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REPUBLIC OF THE PHILIPPINES DEPARTMENT OF HEALTH

DEPARTMENT OF INTERNAL MEDICINE


INTENSIVE CARE UNIT CENSUS
Mortality 0 Admission 1

Residents: Dr DIWA/PATACSIL/SANTIAGO/SO Trans-Out 1 Discharge 0


Date: June 7-8, 2016
Trans-In 0 TOTAL PATIENTS 8

Cubicle 1

BED 1 CBC WBC Hgb Hct N L M E Plt BTRh LDH


ARF Type II sec to IVF: heplock 5/10 9.3 119 0.381 0.82 0.10 0.06 343
COPD IAE CVP 10 cc/hr 5/14 18.8 119 0.394 0.95 0.03 0.02 241
GLORIA, VAP on top of CAP,
Diet: soft diet 5/15 13.4 108 0.349 0.91 0.08 0.01 108 Hold HD for now
RICARDO Meds
resolved 5/17 13.9 106 0.355 0.94 0.03 0.03 178
65/M AKI sec to Sepsis, 1. Omeprazole 40 mg IV
5/20 12.5 90 0.297 0.96 0.02 0.02 202
No objection
resolving OD 5/20 13.6 88 0.285 0.96 0.02 0.01 197 Nephro-wise if
UGIB prob sec to 2. Doxofylline 200 mg 5/22 13.7 82 0.261 0.97 0.02 0.01 203 for trans-out
CHA tab BID 5/23 13.5 82 0.26 0.94 255
stress gastropathy
3. NAC 600 mg tab in 5/25 13.5 75 0.236 0.94 0.03 0.03 286 Target HGB: 110
resolved
DOA: 5/11/16 glass water once/day at 5/31 10.3 68 0.212 0.88 0.06 0.04 274
UTI
bedtime 6/1 10.8 59 0.188 0.89 0.06 0.04 0.01 234
ICU: 5/21/16 4. Chlorhexidine swab 6/4 7.9 92 0.298 0.85 0.10 0.04 0.01 186 OFF BIPAP MASK
TID 6/5 6.3 82 0.259 0.86 0.09 0.04 0.01 167 for 3 hrs every
29th hospital day 5. Salbutamol + ipra neb 6/7 6.1 85 0.274 0.86 0.07 0.06 0.00 207 meal
q12
19th ICU day 6. Hydrocortisone 50 mg Apply
CHEM BUN CREA Na K Cl Ca Mg Pho Ch Trigl UH LDLC AST ALT Alb FBS Uric HbA1c Trop I
IV q8 s oL y DL acid compression
7. ALBUMIN 1 vial plus stockings
I: 1,120 5/10 7.2 116.3 144.6 5.19 103.2
furo 20mg iv od
O: 1,520 9. Ciprofloxacin 400mg
5/11 0.60
5/12 18 130 32. 121. 156.
-400 iv q12 (Day 6)
0.6 3 2 4
10. Digoxin 0.25mg
tab 5/13 11.4 129.4 149.4 4.43 111.4
11. Feso4 1 tab 4x 5/14 17.4 169.2 151 4.27 114.3
12. EPO 4000 u 5/15 157.9 4.54 121.5 1.44 0.99 24
13. Seretide 2 puffs bid 5/17 40.2 791.5 154.8 5.91 117.9 1.23 1.09 2.72 28
5/18 41.8 833.8 151.8 6.09 115.6 1.17 1.12 26
BIPAP SETTINGS 5/19 160.8 5.77 1.25 166 66 25 922.41 0.17
IPAP 14 5/20 35.8 828.3 147.4 5.28 112.1 1.63 1.19 3.02 24
EPAP 4 5/21 42.9 855.4 143.7 4.15 109.2 1.62 1.29 2.74 56
PS 10 5/22 33.4 710.9 138.2 3.86 103.9 1.64 1.05 2.44 21
FIO2 30% 5/23 31 516 136 3.26 103 1.4 0.99 2.43 21
5/25 26 766.4 137.1 2.93 103.6 1.52 0.88 2.48 23
5/31 15.9 287.1 142 3.48 108.2 1.6 0.49
6/1 11.7 204.7 143.5 3.12 109.3 1.72 0.68 1.08 26
6/4 208.1 143 5.09 109.2 1.79 0.75 1.37 31
6/5 16 184.2 145.3 5.13 112.5 1.73 0.71 1.2 27
6/7 15.3 152.3 141.3 5.16 105.6 1.8 0.98 1.1 29

