Her bicarb went up to 23 at the end of the code when she was in sinus rhythm. Oxygen was around 500 on 100% FiO2 (forced inspiration oxygen) with a bicarb of 18. Her ABGs (arterial blood gases) initially were pH (potential of hydrogen) 74.8 and PCO2 (partial pressure of carbon dioxide) 28. She eventually recovered back in sinus rhythm after defibrillation for ventricular tachycardia. She received multiple doses of epinephrine and multiple amps of sodium bicarbonate. She had multiple rhythm problems including asystole, ventricular tachycardia, and pulseless electrical activity. We resuscitated her for more than 20 minutes. Her blood pressure was dropping on occasion and then coming back up again. The patient went bradycardic and then went into a junctional rhythm. She was on a bicarbonate drip, and we gave her multiple amps of bicarbonate. She received multiple doses of Ativan, and then I gave her around 20 mg (milligram) of Versed and started a Versed drip. She received bicarbonate and was sent to the emergency room. Monitor showed wide QRS (Q-wave, R-wave, S-wave) complexes. Paramedics were on the scene in 4 to 5 minutes. She slept for an hour until 10:30, and then she started having generalized seizures on and off four times, during which her husband call 911. She called her husband, who came over at approximately 9:30 tonight. Location: Hospital Emergency Department Patient: Linda Paulo Physician: Marvin Elhart, MD The patient is a 23-year-old Hispanic female who took some medications to sleep tonight, including what sounds like amitriptyline and Hydrocodone. Elhart, the cardiologist on call from the local clinic, to provide critical care services to Linda Paulo. Sutton, emergency room physician, called in Dr. Service Codes: ICD-10-CM DX Codes: ICD-9-CM DX Codes:Ĭritical Care Service Dr. Continue to check blood sugars as stress can sometimes make these go off. Watch for signs of infection follow up if any occur. He may rinse with some hydrogen peroxide and water. She was advised to keep the area clean and to make an appointment with the family practitioner for removal of sutures in 7 days. I reassured her that the laceration was minor and only required two sutures to close adequately. Plan: Discussed my findings and diagnoses with the mother. Upper inner lip laceration, requiring simple suture repair. No TMJ (temporomandibular joint) tenderness. The right lower lip above the vermilion border has an abrasion. Superficial skin edges are not opposed, not bleeding. ![]() Right upper lip: He had a 1- to 1.5-cm (centimeter) laceration. He has some tenderness and erythema in the right cheek where he was hit, no obvious swelling. PERRLA (pupils equal, round, reactive to light and accommodation). Physical examination: Head is normocephalic. Note the patient normally wears glasses but did not have them for this examination. He also notes that he had a cut on his right lower lip and upper inside of his right lip as well. Immediately following this he had some blurry vision in the right eye, which slowly has improved and is near normal now. The patient states that he did get hit on the right cheek area. ![]() ![]() Mother is concerned because he is a diabetic and has a couple of lip lacerations, also complained of some transient blurry vision, which has since improved. ![]() Emergency and Outpatient Record Location: Outpatient, Clinic Patient: Ryan Hoffgrand Physician: Paul Sutton, MD This is a 17-year-old make who comes in after he got punched in the right side of his face.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |