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- 'ed_course section: \n22 year old presenting with left wrist pain, felt a popping sensation. Will obtain x ray.\n\nNo obvious abnormalities on x ray. Patient placed in a Velcro wrist splint. Symptoms consistent with sprain. Will discharge with follow up with Orthopedics in a week if symptoms are not improving.\n\nAmount and/or Complexity of Data Reviewed\nLabs: ordered.\nRadiology: ordered.\n\n\n\n\n\n\n\nNo data recorded\n\ned_diagnosis section: \n1. Wrist sprain, left, initial encounter\n\n\n\n\n\nElectronically signed by\n\nMatthew Loran, MD\n09/20/23 2216\n\n\nbmk\n\n\n\nphysical examination section: \nConstitutional :\nAppearance: Normal appearance.\nHENT:\nHead: Normocephalic.\nMouth/Throat:\nMouth: Mucous membranes are moist.\nEyes:\nPupils: Pupils are equal, round, and reactive to light.\nCardiovascular:\nRate and Rhythm: Normal rate.\nPulmonary:\nEffort: Pulmonary effort is normal.\nAbdominal:\nGeneral: There is no distension.\nMusculoskeletal:\nLeft wrist: Tenderness present. No swelling. Decreased range of motion .\nCervical back: Normal range of motion.\nComments: Distal ulna with tenderness over the ulnar styloid\nSkin:\nGeneral: Skin is warm and dry.\nCapillary Refill: Capillary refill takes less than 2 seconds.\nNeurological:\nMental Status: He is alert and oriented to person, place, and time.\nPsychiatric:\nMood and Affect: Mood normal.\n\n\nEMERGENCY DEPARTMENT Course \xa0MDM\n\nClinical Impressions as of 09/20/23 2216 Wrist sprain, left, initial encounter\nDisposition: Discharge\n\nHistory of present illness section: \n\nHistory reviewed. No pertinent past medical history.\n\nPast Surgical History: Procedure Laterality Date • APPENDECTOMY • FINGER SURGERY • WISDOM TOOTH EXTRACTION Bilateral\n\nNo family history on file.\n\nTobacco Use • Smoking status: Never • Smokeless tobacco: Never Substance Use Topics • Alcohol use: Yes\n\n\nEMERGENCY DEPARTMENT Triage Vitals Temperature Heart Rate Resp BLOOD PRESSURE 09/20/23 2144 09/20/23 2144 09/20/23 2144 09/20/23 2146 37.2 °C (98.9 °F) 89 16 (!) 144/93 SpO2 Temp Source Heart Rate/Pulse Source Patient Position 09/20/23 2144 09/20/23 2144 09/20/23 2144 96 % Temporal Sitting BLOOD PRESSURE Location FiO2 (%) 09/20/23 2144 Right arm\n\nProcedure: \n\n\n\nDisposition: Discharge\n\nReview of System: \nnan\nLab Results: \nNone\nMedications: \n No data to display\n\nResults:\nLabs Reviewed RESPIRATORY PATHOGEN PANEL WITH SARS COV 2 URINALYSIS W/REFLEX MICROPSCOPIC\nX ray Wrist 3+ Views Left Final Result No acute process in the wrist by x ray.\nNo orders to display\n\n'
- 'ed_course section: \n2106: Left lower extremity ultrasound my read via PAC shows Baker cyst but no DVT.\n\nPlaced in knee immobilizer, elevation, NSAIDs p.r.n., referral to Orthopedics\n\nClinical Impressions as of 03/29/23 2139 Bakers cyst of knee, left\nSplint Application\n\nDate/Time: 3/29/2023 9:38 PM\nPerformed by: Terra Rudd, PA C\nAuthorized by: Terra Rudd, PA C\n\ned_diagnosis section: \n1. Bakers cyst of knee, left\nphysical examination section: \nVitals: 03/29/23 1937 BLOOD PRESSURE: 120/76 Pulse: 94 Resp: 16 Temp: 36.6 °C (97.8 °F) SpO2: 93% Weight: 72.6 kg (160 lb) Height: 1.651 m (5 5")\n\n\nVital signs reviewed and triage nurse notes reviewed\nGeneral Appearance/VS: awake, alert, non toxic, polite and cooperative adult female\nEyes: EOMI, no icterus, wears glasses\nENT: Wears a mask, nares patent\nLungs: Symmetric with no chest wall rise, no respiratory distress, no tachypnea\nCARDIOVASCULAR: no pedal edema, good capillary refill\nGASTROINTESTINAL: no abdominal distention, no wincing upon palpation\nMusculoskeletal: 2/2 pulses, strength 5/5, good light touch sensation. no deformities, no clubbing, no cyanosis, no edema. Compartments are soft.