ABG Ph PCO2 PO2 HCO3


5/10 7.225 77 46.9 31.4
5/11 7.281 54.4 304.1 25.1
5/12 7.265 58.6 83.1 26.0
5/13 7.309 53.5 66.0 26.3
5/14 7.329 45.7 72 23.5
5/15 7.230 49.6 88 20.3
5/16 7.106 83 87.4 25.5
5/17 7.190 59 202.3 22.1
5/18 7.128 67.4 247 21.8
5/18 7.080 67.6 67.5 19.6
5/19 7.198 41.2 `262.4 15.7
5/20 7.191 53.7 193.7 20.1
5/21 7.230 50.7 98.6 20.7
5/27 7.288 38.8 110 18.2
5/31 8PM 7.117 87.7 97.6 27.6
5/31 7.184 69.5 89.9 25.9 94.4
9PM
6/1 7.314 47.4 114.4 23.5 97.8

1
12AM
6/1 7.343 46.7 71.4 24.8 93.4
6AM
6/2 7.334 51.6 102.4 26.8 97.3
6/3 7.240 56.0 73.8 23.5 92.1
6/4 7.128 69.3 55.7 22.4 78
6/5 7.248 56.6 134.4 24.1 98.2
6/7 7.373 42.1 68.7 24.0 93.3

UA Color Turbidity SG pH Sugar Protei RBC WBC Ketones Epithelial Cells Mucus Bacteria Amorphous
n Threads Urates
6/1 LY Turbid 1.030 6.0 - +2 18-25 Num - Few Occ Numerous few
erous

Test Official Results


Blood CS x sites No growth after 5 days of incubation
5/20
Sputum GS Pus > 25, Epith < 25, / Gram pos cocci in clusters = few to mod / Gram positive cocci in pairs = occasional to few / Gram pos cocci in chains = occasional /
Gram neg coccobacilli = occasional to few
Plain Cranial CT (5/10) Consider sublenticular cyst, right. Age related cerebral atrophy. Hypoplastic left frontal sinus. Left ethmoid sinusitis. Mastoiditis, left.

CXR (5/11) Suspicious densities, both upper lungs. Apicolordotic view is suggested. Bilateral hilar fullness for which vascular congestion, infectious process or enlarged
lymph nodes is considered
CXR (5/12) Consider interstitial pneumonia, both inner lung zones

CXR (5/19) Present study shows reticulonodular densities in both lungs for which pulmonary tuberculosis is considered. The previously noted ET tube is still seen with its
tip at the level of T3 vertebra. The rest of the findings remain unchanged
CXR 6/5 Progression of haziness in both lungs. Likewise there a subtle nodular densities in the right lung probably secondary to pneumonia The rest of the findings
remain unchanged.
ECHO INITIAL: EF 78, NORMAL contractility, normal dimension
.sputum cs: heavy growth acinetobacter baumani after 2 days, sensitive to amikacin. Resistant to rest
Blood gs left: few pus cell, no microorganism, blood cs r/l no growth after 5 days

2
Bed 2 CHF, RAE, RVH, LVH, Heplock CBC WBC Hgb Hct N L M E Plt BTRh LDH
anterior septal wall Low salt low fat 6/1 7.1 161 0.513 0.57 0.37 196 For PT, PTT
ischemia, prob RHD 6/4 8.4 183 0.573 0.64 0.30 214 after2 days of
Meds:
FC IV
Omeprazole 40 mg IV
initiation of
De Vera, Paula warfarin
OD
30/F Metoclopramide 10 mg
IV q8 Ff up 2decho
Sildenafil 25mg/tab TID result
Carvedilol 6.25mg/tab ABG Ph PCO2 PO2 HCO3 02sat
DOA: 6/1/16 6/7 7.419 31.5 47.6 19.9 84.7 Ideally for
2x a day
chest ct scan
ICU: 6/5/16 Digoxin 0.25, tab
Lactulose 30 cc with
Captopril 25 mg, tab angioggraphy
8th hospital day 3x CHEM BUN CREA Na K Cl Ca Mg Pho Ch Trigl UH LDLC AST ALT Alb FBS Uric HbA1c Trop I Ideally for
4th ICU day Dobumtaine drip 8mkm s oL y DL acid ANA
at 50 kg (14cc/hr) 6/1 3 64.7 136 3.71 0.19
Warfarin 5mg 1 tab od 6/4 134 3.4 0.135
6/5 150.6 128.6 2.86 0.63 1.86
Hold ASA
6/6 78.8 130.6 4.15 2.04
6/7 4.64 2.07 1.19 31

I: 1398
O:2400 UA Color Turbidity SG pH Sugar Protei RBC WBC Ketones Epithelial Cells Mucus Bacteria Amorphous
-1002 n Threads Urates

pt %ACT INR CONT APTT CONT


6/7 11.2 102 1.040 10.8 26.90

CXR: Pneumonia right lower lung. Cardiomegaly with pulmonary arterial hypertension
2d echo with DS (9/3/15): EF 50%; Dilated RV, normal wall thickness and generalized severe hypokinesia and decreased global systolic function
The interventricular septum is flattened systole consistent with right ventricular pressureoverload and pulmonary HPN.
Dilated LA, Dilated RA and main pulmonary artery.
Normal LV dimensions with generalized severe hyokinesia. Global systolic function is decreased. Findings consistent wth myocarditis.
2DEcho with DS (6/6/16) Initial: EF 36%, Dilated RV, Dilated MPA, TR trivial, interventricular septum is flattened in systole consistent with pulmonary HPN

BED 3 CBC WBC Hgb Hct N L M E Plt BTRh LDH


Intraparechymal IVF: PNSS 1 L X 100 cc/hr 6/4 11.4 140 0.432 88 9 299
Diet: OF at 1600 6/6 8.9 132 0.407 84 12 04 208 Ff up Official CXR
bleed left
Quiambao, kcal/day in 6 equal
parietooccipital, s/p feedings For ETA GS/CS
Manuel Craniotomy with
Duraplasty (6/5/16) Meds: For possible
44/M HCVD, LVH, NIF extubation
CAP with aspiration Nicardipine drip
Mannitol 150 cc q4 CHEM BUN CREA Na K Cl Ca Mg Pho Ch Trigl UH LDLC AST ALT Alb FBS Uric HbA1c Trop I
component
DOA: 6/5/16 Omeprazole 40 mg IV s oL y DL acid
HPN st 2 6/4 4.5 86.7 139.2 3.82 102.6
ICU: 6/5/16 OD
Felodipine 5 mg OD 6/6 100.5 143.6 3.21 108.5 2.03
Irbesartan 150 mg OD 6/7 5.1 3.1 1.0 2.66 7.06
th
4 hospital day Cefuroxime 750 mg iv q8 2 5
4th ICU day (Day 2+2)
Clindamycin 300 mgIV
3rd day post op q6 (Day 2+3) ABG Ph PCO2 PO2 HCO3 SpO2
Salbutamol + 6/5 7.362 34.7 243.4 19.3 99.5
Ipratropium
I:
Chlorhexidine solution CT scan cranial: Acute intraparenchymal bleed, left parieto occipito-tenporalregion, with perilesional edema, mass effect, subfalcine and beginning uncal herniation. Lacunar infarct, right BG; left maxillary sinusitis
O:
Mechvent
Vt 400
Spont mode PS 12
Fio2 30%
PEEP 5

