FINDINGS: Severe right-sided chest pain. The __ reported a friction rub. A PM lateral showed questionable mediastinal adenopathy. The patient had no cough or sputum production of ___. CT scan in ___ showed a possibility of a 1x2 cm right paratrachial lymphnode. Several smaller anteromediastinal lymphnodes which were all less than 1 cm were also evaluated. The patient was treated with Indocen with relief of her chest pain. ___ level was 64.5 with a ___ 50. PPD was negative, controls were positive. The CT of the abdomen showed normal liver, spleen, pancreas, kidneys, adrenals, uterus, a left ovarian cyst, a large gall stone neck of the gall bladder, no adenopathy and her mammogram was within normal limits. The patient reports band-like ache around her right chest with changes in pain with cough and deep breathing. There is no change in position. The patient reports increased shortness of breath with exertion over the past 5 months. No nausea, vomiting, fevers, chills, night sweats, abdominal pains, urinary complaints, kidney stones, diarrhea, ___ melena, headache, visual complaints or rash.
PAST MEDICAL HISTORY: Unremarkable.
PAST SURGICAL HISTORY: Remarkable for tubal ligation.
SHE HAS NO KNOWN DRUG ALLERGIES.
MEDICINES ON ADMISSION: Indocin 25-50 mg p.o. q.8 hours and Anaprax 270 mg p.o. b.i.d.
The patient drinks alcohol only rarely and smokes regularly.
PHYSICAL EXAMINATION: Weight of 231 pounds, temperature 98.6, heartrate 60, respiratory rate 24, blood pressure 110/70. HEENT examination was unremarkable. The neck was supple without masses, adenopathy or bruits. The lungs showed small diffuse wheezes, but was otherwise without abnormality. Cardiovascular examination revealed a regular rate and rhythm, normal S1 and S2. Questionably slight change in the S1 with the __ maneuver and a questionable 1/6 systolic ejection murmur heard best at the lower sternal border. The abdomen was obese, showed bowel sounds in all quadrants, soft and nontender. It was difficult to tell if there was organomegaly. Extremities showed no clubbing, cyanosis or edema. Neurologically, the patient was normal.
LABORATORY DATA: Show a white count of 8, hemoglobin 14.5, hematocrit 42.5, platelets 326,000, sodium 139, potassium 4.9, chloride 104, CO2 26, glucose 105, creatinine 0.8 and BUN of 17. Please see consolidated lab flow sheet for lab data regarding this patient.
HOSPITAL COURSE: Patient was admitted in ____ evaluations as well as consultation from pulmonology service. Pulmonology service recommended the patient undergo bronchoscopy which was performed.
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
A complete blood count was done for this patient upon admission in order to give a baseline to help guide his care. The blood count was also done to show how his hematological system was affected by the trauma that he suffered in the motor vehicle accident he was in. If the patient was hemodynamically unstable, he may have needed blood transfusions to bring his blood counts up. White blood cells could help to tell is the patient has an infection in his surgical wound. The patient also underwent surgery to correct the injury to his spine, causing more blood to be lost in the process. The platelet, hemoglobin, and hematocrit counts could help to show in the future if the patient is suffering from internal bleeding after the surgery he had.
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
A 61-year-old gentleman was admitted on 25/1/2016 to Letterkenny General Hospital with central chest pain after history of a fall. He also had drastic weight loss and loss of motor and sensory function. He walks with the aid of a walking stick as he has problems walking due to his lower limb weakness. The patient was a heavy smoker of 90 pack years (3 packs/day for 30 years) and stopped nine years ago. He stopped drinking seven years ago. He is married and lives at home with his wife. He works as a plasterer. He has a strong family history of ischaemic heart disease and type 2 diabetes mellitus. Two of his brothers had coronary bypasses and stents. His father died of a myocardial infarction. Two of his brothers are also type 2 diabetics. During
History of Present Illness: Ms. Lynehan is a very pleasant 34-year-old woman who I had seen previously in July 2014 for the evaluation of a right upper lobe pulmonary nodule. She is currently asymptomatic. She carries a diagnosis of carcinoid, which was resected from the right lower lobe. She additionally had a right upper lobe nodule that was resected, which was found to be a granuloma. Since that time, bronchoscopy has been performed which grew
The patient tells me at least six or eight weeks ago, she noticed that she was having some discomfort in the left axillary area. She around the same time had started doing a lot of exercising, specifically Zumba classes and attributed her discomfort to that. She describes it as an aching, nagging type of pain that is not there consistently. It seems to come and go. Yesterday, she did Zumba and noticed following that it was little bit achy and last evening she was lying down with her arm above her head and was checking the area where it was tender and felt a lump there. This is the first time she felt a lump, despite multiple checks previously.
Mrs. Jones, 78 years old, arrived in the emergency department (ED) via ambulance. She was alert and oriented, but was having episodes of lost consciousness. She was put on the cardiac monitor and her vital signs were obtained. Her cardiac rhythm was normal. Her vital signs were as follows: Temperature 97.3°F, Pulse 43, respirations 26, blood pressure 100/58 and O2 saturation of 94% on room air. Additionally, Mrs. Jones was vomiting and had 2 loose, incontinent stools. She was pale, cool to touch and diaphoretic. Auscultation of her lungs revealed expiratory wheezes.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
This is an 84-year-old Arabic patient with a significant past medical history of hypertension, hyperlipidemia, and hypothyroidism. She also has a question of osteoarthritis and gout. She came to the emergency room with pain in her right ankle and foot extending into her leg. She had difficulty in ambulating. She had no chest pain, shortness of breath or other significant symptoms. Her past medical history she has a history of hypertension, as I noted, congestive heart failure and hyperlipidemia. Her initial diagnostic testing revealed a white count of 12.4 with uric acid of 5.5, creatinine was 2.36 however her previous creatinine was abnormal at 1.43 but that was from 3 years prior. She had a CAT scan of the foot which showed an osteochondral
Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., Edwards, F. D. (2008). Diagnosis
Witter, R. Z., Martyny, J. W., Mueller, K., Gottschall, B. & Newman, L.S. (2007). Symptoms
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Keep the patient NPO, and establish two IV access sites with a large bore catheters running one IV with NS at KVO and morphine sulfate for pain. Initial laboratory testing including a complete blood cell count (CBC), basic metabolic panel (BMP), cardiac enzymes (creatine kinase, creatine kinase-MB, and cardiac Troponin) and repeat in 90 min. Administer antiplatelet ASA 324mg PO (Sen, B., McNab, A., & Burdess, C., 2009, p. 18). Before administering nitroglycerin 0.4 mg SL (every 5 minutes up to three doses) reassess blood pressure if systolic <90 mmHg, patient has used cocaine in the last 24 hours, or taking PDE-5 inhibitors do not administer. Thrombolytic therapy should be implemented within 30 minutes from the patient’s arrival to the emergency department, and if they are a candidate for cardiac catheterization it should be done within 90 minutes from the patient being admitted to the hospital. Delay on either therapy option increases the risk of mortality (Kosowsky, Yiadom, Hermann, & Jagoda, 2009, p. 10).