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0
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 57
- Gender: F
## Transfers [2115-11-02 13:59:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2115-11-02 13:59:00]
- Gender: F
- Race: WHITE
## Triage [2115-11-02 13:59:01]
- Temperature: 100.1
- Heartrate: 101.0
- Resprate: 14.0
- O2Sat: 100.0
- Sbp: 147.0
- Dbp: 91.0
- Pain: 5
- Acuity: 2.0
- Chiefcomplaint: Pleuritic chest pain
## Vitalsign [2115-11-02 14:00:00]
- Temperature: 100.1
- Heartrate: 101.0
- Resprate: 14.0
- O2Sat: 100.0
- Sbp: 147.0
- Dbp: 91.0
- Pain: 5
- Rhythm: nan
## Provider Order Entry [2115-11-02 14:12:23]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
## Labotary Test Events [2115-11-02 14:15:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Bilirubin | nan | mg/dL | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | NEG. |
| Glucose | nan | mg/dL | nan | nan | nan | NEG. |
| Ketone | nan | mg/dL | nan | nan | nan | NEG. |
| Leukocytes | nan | nan | nan | nan | nan | NEG. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 7.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | nan | mg/dL | nan | nan | nan | NEG. |
| Specific Gravity | 1.003 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | Clear. |
| Urine Color | nan | nan | nan | nan | nan | Straw. |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | NEG. |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Uhold | nan | nan | nan | nan | nan | ___ |
## Microbiology Test Events [2115-11-02 14:15:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: < 10,000 CFU/mL.
- Ab_Name: nan
## Provider Order Entry [2115-11-02 14:19:10]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Blood Bank | Blood tests |
| Lab | nan |
## Medrecon [2115-11-02 14:41:00]
| Name | Atc Type |
| ------ | ------ |
| Advair HFA | fluticasone furoate |
| albuterol sulfate | nan |
| multivitamin | None |
## Vitalsign [2115-11-02 14:43:00]
- Temperature: 98.5
- Heartrate: 97.0
- Resprate: 17.0
- O2Sat: 100.0
- Sbp: 152.0
- Dbp: 94.0
- Pain: 6
- Rhythm: nan
## Provider Order Entry [2115-11-02 15:15:08]
| Order_Type | Order_Subtype |
| ------ | ------ |
| IV therapy | IV fluids |
| General Care | Other |
| Lab | nan |
| IV therapy | IV fluids |
| IV therapy | IV fluids |
## Labotary Test Events [2115-11-02 15:55:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Absolute Lymphocyte Count | 1.69 | K/uL | 1.2 | 3.7 | nan | nan |
| Basophils | 0.4 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 0.0 | % | 1.0 | 7.0 | abnormal | nan |
| Hematocrit | 41.4 | % | 34.0 | 45.0 | nan | nan |
| Hemoglobin | 13.4 | g/dL | 11.2 | 15.7 | nan | nan |
| Lymphocytes | 10.5 | % | 19.0 | 53.0 | abnormal | nan |
| MCH | 30.9 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 32.4 | g/dL | 32.0 | 37.0 | nan | nan |
| MCV | 95.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 5.5 | % | 5.0 | 13.0 | nan | nan |
| Neutrophils | 82.5 | % | 34.0 | 71.0 | abnormal | nan |
| Platelet Count | 393.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 12.7 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.34 | m/uL | 3.9 | 5.2 | nan | nan |
| White Blood Cells | 16.1 | K/uL | 4.0 | 10.0 | abnormal | nan |
| Absolute Basophil Count | 0.07 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.0 | K/uL | 0.04 | 0.54 | abnormal | nan |
| Absolute Monocyte Count | 0.89 | K/uL | 0.2 | 0.8 | abnormal | nan |
| Absolute Neutrophil Count | 13.3 | K/uL | 1.6 | 6.1 | abnormal | nan |
| Immature Granulocytes | 1.1 | % | nan | nan | nan | ___ |
| RDW-SD | 43.9 | fL | 35.1 | 46.3 | nan | nan |
| INR(PT) | 1.1 | nan | 0.9 | 1.1 | nan | nan |
| PT | 12.1 | sec | 9.4 | 12.5 | nan | nan |
| PTT | 27.1 | sec | 25.0 | 36.5 | nan | nan |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Anion Gap | 20.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Bicarbonate | 30.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Calcium, Total | 13.2 | mg/dL | 8.4 | 10.3 | abnormal | ___ |
| Chloride | 100.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.7 | mg/dL | 0.4 | 1.1 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.7, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 113.0 | mg/dL | 70.0 | 100.0 | abnormal | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 7.0 | nan | nan | nan | nan | nan |
| I | 1.0 | nan | nan | nan | nan | nan |
| Magnesium | 1.7 | mg/dL | 1.6 | 2.6 | nan | nan |
| Phosphate | 3.2 | mg/dL | 2.7 | 4.5 | nan | nan |
| Potassium | 3.9 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 146.0 | mEq/L | 133.0 | 145.0 | abnormal | nan |
| Urea Nitrogen | 6.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| L | 7.0 | nan | nan | nan | nan | nan |
## Microbiology Test Events [2115-11-02 15:55:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Electronic Medicine Administration Record [2115-11-02 16:29:00]
- Medication: nan
- Event_Txt: Started
## Vitalsign [2115-11-02 16:57:00]
- Temperature: 98.7
- Heartrate: 91.0
- Resprate: 16.0
- O2Sat: 100.0
- Sbp: 166.0
- Dbp: 98.0
- Pain: 6
- Rhythm: nan
## Provider Order Entry [2115-11-02 16:58:15]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
## Pyxis [2115-11-02 16:59:00]
| Name |
| ------ |
| OxyCODONE (Immediate Rel 5mg TAB |
| Acetaminophen 500mg TAB |
## Provider Order Entry [2115-11-02 17:00:53]
- Order_Type: Nutrition
- Order_Subtype: Diet Order
## Electronic Medicine Administration Record [2115-11-02 17:01:00]
| Medication | Event_Txt |
| ------ | ------ |
| Acetaminophen | Administered |
| OxyCODONE (Immediate Release) | Administered |
| nan | Stopped |
## Provider Order Entry [2115-11-02 18:31:21]
| Order_Type | Order_Subtype |
| ------ | ------ |
| IV therapy | IV fluids |
| IV therapy | IV fluids |
|
OBSERVATION ADMIT
|
[
"SURGICAL SAME DAY ADMISSION",
"AMBULATORY OBSERVATION",
"DIRECT OBSERVATION",
"ELECTIVE",
"OBSERVATION ADMIT",
"DIRECT EMER.",
"EW EMER.",
"EU OBSERVATION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"OBSERVATION ADMIT\"]",
"label": [
"OBSERVATION ADMIT"
]
}
|
1
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 63
- Gender: M
## Discharge [2200-03-16 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: M
Service: MEDICINE
Allergies:
Primidone / Bactrim
Attending: ___.
Chief Complaint:
DOE
Major Surgical or Invasive Procedure:
none
History of Present Illness:
___ with hx of cauda equina syndrome ___ L 2 herniated disc,
COPD not on home O2 (FEV1 54%, FEV1/FVC 63 ___,
bronchiectasis presenting with DOE. He notes onset of symptoms
after stress echo on ___ he believes that he suffered an
undiagnosed MI during his stress test. Reports that progress of
his symptoms has been slow but steady.
He was seen in the ___ ___ ___ for DOE. Symptoms during
that ___ visit improved with bronchodilators and patient was
subsequently discharged on prednisone burst (20mg daily X 4
days, ___.
At PCP, pt reported improvement in SOB but DOE with exertion,
most notable after ___ mile of ambulation. Prior to stress test
in ___, he could walk around all day without difficulty.
Continues COPD medications, rarely uses rescue inhaler. No
change in baseline sputum production. Recent stress echo was
notable for limited exercise tolerance, no inducible ischemia at
low workload. Ambulatory SaO2 at ___'s office was 87% on RA. Pt
was sent by PCP to ___ for further evaluation of persistent DOE
and ambulatory hypoxia.
In the ___ ___:
VS: 98.9, 138/88, 95% RA, 88% with ambulation
Labs notable for D-dimer 345, TnT<0.01
otherwise unrevealing
CXR without infiltrate
Received advair, gabapentin
Admitted to medicine for expedited evaluation of DOE and hypoxia
with ambulation.
On the floor, he denies chest pain, fevers, chills, ___ edema, hx
of clots, orthopnea, PND, sick contacts.
Past Medical History:
Per OMR, confirmed with pt:
1. Cauda equina syndrome s/p decompression surgery in ___ with
residual weakness from the waist down c/b right foot drop;
limited sensation in both legs, right greater than left;
erectile dysfunction, he has sensation when urinating/bowel
movements. He is able to ambulate with a cane, wears a brace
under the right foot for footdrop
2. C3-C6 anterior/posterior c-spine fusion for spinal canal
arrowing c/b post-op aspiration pneumonia ___
3. Restless leg syndrome
4. Hypothyroidism: Graves' disease status post ablation;
followed by endocrinologist
5. Mechanical fall with Type 2 Dens fx managed conservatively
(C-collar removed late ___
6. COPD, followed at pulmonary ___ - (FEV1 54%, FEV1/FVC 63
___
7. Left hip cyst s/p excision
8. MRSA sputum positive
9. Swab-positive influenza ___
10. History of upper GI bleed due to duodenal stress ulcers.
CARDIAC HISTORY
1. CAD, Silent inferior MI: Troponin elevation, status post
cervical fusion surgery in ___ complicated by hypoxic
respiratory failure for nuclear stress test on ___
demonstrating fixed inferior perfusion defect consistent with
inferior MI.
2. Ejection fraction of 50%
3. Inferior LV aneurysm
Social History:
___
Family History:
Sister died from lung and breast cancer. Denies hx of CAD, lung
disease.
Physical Exam:
Admission Physical Exam:
VS: 97.9, 130/76, 70, 96% RA
Gen: Very pleasant elderly male, sitting up in bed, NAD
HEENT: PERRL, EOMI, clear oropharynx, anicteric sclera
Neck: supple, no cervical or supraclavicular adenopathy
CV: RRR, no m/r/g
Lungs: good air movement throughout, no crackles, rare end
expiratory wheeze R>L
Abd: soft, nontender, nondistended, no rebound or guarding, +BS,
no hepatomegaly
GU: No foley
Ext: WWP, 1+ pitting edema bilaterally
Neuro: L foot drop, alert and interactive, stands with cane,
grossly intact
Discharge Physical Exam:
T97.2 118/75 P67 R18 92% on RA
General: alert, oriented, no acute distress
HEENT: sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNs2-12 intact, motor function grossly normal
Pertinent Results:
___ 07:07PM D-DIMER-345
___ 05:15PM GLUCOSE-124* UREA N-18 CREAT-0.7 SODIUM-137
POTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13
___ 05:15PM cTropnT-<0.01
___ 05:15PM proBNP-124
___ 05:15PM WBC-7.1 RBC-5.39 HGB-15.4 HCT-47.0 MCV-87
MCH-28.6 MCHC-32.8 RDW-15.4 RDWSD-48.2*
___ 05:15PM NEUTS-77.0* LYMPHS-17.8* MONOS-4.7* EOS-0.0*
BASOS-0.1 IM ___ AbsNeut-5.46# AbsLymp-1.26 AbsMono-0.33
AbsEos-0.00* AbsBaso-0.01
___ 05:15PM PLT COUNT-190
___ 05:15PM ___ PTT-28.3 ___
EKG: Sinus bradycardia at 59 bpm, normal axis, TW flattening in
III, no ST segment changes, no Q waves
Stress echo ___: Poor exercise tolerance without inducible
ischemia at low workload. Abnormal hemodynamic response to
physiologic stress. Normal PA systolic pressure.
CXR: "Again, there is chronic elevation of the left
hemidiaphragm with basilar
atelectasis. Bibasilar atelectasis is seen. No large pleural
effusion is
seen. There is no definite new focal consolidation. Cardiac
and mediastinal
silhouettes are grossly stable.
IMPRESSION:
No significant interval change. "
Echo ___: "Conclusions
The left atrial volume index is moderately increased. Normal
left ventricular wall thickness, cavity size, and
regional/global systolic function (biplane LVEF = 78 %). Doppler
parameters are most consistent with Grade II (moderate) left
ventricular diastolic dysfunction. The A wave duration minus Ar
duration of the pulmonary venous flow is < -30 ms suggesting
elevated mean left atrial pressure. In addition, the A wave
velocity is 0.4 m/s c/w elevated left atrial pressure. These
markers are indicative of elevated intracardiac pressure despite
E/e' ranging in the grey area of prediction of PCWP. Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic stenosis or aortic
regurgitation. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is borderline pulmonary
artery systolic hypertension. There is no pericardial effusion.
IMPRESSION: Normal/hyperdynamic biventricular regional/global
systolic function. Type II LV diastolic dysfunction with
elevated mean left atrial pressure.
Compared with the prior study (images reviewed) of ___,
regional wall motion abnormalities have resolved. There may be a
subtle wall motion abnormality in the basal inferolateral wall.
LV systolic function has significantly improved. LV diastolic
dysfunction was type II pattern on prior echo and has remained
the same. Mean left atrial pressure could not be determined due
to absence of a pulmonary venous flow profile on prior images.
"
Brief Hospital Course:
Mr. ___ is a ___ man with hx of cauda equina syndrome ___ L 2
herniated disc, COPD not on home O2 (FEV1 54%, FEV1/FVC 63
___, CAD (s/p prior MI), who presented for expedited
evaluation of DOE after he was found to have ambulatory hypoxia
in clinic.
Ambulatory sats were performed again while inpatient and were
greater than 90 percent. The patient stated he felt "fine" and
his symptoms were not limiting and preferred an outpatient
workup. Echo was done while inpatient which showed Normal
systolic function, type II LV diastolic dysfunction, elevated
mean left atrial pressure, and "borderline" pulmonary
hypertension. I suspect that perhaps his mild ambulatory
hypoxemia in clinic perhaps related to transient atelectasis in
the context of his chronically elevated left hemidiaphragm.
There was no evidence of CHF or exacerbation of his COPD. PE was
ruled out by negative D dimer. Echo was largely unrevealing but
elevated LA size does raise the possibility of occult atrial
arrhythmia and pulmonary hypertension is conceivable in the
context of his COPD but read as "borderline" on the echo.
Ultimately, given he is functional and mostly asymptomatic, rest
of workup may proceed as outpatient. Rest of hospital
course/plan are outlined below by issue:
# DOE/hypoxia: DDx is broad. Progressive symptoms may reflect
progression of known underlying moderately severe COPD without
evidence of acute exacerbation. He has no Q waves on EKG to
suggest new missed MI or active ischemia. Pulmonary hypertension
is certainly possible; stress TTE on ___ specifically notes
normal PA systolic pressures although borderline on most recent
echo. D-dimer WNL essentially rules out PE. He has no crackles
on examination or findings on CXR to suggest pulmonary edema.
Additionally, ProBNP is low in the abscence of obesity,
essentially rules out overt CHF. Undiagnosed ILD is a
possibility. He has no known relevant occupational exposures.
Also his CXR demonstrated chronically elevated L hemidiaphragm
so diaphragmatic dysfunction and an evolving neuromuscular
restrictive defect is a possiblility.
-PFTs are certainly indicated and may be the most useful
diagnostic tool, and can reasonably be performed as outpatient.
- he was managed inpatient with Duonebs q6h with minimal
improvement.
- Continued home advair
# Hx of CAD: there was no evidence of ischemia on EKG and denied
any signs or symptoms of active ischemia. There was a
questionable WMA on his echo but this may have been from his old
MI from years ago which the patient reported to me.
- Continued home ASA, BB
- he had a stress echo done back in ___ but was a poor
study. He has a stress test scheduled as an outpatient.
# GERD:
- COntinued home PPI
# Hypothyroidism:
- Continued home levothyroxine
# Chronic pain ___ remote cauda equine syndrome:
- Continued home gabapentin 800 6x daily - dose confirmed with
pt and OMR med list, pt notes that this is stable regimen for
years, in the past when it has been held or altered has
developed significant symptoms
# Contact: ___ (daughter) ___ I spoke with ___ in
person several times and updated her with the plan and answered
all questions. I also spoke with his other ___
___ over the phone while with ___. The plan was
discussed with his PCP ___ email and over the phone
who agreed with outpatient workup including CT chest.
#Transitional:
-has a stress test scheduled as an outpatient.
-outpatient PFTs (scheduled)
-unfortunately bubble study was not performed, could consider
repeat echo with bubble if workup negative
-CT chest (high res) suggested as outpatient to rule out
undiagnosed ILD
-given episode nature of his symptoms and elevated LA pressure,
would consider outpatient holter or event monitor to evaluate
for arrhythmia.
Spent >30 minutes seeing patient and organizing discharge.
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheeze
2. Alendronate Sodium 70 mg PO Frequency is Unknown
3. Doxazosin 2 mg PO HS
4. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID
5. Gabapentin 800 mg PO 6 TIMES DAILY
6. Levothyroxine Sodium 150 mcg PO 6X/WEEK (___)
7. Metoprolol Succinate XL 25 mg PO DAILY
8. Omeprazole 20 mg PO DAILY
9. Tiotropium Bromide 1 CAP IH DAILY
10. Aspirin 81 mg PO DAILY
Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Doxazosin 2 mg PO HS
3. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID
4. Gabapentin 800 mg PO 6 TIMES DAILY
5. Levothyroxine Sodium 150 mcg PO 6X/WEEK (___)
6. Metoprolol Succinate XL 25 mg PO DAILY
7. Omeprazole 20 mg PO DAILY
8. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheeze
9. Alendronate Sodium 70 mg PO 1X/WEEK (SA)
10. Tiotropium Bromide 1 CAP IH DAILY
Discharge Disposition:
Home
Discharge Diagnosis:
COPD
Dyspnea on Exertion (unclear etiology)
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
Dr. ___,
You were admitted for ambulatory hypoxia (low oxygen while
walking) and had a test to rule out pulmonary embolism (clot in
the lung) which was negative. You also had an echocardiogram
done which was largely normal but did have some mild
abnormalities including borderline* pulmonary hypertension,
diastolic dysfunction (trouble with the hearts relaxation
phase), and a mildly dilated left atrium.
On repeat testing of your oxygen levels while walking, your
oxygen levels were OK. They may have been low because of
temporary (benign) collapse of an area of your lung or a
transient worsening of your COPD. Regardless, you oxygen levels
seem to have improved.
You should follow up with your outpatient providers including
the pulmonologist appointment to workup your lung issues as an
outpatient. It is important that you attend your pulmonary
function testing as well.
You should follow up with your primary care doctor, ___,
to consider outpatient holter monitor testing as well as getting
a Ct scan of your chest to rule out something call interstitial
lung disease (ILD).
Followup Instructions:
___
## Transfers [2202-10-27 16:54:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2202-10-27 16:54:00]
- Gender: M
- Race: WHITE
## Triage [2202-10-27 16:54:01]
- Temperature: 97.1
- Heartrate: 80.0
- Resprate: 20.0
- O2Sat: 95.0
- Sbp: 150.0
- Dbp: 78.0
- Pain: 0
- Acuity: 2.0
- Chiefcomplaint: S/P FALL WITH HEADSTRIKE
## Vitalsign [2202-10-27 16:57:00]
| Temperature | Heartrate | Resprate | O2Sat | Sbp | Dbp | Pain | Rhythm |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| 97.1 | 80.0 | 20.0 | 95.0 | 150.0 | 78.0 | 0 | nan |
| 98.5 | 69.0 | 17.0 | 95.0 | 136.0 | 90.0 | 0 | nan |
## Provider Order Entry [2202-10-27 17:28:43]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Radiology | CT Scan |
| Radiology | CT Scan |
| General Care | Other |
| Radiology | General Xray |
## Labotary Test Events [2202-10-27 17:30:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Absolute Lymphocyte Count | 1.73 | K/uL | 1.2 | 3.7 | nan | nan |
| Basophils | 0.6 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 4.0 | % | 1.0 | 7.0 | nan | nan |
| Hematocrit | 42.2 | % | 40.0 | 51.0 | nan | nan |
| Hemoglobin | 13.6 | g/dL | 13.7 | 17.5 | abnormal | nan |
| Lymphocytes | 33.0 | % | 19.0 | 53.0 | nan | nan |
| MCH | 28.0 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 32.2 | g/dL | 32.0 | 37.0 | nan | nan |
| MCV | 87.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 9.4 | % | 5.0 | 13.0 | nan | nan |
| Neutrophils | 52.8 | % | 34.0 | 71.0 | nan | nan |
| Platelet Count | 153.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 14.4 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.86 | m/uL | 4.6 | 6.1 | nan | nan |
| White Blood Cells | 5.2 | K/uL | 4.0 | 10.0 | nan | nan |
| Absolute Basophil Count | 0.03 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.21 | K/uL | 0.04 | 0.54 | nan | nan |
| Absolute Monocyte Count | 0.49 | K/uL | 0.2 | 0.8 | nan | nan |
| Absolute Neutrophil Count | 2.77 | K/uL | 1.6 | 6.1 | nan | nan |
| Immature Granulocytes | 0.2 | % | 0.0 | 0.6 | nan | ___ |
| RDW-SD | 45.5 | fL | 35.1 | 46.3 | nan | nan |
| INR(PT) | 1.1 | nan | 0.9 | 1.1 | nan | nan |
| PT | 12.2 | sec | 9.4 | 12.5 | nan | nan |
| PTT | 29.7 | sec | 25.0 | 36.5 | nan | nan |
| Anion Gap | 14.0 | mEq/L | 10.0 | 18.0 | nan | New reference range as of ___. |
| Bicarbonate | 22.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Calcium, Total | 8.7 | mg/dL | 8.4 | 10.3 | nan | nan |
| Chloride | 103.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.6 | mg/dL | 0.5 | 1.2 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.. |
| Glucose | 88.0 | mg/dL | 70.0 | 100.0 | nan | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 27.0 | nan | nan | nan | nan | nan |
| I | 1.0 | nan | nan | nan | nan | nan |
| Magnesium | 1.7 | mg/dL | 1.6 | 2.6 | nan | nan |
| Phosphate | 3.7 | mg/dL | 2.7 | 4.5 | nan | nan |
| Potassium | 4.4 | mEq/L | 3.5 | 5.4 | nan | New reference range as of ___. |
| Sodium | 139.0 | mEq/L | 135.0 | 147.0 | nan | New reference range as of ___. |
| Urea Nitrogen | 14.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| L | 7.0 | nan | nan | nan | nan | nan |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
## Medrecon [2202-10-27 17:56:00]
| Name | Atc Type |
| ------ | ------ |
| alendronate | nan |
| aspirin [Adult Low Dose Aspirin] | acetylsalicylic acid |
| aspirin [Adult Low Dose Aspirin] | acetylsalicylic acid |
| Caltrate 600+D Plus Minerals | calcium compounds |
| cyanocobalamin (vitamin B-12) [Vitamin B-12] | cyanocobalamin |
| doxazosin | doxazosin |
| fluticasone-salmeterol [Advair Diskus] | nan |
| gabapentin | gabapentin |
| hydrocortisone | None |
| levothyroxine | levothyroxine sodium |
| metoprolol succinate | nan |
| Multivitamin | None |
| omeprazole | omeprazole |
| polyethylene glycol 3350 | macrogol |
| prednisolone acetate | prednisolone |
| sildenafil [Viagra] | sildenafil |
| simvastatin | simvastatin |
| tiotropium bromide [Spiriva with HandiHaler] | nan |
## Labotary Test Events [2202-10-27 18:05:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Uhold | nan | nan | nan | nan | nan | ___ |
| Bilirubin | nan | nan | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | NEG. |
| Glucose | nan | mg/dL | 0.0 | 0.0 | nan | NEG. |
| Ketone | nan | mg/dL | 0.0 | 0.0 | nan | NEG. |
| Leukocytes | nan | nan | nan | nan | nan | NEG. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 7.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | nan | mg/dL | 0.0 | 0.0 | nan | NEG. |
| Specific Gravity | 1.019 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | Clear. |
| Urine Color | nan | nan | nan | nan | nan | Yellow. |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | NEG. |
## Microbiology Test Events [2202-10-27 18:05:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: < 10,000 CFU/mL.
- Ab_Name: nan
## Vitalsign [2202-10-27 18:08:00]
- Temperature: nan
- Heartrate: 67.0
- Resprate: 18.0
- O2Sat: 95.0
- Sbp: 127.0
- Dbp: 85.0
- Pain: 0
- Rhythm: nan
## Radiology Examinations [2202-10-27 18:45:00]
| Note_Type | Exam_Name | Text |
| ------ | ------ | ------ |
| RR | ['CT HEAD W/O CONTRAST'] | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with fall and headstrike// eval for fracture/acute process
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Total DLP (Head) = 843 mGy-cm.
