Infectious Medicine Referrals
INFECTIOUS MEDICINE REFERRALS
December 12, 2009 Saturday
# of patients: 19 New: 1 Mortality: 0 Discharge/s: 1
Name/Bed# / Diagnosis / Medications / Labs / Ancillaries / NotesFORBES
203B
Tingzon, Rod 20/M
09L00099
05-43-82 / ALL / Paracetamol 500mg/tab q4h prn
NaHCO3 gr X 1 tab TID / 12/04 Hgb 94 Hct 0.26 Plt 120 WBC 275.00 N 0.01 L 0.04 Blasts 0.95
12/04 U/A yellow, sl turbid, 5, 1.020, alb/sugar -, rbc 0-1, pus 0-3, sq few, bact few, AU +
12/04 Creatinine 0.90, SGOT 23.2, SGPT 17.3
12/04 CXR Normal chest.
12/10 CBC Hgb 75, hct 0.22, platelet 80, WBC 262.20, neutrophils 0.01, lumphocytes 0.09, blast 0.90 / Blood CS results
Cleared for chemotherapy
205°
Clarisse Anne Sistoso 26/F / Round cell malignancy (NET) with osseous metastasis
t/c soft tissue abscess
HAP / Vancomycin 1m/IV infusion q12h shifted to Clindamycin 300mg/cap q6 D5
Pip-tazo 4.5gm/IV q8h (D10)
Paracetamol 500mg/tab q4h prn / 11/28 UA rc 2-4, pc 10-20, bact ++; 11/30 ph 7.463 pCO2 34.8 P02 80.9 HCO3 24.8 dfiO2 21% PF 385
11/30 PT 14.5 inr 1.2 crea .99 Na 133 K 4.6 iCa 1.23
12/02 UTZ of Liver: N size liver with diffuse parenchymal changes and hyperechoic solid nodule at segment 3 of L lobe; minimal pleural effusion
12/03 Hgb 99 Hct 0.33 Plt 300 wbc 15.8 Seg 0.52 Bands 0.07 MM 0.04 Myelo 0.05 L 0.31 Mono 0.01; SGPT 65.3 SGOT 192
12/04 Na 134 K 4.3
12/07 CBC Hgb 83, hct 0.25, platelet 232, WBC 11.50, neutrophils 0.70, lymphocytes 0.22
12/9 Fecalysis no parasite/ova, yeast cell + / Blood CS results
Cleared for RT
207E
Tana, Rodolfo
39/M
05-88-90
09L00193 / HPN emergency, r/o CVA, t/c TB meningitis, PTB Categpry 3 on 2nd month intensive phase treatment, DM type II, multiple electrolyte imbalance secondary to diuretic use / Fixc0m 4 4 tabs OD 30 minutes before breakfast D36
Ceftriaxone 2 g/IV q12 / 12/7 Creatinine 0.65, SGPT 64.3, Na 118, K 3
12/7 CBC Hgb 160, hct 0.45, platelet 444, WBC 21.90, neutrophils 0.89, lymphocytes 0.11
12/8 UA Yellow, clear pH 7, SG 1.010, albumin +, sugar ++, RBC 0-1/hpf, pus cell 0-2/hpf, bacteria few
12/10 CSF (-) cryptococcal antigen, total protein 49.4, glucose 72.9, 2 mL, xanthrochromic, turbid, total RBC 10, 333, total WBC 114, (69 % neutrophils, 31% lymphocytes)
12/10 Sputum Day 1 (-) AFB stain
12/11 IgG, IgM anti-HSV 1 nonreactive, IgG, IgM anti-HSV 2 nonreactive / For HSV 1 and 2 (TT3)
211°
Papa, Adora
44/F
09J00818
05-67-28
P09-22319
P09-21140 / PACI left MCA territory prob cardioembolic, t/c septic-embolic t/c infective endocarditis / Vancomycin 1g in 90cc PNSS every after dialysis x 4
Fluimucil 600mg/tab in ½ glass BID
Combivent neb q4
Fluconazole 200mg/cap OD (D10)
Clindamycin 300 mg/cap q6 D5-6 / 11/2 blood CS: Staph aureus MRSA; Hgb 27 Hct 23 plt 300 wbc 18.5 N 95 L 5
