of CAD SOCIAL HISTORY: Divorced. No children. Retired, previously worked in acupuncture Denies alcohol, tobacco or illicit drug use.

CHIEF COMPLAINT: CC:[**CC Contact Info 59136**] Major Surgical or Invasive Procedure: Radial Artery Cannulation Intubation for respiratory failure PICC line placement and removale Chest tube placement and removal PRESENT ILLNESS: HPI: 50F w/ HIV (last CD4 408 [**10-31**]), Hep C, COPD, asthma, prior aspiration PNA presents from [**Hospital3 672**] Rehab after recent ICU admission to [**Hospital3 **] for COPD flare. Was being treated for COPD flare c steroids, abx, nebs at rehab until yesterday when patient noted to have some dyspnea night prior to [**Hospital1 18**] presentation; otherwise ROS negative from rehab. Evening of admission, pt. found unconscious in bathtub with O2 sat 55% RA. Placed on O2 6L NC c O2 sat 88%. Then started BiPap 6L, [**10-31**] c O2 sat 96%, BP 125/66, 115. ABG done at Rehab showing 7.30/85/71. . In ED, vitals: 75% NRB, 10, 98.0, 101/68, 96. Intubated for GCS 5, hypoxic respiratory failure. Head and C-spine CT done to look for fracture/bleed - negative. CXR done showing diffuse L lung opacity. Given ceftriaxone / flagyl / vancomycin for aspiration PNA and nosocomial PNA. Sputum sent, including samples for PCP. [**Name10 (NameIs) 59137**] to [**Hospital Unit Name 153**]. . In [**Name (NI) 153**], pt. intubated, sedated and no history available. MEDICAL HISTORY: PMH: 1. COPD/asthma - recent admission for COPD flare. Was taking levofloxacin, nebs, theophylline, advair and solumedrol 80 q8 hrs. 2. Aspiration PNA - recurrent but unknown # hosp. 3. DMII - on NPH 52 qAM, 30 qPM + sliding scale 4. HTN 5. R Breast CA s/p lumpectomy/radiation therapy in [**2195**]. 6. HIV - CD4 408, [**10-31**] 7. Hep C 8. OSA 9. Diverticulitis 10. Schizoaffective Disorder 11. Psoriasis MEDICATION ON ADMISSION: Meds: NPH 52 AM, 30 PM Protonix 40 [**Hospital1 **] Theophylline 200 qd Albuterol nebs Solumedrol 80 IV q8 Diamox 250 PO bid Moxifloxacin 400 IV qd Singulair 10 qd Advair 500/50 1 puff [**Hospital1 **] Spiriva 1 puff QD Nifedipine XL 60 PO qd ECASA 81 qd Atorvastatin 40 qd Quetiapine 75 tid Depakote 750 [**Hospital1 **] Celexa 20 qd Nicotine patch Tylenol 650 q8 Arimidex 1 mg daily Potassium chlride 40 meq PO daily prn K<4.0 ALLERGIES: Codeine / Iodine; Iodine Containing / Soybean / Lecithin PHYSICAL EXAM: VS - 97.3, 136/76, 87 - On vent A/C FiO2 0.5, PEEP 5, Vt 500, RR 20 HEENT - MMM, ETT in place, EOMI LUNGS - coarse rhonchi b/l at apices/axillae HEART - RRR, S1, S2, no rmg ABD - soft, NT, ND, BS+ EXT - wwp, no peripheral edema, 2+ DP pulse, denuded, chronic venous stasis changes over legs b/l NEURO - intubated, sedated. Upgoing toe R, no response L Babinski FAMILY HISTORY: FH: Mother with emphysema. SOCIAL HISTORY: SH: Lives in group home, continues to smoke [**1-29**] ppd > 25 yrs, drinks socially.

CHIEF COMPLAINT: Headache. PRESENT ILLNESS: This is a 44 year-old woman with history of multiple sclerosis diagnosed in [**2149**], maintained on Avonex, who was in her usual state of health until one week ago when she went in for an endoscopic retrograde cholangiopancreatography for gallstones. Two days after her endoscopic retrograde cholangiopancreatography, she woke up in the middle of the night with an acute headache involving the back of her head. This was very maximal onset and felt like a punch in the back of the head. The head pain was dull and not throbbing. This did not let up at all and two days later she had some nausea and neck stiffness. She did not have any fever, chills, eye pain or bloody vision or other visual symptoms. She states that the headache is worse when she cough or strains. She has had vertigo in the past but this is not the case now. She went to the [**Hospital3 2358**] Emergency Room yesterday for evaluation and received Demerol 25 mg times six as well as Versed, Phenergan, Dilaudid. She had a normal CT scan and a lumbar puncture which showed 0 white cells (tube number four had 10 white cells), 400 red cells (tube four had 240 red cells), glucose 49 and protein 55. No opening pressure was recorded. Afterward she felt worse with the headache and it extended to the bifrontal region. She also received one dose of ceftriaxone for meningitis coverage. She currently has a 7 out of 10 headache pain. She does report having occasional headaches around her period located in the occiput. There are no fevers, chills, problems breathing or diarrhea. MEDICAL HISTORY: 1) Multiple sclerosis treated with Avonex with past flares including numbness from the waist down, blurred vision. Per patient there were no spinal cord lesions on imaging. 2) Avascular necrosis of bilateral shoulders, status post shoulder replacement. 3) Tubal ligation. 4) Two successful pregnancies, one miscarriage. 5) Gallstones. MEDICATION ON ADMISSION: ALLERGIES: Rifampin. PHYSICAL EXAM: FAMILY HISTORY: There is no history of migraines. SOCIAL HISTORY: She lives at home with her husband. She is a nonsmoker and does not drink alcohol.

CHIEF COMPLAINT: SVC Syndrome PRESENT ILLNESS: 57 year old male from [**State 1727**] with CAD s/p MI x2 ([**2135**], [**2143**]), ?COPD (on 2L home O2, 3ppd smoking for years), atrial flutter on coumadin, found to have new lung mass with recent onset of SVC syndrome, s/p bx at VA [**Location (un) 669**], now transferred to [**Hospital1 18**] for airway protection prior to initiation of XRT. . Patient initially went to [**Hospital6 43614**] Center in [**2152-11-10**] for CP. W/u revealed a new mediastinal mass and he was transferred to Togus VA for further workup. An initial bronchoscopy was performed but biopsies have been nondiagnostic. A f/u CT on [**2153-6-3**] revealed spread of the mass to the right lung. He also developed pneumonia during this time and went into new-onset atrial flutter during another bronchoscopy which had to be aborted because of this event. He was started on diltiazem and coumadin. However, his rate was difficult to control. He underwent repeat bronchoscopy in [**Month (only) 205**] but obtained tissue only revealed necrosis per the patient. . The patient was eventually transferred to the VA [**Location (un) 669**] for CT-guided biopsy given these unsuccessful attempts to make a diagnosis. He was initially on the floor after admission on [**2153-7-3**] but transferred to the CCU b/o 6-8 seconds pauses after diltiazem, digoxin and atenolol given for treatment resistent atrial flutter with RVR in the 150s. His coumadin was held for the biopsy and he was kept on a heparin drip. His rate remained difficult to be controlled despite several treatment attempts. He became symptomatic after relative bradycardia to the 60s (nausea, dizziness, lightheadedness and diarrhea). His symptoms abated after CBB reversal and dopamine drip. . His course was c/b wheezing and SOB as well as increasing SVC syndrome with swelling of his face, both arms and ears. He initially received a 5-day course of PO prednisone for wheezing but was switched to IV decadrone to reduce swelling from his SVC compression. He was also started on azithromycin for post-obstructive PNA. . The CT-guided biopsy showed sarcoma versus melanoma. Plans were made to provide XRT at [**Location (un) 538**] VA. However, he was transferred eventually to [**Hospital1 18**] because of the concern for airway compromise during XRT. He was transferred on Verapamil and Digoxin for rate control as well as a heparin drip. . On ROS, the patient denies any fevers but nightsweats since [**2115**], weightloss (10 lbs in one month) with decreased appetite, and cough with clear sputum and occasional brownish clots coming up. He denies frank hemoptysis, N/V or SOB in rest. However, he did become more SOB over the last few months, most recently he can only walk to the bathroom w/o dyspnea. He is on 2L home O2. He denies any CP, constipation, urinary symptoms or blood in the stool (although he does have bleeding hemorrhoids with occasional blood on top of the stool). MEDICAL HISTORY: Hyperlipidemia CAD, s/p MI ([**2135**] + [**2143**]), each time s/p [**Name (NI) 73511**] PTSD Chronic LBP Depression Atrial flutter, on coumadin (as above) ?COPD MEDICATION ON ADMISSION: Medications: Albuterol inhaler and nebs Ipratroprium inh mom[**Name (NI) 6474**] 220 mcg q12h formoterol 12 mcg q12h Atenolol 100mg daily Digoxin 0.5 daily coumadin 5 qPM (S/T/T/S), 7.5mg (M/W/F) Ativan 1mg q4h prn Folate Vitamin B12 Nitro 0.4 SL prn Diltiazem 240 daily Vicodin 1 tab [**Hospital1 **] prn back pain Home O2 (2L) . Medications on transfer from VA: Heparin gtt at 1900 U/h Verapamil 120 tid Dig 0.25 daily Nebs ISS Trazodone 50 qHS prn Ativan 2mg qHS prn Levalbuterol inh Tylenol 1000mg PPI Senna, docusate Folate, B12 ASA 81 daily Azithromycin 250mg (day 3 out of 10 for post-obstructive PNA) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: Temp: 96.6 BP: 108/72 HR: 156 RR: 14 O2sat 98% on 5L NC GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, bluish discoloration of face and ears, MMM, op without lesions, uvula swollen NECK: severely swollen with elevated neck veins RESP: diffuse wheezes throughout, no rhales or rhonchi CV: tachycardic, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses felt EXT: [**12-12**]+ LE edema b/l (chronic), 2+ b/l UE swelling, warm feet, good pulses SKIN: bluish discoloration of face and ears as above/no jaundice FAMILY HISTORY: No malignancy. Strong FHx of diabetes on mother's side. No heart disease that he knows of. SOCIAL HISTORY: 150 pack year h/o smoking (quit 4 months ago b/o increasing dyspnea), occasional alcohol in the past, [**Doctor Last Name 360**] [**Location (un) 2452**] exposure in the past. Lives with partner in [**Name (NI) 1727**]. Has wheelchair to get around.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 65 year old male with a history of three vessel coronary artery disease with coronary artery bypass graft in [**2138**], hypertension, and hyperlipidemia, who presented to his primary care physician's office on [**2149-12-25**] with a two month history of crescendo angina and dyspnea on exertion. The patient was sent to the Emergency Department after an electrocardiogram was found to have new ST depressions in V5 and V6 and T-wave inversion in 1, AVL, V2-V6. In the Emergency Department, the patient was given aspirin, heparin, Integrilin, and was noted to be pain free. He was subsequently admitted to the C-MED service overnight where he was asymptomatic. At this time, the patient had no electrocardiogram changes. CK's were 170 and 140, MB fraction normal, troponin less than 0.01 times 2. The patient went to catheterization on [**2149-12-26**]. In the Catheterization Laboratory, normal filling pressures were demonstrated. Left ventricular gram demonstrated ejection fraction of 50-55% with mild anterior/inferior HK. Coronary arteries revealed: right dominant with left main coronary artery 40% distal, left anterior descending with a mid-70% lesion, left circumferential 40% proximal lesion, right coronary artery totally occluded to mid-vessel, saphenous vein graft to diagonal graft with an ostial 90% lesion and a 70% mid-lesion, saphenous vein graft to posterior descending artery graft with serial focal stenosis, maximum of 90%. The patient had a free right internal mammary artery to left anterior descending which was occluded. The patient underwent intervention of the saphenous vein graft to diagonal lesion which proved to be a complex intervention, as the case was complicated by no reflow in the distal vasculature following the mid-stent placement. This was successfully treated with intracoronary vasodilator administration and anticoagulation. Final angiography demonstrated no residual stenosis, no dissection, and TIMI 3 flow. The patient was chest pain free at the end of the case, however, a prophylactic intra-aortic balloon pump was placed at that time. Subsequent to this initial procedure, the patient had recurrent angina with ischemic electrocardiogram changes and was taken back to the Cardiac Catheterization Laboratory for emergent re-look angiography. Angiography at that time revealed a patent saphenous vein graft to diagonal with TIMI 2 flow, which was treated with intracoronary vasodilation with near normalization of flow to selective left internal mammary artery. Angiography revealed a native left internal mammary artery without stenosis. The patient subsequently transferred to the Cardiac Care Unit for further monitoring. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft times three in [**2138**] at [**Hospital3 2358**] with right internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to posterior descending artery, In [**4-12**] had exercise treadmill test and MIBI showed ejection fraction of 40% and reversible ischemia. 2. Hypertension. 3. Hyperlipidemia. 4. Gout. 5. Gastroesophageal reflux disease. 6. Percutaneous myocardial revascularization. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Brother died of myocardial infarction at 62, mother and father lived to be 80 each. SOCIAL HISTORY: Lives with wife and daughter. [**Name (NI) **] quit tobacco in [**2121**] after a 60 pack year history. No alcohol history.

CHIEF COMPLAINT: Esophageal cancer. PRESENT ILLNESS: The patient is 51-year-old gentleman who had a local regionally advanced esophageal cancer which was T3n2. He underwent chemotherapy and radiation and had an excellent response by repeat PET imaging. He presented to the OR on [**2110-8-27**] for Minimally-invasive esophagectomy, EGD and laparoscopic jejunostomy tube placement. MEDICAL HISTORY: Past Oncologic History: - [**12-13**] developed symptoms of difficulty swallowing and dysphagia which progressed over several months, saw GI who performed an EGD and biopsy which demonstrated adenocarcinoma - [**2110-5-2**] EUS done at [**Hospital1 18**] showed circumferential mass of malignant appearance at 36-38 cm in the distal esophagus, causing partial obstruction, staged as T3 due to pseudopodia-like tumor extension noted beyond the outer muscularis margin. [**3-7**] paraesophageal lymph nodes were noted, with most suspicious being 0.8cm at 38cm in the esophagus. Repeat biopsies of the mass demonstrated moderately differentiated adenocarcinoma, invasive into at least the mucosa, arising in a background of focal intestinal metaplasia consistent with Barrett's esophagus - [**2110-5-26**] started neoadjuvant treatment with 5-FU via continuous infusion over 4 days, Cisplatin (given [**2110-5-27**]) and XRT; infusion discontinued on day 3 [**2-5**] to chest pain. Recent cycle given end of [**6-14**] - similiar symptoms but tolerated . Other Past Medical History: Insulin-dependent diabetes mellitus Cholecystectomy Appendectomy Rotator cuff surgery Hernia repair Asthma MEDICATION ON ADMISSION: Albuterol inh, insulin (levemir), omeprazole 40'' ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Discharge: Vitals: T97.9 HR 96 BP 147/84 RR 20 O297 RA Gen: NAD, Comfortable CV: rrr Resp: cta b/l Abd: soft, non-tender. j-tube. no erythema Ext: MAE, no calf tenderness FAMILY HISTORY: Mother died of complications of diabetes. Father died of complications of diabetes. Brothers and sisters have diabetes. His children are healthy. There is no cancer in the family. SOCIAL HISTORY: The patient is married and has four children. He works as a heating and an air conditioning technician. He is a lifetime nonsmoker and does not drink alcohol.

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 64 yo M with past medical history significant for positive family history of premature coronary artery disease who was admitted to OSH [**2182-4-24**] with exertional chest pain. He ruled out for MI, but had a positive stress test and was transferred to [**Hospital1 18**] for cardiac catheterization. We are asked to consult for surgical revascularization MEDICAL HISTORY: coronary artery disease hypercholesterolemia Hypertension GERD colon polyps MEDICATION ON ADMISSION: ASA 325mg daily Colace 100mg po daily Lisinopril 10mg po daily Zolpidem 5mg po qHS PRN Simvastatin 40mg po daily Plavix - last dose:300mg [**4-26**] ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse:71 Resp:18 O2 sat:97% RA B/P Right: Left: 157/91 Height:5'9" Weight:97.5kg FAMILY HISTORY: Twin Brother died of MI age 53 SOCIAL HISTORY: Occupation:Electrician Tobacco:quit 3-4 months ago [**2-16**] ppd x 30 years ETOH:couple of beers/week

CHIEF COMPLAINT: End-stage liver disease. Here for liver transplant. PRESENT ILLNESS: The patient is a 51 year old male with hepatitis C virus cirrhosis, right lobe hepatocellular carcinoma, status post radiofrequency ablation on [**2154-5-1**] who presents preop for a liver transplant in a.m. He reports loose stools x10 per 24 hours associated with chronic abdominal pain, no fever or chills, no nausea or vomiting, no cough, no urinary frequency, or symptoms of UTI. Does admit to feeling hungry and has baseline shortness of breath. MEDICAL HISTORY: 1. Significant for hepatocellular carcinoma status post radiofrequency ablation. 2. Hepatitis C virus. 3. Cirrhosis. 4. Hypertension. 5. Nephrolithiasis. 6. DJD. MEDICATION ON ADMISSION: ALLERGIES: Patient is allergic Penicillin. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Lives in [**State 1727**].