\nLeft KNEE: no effusion, no medial and lateral joint line tenderness, full extension to 180°, flexion to 120°. No pain with varus and valgus exam. No pain with anterior drawer or posterior drawer test. Extensor mechanism intact. Popliteal fullness\nLeft calf is slightly larger than right calf without palpable cords. Left foot plantar and dorsiflexion intact. 2/2 pedal pulses. Foot warm to touch.\nNeuro: normal speech, 5/5 strength throughout, ambulatory without deficits\nPsych: normal mood/affect\nSkin: pink, no rash on exposed skin, good capillary refill\n\nHistory of present illness section: \n\nCHIEF COMPLAINT:\nChief Complaint Patient presents with • Leg Pain Posterior Tibial c/o, i just returned from a long flight from scotland on mon night, yest behind my L thigh started to hurt, and some leg swelling/ additionally, sent from an UC for concerns of dvt\n\n\n\nPatient is a 71 year old female with complaints of left thigh atraumatic pain yesterday and some leg swelling. Patient returned from a long flight from Scotland on Monday night. Denies chest pain, shortness of breath, skin color changes, joint pain, fever. Ambulating without difficulty. History of left kneemeniscus injury.\n\nAcuity: Acute\nSeverity: Moderate\nModifying Factors: Baby aspirin without relief\n\nSigns and Symptoms: No bleeding, no radiation, no numbness, no weakness, no tingling, no incontinence, no decreased range of motion, + swelling, + pain, no fever\n\n\nPast Medical History: Diagnosis Date • ADHD • Allergic rhinitis extensive, as young adult. resolved with dietary changes. • Anaphylaxis age 10 bug bite in a lake • Bilateral impacted cerumen 07/16/2020 • Depression • Hallux abducto valgus, left 09/26/2017 • Leg length discrepancy Lifelong process, patient report recalls tailoring her clothing starting in high school due to the difference. • Long COVID • Medial epicondylitis of elbow, right 08/17/2018 • Multiple drug allergies Query allergic response ot epinephrine • Seborrhea 07/16/2020\n\nPast Surgical History: Procedure Laterality Date • BREAST BIOPSY Left • KNEE ARTHROSCOPY W/ MENISCAL REPAIR • TONSILLECTOMY\n\nSocioeconomic History • Marital status: Divorced Spouse name: None • Number of children: None • Years of education: None • Highest education level: None Occupational History • None Tobacco Use • Smoking status: Never • Smokeless tobacco: Never Substance and Sexual Activity • Alcohol use: Not Currently Alcohol/week: 6.0 standard drinks Types: 2 Glasses of wine, 4 Shots of liquor per week • Drug use: Not Currently • Sexual activity: Not Currently Partners: Male Birth control/protection: None Other Topics Concern • None Social History Narrative PhD Psychologist. Single.\nSocial Determinants of Health\nFinancial Resource Strain: Not on file Food Insecurity: Not on file Transportation Needs: Not on file Physical Activity: Not on file Stress: Not on file Social Connections: Not on file Intimate Partner Violence: Not on file Housing Stability: Not on file\n\n\nFamily History Problem Relation Name Age of Onset • Bipolar disorder Mother Judy • Depression Mother Judy • Hearing loss Mother Judy • Mental illness Mother Judy • ADD / ADHD Father Bruce • Alcohol abuse Father Bruce • Heart disease Father Bruce • Hypertension Father Bruce • Depression Sister • Depression Sister Robin • Learning disabilities Son Damon\n\nAllergies:Benzocaine, Epinephrine, Procaine, Anesthetics amide type select amino amides, Cat dander, Corn, Gluten, Methylphenidate hcl, Miconazole nitrate, Shellfish derived, and Estrogel [estradiol]\n\n\n\n\nProcedure: \n\n\n1. Splint Application [43499946] ordered by Terra Rudd, PA C\n\n\n\nAttestation signed by Shannon Sovndal, MD at 3/31/2023 6:57 PM\n\nThe patient was evaluated and managed by the Physician Assistant.R\xa0 My co signature indicates that I have reviewed this chart and I agree with the findings and plan of care as documented.R\xa0 I am the supervising physician.