11/2 retic count: 5, peripheral smear: no abnormal WBC RBC normochromic with anisocytosis, plt adequate RPI 0.17
11/3 yellow, turbid, ph 5, 1.0120, alb +++, sugar -, granular 1-5/CS, RBC >100, pus >100, sq ++, bact ++; BUN 104 Na 134 K 5,4 iPO4 6.3 iCa 1.11 crea 5
11/3 CXR: minimal pleural effusion left. Pneumonic process, left mid and lower lung fields. Calcified right peribronchial lymphadenopathy
11/4 CBC: hgb 86 hct 25 wbc 16.10 plt 317 neutro 94, lympho 6; Na 133 K 6.0; ECG SR, gen low voltage
11/6 BUN 83.6 crea 5.7 Na 139 K 5.9; 11/9 pH 7.325 pCO2 30.3 pO2 140.6 HCO3 15.7 dFiO2 18.36 p/f 502
11/13 hgb 83 hct 0.24 plt 244 wbc 11.2 seg 88 lymph 11 eo 1; 11/25 UA: lt yellow, sl turbid, 6, 1.020, alb/sugar ++, RBC 10-15, pus 30-40, yeast +++ Bact +
11/29Hgb 125 Hct 0.37 Plt 368 WBC 23.7 N 0.85 L 0.13 E 0.02 12/03 Crea 2.0 Na 130 K 3.6 iCa 1.63
10/7 BUN 47.3, creatinine 2.3 / Blood CS
MGH
ESPANA
221G
Alfredo Macaraeg
73/M / ARF 2 to 1 COPD 2 Massive pleural effusion R
ASHD, CAD, SVT- AF in RVR AS TR severe moderate R pericardial effusion, NIF Class IVC
Autoimmune hemolytic anemia
s/p CTT 12/6/09 / Imipenem 500 mg/IV q6 D3
Fluconazole 200 mg/cap OD D1-2
Flixotide nebulization q12
Prednisone 10 mg/tab TID
Combivent neblization q6 / 12/4 iCa 1.18, Trop T +, BUN 32.1, PT 13.6, NC 12.2, INR 1.1, ot 27.8, NC 35.8, Crea 1.6, SGOT 62.9, SGPT 41.1, Na 130, K 5.6, CBC Hgb 103, Hct .32, Plt 345, WBC 37.8, neut .90, lymph .08 metamyelocytes .01, myelocytes .02
12/5 U/A Y, ST, 3, 1.025, alb +, sugar -, pus 1-3, bacteria ++, a. urate few
12/6 Crea .86, Total CHON 6.1, Alb 2.7, Globulin 3.3, A/G .80, LDH 450, Na 134, K 4.6
12/6 Pleural fluid 10 ml, yellow, turbid, protein 5.7, LDH 307, (-) AFB, (-) GS, total RBC 6.7, total WBC 569
12/6 Creatinine 0.86
12/7 CBC Hgb 85, hct 0.26, platelet 365, WBC 15.80, neutrophils 0.90, lymphocytes 0.10
12/9 CBC Hgb 97, hct 0.31, platelet 256, WBC 18.40, neutrophils 0.94, lymphocytes 0.06
12/10 Blood CS No growth after 5 days / For ABG and CXR
NEUROLOGY
202M
Edgardo Santos 50/M
09K00281
05-72-83
P09-23660 / Left cerebellar infarct s/p VP shunt
Acute respiratory failure 2 to central cause s/p tracheostomy / Fluimucil 600mg/tab BID / 11/12 GS trach asp: gram + cocci – few; 11/12 hgb 107 hct 0.31 plt 300 wnc 10.9 seg 81 lymph 17
11/21 hg b113 hct 0.33 wbc 20 neu 0.92 lym 0.07 eo 0.01 plt 436 11/24 Urine GS: no microorganisms
11/25 u/a yellow, sl. Turbid, pH 5.0 spgr 1.020, alb ++, sug (-), rbc 1-4 pus 0-2, bac ++, mt +
11/26 hgb 111 hct 0.32 wbc 10.10 neu 0.34 lym 0.21 mono 0.02 eo 0.03 plt 383
11/29 pH 7.449 pCO2 34.8 pO2 256.7 HCO3 24.1 dFiO2 17.67 P/F 802; 11/30 CXR: minimal PTB right upper lobe; 12/03 Crea 0.77