CHIEF COMPLAINT: Abdominal/back pain s/p nephrostomy tube replacement [**1-31**], also fever/chills. PRESENT ILLNESS: 45 yo woman with recurrent Stage III papillary serous Ovarian CA s/p TAH/BSO, two subsequent tumor debulkings, chemotherapy, RT, now receiving home hospice, who is referred s/p nephrostogram/tube replacement with RLQ pain, R flank pain, fever/chills since day prior to yesterday. She also reports diarrhea that has since resolved. She denies nausea/vomiting. The remainder of her ROS is negative. MEDICAL HISTORY: PAST MEDICAL HISTORY: - Stage III papillary serous ovarian cancer s/p chemotherapy currently receiving RT - recurrent UTI with e. coli and enterococcus - Recent hospitalization for pyelonephritis - migraine headaches - atrophic left kidney - congenitally atrophic right arm below the elbow - seasonal asthma - HTN PAST SURGICAL HISTORY 1. Cholecystectomy 2. Ovarian cancer cytoreduction s/p TAH-BSO & omentectomy in '[**25**], then 2 debulking surgeries in '[**31**] and '[**35**]; 3. R ureteral stent [**2136-5-18**] for right-sided hydronephrosis secondary to extrinsic ureteric compression from advanced ovarian cancer, R percutaneous nephrostomy on [**2136-6-8**], with replacement by IR [**2137-1-31**] (pyelogram revealed distal obstruction) MEDICATION ON ADMISSION: Fentanyl 150 mcg/hr Patch Lorazepam 1mg prn Clonazepam 0.5 mg HS Hydromorphone 10 mg PRN Docusate Sodium 100 mg Capsule po bid Senna QD Reglan PRN Mirtazapine 30 mg HS Omeprazole 20 mg QD ALLERGIES: Codeine / Percocet / Demerol / Ceftin / Toradol / Naprosyn PHYSICAL EXAM: T 98.9 84 92/44 15 98 NAD RRR CTAB Abd soft +TTP RLQ no g/r +R CVAT Nephrostomy tube in place, site intact with no erythema/exudate Pelvic deferred FAMILY HISTORY: Mother: Recurrent lung CA; DM Father: HTN, CVA at age 48 Sister: Cervical CA SOCIAL HISTORY: Lives with: 27 year old daughter ([**Name (NI) **]) in [**Location (un) 2251**] Occupation: previously worked in medical billing at [**Hospital1 2025**] Tobacco: Smoked 1 pack per month x15 years; quit several yeas ago EtOH: Denies Drugs: Denies Mood: Depressed Support system: Feels support from daughter/friends "sometimes"

CHIEF COMPLAINT: Hypotension, bradycardia PRESENT ILLNESS: Mr. [**Known lastname 4281**] is a 56 year old male with a history of CAD s/p DES x2 (LCx and mLAD), DM, OSA, CHF and HTN who presented to [**Hospital1 18**] ED after 1 day of fatigue, bilateral leg pain and left arm pain. The patient was in his usual state of health until the day prior to admission, when he woke up with L arm pain in addition to weakness and achiness in his legs bilaterally. His left arm pain resolves with 2 tablets of nitroglycerin. He also reports feeling "rotten" with general fatigue. These symptoms persisted all day, and prompted the patient to see his cardiologist Dr. [**Last Name (STitle) **] on the day of admission. Dr. [**Last Name (STitle) **] felt that the patient's appearance and symptoms were significantly off of baseline and found the patient to be hypotensive and sent him to the [**Hospital1 18**] ED. Of note, the patient has had several other symptoms off of his baseline recently. He reports feeling light-headed intermittently over the past 2 months with changes in position, and needs to take a pause to steady himself after standing from supine or sitting recently. In addition, he reports in the past 3-4 weeks developing mild chest pain with exertion such as lifting objects and climbing stairs which resolves with rest. He also develops leg achiness after prolonged walks. Of note, patient also had a brief 20 minute of L-sided weakness on awakening about 3-4 weeks ago for which he was going to get a head MRI later this week. He denies dyspnea, PND, orthopnea, palpitations, new leg swelling. No fever, chills, night sweats, n/v/d, cough or URI symptoms, abdominal pain, changes in bowel/bladder habits. Patient also denies any history of thyroid disease, headaches, rashes or other skin changes, any new or changed medications or any deviation from his normal medication regimen/adherence in the past weeks/months. In the ED, the patient's vitals were 96% 2L 115/75 afebrile, 54, 13. Because of concern for stroke, the patient had a CT Head which was negative for acute intracrnial process. Shortly after arrival to the ED, the patient became hypotensive to the 70-80's with some latered mental status. A RIJ central line was placed and shortly afterwards, the patient's HR went down to 35, and responded to atropine going up to 63. He received levophed and his BPs improved to 148/80.. The patient also receieved 4.5g IV Zosyn while in the ED and a CT Thoarx which showed no acute processes. On the floor, the patient's vitals were T Afebrile, HR 54, BP 126/76, RR 12, O2 Sat 95% 4L. He was stable and comfortable, though had some clotted blood in his mouth which appeared to be epistaxis. MEDICAL HISTORY: Severe obstructive sleep apnea: CPAP with 3l nc CAD status post MI and PTCA in [**2181**] - s/p LCX stenting (2.5x18 mm Cypher) on [**2190-11-2**] - s/p mLAD stenting (2.5 x 24mm Taxus)on [**2191-6-14**] - Inferior ischemia after 4.5 minute stress test on [**2196-3-23**] - [**2196-3-29**] PTCA showed widely patent stents and elevated LV and RV filling pressures Hyperlipidemia HTN Bilateral hip replacements S/P hernia repairs DM "Fatty liver" CHF Lower back pain Chronic R shoulder pain Chronic hip pain Bladder CA s/p resection MEDICATION ON ADMISSION: Certirizine 10mg daily Plavix 75mg daily Lipitor 20mg daily Bumex 2mg daily Baby aspirin daily Lisinopril 5 mg daily Ativan 5mg [**Hospital1 **] Hi-CAl ORal Liqud daily Folic ACid 1mg [**Hospital1 **] Dilaudid 4mg PO q6-8h PRN Ritalin 10mg TID Magnesium 200mg [**Hospital1 **] Gabapentin 300mg TID Metopolol succinate 50mg daily Omeprazole 40 mg daily Potassium chloride 20mg daily Metformin 1000mg daily Vitamin B6 100mg daily Celexa 20mg daily Lantus 6u qHS ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: Admission Physical Exam: T Afebrile, HR 54, BP 126/76 (augmented), RR 12, O2 Sat 86% RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx coated with dark, guaiac positive fluid. No temporal tenderness. Neck: supple, JVP 7-8cm, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Bradycardic, normal S1 + S2, no murmurs, rubs, gallops Abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: cool, 2+ pulses, no clubbing, cyanosis or edema. Tenderness to palpation bilaterally below knees. Neuro: MS grossly normal. CN II-XII normal, no nystagmus, PERRL. 2+ biceps/brachioradialis/knee/ankle reflexes. 5/5 strength in UE and LE bilaterally except for hip extensor/flexor which was [**5-8**] bilaterally. Finger to nose testing normal, patient unable to perform heel-to-shin testing because of leg weakness. . Discharge Physical Exam: VS: 98.2 128/80 (128-188/80-96) 58 20 94% RA GEN: NAD, AAOx3, comfortable appropriate HEENT: mild tenderness of midclavicle near subclavian puncture site. No hematoma. Lungs: CTAB Heart: nls1s2 RRR, no m/r/g Abd: soft, NT, ND, +BS Ext: wwp, no edema FAMILY HISTORY: Mother died in 50's, unknown cause, Father w/ CAD, passed away 72. 10 siblings, one with CAD. SOCIAL HISTORY: Patient lives with girlfriend but has multiple family members close by. Patient walks with cane secondary to bilateral hip replacements. Quit tobacco in [**2190**] (3ppd for ~16 years) and quit heavy EtOH use in [**2180**]. Denies IVDU. Patient works as a cook. He is disabled. Daughter, [**First Name4 (NamePattern1) **] [**Known lastname 4281**] can be reached at [**Telephone/Fax (1) 50966**].

CHIEF COMPLAINT: Hypoglycemia PRESENT ILLNESS: This is a 77 year-old male with a history of DM, HTN, CHF (EF 45%), CAD s/p CABG, PAD s/p fem-[**Doctor Last Name **], a-fib, HL who presents with hypoglycemia. The patient was in his usual state of health until this evening when he was noted to confused and altered by his wife. EMS was called and performed a fingerstick and glucose was noted to be 26 and he was given 1 amp of D50 and improved to 109. In the ED, VS 98.2 72 140/62 16 96% 2L NC. Pt glucose on arrive was 41 and was given his second amp of D50 and improved to 112. He was rechecked in one hour and glucose was again low at 49. He was then given his 3rd amp of D50, Octreotide 50ucg x1 and started on a D5 gtt. He was given a total of 400cc NS and 1L D5NS. The patient was also evaluated by toxicology who agreed with the above management. Her lactate was normal at 1.5. He was admitted to the ICU for close glucose monitoring. MEDICAL HISTORY: - Diabetes mellitus, type II, HgbA1c 6.3% - Peripheral arterial disease s/p fem-[**Doctor Last Name **] bypass [**2118**], repeat angioplasty and left popliteal stent, non-healing LLE ulcers - Hypertension - Coronary artery disease s/p CABG x 4 in [**2119**]: s/p 3 drug eluting stents - Inferior MI [**10/2129**] - Systolic heart failure, EF 45% - Hypercholesteremia - Atrial fibrillation - Gastroesophageal reflux disease MEDICATION ON ADMISSION: Reviewed list with son, but patient's ability to take correctly is highly in doubt. - Glyburide 1.25 mg PO Daily - Metoprolol 50 mg PO BID (possibly only taking once daily) - Simvastatin 20 mg PO QHS - Plavix 75 mg PO Daily - Lasix 20 mg PO Daily (ran out 2 weeks ago) - Aspirin 325 mg PO Daily - Vitamin D 400 units 2 tablets PO Daily - Iron 325 mg PO Daily - Calcium 500 mg PO TID (patient does not take) - Omeprazole 20mg PO Daily (patient does not take) ALLERGIES: Penicillins / Linezolid PHYSICAL EXAM: Admission exam in [**Hospital Unit Name 153**]: GEN: Well-appearing, well-nourished, no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear NECK: 8cm JVD, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline COR: RRR, no M/G/R, normal S1 S2 PULM: bibasilar crackles, no W/R/R ABD: Soft, NT, ND, +BS, no HSM, no masses EXT: No C/C/ +1 edema, no palpable cords NEURO: alert, oriented to person, place, and time. CN II ?????? XII grossly intact. Moves all 4 extremities. Strength 5/5 in upper and lower extremities. Patellar DTR +1. Plantar reflex downgoing. Arriving to floor from [**Hospital Unit Name 153**]: VS: Temp 97.5, BP 141/56, HR 69, RR 18, O2 96% on 2L NC PAIN SCORE: 0/10 GEN: Well-appearing, well-nourished, no acute distress HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, oropharynx clear NECK: Supple, JVP 8 cm H20 CHEST: Bibasilar rales, no wheezing or rhonchi CV: Irregularly irregular, normal s1 and s2 ABD: Soft, nontender, nondistended, bowel sounds normal EXT: [**12-12**]+ BLE pitting edema, left hallux s/p amputation SKIN: Chronic venous stasis changes LLE>RLE; ecchymoses in arms NEURO: Alert, oriented to person, place, and [**2134-12-11**], CN 2-12 intact, strength 5/5 BUE/BLE, fluent speech, coordination normal PSYCH: Calm, appropriate FAMILY HISTORY: Mother and father died of old age, both at [**Age over 90 **] years old. Sister with "stomach" cancer. Brother with "water in his lungs". SOCIAL HISTORY: From Sicily, moved to USA [**2089**]. Former smoker, 2 packs per day for 45 years, quit in [**2113**]. Previously drank wine, but stopped a couple of months ago. Lives with wife and son. Retired construction worker.

CHIEF COMPLAINT: Alcohol intoxication, nausea and vomiting. PRESENT ILLNESS: This is a 49-year-old man with multiple prior admissions with alcohol intoxication and withdraw, complicated by ketoacidosis and delirium tremens, who had been sober for approximately 21 months until [**2187-10-17**]; he was subsequently admitted to the [**Hospital6 1760**] in late [**2187-10-7**] for alcohol intoxication and withdraw prophylaxis. Following his discharge on [**2187-11-1**], the patient went to outpatient alcohol rehabilitation and remained sober until five days prior to admission when he began drinking again. That evening, he went to an outside hospital complaining of alcohol intoxication; he was administered intravenous fluids in the Emergency Department and was discharged to home. Three days prior to admission he resumed drinking, and over the three days prior to admission he reported that he drank one six pack of beer, one bottle of wine, and one liter of vodka. He stated that he has had "essentially constant" nausea and vomiting over these three days. Prior to admission, he noted that he had one small episode of coffee-ground emesis (approximately the diameter of a quarter) during this time, but otherwise he denied hematemesis or coffee-ground emesis. He stated that he has had coffee-ground emesis in the past; he added that he had an EGD approximately five years ago that was negative per patient report. He denied abdominal pain. He stated that he has eaten very little over the past three days due to a combination of anorexia and the inability to keep anything down. MEDICAL HISTORY: 1. Alcohol abuse necessitating multiple prior hospital admissions; history of withdraw seizures, DTs, and alcoholic and starvation ketoacidosis. 2. Chronic pancreatitis. 3. History of polysubstance abuse (cocaine, heroin, amphetamines, benzodiazepines). Last use approximately six years ago. 4. History of pancytopenia secondary to chronic alcohol abuse. 5. Left gynecomastia with negative mammogram in the past. 6. Genital herpes. 7. Depression. 8. Right clavicular fracture in [**2185-4-6**]. 9. Peptic ulcer disease with history of upper gastrointestinal bleeding. 10. Left ulnar neuropathy entrapment syndrome with pain and weakness secondary to a remote burn injury. 11. History of slipped disk. 12. Tinea pedis. 13. History of eczema. 14. Allergic rhinitis. 15. Childhood asthma. MEDICATION ON ADMISSION: ALLERGIES: NO KNOWN DRUG ALLERGIES. PHYSICAL EXAM: FAMILY HISTORY: Alcoholism in his parents and brother; father died secondary to cerebrovascular accident. Mother has [**Name (NI) 2481**] disease. SOCIAL HISTORY: The patient has been divorced since [**2176**]. He has one daughter and two step-daughters. [**Name (NI) **] sells art and antiques and has his own business. He is eager to participate in rehabilitation programs. He stated that his current financial turmoil caused him to start drinking again.

CHIEF COMPLAINT: sob PRESENT ILLNESS: HPI: Pt is a 47y/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4746**] w/ a PMH of PAF, HTN, morbid obesity and OSA who presents today with respiratory distress. He was in his USOH until approximately 1wk ago when he noted that his asthma became worse. He developed an exacerbation of his "chronic smokers cough" that was productive of white or brown sputum. At this time, the patient also noted increased SOB and wheezing, especially with exercise. He denies any CP, abdominal pain, N/V, viral symptoms, fevers, or sick contacts over the past week. . On the day of admission, the patient presented to his PCP's office with the complaints above plus malaise for a week. He was sent to an OSH ER where a CXR showed no pulmonary process but ABG showed hypercarbia and a resultant respiratory acidosis. He was transported to [**Hospital1 18**] for further management of his respiratory complaints. . In the ED, the patient was treated with nebulizers, lasix, and solumedrol with symptomatic improvement in his complaints. However, he remained hypercarbic and eventually required a 50% FM to maintain his SpO2 > 90%. . Per the patient he was diagnosed with asthma after receiving PFTs at an OSH but rarely uses his inhalers. His major trigger is cold temperatures and he has never been intubated for his asthma although he does note "lots" of hospitalizations in his lifetime related to breathing problems. MEDICAL HISTORY: 1. OSA s/p uvulectomy in 90s 2. HTN 3. PAF 4. Morbid obesity 5. Hypercholesterolemia 6. Asthma MEDICATION ON ADMISSION: 1. Coumadin 5mg/7.5mg 2. Digoxin 0.25mg 3. Cardizem CD 120mg [**Hospital1 **] 4. Amiodarone 200mg [**Hospital1 **] 5. Ultram 50mg prn 6. Indaral 200mg qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: 98.7, 140/72, 105, 20, 92% on 50%FM HEENT: EOMI, MM slightly dry, O/P clear, poor dentition Neck: No JVP appreciated but exam limited by habitus CV: Tachycardic and irregular, no M/R/G appreciated Lungs: Diffuse expiratory wheezes Abd: Obese, S/NT, +BS Ext: Chronic venous changes in the LE and pitting edema, skin tears in the posterior L calf and an erythematous 1cm x 1cm ulceration in the anterior R shin w/ mild surrounding warmth Neuro: awake and alert, responding appropriately to question and moving all extremities spontaneously FAMILY HISTORY: Father w/ CAD. GM w/ DM. . SOCIAL HISTORY: Divorced w/ 2 children. Currently a construction worker but worked in the military in the past. 60pk/yr smoker w/ current <1ppd habit. Former heavy EtOH user (quart vodka/day) but states he quit 6yrs ago. Occasional marijuana use and remote (>20yrs) cocaine use. No IVDU.

CHIEF COMPLAINT: STEMI PRESENT ILLNESS: 89 yo F with no prior h/o known CAD who presents with inferior STEMI. . Per home aid pt was sitting at home with friend when the friend noted a change in her demeaner, when home aid came to se her she was unresponsive and her eyes were rolling back and so pt's son was called. After hanging up she noted pt to be diaphoretic and nauseous. Since she seemed to improve somewhat after a few minutes without an intervention the family decided to wait initially but then shortly thereafter pt was holding her chest and said "call an ambulance". . Per EMS, when they arrived, EKG tracings were significant for an inferior STEMI and a code STEMI was activated. She was reportedly hypotensive with SBPs in the 60s while in route to the ED. Initial vitals in the ED were BP 129/80, HR 88, and O2 sat 100% NRB. An EKG confirmed an inferoposterior STEMI. She was given ASA 325 mg po X 1, metoprolol 2.5 mg IV X 1, plavix 600 mg po X 1, and started on heparin and integrillin gtts. A total of 1.5 L of IVFs were given prior to arrival to the cath lab. In the cath lab, the pt was started on a dopamine gtt at 5 mcg/kg/min for hypotension. A cardiac cath was significant for 3 vessel disease with total occlusion and thrombus in the prox RCA, total occlusion of the mid LCx, 80% prox and diffuse mid 70% of the LAD, and 40% prox occlusion of the LMCA. A CI was depressed at 1.77 with mixed venous oxygen saturation of 51%. A IABP was unable to be placed [**1-16**] tight R iliac lesion. She was then transferred to the CCU for further care with a Swan-Ganz catheter in place and off integrillin and heparin gtts. . When seen in the CCU, she denied any chest pain, or shortness of breath. Her only complaint was that she was cold. . On review of symptoms, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: # Arthritis, knees # s/p kidney removal as child # Anxiety/Depression # s/p cataract surgery - R eye 2 weeks ago, L eye several years ago # Dementia # GERD MEDICATION ON ADMISSION: Strattera 20mg qam Namenda 10mg qam Lorazepam 0.5mg-1mg qhs Prilosec 20mg qday Rozerem (melatonin) 8mg qpm Tylenol 325-625mg q6hrs prn Advil 200mg with meals ALLERGIES: Hydrochlorothiazide PHYSICAL EXAM: (on admission) VS: T 95.0 , BP 117/72, HR 97, RR 19, O2 93% on 11L NRB Gen: Elderly female in NAD, appearing anxious. Oriented x3. HEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with JVP 7 CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. Chest: Resp were unlabored, no accessory muscle use. Mild crackles at bases L>R. No wheezes, rhonchi. Abd: soft, NTND, No HSM or tenderness. Ext: No c/c/e. Skin: feet cold Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse.

