,DATETIME,24 Hour Events:,full_24 Hour Events:,past_24 Hour Events:,SUBJECT_ID,hadmid
0,2163-02-24 06:47:22,,"['FEVER - 103.0', 'F - [**2163-2-23**] 09:00 PM']",,44146,163043.0
1,2163-02-24 10:54:11,"['Admitted to ICU for relative hypotension', '[**Name2 (NI) 1490**] 7.5L NS o/n', 'BP improved', 'Started on vanc/CTX/azithromycin', 'O2 requirment increased overnight']","['Admitted to ICU for relative hypotension', '[**Name2 (NI) 1490**] 7.5L NS o/n', 'BP improved', 'Started on vanc/CTX/azithromycin', 'O2 requirment increased overnight']","['FEVER - 103.0', 'F - [**2163-2-23**] 09:00 PM']",44146,163043.0
2,2163-02-24 10:57:00,,"['Admitted to ICU for relative hypotension', '[**Name2 (NI) 1490**] 7.5L NS o/n', 'BP improved', 'Started on vanc/CTX/azithromycin', 'O2 requirment increased overnight']",,44146,163043.0
0,2106-03-29 07:13:52,,['- on nasal cannula overnight'],,42055,171088.0
1,2106-03-29 07:14:40,,['- on nasal cannula overnight'],,42055,171088.0
2,2106-03-29 07:15:15,,['- on nasal cannula overnight'],,42055,171088.0
3,2106-03-29 10:14:30,,['- on nasal cannula overnight'],,42055,171088.0
4,2106-03-30 07:52:10,"['CALLED OUT, unable to find a bed', 'Did well overnight', 'History obtained from Patient']","['CALLED OUT, unable to find a bed', 'Did well overnight', 'History obtained from Patient']",['- on nasal cannula overnight'],42055,171088.0
5,2106-03-30 07:53:42,,"['CALLED OUT, unable to find a bed', 'Did well overnight', 'History obtained from Patient']",,42055,171088.0
0,2136-05-29 07:36:55,,"['URINE CULTURE - At [**2136-5-29**] 03:36 AM', ' STOOL CULTURE - At [**2136-5-29**] 03:51 AM', ' FEVER - 101.2', 'F - [**2136-5-29**] 01:30 AM']",,48340,144841.0
1,2136-05-29 11:08:28,,"['URINE CULTURE - At [**2136-5-29**] 03:36 AM', ' STOOL CULTURE - At [**2136-5-29**] 03:51 AM', ' FEVER - 101.2', 'F - [**2136-5-29**] 01:30 AM']",,48340,144841.0
2,2136-05-29 18:10:00,,"['URINE CULTURE - At [**2136-5-29**] 03:36 AM', ' STOOL CULTURE - At [**2136-5-29**] 03:51 AM', ' FEVER - 101.2', 'F - [**2136-5-29**] 01:30 AM']",,48340,144841.0
0,2186-10-18 07:39:34,,"['-IVC filter placed last night', '-head ct obtained']",,73037,192662.0
1,2186-10-18 07:41:41,,"['-IVC filter placed last night', '-head ct obtained']",,73037,192662.0
2,2186-10-18 09:36:49,,"['-IVC filter placed last night', '-head ct obtained']",,73037,192662.0
3,2186-10-18 09:53:46,,"['-IVC filter placed last night', '-head ct obtained']",,73037,192662.0
4,2186-10-19 07:51:19,"['ECHO with bubble study - RV dilation and hypokinesis. Mod pulm HTN.', 'Mild LVH, nl systolic function.  Findings c/w pulmonary emboli. No ASD', 'or PFO identified.', 'CT head - no e/o of recent hemorrhage', 'Heparin gtt started with close monitoring given hx of bleed', 'Neuro consult - risk/benefit ratio favors anticoagulation, but avoid', ""boluses; con't simvastatin/ezetimide for HLD and lisinpril for HTN to"", 'lower ischemic stroke risk.']","['ECHO with bubble study - RV dilation and hypokinesis. Mod pulm HTN.', 'Mild LVH, nl systolic function.  Findings c/w pulmonary emboli. No ASD', 'or PFO identified.', 'CT head - no e/o of recent hemorrhage', 'Heparin gtt started with close monitoring given hx of bleed', 'Neuro consult - risk/benefit ratio favors anticoagulation, but avoid', ""boluses; con't simvastatin/ezetimide for HLD and lisinpril for HTN to"", 'lower ischemic stroke risk.']","['-IVC filter placed last night', '-head ct obtained']",73037,192662.0
5,2186-10-19 07:52:20,,"['ECHO with bubble study - RV dilation and hypokinesis. Mod pulm HTN.', 'Mild LVH, nl systolic function.  Findings c/w pulmonary emboli. No ASD', 'or PFO identified.', 'CT head - no e/o of recent hemorrhage', 'Heparin gtt started with close monitoring given hx of bleed', 'Neuro consult - risk/benefit ratio favors anticoagulation, but avoid', ""boluses; con't simvastatin/ezetimide for HLD and lisinpril for HTN to"", 'lower ischemic stroke risk.']",,73037,192662.0
6,2186-10-19 11:29:09,,"['ECHO with bubble study - RV dilation and hypokinesis. Mod pulm HTN.', 'Mild LVH, nl systolic function.  Findings c/w pulmonary emboli. No ASD', 'or PFO identified.', 'CT head - no e/o of recent hemorrhage', 'Heparin gtt started with close monitoring given hx of bleed', 'Neuro consult - risk/benefit ratio favors anticoagulation, but avoid', ""boluses; con't simvastatin/ezetimide for HLD and lisinpril for HTN to"", 'lower ischemic stroke risk.']",,73037,192662.0
0,2134-10-02 06:46:40,,"['EKG - At [**2134-10-1**] 11:30 AM', '- Viral antigens negative -> taken off droplet precautions', '- Outpatient neurologist e-mail with ? if she wants any MS medication', 'changes.', '- Patient quite confused/hallucinating overnight', '- Desats to mid-80s when she pulls her mask off.']",,54514,125949.0
1,2134-10-02 07:35:15,,"['EKG - At [**2134-10-1**] 11:30 AM', '- Viral antigens negative -> taken off droplet precautions', '- Outpatient neurologist e-mail with ? if she wants any MS medication', 'changes.', '- Patient quite confused/hallucinating overnight', '- Desats to mid-80s when she pulls her mask off.']",,54514,125949.0
2,2134-10-02 08:38:50,,"['EKG - At [**2134-10-1**] 11:30 AM', '- Viral antigens negative -> taken off droplet precautions', '- Outpatient neurologist e-mail with ? if she wants any MS medication', 'changes.', '- Patient quite confused/hallucinating overnight', '- Desats to mid-80s when she pulls her mask off.']",,54514,125949.0
3,2134-10-02 09:50:46,,"['EKG - At [**2134-10-1**] 11:30 AM', '- Viral antigens negative -> taken off droplet precautions', '- Outpatient neurologist e-mail with ? if she wants any MS medication', 'changes.', '- Patient quite confused/hallucinating overnight', '- Desats to mid-80s when she pulls her mask off.']",,54514,125949.0
4,2134-10-03 06:37:58,,[],"['EKG - At [**2134-10-1**] 11:30 AM', '- Viral antigens negative -> taken off droplet precautions', '- Outpatient neurologist e-mail with ? if she wants any MS medication', 'changes.', '- Patient quite confused/hallucinating overnight', '- Desats to mid-80s when she pulls her mask off.']",54514,125949.0
5,2134-10-03 06:40:16,"['- Pt stable overnight from respiratory stance', '- Rash noted on patients skin folds posteriorly']","['- Pt stable overnight from respiratory stance', '- Rash noted on patients skin folds posteriorly']",,54514,125949.0
6,2134-10-03 11:41:03,['- Pt stable overnight from respiratory status'],"['- Pt stable overnight from respiratory status', '- Rash noted on patients skin folds posteriorly']",['- Pt stable overnight from respiratory stance'],54514,125949.0
7,2134-10-04 07:45:55,"['EKG - At [**2134-10-3**] 08:06 AM', ' EKG - At [**2134-10-3**] 02:28 PM', ' INVASIVE VENTILATION - START [**2134-10-3**] 09:25 PM', ' ARTERIAL LINE - START [**2134-10-4**] 04:03 AM', '-Notified Dr. [**First Name8 (NamePattern2) 1806**] [**Last Name (NamePattern1) **] (neuro) by e-mail that the pt is here', '-Pt is stable on Acetazolamide at home so this was restarted', '-At approx 8pm, pt found without O2 mask on in resp distress. Placed', 'back on mask then given a total of 2 mg Ativan and 2 mg morphine for', 'incr WOB, distress without effect. Placed on BiPAP with gas 7.29/ 39', '/111/ 20 but pt still in distress and fighting BiPAP. Anaesthesia', 'intubated. On assist control with fentanyl and versed gtt (needing incr', 'amts- ?tolerance). Post extubation gas with resp acid 7.16/ 61 /346/ 23', '-Just prior to intubation, started on Methylprednisolone 60 Q 8 and', 'given lasix 20 IVx1.', '- In am, EKG taken with some TWI but CE flat', '-Neuro status in pm prior to intubation stable- oriented x3 and freely', 'moving all 4 extremities']","['EKG - At [**2134-10-3**] 08:06 AM', ' EKG - At [**2134-10-3**] 02:28 PM', ' INVASIVE VENTILATION - START [**2134-10-3**] 09:25 PM', ' ARTERIAL LINE - START [**2134-10-4**] 04:03 AM', '-Notified Dr. [**First Name8 (NamePattern2) 1806**] [**Last Name (NamePattern1) **] (neuro) by e-mail that the pt is here', '-Pt is stable on Acetazolamide at home so this was restarted', '-At approx 8pm, pt found without O2 mask on in resp distress. Placed', 'back on mask then given a total of 2 mg Ativan and 2 mg morphine for', 'incr WOB, distress without effect. Placed on BiPAP with gas 7.29/ 39', '/111/ 20 but pt still in distress and fighting BiPAP. Anaesthesia', 'intubated. On assist control with fentanyl and versed gtt (needing incr', 'amts- ?tolerance). Post extubation gas with resp acid 7.16/ 61 /346/ 23', '-Just prior to intubation, started on Methylprednisolone 60 Q 8 and', 'given lasix 20 IVx1.', '- In am, EKG taken with some TWI but CE flat', '-Neuro status in pm prior to intubation stable- oriented x3 and freely', 'moving all 4 extremities']","['- Pt stable overnight from respiratory status', '- Rash noted on patients skin folds posteriorly']",54514,125949.0
8,2134-10-04 09:32:09,,"['EKG - At [**2134-10-3**] 08:06 AM', ' EKG - At [**2134-10-3**] 02:28 PM', ' INVASIVE VENTILATION - START [**2134-10-3**] 09:25 PM', ' ARTERIAL LINE - START [**2134-10-4**] 04:03 AM', '-Notified Dr. [**First Name8 (NamePattern2) 1806**] [**Last Name (NamePattern1) **] (neuro) by e-mail that the pt is here', '-Pt is stable on Acetazolamide at home so this was restarted', '-At approx 8pm, pt found without O2 mask on in resp distress. Placed', 'back on mask then given a total of 2 mg Ativan and 2 mg morphine for', 'incr WOB, distress without effect. Placed on BiPAP with gas 7.29/ 39', '/111/ 20 but pt still in distress and fighting BiPAP. Anaesthesia', 'intubated. On assist control with fentanyl and versed gtt (needing incr', 'amts- ?tolerance). Post extubation gas with resp acid 7.16/ 61 /346/ 23', '-Just prior to intubation, started on Methylprednisolone 60 Q 8 and', 'given lasix 20 IVx1.', '- In am, EKG taken with some TWI but CE flat', '-Neuro status in pm prior to intubation stable- oriented x3 and freely', 'moving all 4 extremities']",,54514,125949.0
9,2134-10-05 07:28:48,"['- Troponin positive -> started on ASA and BB', '- Got repeat CTA to see if decompensation was PE -> no PE, positive for', 'aspiration PNA per radiologist (WET READ).', ""- d/c'ed acetazolamide"", '- Pulled back ET tube', '- Tube feeds started', '- cultures with NGTD- sputum sent overnight']","['- Troponin positive -> started on ASA and BB', '- Got repeat CTA to see if decompensation was PE -> no PE, positive for', 'aspiration PNA per radiologist (WET READ).', ""- d/c'ed acetazolamide"", '- Pulled back ET tube', '- Tube feeds started', '- cultures with NGTD- sputum sent overnight']","['EKG - At [**2134-10-3**] 08:06 AM', ' EKG - At [**2134-10-3**] 02:28 PM', ' INVASIVE VENTILATION - START [**2134-10-3**] 09:25 PM', ' ARTERIAL LINE - START [**2134-10-4**] 04:03 AM', '-Notified Dr. [**First Name8 (NamePattern2) 1806**] [**Last Name (NamePattern1) **] (neuro) by e-mail that the pt is here', '-Pt is stable on Acetazolamide at home so this was restarted', '-At approx 8pm, pt found without O2 mask on in resp distress. Placed', 'back on mask then given a total of 2 mg Ativan and 2 mg morphine for', 'incr WOB, distress without effect. Placed on BiPAP with gas 7.29/ 39', '/111/ 20 but pt still in distress and fighting BiPAP. Anaesthesia', 'intubated. On assist control with fentanyl and versed gtt (needing incr', 'amts- ?tolerance). Post extubation gas with resp acid 7.16/ 61 /346/ 23', '-Just prior to intubation, started on Methylprednisolone 60 Q 8 and', 'given lasix 20 IVx1.', '- In am, EKG taken with some TWI but CE flat', '-Neuro status in pm prior to intubation stable- oriented x3 and freely', 'moving all 4 extremities']",54514,125949.0
10,2134-10-05 13:35:48,,"['- Troponin positive -> started on ASA and BB', '- Got repeat CTA to see if decompensation was PE -> no PE, positive for', 'aspiration PNA per radiologist (WET READ).', ""- d/c'ed acetazolamide"", '- Pulled back ET tube', '- Tube feeds started', '- cultures with NGTD- sputum sent overnight']",,54514,125949.0
11,2134-10-06 06:52:33,"['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent']","['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent']","['- Troponin positive -> started on ASA and BB', '- Got repeat CTA to see if decompensation was PE -> no PE, positive for', 'aspiration PNA per radiologist (WET READ).', ""- d/c'ed acetazolamide"", '- Pulled back ET tube', '- Tube feeds started', '- cultures with NGTD- sputum sent overnight']",54514,125949.0
12,2134-10-06 08:07:28,,"['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent']",,54514,125949.0
13,2134-10-06 11:43:14,,"['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent']",,54514,125949.0
14,2134-10-06 12:09:27,['- Neuro not contact[**Name (NI) **] about ? haldol'],"['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent', '- Neuro not contact[**Name (NI) **] about ? haldol']",,54514,125949.0
15,2134-10-07 07:15:21,,[],"['- Transitioned from AC to PS', '- CT revealing atypical PNA and tracheomalacia', '- IP: No stent', '- Neuro not contact[**Name (NI) **] about ? haldol']",54514,125949.0
16,2134-10-07 07:58:25,"['- Extubated in evening uneventfully- post-extubation gas 7.45/ 44/ 130/', '32', '- Did have agitation s/p extubation treated with Morphine for total of', '4mg in 4 hrs s/p extubation and 2 Ativan.', '-Per family, pt using only 40mg Oxycontin [**Hospital1 **] (converts to 1.6 mg IV', 'morphine/hr) and no benzos PTA however she was apparently seeing people', 'watching her from her porch and called the police on these', 'hallucinatory people at least once.', '-Plan for agitation- try morphine 2mg first then could try haldol.', '- Neuro agrees Haldol is ok in this pt and to treat agitation as you', 'would with any other pt', '- Cx with NGTD', ""- U/A ordered for pt's dark urine""]","['- Extubated in evening uneventfully- post-extubation gas 7.45/ 44/ 130/', '32', '- Did have agitation s/p extubation treated with Morphine for total of', '4mg in 4 hrs s/p extubation and 2 Ativan.', '-Per family, pt using only 40mg Oxycontin [**Hospital1 **] (converts to 1.6 mg IV', 'morphine/hr) and no benzos PTA however she was apparently seeing people', 'watching her from her porch and called the police on these', 'hallucinatory people at least once.', '-Plan for agitation- try morphine 2mg first then could try haldol.', '- Neuro agrees Haldol is ok in this pt and to treat agitation as you', 'would with any other pt', '- Cx with NGTD', ""- U/A ordered for pt's dark urine""]",,54514,125949.0
17,2134-10-07 15:49:55,,"['- Extubated in evening uneventfully- post-extubation gas 7.45/ 44/ 130/', '32', '- Did have agitation s/p extubation treated with Morphine for total of', '4mg in 4 hrs s/p extubation and 2 Ativan.', '-Per family, pt using only 40mg Oxycontin [**Hospital1 **] (converts to 1.6 mg IV', 'morphine/hr) and no benzos PTA however she was apparently seeing people', 'watching her from her porch and called the police on these', 'hallucinatory people at least once.', '-Plan for agitation- try morphine 2mg first then could try haldol.', '- Neuro agrees Haldol is ok in this pt and to treat agitation as you', 'would with any other pt', '- Cx with NGTD', ""- U/A ordered for pt's dark urine""]",,54514,125949.0
18,2134-10-08 06:35:14,"[""- d/c'd a-line"", '- called out, no bed']","[""- d/c'd a-line"", '- called out, no bed']","['- Extubated in evening uneventfully- post-extubation gas 7.45/ 44/ 130/', '32', '- Did have agitation s/p extubation treated with Morphine for total of', '4mg in 4 hrs s/p extubation and 2 Ativan.', '-Per family, pt using only 40mg Oxycontin [**Hospital1 **] (converts to 1.6 mg IV', 'morphine/hr) and no benzos PTA however she was apparently seeing people', 'watching her from her porch and called the police on these', 'hallucinatory people at least once.', '-Plan for agitation- try morphine 2mg first then could try haldol.', '- Neuro agrees Haldol is ok in this pt and to treat agitation as you', 'would with any other pt', '- Cx with NGTD', ""- U/A ordered for pt's dark urine""]",54514,125949.0
19,2134-10-08 06:37:21,,"[""- d/c'd a-line"", '- called out, no bed']",,54514,125949.0
20,2134-10-08 14:51:13,"['- diet advanced', '- Vanc D#7, Zosyn D#5']","[""- d/c'd a-line"", '- called out, no bed', '- diet advanced', '- Vanc D#7, Zosyn D#5']",,54514,125949.0
0,2119-11-07 07:31:15,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
1,2119-11-07 07:32:13,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
2,2119-11-07 10:36:34,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
3,2119-11-07 10:42:20,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
4,2119-11-07 10:52:02,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
5,2119-11-07 10:59:46,,"['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",,92281,164460.0
6,2119-11-08 07:06:29,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']","['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']","['MULTI LUMEN - START [**2119-11-7**] 03:34 AM', '-Hypotensive 80s/40s despite 8L IV fluids', '-HCT 19 -got 3u PRBCs, 3u FFP --> BP 90s/50s', '-NG lavage negative', '-L IJ placed (failed attempt at R IJ)', 'Hepatology planning for EGD and colonoscopy in afternoon', '-wanted prep with 4L Golytely -patient vomited early this morning', ""-AM GI recs: NG tube with prep. If doesn't tolerate, try tap water"", 'enema.', '-swtich to ceftriaxone for presumed SBP']",92281,164460.0
7,2119-11-08 07:07:13,,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",,92281,164460.0
8,2119-11-08 07:10:43,,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",,92281,164460.0
9,2119-11-08 07:11:57,,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",,92281,164460.0
10,2119-11-08 13:33:47,,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",,92281,164460.0
11,2119-11-08 13:45:54,,"['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",,92281,164460.0
12,2119-11-09 06:54:34,"['-cdiff negative, flagyl discontinued', '-stool studies thus far negative, CMV VL pending', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no rpt tap', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']","['-cdiff negative, flagyl discontinued', '-stool studies thus far negative, CMV VL pending', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no rpt tap', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']","['PARACENTESIS - At [**2119-11-7**] 03:33 PM', ' STOOL CULTURE - At [**2119-11-8**] 03:00 AM']",92281,164460.0
13,2119-11-09 06:55:12,,"['-cdiff negative, flagyl discontinued', '-stool studies thus far negative, CMV VL pending', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no rpt tap', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']",,92281,164460.0
14,2119-11-09 08:00:58,,"['-cdiff negative, flagyl discontinued', '-stool studies thus far negative, CMV VL pending', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no rpt tap', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']",,92281,164460.0
15,2119-11-09 12:08:07,"['-stool O+P thus far negative', '-CMV VL borderline positive (600)']","['-cdiff negative, flagyl discontinued', '-stool O+P thus far negative', '-CMV VL borderline positive (600)', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no rpt tap', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']","['-stool studies thus far negative, CMV VL pending']",92281,164460.0
16,2119-11-09 12:16:38,['-hepatology ok with no repeat paracentesis'],"['-cdiff negative, flagyl discontinued', '-stool O+P thus far negative', '-CMV VL borderline positive (600)', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no repeat paracentesis', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']",['-hepatology ok with no rpt tap'],92281,164460.0
17,2119-11-10 06:38:15,"['-Called out -but called back in b/c of significant bleeding from L IJ', 'site', '-changed tenofovir to [**Last Name (LF) 9806**], [**First Name3 (LF) 77**] [**Doctor Last Name 9235**]', '-hepatology wanted end of life discussion', '-palliative care consulted: ativan, dilaudid, family meeting regarding', 'goals of care and hospice, changed code status']","['-Called out -but called back in b/c of significant bleeding from L IJ', 'site', '-changed tenofovir to [**Last Name (LF) 9806**], [**First Name3 (LF) 77**] [**Doctor Last Name 9235**]', '-hepatology wanted end of life discussion', '-palliative care consulted: ativan, dilaudid, family meeting regarding', 'goals of care and hospice, changed code status']","['-cdiff negative, flagyl discontinued', '-stool O+P thus far negative', '-CMV VL borderline positive (600)', '-CXR with worsened edema, but per rads off read canno exclude new', 'consolidation', '-urine anion gap = 65+14-36 =+43 which favors RTA over diahrrea as', 'etiology', '-ketones negative', '-hepatology ok with no repeat paracentesis', '-Hct stable over yesterday, but continued significant oozing on CVL', 'site refractory to topica thrombin']",92281,164460.0
18,2119-11-10 06:39:04,,"['-Called out -but called back in b/c of significant bleeding from L IJ', 'site', '-changed tenofovir to [**Last Name (LF) 9806**], [**First Name3 (LF) 77**] [**Doctor Last Name 9235**]', '-hepatology wanted end of life discussion', '-palliative care consulted: ativan, dilaudid, family meeting regarding', 'goals of care and hospice, changed code status']",,92281,164460.0
19,2119-11-10 19:10:47,,"['-Called out -but called back in b/c of significant bleeding from L IJ', 'site', '-changed tenofovir to [**Last Name (LF) 9806**], [**First Name3 (LF) 77**] [**Doctor Last Name 9235**]', '-hepatology wanted end of life discussion', '-palliative care consulted: ativan, dilaudid, family meeting regarding', 'goals of care and hospice, changed code status']",,92281,164460.0
0,2155-05-09 07:19:50,,"['EKG - At [**2155-5-8**] 08:51 AM', ' INVASIVE VENTILATION - STOP [**2155-5-8**] 11:55 AM', '[**Date range (1) 1972**]', '- extubated', '- 3rd set of cardiac enzymes negative', '- started on ceftriaxone/azithromycin for CAP; blood cultures from [**5-7**]', '([**3-11**]) growing GNR, speciation pending, so ceftriaxone was changed to', 'cefepime', '- urine and sputum cultures with no growth to date', '- patient can follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3887**] in cardiology and [**First Name8 (NamePattern2) 376**] [**Last Name (NamePattern1) **]', 'in general primary care clinic', '- L chest pain, reproducible by exam', '- constipated added miralax']",,12233,147721.0
1,2155-05-09 07:27:28,,"['EKG - At [**2155-5-8**] 08:51 AM', ' INVASIVE VENTILATION - STOP [**2155-5-8**] 11:55 AM', '[**Date range (1) 1972**]', '- extubated', '- 3rd set of cardiac enzymes negative', '- started on ceftriaxone/azithromycin for CAP; blood cultures from [**5-7**]', '([**3-11**]) growing GNR, speciation pending, so ceftriaxone was changed to', 'cefepime', '- urine and sputum cultures with no growth to date', '- patient can follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3887**] in cardiology and [**First Name8 (NamePattern2) 376**] [**Last Name (NamePattern1) **]', 'in general primary care clinic', '- L chest pain, reproducible by exam', '- constipated added miralax']",,12233,147721.0
2,2155-05-09 10:27:52,,"['EKG - At [**2155-5-8**] 08:51 AM', ' INVASIVE VENTILATION - STOP [**2155-5-8**] 11:55 AM', '[**Date range (1) 1972**]', '- extubated', '- 3rd set of cardiac enzymes negative', '- started on ceftriaxone/azithromycin for CAP; blood cultures from [**5-7**]', '([**3-11**]) growing GNR, speciation pending, so ceftriaxone was changed to', 'cefepime', '- urine and sputum cultures with no growth to date', '- patient can follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3887**] in cardiology and [**First Name8 (NamePattern2) 376**] [**Last Name (NamePattern1) **]', 'in general primary care clinic', '- L chest pain, reproducible by exam', '- constipated added miralax']",,12233,147721.0
3,2155-05-09 16:09:03,,"['EKG - At [**2155-5-8**] 08:51 AM', ' INVASIVE VENTILATION - STOP [**2155-5-8**] 11:55 AM', '[**Date range (1) 1972**]', '- extubated', '- 3rd set of cardiac enzymes negative', '- started on ceftriaxone/azithromycin for CAP; blood cultures from [**5-7**]', '([**3-11**]) growing GNR, speciation pending, so ceftriaxone was changed to', 'cefepime', '- urine and sputum cultures with no growth to date', '- patient can follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3887**] in cardiology and [**First Name8 (NamePattern2) 376**] [**Last Name (NamePattern1) **]', 'in general primary care clinic', '- L chest pain, reproducible by exam', '- constipated added miralax']",,12233,147721.0
0,2193-01-09 06:26:54,,[],,13306,188375.0
1,2193-01-09 06:27:31,,[],,13306,188375.0
2,2193-01-09 06:28:09,,[],,13306,188375.0
3,2193-01-09 11:30:47,"['- on CPAP, 0 PEEP, with improved minute ventilations']","['- on CPAP, 0 PEEP, with improved minute ventilations']",,13306,188375.0
4,2193-01-10 05:58:54,"['NON-INVASIVE VENTILATION - STOP [**2193-1-9**] 09:18 AM', ' TRANSTHORACIC ECHO - At [**2193-1-9**] 10:08 AM', '-echo RV dilated and hypokinectic NL LV fxn, NL valves, mild PA HTN', 'similar to [**1-12**] echo', '-lipids NL', '-1.5 L negative I/O with lasix', '- overnight on BIPAP 12/7 on 3L desat to 70s, o2 increased to 10 L', 'without change', '- put on non-invasive on vent at 12/0 and improved']","['NON-INVASIVE VENTILATION - STOP [**2193-1-9**] 09:18 AM', ' TRANSTHORACIC ECHO - At [**2193-1-9**] 10:08 AM', '-echo RV dilated and hypokinectic NL LV fxn, NL valves, mild PA HTN', 'similar to [**1-12**] echo', '-lipids NL', '-1.5 L negative I/O with lasix', '- overnight on BIPAP 12/7 on 3L desat to 70s, o2 increased to 10 L', 'without change', '- put on non-invasive on vent at 12/0 and improved']","['- on CPAP, 0 PEEP, with improved minute ventilations']",13306,188375.0
5,2193-01-10 06:00:03,,"['NON-INVASIVE VENTILATION - STOP [**2193-1-9**] 09:18 AM', ' TRANSTHORACIC ECHO - At [**2193-1-9**] 10:08 AM', '-echo RV dilated and hypokinectic NL LV fxn, NL valves, mild PA HTN', 'similar to [**1-12**] echo', '-lipids NL', '-1.5 L negative I/O with lasix', '- overnight on BIPAP 12/7 on 3L desat to 70s, o2 increased to 10 L', 'without change', '- put on non-invasive on vent at 12/0 and improved']",,13306,188375.0
6,2193-01-10 14:06:00,,"['NON-INVASIVE VENTILATION - STOP [**2193-1-9**] 09:18 AM', ' TRANSTHORACIC ECHO - At [**2193-1-9**] 10:08 AM', '-echo RV dilated and hypokinectic NL LV fxn, NL valves, mild PA HTN', 'similar to [**1-12**] echo', '-lipids NL', '-1.5 L negative I/O with lasix', '- overnight on BIPAP 12/7 on 3L desat to 70s, o2 increased to 10 L', 'without change', '- put on non-invasive on vent at 12/0 and improved']",,13306,188375.0
7,2193-01-11 05:21:49,"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']","['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']","['NON-INVASIVE VENTILATION - STOP [**2193-1-9**] 09:18 AM', ' TRANSTHORACIC ECHO - At [**2193-1-9**] 10:08 AM', '-echo RV dilated and hypokinectic NL LV fxn, NL valves, mild PA HTN', 'similar to [**1-12**] echo', '-lipids NL', '-1.5 L negative I/O with lasix', '- overnight on BIPAP 12/7 on 3L desat to 70s, o2 increased to 10 L', 'without change', '- put on non-invasive on vent at 12/0 and improved']",13306,188375.0
8,2193-01-11 05:23:12,,"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']",,13306,188375.0
9,2193-01-11 07:15:23,,"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']",,13306,188375.0
10,2193-01-11 07:16:27,,"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']",,13306,188375.0
11,2193-01-11 17:14:41,,"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']",,13306,188375.0
12,2193-01-12 06:28:22,,[],"['* talked to pulmonary outpatient phys about baseline - patient poorly', 'compliant, needs mask fitting and outpatient sleep study', '* cm aware we want to d/c to pulm rehab']",13306,188375.0
13,2193-01-12 06:29:05,,[],,13306,188375.0
14,2193-01-12 13:08:24,['-diuresed well to 20mg po lasix- over 4L total'],['-diuresed well to 20mg po lasix- over 4L total'],,13306,188375.0
0,2156-12-11 07:06:29,,[],,58287,178918.0
1,2156-12-11 14:58:20,,[],,58287,178918.0
0,2103-12-17 06:20:10,,"['Attempted PO Diazepam for withdrawal but pt was not responding.  Gave', 'IV Ativan with good response.']",,86146,112417.0
1,2103-12-17 11:49:03,"['IV Ativan with good response.  Unable to take some PO this morning (was', 'spitting out pills).', 'Unable to fully assess mental status but pt denies pain.  Not oriented', 'to place or time.']","['Attempted PO Diazepam for withdrawal but pt was not responding.  Gave', 'IV Ativan with good response.  Unable to take some PO this morning (was', 'spitting out pills).', 'Unable to fully assess mental status but pt denies pain.  Not oriented', 'to place or time.']",['IV Ativan with good response.'],86146,112417.0
2,2103-12-18 05:49:03,"['* agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures']","['* agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures']","['Attempted PO Diazepam for withdrawal but pt was not responding.  Gave', 'IV Ativan with good response.  Unable to take some PO this morning (was', 'spitting out pills).', 'Unable to fully assess mental status but pt denies pain.  Not oriented', 'to place or time.']",86146,112417.0
3,2103-12-18 05:50:16,,"['* agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures']",,86146,112417.0
4,2103-12-18 08:32:37,"['* oriented this morning, speaking broken english']","['* agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures', '* oriented this morning, speaking broken english']",,86146,112417.0
5,2103-12-18 09:27:51,,"['* agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures', '* oriented this morning, speaking broken english']",,86146,112417.0
6,2103-12-18 10:32:53,"['* Agitated, confused.  given valium per CIWA']","['* Agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures', '* oriented this morning, speaking broken english']","['* agitated, confused.  given valium per CIWA']",86146,112417.0
7,2103-12-19 05:27:48,"['- erythromycin eye ointment ordered', '- f/u with neuro re: librium', '- was oozing blood from site in L groin overnight.']","['- erythromycin eye ointment ordered', '- f/u with neuro re: librium', '- was oozing blood from site in L groin overnight.']","['* Agitated, confused.  given valium per CIWA', '* tolerated PO', '* no seizures', '* oriented this morning, speaking broken english']",86146,112417.0
0,2104-02-05 06:55:39,,"['NASAL SWAB - At [**2104-2-4**] 07:40 PM', '- stable overnight, continued to be very tremulous requiring q1 hour', 'dosing of valium', '- s/sw ordered for h/o esophageal stricture']",,86146,128337.0
1,2104-02-05 09:14:40,,"['NASAL SWAB - At [**2104-2-4**] 07:40 PM', '- stable overnight, continued to be very tremulous requiring q1 hour', 'dosing of valium', '- s/sw ordered for h/o esophageal stricture']",,86146,128337.0
2,2104-02-05 10:58:02,,"['NASAL SWAB - At [**2104-2-4**] 07:40 PM', '- stable overnight, continued to be very tremulous requiring q1 hour', 'dosing of valium', '- s/sw ordered for h/o esophageal stricture']",,86146,128337.0
3,2104-02-06 06:23:25,"['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift']","['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift']","['NASAL SWAB - At [**2104-2-4**] 07:40 PM', '- stable overnight, continued to be very tremulous requiring q1 hour', 'dosing of valium', '- s/sw ordered for h/o esophageal stricture']",86146,128337.0
4,2104-02-06 06:42:44,,"['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift']",,86146,128337.0
5,2104-02-06 10:37:55,"['- this morning acutely desated to 74%, ? aspiration event, nurse', 'suctioned copious thick secretions, on NRB at 97%']","['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift', '- this morning acutely desated to 74%, ? aspiration event, nurse', 'suctioned copious thick secretions, on NRB at 97%']",,86146,128337.0
6,2104-02-06 12:19:04,,"['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift', '- this morning acutely desated to 74%, ? aspiration event, nurse', 'suctioned copious thick secretions, on NRB at 97%']",,86146,128337.0
7,2104-02-07 06:02:27,"['- Patient was seen to aspirate in the am during rounds.  During the', 'afternoon he spiked to 102.4 and was cultured.  Also started on', 'aztreonam (given PCN allergy), flagyl, and vancomycin.  Made NPO and', 'given 1 L D5NS IVF.', '- Due to concerns about decreased protection of his airway and', 'continuing to give benzos vs his continued [**Last Name (LF) 5043**], [**First Name8 (NamePattern2) 780**]', '[**Last Name (NamePattern1) 820**] was called and thought he looked benzo intoxicated - recommended', 'stopping valium and giving haldol for agitation.  Also recommended', 'possibly getting a psych consult.', ""- Patient was tachypneic in the 30's, ABG showed respiratory alkalosis"", '7.47/31/100 on 100% NRB.', '- PICC was ordered.', '- Patient was given 1 L NS bolus for lowish UOP.']","['- Patient was seen to aspirate in the am during rounds.  During the', 'afternoon he spiked to 102.4 and was cultured.  Also started on', 'aztreonam (given PCN allergy), flagyl, and vancomycin.  Made NPO and', 'given 1 L D5NS IVF.', '- Due to concerns about decreased protection of his airway and', 'continuing to give benzos vs his continued [**Last Name (LF) 5043**], [**First Name8 (NamePattern2) 780**]', '[**Last Name (NamePattern1) 820**] was called and thought he looked benzo intoxicated - recommended', 'stopping valium and giving haldol for agitation.  Also recommended', 'possibly getting a psych consult.', ""- Patient was tachypneic in the 30's, ABG showed respiratory alkalosis"", '7.47/31/100 on 100% NRB.', '- PICC was ordered.', '- Patient was given 1 L NS bolus for lowish UOP.']","['- During day pt very sleepy did not require much Diazepam', '- PM pt noted to be very tremulous, tachy required 220mmg Diazepam', 'total for PM shift', '- this morning acutely desated to 74%, ? aspiration event, nurse', 'suctioned copious thick secretions, on NRB at 97%']",86146,128337.0
8,2104-02-07 07:15:25,,"['- Patient was seen to aspirate in the am during rounds.  During the', 'afternoon he spiked to 102.4 and was cultured.  Also started on', 'aztreonam (given PCN allergy), flagyl, and vancomycin.  Made NPO and', 'given 1 L D5NS IVF.', '- Due to concerns about decreased protection of his airway and', 'continuing to give benzos vs his continued [**Last Name (LF) 5043**], [**First Name8 (NamePattern2) 780**]', '[**Last Name (NamePattern1) 820**] was called and thought he looked benzo intoxicated - recommended', 'stopping valium and giving haldol for agitation.  Also recommended', 'possibly getting a psych consult.', ""- Patient was tachypneic in the 30's, ABG showed respiratory alkalosis"", '7.47/31/100 on 100% NRB.', '- PICC was ordered.', '- Patient was given 1 L NS bolus for lowish UOP.']",,86146,128337.0
9,2104-02-07 07:16:31,,"['- Patient was seen to aspirate in the am during rounds.  During the', 'afternoon he spiked to 102.4 and was cultured.  Also started on', 'aztreonam (given PCN allergy), flagyl, and vancomycin.  Made NPO and', 'given 1 L D5NS IVF.', '- Due to concerns about decreased protection of his airway and', 'continuing to give benzos vs his continued [**Last Name (LF) 5043**], [**First Name8 (NamePattern2) 780**]', '[**Last Name (NamePattern1) 820**] was called and thought he looked benzo intoxicated - recommended', 'stopping valium and giving haldol for agitation.  Also recommended', 'possibly getting a psych consult.', ""- Patient was tachypneic in the 30's, ABG showed respiratory alkalosis"", '7.47/31/100 on 100% NRB.', '- PICC was ordered.', '- Patient was given 1 L NS bolus for lowish UOP.']",,86146,128337.0
10,2104-02-07 10:40:54,,"['- Patient was seen to aspirate in the am during rounds.  During the', 'afternoon he spiked to 102.4 and was cultured.  Also started on', 'aztreonam (given PCN allergy), flagyl, and vancomycin.  Made NPO and', 'given 1 L D5NS IVF.', '- Due to concerns about decreased protection of his airway and', 'continuing to give benzos vs his continued [**Last Name (LF) 5043**], [**First Name8 (NamePattern2) 780**]', '[**Last Name (NamePattern1) 820**] was called and thought he looked benzo intoxicated - recommended', 'stopping valium and giving haldol for agitation.  Also recommended', 'possibly getting a psych consult.', ""- Patient was tachypneic in the 30's, ABG showed respiratory alkalosis"", '7.47/31/100 on 100% NRB.', '- PICC was ordered.', '- Patient was given 1 L NS bolus for lowish UOP.']",,86146,128337.0
0,2192-12-24 07:38:22,,"['NASAL SWAB - At [**2192-12-24**] 01:51 AM', 'adm mrsa', '-', 'History obtained from [**Hospital 31**] Medical records']",,65449,187354.0
1,2192-12-24 09:41:05,['- swift relief of symptoms on lasix'],"['NASAL SWAB - At [**2192-12-24**] 01:51 AM', 'adm mrsa', '- swift relief of symptoms on lasix', 'History obtained from [**Hospital 31**] Medical records']",['-'],65449,187354.0
2,2192-12-24 09:55:27,,"['NASAL SWAB - At [**2192-12-24**] 01:51 AM', 'adm mrsa', '- swift relief of symptoms on lasix', 'History obtained from [**Hospital 31**] Medical records']",,65449,187354.0
3,2192-12-24 10:16:09,,"['NASAL SWAB - At [**2192-12-24**] 01:51 AM', 'adm mrsa', '- swift relief of symptoms on lasix', 'History obtained from [**Hospital 31**] Medical records']",,65449,187354.0
0,2193-01-09 07:17:46,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
1,2193-01-09 07:18:30,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
2,2193-01-09 07:19:19,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
3,2193-01-09 07:21:08,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
4,2193-01-09 07:39:40,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
5,2193-01-09 07:45:16,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
6,2193-01-09 10:02:56,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
7,2193-01-09 14:19:41,,"['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",,65449,169230.0
8,2193-01-10 07:50:15,"['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['INVASIVE VENTILATION - START [**2193-1-8**] 10:00 PM', ' ARTERIAL LINE - START [**2193-1-9**] 02:03 AM', ' FEVER - 101.4', 'F - [**2193-1-9**] 04:00 AM', '- given lasix IV 40mg x1, followed by lasix gtt at 7mg/hr', '- no UOP after given lasix', '- non-invasive BP read: 90-100s/40s', '- A-line placed', '- Hypotensive to systolic BP in the 70s, lasix gtt discontinued, neo', 'started', '- BP responded very well to neo', '- PEEP decreased from 12 to 8 to help with BP', '- ABG looks good', '- UOP initially 30cc/hr, picked up at about 6am to 250cc/hr']",65449,169230.0
9,2193-01-11 07:02:49,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']",65449,169230.0
10,2193-01-11 07:07:15,,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",,65449,169230.0
11,2193-01-11 07:34:44,,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",,65449,169230.0
12,2193-01-11 07:41:42,"['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",65449,169230.0
13,2193-01-11 08:28:59,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']",65449,169230.0
14,2193-01-11 08:30:41,,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",,65449,169230.0
15,2193-01-11 09:28:19,"['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",65449,169230.0
16,2193-01-11 12:29:00,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']","['TRANSTHORACIC ECHO - At [**2193-1-9**] 08:52 AM', ' ULTRASOUND - At [**2193-1-9**] 10:53 AM', '- spontaneous breathing trial off propofol - patient became very', 'agitated and desaturated to 79 and was 90 on 100%. Placed back on', 'propofol 60 and CPAP. Sputum suction was thick and red tinged, sent for', 'cx.', '- NGT placed for meds', '- met with mother, explained situation. She will be back this PM.', '- TTE: read as EF <20%, but Dr. [**First Name (STitle) **] stated that he felt his EF was', 'likely single digits', '- RUQ u/s: Non-visualization of the gallbladder. Findings are', 'concordant with prior CT colonography and in the absence of a surgical', ""history, gallbladder agenesis is suggested. (No, I'm not kidding. He"", ""really doesn't have one. Check out his CT abdomen/pelvis from [**1-29**] for"", 'confirmation.)', '- PM lytes: look good except Cr still 2.1', '- pt on schedule for cardiac cath (minimal dye load) with planned swann', 'placement, so no further diuresis today, ordered for mucomyst', ""- 8pm ABG looks good, but rr in high 30's, so turned up sedation as he"", 'was awake on 60 of propofol']",65449,169230.0
17,2193-01-11 14:23:48,,"['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",,65449,169230.0
18,2193-01-12 07:04:02,"['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']","['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']","['- swan-ganz catheter placemed and myocardial bx performed', '- swan [**Location (un) 103**] very high wedge pressures', '- started on lasix drip, currently at 6cc/hr', '- Dr. [**First Name (STitle) **] is considering a heart transplant, but barriers include', 'morbid obesity, drug use history, and concern for ongoing alcohol use', '- Sputum gram stain: heavy growth of GNRs']",65449,169230.0
19,2193-01-12 07:22:35,,"['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']",,65449,169230.0
20,2193-01-12 07:39:16,,"['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']",,65449,169230.0
21,2193-01-12 10:30:07,,"['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']",,65449,169230.0
22,2193-01-12 10:36:31,,"['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']",,65449,169230.0
23,2193-01-13 07:19:33,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']","['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']","['- extubation goal: diurese ~10L or goal PA pressures of 20 or RA', 'pressures of [**10-4**]', '- switched from toprol to tartrate 50mg TID will titrate up PRN', '- EP recs re: ok to d/c vanc', '- started on TF, nutrition c/s placed', '- sedation changed to versed+fentanyl since pt has been on propofol for', '3 days']",65449,169230.0
24,2193-01-13 07:21:17,,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",,65449,169230.0
25,2193-01-13 07:48:45,,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",,65449,169230.0
26,2193-01-13 09:43:01,,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",,65449,169230.0
27,2193-01-13 10:29:04,,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",,65449,169230.0
28,2193-01-13 10:29:45,,"['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",,65449,169230.0
29,2193-01-14 07:54:36,"['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']","['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']","['- new TF recs this AM with nutrition, increased free water flushes for', 'hypernatremia', '- AM CXR demonstrated ETtube 10cm above carina, ETtube advanced by 4cm,', 'repeat CXR demonstrates appropriate placement', ""- persistently febrile to 102, blood/sputum/urine cx's sent in AM, U/A"", 'negative, in the PM CVP & SVR both low & mixed venous O2 at 74 but', ""fever still at 102, so repeat blood cx's sent, received vancomycin"", '1500mg IV x 1 (notably all lines and ICD site look fine)']",65449,169230.0
30,2193-01-14 11:54:26,,"['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']",,65449,169230.0
31,2193-01-15 07:10:29,"['[**1-14**]:', ""- metoprolol d/c'd, carvedilol ordered but held given sBP around 100"", '- valsartan decreased from 40 to 20mg daily', '- started to metolazone since UOP was not great on lasix gtt alone', '- diuresing well on lasix gtt and metolazone', '- tried to put in PIVs, no success, plan to keep swan in today, and if', 'afebrile today, will order PICC tomorrow.  If he spikes again, will', 'remove swan and re-site the central line', '- PICC nurse attempted to put in PICC on the left arm, was able to put', ""the line in but couldn't pass the line, then realized the ICD on the"", 'left side.  Will come back to put in the PICC on the right.', '- IR PICC line order in, in case PICC nurse unsuccessful. need to call', 'IR to see if he fit on the IR table.', '- Has not had BM in 7 days']","['[**1-14**]:', ""- metoprolol d/c'd, carvedilol ordered but held given sBP around 100"", '- valsartan decreased from 40 to 20mg daily', '- started to metolazone since UOP was not great on lasix gtt alone', '- diuresing well on lasix gtt and metolazone', '- tried to put in PIVs, no success, plan to keep swan in today, and if', 'afebrile today, will order PICC tomorrow.  If he spikes again, will', 'remove swan and re-site the central line', '- PICC nurse attempted to put in PICC on the left arm, was able to put', ""the line in but couldn't pass the line, then realized the ICD on the"", 'left side.  Will come back to put in the PICC on the right.', '- IR PICC line order in, in case PICC nurse unsuccessful. need to call', 'IR to see if he fit on the IR table.', '- Has not had BM in 7 days']","['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']",65449,169230.0
32,2193-01-15 11:25:36,['- PICC placed at 1030'],"['[**1-14**]:', ""- metoprolol d/c'd, carvedilol ordered but held given sBP around 100"", '- valsartan decreased from 40 to 20mg daily', '- started to metolazone since UOP was not great on lasix gtt alone', '- diuresing well on lasix gtt and metolazone', '- tried to put in PIVs, no success, plan to keep swan in today, and if', 'afebrile today, will order PICC tomorrow.  If he spikes again, will', 'remove swan and re-site the central line', '- PICC nurse attempted to put in PICC on the left arm, was able to put', ""the line in but couldn't pass the line, then realized the ICD on the"", 'left side.  Will come back to put in the PICC on the right.', '- PICC placed at 1030', '- Has not had BM in 7 days']","['- IR PICC line order in, in case PICC nurse unsuccessful. need to call', 'IR to see if he fit on the IR table.']",65449,169230.0
33,2193-01-15 15:39:50,,"['[**1-14**]:', ""- metoprolol d/c'd, carvedilol ordered but held given sBP around 100"", '- valsartan decreased from 40 to 20mg daily', '- started to metolazone since UOP was not great on lasix gtt alone', '- diuresing well on lasix gtt and metolazone', '- tried to put in PIVs, no success, plan to keep swan in today, and if', 'afebrile today, will order PICC tomorrow.  If he spikes again, will', 'remove swan and re-site the central line', '- PICC nurse attempted to put in PICC on the left arm, was able to put', ""the line in but couldn't pass the line, then realized the ICD on the"", 'left side.  Will come back to put in the PICC on the right.', '- PICC placed at 1030', '- Has not had BM in 7 days']",,65449,169230.0
34,2193-01-15 15:50:02,"['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']","['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']","['[**1-14**]:', ""- metoprolol d/c'd, carvedilol ordered but held given sBP around 100"", '- valsartan decreased from 40 to 20mg daily', '- started to metolazone since UOP was not great on lasix gtt alone', '- diuresing well on lasix gtt and metolazone', '- tried to put in PIVs, no success, plan to keep swan in today, and if', 'afebrile today, will order PICC tomorrow.  If he spikes again, will', 'remove swan and re-site the central line', '- PICC nurse attempted to put in PICC on the left arm, was able to put', ""the line in but couldn't pass the line, then realized the ICD on the"", 'left side.  Will come back to put in the PICC on the right.', '- PICC placed at 1030', '- Has not had BM in 7 days']",65449,169230.0
35,2193-01-16 07:36:18,"['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]","['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]","['SPUTUM CULTURE - At [**2193-1-13**] 06:00 PM', ' URINE CULTURE - At [**2193-1-13**] 06:00 PM', ' FEVER - 101.1', 'C - [**2193-1-13**] 09:00 PM', '- AM CXR is markedly improved', '- A/a gradient is 204', '- switching from AC to Pressure support and back to AC at night for', 'high C02', '- giving another dose of 1500mg Vanc', '- Will ask pharmacist if Inspira cross-reacts with spironolactone', '- continuing valasartan', '- asking pulmonary for opinion on extubation goals/strategies', '- Pulm: continue diuresis, broaden abx if spike (to cover GNR),', 'consider Chest CT and BiPap when extubated', '- check ua and sputum for fever/wbc work up', '- drawing vanc trough at 1230 on [**1-14**]', '- UOP drops with BP; Required 15/hr Lasix. Pt woke up and UOP rose to', '500/hr.']",65449,169230.0
36,2193-01-16 07:39:23,,"['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]",,65449,169230.0
37,2193-01-16 12:31:38,,"['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]",,65449,169230.0
38,2193-01-16 14:36:37,,"['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]",,65449,169230.0
39,2193-01-17 06:52:45,"['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']","['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']","['PICC LINE - START [**2193-1-15**] 09:06 AM', ' PA CATHETER - STOP [**2193-1-15**] 05:00 PM', ' BLOOD CULTURED - At [**2193-1-16**] 06:00 AM', ' BLOOD CULTURED - At [**2193-1-16**] 06:29 AM', ' FEVER - 101.6', 'F - [**2193-1-16**] 12:00 AM', '- PICC placed this AM, pulled PA line at 4:30PM', '- Diamox 500 [**Hospital1 **], metolazone 5mg PO x 1', ""- d/c'd carvedilol, switched to tartrate 25mg PO TID given tachycardia"", 'and runs of NSVT', '- held 4pm Lopressor as UOP dipped during the early afternoon when', ""sbp's dropped to the 90's, sbp's continued to be in the 90's without"", 'great UOP', ""- goal 2L negative today (goal: -10L, dPAP 20), but sbp's in the 90's"", 'so UOP was not great', '- 11PM lytes demonstrated significant Cr bump to 2.3 up from 1.3 this', 'AM, so Lasix gtt held', '- got reglan for elevated TF residuals and concern for constipation', ""- TF's held at MN in anticipation of possible extubation"", '- Pt with small amount of BRB from G-tube, T&S ordered, Hct stable, put', 'in IV PPI, gastric lavage demonstrated some small old clots, but no', ""fresh blood, TF's held, GI is aware - will see in the AM""]",65449,169230.0
40,2193-01-17 08:00:38,,"['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']",,65449,169230.0
41,2193-01-17 11:17:31,,"['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']",,65449,169230.0
42,2193-01-17 11:22:27,,"['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']",,65449,169230.0
43,2193-01-18 07:12:29,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']","['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']","['SPUTUM CULTURE - At [**2193-1-16**] 12:20 PM', ' FEVER - 102.0', 'F - [**2193-1-17**] 05:00 AM', '- started on cefepime', ""- persistently febrile even after cefepime was added; d/c'd Vanc"", '- renal consulted for ARF: prerenal, no ATN; likely overdiuresis + [**Last Name (un) 284**].', 'Creatinine improved to 1.7 yesterday afternoon but worsened to 2.4 this', 'morning', '- GI : watch and wait with ppi and hct checks', '- [**Doctor Last Name **]: done with diuresis, maintain neutral balance. continuing', 'diamox [**Hospital1 **]', '- heart rate at 124, restarted on digoxin', '- Urine positive for Eos', '- Heart rate to 140 @ 330; BP 140/69; given 5 mg of Metoprolol IV', '- put back on AC for ph 7.24/86/92/39']",65449,169230.0
44,2193-01-18 07:17:03,,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",,65449,169230.0
45,2193-01-18 07:19:39,,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",,65449,169230.0
46,2193-01-18 07:54:19,,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",,65449,169230.0
47,2193-01-18 12:30:27,,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",,65449,169230.0
48,2193-01-19 07:41:47,"['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']","['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']","['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",65449,169230.0
49,2193-01-19 11:11:58,"['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']","['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']","['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']",65449,169230.0
50,2193-01-19 11:13:57,"['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']","['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']","['- Spiked to 104 this AM, cooling blanket and ice packs on.  Defervesced', 'in the pm with new antibiotic regimen.', '- ID recs: vanc, cefepime and flagyl, d/c levo, CT torso, re-check LFT,', 'amylase and lipase', '- Pulm recs: change levo to cipro, re-start vanc, continue cefepime and', 'flagyl.  Can increase RR to 28 if continues to hypoventilate', '- Renal recs: increase free water flushes, increased from 200 to 250cc', 'q4H free water flushes', '- CT torso & chest peformed, wet read: LLL collapse and partial RLL', 'collapse, likely atelectasis, but cannot exclude infection', '- Sputum cx from [**1-16**] grew out Serratia', '- PA catheter tip final culture negative', '- C. diff ordered, will send with next bm', '- Diamox held given ARF']",65449,169230.0
51,2193-01-19 11:18:07,,"['[**1-18**]:', '- EXTUBATED!', ""- subsequent ABG's look good"", '- S&S consult ordered', '- PT consult ordered', ""- C. difficile negative, Flagyl d/c'd"", '- Respiratory consult for CPAP given OSA', ""- Received 100mg PO Lopressor at night as tachy to 120's & hr did not"", 'respond to 50mg earlier in the day', ""- sbp's rise to 170's with bigeminy, drop down to 130-140's immediately"", 'after resolution', '- given valsartan 40mg x 1']",,65449,169230.0
0,2178-09-25 07:35:59,,"['- Onc recs: start Neupegen today', '- 12AM Hct was 28.7 (down from 34.0 in AM) -> transfused 1U pRBCs', '- post-transf Hct was 35.3', '- post-transf plts 101 (up from 20)', '- GI recs: likely [**Doctor First Name 331**]-[**Doctor Last Name **] tear, however esophageal ca local', 'invasion, viral esophagitis or radiation esophagitis are also on diff.', ""will do EGD tomorrow. keep HOB elev. con't IV PPI [**Hospital1 **]. start sucralfate"", 'after EGD tomorrow.', '- NPO at MN for EGD']",,62707,169169.0