12/05 Hgb 114 Hct 0.33 Plt 279 WBC 18.70 N 0.88 L 0.10 E 0.02 / Signed out
For CXR (AP sitting)
Urinalysis
MGH
202 J
Durante, Gabriel
67/M
09J00857
05-67-98
DOA: 10/31/09
DOR: 10/31/09
P09-21706 / t/c aspiration pneumonia
ICH, right basal ganglia with IVE and mass effect probably hypertensive in origin, ICH score 2 / Doripenem 500mg/IV q8 (completed)
Fluconazole 200mg/cap OD (completed)
Fluimucil 600mg/tab BID
d/c Combivent nebulization
Ciprofloxacin 500 mg/tab 1 tab BID D2-3
Co-amoxyclav 1 gm/tab 1 tab BID D2-3 / 11/1 CXR: opacities in the right lower lung, suggestive of pneumonia. Heart is enlarged. Aorta is atherosclerotic. Diaphragm and sinuses intact. ET tube at the level of T5-T6; ET GS: Gram (-) bacilli +++
11/2 Sputum CS: Klebsiella pneumoniae heavy growth sensitive to Co-amoxyclav, Ciprofloxacin, Tobramycin, Cefazolin, Gentamycin, TMP-SMX, Imipenem, Pip-Tazo, Meropenem. Intermediate to Ampicillin-Sulbactam. Resistant to Ampicillin.
11/4 BUN 21 Crea 0.94 Na 150 K 4.0; CBC: hgb 111 hct 32 wbc 12.9 plt 287 neutro 88 eo 1 lympho 11
11/4 Pulmo parameters: RR: 38, IF: -32 cm H2O, RSBi: 95.5 L, Ve: 15.11 L, LA: 397.62 ml; HBA1c: 5.91 Na 148 K 4.0
11/10 CXR decrease in alveolar densities in RLL secondary to pneumonia, minimal alveolar densities LLL secondary to pneumonia, interstitital densities – diffuse on both lungs. Hemodiaphragm & costophrenic sulci intact.
11/12 pH 7.459 pCO2 36.5 pO2 141.3 HCO3 25.9 dFiO2 34% p/f 235; 11/13 hgb 101 hct 31 plt 709 wbc 11.5 seg 86 lymph13
11/16 ABG pH 7.476 pCO2 44.2 pO2 133.3 HCO3 32.6 O2 sat 98.8 a/A 0.57 dFiO2 27.44 P/F 332
11/17 yellow, turbid, 5, 1.025, alb -, sug +, RBC 80-90 pus 10-15 yeast few; 11/27 Na 133 K 3.6; hgb 108 hct 0.32 wbc 12.20 neu 0.85 lym 0.11 eo 0.04 plt 491
11/30 Hgb 118 Hct 0.35 Plt 549 WBC 16.5 N 0.85 L 0.15; SGPT 17.3; 12/01 pH 7.512 pCO2 44 pO2 88.4 HCO3 35.3 dFiO2 23% P/F 221
12/1 ABG pH 7.512, pCO2 44, pO2 88.4, FiO2 40, HCO3 35.3
12/9 ABG pH 7.411, pCO2 40.5, pO2 42.7, HCO3 25.7
12/9 CBC Hgb 109, hct 0.33, platelet 414, WBC 18.50, neutrophils 0.95, lymphocytes 0.05
12/10 CXR / ET aspirate GS/CS
Blood C/S at 2 diff sites
Debridement specimen GS, CS
T piece weaning
MICU
MICU B
Rosie Cruz
57/F
00-23-78
09L00068
12/3/09 / SLE not flare, ARF 2 to HAP, Hyperglycemia
2 to 1) Stress 2) steroids use,
MDD 2 to General medical condition,
AKI 2 to Hydration / Clindamycin 300 mg/cap q6 D6
Pip Tazo 4.5 g/vial ½ vial q8 D6
Rifampicin 300 mg/tab OD / 12/6 BUN 190 Crea 3.3
12/4 Crea 3.5, Na 137, K 4.2, Cl 99
12/4 U/A Dark yellow, turbid, pH 5,SG 1.o15, alb -, sugar +, RBC 80-90, pus 30-35, bacteria +, A. urate +, Ca oxa few
12/1 Crea 3.7, Na 142, K 3.9 ET Chryseobacterium indologenes S: Cefepime, Imipenem, TMP-Sulfa, Pip Tazo