\n\nShannon Sovndal, MD\n\n\n\n\nConsent obtained: Verbal\nConsent given by: Patient\nRisks, benefits, and alternatives were discussed: yes\nRisks discussed: Discoloration, numbness, pain and swelling\nAlternatives discussed: Referral\nUniversal protocol:\nProcedure explained and questions answered to patient or proxys satisfaction: yes\nImaging studies available: yes\nPatient identity confirmed: Verbally with patient\nDistal perfusion: distal pulses strong\nLocation: Knee\nKnee location: L knee\nSplint type: Knee immobilizer\nSupplies: Prefabricated splint\nDistal neurologic exam: Normal\nDistal perfusion: distal pulses strong\nProcedure completion: Tolerated well, no immediate complications\n\n\nReview of System: \nNone\nLab Results: \nLabs Reviewed No data to display\n\n\n\nMedications: \nUltrasound venous lower extremity left Final Result 1. Left Bakers cyst. 2. No deep venous thrombosis left leg. Findings and recommendations discussed with Emergency Department physician, TERRA RUDD at 3/29/2023 21:11 hour. Final report concurs with initial preliminary interpretation.\n\n\n\n No data to display\n\n\n\nThis Chart was Electronically Signed by Terra Rudd, PA C\n\n\n\n\nEMERGENCY DEPARTMENT Prescriptions None\n\nThis patient was seen under the supervision of my secondary supervising physician. I evaluated and cared for this patient independently.\n\n\n\nTerra Rudd, PA C\n03/29/23 2139\n\n\nbmk\n\n\n'
- 'ed_course section: \nNone\ned_diagnosis section: \n1. Viral exanthem\n\nphysical examination section: \nNone\nHistory of present illness section: \nAs in HPI.\nPAST MEDICAL HISTORY: Normal childhood vaccinations up to date. No vaccination for COVID 19 or influenzaSocial history: Lives with parents\nVisit Vitals\nPulse 134 Temp 37 °C (98.6 °F) (Temporal) Resp 24 Wt (!) 9.582 kg (21 lb 2 oz) SpO2 95% Smoking Status Never\nVital signs reviewed by me.\nPhysical exam: Alert, interactive, crying at times.\nOropharynx clear, mucous membranes moist, no cervical lymphadenopathy, neck supple.\nLungs clear to auscultation bilaterally.\nRegular rate and rhythm.\nAbdomen soft nontender nondistended.\nSkin with scattered small papules better erythematous and mostly flat. There is also what appears to be a mild diaper rash under the diaper, external genitalia otherwise normal exam. Rest of skin is warm and dry.\nNormal movement and strength all 4 extremities.\nEmergency Department course/MDM:\nDifferential considered: Patient with symptoms of upper respiratory infection now at day 4. Presents with likely viral exanthem without evidence of bacterial infection. Afebrile in the emergency department, active, well hydrated. Respiratory pathogen panel sent awaiting results. Return precautions reviewed.\nClinical Impressions as of 02/12/23 1158 Viral exanthem\nProcedure: \nnan\nReview of System: \nNone\nLab Results: \nNone\nMedications: \n No data to display\nLabs Reviewed RESPIRATORY PATHOGEN PANEL WITH SARS COV 2\n\n at discharge:\nEMERGENCY DEPARTMENT Prescriptions None\n\n\nAlison Sheets, MD\n02/12/23 1158\n\n\nbmk\n\n\n'