1,2178-09-25 11:46:14,,"['- Onc recs: start Neupegen today', '- 12AM Hct was 28.7 (down from 34.0 in AM) -> transfused 1U pRBCs', '- post-transf Hct was 35.3', '- post-transf plts 101 (up from 20)', '- GI recs: likely [**Doctor First Name 331**]-[**Doctor Last Name **] tear, however esophageal ca local', 'invasion, viral esophagitis or radiation esophagitis are also on diff.', ""will do EGD tomorrow. keep HOB elev. con't IV PPI [**Hospital1 **]. start sucralfate"", 'after EGD tomorrow.', '- NPO at MN for EGD']",,62707,169169.0
0,2191-12-15 07:19:39,,['Patient comfortable on floor'],,95186,169330.0
1,2191-12-15 08:21:54,,['Patient comfortable on floor'],,95186,169330.0
2,2191-12-15 09:31:07,"['Patient comfortable in unit, called out']","['Patient comfortable in unit, called out']",['Patient comfortable on floor'],95186,169330.0
3,2191-12-15 09:31:25,,"['Patient comfortable in unit, called out']",,95186,169330.0
4,2191-12-15 12:37:44,,"['Patient comfortable in unit, called out']",,95186,169330.0
5,2191-12-18 06:58:24,"['- triggered for hypotension, admitted to black stool, guaiac grossly +,', 'NG lavage clear with clots, IV pantoprazole started, HCTq4h, GI', 'following.', '.', '- HCT 29.7, xfused one unit -> 35.2']","['- triggered for hypotension, admitted to black stool, guaiac grossly +,', 'NG lavage clear with clots, IV pantoprazole started, HCTq4h, GI', 'following.', '.', '- HCT 29.7, xfused one unit -> 35.2']","['Patient comfortable in unit, called out']",95186,169330.0
6,2191-12-18 09:05:41,,"['- triggered for hypotension, admitted to black stool, guaiac grossly +,', 'NG lavage clear with clots, IV pantoprazole started, HCTq4h, GI', 'following.', '.', '- HCT 29.7, xfused one unit -> 35.2']",,95186,169330.0
7,2191-12-18 10:36:13,,"['- triggered for hypotension, admitted to black stool, guaiac grossly +,', 'NG lavage clear with clots, IV pantoprazole started, HCTq4h, GI', 'following.', '.', '- HCT 29.7, xfused one unit -> 35.2']",,95186,169330.0
8,2191-12-18 11:58:30,,"['- triggered for hypotension, admitted to black stool, guaiac grossly +,', 'NG lavage clear with clots, IV pantoprazole started, HCTq4h, GI', 'following.', '.', '- HCT 29.7, xfused one unit -> 35.2']",,95186,169330.0
0,2174-09-02 07:04:23,,"['ARTERIAL LINE - START [**2174-9-1**] 10:00 AM', 'new line placed', ' MULTI LUMEN - START [**2174-9-1**] 12:00 PM', ' PICC LINE - STOP [**2174-9-1**] 01:00 PM', ' FEVER - 101.4', 'F - [**2174-9-2**] 01:00 AM--> cultured', 'Patient started on levophed, vasopressin. When these were maxed,', 'started dopamine. Patient became tacchycardic with bigeminy. Switched', 'to neo. HR back down to low 100s. Patient was bolused with IV NS (3', 'liters) and D5W with 3 amps of bicarb (2 units) until CVPs were at goal', '[**7-12**] and lactate was stable/trending down. Patient oliguric. Patient', 'anxious and in pain overnight. Received IV morphine and 1 mg IV ativan.', 'Patient is alert and oriented x 3 but now making statements like ""can I', 'leave the hospital today."" She feels swollen, diffuse arthralgias,', 'warm. Rash is pruritic and bothering her esp when she was febrile. No', 'chest or abdominal pain. Patient feels that her work of breathing is', 'not worse but she is purse lip breathing.']",,50939,102047.0
1,2174-09-02 09:04:43,,"['ARTERIAL LINE - START [**2174-9-1**] 10:00 AM', 'new line placed', ' MULTI LUMEN - START [**2174-9-1**] 12:00 PM', ' PICC LINE - STOP [**2174-9-1**] 01:00 PM', ' FEVER - 101.4', 'F - [**2174-9-2**] 01:00 AM--> cultured', 'Patient started on levophed, vasopressin. When these were maxed,', 'started dopamine. Patient became tacchycardic with bigeminy. Switched', 'to neo. HR back down to low 100s. Patient was bolused with IV NS (3', 'liters) and D5W with 3 amps of bicarb (2 units) until CVPs were at goal', '[**7-12**] and lactate was stable/trending down. Patient oliguric. Patient', 'anxious and in pain overnight. Received IV morphine and 1 mg IV ativan.', 'Patient is alert and oriented x 3 but now making statements like ""can I', 'leave the hospital today."" She feels swollen, diffuse arthralgias,', 'warm. Rash is pruritic and bothering her esp when she was febrile. No', 'chest or abdominal pain. Patient feels that her work of breathing is', 'not worse but she is purse lip breathing.']",,50939,102047.0
2,2174-09-03 07:18:09,"['INVASIVE VENTILATION - START [**2174-9-2**] 03:00 PM', '- Worsening rash, appears to be purpura fulminans.', '- On 3 pressors, weaned off neo temporarily but restarted.', '- Heme/onc & renal consulted.  Heme/onc felt that pt is in DIC.  No e/o', 'schistos on smear to suggest TTP/HUS.  Renal recommended bicarb.', '- Anuric.', '- Worsening metabolic acidosis along w/ respiratory distress (CXR w/', 'bilat fluffy infiltrates) and patient intubated.', '- Confused after getting ativan, requiring soft restraints.', '- Decision made to give Xigris (96hr) after head CT done & negative.', '- Started Solumedrol 1g/d per rheum & derm, who are concerned that she', 'has Stills, which may be driving DIC.', '- Family confirmed pt full code.', '- Sent off numerous coag studies (ATIII, Prot C &S, Lupus anticoag', 'profile, prothrombin, ADAMTS13)', '- Per rheum, will need to check C3,4 48 hours after steroids initiated.', '- ID recommended TEE given bacteremia', '- Fibrinogen 190, received additonal 2 units cryoprecipitate.', '- Hypotensive with max dose levophed and vaso, phenylephrine restarted.', '- Switched to pressure support with improvement in ABG.']","['INVASIVE VENTILATION - START [**2174-9-2**] 03:00 PM', '- Worsening rash, appears to be purpura fulminans.', '- On 3 pressors, weaned off neo temporarily but restarted.', '- Heme/onc & renal consulted.  Heme/onc felt that pt is in DIC.  No e/o', 'schistos on smear to suggest TTP/HUS.  Renal recommended bicarb.', '- Anuric.', '- Worsening metabolic acidosis along w/ respiratory distress (CXR w/', 'bilat fluffy infiltrates) and patient intubated.', '- Confused after getting ativan, requiring soft restraints.', '- Decision made to give Xigris (96hr) after head CT done & negative.', '- Started Solumedrol 1g/d per rheum & derm, who are concerned that she', 'has Stills, which may be driving DIC.', '- Family confirmed pt full code.', '- Sent off numerous coag studies (ATIII, Prot C &S, Lupus anticoag', 'profile, prothrombin, ADAMTS13)', '- Per rheum, will need to check C3,4 48 hours after steroids initiated.', '- ID recommended TEE given bacteremia', '- Fibrinogen 190, received additonal 2 units cryoprecipitate.', '- Hypotensive with max dose levophed and vaso, phenylephrine restarted.', '- Switched to pressure support with improvement in ABG.']","['ARTERIAL LINE - START [**2174-9-1**] 10:00 AM', 'new line placed', ' MULTI LUMEN - START [**2174-9-1**] 12:00 PM', ' PICC LINE - STOP [**2174-9-1**] 01:00 PM', ' FEVER - 101.4', 'F - [**2174-9-2**] 01:00 AM--> cultured', 'Patient started on levophed, vasopressin. When these were maxed,', 'started dopamine. Patient became tacchycardic with bigeminy. Switched', 'to neo. HR back down to low 100s. Patient was bolused with IV NS (3', 'liters) and D5W with 3 amps of bicarb (2 units) until CVPs were at goal', '[**7-12**] and lactate was stable/trending down. Patient oliguric. Patient', 'anxious and in pain overnight. Received IV morphine and 1 mg IV ativan.', 'Patient is alert and oriented x 3 but now making statements like ""can I', 'leave the hospital today."" She feels swollen, diffuse arthralgias,', 'warm. Rash is pruritic and bothering her esp when she was febrile. No', 'chest or abdominal pain. Patient feels that her work of breathing is', 'not worse but she is purse lip breathing.']",50939,102047.0
3,2174-09-03 12:04:48,,"['INVASIVE VENTILATION - START [**2174-9-2**] 03:00 PM', '- Worsening rash, appears to be purpura fulminans.', '- On 3 pressors, weaned off neo temporarily but restarted.', '- Heme/onc & renal consulted.  Heme/onc felt that pt is in DIC.  No e/o', 'schistos on smear to suggest TTP/HUS.  Renal recommended bicarb.', '- Anuric.', '- Worsening metabolic acidosis along w/ respiratory distress (CXR w/', 'bilat fluffy infiltrates) and patient intubated.', '- Confused after getting ativan, requiring soft restraints.', '- Decision made to give Xigris (96hr) after head CT done & negative.', '- Started Solumedrol 1g/d per rheum & derm, who are concerned that she', 'has Stills, which may be driving DIC.', '- Family confirmed pt full code.', '- Sent off numerous coag studies (ATIII, Prot C &S, Lupus anticoag', 'profile, prothrombin, ADAMTS13)', '- Per rheum, will need to check C3,4 48 hours after steroids initiated.', '- ID recommended TEE given bacteremia', '- Fibrinogen 190, received additonal 2 units cryoprecipitate.', '- Hypotensive with max dose levophed and vaso, phenylephrine restarted.', '- Switched to pressure support with improvement in ABG.']",,50939,102047.0
4,2174-09-03 12:38:41,,"['INVASIVE VENTILATION - START [**2174-9-2**] 03:00 PM', '- Worsening rash, appears to be purpura fulminans.', '- On 3 pressors, weaned off neo temporarily but restarted.', '- Heme/onc & renal consulted.  Heme/onc felt that pt is in DIC.  No e/o', 'schistos on smear to suggest TTP/HUS.  Renal recommended bicarb.', '- Anuric.', '- Worsening metabolic acidosis along w/ respiratory distress (CXR w/', 'bilat fluffy infiltrates) and patient intubated.', '- Confused after getting ativan, requiring soft restraints.', '- Decision made to give Xigris (96hr) after head CT done & negative.', '- Started Solumedrol 1g/d per rheum & derm, who are concerned that she', 'has Stills, which may be driving DIC.', '- Family confirmed pt full code.', '- Sent off numerous coag studies (ATIII, Prot C &S, Lupus anticoag', 'profile, prothrombin, ADAMTS13)', '- Per rheum, will need to check C3,4 48 hours after steroids initiated.', '- ID recommended TEE given bacteremia', '- Fibrinogen 190, received additonal 2 units cryoprecipitate.', '- Hypotensive with max dose levophed and vaso, phenylephrine restarted.', '- Switched to pressure support with improvement in ABG.']",,50939,102047.0
5,2174-09-04 07:01:27,"['Uric acid elevated. Given this finding + hypocalcemia and', 'hyperphosphatemia, concern for tumor lysis. CT chest checked to assess', 'for lymphoma - preliminary report negative (1. Right adnexal dermoid.', '2. Pulmonary edema. 3. Right anterior chest wall subcutaneous soft', 'tissue stranding and asymmetry. 4. Pelvic and inguinal lymph nodes and', 'axillary lymph nodes measuring up to', '1.5 cm), final report pending.', '- CT head without contrast, preliminary read - Subtle loss of', '[**Doctor Last Name 1359**]-white matter differentiation and effacement of sulci consistent', 'with mild edema. No significant change.', ""- Per ID recs, d/c'd clindamycin and started ivermectin in case she has"", 'reactivation of strongyloides on high dose steroids (strongyloides IgG', 'antibody pending)', '- Stopped Zygris (treating sepsis) given that antiphospholipid antibody', 'syndrome may be more likely - started heparin drip and IVIG', '- Several cultures and serologies pending', '- Got cryoprecipitate for fibrinogen < 250', ""- Fevers to 103.5, called blood bank and they said it's okay to still"", 'give the cryoprecipitate', '** Needs C3, C4 48 hours from start of solumedrol', '- Renal recs - Place CVVHD catheter [**9-4**] given Zygris and 3 pressors;', 'added bicarb', '- ID recs - Beta-2 glycoprotein sent; BM biopsy to rule out', 'hemophagocytic lymphohistiocytosis; hold off on plasma exchange at this', 'time given hypotension']","['Uric acid elevated. Given this finding + hypocalcemia and', 'hyperphosphatemia, concern for tumor lysis. CT chest checked to assess', 'for lymphoma - preliminary report negative (1. Right adnexal dermoid.', '2. Pulmonary edema. 3. Right anterior chest wall subcutaneous soft', 'tissue stranding and asymmetry. 4. Pelvic and inguinal lymph nodes and', 'axillary lymph nodes measuring up to', '1.5 cm), final report pending.', '- CT head without contrast, preliminary read - Subtle loss of', '[**Doctor Last Name 1359**]-white matter differentiation and effacement of sulci consistent', 'with mild edema. No significant change.', ""- Per ID recs, d/c'd clindamycin and started ivermectin in case she has"", 'reactivation of strongyloides on high dose steroids (strongyloides IgG', 'antibody pending)', '- Stopped Zygris (treating sepsis) given that antiphospholipid antibody', 'syndrome may be more likely - started heparin drip and IVIG', '- Several cultures and serologies pending', '- Got cryoprecipitate for fibrinogen < 250', ""- Fevers to 103.5, called blood bank and they said it's okay to still"", 'give the cryoprecipitate', '** Needs C3, C4 48 hours from start of solumedrol', '- Renal recs - Place CVVHD catheter [**9-4**] given Zygris and 3 pressors;', 'added bicarb', '- ID recs - Beta-2 glycoprotein sent; BM biopsy to rule out', 'hemophagocytic lymphohistiocytosis; hold off on plasma exchange at this', 'time given hypotension']","['INVASIVE VENTILATION - START [**2174-9-2**] 03:00 PM', '- Worsening rash, appears to be purpura fulminans.', '- On 3 pressors, weaned off neo temporarily but restarted.', '- Heme/onc & renal consulted.  Heme/onc felt that pt is in DIC.  No e/o', 'schistos on smear to suggest TTP/HUS.  Renal recommended bicarb.', '- Anuric.', '- Worsening metabolic acidosis along w/ respiratory distress (CXR w/', 'bilat fluffy infiltrates) and patient intubated.', '- Confused after getting ativan, requiring soft restraints.', '- Decision made to give Xigris (96hr) after head CT done & negative.', '- Started Solumedrol 1g/d per rheum & derm, who are concerned that she', 'has Stills, which may be driving DIC.', '- Family confirmed pt full code.', '- Sent off numerous coag studies (ATIII, Prot C &S, Lupus anticoag', 'profile, prothrombin, ADAMTS13)', '- Per rheum, will need to check C3,4 48 hours after steroids initiated.', '- ID recommended TEE given bacteremia', '- Fibrinogen 190, received additonal 2 units cryoprecipitate.', '- Hypotensive with max dose levophed and vaso, phenylephrine restarted.', '- Switched to pressure support with improvement in ABG.']",50939,102047.0
6,2174-09-04 11:11:06,['syndrome may be more likely - started heparin drip'],"['Uric acid elevated. Given this finding + hypocalcemia and', 'hyperphosphatemia, concern for tumor lysis. CT chest checked to assess', 'for lymphoma - preliminary report negative (1. Right adnexal dermoid.', '2. Pulmonary edema. 3. Right anterior chest wall subcutaneous soft', 'tissue stranding and asymmetry. 4. Pelvic and inguinal lymph nodes and', 'axillary lymph nodes measuring up to', '1.5 cm), final report pending.', '- CT head without contrast, preliminary read - Subtle loss of', '[**Doctor Last Name 1359**]-white matter differentiation and effacement of sulci consistent', 'with mild edema. No significant change.', ""- Per ID recs, d/c'd clindamycin and started ivermectin in case she has"", 'reactivation of strongyloides on high dose steroids (strongyloides IgG', 'antibody pending)', '- Stopped Zygris (treating sepsis) given that antiphospholipid antibody', 'syndrome may be more likely - started heparin drip', '- Several cultures and serologies pending', '- Got cryoprecipitate for fibrinogen < 250', ""- Fevers to 103.5, called blood bank and they said it's okay to still"", 'give the cryoprecipitate', '** Needs C3, C4 48 hours from start of solumedrol', '- Renal recs - Place CVVHD catheter [**9-4**] given Zygris and 3 pressors;', 'added bicarb', '- ID recs - Beta-2 glycoprotein sent; BM biopsy to rule out', 'hemophagocytic lymphohistiocytosis; hold off on plasma exchange at this', 'time given hypotension']",['syndrome may be more likely - started heparin drip and IVIG'],50939,102047.0
7,2174-09-05 06:02:27,"['CT-head official read:', 'Persistent effacement of sulci with poor [**Doctor Last Name 1359**]-white matter', 'differentiation, likely due to mild cerebral edema. The temporal horns', 'of the lateral ventricles and the third ventricle have slightly', 'decreased size, concerning for subtle increase in intracranial', 'pressure. Clinical correlation and close follow-up are recommended. MRI', 'would also be helpful for further evaluation.', '-Pt continues to be on 3 pressors with labile pressures --> MAP went', ""into the 50's and 60's.  Pt given IVF 1.5L, maxed out on levophed &"", 'vasopressin.  Considering starting epi drip if patient is maxed out on', 'neo.']","['CT-head official read:', 'Persistent effacement of sulci with poor [**Doctor Last Name 1359**]-white matter', 'differentiation, likely due to mild cerebral edema. The temporal horns', 'of the lateral ventricles and the third ventricle have slightly', 'decreased size, concerning for subtle increase in intracranial', 'pressure. Clinical correlation and close follow-up are recommended. MRI', 'would also be helpful for further evaluation.', '-Pt continues to be on 3 pressors with labile pressures --> MAP went', ""into the 50's and 60's.  Pt given IVF 1.5L, maxed out on levophed &"", 'vasopressin.  Considering starting epi drip if patient is maxed out on', 'neo.']","['Uric acid elevated. Given this finding + hypocalcemia and', 'hyperphosphatemia, concern for tumor lysis. CT chest checked to assess', 'for lymphoma - preliminary report negative (1. Right adnexal dermoid.', '2. Pulmonary edema. 3. Right anterior chest wall subcutaneous soft', 'tissue stranding and asymmetry. 4. Pelvic and inguinal lymph nodes and', 'axillary lymph nodes measuring up to', '1.5 cm), final report pending.', '- CT head without contrast, preliminary read - Subtle loss of', '[**Doctor Last Name 1359**]-white matter differentiation and effacement of sulci consistent', 'with mild edema. No significant change.', ""- Per ID recs, d/c'd clindamycin and started ivermectin in case she has"", 'reactivation of strongyloides on high dose steroids (strongyloides IgG', 'antibody pending)', '- Stopped Zygris (treating sepsis) given that antiphospholipid antibody', 'syndrome may be more likely - started heparin drip', '- Several cultures and serologies pending', '- Got cryoprecipitate for fibrinogen < 250', ""- Fevers to 103.5, called blood bank and they said it's okay to still"", 'give the cryoprecipitate', '** Needs C3, C4 48 hours from start of solumedrol', '- Renal recs - Place CVVHD catheter [**9-4**] given Zygris and 3 pressors;', 'added bicarb', '- ID recs - Beta-2 glycoprotein sent; BM biopsy to rule out', 'hemophagocytic lymphohistiocytosis; hold off on plasma exchange at this', 'time given hypotension']",50939,102047.0
8,2174-09-05 10:07:34,,"['CT-head official read:', 'Persistent effacement of sulci with poor [**Doctor Last Name 1359**]-white matter', 'differentiation, likely due to mild cerebral edema. The temporal horns', 'of the lateral ventricles and the third ventricle have slightly', 'decreased size, concerning for subtle increase in intracranial', 'pressure. Clinical correlation and close follow-up are recommended. MRI', 'would also be helpful for further evaluation.', '-Pt continues to be on 3 pressors with labile pressures --> MAP went', ""into the 50's and 60's.  Pt given IVF 1.5L, maxed out on levophed &"", 'vasopressin.  Considering starting epi drip if patient is maxed out on', 'neo.']",,50939,102047.0
0,2141-11-20 08:03:43,,"['INVASIVE VENTILATION - START [**2141-11-19**] 06:30 PM', ' ENDOSCOPY - At [**2141-11-19**] 07:00 PM', ""-After EGD, pt on fentanyl, versed gtt's and assist/control vent"", 'settings']",,18739,121377.0
1,2141-11-20 11:18:10,,"['INVASIVE VENTILATION - START [**2141-11-19**] 06:30 PM', ' ENDOSCOPY - At [**2141-11-19**] 07:00 PM', ""-After EGD, pt on fentanyl, versed gtt's and assist/control vent"", 'settings']",,18739,121377.0
2,2141-11-21 07:56:40,"['INVASIVE VENTILATION - STOP [**2141-11-20**] 09:18 AM', ' NASAL SWAB - At [**2141-11-21**] 04:06 AM', '- Patient was extubated in the morning without sequelae.', '- Tolerated clears diet for lunch and dinner with no cough or N/V, was', 'planned to receive dysphagia diet for breakfast in AM', '- Was dialyzed by nephrology', '- Restarted on all home meds aside from warfarin, which was held due to', 'elevated INR to 2.9 on AM labs']","['INVASIVE VENTILATION - STOP [**2141-11-20**] 09:18 AM', ' NASAL SWAB - At [**2141-11-21**] 04:06 AM', '- Patient was extubated in the morning without sequelae.', '- Tolerated clears diet for lunch and dinner with no cough or N/V, was', 'planned to receive dysphagia diet for breakfast in AM', '- Was dialyzed by nephrology', '- Restarted on all home meds aside from warfarin, which was held due to', 'elevated INR to 2.9 on AM labs']","['INVASIVE VENTILATION - START [**2141-11-19**] 06:30 PM', ' ENDOSCOPY - At [**2141-11-19**] 07:00 PM', ""-After EGD, pt on fentanyl, versed gtt's and assist/control vent"", 'settings']",18739,121377.0
3,2141-11-21 13:10:23,"['Patient denies CP, dyspnea. Has a new cough that is loose and', 'occasionally productive. Patient reports that his cough started prior', 'to hospitalization shortly after food got stuck in throat. Has had a', 'sore throat ever since his EGD.']","['INVASIVE VENTILATION - STOP [**2141-11-20**] 09:18 AM', ' NASAL SWAB - At [**2141-11-21**] 04:06 AM', '- Patient was extubated in the morning without sequelae.', '- Tolerated clears diet for lunch and dinner with no cough or N/V, was', 'planned to receive dysphagia diet for breakfast in AM', '- Was dialyzed by nephrology', '- Restarted on all home meds aside from warfarin, which was held due to', 'elevated INR to 2.9 on AM labs', 'Patient denies CP, dyspnea. Has a new cough that is loose and', 'occasionally productive. Patient reports that his cough started prior', 'to hospitalization shortly after food got stuck in throat. Has had a', 'sore throat ever since his EGD.']",,18739,121377.0
0,2126-03-14 06:19:20,,"['BLOOD CULTURED - At [**2126-3-13**] 09:30 PM', '- blood pressure has been stable since CCU transfer']",,47045,188612.0
1,2126-03-14 07:10:12,,"['BLOOD CULTURED - At [**2126-3-13**] 09:30 PM', '- blood pressure has been stable since CCU transfer']",,47045,188612.0
2,2126-03-14 11:26:31,,"['BLOOD CULTURED - At [**2126-3-13**] 09:30 PM', '- blood pressure has been stable since CCU transfer']",,47045,188612.0
3,2126-03-14 13:26:32,,"['BLOOD CULTURED - At [**2126-3-13**] 09:30 PM', '- blood pressure has been stable since CCU transfer']",,47045,188612.0
0,2104-11-13 06:55:25,,"['MULTI LUMEN - START [**2104-11-12**] 12:32 PM', ' IABP LINE - START [**2104-11-12**] 12:32 PM', ' NASAL SWAB - At [**2104-11-12**] 01:45 PM', ' EKG - At [**2104-11-12**] 01:48 PM', ' OR SENT - At [**2104-11-12**] 03:15 PM', 'sent to CATH LAB', ' SHEATH - START [**2104-11-12**] 05:45 PM', ' URINE CULTURE - At [**2104-11-12**] 07:00 PM', ' SHEATH - STOP [**2104-11-12**] 07:52 PM', ' MULTI LUMEN - STOP [**2104-11-12**] 08:00 PM', ' IABP LINE - STOP [**2104-11-12**] 08:00 PM']",,98714,171885.0
1,2104-11-13 12:50:30,"['Cath Lab with DES to OM/LCx - At [**2104-11-12**] 03:15 PM', ' IABP SHEATH STOPPED, pulled [**2104-11-12**] ~08:00 PM', ' No events overnight, pt denies chest pain, SOB, pain at groin.']","['Cath Lab with DES to OM/LCx - At [**2104-11-12**] 03:15 PM', ' IABP SHEATH STOPPED, pulled [**2104-11-12**] ~08:00 PM', ' No events overnight, pt denies chest pain, SOB, pain at groin.']","['MULTI LUMEN - START [**2104-11-12**] 12:32 PM', ' IABP LINE - START [**2104-11-12**] 12:32 PM', ' NASAL SWAB - At [**2104-11-12**] 01:45 PM', ' EKG - At [**2104-11-12**] 01:48 PM', ' OR SENT - At [**2104-11-12**] 03:15 PM', 'sent to CATH LAB', ' SHEATH - START [**2104-11-12**] 05:45 PM', ' URINE CULTURE - At [**2104-11-12**] 07:00 PM', ' SHEATH - STOP [**2104-11-12**] 07:52 PM', ' MULTI LUMEN - STOP [**2104-11-12**] 08:00 PM', ' IABP LINE - STOP [**2104-11-12**] 08:00 PM']",98714,171885.0
2,2104-11-13 13:16:18,,"['Cath Lab with DES to OM/LCx - At [**2104-11-12**] 03:15 PM', ' IABP SHEATH STOPPED, pulled [**2104-11-12**] ~08:00 PM', ' No events overnight, pt denies chest pain, SOB, pain at groin.']",,98714,171885.0
0,2139-10-20 07:01:35,,"['SPUTUM CULTURE - At [**2139-10-19**] 01:07 PM', ' INVASIVE VENTILATION - START [**2139-10-19**] 01:07 PM', ' TUNNELED (HICKMAN) LINE - START [**2139-10-19**] 02:01 PM', ' ARTERIAL LINE - START [**2139-10-19**] 04:31 PM', ' BLOOD CULTURED - At [**2139-10-19**] 05:19 PM', ' URINE CULTURE - At [**2139-10-19**] 05:19 PM', ' ULTRASOUND - At [**2139-10-19**] 05:34 PM', ' WOUND CULTURE - At [**2139-10-19**] 10:30 PM', 'culture from JP drain', ' BLOOD CULTURED - At [**2139-10-20**] 04:00 AM', ' FEVER - 102.3', 'F - [**2139-10-19**] 05:00 PM']",,14176,126791.0
1,2139-10-20 07:16:11,"['[**10-19**]', '- Abd U/S without focal fluid collection or hematoma.', '- Pan CT ordered.', '- Patient required several boluses for hypotension', '- Spiked fever and started on Vanc/Zosyn', '- given 2 U PRBC and 1 U Plts.']","['SPUTUM CULTURE - At [**2139-10-19**] 01:07 PM', ' INVASIVE VENTILATION - START [**2139-10-19**] 01:07 PM', ' TUNNELED (HICKMAN) LINE - START [**2139-10-19**] 02:01 PM', ' ARTERIAL LINE - START [**2139-10-19**] 04:31 PM', ' BLOOD CULTURED - At [**2139-10-19**] 05:19 PM', ' URINE CULTURE - At [**2139-10-19**] 05:19 PM', ' ULTRASOUND - At [**2139-10-19**] 05:34 PM', ' WOUND CULTURE - At [**2139-10-19**] 10:30 PM', 'culture from JP drain', ' BLOOD CULTURED - At [**2139-10-20**] 04:00 AM', ' FEVER - 102.3', 'F - [**2139-10-19**] 05:00 PM', '[**10-19**]', '- Abd U/S without focal fluid collection or hematoma.', '- Pan CT ordered.', '- Patient required several boluses for hypotension', '- Spiked fever and started on Vanc/Zosyn', '- given 2 U PRBC and 1 U Plts.']",,14176,126791.0
2,2139-10-20 07:59:08,"['- CT Head/Thorax ordered. (CT head without intracranial process, no PE)']","['- Abd U/S without focal fluid collection or hematoma.', '- CT Head/Thorax ordered. (CT head without intracranial process, no PE)', '- Patient required several boluses for hypotension', '- Spiked fever and started on Vanc/Zosyn', '- given 2 U PRBC and 1 U Plts.']","['SPUTUM CULTURE - At [**2139-10-19**] 01:07 PM', ' INVASIVE VENTILATION - START [**2139-10-19**] 01:07 PM', ' TUNNELED (HICKMAN) LINE - START [**2139-10-19**] 02:01 PM', ' ARTERIAL LINE - START [**2139-10-19**] 04:31 PM', ' BLOOD CULTURED - At [**2139-10-19**] 05:19 PM', ' URINE CULTURE - At [**2139-10-19**] 05:19 PM', ' ULTRASOUND - At [**2139-10-19**] 05:34 PM', ' WOUND CULTURE - At [**2139-10-19**] 10:30 PM', 'culture from JP drain', ' BLOOD CULTURED - At [**2139-10-20**] 04:00 AM', ' FEVER - 102.3', 'F - [**2139-10-19**] 05:00 PM', '[**10-19**]', '- Pan CT ordered.']",14176,126791.0
3,2139-10-21 06:46:13,"['BLOOD CULTURED - At [**2139-10-21**] 12:00 AM', ' SPUTUM CULTURE - At [**2139-10-21**] 12:00 AM', ' STOOL CULTURE - At [**2139-10-21**] 12:00 AM', ' FEVER - 101.1', 'F - [**2139-10-20**] 08:00 AM']","['BLOOD CULTURED - At [**2139-10-21**] 12:00 AM', ' SPUTUM CULTURE - At [**2139-10-21**] 12:00 AM', ' STOOL CULTURE - At [**2139-10-21**] 12:00 AM', ' FEVER - 101.1', 'F - [**2139-10-20**] 08:00 AM']","['- Abd U/S without focal fluid collection or hematoma.', '- CT Head/Thorax ordered. (CT head without intracranial process, no PE)', '- Patient required several boluses for hypotension', '- Spiked fever and started on Vanc/Zosyn', '- given 2 U PRBC and 1 U Plts.']",14176,126791.0
4,2139-10-21 07:42:19,"['- Patient cultured as above after fever', '- 10 IV lasix given with good UOP', '- given 2 pRBCs with 20 IV lasix', '- Fentanyl boluses given PRN']","['BLOOD CULTURED - At [**2139-10-21**] 12:00 AM', ' SPUTUM CULTURE - At [**2139-10-21**] 12:00 AM', ' STOOL CULTURE - At [**2139-10-21**] 12:00 AM', ' FEVER - 101.1', 'F - [**2139-10-20**] 08:00 AM', '- Patient cultured as above after fever', '- 10 IV lasix given with good UOP', '- given 2 pRBCs with 20 IV lasix', '- Fentanyl boluses given PRN']",,14176,126791.0
5,2139-10-22 06:05:47,['INVASIVE VENTILATION - STOP [**2139-10-21**] 02:11 PM'],['INVASIVE VENTILATION - STOP [**2139-10-21**] 02:11 PM'],"['BLOOD CULTURED - At [**2139-10-21**] 12:00 AM', ' SPUTUM CULTURE - At [**2139-10-21**] 12:00 AM', ' STOOL CULTURE - At [**2139-10-21**] 12:00 AM', ' FEVER - 101.1', 'F - [**2139-10-20**] 08:00 AM', '- Patient cultured as above after fever', '- 10 IV lasix given with good UOP', '- given 2 pRBCs with 20 IV lasix', '- Fentanyl boluses given PRN']",14176,126791.0
6,2139-10-22 06:10:51,"['-pt continued on TPN', '-lovenox given x1- may have procedure in am [**10-22**] so only given once', '-pt successfully extubated with good post-extubation ABG', '-Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV', 'access so changed to Morphine PRN', '-transfused pltx1', '-diuresed with lasix 20 IV x2', '-KCL repleted at 10pm', '- Poor A-Line tracing.']","['-pt continued on TPN', '-lovenox given x1- may have procedure in am [**10-22**] so only given once', '-pt successfully extubated with good post-extubation ABG', '-Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV', 'access so changed to Morphine PRN', '-transfused pltx1', '-diuresed with lasix 20 IV x2', '-KCL repleted at 10pm', '- Poor A-Line tracing.']",['INVASIVE VENTILATION - STOP [**2139-10-21**] 02:11 PM'],14176,126791.0
7,2139-10-22 07:37:05,"['- Pt successfully extubated with good post-extubation ABG', '- Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV access so changed to Morphine PRN (4mg total given', 'overnight)', '- Continued on TPN while NPO', '- No procedure today, restarted on Lovenox', '- Transfused pltx1', '- Diuresed with lasix 20 IV x2 (Put out 1L)', '- KCL repleted at 10pm']","['- Pt successfully extubated with good post-extubation ABG', '- Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV access so changed to Morphine PRN (4mg total given', 'overnight)', '- Continued on TPN while NPO', '- No procedure today, restarted on Lovenox', '- Transfused pltx1', '- Diuresed with lasix 20 IV x2 (Put out 1L)', '- KCL repleted at 10pm']","['-pt continued on TPN', '-lovenox given x1- may have procedure in am [**10-22**] so only given once', '-pt successfully extubated with good post-extubation ABG', '-Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV', 'access so changed to Morphine PRN', '-transfused pltx1', '-diuresed with lasix 20 IV x2', '-KCL repleted at 10pm', '- Poor A-Line tracing.']",14176,126791.0
8,2139-10-23 07:45:45,"['ARTERIAL LINE - STOP [**2139-10-22**] 04:41 PM', ' STOOL CULTURE - At [**2139-10-22**] 11:44 PM', '- Lasix diuresed with K, Mg repletion', '- Tolerating sips and popsicles (okay per Dr. [**Last Name (STitle) **]']","['ARTERIAL LINE - STOP [**2139-10-22**] 04:41 PM', ' STOOL CULTURE - At [**2139-10-22**] 11:44 PM', '- Lasix diuresed with K, Mg repletion', '- Tolerating sips and popsicles (okay per Dr. [**Last Name (STitle) **]']","['- Pt successfully extubated with good post-extubation ABG', '- Pt with difficult to control pain on fentanyl changed to Morphine PCA', 'but limited IV access so changed to Morphine PRN (4mg total given', 'overnight)', '- Continued on TPN while NPO', '- No procedure today, restarted on Lovenox', '- Transfused pltx1', '- Diuresed with lasix 20 IV x2 (Put out 1L)', '- KCL repleted at 10pm']",14176,126791.0
9,2139-10-23 10:28:22,,"['ARTERIAL LINE - STOP [**2139-10-22**] 04:41 PM', ' STOOL CULTURE - At [**2139-10-22**] 11:44 PM', '- Lasix diuresed with K, Mg repletion', '- Tolerating sips and popsicles (okay per Dr. [**Last Name (STitle) **]']",,14176,126791.0
10,2139-10-24 06:38:58,,[],"['ARTERIAL LINE - STOP [**2139-10-22**] 04:41 PM', ' STOOL CULTURE - At [**2139-10-22**] 11:44 PM', '- Lasix diuresed with K, Mg repletion', '- Tolerating sips and popsicles (okay per Dr. [**Last Name (STitle) **]']",14176,126791.0
11,2139-10-24 06:45:34,,[],,14176,126791.0
12,2139-10-24 06:53:45,"['- Had Vac changed, with subsequent small bowel perforation noted', '- Pt initially called-out, then called back-in']","['- Had Vac changed, with subsequent small bowel perforation noted', '- Pt initially called-out, then called back-in']",,14176,126791.0
13,2139-10-24 11:27:54,['- Surgery placed bag of enterotomy wound for drainage'],"['- Had Vac changed, with subsequent small bowel perforation noted', '- Pt initially called-out, then called back-in', '- Surgery placed bag of enterotomy wound for drainage']",,14176,126791.0
14,2139-10-24 11:42:02,,"['- Had Vac changed, with subsequent small bowel perforation noted', '- Pt initially called-out, then called back-in', '- Surgery placed bag of enterotomy wound for drainage']",,14176,126791.0
15,2139-10-25 06:50:06,,[],"['- Had Vac changed, with subsequent small bowel perforation noted', '- Pt initially called-out, then called back-in', '- Surgery placed bag of enterotomy wound for drainage']",14176,126791.0
16,2139-10-25 06:52:15,"['-Reordered TPN', '-INR ordered for am', '-Ordered 20 IV lasix to help diuresis']","['-Reordered TPN', '-INR ordered for am', '-Ordered 20 IV lasix to help diuresis']",,14176,126791.0
17,2139-10-25 08:41:04,,"['-Reordered TPN', '-INR ordered for am', '-Ordered 20 IV lasix to help diuresis']",,14176,126791.0
18,2139-10-26 06:19:17,"['- Abd wound with large drainage (>1L), surgery wrote to replace [**12-24**] to', '1 cc of drainage', '- PTC cancelled for tomorrow, HIDA Scan ordered to determine etiology', 'of leak (? from biliary-jeju leak vs. leak from bowel perf)', '- Changed to Meropenum as Sputum cx grew Klebsiella resistant to Zosyn.']","['- Abd wound with large drainage (>1L), surgery wrote to replace [**12-24**] to', '1 cc of drainage', '- PTC cancelled for tomorrow, HIDA Scan ordered to determine etiology', 'of leak (? from biliary-jeju leak vs. leak from bowel perf)', '- Changed to Meropenum as Sputum cx grew Klebsiella resistant to Zosyn.']","['-Reordered TPN', '-INR ordered for am', '-Ordered 20 IV lasix to help diuresis']",14176,126791.0
19,2139-10-26 06:20:44,,"['- Abd wound with large drainage (>1L), surgery wrote to replace [**12-24**] to', '1 cc of drainage', '- PTC cancelled for tomorrow, HIDA Scan ordered to determine etiology', 'of leak (? from biliary-jeju leak vs. leak from bowel perf)', '- Changed to Meropenum as Sputum cx grew Klebsiella resistant to Zosyn.']",,14176,126791.0
20,2139-10-26 07:46:16,"['- Abd wound with large drainage (>1L) per day, surgery wrote to replace', '[**12-24**] to 1 cc of drainage', '- HIDA Scan ordered to determine etiology of leak (? from biliary-jeju', 'leak vs. leak from bowel perf), with potential PTC afterwards based on', 'findings', '- Changed to Zosyn to Meropenum as Sputum cx grew Klebsiella resistant', 'to Zosyn.', '- Added Flagyl as Bile grew likely Clostridium Perfingens']","['- Abd wound with large drainage (>1L) per day, surgery wrote to replace', '[**12-24**] to 1 cc of drainage', '- HIDA Scan ordered to determine etiology of leak (? from biliary-jeju', 'leak vs. leak from bowel perf), with potential PTC afterwards based on', 'findings', '- Changed to Zosyn to Meropenum as Sputum cx grew Klebsiella resistant', 'to Zosyn.', '- Added Flagyl as Bile grew likely Clostridium Perfingens']","['- Abd wound with large drainage (>1L), surgery wrote to replace [**12-24**] to', '1 cc of drainage', '- PTC cancelled for tomorrow, HIDA Scan ordered to determine etiology', 'of leak (? from biliary-jeju leak vs. leak from bowel perf)', '- Changed to Meropenum as Sputum cx grew Klebsiella resistant to Zosyn.']",14176,126791.0
21,2139-10-27 07:45:07,"['NUCLEAR MEDICINE - At [**2139-10-26**] 02:42 PM', 'Hida scan- gall bladder', ' ULTRASOUND - At [**2139-10-26**] 07:00 PM', '- Underwent HIDA', '- Underwent RUQ with dopplers', '- Pt kept NPO', '- Lovenox restarted', '- Discussed with I.D. antibiotic coverage', 'History obtained from Patient']","['NUCLEAR MEDICINE - At [**2139-10-26**] 02:42 PM', 'Hida scan- gall bladder', ' ULTRASOUND - At [**2139-10-26**] 07:00 PM', '- Underwent HIDA', '- Underwent RUQ with dopplers', '- Pt kept NPO', '- Lovenox restarted', '- Discussed with I.D. antibiotic coverage', 'History obtained from Patient']","['- Abd wound with large drainage (>1L) per day, surgery wrote to replace', '[**12-24**] to 1 cc of drainage', '- HIDA Scan ordered to determine etiology of leak (? from biliary-jeju', 'leak vs. leak from bowel perf), with potential PTC afterwards based on', 'findings', '- Changed to Zosyn to Meropenum as Sputum cx grew Klebsiella resistant', 'to Zosyn.', '- Added Flagyl as Bile grew likely Clostridium Perfingens']",14176,126791.0
22,2139-10-28 06:32:02,"['-PTC planned for am, pt NPO after midnight (currently getting 30cc', 'liquids/ hr)', '-Restarted Zosyn, stopped meropenem', '-SW consulted', '- TPN reordered', '- CT abd and pelvis redone- progession of splenic infarcts, want to', 're-image for possible fluid collection in 1 day (CT abd ordered for', '[**10-28**]), decr pleural effusions.', '- ophtho consulted-think L eye has subconjunctival hemorrhage. Reassure', 'pt. No tx or f/u needed at this time', '-Wound care came and placed new bag over abd wound- will stay for up to', '10 days at a time. They will follow with us']","['-PTC planned for am, pt NPO after midnight (currently getting 30cc', 'liquids/ hr)', '-Restarted Zosyn, stopped meropenem', '-SW consulted', '- TPN reordered', '- CT abd and pelvis redone- progession of splenic infarcts, want to', 're-image for possible fluid collection in 1 day (CT abd ordered for', '[**10-28**]), decr pleural effusions.', '- ophtho consulted-think L eye has subconjunctival hemorrhage. Reassure', 'pt. No tx or f/u needed at this time', '-Wound care came and placed new bag over abd wound- will stay for up to', '10 days at a time. They will follow with us']","['NUCLEAR MEDICINE - At [**2139-10-26**] 02:42 PM', 'Hida scan- gall bladder', ' ULTRASOUND - At [**2139-10-26**] 07:00 PM', '- Underwent HIDA', '- Underwent RUQ with dopplers', '- Pt kept NPO', '- Lovenox restarted', '- Discussed with I.D. antibiotic coverage', 'History obtained from Patient']",14176,126791.0
23,2139-10-28 07:19:03,['- JP drain fell out yesterday'],"['- JP drain fell out yesterday', '-PTC planned for am, pt NPO after midnight (currently getting 30cc', 'liquids/ hr)', '-Restarted Zosyn, stopped meropenem', '-SW consulted', '- TPN reordered', '- CT abd and pelvis redone- progession of splenic infarcts, want to', 're-image for possible fluid collection in 1 day (CT abd ordered for', '[**10-28**]), decr pleural effusions.', '- ophtho consulted-think L eye has subconjunctival hemorrhage. Reassure', 'pt. No tx or f/u needed at this time', '-Wound care came and placed new bag over abd wound- will stay for up to', '10 days at a time. They will follow with us']",,14176,126791.0
24,2139-10-29 06:18:33,,[],"['- JP drain fell out yesterday', '-PTC planned for am, pt NPO after midnight (currently getting 30cc', 'liquids/ hr)', '-Restarted Zosyn, stopped meropenem', '-SW consulted', '- TPN reordered', '- CT abd and pelvis redone- progession of splenic infarcts, want to', 're-image for possible fluid collection in 1 day (CT abd ordered for', '[**10-28**]), decr pleural effusions.', '- ophtho consulted-think L eye has subconjunctival hemorrhage. Reassure', 'pt. No tx or f/u needed at this time', '-Wound care came and placed new bag over abd wound- will stay for up to', '10 days at a time. They will follow with us']",14176,126791.0
25,2139-10-29 06:26:22,"['- CT abd/pelv without fluid collection, gastrografin emptied out of abd', 'wound (pending official read)', '- Patient went for PTC yesterday, but no leak at the biliary jejunal', 'anastamosis was found so no drain was placed.', ""- d/c'd steriods as this likely impairs wound healing."", '- Dr. [**Last Name (STitle) **] wants multidisiplenary family meeting (next week?)', '- No decision made on abx other than to keep them on based on', 'attendings recs.']","['- CT abd/pelv without fluid collection, gastrografin emptied out of abd', 'wound (pending official read)', '- Patient went for PTC yesterday, but no leak at the biliary jejunal', 'anastamosis was found so no drain was placed.', ""- d/c'd steriods as this likely impairs wound healing."", '- Dr. [**Last Name (STitle) **] wants multidisiplenary family meeting (next week?)', '- No decision made on abx other than to keep them on based on', 'attendings recs.']",,14176,126791.0
26,2139-10-29 07:16:21,"['- Pt placed on clears last PM, took in 1500cc, (1600 subsequently out', 'through drain), thus replaced (at 1:1.5 ratio), 2400 cc NS with 50 of', 'KCl.']","['- CT abd/pelv without fluid collection, gastrografin emptied out of abd', 'wound (pending official read)', '- Patient went for PTC yesterday, but no leak at the biliary jejunal', 'anastamosis was found so no drain was placed.', ""- d/c'd steriods as this likely impairs wound healing."", '- Dr. [**Last Name (STitle) **] wants multidisiplenary family meeting (next week?)', '- No decision made on abx other than to keep them on based on', 'attendings recs.', '- Pt placed on clears last PM, took in 1500cc, (1600 subsequently out', 'through drain), thus replaced (at 1:1.5 ratio), 2400 cc NS with 50 of', 'KCl.']",,14176,126791.0
27,2139-10-29 07:57:59,,[],"['- CT abd/pelv without fluid collection, gastrografin emptied out of abd', 'wound (pending official read)', '- Patient went for PTC yesterday, but no leak at the biliary jejunal', 'anastamosis was found so no drain was placed.', ""- d/c'd steriods as this likely impairs wound healing."", '- Dr. [**Last Name (STitle) **] wants multidisiplenary family meeting (next week?)', '- No decision made on abx other than to keep them on based on', 'attendings recs.', '- Pt placed on clears last PM, took in 1500cc, (1600 subsequently out', 'through drain), thus replaced (at 1:1.5 ratio), 2400 cc NS with 50 of', 'KCl.']",14176,126791.0
28,2139-10-29 07:59:41,,,,14176,126791.0
29,2139-10-29 08:00:25,,,,14176,126791.0
30,2139-10-29 08:03:21,,,,14176,126791.0
31,2139-10-29 08:03:44,,,,14176,126791.0
32,2139-10-30 08:05:03,,,,14176,126791.0
33,2139-10-31 06:54:06,"['- Per surgery in afternoon- incr IVF to 1.5:1. Started on low residue', 'diet. Surgery will monitor closely and change diet depending on ostomy', 'outpt. Also per surgery, pt will stay in unit over the weekend.', '-Pm lytes all looked good. No repletion neccessary', '-TPN reordered']",,"['- Discussed patients anatomy with surgery team', '- Lovenox changed to therapeutic doses', ""- Emailed pt's Crohn's physician to discuss steroid taper- would like a"", ""taper, no need to treat Crohn's at this time. Pt currently on hydrocort"", '25mg IV/day', '- Replacing lost enterotomy drainage 1:1 with IVF', ""- Vanc and Zosyn d/c'd, Flagyl left on board"", 'History obtained from Patient']",14176,126791.0
34,2139-10-31 13:39:31,,,,14176,126791.0
35,2139-11-01 06:01:26,,,"['- Per surgery in afternoon- incr IVF to 1.5:1. Started on low residue', 'diet. Surgery will monitor closely and change diet depending on ostomy', 'outpt. Also per surgery, pt will stay in unit over the weekend.', '-Pm lytes all looked good. No repletion neccessary', '-TPN reordered']",14176,126791.0
36,2139-11-01 06:07:39,"['- Surgery indicated to keep in ICU until Monday when they can have a', 'family meeting', '- Pt Bicarb dropped to 19, likely due to fluid replacement with NS ->', 'switched to LR for replacement', '- Repeat bicarb of 23 and VBG with pH of 7.45/35/39, lactate of 1.2']",,,14176,126791.0
37,2139-11-01 16:07:52,['- [**3-28**] Liquid stools overnight'],,,14176,126791.0
38,2139-11-02 08:00:01,,,,14176,126791.0
0,2160-10-04 06:54:50,,"['s/p pericardiocentesis of bloody fluid, 500 cc, sent for cytology', 'RA pressure immediately decreased', 'pig-tail cath drain left in place, about 150 cc bloody fluid this', 'morning', 'pulses checked on arrival to floor = 8 mmHg, unchanged this morning', 'placed on shovel mask for mild desat to 80s, responded well', 'History obtained from Patient']",,59087,146540.0
1,2160-10-04 07:02:34,,"['s/p pericardiocentesis of bloody fluid, 500 cc, sent for cytology', 'RA pressure immediately decreased', 'pig-tail cath drain left in place, about 150 cc bloody fluid this', 'morning', 'pulses checked on arrival to floor = 8 mmHg, unchanged this morning', 'placed on shovel mask for mild desat to 80s, responded well', 'History obtained from Patient']",,59087,146540.0
2,2160-10-04 11:47:01,,"['s/p pericardiocentesis of bloody fluid, 500 cc, sent for cytology', 'RA pressure immediately decreased', 'pig-tail cath drain left in place, about 150 cc bloody fluid this', 'morning', 'pulses checked on arrival to floor = 8 mmHg, unchanged this morning', 'placed on shovel mask for mild desat to 80s, responded well', 'History obtained from Patient']",,59087,146540.0
3,2160-10-05 08:04:24,"['BAL FLUID CULTURE - At [**2160-10-4**] 03:57 PM', 'pericardial fluid sent for cx gm stain']","['BAL FLUID CULTURE - At [**2160-10-4**] 03:57 PM', 'pericardial fluid sent for cx gm stain']","['s/p pericardiocentesis of bloody fluid, 500 cc, sent for cytology', 'RA pressure immediately decreased', 'pig-tail cath drain left in place, about 150 cc bloody fluid this', 'morning', 'pulses checked on arrival to floor = 8 mmHg, unchanged this morning', 'placed on shovel mask for mild desat to 80s, responded well', 'History obtained from Patient']",59087,146540.0
4,2160-10-05 12:12:38,"['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']","['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']","['BAL FLUID CULTURE - At [**2160-10-4**] 03:57 PM', 'pericardial fluid sent for cx gm stain']",59087,146540.0
5,2160-10-05 12:28:11,,"['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']",,59087,146540.0
6,2160-10-05 12:33:34,,"['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']",,59087,146540.0
7,2160-10-05 21:49:11,,"['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']",,59087,146540.0
8,2160-10-06 06:28:36,"['PERICARDIAL DRAIN REMOVED - At [**2160-10-5**] 05:00 PM', 'drain removed by cardiology fellow w/o difficulty, pt [**Name (NI) 1216**] throughout;', 'total 40 cc straw colored fluid in bag since [**75**] hours ago.', '[**2160-10-5**]: NaCl nasal spray. KCl.', 'CXR showed moderate bilateral pleural effusions right greater than', 'left with volume loss in both lower lobes with dense retrocardiac', 'consolidation. Difficult to assess for interval change given different', ""positioning but the lungs appear slightly better aerated on today's"", 'study.']","['PERICARDIAL DRAIN REMOVED - At [**2160-10-5**] 05:00 PM', 'drain removed by cardiology fellow w/o difficulty, pt [**Name (NI) 1216**] throughout;', 'total 40 cc straw colored fluid in bag since [**75**] hours ago.', '[**2160-10-5**]: NaCl nasal spray. KCl.', 'CXR showed moderate bilateral pleural effusions right greater than', 'left with volume loss in both lower lobes with dense retrocardiac', 'consolidation. Difficult to assess for interval change given different', ""positioning but the lungs appear slightly better aerated on today's"", 'study.']","['Pericardial drain put out total of 50 mL in last 16 hrs,', 'serosanguinous. Pericardial fluid sent for cx gm stain, cx grew Gram', 'positive cocci in clusters. Pulsus monitored overnight, 4-6 mmHg.', 'Patient still hypoxic, requiring 5L O2 NC. TTE [**2160-10-4**] showed unchanged,', 'small pericardial effusion. Pericardial drain adjusted due to clogging.', 'CXR [**2160-10-4**] showed small b/l pleural effusions, infiltrate in LLL cannot', 'be excluded.', 'Patient denies pain at drain site. Less pleuritic chest pain and', 'increased cough, c/w resolution of pericardial effusion. Tolerating PO', 'intake, Foley catheter in place.']",59087,146540.0
9,2160-10-06 07:40:09,,"['PERICARDIAL DRAIN REMOVED - At [**2160-10-5**] 05:00 PM', 'drain removed by cardiology fellow w/o difficulty, pt [**Name (NI) 1216**] throughout;', 'total 40 cc straw colored fluid in bag since [**75**] hours ago.', '[**2160-10-5**]: NaCl nasal spray. KCl.', 'CXR showed moderate bilateral pleural effusions right greater than', 'left with volume loss in both lower lobes with dense retrocardiac', 'consolidation. Difficult to assess for interval change given different', ""positioning but the lungs appear slightly better aerated on today's"", 'study.']",,59087,146540.0
10,2160-10-06 08:01:38,,"['PERICARDIAL DRAIN REMOVED - At [**2160-10-5**] 05:00 PM', 'drain removed by cardiology fellow w/o difficulty, pt [**Name (NI) 1216**] throughout;', 'total 40 cc straw colored fluid in bag since [**75**] hours ago.', '[**2160-10-5**]: NaCl nasal spray. KCl.', 'CXR showed moderate bilateral pleural effusions right greater than', 'left with volume loss in both lower lobes with dense retrocardiac', 'consolidation. Difficult to assess for interval change given different', ""positioning but the lungs appear slightly better aerated on today's"", 'study.']",,59087,146540.0
0,2199-01-17 06:39:56,,"['MAGNETIC RESONANCE IMAGING - At [**2199-1-16**] 10:34 AM', ' TRANSTHORACIC ECHO - At [**2199-1-16**] 03:02 PM', ' INVASIVE VENTILATION - STOP [**2199-1-16**] 04:10 PM', ' BLOOD CULTURED - At [**2199-1-16**] 04:32 PM', ' BLOOD CULTURED - At [**2199-1-16**] 09:00 PM', ' FEVER - 101.9', 'F - [**2199-1-16**] 07:00 AM']",,73565,106883.0
1,2199-01-17 07:04:06,"['Pt. extubated yesterday, responsive, alert and oriented.  Per ID she', 'was started on clinda, amp/unasyn was DC', 'd.  TTE negative, pt. will go', 'for TEE possibly today.']","['Pt. extubated yesterday, responsive, alert and oriented.  Per ID she', 'was started on clinda, amp/unasyn was DC', 'd.  TTE negative, pt. will go', 'for TEE possibly today.']","['MAGNETIC RESONANCE IMAGING - At [**2199-1-16**] 10:34 AM', ' TRANSTHORACIC ECHO - At [**2199-1-16**] 03:02 PM', ' INVASIVE VENTILATION - STOP [**2199-1-16**] 04:10 PM', ' BLOOD CULTURED - At [**2199-1-16**] 04:32 PM', ' BLOOD CULTURED - At [**2199-1-16**] 09:00 PM', ' FEVER - 101.9', 'F - [**2199-1-16**] 07:00 AM']",73565,106883.0
2,2199-01-17 07:48:57,"['for TEE possibly today.  Temp to 101.9, cultured']","['Pt. extubated yesterday, responsive, alert and oriented.  Per ID she', 'was started on clinda, amp/unasyn was DC', 'd.  TTE negative, pt. will go', 'for TEE possibly today.  Temp to 101.9, cultured']",['for TEE possibly today.'],73565,106883.0
3,2199-01-17 11:50:16,,"['Pt. extubated yesterday, responsive, alert and oriented.  Per ID she', 'was started on clinda, amp/unasyn was DC', 'd.  TTE negative, pt. will go', 'for TEE possibly today.  Temp to 101.9, cultured']",,73565,106883.0
0,2129-01-18 11:27:17,,"['- admitted for HTN emergency', '- controlled on labetalol']",,75206,128415.0
0,2162-03-29 07:16:53,,"['[**2162-3-28**]:', '- insulin gtt d/c', '- tolerating regular diet', '- started lantus 24 and insulin SS [**First Name8 (NamePattern2) 24**] [**Last Name (un) 294**] recs', '- sugars overnight 80s to 180s', '- re-starting home meds', '- Neuro consult for word finding difficulties and new cerebellar', 'hypodensities on CT - recommend (1) MRA brain and MRA head and neck (2)', 'check lipids  (3) check TTE  (4) aspirin 325mg daily']",,74376,173216.0
1,2162-03-29 07:38:52,,"['[**2162-3-28**]:', '- insulin gtt d/c', '- tolerating regular diet', '- started lantus 24 and insulin SS [**First Name8 (NamePattern2) 24**] [**Last Name (un) 294**] recs', '- sugars overnight 80s to 180s', '- re-starting home meds', '- Neuro consult for word finding difficulties and new cerebellar', 'hypodensities on CT - recommend (1) MRA brain and MRA head and neck (2)', 'check lipids  (3) check TTE  (4) aspirin 325mg daily']",,74376,173216.0
2,2162-03-29 07:41:38,,"['[**2162-3-28**]:', '- insulin gtt d/c', '- tolerating regular diet', '- started lantus 24 and insulin SS [**First Name8 (NamePattern2) 24**] [**Last Name (un) 294**] recs', '- sugars overnight 80s to 180s', '- re-starting home meds', '- Neuro consult for word finding difficulties and new cerebellar', 'hypodensities on CT - recommend (1) MRA brain and MRA head and neck (2)', 'check lipids  (3) check TTE  (4) aspirin 325mg daily']",,74376,173216.0
3,2162-03-29 11:59:50,,"['[**2162-3-28**]:', '- insulin gtt d/c', '- tolerating regular diet', '- started lantus 24 and insulin SS [**First Name8 (NamePattern2) 24**] [**Last Name (un) 294**] recs', '- sugars overnight 80s to 180s', '- re-starting home meds', '- Neuro consult for word finding difficulties and new cerebellar', 'hypodensities on CT - recommend (1) MRA brain and MRA head and neck (2)', 'check lipids  (3) check TTE  (4) aspirin 325mg daily']",,74376,173216.0
4,2162-03-29 12:03:48,,"['[**2162-3-28**]:', '- insulin gtt d/c', '- tolerating regular diet', '- started lantus 24 and insulin SS [**First Name8 (NamePattern2) 24**] [**Last Name (un) 294**] recs', '- sugars overnight 80s to 180s', '- re-starting home meds', '- Neuro consult for word finding difficulties and new cerebellar', 'hypodensities on CT - recommend (1) MRA brain and MRA head and neck (2)', 'check lipids  (3) check TTE  (4) aspirin 325mg daily']",,74376,173216.0
0,2193-06-20 07:34:35,,"['URINE CULTURE - At [**2193-6-19**] 10:19 PM', ' BLOOD CULTURED - At [**2193-6-19**] 10:20 PM', ' FEVER - 101.2', 'F - [**2193-6-20**] 12:00 AM', '-noncon CT chest prelim multifocal peribronchvasc. consolidations Right', 'lung, new lung base consolidations c/w asp pna; mild pulmonary edema', '-lost access, placed by U/S by Dr. [**Last Name (STitle) 906**]', '[**Name (STitle) 7504**] to 100.1, sent blood and urine ctx', '-holding betablocker, because of lower BPs; got isosorbide dinatrate', '-discussed with cards who did not want to treat for ACS (felt demand', 'ischemia from fever, tachycardia, hypoxia) and suggested increasing', 'imdur and metoprolol and restarting home amlodipine if possible with', 'holding off on heparin; stress vs cath as outpt.', '-echo nl, no shunt', '-[**4-29**] week outpatient heme/onc f/u with Dr. [**Last Name (STitle) 2803**] (requested appointment', 'by email service)', '-called for arm and leg pruritis that had been ongoing since this', 'afternoon, examined, no rashes, given benadryl, ?if from Lasix']",,44464,126622.0
1,2193-06-20 07:54:37,"['[**Name (STitle) 7504**] to 101.2, sent blood and urine ctx']","['URINE CULTURE - At [**2193-6-19**] 10:19 PM', ' BLOOD CULTURED - At [**2193-6-19**] 10:20 PM', ' FEVER - 101.2', 'F - [**2193-6-20**] 12:00 AM', '-noncon CT chest prelim multifocal peribronchvasc. consolidations Right', 'lung, new lung base consolidations c/w asp pna; mild pulmonary edema', '-lost access, placed by U/S by Dr. [**Last Name (STitle) 906**]', '[**Name (STitle) 7504**] to 101.2, sent blood and urine ctx', '-holding betablocker, because of lower BPs; got isosorbide dinatrate', '-discussed with cards who did not want to treat for ACS (felt demand', 'ischemia from fever, tachycardia, hypoxia) and suggested increasing', 'imdur and metoprolol and restarting home amlodipine if possible with', 'holding off on heparin; stress vs cath as outpt.', '-echo nl, no shunt', '-[**4-29**] week outpatient heme/onc f/u with Dr. [**Last Name (STitle) 2803**] (requested appointment', 'by email service)', '-called for arm and leg pruritis that had been ongoing since this', 'afternoon, examined, no rashes, given benadryl, ?if from Lasix']","['[**Name (STitle) 7504**] to 100.1, sent blood and urine ctx']",44464,126622.0
2,2193-06-20 13:22:39,,"['URINE CULTURE - At [**2193-6-19**] 10:19 PM', ' BLOOD CULTURED - At [**2193-6-19**] 10:20 PM', ' FEVER - 101.2', 'F - [**2193-6-20**] 12:00 AM', '-noncon CT chest prelim multifocal peribronchvasc. consolidations Right', 'lung, new lung base consolidations c/w asp pna; mild pulmonary edema', '-lost access, placed by U/S by Dr. [**Last Name (STitle) 906**]', '[**Name (STitle) 7504**] to 101.2, sent blood and urine ctx', '-holding betablocker, because of lower BPs; got isosorbide dinatrate', '-discussed with cards who did not want to treat for ACS (felt demand', 'ischemia from fever, tachycardia, hypoxia) and suggested increasing', 'imdur and metoprolol and restarting home amlodipine if possible with', 'holding off on heparin; stress vs cath as outpt.', '-echo nl, no shunt', '-[**4-29**] week outpatient heme/onc f/u with Dr. [**Last Name (STitle) 2803**] (requested appointment', 'by email service)', '-called for arm and leg pruritis that had been ongoing since this', 'afternoon, examined, no rashes, given benadryl, ?if from Lasix']",,44464,126622.0
0,2200-12-16 05:46:31,,['No Events.'],,14603,179511.0
1,2200-12-16 07:50:31,,['No Events.'],,14603,179511.0
2,2200-12-16 10:22:19,,['No Events.'],,14603,179511.0
3,2200-12-17 07:28:11,"['- Renal consult - they also think likely pre-renal (forward flow) v.', 'renal vascular disease.  [**Month (only) 60**] consider Doppler study in future. They', 'were not impressed by 2.5 mm stone. Urine Eos negative. Diuresed', 'aggressively (3.3 L - want to check creatinine before diuresing more -', 'if stable then continue diuresis in a.m.).  Complement levels pending.', '- UA shows blood - maybe due to stone. Repeat.', '- Was anxious on BiPAP this a.m. - gave ativan.  Did well on trial off', 'BiPAP, but back on again now.']","['- Renal consult - they also think likely pre-renal (forward flow) v.', 'renal vascular disease.  [**Month (only) 60**] consider Doppler study in future. They', 'were not impressed by 2.5 mm stone. Urine Eos negative. Diuresed', 'aggressively (3.3 L - want to check creatinine before diuresing more -', 'if stable then continue diuresis in a.m.).  Complement levels pending.', '- UA shows blood - maybe due to stone. Repeat.', '- Was anxious on BiPAP this a.m. - gave ativan.  Did well on trial off', 'BiPAP, but back on again now.']",['No Events.'],14603,179511.0
4,2200-12-17 14:03:44,,"['- Renal consult - they also think likely pre-renal (forward flow) v.', 'renal vascular disease.  [**Month (only) 60**] consider Doppler study in future. They', 'were not impressed by 2.5 mm stone. Urine Eos negative. Diuresed', 'aggressively (3.3 L - want to check creatinine before diuresing more -', 'if stable then continue diuresis in a.m.).  Complement levels pending.', '- UA shows blood - maybe due to stone. Repeat.', '- Was anxious on BiPAP this a.m. - gave ativan.  Did well on trial off', 'BiPAP, but back on again now.']",,14603,179511.0
5,2200-12-18 07:15:24,"['- C3/4 levels: 110/26', '- UA: lg blood / 25 protein / > 50 RBC / [**2-20**] WBC / few bacteria', '- Lasix bolus with I/O @ 21:50 -540, rebolused with I/O of ___.', '- Still no stooling despite colace, senna, biscodyl, soap suds enema,', 'mirilax']","['- C3/4 levels: 110/26', '- UA: lg blood / 25 protein / > 50 RBC / [**2-20**] WBC / few bacteria', '- Lasix bolus with I/O @ 21:50 -540, rebolused with I/O of ___.', '- Still no stooling despite colace, senna, biscodyl, soap suds enema,', 'mirilax']","['- Renal consult - they also think likely pre-renal (forward flow) v.', 'renal vascular disease.  [**Month (only) 60**] consider Doppler study in future. They', 'were not impressed by 2.5 mm stone. Urine Eos negative. Diuresed', 'aggressively (3.3 L - want to check creatinine before diuresing more -', 'if stable then continue diuresis in a.m.).  Complement levels pending.', '- UA shows blood - maybe due to stone. Repeat.', '- Was anxious on BiPAP this a.m. - gave ativan.  Did well on trial off', 'BiPAP, but back on again now.']",14603,179511.0
6,2200-12-18 12:54:47,"['- Lasix bolus with I/O @ 21:50 -540, rebolused with I/O of -1 liter.', '- Pt continues to complain of abdominal pain today.']","['- C3/4 levels: 110/26', '- UA: lg blood / 25 protein / > 50 RBC / [**2-20**] WBC / few bacteria', '- Lasix bolus with I/O @ 21:50 -540, rebolused with I/O of -1 liter.', '- Still no stooling despite colace, senna, biscodyl, soap suds enema,', 'mirilax', '- Pt continues to complain of abdominal pain today.']","['- Lasix bolus with I/O @ 21:50 -540, rebolused with I/O of ___.']",14603,179511.0
0,2148-12-03 08:13:13,,"['EKG - At [**2148-12-2**] 08:50 AM', 'History obtained from Medical records']",,57774,106996.0
1,2148-12-03 08:16:08,,"['EKG - At [**2148-12-2**] 08:50 AM', 'History obtained from Medical records']",,57774,106996.0
2,2148-12-03 09:03:10,,"['EKG - At [**2148-12-2**] 08:50 AM', 'History obtained from Medical records']",,57774,106996.0
3,2148-12-03 09:34:58,['Unable to start CVVH due to inability to withdraw from line.'],"['EKG - At [**2148-12-2**] 08:50 AM', 'Unable to start CVVH due to inability to withdraw from line.', 'History obtained from Medical records']",,57774,106996.0
4,2148-12-03 13:24:16,,"['EKG - At [**2148-12-2**] 08:50 AM', 'Unable to start CVVH due to inability to withdraw from line.', 'History obtained from Medical records']",,57774,106996.0
5,2148-12-04 07:57:40,"['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']","['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']","['EKG - At [**2148-12-2**] 08:50 AM', 'Unable to start CVVH due to inability to withdraw from line.', 'History obtained from Medical records']",57774,106996.0
6,2148-12-04 09:18:41,,"['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']",,57774,106996.0
7,2148-12-04 09:27:53,,"['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']",,57774,106996.0
8,2148-12-04 09:35:04,,"['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']",,57774,106996.0
9,2148-12-04 11:54:25,,"['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']",,57774,106996.0
10,2148-12-05 07:34:01,"['PICC LINE - START [**2148-12-4**] 01:00 PM', 'Power PICC- has heparin', ' DIALYSIS CATHETER - START [**2148-12-4**] 01:30 PM', '[**12-4**] CT abd/pelvis: no intra/RP bleed; got tunneled line and PICC', 'placed']","['PICC LINE - START [**2148-12-4**] 01:00 PM', 'Power PICC- has heparin', ' DIALYSIS CATHETER - START [**2148-12-4**] 01:30 PM', '[**12-4**] CT abd/pelvis: no intra/RP bleed; got tunneled line and PICC', 'placed']","['INVASIVE VENTILATION - STOP [**2148-12-3**] 09:45 AM', ' UNPLANNED LINE/CATHETER REMOVAL (PATIENT INITIATED) - At [**2148-12-4**]']",57774,106996.0
11,2148-12-05 07:35:23,,"['PICC LINE - START [**2148-12-4**] 01:00 PM', 'Power PICC- has heparin', ' DIALYSIS CATHETER - START [**2148-12-4**] 01:30 PM', '[**12-4**] CT abd/pelvis: no intra/RP bleed; got tunneled line and PICC', 'placed']",,57774,106996.0
12,2148-12-06 07:38:53,,[],"['PICC LINE - START [**2148-12-4**] 01:00 PM', 'Power PICC- has heparin', ' DIALYSIS CATHETER - START [**2148-12-4**] 01:30 PM', '[**12-4**] CT abd/pelvis: no intra/RP bleed; got tunneled line and PICC', 'placed']",57774,106996.0
13,2148-12-06 07:40:18,,[],,57774,106996.0
14,2148-12-06 08:01:12,"['Minoxidil added to BP regimen, but remains hypertensive requiring nitro', 'gtt.']","['Minoxidil added to BP regimen, but remains hypertensive requiring nitro', 'gtt.']",,57774,106996.0
15,2148-12-06 15:05:52,"['Minoxidil added to BP regimen, but remains hypertensive with systolic', 'requiring nitro gtt.']","['Minoxidil added to BP regimen, but remains hypertensive with systolic', 'requiring nitro gtt.']","['Minoxidil added to BP regimen, but remains hypertensive requiring nitro', 'gtt.']",57774,106996.0
16,2148-12-07 09:20:25,"['Nitro gtt off ~3 AM.', 'History obtained from Overnight resident']","['Nitro gtt off ~3 AM.', 'History obtained from Overnight resident']","['Minoxidil added to BP regimen, but remains hypertensive with systolic', 'requiring nitro gtt.']",57774,106996.0
17,2148-12-07 09:21:41,,"['Nitro gtt off ~3 AM.', 'History obtained from Overnight resident']",,57774,106996.0
18,2148-12-07 10:46:06,,"['Nitro gtt off ~3 AM.', 'History obtained from Overnight resident']",,57774,106996.0
19,2148-12-07 11:23:26,,"['Nitro gtt off ~3 AM.', 'History obtained from Overnight resident']",,57774,106996.0
0,2200-03-20 07:14:14,,"['- No events', ' slept intermittently, poorly oriented', '- called out']",,7095,167836.0
1,2200-03-20 07:20:04,"[' appropriate at start of shift, oriented to person and at', 'times place but forgetful and needing frequent reminders to keep O2 in', 'place. Slept intermittently but when awoken he was mildly combative and', 'less well oriented.']","['- No events', ' appropriate at start of shift, oriented to person and at', 'times place but forgetful and needing frequent reminders to keep O2 in', 'place. Slept intermittently but when awoken he was mildly combative and', 'less well oriented.', '- called out']","[' slept intermittently, poorly oriented']",7095,167836.0
2,2200-03-20 09:34:02,,"['- No events', ' appropriate at start of shift, oriented to person and at', 'times place but forgetful and needing frequent reminders to keep O2 in', 'place. Slept intermittently but when awoken he was mildly combative and', 'less well oriented.', '- called out']",,7095,167836.0
0,2116-01-12 07:19:49,,"['- off pressors', '- started dilaudid pca for pain management', '- had afib with rvr briefly (few secs) to 200s, self-terminated,', 'asymptomatic', '- started metoprolol', '- placed ppd and moved to respiratory isolation']",,89049,192676.0
1,2116-01-12 08:41:03,,"['- off pressors', '- started dilaudid pca for pain management', '- had afib with rvr briefly (few secs) to 200s, self-terminated,', 'asymptomatic', '- started metoprolol', '- placed ppd and moved to respiratory isolation']",,89049,192676.0
0,2107-09-25 07:47:24,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
1,2107-09-25 07:49:19,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
2,2107-09-25 07:53:01,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
3,2107-09-25 10:16:30,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
4,2107-09-25 10:25:55,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
5,2107-09-25 10:26:21,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
6,2107-09-25 10:41:53,,"['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",,99806,133851.0
7,2107-09-26 07:01:54,"['- TTKG: 2.5, suggesting hypoaldosteronism', '- renal recs: would use either ACEI or [**Last Name (un) 284**] on discharge, discontinue', 'bactrim, triamterine, naproxen.', '- pm K 6.4 up from 6.2 in the am, pm lasix was increased to 60mg from', '40mg', '- am cortisol is ordered']","['- TTKG: 2.5, suggesting hypoaldosteronism', '- renal recs: would use either ACEI or [**Last Name (un) 284**] on discharge, discontinue', 'bactrim, triamterine, naproxen.', '- pm K 6.4 up from 6.2 in the am, pm lasix was increased to 60mg from', '40mg', '- am cortisol is ordered']","['- Renal Recs: hyperkalemia due to renal K secretion inhibition by', 'multiple medications (benzapril, [**Last Name (un) 284**], triamtereme, nsaids, bactrim).', 'Would recommend discontinuing all.  Also possible Type 4 RTA.  D/c IVF', 'given volume overload.  Start IV lasix 20mg [**Hospital1 **] or 40mg PO BID to', 'enhance K secretion and remove volume.  Check urine osm, urine k, urine', 'Na, serum osm.', '- Spoke to ID: replace bactrim with linezolid', '- K at 6PM: 6.4.', '- TSH: 9.0.  Free T4: 1.0.  Cortisol: 15.4', '- EKG at 6PM: persistent PR prolongation']",99806,133851.0
8,2107-09-26 11:48:48,,"['- TTKG: 2.5, suggesting hypoaldosteronism', '- renal recs: would use either ACEI or [**Last Name (un) 284**] on discharge, discontinue', 'bactrim, triamterine, naproxen.', '- pm K 6.4 up from 6.2 in the am, pm lasix was increased to 60mg from', '40mg', '- am cortisol is ordered']",,99806,133851.0
0,2204-01-02 07:25:38,,"[""- Pt cont'ed on CIWA scale"", '- No events overnight']",,26027,132036.0
1,2204-01-02 18:59:18,,"[""- Pt cont'ed on CIWA scale"", '- No events overnight']",,26027,132036.0
0,2158-12-16 07:44:09,,"['Admitted', 'Troponin flat', 'BP low but stable', 'History obtained from Patient']",,2338,145012.0
1,2158-12-16 12:55:53,,"['Admitted', 'Troponin flat', 'BP low but stable', 'History obtained from Patient']",,2338,145012.0
0,2159-08-25 07:29:48,,"['- lactic acidosis workup', '-osmolar gap = 1', '-lactic acid trending down = 13.7 -> 11.2 -> 9.0 -> 4.8', '-serum tox = negative', '-co-ox = 2', '-CN = pending', '- EP consult: pacer interrogation reveals no evidence of ventricular', 'arrythmias, recommend switching to amiodarone from sotalol.', '- emailed Dr. [**Last Name (STitle) **] re: use of Sotalol with EF of 20% - reports', 'patient had reaction to amiodarone and recs continuing Sotalol until', 'f/u with him next week', '- lactate trend: 13.7 -> 11.2 -> 9 -> 4.8 -> 3.4']",,2338,147143.0
1,2159-08-25 11:47:49,,"['- lactic acidosis workup', '-osmolar gap = 1', '-lactic acid trending down = 13.7 -> 11.2 -> 9.0 -> 4.8', '-serum tox = negative', '-co-ox = 2', '-CN = pending', '- EP consult: pacer interrogation reveals no evidence of ventricular', 'arrythmias, recommend switching to amiodarone from sotalol.', '- emailed Dr. [**Last Name (STitle) **] re: use of Sotalol with EF of 20% - reports', 'patient had reaction to amiodarone and recs continuing Sotalol until', 'f/u with him next week', '- lactate trend: 13.7 -> 11.2 -> 9 -> 4.8 -> 3.4']",,2338,147143.0
0,2159-09-16 07:53:50,,"['ARTERIAL LINE - START [**2159-9-15**] 11:32 PM', ' INVASIVE VENTILATION - STOP [**2159-9-16**] 04:29 AM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-9-16**] 04:38 AM']",,2338,184485.0
1,2159-09-16 11:55:48,"['Climbed out of bed to stand this morning, independently.', 'Denies chest pain/pressure, SOB, pain.']","['ARTERIAL LINE - START [**2159-9-15**] 11:32 PM', ' INVASIVE VENTILATION - STOP [**2159-9-16**] 04:29 AM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-9-16**] 04:38 AM', 'Climbed out of bed to stand this morning, independently.', 'Denies chest pain/pressure, SOB, pain.']",,2338,184485.0
2,2159-09-16 13:08:16,"['Confused as to location.', 'After extubation, BP has been higher and diuresis s/p lasix has been', 'significant.']","['ARTERIAL LINE - START [**2159-9-15**] 11:32 PM', ' INVASIVE VENTILATION - STOP [**2159-9-16**] 04:29 AM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-9-16**] 04:38 AM', 'Climbed out of bed to stand this morning, independently.', 'Denies chest pain/pressure, SOB, pain.', 'Confused as to location.', 'After extubation, BP has been higher and diuresis s/p lasix has been', 'significant.']",,2338,184485.0
3,2159-09-17 06:45:09,"['-Initiated Amiodarone 400mg daily', ""-Digoxin d/c'ed for renal failure"", '-Decision for further EP intervention will be made after Haffagee', 'returns Mon', '-(-)1.9L without Lasix drip (never needed, not given)']","['-Initiated Amiodarone 400mg daily', ""-Digoxin d/c'ed for renal failure"", '-Decision for further EP intervention will be made after Haffagee', 'returns Mon', '-(-)1.9L without Lasix drip (never needed, not given)']","['ARTERIAL LINE - START [**2159-9-15**] 11:32 PM', ' INVASIVE VENTILATION - STOP [**2159-9-16**] 04:29 AM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-9-16**] 04:38 AM', 'Climbed out of bed to stand this morning, independently.', 'Denies chest pain/pressure, SOB, pain.', 'Confused as to location.', 'After extubation, BP has been higher and diuresis s/p lasix has been', 'significant.']",2338,184485.0
4,2159-09-17 06:49:40,,"['-Initiated Amiodarone 400mg daily', ""-Digoxin d/c'ed for renal failure"", '-Decision for further EP intervention will be made after Haffagee', 'returns Mon', '-(-)1.9L without Lasix drip (never needed, not given)']",,2338,184485.0
5,2159-09-17 14:12:14,,"['-Initiated Amiodarone 400mg daily', ""-Digoxin d/c'ed for renal failure"", '-Decision for further EP intervention will be made after Haffagee', 'returns Mon', '-(-)1.9L without Lasix drip (never needed, not given)']",,2338,184485.0
6,2159-09-17 14:29:39,,"['-Initiated Amiodarone 400mg daily', ""-Digoxin d/c'ed for renal failure"", '-Decision for further EP intervention will be made after Haffagee', 'returns Mon', '-(-)1.9L without Lasix drip (never needed, not given)']",,2338,184485.0
0,2159-10-23 05:43:02,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
1,2159-10-23 05:43:50,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
2,2159-10-23 05:46:15,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
3,2159-10-23 16:16:36,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
4,2159-10-23 16:38:45,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
5,2159-10-23 16:49:47,,"['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",,2338,114726.0
6,2159-10-24 05:26:31,"['TRANS ESOPHAGEAL ECHO - At [**2159-10-23**] 02:00 PM', 'Patient was started on Lasix yesterday morning out of concern for fluid', 'overload and worsening hyponatremia.', 'Patient did not respond well to', 'Lasix 40mg and then 80mg IV x 1, +600cc at midnight.', 'Blood pressures in high 80s in the afternoon and trended down in to', 'high 70s overnight.  He was given two 250cc IVF boluses with good', 'response, BP 102/69.']","['TRANS ESOPHAGEAL ECHO - At [**2159-10-23**] 02:00 PM', 'Patient was started on Lasix yesterday morning out of concern for fluid', 'overload and worsening hyponatremia.', 'Patient did not respond well to', 'Lasix 40mg and then 80mg IV x 1, +600cc at midnight.', 'Blood pressures in high 80s in the afternoon and trended down in to', 'high 70s overnight.  He was given two 250cc IVF boluses with good', 'response, BP 102/69.']","['FENA 0.15', 'Got 750 IV fluids overnight', 'Lactate down to 5.8']",2338,114726.0
7,2159-10-24 05:27:21,,"['TRANS ESOPHAGEAL ECHO - At [**2159-10-23**] 02:00 PM', 'Patient was started on Lasix yesterday morning out of concern for fluid', 'overload and worsening hyponatremia.', 'Patient did not respond well to', 'Lasix 40mg and then 80mg IV x 1, +600cc at midnight.', 'Blood pressures in high 80s in the afternoon and trended down in to', 'high 70s overnight.  He was given two 250cc IVF boluses with good', 'response, BP 102/69.']",,2338,114726.0
8,2159-10-25 02:53:41,,"['TRANS ESOPHAGEAL ECHO - At [**2159-10-23**] 02:00 PM', 'Patient was started on Lasix yesterday morning out of concern for fluid', 'overload and worsening hyponatremia.', 'Patient did not respond well to', 'Lasix 40mg and then 80mg IV x 1, +600cc at midnight.', 'Blood pressures in high 80s in the afternoon and trended down in to', 'high 70s overnight.  He was given two 250cc IVF boluses with good', 'response, BP 102/69.']",,2338,114726.0
9,2159-10-25 07:28:14,"['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']","['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']","['TRANS ESOPHAGEAL ECHO - At [**2159-10-23**] 02:00 PM', 'Patient was started on Lasix yesterday morning out of concern for fluid', 'overload and worsening hyponatremia.', 'Patient did not respond well to', 'Lasix 40mg and then 80mg IV x 1, +600cc at midnight.', 'Blood pressures in high 80s in the afternoon and trended down in to', 'high 70s overnight.  He was given two 250cc IVF boluses with good', 'response, BP 102/69.']",2338,114726.0
10,2159-10-25 07:28:48,,"['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']",,2338,114726.0
11,2159-10-25 07:29:33,,"['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']",,2338,114726.0
12,2159-10-25 18:25:48,,"['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']",,2338,114726.0
13,2159-10-26 07:49:59,"['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']","['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']","['-CVL inserted', '- started on dopamine and urine output increased to approx 100 cc/hr;', 'tapered off and then lasix gtt was started and now continues with UOP', 'at about 60cc/hr.', '- Na starting to improve; renal following along', '- vascular consulted', '- wound growing MSSA', ' MULTI LUMEN - START [**2159-10-24**] 07:02 PM']",2338,114726.0
14,2159-10-26 07:50:44,,"['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']",,2338,114726.0
15,2159-10-26 08:55:55,,"['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']",,2338,114726.0
16,2159-10-26 11:36:24,,"['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']",,2338,114726.0
17,2159-10-27 07:29:59,,[],"['Pt had worsening tachycardia and then became hypotensive and hypoxic', 'overnight last night.  Required intubation and levophed to correct', 'pressures.', 'Oxygenating well after  intubation.', 'BP stable, but unable to place a-line.  On small amount of levophed and', 'still on dopamine.  Restarted lasix gtt this morning.', ' INVASIVE VENTILATION - START [**2159-10-26**] 01:52 AM']",2338,114726.0
18,2159-10-27 07:44:26,,[],,2338,114726.0
19,2159-10-27 11:07:06,,[],,2338,114726.0
20,2159-10-28 07:39:30,"['BLOOD CULTURED - At [**2159-10-28**] 04:05 AM', '- Attempted to transition dopamine to dobutamine in the AM yesterday', 'which failed [**1-1**] falling blood pressure', '- Kept on dopmine/NEO combination as had been producing urine w/out', 'lasix on this. Added vasopressin in the evening in an effort to wean', 'other pressors.', '- PEEP increased to 8 for preload and afterload reduction', '- ECHO with worsening of MR and mild interval improvement of wall mtn', 'abnml [likely secondary to sepsis/pressors]', '- High residuals, regaln started']","['BLOOD CULTURED - At [**2159-10-28**] 04:05 AM', '- Attempted to transition dopamine to dobutamine in the AM yesterday', 'which failed [**1-1**] falling blood pressure', '- Kept on dopmine/NEO combination as had been producing urine w/out', 'lasix on this. Added vasopressin in the evening in an effort to wean', 'other pressors.', '- PEEP increased to 8 for preload and afterload reduction', '- ECHO with worsening of MR and mild interval improvement of wall mtn', 'abnml [likely secondary to sepsis/pressors]', '- High residuals, regaln started']",,2338,114726.0
21,2159-10-28 10:34:22,,"['BLOOD CULTURED - At [**2159-10-28**] 04:05 AM', '- Attempted to transition dopamine to dobutamine in the AM yesterday', 'which failed [**1-1**] falling blood pressure', '- Kept on dopmine/NEO combination as had been producing urine w/out', 'lasix on this. Added vasopressin in the evening in an effort to wean', 'other pressors.', '- PEEP increased to 8 for preload and afterload reduction', '- ECHO with worsening of MR and mild interval improvement of wall mtn', 'abnml [likely secondary to sepsis/pressors]', '- High residuals, regaln started']",,2338,114726.0
22,2159-10-29 07:24:23,"['- tachycardic and dropping BPs in the AM', '- febrile to 102 over most of day', '- urine output decreased significantly after the morning hemodynamic', 'changes', '- sent for c.diff and empirically added cipro and flagyl; adjust cipro', 'dosing this morning for changing renal function', '- LFTs rising, repeated US which showed wet read:', '1. Very limited study from obscuration of a very distended stomach.', '2. Limited evaluation of the GB.', '3. No intrahepatic biliary ductal dilatation.', '- discussed situation with wife and decided on no escalation of care', '- maintained BPs in 80s/60s and HRs in 110s-120s throughout night', '- got 2 doses of tylenol (in spite of his LFTs) and cooling blanket', 'without change in hemodynamics']","['- tachycardic and dropping BPs in the AM', '- febrile to 102 over most of day', '- urine output decreased significantly after the morning hemodynamic', 'changes', '- sent for c.diff and empirically added cipro and flagyl; adjust cipro', 'dosing this morning for changing renal function', '- LFTs rising, repeated US which showed wet read:', '1. Very limited study from obscuration of a very distended stomach.', '2. Limited evaluation of the GB.', '3. No intrahepatic biliary ductal dilatation.', '- discussed situation with wife and decided on no escalation of care', '- maintained BPs in 80s/60s and HRs in 110s-120s throughout night', '- got 2 doses of tylenol (in spite of his LFTs) and cooling blanket', 'without change in hemodynamics']","['BLOOD CULTURED - At [**2159-10-28**] 04:05 AM', '- Attempted to transition dopamine to dobutamine in the AM yesterday', 'which failed [**1-1**] falling blood pressure', '- Kept on dopmine/NEO combination as had been producing urine w/out', 'lasix on this. Added vasopressin in the evening in an effort to wean', 'other pressors.', '- PEEP increased to 8 for preload and afterload reduction', '- ECHO with worsening of MR and mild interval improvement of wall mtn', 'abnml [likely secondary to sepsis/pressors]', '- High residuals, regaln started']",2338,114726.0
23,2159-10-29 14:18:20,['- Discussed with wife will make [**Name (NI) 617**]'],"['- tachycardic and dropping BPs in the AM', '- febrile to 102 over most of day', '- urine output decreased significantly after the morning hemodynamic', 'changes', '- sent for c.diff and empirically added cipro and flagyl; adjust cipro', 'dosing this morning for changing renal function', '- LFTs rising, repeated US which showed wet read:', '1. Very limited study from obscuration of a very distended stomach.', '2. Limited evaluation of the GB.', '3. No intrahepatic biliary ductal dilatation.', '- discussed situation with wife and decided on no escalation of care', '- maintained BPs in 80s/60s and HRs in 110s-120s throughout night', '- got 2 doses of tylenol (in spite of his LFTs) and cooling blanket', 'without change in hemodynamics', '- Discussed with wife will make [**Name (NI) 617**]']",,2338,114726.0
0,2156-11-13 05:59:34,,[],,402,167615.0
1,2156-11-13 06:02:34,,[],,402,167615.0
2,2156-11-13 06:03:42,,[],,402,167615.0
3,2156-11-13 13:03:22,"['No events. Pt remained afebrile.', 'Cultures from [**Hospital3 **] Hospital', ' GPCs']","['No events. Pt remained afebrile.', 'Cultures from [**Hospital3 **] Hospital', ' GPCs']",,402,167615.0
4,2156-11-13 14:56:07,,"['No events. Pt remained afebrile.', 'Cultures from [**Hospital3 **] Hospital', ' GPCs']",,402,167615.0
0,2190-10-09 06:52:54,,"['CORDIS/INTRODUCER - START [**2190-10-8**] 05:30 PM', ' PA CATHETER - START [**2190-10-8**] 05:30 PM', ' ARTERIAL LINE - START [**2190-10-8**] 06:03 PM', ' NASAL SWAB - At [**2190-10-8**] 06:16 PM', ' CORDIS/INTRODUCER - STOP [**2190-10-8**] 06:24 PM', 'This AM, patient reports feeling well overall.  Continues to have mild', 'anterior chest pain, worsened with inspiration and responsive to', 'percocet.  Otherwise, [**Doctor First Name **] SOB, palpitations, dizziness, groin pain', 'or other issues currently.', 'Post cath-checks at midnight and 6 am wnl', 'No events on telemetry overnight']",,75420,114387.0
1,2190-10-09 10:38:11,"['percocet.  Otherwise, denies SOB, palpitations, dizziness, groin pain', 'No events on telemetry overnight.', 'At 3am, patient transiently Hypotensive to SBP 80s, responsive to 500cc', 'IV fluid bolus.  No pulsus.  Also Hct drop from 39 -> 32.4 -> 28.9, so', 'CT abd/pel obtained.']","['CORDIS/INTRODUCER - START [**2190-10-8**] 05:30 PM', ' PA CATHETER - START [**2190-10-8**] 05:30 PM', ' ARTERIAL LINE - START [**2190-10-8**] 06:03 PM', ' NASAL SWAB - At [**2190-10-8**] 06:16 PM', ' CORDIS/INTRODUCER - STOP [**2190-10-8**] 06:24 PM', 'This AM, patient reports feeling well overall.  Continues to have mild', 'anterior chest pain, worsened with inspiration and responsive to', 'percocet.  Otherwise, denies SOB, palpitations, dizziness, groin pain', 'or other issues currently.', 'Post cath-checks at midnight and 6 am wnl', 'No events on telemetry overnight.', 'At 3am, patient transiently Hypotensive to SBP 80s, responsive to 500cc', 'IV fluid bolus.  No pulsus.  Also Hct drop from 39 -> 32.4 -> 28.9, so', 'CT abd/pel obtained.']","['percocet.  Otherwise, [**Doctor First Name **] SOB, palpitations, dizziness, groin pain', 'No events on telemetry overnight']",75420,114387.0
2,2190-10-09 11:32:04,,"['CORDIS/INTRODUCER - START [**2190-10-8**] 05:30 PM', ' PA CATHETER - START [**2190-10-8**] 05:30 PM', ' ARTERIAL LINE - START [**2190-10-8**] 06:03 PM', ' NASAL SWAB - At [**2190-10-8**] 06:16 PM', ' CORDIS/INTRODUCER - STOP [**2190-10-8**] 06:24 PM', 'This AM, patient reports feeling well overall.  Continues to have mild', 'anterior chest pain, worsened with inspiration and responsive to', 'percocet.  Otherwise, denies SOB, palpitations, dizziness, groin pain', 'or other issues currently.', 'Post cath-checks at midnight and 6 am wnl', 'No events on telemetry overnight.', 'At 3am, patient transiently Hypotensive to SBP 80s, responsive to 500cc', 'IV fluid bolus.  No pulsus.  Also Hct drop from 39 -> 32.4 -> 28.9, so', 'CT abd/pel obtained.']",,75420,114387.0
0,2190-10-21 07:21:18,,"['Pt reports feeling well this morning.  Chest pain/pressure now improved', '--> 3/10 intensity.  Still complains of mild shortness of breath.  No', 'palpitations or dizziness.  Otherwise asymptomatic.  Has been in NSR', 'overnight with no episodes SVT.', 'Pericardial drain']",,75420,151414.0
1,2190-10-21 07:33:59,"['Pericardial drain did not drain anything.  10 cc in bag, flushes but', 'does not aspirate.']","['Pt reports feeling well this morning.  Chest pain/pressure now improved', '--> 3/10 intensity.  Still complains of mild shortness of breath.  No', 'palpitations or dizziness.  Otherwise asymptomatic.  Has been in NSR', 'overnight with no episodes SVT.', 'Pericardial drain did not drain anything.  10 cc in bag, flushes but', 'does not aspirate.']",['Pericardial drain'],75420,151414.0
2,2190-10-21 12:47:54,,"['Pt reports feeling well this morning.  Chest pain/pressure now improved', '--> 3/10 intensity.  Still complains of mild shortness of breath.  No', 'palpitations or dizziness.  Otherwise asymptomatic.  Has been in NSR', 'overnight with no episodes SVT.', 'Pericardial drain did not drain anything.  10 cc in bag, flushes but', 'does not aspirate.']",,75420,151414.0
3,2190-10-22 07:53:12,"['TRANSTHORACIC ECHO - At [**2190-10-21**] 02:47 PM', ' PERICARDIAL DRAIN REMOVED - At [**2190-10-21**] 04:30 PM', '[**2190-10-21**]', '- Pt had ECHO which showed small pericardial effusion. Pericardial', 'drain removed without event. Pt called out to [**Hospital Ward Name 289**] 3 but still in CCU', 'due to lack of beds.  Colchicine started in AM. Rpt ECHO planned for', '[**10-22**], if no significant reaccumulation then Pt can likely be d/c to', 'home. Pt ambulating comfortably, had 6 beats of Vtach last night around']","['TRANSTHORACIC ECHO - At [**2190-10-21**] 02:47 PM', ' PERICARDIAL DRAIN REMOVED - At [**2190-10-21**] 04:30 PM', '[**2190-10-21**]', '- Pt had ECHO which showed small pericardial effusion. Pericardial', 'drain removed without event. Pt called out to [**Hospital Ward Name 289**] 3 but still in CCU', 'due to lack of beds.  Colchicine started in AM. Rpt ECHO planned for', '[**10-22**], if no significant reaccumulation then Pt can likely be d/c to', 'home. Pt ambulating comfortably, had 6 beats of Vtach last night around']","['Pt reports feeling well this morning.  Chest pain/pressure now improved', '--> 3/10 intensity.  Still complains of mild shortness of breath.  No', 'palpitations or dizziness.  Otherwise asymptomatic.  Has been in NSR', 'overnight with no episodes SVT.', 'Pericardial drain did not drain anything.  10 cc in bag, flushes but', 'does not aspirate.']",75420,151414.0
0,2130-07-11 07:45:07,,"['ENDOSCOPY - At [**2130-7-10**] 07:30 PM', ' MULTI LUMEN - START [**2130-7-10**] 10:24 PM', ' ARTERIAL LINE - START [**2130-7-10**] 10:25 PM', ' BLOOD CULTURED - At [**2130-7-10**] 10:49 PM', ' EKG - At [**2130-7-11**] 12:41 AM', ' NASAL SWAB - At [**2130-7-11**] 12:41 AM', '.', '[**7-10**]', '-ERCP demonstrated dislodged stent. Stent removed and replaced. Pt with', 'cholangitis as pus and sludge were found with stent removal.', '-Pt became hypotensive (70s/40s) after procedure. She had been on neo', 'drip throughout procedure. Given cholangitis, concern for septic shock.', '-R Subclavian and A line put in.', '-Pt started on dopamine drip through PIV until central access obtained.', 'Then started on levophed via Subclavian. Continued on Levo 0.04. UOP', 'dropped to 20- 25cc/hr - CVP around 17. Increased levo to 0.06 and', 'bolused 1L LR. Per surgery this AM, ok to have UOP 20cc/hr and MAP>70.', 'Levo currently at 0.04.']",,66831,115882.0
1,2130-07-11 11:12:18,"['drip throughout procedure. Pt was hypotensive on floor and anesthesia', 'gave a neo bolus. R Subclavian CVL and A line put in.', 'bolused 0.5L and 1L LR. Per surgery this AM, ok to have UOP 20cc/hr and', 'MAP>70. Levo currently at 0.04.', '-transfused 1 unit RBCs after ERCP.']","['ENDOSCOPY - At [**2130-7-10**] 07:30 PM', ' MULTI LUMEN - START [**2130-7-10**] 10:24 PM', ' ARTERIAL LINE - START [**2130-7-10**] 10:25 PM', ' BLOOD CULTURED - At [**2130-7-10**] 10:49 PM', ' EKG - At [**2130-7-11**] 12:41 AM', ' NASAL SWAB - At [**2130-7-11**] 12:41 AM', '.', '[**7-10**]', '-ERCP demonstrated dislodged stent. Stent removed and replaced. Pt with', 'cholangitis as pus and sludge were found with stent removal.', '-Pt became hypotensive (70s/40s) after procedure. She had been on neo', 'drip throughout procedure. Pt was hypotensive on floor and anesthesia', 'gave a neo bolus. R Subclavian CVL and A line put in.', '-Pt started on dopamine drip through PIV until central access obtained.', 'Then started on levophed via Subclavian. Continued on Levo 0.04. UOP', 'dropped to 20- 25cc/hr - CVP around 17. Increased levo to 0.06 and', 'bolused 0.5L and 1L LR. Per surgery this AM, ok to have UOP 20cc/hr and', 'MAP>70. Levo currently at 0.04.', '-transfused 1 unit RBCs after ERCP.']","['drip throughout procedure. Given cholangitis, concern for septic shock.', '-R Subclavian and A line put in.', 'bolused 1L LR. Per surgery this AM, ok to have UOP 20cc/hr and MAP>70.', 'Levo currently at 0.04.']",66831,115882.0
0,2197-10-28 08:16:42,,"['ULTRASOUND - At [**2197-10-27**] 08:45 AM', 'cardiac echo', ' ULTRASOUND - At [**2197-10-27**] 09:38 AM', 'right upper extremity', ' EKG - At [**2197-10-28**] 12:28 AM', ' BLOOD CULTURED - At [**2197-10-28**] 03:40 AM', ' URINE CULTURE - At [**2197-10-28**] 03:40 AM']",,74748,167693.0
1,2197-10-28 18:00:06,,"['ULTRASOUND - At [**2197-10-27**] 08:45 AM', 'cardiac echo', ' ULTRASOUND - At [**2197-10-27**] 09:38 AM', 'right upper extremity', ' EKG - At [**2197-10-28**] 12:28 AM', ' BLOOD CULTURED - At [**2197-10-28**] 03:40 AM', ' URINE CULTURE - At [**2197-10-28**] 03:40 AM']",,74748,167693.0
2,2197-10-29 08:29:21,"['EKG - At [**2197-10-28**] 09:00 AM', ' WOUND CULTURE - At [**2197-10-28**] 10:02 AM', 'R BKA incision site', ' BLOOD CULTURED - At [**2197-10-28**] 10:30 AM', ' URINE CULTURE - At [**2197-10-28**] 10:30 AM', '-started meropenem, vancomycin (after curbsiding ID) to cover', 'pseudomonas in wound as well as anaerobes and gram positives', ""-pt w. h/o VRE at OSH from wound. if pt's condition worsens, start"", '[**Year (4 digits) **] (which vascular recommends). Could also c/s adding Gent (per', 'ID).', '-re-started Cellcept [**Pager number **] [**Hospital1 7**]', '-extubated this AM']","['EKG - At [**2197-10-28**] 09:00 AM', ' WOUND CULTURE - At [**2197-10-28**] 10:02 AM', 'R BKA incision site', ' BLOOD CULTURED - At [**2197-10-28**] 10:30 AM', ' URINE CULTURE - At [**2197-10-28**] 10:30 AM', '-started meropenem, vancomycin (after curbsiding ID) to cover', 'pseudomonas in wound as well as anaerobes and gram positives', ""-pt w. h/o VRE at OSH from wound. if pt's condition worsens, start"", '[**Year (4 digits) **] (which vascular recommends). Could also c/s adding Gent (per', 'ID).', '-re-started Cellcept [**Pager number **] [**Hospital1 7**]', '-extubated this AM']","['ULTRASOUND - At [**2197-10-27**] 08:45 AM', 'cardiac echo', ' ULTRASOUND - At [**2197-10-27**] 09:38 AM', 'right upper extremity', ' EKG - At [**2197-10-28**] 12:28 AM', ' BLOOD CULTURED - At [**2197-10-28**] 03:40 AM', ' URINE CULTURE - At [**2197-10-28**] 03:40 AM']",74748,167693.0
3,2197-10-29 18:14:26,,"['EKG - At [**2197-10-28**] 09:00 AM', ""-pt w. h/o VRE at OSH from wound. if pt's condition worsens, start"", '[**Year (4 digits) **] (which vascular recommends). Could also c/s adding Gent (per', 'ID).', ' WOUND CULTURE - At [**2197-10-28**] 10:02 AM', 'R BKA incision site', ' BLOOD CULTURED - At [**2197-10-28**] 10:30 AM', ' URINE CULTURE - At [**2197-10-28**] 10:30 AM', '-started meropenem, vancomycin (after curbsiding ID) to cover', 'pseudomonas in wound as well as anaerobes and gram positives', '-re-started Cellcept [**Pager number **] [**Hospital1 7**]', '-extubated this AM']",,74748,167693.0
4,2197-10-30 07:49:38,"['INVASIVE VENTILATION - STOP [**2197-10-29**] 08:15 AM', 'Lower urine output overnight, so given fluid bolus o/n.', '[**10-28**]', ' urine culture GNR', '[**2197-10-28**] 11:40 am SWAB Source: stump.', 'GRAM STAIN (Final [**2197-10-28**]):', '3+  (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.', '2+', '(1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S).']","['INVASIVE VENTILATION - STOP [**2197-10-29**] 08:15 AM', 'Lower urine output overnight, so given fluid bolus o/n.', '[**10-28**]', ' urine culture GNR', '[**2197-10-28**] 11:40 am SWAB Source: stump.', 'GRAM STAIN (Final [**2197-10-28**]):', '3+  (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.', '2+', '(1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S).']","['EKG - At [**2197-10-28**] 09:00 AM', ""-pt w. h/o VRE at OSH from wound. if pt's condition worsens, start"", '[**Year (4 digits) **] (which vascular recommends). Could also c/s adding Gent (per', 'ID).', ' WOUND CULTURE - At [**2197-10-28**] 10:02 AM', 'R BKA incision site', ' BLOOD CULTURED - At [**2197-10-28**] 10:30 AM', ' URINE CULTURE - At [**2197-10-28**] 10:30 AM', '-started meropenem, vancomycin (after curbsiding ID) to cover', 'pseudomonas in wound as well as anaerobes and gram positives', '-re-started Cellcept [**Pager number **] [**Hospital1 7**]', '-extubated this AM']",74748,167693.0
5,2197-10-30 12:49:02,,"['INVASIVE VENTILATION - STOP [**2197-10-29**] 08:15 AM', 'Lower urine output overnight, so given fluid bolus o/n.', '[**10-28**]', ' urine culture GNR', '[**2197-10-28**] 11:40 am SWAB Source: stump.', 'GRAM STAIN (Final [**2197-10-28**]):', '3+  (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.', '2+', '(1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S).']",,74748,167693.0
6,2197-10-30 12:59:52,,"['INVASIVE VENTILATION - STOP [**2197-10-29**] 08:15 AM', 'Lower urine output overnight, so given fluid bolus o/n.', '[**10-28**]', ' urine culture GNR', '[**2197-10-28**] 11:40 am SWAB Source: stump.', 'GRAM STAIN (Final [**2197-10-28**]):', '3+  (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.', '2+', '(1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S).']",,74748,167693.0
7,2197-10-31 06:50:10,"['NON-INVASIVE VENTILATION - START [**2197-10-30**] 04:50 PM', ' EKG - At [**2197-10-30**] 08:19 PM', 'c/o [**1-24**] CP---resolved without intervention.  Resolved when taking EKG', '[**Doctor Last Name 12153**], jayashri [**Telephone/Fax (1) 12154**] = outpatient neurologist; called &', 'left voicemail', '-pressure dropped while being turned, and was less responsive, checked', 'gas - pH 7.08; started BiPAP with good effect, gave 40 lasix for', 'fluid-overload (effusions) on cxr, on 10 pressure/5 PEEP', '-wife updated', '-ok to take PO per s&s, so restarted po metoprolol and amiodarone -', 'then BiPAP, so holding PO amio and giving IV metoprolol', '- gave 40 methylprednisolone IV tonight', '- need IV steroid plan for tomorrow', ""- vanco d/c'd due to high level, check level in AM, then redose"", '- c/s neuro in the AM']","['NON-INVASIVE VENTILATION - START [**2197-10-30**] 04:50 PM', ' EKG - At [**2197-10-30**] 08:19 PM', 'c/o [**1-24**] CP---resolved without intervention.  Resolved when taking EKG', '[**Doctor Last Name 12153**], jayashri [**Telephone/Fax (1) 12154**] = outpatient neurologist; called &', 'left voicemail', '-pressure dropped while being turned, and was less responsive, checked', 'gas - pH 7.08; started BiPAP with good effect, gave 40 lasix for', 'fluid-overload (effusions) on cxr, on 10 pressure/5 PEEP', '-wife updated', '-ok to take PO per s&s, so restarted po metoprolol and amiodarone -', 'then BiPAP, so holding PO amio and giving IV metoprolol', '- gave 40 methylprednisolone IV tonight', '- need IV steroid plan for tomorrow', ""- vanco d/c'd due to high level, check level in AM, then redose"", '- c/s neuro in the AM']","['INVASIVE VENTILATION - STOP [**2197-10-29**] 08:15 AM', 'Lower urine output overnight, so given fluid bolus o/n.', '[**10-28**]', ' urine culture GNR', '[**2197-10-28**] 11:40 am SWAB Source: stump.', 'GRAM STAIN (Final [**2197-10-28**]):', '3+  (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.', '2+', '(1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S).']",74748,167693.0
8,2197-10-31 18:33:40,"['- hypertensive overnight 160s-170s, metop dropping HR from 90s -> 50s']","['NON-INVASIVE VENTILATION - START [**2197-10-30**] 04:50 PM', ' EKG - At [**2197-10-30**] 08:19 PM', 'c/o [**1-24**] CP---resolved without intervention.  Resolved when taking EKG', '[**Doctor Last Name 12153**], jayashri [**Telephone/Fax (1) 12154**] = outpatient neurologist; called &', 'left voicemail', '-pressure dropped while being turned, and was less responsive, checked', 'gas - pH 7.08; started BiPAP with good effect, gave 40 lasix for', 'fluid-overload (effusions) on cxr, on 10 pressure/5 PEEP', '-wife updated', '-ok to take PO per s&s, so restarted po metoprolol and amiodarone -', 'then BiPAP, so holding PO amio and giving IV metoprolol', '- gave 40 methylprednisolone IV tonight', '- need IV steroid plan for tomorrow', ""- vanco d/c'd due to high level, check level in AM, then redose"", '- c/s neuro in the AM', '- hypertensive overnight 160s-170s, metop dropping HR from 90s -> 50s']",,74748,167693.0
9,2197-11-01 07:30:09,"['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high [**Last Name (un) **] neb. He', 'was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']","['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high [**Last Name (un) **] neb. He', 'was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']","['NON-INVASIVE VENTILATION - START [**2197-10-30**] 04:50 PM', ' EKG - At [**2197-10-30**] 08:19 PM', 'c/o [**1-24**] CP---resolved without intervention.  Resolved when taking EKG', '[**Doctor Last Name 12153**], jayashri [**Telephone/Fax (1) 12154**] = outpatient neurologist; called &', 'left voicemail', '-pressure dropped while being turned, and was less responsive, checked', 'gas - pH 7.08; started BiPAP with good effect, gave 40 lasix for', 'fluid-overload (effusions) on cxr, on 10 pressure/5 PEEP', '-wife updated', '-ok to take PO per s&s, so restarted po metoprolol and amiodarone -', 'then BiPAP, so holding PO amio and giving IV metoprolol', '- gave 40 methylprednisolone IV tonight', '- need IV steroid plan for tomorrow', ""- vanco d/c'd due to high level, check level in AM, then redose"", '- c/s neuro in the AM', '- hypertensive overnight 160s-170s, metop dropping HR from 90s -> 50s']",74748,167693.0
10,2197-11-01 08:22:12,"['difficulty regaining his sats, even when placed on 95% high flow neb.', 'He was intubated at that time.']","['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high flow neb.', 'He was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']","['difficulty regaining his sats, even when placed on 95% high [**Last Name (un) **] neb. He', 'was intubated at that time.']",74748,167693.0
11,2197-11-01 10:21:21,,"['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high flow neb.', 'He was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']",,74748,167693.0
12,2197-11-01 10:26:52,,"['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high flow neb.', 'He was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']",,74748,167693.0
13,2197-11-02 07:47:48,"['SPUTUM CULTURE - At [**2197-11-1**] 09:45 AM', ' BLOOD CULTURED - At [**2197-11-1**] 10:00 AM', 'blood cxs x2 from arterial line and poc.', ' URINE CULTURE - At [**2197-11-1**] 10:00 AM', '- Coumadin re-started', '- Tube feeds started', '- On home Prednisone 5mg daily', ""- Neuro recs:  IVIG for patient's h/o autoimmune necrotizing myopathy."", 'Prior history of decompensation and intubation when cellcept was held.']","['SPUTUM CULTURE - At [**2197-11-1**] 09:45 AM', ' BLOOD CULTURED - At [**2197-11-1**] 10:00 AM', 'blood cxs x2 from arterial line and poc.', ' URINE CULTURE - At [**2197-11-1**] 10:00 AM', '- Coumadin re-started', '- Tube feeds started', '- On home Prednisone 5mg daily', ""- Neuro recs:  IVIG for patient's h/o autoimmune necrotizing myopathy."", 'Prior history of decompensation and intubation when cellcept was held.']","['SPUTUM CULTURE - At [**2197-11-1**] 02:45 AM', ' ARTERIAL LINE - STOP [**2197-11-1**] 06:29 AM', '- Vascular surgery said 14 days until staples removed, ~30 days until', 'granulation tissue visible so no concern at this time for non-healing.', 'Also, ok to start Plavix/ASA from their standpoint.', ""- Neuro c/s: will attempt to contact the patient's primary neurologist"", 'to help determine a course of treatment for this patient. At this', ""point, it is very difficult to know whether worsening of the patient's"", 'underlying neuromuscular process is contributing to his hypercarbia.', 'Recommend additional work-up of encephalopathy (LP, EEG, ct head), if', ""the patient's respiratory status is not clearly contributing. continue"", 'the cellcept at 1000mg [**Hospital1 **] and do not recommendd any additional Rx of', 'the neuromuscular syndrome.', '- Volume status: I&O check at 2300 showed + 964 for last 24 hours, so', 'an additional 40mg IV Lasix given.', '- ID: changed abx from Meropenem to Cefepime given wound cultures', 'showing resistance to [**Last Name (un) **].', '- Metabolic acidosis: Urine lytes and urine pH were sent to help eval', 'for RTA. Urine pH = 5.0. Urine anion gap (Urine [Na 101 + K 14 - Cl', '130]) = -15.', '- Respiratory acidosis: The pt was intubated over night.  Yesterday,', 'the pt was maintained on BiPap in the AM, but was transitioned to face', 'mask in the evening [**12-19**] concern for facial skin breakdown.  Repeat', 'gases were obtained, and the pt maintained o2sats above 95% until just', 'before 2am. At that time, the pt was began de-sating to the 80s with', 'difficulty regaining his sats, even when placed on 95% high flow neb.', 'He was intubated at that time.', '- 1 amp of bicarb given.', '- Anticoag: INR is subtherapeutic, restart coumadin for a. fib today?']",74748,167693.0
14,2197-11-02 11:58:25,"['-IVIG not given because of concern for prior reaction to IVIG, per', 'patient', 's wife. [**Name (NI) 133**] confirm with patient', 's outpatient neurologist', 'today regarding reaction.']","['SPUTUM CULTURE - At [**2197-11-1**] 09:45 AM', ' BLOOD CULTURED - At [**2197-11-1**] 10:00 AM', 'blood cxs x2 from arterial line and poc.', ' URINE CULTURE - At [**2197-11-1**] 10:00 AM', '- Coumadin re-started', '- Tube feeds started', '- On home Prednisone 5mg daily', ""- Neuro recs:  IVIG for patient's h/o autoimmune necrotizing myopathy."", 'Prior history of decompensation and intubation when cellcept was held.', '-IVIG not given because of concern for prior reaction to IVIG, per', 'patient', 's wife. [**Name (NI) 133**] confirm with patient', 's outpatient neurologist', 'today regarding reaction.']",,74748,167693.0
15,2197-11-03 07:18:56,"['- starting IVIG 30g daily x5 days ([**11-2**] through [**11-6**]) with tylenol', 'and famotidine premeciation (per neuro outpatient and [**Hospital1 19**] neuro', 'agrees, wife aware & agrees)', '- check daily vanco trough and then dose as prn if level <15; held', 'today', '- diuresed with 40lasix x2', '- then BP in high 80s and low 90s (note; art line not working, so trust', 'the NIBP monitoring) - gave 500NS x2 with good effect (BP improved, MS', 'improved)']","['- starting IVIG 30g daily x5 days ([**11-2**] through [**11-6**]) with tylenol', 'and famotidine premeciation (per neuro outpatient and [**Hospital1 19**] neuro', 'agrees, wife aware & agrees)', '- check daily vanco trough and then dose as prn if level <15; held', 'today', '- diuresed with 40lasix x2', '- then BP in high 80s and low 90s (note; art line not working, so trust', 'the NIBP monitoring) - gave 500NS x2 with good effect (BP improved, MS', 'improved)']","['SPUTUM CULTURE - At [**2197-11-1**] 09:45 AM', ' BLOOD CULTURED - At [**2197-11-1**] 10:00 AM', 'blood cxs x2 from arterial line and poc.', ' URINE CULTURE - At [**2197-11-1**] 10:00 AM', '- Coumadin re-started', '- Tube feeds started', '- On home Prednisone 5mg daily', ""- Neuro recs:  IVIG for patient's h/o autoimmune necrotizing myopathy."", 'Prior history of decompensation and intubation when cellcept was held.', '-IVIG not given because of concern for prior reaction to IVIG, per', 'patient', 's wife. [**Name (NI) 133**] confirm with patient', 's outpatient neurologist', 'today regarding reaction.']",74748,167693.0
16,2197-11-03 11:07:41,"['- Less responsive this AM, arousable to painful stim and occas to', 'voice.  Per nursing, waxing and [**Doctor Last Name 533**] mental status.']","['- starting IVIG 30g daily x5 days ([**11-2**] through [**11-6**]) with tylenol', 'and famotidine premeciation (per neuro outpatient and [**Hospital1 19**] neuro', 'agrees, wife aware & agrees)', '- check daily vanco trough and then dose as prn if level <15; held', 'today', '- diuresed with 40lasix x2', '- then BP in high 80s and low 90s (note; art line not working, so trust', 'the NIBP monitoring) - gave 500NS x2 with good effect (BP improved, MS', 'improved)', '- Less responsive this AM, arousable to painful stim and occas to', 'voice.  Per nursing, waxing and [**Doctor Last Name 533**] mental status.']",,74748,167693.0
17,2197-11-04 07:53:04,"['ULTRASOUND - At [**2197-11-3**] 12:30 PM', '- R LE US: no fluid collection c/w abscess', '- started patient on electrolyte sliding scales and began checking', ""ionized calciums, in order to maximize pt's electrolytes to maximize"", 'muscle strength', ""- plan for SBT in the AM, and ? extubation, pending improvement in pt's"", 'mental status (today, pt only intermittently responsive and following', 'commands, per his wife, he can have priods of up to 48 hours of this).']","['ULTRASOUND - At [**2197-11-3**] 12:30 PM', '- R LE US: no fluid collection c/w abscess', '- started patient on electrolyte sliding scales and began checking', ""ionized calciums, in order to maximize pt's electrolytes to maximize"", 'muscle strength', ""- plan for SBT in the AM, and ? extubation, pending improvement in pt's"", 'mental status (today, pt only intermittently responsive and following', 'commands, per his wife, he can have priods of up to 48 hours of this).']","['- starting IVIG 30g daily x5 days ([**11-2**] through [**11-6**]) with tylenol', 'and famotidine premeciation (per neuro outpatient and [**Hospital1 19**] neuro', 'agrees, wife aware & agrees)', '- check daily vanco trough and then dose as prn if level <15; held', 'today', '- diuresed with 40lasix x2', '- then BP in high 80s and low 90s (note; art line not working, so trust', 'the NIBP monitoring) - gave 500NS x2 with good effect (BP improved, MS', 'improved)', '- Less responsive this AM, arousable to painful stim and occas to', 'voice.  Per nursing, waxing and [**Doctor Last Name 533**] mental status.']",74748,167693.0
18,2197-11-04 11:28:55,"['commands, per his wife, he can have priods of up to 48 hours of this', 'deep unarousable sleep']","['ULTRASOUND - At [**2197-11-3**] 12:30 PM', '- R LE US: no fluid collection c/w abscess', '- started patient on electrolyte sliding scales and began checking', ""ionized calciums, in order to maximize pt's electrolytes to maximize"", 'muscle strength', ""- plan for SBT in the AM, and ? extubation, pending improvement in pt's"", 'mental status (today, pt only intermittently responsive and following', 'commands, per his wife, he can have priods of up to 48 hours of this', 'deep unarousable sleep']","['commands, per his wife, he can have priods of up to 48 hours of this).']",74748,167693.0
19,2197-11-05 07:32:55,"['ARTERIAL LINE - STOP [**2197-11-4**] 09:03 PM', ' STOOL CULTURE - At [**2197-11-5**] 06:02 AM']","['ARTERIAL LINE - STOP [**2197-11-4**] 09:03 PM', ' STOOL CULTURE - At [**2197-11-5**] 06:02 AM']","['ULTRASOUND - At [**2197-11-3**] 12:30 PM', '- R LE US: no fluid collection c/w abscess', '- started patient on electrolyte sliding scales and began checking', ""ionized calciums, in order to maximize pt's electrolytes to maximize"", 'muscle strength', ""- plan for SBT in the AM, and ? extubation, pending improvement in pt's"", 'mental status (today, pt only intermittently responsive and following', 'commands, per his wife, he can have priods of up to 48 hours of this', 'deep unarousable sleep']",74748,167693.0
20,2197-11-05 07:57:07,"['- Coumadin increased to 4mg daily for sub-therapeutic INR', '- UCx showed Klebsiella, concern for ESBL and micro lab will have', 'results for Cefepime sensitivities tomorrow', '- Repeat UCx ordered to see if pt cleared since on Cefepime', ""- a line d/c'ed bc not working"", '- TSH and T4 not significantly abnormal (sick euthyroid)', '- Jerking movements worsened from this morning, EEG ordered, requested', 'Neuro to come evaluate pt.', '- Neuro: Ativan at bedside, unsure if seizure but will look at EEG', '- EEG:  symmetric, slow, biphasic waves of low amplitude, classic', 'textbook, may be status masked by hepatic encephalopathy vs. hepatic', 'encephalopathy.  Ordering ammonia, LFTs, was going to give 2mg IV', 'Ativan x1 and observe for 30-40 minutes for improvement of myoclonus.', 'However, when patient was evaluated prior to Ativan, myoclonic jerks', 'still present but markedly improved, decided to hold on Ativan and', 'repeat EEG tomorrow AM again.  Discussed w/ Neuro.', '- Increased twitching at 3am, given 2mg Ativan and twitching resolved', 'within 30 minutes. Keppra load held pending discussion with Neuro re:', 'EEG in AM and interference of Keppra/Ativan on EEG.']","['ARTERIAL LINE - STOP [**2197-11-4**] 09:03 PM', ' STOOL CULTURE - At [**2197-11-5**] 06:02 AM', '- Coumadin increased to 4mg daily for sub-therapeutic INR', '- UCx showed Klebsiella, concern for ESBL and micro lab will have', 'results for Cefepime sensitivities tomorrow', '- Repeat UCx ordered to see if pt cleared since on Cefepime', ""- a line d/c'ed bc not working"", '- TSH and T4 not significantly abnormal (sick euthyroid)', '- Jerking movements worsened from this morning, EEG ordered, requested', 'Neuro to come evaluate pt.', '- Neuro: Ativan at bedside, unsure if seizure but will look at EEG', '- EEG:  symmetric, slow, biphasic waves of low amplitude, classic', 'textbook, may be status masked by hepatic encephalopathy vs. hepatic', 'encephalopathy.  Ordering ammonia, LFTs, was going to give 2mg IV', 'Ativan x1 and observe for 30-40 minutes for improvement of myoclonus.', 'However, when patient was evaluated prior to Ativan, myoclonic jerks', 'still present but markedly improved, decided to hold on Ativan and', 'repeat EEG tomorrow AM again.  Discussed w/ Neuro.', '- Increased twitching at 3am, given 2mg Ativan and twitching resolved', 'within 30 minutes. Keppra load held pending discussion with Neuro re:', 'EEG in AM and interference of Keppra/Ativan on EEG.']",,74748,167693.0
21,2197-11-05 12:37:04,"['500cc bolus post-ativan for decreased BP, though not true hypotension.']","['ARTERIAL LINE - STOP [**2197-11-4**] 09:03 PM', ""- a line d/c'ed bc not working"", ' STOOL CULTURE - At [**2197-11-5**] 06:02 AM', '- Coumadin increased to 4mg daily for sub-therapeutic INR', '- UCx showed Klebsiella, concern for ESBL and micro lab will have', 'results for Cefepime sensitivities tomorrow', '- Repeat UCx ordered to see if pt cleared since on Cefepime', '- TSH and T4 not significantly abnormal (sick euthyroid)', '- Jerking movements worsened from this morning, EEG ordered, requested', 'Neuro to come evaluate pt.', '- Neuro: Ativan at bedside, unsure if seizure but will look at EEG', '- EEG:  symmetric, slow, biphasic waves of low amplitude, classic', 'textbook, may be status masked by hepatic encephalopathy vs. hepatic', 'encephalopathy.  Ordering ammonia, LFTs, was going to give 2mg IV', 'Ativan x1 and observe for 30-40 minutes for improvement of myoclonus.', 'However, when patient was evaluated prior to Ativan, myoclonic jerks', 'still present but markedly improved, decided to hold on Ativan and', 'repeat EEG tomorrow AM again.  Discussed w/ Neuro.', '- Increased twitching at 3am, given 2mg Ativan and twitching resolved', 'within 30 minutes. Keppra load held pending discussion with Neuro re:', 'EEG in AM and interference of Keppra/Ativan on EEG.', '500cc bolus post-ativan for decreased BP, though not true hypotension.']",,74748,167693.0
22,2197-11-06 07:51:43,"['EKG - At [**2197-11-6**] 02:11 AM', '-neuro: 24 hour EEG', '-CT head wetread: lots of motion, but no obvious bleed or mass effect', '- given bolus for hypotension in the afternoon', '- jerking again (mostly head/neck/eyes) at 6AM with incr frequency (and', 'now unprovoked, rather than with stimulus like moving him) - gave 0.5mg', 'IV ativan']","['EKG - At [**2197-11-6**] 02:11 AM', '-neuro: 24 hour EEG', '-CT head wetread: lots of motion, but no obvious bleed or mass effect', '- given bolus for hypotension in the afternoon', '- jerking again (mostly head/neck/eyes) at 6AM with incr frequency (and', 'now unprovoked, rather than with stimulus like moving him) - gave 0.5mg', 'IV ativan']","['ARTERIAL LINE - STOP [**2197-11-4**] 09:03 PM', ""- a line d/c'ed bc not working"", ' STOOL CULTURE - At [**2197-11-5**] 06:02 AM', '- Coumadin increased to 4mg daily for sub-therapeutic INR', '- UCx showed Klebsiella, concern for ESBL and micro lab will have', 'results for Cefepime sensitivities tomorrow', '- Repeat UCx ordered to see if pt cleared since on Cefepime', '- TSH and T4 not significantly abnormal (sick euthyroid)', '- Jerking movements worsened from this morning, EEG ordered, requested', 'Neuro to come evaluate pt.', '- Neuro: Ativan at bedside, unsure if seizure but will look at EEG', '- EEG:  symmetric, slow, biphasic waves of low amplitude, classic', 'textbook, may be status masked by hepatic encephalopathy vs. hepatic', 'encephalopathy.  Ordering ammonia, LFTs, was going to give 2mg IV', 'Ativan x1 and observe for 30-40 minutes for improvement of myoclonus.', 'However, when patient was evaluated prior to Ativan, myoclonic jerks', 'still present but markedly improved, decided to hold on Ativan and', 'repeat EEG tomorrow AM again.  Discussed w/ Neuro.', '- Increased twitching at 3am, given 2mg Ativan and twitching resolved', 'within 30 minutes. Keppra load held pending discussion with Neuro re:', 'EEG in AM and interference of Keppra/Ativan on EEG.', '500cc bolus post-ativan for decreased BP, though not true hypotension.']",74748,167693.0
23,2197-11-06 11:49:17,"['- Neurology:  increasing rhythmic activity suggesting non-convulsive', 'seizure.  Recommended Keppra loading and maintenance with [**Hospital1 **] doses.']","['EKG - At [**2197-11-6**] 02:11 AM', '-neuro: 24 hour EEG', '-CT head wetread: lots of motion, but no obvious bleed or mass effect', '- given bolus for hypotension in the afternoon', '- jerking again (mostly head/neck/eyes) at 6AM with incr frequency (and', 'now unprovoked, rather than with stimulus like moving him) - gave 0.5mg', 'IV ativan', '- Neurology:  increasing rhythmic activity suggesting non-convulsive', 'seizure.  Recommended Keppra loading and maintenance with [**Hospital1 **] doses.']",,74748,167693.0
24,2197-11-06 12:22:55,,"['EKG - At [**2197-11-6**] 02:11 AM', '-neuro: 24 hour EEG', '-CT head wetread: lots of motion, but no obvious bleed or mass effect', '- given bolus for hypotension in the afternoon', '- jerking again (mostly head/neck/eyes) at 6AM with incr frequency (and', 'now unprovoked, rather than with stimulus like moving him) - gave 0.5mg', 'IV ativan', '- Neurology:  increasing rhythmic activity suggesting non-convulsive', 'seizure.  Recommended Keppra loading and maintenance with [**Hospital1 **] doses.']",,74748,167693.0
25,2197-11-07 07:33:16,"['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']","['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']","['EKG - At [**2197-11-6**] 02:11 AM', '-neuro: 24 hour EEG', '-CT head wetread: lots of motion, but no obvious bleed or mass effect', '- given bolus for hypotension in the afternoon', '- jerking again (mostly head/neck/eyes) at 6AM with incr frequency (and', 'now unprovoked, rather than with stimulus like moving him) - gave 0.5mg', 'IV ativan', '- Neurology:  increasing rhythmic activity suggesting non-convulsive', 'seizure.  Recommended Keppra loading and maintenance with [**Hospital1 **] doses.']",74748,167693.0
26,2197-11-07 09:30:32,,"['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']",,74748,167693.0
27,2197-11-07 09:51:18,,"['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']",,74748,167693.0
28,2197-11-07 10:15:09,,"['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']",,74748,167693.0
29,2197-11-07 10:18:04,,"['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']",,74748,167693.0
30,2197-11-08 08:05:25,"['PICC LINE - START [**2197-11-7**] 04:00 PM', ' LUMBAR PUNCTURE - At [**2197-11-7**] 06:21 PM', '- Per vascular, keep staples in for another few days and then some,', 'given the way the wound looks; also, staples ARE MRI compatible', '- Per Neuro:  Still in status epilepticus.  ?rebound from benzos, as', 'this causes rebound brain hyperactivity.  Increased daily Keppra dose', 'to 1500mg [**Hospital1 **], re-loaded with 1000mg IV x1.  Keppra level sent.', 'Phenobarbitol should be used over Ativan, at 5mg/kg initially and then', 'to 10mg/kg if not respond.', '- LP sent; will need to contact Neuro re: what tests specifically to', 'run, as primary neuro team is not here to give recs', '- Large right lower quadrant hot, erythematous, indurated region -', 'groin area near the site with what appears to be [**Female First Name (un) **]; ?cellulitis?', '- Hct dropping from 29 -> 22 -> 20.7 but no obvious source of bleed. CT', 'torso stat for r/o bleed.  Guiac negative, NGT drawback negative.  PPI', ""changed to [**Hospital1 7**] and made IV bc pt cannot take po's; bumped appropriately"", 'to 2 unit transfusion', '- Seizing at 1:40am, given Phenobarbital 30mg, then 420mg for total', '450mg (5mg/kg)']","['PICC LINE - START [**2197-11-7**] 04:00 PM', ' LUMBAR PUNCTURE - At [**2197-11-7**] 06:21 PM', '- Per vascular, keep staples in for another few days and then some,', 'given the way the wound looks; also, staples ARE MRI compatible', '- Per Neuro:  Still in status epilepticus.  ?rebound from benzos, as', 'this causes rebound brain hyperactivity.  Increased daily Keppra dose', 'to 1500mg [**Hospital1 **], re-loaded with 1000mg IV x1.  Keppra level sent.', 'Phenobarbitol should be used over Ativan, at 5mg/kg initially and then', 'to 10mg/kg if not respond.', '- LP sent; will need to contact Neuro re: what tests specifically to', 'run, as primary neuro team is not here to give recs', '- Large right lower quadrant hot, erythematous, indurated region -', 'groin area near the site with what appears to be [**Female First Name (un) **]; ?cellulitis?', '- Hct dropping from 29 -> 22 -> 20.7 but no obvious source of bleed. CT', 'torso stat for r/o bleed.  Guiac negative, NGT drawback negative.  PPI', ""changed to [**Hospital1 7**] and made IV bc pt cannot take po's; bumped appropriately"", 'to 2 unit transfusion', '- Seizing at 1:40am, given Phenobarbital 30mg, then 420mg for total', '450mg (5mg/kg)']","['- Neuro: load with 1.8g (20mg/kg) Keppra IV, then start keppra 1000mg', 'tonight for maintenance. Ativan prn szr activity. - Consider LP and MRI', 'to look for source of seizures. Then loaded IV fosphenytoin for', 'seizures. Pt became hypotensive (to 50s) during loading, so loading had', ""to be dc'ed."", ""- Family meeting: be sure to discuss any changes to patient's"", 'management with his wife (including medication changes) as she is very', 'concerned that medication sensitivity is what led to his current', 'situation.', ""- In the evening, pt de-sat'ed to high 80s, came up to >95% with 50%"", 'FiO2 (increased from 40%). Got a CXR (c/w fluid overload, relatively', 'unchanged from prior), and gave lasix 20mg IV x1, as patient was', 'positive for the day.', '- Attempted to place A-line, unsuccessfully.', ""- Unable to do MRI [**12-19**] EEG electrodes on pt's head--will need to be"", 'removed by EEG tech today.', '- Started Acyclovir as empiric HSV encephalitis coverage.', '- Plan for LP this AM. Pt is receiving 2U FFP to reverse INR.']",74748,167693.0
31,2197-11-08 14:21:11,,"['PICC LINE - START [**2197-11-7**] 04:00 PM', ' LUMBAR PUNCTURE - At [**2197-11-7**] 06:21 PM', '- Per vascular, keep staples in for another few days and then some,', 'given the way the wound looks; also, staples ARE MRI compatible', '- Per Neuro:  Still in status epilepticus.  ?rebound from benzos, as', 'this causes rebound brain hyperactivity.  Increased daily Keppra dose', 'to 1500mg [**Hospital1 **], re-loaded with 1000mg IV x1.  Keppra level sent.', 'Phenobarbitol should be used over Ativan, at 5mg/kg initially and then', 'to 10mg/kg if not respond.', '- LP sent; will need to contact Neuro re: what tests specifically to', 'run, as primary neuro team is not here to give recs', '- Large right lower quadrant hot, erythematous, indurated region -', 'groin area near the site with what appears to be [**Female First Name (un) **]; ?cellulitis?', '- Hct dropping from 29 -> 22 -> 20.7 but no obvious source of bleed. CT', 'torso stat for r/o bleed.  Guiac negative, NGT drawback negative.  PPI', ""changed to [**Hospital1 7**] and made IV bc pt cannot take po's; bumped appropriately"", 'to 2 unit transfusion', '- Seizing at 1:40am, given Phenobarbital 30mg, then 420mg for total', '450mg (5mg/kg)']",,74748,167693.0
32,2197-11-09 07:41:59,"['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am --']","['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am --']","['PICC LINE - START [**2197-11-7**] 04:00 PM', ' LUMBAR PUNCTURE - At [**2197-11-7**] 06:21 PM', '- Per vascular, keep staples in for another few days and then some,', 'given the way the wound looks; also, staples ARE MRI compatible', '- Per Neuro:  Still in status epilepticus.  ?rebound from benzos, as', 'this causes rebound brain hyperactivity.  Increased daily Keppra dose', 'to 1500mg [**Hospital1 **], re-loaded with 1000mg IV x1.  Keppra level sent.', 'Phenobarbitol should be used over Ativan, at 5mg/kg initially and then', 'to 10mg/kg if not respond.', '- LP sent; will need to contact Neuro re: what tests specifically to', 'run, as primary neuro team is not here to give recs', '- Large right lower quadrant hot, erythematous, indurated region -', 'groin area near the site with what appears to be [**Female First Name (un) **]; ?cellulitis?', '- Hct dropping from 29 -> 22 -> 20.7 but no obvious source of bleed. CT', 'torso stat for r/o bleed.  Guiac negative, NGT drawback negative.  PPI', ""changed to [**Hospital1 7**] and made IV bc pt cannot take po's; bumped appropriately"", 'to 2 unit transfusion', '- Seizing at 1:40am, given Phenobarbital 30mg, then 420mg for total', '450mg (5mg/kg)']",74748,167693.0
33,2197-11-09 16:36:15,['-urine output tapering off o/n - tried 250cc bolus at 6am'],"['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am']",['-urine output tapering off o/n - tried 250cc bolus at 6am --'],74748,167693.0
34,2197-11-09 18:02:56,,"['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am']",,74748,167693.0
35,2197-11-09 19:34:56,,"['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am']",,74748,167693.0
36,2197-11-10 07:55:54,"['- Outside neurologist [**First Name9 (NamePattern2) 12348**] [**Doctor Last Name **] at [**Hospital1 **], reachable at cell', '[**Telephone/Fax (1) 12349**] over holiday weekend.  Updated her re: status.  Given', 'history that she is hearing, concerned most re: hypoxic/anoxic injury', 'leading to globally altered MS [**First Name (Titles) **] [**Last Name (Titles) **].  His underlying neurologic', 'disease should not be playing a role here.  Also consider restarting', 'acyclovir until PCR back given that he is immunosuppressed and may have', 'normal CSF studies in this setting even with true infection.', ""Interested in our neurologist's input re: prognosis given difficulty"", 'breaking [**Last Name (Titles) **].  She is available for discussion with wife if', 'withdrawal of care recommended.', '- Per neuro, no szr activity in 36hrs since pt first received phenobarb', 'IV, will continue current regimen for now, and start weaning down', 'phenobarb later.', '- Pt w. decreased UOP yesterday (5-15cc/hr).  Sent urine lytes, EOs.', 'Little response to fluid bolus or increased dose of Levo. Suspect this', 'is due to ATN from recent hypotensive episodes.', '- Increased goal MAP to > 70 try to improve perfusion of L LE', 'extremity, which appears cool and grey.']","['- Outside neurologist [**First Name9 (NamePattern2) 12348**] [**Doctor Last Name **] at [**Hospital1 **], reachable at cell', '[**Telephone/Fax (1) 12349**] over holiday weekend.  Updated her re: status.  Given', 'history that she is hearing, concerned most re: hypoxic/anoxic injury', 'leading to globally altered MS [**First Name (Titles) **] [**Last Name (Titles) **].  His underlying neurologic', 'disease should not be playing a role here.  Also consider restarting', 'acyclovir until PCR back given that he is immunosuppressed and may have', 'normal CSF studies in this setting even with true infection.', ""Interested in our neurologist's input re: prognosis given difficulty"", 'breaking [**Last Name (Titles) **].  She is available for discussion with wife if', 'withdrawal of care recommended.', '- Per neuro, no szr activity in 36hrs since pt first received phenobarb', 'IV, will continue current regimen for now, and start weaning down', 'phenobarb later.', '- Pt w. decreased UOP yesterday (5-15cc/hr).  Sent urine lytes, EOs.', 'Little response to fluid bolus or increased dose of Levo. Suspect this', 'is due to ATN from recent hypotensive episodes.', '- Increased goal MAP to > 70 try to improve perfusion of L LE', 'extremity, which appears cool and grey.']","['- stopped coumadin, given pt', 's poor clinical status', '- per neuro: added on multiple CSF micro studies (HSV, VZV, [**Male First Name (un) 561**], protein', 'electrophoresis, beta-2 microglobulin)', '- also per neuro: loaded with phenobarbitol (slowly to avoid', 'hypotension), then 1 hour post-load, check level - goal = 20-30; then', 'start 50tid phenobarbital IV; continue on keppra and dilantin both;', 'still with status epilepticus; neuro felt MRI pretty normal, so unclear', 'etiology; if has visible convulsions through this regimen, change the', 'phenobarb to a pentobarbitol drip', '-left stump looking more grey and with decreasing ease to doppler the', 'pulse', '-urine output tapering off o/n - tried 250cc bolus at 6am']",74748,167693.0
37,2197-11-10 07:57:21,,"['- Outside neurologist [**First Name9 (NamePattern2) 12348**] [**Doctor Last Name **] at [**Hospital1 **], reachable at cell', '[**Telephone/Fax (1) 12349**] over holiday weekend.  Updated her re: status.  Given', 'history that she is hearing, concerned most re: hypoxic/anoxic injury', 'leading to globally altered MS [**First Name (Titles) **] [**Last Name (Titles) **].  His underlying neurologic', 'disease should not be playing a role here.  Also consider restarting', 'acyclovir until PCR back given that he is immunosuppressed and may have', 'normal CSF studies in this setting even with true infection.', ""Interested in our neurologist's input re: prognosis given difficulty"", 'breaking [**Last Name (Titles) **].  She is available for discussion with wife if', 'withdrawal of care recommended.', '- Per neuro, no szr activity in 36hrs since pt first received phenobarb', 'IV, will continue current regimen for now, and start weaning down', 'phenobarb later.', '- Pt w. decreased UOP yesterday (5-15cc/hr).  Sent urine lytes, EOs.', 'Little response to fluid bolus or increased dose of Levo. Suspect this', 'is due to ATN from recent hypotensive episodes.', '- Increased goal MAP to > 70 try to improve perfusion of L LE', 'extremity, which appears cool and grey.']",,74748,167693.0
38,2197-11-10 11:41:21,,"['- Outside neurologist [**First Name9 (NamePattern2) 12348**] [**Doctor Last Name **] at [**Hospital1 **], reachable at cell', '[**Telephone/Fax (1) 12349**] over holiday weekend.  Updated her re: status.  Given', 'history that she is hearing, concerned most re: hypoxic/anoxic injury', 'leading to globally altered MS [**First Name (Titles) **] [**Last Name (Titles) **].  His underlying neurologic', 'disease should not be playing a role here.  Also consider restarting', 'acyclovir until PCR back given that he is immunosuppressed and may have', 'normal CSF studies in this setting even with true infection.', ""Interested in our neurologist's input re: prognosis given difficulty"", 'breaking [**Last Name (Titles) **].  She is available for discussion with wife if', 'withdrawal of care recommended.', '- Per neuro, no szr activity in 36hrs since pt first received phenobarb', 'IV, will continue current regimen for now, and start weaning down', 'phenobarb later.', '- Pt w. decreased UOP yesterday (5-15cc/hr).  Sent urine lytes, EOs.', 'Little response to fluid bolus or increased dose of Levo. Suspect this', 'is due to ATN from recent hypotensive episodes.', '- Increased goal MAP to > 70 try to improve perfusion of L LE', 'extremity, which appears cool and grey.']",,74748,167693.0
39,2197-11-11 08:20:09,"['- neuro recs:', '- phenytoin level this AM was 2.7, corrected for albumin is 18.7', '- vanc level ordered for tomorrow AM', '- PM lytes showed Cr up to 1.4, FeUrea 29%', '- decreased free H2O flushes to 100cc q4h', '- vascular contact[**Name (NI) **]: keep watching stump', '- changed Cefepime to q24h bc of climbing Cr, oliguria', '- change Amiodarone to 200mg daily (from 400md daily x 7d)', '- renal c/s bc of oliguria: saw muddy brown casts suggesting ATN', '(likely from hypotension), agree with keeping pressures up, pt may need', 'dialysis in near future, watch for any indications such as metabolic', 'acidosis, electrolyte abnormalities, volume overload, etc., renally', 'dose meds', '- per renal recs, checked CK which was only 15', '- 12p- started vassopressin', '- 4p- is off Levo, stump is looking better', '- 8p- incr PS 10 to 12 bc desatted', ""- dc'd Lovenox bc poor renal function"", '- corrected Dilantin level is low at 5 so incr dose to 125mg', '- did not get Vanc this AM, got it at MN', '- gave Neutro-Phos for low Ph']","['- neuro recs:', '- phenytoin level this AM was 2.7, corrected for albumin is 18.7', '- vanc level ordered for tomorrow AM', '- PM lytes showed Cr up to 1.4, FeUrea 29%', '- decreased free H2O flushes to 100cc q4h', '- vascular contact[**Name (NI) **]: keep watching stump', '- changed Cefepime to q24h bc of climbing Cr, oliguria', '- change Amiodarone to 200mg daily (from 400md daily x 7d)', '- renal c/s bc of oliguria: saw muddy brown casts suggesting ATN', '(likely from hypotension), agree with keeping pressures up, pt may need', 'dialysis in near future, watch for any indications such as metabolic', 'acidosis, electrolyte abnormalities, volume overload, etc., renally', 'dose meds', '- per renal recs, checked CK which was only 15', '- 12p- started vassopressin', '- 4p- is off Levo, stump is looking better', '- 8p- incr PS 10 to 12 bc desatted', ""- dc'd Lovenox bc poor renal function"", '- corrected Dilantin level is low at 5 so incr dose to 125mg', '- did not get Vanc this AM, got it at MN', '- gave Neutro-Phos for low Ph']","['- Outside neurologist [**First Name9 (NamePattern2) 12348**] [**Doctor Last Name **] at [**Hospital1 **], reachable at cell', '[**Telephone/Fax (1) 12349**] over holiday weekend.  Updated her re: status.  Given', 'history that she is hearing, concerned most re: hypoxic/anoxic injury', 'leading to globally altered MS [**First Name (Titles) **] [**Last Name (Titles) **].  His underlying neurologic', 'disease should not be playing a role here.  Also consider restarting', 'acyclovir until PCR back given that he is immunosuppressed and may have', 'normal CSF studies in this setting even with true infection.', ""Interested in our neurologist's input re: prognosis given difficulty"", 'breaking [**Last Name (Titles) **].  She is available for discussion with wife if', 'withdrawal of care recommended.', '- Per neuro, no szr activity in 36hrs since pt first received phenobarb', 'IV, will continue current regimen for now, and start weaning down', 'phenobarb later.', '- Pt w. decreased UOP yesterday (5-15cc/hr).  Sent urine lytes, EOs.', 'Little response to fluid bolus or increased dose of Levo. Suspect this', 'is due to ATN from recent hypotensive episodes.', '- Increased goal MAP to > 70 try to improve perfusion of L LE', 'extremity, which appears cool and grey.']",74748,167693.0
40,2197-11-11 12:44:08,"['- renal suggests VBG, also try lasix gtt in case low EF as part of the', 'hypotension with poor forward flow', '- consider HCO3 if academic, per renal']","['- vanc level ordered for tomorrow AM', '- PM lytes showed Cr up to 1.4, FeUrea 29%', '- vascular contact[**Name (NI) **]: keep watching stump', '- changed Cefepime to q24h bc of climbing Cr, oliguria', '- change Amiodarone to 200mg daily (from 400md daily x 7d)', '- renal c/s bc of oliguria: saw muddy brown casts suggesting ATN', '(likely from hypotension), agree with keeping pressures up, pt may need', 'dialysis in near future, watch for any indications such as metabolic', 'acidosis, electrolyte abnormalities, volume overload, etc., renally', 'dose meds', '- 8p- incr PS 10 to 12 bc desatted', ""- dc'd Lovenox bc poor renal function"", '- renal suggests VBG, also try lasix gtt in case low EF as part of the', 'hypotension with poor forward flow', '- consider HCO3 if academic, per renal']","['- neuro recs:', '- phenytoin level this AM was 2.7, corrected for albumin is 18.7', '- decreased free H2O flushes to 100cc q4h', '- per renal recs, checked CK which was only 15', '- 12p- started vassopressin', '- 4p- is off Levo, stump is looking better', '- corrected Dilantin level is low at 5 so incr dose to 125mg', '- did not get Vanc this AM, got it at MN', '- gave Neutro-Phos for low Ph']",74748,167693.0
41,2197-11-12 07:05:01,"['DIALYSIS CATHETER - START [**2197-11-12**] 12:13 AM', ""- per neuro, d/c'd phenobarb"", '- VBG = very acidemic (resp & metab); changed from pressure support to', 'AC to try to remove some CO2; CO2 decreased and pH improved, but still', 'very acidemic.', '- renal: lasix drip (increased 5 to 10) and one-time diuril to try to', 'treat anuria conservatively', '- renal: placed left IJ; started CVVH as anuria was diuresis-resistant', '- wife updated & is ok with FFP/line/HD', '- patient tolerating CVVH well o/n']","['DIALYSIS CATHETER - START [**2197-11-12**] 12:13 AM', ""- per neuro, d/c'd phenobarb"", '- VBG = very acidemic (resp & metab); changed from pressure support to', 'AC to try to remove some CO2; CO2 decreased and pH improved, but still', 'very acidemic.', '- renal: lasix drip (increased 5 to 10) and one-time diuril to try to', 'treat anuria conservatively', '- renal: placed left IJ; started CVVH as anuria was diuresis-resistant', '- wife updated & is ok with FFP/line/HD', '- patient tolerating CVVH well o/n']","['- vanc level ordered for tomorrow AM', '- PM lytes showed Cr up to 1.4, FeUrea 29%', '- vascular contact[**Name (NI) **]: keep watching stump', '- changed Cefepime to q24h bc of climbing Cr, oliguria', '- change Amiodarone to 200mg daily (from 400md daily x 7d)', '- renal c/s bc of oliguria: saw muddy brown casts suggesting ATN', '(likely from hypotension), agree with keeping pressures up, pt may need', 'dialysis in near future, watch for any indications such as metabolic', 'acidosis, electrolyte abnormalities, volume overload, etc., renally', 'dose meds', '- 8p- incr PS 10 to 12 bc desatted', ""- dc'd Lovenox bc poor renal function"", '- renal suggests VBG, also try lasix gtt in case low EF as part of the', 'hypotension with poor forward flow', '- consider HCO3 if academic, per renal']",74748,167693.0
42,2197-11-12 19:57:16,,"['DIALYSIS CATHETER - START [**2197-11-12**] 12:13 AM', ""- per neuro, d/c'd phenobarb"", '- VBG = very acidemic (resp & metab); changed from pressure support to', 'AC to try to remove some CO2; CO2 decreased and pH improved, but still', 'very acidemic.', '- renal: lasix drip (increased 5 to 10) and one-time diuril to try to', 'treat anuria conservatively', '- renal: placed left IJ; started CVVH as anuria was diuresis-resistant', '- wife updated & is ok with FFP/line/HD', '- patient tolerating CVVH well o/n']",,74748,167693.0
43,2197-11-12 20:12:13,,"['DIALYSIS CATHETER - START [**2197-11-12**] 12:13 AM', ""- per neuro, d/c'd phenobarb"", '- VBG = very acidemic (resp & metab); changed from pressure support to', 'AC to try to remove some CO2; CO2 decreased and pH improved, but still', 'very acidemic.', '- renal: lasix drip (increased 5 to 10) and one-time diuril to try to', 'treat anuria conservatively', '- renal: placed left IJ; started CVVH as anuria was diuresis-resistant', '- wife updated & is ok with FFP/line/HD', '- patient tolerating CVVH well o/n']",,74748,167693.0
44,2197-11-13 06:51:53,"['Per discussion w. neuro over the phone, EEG is very abnormal and likely', 'has ""subclinical seizure"" activity, with patient off of phenobarb x 1', 'day (still on phenytoin/keppra).  Recommended loading phenytoin w.', '500mg PO, slowly to try to avoid hypotension, and re-starting phenobarb', 'at 50mg TID to try to ""normalize the EEG"".  Per neuro, EEG looks anoxic', 'and highly abnormal, and pt is unlikely to wake up unless some', 'improvement is seen. These were given sequentially so neuro can see', 'individual effects on EEG, w. full dose of phenytoin given by 2200 and', 'phenobarb given at 0020.', '- Although weaned off of pressors during the day, pt had to be', ""re-started on levophed to maintain SBP > 95 in the afternoon. Cont'd on"", 'pressors while loading phenytoin and re-starting phenobarb.', '- Around 2300, went into A. fib w. RVR (rate in 130s, BPs stable). ECG', 'showed Afib w, RVR without STT changes. Tried to wean down levophed to', 'decrease adrenergic stimulus and gave 500cc NS bolus, in case fluid', 'removal with CVVH was trigger, without improvement. Pt also given Dilt', '10mg IV x2 (20mg total)  without improvement. Finally, pt given Metop', '10mg IV x2, Metop 5mg x 1 (25mg total) and Metop 25mg PO x1 and HR', 'returned to 90s.']","['Per discussion w. neuro over the phone, EEG is very abnormal and likely', 'has ""subclinical seizure"" activity, with patient off of phenobarb x 1', 'day (still on phenytoin/keppra).  Recommended loading phenytoin w.', '500mg PO, slowly to try to avoid hypotension, and re-starting phenobarb', 'at 50mg TID to try to ""normalize the EEG"".  Per neuro, EEG looks anoxic', 'and highly abnormal, and pt is unlikely to wake up unless some', 'improvement is seen. These were given sequentially so neuro can see', 'individual effects on EEG, w. full dose of phenytoin given by 2200 and', 'phenobarb given at 0020.', '- Although weaned off of pressors during the day, pt had to be', ""re-started on levophed to maintain SBP > 95 in the afternoon. Cont'd on"", 'pressors while loading phenytoin and re-starting phenobarb.', '- Around 2300, went into A. fib w. RVR (rate in 130s, BPs stable). ECG', 'showed Afib w, RVR without STT changes. Tried to wean down levophed to', 'decrease adrenergic stimulus and gave 500cc NS bolus, in case fluid', 'removal with CVVH was trigger, without improvement. Pt also given Dilt', '10mg IV x2 (20mg total)  without improvement. Finally, pt given Metop', '10mg IV x2, Metop 5mg x 1 (25mg total) and Metop 25mg PO x1 and HR', 'returned to 90s.']","['DIALYSIS CATHETER - START [**2197-11-12**] 12:13 AM', ""- per neuro, d/c'd phenobarb"", '- VBG = very acidemic (resp & metab); changed from pressure support to', 'AC to try to remove some CO2; CO2 decreased and pH improved, but still', 'very acidemic.', '- renal: lasix drip (increased 5 to 10) and one-time diuril to try to', 'treat anuria conservatively', '- renal: placed left IJ; started CVVH as anuria was diuresis-resistant', '- wife updated & is ok with FFP/line/HD', '- patient tolerating CVVH well o/n']",74748,167693.0
45,2197-11-13 14:55:47,,"['Per discussion w. neuro over the phone, EEG is very abnormal and likely', 'has ""subclinical seizure"" activity, with patient off of phenobarb x 1', 'day (still on phenytoin/keppra).  Recommended loading phenytoin w.', '500mg PO, slowly to try to avoid hypotension, and re-starting phenobarb', 'at 50mg TID to try to ""normalize the EEG"".  Per neuro, EEG looks anoxic', 'and highly abnormal, and pt is unlikely to wake up unless some', 'improvement is seen. These were given sequentially so neuro can see', 'individual effects on EEG, w. full dose of phenytoin given by 2200 and', 'phenobarb given at 0020.', '- Although weaned off of pressors during the day, pt had to be', ""re-started on levophed to maintain SBP > 95 in the afternoon. Cont'd on"", 'pressors while loading phenytoin and re-starting phenobarb.', '- Around 2300, went into A. fib w. RVR (rate in 130s, BPs stable). ECG', 'showed Afib w, RVR without STT changes. Tried to wean down levophed to', 'decrease adrenergic stimulus and gave 500cc NS bolus, in case fluid', 'removal with CVVH was trigger, without improvement. Pt also given Dilt', '10mg IV x2 (20mg total)  without improvement. Finally, pt given Metop', '10mg IV x2, Metop 5mg x 1 (25mg total) and Metop 25mg PO x1 and HR', 'returned to 90s.']",,74748,167693.0
46,2197-11-14 07:03:21,,[],"['Per discussion w. neuro over the phone, EEG is very abnormal and likely', 'has ""subclinical seizure"" activity, with patient off of phenobarb x 1', 'day (still on phenytoin/keppra).  Recommended loading phenytoin w.', '500mg PO, slowly to try to avoid hypotension, and re-starting phenobarb', 'at 50mg TID to try to ""normalize the EEG"".  Per neuro, EEG looks anoxic', 'and highly abnormal, and pt is unlikely to wake up unless some', 'improvement is seen. These were given sequentially so neuro can see', 'individual effects on EEG, w. full dose of phenytoin given by 2200 and', 'phenobarb given at 0020.', '- Although weaned off of pressors during the day, pt had to be', ""re-started on levophed to maintain SBP > 95 in the afternoon. Cont'd on"", 'pressors while loading phenytoin and re-starting phenobarb.', '- Around 2300, went into A. fib w. RVR (rate in 130s, BPs stable). ECG', 'showed Afib w, RVR without STT changes. Tried to wean down levophed to', 'decrease adrenergic stimulus and gave 500cc NS bolus, in case fluid', 'removal with CVVH was trigger, without improvement. Pt also given Dilt', '10mg IV x2 (20mg total)  without improvement. Finally, pt given Metop', '10mg IV x2, Metop 5mg x 1 (25mg total) and Metop 25mg PO x1 and HR', 'returned to 90s.']",74748,167693.0
47,2197-11-14 07:59:34,"['- Per Neuro patient still in Status, recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital ->', '- Changed from levophed to neosynephrine, with the hope to minimize', 'peripheral vasoconstriction given patients history of PVD', '- Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', '- Vancomycin check in AM, dose when level <15.']","['- Per Neuro patient still in Status, recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital ->', '- Changed from levophed to neosynephrine, with the hope to minimize', 'peripheral vasoconstriction given patients history of PVD', '- Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', '- Vancomycin check in AM, dose when level <15.']",,74748,167693.0
48,2197-11-14 08:01:20,,"['- Per Neuro patient still in Status, recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital ->', '- Changed from levophed to neosynephrine, with the hope to minimize', 'peripheral vasoconstriction given patients history of PVD', '- Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', '- Vancomycin check in AM, dose when level <15.']",,74748,167693.0
49,2197-11-14 14:09:29,"['Status epilepticus', 'Slow wave activity on bedside EEG.  Still in status per Neurology.', 'They recommended dilantin, Keppra with phenobarb loading.  Now loaded.', 'Little change in mental status (Neuro recommend 10mg/kg bolus', 'phenobarbital -> 23)', 'Hypotension (and AF w/ RVR)', 'Changed from levophed to neosynephrine, with the hope to reduce chance', 'of RVR given underlying AF.', 'Anticoagulation', 'Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'Antibiotics', 'Vancomycin check in AM, dose when level <15.']","['Status epilepticus', 'Slow wave activity on bedside EEG.  Still in status per Neurology.', 'They recommended dilantin, Keppra with phenobarb loading.  Now loaded.', 'Little change in mental status (Neuro recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital -> 23)', 'Hypotension (and AF w/ RVR)', 'Changed from levophed to neosynephrine, with the hope to reduce chance', 'of RVR given underlying AF.', 'Anticoagulation', 'Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', 'Antibiotics', 'Vancomycin check in AM, dose when level <15.']","['- Per Neuro patient still in Status, recommend 10mg/kg bolus', 'phenobarbital ->', '- Changed from levophed to neosynephrine, with the hope to minimize', 'peripheral vasoconstriction given patients history of PVD', '- Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', '- Vancomycin check in AM, dose when level <15.']",74748,167693.0
50,2197-11-14 21:41:43,,"['Status epilepticus', 'Slow wave activity on bedside EEG.  Still in status per Neurology.', 'They recommended dilantin, Keppra with phenobarb loading.  Now loaded.', 'Little change in mental status (Neuro recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital -> 23)', 'Hypotension (and AF w/ RVR)', 'Changed from levophed to neosynephrine, with the hope to reduce chance', 'of RVR given underlying AF.', 'Anticoagulation', 'Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', 'Antibiotics', 'Vancomycin check in AM, dose when level <15.']",,74748,167693.0
51,2197-11-14 22:05:56,"['Later in the day, Neuro thought status now resolved (at 11:30).', 'Loading continued, per Neuro with 5 gm/kg bolus then 75mg TID', 'phenobarb. (cleared by CVVH).']","['Status epilepticus', 'Slow wave activity on bedside EEG.  Still in status per Neurology.', 'They recommended dilantin, Keppra with phenobarb loading.  Now loaded.', 'Little change in mental status (Neuro recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital -> 23)', 'Later in the day, Neuro thought status now resolved (at 11:30).', 'Loading continued, per Neuro with 5 gm/kg bolus then 75mg TID', 'phenobarb. (cleared by CVVH).', 'Hypotension (and AF w/ RVR)', 'Changed from levophed to neosynephrine, with the hope to reduce chance', 'of RVR given underlying AF.', 'Anticoagulation', 'Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', 'Antibiotics', 'Vancomycin check in AM, dose when level <15.']",,74748,167693.0
52,2197-11-15 07:42:14,"['- Per Neuro, no seizure since [**98**]:30 a.m. (this afternoon).  My read of', 'EEG was beat rhythm consistent with some sedation, possibly due to', 'Ativan (given for titibation - in future may use phenobarb because of', 'prolonged benzo action in this patient).  Neuro want us to continue', 'dilantin, Keppra, phenobarb (follow level [**Hospital1 7**] - is lost in CVVH - so', 'will need higher dosing). Gave another bolus of 5mg/kg then will', 'maintain with 75 mg TID.', '- Minimally responsive last night', '- Phosphate low again - gave two packets Neutraphos at 6:00 a.m. (did', 'not want to push fluid for KPhos)', '- [**Month (only) 51**] be able to go to HD today - will help maintain phenobarb level']","['- Per Neuro, no seizure since [**98**]:30 a.m. (this afternoon).  My read of', 'EEG was beat rhythm consistent with some sedation, possibly due to', 'Ativan (given for titibation - in future may use phenobarb because of', 'prolonged benzo action in this patient).  Neuro want us to continue', 'dilantin, Keppra, phenobarb (follow level [**Hospital1 7**] - is lost in CVVH - so', 'will need higher dosing). Gave another bolus of 5mg/kg then will', 'maintain with 75 mg TID.', '- Minimally responsive last night', '- Phosphate low again - gave two packets Neutraphos at 6:00 a.m. (did', 'not want to push fluid for KPhos)', '- [**Month (only) 51**] be able to go to HD today - will help maintain phenobarb level']","['Status epilepticus', 'Slow wave activity on bedside EEG.  Still in status per Neurology.', 'They recommended dilantin, Keppra with phenobarb loading.  Now loaded.', 'Little change in mental status (Neuro recommend 10mg/kg bolus', 'phenobarbital, level 2 hours later = 16.1. Neuro goal level 25-30.', 'Rebolused 600mg phenobarbital -> Pheno level to 17.1. Rebolused 10mg/kg', 'phenobarbital -> 23)', 'Later in the day, Neuro thought status now resolved (at 11:30).', 'Loading continued, per Neuro with 5 gm/kg bolus then 75mg TID', 'phenobarb. (cleared by CVVH).', 'Hypotension (and AF w/ RVR)', 'Changed from levophed to neosynephrine, with the hope to reduce chance', 'of RVR given underlying AF.', 'Anticoagulation', 'Heparin [**Hospital1 7**] restarted - coags check in AM, hx of increased ptt on', 'heparin.', 'Antibiotics', 'Vancomycin check in AM, dose when level <15.']",74748,167693.0
53,2197-11-15 14:11:42,,"['- Per Neuro, no seizure since [**98**]:30 a.m. (this afternoon).  My read of', 'EEG was beat rhythm consistent with some sedation, possibly due to', 'Ativan (given for titibation - in future may use phenobarb because of', 'prolonged benzo action in this patient).  Neuro want us to continue', 'dilantin, Keppra, phenobarb (follow level [**Hospital1 7**] - is lost in CVVH - so', 'will need higher dosing). Gave another bolus of 5mg/kg then will', 'maintain with 75 mg TID.', '- Minimally responsive last night', '- Phosphate low again - gave two packets Neutraphos at 6:00 a.m. (did', 'not want to push fluid for KPhos)', '- [**Month (only) 51**] be able to go to HD today - will help maintain phenobarb level']",,74748,167693.0
54,2197-11-16 06:57:43,"['- Per Neuro, patient continues to experience seizures, anti-epileptic', 'medicines re-adjusted as follows:', '** Phenobarbital load 900 mg IV then 450 mg IV and maintenance @', '100 mg QID goal level 30', '** Dilantin load 500 mg PO then 500 mg PO (AGAIN) and maitenance @', '300 mg TID for goal level 15-20', 'Patient at one point experiencing motor phenomena of seizure with head', 'and eyes going side to side, given 2 mg IV ativan with sessation of', 'motor symptoms. Neuro will round on patient in AM and plan to', 'potentially start pentobarb coma.']","['- Per Neuro, patient continues to experience seizures, anti-epileptic', 'medicines re-adjusted as follows:', '** Phenobarbital load 900 mg IV then 450 mg IV and maintenance @', '100 mg QID goal level 30', '** Dilantin load 500 mg PO then 500 mg PO (AGAIN) and maitenance @', '300 mg TID for goal level 15-20', 'Patient at one point experiencing motor phenomena of seizure with head', 'and eyes going side to side, given 2 mg IV ativan with sessation of', 'motor symptoms. Neuro will round on patient in AM and plan to', 'potentially start pentobarb coma.']","['- Per Neuro, no seizure since [**98**]:30 a.m. (this afternoon).  My read of', 'EEG was beat rhythm consistent with some sedation, possibly due to', 'Ativan (given for titibation - in future may use phenobarb because of', 'prolonged benzo action in this patient).  Neuro want us to continue', 'dilantin, Keppra, phenobarb (follow level [**Hospital1 7**] - is lost in CVVH - so', 'will need higher dosing). Gave another bolus of 5mg/kg then will', 'maintain with 75 mg TID.', '- Minimally responsive last night', '- Phosphate low again - gave two packets Neutraphos at 6:00 a.m. (did', 'not want to push fluid for KPhos)', '- [**Month (only) 51**] be able to go to HD today - will help maintain phenobarb level']",74748,167693.0
55,2197-11-16 13:06:54,,"['- Per Neuro, patient continues to experience seizures, anti-epileptic', 'medicines re-adjusted as follows:', '** Phenobarbital load 900 mg IV then 450 mg IV and maintenance @', '100 mg QID goal level 30', '** Dilantin load 500 mg PO then 500 mg PO (AGAIN) and maitenance @', '300 mg TID for goal level 15-20', 'Patient at one point experiencing motor phenomena of seizure with head', 'and eyes going side to side, given 2 mg IV ativan with sessation of', 'motor symptoms. Neuro will round on patient in AM and plan to', 'potentially start pentobarb coma.']",,74748,167693.0
56,2197-11-17 06:52:43,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']","['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']","['- Per Neuro, patient continues to experience seizures, anti-epileptic', 'medicines re-adjusted as follows:', '** Phenobarbital load 900 mg IV then 450 mg IV and maintenance @', '100 mg QID goal level 30', '** Dilantin load 500 mg PO then 500 mg PO (AGAIN) and maitenance @', '300 mg TID for goal level 15-20', 'Patient at one point experiencing motor phenomena of seizure with head', 'and eyes going side to side, given 2 mg IV ativan with sessation of', 'motor symptoms. Neuro will round on patient in AM and plan to', 'potentially start pentobarb coma.']",74748,167693.0
57,2197-11-17 06:58:48,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
58,2197-11-17 08:31:47,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
59,2197-11-17 11:12:38,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
60,2197-11-17 11:19:01,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
61,2197-11-17 11:33:18,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
62,2197-11-17 13:04:28,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
63,2197-11-17 13:08:25,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
64,2197-11-17 19:31:05,,"['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",,74748,167693.0
65,2197-11-18 07:54:26,"['- Remained out of status yesterday, but with very slow, near', 'isoelectric EEG (my read), essentially unresposive.', '- Renal following - this a.m.: HD today, goal - 2-3 L if BP tolerates,', 'avoid CVVH for now; no sign renal recovery.', '- Spoke to wife about EEG/seizure last night.', ""- (Renal suggested TTE in yesterday's note)"", '- SBPs decent despite low MAP.']","['- Remained out of status yesterday, but with very slow, near', 'isoelectric EEG (my read), essentially unresposive.', '- Renal following - this a.m.: HD today, goal - 2-3 L if BP tolerates,', 'avoid CVVH for now; no sign renal recovery.', '- Spoke to wife about EEG/seizure last night.', ""- (Renal suggested TTE in yesterday's note)"", '- SBPs decent despite low MAP.']","['- Neuro: Pt out of status this morning. Given CVVH has been stopped', 'would recommend continuing doses at current level and rechecking', 'dilantin/phenobarbital level in the AM. Would redose at 5mg/kg', 'phenobarbital if patients enters status.', '- Wound care consulted re: Peri anal breakdown. Currently without signs', 'of infection.', '- MAP 48 in AM [**11-16**] -> Phenylepherine restarted, Midodrine started,', 'Hydrocortisone increase back to 50mg Q8H. One L NS given. Pressures', 'improved to MAP 57-60.', '- Family Meeting: Made DNR/DNI, No CPR, No Shock. See attending note', 'for detail.', '- Increased WBC Count, remained afebrile, Blood Cultures, Urine', 'Cultures, C. Diff checked - pending.', '- C. Diff positive - Started Vancomycin PO 125mg Q6Hrs', '- HCT 22.7 this AM - ordered one unit PRBCs.']",74748,167693.0
66,2197-11-18 12:01:52,,"['- Remained out of status yesterday, but with very slow, near', 'isoelectric EEG (my read), essentially unresposive.', '- Renal following - this a.m.: HD today, goal - 2-3 L if BP tolerates,', 'avoid CVVH for now; no sign renal recovery.', '- Spoke to wife about EEG/seizure last night.', ""- (Renal suggested TTE in yesterday's note)"", '- SBPs decent despite low MAP.']",,74748,167693.0
67,2197-11-18 13:51:00,,"['- Remained out of status yesterday, but with very slow, near', 'isoelectric EEG (my read), essentially unresposive.', '- Renal following - this a.m.: HD today, goal - 2-3 L if BP tolerates,', 'avoid CVVH for now; no sign renal recovery.', '- Spoke to wife about EEG/seizure last night.', ""- (Renal suggested TTE in yesterday's note)"", '- SBPs decent despite low MAP.']",,74748,167693.0
68,2197-11-19 07:37:08,"['INDWELLING PORT (PORTACATH) - STOP [**2197-11-18**] 09:11 PM', '- Did well with HD, able to take 1.5 liters off without pressor', 'support.  However, temp L IJ HD line is no longer working, despite', 'attempts to reposition, flush etc.  Pt will need a new line on Monday,', ""per renal.  Need to discuss with patient's family if they want to"", 'continue HD, as pt should have IR placed tunnelled catheter placed', 'instead of temporary line.', '- Spoke w. neuro re: AED dosages - make no changes, also would not', 'recommend MRI to assess for anoxic brain injury at this time, can', 'address w. primary neuro team on Monday.', '- became hypotensive to 80s/30s, did not respond to 500cc bolus.', 'Re-started Neo. Appeared comfortable, afebrile, no tachycardia, no', 'change in respiratory status.']","['INDWELLING PORT (PORTACATH) - STOP [**2197-11-18**] 09:11 PM', '- Did well with HD, able to take 1.5 liters off without pressor', 'support.  However, temp L IJ HD line is no longer working, despite', 'attempts to reposition, flush etc.  Pt will need a new line on Monday,', ""per renal.  Need to discuss with patient's family if they want to"", 'continue HD, as pt should have IR placed tunnelled catheter placed', 'instead of temporary line.', '- Spoke w. neuro re: AED dosages - make no changes, also would not', 'recommend MRI to assess for anoxic brain injury at this time, can', 'address w. primary neuro team on Monday.', '- became hypotensive to 80s/30s, did not respond to 500cc bolus.', 'Re-started Neo. Appeared comfortable, afebrile, no tachycardia, no', 'change in respiratory status.']","['- Remained out of status yesterday, but with very slow, near', 'isoelectric EEG (my read), essentially unresposive.', '- Renal following - this a.m.: HD today, goal - 2-3 L if BP tolerates,', 'avoid CVVH for now; no sign renal recovery.', '- Spoke to wife about EEG/seizure last night.', ""- (Renal suggested TTE in yesterday's note)"", '- SBPs decent despite low MAP.']",74748,167693.0
69,2197-11-19 12:01:08,,"['INDWELLING PORT (PORTACATH) - STOP [**2197-11-18**] 09:11 PM', '- Did well with HD, able to take 1.5 liters off without pressor', 'support.  However, temp L IJ HD line is no longer working, despite', 'attempts to reposition, flush etc.  Pt will need a new line on Monday,', ""per renal.  Need to discuss with patient's family if they want to"", 'continue HD, as pt should have IR placed tunnelled catheter placed', 'instead of temporary line.', '- Spoke w. neuro re: AED dosages - make no changes, also would not', 'recommend MRI to assess for anoxic brain injury at this time, can', 'address w. primary neuro team on Monday.', '- became hypotensive to 80s/30s, did not respond to 500cc bolus.', 'Re-started Neo. Appeared comfortable, afebrile, no tachycardia, no', 'change in respiratory status.']",,74748,167693.0
70,2197-11-19 16:02:10,,"['INDWELLING PORT (PORTACATH) - STOP [**2197-11-18**] 09:11 PM', '- Did well with HD, able to take 1.5 liters off without pressor', 'support.  However, temp L IJ HD line is no longer working, despite', 'attempts to reposition, flush etc.  Pt will need a new line on Monday,', ""per renal.  Need to discuss with patient's family if they want to"", 'continue HD, as pt should have IR placed tunnelled catheter placed', 'instead of temporary line.', '- Spoke w. neuro re: AED dosages - make no changes, also would not', 'recommend MRI to assess for anoxic brain injury at this time, can', 'address w. primary neuro team on Monday.', '- became hypotensive to 80s/30s, did not respond to 500cc bolus.', 'Re-started Neo. Appeared comfortable, afebrile, no tachycardia, no', 'change in respiratory status.']",,74748,167693.0
71,2197-11-20 06:33:10,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']","['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']","['INDWELLING PORT (PORTACATH) - STOP [**2197-11-18**] 09:11 PM', '- Did well with HD, able to take 1.5 liters off without pressor', 'support.  However, temp L IJ HD line is no longer working, despite', 'attempts to reposition, flush etc.  Pt will need a new line on Monday,', ""per renal.  Need to discuss with patient's family if they want to"", 'continue HD, as pt should have IR placed tunnelled catheter placed', 'instead of temporary line.', '- Spoke w. neuro re: AED dosages - make no changes, also would not', 'recommend MRI to assess for anoxic brain injury at this time, can', 'address w. primary neuro team on Monday.', '- became hypotensive to 80s/30s, did not respond to 500cc bolus.', 'Re-started Neo. Appeared comfortable, afebrile, no tachycardia, no', 'change in respiratory status.']",74748,167693.0
72,2197-11-20 06:57:43,,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",,74748,167693.0
73,2197-11-20 07:39:12,,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",,74748,167693.0
74,2197-11-20 07:42:28,,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",,74748,167693.0
75,2197-11-20 07:46:00,,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",,74748,167693.0
76,2197-11-20 13:33:42,,"['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",,74748,167693.0
