72 y/o M with h/o CAD, PAD, HTN, CKD stage 3, and DM2 presents to the ED with worsening RLE pain and coolness x3 days. Denies trauma. Duplex US showed diminished flow c/w acute on chronic PVD. CTA abd/pelvis ordered to evaluate for arterial occlusion. On ASA and statin at baseline. No CP or SOB. Plan for IR consult for possible endovascular intervention.
83 y/o F from ALF with H/O DM2, CKD3, and PAD presents with fever, hypotension, and confusion. Exam: foul-smelling LLE wound. Labs: leukocytosis, lactate 4.1 → concern for sepsis 2/2 infected ulcer. Started on IV fluids (NS), broad-spectrum abx, and wound Cx sent. Podiatry consulted for debridement. SIRS criteria met on arrival.
65 y/o M with metastatic colon Ca on chemo presents with SOB and pleuritic CP. CTA chest shows segmental PE. Started on heparin drip, plan to transition to DOAC. No evidence of DVT on US. Mild AKI likely 2/2 dehydration. Oncology and SW notified. DNR/DNI status confirmed per patient preference.
42 y/o F with H/O GAD, MDD, and prior CD (EtOH) presents with worsening anxiety and insomnia after stopping sertraline abruptly. Reports passive SI, denies plan or intent. No HI or AVH. CIWA negative. Restarted SSRI, PRN hydroxyzine ordered. SW and psych consulted for med management and outpatient follow-up. No acute medical complaints.
79 y/o M with H/O osteoporosis and RA presents from SNF after unwitnessed fall with L hip pain. XR shows displaced femoral neck Fx. Ortho consulted for ORIF. Patient on AC for PAF; held pre-op. WBAT post-op anticipated. Pain controlled with APAP and limited opioids. PT/OT to evaluate post-surgery for safe transfer back to SNF.
63 y/o F with H/O HTN, CAD, and PAF (on DOAC) presents with sudden-onset right-sided weakness and slurred speech x2 hours. CT head negative for bleed. CTA head/neck with L MCA occlusion. Stroke code activated → candidate for thrombectomy. Neurology and IR at bedside. BP elevated to 198/102. No prior stroke history.
37 y/o F with DM1 presents with N/V, abdominal pain, and malaise. CBG 545. Labs with AGMA (anion gap 24), positive ketones → DKA. Started on IV insulin drip, D5NS once glucose <250. Monitoring CBG Q1H. No evidence of infection or AKI. Patient reports missing insulin doses due to recent move. Diabetes educator consulted.
51 y/o F with H/O GERD, IBS, and EtOH use disorder presents with 3 days of epigastric pain, nausea, and dark stools. EGD shows gastric ulcer with stigmata of recent bleed. Started on IV PPI and NS. Hgb stable. CIWA protocol initiated. SW involved for CD resources. Denies hematemesis or melena currently.
59 y/o M with H/O DM2, HTN, and CKD4 presents with weakness and decreased urine output x3 days. Labs: BUN/Cr 92/5.1 → AKI on CKD, likely 2/2 dehydration and ACE inhibitor use. Started on IV LR at 75 mL/hr. Renal US pending to r/o obstruction. Nephrology consulted. Will hold nephrotoxic meds and monitor I/O strictly.
68 y/o F with H/O COPD, OSA, and HFpEF presents to ED with acute SOB and productive cough x3 days. SpO₂ 86% on RA → improved to 92% on 2L NC. CXR with bibasilar opacities. Concern for COPD exacerbation vs PNA. Started on DuoNebs, IV steroids, and empiric abx. Will monitor for AHRF. Denies CP or leg swelling.
74 y/o M with H/O CAD s/p CABG, HTN, HLD, and prior MI presents with substernal CP x2 hours, radiating to jaw. EKG shows ST elevations in inferior leads. Troponin markedly elevated → STEMI. Started on ASA, heparin bolus, and loaded with ticagrelor. Cath lab activated for emergent PCI. Denies SOB or syncope. Wife at bedside for GOC discussion.
78 y/o F with H/O osteoporosis, recent L hip Fx s/p ORIF, CKD, and DM2 presents with poor PO intake and constipation. On TF via G tube for nutrition. Denies pain at incision site. Labs show stable electrolytes. PT/OT eval pending for mobility; WBAT on LLE. Plan for transfer to IRF once medically stable. SW coordinating DME for home use.
61 y/o M with H/O HTN, DM2, GERD, and prior NSTEMI presents with CP radiating to LUE. ECG with ST depressions. Troponin elevated. Diagnosed with NSTEMI. Started on ASA, heparin, and beta-blocker. Cardiology consulted for possible cath. CXR negative. Plan for TTE to evaluate for HF or CM. Patient admitted to CCU.
45 y/o M with H/O EtOH use disorder, recent admission for CIWA protocol, presents with abdominal pain and hematemesis. CT abd/pelvis shows gastritis; EGD planned by GI. LFTs elevated. Started on IV PPI and NS. SW consulted for CD support. DNR/DNI status confirmed. Patient requesting GOC discussion with family present.
70 y/o F with H/O breast Ca s/p mastectomy, currently on chemo, presents from SNF with swelling and pain to LLE. Venous US +DVT. Started on DOAC. No SOB or CP. On SCDs to contralateral leg. Will monitor for signs of PE. Labs also show mild AKI 2/2 dehydration; fluids started.
63 y/o M with H/O COPD, CAD s/p CABG, and ICM (EF 35%) presents with acute SOB and orthopnea. Exam shows bibasilar crackles, BLLE edema. BNP elevated. ECG negative for STEMI/NSTEMI. Started on IV diuretics. Will continue DAPT, statin, and monitor for AHRF. No fever or chest pain reported.
47 y/o F with H/O RA, MDD, and GAD presents with worsening joint pain and morning stiffness. Has been using NSAIDs PRN with limited relief. Denies fever or rash. No SOB or CP. Labs pending to r/o SIRS or infection. Discussed medication compliance and mental health follow-up with PCP. Plan for rheum consult and PT for mobility.
82 y/o M from ALF with H/O BPH, HFpEF, and CAD presents with fever, dysuria, and confusion. UA positive for nitrites and leukocytes c/w UTI. BCx pending. Started on IV NS and ceftriaxone. Foley placed. Will monitor renal function given baseline CKD. No flank pain. SW and RNCM involved for D/C planning back to ALF once stable.
56 y/o M with DM2, CKD4, and HTN presents with nausea, vomiting, and poor PO intake x4 days. CBG >400. Labs with AGMA, elevated BUN/Cr suggesting AKI on CKD. Concern for DKA. Started on IV insulin drip and LR. Will monitor CBG Q1H. No CP, SOB, or infectious symptoms.
68 y/o F with H/O COPD, OSA (on CPAP), HTN, and PAF on DOAC presents with acute SOB and pleuritic CP. CTA chest +PE in RLL. On LMWH bridge to warfarin. Labs notable for mild AKI likely 2/2 dehydration. S/P admission to telemetry for anticoagulation monitoring. No signs of HF or infection.