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HPI 1 by user115903

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.

Infectious Disease by user115903

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.

Heme/Onc by user115903

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.

Psychiatric by user115903

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.

Musculoskeletal by user115903

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.

Neurological by user115903

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.

Endocrine/Metabolic by user115903

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.

GI/Hepatobiliary by user115903

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.

Renal by user115903

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.

Respiratory by user115903

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.

Cardiac by user115903

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.

HPI 10 by user115903

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.

HPI 9 by user115903

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.

HPI 8 by user115903

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.

HPI 7 by user115903

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.

HPI 6 by user115903

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.

HPI 5 by user115903

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.

HPI 4 by user115903

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.

HPI 3 by user115903

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.

HPI 2 by user115903

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.