COMPARISON: Noncontrast head CT ___
FINDINGS:
There is a small 5 mm focus of intraparenchymal hematoma in the medial left
frontal lobe (3:32, 602:48). Additional subcentimeter focus of
intraparenchymal hematoma seen in the posterior medial left frontal lobe
(03:35). Chronic right frontal infarct is again noted. Small chronic right
parietal infarct is also again noted. No evidence of acute infarction.
Ventricles and sulci are prominent consistent with age related involutional
changes. Nonspecific mild periventricular white matter hypodensities are
suggestive of chronic small vessel ischemic disease.
There is soft tissue swelling overlying the left parietal region. There is
nondisplaced left zygomatic arch fracture. There is near complete
opacification of the frontal sinuses as well as several ethmoidal air cells.
There is moderate mucosal thickening of the maxillary sinuses bilaterally. As
well as of the left sphenoid sinus. Mastoid air cells and middle ear cavities
are clear. The orbits are unremarkable.
IMPRESSION:
1. Two small foci of intraparenchymal hematoma in the medial left frontal
lobe.
2. Nondisplaced left zygomatic arch fracture.
3. Left parietal soft tissue swelling.
4. Paranasal sinus disease as described above.
NOTIFICATION: Updates to the wet read were discussed with ___ via
telephone at approximately 21:15 on ___.
|
| RR | ['CT C-SPINE W/O CONTRAST'] | EXAMINATION: CT ___ W/O CONTRAST
INDICATION: ___ with fall and headstrike// eval for fracture/acute process
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Total DLP (Body) = 536 mGy-cm.
COMPARISON: MR ___ ___
CT ___ ___
FINDINGS:
Status post laminectomies as well as anterior and posterior fusions at the C3
through C6 levels. Acute kyphotic angulation of C6 with respect to C7 is
unchanged from prior. Chronic ununited type 2 dens fracture is similar
prior.No acute fractures are identified.There are multilevel degenerative
changes of the cervical spine, not significantly progressed from prior.
Moderate spinal canal narrowing at C1-2 is similar to prior exams.
Uncovertebral and facet hypertrophy cause moderate neural foraminal narrowing
at several levels, worst at the C3-4 through C5-6 levels.There is no
prevertebral soft tissue swelling.Emphysematous changes of the lung apices are
noted.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Redemonstration of chronic ununited type 2 dens fracture as well as
postsurgical changes status post fusion and laminectomies of C3 through C6.
|
## Provider Order Entry [2202-10-27 18:59:27]
- Order_Type: Medications
- Order_Subtype: nan
## Radiology Examinations [2202-10-27 19:04:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PA & LAT)']
- Text: EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with fall/headstrike// pna?
COMPARISON: Chest CT from ___
FINDINGS:
PA and lateral views of the chest provided. Chronic elevation of the left
hemidiaphragm is re-demonstrated. The lungs remain relatively hyperinflated
without consolidation concerning for pneumonia. No large effusion or
pneumothorax. No signs of edema. Heart size is not reliably assessed.
Mediastinal contour is normal. Cervical fusion hardware is partially
visualized. No acute fracture is seen. A midthoracic spine compression
deformity is similar to prior as well as a compression deformity at the
thoracolumbar junction.
IMPRESSION:
No acute sequelae of trauma. Chronic elevation of the left hemidiaphragm.
## Pyxis [2202-10-27 20:12:00]
| Name |
| ------ |
| Gabapentin 100mg CAP |
| Gabapentin 300mg CAP |
## Electronic Medicine Administration Record [2202-10-27 20:16:00]
- Medication: Gabapentin
- Event_Txt: Administered
## Vitalsign [2202-10-27 20:17:00]
- Temperature: nan
- Heartrate: 76.0
- Resprate: 27.0
- O2Sat: 93.0
- Sbp: 145.0
- Dbp: 66.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2202-10-27 20:21:57]
- Order_Type: Medications
- Order_Subtype: nan
## Pyxis [2202-10-27 20:23:00]
- Name: Acetaminophen 500mg TAB
## Electronic Medicine Administration Record [2202-10-27 20:26:00]
- Medication: Acetaminophen
- Event_Txt: Administered
## Provider Order Entry [2202-10-27 21:12:27]
- Order_Type: ADT orders
- Order_Subtype: Admit
## Vitalsign [2202-10-27 21:17:00]
- Temperature: nan
- Heartrate: 67.0
- Resprate: 16.0
- O2Sat: 92.0
- Sbp: 128.0
- Dbp: 64.0
- Pain: nan
- Rhythm: nan
|
EU OBSERVATION
|
[
"SURGICAL SAME DAY ADMISSION",
"ELECTIVE",
"OBSERVATION ADMIT",
"EW EMER.",
"AMBULATORY OBSERVATION",
"DIRECT OBSERVATION",
"DIRECT EMER.",
"EU OBSERVATION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EU OBSERVATION\"]",
"label": [
"EU OBSERVATION"
]
}
|
2
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 52
- Gender: F
## Discharge [2186-12-12 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: F
Service: MEDICINE
Allergies:
Sulfa (Sulfonamide Antibiotics) / ceftriaxone / lidocaine /
adhesive tape
Attending: ___
Chief Complaint:
Dyspnea
Major Surgical or Invasive Procedure:
None
History of Present Illness:
Ms. ___ is a very pleasant ___ with a PMH of
tracheobroncheomalacia, COP (from VATS ___ and multifocal
airway stenosis (FEV1/FVC 35%) s/p attempted stent placements
c/b multiple intubations, OSA on CPAP, and severe acid reflux
s/p fundoplication ___, who presents to the ED with
increasing dyspnea over the past 10 days. Patient was in her
usual state of health until ___ when she developed
rhinorrhea and a cough productive of yellowish sputum. She
started a 10-day course of levofloxacin at the time without
improvement. She visited her PCP the following ___ who
performed a CXR without evidence of PNA. He gave her albuterol
inhaler to help with her SOB. Her symptoms continued to worsen
throughout the week so she saw her physician again over the
weekend who gave her a prednisone pulse and taper. She started
with 60mg x2 days and took 50mg x2 days. Overnight she noted
that her SpO2 was in the low ___ at home. She started herself on
5L of O2 through her trilogy with SpO2 back up to the ___. She
called her doctor this AM who recommended that she go in to the
ED.
In the ED, the patient was comfortable on 4L NC. Her cough has
improved with mucinex DM. She denies headache, fevers, chills,
nausea, or vomiting. She denies palpiations, dizziness, or
lightheadedness. She denies any recent leg swelling or pain.
Of note, the patient has had extensive workup for her TBM. She
has had stents placed to LMS and trachea in ___, which then had
to be removed several days later due to strep pneumo PNA. She
underwent bronchoscopy ___ showing severe TM, severe R
bronchomalacia, and severe left mainstem stenosis. She is s/p
lap Toupet fundoplication ___ and repeat EGD with esophageal
dilation on ___ due to esophageal dysmotility. She also carries
a diagnosis of OSA and uses Bipap/trilogy at night, which has
helped her symptoms.
In the ED, initial vitals were: 98.3 83 186/92 18 98% 4L NC
Exam notable for:
AOx3, Comfortable on 4L NC
- Coarse bronchial breath sounds through all lung fields
- Heart sounds normal
- MMM, mild OP erythema
- Extremities w 2+ pulses, no erythema
Labs showed:
9.5 > 13.0/40.4 < ___
---------< 122
4.4 23 0.7
Lactate 1.5
CXR showed no acute cardiopulmonary process.
EKG: NSR @84 bpm, no ischemic changes
Received a total of 2 mg IV lorazepam, 500 mg azithromycin, and
1 ipratropium-albuterol nebulizer.
Transfer VS were: 76 144/76 16 93% Nasal Cannula
Decision was made to admit to medicine for further management,
after discussion with IP. On arrival to the floor, patient
reports that she is still is having cough and some SOB,
consistent with prior flare-ups of her TBM. She denies sputum
production. She denies fevers or myalgias. She reports that
several of her grandchildren have had URIs recently. Her O2
requirement continued to worsen, requiring NRB, and after
discussion with IP, it was decided patient would require higher
level of care and so was on the floor very briefly before coming
to MICU.
Past Medical History:
PAST MEDICAL HISTORY:
COP (off prednisone)
TBM
Hypothyroidism
Crohn'sdisease
glaucoma
iritis
TBM
GERD
HTN
Recurrent strep pneumonia
Folliculitis both lower extremities
PSH
1. S/p Right VATS wedge Bx
2. S/P C section
3. S/P breast reduction/tummy tuck
Social History:
___
Family History:
Positive for leukemia in father, hearing loss and diabetes.
Physical Exam:
ADMISSION EXAM:
===============
Vital Signs: T 99.4 BP 138/86 HR 77 RR 22 SpO2 99% NRB
General: Middle-aged female in NAD, with occasional cough and
raspy voice, no stridor. Sitting in some distress, pleasant.
Unable to complete full sentences.
HEENT: Anicteric sclerae.
CV: RRR S1+S2 no m/r/g
Lungs: Bilateral wheezes and rhonchorous breath sounds heard in
upper and lower lung fields bilaterally.
Abdomen: Soft, nontender, nondistended.
GU: No foley
Ext: Warm, well perfused, no edema
Neuro: AAOx3, no focal neuro deficits identified.
DISCHARGE EXAM:
================
Vitals: 98.1PO 132/84 72 18 89%2L
General: Sitting up in bed, appears comfortable, no acute
distress
HEENT: atraumatic, normocephalic, EOMI, MMM
CV: RRR, no murmurs, rubs, gallops
Lungs: diffuse wheezes and ronchi, no crackles, unable to speak
in full sentences
Abdomen: soft, non-tender, non-distended
GU: No foley in place
Ext: WWP
Neuro: AAOX3, moving all 4 extremities spontaneously and
purposefully
Pertinent Results:
ADMISSION RESULTS:
==================
___ 04:00PM BLOOD WBC-9.5 RBC-4.71 Hgb-13.0 Hct-40.4 MCV-86
MCH-27.6 MCHC-32.2 RDW-15.8* RDWSD-49.1* Plt ___
___ 04:00PM BLOOD Neuts-92.2* Lymphs-4.1* Monos-3.2*
Eos-0.0* Baso-0.2 Im ___ AbsNeut-8.73* AbsLymp-0.39*
AbsMono-0.30 AbsEos-0.00* AbsBaso-0.02
___ 04:00PM BLOOD Glucose-122* UreaN-14 Creat-0.7 Na-136
K-4.4 Cl-98 HCO3-23 AnGap-19
___ 06:46AM BLOOD ___ pO2-157* pCO2-48* pH-7.40
calTCO2-31* Base XS-4 Comment-GREEN TOP
___ 04:25PM BLOOD Lactate-1.5
IMAGING:
========
___ CXR
No acute cardiopulmonary abnormality.
MICRO:
======
None
DISCHARGE RESULTS:
==================
___ 07:45AM BLOOD WBC-11.5* RBC-4.42 Hgb-12.0 Hct-38.5
MCV-87 MCH-27.1 MCHC-31.2* RDW-15.9* RDWSD-50.5* Plt ___
___ 07:45AM BLOOD Plt ___
___ 07:45AM BLOOD Glucose-86 UreaN-26* Creat-0.8 Na-140
K-3.9 Cl-102 HCO3-25 AnGap-17
___ 07:45AM BLOOD Calcium-8.9 Phos-4.0 Mg-2.5
Brief Hospital Course:
___ is a ___ PMH tracheobroncheomalacia, COP (from
VATS ___ and multifocal airway stenosis (FEV1/FVC 35%) s/p
attempted stent placements c/b multiple intubations, OSA on
CPAP, and severe acid reflux s/p fundoplication ___,
presented to the ED with increasing dyspnea over the past 10
days. She was admitted from the ED to the floor, but was quickly
transferred to the MICU as she was requiring NRB to maintain her
O2 saturation. IP was consulted and she was started on
methylpred 125mg Q6H and azithromycin x5d. Her flu also came
back positive so she was started on oseltamivir. Her respitatory
status improved overnight in the MICU to requiring only nasal
cannula so she was transferred to the general medicine service.
She was put on a steroid taper of 2 weeks. she completed her
courses of tamiflu and azithromycin prior to discharge. Her
respiratory status improved so she was discharged home with IP
follow up.
ACUTE ISSUES:
#Influenza:
The patient's flu PCR came back positive, so this was the most
likely cause of her acute presentation. She was started on
supplemental O2, tamiflu x3d, azithromycin x5d, duonebs, and IV
steroids. Because of her tracheobronchomalacia, IP, who she sees
as an outpatient, was consulted and recommended flutter valve
QID, guaifenisin, and benzonatate for cough. She initially
required NRB and MICU admission, but after less than 24h she was
weaned to nasal cannula and transferred to the general medicine
service. On the general medicine floor she continued to improve
and her O2 requirement decreased, and she was discharged home.
She completed her courses of tamiflu and azithromycin prior to
discharge, and was given an Rx to continue her 2 week prednisone
taper at home.
******Of note, per pt's husband, she needs special #6 tube
(pediatric) for intubation (which was not required on this
admission.)********
CHRONIC ISSUES:
# GERD: Continued home ranitidine
# HTN: BPs since admission to ED 170s-180s. Could be exacerbated
by coughing, acute illness, or from recent initiation of
prednisone. Continued home amlodipine 5 mg daily.
# Hypothyroidism: continued home levothyroxine
# Hx folliculitis of lower extremities: Continued home
calcipotriene and tacro ointment
# Iritis: Continued home difluprednate (patient brought own
meds)
Transitional Issues:
- IP would like CT of her trachea which is scheduled for ___
- Last day of prednisone taper is ___. Prednisone taper as
follows: 60mg ___, 40mg ___, 20mg ___, 10mg
___.
- Patient discharged on 2L O2 to be weaned off at home. She
demonstrated understanding of home O2 weaning and has done this
before. Home O2 already set up at time of discharge.
- patient discharged with PO Ativan limited script for cough.
#Code: Full code
#Contact/HCP: ___ ___
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. amLODIPine 5 mg PO HS
2. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN SOB
3. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg
calcium- 200 unit oral DAILY
4. difluprednate 0.05 % ophthalmic DAILY
5. Docusate Sodium 100 mg PO BID
6. Ibuprofen 800 mg PO Q8H:PRN pain
7. Levothyroxine Sodium 150 mcg PO DAILY
8. LORazepam 0.5-1 mg PO Q6H:PRN cough
9. Magnesium Oxide 400 mg PO DAILY
10. mometasone-formoterol 200-5 mcg/actuation inhalation BID
11. Ranitidine 300 mg PO QHS
12. Milk of Magnesia 30 mL PO Q12H:PRN constipation
13. Tiotropium Bromide 1 CAP IH DAILY
14. tacrolimus 0.1 % topical DAILY
15. Calcipotriene 0.005% Cream 1 Appl TP DAILY
16. Minocycline 100 mg PO Q24H
17. Pantoprazole 40 mg PO Q12H
Discharge Medications:
1. PredniSONE 60 mg PO DAILY Duration: 3 Doses
This is dose # 1 of 4 tapered doses
RX *prednisone 10 mg 1 tablet(s) by mouth DAILY Disp #*31 Tablet
Refills:*0
2. PredniSONE 40 mg PO DAILY Duration: 4 Doses
Start: After 60 mg DAILY tapered dose
This is dose # 2 of 4 tapered doses
3. PredniSONE 20 mg PO DAILY Duration: 3 Doses
Start: After 40 mg DAILY tapered dose
This is dose # 3 of 4 tapered doses
4. PredniSONE 10 mg PO DAILY Duration: 3 Doses
This is dose # 4 of 4 tapered doses
RX *prednisone 10 mg as directed tablet(s) by mouth daily Disp
#*43 Tablet Refills:*0
5. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN SOB
6. amLODIPine 5 mg PO HS
7. Calcipotriene 0.005% Cream 1 Appl TP DAILY
8. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg
calcium- 200 unit oral DAILY
9. difluprednate 0.05 % ophthalmic DAILY
10. Docusate Sodium 100 mg PO BID
11. Ibuprofen 800 mg PO Q8H:PRN pain
12. Levothyroxine Sodium 150 mcg PO DAILY
13. LORazepam 0.5-1 mg PO Q6H:PRN cough
RX *lorazepam [Ativan] 0.5 mg ___ tablets by mouth Q6H:PRN Disp
#*15 Tablet Refills:*0
14. Magnesium Oxide 400 mg PO DAILY
15. Milk of Magnesia 30 mL PO Q12H:PRN constipation
16. mometasone-formoterol 200-5 mcg/actuation inhalation BID
17. Pantoprazole 40 mg PO Q12H
18. Ranitidine 300 mg PO QHS
19. Tacrolimus 0.1 % topical DAILY
20. Tiotropium Bromide 1 CAP IH DAILY
Discharge Disposition:
Home
Discharge Diagnosis:
Primary:
Influenza
Tracheobronchomalacia
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
Dear Ms. ___,
You were admitted to the hospital because you were having
worsening shortness of breath and cough. You were found to have
the flu so you were treated with Tamiflu. In order to decrease
inflammation you were also given steroids. The suspicion for
bacterial infection was low, but you were treated empirically
with azithromycin.
Your symptoms improved so you were discharged home. You will
continue taking prednisone to complete a 2 week taper.
You will get a CT scan prior to your appointment with
pulmonology on ___.
You will take the prednisone as follows:
- 60mg ___
- 20mg ___
- 10mg ___
Please attend your follow up appointments as listed below.
Thank you for choosing ___ for your healthcare needs. It was a
pleasure taking care of you.
Sincerely,
Your ___ Team
Followup Instructions:
___
## Procedures on International Classification of Diseases [2187-11-26 00:00:00]
- Procedures: Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure
- Ccs Type: Respiratory intubation and mechanical ventilation
## Transfers [2187-11-26 12:00:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2187-11-26 12:00:00]
- Gender: F
- Race: WHITE
## Vitalsign [2187-11-26 12:00:00]
- Temperature: nan
- Heartrate: nan
- Resprate: nan
- O2Sat: nan
- Sbp: nan
- Dbp: nan
- Pain: unable
- Rhythm: nan
## Triage [2187-11-26 12:00:01]
- Temperature: nan
- Heartrate: nan
- Resprate: nan
- O2Sat: nan
- Sbp: nan
- Dbp: nan
- Pain: unable
- Acuity: 1.0
- Chiefcomplaint: Respiratory distress
## Microbiology Test Events [2187-11-26 12:06:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Vitalsign [2187-11-26 12:06:00]
- Temperature: nan
- Heartrate: 124.0
- Resprate: 32.0
- O2Sat: 85.0
- Sbp: nan
- Dbp: nan
- Pain: unable
- Rhythm: nan
## Provider Order Entry [2187-11-26 12:06:46]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
| Medications | nan |
## Pyxis [2187-11-26 12:07:00]
| Name |
| ------ |
| Ipratropium Bromide Neb 1Neb |
| MethylPREDNISolone So 125mg VIAL |
| MethylPREDNISolone So 125mg VIAL |
| MethylPREDNISolone So 125mg VIAL |
| Albuterol 0.083% Neb Soln 1Neb |
| LORazepam 2mg/1mL 1mL SYR |
| LORazepam 2mg/1mL 1mL SYR |
| LORazepam 2mg/1mL 1mL SYR |
## Labotary Test Events [2187-11-26 12:10:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Anion Gap | 13.0 | mEq/L | 10.0 | 18.0 | nan | New reference range as of ___. |
| Bicarbonate | 27.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Chloride | 100.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.7 | mg/dL | 0.4 | 1.1 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.. |
| Glucose | 133.0 | mg/dL | 70.0 | 100.0 | abnormal | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 8.0 | nan | nan | nan | nan | nan |
| I | 1.0 | nan | nan | nan | nan | nan |
| Potassium | 4.2 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 140.0 | mEq/L | 135.0 | 147.0 | nan | New reference range as of ___. |
| Urea Nitrogen | 22.0 | mg/dL | 6.0 | 20.0 | abnormal | nan |
| L | 5.0 | nan | nan | nan | nan | nan |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Absolute Lymphocyte Count | 1.81 | K/uL | 1.2 | 3.7 | nan | nan |
| Basophils | 0.3 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 0.1 | % | 1.0 | 7.0 | abnormal | nan |
| Hematocrit | 36.7 | % | 34.0 | 45.0 | nan | nan |
| Hemoglobin | 11.7 | g/dL | 11.2 | 15.7 | nan | nan |
| Lymphocytes | 14.5 | % | 19.0 | 53.0 | abnormal | nan |
| MCH | 27.5 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 31.9 | g/dL | 32.0 | 37.0 | abnormal | nan |
| MCV | 86.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 14.5 | % | 5.0 | 13.0 | abnormal | nan |
| Neutrophils | 70.1 | % | 34.0 | 71.0 | nan | nan |
| Platelet Count | 355.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 15.5 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.26 | m/uL | 3.9 | 5.2 | nan | nan |
| White Blood Cells | 12.5 | K/uL | 4.0 | 10.0 | abnormal | nan |
| Absolute Basophil Count | 0.04 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.01 | K/uL | 0.04 | 0.54 | abnormal | nan |
| Absolute Monocyte Count | 1.82 | K/uL | 0.2 | 0.8 | abnormal | nan |
| Absolute Neutrophil Count | 8.78 | K/uL | 1.6 | 6.1 | abnormal | nan |
| Immature Granulocytes | 0.5 | % | 0.0 | 0.6 | nan | ___ |
| RDW-SD | 48.4 | fL | 35.1 | 46.3 | abnormal | nan |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
## Microbiology Test Events [2187-11-26 12:10:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Provider Order Entry [2187-11-26 12:10:09]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Radiology | General Xray |
| General Care | Other |
## Radiology Examinations [2187-11-26 12:12:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PORTABLE AP)']
- Text: EXAMINATION: Chest radiograph
INDICATION: History: ___ with sob// ?> pna
TECHNIQUE: AP frontal view of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
There is no consolidation, pleural effusion, pneumothorax. Cardiomediastinal
silhouette is within normal limits. The aorta is tortuous. Chain sutures are
again noted in overlying the right upper and lower lobes.
IMPRESSION:
No acute intrathoracic abnormality.