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- 'ed_course section: \n 05/20/23 1859 Sat May 20, 2023 1518 X ray personally interpreted proximal fibula reviewed with patient on the computer system. Crutches and orthopedic referral. Clinical Impressions as of 05/20/23 1859 Closed fracture of proximal end of left fibula, unspecified fracture morphology, initial encounter\ned_diagnosis section: \n1. Closed fracture of proximal end of left fibula, unspecified fracture morphology, initial encounter\n\nphysical examination section: \nNone\nHistory of present illness section: \nDoes not have other injuries.REVIEW OF SYSTEMS:\nAs in HPI.\nPAST MEDICAL HISTORY: Previous ankle fracture, also on metformin and a statin. History of CEREBROVASCULAR ACCIDENT and type 2 diabetes, hyperlipidemia and hypertensionSocial history: Lives boulder\nVisit Vitals\nBLOOD PRESSURE 143/90 (BLOOD PRESSURE Location: Right arm, Patient Position: Sitting) Pulse 58 Temp 36.8 °C (98.3 °F) (Temporal) Resp 17 Ht 1.829 m (6) Wt 93 kg (205 lb) SpO2 96% BMI 27.80 kg/m² Smoking Status Never BSA 2.17 m²\nVital signs reviewed by me.\nPhysical exam: Abrasion to the left leg just below the knee\nFull range of motion left knee and ankle with joint stability both places.\nCompartments soft in the lower leg but has lateral fibular tenderness.\n\nEmergency Department course/MDM:\nDifferential considered: Fibula fracture, tibia fracture, knee or ankle injury x rays ordered.\n\nImaging studies personally viewed and interpreted: yes.\nReviewed with the patient. Plan nonweightbearing at ortho follow up next week. Warned at least 6 weeks for healing.\nProcedure: \nX ray knee 4+ views left Final Result Comminuted mildly displaced proximal fibular fracture. XR ankle left 3+ views Final Result No acute osseous findings. XR tibia fibula left 2 views Final Result Comminuted mildly displaced proximal fibular fracture.\n\nReview of System: \nNone\nLab Results: \nNone\nMedications: \n No data to display\nLabs Reviewed No data to display\n\n at discharge:\nEMERGENCY DEPARTMENT Prescriptions None\n\n\n\nDale Wang, MD\n05/20/23 1859\n\n\nbmk\n\n\n'
- 'ed_course section: \n\n\nDdx includes laceration, tendon injury, arterial injury, foreign body, open fracture\n\nLaceration cleaned and irrigated.\nNo fb on inspection or on xray\nNo fxr clinically.\nTetanus utd\nLaceration cleaned, irrigated, surgicel applied and and dressed. Given sub centimeter lacerations will hold on sutures given high risk of infection. Home with f/you and return precautions\n\n\n\nRESPONSE TO TREATMENTS: bleeding controlled\n\nEMERGENCY DEPARTMENT Prescriptions None\n\nFOLLOW UP:\nFoothills Emergency Department\n4747 Arapahoe Avenue\nBoulder Colorado 80303 1131\n303 415 7606\nGo to\nIf symptoms worsen\n\n\nEMERGENCY DEPARTMENT Course\nClinical Impressions as of 09/03/23 1037 Laceration of finger of left hand without foreign body without damage to nail, unspecified finger, initial encounter\n\nAmount and/or Complexity of Data Reviewed\nRadiology: ordered.\n\n\n\n\n\n\ned_diagnosis section: \nNone\nphysical examination section: \nEMERGENCY DEPARTMENT Triage Vitals [09/02/23 1853] Temperature Heart Rate Resp BLOOD PRESSURE 36.3 °C (97.3 °F) (!) 120 16 (!) 143/94 SpO2 Temp Source Heart Rate/Pulse Source Patient Position 95 % Temporal Sitting BLOOD PRESSURE Location FiO2 (%) Right arm\nVisit Vitals\nBLOOD PRESSURE (!) 143/94 (BLOOD PRESSURE Location: Right arm, Patient Position: Sitting) Pulse (!) 120 Temp 36.3 °C (97.3 °F) (Temporal) Resp 16 Ht 1.778 m (5 10") Wt 79.4 kg (175 lb) SpO2 95% BMI 25.11 kg/m² Smoking Status Never BSA 1.98 m²\n\nVitals and nursing note reviewed.\nConstitutional:\nGeneral: He is in acute distress.