3
bed 4 Vegetative state IVF: PNNSS 1L X 40cc/hr CBC WBC Hgb Hct N L M E Plt BTRh
s/p CP DIET: OF 5/5 14.2 78 0.24 0.66 0.30 0.04 122 A+
arrest(15mins) 5/7 25.3 92 0.287 0.88 0.06 0.06 185 Failed weaning
Retrieve official
MANUEL VAP
Omeprazole 40MG/TAB
5/8 23.2 93 0.295 0.87 0.09 0.04 139
echo
Microbial keratitis, 5/9 11.5 87 0.269 0.87 0.07 146
RICARDO OU
Q12
5/13 8.3 90 0.285 0.73 0.21 0.06 130
Mucosta 100mg tid
60/m UGIB and LGIB 5/14 11.9 85 0.26 0.81 0.13 225
miracoline 1gm IV q6
resolved 5/16 17.2 93 0.299 0.86 0.10 0.04 242
PAY CHA Decubitus ulcer Paracetamol 300mg lv 5/19 10.8 110 0.76 351
DOA 5/5/16 q4 prn 5/23 15.7 105 0.33 0.92 0.03 236
right gluteal area
5/26 15 97 0.29 0.82 0.13 178
gr2
Piracetam 1.2 gm IV Q12 5/30 11.3 88 0.28 0.76 0.19 0.04 259
s/p EGD hrs. 6/6 13.9 92 0.28 0.79 0.16 0.04 535
I: s/P Colonoscopy
O: with hemoclipping D5050 vial fr cbg less (5/24) CLOTTING TIME: 6 MINS / BLEEDING TIME: 3:30 MINS
Sp than 80
cardioversion(100/2 CHEM BUN CREA Na K Cl Ca Mg Phos Chol Trig UHDL LDLC AST ALT Alb FBS Uric HbA1c Trop I
00j) DEPAKOTE 500 MG TAB ly acid
Q12HRS 5/5/16 5.4 103 142 3.71 111.7
5/7 64.5 161.1 3.29 1.82 0.82 33
Chlorhexidine TID
Sp bt 7u PRBC 5/8 6 147.8 3.44 3.93 1.5 0.95 2.27 8.05
7
LAST 5/30/16 Mucosta 100 mg tab TID
5/8 149.8
5/8 147.9
Sp trachostomy Cefepime 1gm iv q12
(D10+2) 5/9 147.8
s/P PEG (6/1/1/6) 5/9 148.6
FeSO4 + FA tab TID 5/9 80.9 145.2 2.99
139.4 3.46 30
MV Settings 5/10 146.9 2.8
SIMV 5/12 139.4 3.46 30
BUR 8 5/13 77.4 3.66 1.81 1.0
PS 8 5/14 140 1.76 0.87 28
FI0240% 5/19 52 136 3.4
PEEP 5 5/23 5.2 29 136 3.05 101 2 0.88
5/26 5 48 140 3.29 106 1.94 0.88
5/30 141.3 3.37
6/1 2.92
6/3 42.4 137.4 3.91 103.9
6/6 3.3 38.8 26 3.31 101.2 1.87 074 26

ABG Ph PCO2 PO2 HCO3


5/5 7.254 22.9 121.9 9.9
5/5 7.345 27.7 359.3 14.8
5/6 7.444 33.6 104.7 22.5
5/7 7.429 25.8 103.8 16.7
5/9 7.456 30.8 111.0 21.2
5/29 7.48 38 127 28

pt %ACT INR CONT APTT CONT


13.5 72.9 1.21 11.3 31.7 27.9
10.4 124 0.92 12 25 29.
14 68 1.25 12.1 33 29

UA Color Turbidity SG pH Sugar Protein RBC WBC Ketones Epithelial Cells


5/23 Y t 1.030 6 neg neg many 18-25 Neg moderate

CVP line GS: 6/6/16: No Microorganism seem


BLOOD CS 5/12 (L) dorsalis pedis: No growth after 5 days /
Cxr initial: negative
CXR 5/12: PRESENT STUDY SHOWS SIGNIFICANT REGRESSION OF HAXZNIESS IN THE R PERIHILAR REGION ASCRIBED TO PNEUMONIA, REST OF FINDINGS REMAIN UNCHANGED
Blood type A+
Ecg CRBBB
Official plain cranial ct scan (5/5): Falx cerebri calcifications, age-related cerebral atrophy, no CT evidence of intracerebral hemorrhage
Initial cxr: beginning pulmonary congestion, prominent bronchovascular marking, hazy infiltrate right paracardiac and lower lung field, dilated aorta, ET at T4
Repeat cxr: compare w previous cxr noted with decrease infiltrate on right lower lung field