## Vitalsign [2187-11-26 12:12:00]
- Temperature: nan
- Heartrate: 111.0
- Resprate: 28.0
- O2Sat: 94.0
- Sbp: 177.0
- Dbp: 102.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2187-11-26 12:12:29]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Vitalsign [2187-11-26 12:14:00]
- Temperature: nan
- Heartrate: 107.0
- Resprate: 23.0
- O2Sat: 99.0
- Sbp: 177.0
- Dbp: 102.0
- Pain: nan
- Rhythm: nan
## Electronic Medicine Administration Record [2187-11-26 12:15:00]
| Medication | Event_Txt |
| ------ | ------ |
| Albuterol 0.083% Neb Soln | Administered |
| Ipratropium Bromide Neb | Administered |
| MethylPREDNISolone Sodium Succ | Administered |
## Vitalsign [2187-11-26 12:16:00]
- Temperature: nan
- Heartrate: 107.0
- Resprate: 19.0
- O2Sat: 96.0
- Sbp: 177.0
- Dbp: 109.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2187-11-26 12:16:30]
- Order_Type: Medications
- Order_Subtype: nan
## Electronic Medicine Administration Record [2187-11-26 12:17:00]
- Medication: LORazepam
- Event_Txt: Administered
## Vitalsign [2187-11-26 12:21:00]
- Temperature: nan
- Heartrate: 103.0
- Resprate: 16.0
- O2Sat: 97.0
- Sbp: 164.0
- Dbp: 100.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2187-11-26 12:23:40]
- Order_Type: Lab
- Order_Subtype: nan
## Vitalsign [2187-11-26 12:26:00]
| Temperature | Heartrate | Resprate | O2Sat | Sbp | Dbp | Pain | Rhythm |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| nan | 100.0 | 16.0 | 98.0 | 157.0 | 105.0 | nan | nan |
| nan | 102.0 | 18.0 | 99.0 | 157.0 | 105.0 | 0 | nan |
| nan | 99.0 | 16.0 | 98.0 | 158.0 | 96.0 | nan | nan |
## Provider Order Entry [2187-11-26 12:48:31]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Medications | nan |
## Pyxis [2187-11-26 12:50:00]
- Name: Albuterol 0.083% Neb Soln 1Neb
## Labotary Test Events [2187-11-26 13:00:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| H | 8.0 | nan | nan | nan | nan | nan |
| I | 0.0 | nan | nan | nan | nan | nan |
| NTproBNP | 140.0 | pg/mL | 0.0 | 226.0 | nan | Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information. |
| L | 5.0 | nan | nan | nan | nan | nan |
| H | 3.0 | nan | nan | nan | nan | nan |
| I | 0.0 | nan | nan | nan | nan | nan |
| Troponin T | nan | ng/mL | 0.0 | 0.01 | nan | <0.01. cTropnT > 0.10 ng/mL suggests Acute MI. |
| L | 8.0 | nan | nan | nan | nan | nan |
| INR(PT) | 1.1 | nan | 0.9 | 1.1 | nan | nan |
| PT | 11.4 | sec | 9.4 | 12.5 | nan | nan |
| PTT | 23.4 | sec | 25.0 | 36.5 | abnormal | VERIFIED BY REPLICATE ANALYSIS. |
| Base Excess | 0.0 | mEq/L | nan | nan | nan | nan |
| Calculated Total CO2 | 29.0 | mEq/L | 21.0 | 30.0 | nan | nan |
| Lactate | 0.8 | mmol/L | 0.5 | 2.0 | nan | nan |
| Oxygen Saturation | 94.0 | % | nan | nan | nan | nan |
| pCO2 | 52.0 | mm Hg | 35.0 | 45.0 | abnormal | nan |
| pH | 7.33 | units | 7.35 | 7.45 | abnormal | nan |
| pO2 | 78.0 | mm Hg | 85.0 | 105.0 | abnormal | nan |
| Specimen Type | nan | nan | nan | nan | nan | ___ |
| Influenza A by PCR | nan | nan | nan | nan | nan | ___ |
| Influenza B by PCR | nan | nan | nan | nan | nan | ___ |
## Vitalsign [2187-11-26 13:20:00]
- Temperature: nan
- Heartrate: 99.0
- Resprate: 20.0
- O2Sat: 95.0
- Sbp: 164.0
- Dbp: 91.0
- Pain: 0
- Rhythm: nan
## Pyxis [2187-11-26 13:21:00]
- Name: Azithromyc 500mg/250mL 250mL BAG
## Electronic Medicine Administration Record [2187-11-26 13:25:00]
- Medication: Azithromycin
- Event_Txt: Started
## Medrecon [2187-11-26 13:28:00]
| Name | Atc Type |
| ------ | ------ |
| albuterol sulfate [ProAir HFA] | nan |
| amlodipine | amlodipine |
| budesonide-formoterol [Symbicort] | None |
| calcium carbonate-vitamin D3 [Calcium+D] | None |
| cholecalciferol (vitamin D3) | colecalciferol |
| clindamycin phosphate | clindamycin |
| dapsone [Aczone] | nan |
| difluprednate [Durezol] | nan |
| folic acid | folic acid |
| ibuprofen [Advil] | ibuprofen |
| levothyroxine | levothyroxine sodium |
| lorazepam | None |
| lorazepam | None |
| magnesium | None |
| methotrexate sodium | methotrexate |
| methotrexate sodium | methotrexate |
| ropinirole | nan |
| tiotropium bromide [Spiriva with HandiHaler] | nan |
## Vitalsign [2187-11-26 14:21:00]
- Temperature: nan
- Heartrate: 96.0
- Resprate: 18.0
- O2Sat: 93.0
- Sbp: 162.0
- Dbp: 90.0
- Pain: 0
- Rhythm: nan
## Electronic Medicine Administration Record [2187-11-26 14:32:00]
- Medication: Azithromycin
- Event_Txt: Stopped
## Vitalsign [2187-11-26 15:21:00]
- Temperature: nan
- Heartrate: 92.0
- Resprate: 20.0
- O2Sat: 95.0
- Sbp: 14.0
- Dbp: 684.0
- Pain: 0
- Rhythm: nan
## Provider Order Entry [2187-11-26 16:53:10]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
| Medications | nan |
| Medications | nan |
| Medications | nan |
|
URGENT
|
[
"SURGICAL SAME DAY ADMISSION",
"DIRECT EMER.",
"OBSERVATION ADMIT",
"AMBULATORY OBSERVATION",
"EU OBSERVATION",
"DIRECT OBSERVATION",
"ELECTIVE",
"EW EMER."
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"URGENT\"]",
"label": [
"URGENT"
]
}
|
3
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 55
- Gender: F
## Discharge [2124-08-18 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: F
Service: ORTHOPAEDICS
Allergies:
Penicillins / Percodan / Compazine / Reglan / Flonase
Attending: ___
___ Complaint:
Right knee pain after TKA
Major Surgical or Invasive Procedure:
I & D right knee with liner exchange
PICC line placement
History of Present Illness:
___ y/o pt with increasing right knee pain and swelling over last
week. No trauma, no fevers. Joint aspirate revealed ___ WBC's.
Past Medical History:
1. Situs inversus
2. Asthma
3. Gastric ulcer
4. s/p Billroth II
5. s/p Roux en Y revision of Billroth II
6. s/p choledochoduodenostomy
7. s/p subtotal colectomy
Social History:
___
Family History:
NC
Physical Exam:
Afebrile, All vital signs stable
General: NCAT, NAD
Pulm: lungs CTA bilaterally, no w/r/r
Card:s1/s2 clear no m/g/r
Abd: soft NT/ND, +BS
Ext: incision C/D/I calf nt nvi distally
Brief Hospital Course:
Mrs. ___ was admitted to ___ on ___ for right knee
pain after replacement in ___. No trauma, no fevers.
Joint aspirate revealed ___ WBC's. Decision made with patient
to proceed with I&D and polyethylene exchange. Pre-operatively,
she was consented and history and physical performed.
Intra-operatively, she was closely monitored and remained
stable. She tolerated the procedure well without any difficulty.
Post-operatively, she was transferred to the PACU and floor for
further recovery. On the floor, she remained stable and started
on Vancomycin antibiotics. Infectious disease also followed and
managed her inpatient care. She got a PICC line placed for home
IV antibiotics for 6 weeks therapy. Her OR cultures were
negative to date. She progressed with physical therapy to
improve her strength and mobility. She continued to make steady
progress. She was discharged home with services in stable
condition.
Medications on Admission:
Albuterol MDI 2 PUFF IH Q6H:PRN ___
Discharge Medications:
1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous
DAILY (Daily) for 3 weeks.
Disp:*21 * Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever or pain.
4. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours) as needed.
5. Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q4H (every 4
hours) as needed.
Disp:*90 Tablet(s)* Refills:*0*
6. Vancomycin 1,000 mg Recon Soln Sig: 1250 (1250) mg
Intravenous every twelve (12) hours for 6 weeks: Start ___
End ___.
Disp:*qs * Refills:*0*
7. PICC line
Care per protocol
8. NS flushes
PICC line care per protocol
9. Heparin flushes
PICC line care per protocol
10. Outpatient Lab Work
Please have weekly blood work (CBC/Lytes/LFTs/Bun/Cre/Vanco
trough) drawn and have the results faxed to the Infectious
Disease department at ___.
Discharge Disposition:
Home With Service
Facility:
___
Discharge Diagnosis:
infection s/p R TKA
Discharge Condition:
stable
Discharge Instructions:
Keep the incision clean and dry. Please apply a dry sterile
dressing daily as needed for drainage or comfort.
If you have any shortness of breath, increased redness,
increased swelling, pain, or drainage, or have a temperature
>101, please call your doctor or go to the emergency room for
evaluation.
You may bear partial weight on your right leg.
Please resume all of the medications you took prior to your
admission unless discussed with your provider. Take all
medication as prescribed by your provider.
Continue your Lovenox injections as prescribed to help reduce
the chances of developing a blood clot.
Feel free to call our office with any questions or concerns.
Physical Therapy:
ROM as tolerated
partial weight bearing R leg
CPM -___
daily dressing changes DSD
Treatments Frequency:
Your skin staples/sutures may be removed ___ days after your
surgery.
Advance your CPM daily. -___ degrees as tolerated
You have a PICC line for IV antibiotic therapy for weeks.
Please have weekly blood work (CBC/Lytes/LFTs/Bun/Cre/Vanco
trough) drawn and have the results faxed to ID at ___
Followup Instructions:
___
## Prescriptions [2124-08-27 10:00:00]
| Drug | Atc Type | Prod_Strength | Dose_Val_Rx | Dose_Unit_Rx |
| ------ | ------ | ------ | ------ | ------ |
| Omeprazole | nan | 20mg Cap | 20 | mg |
| Fexofenadine | nan | 60mg Tablet | 60 | mg |
## Transfers [2124-08-27 12:45:00]
- Eventtype: ED
- Careunit: Emergency Department
## Labotary Test Events [2124-08-27 13:37:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Bacteria | nan | nan | nan | nan | nan | nan |
| Bilirubin | nan | mg/dL | nan | nan | nan | nan |
| Blood | nan | nan | nan | nan | nan | nan |
| Epithelial Cells | nan | #/hpf | nan | nan | nan | nan |
| Glucose | nan | mg/dL | nan | nan | nan | nan |
| Ketone | nan | mg/dL | nan | nan | nan | nan |
| Leukocytes | nan | nan | nan | nan | nan | nan |
| Nitrite | nan | nan | nan | nan | nan | nan |
| pH | 5.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | nan | mg/dL | nan | nan | nan | nan |
| RBC | nan | #/hpf | 0.0 | 2.0 | nan | nan |
| Specific Gravity | 1.004 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | nan |
| Urine Color | nan | nan | nan | nan | nan | nan |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | nan |
| WBC | nan | #/hpf | 0.0 | 5.0 | nan | nan |
| Yeast | nan | nan | nan | nan | nan | nan |
## Microbiology Test Events [2124-08-27 13:37:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Labotary Test Events [2124-08-27 13:54:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Basophils | 0.2 | % | 0.0 | 2.0 | nan | nan |
| Eosinophils | 0.8 | % | 0.0 | 4.0 | nan | nan |
| Hematocrit | 26.2 | % | 36.0 | 48.0 | abnormal | nan |
| Hemoglobin | 8.0 | g/dL | 12.0 | 16.0 | abnormal | nan |
| Lymphocytes | 12.6 | % | 18.0 | 42.0 | abnormal | nan |
| MCH | 24.4 | pg | 27.0 | 32.0 | abnormal | nan |
| MCHC | 30.5 | % | 31.0 | 35.0 | abnormal | nan |
| MCV | 80.0 | fL | 82.0 | 98.0 | abnormal | nan |
| Monocytes | 5.5 | % | 2.0 | 11.0 | nan | nan |
| Neutrophils | 81.0 | % | 50.0 | 70.0 | abnormal | nan |
| Platelet Count | 551.0 | K/uL | 150.0 | 440.0 | abnormal | nan |
| RDW | 15.6 | % | 10.5 | 15.5 | abnormal | nan |
| Red Blood Cells | 3.28 | m/uL | 4.2 | 5.4 | abnormal | nan |
| Sedimentation Rate | 101.0 | mm/hr | 0.0 | 20.0 | abnormal | nan |
| White Blood Cells | 8.9 | K/uL | 4.0 | 11.0 | nan | nan |
| Anion Gap | 19.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Bicarbonate | 26.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| C-Reactive Protein | 231.5 | mg/L | 0.0 | 5.0 | abnormal | LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10). |
| Calcium, Total | 8.6 | mg/dL | 8.4 | 10.2 | nan | nan |
| Chloride | 96.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 4.1 | mg/dL | 0.4 | 1.1 | abnormal | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 4.1,. Estimated GFR = 11 if non African-American (mL/min/1.73 m2). Estimated GFR = 14 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Magnesium | 1.8 | mg/dL | 1.6 | 2.6 | nan | nan |
| Phosphate | 3.7 | mg/dL | 2.7 | 4.5 | nan | nan |
| Potassium | 2.8 | mEq/L | 3.3 | 5.1 | abnormal | ___ |
| Sodium | 138.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 17.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| Vancomycin | 122.4 | ug/mL | 10.0 | 20.0 | abnormal | ___ |
| INR(PT) | 1.4 | nan | 0.9 | 1.1 | abnormal | nan |
| PT | 15.5 | sec | 10.4 | 13.4 | abnormal | nan |
| PTT | 63.5 | sec | 22.0 | 35.0 | abnormal | ___ |
## Microbiology Test Events [2124-08-27 13:54:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Labotary Test Events [2124-08-27 13:56:00]
- Item_Name: Lactate
- Valuenum: 1.6
- Valueuom: mmol/L
- Ref_Range_Lower: 0.5
- Ref_Range_Upper: 2.0
- Flag: nan
- Comments: nan
## Provider Order Entry [2124-08-27 14:27:45]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Radiology | General Xray |
| Radiology | General Xray |
| Radiology | Ultrasound |
| Radiology | Noninvasive Vascular |
| Lab | nan |
| Radiology | Ultrasound |
| Radiology | Noninvasive Vascular |
| Radiology | Ultrasound |
## Microbiology Test Events [2124-08-27 14:50:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Radiology Examinations [2124-08-27 14:51:00]
| Note_Type | Exam_Name | Text |
| ------ | ------ | ------ |
| RR | ['KNEE (AP, LAT & OBLIQUE) RIGHT'] | INDICATION: ___ female with postoperative fever, and history of
septic arthritis.
FINDINGS: Three views of the right knee are reviewed and compared to multiple
priors, most recently ___. Right total knee arthroplasty with metallic
femoral and tibial components is unchanged. There is no sign of hardware-
related complication. Small osseous fragments in the region of the resected
patella are stable. There is no soft tissue gas. There is no new osseous
erosion, or lucent or sclerotic bony lesion. Surgical staples now seen in the
anterior knee soft tissues.
IMPRESSION: Unchanged appearance of right total knee arthroplasty.
|
| RR | ['CHEST (PA & LAT)'] | HISTORY: Right knee inflammation and fever.
COMPARISON: ___.
FINDINGS: PA and lateral views of the chest in upright position demonstrates
situs inversus with right-sided aortic arch, right-sided cardiac apex and
right-sided stomach. There is no pneumothorax, consolidation, or pleural
effusion. The pulmonary vasculature is normal. Surgical clips at the GE
junction are again seen. The osseous structures are unremarkable. Right-sided
PICC with the tip at the superior SVC.
IMPRESSION: No acute cardiopulmonary process. Situs inversus as described
above.
|
| RR | ['UNILAT LOWER EXT VEINS RIGHT'] | HISTORY: Fever, calf and leg swelling, rule out DVT.
COMPARISON: None.
FINDINGS: Ultrasound evaluation of the right lower extremity deep venous
system using grayscale, color, and pulse wave Doppler reveals the veins to be
fully compressible with normal color flow, Doppler waveforms, augmentation,
and respiratory variation in flow. Edema in the prepatellar soft tissues, but
no discrete drainable fluid collection is seen.
IMPRESSION: No evidence of DVT involving the right lower extremity.
|
## Provider Order Entry [2124-08-27 16:24:00]
- Order_Type: Lab
- Order_Subtype: nan
## Labotary Test Events [2124-08-27 16:34:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Creatinine | 4.1 | mg/dL | 0.4 | 1.1 | abnormal | nan |
| Potassium | 2.4 | mEq/L | 3.3 | 5.1 | abnormal | ___ |
| Bacteria | nan | nan | nan | nan | nan | nan |
| Bilirubin | nan | mg/dL | nan | nan | nan | nan |
| Blood | nan | nan | nan | nan | nan | nan |
| Epithelial Cells | 0.0 | #/hpf | nan | nan | nan | nan |
| Glucose | nan | mg/dL | nan | nan | nan | nan |
| Ketone | nan | mg/dL | nan | nan | nan | nan |
| Leukocytes | nan | nan | nan | nan | nan | nan |
| Nitrite | nan | nan | nan | nan | nan | nan |
| pH | 5.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | nan | mg/dL | nan | nan | nan | nan |
| RBC | nan | #/hpf | 0.0 | 2.0 | nan | nan |
| Specific Gravity | 1.003 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | nan |
| Urine Color | nan | nan | nan | nan | nan | nan |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | nan |
| WBC | nan | #/hpf | 0.0 | 5.0 | nan | nan |
| Yeast | nan | nan | nan | nan | nan | nan |
| Bicarbonate, Urine | nan | mEq/L | nan | nan | nan | LESS THAN 5. |
| Chloride, Urine | 21.0 | mEq/L | nan | nan | nan | nan |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Potassium, Urine | 9.0 | mEq/L | nan | nan | nan | nan |
| Sodium, Urine | 17.0 | mEq/L | nan | nan | nan | nan |
## Microbiology Test Events [2124-08-27 17:02:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION.
- Ab_Name: nan
## Provider Order Entry [2124-08-27 17:16:49]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Radiology | Ultrasound |
## Radiology Examinations [2124-08-27 17:30:00]
- Note_Type: RR
- Exam_Name: ['RENAL U.S.']
- Text: INDICATION: ___ female with acute renal failure of unknown cause.
Please evaluate for obstructive uropathy.
FINDINGS: Comparison made to CT study from ___. Right kidney measures
9.6 cm, and left kidney measures 10.4 cm. The kidneys are slightly echogenic,
which may relate to medical renal disease. There is no hydronephrosis. There
is no evidence of stone or renal mass. Pre-void bladder is unremarkable.
IMPRESSION: No hydronephrosis.
## Provider Order Entry [2124-08-27 17:32:13]
- Order_Type: Lab
- Order_Subtype: nan
|
EW EMER.
|
[
"OBSERVATION ADMIT",
"EU OBSERVATION",
"EW EMER.",
"ELECTIVE",
"AMBULATORY OBSERVATION",
"DIRECT OBSERVATION",
"DIRECT EMER.",
"SURGICAL SAME DAY ADMISSION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EW EMER.\"]",
"label": [
"EW EMER."
]
}
|
4
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 43
- Gender: F
## Transfers [2152-01-13 14:20:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2152-01-13 14:20:00]
- Gender: F
- Race: WHITE
## Triage [2152-01-13 14:20:01]
- Temperature: 99.6
- Heartrate: 97.0
- Resprate: 18.0
- O2Sat: 100.0
- Sbp: 128.0
- Dbp: 59.0
- Pain: 10
- Acuity: 2.0
- Chiefcomplaint: Abd pain, Transfer, Appendicitis
## Provider Order Entry [2152-01-13 14:26:21]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Blood Bank | Blood tests |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Vitalsign [2152-01-13 14:43:00]
- Temperature: nan
- Heartrate: nan
- Resprate: nan
- O2Sat: nan
- Sbp: nan
- Dbp: nan
- Pain: 10
- Rhythm: nan
## Provider Order Entry [2152-01-13 14:52:07]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| General Care | Other |
| IV therapy | IV fluids |
| Medications | nan |
| Medications | nan |
## Pyxis [2152-01-13 15:16:00]
| Name |
| ------ |
| Morphine |
| Ondansetron |
| Ondansetron |
## Electronic Medicine Administration Record [2152-01-13 15:20:00]
| Medication | Event_Txt |
| ------ | ------ |
| Morphine Sulfate | Administered |
| Ondansetron | Administered |
| nan | Administered |
## Vitalsign [2152-01-13 15:25:00]
- Temperature: nan
- Heartrate: nan
- Resprate: nan
- O2Sat: nan
- Sbp: nan
- Dbp: nan
- Pain: 10
- Rhythm: nan
## Microbiology Test Events [2152-01-13 15:36:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Vitalsign [2152-01-13 15:40:00]
- Temperature: nan
- Heartrate: nan
- Resprate: nan
- O2Sat: nan
- Sbp: nan
- Dbp: nan
- Pain: 9
- Rhythm: nan
## Microbiology Test Events [2152-01-13 15:43:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Labotary Test Events [2152-01-13 15:59:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Lactate | 1.6 | mmol/L | 0.5 | 2.0 | nan | GREEN TOP. |
| HCG, Urine, Qualitative | nan | +/- | nan | nan | nan | NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG. |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Urine tube, held | nan | nan | nan | nan | nan | ___ |
| Bacteria | nan | nan | nan | nan | nan | NONE. |
| Bilirubin | nan | mg/dL | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | SM . |
| Epithelial Cells | nan | #/hpf | nan | nan | nan | <1. |
| Glucose | nan | mg/dL | nan | nan | nan | NEG. |
| Ketone | 10.0 | mg/dL | nan | nan | nan | nan |
| Leukocytes | nan | nan | nan | nan | nan | NEG. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 7.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | 30.0 | mg/dL | nan | nan | nan | nan |
| RBC | 7.0 | #/hpf | 0.0 | 2.0 | abnormal | nan |
| Specific Gravity | nan | | 1.001 | 1.035 | nan | >1.050*. |
| Urine Appearance | nan | nan | nan | nan | nan | Clear. |
| Urine Color | nan | nan | nan | nan | nan | Yellow. |
| Urine Mucous | nan | nan | nan | nan | nan | RARE. |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | NEG. |
| WBC | 2.0 | #/hpf | 0.0 | 5.0 | nan | nan |
| Yeast | nan | nan | nan | nan | nan | nan |
## Pyxis [2152-01-13 17:03:00]
- Name: Ampicillin-Sulbactam
## Electronic Medicine Administration Record [2152-01-13 17:05:00]
- Medication: Ampicillin-Sulbactam
- Event_Txt: Administered
## Vitalsign [2152-01-13 17:11:00]
- Temperature: 102.0
- Heartrate: 102.0
- Resprate: 18.0
- O2Sat: 99.0
- Sbp: 116.0
- Dbp: 54.0
- Pain: 5
- Rhythm: nan
## Provider Order Entry [2152-01-13 17:15:53]
- Order_Type: Medications
- Order_Subtype: nan
## Pyxis [2152-01-13 17:29:00]
- Name: Acetaminophen
## Electronic Medicine Administration Record [2152-01-13 17:31:00]
- Medication: Acetaminophen
- Event_Txt: Administered
## Vitalsign [2152-01-13 18:26:00]
| Temperature | Heartrate | Resprate | O2Sat | Sbp | Dbp | Pain | Rhythm |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| nan | 94.0 | 16.0 | 98.0 | 105.0 | 50.0 | 5 | nan |
| nan | 87.0 | 16.0 | 97.0 | nan | nan | asleep | nan |
| 98.9 | 81.0 | 17.0 | 97.0 | 101.0 | 46.0 | 5-6 | nan |
## Pyxis [2152-01-13 19:19:00]
- Name: Morphine
## Electronic Medicine Administration Record [2152-01-13 19:22:00]
- Medication: Morphine Sulfate
- Event_Txt: Administered
|
EW EMER.
|
[
"DIRECT EMER.",
"OBSERVATION ADMIT",
"ELECTIVE",
"SURGICAL SAME DAY ADMISSION",
"EU OBSERVATION",
"EW EMER.",
"DIRECT OBSERVATION",
"AMBULATORY OBSERVATION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EW EMER.\"]",
"label": [
"EW EMER."
]
}
|
5
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 85
- Gender: M
## Discharge [2162-01-02 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: M
Service: MEDICINE
Allergies:
Penicillins / prednisone / nitroglycerin / Cortisone
Attending: ___.
Chief Complaint:
hematuria, dysuria
Major Surgical or Invasive Procedure:
- Cystoscopically-assisted Foley catheter placement
History of Present Illness:
___ with CAD s/p CABG with AVR, HTN, CKD baseline (cr 2.2), BPH,
recurrent UTI ___ urinary obstruction, BPH s/p recent TURP
presenting from nursing home with hematuria and dysuria. Of
note, the patient is a very poor historian, and has difficulty
asnwering questions. He states that he has not been able to
urinate as of recently and has had pain with urination. He was
seen by Urology today in the ED, who placed a Foley for relief
of urinary retention. Per their documentation, the placement of
this catheter was rather traumatic, with resistance noted at
approximately the prostatic urethra, likely related to a false
passage. Ultimately, Foley was placed via cystoscopic guidance,
and blood-tinged urine was drained. His bladder was irrigated
with 2L NS, and the catheter was left in place. During the
irrigation process, he did have passage of a small amount of
clot. Now, the patient complains of weakness.