CHIEF COMPLAINT: Lightheadedness/Fatigue PRESENT ILLNESS: This is a 77-year-old female who had been followed for approximately one year for known aortic stenosis and recently had undergone increasing shortness of breath and exertional dyspnea. Recent echocardiogram showed and [**Location (un) 109**] of 0.6 as well as 1 to 2+ MR and an EF of 55%. The patient has a history of atrial fibrillation and also had a previous recent CT of the chest which revealed calcifications throughout her ascending aorta. Based on all of these findings, the patient was to undergo an aortic valve replacement as well as possibility of the ascending aorta replacement. MEDICAL HISTORY: PMH: -Severe aortic stenosis (ao valve area 1.0) -Afib -HTN -GERD -thyroid nodules -cholesterol embolus to eye -peripheral neuropathy -degenerative joint disease -chronic bilateral pleural effusions PSH: -tonsillectomy -D+C NKDA MEDICATION ON ADMISSION: toprol 100A/50P, coumadin 4', lasix, verapamil, lisinopril, protonix, levoxyl ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: Well developed, well nourished, and in no acute distress. HEENT: Sclerae anicteric. LYMPHATICS: Lymph node survey was negative. LUNGS: Clear to auscultation on right, diminished BS on left base. HEART: Irregularly irregular with a harsh 3/6 systolic ejection murmur. There were no gallops. ABDOMEN: Soft and nondistended and without palpable masses. There was no appreciable ascites. EXTREMITIES: Without edema. Nonpalpable DP pulse bilaterally. NEURO: Nonfocal FAMILY HISTORY: Significant for cancer: Tissue of origin is unkown. SOCIAL HISTORY: The patient does not smoke or drink currently. She is retired. She has a past 45 packyear history of smoking

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: This is an 85 yo M with a PMH significant for NIDCM (EF 25% in [**2175**]), pAF on coumadin, stage IV CKD, HTN, and hyperlipidemia who presents with 1 week of progressive shortness of breath and wheezing. The patient was in his normal state of health until one week prior to admission when he noticed mild shortness of breath associated with exertion. Since then, this shortness of breath has been progressive and now occurs with only slight activities. The patient also notes audible wheezing during these episodes and he has had to sit frequently in order to catch his breath. The patient endorses stable 2 pillow orthopnea, no PND, no palpitations, no chest pain, no lightheadedness, no syncope. The patient notes medication compliance. He does not follow a low salt diet and he frequently eats KFC. . On review of systems, the patient denies recent illnesses, cough, sputum production, rhonorrhea, diarrhea, stomach upset, or dysuria. The patient endorses a decreased appetite, 15 pound unintentional weight loss over the last two months, urinary frequency, and nocturia. He had a gout flare one month prior. . In the ED, initial vitals were 99.8 74 124/67 18 94% RA. The patient had a CXR done that showed central pulmonary edema. He was given 40mg IV lasix and placed on NRB. The patient also recieved 1 dose of ceftriaxone and azithromycin for his leukocytosis. The patient recieved a Duoneb. On arrival to the floor, the patient is comfortable and would like to order dinner. After 2 hours, the patient became more tachypnic, desaturations to 85%, and increased wheezes and crackles. The patient was deemes to require BiPap for pulmonary edema and was transfered to the CCU overnight for monitoring. The next day, the patient was transfered back to the floor for further management. MEDICAL HISTORY: NIDCM (EF 25-30%) [**2175**] paroxysmal atrial fibrillation on coumadin Hypertension Hyperlipidemia Ventricular Ectopy Chronic renal failure - followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**] at [**Last Name (un) **] History of gout History of bleeding gastric ulcer from NSAIDS ([**2165**]) Inguinal hernia repair ([**2125**]) Hyperkalemia MEDICATION ON ADMISSION: AMLODIPINE - 10 mg Tablet - 1 Tablet(s) by mouth once a day CALCITRIOL - (Dose adjustment - no new Rx) - 0.50 mcg Capsule - 1 Capsule(s) by mouth every other day CARVEDILOL - (Prescribed by Other Provider) - 3.125 mg Tablet - 2 Tablet(s) by mouth twice a day CLONIDINE - (Prescribed by Other Provider) - 0.1 mg Tablet - 1 Tablet(s) by mouth twice a day COLCHICINE [COLCRYS] - 0.6 mg Tablet - 1 Tablet(s) by mouth once a day as needed for for gout attack as needed FUROSEMIDE - (Prescribed by Other Provider) - 20 mg Tablet - 1 Tablet(s) by mouth once a day HYDRALAZINE - 100 mg Tablet - 1 Tablet(s) by mouth twice a day HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a day PRAVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day WARFARIN - (Prescribed by Other Provider) - 2 mg Tablet - 1 Tablet(s) by mouth once a day ALLERGIES: Diovan PHYSICAL EXAM: VS: T= 97.9 BP= 149/67 HR= 71 RR= 22 O2 sat= 96% 2L NC GENERAL: NAD, breathing unlabored, speaking in full sentences. Oriented x3. Mood, affect appropriate. HEENT: maculopapular erythematous rash on central forehead, sclera anicteric, no oral lesions NECK: cachectic, JVD to ear lobe with + HJR CARDIAC: PMI located in 5th intercostal space, midclavicular line. RRR, normal S1, S2. +S3 at apex, prominent S2, no MRG LUNGS: Bibasilar crackles with extension to mid lung fields bilaterally, no wheezes, no consolidations, no dullness to percussion ABDOMEN: Hypoactive bowel sounds, Soft, NTND. No HSM or tenderness. EXTREMITIES: Large nontender bursa of left elbow, arthritic changes of hands and left ankle, no acutely swollen joints, trace lower extremity edema NEURO: CN II-XII tested and intact, strength 5/5 throughout, sensation grossly normal. Gait not tested. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: equal, symmetric FAMILY HISTORY: Denies history of sudden cardiac death, arrhythmias, malignancies. SOCIAL HISTORY: -Tobacco history: none -ETOH: rarely -Illicit drugs: none The patient moved in with his son recently after his wife passed away one year prior. The patient is retired [**Company 2318**] bus driver. He is independent in his ADLs and still drives.

CHIEF COMPLAINT: Pre-syncope PRESENT ILLNESS: 87M with AS s/p valvuloplasty x3 most recet of which was in [**1-/2185**], MVP, CABG x 6 vessel (remote), bradycardia s/p dual ICD/pacer, ischemic cardiomyopathy with EF 45%, now presenting with 3 day history worsening shortness of breath. The patient reports he developed dyspnea on exertion last week which progressively became worse. He reports he was getting out of bed and developed a hot flash and became short of breath as he was getting up, then felt dyspneic as he was walking to the bathroom. This was almost identical to the syncopal episode he had that led to his valvulopsty in 12/[**2184**]. He denies chest pain, shortness of breath at rest, lightheadedness, dizziness, nausea/vomiting. The patient reported to [**Hospital 6930**] [**Hospital 12018**] Hospital in NH for the dyspnea on exertion and was found there to have guiac posistive stool (he's on iron supplements), anemia (at his baseline), and increased weakness. He remained chest-pain free and did not report changes in dyspnea. The patient denies abdominal pain, hematemesis, changes in his bowel movements, but does report black stool due to iron supplements he takes every morning. On arrival to the [**Hospital1 18**] ED, initial vital signs were: 97.6 62 122/68 18 98% 2L NC. The patient had a CXR which was clear, and had a stool guiac which was brown and faintly positive. Cr was 1.4 from baseline 1.1, BNP 6985, CE's neg x1. The patient has had a remote h/o DVT, so underwent a CTA to r/o PE which was negative. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -Aortic Stenosis s/p valvuloplasty [**2184-10-15**] -CAD, prior CABG x 6 ([**Hospital3 17921**] Center, [**2174**]) Anatomical detail: LIMA to LAD, aortosaphenous Y-graft to the diagonal and intermediate arteries, aortosequential saphenous vein to right acute marginal - to RPDA, OM3, OM2. -h/o bradycardia s/p ICD placement in [**2181**] for VT ([**Hospital 3278**] Medical Center) -Ischemic cardiomyopathy 3. OTHER PAST MEDICAL HISTORY: -BPH -s/p cataract surgeries -s/p cholecystectomy MEDICATION ON ADMISSION: 1. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY 2. doxazosin 2 mg Tablet Sig: One (1) Tablet PO at bedtime. 3. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO twice a day. 4. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. 6. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous every twelve (12) hours: Please take until instructed otherwise by your outpatient physician. [**Name Initial (NameIs) **]:*2 syringes* Refills:*0* 8. amiodarone 400 mg Tablet Sig: One (1) Tablet PO once a day: to be started after completion of 12 days of 400mg twice a day. [**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*0* 9. warfarin 1 mg Tablet Sig: Two (2) Tablet PO every Mon/Wed/Fri. 10. warfarin 1 mg Tablet Sig: Four (4) Tablet PO every Sun/Tues/Thurs/Sat. 11. amiodarone 400 mg Tablet Sig: One (1) Tablet PO every twelve (12) hours for 12 days. [**Name Initial (NameIs) **]:*24 Tablet(s)* Refills:*0* ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Morphine PHYSICAL EXAM: VS: 98.8 95-125/60-73 65 18 95RA GENERAL: Alert, interactive, appropriate, NAD. HEENT: Sclera anicteric, pupils round and equal, MMM. NECK: Supple, JVP 8cm CARDIAC: RRR, 2/6 systolic murmer at RUSB, [**2-17**] holosystolic murmer at apex with faint diastolic component. LUNGS: CTAB, fair air movement, no crackles, wheezes, rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. EXTREMITIES: No c/c/e. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: 2+ DP 2+ PT 2+ FAMILY HISTORY: NC SOCIAL HISTORY: Lives in [**Location 84728**] NH with his wife. [**Name (NI) **] is a retired construction worker/contractor. He smoked unknown amount for 40 years quit smoking 30 years ago and drinks beer rarely. No illicit drugs.

CHIEF COMPLAINT: s/p fall, tx from OSH with C1 and type 2 dens fx PRESENT ILLNESS: [**Age over 90 **] year old female who experinced an unwitnessed fall and the patient was found down on the ground by her daughter who lives next door. The patient's daughter believes that her mother was looking for her,was looking out the door,and possibly fell from her door down 3 steps. EMS came the house on [**9-11**] and picked the patient off the ground and brought her back into the house and sat her in a chair. The patient continued to decline over 24 hours and was in bed and began experiencing difficulty with swallowing pills and neck pain. The patient was brought to [**Hospital 8125**] Hospital and airlifted to [**Hospital1 18**] for further care. MEDICAL HISTORY: dementia, HTN, MVP, GERD, bilateral cataracts, hyponatremia, laminectomy, thyroid surgery, umbilical hernia MEDICATION ON ADMISSION: 1. Asa 81 mg qd, atenolol 75 qd, diltiazem 180 mg qd, isosorbide mononitrate 20 mg qd, nitroglycerin .4 mg sublingualq prn 2. Synthroid 112 mcq qd 3. Cipro 500 mg [**Hospital1 **] x 7 days 4. Calcium 500/vitamin D 200 qd 5 Prilosec 40 mg qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T:96.8 BP:158/64 HR:88 R:25 O2Sats:99% NRB NAD/tired/non-cooperative/AAO times 0 R eye 2.5-2 mm, L eye opacified/blind (longstanding per daughter) [**Name (NI) 84667**] not participating in exam hard cervical collar, point tenderness C-[**12-15**] RRR coarse bs b/l, decreased bs at bases SNDNT abdominal exam, + normal bs multiple skin tears noted on bilateral lower extremities no e/c/c FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Lives alone. No EtOH, tobacco, drug use.

CHIEF COMPLAINT: Back pain PRESENT ILLNESS: 84 y/o F with known h/o asc. aortic aneurysm with ? dissection [**4-16**]. c/o CP this AM, went to OSH ER where CT showed possible dissection flap in ascending aorta. Remained neuro intact during transfer to [**Hospital1 18**]. Pt has severe COPD, on home O2 2-3 L/min. Lives with daughter currently who takes care of her. Able to walk to restroom. Back in [**4-16**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] was consulted on pt and did not recommend surgical Rx. Family was not inclined to go for surgery back then anyway. Pt currently denies seizures, weakness in extremities or severe SOB. Reports significant weitgh loss > 30 lbs, denies dysphagia, hhematemesis. Pt seems to be leaning towards DNR/DNI. MEDICAL HISTORY: - Hypertension - COPD on home o2 2.5L - hypothyroidism - thoracic aortic aneurysm - multiple hospitalizations for PNA - hysterectomy [**2071**] for uterine cancer - anxiety MEDICATION ON ADMISSION: levothyroxine 25', others are unknown ALLERGIES: Sulfa (Sulfonamides) / Codeine PHYSICAL EXAM: Pulse:67 Resp:33 O2 sat: 98 B/P Right: 100/56 Left: 120/67 Height: Weight: FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use, but long history of smoking quit in [**2093**]. There is no history of alcohol abuse. Lives alone and is independent with ADLs in past per family.

CHIEF COMPLAINT: Weight loss, found to have small bowel lymphoma Intra-abdominal abscess PRESENT ILLNESS: The patient presented to her oncologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2405**], on her routine follow up with significant amount of weight loss. She underwent staging scans which demonstrated a large mass involving the fourth part of the duodenum, possibly the first part of the jejunum with some necrotic areas and air within them; in addition, a second small bowel mass involving the small bowel. Given the location of the retroperitoneal tumor as well as the necrotic nature of the tumor, decision was made to proceed with surgical resection if possible as endoscopic biopsy would not provide adequate diagnosis. MEDICAL HISTORY: PMH: - Hypercholesterolemia - Parkinson's disease - Celiac sprue - Diaphragmatic hernia - Osteoporosis - Esophageal web - Hypothyroid - Polyarthropathy - lower extremity neuropathy MEDICATION ON ADMISSION: Carbidopa/Levodopa (SINEMET) 25/100mg TID, Carbidopa (LODOSYN) 25mg qAM, Rasagiline 0.5mg qAM, Gabapentin 600mg [**Name (NI) 5910**] (per pt), [**Name (NI) **] 81mg daily, omeprazole 20mg qAM, levothyroxine 88mcg daily, simvastatin 20mg daily, hydroxychloroquine 400mg daily, calcium carbonate & MVI ALLERGIES: Nitrofurantoin / Amoxicillin / clarithromycin / Sulfisoxazole / Gluten PHYSICAL EXAM: Discharge Exam: Absence of heart sounds, absence of spontaneous respiration, absence of pupillary reflexes. FAMILY HISTORY: Parents died of noncancer causes. A brother had [**Name2 (NI) 499**] cancer and lung cancer, but died of COPD. One of her daughters had breast cancer. SOCIAL HISTORY: - No tobacco - Rare EtOH - Widow w/ 7 children, 2 deceased, lives in senior housing.

CHIEF COMPLAINT: Fatigue PRESENT ILLNESS: 88 yo M PMH of pancreatic CA, no recent tx, in clinic for survaillence CT scan (which showed no change) mentioned that he was tired to his oncologist, hct was 18.8 down from 28 in [**Month (only) 359**], sent to ED for eval. In the ED, vitals on presentation were T 97.7 BP 153/65 HR 70 RR 24 97%RA. On exam, he had no stool in rectal vault, but mucous was guaiac (+). NG lavage negative. 2u pRBC ordered, but not yet hung. He was given Protonix 40 mg IV x 1. On transfer to unit, patient reports a 2 month history of progressive DOE, now SOB when he walks to the bathroom. Was able to walk a city block and work in his garden over the summer. Denies PND, no orthopnea. No increased lower extremity edema - has chronic on L side from vein harvest for CABG. Denies any BRBPR, stool is always black as he is on iron, but no sticky stool suggestive of melena. Occasionally has blood on toilet paper when he wipes, but nothing that has turned the toilet bowl red. Denies any hematemesis, no hemoptysis. MEDICAL HISTORY: # Pancreatic CA localized to pancreatic tail s/p cyber knife therapy, deemed a poor surgical candidate # Anemia - Chronic GI bleed with recent hospitalization [**10/2141**] # Coronary artery disease status post coronary artery bypass graft in [**2127**], left internal mammary coronary artery to left anterior descending coronary artery, saphenous vein graft to posterior descending coronary artery, saphenous vein graft to D1/OM1 # Noninsulin dependent diabetes mellitus # Status post cholecystectomy # Hypertension # Hypercholesterolemia MEDICATION ON ADMISSION: Atenolol 25 mg PO daily Lasix 20 mg PO 2X/week Zocor 40 mg PO daily Omeprazole 20 mg PO daily Cozaar 25 mg PO daily Compazine 10 mg PO PRN nausea Imdur 30 mg PO daily Glyburide 2.5 mg PO daily Nitro SL PRN Iron 325 mg PO TID ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Presentation: FAMILY HISTORY: No history of colon CA. SOCIAL HISTORY: Positive tobacco times thirty five pack years. Quit approximately twenty years ago. Lives with wife. Retired from [**Company 2676**]. Rare EtOH, no drugs.

CHIEF COMPLAINT: unable to give PRESENT ILLNESS: HPI:This is 55 year old who was at home and was experiencing hallucination, nausea, vomiting, incontinence of stool and urine as well as severe headache prior to bed last night. This morning the patient was unarousable and was brought to an outside hospital where his Head CT was consistent with diffuse subarachnoid hemorrhage. The patient was transferred here after difficult intubation and dilantin load with 1 gram IV for further management. This HPI was obtained from the medical record form the outside hospital and verbal report from the Emergency Department Resident as the patient is unable to answers questions at the time of the initial evaluation. MEDICAL HISTORY: PMHx:none MEDICATION ON ADMISSION: none ALLERGIES: Shellfish Derived PHYSICAL EXAM: PHYSICAL EXAM: Gen: GCS=6T, intubated -non responsive HEENT: Pupils:2mm minimally reactive EOMs unable to test Neck: unable to test Extrem: Warm and well-perfused. Neuro: Mental status/Orientation:intubated non-responsive Recall/Language: unable to respond FAMILY HISTORY: Family Hx:non contributory SOCIAL HISTORY: Social Hx:lives at home with wife

CHIEF COMPLAINT: Status epilepticus PRESENT ILLNESS: The pt is a 42 year-old man, with a past medical history significant for TBI and seizure disorder, reported EtOH use, who presents after being found down at or around his house, and then taken to an OSH where he was intubated and sedated out of concern for status. There is not a great deal of information known about this patient. All information is obtained throughout the [**Hospital3 **] chart and EMS report. He had an address without a phone number listed, there was no contact information otherwise and could not find a number for the given address. What is known is that EMS was called to his house where he was found lying on the floor breathing, presumed post ictal from a seizure. At first he was given Narcan because there was a concern that there was an overdose, but here was no effect. fter learning the patient has a seizure d/o he was given ~4mg of Ativan in the field and taken to [**Hospital6 **]. There he was noted on exam to have brainstem reflexes, but minimal withdrawal to pain. A head CT was obtained but did not show any acute pathology. He had levels of the two AEDs he is reportedly on (PHT and VPA), pHT was 12 and VPA 44, but it is not clear if these are pre or post load. He may have gotten 2 more mg of Ativan at this point. He was seen by neurology at the outside hospital who felt that he was still not very responsive and that this may be due to "subtle" status, and recommended intubating the patient, he was bolused 500mg PHT and started on a versed gtt and transferred to BIMDC for further neurological management. MEDICAL HISTORY: Traumatic brain injury Epilepsy Previous alcohol dependence MEDICATION ON ADMISSION: He was on Depakote and Dilantin but the drug doses were not the same as what his neurologist prescribed, as his doses were checked with his pharmacy. The patient was non-compliant with his meds so the actual drug dose was unclear. [**Name2 (NI) **] was supposed to be on Dilantin 400 mg QHS and Depakote 1 g [**Hospital1 **] as per his neurologist Dr. [**Last Name (STitle) 35852**]. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: Vitals: T: 99 P: 100 R: 16 BP: 136/92 SaO2: 100 General: Intubated/sedatated HEENT: NC/AT, no scleral icterus noted, MMM, Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds Extremities: No C/C/E bilaterally, FAMILY HISTORY: non-contributory SOCIAL HISTORY: He lives with his mother who is [**Name8 (MD) **] RN at [**Hospital 1263**] Hospital. He smokes (unclear amount), and has not drunk any alcohol for many years.

CHIEF COMPLAINT: Respiratory Failure PRESENT ILLNESS: The patient is a 68 yo F with end stage pulmonary fibrosis likely secondary to hypersensitivity pneumonitis, progressively declining over the last few months. On [**2119-12-6**], the patient had a transtracheal O2 catheter placed. Since then she developed mucus plugging with increased coughing. Yesterday morning her family called 911 because of respiratory distress. She was brought to an OSH where she was found to be oxygenating in the low 80's with a decreased mental status. She was emergently intubated and a chest tube was placed for a tension pneumothorax. A chest tube was placed and her lung reexpanded 80% by CXR over night. Per report her chest tube was to low wall suction with serosanguinous output. The records indicate that they gave her of trial of chest tube to suction prior to transfer. She has been sedated and mechanically ventilated (FiO2 .5 and airway pressures in high 20s, low 30s). She developed an air leak in her chest tube on the evening of transfer. She is being transferred in at the request of her family. Enroute to [**Hospital1 18**], the patient was originally on a propofol drip but became hypotensive. Levophed was started. The propofol was stopped and the patient received a given a 600cc bolus. She then received a total of 650 fenanyl and 1mg midazolam. Chest tube on suction throughout flight. Decreased urine output. The patient arrived at [**Hospital1 18**] on the following vent setting: AC 350 x 14 100% FIO2 5 PEEP. The 5 of PEEP was added inflight to [**Hospital1 18**]. MEDICAL HISTORY: --Idiopathic diffiuse pulmonary fibrosis, managed on home O2 --Hypersensitivity pneumonitis, diagnosed [**2112**] --TMJ --Anxiety, clonazepam at night --Depression, mantained with mirtazipine and zoloft --GERD, managed with Dr. [**Last Name (STitle) 2305**] [**Name (STitle) 93822**] --Squamous cell ca, skin, LLE MEDICATION ON ADMISSION: Home Medications: Acetaminophen 325 mg 1-2 Tabs PO Q6H Albuterol 90 mcg1-2 Puffs Q6H as needed. Metformin 850 mg [**Hospital1 **] Ranitidine 150 mg HS Simethicone 80 mg DAILY Prednisone 20 mg DAILY Sertraline 50 mg DAILY Azathioprine 100/50 mg AM/PM Sildenafil 25 mg TID Guaifenesin 600 mg [**Hospital1 **] Mirtazapine 15 mg HS Benzonatate 100 mg TID BActrim 160-800 mg 1 Tablet PO 3X/WEEK (MO,WE,FR) Clonazepam 1 mg QHS Dorzolamide 2 % Drops One Drop Ophthalmic [**Hospital1 **] ALLERGIES: Erythromycin PHYSICAL EXAM: Vitals - HR 93 SBP 94/64 RR 8 O2100% on AC 350 x 14 100% FIO2 5 PEEP General - sedated, follows simple commands HEENT - PERRL Neck - supple, transtracheal catether in place; insertion site clean, dry, and intact CV - RRR Lungs - diffuse rhonchi Abdomen - soft, NT/ND Ext - 1+ edema bilateral lower extreities FAMILY HISTORY: Brother - cystic fibrosis Mother - died age 87 [**1-13**] CHF (? lung disease) Father - died age 64 colon cancer SOCIAL HISTORY: She is married, does not smoke cigarettes (quit 40 yrs ago) or drink alcohol.

CHIEF COMPLAINT: urinary urgency, dysuria PRESENT ILLNESS: 53 yo with h/o renal and pancreas transplant in [**2142**], repeated renal transplant in [**2158-9-9**] who presents with dysuria, fever and urgency x2 days. THe pt states that 2 days ago she started to experience dysuria and urgency. THen the day prior to admission she started to experience fever up to 103, chills and LH. SHe went to see her PCP who sent her into the ED. MEDICAL HISTORY: 1.Gastroparesis 2.h/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 15532**]??????s Esophagus 3.h/o gastric adenoma 4.Pancreatic Insufficiency 5.Esophageal Ulcer 6.Left Upper Extermity Chronic Edema 7.h/o renal transplant in [**2142**] 8.h/o pancreatic transplant in [**2142**] 9.s/p CCY 10.Mild neuropathy 11.Moderate retinopathy s/p multiple laser treatments 12.h/o HD and PD 13.Lactose intolerance 14.Frequent UTIs since transplant every 6-8 months 15.s/p L subclavian stent due to chronically swollen left arm 16.Right foot osteomyletis MEDICATION ON ADMISSION: Lasix 80 mg in the morning, 40 mg in the pm CellCept [**Pager number **] mg b.i.d. Prograf one milligram in the morning and two milligrams in the evening prednisone five milligrams a day Creon with meals Nexium 20 mg b.i.d. Zofran four milligrams t.i.d. fluconazole 100 mg three days per month Levsin potassium 20 meq daily 1 single strength tab Bactrim a day Levoxyl 50 mcg once a day collagenase nystatin pamidronate 30 mg every three months MVI Vit E, Vit B, Vit D complex Ecotrin Iron Calcium Citrate Glucosamine Flaxseed Cranberry ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 98.4 103/74 84 NB100% SVO2 70 GEN: NAD, comfortable, talking in full sentences HEENT: anicteric sclera, MMM, good dentition Neck: neck supple, no LAD, no thryomegaly Pulm: coarse, bronchial breath sounds on the R, + egophony Cardio: nl rate, regular rhythm, nl S1 S2, no murmurs Abd: soft, NT, ND, palpable kidney in LLQ that is slightly tender, positive bowel sounds Ext: 2+ edema left upper extremity, trace edema in extremity; 5th digit amputated Neuro: A&O x3, Cn 2-12 intact, PERRL, EOMI, moving all extremities FAMILY HISTORY: Father died from alcoholism Mother 81 no med problems Sister with anal cancer SOCIAL HISTORY: No tobacco. Occassional EtOH. No drugs or herbal meds. Lives with her husband.

CHIEF COMPLAINT: PRESENT ILLNESS: This 40-year-old woman is transferred from the [**Hospital Ward Name 516**] to the [**Hospital Ward Name 517**] on [**2200-4-15**] for further management of liver failure. She has a past medical history significant for HIV and hepatitis C seropositivity. A liver biopsy in [**2196-2-1**] revealed the presence of grade 2 inflammation and Stage II-III fibrosis. Prior to admission, the patient had been receiving a course of PEG-interferon and ribavirin for her hepatitis C. She was also taking Trizivir antiretroviral therapy for HIV. She initially presented to the ED on [**4-1**] with a three week history of sore throat, pain with swallowing, nasal congestion, cough productive of white sputum, nausea, vomiting, and painful swelling of the left lower extremity. She reports taking [**1-6**] Extra Strength Tylenol every four hours for several weeks for management of her painful symptoms. On admission, she was found to be in acute liver failure with AST of 2,158, ALT 948, total bilirubin 6.0, and alkaline phosphatase of 142. She was additionally found to have pancreatitis with amylase in the 400's and lipase in the 300's. She was admitted to the [**Hospital Unit Name 153**] and stayed there for seven days and before being transferred to the floor on the [**Hospital Ward Name 516**]. A summary of her medical problems up until time of transfer to the [**Hospital Ward Name 517**] is as follows: 1. Liver disease/pancreatitis: The patient's acute liver failure was attributed to Tylenol toxicity in the setting of chronic liver disease secondary to hepatitis C. She was treated with intravenous N-acetylcysteine and her antiretroviral therapy was held. With treatment her liver function tests improved. The pancreatitis was also attributed to acetaminophen toxicity by the Toxicology consult service. Her amylase and lipase also improved with treatment. Complications of her liver failure included thrombocytopenia, impaired synthetic function with coagulopathy and hypoalbuminemia, and portal hypertension with ascites and splenomegaly. The patient's peak INR was 4.6 on [**4-2**] and her peak PTT was 80 on [**4-16**]. She developed epistaxis as well as grossly bloody stools in the course of her hospital stay. She received several units of fresh-frozen plasma and was transfused a unit of packed red cells for a drop in her hematocrit to 24.2 on [**4-8**]. A MRCP was performed to evaluate for additional causes of pancreatitis and/or obstructive biliary disease. This study was negative for obstruction of the bile ducts, but did show evidence of acute liver inflammation as well as portal hypertension. The pancreas appeared normal. Patient had a brief period of hepatic encephalopathy with confusion and asterixis. She was placed on lactulose with an appropriate increase in stool output and resolution of her confusion and asterixis. 2. Cellulitis: The patient received an ultrasound evaluation of the left lower extremity for her pain, erythema, and swelling on [**2200-4-3**]. This study revealed an area of tracking subcutaneous edema, but no deep vein thrombosis. The clinical picture was felt to be most consistent with cellulitis, and the patient was started on cefazolin. This antibiotic was changed to Unasyn when the patient did not appear to respond. As of time of transfer to the [**Hospital Ward Name 12053**], the patient was on day 10 of IV Unasyn. 3. Pharyngitis: The patient was initially felt to most likely have a viral supraglottitis. The ENT service was consulted and after an evaluation with laryngoscopy, they recommended administration of a proton-pump inhibitor for potential laryngeal reflux. They also recommended starting nystatin for empiric treatment of [**Female First Name (un) **] esophagitis. Swabs for viral culture were obtained and at time of transfer to the [**Hospital Ward Name 517**], had not revealed the presence of a viral infection. 4. Skin changes: The patient had two bullous skin lesions on her back on admission. She was evaluated by the Dermatology service. A biopsy revealed changes consistent with bullous impetigo. The consult recommended initiating topical mupirocin in addition to sterile dressings. 5. HIV: Patient's HAART was held on admission because of her liver failure. A CD4 count was drawn on [**4-2**] and returned at 574. In summary, the patient's main issues at time of transfer to the [**Hospital Ward Name 517**] were her continued liver failure, GI bleed of unknown source, persistent left lower extremity cellulitis, and persistent sore throat. She was transferred to be followed more closely by the Hepatology service. MEDICAL HISTORY: 1. HIV diagnosed in [**2194**] when the patient requested in-[**Last Name (un) 5153**] fertilization. The infection is most likely secondary to heterosexual contact as the patient had a previous significant other who is deceased from HIV. 2. Hepatitis C diagnosed in [**2194**] and treated with ribavirin and PEG-interferon. 3. Anemia. 4. Depression. 5. Hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient previously smoked [**6-10**] cigarettes per day prior to admission. She denies the use of recreational drugs. She drinks alcohol occasionally. She formally worked as a salesperson until [**2194**].

CHIEF COMPLAINT: Hematochezia. PRESENT ILLNESS: Mrs. [**Known lastname 2251**] is a 79 y/o F with PMHx of CAD s/p CABG, HTN, DM, Dementia and Glaucoma who presents with lower GI bleed. Pt was in her USOH and making lunch today when she noticed red drainage down her legs. She called her daughters concerned that she was having vaginal bleeding or that the blood may be coming from her urine. Pt reported a recent fall onto her left buttocks, denied any LOC or head trauma. Her daughters brought her into the [**Name (NI) **] for evaluation of bleeding. MEDICAL HISTORY: bilateral internal carotid artery stenosis 70-79%, s/p right ICA angioplasty and stenting [**2123**] CAD s/p CABG [**2118**], s/p cath x 12 with several stents including re-stenosis of LAD stent x 2 DM2 (A1C 6.7 [**2127-8-11**]), with complications severe HTN hyperlipidemia (LDL 78, chol 198, TG 136 [**2127-2-24**]) CKD - baseline Cr 1.4 diverticulosis glaucoma ?asymptomatic L cerebellar stroke seen on CT s/p b/l cataract surgery s/p cholecystectomy s/p hysterectomy for uterine fibroids reactive airways in the setting of URI MEDICATION ON ADMISSION: ALBUTEROL SULFATE 1-2 puffs inhaled prn ** should be reconciled ** ATORVASTATIN [LIPITOR] 80 mg daily CLOPIDOGREL [PLAVIX] 75 mg daily DONEPEZIL [ARICEPT] 10 mg daily DORZOLAMIDE-TIMOLOL [COSOPT] 1 drop opth in both eye(s) twice daily HYDROCHLOROTHIAZIDE 25mg daily IOPIDINE - 0.5% Drops - ONE GTT EACH EYE TWICE A DAY ISOSORBIDE MONONITRATE - 60 mg SR LOSARTAN [COZAAR] - 100 mg Tablet [**Hospital1 **] MEMANTINE [NAMENDA] - 10 mg Tablet [**Hospital1 **] METHAZOLAMIDE - 50 mg Tablet [**Hospital1 **] METOPROLOL SUCCINATE - 150mg daily NIFEDIPINE [NIFEDICAL XL] - 60 mg [**Hospital1 **] PANTOPRAZOLE [PROTONIX] - 40 mg [**Hospital1 **] PIOGLITAZONE [ACTOS] - 15 mg Tablet [**Hospital1 **] XALATAN - 0.005% Drops - ONE GTT EACH EYE AT BEDTIME ASPIRIN - 325 mg Tablet daily CALCIUM CARBONATE [CALCIUM 600] tablet [**Hospital1 **] ALLERGIES: Vioxx / Celebrex / Motrin / Iodine; Iodine Containing PHYSICAL EXAM: VS: T 97.4 HR 55 BP 146/86 RR 20 Sat 100% RA Gen: Well appearing elderly woman in NAD Eye: extra-occlar movements intact, pupils equal round, minimally reactive to light, sclera anicteric, not injected, no exudates ENT: mucus membranes moist, no ulcerations or exudates Neck: no thyromegally, JVD: 8 cm Cardiovascular: regular rate and rhythm, normal s1, s2, no murmurs, rubs or gallops Respiratory: Clear to auscultation bilaterally, no wheezes, rales or rhonchi Abd: Soft, non tender, non distended, no heptosplenomegally, bowel sounds present Extremities: No cyanosis, clubbing, edema, joint swelling Neurological: Alert and oriented x1, CN II-XII intact, normal attention, sensation normal, speech fluent Integument: Warm, moist, no rash or ulceration Psychiatric: appropriate, pleasant, not anxious Hematologic: no cervical or supraclavicular LAD FAMILY HISTORY: Diabetes in niece and mother, sister with Rheumatic heart disease, no other CAD or stroke. Father died at age 75 of cancer (unknown type); mother died of MI at age 67. Four siblings still alive and well, one brother died of cancer, one brother died of a fall, and a sister died at age 28 of rheumatic heart disease. SOCIAL HISTORY: Lives in [**Location 686**] with granddaughter. [**Name (NI) 6934**] with a cane. For 20 years, smoked ~1 ppd (quit [**10-3**] yrs ago). Denies alcohol and drug use.