4
Eta gs: PUS CELL>25 HPF, SQUAMOUS EPITHELIAL CELL<25/HPF, GRAM NEGATIVE BACILLI OCCASIONAL, GRAM POSITIVE COCCI IN PAIR OCC
2D ECHO W DS: AS WITH TRIVIAL AR, MS WITH TRIVIAL MR, MOD TO SEVERE PERICARDIAL EFFUSION W/ NO ECHO EVIDENCE OF TAMPONADE DEMONSTRATED, THERE IS MILD
SWINGING MOTION OF THE HEART. THE PERICARDIUM IS THICKENED. THE ECHO FREE SPACE MEASURES 1.6-1.8 CM LATERALLY AND POSTERIORLY. FINDINGS MAYBE SEC TO
CHRONIC EFFUSIVE PERICARDITIS.
Cxr: progression of haziness both lungs
ETA CS 1: light growth acintobacter baumani, sensitive to amikacin, ceftazidime, ciprofloxacin, but resistant to piptazo, meropenem, imipenem, ertapenem,
ETA CS2: light growth of burkhorderia cepacia after three days, sensitive to amikacin, but resistant to ciprofloxacin, gentamycin, piptazo, meropenem, imipenem, ertapenem.
Lens contact cs: elizabethkineg meningosetiea, sensitive to ciprofloxacin.
Cxr 5/30: partial clearing of the previously noted hazy parenchymal infiltrates in the right lung. A trachesostomy tube is niw noted in place.
Tracheal isolate 5/31: Sensitive to Amikacin, Reseisant to Ceftazidime, Cipro, Aztreonam, Piptaz, Meropenem

Bed 5 Decrease IVF: PNSS 1L x CBC WBC Hgb Hct N L M E Plt BTRh
40 cc/hr 4/28 10.3 69 0.214 0.76 0.19 0.05 303
VAP, resolved 5/1 12.4 66 0.213 0.82 0.12 0.06 121 Ongoing MgS04 drip
Diet: OF at 1500
GOJAR, UTI
kcal/day divided into 6
5/6 7.0 73 0.213 0.75 0.18 0.05 156
s/p CVA infarct 2x 5/8 8.8 91 0.266 0.80 0.16 0.04 214 Repeat Mg post
CARMELITA equal feedings
5/11 11.7 96 0.27 0.82 0.12 341 correction
(May 2015, Feb
60/f 5/13 11.5 82 0.239 0.84 0.11 0.05 279 include CBC
2016) Tx:
01419578 5/16 8.6 95 0.283 0.63 0.29 0.06 0.01 233
Sacral decubitus NAC 600 mg OD
5/23 11.6 99 0.28 0.68 225
ulcer gr3
Date Admited: CIPROFLOXACIN 400MG 5/29 11 76 0.22 0.73 0.23 234
ANEMIA OF
04/29 IV Q12 (D6) 5/30 12.9 84 0.25 0.72 0.24 0.04 245
FOR TRANSFER
CHRONIC DISEASE
6/1 16.1 86 0.253 0.84 0.12 0.03 197
S/P Rosuvastatin 20 mg 6/2 16.2 113 0.341 0.90 0.09 0.00 169
TO REGULAR
TRACHEOSTOMY ODHS 6/5 10.5 98 0.283 0.72 0.23 0.04 0.01 157 WARD
5/28/16
Lactulose 30cc ODHS PBS: macrocytic hyppochromic, with aniso and poikilocytosis
Retic count: 8
FeSo+FA tab TID
I: 3,738 CHEM BUN CREA Na K Cl Ca M Pho Choles Trigly UHDL LDLC AST ALT Alb FBS Uric acid HbA1c Trop I
O: 770 Salbutamol + ipratropim g s
+2968 neb q12 4/29 17.1 91.6 128.6 3.1 99.2 1.98 0.8 26 6.5 1.2
OPD 4
Dabigatran 110mgtab
4/30 146.7 3.37 116.4 2.03 0.8 3.05 0.97 0.91 1.7 25 6.9
bid
7
5/1 6.7%
K-lyte tab TID
5/2 4.35
ALBUMIN 25% + Furo 20 5/4 3.3 46.8 141.1 2.44
IV OD 5/6 134.5 2.78 20
5/7 3.74
LOSARTAN 50 MG TAB 5/13 0.7 53.8 135.9 1.32 99.6 1.68 25
BID - hold CCA
1.98
CHEST PHYSIOTHERAPY 5/14 3.24 1.67 23
CCA
2.01
MV SETTINGS: 5/16 49.7 131.9 3.05 102.3 1.92 30
SIMV CCA
BUR 12 2.12
PS 12 5/20 1.8 46 131 1.72 101 1.93 0.5
FIO2 40% 5/23 3.12 1.91 0,7 29
PEEP 2 9
5/30 35.2 133 2.21
6/1 36.1 133.4 2.32
6/2 3.32
6/5 36.1 139.2 1.66
6/6 2.62
6/7 137.9 3.69 0.5
3