In the ED, initial vs were: 6 97.8 59 159/87 14 99%RA. Labs were
notable for Hct 29.3 (baseline 32), potassium 4.8, Creatine 2.5
(baseline ~2.1), and a very dirty urine. He was seen by Urology
for placement of Foley (as above), and was started on Cipro for
treatment of presumed UTI. He was admitted to medicine for
monitoring.
On the floor, he had no complaints.
Past Medical History:
- BPH w/ urinary retention and chronic indwelling catheter now
s/p Transurethral resection of prostate.
- CAD s/p CABG w/ AVR
- psychiatric d/o NOS,
- hx recurrent UTI (requiring 2wks course Ertapenem in ___
and ___.
- Vitamin D deficiency
- GOUT
- GERD
- HTN
- diastrolic CHF with EF 55%
- Seizure disorder
Social History:
___
Family History:
Per the patient, no family history of bladder, prostate, or
renal disease.
Physical Exam:
ADMISSION PHYSICAL EXAM:
Vitals: 98.1, 148/58, 60, 18, 98%RA
General: NAD, confused
HEENT: Sclera anicteric, mucus membranes dry
Neck: supple
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, ___ systolic murmur heard throughout
precordium
Abdomen: soft, non-distended, tender to palpation in the
suprapubic region, bowel sounds present but diminished, no
guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A+Ox2 (self, date), CN ___ grossly intact
DISCHARGE PHYSICAL EXAM:
Vitals: 97.3, 130/80 (SBP 130-188), 64, 20, 99%RA
General: NAD, confused, pleasant
HEENT: Sclera anicteric
Neck: supple
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, ___ systolic murmur heard throughout
precordium
Abdomen: soft, non-distended, non-tender to palpation, bowel
sounds present but diminished, no guarding
GU: urine in Foley bag cloudy, light pink with no clots
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A+Ox2 (self, date), CN ___ grossly intact
Pertinent Results:
ADMISSION LABS:
___ 10:10PM URINE HOURS-RANDOM UREA N-258 CREAT-42
SODIUM-38 POTASSIUM-28 CHLORIDE-44
___ 10:10PM URINE OSMOLAL-248
___ 03:04PM WBC-6.1 RBC-2.89* HGB-9.0* HCT-28.3* MCV-98
MCH-31.2 MCHC-31.9 RDW-14.8
___ 07:37AM K+-4.8
___ 06:00AM GLUCOSE-103* UREA N-46* CREAT-2.5* SODIUM-140
POTASSIUM-5.7* CHLORIDE-111* TOTAL CO2-20* ANION GAP-15
___ 06:00AM WBC-6.0 RBC-2.99* HGB-9.3* HCT-29.3* MCV-98
MCH-31.2 MCHC-31.8 RDW-14.9
MICRO:
- URINE CULTURE (Preliminary):
MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
AND/OR GENITAL CONTAMINATION.
WORK-UP REQUESTED BY ___ ___ ___.
GRAM POSITIVE COCCUS(COCCI). >100,000 ORGANISMS/ML..
ESCHERICHIA COLI. ___. PRESUMPTIVE
IDENTIFICATION.
CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). ~3000/ML.
IMAGING:
- CXR (___): IMPRESSION: AP chest compared to ___: PICC line ends in the left axilla, far from the left
axillary or subclavian veins. The patient has had median
sternotomy and AVR. Opacification of the base of the left lung
could be pneumonia. Conventional radiography recommended if
feasible. Right lung clear. Heart mildly enlarged. No
pulmonary edema.
- CXR (___): FINDINGS: In comparison with the study of
___, there has been almost complete clearing of the
opacification in the retrocardiac region. The residual most
likely represents atelectatic change. No evidence of vascular
congestion and the right lung is clear. Intact sternal wires are
again seen and there is mild tortuosity of the aorta.
DISCHARGE LABS:
___ 07:50AM BLOOD WBC-4.9 RBC-2.96* Hgb-9.7* Hct-28.7*
MCV-97 MCH-32.8* MCHC-33.8 RDW-15.2 Plt ___
___ 07:50AM BLOOD Glucose-97 UreaN-39* Creat-2.1* Na-139
K-4.2 Cl-110* HCO3-19* AnGap-14
___ 07:50AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.___ with CAD s/p CABG with AVR, HTN, CKD baseline (cr 2.2), BPH,
recurrent UTI ___ urinary obstruction, BPH s/p recent TURP
presenting from nursing home with hematuria and dysuria.
# UTI bacterial: He presents from the nursing home with
hematuria and dysuria, and UA in the ED was grossly positive.
Although our culture data was only consistent with mixed flora,
the records from his nursing home suggest E. coli UTI, with
numerous resistances. On the day or admission he received a dose
of ertapenem at the nursing home, which may explain why our
culture results are not consistent with those from the nursing
home. Here, he was treated with meropenem and linezolid, based
on current and prior culture data. Of note, he was experiencing
some urinary retention and had a rather traumatic Foley catheter
placed via urology, ultimately requiring cystocopic guidance.
Per the instructions of Urology, this is to remain in place for
2 weeks, at which point he should be seen by Urology as an
outpatient. Due to the ongoing hematuria, while hospitalized
this Foley was flushed with saline every 4 hours, with good
effect.
# Metabolic Encephalopathy: Noted to be confused on admission,
with difficulty answering questions and with some speech
difficulties as well. This improved with treatment of his UTI.
# Acute renal failure, on CKD: On admission his Creatinine was
2.5, with a baseline of 2.1. FeNa was consistent with pre-renal
etiology. He was encouraged to drink and all meds were renally
dosed. His Creatinine prior to discharge was downtrending.
# BPH: History of BPH, s/p TURP in ___. Following TURP
his urethra was reported to be widely patent, however Foley
placement by urology was very difficult. Foley was maintained to
assist in management of potential urinary obstruction, and he
was continued on finasteride and tamsulosin.
# Anemia: Baseline Hct appears to be approximately 32. Likely
acute blood-loss anemia given recent hematuria. His crit
remained stable during this admission, and he did not require
any blood transfusions. Prior to discharge his hematuria had
improved significantly.
CHRONIC ISSUES:
# Seizure disorder: He has not been on keppra at his nursing
home for unclear reasons. While he was hospitalized, his
medications were adjusted so as to minimized alteration in the
seizure threshold. We attempted to clarify why this medication
has been discontinued as an outpatient but were unable.
# HTN, benign: Normotensive on throughout this stay. He was
maintained on amlodipine, metoprolol.
# CAD s/p CABG w/ AVR: No active issues on this admission. He
was maintained on statin, metoprolol. Aspirin was held
# HL: No active issues on this admission. He was maintained on
atorvastatin.
# GERD: No active issues on this admission. He was maintained
on omeprazole.
# CONSTIPATION: No active issues on this admission. He was
maintained on mirilax, Docusate.
# GOUT: No active issues on this admission. He was maintained
on allopurinol.
TRANSITIONAL ISSUES:
- Will need a 10 day course of antibiotics for treatment of UTI
(through ___
- Unclear why Keppra was discontinued as an outpatient. We
attempted to contact his listed PCP, and the attending who
rounds at ___, but were not able to contact
them to determine why this was stopped. It may be necessary to
restart this medication, and we will defer this decision to his
outpatient doctors.
- follow up with urology
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Bacitracin Ointment 1 Appl TP QID urethral meatus pain
2. Acetaminophen 650 mg PO Q6H:PRN pain
3. Allopurinol ___ mg PO DAILY
4. Amlodipine 10 mg PO DAILY
5. Aspirin 81 mg PO DAILY
6. Atorvastatin 40 mg PO HS
7. Calcium Acetate 667 mg PO DAILY
8. Docusate Sodium 100 mg PO BID
9. Finasteride 5 mg PO DAILY
10. Florastor *NF* (saccharomyces boulardii) 250 mg Oral BID
11. melatonin *NF* 3 mg Oral QHS
12. Metoprolol Succinate XL 100 mg PO DAILY
13. Omeprazole 20 mg PO DAILY
14. Polyethylene Glycol 17 g PO DAILY
15. Tamsulosin 0.8 mg PO HS
16. Oxybutynin 5 mg PO TID bladder spasms
STOP THIS MEDICATION ___ or 24 hours before planned
trial of void.
17. ertapenem *NF* 500 mg Injection daily
through ___
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H:PRN pain
2. Allopurinol ___ mg PO DAILY
3. Amlodipine 10 mg PO DAILY
4. Atorvastatin 40 mg PO HS
5. Calcium Acetate 667 mg PO DAILY
6. Docusate Sodium 100 mg PO BID
7. Finasteride 5 mg PO DAILY
8. Metoprolol Succinate XL 100 mg PO DAILY
9. Omeprazole 20 mg PO DAILY
10. Polyethylene Glycol 17 g PO DAILY
11. Tamsulosin 0.8 mg PO HS
12. Linezolid ___ mg PO Q12H
13. Meropenem 500 mg IV Q8H
14. Aspirin 81 mg PO DAILY
15. Bacitracin Ointment 1 Appl TP QID urethral meatus pain
16. Florastor *NF* (saccharomyces boulardii) 250 mg Oral BID
17. melatonin *NF* 3 mg Oral QHS
18. Oxybutynin 5 mg PO TID bladder spasms
Discharge Disposition:
Extended Care
Facility:
___
___ Diagnosis:
Primary: Urinary tract infection, metabolic encephalopathy,
benign prostatic hypertrophy
Secondary: coronary artery disease, hypertension,
hyperlipidemia, gastroesophageal reflux disorder, gout, chronic
diastolic congestive heart failure
Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.
Discharge Instructions:
Dear Mr. ___,
It was a pleasure taking care of you at ___
___. You were admitted for evaluation and treatment
of your UTI. While you were here you had a Foley catheter placed
to assist in the drainage of urine from your bladder. The
placement of this catheter was somewhat difficult and traumatic.
The Urologists ultimately needed to use a cystoscopy to assist
in the placement of this device. You tolerated this well. You
were treated with IV and oral antibiotics, and you will need to
continue to take these medications for a total course of 10 days
(through ___. Additionally, you will need to keep the
Foley catheter in place for 2 weeks, until you are able to see
Dr. ___.
Followup Instructions:
___
## Transfers [2162-08-22 12:26:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2162-08-22 12:26:00]
- Gender: M
- Race: WHITE
## Triage [2162-08-22 12:26:01]
- Temperature: 97.6
- Heartrate: 55.0
- Resprate: 20.0
- O2Sat: 99.0
- Sbp: 130.0
- Dbp: 64.0
- Pain: 0
- Acuity: 3.0
- Chiefcomplaint: Hyperkalemia
## Microbiology Test Events [2162-08-22 12:30:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Provider Order Entry [2162-08-22 12:36:03]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
## Labotary Test Events [2162-08-22 12:45:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Basophils | 0.4 | % | 0.0 | 2.0 | nan | nan |
| Eosinophils | 1.4 | % | 0.0 | 4.0 | nan | nan |
| Hematocrit | 32.8 | % | 40.0 | 52.0 | abnormal | nan |
| Hemoglobin | 10.2 | g/dL | 14.0 | 18.0 | abnormal | nan |
| Lymphocytes | 17.9 | % | 18.0 | 42.0 | abnormal | nan |
| MCH | 32.3 | pg | 27.0 | 32.0 | abnormal | nan |
| MCHC | 31.2 | % | 31.0 | 35.0 | nan | nan |
| MCV | 104.0 | fL | 82.0 | 98.0 | abnormal | VERIFIED. |
| Monocytes | 5.0 | % | 2.0 | 11.0 | nan | nan |
| Neutrophils | 75.3 | % | 50.0 | 70.0 | abnormal | nan |
| Platelet Count | 238.0 | K/uL | 150.0 | 440.0 | nan | nan |
| RDW | 14.8 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 3.17 | m/uL | 4.6 | 6.2 | abnormal | nan |
| White Blood Cells | 7.1 | K/uL | 4.0 | 11.0 | nan | nan |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
| Bacteria | nan | nan | nan | nan | nan | FEW. |
| Bilirubin | nan | mg/dL | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | MOD. |
| Epithelial Cells | 0.0 | #/hpf | nan | nan | nan | nan |
| Glucose | nan | mg/dL | nan | nan | nan | NEG. |
| Ketone | nan | mg/dL | nan | nan | nan | NEG. |
| Leukocytes | nan | nan | nan | nan | nan | LG. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 6.5 | units | 5.0 | 8.0 | nan | nan |
| Protein | 300.0 | mg/dL | nan | nan | nan | nan |
| RBC | 131.0 | #/hpf | 0.0 | 2.0 | abnormal | nan |
| Specific Gravity | 1.017 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | Cloudy. |
| Urine Color | nan | nan | nan | nan | nan | Orange. |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | NEG. |
| WBC | nan | #/hpf | 0.0 | 5.0 | nan | >182*. |
| Yeast | nan | nan | nan | nan | nan | nan |
| Anion Gap | 19.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Bicarbonate | 12.0 | mEq/L | 22.0 | 32.0 | abnormal | ___ |
| Chloride | 113.0 | mEq/L | 96.0 | 108.0 | abnormal | nan |
| Creatinine | 4.5 | mg/dL | 0.5 | 1.2 | abnormal | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 4.5,. Estimated GFR = 12 if non African-American (mL/min/1.73 m2). Estimated GFR = 15 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 120.0 | mg/dL | 70.0 | 100.0 | abnormal | IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES. |
| Potassium | 5.9 | mEq/L | 3.3 | 5.1 | abnormal | nan |
| Sodium | 138.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 86.0 | mg/dL | 6.0 | 20.0 | abnormal | nan |
## Provider Order Entry [2162-08-22 12:53:44]
- Order_Type: Lab
- Order_Subtype: nan
## Labotary Test Events [2162-08-22 12:56:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Lactate | 1.2 | mmol/L | 0.5 | 2.0 | nan | nan |
| Potassium, Whole Blood | 5.8 | mEq/L | 3.3 | 5.1 | abnormal | nan |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Urine tube, held | nan | nan | nan | nan | nan | ___ |
| Chloride, Urine | 58.0 | mEq/L | nan | nan | nan | nan |
| Creatinine, Urine | 67.0 | mg/dL | nan | nan | nan | nan |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Osmolality, Urine | 380.0 | mOsm/kg | nan | nan | nan | nan |
| Potassium, Urine | 30.0 | mEq/L | nan | nan | nan | nan |
| Sodium, Urine | 72.0 | mEq/L | nan | nan | nan | nan |
| Uhold | nan | nan | nan | nan | nan | ___ |
## Microbiology Test Events [2162-08-22 13:00:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: nan
- Ab_Name: nan
## Provider Order Entry [2162-08-22 13:14:02]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Medrecon [2162-08-22 13:39:00]
| Name | Atc Type |
| ------ | ------ |
| acetaminophen [Tylenol] | paracetamol |
| allopurinol | None |
| amlodipine | amlodipine |
| aspirin [Aspir-81] | acetylsalicylic acid |
| aspirin [Aspir-81] | acetylsalicylic acid |
| atorvastatin | atorvastatin |
| calcium carbonate [Calcium 500] | calcium compounds |
| finasteride | nan |
| levetiracetam | levetiracetam |
| melatonin | melatonin |
| melatonin | melatonin |
| metoprolol succinate [Toprol XL] | nan |
| omeprazole | omeprazole |
| saccharomyces boulardii [Florastor] | nan |
| tamsulosin | tamsulosin |
## Microbiology Test Events [2162-08-22 13:40:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Pyxis [2162-08-22 14:32:00]
| Name |
| ------ |
| Lidocaine Jelly 2% (Urojet) |
| Lidocaine Jelly 2% (Urojet) |
## Vitalsign [2162-08-22 14:56:00]
- Temperature: nan
- Heartrate: 54.0
- Resprate: 16.0
- O2Sat: 94.0
- Sbp: 120.0
- Dbp: 59.0
- Pain: 0
- Rhythm: nan
## Provider Order Entry [2162-08-22 15:35:52]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
|
EW EMER.
|
[
"DIRECT EMER.",
"SURGICAL SAME DAY ADMISSION",
"DIRECT OBSERVATION",
"AMBULATORY OBSERVATION",
"EW EMER.",
"ELECTIVE",
"EU OBSERVATION",
"OBSERVATION ADMIT"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EW EMER.\"]",
"label": [
"EW EMER."
]
}
|
6
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 61
- Gender: F
## Procedures on International Classification of Diseases [2181-08-18 00:00:00]
- Procedures: Laparoscopic appendectomy
- Ccs Type: Appendectomy
## Transfers [2181-08-18 07:13:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2181-08-18 07:13:00]
- Gender: F
- Race: WHITE
## Triage [2181-08-18 07:13:01]
- Temperature: 97.6
- Heartrate: 77.0
- Resprate: 18.0
- O2Sat: 100.0
- Sbp: 152.0
- Dbp: 95.0
- Pain: 7
- Acuity: 3.0
- Chiefcomplaint: ABD PAIN
## Medrecon [2181-08-18 07:28:00]
| Name | Atc Type |
| ------ | ------ |
| hyoscyamine sulfate | None |
| nortriptyline | nan |
## Provider Order Entry [2181-08-18 07:35:54]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Radiology | Ultrasound |
| Lab | nan |
## Medrecon [2181-08-18 07:40:00]
| Name | Atc Type |
| ------ | ------ |
| lisinopril | lisinopril |
| aspirin | nan |
| aspirin | nan |
| simvastatin | simvastatin |
| VSL#3 | nan |
| magnesium | paracetamol, combinations excl. psycholeptics |
| multivitamin | None |
| Vitamin D3 | colecalciferol |
## Labotary Test Events [2181-08-18 07:44:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Alanine Aminotransferase (ALT) | 19.0 | IU/L | 0.0 | 40.0 | nan | nan |
| Albumin | 4.2 | g/dL | 3.5 | 5.2 | nan | nan |
| Alkaline Phosphatase | 57.0 | IU/L | 35.0 | 105.0 | nan | nan |
| Anion Gap | 12.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Asparate Aminotransferase (AST) | 19.0 | IU/L | 0.0 | 40.0 | nan | nan |
| Bicarbonate | 28.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Bilirubin, Total | 0.5 | mg/dL | 0.0 | 1.5 | nan | nan |
| Chloride | 102.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.6 | mg/dL | 0.4 | 1.1 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 127.0 | mg/dL | 70.0 | 100.0 | abnormal | IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES. |
| Lipase | 26.0 | IU/L | 0.0 | 60.0 | nan | nan |
| Potassium | 4.1 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 138.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 16.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| Basophils | 1.0 | % | 0.0 | 2.0 | nan | nan |
| Eosinophils | 1.6 | % | 0.0 | 4.0 | nan | nan |
| Hematocrit | 42.0 | % | 36.0 | 48.0 | nan | nan |
| Hemoglobin | 14.2 | g/dL | 12.0 | 16.0 | nan | nan |
| Lymphocytes | 11.4 | % | 18.0 | 42.0 | abnormal | nan |
| MCH | 31.8 | pg | 27.0 | 32.0 | nan | nan |
| MCHC | 33.8 | % | 31.0 | 35.0 | nan | nan |
| MCV | 94.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 4.1 | % | 2.0 | 11.0 | nan | nan |
| Neutrophils | 82.0 | % | 50.0 | 70.0 | abnormal | nan |
| Platelet Count | 384.0 | K/uL | 150.0 | 440.0 | nan | nan |
| RDW | 12.2 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.46 | m/uL | 4.2 | 5.4 | nan | nan |
| White Blood Cells | 13.7 | K/uL | 4.0 | 11.0 | abnormal | nan |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
## Radiology Examinations [2181-08-18 07:44:00]
- Note_Type: RR
- Exam_Name: ['LIVER OR GALLBLADDER US (SINGLE ORGAN)']
- Text: HISTORY: Right upper quadrant tenderness with history of IBS.
TECHNIQUE: Grayscale abdominal ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
Liver: Homogeneous echotexture without focal liver lesions. No intra or
extrahepatic biliary dilatation. The CBD measures 2 mm. The main portal vein
is patent with hepatopetal flow.
Gallbladder: Normal without evidence of stones, pericholecystic fluid or
gallbladder wall edema.
Pancreas: Unremarkable, although the tail is not well seen due to overlying
bowel gas.
Aorta: Normal in caliber without evidence of aneurysmal dilatation.
IVC: Visualized portions are normal.
Spleen: 10.8 cm which is a normal size, with a homogeneous echotexture.
Kidneys: In the right mid kidney, a 4 mm echogenic focus without distal
shadowing is noted adjacent to a hypoechoic region, likely calcification
within a calyceal diverticulum. The kidneys are otherwise normal in size
without masses, hydronephrosis or additional renal calculi.
Misc: No ascites.
IMPRESSION:
1. No evidence of acute cholecystitis or cholelithiasis.
2. No free fluid.
3. Small 4 mm calcification likely within a calyceal diverticulum in the right
mid kidney. No hydronephrosis.
## Labotary Test Events [2181-08-18 07:52:00]
- Item_Name: Lactate
- Valuenum: 1.9
- Valueuom: mmol/L
- Ref_Range_Lower: 0.5
- Ref_Range_Upper: 2.0
- Flag: nan
- Comments: GREENTOP.
## Provider Order Entry [2181-08-18 08:07:19]
| Order_Type | Order_Subtype |
| ------ | ------ |
| General Care | Other |
| Radiology | Ultrasound |
## Radiology Examinations [2181-08-18 09:10:00]
- Note_Type: RR
- Exam_Name: ['-76 BY SAME PHYSICIAN', 'US APPENDIX']
- Text: HISTORY: Right upper quadrant and right lower quadrant pain. Assess for
appendicitis.
COMPARISON: None.
TECHNIQUE: Grayscale and color abdominal ultrasound images of the right lower
quadrant were obtained.
FINDINGS: Focal right lower quadrant ultrasound demonstrates an 8 mm
non-compressible tubular blind ending hypoechoic structure within the right
lower quadrant with associated mural edema and hyperemia and adjacent
echogenic inflamed fat consistent with acute appendicitis. Terminal ileum is
unremarkable. No free fluid. The patient had significant pain on compression
of this structure.
IMPRESSION: Acute appendicitis. No free fluid.
## Provider Order Entry [2181-08-18 09:39:18]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Radiology | CT Scan |
| Radiology | CT Scan |
| Lab | nan |
| Radiology | General Xray |
## Labotary Test Events [2181-08-18 09:52:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| INR(PT) | 1.0 | nan | 0.9 | 1.1 | nan | nan |
| PT | 10.8 | sec | 9.4 | 12.5 | nan | nan |
| PTT | 32.0 | sec | 25.0 | 36.5 | nan | nan |
## Radiology Examinations [2181-08-18 09:58:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PA & LAT)']
- Text: HISTORY: Acute appendicitis.
COMPARISON: None.
TECHNIQUE:
PA and views of chest.
FINDINGS:
The cardiac, mediastinal and hilar contours are normal. Lungs are clear and
the pulmonary vasculature is normal. No pleural effusion or pneumothorax is
seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary process.
## Provider Order Entry [2181-08-18 09:59:05]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Blood Bank | Blood tests |
| Medications | nan |
| Medications | nan |
| Medications | nan |
|
EU OBSERVATION
|
[
"SURGICAL SAME DAY ADMISSION",
"EU OBSERVATION",
"EW EMER.",
"ELECTIVE",
"AMBULATORY OBSERVATION",
"OBSERVATION ADMIT",
"DIRECT OBSERVATION",
"DIRECT EMER."