11/30 CBC Hgb 86, Hct .26, Plt 290, WBC 25.0, Neut .91, Lymph .09 bands .01
11/30 CT scan Fibrosis on the left apex there is a separated pleural effusion seen over the R lateral hemithorax
extending into the R paravertebral region. Pleural thickening is seen. Mediastinal fascial are intact
11/29 BUN 87.7, Crea 4.1, Na 150, K 5.3, ETA no acid fast seen PMN >25, SQ 0-5
Na 140, K 5.1, iCa 1.31 CXR: partial clearing of the loculated effusion on the right side. Patchy opacities
with lucencies are still right lung cardiac size magnified
12/5 CBC Hgb 102, hct 0.31, platelet 209, WBC 21.10, neutrophils 0.90, lymphocytes 0.10
12/6 Creatinine 3.3, BUN 190
12/6 Fecalysis no parasite/ova, few RBC, few yeast cell
12/7 Na 143, K 4.6
12/8 CBC Hgb 87, hct 0.26, platelet 250, WBC 20.20, neutrophils 0.90, lymphocytes 0.09, monocytes 0.1
12/9 CXR Moderate R sided pleural effusion / For UTZ KUB
For diagnostic tap of pleural effusion
FSW
302C
Perez, Meynardo
63/M
03-49-91
09L00180 / Complicated UTI secondary to prostate adenocarcinoma Gleason’s score 9 / Piptazo 4.5 g/IV q8 (1 dose given) decreased to 2.25 g/IV q8 then shift to Ertapenem 500 mg/IV OD D2 / 12/1 Urine CS K. pneumoniae >100,000 CFU/ml sensitive to Amikacin, Piperacillin-Tazobactam, Cefazolin, Ertapenem, Imipenem
12/7 CBC Hgb 136, hct 0.39, platelet 453, WBC 15.40, neutrophils 0.88, bands 0.01, lymphocytes 0.10, monocytes 0.01, eosinophils 0.01
12/7 creatinine 3.8
12/8 Na 131, K 3.2, iPO4 4.1, iCa 1.27
12/8 ABG pH 7.404, pCO2 23.5, pO2 100.6, FiO2 21, HCO3 14.7
12/10 Urine GS no microorganisms seen
12/10 UA light yellow, alightly turbid, pH 6, SG 1.015, albumin ++, sugar +, RBC 20-25/hpf, pus cell 60-65/hpf, bacteria ++
12/10 Creatinine 2.7 / Awaiting urine CS
304C
Pilar Singson
85/F
05-67-24
09L00147 / Ureterolithiasis, nephrolithiasis, complicated UTI / Co-amoxyclav 625 mg/tab BID D2 / 12/6 UA yellow, turbid, pH 6.5, SG 1.015, + albumin, (-) sugar, RBC 2-5/hpf, pus cells over 100/hpf, bacteria ++++
12/6 CBC Hgb 99, hct 0.29, platelet 300, WBC 5.20, neutrophils 0.52, lymphocytes 0.44, monocytes 0.01, eosinophils 0.03
12/6 Urine GS No microorganisms seen
12/10 Urine CS E. coli sensitive to Co-amoxyclav
12/10 Ureteral stone analysis Ca oxalate ++, Ca phosphate + / MGH
306B
Pacino, Adelina
54/F
00-93-83
09K00817 / Breast CA St. IVA, L, s/p MRM, t/c AGE, complicated UTI, acute gout / Ceftazidime 2 gm/IV q48h discontinued
Ciprofloxacin 500 mg/tab q12 (completed)
Medrol 4 mg/tab 1 tab OD post breakfast / 12/5 CBC Hgb 103, hct 0.30, platelet 371, WBC 11.70, neutrophils 0.81, lymphocytes 0.17, eosinophils 0.02
12/5 UA yellow, slightly turbid, pH 7, SG 1.015, + albumin, (-) sugar, pus cell 50-55/hpf, bacteria +++