ABG Ph PCO2 PO2 HCO3


4/29 7.45 18.9 375 12.8

5
5/1 7.398 23.2 126.7 14.0
5/11 7.47 30 150 22
5/12 7.479 30.7 150.1 22.3
5/30 7.516 29.1 260.7 23.0

UA Color Turbidity SG pH Sugar Protein RBC WBC Ketones Epithelial Cells bacteria
4/28 Y Cl 1.015 6.5 +1 Trace 18-20 Many Neg Few
6/1 DY Turbid 1.030 6.0 - - Many Many few many

Imaging Official Results


CXR previous study dated 2/6/2016 was reviewed. Follow up study shows poor inspiratory effort with fibrotic and hazy infiltrates in both upper lung

CXR previous study done on 4/15/16 was reviewed


Present study shows no significant interval changes in few faint densities in both upper lngs for which residual fibrosis is considered. An
endotracheal tube is noted with its tip at the level of T2 vertebrae. The rest of the findings remain unchanged

Cranial CT 4/29 Present study shows no significant interval changes. Previously noted findings of chronic infarct with encephalomalacic changes along the right posterior
cerebral artery vascular territory, old infarcts in the right thalamus and left corona radiate as well as small vessel ischemic changes in both fronto-parietal
periventricular white matter regions are still seen. The rest of the findings remain the same.
CXR 5/4 Compare to previous study, show faint haziness in both lower lungs which may be due to pneumonia.

CXR 5/8 (INITIAL) No significant interval changes; ET tube tip noted at T3-T4

CXR 5/13 (INITIAL) WHITE LUNG, LEFT LUNG FIELD, TC ATELECTASIS

Cxr: clearing of haziness on left, et at t4


Urine GS: Pus cells = occasional / Squamous epithelial cells = occasional / No microorganism / NO GROWTH AFTER 2 DAYS
Blood cs: negative after 5 days
ETA GS:PUS >25, EC <25, No organism seen
ETA CS:Positive for pseudomonas aeruginosa after 3 days
S: Amikacin, Piptazo, Meropenem, Imipenem
I: Ceftazidime
R: Ciprofloxacin, Gentamycin, Aztreonam

ETA GS: pus cell 0-3/ squamous epithelia cells 2-7cell/ gram negative bacilli occasional
ETA CS: unfit