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EU OBSERVATION\"]",
"label": [
"EU OBSERVATION"
]
}
|
7
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 58
- Gender: M
## Online Medical Record [2159-11-18 00:00:00]
| Result_Name | Result_Value |
| ------ | ------ |
| BMI (kg/m2) | 29.5 |
| Weight (Lbs) | 230 |
| Blood Pressure | 150/90 |
| BMI (kg/m2) | 29.1 |
| Weight (Lbs) | 227 |
| BMI (kg/m2) | 29.5 |
| Weight (Lbs) | 230.00 |
## Transfers [2160-01-16 10:17:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2160-01-16 10:17:00]
- Gender: M
- Race: WHITE
## Vitalsign [2160-01-16 10:17:00]
- Temperature: 98.2
- Heartrate: 91.0
- Resprate: 20.0
- O2Sat: 100.0
- Sbp: 168.0
- Dbp: 95.0
- Pain: 10
- Rhythm: nan
## Triage [2160-01-16 10:17:01]
- Temperature: 98.2
- Heartrate: 91.0
- Resprate: 20.0
- O2Sat: 100.0
- Sbp: 168.0
- Dbp: 95.0
- Pain: 10
- Acuity: 2.0
- Chiefcomplaint: Anxiety, Back pain
## Medrecon [2160-01-16 10:35:00]
- Name: ibuprofen
- Atc Type: ibuprofen
## Labotary Test Events [2160-01-16 11:07:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Absolute Lymphocyte Count | 1.35 | K/uL | 1.2 | 3.7 | nan | nan |
| Basophils | 0.6 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 0.3 | % | 1.0 | 7.0 | abnormal | nan |
| Hematocrit | 43.3 | % | 40.0 | 51.0 | nan | nan |
| Hemoglobin | 15.2 | g/dL | 13.7 | 17.5 | nan | nan |
| Lymphocytes | 18.8 | % | 19.0 | 53.0 | abnormal | nan |
| MCH | 29.6 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 35.1 | g/dL | 32.0 | 37.0 | nan | nan |
| MCV | 84.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 8.1 | % | 5.0 | 13.0 | nan | nan |
| Neutrophils | 71.8 | % | 34.0 | 71.0 | abnormal | nan |
| Platelet Count | 240.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 12.6 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 5.13 | m/uL | 4.6 | 6.1 | nan | nan |
| White Blood Cells | 7.2 | K/uL | 4.0 | 10.0 | nan | nan |
| Absolute Basophil Count | 0.04 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.02 | K/uL | 0.04 | 0.54 | abnormal | nan |
| Absolute Monocyte Count | 0.58 | K/uL | 0.2 | 0.8 | nan | nan |
| Absolute Neutrophil Count | 5.16 | K/uL | 1.6 | 6.1 | nan | nan |
| Immature Granulocytes | 0.4 | % | 0.0 | 0.6 | nan | ___ |
| RDW-SD | 38.5 | fL | 35.1 | 46.3 | nan | nan |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Anion Gap | 23.0 | mEq/L | 8.0 | 20.0 | abnormal | nan |
| Bicarbonate | 17.0 | mEq/L | 22.0 | 32.0 | abnormal | nan |
| Calcium, Total | 10.4 | mg/dL | 8.4 | 10.3 | abnormal | nan |
| Chloride | 101.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.8 | mg/dL | 0.5 | 1.2 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.8, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.. |
| Glucose | 95.0 | mg/dL | 70.0 | 100.0 | nan | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 47.0 | nan | nan | nan | nan | nan |
| I | 1.0 | nan | nan | nan | nan | nan |
| Magnesium | 2.3 | mg/dL | 1.6 | 2.6 | nan | nan |
| Phosphate | 1.5 | mg/dL | 2.7 | 4.5 | abnormal | nan |
| Potassium | 4.5 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 136.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 20.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| L | 8.0 | nan | nan | nan | nan | nan |
## Provider Order Entry [2160-01-16 11:08:57]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
## Medrecon [2160-01-16 11:11:00]
| Name | Atc Type |
| ------ | ------ |
| carbamazepine | None |
| carbamazepine | None |
| tizanidine | tizanidine |
| gabapentin | gabapentin |
| hydrocortisone | hydrocortisone |
## Provider Order Entry [2160-01-16 11:21:05]
- Order_Type: Medications
- Order_Subtype: nan
## Pyxis [2160-01-16 11:32:00]
- Name: LORazepam 1mg TAB
## Electronic Medicine Administration Record [2160-01-16 11:33:00]
- Medication: Lorazepam
- Event_Txt: Administered
## Provider Order Entry [2160-01-16 11:44:59]
- Order_Type: Medications
- Order_Subtype: nan
## Pyxis [2160-01-16 11:47:00]
| Name |
| ------ |
| LORazepam 2mg/1mL 1mL SYR |
| LORazepam 2mg/1mL 1mL SYR |
| LORazepam 2mg/1mL 1mL SYR |
## Electronic Medicine Administration Record [2160-01-16 11:48:00]
- Medication: Lorazepam
- Event_Txt: Administered
## Vitalsign [2160-01-16 11:51:00]
- Temperature: 97.7
- Heartrate: 81.0
- Resprate: 18.0
- O2Sat: 100.0
- Sbp: nan
- Dbp: nan
- Pain: nan
- Rhythm: nan
|
EU OBSERVATION
|
[
"DIRECT EMER.",
"ELECTIVE",
"DIRECT OBSERVATION",
"OBSERVATION ADMIT",
"AMBULATORY OBSERVATION",
"EW EMER.",
"SURGICAL SAME DAY ADMISSION",
"EU OBSERVATION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EU OBSERVATION\"]",
"label": [
"EU OBSERVATION"
]
}
|
8
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 71
- Gender: M
## Discharge [2178-10-03 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: M
Service: MEDICINE
Allergies:
No Known Allergies / Adverse Drug Reactions
Attending: ___
Chief Complaint:
hematuria
Major Surgical or Invasive Procedure:
none
History of Present Illness:
___ with COPD, CHF, who presented initially with stage
IIIB adenocarcinoma of the lung in ___ c/b recurrence in ___
currently on watchful waiting since ___ following radiation
and treatment with premetrexed, DVT with filter, presenting with
recurrence of hematuria, which was treated 3 weeks ago with 1
week of Cipro.Otherwise asymptomatic. "+mild R flank pain. no
fcnvcd" Per ED dashboard. Admitted for concern of
UTI/pyelonephritis.
.
In ER: (Triage Vitals:99.2 108 119/59 16 94% )
Meds Given: IV ceftriaxone
.
ROS otherwise limited since pt refuses to talk with author.
Past Medical History:
ONCOLOGIC HISTORY:
Stage IIIB adenocarcinoma of the lung
-Diagnosed in ___. At that time, he had experienced a TIA and
developed slurred speech. During that evaluation, he had a chest
CT, which showed a 2.5 cm right upper lobe lesion. He underwent
a
biopsy of this, which showed anadenocarcinoma.
-PET scan on ___ that showed right upper lobe nodules with
right hilar and mediastinal lymphadenopathy.
-Mediastinoscopy on ___ that revealed stage IIIB disease. In
the 4L area, five lymph nodes were removed with no malignancy
identified, in the 4R area ___ lymph nodes were positive, and in
the 2L area ___ lymph nodes was positive.
-Etoposide, cisplatin, XRT on ___. He completed two cycles
and XRT on ___.
-___ FNA of his right supraclavicular node was positive for
metastatic adenocarcinoma. Since he was asymptomatic, systemic
chemotherapy was not given, and he was closely followed.
-Bilateral supraclavicular nodes enlarged, and he was treated w/
palliative radiation from ___, 200cGy per fraction.
-___ CT chest & neck: Enlarged right prevascular lymph node
unchanged. Increasing bilateral supraclavicular lymphadenopathy.
-___ PET CT: Overall decrease in size and avidity of the
supraclavicular lymph nodes when compared to prior. Increased
size and avidity of the visualized superior mediastinal node.
-___ CT neck: The left supraclavicular node has slightly
increased in size measuring 13 mm x 13 mm x 12 mm, previously 10
mm x 11 mm x 9 mm. A small node lateral to this, appears almost
fully resolved. The 5.5 mm left medial supraclavicular node is
largely unchanged. A 5.5-mm right medial supraclavicular node
similar to the counterpart on the left is redemonstrated. The
superior mediastinal node measures 22 mm x 20 mm x 20 mm,
previously 17 mm x 15 mm x 20 mm.
-___ CT chest: There is new mucous impaction of a lingular
bronchus. The lungs reveal fibrotic changes medially as well as
confluent opacity along the right hilum, both of which are
unchanged from the previous study. There is no new or enlarging
pulmonary mass. There is no pleural effusion. A moderate-sized
pericardial effusion is redemonstrated, having minimally
increased from the most recent comparison study. Right
paratracheal lymph node is 22 x 21 mm, slightly increased. New
11x10 mm left axillary lymph node. caudal surface of the
aortic arch is notable for an irregular outpouching just
proximal
to the origin of the right subclavian artery. This irregular
outpouching has been seen since ___, and though stable in
overall size, the component of plaque has decreased and the
component of blood pool has increased. No suspicious
osseouslesions.
-___hronic lung radiation changes and scarring,
unchanged from previous exams. New small left upper lobe nodule,
no size given. Stable lymphadenopathy, with largest lymph nodes
in left axilla and right paratracheal region.
-___ Torso/Neck CT: Four lymph nodes are now seen at the
site of the previously noted 13 mm lateral supraclavicular lymph
node. These measure 9 mm, 5 mm, 9 mm, and 7 mm. A previously
noted 5 mm medial left supraclavicular lymph node is stable. Two
previously noted right supraclavicular lymph nodes with normal
fatty hila are stable, measuring 5 mm and 3 mm, respectively.
new
enlarged lymph nodes seen in the left axilla though no dominant
node. The large right paratracheal lymph node has slightly
increased in size, now measuring 25 x 25 mm, compared to prior
study when it measured 21 x 20 mm. moderately sized pericardial
effusion, similar in size to CT done on ___. The small
left upper lobe nodule is seen and unchanged .
-___, CT torso and neck, previously noted 2.1 x 0.6 left
axillary lymph node is now 2.5 x
1.1 and another axillary lymph node previously 1.6 x 1.0 cm is
now 2.5 x 1.0. No definite new lymphadenopathy in the left
axilla. Previously noted large right paratracheal lymph node
has
also slightly increased in size from 25 mm x 25 mm to 29 mm x 29
mm. No new lymph nodes which meet pathologic criteria for
enlargement and no hilar lymphadenopathy. Stable pericardial
effusion, stable soft tissue density at the right hilum,
narrowing of the bronchus intermedius, likely secondary to
radiation changes versus a stable residual. Previously noted
left upper lobe nodularity is stable. Also noted is a
conglomeration of left supraclavicular lymph nodes, the largest
9
mm. Multiple bilateral thyroid nodules are stable.
-___ - underwent biopsy of a skin lesion in the cervix, c/w
with lung adenocarcinoma
-___, PET/CT Interval increase in size and FDG avidity of
right paratracheal lymph node as well as increase in size and
FDG
avidity of multiple left axillary lymph nodes compared to the
FDG
PET-CT ___. Right hilar soft tissue conglomerate
suggesting progression of disease. FDG avid left
supraclavicular
lymphadenopathy .Stable left upper lobe pulmonary nodule.
-___, CT neck and torso Interval decrease in number and size
of left axillary lymphadenopathy and right pretracheal lymph
node
in comparison with the prior CT torso from ___.
Stable right hilar soft tissue mass. Stable moderate-sized
simple
pericardial effusion and stable left upper lobe pulmonary
nodule.
Resolution of left supraclavicular lymphadenopathy. Significant
improvement in left level 5 lymphadenopathy.
-___: CT Chest
1) The right hilar mass is slightly increased, with bronchial
wall thickening of the RMSB and the upper trunk for the RUL
2) Lymph nodes are enlarged, especially the hilar lymph nodes
3) The superior vena cava seems invaded by the lesion at the
level of the atriocaval junction, 3, 40 with large collateral
venous return, mainly provided by the internal mammarian and the
paraspinals and the intercostal vein.
4) Aneurysmatic dilatation of the aortich arch
-___: CK therapy to his enlarging lung lesion by Dr. ___.
-___: MRI Brain: no evidence of metastatic disease,
some subcortical infarcts in the basal ganglia and cerebellum.
No mass effect or hydrocephalus. Chronic left basal ganglia
infarct is unchanged from prior MRI of ___: TTE
Left ventricular wall thicknesses and cavity size are normal.
There is mild global left ventricular hypokinesis (LVEF = 40%).
There is considerable beat-to-beat variability of the left
ventricular ejection fraction due to an irregular
rhythm/premature beats. Right ventricular chamber size and free
wall motion are normal. The aortic valve is not well seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. The pulmonary artery systolic pressure could not
be determined. There is a small pericardial effusion
-___: CTA
*No evidence of pulmonary embolus.
*Stable superior right paratracheal soft tissue mass. Stable
post treatment changes.
*Small persistent pericardial effusion. Small right and minimal
left pleural effusion.
*Stable appearance of pseudoaneurysm arising from inframedial
aspect of proximal aortic arch.
*Stable lipomatous hypertrophy of interatrial septum.
Heterogenous 2.9 cm soft tissue attenuation at the inferior
aspect of interatrial septum likely relates to mixing of
unopacified blood at IVC-atrial confluence.
-___: CT Chest:
*Unchanged right hilar and paramediastinal post treatment
changes. NO evidence for local progression or metastatic
disease.
*Stable right paratracheal mass from ___.
*Slight increase in size of a small to moderate right pleural
effusion.
*Numerous pulmonary nodules, all less than 4 mm and unchanged
over three months.
OTHER PAST MEDICAL HISTORY
-CMY either due to coronary artery disease
(possibly accelerated by radiation) vs. tachymyopathy related to
malignancy dxed in ___
-DVT status post filter placement in ___.
-Hypertension, stable
-Macular degeneration, stable
-H/O CVA, stable.
Social History:
___
Family History:
No family history of early MI, does have a brother with a "bad
heart" that also beats slow
Physical Exam:
1. VS: T = 97.8 P ___ BP 104/66 RR 18 O2Sat on __95% on RA
GENERAL: Slightly dishevelled elderly male in laying in bed.
Nourishment:OK
Mentation:OK
2. ENT [] WNL
[] Moist [] Endentulous [] Ulcers [] Erythema [] JVD ____ cm
[+] Dry [] Poor dentition [] Thrush [] Swelling [] Exudate
3. Musculoskeletal-Extremities [] WNL
[ ] Tone WNL [ X]Upper extremity strength ___ and symmetrical
[
]Other:
4. PULM: Laying flat in bed, NAD
5. Psychiatric [] WNL
[] Appropriate [] Flat affect [] Anxious [] Manic [] Intoxicated
[] Pleasant [] Depressed [] Agitated [] Psychotic
[+] suspicious
Pertinent Results:
___ 09:15PM URINE HOURS-RANDOM
___ 09:15PM URINE UHOLD-HOLD
___ 09:15PM URINE COLOR-RED APPEAR-Cloudy SP ___
___ 09:15PM URINE BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-2* PH-6.0 LEUK-MOD
___ 09:15PM URINE RBC->182* WBC-128* BACTERIA-FEW
YEAST-NONE EPI-0
___ 09:15PM URINE MUCOUS-MANY
___ 08:20PM GLUCOSE-138* UREA N-27* CREAT-1.2 SODIUM-136
POTASSIUM-3.9 CHLORIDE-95* TOTAL CO2-32 ANION GAP-13
___ 08:20PM estGFR-Using this
___ 08:20PM ALT(SGPT)-22 AST(SGOT)-26 ALK PHOS-105 TOT
BILI-0.7
___ 08:20PM WBC-19.1*# RBC-4.40* HGB-13.7* HCT-40.6
MCV-92 MCH-31.1 MCHC-33.7 RDW-16.1*
___ 08:20PM NEUTS-87.5* LYMPHS-6.4* MONOS-5.0 EOS-0.8
BASOS-0.3
___ 08:20PM PLT COUNT-316
___ 08:20PM ___ PTT-29.1 ___
CXR:
Right basal pleural tube has been removed or at least partially
withdrawn.
Previous small right apical pneumothorax is smaller. The small
right pleural
effusion is little changed.
Right perihilar radiation fibrosis and small right upper lobe
are unchanged.
Left lung is hyperinflated but grossly clear. Previous early
edema there has
resolved and there is little residual left pleural effusion.
Heart is normal
Brief Hospital Course:
Pt is a ___ y.o male with h.o lung cancer s/p pleurex catheter,
CAD, h.o DVT, h.o CVA who presents with hematuria and
leukocytosis c/w UTI.
.
#urinary tract infection: Pt diagnosed with UTI on ___ after
presenting to ED with hematuria; ucx grew mixed flora, and he
was treated with cipro. For the current UTI, he was started
empirically on CTX while UCX pending. Urine cx again grew mixed
flora. Given UA and pt's immunocompromised state, opted to
continue empiric treatment for UTI with a 7day course of
cefpodoxime. Pt asymptomatic and clinically stable at time of
discharge.
#metastatic NSLC: not currently undergoing any treatment; no
acute issues. Continued advair, spiriva. Pleurex catheter
maintained.
.
#HLD-statin
.
#depression-celexa, remeron
.
#chronic systolic heart failure-stable on current regimen
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Omeprazole 20 mg PO DAILY
2. Mirtazapine 7.5 mg PO QHS
3. OxycoDONE (Immediate Release) ___ mg PO BID:PRN pain
4. Tiotropium Bromide 1 CAP IH DAILY
5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID
6. Albuterol Inhaler 2 PUFF IH Q4H:PRN sob/wheeze
7. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob/wheeze
8. Atorvastatin 80 mg PO QPM
9. Citalopram 20 mg PO DAILY
10. Furosemide 20 mg PO DAILY
11. Aspirin 81 mg PO DAILY
12. Ocutabs (vitamin A-vitamin C-vit E-min) 1 tab oral daily
Discharge Medications:
1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob/wheeze
2. Albuterol Inhaler 2 PUFF IH Q4H:PRN sob/wheeze
3. Atorvastatin 80 mg PO QPM
4. Citalopram 20 mg PO DAILY
5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID
6. Furosemide 20 mg PO DAILY
7. Mirtazapine 7.5 mg PO QHS
8. OxycoDONE (Immediate Release) ___ mg PO BID:PRN pain
9. Tiotropium Bromide 1 CAP IH DAILY
10. Omeprazole 20 mg PO DAILY
11. Cefpodoxime Proxetil 200 mg PO Q12H Duration: 7 Days
RX *cefpodoxime 200 mg 1 tablet(s) by mouth Q12hrs Disp #*14
Tablet Refills:*0
12. Aspirin 81 mg PO DAILY
13. Ocutabs (vitamin A-vitamin C-vit E-min) 1 tab oral daily
Discharge Disposition:
Home With Service
Facility:
___
Discharge Diagnosis:
urinary tract infection
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted for evaluation of blood in the urine and found
to have a urinary tract infection. For this, you were started on
antibiotics which you should continue for 7 days.
Weigh yourself every morning, call MD if weight goes up more
than 3 lbs.
Followup Instructions:
___
## Procedures on International Classification of Diseases [2178-10-22 00:00:00]
- Procedures: Percutaneous aspiration of gallbladder
- Ccs Type: Other non-OR gastrointestinal therapeutic procedures
## Transfers [2178-10-22 13:01:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2178-10-22 13:01:00]
- Gender: M
- Race: WHITE
## Triage [2178-10-22 13:01:01]
- Temperature: 98.5
- Heartrate: 108.0
- Resprate: 24.0
- O2Sat: 95.0
- Sbp: 88.0
- Dbp: 52.0
- Pain: 3
- Acuity: 1.0
- Chiefcomplaint: Dyspnea
## Vitalsign [2178-10-22 13:15:00]
- Temperature: nan
- Heartrate: 103.0
- Resprate: 29.0
- O2Sat: 93.0
- Sbp: 79.0
- Dbp: 48.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2178-10-22 13:28:46]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Blood Bank | Blood tests |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Vitalsign [2178-10-22 14:02:00]
- Temperature: nan
- Heartrate: 104.0
- Resprate: 28.0
- O2Sat: 93.0
- Sbp: 86.0
- Dbp: 46.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2178-10-22 14:11:16]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Cardiology | Echo |
## Labotary Test Events [2178-10-22 14:30:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Basophils | 0.1 | % | 0.0 | 2.0 | nan | nan |
| Eosinophils | 0.1 | % | 0.0 | 4.0 | nan | nan |
| Hematocrit | 34.6 | % | 40.0 | 52.0 | abnormal | nan |
| Hemoglobin | 11.6 | g/dL | 14.0 | 18.0 | abnormal | nan |
| Lymphocytes | 5.3 | % | 18.0 | 42.0 | abnormal | nan |
| MCH | 31.2 | pg | 27.0 | 32.0 | nan | nan |
| MCHC | 33.5 | % | 31.0 | 35.0 | nan | nan |
| MCV | 93.0 | fL | 82.0 | 98.0 | nan | nan |
| Monocytes | 3.7 | % | 2.0 | 11.0 | nan | nan |
| Neutrophils | 90.8 | % | 50.0 | 70.0 | abnormal | nan |
| Platelet Count | 303.0 | K/uL | 150.0 | 440.0 | nan | nan |
| RDW | 16.1 | % | 10.5 | 15.5 | abnormal | nan |
| Red Blood Cells | 3.71 | m/uL | 4.6 | 6.2 | abnormal | nan |
| White Blood Cells | 15.4 | K/uL | 4.0 | 11.0 | abnormal | nan |
| Alanine Aminotransferase (ALT) | 16.0 | IU/L | 0.0 | 40.0 | nan | nan |
| Albumin | 2.7 | g/dL | 3.5 | 5.2 | abnormal | nan |
| Alkaline Phosphatase | 91.0 | IU/L | 40.0 | 130.0 | nan | nan |
| Anion Gap | 15.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Asparate Aminotransferase (AST) | 16.0 | IU/L | 0.0 | 40.0 | nan | nan |
| Bicarbonate | 27.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Bilirubin, Total | 0.7 | mg/dL | 0.0 | 1.5 | nan | nan |
| Chloride | 101.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 1.4 | mg/dL | 0.5 | 1.2 | abnormal | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 1.4,. Estimated GFR = 49 if non African-American (mL/min/1.73 m2). Estimated GFR = 60 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 140.0 | mg/dL | 70.0 | 100.0 | abnormal | IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES. |
| Lipase | 21.0 | IU/L | 0.0 | 60.0 | nan | nan |
| Potassium | 3.7 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 139.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 20.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| INR(PT) | 1.2 | nan | 0.9 | 1.1 | abnormal | nan |
| PT | 13.3 | sec | 9.4 | 12.5 | abnormal | nan |
| PTT | 26.2 | sec | 25.0 | 36.5 | nan | nan |
## Microbiology Test Events [2178-10-22 14:30:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Labotary Test Events [2178-10-22 14:40:00]
- Item_Name: Lactate
- Valuenum: 2.3
- Valueuom: mmol/L
- Ref_Range_Lower: 0.5
- Ref_Range_Upper: 2.0
- Flag: abnormal
- Comments: GREEN TOP.
## Vitalsign [2178-10-22 14:57:00]
- Temperature: nan
- Heartrate: 100.0
- Resprate: 36.0
- O2Sat: 96.0
- Sbp: 85.0
- Dbp: 52.0
- Pain: nan
- Rhythm: nan
|
URGENT
|
[
"OBSERVATION ADMIT",
"AMBULATORY OBSERVATION",
"ELECTIVE",
"EU OBSERVATION",
"DIRECT OBSERVATION",
"EW EMER.",
"DIRECT EMER.",
"SURGICAL SAME DAY ADMISSION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"URGENT\"]",
"label": [
"URGENT"
]
}
|
9
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 64
- Gender: F
## Discharge [2165-08-06 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: F
Service: MEDICINE
Allergies:
linezolid / allopurinol
Attending: ___.
Chief Complaint:
leg wound
Major Surgical or Invasive Procedure:
none
History of Present Illness:
___ yo F with lymphedema and recurrent lower extremity cellulitis
who presents from wound clinic with a LLE wound. She says a left
leg skin tear occurred on ___ after she had a fall while
trying to ambulate with her Rollator. She initially went to an
ED
in ___, where steri strips were applied to the flap of skin,
and xeroform to the open part of the wound. She was also given
a
four day course of Keflex.
She was seen in the wound care clinic today, and was thought to
have concerning signs for an infection of the wound so she was
referred to the ED for admission.
In the ED, initial VS are 98.2 79 127/60 18 95% RA.