12/7 UA yellow, slightly turbid, pH 7, SG 1.010, albumin +, sugar (-), RBC 0-1/hpf, pus cells 4-8/hpf, squamous cell few, bacteria +++
12/7 Urine GS (-) / Cleared for chemotherapy
310B
Nolasco, Gloria Greta 44/F
05-85-98
P09-23098 / TB Lymphadenitis
T9-T10 spinal tumor intradual, extramedullary; t/c nerve sheath tumor, s/p T9-T10 laminectomy for excision of spinal cord tumor (12/10/09) / Oxacillin 500 mg/IV q8 / 12/02 CXR: normal chest; Hgb 138 Hct 0.41 Plt 251 WBC 7.50 N 0.65 L 0.30 E 0.04 M 0.01
12/02 Crea 0.77 SGPT 22.3 Na 135 K 3.9; U/A: dark yellow, clear, 6, 1.020, alb/sugar -, RBC 0-2 AU few / Signed out
SICU
SICU C
Alcoran, Luz
62/F
05-80-00
09L00137 / SAH 2 to ruptured ACOM aneurysm s/p VPS (12/02/09) / Piptazo 4.5 g/IV q8 D2 / 12/8 CBC Hgb 128, hct 0.41, platelet 247, WBC 17.20, neutrophils 0.87, lymhphocytes 0.13
12/8 BUN 9.6, creatinine 0.71, Na 138, K 3.4, iCa 1.12
12/10 CBC Hgb 111, hct 0.33, platelet 319, WBC 21.80, neutrophils 0.89, lymphocytes 0.11
12/10 CXR Haziness both UL and R paracardiac area, there is progression of the suspicious infiltrates ote don the RUL on previous CXR (12/09/09), t/c pneumonia
SICU D
Nazareno, Jimmy / ICH, L thalamoganglionic area approx 145 cc w/ IVE & acute communicating hydrocephalus ICH 3
ARF prob sec to central cause r/o aspiration pneumonia
s/p IJ catheter insertion
s/p tracheostomy (12/10/09) / Combivent neb q8h
Pip-tazo 2.25g/IV q8 (D5-6)
Fluimucil 200mg/IV BID
Imipenem 250 mg/IV q12 D3 / 11/27 BUN 55.3 Crea 5.2 SGOT 29.1 SGPT 14.3 Na 137 K 3.0 iCa 1.19; FBS 106 Chole 202 TG 88.7 HDL 50.5 LDL 127
11/27 u/a light yellow, turbid, pH 5.0 spgr 1.020 alb +++, sug +, rbc 3-5, Pus 2-4, sq few, bac +, transitional cell ++, a urate ++++
11/27 hgb 121 hct 0.36 wbc 17.10 neu 0.85 lym 0.14 eo 0.01 plt 269: PT 11.7 PT ratio 1.0 APTT 25.4
11/27 CXR: cardiomegaly, tortuous aorta, sl. Elevated hemidiaphrgm most likely due to sitting position
11/29 BUN 59.6 Crea 5.5 Na 141 K 4.8 iPO4 5.9; pH 7.22 pCO2 32.3 pO2 138.3 HCO3 13.3 dFiO2 25.69 P/F 345
12/01 ET culture: Serratia marcescens S: Pip-tazo; Crea 5.9, Na 144, K 4.6
12/01 Hgb 104 hct 0.31 plt 220 WBC 9.40 N 0.89 L 0.11; pH 7.381 pCO2 20.9 pO2 66.1 HCO3 12.4 dFiO2 95.9% P/F 82.63
12/02 ET aspirate CS: Serratia marcescens – heavy growth
12/03 CXR R sided IJ catheter with its tip located in the SVC
12/7 Blood CS No growth after 5 days
12/7 CBC Hgb 102, hct 0.30, platelet 261, WBC 10, neutrophils 0.87, lymphocytes 0.12, eosinophils 0.01 / On HD
MSW
307D
Espinosa, Felix 60/M / DM foot s/p ‘E’ debridement / Pip-tazo 4.5g/IV ½ vial q8h (D9)
Paracetamol 500mg/tab q4h prn
Clindamycin 300 mg/cap q6 discontinued
Ciprofloxacin 500 mg/tab BID discintinued / 11/30 CBC: Hgb 88 Hct 0.25 Plt 281 WBC 19.40 N 0.90 L 0.10; HbA1C 6.50 Crea 2.4 SGPT 44.5