Maintain mv
Central herniation IVF : 0.45 NaCl L X 100 CBC WBC Hgb Hct N L M E Plt BTRh LDH settings
BED 6 CC/HR Ongoing
sec Massive CVA 5/31 7.4 13.6 0.395 44 43 9 215
DIET OF AT 1800 amiodarone drip
INFARCT, R MCA 6/3 10.9 118 0.347 0.86 0.10 0.04 166
ZULUETA, KCAL/DAY IN 6 EQUALLY
TERRITORY 6/7 9.1 109 0.325 0.83 0.10 0.06 0.01
DIVIDED FEEDINGS
RAFAEL s/p Craniectomy CHEM BUN CREA Na K Cl iCa Mg Pho Ch Trigl UH LDLC AST ALT Alb FB Uric HbA1c Trop I
60M with Duraplasty MED: s oL y DL S acid
Mannitol150cc q4 5/31 10 0.82 139.5 3.6 1.22 2.2 48 6.4
HYPERTENSION ST 2 Ceftriaxone 2g IV OD N N
DOA 5/31/16 CAPMR with prob (D5) 6/6 57.9 148.1 2.78 112.2 1.98 0.86
Clindamycin 600mg/tab 6/7 148.9 3.28 112.7 1.94 0.91 31
aspiration
q6 (D3)
DR component Combivent neb q12 and PTT 26.7
PRIETO/REJUSO PRN PT 11.7
/IDOLOR/SABINI MC SETTINGS: NAC 600 mg/tab in INR 1.0
AC mode glass water OD
ANO/ALCARDE BUR 14 CITICOLINE 1G IV Q8
ABG Ph PCO2 PO2 HCO3 SpO2
TV 500 Metoprolo 50 mg/tab
6/4 7.489 35.9 120.3 26.7 98.6
Fio2 30% BID
I: 5472 PEEP 5 6/6 7.510 33.5 106.7 26.1 98.3
MIRAVAST 10/10MG TAB
O: 2900 OD
+2572 Valproic acid 500 mg IV
CRANIAL MRI 5/31/16: HYPERACUTE R MIDDLE CEREBRAL ARTERY TERRITORIAL INFARCT
q12
LACTULOSE 30 CC ODHS CX 6/4: linear densities in the left lower lung which may be due to atelectasis. No significant interval change in the previously noted pneumonic infiltrates in the left lower lung. The left costophrenic sulcus is
Digoxin 0.25 mg/tab 1 blunted which may be due to pleural effusion. The rest of the findings remain unchanged.
tab OD CT scan cranial 6/2/16: Acute to subacute right MCA vascular territory with mass effect, subfalcine herniation, diffuse cerebral edema and secondary obstructive hydrocephalus. Gyral hyperdensities may
OMEPRAZOLE 40MG represent hemorrhagic conversion or luxury perfusion.
TAB OD
Amiodarone drip for
24hrs

6
BED 7 Ischemic infarct Left PNSS 1 LI X 100CC/HR + CHEM BUN CREA Na K Cl Ca Mg Pho Ch Trigl UH LDLC AST ALT Alb FB Uric HbA1c Trop I FBS lipid profile
MCA NIHSS=11 40meqs kcl s oL y DL S acid Repeat trop I
Unstable Angina 6/6 2.8 72.6 140.7 3.34 0.07 Urinalysis
ABANTO, Rafael OF at 1800kcal 6/7 0.12 Rpt 12 lead ecg
46M CHEM TB Direct Indirect Ff up cxr and ct scan
Citicoline 1g iv q8 Bil Bil official result
ASA 80mg od post lunch
DOA 6/6/16 Omeprazole 40mg iv od
Lactulose 30 cc odhs
ICU ADMISSION Rosuvastatin 20mg 1 tab
6/8/16 CBC WBC Hgb Hct N L M E Plt MCV MCH MCHC RDW BTRh LDH
odhs
Enoxaparin 0.6cc sq q12 6/6 10.9 156 0.472 74 20 06 300
CLopidogrel 75mg1 tab
2nd HD od UA Color Turbidity SG pH Sugar Protein RBC WBC Ketones Epithelial Cells bacteria
1st ICU day Carvedilol 6.25mg 1 tab
RED TEAM od
ISMN 30mg 1 tab od COAGUL pt %ACT INR CONT APTT CONT
Amlodipine 10mg 1 tab ATION
I: 920 od
O:560
+360
Tests Official Results
CXR