CBC notable for WBC of 6.3, H/H of 10.6/34.8, Plt 147. BMP with
BUN/Cr of 39/1.0. Lactate 1.1.
The patient received IV vancomycin.
Surgery was consulted and recommended IV antibiotics and no
surgical intervention.
Plastic surgery consulted and stated that given the acute nature
of the wound, no indication for a skin graft.
Upon arrival to the floor, the patient confirms the above story.
She reports that she did start the cephalexin therapy that was
ordered by the ED. She reports clear profuse discharge from the
wound with minimal bleeding. She denies any fevers or chills
though had a temperature of 99.2F. She has not had any shortness
of breath, nausea, vomiting. Bowel movements are chronically
problematic with episodes of incontinence for which the patient
is following with Dr. ___. In addition, patient has history
of NHL s/p auto SCT on maintenance Rituximab and IVIG infusions
every 6 weeks. Her last IVIG infusion was in ___, and her
___
appointment was cancelled.
ROS: Pertinent positives and negatives as noted in the HPI. All
other systems were reviewed and are negative.
Past Medical History:
- Progressive MS ___ frequent UTI ___ neurogenic bladder, and
fecal incontinence)
- Chronic Pain
- Chronic Raynaud's
- Hypertension
- b/l venous stasis
- ___ lymphoma - s/p auto SCT in ___ with recurrence
on maintenance Rituxan (q12w)/IVIG(q6w)
- Neurogenic bladder
- Breast cancer (___)
- Macular degeneration
- ___
- Depression
Social History:
___
Family History:
Grandmother with diabetes. MGF had bowel cancer.
Uncle with ___ lymphoma and Aunt with NHL.
Physical Exam:
ADMISSION PHYSICAL EXAM:
VITALS: ___ 0703 Temp: 98.2 PO BP: 165/69 L Lying HR: 67
RR:
20 O2 sat: 94% O2 delivery: RA
GENERAL: Alert and in no apparent distress. Talks with her eyes
closed.
EYES: Anicteric, PERRL
ENT: Ears and nose without visible erythema, masses, or trauma.
Oropharynx without visible lesion, erythema or exudate
Mucous membranes moist
CV: Heart regular, no murmur, rubs or gallops
RESP: Lungs clear to auscultation with good air movement
bilaterally, faint crackles at R base
GI: Abdomen soft, non-distended, non-tender to palpation
MSK: Neck supple, moves all extremities, strength grossly full
and symmetric bilaterally in all limbs
EXT: 3+ pitting edema with erythematous circumferential skin
changes and warmth from ankle to mid-shin.
SKIN: curvilinear skin tear on shin with subcutaneous tissue
exposed, overlying skin necrotic, with some mild serous drainage
NEURO: Alert, oriented, face symmetric, gaze conjugate with
EOMI,
speech fluent, moves all limbs
PSYCH: pleasant, appropriate affect
DISCHARGE EXAM:
Temp: 97.5 PO BP: 150/71 R Lying HR: 64 RR: 16 O2sat: 94% O2
delivery: ra
GEN: pleasant elderly female in NAD
HEENT: MM slightly dry
CV: Heart regular, no murmur, rubs or gallops
RESP: Lungs clear to auscultation bilaterally
GI: Abdomen soft, non-distended, non-tender to palpation
MSK: Neck supple, moves all extremities, strength grossly full
and symmetric bilaterally in all limbs
EXT: 1+ pitting edema with mild erythematous circumferential
chronic skin changes bilaterally
LLE: curvilinear skin tear on shin with subcutaneous tissue
exposed, overlying skin eschar mild surrounded by mild erythema.
No purulence or fluctuance.
NEURO: Alert, oriented, face symmetric, gaze conjugate with
EOMI,
speech fluent, moves all limbs
PSYCH: pleasant, appropriate affect
Pertinent Results:
LABS ON ADMISSION:
___ 10:49AM BLOOD WBC: 9.8 RBC: 4.23 Hgb: 11.1* Hct: 36.0
MCV: 85 MCH: 26.2 MCHC: 30.8* RDW: 17.6* Plt Ct: 200
___ 10:49AM BLOOD ___: 10.3 PTT: 33.8 ___: 0.9
___ 10:49AM BLOOD Glucose: 96 UreaN: 31* Creat: 0.9 Na: 145
K: 3.7 Cl: 107 HCO3: 27 AnGap: 11
___ 10:49AM BLOOD Calcium: 9.0 Phos: 3.4
___ 06:00AM BLOOD WBC-7.9 RBC-3.62* Hgb-9.4* Hct-30.1*
MCV-83 MCH-26.0 MCHC-31.2* RDW-17.5* RDWSD-53.5* Plt ___
___ 03:54AM BLOOD WBC-5.6 RBC-3.37* Hgb-8.8* Hct-28.5*
MCV-85 MCH-26.1 MCHC-30.9* RDW-17.6* RDWSD-54.4* Plt ___
___ 03:54AM BLOOD Glucose-87 UreaN-36* Creat-1.4* Na-144
K-3.9 Cl-107 HCO3-26 AnGap-11
___ 05:45AM BLOOD Glucose-89 UreaN-26* Creat-1.0 Na-146
K-4.3 Cl-108 HCO3-24 AnGap-14
___ 05:45AM BLOOD Calcium-8.8 Phos-4.2 Mg-2.0
___ 10:49AM BLOOD IgG-395* IgA-13* IgM-10*
Blood Cx NGTD
Cdiff negative stool sample
Brief Hospital Course:
___ yo F with history of MS, NHL s/p autoSCT on rituxan/IVIG,
with lymphedema and recurrent lower extremity cellulitis who
presented from wound clinic with a skin tear and concern for
skin and soft tissue infection.
HOSPITAL COURSE BY PROBLEM:
===========================
# LLE Wound ___ Skin and soft tissue infection: Patient
presented with a deep traumatic skin tear after a fall with
concern for surrounding cellulitis. Wound was notable for
serpentine exposed area with serosanguinous discharge and a
necrotic skin flap. Patient was evaluated by wound care
outpatient who recommended surgical evaluation. She was seen by
ACS and plastic surgery in the ED who felt that the wound did
not require surgical debridement at this time. She was treated
with vancomycin and ceftriaxone. Blood cultures were sent and
remained negative for growth. Antibiotics were transitioned to
Augmentin and Doxycycline with plan to complete a 10 day course
given immunocompromised state. Exam was reassuring throughout
admission without any purulence and drainage decreased
significantly. Wound care team provided updated recommendations
and pt will be following up with ___ wound care clinic for
consideration of advanced wound healing modalities. Pt was
discharged home with wound care supplies and plan for ___ to
provide assistance with daily wound care changes.
___: pt developed mild ___ during admission that was felt
likely prerenal and it resolved with IVF.
#Chronic venous stasis: Managed with leg elevation, wraps and
treatment of infection per above.
# ___ lymphoma: S/p auto SCT ___ with recurrence on
maintenance Rituxan/IVIG. Per discussion with Dr ___
outpatient oncologist, Rituximab and IVIG infusions were held
outpatient with plan to monitor her response and determine
ability to be weaned off both. In-house her immunoglobulins were
checked and were low. Dr. ___ not recommend any IVIG as
it would not be helpful for SSTI infection. Pt was discharged
with outpt follow up with Dr. ___.
# Multiple sclerosis: continued home Duloxetine ___ 120 mg daily,
Pregabalin 150 mg PO TID, Baclofen 10 mg PO QID,
Amphetamine-Dextroamphetamine 10 mg PO TID. Seen by ___ who know
patient from before and felt she was at her baseline. She was
deemed safe to discharge to home with home services including
___.
# Chronic diarrhea: continued on home regimen and was ruled out
for Cdiff while in the hospital.
> 30min spent on clinical care on the day of discharge including
time spent coordinating transition of care documents and
speaking with pt/family.
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Cephalexin 500 mg PO Q12H
2. DULoxetine ___ 120 mg PO DAILY
3. Baclofen 25 mg PO BID
4. Pregabalin 150 mg PO TID
5. Amphetamine-Dextroamphetamine 10 mg PO TID
6. Vitamin D 1000 UNIT PO DAILY
7. Culturelle (Lactobacillus rhamnosus GG) 10 billion cell oral
DAILY
8. Digest Probiotic (S.boulardii) (Saccharomyces boulardii) 250
mg oral DAILY
9. Acetaminophen 650 mg PO BID:PRN Pain - Mild/Fever
10. Baclofen 20 mg PO QHS
11. Vitamin E 200 UNIT PO DAILY
12. LOPERamide 2 mg PO QID:PRN loose stool
13. Psyllium Powder 1 PKT PO QAM
Discharge Medications:
1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H
RX *amoxicillin-pot clavulanate 875 mg-125 mg one tablet(s) by
mouth twice a day Disp #*14 Tablet Refills:*0
2. Doxycycline Hyclate 100 mg PO BID Duration: 7 Days
RX *doxycycline hyclate 100 mg one capsule(s) by mouth twice a
day Disp #*14 Tablet Refills:*0
3. Acetaminophen 650 mg PO BID:PRN Pain - Mild/Fever
4. Amphetamine-Dextroamphetamine 10 mg PO TID
5. Baclofen 25 mg PO BID
6. Baclofen 20 mg PO QHS
7. Culturelle (Lactobacillus rhamnosus GG) 10 billion cell oral
DAILY
8. Digest Probiotic (S.boulardii) (Saccharomyces boulardii) 250
mg oral DAILY
9. DULoxetine ___ 120 mg PO DAILY
10. LOPERamide 2 mg PO QID:PRN loose stool
11. Pregabalin 150 mg PO TID
12. Psyllium Powder 1 PKT PO QAM
13. Vitamin D 1000 UNIT PO DAILY
14. Vitamin E 200 UNIT PO DAILY
Discharge Disposition:
Home With Service
Facility:
___
___:
PRIMARY
Cellulitis
Traumatic skin tear
Hypogammaglobulinemia
SECONDARY
___ lymphoma s/p auto-SCT
multiple sclerosis
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Discharge Instructions:
You were admitted with a deep traumatic wound on your left shin
with concern for surrounding cellulitis. You were seen by two
surgical teams who did not recommend any debridement. You have
been treated with antibiotics, wound care and hydration with
improvement. The wound care team has provided some updated
recommendations and you will be following up at the wound care
clinic in ___ as shown below. The ___ team will be
assisting with your home wound care and we recommend that you
continue taking Augmentin and Doxycycline for another 7 days.
Please resume your home regimen with probiotics, stool bulking
agents and immodium as needed for diarrhea.
Best wishes from your team at ___
Followup Instructions:
___
## Transfers [2165-10-06 12:07:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2165-10-06 12:07:00]
- Gender: F
- Race: WHITE
## Triage [2165-10-06 12:07:01]
- Temperature: 99.6
- Heartrate: 86.0
- Resprate: 18.0
- O2Sat: 97.0
- Sbp: 132.0
- Dbp: 74.0
- Pain: 0
- Acuity: 2.0
- Chiefcomplaint: Altered mental status, Fever
## Vitalsign [2165-10-06 12:08:00]
- Temperature: 99.6
- Heartrate: 86.0
- Resprate: 18.0
- O2Sat: 97.0
- Sbp: 132.0
- Dbp: 74.0
- Pain: 0
- Rhythm: nan
## Provider Order Entry [2165-10-06 12:31:14]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Labotary Test Events [2165-10-06 12:32:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| INR(PT) | 1.1 | nan | 0.9 | 1.1 | nan | nan |
| PT | 11.5 | sec | 9.4 | 12.5 | nan | nan |
| PTT | 38.0 | sec | 25.0 | 36.5 | abnormal | nan |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Anion Gap | 11.0 | mEq/L | 10.0 | 18.0 | nan | nan |
| Bicarbonate | 23.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| C-Reactive Protein | 65.7 | mg/L | 0.0 | 5.0 | abnormal | nan |
| Calcium, Total | 8.2 | mg/dL | 8.4 | 10.3 | abnormal | nan |
| Chloride | 103.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 1.0 | mg/dL | 0.4 | 1.1 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely between 54 and 66 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.. |
| Glucose | 91.0 | mg/dL | 70.0 | 100.0 | nan | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 543.0 | nan | nan | nan | nan | nan |
| I | 0.0 | nan | nan | nan | nan | nan |
| Magnesium | 2.0 | mg/dL | 1.6 | 2.6 | nan | nan |
| Phosphate | 3.9 | mg/dL | 2.7 | 4.5 | nan | Hemolysis falsely elevates this test. |
| Potassium | 6.5 | mEq/L | 3.5 | 5.4 | abnormal | ___ |
| Sodium | 137.0 | mEq/L | 135.0 | 147.0 | nan | nan |
| Urea Nitrogen | 17.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| L | 7.0 | nan | nan | nan | nan | nan |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Absolute Lymphocyte Count | 0.92 | K/uL | 1.2 | 3.7 | abnormal | nan |
| Basophils | 0.4 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 0.3 | % | 1.0 | 7.0 | abnormal | nan |
| Hematocrit | 31.4 | % | 34.0 | 45.0 | abnormal | nan |
| Hemoglobin | 9.9 | g/dL | 11.2 | 15.7 | abnormal | nan |
| Lymphocytes | 7.8 | % | 19.0 | 53.0 | abnormal | nan |
| MCH | 25.6 | pg | 26.0 | 32.0 | abnormal | nan |
| MCHC | 31.5 | g/dL | 32.0 | 37.0 | abnormal | nan |
| MCV | 81.0 | fL | 82.0 | 98.0 | abnormal | nan |
| Monocytes | 9.5 | % | 5.0 | 13.0 | nan | nan |
| Neutrophils | 81.6 | % | 34.0 | 71.0 | abnormal | nan |
| Platelet Count | 294.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 16.9 | % | 10.5 | 15.5 | abnormal | nan |
| Red Blood Cells | 3.87 | m/uL | 3.9 | 5.2 | abnormal | nan |
| White Blood Cells | 11.7 | K/uL | 4.0 | 10.0 | abnormal | nan |
| Absolute Basophil Count | 0.05 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.04 | K/uL | 0.04 | 0.54 | nan | nan |
| Absolute Monocyte Count | 1.11 | K/uL | 0.2 | 0.8 | abnormal | nan |
| Absolute Neutrophil Count | 9.56 | K/uL | 1.6 | 6.1 | abnormal | nan |
| Immature Granulocytes | 0.4 | % | 0.0 | 0.6 | nan | ___ |
| RDW-SD | 49.2 | fL | 35.1 | 46.3 | abnormal | nan |
## Microbiology Test Events [2165-10-06 12:32:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Labotary Test Events [2165-10-06 12:35:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Lactate | 0.8 | mmol/L | 0.5 | 2.0 | nan | nan |
| Potassium, Whole Blood | 3.7 | mEq/L | 3.5 | 5.4 | nan | nan |
## Provider Order Entry [2165-10-06 12:50:56]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| General Care | Other |
| IV therapy | IV fluids |
| Lab | nan |
| Radiology | General Xray |
| Radiology | CT Scan |
## Electronic Medicine Administration Record [2165-10-06 12:57:00]
- Medication: nan
- Event_Txt: Started
## Radiology Examinations [2165-10-06 13:01:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PA & LAT)']
- Text: INDICATION: History: ___ with weakness, cough // ?PNA
COMPARISON: Prior CT ___
IMPRESSION:
Right-sided vascular access catheter tip at the cavoatrial junction.
Cardiomediastinal silhouette is at upper limits for normal for size.
Small-to-moderate bilateral pleural effusions with compressive atelectatic
changes. Bilateral atelectatic changes. There are no pneumothoraces. Mild
degenerative changes the left shoulder joint.
## Medrecon [2165-10-06 13:01:00]
| Name | Atc Type |
| ------ | ------ |
| acetaminophen | paracetamol |
| amoxicillin | nan |
| baclofen | baclofen |
| calcium carb-magnesium ox,carb [Cal-Mag] | ubidecarenone |
| Cholecalciferol (Vitamin D3) | colecalciferol |
| dextroamphetamine-amphetamine | dexamfetamine |
| dextroamphetamine-amphetamine | dexamfetamine |
| dextroamphetamine-amphetamine | dexamfetamine |
| duloxetine [Cymbalta] | duloxetine |
| duloxetine [Cymbalta] | duloxetine |
| fluticasone | fluticasone |
| Lactobacillus rhamnosus GG [Culturelle] | nan |
| loperamide [Imodium A-D] | loperamide |
| multivitamin | None |
| pregabalin [Lyrica] | nan |
| pregabalin [Lyrica] | nan |
| Saccharomyces boulardii [Daily Probiotic (S. boulardii)] | None |
| Saccharomyces boulardii [Digest Probiotic (S.boulardii)] | None |
| triamcinolone acetonide | None |
| vitamin E | tocopherol |
## Vitalsign [2165-10-06 13:07:00]
- Temperature: 99.8
- Heartrate: 91.0
- Resprate: 18.0
- O2Sat: 90.0
- Sbp: 128.0
- Dbp: 78.0
- Pain: 0
- Rhythm: nan
## Provider Order Entry [2165-10-06 13:16:16]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
## Labotary Test Events [2165-10-06 13:28:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Influenza A by PCR | nan | nan | nan | nan | nan | ___ |
| Influenza B by PCR | nan | nan | nan | nan | nan | ___ |
## Provider Order Entry [2165-10-06 13:33:59]
- Order_Type: Lab
- Order_Subtype: nan
## Radiology Examinations [2165-10-06 13:34:00]
- Note_Type: RR
- Exam_Name: ['CT LOWER EXT W/C RIGHT']
- Text: EXAMINATION: CT LOWER EXT W/C RIGHT
INDICATION: ___ year old woman with R leg cellulitis. ?Nec fasc: please obtain
knee and below.
TECHNIQUE: Axial images were obtained of the knee through the foot with bone
algorithm as well as standard algorithm. Coronal and sagittal reformats were
obtained and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.7 s, 60.6 cm; CTDIvol = 22.6 mGy (Body) DLP =
1,372.9 mGy-cm.
Total DLP (Body) = 1,373 mGy-cm.
COMPARISON: None.
FINDINGS:
Knee joint in soft tissue stranding and edema involving the entire calf,
mostly involving the medial posterior compartment. No emphysema to suggest
necrotizing fasciitis. No fracture or dislocation is identified. There is
substantial skin thickening of the calf.
IMPRESSION:
1. Soft tissue edema involving the entire calf and visualized knee, and skin
thickening, predominantly posteriorly is most consistent with cellulitis.
2. No evidence for necrotizing fasciitis.
3. Trace knee joint effusion.
## Pyxis [2165-10-06 13:36:00]
- Name: Piperacillin-Tazob premix
## Electronic Medicine Administration Record [2165-10-06 13:38:00]
- Medication: Piperacillin-Tazobactam
- Event_Txt: Started
## Pyxis [2165-10-06 14:13:00]
| Name |
| ------ |
| Vancomycin |
| Vancomycin |
## Electronic Medicine Administration Record [2165-10-06 14:14:00]
| Medication | Event_Txt |
| ------ | ------ |
| Vancomycin | Started |
| Piperacillin-Tazobactam | Stopped |
| nan | Stopped |
## Provider Order Entry [2165-10-06 15:09:41]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Radiology | Ultrasound |
| General Care | Other |
## Vitalsign [2165-10-06 15:11:00]
- Temperature: 97.5
- Heartrate: 87.0
- Resprate: 18.0
- O2Sat: 92.0
- Sbp: 138.0
- Dbp: 63.0
- Pain: 0
- Rhythm: nan
## Labotary Test Events [2165-10-06 15:20:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Uhold | nan | nan | nan | nan | nan | ___ |
| Bacteria | nan | /hpf | nan | nan | abnormal | FEW*. |
| Bilirubin | nan | nan | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | NEG. |
| Epithelial Cells | nan | #/hpf | nan | nan | nan | <1. |
| Glucose | nan | mg/dL | 0.0 | 0.0 | nan | NEG. |
| Ketone | nan | mg/dL | 0.0 | 0.0 | abnormal | TR*. |
| Leukocytes | nan | nan | nan | nan | abnormal | SM*. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 8.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | nan | mg/dL | 0.0 | 0.0 | abnormal | TR*. |
| RBC | 0.0 | #/hpf | 0.0 | 2.0 | nan | nan |
| Specific Gravity | 1.029 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | Clear. |
| Urine Color | nan | nan | nan | nan | nan | Straw. |
| Urobilinogen | nan | mg/dL | 0.2 | 1.0 | nan | NEG. |
| WBC | 15.0 | #/hpf | 0.0 | 5.0 | abnormal | nan |
| Yeast | nan | /hpf | nan | nan | nan | nan |
## Microbiology Test Events [2165-10-06 15:20:00]
- Test_Name: URINE CULTURE
- Dilution_Text: nan
- Interpretation: nan
- Comments: MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION.
- Ab_Name: nan
## Radiology Examinations [2165-10-06 15:46:00]
- Note_Type: RR
- Exam_Name: ['UNILAT LOWER EXT VEINS RIGHT']
- Text: EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with right leg swelling. Question of DVT.
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins. Patient denied imaging of the right calf
veins due to tenderness.
COMPARISON: Same day CT of the right lower extremity.
FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral, femoral, and popliteal veins. Due to patient pain, right calf
veins were not evaluated. There is significant soft tissue swelling involving
the right popliteal fossa.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
IMPRESSION:
1. Right calf veins were not evaluated due to patient pain. Otherwise, no
deep venous thrombosis visualized in the right femoral and popliteal veins.
2. Significant soft tissue swelling in the right popliteal fossa.
## Electronic Medicine Administration Record [2165-10-06 16:10:00]
- Medication: Vancomycin
- Event_Txt: Stopped
## Provider Order Entry [2165-10-06 16:25:29]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Medications | nan |
| Medications | nan |
| Medications | nan |
| Medications | nan |
| Nutrition | Diet Order |
## Pyxis [2165-10-06 17:05:00]
| Name |
| ------ |
| Baclofen |
| Pregabalin |
## Electronic Medicine Administration Record [2165-10-06 17:07:00]
| Medication | Event_Txt |
| ------ | ------ |
| Baclofen | Administered |
| Pregabalin | Administered |
## Vitalsign [2165-10-06 17:27:00]
- Temperature: nan
- Heartrate: 85.0
- Resprate: 18.0
- O2Sat: 94.0
- Sbp: nan
- Dbp: nan
- Pain: 0
- Rhythm: nan
|
OBSERVATION ADMIT
|
[
"DIRECT EMER.",
"AMBULATORY OBSERVATION",
"EU OBSERVATION",
"OBSERVATION ADMIT",
"ELECTIVE",
"EW EMER.",
"DIRECT OBSERVATION",
"SURGICAL SAME DAY ADMISSION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"OBSERVATION ADMIT\"]",
"label": [
"OBSERVATION ADMIT"
]
}
|
10
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 83
- Gender: M
## Discharge [2196-08-30 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: M
Service: MEDICINE
Allergies:
___
Attending: ___.
Chief Complaint:
Hemarthrosis
Major Surgical or Invasive Procedure:
none
History of Present Illness:
___ year old gentleman with a history of atrial fibrillation on
Coumadin with recent hemarthrosis, CAD, s/p PPM, CHF,
seronegative rheumatoid arthritis vs chronic CPPD disease who is
brought in by ambulance after his nurse noted his INR to be 8.0.
In the ED, initial vitals were: 98.0 70 161/84 18 100% RA Labs
were notable for WBC 8.6 Hgb 9.1 Hct 28.0 Plt 155. Chemistry
with Cl 95, BUN 31, otherwise WNL. INR 9.0. He received Vitamin
K 5 mg PO and was transferred to the medicine floor. Of note he
was seen on ___ by his rheumatologist for evaluation of
acute right knee hemarthrosis. Arthrocentesis was performed and
sent for culture. On the floor, he is comfortable and denies any
pain. He denies chest pain, dyspnea, abdominal pain, nausea,
vomiting, melena, hematochezia. He endorses chronic lower
extremity edema. Right knee pain somewhat improved. Denies
recent trauma/falls. He states that recently he has had a few
changes made to his Coumadin regimen, though cannot recall what
the changes have
been. He was recently taking a "green" Coumadin pill and is now
taking a "red" Coumadin pill and feels like this has been the
main culprit to cause his elevated INR.