77,2197-11-21 07:32:57,"['MAGNETIC RESONANCE IMAGING - At [**2197-11-20**] 03:45 PM', '- Neuro are following: To help prognosticate suggested MRI w&w/o', '- Given Renal failure, Renal very helpful to arrange dialysis', 'immediately after to dialyse gadolinium.', '- EEG removed prior to MRI and replaced later', '- Dr. [**Last Name (STitle) 775**] met with family to discuss MRI prognostication - if poor', 'neurologic prognosis will re-address goals of care - they are coming', 'around.', '- HD line is patent (after tPA) and did not need rewiring or', 'replacement.', '- MRI by our read looks unremarkable but waiting for real read.', '- Desaturating events last night, x 2 down to high 80s % - took longer', 'to recover than usual. Increased sectretions and some cough yesterday.', 'Was on PSV and changed back to AC given variable tidal volumes - AC of', 'benefit. VBG similar to previous and no change on CXR yet.']","['MAGNETIC RESONANCE IMAGING - At [**2197-11-20**] 03:45 PM', '- Neuro are following: To help prognosticate suggested MRI w&w/o', '- Given Renal failure, Renal very helpful to arrange dialysis', 'immediately after to dialyse gadolinium.', '- EEG removed prior to MRI and replaced later', '- Dr. [**Last Name (STitle) 775**] met with family to discuss MRI prognostication - if poor', 'neurologic prognosis will re-address goals of care - they are coming', 'around.', '- HD line is patent (after tPA) and did not need rewiring or', 'replacement.', '- MRI by our read looks unremarkable but waiting for real read.', '- Desaturating events last night, x 2 down to high 80s % - took longer', 'to recover than usual. Increased sectretions and some cough yesterday.', 'Was on PSV and changed back to AC given variable tidal volumes - AC of', 'benefit. VBG similar to previous and no change on CXR yet.']","['- Neuro: No seizure activity. Recheck Phenobarbital/Phenytoin levels in', 'AM.', '- MAP 48 during afternoon off pressors. Neo restarted to MAP 58.', '- Per Renal Consider TTE this week to evaluate cardiac function.', '- Pt ordered for Tunneled HD line (Monday).']",74748,167693.0
78,2197-11-21 09:58:38,,"['MAGNETIC RESONANCE IMAGING - At [**2197-11-20**] 03:45 PM', '- Neuro are following: To help prognosticate suggested MRI w&w/o', '- Given Renal failure, Renal very helpful to arrange dialysis', 'immediately after to dialyse gadolinium.', '- EEG removed prior to MRI and replaced later', '- Dr. [**Last Name (STitle) 775**] met with family to discuss MRI prognostication - if poor', 'neurologic prognosis will re-address goals of care - they are coming', 'around.', '- HD line is patent (after tPA) and did not need rewiring or', 'replacement.', '- MRI by our read looks unremarkable but waiting for real read.', '- Desaturating events last night, x 2 down to high 80s % - took longer', 'to recover than usual. Increased sectretions and some cough yesterday.', 'Was on PSV and changed back to AC given variable tidal volumes - AC of', 'benefit. VBG similar to previous and no change on CXR yet.']",,74748,167693.0
79,2197-11-21 10:56:42,,"['MAGNETIC RESONANCE IMAGING - At [**2197-11-20**] 03:45 PM', '- Neuro are following: To help prognosticate suggested MRI w&w/o', '- Given Renal failure, Renal very helpful to arrange dialysis', 'immediately after to dialyse gadolinium.', '- EEG removed prior to MRI and replaced later', '- Dr. [**Last Name (STitle) 775**] met with family to discuss MRI prognostication - if poor', 'neurologic prognosis will re-address goals of care - they are coming', 'around.', '- HD line is patent (after tPA) and did not need rewiring or', 'replacement.', '- MRI by our read looks unremarkable but waiting for real read.', '- Desaturating events last night, x 2 down to high 80s % - took longer', 'to recover than usual. Increased sectretions and some cough yesterday.', 'Was on PSV and changed back to AC given variable tidal volumes - AC of', 'benefit. VBG similar to previous and no change on CXR yet.']",,74748,167693.0
80,2197-11-22 07:26:58,"['- Epilepsy recommends dilantin and free dilantin level; keep', 'phenobarbital level at 20; keep AEDs at current levels to prevent', 'status epilepticus; prognosis difficult to predict as no evidence of', 'anoxic brain injury on MRI and symptoms can be related to post status', 'epilepticus and recommend up to three weeks of current supportive', 'management', '- Neurology recommends to restart continuous EEG to further evaluate', 'for NCSE', '- Added propofol as an allergy as remote possibility of propofol', 'related infusion syndrome', '- Final MRI read: no acute intracranial abnormality present']","['- Epilepsy recommends dilantin and free dilantin level; keep', 'phenobarbital level at 20; keep AEDs at current levels to prevent', 'status epilepticus; prognosis difficult to predict as no evidence of', 'anoxic brain injury on MRI and symptoms can be related to post status', 'epilepticus and recommend up to three weeks of current supportive', 'management', '- Neurology recommends to restart continuous EEG to further evaluate', 'for NCSE', '- Added propofol as an allergy as remote possibility of propofol', 'related infusion syndrome', '- Final MRI read: no acute intracranial abnormality present']","['MAGNETIC RESONANCE IMAGING - At [**2197-11-20**] 03:45 PM', '- Neuro are following: To help prognosticate suggested MRI w&w/o', '- Given Renal failure, Renal very helpful to arrange dialysis', 'immediately after to dialyse gadolinium.', '- EEG removed prior to MRI and replaced later', '- Dr. [**Last Name (STitle) 775**] met with family to discuss MRI prognostication - if poor', 'neurologic prognosis will re-address goals of care - they are coming', 'around.', '- HD line is patent (after tPA) and did not need rewiring or', 'replacement.', '- MRI by our read looks unremarkable but waiting for real read.', '- Desaturating events last night, x 2 down to high 80s % - took longer', 'to recover than usual. Increased sectretions and some cough yesterday.', 'Was on PSV and changed back to AC given variable tidal volumes - AC of', 'benefit. VBG similar to previous and no change on CXR yet.']",74748,167693.0
81,2197-11-22 14:44:41,,"['- Epilepsy recommends dilantin and free dilantin level; keep', 'phenobarbital level at 20; keep AEDs at current levels to prevent', 'status epilepticus; prognosis difficult to predict as no evidence of', 'anoxic brain injury on MRI and symptoms can be related to post status', 'epilepticus and recommend up to three weeks of current supportive', 'management', '- Neurology recommends to restart continuous EEG to further evaluate', 'for NCSE', '- Added propofol as an allergy as remote possibility of propofol', 'related infusion syndrome', '- Final MRI read: no acute intracranial abnormality present']",,74748,167693.0
0,2140-10-12 06:53:18,,"['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",,10774,130230.0
1,2140-10-12 06:54:47,,"['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",,10774,130230.0
2,2140-10-12 06:56:02,,"['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",,10774,130230.0
3,2140-10-12 12:26:20,,"['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",,10774,130230.0
4,2140-10-12 12:34:51,,"['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",,10774,130230.0
5,2140-10-13 07:05:24,"['TRANSTHORACIC ECHO - At [**2140-10-12**] 10:09 AM', '-', 'Hct stable @ 34', '-', 'D/W pt', 's cardiologist and pt risk of bleeding on coumadin', 'and risk of stroke from AF, decided to discontinue coumadin; also', 'discussed possibility of ischemic colitis as etiology of pt', 's sxs', '-']","['TRANSTHORACIC ECHO - At [**2140-10-12**] 10:09 AM', '-', 'Hct stable @ 34', '-', 'D/W pt', 's cardiologist and pt risk of bleeding on coumadin', 'and risk of stroke from AF, decided to discontinue coumadin; also', 'discussed possibility of ischemic colitis as etiology of pt', 's sxs', '-']","['- Hct stabilized at 32', '- Lactate 0.7', '- Two sets CE flat, third troponin 0.02 (has been this in the past)', '- BP stable overnight', '- Pain improved']",10774,130230.0
6,2140-10-13 07:15:40,,"['TRANSTHORACIC ECHO - At [**2140-10-12**] 10:09 AM', '-', 'Hct stable @ 34', '-', 'D/W pt', 's cardiologist and pt risk of bleeding on coumadin', 'and risk of stroke from AF, decided to discontinue coumadin; also', 'discussed possibility of ischemic colitis as etiology of pt', 's sxs', '-']",,10774,130230.0
7,2140-10-13 07:25:42,['s sxs.'],"['TRANSTHORACIC ECHO - At [**2140-10-12**] 10:09 AM', '-', 'Hct stable @ 34', '-', 'D/W pt', 's cardiologist and pt risk of bleeding on coumadin', 'and risk of stroke from AF, decided to discontinue coumadin; also', 'discussed possibility of ischemic colitis as etiology of pt', 's sxs.', '-']",['s sxs'],10774,130230.0
8,2140-10-13 13:03:57,,"['TRANSTHORACIC ECHO - At [**2140-10-12**] 10:09 AM', '-', 'Hct stable @ 34', '-', 'D/W pt', 's cardiologist and pt risk of bleeding on coumadin', 'and risk of stroke from AF, decided to discontinue coumadin; also', 'discussed possibility of ischemic colitis as etiology of pt', 's sxs.', '-']",,10774,130230.0
0,2140-10-24 16:08:33,,['Continued to have back pain and abdominal pain.  Chest pain improved.'],,10774,142104.0
1,2140-10-24 16:11:07,,['Continued to have back pain and abdominal pain.  Chest pain improved.'],,10774,142104.0
2,2140-10-24 16:32:33,,['Continued to have back pain and abdominal pain.  Chest pain improved.'],,10774,142104.0
0,2141-03-15 06:12:40,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM', 'Pressure support trial in am']",,10774,173586.0
1,2141-03-15 06:15:06,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM', 'Pressure support trial in am']",,10774,173586.0
2,2141-03-15 06:17:59,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM', 'Pressure support trial in am']",,10774,173586.0
3,2141-03-15 06:19:41,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM']",['Pressure support trial in am'],10774,173586.0
4,2141-03-15 08:20:12,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM']",,10774,173586.0
5,2141-03-15 12:52:15,,"['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM']",,10774,173586.0
6,2141-03-16 06:29:08,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']","['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']","['INVASIVE VENTILATION - START [**2141-3-14**] 09:56 AM', ' MULTI LUMEN - START [**2141-3-14**] 10:44 AM', ' URINE CULTURE - At [**2141-3-14**] 10:45 AM', ' ARTERIAL LINE - START [**2141-3-14**] 07:00 PM', ' MULTI LUMEN - STOP [**2141-3-15**] 12:10 AM']",10774,173586.0
7,2141-03-16 06:29:53,,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",,10774,173586.0
8,2141-03-16 07:46:31,,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",,10774,173586.0
9,2141-03-16 08:47:57,,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",,10774,173586.0
10,2141-03-16 09:01:38,,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",,10774,173586.0
11,2141-03-16 10:42:40,,"['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",,10774,173586.0
12,2141-03-17 06:13:39,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM']","['- Extubated.', '- Morphine given for substantial chest wall pain s/p CPR.', '- Taken off lidocaine gtt and changed to PO amiodarone. Had episode of', 'VT with hypotension -> ICD fired and rhythm converted. Given IV amio', 'bolus and gtt restarted. Also restarted on mexiletine.', '- Had second episode of VT with hypotension -> converted with 4 ICD', 'shocks. Given another 150mg IV amio and 100mg IV lidocaine bolus.']",10774,173586.0
13,2141-03-17 06:16:45,,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM']",,10774,173586.0
14,2141-03-17 09:02:44,"['-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm?Aflutter', '-got 1mg Ativan for PTSDish symptoms']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm?Aflutter', '-got 1mg Ativan for PTSDish symptoms']",,10774,173586.0
15,2141-03-17 09:03:55,,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm?Aflutter', '-got 1mg Ativan for PTSDish symptoms']",,10774,173586.0
16,2141-03-17 09:13:03,,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm?Aflutter', '-got 1mg Ativan for PTSDish symptoms']",,10774,173586.0
17,2141-03-17 09:39:43,"['-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']","['-questionable different underlying rhythm?Aflutter', '-got 1mg Ativan for PTSDish symptoms']",10774,173586.0
18,2141-03-17 09:42:45,,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']",,10774,173586.0
19,2141-03-17 09:47:46,,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']",,10774,173586.0
20,2141-03-18 05:12:17,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']","['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']",10774,173586.0
21,2141-03-18 05:13:02,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
22,2141-03-18 05:14:45,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
23,2141-03-18 08:25:05,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
24,2141-03-18 08:30:17,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
25,2141-03-18 08:31:08,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
26,2141-03-18 10:51:58,,"['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",,10774,173586.0
27,2141-03-18 10:53:10,"['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']","['[**2141-3-17**]', 'Slow VT HR 120s-130 around 4pm. Dropped SBP 130s to 90s. Lightheaded.', 'Paced out of it by EP. Given Lidocaine 100 IV. They lowered threshold', 'to 125. Now just RV pacing. No longer BiV pacing.', 'Had 2 episodes of VT again 3 am - rate 130s lasted 3min without', 'attempted ATP by ICD, was then shocked by ICD X 2 - lidocaine gtt', 'restarted', ' ARTERIAL LINE - STOP [**2141-3-17**] 09:41 AM', ' EKG - At [**2141-3-18**] 03:16 AM', 's/p 2 VT /ICD shock events within 1/2 hour EKG obtained- remains AV', 'paced 100%.']",10774,173586.0
28,2141-03-19 06:28:30,"['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT at 12am, successfully shocked x1. Given', 'lorazepam for sedation.', '- Poor peripheral IV access.']","['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT at 12am, successfully shocked x1. Given', 'lorazepam for sedation.', '- Poor peripheral IV access.']","['URINE CULTURE - At [**2141-3-16**] 09:00 PM', ' EKG - At [**2141-3-17**] 12:00 AM', '-Was in Vtach for 30 min last night, held pressures, given 150mg IV', 'amiodarone and increased rate to 1mg/ml, also given 100mg lidocaine IV', 'bolus, broke on his own', '-questionable different underlying rhythm ?Aflutter', '-got 1mg Ativan for anxiety']",10774,173586.0
29,2141-03-19 06:29:42,,"['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT at 12am, successfully shocked x1. Given', 'lorazepam for sedation.', '- Poor peripheral IV access.']",,10774,173586.0
30,2141-03-19 08:59:53,,"['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT at 12am, successfully shocked x1. Given', 'lorazepam for sedation.', '- Poor peripheral IV access.']",,10774,173586.0
31,2141-03-19 10:48:07,"['- Second episode of VT(rate of 150s) at 12am, successfully shocked x1.', 'Given lorazepam for sedation.']","['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT(rate of 150s) at 12am, successfully shocked x1.', 'Given lorazepam for sedation.', '- Poor peripheral IV access.']","['- Second episode of VT at 12am, successfully shocked x1. Given', 'lorazepam for sedation.']",10774,173586.0
32,2141-03-19 10:56:52,,"['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT(rate of 150s) at 12am, successfully shocked x1.', 'Given lorazepam for sedation.', '- Poor peripheral IV access.']",,10774,173586.0
33,2141-03-19 11:31:57,,"['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT(rate of 150s) at 12am, successfully shocked x1.', 'Given lorazepam for sedation.', '- Poor peripheral IV access.']",,10774,173586.0
34,2141-03-20 05:46:22,"['-NPO for cath in am', '-trying to control heart rate with ativan and dilaudid', '-on lasix gtt to keep even', '-put on amiodarone gtt 0.5mg/min']","['-NPO for cath in am', '-trying to control heart rate with ativan and dilaudid', '-on lasix gtt to keep even', '-put on amiodarone gtt 0.5mg/min']","['- Started on lasix gtt for diuresis.', '- Lidocaine gtt rate dropped to 1mg/min, but had episode of VT,', 'successfully shocked x1, at 8pm. Given 100mg lidocaine bolus and gtt', 'increased to 2mg/min.', '- Second episode of VT(rate of 150s) at 12am, successfully shocked x1.', 'Given lorazepam for sedation.', '- Poor peripheral IV access.']",10774,173586.0
35,2141-03-20 05:47:27,,"['-NPO for cath in am', '-trying to control heart rate with ativan and dilaudid', '-on lasix gtt to keep even', '-put on amiodarone gtt 0.5mg/min']",,10774,173586.0
36,2141-03-21 05:53:06,"['CARDIAC CATH - At [**2141-3-20**] 02:00 PM', 'Dx cath', ' BLOOD CULTURED - At [**2141-3-20**] 11:00 PM', ' URINE CULTURE - At [**2141-3-20**] 11:00 PM', ' INVASIVE VENTILATION - START [**2141-3-21**] 02:30 AM', ' SPUTUM CULTURE - At [**2141-3-21**] 03:03 AM', ' BLOOD CULTURED - At [**2141-3-21**] 04:00 AM', 'Intubated overnight due to somnolence, concern for airway protection', 'with increased ativan, dilaudid doses for recurrent shocks', 'VT x 6 episodes (approx 1 per hour) with HR 200s-230s. Straight to ICD', 'firing; no attempts at pacing', 'Plasn for EP study in am', 's/p cath with no onstructive disease to suggest etiology of VT', 'Cultured for T 100.7 (urine, sputum, blood)', 'Difficulty seeing PICC tip on CXR so ordered IR guided PICC to place', 'under fluoro', 'BP slightly lower MAPs around 60 in am after intubation while on', 'propofol']","['CARDIAC CATH - At [**2141-3-20**] 02:00 PM', 'Dx cath', ' BLOOD CULTURED - At [**2141-3-20**] 11:00 PM', ' URINE CULTURE - At [**2141-3-20**] 11:00 PM', ' INVASIVE VENTILATION - START [**2141-3-21**] 02:30 AM', ' SPUTUM CULTURE - At [**2141-3-21**] 03:03 AM', ' BLOOD CULTURED - At [**2141-3-21**] 04:00 AM', 'Intubated overnight due to somnolence, concern for airway protection', 'with increased ativan, dilaudid doses for recurrent shocks', 'VT x 6 episodes (approx 1 per hour) with HR 200s-230s. Straight to ICD', 'firing; no attempts at pacing', 'Plasn for EP study in am', 's/p cath with no onstructive disease to suggest etiology of VT', 'Cultured for T 100.7 (urine, sputum, blood)', 'Difficulty seeing PICC tip on CXR so ordered IR guided PICC to place', 'under fluoro', 'BP slightly lower MAPs around 60 in am after intubation while on', 'propofol']","['-NPO for cath in am', '-trying to control heart rate with ativan and dilaudid', '-on lasix gtt to keep even', '-put on amiodarone gtt 0.5mg/min']",10774,173586.0
37,2141-03-21 05:55:39,,"['CARDIAC CATH - At [**2141-3-20**] 02:00 PM', 'Dx cath', ' BLOOD CULTURED - At [**2141-3-20**] 11:00 PM', ' URINE CULTURE - At [**2141-3-20**] 11:00 PM', ' INVASIVE VENTILATION - START [**2141-3-21**] 02:30 AM', ' SPUTUM CULTURE - At [**2141-3-21**] 03:03 AM', ' BLOOD CULTURED - At [**2141-3-21**] 04:00 AM', 'Intubated overnight due to somnolence, concern for airway protection', 'with increased ativan, dilaudid doses for recurrent shocks', 'VT x 6 episodes (approx 1 per hour) with HR 200s-230s. Straight to ICD', 'firing; no attempts at pacing', 'Plasn for EP study in am', 's/p cath with no onstructive disease to suggest etiology of VT', 'Cultured for T 100.7 (urine, sputum, blood)', 'Difficulty seeing PICC tip on CXR so ordered IR guided PICC to place', 'under fluoro', 'BP slightly lower MAPs around 60 in am after intubation while on', 'propofol']",,10774,173586.0
38,2141-03-21 12:26:33,,"['CARDIAC CATH - At [**2141-3-20**] 02:00 PM', 'Dx cath', ' BLOOD CULTURED - At [**2141-3-20**] 11:00 PM', ' URINE CULTURE - At [**2141-3-20**] 11:00 PM', ' INVASIVE VENTILATION - START [**2141-3-21**] 02:30 AM', ' SPUTUM CULTURE - At [**2141-3-21**] 03:03 AM', ' BLOOD CULTURED - At [**2141-3-21**] 04:00 AM', 'Intubated overnight due to somnolence, concern for airway protection', 'with increased ativan, dilaudid doses for recurrent shocks', 'VT x 6 episodes (approx 1 per hour) with HR 200s-230s. Straight to ICD', 'firing; no attempts at pacing', 'Plasn for EP study in am', 's/p cath with no onstructive disease to suggest etiology of VT', 'Cultured for T 100.7 (urine, sputum, blood)', 'Difficulty seeing PICC tip on CXR so ordered IR guided PICC to place', 'under fluoro', 'BP slightly lower MAPs around 60 in am after intubation while on', 'propofol']",,10774,173586.0
39,2141-03-22 07:01:47,"['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']","['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']","['CARDIAC CATH - At [**2141-3-20**] 02:00 PM', 'Dx cath', ' BLOOD CULTURED - At [**2141-3-20**] 11:00 PM', ' URINE CULTURE - At [**2141-3-20**] 11:00 PM', ' INVASIVE VENTILATION - START [**2141-3-21**] 02:30 AM', ' SPUTUM CULTURE - At [**2141-3-21**] 03:03 AM', ' BLOOD CULTURED - At [**2141-3-21**] 04:00 AM', 'Intubated overnight due to somnolence, concern for airway protection', 'with increased ativan, dilaudid doses for recurrent shocks', 'VT x 6 episodes (approx 1 per hour) with HR 200s-230s. Straight to ICD', 'firing; no attempts at pacing', 'Plasn for EP study in am', 's/p cath with no onstructive disease to suggest etiology of VT', 'Cultured for T 100.7 (urine, sputum, blood)', 'Difficulty seeing PICC tip on CXR so ordered IR guided PICC to place', 'under fluoro', 'BP slightly lower MAPs around 60 in am after intubation while on', 'propofol']",10774,173586.0
40,2141-03-22 07:03:15,,"['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']",,10774,173586.0
41,2141-03-22 08:58:48,,"['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']",,10774,173586.0
42,2141-03-22 13:10:16,,"['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']",,10774,173586.0
43,2141-03-23 06:46:57,"['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']","['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']","['CARDIAC CATH - At [**2141-3-21**] 11:00 AM. Pt taken to  EP on propofol.', 'Lasixs and anti-arrythmics off.', ' ARTERIAL LINE - START [**2141-3-21**] 03:00 PM', ' ARTERIAL LINE - STOP [**2141-3-21**] 06:51 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2141-3-22**] 01:40 AM', '200j x1- to AV paced at 70bpm', ' BLOOD CULTURED - At [**2141-3-22**] 02:15 AM', '[**2141-3-21**]', '- EP: Ablated 1 circuit, interrupted an epicardial circuit. Recs to', 'keep sedated, wean phenylephrine, keep on amio/lido gtts and transition', 'to mexilitene tomorrow.', '- Had VTach to 140s, ICD did not pick up (set to detect VTach over', '180). Resolved with external defibrillation x1, given 100mg lidocaine', 'bolus, ICD set to detect VTach over 130.']",10774,173586.0
44,2141-03-23 06:48:03,,"['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']",,10774,173586.0
45,2141-03-23 06:50:46,,"['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']",,10774,173586.0
46,2141-03-23 08:03:03,,"['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']",,10774,173586.0
47,2141-03-23 14:07:43,,"['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']",,10774,173586.0
48,2141-03-24 05:27:02,"['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and dopa', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']","['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and dopa', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']","['BLOOD CULTURED - At [**2141-3-22**] 10:30 AM', ' SPUTUM CULTURE - At [**2141-3-22**] 11:00 AM', ' FEVER - 102.0', 'F - [**2141-3-22**] 08:00 AM', 'Per EP, stopped amio, lido, mexilitene since VT morphology triggered', 'and different from previous VT, ? from proarrhythmic effects of meds.', '- Started spironolactone [**First Name8 (NamePattern2) **] [**Doctor Last Name **] to maintain elevated K', '-started on vasopressin to wean off neo', '-febrile to 102', '-started Vanc/Zosyn for VAP', '-6 episodes of Vtach but paced out, no shocks', '-spiking temps to 102']",10774,173586.0
49,2141-03-24 05:28:54,,"['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and dopa', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']",,10774,173586.0
50,2141-03-24 08:14:04,,"['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and dopa', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']",,10774,173586.0
51,2141-03-24 13:59:36,['neo and vasopressin'],"['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and vasopressin', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']",['neo and dopa'],10774,173586.0
52,2141-03-25 06:00:38,"['- Pip-tazo narrowed to ceftx for E coli UTI.', '- EP recs unchanged.', '- Weaned off of pressors (vasopressin and phenylephrine).']","['- Pip-tazo narrowed to ceftx for E coli UTI.', '- EP recs unchanged.', '- Weaned off of pressors (vasopressin and phenylephrine).']","['BLOOD CULTURED - At [**2141-3-23**] 12:00 PM', 'from picc line blue port', ' BLOOD CULTURED - At [**2141-3-23**] 03:00 PM', 'venipuncture right forearm', 'Fever curve trending down since am', 'Sputum x 2 with coag positive staph; sensitivities pending', 'Unable to wean neo overnight', 'Attempting to wean sedation for possible extubation, SBT but still on', 'neo and vasopressin', 'Started mexilitene; ideally would add beta blocker (metoprolol) but', 'would wait until off pressors', 'Avoid amio', 'Reglan added; TFs were going to be started but were not since would', 'need to be held for possible extubation', 'CXR [**2141-3-23**]: IMPRESSION: No acute intrathoracic pathology including no', 'pneumonia.']",10774,173586.0
53,2141-03-25 09:06:11,,"['- Pip-tazo narrowed to ceftx for E coli UTI.', '- EP recs unchanged.', '- Weaned off of pressors (vasopressin and phenylephrine).']",,10774,173586.0
54,2141-03-26 05:57:20,"['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']","['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']","['- Pip-tazo narrowed to ceftx for E coli UTI.', '- EP recs unchanged.', '- Weaned off of pressors (vasopressin and phenylephrine).']",10774,173586.0
55,2141-03-26 05:58:58,,"['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']",,10774,173586.0
56,2141-03-26 06:02:32,,"['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']",,10774,173586.0
57,2141-03-26 08:21:26,,"['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']",,10774,173586.0
58,2141-03-26 08:25:47,,"['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']",,10774,173586.0
59,2141-03-27 05:57:51,"['No VT', 'OOB to chair']","['No VT', 'OOB to chair']","['-start home lasix 40mg daily', '-consider starting metoprolol today', '-no VT overnight', '-started eating and drinking']",10774,173586.0
60,2141-03-27 06:00:37,,"['No VT', 'OOB to chair']",,10774,173586.0
61,2141-03-27 08:29:15,"['- No VT', '- OOB to chair', '- Psych consulted: Recommended seroquel 12.5 [**Hospital1 **] prn anxiety; use', 'benzos with care; monitor Qt', '- LUE US:Venous thrombosis is seen, nearly occlusive, extending from', 'the superficial left basilic and cephalic veins into the deep brachial', 'and axillary veins.  The left subclavian vein appears patent. Note is', 'made of pacemaker wires in the left subclavian vein ->Started heparin', 'gtt. Had recurrent UGIBs in past (most recently [**10-19**]) so coumadin for', 'afib had been stopped by Dr [**First Name (STitle) **]. Did not restart coumadin (will', 'discuss with [**Doctor Last Name **]). Continued PPI [**Hospital1 **], sucralfate. Guaiac stools neg.', 'Changed ASA 325 to 81 to decrease risk of bleeding', '- Started metoprolol 12.5 [**Hospital1 **]->uptitrated to 25 in evening. HR 90s-100;', 'SBP130s-150']","['- No VT', '- OOB to chair', '- Psych consulted: Recommended seroquel 12.5 [**Hospital1 **] prn anxiety; use', 'benzos with care; monitor Qt', '- LUE US:Venous thrombosis is seen, nearly occlusive, extending from', 'the superficial left basilic and cephalic veins into the deep brachial', 'and axillary veins.  The left subclavian vein appears patent. Note is', 'made of pacemaker wires in the left subclavian vein ->Started heparin', 'gtt. Had recurrent UGIBs in past (most recently [**10-19**]) so coumadin for', 'afib had been stopped by Dr [**First Name (STitle) **]. Did not restart coumadin (will', 'discuss with [**Doctor Last Name **]). Continued PPI [**Hospital1 **], sucralfate. Guaiac stools neg.', 'Changed ASA 325 to 81 to decrease risk of bleeding', '- Started metoprolol 12.5 [**Hospital1 **]->uptitrated to 25 in evening. HR 90s-100;', 'SBP130s-150']","['No VT', 'OOB to chair']",10774,173586.0
62,2141-03-27 12:23:53,,"['- No VT', '- OOB to chair', '- Psych consulted: Recommended seroquel 12.5 [**Hospital1 **] prn anxiety; use', 'benzos with care; monitor Qt', '- LUE US:Venous thrombosis is seen, nearly occlusive, extending from', 'the superficial left basilic and cephalic veins into the deep brachial', 'and axillary veins.  The left subclavian vein appears patent. Note is', 'made of pacemaker wires in the left subclavian vein ->Started heparin', 'gtt. Had recurrent UGIBs in past (most recently [**10-19**]) so coumadin for', 'afib had been stopped by Dr [**First Name (STitle) **]. Did not restart coumadin (will', 'discuss with [**Doctor Last Name **]). Continued PPI [**Hospital1 **], sucralfate. Guaiac stools neg.', 'Changed ASA 325 to 81 to decrease risk of bleeding', '- Started metoprolol 12.5 [**Hospital1 **]->uptitrated to 25 in evening. HR 90s-100;', 'SBP130s-150']",,10774,173586.0
0,2141-04-03 06:48:11,,"['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.']",,10774,197363.0
1,2141-04-03 08:00:10,,"['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.']",,10774,197363.0
2,2141-04-03 08:14:54,,"['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.']",,10774,197363.0
3,2141-04-03 10:26:01,"['S: Intubated, sedated.', 'Allergies:', 'No Known Drug Allergies', 'Last dose of Antibiotics:', 'Infusions:', 'Other ICU medications:', 'Pantoprazole (Protonix) - [**2141-4-2**] 08:00 PM', 'Dextrose 50% - [**2141-4-2**] 10:35 PM', 'Insulin - Regular - [**2141-4-2**] 10:35 PM', 'Other medications:', 'Changes to medical and family history:', 'Review of systems is unchanged from admission except as noted below', 'Review of systems:', 'Flowsheet Data as of  [**2141-4-3**] 06:44 AM', 'Vital signs', 'Hemodynamic monitoring', 'Fluid balance', '24 hours', 'Since 12 AM', 'Tmax: 37.7', 'C (99.8', 'Tcurrent: 37.2', 'C (98.9', 'HR: 88 (70 - 98) bpm', 'BP: 114/51(66) {107/49(64) - 164/73(92)} mmHg', 'RR: 17 (12 - 20) insp/min', 'SpO2: 100%', 'Heart rhythm: AV Paced', 'Total In:', '910 mL', 'PO:', '360 mL', 'TF:', 'IVF:', '500 mL', 'Blood products:', 'Total out:', '1,700 mL', '495 mL', 'Urine:', '1,700 mL', '495 mL', 'NG:', 'Stool:', 'Drains:', 'Balance:', '-790 mL', '-495 mL', 'Respiratory support', 'O2 Delivery Device: Nasal cannula', 'Ventilator mode: CMV/ASSIST/AutoFlow', 'Vt (Set): 530 (530 - 530) mL', 'RR (Set): 12', 'RR (Spontaneous): 0', 'PEEP: 5 cmH2O', 'FiO2: 100%', 'PIP: 34 cmH2O', 'Plateau: 17 cmH2O', 'SpO2: 100%', 'ABG: ///25/', 'Ve: 5.7 L/min', 'Physical Examination', 'GENERAL: WDWN male, intubated, sedated, does not respond to commands', 'HEENT: NCAT. ETT in place', 'NECK: Supple with no JVD', 'CARDIAC: PMI laterally displaced with prominent apical lift. RRR,', 'normal S1, S2. [**3-17**] high-pitched systolic murmur at RUSB with 2/6', 'lower-pitched systolic murmur at apex. No r/g.', 'LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse BS with', 'occ wheeze on L.', 'ABDOMEN: NABS. S, nontender and nondistended.', 'EXTREMITIES: Trace edema b/l LE. 1+ DP and 2+ radial pulses. LUE with', '2+ edema.', 'Labs / Radiology', '221 K/uL', '7.3 g/dL', '90 mg/dL', '2.6 mg/dL', '25 mEq/L', '5.0 mEq/L', '56 mg/dL', '97 mEq/L', '131 mEq/L', '22.8 %', '6.5 K/uL', '[image002.jpg]', '[**2141-4-2**]  06:57 PM', '[**2141-4-3**]  04:09 AM', 'WBC', '6.5', 'Hct', '22.8', 'Plt', '221', 'Cr', '3.1', '2.6', 'Glucose', '105', '90', 'Other labs: PT / PTT / INR:23.0/36.4/2.2, CK / CKMB /', 'Troponin-T:2404/10/, ALT / AST:36/76, Alk Phos / T Bili:151/0.3,', 'Differential-Neuts:76.1 %, Lymph:11.6 %, Mono:6.9 %, Eos:5.3 %, LDH:341', 'IU/L, Ca++:8.6 mg/dL, Mg++:2.5 mg/dL, PO4:4.6 mg/dL', 'Assessment and Plan', '73 year old male with CAD, aortic stenosis, VT/VF arrest s/p ICD and', 'ablation, CHF (EF 20%) s/p BiV pacer, Afib on coumadin, CRI who', 'presents after recent discharge with multiple episodes of VT.', '.', '# VT: Recurrent Vtach and defibrillator unable to pace him out of it.', 'Failed multiple antiarrythmics during past admissions.  Goals of care', 'addressed overnight.  Plan to turn off defibrillator and keep patient', 'comfortable.', '.', '# Intubation: For comfort in setting of recurrent ICD shocks.', '- Continue vent', '- Neo gtt', '.', '# Acute on chronic renal failure: Baseline Cr around 1.6, currently', '2.6.  Possibly from diuresis and lisinopril and poor forward flow from', 'Vtach.', '- Hold diuretics and ACE-I', '- Renally dose meds and avoid nephrotoxins', '.', '# Chest wall pain: From previous CPR and shocks.  Intubated now but', 'will aim to keep patient comfortable once extubated.', '.', '# Anxiety:  From repeated shocks.', '- Cont seroquel scheduled and PRN', '- Cont citalopram and clonazepam', '.', '# DVT: Located in LUE per US.', '- Cont warfarin with goal INR 2-2.5 (h/o GI bleed)', '- Continue PPI and sucralfate', '- F/u US in [**3-15**] mos', '.', '# Chronic Systolic heart Failure: LVEF 20% on TTE [**10-19**]. Also has known', 'AS, although at last admission refused AVR and valvuloplasty. He', 'currently is likely intravascularly dry given his ARF and exam.', '- Gentle IVF.', '- Cont metoprolol, holding digoxin as above', '- Hold diuretics for now', '.', '# Anemia: Chronic, normocytic. Hct stable at recent baseline of high', '20s to low 30s.', '- Trend hct.', '.', '# CAD: Stable, clean cath [**3-20**].', '- Continue aspirin, statin, beta blocker', '.', '# Hyperkalemia/Hyponatremia: Likely from volume down.', '- NS as above', '- Monitor K', '.', '# Ppx: Therapeutic INR, bowel regimen', '.', '# Access: PICC', '.', '# Comm: [**Name (NI) 53**] and wife, [**Name (NI) 16**] [**Name (NI) 5730**]', '.', '# Code: For now, shocks and intubation okay, but no chest compressions.', 'Dr [**First Name (STitle) **] has discussed this with the patient and his wife.  However,', 'given hospital course, will have to readdress with plan to keep patient', 'comfortable.', '.', '# Dispo: pending', 'ICU Care', 'Nutrition: NPO for now', 'Glycemic Control:', 'Lines:', 'PICC Line - [**2141-4-2**] 02:25 PM', '18 Gauge - [**2141-4-2**] 08:11 PM', 'Prophylaxis:', 'DVT: Warfarin', 'Stress ulcer: PPI, sucralfate', 'VAP:  HOB over 30 degrees', 'Comments:', 'Communication:  Comments:', 'Code status:', 'Disposition:', '------ Protected Section ------', 'Chief Complaint:', 'I saw and examined the patient, and was physically present with the ICU', 'Resident for key portions of the services provided.  I agree with his /', 'her note above, including assessment and plan.', 'HPI:', '24 Hour Events:', 'Multiple episodes of VT, necessitating either ATP, internal shocks or', 'external cardioversion', 'History obtained from Family / [**Hospital 56**] Medical records']","['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.', 'S: Intubated, sedated.', 'Allergies:', 'No Known Drug Allergies', 'Last dose of Antibiotics:', 'Infusions:', 'Other ICU medications:', 'Pantoprazole (Protonix) - [**2141-4-2**] 08:00 PM', 'Dextrose 50% - [**2141-4-2**] 10:35 PM', 'Insulin - Regular - [**2141-4-2**] 10:35 PM', 'Other medications:', 'Changes to medical and family history:', 'Review of systems is unchanged from admission except as noted below', 'Review of systems:', 'Flowsheet Data as of  [**2141-4-3**] 06:44 AM', 'Vital signs', 'Hemodynamic monitoring', 'Fluid balance', '24 hours', 'Since 12 AM', 'Tmax: 37.7', 'C (99.8', 'Tcurrent: 37.2', 'C (98.9', 'HR: 88 (70 - 98) bpm', 'BP: 114/51(66) {107/49(64) - 164/73(92)} mmHg', 'RR: 17 (12 - 20) insp/min', 'SpO2: 100%', 'Heart rhythm: AV Paced', 'Total In:', '910 mL', 'PO:', '360 mL', 'TF:', 'IVF:', '500 mL', 'Blood products:', 'Total out:', '1,700 mL', '495 mL', 'Urine:', '1,700 mL', '495 mL', 'NG:', 'Stool:', 'Drains:', 'Balance:', '-790 mL', '-495 mL', 'Respiratory support', 'O2 Delivery Device: Nasal cannula', 'Ventilator mode: CMV/ASSIST/AutoFlow', 'Vt (Set): 530 (530 - 530) mL', 'RR (Set): 12', 'RR (Spontaneous): 0', 'PEEP: 5 cmH2O', 'FiO2: 100%', 'PIP: 34 cmH2O', 'Plateau: 17 cmH2O', 'SpO2: 100%', 'ABG: ///25/', 'Ve: 5.7 L/min', 'Physical Examination', 'GENERAL: WDWN male, intubated, sedated, does not respond to commands', 'HEENT: NCAT. ETT in place', 'NECK: Supple with no JVD', 'CARDIAC: PMI laterally displaced with prominent apical lift. RRR,', 'normal S1, S2. [**3-17**] high-pitched systolic murmur at RUSB with 2/6', 'lower-pitched systolic murmur at apex. No r/g.', 'LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse BS with', 'occ wheeze on L.', 'ABDOMEN: NABS. S, nontender and nondistended.', 'EXTREMITIES: Trace edema b/l LE. 1+ DP and 2+ radial pulses. LUE with', '2+ edema.', 'Labs / Radiology', '221 K/uL', '7.3 g/dL', '90 mg/dL', '2.6 mg/dL', '25 mEq/L', '5.0 mEq/L', '56 mg/dL', '97 mEq/L', '131 mEq/L', '22.8 %', '6.5 K/uL', '[image002.jpg]', '[**2141-4-2**]  06:57 PM', '[**2141-4-3**]  04:09 AM', 'WBC', '6.5', 'Hct', '22.8', 'Plt', '221', 'Cr', '3.1', '2.6', 'Glucose', '105', '90', 'Other labs: PT / PTT / INR:23.0/36.4/2.2, CK / CKMB /', 'Troponin-T:2404/10/, ALT / AST:36/76, Alk Phos / T Bili:151/0.3,', 'Differential-Neuts:76.1 %, Lymph:11.6 %, Mono:6.9 %, Eos:5.3 %, LDH:341', 'IU/L, Ca++:8.6 mg/dL, Mg++:2.5 mg/dL, PO4:4.6 mg/dL', 'Assessment and Plan', '73 year old male with CAD, aortic stenosis, VT/VF arrest s/p ICD and', 'ablation, CHF (EF 20%) s/p BiV pacer, Afib on coumadin, CRI who', 'presents after recent discharge with multiple episodes of VT.', '.', '# VT: Recurrent Vtach and defibrillator unable to pace him out of it.', 'Failed multiple antiarrythmics during past admissions.  Goals of care', 'addressed overnight.  Plan to turn off defibrillator and keep patient', 'comfortable.', '.', '# Intubation: For comfort in setting of recurrent ICD shocks.', '- Continue vent', '- Neo gtt', '.', '# Acute on chronic renal failure: Baseline Cr around 1.6, currently', '2.6.  Possibly from diuresis and lisinopril and poor forward flow from', 'Vtach.', '- Hold diuretics and ACE-I', '- Renally dose meds and avoid nephrotoxins', '.', '# Chest wall pain: From previous CPR and shocks.  Intubated now but', 'will aim to keep patient comfortable once extubated.', '.', '# Anxiety:  From repeated shocks.', '- Cont seroquel scheduled and PRN', '- Cont citalopram and clonazepam', '.', '# DVT: Located in LUE per US.', '- Cont warfarin with goal INR 2-2.5 (h/o GI bleed)', '- Continue PPI and sucralfate', '- F/u US in [**3-15**] mos', '.', '# Chronic Systolic heart Failure: LVEF 20% on TTE [**10-19**]. Also has known', 'AS, although at last admission refused AVR and valvuloplasty. He', 'currently is likely intravascularly dry given his ARF and exam.', '- Gentle IVF.', '- Cont metoprolol, holding digoxin as above', '- Hold diuretics for now', '.', '# Anemia: Chronic, normocytic. Hct stable at recent baseline of high', '20s to low 30s.', '- Trend hct.', '.', '# CAD: Stable, clean cath [**3-20**].', '- Continue aspirin, statin, beta blocker', '.', '# Hyperkalemia/Hyponatremia: Likely from volume down.', '- NS as above', '- Monitor K', '.', '# Ppx: Therapeutic INR, bowel regimen', '.', '# Access: PICC', '.', '# Comm: [**Name (NI) 53**] and wife, [**Name (NI) 16**] [**Name (NI) 5730**]', '.', '# Code: For now, shocks and intubation okay, but no chest compressions.', 'Dr [**First Name (STitle) **] has discussed this with the patient and his wife.  However,', 'given hospital course, will have to readdress with plan to keep patient', 'comfortable.', '.', '# Dispo: pending', 'ICU Care', 'Nutrition: NPO for now', 'Glycemic Control:', 'Lines:', 'PICC Line - [**2141-4-2**] 02:25 PM', '18 Gauge - [**2141-4-2**] 08:11 PM', 'Prophylaxis:', 'DVT: Warfarin', 'Stress ulcer: PPI, sucralfate', 'VAP:  HOB over 30 degrees', 'Comments:', 'Communication:  Comments:', 'Code status:', 'Disposition:', '------ Protected Section ------', 'Chief Complaint:', 'I saw and examined the patient, and was physically present with the ICU', 'Resident for key portions of the services provided.  I agree with his /', 'her note above, including assessment and plan.', 'HPI:', '24 Hour Events:', 'Multiple episodes of VT, necessitating either ATP, internal shocks or', 'external cardioversion', 'History obtained from Family / [**Hospital 56**] Medical records']",,10774,197363.0
4,2141-04-03 12:24:01,,"['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.', 'S: Intubated, sedated.', 'Allergies:', 'No Known Drug Allergies', 'Last dose of Antibiotics:', 'Infusions:', 'Other ICU medications:', 'Pantoprazole (Protonix) - [**2141-4-2**] 08:00 PM', 'Dextrose 50% - [**2141-4-2**] 10:35 PM', 'Insulin - Regular - [**2141-4-2**] 10:35 PM', 'Other medications:', 'Changes to medical and family history:', 'Review of systems is unchanged from admission except as noted below', 'Review of systems:', 'Flowsheet Data as of  [**2141-4-3**] 06:44 AM', 'Vital signs', 'Hemodynamic monitoring', 'Fluid balance', '24 hours', 'Since 12 AM', 'Tmax: 37.7', 'C (99.8', 'Tcurrent: 37.2', 'C (98.9', 'HR: 88 (70 - 98) bpm', 'BP: 114/51(66) {107/49(64) - 164/73(92)} mmHg', 'RR: 17 (12 - 20) insp/min', 'SpO2: 100%', 'Heart rhythm: AV Paced', 'Total In:', '910 mL', 'PO:', '360 mL', 'TF:', 'IVF:', '500 mL', 'Blood products:', 'Total out:', '1,700 mL', '495 mL', 'Urine:', '1,700 mL', '495 mL', 'NG:', 'Stool:', 'Drains:', 'Balance:', '-790 mL', '-495 mL', 'Respiratory support', 'O2 Delivery Device: Nasal cannula', 'Ventilator mode: CMV/ASSIST/AutoFlow', 'Vt (Set): 530 (530 - 530) mL', 'RR (Set): 12', 'RR (Spontaneous): 0', 'PEEP: 5 cmH2O', 'FiO2: 100%', 'PIP: 34 cmH2O', 'Plateau: 17 cmH2O', 'SpO2: 100%', 'ABG: ///25/', 'Ve: 5.7 L/min', 'Physical Examination', 'GENERAL: WDWN male, intubated, sedated, does not respond to commands', 'HEENT: NCAT. ETT in place', 'NECK: Supple with no JVD', 'CARDIAC: PMI laterally displaced with prominent apical lift. RRR,', 'normal S1, S2. [**3-17**] high-pitched systolic murmur at RUSB with 2/6', 'lower-pitched systolic murmur at apex. No r/g.', 'LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse BS with', 'occ wheeze on L.', 'ABDOMEN: NABS. S, nontender and nondistended.', 'EXTREMITIES: Trace edema b/l LE. 1+ DP and 2+ radial pulses. LUE with', '2+ edema.', 'Labs / Radiology', '221 K/uL', '7.3 g/dL', '90 mg/dL', '2.6 mg/dL', '25 mEq/L', '5.0 mEq/L', '56 mg/dL', '97 mEq/L', '131 mEq/L', '22.8 %', '6.5 K/uL', '[image002.jpg]', '[**2141-4-2**]  06:57 PM', '[**2141-4-3**]  04:09 AM', 'WBC', '6.5', 'Hct', '22.8', 'Plt', '221', 'Cr', '3.1', '2.6', 'Glucose', '105', '90', 'Other labs: PT / PTT / INR:23.0/36.4/2.2, CK / CKMB /', 'Troponin-T:2404/10/, ALT / AST:36/76, Alk Phos / T Bili:151/0.3,', 'Differential-Neuts:76.1 %, Lymph:11.6 %, Mono:6.9 %, Eos:5.3 %, LDH:341', 'IU/L, Ca++:8.6 mg/dL, Mg++:2.5 mg/dL, PO4:4.6 mg/dL', 'Assessment and Plan', '73 year old male with CAD, aortic stenosis, VT/VF arrest s/p ICD and', 'ablation, CHF (EF 20%) s/p BiV pacer, Afib on coumadin, CRI who', 'presents after recent discharge with multiple episodes of VT.', '.', '# VT: Recurrent Vtach and defibrillator unable to pace him out of it.', 'Failed multiple antiarrythmics during past admissions.  Goals of care', 'addressed overnight.  Plan to turn off defibrillator and keep patient', 'comfortable.', '.', '# Intubation: For comfort in setting of recurrent ICD shocks.', '- Continue vent', '- Neo gtt', '.', '# Acute on chronic renal failure: Baseline Cr around 1.6, currently', '2.6.  Possibly from diuresis and lisinopril and poor forward flow from', 'Vtach.', '- Hold diuretics and ACE-I', '- Renally dose meds and avoid nephrotoxins', '.', '# Chest wall pain: From previous CPR and shocks.  Intubated now but', 'will aim to keep patient comfortable once extubated.', '.', '# Anxiety:  From repeated shocks.', '- Cont seroquel scheduled and PRN', '- Cont citalopram and clonazepam', '.', '# DVT: Located in LUE per US.', '- Cont warfarin with goal INR 2-2.5 (h/o GI bleed)', '- Continue PPI and sucralfate', '- F/u US in [**3-15**] mos', '.', '# Chronic Systolic heart Failure: LVEF 20% on TTE [**10-19**]. Also has known', 'AS, although at last admission refused AVR and valvuloplasty. He', 'currently is likely intravascularly dry given his ARF and exam.', '- Gentle IVF.', '- Cont metoprolol, holding digoxin as above', '- Hold diuretics for now', '.', '# Anemia: Chronic, normocytic. Hct stable at recent baseline of high', '20s to low 30s.', '- Trend hct.', '.', '# CAD: Stable, clean cath [**3-20**].', '- Continue aspirin, statin, beta blocker', '.', '# Hyperkalemia/Hyponatremia: Likely from volume down.', '- NS as above', '- Monitor K', '.', '# Ppx: Therapeutic INR, bowel regimen', '.', '# Access: PICC', '.', '# Comm: [**Name (NI) 53**] and wife, [**Name (NI) 16**] [**Name (NI) 5730**]', '.', '# Code: For now, shocks and intubation okay, but no chest compressions.', 'Dr [**First Name (STitle) **] has discussed this with the patient and his wife.  However,', 'given hospital course, will have to readdress with plan to keep patient', 'comfortable.', '.', '# Dispo: pending', 'ICU Care', 'Nutrition: NPO for now', 'Glycemic Control:', 'Lines:', 'PICC Line - [**2141-4-2**] 02:25 PM', '18 Gauge - [**2141-4-2**] 08:11 PM', 'Prophylaxis:', 'DVT: Warfarin', 'Stress ulcer: PPI, sucralfate', 'VAP:  HOB over 30 degrees', 'Comments:', 'Communication:  Comments:', 'Code status:', 'Disposition:', '------ Protected Section ------', 'Chief Complaint:', 'I saw and examined the patient, and was physically present with the ICU', 'Resident for key portions of the services provided.  I agree with his /', 'her note above, including assessment and plan.', 'HPI:', '24 Hour Events:', 'Multiple episodes of VT, necessitating either ATP, internal shocks or', 'external cardioversion', 'History obtained from Family / [**Hospital 56**] Medical records']",,10774,197363.0
5,2141-04-04 05:42:26,['-ICD shut off but no overnight events'],['-ICD shut off but no overnight events'],"['Multiple episodes of VT resulting in ICD shocks (~11). Intubated and', 'sedated. Given amiodarone 150mg IV x3, started on gtt at 1mg/min. Also', 'given lidocaine 100mg IV, started on gtt at 2mg/min. Had two episodes', 'of VT at 130s, not detected by ICD. First episode externally shocked at', '125, then 200J with maintained perfusion throughout. Second episode', 'eventually detected and successfully ATPed.', 'S: Intubated, sedated.', 'Allergies:', 'No Known Drug Allergies', 'Last dose of Antibiotics:', 'Infusions:', 'Other ICU medications:', 'Pantoprazole (Protonix) - [**2141-4-2**] 08:00 PM', 'Dextrose 50% - [**2141-4-2**] 10:35 PM', 'Insulin - Regular - [**2141-4-2**] 10:35 PM', 'Other medications:', 'Changes to medical and family history:', 'Review of systems is unchanged from admission except as noted below', 'Review of systems:', 'Flowsheet Data as of  [**2141-4-3**] 06:44 AM', 'Vital signs', 'Hemodynamic monitoring', 'Fluid balance', '24 hours', 'Since 12 AM', 'Tmax: 37.7', 'C (99.8', 'Tcurrent: 37.2', 'C (98.9', 'HR: 88 (70 - 98) bpm', 'BP: 114/51(66) {107/49(64) - 164/73(92)} mmHg', 'RR: 17 (12 - 20) insp/min', 'SpO2: 100%', 'Heart rhythm: AV Paced', 'Total In:', '910 mL', 'PO:', '360 mL', 'TF:', 'IVF:', '500 mL', 'Blood products:', 'Total out:', '1,700 mL', '495 mL', 'Urine:', '1,700 mL', '495 mL', 'NG:', 'Stool:', 'Drains:', 'Balance:', '-790 mL', '-495 mL', 'Respiratory support', 'O2 Delivery Device: Nasal cannula', 'Ventilator mode: CMV/ASSIST/AutoFlow', 'Vt (Set): 530 (530 - 530) mL', 'RR (Set): 12', 'RR (Spontaneous): 0', 'PEEP: 5 cmH2O', 'FiO2: 100%', 'PIP: 34 cmH2O', 'Plateau: 17 cmH2O', 'SpO2: 100%', 'ABG: ///25/', 'Ve: 5.7 L/min', 'Physical Examination', 'GENERAL: WDWN male, intubated, sedated, does not respond to commands', 'HEENT: NCAT. ETT in place', 'NECK: Supple with no JVD', 'CARDIAC: PMI laterally displaced with prominent apical lift. RRR,', 'normal S1, S2. [**3-17**] high-pitched systolic murmur at RUSB with 2/6', 'lower-pitched systolic murmur at apex. No r/g.', 'LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse BS with', 'occ wheeze on L.', 'ABDOMEN: NABS. S, nontender and nondistended.', 'EXTREMITIES: Trace edema b/l LE. 1+ DP and 2+ radial pulses. LUE with', '2+ edema.', 'Labs / Radiology', '221 K/uL', '7.3 g/dL', '90 mg/dL', '2.6 mg/dL', '25 mEq/L', '5.0 mEq/L', '56 mg/dL', '97 mEq/L', '131 mEq/L', '22.8 %', '6.5 K/uL', '[image002.jpg]', '[**2141-4-2**]  06:57 PM', '[**2141-4-3**]  04:09 AM', 'WBC', '6.5', 'Hct', '22.8', 'Plt', '221', 'Cr', '3.1', '2.6', 'Glucose', '105', '90', 'Other labs: PT / PTT / INR:23.0/36.4/2.2, CK / CKMB /', 'Troponin-T:2404/10/, ALT / AST:36/76, Alk Phos / T Bili:151/0.3,', 'Differential-Neuts:76.1 %, Lymph:11.6 %, Mono:6.9 %, Eos:5.3 %, LDH:341', 'IU/L, Ca++:8.6 mg/dL, Mg++:2.5 mg/dL, PO4:4.6 mg/dL', 'Assessment and Plan', '73 year old male with CAD, aortic stenosis, VT/VF arrest s/p ICD and', 'ablation, CHF (EF 20%) s/p BiV pacer, Afib on coumadin, CRI who', 'presents after recent discharge with multiple episodes of VT.', '.', '# VT: Recurrent Vtach and defibrillator unable to pace him out of it.', 'Failed multiple antiarrythmics during past admissions.  Goals of care', 'addressed overnight.  Plan to turn off defibrillator and keep patient', 'comfortable.', '.', '# Intubation: For comfort in setting of recurrent ICD shocks.', '- Continue vent', '- Neo gtt', '.', '# Acute on chronic renal failure: Baseline Cr around 1.6, currently', '2.6.  Possibly from diuresis and lisinopril and poor forward flow from', 'Vtach.', '- Hold diuretics and ACE-I', '- Renally dose meds and avoid nephrotoxins', '.', '# Chest wall pain: From previous CPR and shocks.  Intubated now but', 'will aim to keep patient comfortable once extubated.', '.', '# Anxiety:  From repeated shocks.', '- Cont seroquel scheduled and PRN', '- Cont citalopram and clonazepam', '.', '# DVT: Located in LUE per US.', '- Cont warfarin with goal INR 2-2.5 (h/o GI bleed)', '- Continue PPI and sucralfate', '- F/u US in [**3-15**] mos', '.', '# Chronic Systolic heart Failure: LVEF 20% on TTE [**10-19**]. Also has known', 'AS, although at last admission refused AVR and valvuloplasty. He', 'currently is likely intravascularly dry given his ARF and exam.', '- Gentle IVF.', '- Cont metoprolol, holding digoxin as above', '- Hold diuretics for now', '.', '# Anemia: Chronic, normocytic. Hct stable at recent baseline of high', '20s to low 30s.', '- Trend hct.', '.', '# CAD: Stable, clean cath [**3-20**].', '- Continue aspirin, statin, beta blocker', '.', '# Hyperkalemia/Hyponatremia: Likely from volume down.', '- NS as above', '- Monitor K', '.', '# Ppx: Therapeutic INR, bowel regimen', '.', '# Access: PICC', '.', '# Comm: [**Name (NI) 53**] and wife, [**Name (NI) 16**] [**Name (NI) 5730**]', '.', '# Code: For now, shocks and intubation okay, but no chest compressions.', 'Dr [**First Name (STitle) **] has discussed this with the patient and his wife.  However,', 'given hospital course, will have to readdress with plan to keep patient', 'comfortable.', '.', '# Dispo: pending', 'ICU Care', 'Nutrition: NPO for now', 'Glycemic Control:', 'Lines:', 'PICC Line - [**2141-4-2**] 02:25 PM', '18 Gauge - [**2141-4-2**] 08:11 PM', 'Prophylaxis:', 'DVT: Warfarin', 'Stress ulcer: PPI, sucralfate', 'VAP:  HOB over 30 degrees', 'Comments:', 'Communication:  Comments:', 'Code status:', 'Disposition:', '------ Protected Section ------', 'Chief Complaint:', 'I saw and examined the patient, and was physically present with the ICU', 'Resident for key portions of the services provided.  I agree with his /', 'her note above, including assessment and plan.', 'HPI:', '24 Hour Events:', 'Multiple episodes of VT, necessitating either ATP, internal shocks or', 'external cardioversion', 'History obtained from Family / [**Hospital 56**] Medical records']",10774,197363.0
6,2141-04-04 05:44:02,,['-ICD shut off but no overnight events'],,10774,197363.0
7,2141-04-04 05:44:53,,['-ICD shut off but no overnight events'],,10774,197363.0
8,2141-04-04 07:54:02,,['-ICD shut off but no overnight events'],,10774,197363.0
9,2141-04-04 10:11:45,,['-ICD shut off but no overnight events'],,10774,197363.0
10,2141-04-04 10:44:41,,['-ICD shut off but no overnight events'],,10774,197363.0
11,2141-04-05 06:17:36,"['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']","['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']",['-ICD shut off but no overnight events'],10774,197363.0
12,2141-04-05 06:18:59,,"['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']",,10774,197363.0
13,2141-04-05 08:33:10,,"['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']",,10774,197363.0
14,2141-04-05 11:58:44,,"['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']",,10774,197363.0
15,2141-04-05 12:36:59,,"['-Attempted weaning sedation and went into VT around 4pm->resolved with', 'increased sedation', '-[**First Name8 (NamePattern2) **] [**Last Name (LF) **], [**First Name3 (LF) 178**] maintain status quo, possibly extubate in am', '-Wanted metoprolol PO but OGT clogged so ordered IV rather than replace', 'OGT', '-Second episode of VT around midnight, resolved with sedation']",,10774,197363.0
0,2177-11-05 07:44:14,,"['Pt with low urine output (10-15cc/hr) given bolus of 1L and 500cc', 'overnight.', ' ARTERIAL LINE - START [**2177-11-4**] 09:54 PM', ' ARTERIAL LINE - STOP [**2177-11-4**] 10:43 PM', 'History obtained from Patient']",,15041,189077.0
1,2177-11-05 11:00:08,,"['Pt with low urine output (10-15cc/hr) given bolus of 1L and 500cc', 'overnight.', ' ARTERIAL LINE - START [**2177-11-4**] 09:54 PM', ' ARTERIAL LINE - STOP [**2177-11-4**] 10:43 PM', 'History obtained from Patient']",,15041,189077.0
0,2195-03-13 12:40:27,,['Successfully extubated w/o incident'],,84318,188604.0
1,2195-03-14 06:50:07,"['-HCT stable', '-got bone marrow biopsy', '-CXR stable', '-Oncology recs antibiotics x5 days', '-ID recs no change in management', '-called out to BMT']","['-HCT stable', '-got bone marrow biopsy', '-CXR stable', '-Oncology recs antibiotics x5 days', '-ID recs no change in management', '-called out to BMT']",['Successfully extubated w/o incident'],84318,188604.0
2,2195-03-14 15:39:15,,"['-HCT stable', '-got bone marrow biopsy', '-CXR stable', '-Oncology recs antibiotics x5 days', '-ID recs no change in management', '-called out to BMT']",,84318,188604.0
0,2165-12-08 06:10:24,,"['- tacrolimus level at EMMC [**12-6**] 5.6, c-diff [**12-4**] negative', '- per renal changed fluids to D5W - montior lytes 163 -> 162 -> 159 ->', 'over last 12 hours', '- cont to trend lytes', '- repleted K and Phos, cont to follow UOP', '- has two peripheral lines now, ? during rounds about needing PICC for', 'floor']",,6850,167393.0
1,2165-12-08 06:11:05,,"['- tacrolimus level at EMMC [**12-6**] 5.6, c-diff [**12-4**] negative', '- per renal changed fluids to D5W - montior lytes 163 -> 162 -> 159 ->', 'over last 12 hours', '- cont to trend lytes', '- repleted K and Phos, cont to follow UOP', '- has two peripheral lines now, ? during rounds about needing PICC for', 'floor']",,6850,167393.0
2,2165-12-08 12:56:49,"['- one good peripheral line', ' to IR [**12-8**] for PICC']","['- tacrolimus level at EMMC [**12-6**] 5.6, c-diff [**12-4**] negative', '- per renal changed fluids to D5W - montior lytes 163 -> 162 -> 159 ->', 'over last 12 hours', '- cont to trend lytes', '- repleted K and Phos, cont to follow UOP', '- one good peripheral line', ' to IR [**12-8**] for PICC']","['- has two peripheral lines now, ? during rounds about needing PICC for', 'floor']",6850,167393.0
3,2165-12-08 14:24:28,,"['- tacrolimus level at EMMC [**12-6**] 5.6, c-diff [**12-4**] negative', '- per renal changed fluids to D5W - montior lytes 163 -> 162 -> 159 ->', 'over last 12 hours', '- cont to trend lytes', '- repleted K and Phos, cont to follow UOP', '- one good peripheral line', ' to IR [**12-8**] for PICC']",,6850,167393.0
4,2165-12-09 06:11:02,,[],"['- tacrolimus level at EMMC [**12-6**] 5.6, c-diff [**12-4**] negative', '- per renal changed fluids to D5W - montior lytes 163 -> 162 -> 159 ->', 'over last 12 hours', '- cont to trend lytes', '- repleted K and Phos, cont to follow UOP', '- one good peripheral line', ' to IR [**12-8**] for PICC']",6850,167393.0
5,2165-12-09 06:11:42,,[],,6850,167393.0
6,2165-12-09 13:29:42,"['- lost peripheral access', '-scheduled for re-eval by PICC team']","['- lost peripheral access', '-scheduled for re-eval by PICC team']",,6850,167393.0
7,2165-12-09 14:33:42,,"['- lost peripheral access', '-scheduled for re-eval by PICC team']",,6850,167393.0
0,2154-02-07 07:23:48,,"['- No O/N events', '- Vital signs are stable', '- Home today']",,72998,151422.0
1,2154-02-07 07:49:51,['- Ongoing UOP'],"['- No O/N events', '- Vital signs are stable', '- Ongoing UOP', '- Home today']",,72998,151422.0
2,2154-02-07 11:30:31,,"['- No O/N events', '- Vital signs are stable', '- Ongoing UOP', '- Home today']",,72998,151422.0
0,2159-10-22 07:13:58,,"['-received 500cc bolus, followed by 2L of maintenance fluids at 125cc/h', 'of LR', '-2AM Hct: 27.9 (down from 30.9)', '-GI recs: no plans for scoping today given that bleeding has stopped.', 'Active type and screen.  If pt bleeds again, please obtain bleeding', 'scan followed by angio.  Hct Q8H.']",,30564,118586.0
1,2159-10-22 10:00:58,,"['-received 500cc bolus, followed by 2L of maintenance fluids at 125cc/h', 'of LR', '-2AM Hct: 27.9 (down from 30.9)', '-GI recs: no plans for scoping today given that bleeding has stopped.', 'Active type and screen.  If pt bleeds again, please obtain bleeding', 'scan followed by angio.  Hct Q8H.']",,30564,118586.0
2,2159-10-22 11:17:20,,"['-received 500cc bolus, followed by 2L of maintenance fluids at 125cc/h', 'of LR', '-2AM Hct: 27.9 (down from 30.9)', '-GI recs: no plans for scoping today given that bleeding has stopped.', 'Active type and screen.  If pt bleeds again, please obtain bleeding', 'scan followed by angio.  Hct Q8H.']",,30564,118586.0
0,2125-06-24 07:58:31,,"['MULTI LUMEN - START [**2125-6-23**] 02:00 PM', 'inserted @ OSH, placement confirmed in ED by XRay', '#']",,28136,126974.0
1,2125-06-24 08:04:30,"['# Code status addressed with family and patient separately. The family', 'wants to get a definitive diagnosis and give the patient time to', 'recover before fully addressing code status.']","['MULTI LUMEN - START [**2125-6-23**] 02:00 PM', 'inserted @ OSH, placement confirmed in ED by XRay', '# Code status addressed with family and patient separately. The family', 'wants to get a definitive diagnosis and give the patient time to', 'recover before fully addressing code status.']",['#'],28136,126974.0
2,2125-06-24 12:05:40,,"['MULTI LUMEN - START [**2125-6-23**] 02:00 PM', 'inserted @ OSH, placement confirmed in ED by XRay', '# Code status addressed with family and patient separately. The family', 'wants to get a definitive diagnosis and give the patient time to', 'recover before fully addressing code status.']",,28136,126974.0
0,2153-04-25 06:34:41,,"['new episode of hematemesis x150 cc, prbc, FFP, vitk, protonix ggt']",,8559,145304.0
1,2153-04-25 06:46:36,,"['new episode of hematemesis x150 cc, prbc, FFP, vitk, protonix ggt']",,8559,145304.0
2,2153-04-25 10:22:13,,"['new episode of hematemesis x150 cc, prbc, FFP, vitk, protonix ggt']",,8559,145304.0
3,2153-04-26 07:39:11,"['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']","['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']","['new episode of hematemesis x150 cc, prbc, FFP, vitk, protonix ggt']",8559,145304.0
4,2153-04-26 07:43:10,,"['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']",,8559,145304.0
5,2153-04-26 11:38:39,,"['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']",,8559,145304.0
6,2153-04-26 12:15:17,,"['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']",,8559,145304.0
7,2153-04-27 06:49:17,"['RADIATION THERAPY - At [**2153-4-26**] 11:56 AM', 'pt went to XRT for second treatment. Plan to do another treatment', 'tomorrow.', ' ULTRASOUND - At [**2153-4-26**] 02:43 PM', 'vascular studies lower extremities.', ' MULTI LUMEN - START [**2153-4-26**] 09:44 PM', ""- Received 3 units prbc's, 1 cryo"", '- RIJ placed', '- Got [**1-16**] XRT', '- Got vascular study, results pending', '- Thoracics: No surgical intervention (esophagectomy would kill him)', '- Onc: Poor prognosis, hesitant to start chemo, but may consider Fri', 'vs. weekend', '- Distended belly, manually removed some maroon stool, got 2 enemas,', 'started Zosyn, KUB showed impaction, getting CT abd/pelvis (delayed', 'because has barium in colon so study will not be diagnostic anyway),', 'started IV Reglan']","['RADIATION THERAPY - At [**2153-4-26**] 11:56 AM', 'pt went to XRT for second treatment. Plan to do another treatment', 'tomorrow.', ' ULTRASOUND - At [**2153-4-26**] 02:43 PM', 'vascular studies lower extremities.', ' MULTI LUMEN - START [**2153-4-26**] 09:44 PM', ""- Received 3 units prbc's, 1 cryo"", '- RIJ placed', '- Got [**1-16**] XRT', '- Got vascular study, results pending', '- Thoracics: No surgical intervention (esophagectomy would kill him)', '- Onc: Poor prognosis, hesitant to start chemo, but may consider Fri', 'vs. weekend', '- Distended belly, manually removed some maroon stool, got 2 enemas,', 'started Zosyn, KUB showed impaction, getting CT abd/pelvis (delayed', 'because has barium in colon so study will not be diagnostic anyway),', 'started IV Reglan']","['--given 3 U PRBC since arrival awith one unit of cryoprecipitate', '--VSS,  but Hct not bumping appropriately']",8559,145304.0
8,2153-04-27 11:59:48,"['started Zosyn, KUB showed impaction, planned to get CT abd/pelvis but', 'this was delayed because he has barium in colon so study will not be', 'diagnostic anyway, started IV Reglan for motility']","['RADIATION THERAPY - At [**2153-4-26**] 11:56 AM', 'pt went to XRT for second treatment. Plan to do another treatment', 'tomorrow.', ' ULTRASOUND - At [**2153-4-26**] 02:43 PM', 'vascular studies lower extremities.', ' MULTI LUMEN - START [**2153-4-26**] 09:44 PM', ""- Received 3 units prbc's, 1 cryo"", '- RIJ placed', '- Got [**1-16**] XRT', '- Got vascular study, results pending', '- Thoracics: No surgical intervention (esophagectomy would kill him)', '- Onc: Poor prognosis, hesitant to start chemo, but may consider Fri', 'vs. weekend', '- Distended belly, manually removed some maroon stool, got 2 enemas,', 'started Zosyn, KUB showed impaction, planned to get CT abd/pelvis but', 'this was delayed because he has barium in colon so study will not be', 'diagnostic anyway, started IV Reglan for motility']","['started Zosyn, KUB showed impaction, getting CT abd/pelvis (delayed', 'because has barium in colon so study will not be diagnostic anyway),', 'started IV Reglan']",8559,145304.0
9,2153-04-28 07:12:47,"['BLOOD CULTURED - At [**2153-4-27**] 10:00 AM', ' BLOOD CULTURED - At [**2153-4-27**] 10:11 AM', ' RADIATION THERAPY - At [**2153-4-27**] 02:14 PM', ' EKG - At [**2153-4-27**] 10:00 PM', ' FEVER - 101.8', 'F - [**2153-4-27**] 10:00 AM', '[**4-27**]', '- Transfused 4 units YESTERDAY, 1 unit platelets, 1 unit cryo', '- Bumped fibrinogen & platelets appropriately, did not bump Hct', '- Creatinine improving with transfusions', '- Free water deficit ~ 5L.  Given 2L D5W, will reassess with AM labs']","['BLOOD CULTURED - At [**2153-4-27**] 10:00 AM', ' BLOOD CULTURED - At [**2153-4-27**] 10:11 AM', ' RADIATION THERAPY - At [**2153-4-27**] 02:14 PM', ' EKG - At [**2153-4-27**] 10:00 PM', ' FEVER - 101.8', 'F - [**2153-4-27**] 10:00 AM', '[**4-27**]', '- Transfused 4 units YESTERDAY, 1 unit platelets, 1 unit cryo', '- Bumped fibrinogen & platelets appropriately, did not bump Hct', '- Creatinine improving with transfusions', '- Free water deficit ~ 5L.  Given 2L D5W, will reassess with AM labs']","['RADIATION THERAPY - At [**2153-4-26**] 11:56 AM', 'pt went to XRT for second treatment. Plan to do another treatment', 'tomorrow.', ' ULTRASOUND - At [**2153-4-26**] 02:43 PM', 'vascular studies lower extremities.', ' MULTI LUMEN - START [**2153-4-26**] 09:44 PM', ""- Received 3 units prbc's, 1 cryo"", '- RIJ placed', '- Got [**1-16**] XRT', '- Got vascular study, results pending', '- Thoracics: No surgical intervention (esophagectomy would kill him)', '- Onc: Poor prognosis, hesitant to start chemo, but may consider Fri', 'vs. weekend', '- Distended belly, manually removed some maroon stool, got 2 enemas,', 'started Zosyn, KUB showed impaction, planned to get CT abd/pelvis but', 'this was delayed because he has barium in colon so study will not be', 'diagnostic anyway, started IV Reglan for motility']",8559,145304.0
10,2153-04-28 07:19:55,,"['BLOOD CULTURED - At [**2153-4-27**] 10:00 AM', ' BLOOD CULTURED - At [**2153-4-27**] 10:11 AM', ' RADIATION THERAPY - At [**2153-4-27**] 02:14 PM', ' EKG - At [**2153-4-27**] 10:00 PM', ' FEVER - 101.8', 'F - [**2153-4-27**] 10:00 AM', '[**4-27**]', '- Transfused 4 units YESTERDAY, 1 unit platelets, 1 unit cryo', '- Bumped fibrinogen & platelets appropriately, did not bump Hct', '- Creatinine improving with transfusions', '- Free water deficit ~ 5L.  Given 2L D5W, will reassess with AM labs']",,8559,145304.0
11,2153-04-28 18:57:26,"['- Transfused 5 units YESTERDAY, 2 Units overnight, 2 unit platelets, 1', 'unit cryo', '- Bumped fibrinogen & platelets appropriately, and bumped Hct to', 'overnight transfusions']","['BLOOD CULTURED - At [**2153-4-27**] 10:00 AM', ' BLOOD CULTURED - At [**2153-4-27**] 10:11 AM', ' RADIATION THERAPY - At [**2153-4-27**] 02:14 PM', ' EKG - At [**2153-4-27**] 10:00 PM', ' FEVER - 101.8', 'F - [**2153-4-27**] 10:00 AM', '[**4-27**]', '- Transfused 5 units YESTERDAY, 2 Units overnight, 2 unit platelets, 1', 'unit cryo', '- Bumped fibrinogen & platelets appropriately, and bumped Hct to', 'overnight transfusions', '- Creatinine improving with transfusions', '- Free water deficit ~ 5L.  Given 2L D5W, will reassess with AM labs']","['- Transfused 4 units YESTERDAY, 1 unit platelets, 1 unit cryo', '- Bumped fibrinogen & platelets appropriately, did not bump Hct']",8559,145304.0
12,2153-04-29 07:50:03,"['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo']","['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo']","['BLOOD CULTURED - At [**2153-4-27**] 10:00 AM', ' BLOOD CULTURED - At [**2153-4-27**] 10:11 AM', ' RADIATION THERAPY - At [**2153-4-27**] 02:14 PM', ' EKG - At [**2153-4-27**] 10:00 PM', ' FEVER - 101.8', 'F - [**2153-4-27**] 10:00 AM', '[**4-27**]', '- Transfused 5 units YESTERDAY, 2 Units overnight, 2 unit platelets, 1', 'unit cryo', '- Bumped fibrinogen & platelets appropriately, and bumped Hct to', 'overnight transfusions', '- Creatinine improving with transfusions', '- Free water deficit ~ 5L.  Given 2L D5W, will reassess with AM labs']",8559,145304.0
13,2153-04-29 07:51:46,,"['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo']",,8559,145304.0
14,2153-04-29 12:59:04,"['[**4-29**]:', '- required one unit of cryo this am for fibrinogen<100', '- spontaneously converted to sinus']","['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo', '[**4-29**]:', '- required one unit of cryo this am for fibrinogen<100', '- spontaneously converted to sinus']",,8559,145304.0
15,2153-04-29 16:22:29,,"['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo', '[**4-29**]:', '- required one unit of cryo this am for fibrinogen<100', '- spontaneously converted to sinus']",,8559,145304.0
16,2153-04-30 07:25:03,"['MULTI LUMEN - STOP [**2153-4-29**] 11:00 AM', ' PICC LINE - START [**2153-4-29**] 11:00 AM', ' EKG - At [**2153-4-29**] 11:00 AM', ' PICC LINE - STOP [**2153-4-29**] 07:00 PM', ' MIDLINE - START [**2153-4-29**] 07:00 PM', '- No further blood transfusions (except for the two overnight last', 'night)', '- 2 units cryo given for low fibrinogen', '- KUB showed stable dilatation of colon, had continued bowel movements', '- RIJ ""popped out"" while moving him to chair, lots of bleeding (plus', 'the added bonus of a chemo spill)', '- PICC placed, lots of bleeding', '- PICC ""popped out"", lots of bleeding', '- Mid-line placed, still with lots of bleeding, but hopefully okay.', '- Dilt drip stopped, transitioned to PO dilt', '- Still hypernatremic, but given access issues (see above, lots of', 'bleeding), encouraged PO free water; once access sorted out, written', 'for D5W', '- PM hct down to 22 from 26-->giving 2 units prior to morning labs', '- repleting calcium (written for sliding scale based on free calcium)']","['MULTI LUMEN - STOP [**2153-4-29**] 11:00 AM', ' PICC LINE - START [**2153-4-29**] 11:00 AM', ' EKG - At [**2153-4-29**] 11:00 AM', ' PICC LINE - STOP [**2153-4-29**] 07:00 PM', ' MIDLINE - START [**2153-4-29**] 07:00 PM', '- No further blood transfusions (except for the two overnight last', 'night)', '- 2 units cryo given for low fibrinogen', '- KUB showed stable dilatation of colon, had continued bowel movements', '- RIJ ""popped out"" while moving him to chair, lots of bleeding (plus', 'the added bonus of a chemo spill)', '- PICC placed, lots of bleeding', '- PICC ""popped out"", lots of bleeding', '- Mid-line placed, still with lots of bleeding, but hopefully okay.', '- Dilt drip stopped, transitioned to PO dilt', '- Still hypernatremic, but given access issues (see above, lots of', 'bleeding), encouraged PO free water; once access sorted out, written', 'for D5W', '- PM hct down to 22 from 26-->giving 2 units prior to morning labs', '- repleting calcium (written for sliding scale based on free calcium)']","['[**4-28**]', '- Pt went into Afib with RVR  (assymptomatic), failed lopressor IV,', 'eventually bolused and dripped with diltiazem with good control', '- Given 2 U pRBC overnight, did not require transfusions during the', 'day--> blood loss has slowed; also given 2U plts, did not require', 'further cryo', '[**4-29**]:', '- required one unit of cryo this am for fibrinogen<100', '- spontaneously converted to sinus']",8559,145304.0
17,2153-04-30 12:39:22,,"['MULTI LUMEN - STOP [**2153-4-29**] 11:00 AM', ' PICC LINE - START [**2153-4-29**] 11:00 AM', ' EKG - At [**2153-4-29**] 11:00 AM', ' PICC LINE - STOP [**2153-4-29**] 07:00 PM', ' MIDLINE - START [**2153-4-29**] 07:00 PM', '- No further blood transfusions (except for the two overnight last', 'night)', '- 2 units cryo given for low fibrinogen', '- KUB showed stable dilatation of colon, had continued bowel movements', '- RIJ ""popped out"" while moving him to chair, lots of bleeding (plus', 'the added bonus of a chemo spill)', '- PICC placed, lots of bleeding', '- PICC ""popped out"", lots of bleeding', '- Mid-line placed, still with lots of bleeding, but hopefully okay.', '- Dilt drip stopped, transitioned to PO dilt', '- Still hypernatremic, but given access issues (see above, lots of', 'bleeding), encouraged PO free water; once access sorted out, written', 'for D5W', '- PM hct down to 22 from 26-->giving 2 units prior to morning labs', '- repleting calcium (written for sliding scale based on free calcium)']",,8559,145304.0
18,2153-05-01 06:44:03,"['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets']","['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets']","['MULTI LUMEN - STOP [**2153-4-29**] 11:00 AM', ' PICC LINE - START [**2153-4-29**] 11:00 AM', ' EKG - At [**2153-4-29**] 11:00 AM', ' PICC LINE - STOP [**2153-4-29**] 07:00 PM', ' MIDLINE - START [**2153-4-29**] 07:00 PM', '- No further blood transfusions (except for the two overnight last', 'night)', '- 2 units cryo given for low fibrinogen', '- KUB showed stable dilatation of colon, had continued bowel movements', '- RIJ ""popped out"" while moving him to chair, lots of bleeding (plus', 'the added bonus of a chemo spill)', '- PICC placed, lots of bleeding', '- PICC ""popped out"", lots of bleeding', '- Mid-line placed, still with lots of bleeding, but hopefully okay.', '- Dilt drip stopped, transitioned to PO dilt', '- Still hypernatremic, but given access issues (see above, lots of', 'bleeding), encouraged PO free water; once access sorted out, written', 'for D5W', '- PM hct down to 22 from 26-->giving 2 units prior to morning labs', '- repleting calcium (written for sliding scale based on free calcium)']",8559,145304.0
19,2153-05-01 06:45:15,,"['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets']",,8559,145304.0
20,2153-05-01 08:16:39,,"['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets']",,8559,145304.0
21,2153-05-01 19:38:06,['-Post transfusion Hct 23.1'],"['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets', '-Post transfusion Hct 23.1']",,8559,145304.0
22,2153-05-02 06:32:21,"['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']","['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']","['MIDLINE - STOP [**2153-4-30**] 12:00 PM', ' PICC LINE - START [**2153-4-30**] 12:00 PM', ' RADIATION THERAPY - At [**2153-4-30**] 02:00 PM', ' ULTRASOUND - At [**2153-4-30**] 03:00 PM', ""LENI's"", '-PICC placed, TPN started', '- Continued to hold Blood, platelets, coags until midnight, required 2', 'units pRBCs, 1 unit platelets', '-Post transfusion Hct 23.1']",8559,145304.0
23,2153-05-02 06:35:09,,"['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']",,8559,145304.0
24,2153-05-02 07:39:24,"['--> 23.1 but fell back to 18.9 this morning', '- received 1 unit platelets yesterday for platelet 34', '- no cryo required (fibrinogens now >200)']","['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1 but fell back to 18.9 this morning', '- received 1 unit platelets yesterday for platelet 34', '- no cryo required (fibrinogens now >200)', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']",['--> 23.1'],8559,145304.0
25,2153-05-02 15:16:02,,"['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1 but fell back to 18.9 this morning', '- received 1 unit platelets yesterday for platelet 34', '- no cryo required (fibrinogens now >200)', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']",,8559,145304.0
26,2153-05-03 07:31:19,"['- Fibrinogen now normal', '- Advanced diet (but hung TPN because it was already made)', '- No bed on 7-[**Hospital Ward Name 713**] (Not called out)', '- Finished chemotherapy', '- finished 7-day course of Zosyn-->d/ced']","['- Fibrinogen now normal', '- Advanced diet (but hung TPN because it was already made)', '- No bed on 7-[**Hospital Ward Name 713**] (Not called out)', '- Finished chemotherapy', '- finished 7-day course of Zosyn-->d/ced']","['RADIATION THERAPY - At [**2153-5-1**] 12:15 PM', '-Appropriate bump in Hct after blood transfusion yesterday from 18.7', '--> 23.1 but fell back to 18.9 this morning', '- received 1 unit platelets yesterday for platelet 34', '- no cryo required (fibrinogens now >200)', '-2 Units PRBCs ordered this AM for on-going blood loss and recurrent', 'anemia', 'History obtained from Patient']",8559,145304.0
27,2153-05-03 07:36:41,,"['- Fibrinogen now normal', '- Advanced diet (but hung TPN because it was already made)', '- No bed on 7-[**Hospital Ward Name 713**] (Not called out)', '- Finished chemotherapy', '- finished 7-day course of Zosyn-->d/ced']",,8559,145304.0
28,2153-05-03 15:55:09,,"['- Fibrinogen now normal', '- Advanced diet (but hung TPN because it was already made)', '- No bed on 7-[**Hospital Ward Name 713**] (Not called out)', '- Finished chemotherapy', '- finished 7-day course of Zosyn-->d/ced']",,8559,145304.0
0,2153-08-16 11:55:22,,"['- pt had a [** 4137**] ULTRASOUND', ' sludge, no obstruction, no liver pathology', '- FEVER - 101.4', 'F - [**2153-8-15**] 10:00 PM', '- continued vanc/zosyn, added azithromycin for atypical CAP coverage', '- received 1 bag of plts, 2U FFP, 5 PO Vit K, no cryo, no pRBCs', '- onc is following, will do chemo in hospital today']",,8559,105407.0
1,2153-08-17 07:13:46,"['BLOOD CULTURED - At [**2153-8-16**] 09:28 PM', ' FEVER - 101.3', 'F - [**2153-8-16**] 08:00 PM', '[**8-16**]', '-T 101.3 at 8 p.m., blood and urine cx sent', '-KUB normal', '-Hepatitis Panel negative (HAV ab + but IgM -)', '-DIC labs stable']","['BLOOD CULTURED - At [**2153-8-16**] 09:28 PM', ' FEVER - 101.3', 'F - [**2153-8-16**] 08:00 PM', '[**8-16**]', '-T 101.3 at 8 p.m., blood and urine cx sent', '-KUB normal', '-Hepatitis Panel negative (HAV ab + but IgM -)', '-DIC labs stable']","['- pt had a [** 4137**] ULTRASOUND', ' sludge, no obstruction, no liver pathology', '- FEVER - 101.4', 'F - [**2153-8-15**] 10:00 PM', '- continued vanc/zosyn, added azithromycin for atypical CAP coverage', '- received 1 bag of plts, 2U FFP, 5 PO Vit K, no cryo, no pRBCs', '- onc is following, will do chemo in hospital today']",8559,105407.0
2,2153-08-17 13:43:29,,"['BLOOD CULTURED - At [**2153-8-16**] 09:28 PM', ' FEVER - 101.3', 'F - [**2153-8-16**] 08:00 PM', '[**8-16**]', '-T 101.3 at 8 p.m., blood and urine cx sent', '-KUB normal', '-Hepatitis Panel negative (HAV ab + but IgM -)', '-DIC labs stable']",,8559,105407.0
3,2153-08-17 14:38:56,"['-Received FFP x2, Platelets x2, PRBCs x1']","['BLOOD CULTURED - At [**2153-8-16**] 09:28 PM', ' FEVER - 101.3', 'F - [**2153-8-16**] 08:00 PM', '[**8-16**]', '-T 101.3 at 8 p.m., blood and urine cx sent', '-KUB normal', '-Hepatitis Panel negative (HAV ab + but IgM -)', '-DIC labs stable', '-Received FFP x2, Platelets x2, PRBCs x1']",,8559,105407.0
0,2173-04-10 05:30:59,,"['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Weaning vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1..']",,56459,157405.0
1,2173-04-10 05:32:48,,"['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Weaning vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1..']",,56459,157405.0
2,2173-04-10 07:47:26,"['effect. Back on nitro gtt.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']","['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']","['effect.', '- Weaning vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1..']",56459,157405.0
3,2173-04-10 08:16:30,,"['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']",,56459,157405.0
4,2173-04-10 09:04:55,,"['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']",,56459,157405.0
5,2173-04-11 06:46:10,"['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']","['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']","['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']",56459,157405.0
6,2173-04-11 06:47:30,,"['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']",,56459,157405.0
7,2173-04-11 09:00:43,,"['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']",,56459,157405.0
8,2173-04-11 10:38:23,,"['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']",,56459,157405.0
9,2173-04-11 11:02:06,"['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']","['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']","['- Episode of BP 70s/40s on labetalol gtt -> stopped and gave 500cc', 'bolus. Amlodipine held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.']",56459,157405.0
10,2173-04-11 12:32:20,"['- Episode of BP to 250s/100s. Labetalol gtt started, with resultant', 'drop to 70s/40s', '-> gtt stopped and gave 500cc bolus. Amlodipine', 'held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.', '- Pulling Vt of ~500 on PSV 10/8 off sedation this am.']","['- Episode of BP to 250s/100s. Labetalol gtt started, with resultant', 'drop to 70s/40s', '-> gtt stopped and gave 500cc bolus. Amlodipine', 'held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.', '- Pulling Vt of ~500 on PSV 10/8 off sedation this am.']","['SHEATH - STOP [**2173-4-9**] 08:00 AM', ' FEVER - 101.8', 'F - [**2173-4-10**] 12:00 AM', '- Given lasix 100 IV. Repeated lasix 100 IV x 1.', '- Attempted contacting Dr.[**Name (NI) 4601**] office but closed. Wife had 2', 'different lists of meds.', '- Resumed home BB, uptitrated to TID dosing given hypertension. Labile', 'BPs all day. Sedation increased. Given hydral 10 IV x1 with minimal', 'effect. Back on nitro gtt.', '- Spiked temp 100-101.2. Pancultured. CXR in am.', '- A line placed.', '- Unable to wean vent settings.', '- 445 am converted to SVT, given lopressor 5 IV x 1.']",56459,157405.0
11,2173-04-11 13:22:17,,"['- Episode of BP to 250s/100s. Labetalol gtt started, with resultant', 'drop to 70s/40s', '-> gtt stopped and gave 500cc bolus. Amlodipine', 'held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.', '- Pulling Vt of ~500 on PSV 10/8 off sedation this am.']",,56459,157405.0
12,2173-04-12 05:50:40,"['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']","['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']","['- Episode of BP to 250s/100s. Labetalol gtt started, with resultant', 'drop to 70s/40s', '-> gtt stopped and gave 500cc bolus. Amlodipine', 'held. ABG 7.48/28/95. Lact 1.9. ScvO2 76. SmvO2 67.', '- FENa 5.2 and FEurea 38.2 c/w ATN.', '- Hct still slowly dropping.', '- Continued fevers -> blood cx sent.', '- AFib with RVR to 110s-130s in am, self-limited.', '- Started 20 units glargine.', '- Pulling Vt of ~500 on PSV 10/8 off sedation this am.']",56459,157405.0
13,2173-04-12 05:52:54,,"['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']",,56459,157405.0
14,2173-04-12 09:36:53,,"['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']",,56459,157405.0
15,2173-04-12 13:40:05,,"['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']",,56459,157405.0
16,2173-04-13 05:32:27,"['NASAL SWAB - At [**2173-4-13**] 04:00 AM', 'HCT slightly decreased; stable on repeat 23-24, type and screen ordered', 'Continued labetalol drip for now while considering extubation', 'Started TFs; consider hold in am for possible extubation', 'PEEP increased with improved oxygenation, but will need to decrease', 'prior to extubation', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']","['NASAL SWAB - At [**2173-4-13**] 04:00 AM', 'HCT slightly decreased; stable on repeat 23-24, type and screen ordered', 'Continued labetalol drip for now while considering extubation', 'Started TFs; consider hold in am for possible extubation', 'PEEP increased with improved oxygenation, but will need to decrease', 'prior to extubation', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']","['PA CATHETER - STOP [**2173-4-11**] 08:19 PM', '-?mental status, Ct head neg', '-weaning vent', '-got 100mg IV lasix bolus', '-had fever started Vanc/Zosyn for VAP', '-swan d/ced']",56459,157405.0
17,2173-04-13 05:37:21,,"['NASAL SWAB - At [**2173-4-13**] 04:00 AM', 'HCT slightly decreased; stable on repeat 23-24, type and screen ordered', 'Continued labetalol drip for now while considering extubation', 'Started TFs; consider hold in am for possible extubation', 'PEEP increased with improved oxygenation, but will need to decrease', 'prior to extubation', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",,56459,157405.0
18,2173-04-13 05:38:09,,"['NASAL SWAB - At [**2173-4-13**] 04:00 AM', 'HCT slightly decreased; stable on repeat 23-24, type and screen ordered', 'Continued labetalol drip for now while considering extubation', 'Started TFs; consider hold in am for possible extubation', 'PEEP increased with improved oxygenation, but will need to decrease', 'prior to extubation', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",,56459,157405.0
19,2173-04-13 05:48:10,"['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Continued labetalol drip for now while considering extubation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am']","['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Continued labetalol drip for now while considering extubation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']","['NASAL SWAB - At [**2173-4-13**] 04:00 AM', 'HCT slightly decreased; stable on repeat 23-24, type and screen ordered', 'Continued labetalol drip for now while considering extubation', 'Started TFs; consider hold in am for possible extubation', 'PEEP increased with improved oxygenation, but will need to decrease', 'prior to extubation']",56459,157405.0
20,2173-04-13 06:10:43,"['-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation']","['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",['-Continued labetalol drip for now while considering extubation'],56459,157405.0
21,2173-04-13 07:54:25,,"['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",,56459,157405.0
22,2173-04-13 09:57:06,,"['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",,56459,157405.0
23,2173-04-14 08:03:31,,"['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",,56459,157405.0
24,2173-04-14 08:07:28,"['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']","['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']","['-HCT slightly decreased; stable on repeat 23-24, type and screen', 'ordered', '-Off labetalol gtt most of the day with well controlled BPs but BP', 'increased in am [**4-13**] with SBP 170s-180s, increased agitation', '-Started TFs', '-PEEP increased with improved oxygenation so unable to do RSBI this am', 'Bolused with lasix 100 IV, repeat 120 IV', 'Hyperglycemic-> Increased lantus from 20 to 30 units qhs']",56459,157405.0
25,2173-04-14 08:41:24,,"['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']",,56459,157405.0
26,2173-04-15 06:32:26,"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to']","['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to']","['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']",56459,157405.0
27,2173-04-15 06:33:02,,"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to']",,56459,157405.0
28,2173-04-15 06:33:43,,"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to']",,56459,157405.0
29,2173-04-15 07:59:14,,"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to']",,56459,157405.0
30,2173-04-15 10:09:45,"['NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']","['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']",['NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome) will call back tomorrow to'],56459,157405.0
31,2173-04-16 05:35:49,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']",56459,157405.0
32,2173-04-16 05:37:11,,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],,56459,157405.0
33,2173-04-16 08:08:01,,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],,56459,157405.0
34,2173-04-16 11:26:14,"['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']","['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']",['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],56459,157405.0
35,2173-04-16 11:27:27,"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']","['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']","['- Off labetalol gtt since 7pm. NGT placed and taking meds via this.', '- Lantus increased to 40 units.', ""- Meds reconciled via patient's pharmacy."", '- S+S eval ordered.', '- Requiring NRB for most of day. Intermittent desats, improved with', 'suctioning. CXR suggested fluid overload. Got 3 doses of lasix 120mg', 'IV. Due to progressive desats and poor airway protection, reintubated.']",56459,157405.0
36,2173-04-16 12:35:33,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],"['EEG - At [**2173-4-14**] 03:30 PM', ' STOOL CULTURE - At [**2173-4-15**] 02:00 AM', 'CDIff sample', 'Restarted TFs (nutren pulm); consulted nutrition for TF recs', 'Neuro requests EEG', 'NP from Dr.[**Name (NI) 4601**] office (Rebacca Acome):', 'baseline MS normal, no history of anemia or renal failure, never on', 'coumadin at home.', '-had loose stools, sent Cdiff, started flexiseal', '-found to be B12 def, started B12 shots', '-titrated up labetolol', '-continued with lasix drip']",56459,157405.0
37,2173-04-16 13:12:09,,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],,56459,157405.0
38,2173-04-17 05:56:50,"['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps']","['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps']",['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],56459,157405.0
39,2173-04-17 07:51:44,['- Having some hematuria and bloody secretions.'],"['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']",,56459,157405.0
40,2173-04-17 08:52:01,,"['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']",,56459,157405.0
41,2173-04-18 06:13:43,"['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes so reminded nurse and then sodium"", 'improved', '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']","['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes so reminded nurse and then sodium"", 'improved', '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']","['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']",56459,157405.0
42,2173-04-18 06:14:44,,"['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes so reminded nurse and then sodium"", 'improved', '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']",,56459,157405.0
43,2173-04-18 06:15:34,,"['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes so reminded nurse and then sodium"", 'improved', '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']",,56459,157405.0
44,2173-04-18 09:14:28,"[""-wasn't getting water flushes; upon starting flushes, sodium improved""]","['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes; upon starting flushes, sodium improved"", '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']","[""-wasn't getting water flushes so reminded nurse and then sodium"", 'improved']",56459,157405.0
45,2173-04-18 11:51:00,['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],"['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes; upon starting flushes, sodium improved"", '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']",56459,157405.0
46,2173-04-18 11:52:41,"['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']","['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']",['MAGNETIC RESONANCE IMAGING - At [**2173-4-16**] 02:15 AM'],56459,157405.0
47,2173-04-18 11:54:06,"['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes; upon starting flushes, sodium improved"", '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']","['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes; upon starting flushes, sodium improved"", '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']","['- Neuro recs: 40min EEG.', '- Free water flushes increased for elevated Na.', '- Started heparin gtt for PAF.', '- Patient interactive, following commands, having spontaneous resps', '- Having some hematuria and bloody secretions.']",56459,157405.0
48,2173-04-19 05:46:18,"['PICC LINE - START [**2173-4-18**] 01:00 PM', '1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with 120 so ordered 200 IV with metolazone', '5mg with good UOP (200-300cc per hour)', 'Changed free water flushes to 150 q6 to decrease ins', 'Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', 'ABG with improved oxygenation', 'Started coumadin', 'Started imdur', 'Ordered atrovent nebs for wheezes, decreased air movement']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with 120 so ordered 200 IV with metolazone', '5mg with good UOP (200-300cc per hour)', 'Changed free water flushes to 150 q6 to decrease ins', 'Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', 'ABG with improved oxygenation', 'Started coumadin', 'Started imdur', 'Ordered atrovent nebs for wheezes, decreased air movement']","['EEG - At [**2173-4-17**] 12:00 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:15 PM', ' INVASIVE VENTILATION - STOP [**2173-4-17**] 07:15 PM', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2173-4-17**] 07:20 PM', ""-wasn't getting water flushes; upon starting flushes, sodium improved"", '-self extubated and did well, poor cough and upper airways noises', '-uptitrated Lantus to 48 U', '-put in PICC request', '-started D5W for hypernatremia, turned lasix gtt down to 10']",56459,157405.0
49,2173-04-19 05:47:45,['Ordered S/S consult'],"['PICC LINE - START [**2173-4-18**] 01:00 PM', '1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with 120 so ordered 200 IV with metolazone', '5mg with good UOP (200-300cc per hour)', 'Changed free water flushes to 150 q6 to decrease ins', 'Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', 'ABG with improved oxygenation', 'Started coumadin', 'Started imdur', 'Ordered atrovent nebs for wheezes, decreased air movement', 'Ordered S/S consult']",,56459,157405.0
50,2173-04-19 07:59:35,"['Finished abx this am.', 'Pulled NGT this am, replaced.']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with 120 so ordered 200 IV with metolazone', '5mg with good UOP (200-300cc per hour)', 'Changed free water flushes to 150 q6 to decrease ins', 'Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', 'ABG with improved oxygenation', 'Started coumadin', 'Started imdur', 'Ordered atrovent nebs for wheezes, decreased air movement', 'Ordered S/S consult', 'Finished abx this am.', 'Pulled NGT this am, replaced.']",,56459,157405.0
51,2173-04-19 09:22:39,"['- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']","['1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with 120 so ordered 200 IV with metolazone', '5mg with good UOP (200-300cc per hour)', 'Changed free water flushes to 150 q6 to decrease ins', 'Ordered plasma and urine metanephrines and catecholamines to eval for', 'ABG with improved oxygenation', 'Started coumadin', 'Started imdur', 'Ordered atrovent nebs for wheezes, decreased air movement', 'Ordered S/S consult', 'Finished abx this am.', 'Pulled NGT this am, replaced.']",56459,157405.0
52,2173-04-20 06:06:10,"['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']",56459,157405.0
53,2173-04-20 07:49:33,,"['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']",,56459,157405.0
54,2173-04-20 09:14:31,"['PICC LINE - START [**2173-4-18**] 01:00 PM', '- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']",56459,157405.0
55,2173-04-20 10:00:10,"['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['PICC LINE - START [**2173-4-18**] 01:00 PM', '- 1500cc positive around 5pm so ordered Lasix 120IV (trying to keep', 'even). No significant UOP with lasix 120mg IV so ordered 200mg IV lasix', 'with metolazone 5mg with good UOP (200-300cc per hour)', '- Changed free water flushes to 150 q6 to decrease ins', '- Ordered plasma and urine metanephrines and catecholamines to eval for', 'pheo (plasma free normetanephrines positive earlierbut false positives', 'can occur with withdrawal from clonidine)', '- ABG with improved oxygenation', '- Started coumadin', '- Started imdur', '- Ordered atrovent nebs for wheezes, decreased air movement', '- Ordered S/S consult', '- Finished abx this am.', '- Pulled NGT this am, replaced.']",56459,157405.0
56,2173-04-21 06:05:52,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']","['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']",56459,157405.0
57,2173-04-21 06:09:49,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
58,2173-04-21 06:11:02,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
59,2173-04-21 07:58:13,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
60,2173-04-21 09:38:52,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
61,2173-04-21 09:40:23,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
62,2173-04-21 13:01:58,,"['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",,56459,157405.0
63,2173-04-21 17:10:25,"['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']","['URINE CULTURE - At [**2173-4-20**] 11:30 PM', 'UCx /urine lytes, FENA 2.2%', '-holding diureses in setting of worsening renal failure', '-improved BP control despite holding aceI for renal failure', '-NG tube d/ced and patient tolerated PO diet', '-increased lantus to 55U at night, went down to 50U', '-EEG mostly normal']",56459,157405.0
64,2173-04-22 06:18:41,"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal US:  No hydronephrosis/obstruction. Filling defect posterior', 'wall of the bladder. Urology consult/cystoscopy or MRI wthoutc ontrast', 'for futher evaluation.', '-Called urology who recommended urine cytology and will see tomorrow.', '-Ordered hypercoag w/u (prothrombin gene, factor V leiden, anti beta 2', 'glycoprotein, anticardiolipin)']","['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal US:  No hydronephrosis/obstruction. Filling defect posterior', 'wall of the bladder. Urology consult/cystoscopy or MRI wthoutc ontrast', 'for futher evaluation.', '-Called urology who recommended urine cytology and will see tomorrow.', '-Ordered hypercoag w/u (prothrombin gene, factor V leiden, anti beta 2', 'glycoprotein, anticardiolipin)']","['- Swallow eval: regular diet', '- Gave 200mg IV furosemide in pm for 900ml.']",56459,157405.0
65,2173-04-22 06:21:45,['- BP much improved last 12 hours SBPs 110s'],"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal US:  No hydronephrosis/obstruction. Filling defect posterior', 'wall of the bladder. Urology consult/cystoscopy or MRI wthoutc ontrast', 'for futher evaluation.', '-Called urology who recommended urine cytology and will see tomorrow.', '-Ordered hypercoag w/u (prothrombin gene, factor V leiden, anti beta 2', 'glycoprotein, anticardiolipin)', '- BP much improved last 12 hours SBPs 110s']",,56459,157405.0
66,2173-04-22 06:35:41,,"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal US:  No hydronephrosis/obstruction. Filling defect posterior', 'wall of the bladder. Urology consult/cystoscopy or MRI wthoutc ontrast', 'for futher evaluation.', '-Called urology who recommended urine cytology and will see tomorrow.', '-Ordered hypercoag w/u (prothrombin gene, factor V leiden, anti beta 2', 'glycoprotein, anticardiolipin)', '- BP much improved last 12 hours SBPs 110s']",,56459,157405.0
67,2173-04-22 08:00:01,['-Renal U'],"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal U']","['-Renal US:  No hydronephrosis/obstruction. Filling defect posterior', 'wall of the bladder. Urology consult/cystoscopy or MRI wthoutc ontrast', 'for futher evaluation.', '-Called urology who recommended urine cytology and will see tomorrow.', '-Ordered hypercoag w/u (prothrombin gene, factor V leiden, anti beta 2', 'glycoprotein, anticardiolipin)', '- BP much improved last 12 hours SBPs 110s']",56459,157405.0
68,2173-04-22 09:44:40,,"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal U']",,56459,157405.0
69,2173-04-22 09:50:35,,"['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal U']",,56459,157405.0
70,2173-04-23 06:10:16,"['- Renal recs: Start sevelamer, hydrate. C3, C4 normal.', '- Urology: Irrigate q4h for clots (can increase to 22F foley if', 'obstructing), re-US bladder once clear (clamp foley for 2hrs prior to', 'procedure). Ucytology sent. F/u with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3410**] for cystoscopy.', '- Transfused 1 unit RBCs with hct 25 -> 28.', '- Imdur stopped for SBP down to 80s.', '- Repeat urine and serum metanephrines: mildly positive.', ""- Hypercoagulable workup shouldn't be done inpatient per path"", '(expensive, takes a long time)']","['- Renal recs: Start sevelamer, hydrate. C3, C4 normal.', '- Urology: Irrigate q4h for clots (can increase to 22F foley if', 'obstructing), re-US bladder once clear (clamp foley for 2hrs prior to', 'procedure). Ucytology sent. F/u with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3410**] for cystoscopy.', '- Transfused 1 unit RBCs with hct 25 -> 28.', '- Imdur stopped for SBP down to 80s.', '- Repeat urine and serum metanephrines: mildly positive.', ""- Hypercoagulable workup shouldn't be done inpatient per path"", '(expensive, takes a long time)']","['ARTERIAL LINE - STOP [**2173-4-21**] 06:03 PM', '-Renal consulted:No note in chart yet but recommended encourage fluids', 'and PO intake, no diuresis. Reviewed sediment which showed hyaline', 'casts and [**4-7**] WBC per HPF. Recommended repeating urine eos, urine', 'protein/cr ratio, check C3, c4, check FEurea (12.9%)', '-Renal U']",56459,157405.0
71,2173-04-23 09:28:21,,"['- Renal recs: Start sevelamer, hydrate. C3, C4 normal.', '- Urology: Irrigate q4h for clots (can increase to 22F foley if', 'obstructing), re-US bladder once clear (clamp foley for 2hrs prior to', 'procedure). Ucytology sent. F/u with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3410**] for cystoscopy.', '- Transfused 1 unit RBCs with hct 25 -> 28.', '- Imdur stopped for SBP down to 80s.', '- Repeat urine and serum metanephrines: mildly positive.', ""- Hypercoagulable workup shouldn't be done inpatient per path"", '(expensive, takes a long time)']",,56459,157405.0
0,2200-04-07 08:00:13,,"['- Intubated for respiratory distress', '- Tachycardic to 180 --> Diltiazem 10mg IV x2 administered with', 'response', '- Pressors (vasopressin, norepinephrine, phenylephrine) added for SBP', '70s', '- Hydrocortisone 100 mg IV Q8H started for hypotension', '- IVF: NS, then 150meq bicarb + D5W to avoid hyperchloremic metabolic', 'acidosis', '- Bedside echo: RV enlarged, with ?WMA; EKG S1Q3T3 --> concern for PE', '- CTA: No PE, extensive mucus plugging, atelectasis', '- Femoral temporary HD line placed to prepare for CVVH', '- Norepinephrine now weaning']",,28178,132598.0
1,2200-04-07 11:08:10,,"['- Intubated for respiratory distress', '- Tachycardic to 180 --> Diltiazem 10mg IV x2 administered with', 'response', '- Pressors (vasopressin, norepinephrine, phenylephrine) added for SBP', '70s', '- Hydrocortisone 100 mg IV Q8H started for hypotension', '- IVF: NS, then 150meq bicarb + D5W to avoid hyperchloremic metabolic', 'acidosis', '- Bedside echo: RV enlarged, with ?WMA; EKG S1Q3T3 --> concern for PE', '- CTA: No PE, extensive mucus plugging, atelectasis', '- Femoral temporary HD line placed to prepare for CVVH', '- Norepinephrine now weaning']",,28178,132598.0
2,2200-04-08 07:27:13,"['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']","['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']","['- Intubated for respiratory distress', '- Tachycardic to 180 --> Diltiazem 10mg IV x2 administered with', 'response', '- Pressors (vasopressin, norepinephrine, phenylephrine) added for SBP', '70s', '- Hydrocortisone 100 mg IV Q8H started for hypotension', '- IVF: NS, then 150meq bicarb + D5W to avoid hyperchloremic metabolic', 'acidosis', '- Bedside echo: RV enlarged, with ?WMA; EKG S1Q3T3 --> concern for PE', '- CTA: No PE, extensive mucus plugging, atelectasis', '- Femoral temporary HD line placed to prepare for CVVH', '- Norepinephrine now weaning']",28178,132598.0
3,2200-04-08 15:45:08,,"['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']",,28178,132598.0
4,2200-04-08 17:40:11,,"['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']",,28178,132598.0
5,2200-04-08 17:41:52,,"['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']",,28178,132598.0
6,2200-04-09 06:39:19,"['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**])', '- FiO2 reduced to 40% (from 50%) --> ABG: 7.29/43/87', '- PEEP down to 8 (from 10) --> ABG: 7.37/38/90/23 --> ABG: 7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']","['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**])', '- FiO2 reduced to 40% (from 50%) --> ABG: 7.29/43/87', '- PEEP down to 8 (from 10) --> ABG: 7.37/38/90/23 --> ABG: 7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']","['ULTRASOUND - At [**2200-4-7**] 11:00 AM', 'Bedside echocardiogram', 'esophageal balloon - pressure -6mmHg', 'bladder pressure 10mmHg', 'weaning norepi', 'CVVH running', 'change vent fi02 50%, peep 10', 'tamiflu dose changed to daily w/ renal dosing', 'melanotic--then maroon bloody stools', '- lactate stable', '- KUB unchanged', '- hct stable', '- iNR elevated: ffp x 2 given, PPI IV, sub Q vitk']",28178,132598.0
7,2200-04-09 06:45:43,,"['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**])', '- FiO2 reduced to 40% (from 50%) --> ABG: 7.29/43/87', '- PEEP down to 8 (from 10) --> ABG: 7.37/38/90/23 --> ABG: 7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']",,28178,132598.0
8,2200-04-09 16:38:19,"['it does not account for HD; pt is approx 2L negative for [**4-8**] **', '- FiO2 reduced to 40% (from 50%) --> PEEP down to 8 (from 10) --> ABG:', '7.39/40/75']","['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**] **', '- FiO2 reduced to 40% (from 50%) --> PEEP down to 8 (from 10) --> ABG:', '7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']","['it does not account for HD; pt is approx 2L negative for [**4-8**])', '- FiO2 reduced to 40% (from 50%) --> ABG: 7.29/43/87', '- PEEP down to 8 (from 10) --> ABG: 7.37/38/90/23 --> ABG: 7.39/40/75']",28178,132598.0
9,2200-04-09 16:56:40,,"['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**] **', '- FiO2 reduced to 40% (from 50%) --> PEEP down to 8 (from 10) --> ABG:', '7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']",,28178,132598.0
10,2200-04-09 17:22:05,,"['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**] **', '- FiO2 reduced to 40% (from 50%) --> PEEP down to 8 (from 10) --> ABG:', '7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']",,28178,132598.0
11,2200-04-10 07:21:53,"['- Clarified with renal why we want to remove more fluid', '- Vancomycin dosing by level: Received one dose [**4-9**]', '- AFib/RVR: 140s, amiodarone 150mg IV x1, amio PO', '- Pressors: Both pressors off less than one hour, then phenylephrine', 'on; vasopressin completely off', '- Vent mgt: Did well on PS trial.  Turned off sedation.  pO2 went to', '65, and therefore FiO2 turned to 50%.  RSBI 96 on PS [**5-15**].']","['- Clarified with renal why we want to remove more fluid', '- Vancomycin dosing by level: Received one dose [**4-9**]', '- AFib/RVR: 140s, amiodarone 150mg IV x1, amio PO', '- Pressors: Both pressors off less than one hour, then phenylephrine', 'on; vasopressin completely off', '- Vent mgt: Did well on PS trial.  Turned off sedation.  pO2 went to', '65, and therefore FiO2 turned to 50%.  RSBI 96 on PS [**5-15**].']","['** Please note that fluid output is listed incorrectly in flowsheet as', 'it does not account for HD; pt is approx 2L negative for [**4-8**] **', '- FiO2 reduced to 40% (from 50%) --> PEEP down to 8 (from 10) --> ABG:', '7.39/40/75', '- Pressor support: Off norepinephrine, phenylephrine weaned down to', '1.5, remains on vasopressin', ""- Metronidazole, steriods d/c'd"", '- CVVH output increased from 75cc/hr to +100cc/hr in the AM, around', '11pm back to 75cc/hr', '- Surgery consult --> not a surgical candidate', '- Per pharm, amiodarone can be discontinued after loading, and start PO', 'when tolerating PO. No need for IV boluses given very long half life.']",28178,132598.0
12,2200-04-10 15:36:05,,"['- Clarified with renal why we want to remove more fluid', '- Vancomycin dosing by level: Received one dose [**4-9**]', '- AFib/RVR: 140s, amiodarone 150mg IV x1, amio PO', '- Pressors: Both pressors off less than one hour, then phenylephrine', 'on; vasopressin completely off', '- Vent mgt: Did well on PS trial.  Turned off sedation.  pO2 went to', '65, and therefore FiO2 turned to 50%.  RSBI 96 on PS [**5-15**].']",,28178,132598.0
13,2200-04-11 06:32:37,"['HIT score 1, so no hit antibody sent, heparin kept on', 'increased tachy, tachypneic: 7.337/43/63', 'aprv maneuver to recruit alveoli', 'switched to a/c to help figure out if decompensation was resp or', 'cardiac or other ?', 'for HR, w/ progressive ST depressions, added esmolol for better', 'control, was little low BP w/ 50, so switched to 25.', ""hypotensive....250 cc NS bolus x 3.  amio gtts d/c'd. esmolol d/c'd"", 'next.', 'increased abd distention, kub w/ increased colonic dilation.  surgery', 'called, rectal tube placed and left open to equilibrate w/ atmospheric', 'pressure']","['HIT score 1, so no hit antibody sent, heparin kept on', 'increased tachy, tachypneic: 7.337/43/63', 'aprv maneuver to recruit alveoli', 'switched to a/c to help figure out if decompensation was resp or', 'cardiac or other ?', 'for HR, w/ progressive ST depressions, added esmolol for better', 'control, was little low BP w/ 50, so switched to 25.', ""hypotensive....250 cc NS bolus x 3.  amio gtts d/c'd. esmolol d/c'd"", 'next.', 'increased abd distention, kub w/ increased colonic dilation.  surgery', 'called, rectal tube placed and left open to equilibrate w/ atmospheric', 'pressure']","['- Clarified with renal why we want to remove more fluid', '- Vancomycin dosing by level: Received one dose [**4-9**]', '- AFib/RVR: 140s, amiodarone 150mg IV x1, amio PO', '- Pressors: Both pressors off less than one hour, then phenylephrine', 'on; vasopressin completely off', '- Vent mgt: Did well on PS trial.  Turned off sedation.  pO2 went to', '65, and therefore FiO2 turned to 50%.  RSBI 96 on PS [**5-15**].']",28178,132598.0
14,2200-04-11 06:36:00,,"['HIT score 1, so no hit antibody sent, heparin kept on', 'increased tachy, tachypneic: 7.337/43/63', 'aprv maneuver to recruit alveoli', 'switched to a/c to help figure out if decompensation was resp or', 'cardiac or other ?', 'for HR, w/ progressive ST depressions, added esmolol for better', 'control, was little low BP w/ 50, so switched to 25.', ""hypotensive....250 cc NS bolus x 3.  amio gtts d/c'd. esmolol d/c'd"", 'next.', 'increased abd distention, kub w/ increased colonic dilation.  surgery', 'called, rectal tube placed and left open to equilibrate w/ atmospheric', 'pressure']",,28178,132598.0
15,2200-04-11 11:26:26,"['HIT score 1, so no hit antibody sent, heparin kept on -> for YESTERDAY', 'pressure.  No change w/ KUB, removed this AM.']","['HIT score 1, so no hit antibody sent, heparin kept on -> for YESTERDAY', 'increased tachy, tachypneic: 7.337/43/63', 'aprv maneuver to recruit alveoli', 'switched to a/c to help figure out if decompensation was resp or', 'cardiac or other ?', 'for HR, w/ progressive ST depressions, added esmolol for better', 'control, was little low BP w/ 50, so switched to 25.', ""hypotensive....250 cc NS bolus x 3.  amio gtts d/c'd. esmolol d/c'd"", 'next.', 'increased abd distention, kub w/ increased colonic dilation.  surgery', 'called, rectal tube placed and left open to equilibrate w/ atmospheric', 'pressure.  No change w/ KUB, removed this AM.']","['HIT score 1, so no hit antibody sent, heparin kept on', 'pressure']",28178,132598.0
16,2200-04-12 06:14:48,"['- Metoprolol 25 TID, got 5mg IV PRN', '- RIJ is heparin coated, HD line is NOT.', '- IV nurse could not get IV line, IR would not do it because of', 'emergent case. will optimize medications in terms of thromboyctopenia,', 'and possible place new central line tomorrow with heparin free line.', '- EKG shows persistent but improving ST depressions in V2 v3 V4.', '- discontinued antibiotics- vanco and cefepime, s/p 6 day courses.', '- unable to extubate because heart rate not adequately controlled']","['- Metoprolol 25 TID, got 5mg IV PRN', '- RIJ is heparin coated, HD line is NOT.', '- IV nurse could not get IV line, IR would not do it because of', 'emergent case. will optimize medications in terms of thromboyctopenia,', 'and possible place new central line tomorrow with heparin free line.', '- EKG shows persistent but improving ST depressions in V2 v3 V4.', '- discontinued antibiotics- vanco and cefepime, s/p 6 day courses.', '- unable to extubate because heart rate not adequately controlled']","['HIT score 1, so no hit antibody sent, heparin kept on -> for YESTERDAY', 'increased tachy, tachypneic: 7.337/43/63', 'aprv maneuver to recruit alveoli', 'switched to a/c to help figure out if decompensation was resp or', 'cardiac or other ?', 'for HR, w/ progressive ST depressions, added esmolol for better', 'control, was little low BP w/ 50, so switched to 25.', ""hypotensive....250 cc NS bolus x 3.  amio gtts d/c'd. esmolol d/c'd"", 'next.', 'increased abd distention, kub w/ increased colonic dilation.  surgery', 'called, rectal tube placed and left open to equilibrate w/ atmospheric', 'pressure.  No change w/ KUB, removed this AM.']",28178,132598.0
17,2200-04-12 11:30:27,,"['- Metoprolol 25 TID, got 5mg IV PRN', '- RIJ is heparin coated, HD line is NOT.', '- IV nurse could not get IV line, IR would not do it because of', 'emergent case. will optimize medications in terms of thromboyctopenia,', 'and possible place new central line tomorrow with heparin free line.', '- EKG shows persistent but improving ST depressions in V2 v3 V4.', '- discontinued antibiotics- vanco and cefepime, s/p 6 day courses.', '- unable to extubate because heart rate not adequately controlled']",,28178,132598.0
18,2200-04-13 07:22:08,"['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Holding on CVVH today, as well-dialyzed.', '- Depressed but hold on antidepressants given h/o hallucinations', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']","['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Holding on CVVH today, as well-dialyzed.', '- Depressed but hold on antidepressants given h/o hallucinations', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']","['- Metoprolol 25 TID, got 5mg IV PRN', '- RIJ is heparin coated, HD line is NOT.', '- IV nurse could not get IV line, IR would not do it because of', 'emergent case. will optimize medications in terms of thromboyctopenia,', 'and possible place new central line tomorrow with heparin free line.', '- EKG shows persistent but improving ST depressions in V2 v3 V4.', '- discontinued antibiotics- vanco and cefepime, s/p 6 day courses.', '- unable to extubate because heart rate not adequately controlled']",28178,132598.0
19,2200-04-13 07:24:47,,"['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Holding on CVVH today, as well-dialyzed.', '- Depressed but hold on antidepressants given h/o hallucinations', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']",,28178,132598.0
20,2200-04-13 07:34:53,,"['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Holding on CVVH today, as well-dialyzed.', '- Depressed but hold on antidepressants given h/o hallucinations', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']",,28178,132598.0
21,2200-04-13 11:52:43,['- Renal: Held CVVH yesterday.  Orders still active.'],"['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Held CVVH yesterday.  Orders still active.', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']","['- Renal: Holding on CVVH today, as well-dialyzed.', '- Depressed but hold on antidepressants given h/o hallucinations']",28178,132598.0
22,2200-04-13 13:40:46,,"['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Held CVVH yesterday.  Orders still active.', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters']",,28178,132598.0
23,2200-04-13 14:34:15,"['Cefepime', ' zosyn for increased abdominal coverage.', 'Code changed to FULL']","['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Held CVVH yesterday.  Orders still active.', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters', 'Cefepime', ' zosyn for increased abdominal coverage.', 'Code changed to FULL']",,28178,132598.0
24,2200-04-14 06:56:24,"['EKG - At [**2200-4-13**] 06:41 PM', ""-IV metop d/c'd"", '-Started po metoprolol w/ ngtube (cant take POs reliably)', '-Cvvh restarted for volume optimization.  goal -500 mL', '-Still flu DFA A + but no evidence to continue therapy', '-Hypotension with w/ cvvh overnight, MAPs low 50s as cvvh clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  albumin 25 g x 1.', 'CVVH held for now.']","['EKG - At [**2200-4-13**] 06:41 PM', ""-IV metop d/c'd"", '-Started po metoprolol w/ ngtube (cant take POs reliably)', '-Cvvh restarted for volume optimization.  goal -500 mL', '-Still flu DFA A + but no evidence to continue therapy', '-Hypotension with w/ cvvh overnight, MAPs low 50s as cvvh clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  albumin 25 g x 1.', 'CVVH held for now.']","['BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' BLOOD CULTURED - At [**2200-4-12**] 11:33 AM', ' EKG - At [**2200-4-12**] 11:33 AM', ' INVASIVE VENTILATION - STOP [**2200-4-12**] 06:40 PM', '-------------------------', '- Renal: Held CVVH yesterday.  Orders still active.', '- Extubated', '- HR: Using metoprolol 2.5 mg IV Q8H with no success in controlling', 'tachycardia to 110s.  Increased standing metoprolol to 5mg IV Q8H with', 'holding parameters', 'Cefepime', ' zosyn for increased abdominal coverage.', 'Code changed to FULL']",28178,132598.0
25,2200-04-14 15:46:07,"['-CVVH restarted for volume optimization.', '-Hypotension with w/ CVVH overnight, MAPs low 50s as CVVH clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  Albumin 25 g x 1 with', 'mild improvement.  CVVH held for now.']","['EKG - At [**2200-4-13**] 06:41 PM', ""-IV metop d/c'd"", '-Started po metoprolol w/ ngtube (cant take POs reliably)', '-CVVH restarted for volume optimization.', '-Still flu DFA A + but no evidence to continue therapy', '-Hypotension with w/ CVVH overnight, MAPs low 50s as CVVH clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  Albumin 25 g x 1 with', 'mild improvement.  CVVH held for now.']","['-Cvvh restarted for volume optimization.  goal -500 mL', '-Hypotension with w/ cvvh overnight, MAPs low 50s as cvvh clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  albumin 25 g x 1.', 'CVVH held for now.']",28178,132598.0
26,2200-04-14 16:01:02,['- On 50%FM'],"[""-IV metop d/c'd"", '-Started po metoprolol w/ ngtube (cant take POs reliably)', '-CVVH restarted for volume optimization.', '-Still flu DFA A + but no evidence to continue therapy', '-Hypotension with w/ CVVH overnight, MAPs low 50s as CVVH clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  Albumin 25 g x 1 with', 'mild improvement.  CVVH held for now.', '- On 50%FM']",['EKG - At [**2200-4-13**] 06:41 PM'],28178,132598.0
27,2200-04-15 07:18:22,"['-Restarted on CVVH', '- Decreased MAP late in the evening (55), CVVH slowed and neo gtt', 'initiated to maintain MAP >60, now at goal', '- Tolerating TF, discontinued TPN given fluid status']","['-Restarted on CVVH', '- Decreased MAP late in the evening (55), CVVH slowed and neo gtt', 'initiated to maintain MAP >60, now at goal', '- Tolerating TF, discontinued TPN given fluid status']","[""-IV metop d/c'd"", '-Started po metoprolol w/ ngtube (cant take POs reliably)', '-CVVH restarted for volume optimization.', '-Still flu DFA A + but no evidence to continue therapy', '-Hypotension with w/ CVVH overnight, MAPs low 50s as CVVH clotted.  ?', '80-150 cc blood lost in machine. 250 cc NS x 2.  Albumin 25 g x 1 with', 'mild improvement.  CVVH held for now.', '- On 50%FM']",28178,132598.0
28,2200-04-15 15:00:38,"['- Bedside swallowing eval -> NPO with tubefeeds via NGT, will re-eval', 'later in the week']","['-Restarted on CVVH', '- Decreased MAP late in the evening (55), CVVH slowed and neo gtt', 'initiated to maintain MAP >60, now at goal', '- Tolerating TF, discontinued TPN given fluid status', '- Bedside swallowing eval -> NPO with tubefeeds via NGT, will re-eval', 'later in the week']",,28178,132598.0
29,2200-04-15 15:15:18,,"['-Restarted on CVVH', '- Decreased MAP late in the evening (55), CVVH slowed and neo gtt', 'initiated to maintain MAP >60, now at goal', '- Tolerating TF, discontinued TPN given fluid status', '- Bedside swallowing eval -> NPO with tubefeeds via NGT, will re-eval', 'later in the week']",,28178,132598.0
30,2200-04-16 06:51:04,"['-Femoral line removed (off CVVH), tip sent for culture', '-repeat blood/mycolytic and sputum cultures, sputum sample cancelled', 'for OP flora.', '-repeat code discussion (PTROY), still FULL code', '-renal recs, if off pressors tomorrow will try HD via LUE AVF tomorrow,', 'decrease zosyn to 2.25gIV Q6, redose vanc 1g if level <15']","['-Femoral line removed (off CVVH), tip sent for culture', '-repeat blood/mycolytic and sputum cultures, sputum sample cancelled', 'for OP flora.', '-repeat code discussion (PTROY), still FULL code', '-renal recs, if off pressors tomorrow will try HD via LUE AVF tomorrow,', 'decrease zosyn to 2.25gIV Q6, redose vanc 1g if level <15']","['-Restarted on CVVH', '- Decreased MAP late in the evening (55), CVVH slowed and neo gtt', 'initiated to maintain MAP >60, now at goal', '- Tolerating TF, discontinued TPN given fluid status', '- Bedside swallowing eval -> NPO with tubefeeds via NGT, will re-eval', 'later in the week']",28178,132598.0
31,2200-04-16 08:04:17,,"['-Femoral line removed (off CVVH), tip sent for culture', '-repeat blood/mycolytic and sputum cultures, sputum sample cancelled', 'for OP flora.', '-repeat code discussion (PTROY), still FULL code', '-renal recs, if off pressors tomorrow will try HD via LUE AVF tomorrow,', 'decrease zosyn to 2.25gIV Q6, redose vanc 1g if level <15']",,28178,132598.0
32,2200-04-16 17:20:43,"['-repeat code discussion (PTROY), still FULL code over the day yesterday', '- TTE, awaiting final read', '- Cipro added for double pseudomonal coverage']","['-Femoral line removed (off CVVH), tip sent for culture', '-repeat blood/mycolytic and sputum cultures, sputum sample cancelled', 'for OP flora.', '-repeat code discussion (PTROY), still FULL code over the day yesterday', '-renal recs, if off pressors tomorrow will try HD via LUE AVF tomorrow,', 'decrease zosyn to 2.25gIV Q6, redose vanc 1g if level <15', '- TTE, awaiting final read', '- Cipro added for double pseudomonal coverage']","['-repeat code discussion (PTROY), still FULL code']",28178,132598.0
33,2200-04-17 07:26:59,"['- Made DNR/DNI yesterday', '- Family in overnight, will discuss dc of pressors today']","['- Made DNR/DNI yesterday', '- Family in overnight, will discuss dc of pressors today']","['-Femoral line removed (off CVVH), tip sent for culture', '-repeat blood/mycolytic and sputum cultures, sputum sample cancelled', 'for OP flora.', '-repeat code discussion (PTROY), still FULL code over the day yesterday', '-renal recs, if off pressors tomorrow will try HD via LUE AVF tomorrow,', 'decrease zosyn to 2.25gIV Q6, redose vanc 1g if level <15', '- TTE, awaiting final read', '- Cipro added for double pseudomonal coverage']",28178,132598.0
34,2200-04-17 07:29:15,,"['- Made DNR/DNI yesterday', '- Family in overnight, will discuss dc of pressors today']",,28178,132598.0
35,2200-04-17 11:02:17,,"['- Made DNR/DNI yesterday', '- Family in overnight, will discuss dc of pressors today']",,28178,132598.0
0,2101-06-07 07:24:44,,"['- Remained in afib overnight but HR better controlled after bolus dose', 'of diltiazem', '- Bcx growing out GPC in pairs and clusters in 4 of 4 bottles.']",,43122,168271.0
1,2101-06-07 10:58:17,,"['- Remained in afib overnight but HR better controlled after bolus dose', 'of diltiazem', '- Bcx growing out GPC in pairs and clusters in 4 of 4 bottles.']",,43122,168271.0
2,2101-06-08 06:18:03,"['TRANSTHORACIC ECHO - At [**2101-6-7**] 09:30 AM', ' STOOL CULTURE - At [**2101-6-7**] 10:00 AM', '[**6-7**]', '- Continued to require Pressors so A-line attempted.', '- Multiple attempts, but unable to get a-line.', '- ID recommended 1) continuing Zosyn. 2) TTE. 3) MR spine if', 'unrevealing. 4) Consider Para/[**Female First Name (un) 217**] if above unrevealing.', '- ECHO IMPRESSION: Normal systolic function (EF 65%). Moderate-severe', 'tricuspid regurgitation. Mild aortic stenosis. Moderate mitral', 'regurgitation. Moderate pulmonary hypertension.']","['TRANSTHORACIC ECHO - At [**2101-6-7**] 09:30 AM', ' STOOL CULTURE - At [**2101-6-7**] 10:00 AM', '[**6-7**]', '- Continued to require Pressors so A-line attempted.', '- Multiple attempts, but unable to get a-line.', '- ID recommended 1) continuing Zosyn. 2) TTE. 3) MR spine if', 'unrevealing. 4) Consider Para/[**Female First Name (un) 217**] if above unrevealing.', '- ECHO IMPRESSION: Normal systolic function (EF 65%). Moderate-severe', 'tricuspid regurgitation. Mild aortic stenosis. Moderate mitral', 'regurgitation. Moderate pulmonary hypertension.']","['- Remained in afib overnight but HR better controlled after bolus dose', 'of diltiazem', '- Bcx growing out GPC in pairs and clusters in 4 of 4 bottles.']",43122,168271.0
3,2101-06-08 06:18:54,,"['TRANSTHORACIC ECHO - At [**2101-6-7**] 09:30 AM', ' STOOL CULTURE - At [**2101-6-7**] 10:00 AM', '[**6-7**]', '- Continued to require Pressors so A-line attempted.', '- Multiple attempts, but unable to get a-line.', '- ID recommended 1) continuing Zosyn. 2) TTE. 3) MR spine if', 'unrevealing. 4) Consider Para/[**Female First Name (un) 217**] if above unrevealing.', '- ECHO IMPRESSION: Normal systolic function (EF 65%). Moderate-severe', 'tricuspid regurgitation. Mild aortic stenosis. Moderate mitral', 'regurgitation. Moderate pulmonary hypertension.']",,43122,168271.0
4,2101-06-08 06:19:38,,"['TRANSTHORACIC ECHO - At [**2101-6-7**] 09:30 AM', ' STOOL CULTURE - At [**2101-6-7**] 10:00 AM', '[**6-7**]', '- Continued to require Pressors so A-line attempted.', '- Multiple attempts, but unable to get a-line.', '- ID recommended 1) continuing Zosyn. 2) TTE. 3) MR spine if', 'unrevealing. 4) Consider Para/[**Female First Name (un) 217**] if above unrevealing.', '- ECHO IMPRESSION: Normal systolic function (EF 65%). Moderate-severe', 'tricuspid regurgitation. Mild aortic stenosis. Moderate mitral', 'regurgitation. Moderate pulmonary hypertension.']",,43122,168271.0
5,2101-06-08 08:06:56,"['- Seen by ID for bcx growing coag positive staph. Thought endocarditis', 'was concerning source. Enterococcus UTI may represent spill-over from', 'bacteremia. Vegetation not seen on TTE. Also spine infection, empyema.', 'Lower on differential would be likely line source, peritonitis. Also', 'concern for influenza.', '- Received metoprolol 5mg IV x 1 for afib with RVR with response in HR', 'but drop in BP. Continued to require pressors.  A-line planned but', 'placement unsuccessful despite multiple attempts.']","['- Seen by ID for bcx growing coag positive staph. Thought endocarditis', 'was concerning source. Enterococcus UTI may represent spill-over from', 'bacteremia. Vegetation not seen on TTE. Also spine infection, empyema.', 'Lower on differential would be likely line source, peritonitis. Also', 'concern for influenza.', '- Received metoprolol 5mg IV x 1 for afib with RVR with response in HR', 'but drop in BP. Continued to require pressors.  A-line planned but', 'placement unsuccessful despite multiple attempts.']","['TRANSTHORACIC ECHO - At [**2101-6-7**] 09:30 AM', ' STOOL CULTURE - At [**2101-6-7**] 10:00 AM', '[**6-7**]', '- Continued to require Pressors so A-line attempted.', '- Multiple attempts, but unable to get a-line.', '- ID recommended 1) continuing Zosyn. 2) TTE. 3) MR spine if', 'unrevealing. 4) Consider Para/[**Female First Name (un) 217**] if above unrevealing.', '- ECHO IMPRESSION: Normal systolic function (EF 65%). Moderate-severe', 'tricuspid regurgitation. Mild aortic stenosis. Moderate mitral', 'regurgitation. Moderate pulmonary hypertension.']",43122,168271.0
6,2101-06-08 08:23:53,,"['- Seen by ID for bcx growing coag positive staph. Thought endocarditis', 'was concerning source. Enterococcus UTI may represent spill-over from', 'bacteremia. Vegetation not seen on TTE. Also spine infection, empyema.', 'Lower on differential would be likely line source, peritonitis. Also', 'concern for influenza.', '- Received metoprolol 5mg IV x 1 for afib with RVR with response in HR', 'but drop in BP. Continued to require pressors.  A-line planned but', 'placement unsuccessful despite multiple attempts.']",,43122,168271.0
7,2101-06-08 11:11:42,,"['- Seen by ID for bcx growing coag positive staph. Thought endocarditis', 'was concerning source. Enterococcus UTI may represent spill-over from', 'bacteremia. Vegetation not seen on TTE. Also spine infection, empyema.', 'Lower on differential would be likely line source, peritonitis. Also', 'concern for influenza.', '- Received metoprolol 5mg IV x 1 for afib with RVR with response in HR', 'but drop in BP. Continued to require pressors.  A-line planned but', 'placement unsuccessful despite multiple attempts.']",,43122,168271.0
8,2101-06-09 04:40:03,"['- Blood cultures grew MRSA', '- Urine cultures grew VRE->changed vanc to linezolid', '- Went to MRI spine for ?abscess->Wet read: No epidural abscess.', 'Multilevel degenerative changes in the lumbar spine most', 'pronounced at L4-5 level with severe multifactorial spinal canal', 'stenosis.', '- Hct to 24. Sent guaiac and hapto/TBili (pending)', '- O2 weaned to 1L NC during day then back to 3L NC overnight', '- HRs into 120s with BPs 120s/70s. Gave 5mg lopressor with good effect', '- DFA was inadequate sample so re-sent']","['- Blood cultures grew MRSA', '- Urine cultures grew VRE->changed vanc to linezolid', '- Went to MRI spine for ?abscess->Wet read: No epidural abscess.', 'Multilevel degenerative changes in the lumbar spine most', 'pronounced at L4-5 level with severe multifactorial spinal canal', 'stenosis.', '- Hct to 24. Sent guaiac and hapto/TBili (pending)', '- O2 weaned to 1L NC during day then back to 3L NC overnight', '- HRs into 120s with BPs 120s/70s. Gave 5mg lopressor with good effect', '- DFA was inadequate sample so re-sent']","['- Seen by ID for bcx growing coag positive staph. Thought endocarditis', 'was concerning source. Enterococcus UTI may represent spill-over from', 'bacteremia. Vegetation not seen on TTE. Also spine infection, empyema.', 'Lower on differential would be likely line source, peritonitis. Also', 'concern for influenza.', '- Received metoprolol 5mg IV x 1 for afib with RVR with response in HR', 'but drop in BP. Continued to require pressors.  A-line planned but', 'placement unsuccessful despite multiple attempts.']",43122,168271.0
9,2101-06-09 07:32:39,"['- HRs into 120s with BPs 120s/70s. Tried fluid bolus with no change.', 'Gave 5mg lopressor with good effect->HRs to 80s-90s and BPs stable.', '- Weaned off pressors in am and remained off all day.']","['- Blood cultures grew MRSA', '- Urine cultures grew VRE->changed vanc to linezolid', '- Went to MRI spine for ?abscess->Wet read: No epidural abscess.', 'Multilevel degenerative changes in the lumbar spine most', 'pronounced at L4-5 level with severe multifactorial spinal canal', 'stenosis.', '- Hct to 24. Sent guaiac and hapto/TBili (pending)', '- O2 weaned to 1L NC during day then back to 3L NC overnight', '- HRs into 120s with BPs 120s/70s. Tried fluid bolus with no change.', 'Gave 5mg lopressor with good effect->HRs to 80s-90s and BPs stable.', '- DFA was inadequate sample so re-sent', '- Weaned off pressors in am and remained off all day.']",['- HRs into 120s with BPs 120s/70s. Gave 5mg lopressor with good effect'],43122,168271.0
10,2101-06-09 09:11:51,['- Hct to 24. Guaiac and hemolysis labs not c/w hemolysis'],"['- Blood cultures grew MRSA', '- Urine cultures grew VRE->changed vanc to linezolid', '- Went to MRI spine for ?abscess->Wet read: No epidural abscess.', 'Multilevel degenerative changes in the lumbar spine most', 'pronounced at L4-5 level with severe multifactorial spinal canal', 'stenosis.', '- Hct to 24. Guaiac and hemolysis labs not c/w hemolysis', '- O2 weaned to 1L NC during day then back to 3L NC overnight', '- HRs into 120s with BPs 120s/70s. Tried fluid bolus with no change.', 'Gave 5mg lopressor with good effect->HRs to 80s-90s and BPs stable.', '- DFA was inadequate sample so re-sent', '- Weaned off pressors in am and remained off all day.']",['- Hct to 24. Sent guaiac and hapto/TBili (pending)'],43122,168271.0
0,2188-07-20 06:05:09,,[],,13203,122842.0
1,2188-07-20 06:07:18,"['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']","['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",,13203,122842.0
2,2188-07-20 06:20:26,,"['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",,13203,122842.0
3,2188-07-20 07:27:51,,"['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",,13203,122842.0
4,2188-07-20 07:34:11,,"['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",,13203,122842.0
5,2188-07-20 08:45:38,,"['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",,13203,122842.0
6,2188-07-21 06:02:37,"['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and L effusion, cannot tell lymphangitic spread.']","['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and L effusion, cannot tell lymphangitic spread.']","['- admitted to MICU', '- started on vancomycin, cefepime and ciprofloxacin for HAP', '- appeared extremely uncomfortable and received ativan and diluadid for', 'pain and anxiety', '- received 10 mg IV lasix for potential component of volume overload', 'without improvement in respiratory status', '- BNP negative at 436']",13203,122842.0
7,2188-07-21 06:03:20,,"['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and L effusion, cannot tell lymphangitic spread.']",,13203,122842.0
8,2188-07-21 06:03:50,,"['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and L effusion, cannot tell lymphangitic spread.']",,13203,122842.0
9,2188-07-21 06:04:41,,"['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and L effusion, cannot tell lymphangitic spread.']",,13203,122842.0
10,2188-07-21 07:51:35,"['pna and dependent L effusion, cannot tell lymphangitic spread.']","['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stablized during day - on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and dependent L effusion, cannot tell lymphangitic spread.']","['pna and L effusion, cannot tell lymphangitic spread.']",13203,122842.0
11,2188-07-21 09:30:09,"['- Respiratory status stabilized during day on 4L NC', 'pneumonia vs. lymphangitic spread.  They recommended continuing to hold']","['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stabilized during day on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended continuing to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and dependent L effusion, cannot tell lymphangitic spread.']","['- Respiratory status stablized during day - on 4L NC', 'pneumonia vs. lymphangitic spread.  They recommended - continue to hold']",13203,122842.0
12,2188-07-22 06:44:19,"['FEVER - 102.2', 'F - [**2188-7-21**] 04:00 PM', '- Persistent tachycardia in high 120s. ?Acute on chronic illness v. neb', 'v. anemia. Albuterol changed to xopenex. Spiked fever to 102.2.', 'Pancultured and defervesced with tylenol. Transfused 1 unit pRBC with', 'lasix after given anemia. At end of transfusion, had episode of', 'respiratory distress. LLL crackles and diffuse wheezes on exam.', 'Breathing improved with ativan. Also received scheduled post-txn lasix.', 'Continued to have coughing fits overnight which resolved spontaneously.', 'HR improved in 110s.', '- Ambulated with PT.', '- Onc: No anticancer rx till at least [**7-29**] as planned.', '- Neurosurg: No new recs.']","['FEVER - 102.2', 'F - [**2188-7-21**] 04:00 PM', '- Persistent tachycardia in high 120s. ?Acute on chronic illness v. neb', 'v. anemia. Albuterol changed to xopenex. Spiked fever to 102.2.', 'Pancultured and defervesced with tylenol. Transfused 1 unit pRBC with', 'lasix after given anemia. At end of transfusion, had episode of', 'respiratory distress. LLL crackles and diffuse wheezes on exam.', 'Breathing improved with ativan. Also received scheduled post-txn lasix.', 'Continued to have coughing fits overnight which resolved spontaneously.', 'HR improved in 110s.', '- Ambulated with PT.', '- Onc: No anticancer rx till at least [**7-29**] as planned.', '- Neurosurg: No new recs.']","['BLOOD CULTURED - At [**2188-7-20**] 08:31 AM', ' URINE CULTURE - At [**2188-7-20**] 08:32 AM', ' FEVER - 102.6', 'F - [**2188-7-20**] 12:00 PM', '- Respiratory status stabilized during day on 4L NC', '- Neurosurgery: No new recs', '- Onc consulted as husband was [**Name2 (NI) **] to get Dr.[**Name (NI) 9591**] input on', 'pneumonia vs. lymphangitic spread.  They recommended continuing to hold', 'the study drug and can image as MICU team feels necessary.', '- CT torso ordered for better characterization of lungs and CT neck', 'ordered for wheezing/possible stridor.  CT chest pre-lim read with LLL', 'pna and dependent L effusion, cannot tell lymphangitic spread.']",13203,122842.0
13,2188-07-22 07:24:02,,"['FEVER - 102.2', 'F - [**2188-7-21**] 04:00 PM', '- Persistent tachycardia in high 120s. ?Acute on chronic illness v. neb', 'v. anemia. Albuterol changed to xopenex. Spiked fever to 102.2.', 'Pancultured and defervesced with tylenol. Transfused 1 unit pRBC with', 'lasix after given anemia. At end of transfusion, had episode of', 'respiratory distress. LLL crackles and diffuse wheezes on exam.', 'Breathing improved with ativan. Also received scheduled post-txn lasix.', 'Continued to have coughing fits overnight which resolved spontaneously.', 'HR improved in 110s.', '- Ambulated with PT.', '- Onc: No anticancer rx till at least [**7-29**] as planned.', '- Neurosurg: No new recs.']",,13203,122842.0
14,2188-07-22 09:20:23,,"['FEVER - 102.2', 'F - [**2188-7-21**] 04:00 PM', '- Persistent tachycardia in high 120s. ?Acute on chronic illness v. neb', 'v. anemia. Albuterol changed to xopenex. Spiked fever to 102.2.', 'Pancultured and defervesced with tylenol. Transfused 1 unit pRBC with', 'lasix after given anemia. At end of transfusion, had episode of', 'respiratory distress. LLL crackles and diffuse wheezes on exam.', 'Breathing improved with ativan. Also received scheduled post-txn lasix.', 'Continued to have coughing fits overnight which resolved spontaneously.', 'HR improved in 110s.', '- Ambulated with PT.', '- Onc: No anticancer rx till at least [**7-29**] as planned.', '- Neurosurg: No new recs.']",,13203,122842.0
0,2179-03-05 07:22:41,,['-no overnight events'],,83014,150856.0
1,2179-03-05 10:30:06,['-post-cath check included in this progress note'],"['-no overnight events', '-post-cath check included in this progress note']",,83014,150856.0
0,2129-09-04 07:49:49,,"['FEVER - 101.7', 'F - [**2129-9-3**] 12:33 PM', '-received boluses overnight for low SBP', '-disimpacted large amount of stool. restarted on bowel regimen', '-CT torso: 1. No pneumonia, as questioned. 2. No abdominal or pelvic', 'collections. No findings suggestive of ischemic colitis.', '-call ID approval for cefepime tomorrow']",,305,194340.0
1,2129-09-04 11:27:40,,"['FEVER - 101.7', 'F - [**2129-9-3**] 12:33 PM', '-received boluses overnight for low SBP', '-disimpacted large amount of stool. restarted on bowel regimen', '-CT torso: 1. No pneumonia, as questioned. 2. No abdominal or pelvic', 'collections. No findings suggestive of ischemic colitis.', '-call ID approval for cefepime tomorrow']",,305,194340.0
2,2129-09-05 08:00:44,"['-tachycardic to 100-110s this seemed to correlate c low grade temps so', 'started tylenol', '-tried to sign out to floor ([**Hospital1 2259**]) but team was reluctant to take pt', '[**1-10**] altered mental status.', '-tightened ISS, probably should start on some lantus tomorrow.', '-gave 500cc boluses x2 for low uop c good effect', '-fam called and told transferring to floor and then called back to tell', 'not transferred to floor.', '-stooling well after lactulose', '-[**Doctor Last Name 10390**] recs  repeat ECHO and --- , if both are neg should pull off', 'of abx.  TTE ordered for today.', '- pt NPO when she transferred her here.  she does have NGT so could get', 'tube feeds.  Plan to restart TF today.  s+s also following.']","['-tachycardic to 100-110s this seemed to correlate c low grade temps so', 'started tylenol', '-tried to sign out to floor ([**Hospital1 2259**]) but team was reluctant to take pt', '[**1-10**] altered mental status.', '-tightened ISS, probably should start on some lantus tomorrow.', '-gave 500cc boluses x2 for low uop c good effect', '-fam called and told transferring to floor and then called back to tell', 'not transferred to floor.', '-stooling well after lactulose', '-[**Doctor Last Name 10390**] recs  repeat ECHO and --- , if both are neg should pull off', 'of abx.  TTE ordered for today.', '- pt NPO when she transferred her here.  she does have NGT so could get', 'tube feeds.  Plan to restart TF today.  s+s also following.']","['FEVER - 101.7', 'F - [**2129-9-3**] 12:33 PM', '-received boluses overnight for low SBP', '-disimpacted large amount of stool. restarted on bowel regimen', '-CT torso: 1. No pneumonia, as questioned. 2. No abdominal or pelvic', 'collections. No findings suggestive of ischemic colitis.', '-call ID approval for cefepime tomorrow']",305,194340.0
3,2129-09-05 16:13:44,,"['-tachycardic to 100-110s this seemed to correlate c low grade temps so', 'started tylenol', '-tried to sign out to floor ([**Hospital1 2259**]) but team was reluctant to take pt', '[**1-10**] altered mental status.', '-tightened ISS, probably should start on some lantus tomorrow.', '-gave 500cc boluses x2 for low uop c good effect', '-fam called and told transferring to floor and then called back to tell', 'not transferred to floor.', '-stooling well after lactulose', '-[**Doctor Last Name 10390**] recs  repeat ECHO and --- , if both are neg should pull off', 'of abx.  TTE ordered for today.', '- pt NPO when she transferred her here.  she does have NGT so could get', 'tube feeds.  Plan to restart TF today.  s+s also following.']",,305,194340.0
0,2136-03-25 07:35:19,,[],,53803,165032.0
0,2161-03-13 07:50:58,,"['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",,93983,193351.0
1,2161-03-13 07:51:47,,"['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",,93983,193351.0
2,2161-03-13 07:58:21,,"['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",,93983,193351.0
3,2161-03-13 08:55:36,,"['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",,93983,193351.0
4,2161-03-13 11:44:38,,"['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",,93983,193351.0
5,2161-03-14 08:13:27,"['-patient extubated and doing well', '-R trapezius pain with some numbness of fingertips, patient refusing CT', 'scan of neck', '-ECHO with moderate RV dilation and moderate RV hypokinesis', '-hct stable', '-cefepime discontinued, on vanc/cipro', '-40mg IV lasix given x 2, with very brisk diuresis', '-seroquel discontinued', '-percocet ordered for pain']","['-patient extubated and doing well', '-R trapezius pain with some numbness of fingertips, patient refusing CT', 'scan of neck', '-ECHO with moderate RV dilation and moderate RV hypokinesis', '-hct stable', '-cefepime discontinued, on vanc/cipro', '-40mg IV lasix given x 2, with very brisk diuresis', '-seroquel discontinued', '-percocet ordered for pain']","['FEVER - 101.3', 'F - [**2161-3-12**] 04:00 PM', '-- patient with elevated blood pressure (SBP > 180) due to recent', 'hemoptysis and history of DM2 started lisinopril 10 mg po daily', '-- overnight given lasix 40 mg IV once in preparation for possible', 'extubation in the am', '-- patient required several boluses of propofol overnight for agitation', 'during cleaning', '-- subsequent to propofol boluses and lasix IV patient became', 'hypotensive with SBP 80-90 and MAP (52-60).  Propofol gtt decreased', 'from 50 to 30.  Patient given 250 cc NS x 2.']",93983,193351.0
6,2161-03-14 11:13:53,,"['-patient extubated and doing well', '-R trapezius pain with some numbness of fingertips, patient refusing CT', 'scan of neck', '-ECHO with moderate RV dilation and moderate RV hypokinesis', '-hct stable', '-cefepime discontinued, on vanc/cipro', '-40mg IV lasix given x 2, with very brisk diuresis', '-seroquel discontinued', '-percocet ordered for pain']",,93983,193351.0
7,2161-03-14 11:38:43,,"['-patient extubated and doing well', '-R trapezius pain with some numbness of fingertips, patient refusing CT', 'scan of neck', '-ECHO with moderate RV dilation and moderate RV hypokinesis', '-hct stable', '-cefepime discontinued, on vanc/cipro', '-40mg IV lasix given x 2, with very brisk diuresis', '-seroquel discontinued', '-percocet ordered for pain']",,93983,193351.0
0,2130-09-09 08:09:57,,['Transfused 2U pRBCs'],,58403,109390.0
1,2130-09-09 11:40:41,,['Transfused 2U pRBCs'],,58403,109390.0
0,2122-06-29 07:14:12,,"['72yo man w progressive HCC with mx liver lesions and [**Hospital 90**] transferred to', 'the ICU after episode of BRBPR.', '--Consults from Liver, [**Doctor First Name **] and Renal.  Deferred further investigation', 'of LGIB.  Thought to be secondary to hemorrhoids.', '-- PARACENTESIS - At [**2122-6-28**] 06:56 PM - done for diagnostic purposes', 'to dx abdominal mets vs. portal HTN vs. SBP. Shows SAAG 1.1 and Polys', '440, cx and cytology pending.', '-- Yesterday late afternoon/evening - notified of low UOP.  Thought was', 'foley cath obstructed & not draining.  The cath was flushed with no', 'result.  Bladder scan showed 480 cc urine in bladder.  Foley was pulled', 'Cadey cath ordered.  Could not be placed by nursing.  Urology consult', '-- cystocopy showed pt was aneuric with contracted bladder.', '-- Approx 1 hour after cystocopy, the patient developed severe dyspnea', 'and required 2L of O2.  The patient was given an aerosolized saline tx', 'to help with secretions.  It became apparent that SOB was worsening', 'thought to be mechanical due to worsening ascites and .  Patient became', 'diaphoretic, cold and clammy.', '--ABG was done PH 7.2  O2 78  CO2 40  HCO3 16  XS -11', '--Decision made to intubate for hypoxic respiratory failure.', '--Patient placed on fentanyl and versed and was bolused approx 2 liters', 'of fluid.  He became hypotensive to SBPs in 70s after intubation.', '-- He has required dopamine currently at 10 to maintain MAP >60', '--Recently his Vent Peak pressures have been increasing PIP 40, plat', '35.  Decreased TV, Increased RR and Increased PEEP.', '--Attempted A-line -- could not do.  2 peripheral IVs', '--daughter came by around the time the patient was intubated.  request', 'family mtg with onc today.']",,92933,129028.0
1,2122-06-29 11:42:13,"['-- Patient', 's urine output increased to 20-30cc/hr with IVF boluses.', '--Bladder scan at 36.']","['72yo man w progressive HCC with mx liver lesions and [**Hospital 90**] transferred to', 'the ICU after episode of BRBPR.', '--Consults from Liver, [**Doctor First Name **] and Renal.  Deferred further investigation', 'of LGIB.  Thought to be secondary to hemorrhoids.', '-- PARACENTESIS - At [**2122-6-28**] 06:56 PM - done for diagnostic purposes', 'to dx abdominal mets vs. portal HTN vs. SBP. Shows SAAG 1.1 and Polys', '440, cx and cytology pending.', '-- Yesterday late afternoon/evening - notified of low UOP.  Thought was', 'foley cath obstructed & not draining.  The cath was flushed with no', 'result.  Bladder scan showed 480 cc urine in bladder.  Foley was pulled', 'Cadey cath ordered.  Could not be placed by nursing.  Urology consult', '-- cystocopy showed pt was aneuric with contracted bladder.', '-- Approx 1 hour after cystocopy, the patient developed severe dyspnea', 'and required 2L of O2.  The patient was given an aerosolized saline tx', 'to help with secretions.  It became apparent that SOB was worsening', 'thought to be mechanical due to worsening ascites and .  Patient became', 'diaphoretic, cold and clammy.', '--ABG was done PH 7.2  O2 78  CO2 40  HCO3 16  XS -11', '--Decision made to intubate for hypoxic respiratory failure.', '--Patient placed on fentanyl and versed and was bolused approx 2 liters', 'of fluid.  He became hypotensive to SBPs in 70s after intubation.', '-- He has required dopamine currently at 10 to maintain MAP >60', '-- Patient', 's urine output increased to 20-30cc/hr with IVF boluses.', '--Recently his Vent Peak pressures have been increasing PIP 40, plat', '35.  Decreased TV, Increased RR and Increased PEEP.', '--Attempted A-line -- could not do.  2 peripheral IVs', '--daughter came by around the time the patient was intubated.  request', 'family mtg with onc today.', '--Bladder scan at 36.']",,92933,129028.0
2,2122-06-30 07:01:53,"['ULTRASOUND - At [**2122-6-29**] 09:45 AM', 'No evidence of hydronephrosis, Ascites, Partially visualized multiple', 'hepatic masses, compatible with known', 'hepatocellular carcinoma.', 'Meeting with family [**2122-6-29**]:  Decision was made not to escalate care,', 'DNR, DNI.', 'Increased ascites, rectal prolapse overnight with BRBPR.']","['ULTRASOUND - At [**2122-6-29**] 09:45 AM', 'No evidence of hydronephrosis, Ascites, Partially visualized multiple', 'hepatic masses, compatible with known', 'hepatocellular carcinoma.', 'Meeting with family [**2122-6-29**]:  Decision was made not to escalate care,', 'DNR, DNI.', 'Increased ascites, rectal prolapse overnight with BRBPR.']","['72yo man w progressive HCC with mx liver lesions and [**Hospital 90**] transferred to', 'the ICU after episode of BRBPR.', '--Consults from Liver, [**Doctor First Name **] and Renal.  Deferred further investigation', 'of LGIB.  Thought to be secondary to hemorrhoids.', '-- PARACENTESIS - At [**2122-6-28**] 06:56 PM - done for diagnostic purposes', 'to dx abdominal mets vs. portal HTN vs. SBP. Shows SAAG 1.1 and Polys', '440, cx and cytology pending.', '-- Yesterday late afternoon/evening - notified of low UOP.  Thought was', 'foley cath obstructed & not draining.  The cath was flushed with no', 'result.  Bladder scan showed 480 cc urine in bladder.  Foley was pulled', 'Cadey cath ordered.  Could not be placed by nursing.  Urology consult', '-- cystocopy showed pt was aneuric with contracted bladder.', '-- Approx 1 hour after cystocopy, the patient developed severe dyspnea', 'and required 2L of O2.  The patient was given an aerosolized saline tx', 'to help with secretions.  It became apparent that SOB was worsening', 'thought to be mechanical due to worsening ascites and .  Patient became', 'diaphoretic, cold and clammy.', '--ABG was done PH 7.2  O2 78  CO2 40  HCO3 16  XS -11', '--Decision made to intubate for hypoxic respiratory failure.', '--Patient placed on fentanyl and versed and was bolused approx 2 liters', 'of fluid.  He became hypotensive to SBPs in 70s after intubation.', '-- He has required dopamine currently at 10 to maintain MAP >60', '-- Patient', 's urine output increased to 20-30cc/hr with IVF boluses.', '--Recently his Vent Peak pressures have been increasing PIP 40, plat', '35.  Decreased TV, Increased RR and Increased PEEP.', '--Attempted A-line -- could not do.  2 peripheral IVs', '--daughter came by around the time the patient was intubated.  request', 'family mtg with onc today.', '--Bladder scan at 36.']",92933,129028.0
3,2122-06-30 19:05:29,"['Family wishes to make pt [**Name (NI) 115**] after family members have arrived at the', 'hospital.']","['ULTRASOUND - At [**2122-6-29**] 09:45 AM', 'No evidence of hydronephrosis, Ascites, Partially visualized multiple', 'hepatic masses, compatible with known', 'hepatocellular carcinoma.', 'Meeting with family [**2122-6-29**]:  Decision was made not to escalate care,', 'DNR, DNI.', 'Family wishes to make pt [**Name (NI) 115**] after family members have arrived at the', 'hospital.', 'Increased ascites, rectal prolapse overnight with BRBPR.']",,92933,129028.0
0,2163-09-15 06:33:01,,"['TRANSTHORACIC ECHO - At [**2163-9-14**] 09:36 AM', 'Performed at bedside.', ' FEVER - 102.2', 'F - [**2163-9-14**] 01:00 PM, persistently febrile', 'High grade bacteremia with 10/12 blood cultures positive for GPCs', 'ID consulted, recommends keeping pt on vanc and gent dosed by', 'level/after HD.', 'Pt had MRI of spine though without gad, rads attending confident that', 'there was no evidence of osteomyelitis or epidural abscess and that', 'pain symptoms most consistent with radiculopathy visualized on scan.', 'TTE showed no evidence of vegetations', 'HD yesterday, no UF removed due to borderline hypotension.']",,18996,164005.0
1,2163-09-15 17:48:50,,"['TRANSTHORACIC ECHO - At [**2163-9-14**] 09:36 AM', 'Performed at bedside.', ' FEVER - 102.2', 'F - [**2163-9-14**] 01:00 PM, persistently febrile', 'High grade bacteremia with 10/12 blood cultures positive for GPCs', 'ID consulted, recommends keeping pt on vanc and gent dosed by', 'level/after HD.', 'Pt had MRI of spine though without gad, rads attending confident that', 'there was no evidence of osteomyelitis or epidural abscess and that', 'pain symptoms most consistent with radiculopathy visualized on scan.', 'TTE showed no evidence of vegetations', 'HD yesterday, no UF removed due to borderline hypotension.']",,18996,164005.0
2,2163-09-15 18:03:22,,"['TRANSTHORACIC ECHO - At [**2163-9-14**] 09:36 AM', 'Performed at bedside.', ' FEVER - 102.2', 'F - [**2163-9-14**] 01:00 PM, persistently febrile', 'High grade bacteremia with 10/12 blood cultures positive for GPCs', 'ID consulted, recommends keeping pt on vanc and gent dosed by', 'level/after HD.', 'Pt had MRI of spine though without gad, rads attending confident that', 'there was no evidence of osteomyelitis or epidural abscess and that', 'pain symptoms most consistent with radiculopathy visualized on scan.', 'TTE showed no evidence of vegetations', 'HD yesterday, no UF removed due to borderline hypotension.']",,18996,164005.0
3,2163-09-15 18:04:55,,"['TRANSTHORACIC ECHO - At [**2163-9-14**] 09:36 AM', 'Performed at bedside.', ' FEVER - 102.2', 'F - [**2163-9-14**] 01:00 PM, persistently febrile', 'High grade bacteremia with 10/12 blood cultures positive for GPCs', 'ID consulted, recommends keeping pt on vanc and gent dosed by', 'level/after HD.', 'Pt had MRI of spine though without gad, rads attending confident that', 'there was no evidence of osteomyelitis or epidural abscess and that', 'pain symptoms most consistent with radiculopathy visualized on scan.', 'TTE showed no evidence of vegetations', 'HD yesterday, no UF removed due to borderline hypotension.']",,18996,164005.0
0,2165-03-01 07:03:00,,"['EKG - At [**2165-2-28**] 08:20 PM', ' FEVER - 104.4', 'F - [**2165-2-28**] 08:00 PM', '-Episode of chest pain in setting of temp 104.4 and systolic BP in low', ""80's. ECG with increase in anterior ST elevations and lateral"", 'depressions. Cards [**Name (NI) 420**], recommend TEE as scheduled in AM']",,18996,159330.0
1,2165-03-01 11:31:35,,"['EKG - At [**2165-2-28**] 08:20 PM', ' FEVER - 104.4', 'F - [**2165-2-28**] 08:00 PM', '-Episode of chest pain in setting of temp 104.4 and systolic BP in low', ""80's. ECG with increase in anterior ST elevations and lateral"", 'depressions. Cards [**Name (NI) 420**], recommend TEE as scheduled in AM']",,18996,159330.0
2,2165-03-02 07:06:18,"['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '[**3-1**]:', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']","['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '[**3-1**]:', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']","['EKG - At [**2165-2-28**] 08:20 PM', ' FEVER - 104.4', 'F - [**2165-2-28**] 08:00 PM', '-Episode of chest pain in setting of temp 104.4 and systolic BP in low', ""80's. ECG with increase in anterior ST elevations and lateral"", 'depressions. Cards [**Name (NI) 420**], recommend TEE as scheduled in AM']",18996,159330.0
3,2165-03-02 08:04:36,['.'],"['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '.', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']",['[**3-1**]:'],18996,159330.0
4,2165-03-02 08:09:22,,"['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '.', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']",,18996,159330.0
5,2165-03-02 12:33:36,,"['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '.', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']",,18996,159330.0
6,2165-03-02 12:37:51,,"['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '.', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']",,18996,159330.0
7,2165-03-03 07:24:37,"['FEVER - 101.9', 'F - [**2165-3-2**] 12:00 PM', '[**3-2**]:', '- Had Ampicillin challenge at 14:30, premedicated w/Benadryl. No', 'change. Went on to have full 2 mg dose.', '- PM labs: fibrinogen normal-to-elevated, hct stable (29.4-> 28.9),', 'platelets stable (83->77->109)', '- HD removed 4 liters, breathing better after']","['FEVER - 101.9', 'F - [**2165-3-2**] 12:00 PM', '[**3-2**]:', '- Had Ampicillin challenge at 14:30, premedicated w/Benadryl. No', 'change. Went on to have full 2 mg dose.', '- PM labs: fibrinogen normal-to-elevated, hct stable (29.4-> 28.9),', 'platelets stable (83->77->109)', '- HD removed 4 liters, breathing better after']","['ULTRASOUND - At [**2165-3-1**] 09:45 AM', 'to assess left AV fistula', ' TRANS ESOPHAGEAL ECHO - At [**2165-3-1**] 12:07 PM', '.', '- Fistula u/s:  1) Non-occlusive thrombus seen within the left basilic', 'vein within the left forearm. No discrete subcutaneous fluid collection', 'identified. 2) Area of stenosis in the AV fistula seen in the mid upper', 'arm.', '- Has two PIV, access will be issue (PICC, temp HD line?)', '- BPs consistently 80/40, Hct 33 --> 26 but asymptomatic. Getting IVF', 'and PO diet', '- Renal: Okay to do HD through fistula tomorrow, not infected', '- 3/3 bottles from ED now + for enterococcus, [**Last Name (un) **] to Amp. Given PCN', 'allergy and last Keflex yesterday morning, undergoing Amp', 'desensitization today. Will check Gent trough in AM pre HD and give', '60mg after HD if trough <1. Will start Ampicillin 2G q12h after HD', 'tomorrow', '- CT [**Doctor First Name 458**]: Will need Redo/Redo AVR with Dr. [**Last Name (STitle) 5648**] after', 'antibiotic treatment.', '- CT abd/pelvis: Suboptimal exam to evaluate for abscess without IV', 'contrast. No large abscess in chest, abdomen or pelvis - but limited', 'GG nodule and nodules suggest tree-in-[**Male First Name (un) 667**] proximally raise the', 'possibiliy of a pulmonary infection.', '- ECHO prelim: No spontaneous echo contrast or thrombus is seen in the', 'body of the left atrium/left atrial appendage or the body of the right', 'atrium/right atrial appendage. No atrial septal defect is seen by 2D or', 'color Doppler. Overall left ventricular systolic function is normal', '(LVEF>55%). No aortic plaque was identified to 47 centimeters from the', 'incisors. Right ventricular chamber size and free wall motion are', 'normal. A well-seated bioprosthetic aortic valve prosthesis with', 'thickened leaflets is present. No masses or vegetations are seen on the', 'aortic valve. Moderate to severe (3+) aortic regurgitation is seen. The', 'mitral valve appears structurally normal with trivial mitral', 'regurgitation. No mass or vegetation is seen on the mitral valve. Mild', '(1+) mitral regurgitation is seen.']",18996,159330.0
8,2165-03-03 11:00:47,"['- HD removed 4 liters, breathing better after. Patient again rigors and', 'chills w/HD, last 15 minutes of cut short.']","['FEVER - 101.9', 'F - [**2165-3-2**] 12:00 PM', '- Had Ampicillin challenge at 14:30, premedicated w/Benadryl. No', 'change. Went on to have full 2 mg dose.', '- HD removed 4 liters, breathing better after. Patient again rigors and', 'chills w/HD, last 15 minutes of cut short.']","['[**3-2**]:', '- PM labs: fibrinogen normal-to-elevated, hct stable (29.4-> 28.9),', 'platelets stable (83->77->109)', '- HD removed 4 liters, breathing better after']",18996,159330.0
0,2126-02-10 08:05:31,,"['ARTERIAL LINE - START [**2126-2-9**] 11:50 PM', 'inserted in ED [**2125-2-9**]', ' MULTI LUMEN - START [**2126-2-9**] 11:53 PM', 'ABG with marked alkalosis; minute ventilation decreased until pH down', 'to 7.47', 'Increasingly hypertensive O/N', 'Put in restraints in early AM as she became more awake, restless']",,29705,161764.0
1,2126-02-10 10:21:58,,"['ARTERIAL LINE - START [**2126-2-9**] 11:50 PM', 'inserted in ED [**2125-2-9**]', ' MULTI LUMEN - START [**2126-2-9**] 11:53 PM', 'ABG with marked alkalosis; minute ventilation decreased until pH down', 'to 7.47', 'Increasingly hypertensive O/N', 'Put in restraints in early AM as she became more awake, restless']",,29705,161764.0
2,2126-02-10 11:02:07,,"['ARTERIAL LINE - START [**2126-2-9**] 11:50 PM', 'inserted in ED [**2125-2-9**]', ' MULTI LUMEN - START [**2126-2-9**] 11:53 PM', 'ABG with marked alkalosis; minute ventilation decreased until pH down', 'to 7.47', 'Increasingly hypertensive O/N', 'Put in restraints in early AM as she became more awake, restless']",,29705,161764.0
3,2126-02-11 06:35:40,"['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']","['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']","['ARTERIAL LINE - START [**2126-2-9**] 11:50 PM', 'inserted in ED [**2125-2-9**]', ' MULTI LUMEN - START [**2126-2-9**] 11:53 PM', 'ABG with marked alkalosis; minute ventilation decreased until pH down', 'to 7.47', 'Increasingly hypertensive O/N', 'Put in restraints in early AM as she became more awake, restless']",29705,161764.0
4,2126-02-11 06:38:55,,"['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']",,29705,161764.0
5,2126-02-11 08:02:27,,"['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']",,29705,161764.0
6,2126-02-11 14:52:19,,"['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']",,29705,161764.0
7,2126-02-12 07:26:47,"['TTE - At [**2126-2-11**] 11:00 AM', ' PICC LINE - START [**2126-2-11**] 05:00 PM', 'placed in IR', ' MULTI LUMEN - STOP [**2126-2-11**] 11:00 PM', ""Had PICC line placed, fem venous line D/C'ed"", ""Tried to place radial Aline but couldn't so left fem one in place"", 'Started heparin gtt for afib', 'Diuresed to goal', 'Echo done, normal fxn but severe PAH', ""? tachy-brady as HR as low as 40's""]","['TTE - At [**2126-2-11**] 11:00 AM', ' PICC LINE - START [**2126-2-11**] 05:00 PM', 'placed in IR', ' MULTI LUMEN - STOP [**2126-2-11**] 11:00 PM', ""Had PICC line placed, fem venous line D/C'ed"", ""Tried to place radial Aline but couldn't so left fem one in place"", 'Started heparin gtt for afib', 'Diuresed to goal', 'Echo done, normal fxn but severe PAH', ""? tachy-brady as HR as low as 40's""]","['BLOOD CULTURED - At [**2126-2-10**] 01:25 PM', ""Weaned sedation in afternoon in anticipation of ?extubation -- pCO2's"", ""in 70's"", 'Started on diamox for metabolic alkalosis. Urine lytes c/w diuretic tx', 'CXR with continued evidence of pulmonary edema, diuresing well on lasix', 'Started nitroglycerin drip as weaning propofol']",29705,161764.0