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 76 year-old white male with a history of Parkinson's disease, idiopathic cardiomyopathy with an EF of 15%, who presented to an outside hospital on [**11-15**] with a chief complaint of shortness of breath. He was found to have mild congestive heart failure and treated with diuresis and Accupril. The patient was also found to have decrease hematocrit and guaiac in stools. He had an upper endoscopy significant for peptic ulcer disease. The patient notes subacute decline with increase dyspnea on exertion in [**2162-7-29**]. The patient was admitted in early [**Month (only) 359**] with congestive heart failure with an echocardiogram revealing an ejection fraction 50%, moderate AS and 4+ MR. The patient had an extensive workup to investigate the cause of this cardiac myopathy, which was suspected to be nonischemic. The patient was readmitted on [**11-15**] with similar symptoms, given unclear etiology of decreased cardiac function, transferred to [**Hospital1 346**] for catheterization. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: DOE and angina PRESENT ILLNESS: 51 yoM smoker w/ a h/o hyperlipidemia presents for elective cath. The patient has had 3 months of dyspnea on exertion (6 stairs while carrying boxes, in addition to chest pain if he proceeded beyond 6 stairs). He did not experience any lightheadedness, or any palpitations. He did not see a physician about this until last week where he saw his PCP. [**Name10 (NameIs) **] was sent for a stress this week, was positive and sent for cath today. He was noted to have elevated LV pressures consistent with fluid overload. Was admitted for diuresis. . He denies any rest symptoms. The symptoms have not been very progressive, they have been relatively stable over the past few weeks. He had no radiation of his symptoms, no association with nausea or other symptoms. . He denies orthopnea, PND, pedal edema. He has had some diaphoresis at nighttime in addition to possible claudication symptoms (R calf cramping during sleep). . For these symptoms he had a stress test which was positive (limited exercise tolerance, nuclear imaging with an EF 18%, marked LV dilation and large inf wall fixed defect, small apical fixed defect, reversible septal perfusion abnormality- performed on [**2195-12-29**]). Based on these stress results he was referred to the [**Hospital1 18**] for cardiac cathterization. . His cardiac cath revealed 3VD in addition to Left Main disease (LMCA ostial 70%, 100% mid LAD, 80% prox D1, LCx 50-60% proximal, OM1 70%, RCA 100% mid- fills via L--> R collaterals from LAD. MEDICAL HISTORY: Hypercholesterolemia Hypertension Depression Minor Arthritis MVA at the age of 17, with head injury (no-residual) History of Alcoholism MEDICATION ON ADMISSION: BUPROPION 150mg po bid METOPROLOL SUCCINATE 25mg po daily SIMVASTATIN 40mg po daily ASPIRIN 81mg po daily MULTIVITAMIN daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS - 98/77 88 97% RA Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Mother w/ onset of angina in mid 50s. SOCIAL HISTORY: + tobacco abuse- quit two days prior to admission, 30 pk year history. ETOH abuse in past, in remission since [**2179**]. Works as a brick layer, lives with his girlfriend. Brother [**Name (NI) **] [**Name (NI) **] (cell [**Telephone/Fax (1) 86755**]) would like to be contact[**Name (NI) **] upon discharge

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: This is a 58 y.o. female with a history of type II DM, hypertension, and schizophrenia who presented to [**Hospital3 **] on [**11-8**] with chest pain. She reports that on the day of admission, while babys[**Name (NI) 12854**] her grandchildren, she began to have sudden onset of substernal chest pain radiating to the neck and to the left arm. She reports that this pain was [**11-7**] in severity and she describes it as a "squeezing" pain. She also reports that her pain was accompanied by left arm numbness. She also notes lightheadedness, diaphoresis, and nausea. She also became acutely short of breath and called EMS. She was brought to the ED where she had VS as follows: BP 123/70, HR 90, T 98.4, O2 Sat 99% RA. She continued to have pain despite sl NTG x 3 with only mild improvement. Her pain improved from [**11-7**] to [**7-8**] in severity after NTG x 3 and she was started on nitro gtt and her pain resolved approximately 4 hours following its onset. . Her cardiac markers were negative x 3 and she had no EKG changes. She had 3 more transient episodes of chest pain during her hospitalization at the OSH. These episodes lasted for approximately 5 minutes each and resolved with SL NTG. Her last episode was on the evening of [**11-10**]. Of note, she had a positive stress test with a reversible anterior apical defect on [**11-9**]. She was transferred here for aspirin desensitization follwed by cardiac cath. . She reports that she has been having similar chest pain on exertion for approximately 3 weeks. She reports that she has had chest pain on climbing approximately 2 flights of stairs. She has complete resolution of pain with rest. Her chest pain has been progressively more severe in intensity and more frequent leading up to her chest pain that brought her to the ED. She also reports that approximately 10 years ago, she had chest pain on exertion which self-resolved without intervention. She was told that these episodes were episodes of "angina." She reportedly had a negative stress test at that time. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for chest pain. No history of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: Schizophrenia Type II DM Hypertension Asthma Rhinitis Hiatal hernia MEDICATION ON ADMISSION: MEDICATIONS on admission at OSH: Glucophage 500 [**Hospital1 **] Cogentin 0.5 [**Hospital1 **] Diovan 40 daily Zoloft 100 daily Omeprazole 20 daily Abilify 5 daily Vytorin 1 daily Oxazepam 15 qhs Alprazolam 0.5 TID Albuterol nebs Flovent ALLERGIES: Aspirin / Iodine / Shellfish / Demerol / Darvon / Sulfa (Sulfonamides) PHYSICAL EXAM: VS: T 99.8, BP 113/56, HR 65, RR 22 , O2 97% on RA Gen: WDWN middle aged female in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with no JVD CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No S4, no S3. No m/r/g. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: Her father had an MI in his 40s and died in his 60s from an MI. Mother with stroke in her 60s. Cousin who died of an MI at age 44. SOCIAL HISTORY: Social history is significant for the absence of current tobacco use. There is no history of alcohol abuse. She is a retired teacher's aide.

CHIEF COMPLAINT: DOE/Fatigue PRESENT ILLNESS: The patient is 61-year-old man with severe peripheral vascular disease status post above knee amputation who presents with severe vessel disease but preserved left ventricular function. The risks and the benefits of the procedure were explained to the patient and he wishes to proceed. MEDICAL HISTORY: CAD s/p CABGx3 Hyperlipidemia PVD s/p revascularization x6 of right leg Claudication Right AKA Right arm surgery GERD Depression Hernia repair Prior ETOH abuse MEDICATION ON ADMISSION: Simvastatin 80mg one tablet a day every morning Atenolol 50mg daily every morning Salsalate 750 one tablet twice a day Omeprazole 20mg one tablet twice a day Aspirin 325mg daily every morning Oxycodone 20mg 1-2 tablets a day as needed Percocet 5-325mg 1-2 tablets as needed for right leg phantom pain Gabapentin 600mg, one three times a day ALLERGIES: Tylenol/Codeine No.3 PHYSICAL EXAM: Ht: 5 feet 6 inches Wt: 164 lbs FAMILY HISTORY: Mother and father both died from cardiovascular diseasein their 50's. Siblings with PVD and CVD. SOCIAL HISTORY: Married with 6 children. Currently unemployed. denies alcohol use. Active smoker for past 40 years. 1/2-1ppd.

CHIEF COMPLAINT: Abdominal Pain, Confusion PRESENT ILLNESS: 44 y/o F with ESRD on HD, CAD s/p MI [**2129**], DM, IVC filters with multiple DVTs in the past who was just admitted [**1-12**] to [**1-15**] for altered mental status. She presents today with abdominal pain and altered mental status. Her last admission, she was in HD and was negative 600-800cc, and subsequently developed hypotension with SBP in 80s. During that time, her infectious workup, metabolic workup with LFTs and TFTs, and physical exam besides mental status were normal at first. She did grow blood cultures positive for coag neg staph and gran-positive rods in 1 out of 2 sets from [**2139-1-12**]. No other blood cultures following were positive. This was thought likely contaminate. Regardless, she was given vanco and had a plan to receive one week of vanco at HD. She eventually cleared without intervention. She was discharged to [**Hospital 16662**] Nursing and Rehab Center - [**Street Address(1) **]. . Today, she was found altered and with severe abdominal pain. Was not able to get much history as she is not cooperating. In the ED, initial vitals were P 97, BP 116/65, R 16, and 100%RA. She had a femoral line placed and was given cipro, flagyl and vanco. She had a CT scan showing mesenteric edema. She was noted to have a lactate of 5.1 and received approximately 2L NS in the ED. She also had dilaudid for her pain and had some apnea. She received narcan. She was noted to be hypotensive but did not require pressors. It improved with fluids. Of note, per HD nurse, her baseline BPs during HD are usually systolics 80s-90s. . She was admitted to the floor and was in severe pain. HD was started and she was tolerating well. Her vital signs were stable. She has strange writhing movements and cannot answer questions appropriately. MEDICAL HISTORY: ESRD on HD with RUE AV fistula CAD s/p inferior MI (cath [**2129**] with nonobstructive CAD, EF 65%, inf hypokinesis) DM II h/o LLE DVT (no longer on coumadin), popliteal DVT [**2136-8-25**] s/p IVC filter placement HTN Hyperlipidema GERD Reported history of MRSA MEDICATION ON ADMISSION: 1. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1) Spray Nasal [**Hospital1 **] (2 times a day). 2. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for pain. 3. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 4. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily). 5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 8. fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 12. Vancomycin 1000 mg IV HD PROTOCOL 13. erythromycin 5 mg/gram (0.5 %) Ointment Sig: One (1) Ophthalmic QID (4 times a day) for 7 days: day 1=[**2139-1-15**]. Apply to both eyes. 14. Aranesp (polysorbate) 40 mcg/0.4 mL Syringe Sig: One (1) Injection Injection once a week. 15. white petrolatum-mineral oil 56.8-42.5 % Ointment Sig: One (1) Application Ophthalmic twice a day. 16. bisacodyl 5 mg Tablet Sig: Two (2) Tablet PO once a day. 17. Levemir 100 unit/mL Solution Sig: Six (6) units Subcutaneous at bedtime. 18. Humalog 100 unit/mL Solution Sig: Per sliding scale Subcutaneous four times a day: As previous. 19. Renagel 800 mg Tablet Sig: Three (3) Tablet PO three times a day. 20. Dilaudid 2 mg Tablet Sig: 0.5 Tablet PO every six (6) hours as needed for pain. ALLERGIES: Penicillins / Zantac / Morphine / Tylenol / Naprosyn / ketorolac PHYSICAL EXAM: GENERAL: Lethargic and arousable to sternal rub and voice. Answers one word answers. HEENT: Right eye PERRL, EOMI, Artifical left eye, left sided ptosis, sclera slightly dry MM No nystagmus. NECK: supple, no appreciable JVD CARDIAC: RRR, no r/m/g appreciated LUNGS: transmitted, coarse, upper airways sounds ABDOMEN: bowel sounds present, soft, non-tender, non-distened, no hepatosplenomegaly EXTREMITIES: warm, DP/PT pulses 1+, radial pulses palpable but faint, no edema, RUE AV fistula with bruit and palpable thrill, dressing over fistula C/D/I, area without erythema, tenderness or fluctuance NEURO: lethargic, arousable to voice and sternal rub but frequently falls back to sleep, oriented to person, place, year, follows commands when awake, CN 2-12 grossly intact, strength [**4-2**] in all four extremities, swollen eyes, has chorea-like movements and writhing in pain SKIN: RUE AV fistula site without erythema FAMILY HISTORY: Mother died from DM complications, Brother also died from DM complications, Sister has DM. SOCIAL HISTORY: Born in [**Country 2045**]. Moved from [**State 108**] to Mass. recently. Lives at [**Location **] Manor. Divorced; has 21 and 16 y/o daughters who live with their father. [**Name (NI) **] tobacco, EtOH, or illicit drug use.

CHIEF COMPLAINT: SOB PRESENT ILLNESS: 85 yoM w/ class III CHF [**2-26**] ischemic cardiomyopathy s/p BiV ICD, CAD s/p CABG x2 and multiple PCIs, s/p bioprosthetic MVR, pacemaker dependent due to complete heart block [**2-26**] cardiac surgery, PAF, CRI who presents w/ worsening DOE after a recent admission and discharge from the hospital in [**2129-1-17**]. . At the time of discharge, he was feeling at his best meaning that he was able to walk 2 blocks before becoming SOB. However, since returning home, he has become progressively more letharigic, SOB, and DOE to the point that he can only walk minimally. He is still able to do ADLs such as drive, shop, wash, etc. He called his PCP today because of the lethargy and PCP spoke to Dr. [**First Name (STitle) 437**], and patient electively admitted for tailored milrinone therapy. . Upon arrival to CCU, patient walked in himself, and reports feeling more fatigued, but breathing comfortably if he does not move. He denies any CP, palpitations. He does have dyspnea on exertion, paroxysmal nocturnal dyspnea every night, 3 pillow orthopnea, and ankle edema. His weight this morning was 109. . Cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: 1. CAD s/p CABG in [**2102**] with a redo in [**4-/2121**] - stent to LAD in [**2122-1-26**]. 3. Mitral valve replacement porcine [**2121**] 4. CHF with an EF of less then 20%. 5. Pacemaker/DDD for post surgical complete heart block [**2121**] 6. Atrial fibrillation - Anticoagulation stopped secondary to hemoptysis in [**2121-7-26**], but now resumed on coumadin 7. CRI (baseline creatinine of 2.4 to 2.9) 8. Prostate cancer. 9. L eye lens replacement 10. Dyslipidemia 11. Hypertension 12. Anemia: baseline HCT 38-40 MEDICATION ON ADMISSION: Amiodarone 200 mg daily Atorvastatin 10 mg daily Captopril ???? Carvedilol 6.25 mg [**Hospital1 **] Isosorbide Mononitrate 90 mg daily Digoxin 125 mcg as directed Furosemide 80 mg [**Hospital1 **] Allopurinol 50 mg daily Warfarin 2.5 mg daily Albuterol IH Colchicine 0.3 mg daily PRN Epogen 10,000 unit/mL every other week ALLERGIES: Penicillins / Clarithromycin / Doxycycline PHYSICAL EXAM: VS: T , BP 110/78, HR 80 , RR 21, O2 % on Gen: thin, elderly aged male in mild resp distress. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple with JVP at earlobe. CV: Regular, II/VI holosystolic murmur, split S2 Chest: No crackles, but very coarse breath sounds throughout Abd: soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: No c/c/e. warm Skin: mild erythema around a small skin abrasion at left shin Pulses: Right: Carotid 2+ without bruit; 2+ DP Left: Carotid 2+ without bruit; 2+ DP FAMILY HISTORY: all siblings and both parents have CAD. SOCIAL HISTORY: The patient lives lone and wife died 4 years ago. He had sons in [**Name (NI) **] and [**Name (NI) 3844**]. Tobacco, he has a fifteen pack year history. He quit greater then 50years ago. Occasional alcohol. No elicits. Independent in all of his ADLS and recently moved to a retirement community in [**Location (un) **]

CHIEF COMPLAINT: Exertional angina PRESENT ILLNESS: This 51M is s/p CABGx2 in [**2137**] and presented to the ED on [**12-23**] with exertional chest pain. He has a known ascending aortic aneurysm of 4.9 cm. He was cathed and admitted to the CCU. MEDICAL HISTORY: - CAD s/p MI and CABG in [**2138**] (LIMA-LAD, RIMA-RCA), PTCA [**9-2**] showed 100% native vessel occlusion with patent grafts, MIBI [**8-5**] with fixed defect. - EtOH abuse - Remote head trauma '[**18**] - Hypercholesterolemia - History of seizure disorder (?EtOH vs. head trauma) - HTN - s/p skin graft to leg following MVA MEDICATION ON ADMISSION: Protonix 40mg PO daily Lipitor 80 mg PO daily Lopressor 25 mg PO BID Plavix 75 mg PO daily ASA 325 mg PO daily Lisinopril 5 mg PO daily ALLERGIES: Penicillins / Codeine PHYSICAL EXAM: Gen: Thin, [**Male First Name (un) 4746**], appears older than stated age, in NAD HEENT: NC/AT, PERLA, EOMI, oropharynx benign, carotids 2+=bilat. without bruits Lungs: Clear to A+P CV: RRR without R/G/M Abd: +BS, soft, nontender without masses or hepatosplenomegaly Ext: no C/C/E, pulses 2+= bilat. throughout Neuro: nonfocal FAMILY HISTORY: positive for early CAD Mother - died of MI at 59. Father - died at 61 of "MI and cancer.' SOCIAL HISTORY: Married ten years ago, was living in [**Location (un) 3844**]. Wife died 5 months ago, patient moved back to [**Location (un) 86**]. Funeral director. Living part time in funeral home and with his sister-in-law. Drinks 6-12 pack/day each day, [**12-3**] pack/day tobacco use, both for nearly 30 years.

CHIEF COMPLAINT: shortness of breath, fever PRESENT ILLNESS: 51 yo female with metastatic breast cancer, pt. of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] recently received herceptin/gemzer on [**10-3**] presenting to the ED with shortness of breath and fever to 104 at home. Patient reports that after her chemo on Monday, she became more "wiped out" and her appetite was poor. Her duaghter noticed that she was more sob although pt denies she was sob until today around noon. She had fever to 104 on and off and shaking chills along with diffuse joint pain. Pt denies dizziness, cp, palp, nausea, vomiting, dysuria, diarrhea. Did have loose stools on day of admission. Pt denies CHF symtpoms of PND, orthopnea, LE edema. MEDICAL HISTORY: 1. Metastatic Breast CA - - diagnosed in [**10-21**] in [**State 4565**] after feeling a lump - biopsy in [**2157**] showed infiltrating ductal CA that was high grade - ER negative, PR positive, HER2/neu positive - liver and lung metastases - s/p [**5-22**] left mastectomy and axillary node dissection - Her disease has been in her left hilar lymph node, right lower lobe pulmonary nodule and a celiac axis lymph node (per Dr. [**Name (NI) 44675**] last note) . - followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], on chemotherapy (Navelbine/herceptin last on [**2162-2-26**]) 2. DVT [**11-23**] 3. HTN 4. Depression . Her ovaries were removed in [**2160-7-20**]. She was postmenopausal since her chemotherapy in [**2159-1-20**]. MEDICATION ON ADMISSION: lisinopril 5 mg daily Calcium 600 mg [**Hospital1 **] MVI QD Ferrous sulfate 325 mg QD Zoloft 50 mg qd Lovenox 120 [**Hospital1 **] ALLERGIES: Carboplatin PHYSICAL EXAM: Vitals: T 104 BP 127/63 HR 109 O2 sat 99% on 100% NRB FAMILY HISTORY: Significant for mother who died without cancer at age 70 and a maternal aunt diagnosed with breast cancer at age 45. The patient's sister also was diagnosed with breast cancer at age 53. Her father died at 80 having been diagnosed with prostate cancer at 75. There were two paternal first cousins, one who died of leukemia at age 35 and one who died of colon cancer at a young age. SOCIAL HISTORY: Pt orig from [**Country **], lives with daughter. Widowed. [**Name2 (NI) 4084**] worked outside4 the home. 20 pk year tobacco history, quit 3 yrs ago, no etoh or drugs.