Past Medical History:
Atrial fibrillation on Coumadin
CAD
S/P PPM
CHF
Seronegative rheumatoid arthritis vs chronic CPPD disease
BPH
Colon cancer s/p right hemicolectomy
Hypertension
Osteoarthritis
Social History:
___
Family History:
FAMILY HISTORY:
- denies family history of heart or pulmonary disease
Physical Exam:
Vital Signs:98.0 PO 152 / 57 73 16 98 RA
General: Alert, oriented, no acute distress
HEENT: Sclerae anicteric, MMM, oropharynx clear, EOMI, PERRL,
neck supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no organomegaly, no rebound or guarding
GU: No foley
Ext: Right knee>L and slightly warmer to the touch. Extensive
venous stasis changes bilaterally. 2+ pitting edema bilaterally.
Large ecchymosis extending from the right knee to the
lateral/posterior right thigh. Faint petechiae on the lower
extremities bilaterally.
Neuro: Alert and oriented x3
Pertinent Results:
___ 11:30AM BLOOD WBC-8.6# RBC-2.47* Hgb-9.1* Hct-28.0*
MCV-113* MCH-36.8* MCHC-32.5 RDW-14.6 RDWSD-60.6* Plt ___
___ 06:35AM BLOOD WBC-7.9 RBC-2.41* Hgb-8.9* Hct-27.7*
MCV-115* MCH-36.9* MCHC-32.1 RDW-14.7 RDWSD-60.7* Plt ___
___ 11:30AM BLOOD Plt ___
___ 06:35AM BLOOD Plt ___
___ 11:30AM BLOOD ___ PTT-63.1* ___
___ 06:35AM BLOOD ___ PTT-44.5* ___
___ 11:30AM BLOOD Neuts-78.8* Lymphs-10.8* Monos-9.4
Eos-0.1* Baso-0.1 Im ___ AbsNeut-6.79*# AbsLymp-0.93*
AbsMono-0.81* AbsEos-0.01* AbsBaso-0.01
___ 06:35AM BLOOD Glucose-102* UreaN-24* Creat-1.0 Na-139
K-3.9 Cl-100 HCO3-33* AnGap-10
___ 06:35AM BLOOD TotBili-2.1* DirBili-0.6* IndBili-1.5
___ 06:35AM BLOOD Calcium-8.6 Phos-3.0 Mg-2.3
___ 06:05AM BLOOD WBC-7.2 RBC-2.32* Hgb-8.4* Hct-26.6*
MCV-115* MCH-36.2* MCHC-31.6* RDW-15.0 RDWSD-62.4* Plt ___
___ 06:05AM BLOOD ___ PTT-36.6* ___
___ 06:35AM BLOOD Glucose-102* UreaN-24* Creat-1.0 Na-139
K-3.9 Cl-100 HCO3-33* AnGap-___ year old gentleman with a history of atrial fibrillation on
Coumadin, CAD, rheumatoid arthritis/CPPD, and hypertension who
presents with supratherapeutic INR complicated by hemarthrosis.
I suspect low haptoglobin, elevated LDH likely from hemolysis
due to large hematoma burden. Coombs was negative.
# Supratherapeutic INR
# Macrocytic acute/chronic anemia
# Hemarthrosis
# HTN
# Seronegative rheumatoid arthritis versus CPPD disease
CHRONIC:
# BPH: Continue finasteride
# HTN: Continue lisinopril
# CAD: Continue metoprolol, aspirin, isosorbide moninitrate
# Hyperlipidemia: Continue simvastatin
# CHF: Continue furosemide
# GERD: Continue omeprazole
# B12 deficiency: Continue vitamin B12
# HCV Ab (+): sent by rehumatologist who will f/u results with
patient
He was given 5mg Vitamin K and warfarin was held. On day of
discharge, INR was still 2.7. He was instructed to hold warfarin
for 2 more days and to restart ___, with repeat INR
check ___. PCP and ___ clinic were informed
of this plan, and ___ clinic recommended restarting
at home dose. He was referred to PACT program, and I spoke with
PCP about getting him home medication reconciliation evaluation
to make sure there was no unintentional erroneous medication
administration if using pill box, etc. Family reports prior
administration error in past. ___ evaluation was done and he was
deemed safe to go home with family support, family to stay with
him until outpatient ___ home eval. ___ services with ___ to be
resumed. He will otherwise continue other home regimen.
Patient will f/u with rheumatologist next week who will inform
about ___ HCV results (confirmed per personal communication
with rheum).
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Finasteride 5 mg PO DAILY
2. PredniSONE 10 mg PO DAILY
3. Doxazosin 4 mg PO HS
4. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild
5. Lisinopril 20 mg PO DAILY
6. olopatadine 0.1 % ophthalmic daily PRN
7. Gabapentin 300 mg PO DAILY
8. Hydroxychloroquine Sulfate 200 mg PO BID
9. Methotrexate Sodium P.F. 15 mg IT 1X/WEEK (___)
10. Lidocaine 5% Patch 1 PTCH TD QAM
11. Metoprolol Succinate XL 50 mg PO DAILY
12. Docusate Sodium 100 mg PO BID
13. Senna 8.6 mg PO BID:PRN constipation
14. Warfarin 5 mg PO 3X/WEEK (___)
15. Carbamide Peroxide 6.5% ___ DROP BOTH EARS NIGHTLY
16. Simvastatin 10 mg PO QPM
17. Furosemide 20 mg PO DAILY
18. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY
19. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Mild
20. diclofenac sodium 1 % topical four times daily PRN
21. Omeprazole 20 mg PO DAILY
22. Aspirin 81 mg PO DAILY
23. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN
24. Cyanocobalamin 1000 mcg PO DAILY
25. FoLIC Acid 1 mg PO DAILY
26. Warfarin 2.5 mg PO 4X/WEEK (___)
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild
2. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN
3. Aspirin 81 mg PO DAILY
4. Carbamide Peroxide 6.5% ___ DROP BOTH EARS NIGHTLY
5. Cyanocobalamin 1000 mcg PO DAILY
6. diclofenac sodium 1 % TOPICAL FOUR TIMES DAILY PRN to knees
/ hands for pain
7. Docusate Sodium 100 mg PO BID
8. Doxazosin 4 mg PO HS
9. Finasteride 5 mg PO DAILY
10. FoLIC Acid 1 mg PO DAILY
11. Furosemide 20 mg PO DAILY
12. Gabapentin 300 mg PO DAILY
13. Hydroxychloroquine Sulfate 200 mg PO BID
14. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY
15. Lidocaine 5% Patch 1 PTCH TD QAM
16. Lisinopril 20 mg PO DAILY
17. Methotrexate Sodium P.F. 15 mg IT 1X/WEEK (___)
18. Metoprolol Succinate XL 50 mg PO DAILY
19. olopatadine 0.1 % ophthalmic daily PRN
20. Omeprazole 20 mg PO DAILY
21. PredniSONE 10 mg PO DAILY
22. Senna 8.6 mg PO BID:PRN constipation
23. Simvastatin 10 mg PO QPM
24. Warfarin 5 mg PO 3X/WEEK (___)
25. Warfarin 2.5 mg PO 4X/WEEK (___)
26. HELD- OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain -
Mild This medication was held. Do not restart OxyCODONE
(Immediate Release) until PCP follow up; it is a high fall risk
medication
Discharge Disposition:
Home With Service
Facility:
___
Discharge Diagnosis:
Hemarthrosis
Coagulopathy from warfarin
Atrial fibrillation
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Discharge Instructions:
You were admitted with bleeding in the right knee and elevated
INR to 9.0. Warfarin was held and Vitamin K was given to
reverse. Your PCP, ___ clinic
providers were contacted. You were seen by physical therapy and
are recommended to go home with family support. You will have
___ and home health aide service. We have asked ___ to assess
your coumadin home dosing. Please restart your home warfarin
dose ___. ___ will check your INR level ___.
Followup Instructions:
___
## Transfers [2197-01-08 16:58:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2197-01-08 16:58:00]
- Gender: M
- Race: WHITE - RUSSIAN
## Triage [2197-01-08 16:58:01]
- Temperature: 98.1
- Heartrate: nan
- Resprate: 16.0
- O2Sat: 98.0
- Sbp: 92.0
- Dbp: 46.0
- Pain: 0
- Acuity: 2.0
- Chiefcomplaint: Fever, URI
## Vitalsign [2197-01-08 17:00:00]
- Temperature: 98.1
- Heartrate: nan
- Resprate: 16.0
- O2Sat: 98.0
- Sbp: 92.0
- Dbp: 46.0
- Pain: 0
- Rhythm: afib
## Provider Order Entry [2197-01-08 17:07:32]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Radiology | General Xray |
## Radiology Examinations [2197-01-08 17:23:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PA & LAT)']
- Text: EXAMINATION: CHEST (AP AND LAT)
INDICATION: ___ with fever
COMPARISON: ___
FINDINGS:
AP upright and lateral views of the chest provided.
Left chest wall pacer device is again seen with single lead extending to the
region of the right ventricle. The heart remains markedly enlarged. The hila
are congested and there is cephalization and mild interstitial pulmonary
edema. No convincing evidence for pneumonia. No large effusion or
pneumothorax. Mediastinal contour is unchanged with aortic calcification
again noted. Bony structures are intact. No free air below the right
hemidiaphragm.
IMPRESSION:
Cardiomegaly, congestion and mild interstitial pulmonary edema. No signs of
pneumonia.
## Provider Order Entry [2197-01-08 18:45:05]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Medications | nan |
| Medications | nan |
| Medications | nan |
| IV therapy | IV fluids |
| Medications | nan |
| Medications | nan |
## Pyxis [2197-01-08 19:43:00]
| Name |
| ------ |
| CefTRIAXone 1gm/100mL 100mL Bag |
| PredniSONE 20mg TAB |
| PredniSONE 20mg TAB |
| Albuterol 0.083% Neb Soln 1Neb |
| Ipratropium Bromide Neb 1Neb |
| Azithromyc 500mg/250mL 250mL BAG |
## Provider Order Entry [2197-01-08 19:47:15]
- Order_Type: Lab
- Order_Subtype: nan
## Labotary Test Events [2197-01-08 19:59:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Anion Gap | 16.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Bicarbonate | 24.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Calcium, Total | 8.4 | mg/dL | 8.4 | 10.3 | nan | nan |
| Chloride | 100.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 1.3 | mg/dL | 0.5 | 1.2 | abnormal | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 1.3, . Estimated GFR = 52 if non African-American (mL/min/1.73 m2) . Estimated GFR = 63 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 107.0 | mg/dL | 70.0 | 100.0 | abnormal | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 5.0 | nan | nan | nan | nan | nan |
| I | 1.0 | nan | nan | nan | nan | nan |
| Magnesium | 2.2 | mg/dL | 1.6 | 2.6 | nan | nan |
| NTproBNP | 1401.0 | pg/mL | 0.0 | 852.0 | abnormal | Reference values vary with age, sex, and renal function. at 35% prevalence, NTproBNP values:. < 450 have 99% Neg pred value. >1000 have 78% Pos pred value. See online lab manual for more detailed information. |
| Phosphate | 3.6 | mg/dL | 2.7 | 4.5 | nan | nan |
| Potassium | 4.2 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 136.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 33.0 | mg/dL | 6.0 | 20.0 | abnormal | nan |
| L | 12.0 | nan | nan | nan | nan | nan |
| Absolute Lymphocyte Count | 1.57 | K/uL | 1.2 | 3.7 | nan | nan |
| Basophils | 0.2 | % | 0.0 | 1.0 | nan | nan |
| Eosinophils | 0.9 | % | 1.0 | 7.0 | abnormal | nan |
| Hematocrit | 36.2 | % | 40.0 | 51.0 | abnormal | nan |
| Hemoglobin | 11.4 | g/dL | 13.7 | 17.5 | abnormal | nan |
| Lymphocytes | 35.5 | % | 19.0 | 53.0 | nan | nan |
| MCH | 34.3 | pg | 26.0 | 32.0 | abnormal | nan |
| MCHC | 31.5 | g/dL | 32.0 | 37.0 | abnormal | nan |
| MCV | 109.0 | fL | 82.0 | 98.0 | abnormal | nan |
| Monocytes | 15.6 | % | 5.0 | 13.0 | abnormal | nan |
| Neutrophils | 47.3 | % | 34.0 | 71.0 | nan | nan |
| Platelet Count | 108.0 | K/uL | 150.0 | 400.0 | abnormal | nan |
| RDW | 13.3 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 3.32 | m/uL | 4.6 | 6.1 | abnormal | nan |
| White Blood Cells | 4.4 | K/uL | 4.0 | 10.0 | nan | nan |
| Absolute Basophil Count | 0.01 | K/uL | 0.01 | 0.08 | nan | nan |
| Absolute Eosinophil Count | 0.04 | K/uL | 0.04 | 0.54 | nan | nan |
| Absolute Monocyte Count | 0.69 | K/uL | 0.2 | 0.8 | nan | nan |
| Absolute Neutrophil Count | 2.09 | K/uL | 1.6 | 6.1 | nan | nan |
| Immature Granulocytes | 0.5 | % | nan | nan | nan | ___ |
| RDW-SD | 53.3 | fL | 35.1 | 46.3 | abnormal | nan |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
## Microbiology Test Events [2197-01-08 19:59:00]
| Test_Name | Dilution_Text | Interpretation | Comments | Ab_Name |
| ------ | ------ | ------ | ------ | ------ |
| Blood Culture, Routine | nan | nan | NO GROWTH. | nan |
| Blood Culture, Routine | nan | nan | NO GROWTH. | nan |
## Electronic Medicine Administration Record [2197-01-08 20:00:00]
| Medication | Event_Txt |
| ------ | ------ |
| Albuterol 0.083% Neb Soln | Administered |
| Ipratropium Bromide Neb | Administered |
| nan | Started |
| PredniSONE | Administered |
| CeftriaXONE | Started |
## Vitalsign [2197-01-08 20:06:00]
- Temperature: 97.6
- Heartrate: 58.0
- Resprate: 16.0
- O2Sat: 97.0
- Sbp: 129.0
- Dbp: 70.0
- Pain: 0
- Rhythm: nan
## Electronic Medicine Administration Record [2197-01-08 20:10:00]
- Medication: nan
- Event_Txt: Stopped
## Labotary Test Events [2197-01-08 20:12:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
| Lactate | 1.4 | mmol/L | 0.5 | 2.0 | nan | GREEN TOP. VENOUS. |
## Vitalsign [2197-01-08 20:14:00]
- Temperature: nan
- Heartrate: 80.0
- Resprate: 18.0
- O2Sat: 100.0
- Sbp: 120.0
- Dbp: 70.0
- Pain: nan
- Rhythm: nan
## Provider Order Entry [2197-01-08 20:19:47]
- Order_Type: Lab
- Order_Subtype: nan
## Pyxis [2197-01-08 20:23:00]
| Name |
| ------ |
| Albuterol 0.083% Neb Soln 1Neb |
| Ipratropium Bromide Neb 1Neb |
## Electronic Medicine Administration Record [2197-01-08 20:27:00]
| Medication | Event_Txt |
| ------ | ------ |
| CeftriaXONE | Stopped |
| Albuterol 0.083% Neb Soln | Administered |
| Ipratropium Bromide Neb | Administered |
| Azithromycin | Started |
## Labotary Test Events [2197-01-08 20:35:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Influenza A by PCR | nan | nan | nan | nan | nan | ___ |
| Influenza B by PCR | nan | nan | nan | nan | nan | ___ |
|
OBSERVATION ADMIT
|
[
"AMBULATORY OBSERVATION",
"EW EMER.",
"SURGICAL SAME DAY ADMISSION",
"DIRECT EMER.",
"EU OBSERVATION",
"DIRECT OBSERVATION",
"ELECTIVE",
"OBSERVATION ADMIT"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"OBSERVATION ADMIT\"]",
"label": [
"OBSERVATION ADMIT"
]
}
|
11
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 60
- Gender: M
## Discharge [2123-05-19 00:00:00]
- Note_Type: DS
- Text:
Name: ___ Unit No: ___
Admission Date: ___ Discharge Date: ___
Date of Birth: ___ Sex: M
Service: NEUROSURGERY
Allergies:
No Known Allergies / Adverse Drug Reactions
Attending: ___.
Chief Complaint:
R parietal brain lesion
Major Surgical or Invasive Procedure:
___ - Right parietal craniotomy for tumor resection
___ - Right craniotomy for evacuation of intraparenchymal
hemorrhage and subdural hematoma
History of Present Illness:
Mr. ___ is a ___ year old male with history of T2N0
laryngeal cancer s/p XRT in ___ who presented initially to his
PCP with neck pain and orthopnea in ___ CXR showed a LLL
mass. He was transferred to ___ where CT Chest showed a
3.8x2.7x3cm irregular speculated mass concering for malignancy
with enlarged lymph nodes and an adrenal mass. He underwent PET
CT on ___ which revealed righ brain mass with vasogenic edema,
likely primary pulmonary malignancy, osseous mets and possible
laryngeal malignancy. His PCP referred him for brain MRI on
___
which showed a 4.5x3.7x4.7cm right parietal lesion. He was
referred to the ED at that time, but declined. He was started
on
dexamethasone. He presents to the ED today for evaluation of
brain mass.
On eval in the ED, the patient reports headache for several
weeks
and being "off balance," walking into walls and having several
small motor vehicle accidents. He has had nausea and vomiting
on
waking which improves during the day. Denies dizziness,
weakness, paresthesias, vision changes, seizures.
Past Medical History:
Laryngeal cancer
HLD
HSV dendritic keratitis
Social History:
___
Family History:
Father with colon cancer
Physical Exam:
On Discharge:
Awake, alert, oriented x3, Hypophonic. PERRL. Slight R ptosis,
Slight R facial. R drift. Moves all extremities full strength
___. Incision C/D/I.
Pertinent Results:
Please see OMR for relevant imaging reports.
Brief Hospital Course:
___ year old male with R parietal brain lesion.
#Right parietal brain lesion
The patient was admitted to the floor with q4h neuro checks. MRI
wand and CTA head was performed for pre-op planning. He was
started on Keppra for seizure prophylaxis. On ___ he was taken
to the OR and underwent a right craniotomy for resection of
lesion. He tolerated the procedure well and was extubated in the
OR. He was later transferred to the PACU for close monitoring.
He underwent a post-operative head CT which showed expected
post-operative changes. He was later transferred to the ___ for
close neurologic monitoring. On ___, the patient remained
neurologically stable on examination. He underwent post-op MRI
which showed expected post-operative changes. He was transferred
to the floor. His neurological exam remained stable as he
awaited disposition planning.
#Intraparenchymal hemorrhage/Subdural hematoma
In the evening of ___, the patient fell and struck his head.
His neurological exam was significantly worse and he was sent
for a STAT NCHCT, which showed intraparenchymal hemorrhage and
acute subdural hematoma with mass effect and significant midline
shift. He was taken emergently to the operating room for right
craniotomy for evacuation of clot. The procedure was
uncomplicated. For further procedure details, please see
separately dictated operative report by Dr. ___.
Post-operative NCHCT showed good evacuation of the clot with
improved midline shift. He was transferred to the NICU for close
neurological monitoring. He remained in the Neuro ICU on ___
for close neurologic monitoring. On ___, he was transferred to
the ___. On ___, he was transferred to the floor. Case
management screened for rehab placement.
#Hyponatremia
The patient was started on salt tablets three times daily
post-operatively. His serum Na continued to be checked daily. On
___, the patient underwent placement of a PICC line for
continued 3% HTS. This was weaned as tolerated. On ___, he was
started on salt tabs. 3% HTS was discontinued ___. He was able
to maintain appropriate serum sodium levels. On ___, PICC line
was removed. He remained on salt tabs 2gm TID with a stable
sodium level of 138.
#Cerebral edema
The patient was started on dexamethasone for cerebral edema. On
___, he was weaned to 2mg Q12h.
#Hypertension
The patient was hypertensive in the 200s and was on a
nicardipine gtt. Metoprolol IV was started with PRN IV
Labetalol. On ___, Metoprolol was changed to PO. On ___,
Metoprolol was increased to 50mg Q6h in order to facilitate
weaning the nicardipine gtt, which was discontinued on ___.
#ETOH
The patient was started on CIWA monitoring for ETOH withdrawal
when admitted.
#Nutrition
NGT was placed and placement was confirmed with CXR. On ___,
speech and swallow evaluated him and he was cleared for ground
solids and nectar thick liquids with 1:1 supervision. On ___,
he underwent video swallow, which was concerning for some
aspiration with any diet. Pureed solids and nectar thick liquids
with maximum supervision was recommended.
#Agitation
While in the ICU, the patient required Precedex for agitation.
Precedex was weaned as tolerated. On ___, he was started on
standing Seroquel QHS. He remained agitated and was started on
standing Seroquel ___. His agitation improved and there was no
reported overnight issues.
#Elevated BUN/Creat
On ___, the patient's BUN and creatinine were elevated. He
received a fluid bolus and recheck remained elevated. He was
started on maintenance IV fluid and his labs downtrended.
Medications on Admission:
Dexamethasone 4mg Q6H, Metoprolol 25mg BID, tramadol 50mg Q6H
PRN, omeprazole 20mg daily, APAP PRN
Discharge Medications:
1. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild
2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
3. Docusate Sodium 100 mg PO BID
4. FoLIC Acid 1 mg PO DAILY
5. Heparin 5000 UNIT SC BID
6. LevETIRAcetam 1000 mg PO BID
7. Multivitamins 1 TAB PO DAILY
8. Nicotine Patch 14 mg TD DAILY
9. QUEtiapine Fumarate 12.5 mg PO BID
10. Senna 17.2 mg PO QHS
11. Sodium Chloride 2 gm PO Q8H
12. Thiamine 100 mg PO DAILY
13. Dexamethasone 2 mg PO Q12H
14. Metoprolol Tartrate 50 mg PO Q6H
15. Omeprazole 20 mg PO DAILY
Discharge Disposition:
Extended Care
Facility:
___
Discharge Diagnosis:
R parietal brain lesion
Cerebral edema and compression
Intraparenchymal hemorrhage
Subdural hematoma
Agitation
Hyponatremia
Dysphagia
Leukocytosis
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Discharge Instructions:
Discharge Instructions
Brain Tumor
Surgery
You underwent surgery to remove a brain lesion from your brain
and you returned to the OR to evacuate a hemorrhage that
developed post-operatively.
Please keep your incision dry until your sutures/staples are
removed.
You may shower at this time but keep your incision dry.
It is best to keep your incision open to air but it is ok to
cover it when outside.
Call your surgeon if there are any signs of infection like
redness, fever, or drainage.
Activity
We recommend that you avoid heavy lifting, running, climbing,
or other strenuous exercise until your follow-up appointment.
You make take leisurely walks and slowly increase your
activity at your own pace once you are symptom free at rest.
___ try to do too much all at once.
No driving while taking any narcotic or sedating medication.
If you experienced a seizure while admitted, you are NOT
allowed to drive by law.
No contact sports until cleared by your neurosurgeon. You
should avoid contact sports for 6 months.
Medications
Please do NOT take any blood thinning medication (Aspirin,
Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon.
You have been discharged on Keppra (Levetiracetam). This
medication helps to prevent seizures. Please continue this
medication as indicated on your discharge instruction. It is
important that you take this medication consistently and on
time.
You may use Acetaminophen (Tylenol) for minor discomfort if
you are not otherwise restricted from taking this medication.
What You ___ Experience:
You may experience headaches and incisional pain.
You may also experience some post-operative swelling around
your face and eyes. This is normal after surgery and most
noticeable on the second and third day of surgery. You apply
ice or a cool or warm washcloth to your eyes to help with the
swelling. The swelling will be its worse in the morning after
laying flat from sleeping but decrease when up.
You may experience soreness with chewing. This is normal from
the surgery and will improve with time. Softer foods may be
easier during this time.
Feeling more tired or restlessness is also common.
Constipation is common. Be sure to drink plenty of fluids and
eat a high-fiber diet. If you are taking narcotics (prescription
pain medications), try an over-the-counter stool softener.
When to Call Your Doctor at ___ for:
Severe pain, swelling, redness or drainage from the incision
site.