12/01 CXR: solitary pulmonary nodule probably small granuloma at the left mid lung field; atheromatous aorta
12/01 XR of R foot: suggestive of diabetic gangrene; no roentgen evidence of osteomyelitis
12/01 Urine Na 20.4 Urine K 23.0 Urine Osm 252; BUN 54.0 Na 122 K 3.5 SGPT 62.5 iPO4 2.4 iCa 1.14 Plasma Osm 276
12/01 CBC: Hgb 91 Hct 0.26 Plt 250 WBC 15.80 N 0.87 L 0.13; pH 7.457, pCO2 28.5, pO2 91.1, dFiO2 19.2, P/F 433.81
12/02 BUN 51.6 Crea 1.9 Na 120 K 3.8; 12/03 Hgb 80 Hct 0.23 Plt 241 WBC 20 N 0.95 L 0.05
12/04 yellow, sl turbid, 5, 1.015, alb/sugar -, RBC 1-2, pus 0-1, sq few, bact +++, AU +; iCa 1.14 Crea 2.5 Na 122 K 3.6; drainage GS: (+) cocci in pairs few
12/6 Blood CS no growth after 5 days
12/6 CXR Consider pneumoniaboth lower lobes more on the R, r/o pleural effusion R, atheromatous aorta
12/9 TSH 0.61, FT3 <0.31, FT4 12.5 / BKA 12/14/09 7 am
307E
Commendador, Crister
18/M
09K00619
057989 / Ruptured hepatic abscess s/p drainage / Metronidazole 500mg/tab 1½ q8h discontinued
Clindamycin 300mg/cap q6 D10 / 11/24 hgb 115, hct 0.33, wbc 17.3, seg 0.82, lym 0.18, plt 267
11/24 BUN 25.3, crea 1.2, Na 135, K 3.7
11/24 peritoneal fluid C/S + MRSA
11/27 HGB 110 HCT 0.32 PLT 259 WBC 34.4 neutro 0.93 lympho 0.07
11/27 Crea 0.59 ALP 159 SGOT 38.6 SGPT 45 PT 17.5 INR 1.4 APTT 40
11/28 CXR: moderate effusion, L side, UTZ of whole abdomen – bilateral pleural effusion / For aspiration of hepatic abscess, GS, CS, repeat CBC
311F
Arnel Eugenio
44/M
05-75-93
09K00429 / SAH probably 2 to ruptured ACOM aneurysm s/p ‘E’ ventricuostomy (11/28/09) / Cetriaxone 2 gm/IV q12 D3-4 shifted to Vancomycin 1 g in 90 cc PNSS to run for 2 hours q12, Levofloxacin 750 mg/tab OD / 12/8 CSF CS S. epidermidis sensitive to chloramphenicol, tetracycline, vancomycin, 2 mL, reddish, turbid CBG 140, glucose 68.8 – 49%, total protein 55.7, total RBC 12.83, total WBC 54
12/10 CSF with ARD: (+) bacterial growth after 5 hours total protein 138, glucose 49.7, GS – gram (+) cocci in pairs, total RBC 8.4, total WBC 1.1 (97% neutrophils, 3% lymphocytes) / For foley catheter removal and UA
SAN DAMIAN
317C
Daniel Eusantos
63/M
09100586
02-38-88
P09-21179
P09-20028 / SCCA floor of the mouth St. IVA (T3N2Amx) s/p wide excision of floor of the mouth with mandibulectomy, MRND,L Reconstruction using clavicle and SCM graft with tracheostomy s/p closure of fistula with tongue flap reconstruction (5/8) s/p radial forearm flap with reconstruction with split thickness skin graft, L
Surgical site infection / Erdosteine 300mg/cap BID
Combivent nebullization q6h