CHIEF COMPLAINT: Altered Mental Status PRESENT ILLNESS: 70 F with PMH of urosepsis and recent Klebsiella urosepsis(R to quinolones and nitrofurantoin) who presented with mental status changes, fevers, and hypotension SBP 100s. Pt was well until [**10-13**] when daughter noted she appeared more lethargic. + chills. Decreased po intake. Pt also hypoglycemic to 60s last night. Daughter called EMS. By the time they arrived FS 80s. Daughter gave pt apple juice, peanut butter crackers with improvement in blood glucose to 150s. Today, however "pt not herself." At baseline, pt is alert and oriented x 3, conversive, whereas on admission, patient was sleepy, not responding to questions. In ER, fever for the first time. In MICU, patient was noted to have altered MS, non anion gap and respiratory acidosis, ARF and hyperkalemia. Patient was hydrated with about 3L of fluids and her creatinine dropped from 2.6 to 1.7 (still off from baseline of 1.2). Kayexalate for hyperkalemia and medications with the ability to cloud sensorium were held. Patient with reported improved mental status, acidemia on callout. MEDICAL HISTORY: Right Femur Fx S/P ORIF ([**10/2165**]: Tripped Over Commode), HTN, Hyperlipidemia, DMII, Peripheral Neuropathy, Obesity, IBS (Chronic Constipation, Abdominal Pain and Intermittent Diarrhea), Chronic LBP/Sciatica (Osteoporisis, DJD/OA, Spinal Stenosis), Depression/Anxiety, Panic Disorder, Parotid Gland Tumor S/P Resection, S/P Multiple Falls, H/O Herpes Zoster, S/P CCY, B/L Cataract Removal. . MEDICATION ON ADMISSION: pantoprazole folic acid EC ASA lipitor cyanocobalmin fluoxetine dulcolax PRN MVI tizanidine senna olanzapine HS oxycodone 5 Q6hr clonazepam 2 QHS lisinopril gabapentin doxepin glipizide ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 100.2 rectal HR 85 BP 101/38 RR 15 O2 100% on 3L NC gen: obese F lying in bed intermittently moaning of pain. HEENT: PERRL. EOMI. MM dry. Neck: No increased JVP. + surgical scar on left anterior neck. CV: RRR. Nl S1, S2. No M/r/g. Lungs: decreased BS throughout [**1-22**] body habitus. no wheezes/ crackles. Abd: obese. large pannus. + minimal skin breakdown beneath pannus. soft. NT. ND. No masses. Back: unable to examine [**1-22**] size Extr: 1+ edema sl greater on R than L. Dp 1+ B/L. no c/c/e. Neuro: unable to follow commands. FAMILY HISTORY: Her mother had DM. She knows nothing of her father. [**Name (NI) **] sister died of [**Name (NI) **] at 60. SOCIAL HISTORY: She lives with her daughter, who is very involved with her care. She had 11 children, and one passed away. She was a homemaker. She quit smoking 20 years ago and had between [**4-29**] py. She uses ETOH rarely (<1x/month).

CHIEF COMPLAINT: Melena PRESENT ILLNESS: 47 yo man with h/o etoh/HCC cirrhosis, esophageal varices with melena with black emesis and dark tarry stools [**5-6**]. He states the melena started [**5-5**]. He also had some lightheadedness. He notes some abdominal pain during the ambulance ride that improved with zofran. His partner encouraged him to go to the [**Name (NI) **]. At [**Doctor First Name 8125**] hct 37.2. MEDICAL HISTORY: - Etoh/HCV cirrhosis with varices, ascites, and previous episodes of encephalopathy, Last viral load 7,340 IU/mL [**2117-2-26**]. The patient has not had a liver biopsy nor has the patient had any treatment to date for his hepatitis C followed by Dr. [**Last Name (STitle) 497**] (last seen [**4-11**]). EGD [**2115-12-23**] revealing varices at the lower third of the esophagus, with two bands placed, and portal gastropathy. Grade 3 esophageal varices with multiple admissions for GIB, banding in past; last EGD [**9-11**] varices too small to band. - Ethanol abuse with history of DTs: + hallucinations in the past but no intubations or seizures. - h/o Nephrolithiasis. - MVA [**2113-5-4**] with two fractured lumbar vertebrae, torn rotator cuff, and humeral head fracture. - h/o coagulopathy, anemia (baseline Hct ~30), thrombocytopenia - foot surgery - facial reconstruction as a child - leg cramps - asthma - Hep B SAg/sAb negative ; Hep A immune - HIV negative [**2115-7-5**] - AFP 1.81 [**2117-2-4**], U/S [**2117-2-25**] with 1.1cm echogenic focus in left lobe, f/u MRI limited MEDICATION ON ADMISSION: Pt poor historian, unable to verify meds Clonidine 0.1 mg PO TID Fluticasone 50 mcg/Actuation Nasal [**Hospital1 **] Folic Acid 1 mg PO DAILY Furosemide 40 mg PO DAILY Gabapentin 300 mg PO Q8H Lactulose 10 gram/15 mL ThirtyML PO four times a day - only takes when constipated Nadolol 40 mg PO DAILY Pantoprazole 40 mg PO Q24H - states [**Hospital1 **] Ferrous Sulfate 325 mg PO DAILY Hexavitamin PO DAILY - not likely taking Thiamine HCl 100 mg PO DAILY Lidocaine 5 %(700 mg/patch) Topical DAILY Spironolactone 100 mg PO DAILY Nicotine 21 mg/24 hr Transdermal DAILY ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T 97.9 HR 89 BP 129/82 RR 24 Sat 93% on RA GEN: NAD HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, anicteric, OP clear, MMM Neck: supple, no LAD, no carotid bruits CV: RRR, nl s1, s2, no m/r/g PULM: CTAB, no w/r/r with good air movement throughout ABD: protuberant, soft, NT, ND, + BS, no obvious HSM on percusion, ? small fluid wave, no caput EXT: warm, dry, +2 distal pulses BL, no femoral bruits Skin: spider angiomas on chest, scattered [**Last Name (LF) 94195**], [**First Name3 (LF) **] damage FAMILY HISTORY: He does not know of any liver disease or colon cancer. Father with a history of alcoholism SOCIAL HISTORY: He has a long history of alcohol abuse (since high school). currently drinking a pint of vodka per day with some mixed drinks, last drink [**5-6**] am. He has a history of DTs, no seizures or intubations for this but + hallucinations. He currently smokes less than a pack per day and has smoked 30+ years. He is unemployed but used to work as a carpenter. He has a history of IVDU (cocaine and heroin) but last use 15 years ago. He has a history of incarceration in the past.

CHIEF COMPLAINT: transfer for cath PRESENT ILLNESS: 75 year-old man with a history of coronary artery disease s/p CABG, Aortic Stenosis with unstable angina over the past few weeks who was schedued for diagnostic cath at NEBH on [**8-6**]. At that time, found to have tight SVG-OM, occluded SVG-RCA, occluded RCA and patent SVG LAD PCI. Patient transferred to [**Hospital1 **] for intervention, had PTCA/bare metal stent SVG to OM2. Cath complicated by lt main/LCX dissection and severe chest pain. Had transeint hypotension to 80s. Brief dopamein. Also had emergent echo that was negative for tamponade. BP came up quickly to 164/73. Dopa was turned off. Patient transferred to CCU from cath lab. . On arrival to the CCU had [**10-27**] midsternal chest pain radiating to both arms and diaphoresis. EKG showed old IMI and ST depressions V1 to V6 which was unchanged from EKG in cath lab. SBP in 160s. Patient placed on O2 by NC, given 3 sl NTG, morphine and started on NTG drip. pain decreased to [**2148-1-20**] and then subsided. . The events prompting [**8-6**] cath included an episode of CP, dizziness, blurring of vision on exertion 2 days ago which self-resolved. he was also found to have moderate AS at NEBH. Aortic valve area of 0.8 with a gradient of 40. ROS: h/o sob. no dizziness, palpitations, nausea, vomiting, pain in [**Last Name (un) 103**]. no h/o weakness in arms or legs. no orthopnea, PND, leg swelling MEDICAL HISTORY: CABG [**2121**] at [**Hospital1 112**] PCI w/ stent [**2141**] Hyperlipidemia L hip replacement [**2134**] R hip replacement [**2139**] Prostate resection for BPH Gout cholecystectomy GERD MEDICATION ON ADMISSION: ASA plavix atenolol lisinopril atorvastatin allopurinol ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 97.8 90 114/63 16 98 (after nitro drip on and beta-blocker) Skin: no jaundice HEENT: no JVD, MMM CV: nl S1 S2, 3/6 systolic murmur in aortic area radiating to neck Lungs: [**First Name9 (NamePattern2) 34328**] [**Last Name (un) **]: soft, NT, ND, no HSM Extr: cath site-- no bruit, no hematoma, no edema, 2+dp pulses neuro:AAOX3, no deficits in lower extremities FAMILY HISTORY: DM in siblings SOCIAL HISTORY: --Wife died 6 months ago of cancer, now lives alone. Jas a daughter who is HCP. --smoked 160 pack yrs. quit 15 yrs ago --drinks 2 glasses of red wine everyday --was a home builder. does not work anymore.

CHIEF COMPLAINT: exertional angina PRESENT ILLNESS: Mr. [**Known lastname **] is a 68 year old male who underwent tissue aortic valve replacement in [**2150-12-29**] Medical Center. While recovering in [**State 108**] in [**2151-3-29**], he experienced left sided chest pain at rest. Cardiac catheterization revealed significant multivessel coronary artery disease with preserved EF. Cardiac surgeon in [**State 108**] recommended surgical revascularization but he has decided to return to [**Location (un) 86**] for medical care. Since [**2151-3-29**], he has experienced no further chest pain. He currently admits to exertional shortness of breath and increasing fatigue. He denies orthopnea, PND, pedal edema and syncope. MEDICAL HISTORY: Past Medical History: History of Aortic Valve Disease, Coronary artery disease, Hypertension, Hyperlipidemia, History of Prostate CA-tx w/seed implants, History of [**Doctor Last Name **] [**Location (un) **] Exposure, Asthma Past Surgical History: - Aortic valve replacement [**2151-1-11**] (#23 CE bovine pericardial) - Right Lower Extremity Trauma - Shrapnel Removal from Finger/Hand - Uretheral dilitation MEDICATION ON ADMISSION: Plavix 75 daily(last dose [**2151-6-28**]), ASA 325 daily, Simvastatin 20 daily, Metoprolol 50 twice daily, Diovan 80 daily, Advair 100/50 daily, Proventil prn ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam Vitals: Obtained at PAT today General: WDWN male in no acute distress Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] no JVD Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur - soft systolic murmur which radiated to carotids Abd: Soft [x] non-distended [x] non-tender [x] bowel sounds [x] Extremities: Warm [x], well-perfused [x] Edema: none Varicosities: None Neuro: Alert and oriented x3. CN 2-12 gorssly intact. 5/5 strength in all extremities. FROM. No focal deficits noted Pulses: Femoral Right: 2 Left: 2 DP Right: 1 Left: 1 PT [**Name (NI) 167**]: 1 Left: 1 Radial Right: 2 Left: 2 FAMILY HISTORY: Family History: father died of MI at 66 SOCIAL HISTORY: Race: Caucasian Lives with: alone Occupation: retired military(Marines), now investment broker Tobacco: remote cigar, denies cigarettes ETOH: social, no h/o abuse Drugs: denies

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 51-year-old male transfer from [**Hospital3 10310**] Hospital. He was admitted there with wide variety of medical problems, most arising from longstanding insulin-dependent diabetes mellitus. His functional status was mediocre, but he managed independently with some help from his mother. [**Name (NI) **] is status post a renal transplant for diabetes-induced nephropathy. He had an attempted pancreatic transplant in [**2143**] for treatment of diabetes which was complicated by early acute rejection, with septic shock, with necrosis with the transplanted pancreas, a large abdominal would which took more than one year to heal, peripheral ischemia, and gangrene of his feet (ultimately requiring amputation). He had done well in terms of recovery from those problems with a baseline creatinine which ran into the vicinity of 2.5 to 2.8. He was followed by the [**Hospital 1326**] Clinic here at [**Hospital1 346**]. He was doing reasonably well until about three weeks prior to admission when he became nauseated daily. About two weeks prior, he started having bouts of vomiting every other day which became more frequent and more severe. There did not seem to be any precipitating factors. The vomiting seemed to be consistent with what he had just eaten. No bile. No blood. He would have considerable retching. Along with this, he had some loose stool, but no overt diarrhea. This persisted and he had eaten rather little in the past few days prior to admission. He had not been vomiting up his pills. He came to the Emergency Room when he became overtly dehydrated. He had not had significant headaches, confusion, loss of consciousness, shortness of breath, cough, sputum production, significant abdominal pain, dysuria, hematuria, skin rashes, fevers, or sweats. He had had some mild chills in the evening. MEDICAL HISTORY: Extensive - including longstanding insulin-dependent diabetes mellitus, diabetic nephropathy, with renal failure, renal transplant, hypertension, diabetic retinopathy, and attempted pancreatic transplant (as above). MEDICATION ON ADMISSION: Insulin, metoprolol, Kayexalate, prednisone, Bactrim, Protonix, Imuran, zinc, aspirin, Percocet, Rapamune, Lipitor, Paxil, and Epogen. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: He lives at home with his mother who helps him out. He has ongoing visiting nurse services. His functional status is mediocre. He is a former smoker.

CHIEF COMPLAINT: hypoxiema at rehab PRESENT ILLNESS: 80 yo male with history of COPD on home oxygen, lung Cancer with recent admission to [**Hospital1 **] [**2-6**] - [**2-13**] for recurrent LLL PNA with effusion, treated for H. Flu PNA at the VA in [**12-19**] and had been at [**Hospital **] [**Hospital 21079**] Rehab for 2 days and today developed shortness of breath, decreased oxygen saturation to 80% and RLQ pain, taken to [**Location (un) 24356**] ED and then transferred to [**Hospital1 **]. In the ED, the patient was in moderate respiratory distress, 80% room air oxygen saturation and was put on NRB with sats of 100%, ABG on NRB was 7.24/87/139 and had RLQ fullness. The patient's repeat gas was 7.29/74/50 and he was placed on 100% O2. He was initally felt to have pulmonary edema and given 60mg Lasix IV prior to arrival and placed on a nitro drip for 1 hour which was stopped after his pressure decreased. The patient was placed on Bipap 3 hours after arrival however still had a PaO2 of 50. He was then intubated for continued hypoxima. CT abd showed large rectus sheath hematoma but not dissection or retroperitoneal bleeding. He was given Levofloxacin and Flagyl for concern for PNA and morphine for pain. He was also gien 2 mg Ativan, 100mcg of Fentanyl, and Solumedrol 80mg. MEDICAL HISTORY: 1. Recent hospitalization at the VA for pneumonia with intubation for H. flu pneumonia (grew in sputum culture) treated with Ceftazidime, Flagyl and Vancomycin 2. AAA repaired [**12/2187**] 3. COPD- on home O2 1L 4. Hx Lung Ca - [**2187**]; details of tx unavailable 5. Depression 6. Recurrent hip fx- last [**6-18**] 7. HTN 8. Hypercholesterolemia 9. Anemia - Hct at bl 31-35 MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T= 97.2, HR = 112 afib, BP = 105/56, AC, 600 TV, 12 RR, PEEP 5 , SaO2 = 100% General: Shivering elderly male, NAD. HEENT: Normocephalic and atraumatic head, no nuchal rigidity, anicteric sclera, moist mucous membranes. Neck: No thyromegaly, no lymphadenopathy, no carotid bruits. Chest: chest rose and fell with equal size, shape and symmetry, lungs had clear BS ant. CV: [**Last Name (un) 3526**], [**Last Name (un) 3526**], very distant heart sounds Abd: Normoactive BS, NT. RUQ fullness with multiple ecchymosis Back: No spinal or CVA tenderness. Ext: Cool mottled extremities, no clubbing; [**3-20**] + pitting edema over both legs L > R Integument: no rash Neuro: PERRLA. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Patient is retired, normally lives with his wife but has been in rehab for the last 2 days. >100 pack year hx of smoking. He has two daughters, both involved in his care. Daughter [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 17**] and wife are health care proxy.

CHIEF COMPLAINT: [**Hospital 7792**] transfer from OSH PRESENT ILLNESS: 75 yo male with PMH of CHF, hyperlipidemia , ESRD (on HD), HTN, GERD, DM-II, PAF, and PVD who is transferred from [**Hospital 16186**] for NSTEMI. The patient was recently discharged from [**Hospital1 18**] for gastroparesis, and presented to [**Hospital3 **] from his home for respiratory distress and chest pain. On presentation there, cardiac enzymes were cycled and his troponin 1.424 -> 5.116 -> 6.993 -> 4.905. He was thought to have pulmonary edema in the setting of NSTEMi, and required 6L O2 to maintain O2 sats. He was admitted to the ICU there. Prior to transfer, it was reported that he brady'ed to the 30s, but after further investigation, realized this did not happen. On arrival to our CCU, he was satting well on 2L NC. He was transferred for NSTEMI and cardiac catheterization. At Sturdy, he was continued on his ASA, plavix, and placed on a heparin gtt. He was also hyperkalemic, and was dialyzed prior to transfer. On arrival, he was chest pain free and without complaints. He only would like to eat something. . On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He reports exertional buttock and calf pain thought does not do much activity. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. He reports recently worsening dyspnea MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (+)Diabetes, (+)Dyslipidemia, (+)Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: CHF (most recent documented EF 50% on [**2187-12-6**])-patient on 2-3L oxygen at home ESRD (HD qM,W,F) Type 2 DM HTN Hypercholesterolemia GERD Lymphangiectasia and erosions of prox colon PVD s/p LE percutaneous intervetions Paroxysmal atrial fibrillation . PAST SURGICAL HISTORY: . Ex-lap for ruptured appendectomy many years ago 10 years ago - R 1st toe amp [**7-/2184**] - L radiocephalic AVF [**9-/2184**] - Ligation of L radiocephalic AVF/creation left brachial basilic AVF [**2-/2185**] - Superficialization of left upper arm AVF [**2187-12-5**] - LLE angioplasty, stenting of SFA [**2187-12-10**] - L 3rd toe amputation MEDICATION ON ADMISSION: 1. Atorvastatin 80 mg PO DAILY 2. Digoxin 125 mcg PO EVERY OTHER DAY 3. Lorazepam 0.5 mg PO Q8H 4. Metoprolol Succinate 100 mg PO DAILY 5. Nifedipine 90 mg Sustained Release PO DAILY 6. Lisinopril 40 mg PO DAILY 7. Isosorbide Mononitrate 60 mg PO DAILY 8. Metoclopramide 10 mg Tablet PO QIDACHS 9. Glipizide 10 mg PO qam. 10. Glipizide 7.5 mg at bedtime. 11. Aspirin 325 mg PO DAILY 12. Clopidogrel 75 mg PO DAILY 13. Nitroglycerin 0.3 mg Sublingual PRN 14. Senna 8.6 mg PO BID PRN 15. Nephrocaps PO DAILY (Daily). 16. Docusate Sodium 100 mg [**Hospital1 **] PRN 17. Sevelamer Carbonate 1600 mg PO TID W/MEALS 18. Acetaminophen 325 mg PO Q6H as needed ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: T=97.8 BP=144/56 (131/144) HR=76 (75-82) RR=23 O2sat= 100%2L FAMILY HISTORY: No family history of early MI, otherwise non-contributory SOCIAL HISTORY: The patient had been living with his wife in an in-law apartment attached to his daughter's home up until his last admission earlier this month for his vascular surgeries and he was then discharged to a rehab/NH facility. He has a prior 30 pack-year tobacco history but states he quit 35 yrs ago. No ETOH use and no IVDA/illicit drug history. At home, the patient had been very functional according to his daughter and he was using a cane and walker to ambulate.