\nHENT:\nHead: Normocephalic and atraumatic.\nMouth/Throat:\nMouth: Mucous membranes are moist.\nEyes:\nConjunctiva/sclera: Conjunctivae normal.\nPupils: Pupils are equal, round, and reactive to light.\nCardiovascular:\nRate and Rhythm: Normal rate and regular rhythm.\nPulmonary:\nEffort: Pulmonary effort is normal. No respiratory distress.\nMusculoskeletal:\nCervical back: Normal range of motion and neck supple.\nComments: Left hand: 5 subcentimeter lacerations over dorsal aspect of fingers and medial aspect of hand. No large glass seen.\nAble to flex and extend against resistance.\nSILT\n\nContinued small amount of bleeding until surgicel applied\nSkin:\nCapillary Refill: Capillary refill takes less than 2 seconds.\nComments: As above\nNeurological:\nMental Status: He is alert and oriented to person, place, and time.\n\n\nHistory of present illness section: \n\nChief Complaint Patient presents with • Finger Laceration WI posterior tibial presents to EMERGENCY DEPARTMENT with CC of L hand lacerations approx 30 mins PTA after smashing glass bottle down. Fingers 3,4,5 laceration as well as medial palm. Bandaged at triage, bleeding controlled. CMS intact. 15 20 beers today.\n21 year old male, healthy, tetanus up to date presents with lacerations to the left hand after breaking a beer bottle. No other injuries. Pain described as mild, no meds prior to arrival. No difficulty moving his fingers. Bleeding controlled. No other injuries.\n\n\n\nHistory reviewed. No pertinent past medical history.\nHistory reviewed. No pertinent surgical history.\nNo family history on file.\nTobacco Use • Smoking status: Never • Smokeless tobacco: Current Types: Chew Vaping Use • Vaping Use: Some days Substance Use Topics • Alcohol use: Yes Alcohol/week: 20.0 standard drinks Types: 20 Standard drinks or equivalent per week • Drug use: Yes Frequency: 4.0 times per week Types: Marijuana\nAllergies Patient has no known allergies.\n\n\nProcedure: \n\n\nReview of System: \nA complete 10 point REVIEW OF SYSTEMS was performed and is negative with the exception of those items previously documented in the HPI and nursing notes. As is my standard practice, ALL positives from the ROS are documented in the HPI.\n\nLab Results: \nX ray hand 3+ views left Final Result Negative left hand radiographs.\nImages personally reviewed by me: YES\n\n\n\n\n\n\n\nJustin McLean, MD\n09/03/23 1037\n\n\nbmk\n\n\n\nMedications: \nNone'
- 'ed_course section: \nBlake T Romine is a 41 y.o. male with no reported medical history who presents to the emergency department for evaluation of acute atraumatic left shoulder pain x1 week. This is not associated with joint erythema, cellulitic change, asymmetric swelling, or neurovascular changes. Grip strength symmetric bilaterally. Patient has significantly reduced range of motion both active and passively to abduction internal and external rotation. Tricep DTRs intact. No associated neck pain, chest pain, shortness of breath, headache, dizziness or fever. No visible rash. Differential includes but not limited to adhesive capsulitis, rotator cuff injury, musculoskeletal strain, less likely DVT and brachial plexus injury. With lack of neck pain, prior neck injury or surgery I have low clinical suspicion for referred pain from C spine. His x rays are reassuring without acute bony abnormality. Patient was placed in a sling and provided outpatient orthopedic referral for follow up. NSAIDs advised. Return precautions outlined in discharge.\n\nAmount and/or Complexity of Data Reviewed\nRadiology: ordered.