Pip-Tazo 4.5gm/IV q8h (D2-3) / 10/20 wound discharge from neck Cand S kleb pnemonia: heavy growth, sen to co-amox, cipro, sulb-amp, gentamycin, tobra, merop, imipenem, pip-tazo, TMP-smx; resistant to ampicillin; pseudo au: heavy growth, sen to amikacin, imipenem, piptazo, ceftazidime, cipro, tobra, cefexime, genta, int to aztreonam,
10/20 Crea 0.51 hgb 105, hct 0.29, plt 354, wbc 10.80, neutro 0.88/bands 0.01/segm 0.87, lympho 0.11, mono 0.01
10/20 CXR: chronic fibroid right upper lobe; bronchiectasis right lower lobe, atheromatous aorta
10/30 CBC: hgb 98 hct 27 wbc 13.8 plt 406 neutro 87 mono 1 lympho 12
11/3 CXR: no significant interval change
11/3 Crea 0.54
11/3 CBC: hgb 96 hct 27 wbc 9.9 plt 399 neutro 74 mono 1 eo 1 lympho 24
11/26 hgb 101 hct 0.30 wbc 16.70 neu 0.92 lym 0.08
11/29 hgb 113 hct .33 plt 380 WBC 16.8 seg .76 bands .03 lym .18 mono .02 eo .01
12/5 Abscess CS Citrobacter kosesi (heavy growth) sensitive to Amikacin, Ciprofloxacin, Cefazolin, Piperacillin-Tazobactam, Ertapenem, Imipinem, Tobramycin / s/p suturing of wound dehiscence
323F
Vargas, Rosa
48/F
04-09-30
09L00120 / SJS, s/p PKP, OS (Jan. 2009), s/p amniotic membrane tranplant, OS (June 2009) secondary to fungal keratitis / Cefazolin eye drops q2
Fluconazole eye drops q2
Moxifloxacin eye drops q2
Itraconazole 200 mg/tab BID D1
Ciprofloxacin 500 mg/tab BID D1 / 12/5 CXR Pneumonitis R base, suspicious R mid lung calcification
12/5 CBC Hgb 114, hct 0.34, platelet 271, WBC 6.10, neutrophils 0.47, lymphocytes 0.51, eosinophils 0.02 / Cleared for Ciprofloxacin use
OB-GYN
ISO 143 A
Roselyn Sordilla
29/F
09K00494
05-77=24 / Ovarian new growth, probably malignant, t/c cervical pathology, t/c epidermal inclusion cyst, Miliary TB / Myrin P forte, 3 tabs 30 minutes before breakfast OD (started 11/17/09) / 11/16 CXR: highly suggestive of military TB
11/17 Sputum AFB no acid fast bacilli
11/17 Urine GS- no microorganism seen in both centrifuged and uncentrifuged samples
11/18 Endometrial and endocervical biopsy: Chronic caseating granulomatous endometritis and endocervcitis consistent with TB
11/19 Sputum AFB day1: (-) AFB Day 2: 3+ AFB Day 3: (-) AFB
11/19 hgb 140 hct 0.43
11/20 Total CHON: 6.6, alb 2.0, glob 4.6, A/G 6.43, ; 11/20 hgb 140 hct 0.43
11/20 pH 7.385 pCO2 28.6 PO2 93.1 Hco3 97.1 dfiO2 18.87 PF 443
11/24 u/A yellow, sl. Turbid, pH 5.0, spgr 1.020, alb (-), sug (-), rbc 4-6, pus 15-20, sq cell +, bac +, MT few
11/25 urine AFB: (-) AFB; 11/27 Sputum (-) AFB PMN > 25 sq >25; 11/29 Sputum (-) AFB PMN >25 Sq > 25
12/01 SFA: persistent min. extravasation of barium noted at rectosigmoid region, neoplastic infiltration cannot be totally ruled out
12/03 U/A yellow, sl turbid, 5.0, 1.015, alb/sugar +++, hyaline 02, granular 02, RBC 2-4, pus 10-15, sq few, TEC +, Bact ++
Consultant: Dr. PanaliganID Fellow: Dr. RanolaID Resident: Dr. Sempio