CHIEF COMPLAINT: Pericardial effusion. PRESENT ILLNESS: The patient is a 52-year old female with a history of metastatic breast cancer, s/p lt. mastectomy now enrolled in clinical trial "05-395" (lapatinib monotherapy 1500 mg), who noted lt. arm swelling [**2-28**]. Doppler neg for clot, but CT (routine, restaging) revealed pericardial effusion. Echo [**3-3**] revealed: small to moderate sized circumferential pericardial effusion, most prominently inferolateral to the left ventricle and around the right atrium, but ~1cm anterior to the right ventricle. There is mild right ventricular diastolic collapse consistent with increased pericardial pressure/early tamponade physiology. . [**3-5**]: Compared with the prior study (images reviewed) of [**2177-3-3**], the pericardial effusion appears similar to slightly larger. There is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. . [**3-7**]: There is subtle RV diastolic compression without collapse (no overt tamponade). Compared with the prior study (images reviewed) of [**2177-3-5**], there is slightly less pericardial fluid anteriorly. Otherwise no change. . A pericardial drain was placed with return of approximately 250 cc of serosanginous fluid and normalization of right heart pressures. She is admitted to the CCU for further monitoring. MEDICAL HISTORY: ONCOLOGY HISTORY: She was initially diagnosed in [**2164**] with a 3.5 cm infiltrating ductal carcinoma, lymph node positive, LVI positive, ER positive. She is status post left mastectomy with reconstruction, CAF followed by tamoxifen. She recurred in [**7-/2169**], with metastasis to her left supraclavicular node and lung. Biopsy documented HER-2/neu over expression by immunohistochemistry. ER positive. She was treated with Arimidex for six months, which was followed by Taxol and Herceptin. She was then treated with high-dose chemo and Herceptin followed by transplant as part of the clinical trial. This chemo included thiotepa, [**Doctor Last Name **], and Taxol. In [**9-/2173**], she was treated with letrozole and Herceptin and was then switched to Aromasin and Herceptin in 11/[**2174**]. Upon progression [**Male First Name (un) **] was switched to the lapatinib phase II trial in [**7-28**], and herceptin was discontinued. She has received 8 cycles of lapatinib. . PAST MEDICAL HISTORY: 1. Metastatic breast cancer as above. 2. Autologous bone marrow transplant in [**2169**]. 3. History of meningoceles. 4. Hyperlipidemia. MEDICATION ON ADMISSION: Simvastatin 20 mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Blood pressure was 116/66 mm Hg while seated. Pulse was 73 beats/min and regular, respiratory rate was 15 breaths/min. Generally the patient was well developed, well nourished and well groomed. The patient was oriented to person, place and time. The patient's mood and affect were not inappropriate. . There was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. The neck was supple with JVP of less than 6 cm. The carotid waveform was normal. There was no thyromegaly. The were no chest wall deformities, scoliosis or kyphosis. The respirations were not labored and there were no use of accessory muscles. The lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . Palpation of the heart revealed the PMI to be located in the 5th intercostal space, mid clavicular line. There were no thrills, lifts or palpable S3 or S4. The heart sounds revealed a normal S1 and the S2 was normal. There were no rubs, clicks or gallops. There was a slight [**1-28**] HSM. . There is a pericardial drain in place in the sub-xiphoid position. Drainage bag connected, contains approx 10 cc of serosanguinous fluid. . The abdominal aorta was not enlarged by palpation. There was no hepatosplenomegaly or tenderness. The abdomen was soft nontender and nondistended. The extremities had no pallor, cyanosis, clubbing. There is slight (1+), diffuse, Lt. UE edema. There were no abdominal, femoral or carotid bruits. Inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. . Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: Father has lymphoma. SOCIAL HISTORY: A single parent. She lives with her 13-year-old daughter. [**Name (NI) **] tobacco, alcohol, or drugs.

CHIEF COMPLAINT: s/p vfib arrest PRESENT ILLNESS: 47 y/o female with a h/o breast cancer currently on chemotherapy who was found down, unresponsive this PM. History obtained from OSH records that accommpanied pt, [**Name (NI) 9168**], and pt's family. Per pt's husband, he and the pt had been visiting their daughter who just had a baby the day of admission. Subsequently, husband and pt went to the grocery store and returned home. Pt went down to the basement and did not return in [**4-29**] minutes. Family found her unresponsive around 5:20PM and initiated CPR along with defibrillation x 2. Ambulance arrived 5 minutes later. She was intubated, shocked three more times, and received lidocaine 100 and epi 3 via ETT while traveling to the hospital. She arrived at an OSH at 5:50PM where she was found to be in pulseless v-fib. BP was unable to be obtained without any palpable pulses. Pupils were fixed. She received 100 mg lidocaine, shocked 360J, 1 mg epi, shocked 360J, and had a rhythm of ST 140s with a BP 170/100. She was started on a lidocaine gtt and then switched to amiodarone bolus and then gtt. She received decadron 20 mg IV at about 6PM. OSH head CT revealed diffuse edema, large frontal and right parietal lobe edema with a concern for metastatic disease. She had a 1 cm frontal hemorrhage along with possible SAH in frontal lobe. She arrived to the ED at [**Hospital1 18**] at 8:48PM and required IVF bolus for BPs 80/50s. She was maintained on an amiodarone gtt. She was loaded with Dilantin 1200 mg x 1. Neurosurgery was consult and they reviewed the head CT. Findings were significant for dense cerebral edema and borderline herniation. Recommended decadron. Cardiology was also consulted who recommended continuing the amiodarone gtt. MEDICAL HISTORY: Breast cancer, unclear stage, husband reports pt is on some form of chemotherapy MEDICATION ON ADMISSION: Unclear ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: Vitals T 97.4 BP 103/72 HR 99 RR 24 100% AC FiO2 60% TV 500 PEEP 5 General: 47 y/o female intubated with occasional myoclonic jerking. HEENT: NC/AT. No corneal reflexes. Pupils constricted. Neck: No JVD or LAD. CV: Normal S1, S2 without m/r/g. Pulm: CTAB without wheezes or crackles. Abd: Soft, ND, NT with normoactive BS. Ext: No c/c/e. Neuro: Unresponsive. Pupils reactive to light. Decreased tone throughout. FAMILY HISTORY: Unknown SOCIAL HISTORY: Married and lives with her husband

CHIEF COMPLAINT: Multiple gunshot wounds of the abdomen and chest. PRESENT ILLNESS: This man was brought to the emergency room with multiple gunshot wounds to the chest and wounds in the back as well. He was taken to the operating room emergently and underwent a laparotomy first because his abdomen was positive. MEDICAL HISTORY: PMH: HTN PSH: none MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: NC SOCIAL HISTORY: married

CHIEF COMPLAINT: nausea, hypotension, dizziness PRESENT ILLNESS: Patient is an 81 year old female with metastatic melanoma, known metastases to brain and adrenals, who was receiving chemotherapy on day of admission (cycle 2 of dacarbazine), and sent to ED for hypotension after chemo and dizziness on [**2120-3-13**]. Per admission note from that time, she is poor historian, and details from OMR documentation. She presented to chemotherapy with nausea and anxiety. She received dexamethasone and zofran, and eventually ativan, which helped her relax. During treatment noted to be sleepy, and vitals signs reveal SBP 70, HR 80, 96% RA. She received a bolus of IVF (2L NS in total) with improvement of SBP to 106, but remained orthostatic (BP dropped to 88/60 with sitting). She had been vomiting up to 3x daily at home after chemotherapy, with poor PO intake. Of note, also c/o indigestion, vague right sided abdominal vs chest discomfort ("dull, achy"). She is known to have hiatal hernia; she reported a recent abdominal U/S at OSH was normal. She received IV pepcid at infusion center and took own home omeprazole. MEDICAL HISTORY: PMH: - Metastatic melanoma, with known brain metastases (see details below) - Hypertension - Osteoporosis - Tuberculosis in [**2057**] and [**2071**] - GERD - Thyroid adenoma diagnosed in [**2072**] - Hiatal hernia - Cholecystectomy in [**2114**] - Hysterectomy in [**2100**] - Diverticulitis with lower GI bleeds - Neurogenic bladder from disk disease - Benign paroxysmal positional vertigo > 10 years . Oncologic history: Metastatic Melanoma PRIOR TREATMENT: 1. Resection of a left nasal primary melanoma in [**2091**]. 2. Recurrence on the left mandible (biopsy-documented) in [**2114**]. 3. Left radical lymph node dissection and partial thyroidectomy in 08/[**2114**]. 4. Thirteen cycles of GM-CSF per ECOG 4697. 5. [**Year (4 digits) 4338**] in [**12/2115**] revealed right frontal and left central sulcus metastases with hemorrhage with question of leptomeningeal disease. [**1-/2116**], underwent resection of the frontal lesion; path c/w met melanoma. She subsequently underwent stereotactic radiosurgery to the left central sulcus metastasis and the right frontal surgical cavity. Recurrance of brain tumor in [**2119**]. 6. [**2119-9-15**] had two new subcutaneous nodules in the right lateral abdominal wall and the anterior lower chest wall, progression of bilateral adrenal metastases, new lesion in the anterolateral left kidney, and slight retroperitoneal lymphadenopathy. 7. Initiation of treatment with off-study dacarbazine [**2120-2-23**] because of fulminant disease progression at multiple sites. Second cycle given [**2120-3-13**]. MEDICATION ON ADMISSION: Emend 125 mg (1)-80 mg (1)-80 mg (1) Capsule, Dose Pack Daily Riopan (apparently low sodium maalox) prn Dexamethasone 8mg PO BID PRN nausea Zofran 8mg PO Q8H PRN nausea Compazine 10mg PO Q6H PRN nausea Ativan 0.5mg, 1-2 tabs Q8H prn nausea Levoxyl 125mcg po Daily Omeprazole 20mg PO daily Raloxifene (Evista) 60mg PO daily Acetaminophen 325mg PO q4h prn Ascorbic acid 1000mg PO daily Calclium carbonate Multivitamin, 1 tab PO daily Vitamin E 400 units PO daily VIT C-VIT E-LUTEIN-MINERALS [OCUVITE LUTEIN] - 1 Capsule(s) by mouth daily ALLERGIES: Aspirin / Nsaids / Technetium-[**Age over 90 **]m / Gadolinium-Containing Agents PHYSICAL EXAM: vs: T 95.1 (ax), BP 158/85, HR 78, RR 18, 100% RA gen: comfortable appearing heent: dry mucous membranes lungs: CTA b/l heart: RRR, nl S1S2, no m/r/g abd: +BS, soft, non-distended. mild TTP LLQ ext: [**1-5**]+ pitting edema ankles b/l neuro: AAOx3 Skin: seborrheic keratosis scattered over entire skin FAMILY HISTORY: Non contributory SOCIAL HISTORY: She is widowed, lives in senior citizen housing, denies smoking. She rarely drinks alcohol. Her son, daughter-in-law, and children live in the area. Her daughter-[**Doctor First Name **]-law is [**Name8 (MD) **] NP. Son, [**Name (NI) **] [**Name (NI) **] identified as HCP although she has not signed the HCP forms yet.

CHIEF COMPLAINT: threatening behavior PRESENT ILLNESS: Mrs. [**Known lastname 80671**] is a 54 year old Greek-speaking only female with a long-standing history of unusual behavior, brought into the hospital by her daughter due to concern for increased agitation and threatening behavior toward her husband with concern for potential violent behavior. . Per the patient's daughter, the patient has been "crazy" for as long as she can remember. She reports her mother's mood as often being "down" and "[**Doctor Last Name 11506**]" and "angry", but at times "laughing for no reason". She speaks constantly and has hallucinations, though it is unclear if these are visual or auditory or both. She reportedly also has had many delusions, for example, that she is being poisoned. The patient never leaves the house, except for once a month when a family member visits to assist with personal care. She has also occassionally displayed threatening behavior to family in the past. These behaviors have been ongoing for years. The daughter reports, however, that within the last few months to weeks the patient's behavior has become more bizzarre. The patient who was once a "clean freak" now does not clean her home or herself. The daughter has to bathe her mother and has recently found used menstrual pads hidden around the house and believes that the patient is having heavier periods. There are no other physical symptoms that the patient is having of which the daughter is aware. Today the patient's husband became scared because of the wife's threatening behavior with a knife, and the daughter decided that she needed to seek medical attention. . In the ED, initial vs were: T 97.9 (first temperature taken 3 hours after arrival) P 137 BP 160/90 O2 sat 100% on room air. The patient was very agitated. Stool guaiac was negative. Pelvic exam showed no active bleeding from the os but blood in the vaginal vault. The patient was intermittently severely agitated and was intubated for agitation and need for CT. Intubation was reportedly difficult. CT head showed no acute process. CT chest showed no PE. The patient was given a total of 2L NS, Levaquin 750 mg PO, ativan 4 mg IV, haldol 5 mg IM, veccuronium 15 mg IV, versed 5 mg IV, fentanyl 150 mg IV, and a propofol gtt was started. . On arrival to the floor the patient was intubated and sedated. History was taken from the patient's daughter. . Review of sytems: Could not obtain as the patient is intubated and sedated. MEDICAL HISTORY: Morbid Obesity Possible psychosis disorder- had in pt tx in [**2118**] No medical care since [**2118**] MEDICATION ON ADMISSION: occasional tylenol use ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 100.1 BP: 142/60 P: 120 R: 18 O2: 93% RA General: Morbidly obese, sedated, but arousable, comfortable HEENT: 1-2 mm pupils b/l, equal round and minimally reactive to light. Sclera anicteric, MMM, oropharynx with poor dentition, Neck: supple, unable to assess JVD due to body habitus, unable to palpate any masses Lungs: Bronchial breath sounds bilaterally, no crackles CV: Regular rate and rhythm, normal S1 + S2, no murmurs Abdomen: soft, non-tender, non-distended, + bowel sounds, very large panus, skin without infection Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Father died in 90s with dementia Mother alive and well in [**Country 5881**] Siblings alive and well Paternal grandmother was "crazy" SOCIAL HISTORY: Came to the U.S. from [**Country 5881**] with her husband in [**2124**]. [**Name2 (NI) **] known medical contact [**2126**]. Denies alcohol, tobacco, or illicit drug use.

CHIEF COMPLAINT: bright red blood per rectum PRESENT ILLNESS: 62 yo male with Hep C cirrhosis and HCC who presented to OSH today after noting several weeks of worsening abd girth and associated diffuse pain, as well as new lower extr edema. The pt also experienced two episodes of BRBPR on the day of admission, which is what prompted him acutely to seek medication attention. Pt's HCT at the OSH was found to be 29 (unclear baseline) and he was noted to be hypotensive with an SBP first in the 80s-90s (close to baseline per pt) and then lower to the 70s. The pt was started on a dopamine gtt to support his BP and was transferred to [**Hospital1 18**] for further care. In the [**Hospital1 18**] ED, initial vitals were HR 98, R 16, 92/58, 96% RA. The pt had an NG levage which was negative and a transfusion of 2 units pRBCs was initiated. On ROS, the endorses occasional chills but no fevers. No chest pain or SOB. Abd pain as above but no nausea or vomiting. No urinary sxs. Blood per rectum as described above but otherwise no change in stool. No neuro or MSK sxs. MEDICAL HISTORY: Hep C complicated by HCC CAD s/p LAD stenting and ICD impant COPD, 35 pack year smoking hx psoriasis MEDICATION ON ADMISSION: spironolactone 25 mg daily Coreg 3.125 mg [**Hospital1 **] trazodone 50 mg daily Lipitor 80 mg daily Altace 5 mg [**Hospital1 **] Plavix 75 mg daily Advair daily Spiriva daily Requip 2 mg daily Oxycodone 20 mg PRN Ativan 0.5 mg PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Gen: Adult male, chronically ill appearing but no acute distress. HEENT: PERRL, EOMI. MMM. Conjunctival icterus. Neck: Supple, without adenopathy or JVD. No tenderness with palpation. Chest: CTAB anterior and posterior. Cor: Normal S1, S2. RRR. No murmurs appreciated. Abdomen: Firm and distended with minimal diffuse tenderness. +BS, no HSM. Extremity: Warm, pitting edema to mid thighs bilat. 2+ DP pulses bilat. Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact in all extremities. Sensation intact grossly. FAMILY HISTORY: Pt is adopted and thus not aware of FH. SOCIAL HISTORY: Former construction worker, now diabled. Prior smoker. Denies EtOH.

