Richardson 86yoF Afib on pradaxa, recently admitted for I/D for seroma and w.

v
placement, presented to ED with hypotension to 90s and night sweats and WBC ct
28.2, plan for OR washout 8/23
-v/c/flagyl/NPO MN SQHh and Pradaxa helf/consented

Bailey: 78 y.o. male w/ DM, CKD, HLD, HTN, CVAs x 3 (last in 2003), CAD, MIs x 2 s/p
CABG x 4, severe PAD s/p multiple vascular procedures to the LLE (including revision
of the left fem-pop bypass on 5/2016), s/p pacemaker 6/18/2016, admitted to UMHS
8/9 for occluded fem-pop bypass graft.

S/p L AKA on 8/9 c/b AoCKI

-HTN to the
;not given IV; on metoprolol tartrate 25 BID and doxazosin
-AKI: K
Cr
-DC to sparrow rehab 6-8wk f/u Coleman clinic for (Staple) removal
- Nephro recs upon d/c: do not restart home lasix, R/s Lisinopril o/p (PCP),
consider daxazosin
Downs: 51 yo M w/PMH HTN, CAD w/stent (2008), renal transplant (2013),
thrombocytopenia, remote left leg arterial bypass, stent in leg 5 months ago, and
balloon angio 8/14/16 (all at OSH). Transferred from OSH with cold left foot.

S/p L AKA on 8/18

-rewrapped 8/23
- TNeph:Cr bump and looked dry: encourage to drink 2L, Tacro lvl Wed
-V/C/F for possible stump infx: if afebrile BCx
-new shrinker ordered
- PT cleared for home with assist, PMR op f/u 6-8wk, OP sleep study r/o OSA
(heme)
Carrigan is a 70 yo M with hx of ESRD s/p renal transplant, DMII, PVOD
s/p RLE BKA and LLE popliteal artery-AT artery bypass, HTN, HLD, atrial
fibrillation on warfarin, diabetic retinopathy, and hearing loss admitted for
LLE arterial bypass graft stenosis
-POD 1 dx angio bypass graft stenosis
-DC Foley: making good UOP,
-home meds except heparin, Warfarin to start 8/24,
-Pain controlled
-tacro level 8/24 am (make sure drawn)
-DC home 8/24
Greene: 63 yo female s/p TAAA repair on 7/22 with bypass to SMA and left renal
artery and s/p fem-fem bypass on 7/23 with BL paralysis of LE.
- Dysphagia 3 diet and cyclic TF (9p-7a) some N, no V, 3d calorie count: per
nutrition eating <25% goal report 8/23
- on Bactrim x7d for Foley related UTI (rbc, yeasts)
- INR therapeutic on Warfarin 2

- UOP (Foley) _____ (___, ____, ____) BUN

Cr
Clearance 10 (nl 80-120); MWF; nephro:
- Questionable RLE movement per nursing
pre-albumin 22; albumin 2.6, INR 2.4, LFTs wnl

reprsent plateau, Creatine

Torres: 67 yo M with hx of Arthritis; Myocardial infarction (CMS/HCC) (2007);

Diabetes mellitus (CMS/HCC) (2005); PAD (peripheral artery disease) (CMS/HCC);
Hyperlipidemia; Coronary artery disease; and Hypertension now s/p L AKA on
8/10/16 s/p ortho rewashout 8/23 for tissue loss c/b septic arthritis.
-re-washout 8/23
-heparin per nomogram for thrombous in CTA
-TEE, PET today: f/u
- Blood culture from 8/18/2016 positive for pseudomonas; 8/22 GNR: daily BCx until
negative, afebrile, WBC stable on mero2q8, ID following
Daniels: 49 yo F h/o HTN, DM, ESRD on HD, prior right AKA, and left heel ulcer now
s/p Left BKA S/p L BKA 8/5, prior AKA

S/p L BKA 8/5, R AKA revision held d/t poor nutrition

-day 4 TPN (started 8/19): insulin 20; sugars
dose SSI, re-eval revision Thurs?
-w.v change today
-TTS
-PO fluconazole until 8/24 for cutaneous candidiasis
-L stump not wrapped due to calciphylaxis/ulcer
pre-albumin 15 (9), albumin 2 on Mon/Thurs.

(gtt), customized low-

Slon: 24yoAberrant R subclavian artery s/p R subclavian-carotid transposition

8/17, back 8/22 for second phase proecedure L carotid subclavian bypass
-bASA, SQH
- Pain controlled sch tylenol, incr oxy 5-10q3
,RD, TKO,
UOP, RA,
Foley DC today
Dacko: 71 yo M w/PMH CAD s/p CABG x3, HLD, b/l carotid stenosis s/p R carotid
endart, stroke, AAA. Now s/p open AAA repair with 24 mm Dacron graft, left renal
a. bypass w/6mm Dacron, omental patch
-NG out -> trial CLD?
-BUN , Cr
,hypernatremic @
on D5 @75-- , re-val need for dialysis,
IV pushes of lasix as need goal net neg 1-2 L
Pain with oxy; epidural DCd 8/22
-ABIs
-PT b/c not moviong RLE
-delined
Dart: 73yo Male with a history of PVD with critical limb ischemia starting in spring
2016 s/p multiple vascular procedures including aortobifemoral and right lower
extremity bypass, NSTEMI, L BKA, L AKA when BKA became necrotic 5/12/16,
recently hospitalized 7/27 for new foot wound RLE angio showing bypass loss and

progression of disease in distal foot, admitted 8/11/16 for R PT to lateral plantar

artery bypass.
-DC to rehab today /Lovenox/Warfarin/keflex for 2 week; w/ 1 wk f/u Eli clinic
wound check
- toe touch weight bearing with wheelchair
-has new shoe
(lovenox 60BID/warfarin 6/INR
fitted for new shoe
-b-diene BID)
Horne: 48 yo F w/PMH DM, HTN, CAD s/p CABG & MVR, HLD, ESRD on HD s/p LE
angio 8/17. Has exposed bone on L 3rd toe.
S/p L 2-3rd toe amputation on 8/20
-Bone cx GPC GPR, awaiting speciation, afebrile, WBC Stable on Vanc and Cefepime
(Flagyl Dc nausea)
- Pain schd tylenol, PO Oxy 5-10
-Renal diet with Nausea
-HD terminated early 8/22 tachy/cp; ekg unremarkable, trop 0.36->
->
-MWF
Smith: 62 yo F with history of COPD, hypothyroidism, and ruptured AAA s/p open
repair on 8/19/2016, s/p closure 8/21
- extubated 8/21,
L, transfer to floor today
- febrile, WBC ct stable on Vanc/cefepime
-NGT in ?
-UOP
Kruger: 57yo man with PMH CAD, paraplegia 2/2 MVA, and locally recurrent,
unresectable gastric cancer at GE junction s/p esophageal stent placement on
taxol who presented with hematemesis and concern for esophageal-aortic
fistula s/p TEVAR
Overnight
-agitation/? d/t constipation->BR->
-Extubated, transfer to floor
-GI no further imaging
-ID: fluconazole and Ivzosyn