Fever greater than 101.5 degrees Fahrenheit
Nausea and/or vomiting
Extreme sleepiness and not being able to stay awake
Severe headaches not relieved by pain relievers
Seizures
Any new problems with your vision or ability to speak
Weakness or changes in sensation in your face, arms, or leg
Call ___ and go to the nearest Emergency Room if you experience
any of the following:
Sudden numbness or weakness in the face, arm, or leg
Sudden confusion or trouble speaking or understanding
Sudden trouble walking, dizziness, or loss of balance or
coordination
Sudden severe headaches with no known reason
Followup Instructions:
___
## Procedures on International Classification of Diseases [2123-06-16 00:00:00]
- Procedures: Insertion of Infusion Device into Superior Vena Cava, Percutaneous Approach
- Ccs Type: Other vascular catheterization; not heart
## Labotary Test Events [2123-06-16 08:30:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Alanine Aminotransferase (ALT) | 131.0 | IU/L | 0.0 | 40.0 | abnormal | nan |
| Albumin | 3.5 | g/dL | 3.5 | 5.2 | nan | nan |
| Alkaline Phosphatase | 389.0 | IU/L | 40.0 | 130.0 | abnormal | nan |
| Anion Gap | 16.0 | mEq/L | 8.0 | 16.0 | nan | NEW CALCULATION AND REFERENCE RANGE AS OF ___. |
| Asparate Aminotransferase (AST) | 173.0 | IU/L | 0.0 | 40.0 | abnormal | nan |
| Bicarbonate | 20.0 | mEq/L | 22.0 | 32.0 | abnormal | nan |
| Bilirubin, Total | 0.4 | mg/dL | 0.0 | 1.5 | nan | nan |
| Calcium, Total | 9.0 | mg/dL | 8.4 | 10.3 | nan | nan |
| Chloride | 79.0 | mEq/L | 96.0 | 108.0 | abnormal | ___ |
| Cortisol | 16.0 | ug/dL | 2.0 | 20.0 | nan | New Reference Range as of ___. Normal Diurnal Pattern: 7-10AM 6.0-18.4 ug/dL / 4-8PM 2.7-10.5 ug/dL. |
| Creatinine | 1.0 | mg/dL | 0.5 | 1.2 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.. |
| Globulin | 2.4 | g/dL | 2.0 | 4.0 | nan | nan |
| H | 19.0 | nan | nan | nan | nan | nan |
| Hepatitis B Surface Antibody | nan | nan | nan | nan | nan | NEG. |
| Hepatitis B Surface Antigen | nan | nan | nan | nan | nan | NEG. |
| Hepatitis B Virus Core Antibody | nan | nan | nan | nan | nan | NEG. |
| Hepatitis C Virus Antibody | nan | nan | nan | nan | nan | NEG. |
| I | 0.0 | nan | nan | nan | nan | nan |
| Magnesium | 1.7 | mg/dL | 1.6 | 2.6 | nan | nan |
| Osmolality, Measured | 245.0 | mOsm/kg | 275.0 | 310.0 | abnormal | ___ |
| Phosphate | 3.0 | mg/dL | 2.7 | 4.5 | nan | nan |
| Potassium | 5.3 | mEq/L | 3.3 | 5.1 | abnormal | nan |
| Protein, Total | 5.9 | g/dL | 6.4 | 8.3 | abnormal | nan |
| Sodium | 115.0 | mEq/L | 133.0 | 145.0 | abnormal | ___ |
| Thyroid Stimulating Hormone | 30.0 | uIU/mL | 0.27 | 4.2 | abnormal | nan |
| Thyroxine (T4), Free | 0.4 | ng/dL | 0.93 | 1.7 | abnormal | nan |
| Urea Nitrogen | 21.0 | mg/dL | 6.0 | 20.0 | abnormal | nan |
| HPE1 | 0.519 | nan | nan | nan | nan | nan |
| HPE2 | nan | nan | nan | nan | nan | ___ |
| HPE3 | 1.84 | nan | nan | nan | nan | nan |
| HPE7 | 0.034 | nan | nan | nan | nan | nan |
| L | 10.0 | nan | nan | nan | nan | nan |
| Absolute Lymphocyte Count | 0.59 | K/uL | 1.2 | 3.7 | abnormal | nan |
| Anisocytosis | nan | nan | nan | nan | nan | NORMAL. |
| Atypical Lymphocytes | 0.0 | % | 0.0 | 0.0 | nan | nan |
| Bands | 1.0 | % | 0.0 | 5.0 | nan | nan |
| Basophils | 2.0 | % | 0.0 | 1.0 | abnormal | nan |
| Eosinophils | 1.0 | % | 1.0 | 7.0 | nan | nan |
| Hematocrit | 37.0 | % | 40.0 | 51.0 | abnormal | nan |
| Hemoglobin | 13.2 | g/dL | 13.7 | 17.5 | abnormal | nan |
| Hypochromia | nan | nan | nan | nan | nan | NORMAL. |
| Lymphocytes | 4.0 | % | 19.0 | 53.0 | abnormal | nan |
| Macrocytes | nan | nan | nan | nan | nan | NORMAL. |
| MCH | 31.5 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 35.7 | g/dL | 32.0 | 37.0 | nan | nan |
| MCV | 88.0 | fL | 82.0 | 98.0 | nan | VERIFIED. |
| Metamyelocytes | 1.0 | % | 0.0 | 0.0 | abnormal | nan |
| Microcytes | nan | nan | nan | nan | nan | NORMAL. |
| Monocytes | 4.0 | % | 5.0 | 13.0 | abnormal | nan |
| Myelocytes | 0.0 | % | 0.0 | 0.0 | nan | nan |
| Neutrophils | 87.0 | % | 34.0 | 71.0 | abnormal | nan |
| Platelet Count | 268.0 | K/uL | 150.0 | 400.0 | nan | nan |
| Platelet Smear | nan | nan | nan | nan | nan | NORMAL. |
| Poikilocytosis | nan | nan | nan | nan | abnormal | OCCASIONAL*. |
| Polychromasia | nan | nan | nan | nan | nan | NORMAL. |
| RDW | 13.0 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.19 | m/uL | 4.6 | 6.1 | abnormal | nan |
| White Blood Cells | 14.7 | K/uL | 4.0 | 10.0 | abnormal | nan |
| Absolute Basophil Count | 0.29 | K/uL | 0.01 | 0.08 | abnormal | nan |
| Absolute Eosinophil Count | 0.15 | K/uL | 0.04 | 0.54 | nan | nan |
| Absolute Monocyte Count | 0.59 | K/uL | 0.2 | 0.8 | nan | nan |
| Absolute Neutrophil Count | 12.94 | K/uL | 1.6 | 6.1 | abnormal | nan |
| Echinocytes | nan | nan | nan | nan | abnormal | ___ |
| RDW-SD | 42.1 | fL | 35.1 | 46.3 | nan | nan |
| Glucose | 82.0 | mg/dL | 70.0 | 100.0 | nan | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 45.0 | nan | nan | nan | nan | nan |
| I | 0.0 | nan | nan | nan | nan | nan |
| L | 6.0 | nan | nan | nan | nan | nan |
## Transfers [2123-06-16 11:14:00]
- Eventtype: ED
- Careunit: Emergency Department
## EDstays [2123-06-16 11:14:00]
- Gender: M
- Race: WHITE
## Triage [2123-06-16 11:14:01]
- Temperature: 97.7
- Heartrate: 80.0
- Resprate: 18.0
- O2Sat: 91.0
- Sbp: 114.0
- Dbp: 74.0
- Pain: 0
- Acuity: 2.0
- Chiefcomplaint: Fatigue
## Vitalsign [2123-06-16 11:16:00]
| Temperature | Heartrate | Resprate | O2Sat | Sbp | Dbp | Pain | Rhythm |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| 97.7 | 80.0 | 18.0 | 91.0 | 114.0 | 74.0 | 0 | nan |
| nan | 82.0 | 20.0 | 98.0 | 118.0 | 80.0 | 0 | nan |
## Provider Order Entry [2123-06-16 12:34:36]
| Order_Type | Order_Subtype |
| ------ | ------ |
| Lab | nan |
| Radiology | General Xray |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
| Lab | nan |
## Labotary Test Events [2123-06-16 12:50:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Red Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Anion Gap | 18.0 | mEq/L | 8.0 | 16.0 | abnormal | New calculation and Reference range as of ___. |
| Bicarbonate | 20.0 | mEq/L | 22.0 | 32.0 | abnormal | nan |
| Chloride | 78.0 | mEq/L | 96.0 | 108.0 | abnormal | ___ |
| Creatinine | 1.0 | mg/dL | 0.5 | 1.2 | nan | nan |
| Glucose | 74.0 | mg/dL | 70.0 | 100.0 | nan | If fasting, 70-100 normal, >125 provisional diabetes. |
| H | 13.0 | nan | nan | nan | nan | nan |
| I | 0.0 | nan | nan | nan | nan | nan |
| Potassium | 5.5 | mEq/L | 3.3 | 5.1 | abnormal | nan |
| Red Top Hold | nan | nan | nan | nan | nan | HOLD. |
| Sodium | 113.0 | mEq/L | 133.0 | 145.0 | abnormal | ___ |
| Urea Nitrogen | 24.0 | mg/dL | 6.0 | 20.0 | abnormal | nan |
| L | 6.0 | nan | nan | nan | nan | nan |
| EDTA Hold | nan | nan | nan | nan | nan | HOLD. DISCARD GREATER THAN 8 HOURS OLD. |
## Microbiology Test Events [2123-06-16 12:50:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Medrecon [2123-06-16 12:55:00]
| Name | Atc Type |
| ------ | ------ |
| acetaminophen [Acetaminophen Extra Strength] | None |
| bisacodyl | bisacodyl |
| dexamethasone | nan |
| docusate sodium [Colace] | docusate sodium |
| folic acid | folic acid |
| levetiracetam [Keppra] | levetiracetam |
| metoprolol tartrate | nan |
| naproxen sodium [Aleve] | naproxen |
| nicotine [Nicoderm CQ] | nicotine |
| omeprazole | omeprazole |
| pediatric multivit-iron-min [Multi-Vitamins with Iron] | None |
| quetiapine | quetiapine |
| quetiapine | quetiapine |
| sennosides [senna] | senna glycosides |
| sodium chloride | None |
| thiamine HCl (vitamin B1) | thiamine (vit B<n>1</n>) |
## Labotary Test Events [2123-06-16 12:59:00]
- Item_Name: Lactate
- Valuenum: 2.4
- Valueuom: mmol/L
- Ref_Range_Lower: 0.5
- Ref_Range_Upper: 2.0
- Flag: abnormal
- Comments: nan
## Radiology Examinations [2123-06-16 13:10:00]
- Note_Type: RR
- Exam_Name: ['CHEST (PORTABLE AP)']
- Text: EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with NSCLC p/w fatigue, drowsiness// infectious
process?
TECHNIQUE: Single frontal view of the chest
COMPARISON: Chest radiograph from ___ and PET-CT from ___
FINDINGS:
Persistent left lower lobe pulmonary opacity which appears slightly more dense
may represent pulmonary mass in this patient with reported history of non
small cell lung cancer. Underlying infectious process is not excluded. No new
focal consolidation is seen. There is no large pleural effusion or
pneumothorax. Cardiac and mediastinal silhouettes are stable. There has been
interval removal of a previously seen right-sided PICC.
IMPRESSION:
Persistent left lower lobe opacity appears slightly more dense and defined,
and may represent pulmonary mass in this patient with reported history of
non-small cell lung cancer; underlying infectious process is not excluded.
## Microbiology Test Events [2123-06-16 13:25:00]
- Test_Name: Blood Culture, Routine
- Dilution_Text: nan
- Interpretation: nan
- Comments: NO GROWTH.
- Ab_Name: nan
## Vitalsign [2123-06-16 13:30:00]
- Temperature: nan
- Heartrate: 86.0
- Resprate: 20.0
- O2Sat: 97.0
- Sbp: 127.0
- Dbp: 76.0
- Pain: 0
- Rhythm: nan
## Provider Order Entry [2123-06-16 13:40:09]
- Order_Type: Lab
- Order_Subtype: nan
## Labotary Test Events [2123-06-16 13:48:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Hematocrit | 35.7 | % | 40.0 | 51.0 | abnormal | nan |
| Hemoglobin | 12.7 | g/dL | 13.7 | 17.5 | abnormal | nan |
| MCH | 31.6 | pg | 26.0 | 32.0 | nan | nan |
| MCHC | 35.6 | g/dL | 32.0 | 37.0 | nan | nan |
| MCV | 89.0 | fL | 82.0 | 98.0 | nan | nan |
| Platelet Count | 257.0 | K/uL | 150.0 | 400.0 | nan | nan |
| RDW | 13.1 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 4.02 | m/uL | 4.6 | 6.1 | abnormal | nan |
| White Blood Cells | 16.2 | K/uL | 4.0 | 10.0 | abnormal | nan |
| RDW-SD | 42.8 | fL | 35.1 | 46.3 | nan | nan |
|
EW EMER.
|
[
"EW EMER.",
"ELECTIVE",
"SURGICAL SAME DAY ADMISSION",
"DIRECT OBSERVATION",
"EU OBSERVATION",
"DIRECT EMER.",
"AMBULATORY OBSERVATION",
"OBSERVATION ADMIT"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"EW EMER.\"]",
"label": [
"EW EMER."
]
}
|
12
|
Given the sequence of events that have occurred in a hospital, please give the next Admissions suggestion for the patiens.
|
## Patient Demographics [None]
- Anchor_Age: 47
- Gender: F
## EDstays [2133-12-03 18:06:00]
- Gender: F
- Race: BLACK/AFRICAN AMERICAN
## Triage [2133-12-03 18:06:01]
- Temperature: 98.0
- Heartrate: 78.0
- Resprate: 18.0
- O2Sat: 99.0
- Sbp: 145.0
- Dbp: 87.0
- Pain: 10
- Acuity: 3.0
- Chiefcomplaint: Lower back pain, Dizziness
## Labotary Test Events [2133-12-03 19:20:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Bacteria | nan | nan | nan | nan | nan | NONE. |
| Bilirubin | nan | mg/dL | nan | nan | nan | NEG. |
| Blood | nan | nan | nan | nan | nan | NEG. |
| Epithelial Cells | 2.0 | #/hpf | nan | nan | nan | nan |
| Glucose | nan | mg/dL | nan | nan | nan | NEG. |
| Ketone | 10.0 | mg/dL | nan | nan | nan | nan |
| Leukocytes | nan | nan | nan | nan | nan | TR. |
| Nitrite | nan | nan | nan | nan | nan | NEG. |
| pH | 6.0 | units | 5.0 | 8.0 | nan | nan |
| Protein | 30.0 | mg/dL | nan | nan | nan | nan |
| RBC | 1.0 | #/hpf | 0.0 | 2.0 | nan | nan |
| Specific Gravity | 1.03 | | 1.001 | 1.035 | nan | nan |
| Urine Appearance | nan | nan | nan | nan | nan | Clear. |
| Urine Color | nan | nan | nan | nan | nan | Yellow. |
| Urine Mucous | nan | nan | nan | nan | nan | RARE. |
| Urobilinogen | 2.0 | mg/dL | 0.2 | 1.0 | abnormal | nan |
| WBC | 1.0 | #/hpf | 0.0 | 5.0 | nan | nan |
| Yeast | nan | nan | nan | nan | nan | nan |
| HCG, Urine, Qualitative | nan | +/- | nan | nan | nan | NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG. |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Length of Urine Collection | nan | nan | nan | nan | nan | RANDOM. |
| Urine tube, held | nan | nan | nan | nan | nan | ___ |
## Medrecon [2133-12-03 19:20:00]
- Name: hydrochlorothiazide
- Atc Type: None
## Labotary Test Events [2133-12-03 19:30:00]
| Item_Name | Valuenum | Valueuom | Ref_Range_Lower | Ref_Range_Upper | Flag | Comments |
| ------ | ------ | ------ | ------ | ------ | ------ | ------ |
| Green Top Hold (plasma) | nan | nan | nan | nan | nan | ___ |
| Basophils | 0.2 | % | 0.0 | 2.0 | nan | nan |
| Eosinophils | 0.9 | % | 0.0 | 4.0 | nan | nan |
| Hematocrit | 40.6 | % | 36.0 | 48.0 | nan | nan |
| Hemoglobin | 12.3 | g/dL | 12.0 | 16.0 | nan | nan |
| Lymphocytes | 54.1 | % | 18.0 | 42.0 | abnormal | nan |
| MCH | 23.9 | pg | 27.0 | 32.0 | abnormal | nan |
| MCHC | 30.3 | % | 31.0 | 35.0 | abnormal | nan |
| MCV | 79.0 | fL | 82.0 | 98.0 | abnormal | nan |
| Monocytes | 4.1 | % | 2.0 | 11.0 | nan | nan |
| Neutrophils | 40.8 | % | 50.0 | 70.0 | abnormal | nan |
| Platelet Count | 218.0 | K/uL | 150.0 | 440.0 | nan | nan |
| RDW | 14.7 | % | 10.5 | 15.5 | nan | nan |
| Red Blood Cells | 5.14 | m/uL | 4.2 | 5.4 | nan | nan |
| White Blood Cells | 6.7 | K/uL | 4.0 | 11.0 | nan | nan |
| Blue Top Hold | nan | nan | nan | nan | nan | ___ |
| Anion Gap | 14.0 | mEq/L | 8.0 | 20.0 | nan | nan |
| Bicarbonate | 28.0 | mEq/L | 22.0 | 32.0 | nan | nan |
| Chloride | 105.0 | mEq/L | 96.0 | 108.0 | nan | nan |
| Creatinine | 0.8 | mg/dL | 0.4 | 1.1 | nan | nan |
| Estimated GFR (MDRD equation) | nan | nan | nan | nan | nan | Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure. |
| Glucose | 80.0 | mg/dL | 70.0 | 100.0 | nan | IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES. |
| Potassium | 4.8 | mEq/L | 3.3 | 5.1 | nan | nan |
| Sodium | 142.0 | mEq/L | 133.0 | 145.0 | nan | nan |
| Urea Nitrogen | 19.0 | mg/dL | 6.0 | 20.0 | nan | nan |
| Light Green Top Hold | nan | nan | nan | nan | nan | HOLD. |
## Pyxis [2133-12-03 19:31:00]
| Name |
| ------ |
| OxyCODONE (Immediate Release) |
| Diazepam |
| OxyCODONE (Immediate Release) |
| Diazepam |
## Vitalsign [2133-12-03 21:12:00]
- Temperature: 98.0
- Heartrate: 70.0
- Resprate: 16.0
- O2Sat: 99.0
- Sbp: 140.0
- Dbp: 99.0
- Pain: nan
- Rhythm: nan
## ED Diagnoses on International Classification of Diseases [2133-12-03 21:24:00]
| Icd_Title | Ccs Type |
| ------ | ------ |
| OTHER CHRONIC PAIN | Other nervous system disorders |
| LUMBAGO | Spondylosis; intervertebral disc disorders; other back problems |
## Online Medical Record [2134-01-20 00:00:00]
| Result_Name | Result_Value |
| ------ | ------ |
| Blood Pressure | 120/69 |
| BMI (kg/m2) | 33.3 |
| Height (Inches) | 64 |
| Weight (Lbs) | 194 |
## Radiology Examinations [2134-01-20 08:09:00]
| Note_Type | Exam_Name | Text |
| ------ | ------ | ------ |
| RR | ['L-SPINE (AP,LAT,FLEX,EXT)'] | INDICATION: ___ year old woman with low back pain // evaluate lumbar spine
COMPARISON: None available.
FINDINGS:
AP and lateral views of the lumbar spine show no displacement on flexion and
extension views. Minimal spurring is noted anterior at multiple levels. The
SI joints are preserved. Though the left iliac wing is only partially
visualized, no suspicious lytic or sclerotic osseous lesions are noted
IMPRESSION:
Mild degenerative changes of the lumbar spine noted above.
|
| RR | ['LUMBAR SINGLE VIEW IN OR', '-76 BY SAME PHYSICIAN'] | EXAMINATION: LUMBAR SINGLE VIEW IN OR
INDICATION: L5-S1 microdiskectomy.
COMPARISON: Radiographs from ___.
FINDINGS:
2 lateral views of the lumbar spine from the operating room have been
submitted for dictation. On both images, there are posterior marker at the
level of the L5/S1 disc space. This disk space is slightly narrowed. There are
no compression deformities or abnormal ___ or ___.
IMPRESSION:
Intraoperative localization at L5/S1 in anticipation of lumbar surgery.
|
## Procedures on International Classification of Diseases [2134-02-22 00:00:00]
| Procedures | Ccs Type |
| ------ | ------ |
| Excision of intervertebral disc | Laminectomy; excision intervertebral disc |
| Closure of skin and subcutaneous tissue of other sites | Suture of skin and subcutaneous tissue |
| Other fasciectomy | Other therapeutic procedures on muscles and tendons |
| Open biopsy of soft tissue | Other diagnostic procedures on musculoskeletal system |
|
DIRECT OBSERVATION
|
[
"EW EMER.",
"SURGICAL SAME DAY ADMISSION",
"OBSERVATION ADMIT",
"EU OBSERVATION",
"ELECTIVE",
"DIRECT OBSERVATION",
"DIRECT EMER.",
"AMBULATORY OBSERVATION"
] |
{
"target_key": "admission_type",
"metric": "em",
"task_type": "decision_making",
"task": "admissions",
"event": "admissions",
"target": "[\"DIRECT OBSERVATION\"]",
"label": [
"DIRECT OBSERVATION"
]
}
|
End of preview.
EHR-R1: A Reasoning-Enhanced Foundational Language Model for Electronic Health Record Analysis
This repository contains the EHR-Bench dataset, as presented in the paper EHR-R1: A Reasoning-Enhanced Foundational Language Model for Electronic Health Record Analysis.
EHR-Bench is a new, comprehensive benchmark introduced to rigorously evaluate Large Language Models (LLMs) on Electronic Health Record (EHR) analysis tasks.
- Source and Purpose: It is derived from the MIMIC-IV dataset and serves as the primary in-distribution benchmark for the EHR-R1 model. Its goal is to provide a balanced and comprehensive assessment of both reasoning and task-specific performance across a broad spectrum of clinically relevant settings, mirroring real-world EHR challenges.
- Composition: The benchmark spans 42 distinct tasks organized into two major types:
- Decision-Making Tasks (24 tasks): These are generative problems that require the model to recommend the next appropriate intervention given a specific medical event. They include tasks like diagnosis, treatment, and service recommendation.
- Risk-Prediction Tasks (18 tasks): These are binary classification problems where the model forecasts the occurrence of a significant medical event within a specified horizon. They cover subtypes such as mortality, readmission, and length of stay.
- Paper: https://huggingface.co/papers/2510.25628
- GitHub Repository: https://github.com/MAGIC-AI4Med/EHR-R1
Structure
Each item in the jsonl file contains the key as below:
- idx: Unique ID for each sample
- instruction: Task instruction; the instruction is the same if the task is the same
- input: EHR input after text serialization
- output: Output used for training (this item is not useful for the test set)
- candidates: Candidate options provided for the untrained model
- task_info: Task-related information is included in this item, including:
- target_key: The column name from the EHR used to retrieve the prediction label; this item is
Nonefor therisk predictiontask - events: Event types related to the prediction label
- metric: The metric used to calculate the score for this task
- target: The raw label in string format
- label: The label used to calculate the score
- target_key: The column name from the EHR used to retrieve the prediction label; this item is
To prevent the leakage of native data information within the MIMIC-IV dataset, we removed information such as subject_id, harm_id, and other details that might link to the original MIMIC-IV data. The complete dataset can be found in MIMIC-IV-Ext-EHR-Analysis on PhysioNet (not yet released).
📖 Citation
If you find our work helpful or inspiring, please feel free to cite it:
@article{liao2025ehrr1,
title={{EHR-R1: A Reasoning-Enhanced Foundational Language Model for Electronic Health Record Analysis}},
author={Liao, Yusheng and Wu, Chaoyi and Liu, Junwei and Jiang, Shuyang and Qiu, Pengcheng and Wang, Haowen and Yue, Yun and Zhen, Shuai and Wang, Jian and Fan, Qianrui and Gu, Jinjie and Zhang, Ya and Wang, Yanfeng and Wang, Yu and Xie, Weidi},
journal={arXiv preprint arXiv:2510.25628},
year={2025}
}
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