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 64 year-old gentleman who had been admitted previously for cardiac catheterization following a positive ET test. Catheterization done on [**12-28**] showed an EF of 65%, left main of 60 to 70%, left anterior descending coronary artery 70% and LVEDP of 22. Please see catheterization report for full details. The patient is admitted to the Cardiothoracic Service as an outpatient admission and admitted directly to the Operating Room on [**1-5**]. At that time the patient came to the Operating Room where he underwent coronary artery bypass grafting times two. Please see the operative report for full details. In summary, the patient had a coronary artery bypass graft times two with a left internal mammary coronary artery to the left anterior descending coronary artery and an saphenous vein graft to the obtuse marginal. He tolerated the operation well and was transferred from the Operating Room to the Cardiothoracic Intensive Care Unit. At the time of transfer the patient had an arteriole line, two atrial pacing wires, two mediastinal and one left pleural chest tube. He was transferred with Propofol infusing at 30 mics per kilogram per minute. His mean arteriole pressure was 85. His CVP was 5. He was in normal sinus rhythm. The patient did well in the immediate postoperative period. He was allowed to awaken from his anesthesia and was appropriately responsive weaning from the ventilator at which time the patient was noted to have increasing frequency of premature ventricular contractions and increasing episodes of premature ventricular contractions quickly accelerated to ventricular tachycardia and then to ventricular fibrillation. The patient was resuscitated from his ventricular fibrillation. Please see the resuscitation report for full details. Following resuscitation the patient was transferred to the Cardiac Catheterization Laboratory where he underwent cardiac catheterization to assess the patency of his new coronary artery bypass graft. Once in the Catheterization Laboratory the patient was found to have a widely patent left internal mammary coronary artery to the left anterior descending coronary artery and the saphenous vein graft to left circumflex was patent with an 80% narrowing immediately antegrade and distal to the anastomosis. This narrowing improved, but did not fully normalize with intragraft intravenous nitroglycerin and Diltiazem. An intra-aortic balloon pump was also placed while the patient was in the Cardiac Catheterization Laboratory. The patient was transferred from the Catheterization Laboratory back to the Cardiac Surgery Recovery Unit. The patient returned to the Cardiac Surgery Recovery Unit in good condition. At the time of transfer his medications included neo-synephrine and Propofol. He remained hemodynamically stable overnight without any further episodes of ventricular ectopy. On the morning of postoperatively day one his Propofol was weaned to off. He was weaned from the ventilator and extubated. Following that the intra-aortic balloon pump was weaned and ultimately discontinued also on postoperative day one. The patient remained hemodynamically stable without any further episodes of ventricular ectopy throughout the remainder of postoperative day one. On postoperative day two the patient was transferred from the Cardiac Surgery Recovery Unit to Far Six for continuing postoperative care and cardiac rehabilitation. Over the next several days the patient's activity level was progressively increased with the assistance of physical therapy and the nursing staff. His diet was advanced to regular. He remained hemodynamically stable with no further episodes of ventricular ectopy. On postoperative day five the patient's activity level had progressed to a level five, which is ambulating 500 feet and up a flight of stairs. He remained hemodynamically stable and it was decided that he was stable and ready for discharge. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: CC:[**CC Contact Info 66561**] Major Surgical or Invasive Procedure: placement of arterial line PRESENT ILLNESS: 60 yo F with h/o HTN, CVA, bipolar, depression transferred from [**Hospital1 1474**] for SOB and new LBBB. Patient was apparently doing well 2 weeks ago, when she visited her PCP and had an EKG which was reportedly normal. Patient was found at home by son very lethargic, diaphoretic with labored breathing. Called ambulance and was brought to [**Hospital 1474**] hospital. She was initially responsive to questions and denied chest pain. Pupils were found to be 3mm bilaterally, she had rales in her lungs. She was given 40 mg IV lasix, NTG SL x 1, placed on a nonrebreather and then she became unresponsive and unarousable. She was intubated for airway protection with etomidate and succinyl choline and vecuronium. An EKG showed a new LBBB, Trop I 6.0 (0-1.4) CK 282, MB 23.7 (0-5),K 6.4. At the OSH, she was given protonix, bicarb, kayexalate, ativan 2 mg, ASA, lopressor, heparin. She was transferred to [**Hospital1 **] for further mgmt. In the ED, she was given ASA and continued on heparin drip. Patient's family does not want aggressive management and would not want her to be receive a cath. They would like her to be DNR, but continue her intubation. MEDICAL HISTORY: PMH: CVA [**6-28**] with difficult speech and walking Bipolar dx'ed 30 years ago HTN Depression, Weight loss since [**9-27**] (husband passed away) L CEA MEDICATION ON ADMISSION: lamictal abilify ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T101 BP 90s/50s HR 100-110 RR 16 Sat 99% CMV FiO2 40% Tv 400 RR 16 PEEP 5 Gen: Patient is obtunded, grimaces with sternal rub, thin and nearly cachectic woman lying in bed intubated HEENT: anicteric, pupils 2-3 mm bilaterally, minimally responsive to light, Neck: JVP not seen, large thyroid CV: tachy, regular, nl s1, s2, no m/g/r Lungs: ventilator breath sounds bilaterally Abd: BS+, soft, ND, no organomegaly Ext: 2+ R radial pulse, 1+ L radial pulse with bandage over radial artery, DP 2+ bilaterally, no c/c/e Neuro: slight corneal reflex bilaterally, withdraws all 4 extremities to pain, 2+ patellar reflexes bilaterally FAMILY HISTORY: both brothers were bipolar, no history of heart failure, CAD, stroke, diabetes or cancer in family SOCIAL HISTORY: Patient lives by herself and takes care of all ADLs. Has 2 sons and 1 daughter that she sees on an almost daily basis, and that all live close by (son and daughter within 1 mile). Babysits for daughter's children once weekly. Has been smoking since age 18 and is now down to 2 packs per week. Rare EtOH. Husband passed away in [**9-27**], and she was severely depressed afterwards, but her mood has improved since then.

CHIEF COMPLAINT: SOB, leg edema PRESENT ILLNESS: Ms [**Known lastname 13474**] is a 63 yo F with h/o severe diastolic heart failure (EF 55%) w/ RV failure, severe TR, AF (not on coumadin due to GIB), PFO closure ([**3-29**]). ulcerative colitis, HTN and pulmonary hypertension who presented to Dr.[**Name (NI) 3536**] office today with complaints of increasing SOB, and inability to walk due to leg edema for the past month. She has noted a 45 lbs. weight gain and admits to med non-compliance with torsemide. On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, cough. She denies recent fevers, chills or rigors. (+) Loose dark stools (not black/tarry) and has seen a small amount of blood mixed w/ stool and in toilet paper. All of the other review of systems were negative. Cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope. (+) 3 pillow orthopnea. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Hyperlipidemia, Hypertension 2. CARDIAC HISTORY: -CABG: NONE -PERCUTANEOUS CORONARY INTERVENTIONS: RHC (see below) -PACING/ICD: NONE 3. Diastolic LV failure 4. Pulmonary hypertension 5. RV systolic dysfunction 6. Tricuspid regurgitation 7. Atrial fibrillation not on anticoagulation due to GIB 8. Ulcerative Colitis 9. Liver disease 10. Alcohol abuse, remote 11. Ventral hernia repair 12. Back surgery [**11**]. History of GI bleed, [**10-28**] with 5cm duodenal ulcer 14. Hypokalemia 15. Hyponatremia 16. Hyperlipidemia MEDICATION ON ADMISSION: 1. Omeprazole 20 mg [**Hospital1 **] 2. Folic Acid 1 mg daily 3. Ferrous Sulfate 325 mg daily 4. HCTZ 25 mg daily 5. Aspirin 81 mg daily 6. Torsemide 20 mg [**Hospital1 **] 7. Trazodone 25 mg HS 8. Mesalamine 2.4 g daily 9. Gabapentin 200 mg HS 10. Metoprolol Tartrate 25 mg [**Hospital1 **] 11. Albuterol 90 mcg IH q4h PRN 12. Oxycodone 5 mg [**Hospital1 **] PRN ALLERGIES: Lisinopril / Kefzol / Sulfa (Sulfonamide Antibiotics) / Shellfish Derived PHYSICAL EXAM: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP to the tragus. CARDIAC: PMI located in 5th intercostal space, midclavicular line. Irregularly irregular, normal rate. S1, S2. No m/r/g. No thrills, lifts. +S3. LUNGS: Resp were unlabored, no accessory muscle use. bibasilar crackles [**12-24**] of the way up the lung fields, wheezes or rhonchi. FAMILY HISTORY: Father with MI at age 68. Mother with breast cancer at 52. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: The patient is married. Husband is mentally ill. She has very supportive children and 17 grandchildren. -Tobacco history: Denies -ETOH: Drinks when she is upset, cannot quantify. Does not drink when feeling well. -Illicit drugs: Denies

CHIEF COMPLAINT: PRESENT ILLNESS: [**Known firstname 46**] [**Known lastname 75745**] is a 23 year-old gentleman who was in a high speed motor vehicle collision with rollover and subsequent submersion into water on [**12-21**] of [**2164**]. From the transferring hospital reports, the time of submersion was at least 3 minutes before the patient was extricated. The patient was immediately intubated in the field and transferred via Life Flight from regional hospital for management. The patient arrived to the [**Hospital1 1444**] on [**12-21**] intubated with stable hemodynamics. MEDICAL HISTORY: His past medical history was unknown. Upon the initial trauma survey, the patient was found to be neurologically unresponsive. The only neurologically suppressive medication he had been given prior to transfer was succinylcholine for the intubation. He was found to be unresponsive. Corneal, gag and cough reflexes were all absent. No motor function was present in the extremities. His pupils were fixed and dilated. His examination was otherwise only remarkable for some superficial lacerations without significant bleeding. His lab values upon admission were notable for a hematocrit of 45.3. His sodium was 146. His troponin value was 0.11. His lactate value was 4.1. It should also be noted that the patient was normothermic on admission. In terms of his imaging, review of imaging from the referring hospital demonstrated a subdural hematoma which was not causing significant mass effect or shift but there was significant blurring of the [**Doctor Last Name 352**]-white matter interface. His chest x-ray demonstrated diffuse alveolar opacities with edema, consistent with his prior neurologic injury. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

CHIEF COMPLAINT: Elective admission for R carotid stent/angioplasty PRESENT ILLNESS: 60 yo male with hx of CAD s/p CABG in [**2159**], and hx of bilateral carotid disease initially found during the pre-op workup for CABG. Pt had [**Doctor First Name 3098**] stent in [**2159**] prior to CABG. He hever had a TIA or any neurological symptoms. No weakness, numbness, transient blindness, word finding difficulty, or gait instability. Pt has not had any anginal like sx since CABG. Pt had follow up carotid U/S in [**2161-5-16**] which showed right sided stenosis of 80-99%, and left sided stenosis of 70-79% distal to the stent. Pt has been followed by his neurologist and was decided to pursue conservative measure at that time. He had another carotid u/s on [**2161-12-1**] which showed again 80-89% [**Country **] stenosis and 70-79% [**Doctor First Name 3098**] stenosis. CTA of the head and neck was done which showed high grade stenosis at the [**Country **], and high grade stenosis of the [**Doctor First Name 3098**] with concordant narrowing of the stent. He denies ever having any neurological symtoms. Pt was electively admitted for [**Country **] stent/angioplasty. [**Last Name (NamePattern4) **]dical History: HTN Hyperlipidemia CAD s/p CABG [**6-17**] (LIMA to LAD, SVG to OM1, SVG to ramus, SVG to PDA) by Dr. [**Last Name (Prefixes) **] Hernia repair L thumb repair after laceration Carotid dz s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3098**] stent in [**6-17**] Anxiety disorder MEDICAL HISTORY: MEDICATION ON ADMISSION: [**First Name3 (LF) **] 325 mg po qd Lisinopril 2.5 mg po qd Plavix 75 mg po qd Lipitor 40 mg po qd Atenolol 100 mg po qd ALLERGIES: Penicillins PHYSICAL EXAM: VS: T 97.0 BP 139/79 HR 67 RR 16 O2sat 96% RA GEN: Pleasant, well nourished, male lying in bed in NAD HEENT: NC/AT, PERRL (3->2mm bilaterally), nl OP, neck supple, no carotid bruits bilaterally, no JVD. COR: RRR S1, S2, no murmurs/rubs/gallops LUNGS: CTA anteriorly ABD: +BS, soft, NTND, no guarding EXT: no edema, R groin with no hematoma, no bruit. 2+ DP bilaterally NEURO: A+Ox3, CN III-XII intact, [**5-20**] strengths inall major muscle groups. Quad not tested since pt post-cath. No obvious higher cognitive fxn deficits. FAMILY HISTORY: Father with stroke in 60's SOCIAL HISTORY: Pt lives with hs wife and their dog. Has one adult daughter. [**Name (NI) **] works as an insurance broker. He smokes socially (4 packs/month x 35 yrs), and drinks 1-2 drinks daily. Denies illicit drug use.

CHIEF COMPLAINT: VF arrest PRESENT ILLNESS: This 54 year old male with no known pmh presented s/p ventricular fibrillation arrest on [**2179-9-22**]. He was at the Red Sox game with his sister and they were walking to their car when he stopped to smoke a cigarette and then he collapsed. A passing physician initiated CPR within 3-5 minutes per his sister's report. He was found to be in ventricular fibrillation and was shocked 5 times, given 3mg of epinephrine, 2mg of magnesium for torsades rhythm. He eventually had spontaneous return of circulation and breathing. He was intubated in the field on route to [**Hospital1 18**]. He was transferred from the ED to the CCU and put on the arctic sun protocol. He was unresponsive and sedated and was eventually extubated on [**9-25**] and has been very agitated and uncooperative. He has a history of ETOH and is a heavy smoker. Cardiac cath [**2179-9-29**] revealed no coronary disease but he has 3+ mitral regurgitation. He is being evaluated for mitral valve repair. MEDICAL HISTORY: unknown, has not gone to a doctor for at least 20 years. MEDICATION ON ADMISSION: None ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse:108 Resp: 20 O2 sat: B/P Right: 93/81 Left: Height: 6'3" Weight: 60.7 kgs FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Lives with: sisters Occupation: works in [**Last Name (un) **] chemical pipefitting Tobacco:1.5 ppd for many years, current ETOH: a few beers per night, several on weekends

CHIEF COMPLAINT: Shortness of breath. PRESENT ILLNESS: Ms. [**Known lastname **] is a 77 year-old lady with a history of rheumatic fever and heart murmur who is being followed by Dr. [**Last Name (STitle) 13248**] who noticed a change in her murmur on [**2104-1-18**]. She was subsequently referred to Dr. [**First Name (STitle) 31011**] [**Name (STitle) 43479**]. Ms. [**Known lastname **] was also hospitalized in [**2104-2-15**] for an H-pylori bleeding stomach ulcer after which she underwent an echocardiogram and cardiac catheterization . These tests revealed critical aortic stenosis and Ms. [**Known lastname **] was subsequently referred to Dr. [**Last Name (STitle) 1537**] for aortic valve replacement. MEDICAL HISTORY: 1. Critical aortic stenosis. 2. Hyperlipidemia. 3. Gastroesophageal reflux disease. 4. anemia. 5. Cerebrovascular accident with residual right side weakness. 6. History of breast cancer. 7. Claustrophobia with panic attacks. 8. Rheumatic fever. 9. Rheumatoid arthritis. 10. History of trauma and elevated with skull fracture. 11. Status post appendectomy. 12. Status post left knee replacement. 13. Status post benign cervical tumor removal. 14. Breast mass excision. MEDICATION ON ADMISSION: ALLERGIES: Aspirin, serum, nitroglycerin. PHYSICAL EXAM: FAMILY HISTORY: Brother who died of melanoma age 48, brother who died at age 57 of lung cancer and her father died at age 78 of emphysema. SOCIAL HISTORY: Ms. [**Known lastname **] does not consume any tobacco and rarely consumes alcohol.

CHIEF COMPLAINT: BRBPR PRESENT ILLNESS: 58 year old man with hepatitis C cirrhosis complicated by portal HTN and esophageal varices who presented hematemesis and hematochezia. He had an EGD on [**2129-2-1**] which revealed 3 cords of grade II-III varices that were banded. Then, yesterday he had two episodes of BRBPR and presented to [**Hospital3 **] hospital where his Hct was stable and he was sent to [**Hospital1 18**]. In our ED, his BP was 91/57 and rectal exam revealed gross blood. He was started on IV protonix and octreotide, and had an episode of hematemesis. He was then admitted to the MICU. MEDICAL HISTORY: HCV cirrhosis genotype 2B secondary to remote IV drug use --> Started Pegasys/ribavirin on [**2127-12-26**] with rapid virological response. Stopped treatment at 10 wks due to bone marrow toxicity and hepatic decompensation including ascites and hepatic encephalopathy. Following the end of treatment, he relapsed and his HCV VL is now 6,454,517 IU/ml. - Esophageal varices -> EGD on [**2129-2-1**] showed 3 cords of grade II-III varices with red whale sign in the lower third of the esophagus. 3 bands were placed. - Portal HTN - GERD - CAD with MI s/p 3-vessel CABG [**7-/2125**] at [**Hospital3 **] Hospital - Type 2 DM MEDICATION ON ADMISSION: - furosemide 40mg daily - glyburide 5mg [**Hospital1 **] - nadolol 10mg daily - omeprazole 20mg daily - rifaximin 550mg [**Hospital1 **] - spironolactone 100mg alternating with 200mg daily - sucralfate 10ml QID (hasn't been taking) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: Vitals: Afebrile 100/53 45 18 98%RA General: Alert and oriented x3, NAD. HEENT: Sclera anicteric, conjunctiva slightly pale, EOMI, PERRL, MMM, oropharynx clear Neck: Supple, JVP not elevated, no LAD Chest: Several spider angiomas on chest, bradycardia but 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 Ext: Warm, well perfused, 2+ pulses, trace pedal edema DISCHARGE PHYSICAL EXAM Vitals: Afebrile Bp 110/70's HR 50-60 18 98%RA General: Alert and oriented x3, NAD. HEENT: Sclera anicteric, EOMI, PERRL, MMM, oropharynx clear Neck: Supple, JVP not elevated, no LAD Chest: Several spider angiomas on chest, RRR, 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 Ext: Warm, well perfused, 2+ pulses, trace pedal edema FAMILY HISTORY: Father alcoholic, h/o CHF and DM. Mother with h/o CVA, DM. No FH of heart or liver disease. SOCIAL HISTORY: Lives with wife. [**Name (NI) **] multiple grown children. Smoked tobacco until [**2124**] when he had his CABG. Drank alcohol heavily in the past as well, no use since cirrhosis diagnosis. H/o IVDU in the past, none recently.