\n\n\n\nFollow Up Plan\nJeffrey Gagliano, MD\n4820 Riverbend Rd\nSte 200\nBoulder CO 80301 2618\n303 665 0286\n\nSchedule an appointment as soon as possible for a visit in 3 days\n\n\nErik Bowman, MD\n4740 Pearl Pkwy\nSte 200\nBoulder CO 80301 3080\n303 449 2730\n\nSchedule an appointment as soon as possible for a visit in 3 days\n\n\n\nDischarge Medications\n (if applicable):\nEMERGENCY DEPARTMENT Prescriptions None\n\n\n 06/08/23 1207 Thu Jun 08, 2023 1133\nImpression:\nNegative.\nClinical Impressions as of 06/08/23 1207 Acute pain of left shoulder\n\ned_diagnosis section: \nNone\nphysical examination section: \nEMERGENCY DEPARTMENT Triage Vitals [06/08/23 1107] Temperature Heart Rate Resp BLOOD PRESSURE 36.9 °C (98.5 °F) 86 18 117/77 SpO2 Temp Source Heart Rate/Pulse Source Patient Position 94 % Temporal Sitting BLOOD PRESSURE Location FiO2 (%) Right arm\n\nGeneral Appearance: Alert, oriented, appropriate for age, cooperative, NAD, VSS, no hypoxia.\nNeurological: Alert and oriented x 3, normal sensation of extremities\nSkin: Warm, dry, no rashes, no nodules on palpation. No obvious erythema, warmth, asymmetric swelling to the left arm compared to right. No visible wound or lesions.\nMusculoskeletal: Patient endorses significant pain with attempted abduction of the shoulder as well as crossing the left arm over the body. No pain with flexion of the elbow or wrist. Intact distal radial, ulnar, median nerve function. Slight subjective decreased sensation over the deltoid. No scapular winging. I can reproduce some pain along the posterior deltoid to palpation although patient states most of the pain feels like it is "deep in the joint". Intact tricep DTR bilaterally. Grip strength 5/5.\nCardiac: Regular rate and rhythm no murmur\nRespiratory: Lungs clear bilaterally.\n\nPAST HISTORIES / Medications\n / ALLERGIES\nPast Medical History: Diagnosis Date • Sepsis (CMS/HCC)\nNo past surgical history on file.\nHistory of present illness section: \n41 y.o. male who is otherwise healthy with no reported medical history, presents to the emergency department with complaints of atraumatic left shoulder pain for the last 5 days. Patient states he is right hand dominant, works in the construction industry but prior to onset of pain and more recently has been doing more desk and administrative work. Has been spending slightly more time on the computer. He reports he has significant pain with any attempt at moving the shoulder, this pain is usually worse at night. Not report numbness or tingling to the hand or fingers or weakness to the lower arm. He reports some minor sensory changes to the deltoid region. He denies any neck or back pain, fevers, headache, dizziness, chest pain, palpitations or shortness of breath. No upper respiratory symptoms or body aches. No obvious asymmetric swelling to the arm, redness or warmth to the joint. Prior shoulder injury or surgery. No pain extending into the anterior or posterior chest wall. No rash or insect bite. No personal or family history of rheumatoid arthritis or autoimmune disease. No other joint involvement. He has been trying ibuprofen intermittently with minimal pain relief.\n\n\nTobacco Use • Smoking status: Every Day • Smokeless tobacco: Never Substance Use Topics • Alcohol use: Not Currently • Drug use: Not Currently\n\nProcedure: \nPatients left arm was placed in a sling, ortho referral given.\n\nELECTRONICALLY SIGNED BY Jamie Canino, PA C\n\nJamie Canino, PA C\n06/08/23 1207\n\n\nbmk\n\n\n\nReview of System: \nNone\nLab Results: \nXR shoulder left 2+ views Final Result Negative.\nImages personally reviewed by me: YES\n\nMedications: \nNone'
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