CBC WBC Hgb Hct N L M E Plt BTRh LDH For ETA AFB, Gene X-
ARF mixed type IVF: PNSS 1L x 80cc.hr 5/23 9.3 120 0.39 0.83 0.10 0.05 185 pert
BED 8 Diet: OF
secondary to 5/27 7.8 134 0.44 0.86 0.10 223
5/28 5.3 115 0.77 0.77 231 Repeat K, Mg post
PULMONALE sec TB
BACARISAS , Sildenafil 25mg/tab tid correction
Brionchiectasis 5/29 6.4 112 0.37 0.82 0.12 226
K lyte 1 tab TID
JASMINE Piptazo 4.5gm q8 day
6/3 6.2 118 0.387 0/78 0.145 0.04 0.03 163
Chest utz with
34/F VAP 9+2 mapping (refused by
Salbu+Ipra neb q12 CHEM BUN CREA Na K Cl Ca Mg Pho Ch Trigl UH LDLC AST ALT Alb FB Uric HbA1c Trop I radio)
NAC 600mg od s oL y DL S acid Ideally for ytz
PTB COMPLETED
DOA: 5/23/16 TREATMENT Doxophylline 200mg BID 5/23 6.1 63 124 3.74 guided thoracentesis
ICU A:5/29/16 5/25 1.79 0.53 1.63 19
Mech ven 5/27 2.3 43 131 1.86 For PPD testing
Spontmode 5/28 2.5 51 132 1.72 72 1.62 0.42 18
17th Hosp day Vt380 5/29 2.52 d/c levofloxacin
11th ICU day PS 10 5/29 3.6 49 131 2.69 1.61 0.4 0.04
PEEP 4 5/30 3.08 0.74
Yellow team FIO2 60% 5/31 128.7 3.41 91.6 0.61
6/1 130.7 93.6 0.78
I: 1,628 6/3 1.3 41.4 131.8 2.46
O: 970 6/4 3.9 0.5
6/7 0.8 37.3 136.2 2.84 94 1.8 0.45 16
+658
COAGUL pt %ACT INR CONT APTT CONT
ATION
5/23 17.9 45 1.62 12 32 29

ABG Ph PCO2 PO2 HCO3


5/23 7.40 57 62 34
5/27 7.40 95 89 57
5/28 7.55 55 96 47
5/30 7.477 54.9 145.4 39.7
6/2 7.441 51.7 63.7 34.4 92.8
6/3 7.314 66.9 99.1 33.3 96.8
6/6 7.376 58.3 87.2 33.4 96.2

Chest CT sca (6/2/16) Bilateral emphysematous lungs with inflammatory process as described. Bilateral pleural effusion right more than left. Dextro-levoscoliosis, thoracic and lumbar vertebrae
5/31 BLOOD GS (R ARM): PUS CELLS FE, NO MICRO ORGNANISM SEEN
BLOOD CS (R ARM) : NO GROWTH AFTER 5 DAYS OF INCUBATION

5/31 ETA GS: PUS CELLS = >25/HPF, SQUAMOUS EPITH CELLS=<25/HPF, GR (-) BACILLI = FEW

7
6/3 ETA CS: Klebsiella pneumonae: SENSI: Amikacin, Ceftazidime, Cefuroxime, Ciprofloxacin, Gentamycin, Aztreonam, Pip-Tazo, Co-amoxiclav, Meropenem, Ertapene
RESITANT cotrimoxazole
CXR 5/29: Previous study done on 5/23/16 was reviewed. Present study now shows a veil like opacity in the right lung and a pleural density outlining the right lateral hemithorax which may be due to a shift of
fluid in the supine position. No significant interval changes in the previously noted prominence of vascular markings. An endotracheal tube is still now noted with its tip at the level of T5 vertebra for which
repositioning is suggested. The rest of the finding remains unchanged.

CXR 5/30: Present study shows progression of homogenous density in the right lung ascribed to pleural effusion, however cannot rule put underlying pneumonia or congestive changes. Dextro-scoliosis of lower
thoracic spine is still noted. Previosuly noted ET is still in place. The rest of the findings remain unchanged.

CXR 6/5: Regression of haziness in the right lung previously ascribed to pleural effusion. An ET is noted with its tip at the level of T5 vertebrae. The rest of the findings remain unchanged.

2Decho 5/27: EF 66%; Moderate pulmonary hypertension with systolic pulmonary artery pressure of 55-60mmHg by peak TR gradient. Dilated RV with normal wall thickness and generalized severe hypokinesia
and decreased systolic function. The interventricular septum is flattened in systole with paradoxical motion consistent with right ventricular pressure overload/pulmonary or right ventricular dysfunction. Normal
left ventricular dimensions with normal contractility and systolic function. Dilated right atrium and main pulmonary artery. Normal left atrium and aortic root dimension. No thrombus and no pericardial effusion.
Significant bilateral pleural effusion noted with atelectatic lung segment.