8,2126-02-12 14:46:26,,"['TTE - At [**2126-2-11**] 11:00 AM', ' PICC LINE - START [**2126-2-11**] 05:00 PM', 'placed in IR', ' MULTI LUMEN - STOP [**2126-2-11**] 11:00 PM', ""Had PICC line placed, fem venous line D/C'ed"", ""Tried to place radial Aline but couldn't so left fem one in place"", 'Started heparin gtt for afib', 'Diuresed to goal', 'Echo done, normal fxn but severe PAH']","[""? tachy-brady as HR as low as 40's""]",29705,161764.0
9,2126-02-13 06:52:08,"['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']","['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']","['TTE - At [**2126-2-11**] 11:00 AM', ' PICC LINE - START [**2126-2-11**] 05:00 PM', 'placed in IR', ' MULTI LUMEN - STOP [**2126-2-11**] 11:00 PM', ""Had PICC line placed, fem venous line D/C'ed"", ""Tried to place radial Aline but couldn't so left fem one in place"", 'Started heparin gtt for afib', 'Diuresed to goal', 'Echo done, normal fxn but severe PAH']",29705,161764.0
10,2126-02-13 07:39:59,,"['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']",,29705,161764.0
11,2126-02-13 07:42:26,,"['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']",,29705,161764.0
12,2126-02-13 10:37:03,,"['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']",,29705,161764.0
13,2126-02-14 07:47:23,"['Failed her SBT [**2-2**] pO2 of 54, plan to reattempt in AM', 'Continued to diurese well', 'Spoke with daughter, confirmed full code status']","['Failed her SBT [**2-2**] pO2 of 54, plan to reattempt in AM', 'Continued to diurese well', 'Spoke with daughter, confirmed full code status']","['ARTERIAL LINE - STOP [**2126-2-13**] 12:00 AM', 'inserted in ED [**2125-2-9**]', 'Nitro gtt DC', 'd and captopril dose increased', 'Art line DC']",29705,161764.0
14,2126-02-14 14:30:23,,"['Failed her SBT [**2-2**] pO2 of 54, plan to reattempt in AM', 'Continued to diurese well', 'Spoke with daughter, confirmed full code status']",,29705,161764.0
15,2126-02-15 07:45:55,"['Diarrhea x 4-5 times overnight; watery mixed with bloody mucous', '+Productive cough', 'Continued diuresis, though decreased response to lasix']","['Diarrhea x 4-5 times overnight; watery mixed with bloody mucous', '+Productive cough', 'Continued diuresis, though decreased response to lasix']","['Failed her SBT [**2-2**] pO2 of 54, plan to reattempt in AM', 'Continued to diurese well', 'Spoke with daughter, confirmed full code status']",29705,161764.0
16,2126-02-15 18:07:17,,"['Diarrhea x 4-5 times overnight; watery mixed with bloody mucous', '+Productive cough', 'Continued diuresis, though decreased response to lasix']",,29705,161764.0
17,2126-02-15 20:18:51,,"['Diarrhea x 4-5 times overnight; watery mixed with bloody mucous', '+Productive cough', 'Continued diuresis, though decreased response to lasix']",,29705,161764.0
0,2186-04-28 11:35:39,,"['- Started on meropenem for cholangitis and vanco for S. aureus', 'parotiditis', '- Lasix 40mg IV x 1', '- On D5 1/2NS with K for hypernatremia and hypokalemia', '- Hypoxic per pulse-ox overnight but not hypoxemic on multiple ABGs']",,80187,154261.0
0,2142-05-21 07:25:56,,"['DIALYSIS CATHETER - START [**2142-5-20**] 08:19 PM', ""- tried to titrate off nicardipine gtt, but BP would return to 200's"", '- still complaining of abd pain/N with guaiac negative emesis', '- trace guaiac positive brown stool X 1', 'By this morning, she states that her abd pain has improved. No', 'headache, visions changes, nausea is also improved']",,109,102024.0
1,2142-05-21 09:28:06,['-- off nicardipine gtt'],"['DIALYSIS CATHETER - START [**2142-5-20**] 08:19 PM', ""- tried to titrate off nicardipine gtt, but BP would return to 200's"", '- still complaining of abd pain/N with guaiac negative emesis', '- trace guaiac positive brown stool X 1', 'By this morning, she states that her abd pain has improved. No', 'headache, visions changes, nausea is also improved', '-- off nicardipine gtt']",,109,102024.0
2,2142-05-22 07:39:21,"['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']","['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']","['DIALYSIS CATHETER - START [**2142-5-20**] 08:19 PM', ""- tried to titrate off nicardipine gtt, but BP would return to 200's"", '- still complaining of abd pain/N with guaiac negative emesis', '- trace guaiac positive brown stool X 1', 'By this morning, she states that her abd pain has improved. No', 'headache, visions changes, nausea is also improved', '-- off nicardipine gtt']",109,102024.0
3,2142-05-22 07:41:06,,"['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']",,109,102024.0
4,2142-05-22 07:56:39,,"['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']",,109,102024.0
5,2142-05-22 07:59:15,,"['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']",,109,102024.0
6,2142-05-22 12:14:37,,"['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']",,109,102024.0
7,2142-06-02 07:09:34,"['DIALYSIS CATHETER - START [**2142-6-1**] 08:00 PM', ' LUMBAR PUNCTURE - At [**2142-6-1**] 10:24 PM', 'attempted but unsuccessful', ' MAGNETIC RESONANCE IMAGING - At [**2142-6-2**] 12:00 AM', 'MRA, MRI, pt unable to tolerate MRV', '- Surgery eval for SBO, NGT placed, rec NPO and serial abdominal', ""exams.  Patient d/c'd NGT overnight.""]","['DIALYSIS CATHETER - START [**2142-6-1**] 08:00 PM', ' LUMBAR PUNCTURE - At [**2142-6-1**] 10:24 PM', 'attempted but unsuccessful', ' MAGNETIC RESONANCE IMAGING - At [**2142-6-2**] 12:00 AM', 'MRA, MRI, pt unable to tolerate MRV', '- Surgery eval for SBO, NGT placed, rec NPO and serial abdominal', ""exams.  Patient d/c'd NGT overnight.""]","['- Serum hCG negative', '- Weaned off nicardipine gtt', '- Underwent HD with improvement of BP', '- GI c/s re: abdominal pain.  Recommended:', '- CTA-abdomen to eval for mesenteric ischemia vs. partial SBO; if', 'not able, check KUB to r/o partial SBO', '- Check urine porphyrobilinogen and serum lead levels, follow LFTs.']",109,102024.0
8,2142-06-02 07:22:36,,"['DIALYSIS CATHETER - START [**2142-6-1**] 08:00 PM', ' LUMBAR PUNCTURE - At [**2142-6-1**] 10:24 PM', 'attempted but unsuccessful', ' MAGNETIC RESONANCE IMAGING - At [**2142-6-2**] 12:00 AM', 'MRA, MRI, pt unable to tolerate MRV', '- Surgery eval for SBO, NGT placed, rec NPO and serial abdominal', ""exams.  Patient d/c'd NGT overnight.""]",,109,102024.0
9,2142-06-02 11:20:16,,"['DIALYSIS CATHETER - START [**2142-6-1**] 08:00 PM', ' LUMBAR PUNCTURE - At [**2142-6-1**] 10:24 PM', 'attempted but unsuccessful', ' MAGNETIC RESONANCE IMAGING - At [**2142-6-2**] 12:00 AM', 'MRA, MRI, pt unable to tolerate MRV', '- Surgery eval for SBO, NGT placed, rec NPO and serial abdominal', ""exams.  Patient d/c'd NGT overnight.""]",,109,102024.0
10,2142-06-03 07:35:21,"['FEVER - 101.6', 'F - [**2142-6-2**] 08:00 AM', '- abdominal CT showed SBO', '- NGT placed, then pulled out, then replaced by surgery, then pulled', 'out this a.m.', '- continued keppra per neuro', '- started on heparin gtt', ""- called out but kept overnight b/c unable to tolerate PO's and high"", 'risk for flash pulm edema/htn urgency w/o po BP meds']","['FEVER - 101.6', 'F - [**2142-6-2**] 08:00 AM', '- abdominal CT showed SBO', '- NGT placed, then pulled out, then replaced by surgery, then pulled', 'out this a.m.', '- continued keppra per neuro', '- started on heparin gtt', ""- called out but kept overnight b/c unable to tolerate PO's and high"", 'risk for flash pulm edema/htn urgency w/o po BP meds']","['DIALYSIS CATHETER - START [**2142-6-1**] 08:00 PM', ' LUMBAR PUNCTURE - At [**2142-6-1**] 10:24 PM', 'attempted but unsuccessful', ' MAGNETIC RESONANCE IMAGING - At [**2142-6-2**] 12:00 AM', 'MRA, MRI, pt unable to tolerate MRV', '- Surgery eval for SBO, NGT placed, rec NPO and serial abdominal', ""exams.  Patient d/c'd NGT overnight.""]",109,102024.0
11,2142-06-03 11:21:42,,"['FEVER - 101.6', 'F - [**2142-6-2**] 08:00 AM', '- abdominal CT showed SBO', '- NGT placed, then pulled out, then replaced by surgery, then pulled', 'out this a.m.', '- continued keppra per neuro', '- started on heparin gtt', ""- called out but kept overnight b/c unable to tolerate PO's and high"", 'risk for flash pulm edema/htn urgency w/o po BP meds']",,109,102024.0
12,2142-06-03 11:22:58,,"['FEVER - 101.6', 'F - [**2142-6-2**] 08:00 AM', '- abdominal CT showed SBO', '- NGT placed, then pulled out, then replaced by surgery, then pulled', 'out this a.m.', '- continued keppra per neuro', '- started on heparin gtt', ""- called out but kept overnight b/c unable to tolerate PO's and high"", 'risk for flash pulm edema/htn urgency w/o po BP meds']",,109,102024.0
0,2142-07-04 00:45:50,,['SBP down to 100s overnight and currently holding BP meds'],,109,174489.0
1,2142-07-04 01:03:31,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving']","['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving']",['SBP down to 100s overnight and currently holding BP meds'],109,174489.0
2,2142-07-04 01:06:52,"['- occasional c/o emesis, with dry heaving resolved with zofran']","['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']","['- occasional c/o emesis, with dry heaving']",109,174489.0
3,2142-07-04 01:10:56,,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",,109,174489.0
4,2142-07-04 01:12:41,,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",,109,174489.0
5,2142-07-04 01:14:17,,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",,109,174489.0
6,2142-07-04 02:12:36,,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",,109,174489.0
7,2142-07-04 02:40:46,,"['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",,109,174489.0
8,2142-07-04 07:49:13,"['- SBP down to 100s overnight while on nitro and labetalol gtt', ' BP meds', 'have been on hold.', '- overnight, c/o nausea x 1, with dry heaving, resolved with zofran.', '- no concerns this AM.', '- plan for HD today, as per renal.']","['- SBP down to 100s overnight while on nitro and labetalol gtt', ' BP meds', 'have been on hold.', '- overnight, c/o nausea x 1, with dry heaving, resolved with zofran.', '- no concerns this AM.', '- plan for HD today, as per renal.']","['- SBP down to 100s overnight and currently holding BP meds', '- occasional c/o emesis, with dry heaving resolved with zofran']",109,174489.0
9,2142-07-04 09:19:55,,"['- SBP down to 100s overnight while on nitro and labetalol gtt', ' BP meds', 'have been on hold.', '- overnight, c/o nausea x 1, with dry heaving, resolved with zofran.', '- no concerns this AM.', '- plan for HD today, as per renal.']",,109,174489.0
10,2142-07-04 09:41:02,,"['- SBP down to 100s overnight while on nitro and labetalol gtt', ' BP meds', 'have been on hold.', '- overnight, c/o nausea x 1, with dry heaving, resolved with zofran.', '- no concerns this AM.', '- plan for HD today, as per renal.']",,109,174489.0
0,2142-07-08 07:20:14,,"['TUNNELED (HICKMAN) LINE - START [**2142-7-7**] 07:00 PM', '[**7-7**]', '-Abd u/s shows acites.  NTD at this time regarding finding.', ""-CE's Trop at baseline"", ""-LFT's at baseline, AP mild elevation to 126 from baseline 110's"", '-Goa SBP ~160']",,109,131376.0
1,2142-07-08 10:24:00,['-Goal SBP ~160'],"['TUNNELED (HICKMAN) LINE - START [**2142-7-7**] 07:00 PM', '[**7-7**]', '-Abd u/s shows acites.  NTD at this time regarding finding.', ""-CE's Trop at baseline"", ""-LFT's at baseline, AP mild elevation to 126 from baseline 110's"", '-Goal SBP ~160']",['-Goa SBP ~160'],109,131376.0
2,2142-07-08 10:33:18,,"['TUNNELED (HICKMAN) LINE - START [**2142-7-7**] 07:00 PM', '[**7-7**]', '-Abd u/s shows acites.  NTD at this time regarding finding.', ""-CE's Trop at baseline"", ""-LFT's at baseline, AP mild elevation to 126 from baseline 110's"", '-Goal SBP ~160']",,109,131376.0
0,2142-07-13 05:37:08,,"['- fever to 102.7 --> blood, urine, sputum cx sent', '- started on vanc and levofloxacin', '- blood pressure elevated to SBP > 180 at times']",,109,196721.0
1,2142-07-13 05:39:14,,"['- fever to 102.7 --> blood, urine, sputum cx sent', '- started on vanc and levofloxacin', '- blood pressure elevated to SBP > 180 at times']",,109,196721.0
2,2142-07-13 05:56:12,,"['- fever to 102.7 --> blood, urine, sputum cx sent', '- started on vanc and levofloxacin', '- blood pressure elevated to SBP > 180 at times']",,109,196721.0
3,2142-07-13 10:58:10,"['- started on vanc and levofloxacin given fevers and ground glass', 'infiltrates on cxr']","['- fever to 102.7 --> blood, urine, sputum cx sent', '- started on vanc and levofloxacin given fevers and ground glass', 'infiltrates on cxr', '- blood pressure elevated to SBP > 180 at times']",['- started on vanc and levofloxacin'],109,196721.0
4,2142-07-14 07:55:11,,[],"['- fever to 102.7 --> blood, urine, sputum cx sent', '- started on vanc and levofloxacin given fevers and ground glass', 'infiltrates on cxr', '- blood pressure elevated to SBP > 180 at times']",109,196721.0
5,2142-07-14 07:56:28,,[],,109,196721.0
6,2142-07-14 07:57:08,,[],,109,196721.0
7,2142-07-14 08:01:24,,[],,109,196721.0
8,2142-07-14 08:18:09,,[],,109,196721.0
9,2142-07-14 18:01:54,,[],,109,196721.0
10,2142-07-15 06:03:40,"['- was going to get transferred to the floor today, but then increased', 'BP and pain in abdomen - given 10 mg labetalol IV and 0.5 mg dilaudid', 'IV', '-later in evening - pain still there but better - pt still hypertensive', 'and tachy - given another labetalol IV', '- gave another dose of labetalol in the am [**2-12**] still increased BP and', 'HR']","['- was going to get transferred to the floor today, but then increased', 'BP and pain in abdomen - given 10 mg labetalol IV and 0.5 mg dilaudid', 'IV', '-later in evening - pain still there but better - pt still hypertensive', 'and tachy - given another labetalol IV', '- gave another dose of labetalol in the am [**2-12**] still increased BP and', 'HR']",,109,196721.0
11,2142-07-15 06:24:18,,"['- was going to get transferred to the floor today, but then increased', 'BP and pain in abdomen - given 10 mg labetalol IV and 0.5 mg dilaudid', 'IV', '-later in evening - pain still there but better - pt still hypertensive', 'and tachy - given another labetalol IV', '- gave another dose of labetalol in the am [**2-12**] still increased BP and', 'HR']",,109,196721.0
12,2142-07-15 10:08:20,"['- Pt was going to get transferred to the floor yesterday, but then had', 'increased BP (to the 240', 's) and pain in abdomen - given 10 mg', 'labetalol IV and 0.5 mg dilaudid IV', 'and tachy - given another labetalol 10mg IV']","['- Pt was going to get transferred to the floor yesterday, but then had', 'increased BP (to the 240', 's) and pain in abdomen - given 10 mg', 'labetalol IV and 0.5 mg dilaudid IV', '-later in evening - pain still there but better - pt still hypertensive', 'and tachy - given another labetalol 10mg IV', '- gave another dose of labetalol in the am [**2-12**] still increased BP and', 'HR']","['- was going to get transferred to the floor today, but then increased', 'BP and pain in abdomen - given 10 mg labetalol IV and 0.5 mg dilaudid', 'IV', 'and tachy - given another labetalol IV']",109,196721.0
13,2142-07-18 08:05:41,"['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']","['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']","['- Pt was going to get transferred to the floor yesterday, but then had', 'increased BP (to the 240', 's) and pain in abdomen - given 10 mg', 'labetalol IV and 0.5 mg dilaudid IV', '-later in evening - pain still there but better - pt still hypertensive', 'and tachy - given another labetalol 10mg IV', '- gave another dose of labetalol in the am [**2-12**] still increased BP and', 'HR']",109,196721.0
14,2142-07-18 08:06:35,,"['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']",,109,196721.0
15,2142-07-18 08:53:38,,"['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']",,109,196721.0
16,2142-07-18 08:54:18,,"['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']",,109,196721.0
17,2142-07-18 14:32:15,,"['DIALYSIS CATHETER - START [**2142-7-17**] 08:00 AM', 'Pt had HD']",,109,196721.0
0,2142-08-14 08:10:37,,"['DIALYSIS CATHETER - START [**2142-8-13**] 08:47 AM', 'TUNNELED', ' TRANSTHORACIC ECHO - At [**2142-8-13**] 01:00 PM', 'TTE results - left atrium is mildly dilated, severe symmetric left', 'ventricular hypertrophy with normal cavity size and regional/global', 'systolic function (LVEF>55%). Right ventricular chamber size and free', 'wall motion are normal. No AS. Mild [1+] aortic regurgitation.', 'Significant pulmonic regurgitation is seen. The end-diastolic pulmonic', 'regurgitation velocity is increased suggesting pulmonary artery', 'diastolic hypertension. There is a small to moderate sized', 'circumferential pericardial effusion without echocardiographic signs of', 'tamponade.', 'CXR - Improving pulmonary']",,109,155726.0
1,2142-08-14 21:21:23,['tamponade. Infiltrative cardiomyopathy (due eg to amyloidosis).'],"['DIALYSIS CATHETER - START [**2142-8-13**] 08:47 AM', 'TUNNELED', ' TRANSTHORACIC ECHO - At [**2142-8-13**] 01:00 PM', 'TTE results - left atrium is mildly dilated, severe symmetric left', 'ventricular hypertrophy with normal cavity size and regional/global', 'systolic function (LVEF>55%). Right ventricular chamber size and free', 'wall motion are normal. No AS. Mild [1+] aortic regurgitation.', 'Significant pulmonic regurgitation is seen. The end-diastolic pulmonic', 'regurgitation velocity is increased suggesting pulmonary artery', 'diastolic hypertension. There is a small to moderate sized', 'circumferential pericardial effusion without echocardiographic signs of', 'tamponade. Infiltrative cardiomyopathy (due eg to amyloidosis).', 'CXR - Improving pulmonary']",['tamponade.'],109,155726.0
0,2142-08-29 06:45:28,,"['- AM potassium 6.0, EKG checked', '- HD this AM', ' EKG - At [**2142-8-28**] 09:31 PM', ' DIALYSIS CATHETER - START [**2142-8-28**] 09:44 PM', ' EKG - At [**2142-8-29**] 05:15 AM']",,109,189332.0
1,2142-08-29 10:02:54,,"['- AM potassium 6.0, EKG checked', '- HD this AM', ' EKG - At [**2142-8-28**] 09:31 PM', ' DIALYSIS CATHETER - START [**2142-8-28**] 09:44 PM', ' EKG - At [**2142-8-29**] 05:15 AM']",,109,189332.0
0,2170-01-08 07:29:48,,"['- Aline', '- Central line - RIGHT IJ', '- OG tube', '- Advanced ET tube 2 cm', '- Febrile to 101.1 --> started cooling blanket', '- Continued CTX, Levo, Vanco', '- K 6.3 --> Gave kayexelate', '- Aline accidentally removed while Nursing cleaning patient', '- Ordered RUQ U/s given elevated LFts with AMls']",,3250,171462.0
1,2170-01-08 07:39:32,"['- BMT - advised changing Vancomycin to Daptomycin to cover VRE,', 'Ambisome to Posaconazole, and Ciprfloxacin to Tobramycin for', 'Acanetabacter', '- Hypotension - responded fluid resusicitation prior to icu admission', '- Fever - Spiked to 102.9 o/n and responded to Tylenol', '- Picc line removed and extra peripheral placed. No Central line.']","['- BMT - advised changing Vancomycin to Daptomycin to cover VRE,', 'Ambisome to Posaconazole, and Ciprfloxacin to Tobramycin for', 'Acanetabacter', '- Hypotension - responded fluid resusicitation prior to icu admission', '- Fever - Spiked to 102.9 o/n and responded to Tylenol', '- Picc line removed and extra peripheral placed. No Central line.']","['- Aline', '- Central line - RIGHT IJ', '- OG tube', '- Advanced ET tube 2 cm', '- Febrile to 101.1 --> started cooling blanket', '- Continued CTX, Levo, Vanco', '- K 6.3 --> Gave kayexelate', '- Aline accidentally removed while Nursing cleaning patient', '- Ordered RUQ U/s given elevated LFts with AMls']",3250,171462.0
2,2170-01-08 11:53:05,,"['- BMT - advised changing Vancomycin to Daptomycin to cover VRE,', 'Ambisome to Posaconazole, and Ciprfloxacin to Tobramycin for', 'Acanetabacter', '- Hypotension - responded fluid resusicitation prior to icu admission', '- Fever - Spiked to 102.9 o/n and responded to Tylenol', '- Picc line removed and extra peripheral placed. No Central line.']",,3250,171462.0
3,2170-01-11 07:43:15,"['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']","['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']","['- BMT - advised changing Vancomycin to Daptomycin to cover VRE,', 'Ambisome to Posaconazole, and Ciprfloxacin to Tobramycin for', 'Acanetabacter', '- Hypotension - responded fluid resusicitation prior to icu admission', '- Fever - Spiked to 102.9 o/n and responded to Tylenol', '- Picc line removed and extra peripheral placed. No Central line.']",3250,171462.0
4,2170-01-11 07:51:15,,"['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']",,3250,171462.0
5,2170-01-11 07:52:46,,"['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']",,3250,171462.0
6,2170-01-11 11:57:14,,"['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']",,3250,171462.0
7,2170-02-15 06:09:53,"['- Patient had repeat head CT at 4 pm per neurosurg which was stable and', 'is ordered for a CT in the am per neurosurg.', ""- Heme-onc decided to hold today's chemo and in two day's will plan to"", 'give her the SCT.', ""- Plt in the 200's in the afternoon, INR < 1.3.  Plts 180's at night,"", 'INR', ""- Concern for aspiration today, made NPO.  Metoprolol dc'ed (was on"", '12.5 mg [**Hospital1 **]).  PPI changed to IV, other PO meds held.  S&S consult', 'ordered.']","['- Patient had repeat head CT at 4 pm per neurosurg which was stable and', 'is ordered for a CT in the am per neurosurg.', ""- Heme-onc decided to hold today's chemo and in two day's will plan to"", 'give her the SCT.', ""- Plt in the 200's in the afternoon, INR < 1.3.  Plts 180's at night,"", 'INR', ""- Concern for aspiration today, made NPO.  Metoprolol dc'ed (was on"", '12.5 mg [**Hospital1 **]).  PPI changed to IV, other PO meds held.  S&S consult', 'ordered.']","['- received 1.5 L NS prior to admission', '- started on lasix gtt with goal -500 cc', '- BMT - no recs; continue current management', '- ID - pulmonary bx; continue abx', '- i/o + 590 cc @ 2130 --> inc.d lasix rate to 3 /hr; 0400 -1.5 L -->', 'd/cd lasix gtt', '- Contact precautions for VRE']",3250,171462.0
8,2170-02-15 06:34:25,"['- Per neuro her SBP should be kept  120-160.', ""- Heme-onc decided to hold today's chemo and in two days will plan to"", 'INR <1.3', '- She had no acute changes overnight, but continues to look more', 'sleepy.']","['- Patient had repeat head CT at 4 pm per neurosurg which was stable and', 'is ordered for a CT in the am per neurosurg.', '- Per neuro her SBP should be kept  120-160.', ""- Heme-onc decided to hold today's chemo and in two days will plan to"", 'give her the SCT.', ""- Plt in the 200's in the afternoon, INR < 1.3.  Plts 180's at night,"", 'INR <1.3', ""- Concern for aspiration today, made NPO.  Metoprolol dc'ed (was on"", '12.5 mg [**Hospital1 **]).  PPI changed to IV, other PO meds held.  S&S consult', 'ordered.', '- She had no acute changes overnight, but continues to look more', 'sleepy.']","[""- Heme-onc decided to hold today's chemo and in two day's will plan to"", 'INR']",3250,171462.0
9,2170-02-15 09:48:33,,"['- Patient had repeat head CT at 4 pm per neurosurg which was stable and', 'is ordered for a CT in the am per neurosurg.', '- Per neuro her SBP should be kept  120-160.', ""- Heme-onc decided to hold today's chemo and in two days will plan to"", 'give her the SCT.', ""- Plt in the 200's in the afternoon, INR < 1.3.  Plts 180's at night,"", 'INR <1.3', ""- Concern for aspiration today, made NPO.  Metoprolol dc'ed (was on"", '12.5 mg [**Hospital1 **]).  PPI changed to IV, other PO meds held.  S&S consult', 'ordered.', '- She had no acute changes overnight, but continues to look more', 'sleepy.']",,3250,171462.0
0,2198-04-27 07:26:58,,"['ARTERIAL LINE - START [**2198-4-26**] 04:40 PM', ' MULTI LUMEN - START [**2198-4-26**] 04:40 PM', ' ARTERIAL LINE - START [**2198-4-26**] 10:00 PM', ' ARTERIAL LINE - STOP [**2198-4-26**] 10:13 PM']",,19833,120759.0
1,2198-04-27 10:03:53,,"['ARTERIAL LINE - START [**2198-4-26**] 04:40 PM', ' MULTI LUMEN - START [**2198-4-26**] 04:40 PM', ' ARTERIAL LINE - START [**2198-4-26**] 10:00 PM', ' ARTERIAL LINE - STOP [**2198-4-26**] 10:13 PM']",,19833,120759.0
2,2198-04-28 07:15:53,"['RADIATION THERAPY - At [**2198-4-27**] 02:00 PM', ' PICC LINE - START [**2198-4-27**] 03:41 PM', 'placed in ir', '- Had XRT/Mapping', '- Chest tube put out 250cc during day shift so did not put to water', 'seal during day - placed on water seal at 3AM in prep for AM CXR.', '- 3pm Lytes with Sodium of 148 - increased free water boluses.', '- PICC not done - will have to go to IR on Monday.', 'History obtained from Patient']","['RADIATION THERAPY - At [**2198-4-27**] 02:00 PM', ' PICC LINE - START [**2198-4-27**] 03:41 PM', 'placed in ir', '- Had XRT/Mapping', '- Chest tube put out 250cc during day shift so did not put to water', 'seal during day - placed on water seal at 3AM in prep for AM CXR.', '- 3pm Lytes with Sodium of 148 - increased free water boluses.', '- PICC not done - will have to go to IR on Monday.', 'History obtained from Patient']","['ARTERIAL LINE - START [**2198-4-26**] 04:40 PM', ' MULTI LUMEN - START [**2198-4-26**] 04:40 PM', ' ARTERIAL LINE - START [**2198-4-26**] 10:00 PM', ' ARTERIAL LINE - STOP [**2198-4-26**] 10:13 PM']",19833,120759.0
3,2198-04-28 11:32:49,,"['RADIATION THERAPY - At [**2198-4-27**] 02:00 PM', ' PICC LINE - START [**2198-4-27**] 03:41 PM', 'placed in ir', '- Had XRT/Mapping', '- Chest tube put out 250cc during day shift so did not put to water', 'seal during day - placed on water seal at 3AM in prep for AM CXR.', '- 3pm Lytes with Sodium of 148 - increased free water boluses.', '- PICC not done - will have to go to IR on Monday.', 'History obtained from Patient']",,19833,120759.0
4,2198-04-29 08:38:20,"['RADIATION THERAPY - At [**2198-4-28**] 08:05 AM', ' ARTERIAL LINE - STOP [**2198-4-28**] 11:07 AM', ' MULTI LUMEN - STOP [**2198-4-28**] 11:11 AM', ' CALLED OUT', ""-D/C'ed A-line, central line and NGT when tolerated diet"", '-called out']","['RADIATION THERAPY - At [**2198-4-28**] 08:05 AM', ' ARTERIAL LINE - STOP [**2198-4-28**] 11:07 AM', ' MULTI LUMEN - STOP [**2198-4-28**] 11:11 AM', ' CALLED OUT', ""-D/C'ed A-line, central line and NGT when tolerated diet"", '-called out']","['RADIATION THERAPY - At [**2198-4-27**] 02:00 PM', ' PICC LINE - START [**2198-4-27**] 03:41 PM', 'placed in ir', '- Had XRT/Mapping', '- Chest tube put out 250cc during day shift so did not put to water', 'seal during day - placed on water seal at 3AM in prep for AM CXR.', '- 3pm Lytes with Sodium of 148 - increased free water boluses.', '- PICC not done - will have to go to IR on Monday.', 'History obtained from Patient']",19833,120759.0
0,2117-10-03 07:06:42,,"['MICU RESIDENT HISTORY AND PHYSICAL', '.']",,95555,103704.0
1,2117-10-03 12:59:36,"['This morning, the patient', 's breathing is significantly more labored,', 'she is more dyspneic.  Still mentating well, but has difficulty', 'completing sentences.', 'There is radiographic worsening infiltrates in right upper and middle', 'lobes.', 'The patient is desatting into 80s on 50% humidified face mask.']","['This morning, the patient', 's breathing is significantly more labored,', 'she is more dyspneic.  Still mentating well, but has difficulty', 'completing sentences.', 'There is radiographic worsening infiltrates in right upper and middle', 'lobes.', 'The patient is desatting into 80s on 50% humidified face mask.']","['MICU RESIDENT HISTORY AND PHYSICAL', '.']",95555,103704.0
2,2117-10-04 07:45:57,"['INVASIVE VENTILATION - START [**2117-10-3**] 09:15 AM', ' ARTERIAL LINE - START [**2117-10-3**] 11:30 PM', '-Intubated yesterday AM  for respiratory failure', '-CT torso (w/o IV contrast) showed:', '1. Large L- pleural effusion, w/ near complete collapse and', 'consolidation of L-lungs', '2. Moderate-to-large R pleural effusion.', '3. Ascites, with diffuse nodularity of the peritoneum, suspicious for', 'peritoneal carcinomatosis.', '4. Mesenteric lymphadenopathy.', '5. Ill-defined lesion within the left lower pelvis, in the expected', 'location of the uterus and adnexa, with calcifications seen. The origin', 'and etiology of this lesion is unclear without intravenous contrast,', 'and could reflect a uterine fibroid, or adnexal lesion. This can be', 'correlated by ultrasound if clinically indicated.', '6. Prominence of the cecal and sigmoid colonic walls. Correlate with', 'colonoscopy findings.', '-Thoracentesis done (2300 mL off); chest tube placed to water seal', '-Renal recs: etiology of renal failure is pre-renal, can treat with', 'fluids; at high risk of transition to ATN; need to determine baseline', 'creatinine', '-Obtained outside records from [**Hospital3 **] (in chart) -', 'thoracentesis cultures negative to date', '-Will need gyn/onc consult', '-Placed left femoral a-line after failed attempts at both radial', 'arteries', '-Will need central line (so that right femoral central venous line can', ""be d/c'ed)"", '-Received multiple fluid boluses for decreased urine output', '-Vigileo showed cardiac index good, improved with fluid bolus of 1L,', 'urine output also improved with fluid bolus of 1 liter']","['INVASIVE VENTILATION - START [**2117-10-3**] 09:15 AM', ' ARTERIAL LINE - START [**2117-10-3**] 11:30 PM', '-Intubated yesterday AM  for respiratory failure', '-CT torso (w/o IV contrast) showed:', '1. Large L- pleural effusion, w/ near complete collapse and', 'consolidation of L-lungs', '2. Moderate-to-large R pleural effusion.', '3. Ascites, with diffuse nodularity of the peritoneum, suspicious for', 'peritoneal carcinomatosis.', '4. Mesenteric lymphadenopathy.', '5. Ill-defined lesion within the left lower pelvis, in the expected', 'location of the uterus and adnexa, with calcifications seen. The origin', 'and etiology of this lesion is unclear without intravenous contrast,', 'and could reflect a uterine fibroid, or adnexal lesion. This can be', 'correlated by ultrasound if clinically indicated.', '6. Prominence of the cecal and sigmoid colonic walls. Correlate with', 'colonoscopy findings.', '-Thoracentesis done (2300 mL off); chest tube placed to water seal', '-Renal recs: etiology of renal failure is pre-renal, can treat with', 'fluids; at high risk of transition to ATN; need to determine baseline', 'creatinine', '-Obtained outside records from [**Hospital3 **] (in chart) -', 'thoracentesis cultures negative to date', '-Will need gyn/onc consult', '-Placed left femoral a-line after failed attempts at both radial', 'arteries', '-Will need central line (so that right femoral central venous line can', ""be d/c'ed)"", '-Received multiple fluid boluses for decreased urine output', '-Vigileo showed cardiac index good, improved with fluid bolus of 1L,', 'urine output also improved with fluid bolus of 1 liter']","['This morning, the patient', 's breathing is significantly more labored,', 'she is more dyspneic.  Still mentating well, but has difficulty', 'completing sentences.', 'There is radiographic worsening infiltrates in right upper and middle', 'lobes.', 'The patient is desatting into 80s on 50% humidified face mask.']",95555,103704.0
3,2117-10-04 13:36:25,,"['INVASIVE VENTILATION - START [**2117-10-3**] 09:15 AM', ' ARTERIAL LINE - START [**2117-10-3**] 11:30 PM', '-Intubated yesterday AM  for respiratory failure', '-CT torso (w/o IV contrast) showed:', '1. Large L- pleural effusion, w/ near complete collapse and', 'consolidation of L-lungs', '2. Moderate-to-large R pleural effusion.', '3. Ascites, with diffuse nodularity of the peritoneum, suspicious for', 'peritoneal carcinomatosis.', '4. Mesenteric lymphadenopathy.', '5. Ill-defined lesion within the left lower pelvis, in the expected', 'location of the uterus and adnexa, with calcifications seen. The origin', 'and etiology of this lesion is unclear without intravenous contrast,', 'and could reflect a uterine fibroid, or adnexal lesion. This can be', 'correlated by ultrasound if clinically indicated.', '6. Prominence of the cecal and sigmoid colonic walls. Correlate with', 'colonoscopy findings.', '-Thoracentesis done (2300 mL off); chest tube placed to water seal', '-Renal recs: etiology of renal failure is pre-renal, can treat with', 'fluids; at high risk of transition to ATN; need to determine baseline', 'creatinine', '-Obtained outside records from [**Hospital3 **] (in chart) -', 'thoracentesis cultures negative to date', '-Will need gyn/onc consult', '-Placed left femoral a-line after failed attempts at both radial', 'arteries', '-Will need central line (so that right femoral central venous line can', ""be d/c'ed)"", '-Received multiple fluid boluses for decreased urine output', '-Vigileo showed cardiac index good, improved with fluid bolus of 1L,', 'urine output also improved with fluid bolus of 1 liter']",,95555,103704.0
4,2117-10-05 07:10:07,"['- hypercarbic resp acidosis on ABG, will up Vt', '- bolus 1 L NS, still on levophed/ vasopressin', '- re-site central line (fem to IJ) and fem art to radial', '- started TF today, nutrition recs are in!', '- ct zosyn, vanc per renal dosing recs (cr 2.1 today slightly improved)', '- gyn onc c/s', '- f/u OSH recs', '- need to fix central line (tried pulling it back 5cm and repositioning', 'but still not right- will try again in AM, pt has fem line working)', '- did not re-site fem a-line d/t possible extubation in AM, will try PS', '[**3-30**] sbt', '- d/c vigileo (vigi-who?) after re-siting or d/c-ing fem line']","['- hypercarbic resp acidosis on ABG, will up Vt', '- bolus 1 L NS, still on levophed/ vasopressin', '- re-site central line (fem to IJ) and fem art to radial', '- started TF today, nutrition recs are in!', '- ct zosyn, vanc per renal dosing recs (cr 2.1 today slightly improved)', '- gyn onc c/s', '- f/u OSH recs', '- need to fix central line (tried pulling it back 5cm and repositioning', 'but still not right- will try again in AM, pt has fem line working)', '- did not re-site fem a-line d/t possible extubation in AM, will try PS', '[**3-30**] sbt', '- d/c vigileo (vigi-who?) after re-siting or d/c-ing fem line']","['INVASIVE VENTILATION - START [**2117-10-3**] 09:15 AM', ' ARTERIAL LINE - START [**2117-10-3**] 11:30 PM', '-Intubated yesterday AM  for respiratory failure', '-CT torso (w/o IV contrast) showed:', '1. Large L- pleural effusion, w/ near complete collapse and', 'consolidation of L-lungs', '2. Moderate-to-large R pleural effusion.', '3. Ascites, with diffuse nodularity of the peritoneum, suspicious for', 'peritoneal carcinomatosis.', '4. Mesenteric lymphadenopathy.', '5. Ill-defined lesion within the left lower pelvis, in the expected', 'location of the uterus and adnexa, with calcifications seen. The origin', 'and etiology of this lesion is unclear without intravenous contrast,', 'and could reflect a uterine fibroid, or adnexal lesion. This can be', 'correlated by ultrasound if clinically indicated.', '6. Prominence of the cecal and sigmoid colonic walls. Correlate with', 'colonoscopy findings.', '-Thoracentesis done (2300 mL off); chest tube placed to water seal', '-Renal recs: etiology of renal failure is pre-renal, can treat with', 'fluids; at high risk of transition to ATN; need to determine baseline', 'creatinine', '-Obtained outside records from [**Hospital3 **] (in chart) -', 'thoracentesis cultures negative to date', '-Will need gyn/onc consult', '-Placed left femoral a-line after failed attempts at both radial', 'arteries', '-Will need central line (so that right femoral central venous line can', ""be d/c'ed)"", '-Received multiple fluid boluses for decreased urine output', '-Vigileo showed cardiac index good, improved with fluid bolus of 1L,', 'urine output also improved with fluid bolus of 1 liter']",95555,103704.0
5,2117-10-05 13:13:42,"['- Tidal volume was increased after the patient', 's left lung re-expanded', '- The patient received several IVF boluses, continued on levophed/', 'vasopressin', '- Tube feeds were started', '- Family meeting was held along with Ob/Gyn doctors to discuss', '[**Name5 (PTitle) 11392**]', '- New IJ CVL was placed, but was found to be in azygous v., was pulled', 'back, but is still not in proper position.  The patient continues to', 'have femoral CVL for now.', 'This AM, the pt. opens eyes, nods to voice command.  Denies having', 'pain.']","['- Tidal volume was increased after the patient', 's left lung re-expanded', '- The patient received several IVF boluses, continued on levophed/', 'vasopressin', '- Tube feeds were started', '- Family meeting was held along with Ob/Gyn doctors to discuss', '[**Name5 (PTitle) 11392**]', '- New IJ CVL was placed, but was found to be in azygous v., was pulled', 'back, but is still not in proper position.  The patient continues to', 'have femoral CVL for now.', 'This AM, the pt. opens eyes, nods to voice command.  Denies having', 'pain.']","['- hypercarbic resp acidosis on ABG, will up Vt', '- bolus 1 L NS, still on levophed/ vasopressin', '- re-site central line (fem to IJ) and fem art to radial', '- started TF today, nutrition recs are in!', '- ct zosyn, vanc per renal dosing recs (cr 2.1 today slightly improved)', '- gyn onc c/s', '- f/u OSH recs', '- need to fix central line (tried pulling it back 5cm and repositioning', 'but still not right- will try again in AM, pt has fem line working)', '- did not re-site fem a-line d/t possible extubation in AM, will try PS', '[**3-30**] sbt', '- d/c vigileo (vigi-who?) after re-siting or d/c-ing fem line']",95555,103704.0
6,2117-10-05 16:49:05,,"['- Tidal volume was increased after the patient', 's left lung re-expanded', '- The patient received several IVF boluses, continued on levophed/', 'vasopressin', '- Tube feeds were started', '- Family meeting was held along with Ob/Gyn doctors to discuss', '[**Name5 (PTitle) 11392**]', '- New IJ CVL was placed, but was found to be in azygous v., was pulled', 'back, but is still not in proper position.  The patient continues to', 'have femoral CVL for now.', 'This AM, the pt. opens eyes, nods to voice command.  Denies having', 'pain.']",,95555,103704.0
7,2117-10-06 07:28:43,"[""-Extubated, pressors d/c'd, mentating well."", '-However, later in PM, hypotensive to SBP of 70, continues to mentate', 'normally', '-Transiently responded to IVF boluses x3, but we did not want to', 'continue load the pt. with IVF as she was getting very edematous , and', 'there was concern about accumulation of pleural fluid, which would', 'likely require re-intubation.  The patient was re-started on Levophed.', '-ABG at 10pm: 7.35/39/92/22/-3', 'This AM, concern about oozing from a CVL as well as movement of CVL.', 'Re-stiched at a closer site to insertion.  Switched from Levophed to', 'Vasopressin due to concern over']","[""-Extubated, pressors d/c'd, mentating well."", '-However, later in PM, hypotensive to SBP of 70, continues to mentate', 'normally', '-Transiently responded to IVF boluses x3, but we did not want to', 'continue load the pt. with IVF as she was getting very edematous , and', 'there was concern about accumulation of pleural fluid, which would', 'likely require re-intubation.  The patient was re-started on Levophed.', '-ABG at 10pm: 7.35/39/92/22/-3', 'This AM, concern about oozing from a CVL as well as movement of CVL.', 'Re-stiched at a closer site to insertion.  Switched from Levophed to', 'Vasopressin due to concern over']","['- Tidal volume was increased after the patient', 's left lung re-expanded', '- The patient received several IVF boluses, continued on levophed/', 'vasopressin', '- Tube feeds were started', '- Family meeting was held along with Ob/Gyn doctors to discuss', '[**Name5 (PTitle) 11392**]', '- New IJ CVL was placed, but was found to be in azygous v., was pulled', 'back, but is still not in proper position.  The patient continues to', 'have femoral CVL for now.', 'This AM, the pt. opens eyes, nods to voice command.  Denies having', 'pain.']",95555,103704.0
8,2117-10-06 10:24:05,"['This AM, concern about leaking from a CVL as well as movement of CVL.', 'Vasopressin due to concern over  levophed leaking out / skin necrosis.']","[""-Extubated, pressors d/c'd, mentating well."", '-However, later in PM, hypotensive to SBP of 70, continues to mentate', 'normally', '-Transiently responded to IVF boluses x3, but we did not want to', 'continue load the pt. with IVF as she was getting very edematous , and', 'there was concern about accumulation of pleural fluid, which would', 'likely require re-intubation.  The patient was re-started on Levophed.', '-ABG at 10pm: 7.35/39/92/22/-3', 'This AM, concern about leaking from a CVL as well as movement of CVL.', 'Re-stiched at a closer site to insertion.  Switched from Levophed to', 'Vasopressin due to concern over  levophed leaking out / skin necrosis.']","['This AM, concern about oozing from a CVL as well as movement of CVL.', 'Vasopressin due to concern over']",95555,103704.0
9,2117-10-07 06:55:32,"['[ ]f/u micro data', '[**2117-9-29**] urine culture: <10K, mixed gram positive flora', '[ ]repeat cultures', '[ ]add differential to Hct', '[ ]give albumin rather than crystalloid to support BP', '[ ]f/u gyn/onc recs', '[ ]f/u cytology, path', '[ ]discuss diagnosis with patient - patient aware', '[ ]check vanc trough']","['[ ]f/u micro data', '[**2117-9-29**] urine culture: <10K, mixed gram positive flora', '[ ]repeat cultures', '[ ]add differential to Hct', '[ ]give albumin rather than crystalloid to support BP', '[ ]f/u gyn/onc recs', '[ ]f/u cytology, path', '[ ]discuss diagnosis with patient - patient aware', '[ ]check vanc trough']","[""-Extubated, pressors d/c'd, mentating well."", '-However, later in PM, hypotensive to SBP of 70, continues to mentate', 'normally', '-Transiently responded to IVF boluses x3, but we did not want to', 'continue load the pt. with IVF as she was getting very edematous , and', 'there was concern about accumulation of pleural fluid, which would', 'likely require re-intubation.  The patient was re-started on Levophed.', '-ABG at 10pm: 7.35/39/92/22/-3', 'This AM, concern about leaking from a CVL as well as movement of CVL.', 'Re-stiched at a closer site to insertion.  Switched from Levophed to', 'Vasopressin due to concern over  levophed leaking out / skin necrosis.']",95555,103704.0
10,2117-10-07 17:11:20,"['Vanc level was 17.1.  The patient received 1g of Vanco at 1:00.', 'The patient remains on a small dose of Levophed.  This AM, she', 'complains of not being able to sleep, but otherwise states she feels a', 'little better.  Pain is under control.  No abdominal pain at this', 'point.']","['Vanc level was 17.1.  The patient received 1g of Vanco at 1:00.', 'The patient remains on a small dose of Levophed.  This AM, she', 'complains of not being able to sleep, but otherwise states she feels a', 'little better.  Pain is under control.  No abdominal pain at this', 'point.']","['[ ]f/u micro data', '[**2117-9-29**] urine culture: <10K, mixed gram positive flora', '[ ]repeat cultures', '[ ]add differential to Hct', '[ ]give albumin rather than crystalloid to support BP', '[ ]f/u gyn/onc recs', '[ ]f/u cytology, path', '[ ]discuss diagnosis with patient - patient aware', '[ ]check vanc trough']",95555,103704.0
11,2117-10-08 07:05:08,"['Off pressors', 'D/c central line- leaking (pulled at 2300)', 'PICC consult in', 'c/o in AM', 'Dr [**Last Name (STitle) 3080**] met w/ family re: code status, she is DNR (chest compressions', 'no?) but can be intubated for short periods of time', 'Got a baby dose of Ativan for sleep.']","['Off pressors', 'D/c central line- leaking (pulled at 2300)', 'PICC consult in', 'c/o in AM', 'Dr [**Last Name (STitle) 3080**] met w/ family re: code status, she is DNR (chest compressions', 'no?) but can be intubated for short periods of time', 'Got a baby dose of Ativan for sleep.']","['Vanc level was 17.1.  The patient received 1g of Vanco at 1:00.', 'The patient remains on a small dose of Levophed.  This AM, she', 'complains of not being able to sleep, but otherwise states she feels a', 'little better.  Pain is under control.  No abdominal pain at this', 'point.']",95555,103704.0
12,2117-10-08 13:18:19,"['The patient is maintaining BPs off pressors.', 'CVL was leaking and was d/c', 'd at 2300.  She will get a new PICC in AM.', 'Dr [**Last Name (STitle) 3080**] met w/ patient and family re: code status.  She is now DNR', 'but can be intubated for short periods of time', 'Got a small dose of Ativan for sleep this AM.', 'This AM, pt. reports breathing better.  States her pain is under', 'control.']","['The patient is maintaining BPs off pressors.', 'CVL was leaking and was d/c', 'd at 2300.  She will get a new PICC in AM.', 'Dr [**Last Name (STitle) 3080**] met w/ patient and family re: code status.  She is now DNR', 'but can be intubated for short periods of time', 'Got a small dose of Ativan for sleep this AM.', 'This AM, pt. reports breathing better.  States her pain is under', 'control.']","['Off pressors', 'D/c central line- leaking (pulled at 2300)', 'PICC consult in', 'c/o in AM', 'Dr [**Last Name (STitle) 3080**] met w/ family re: code status, she is DNR (chest compressions', 'no?) but can be intubated for short periods of time', 'Got a baby dose of Ativan for sleep.']",95555,103704.0
0,2143-12-24 06:58:55,,"['A fib o/n', 'Diuresis', 'Replacing lytes']",,84952,176926.0
1,2143-12-24 11:07:59,"['Pt. being diuresed yesterday with good effect.  She is remained', 'asymptomatic, free of chest pain or shortness of breath, denies n/v,', 'diaphoresis.  She was in A fib o/n, in and out.  Require lytes', 'replacement.  Amiodarone decreased to 0.5mg/min.']","['Pt. being diuresed yesterday with good effect.  She is remained', 'asymptomatic, free of chest pain or shortness of breath, denies n/v,', 'diaphoresis.  She was in A fib o/n, in and out.  Require lytes', 'replacement.  Amiodarone decreased to 0.5mg/min.']","['A fib o/n', 'Diuresis', 'Replacing lytes']",84952,176926.0
2,2143-12-25 05:44:02,"[""The patient's amiodarone was stopped.  She had afib with RVR with rates"", ""in the 130's to 140's in the afternoon.  She was given 5 mg IV"", 'metoprolol x 1 and her po metoprolol was increased to 25 mg po tid.', 'Her K was repleted.  She converted back into NSR with the metoprolol.', 'CTsurg was contact[**Name (NI) **] to evaluate her for CABG.  Her UA ordered by', 'CTSurg for CABG workup returned with 3-5 WBC, tr leuk and mod bact (no', 'Ucx sent).  Will recheck UA and send UCx.', 'TTE showed  Suboptimal image quality. Mild distal septal and apical', 'hypokinesis with preserved left ventricular ejection fraction, EF of', '45-50% vs 55% (discordant in the report). Mild pulmonary hypertension.', ' EKG - At [**2143-12-24**] 08:00 AM', ' EKG - At [**2143-12-24**] 05:30 PM', 'conversion to SR', ' URINE CULTURE - At [**2143-12-24**] 05:43 PM']","[""The patient's amiodarone was stopped.  She had afib with RVR with rates"", ""in the 130's to 140's in the afternoon.  She was given 5 mg IV"", 'metoprolol x 1 and her po metoprolol was increased to 25 mg po tid.', 'Her K was repleted.  She converted back into NSR with the metoprolol.', 'CTsurg was contact[**Name (NI) **] to evaluate her for CABG.  Her UA ordered by', 'CTSurg for CABG workup returned with 3-5 WBC, tr leuk and mod bact (no', 'Ucx sent).  Will recheck UA and send UCx.', 'TTE showed  Suboptimal image quality. Mild distal septal and apical', 'hypokinesis with preserved left ventricular ejection fraction, EF of', '45-50% vs 55% (discordant in the report). Mild pulmonary hypertension.', ' EKG - At [**2143-12-24**] 08:00 AM', ' EKG - At [**2143-12-24**] 05:30 PM', 'conversion to SR', ' URINE CULTURE - At [**2143-12-24**] 05:43 PM']","['Pt. being diuresed yesterday with good effect.  She is remained', 'asymptomatic, free of chest pain or shortness of breath, denies n/v,', 'diaphoresis.  She was in A fib o/n, in and out.  Require lytes', 'replacement.  Amiodarone decreased to 0.5mg/min.']",84952,176926.0
3,2143-12-25 06:20:15,['Ucx sent).  Will recheck UA and send UCx'],"[""The patient's amiodarone was stopped.  She had afib with RVR with rates"", ""in the 130's to 140's in the afternoon.  She was given 5 mg IV"", 'metoprolol x 1 and her po metoprolol was increased to 25 mg po tid.', 'Her K was repleted.  She converted back into NSR with the metoprolol.', 'CTsurg was contact[**Name (NI) **] to evaluate her for CABG.  Her UA ordered by', 'CTSurg for CABG workup returned with 3-5 WBC, tr leuk and mod bact (no', 'Ucx sent).  Will recheck UA and send UCx']","['Ucx sent).  Will recheck UA and send UCx.', 'TTE showed  Suboptimal image quality. Mild distal septal and apical', 'hypokinesis with preserved left ventricular ejection fraction, EF of', '45-50% vs 55% (discordant in the report). Mild pulmonary hypertension.', ' EKG - At [**2143-12-24**] 08:00 AM', ' EKG - At [**2143-12-24**] 05:30 PM', 'conversion to SR', ' URINE CULTURE - At [**2143-12-24**] 05:43 PM']",84952,176926.0
4,2143-12-25 15:57:20,"['CTsurg was contact[**Name (NI) **] to evaluate her for CABG.', 'She denies SOB, CP, dizziness or lightheadedness.  Walked OOB to', 'commode.']","[""The patient's amiodarone was stopped.  She had afib with RVR with rates"", ""in the 130's to 140's in the afternoon.  She was given 5 mg IV"", 'metoprolol x 1 and her po metoprolol was increased to 25 mg po tid.', 'Her K was repleted.  She converted back into NSR with the metoprolol.', 'CTsurg was contact[**Name (NI) **] to evaluate her for CABG.', 'She denies SOB, CP, dizziness or lightheadedness.  Walked OOB to', 'commode.']","['CTsurg was contact[**Name (NI) **] to evaluate her for CABG.  Her UA ordered by', 'CTSurg for CABG workup returned with 3-5 WBC, tr leuk and mod bact (no', 'Ucx sent).  Will recheck UA and send UCx']",84952,176926.0
5,2143-12-25 17:13:20,,"[""The patient's amiodarone was stopped.  She had afib with RVR with rates"", ""in the 130's to 140's in the afternoon.  She was given 5 mg IV"", 'metoprolol x 1 and her po metoprolol was increased to 25 mg po tid.', 'Her K was repleted.  She converted back into NSR with the metoprolol.', 'CTsurg was contact[**Name (NI) **] to evaluate her for CABG.', 'She denies SOB, CP, dizziness or lightheadedness.  Walked OOB to', 'commode.']",,84952,176926.0
0,2179-03-01 14:22:49,,"['PICC LINE - START [**2179-2-28**] 06:38 PM', 'placed approximately in [**Month (only) **]', ' URINE CULTURE - At [**2179-2-28**] 10:15 PM', ' PICC LINE - STOP [**2179-3-1**] 04:37 AM', 'placed approximately in [**Month (only) **]']",,28999,128539.0
1,2179-03-01 14:26:01,,"['PICC LINE - START [**2179-2-28**] 06:38 PM', 'placed approximately in [**Month (only) **]', ' URINE CULTURE - At [**2179-2-28**] 10:15 PM', ' PICC LINE - STOP [**2179-3-1**] 04:37 AM', 'placed approximately in [**Month (only) **]']",,28999,128539.0
0,2146-05-13 06:56:54,,"['- fever downtrending, CK peaked at 3082', '- metoprolol increased, then decreased', '- started hydralazine PRN', '- reduced dantrolene dose per pharmacy', '- intubated for airway protection', '- tox c/s - suggested paralysis (cisatracurium), deferred as CK', 'downtrending', '- EEG - no seizure', '- right radial a-line placed', '- TTE - LVEF 45%, infero-lateral akinesis, [**11-26**]+ MR', '- EKG - QTc 457', '- CT: Hypodensity in right frontal lobe, consider MRI w gad for further', 'eval']",,42811,154794.0
1,2146-05-13 07:31:41,,"['- fever downtrending, CK peaked at 3082', '- metoprolol increased, then decreased', '- started hydralazine PRN', '- reduced dantrolene dose per pharmacy', '- intubated for airway protection', '- tox c/s - suggested paralysis (cisatracurium), deferred as CK', 'downtrending', '- right radial a-line placed']","['- EEG - no seizure', '- TTE - LVEF 45%, infero-lateral akinesis, [**11-26**]+ MR', '- EKG - QTc 457', '- CT: Hypodensity in right frontal lobe, consider MRI w gad for further', 'eval']",42811,154794.0
2,2146-05-13 10:06:31,,"['- fever downtrending, CK peaked at 3082', '- metoprolol increased, then decreased', '- started hydralazine PRN', '- reduced dantrolene dose per pharmacy', '- intubated for airway protection', '- tox c/s - suggested paralysis (cisatracurium), deferred as CK', 'downtrending', '- right radial a-line placed']",,42811,154794.0
3,2146-05-14 07:40:18,"['- had a trial of decreased propofol to 20, pt then had tremors and', 'increased stiffness on right side, raised propofol back to 40 and did', 'not decrease dantrolene dose (kept at 150)', '- CK trending down', '- stopped benadryl', '- started tube feeds']","['- had a trial of decreased propofol to 20, pt then had tremors and', 'increased stiffness on right side, raised propofol back to 40 and did', 'not decrease dantrolene dose (kept at 150)', '- CK trending down', '- stopped benadryl', '- started tube feeds']","['- fever downtrending, CK peaked at 3082', '- metoprolol increased, then decreased', '- started hydralazine PRN', '- reduced dantrolene dose per pharmacy', '- intubated for airway protection', '- tox c/s - suggested paralysis (cisatracurium), deferred as CK', 'downtrending', '- right radial a-line placed']",42811,154794.0
4,2146-05-14 10:14:14,,"['- had a trial of decreased propofol to 20, pt then had tremors and', 'increased stiffness on right side, raised propofol back to 40 and did', 'not decrease dantrolene dose (kept at 150)', '- CK trending down', '- stopped benadryl', '- started tube feeds']",,42811,154794.0
5,2146-05-15 07:25:17,"['PAN CULTURE - At [**2146-5-15**] 12:02 AM', ' FEVER - 101.5', 'F - [**2146-5-15**] 12:00 AM', '- increased metoprolol to 25 PO TID', '- tolerated PS 12/5, off propofol trial', '- extra hydralazine dose for hypertension']","['PAN CULTURE - At [**2146-5-15**] 12:02 AM', ' FEVER - 101.5', 'F - [**2146-5-15**] 12:00 AM', '- increased metoprolol to 25 PO TID', '- tolerated PS 12/5, off propofol trial', '- CK trending down', '- extra hydralazine dose for hypertension']","['- had a trial of decreased propofol to 20, pt then had tremors and', 'increased stiffness on right side, raised propofol back to 40 and did', 'not decrease dantrolene dose (kept at 150)', '- stopped benadryl', '- started tube feeds']",42811,154794.0
6,2146-05-15 10:14:12,,"['- increased metoprolol to 25 PO TID', '- tolerated PS 12/5, off propofol trial', '- CK trending down', '- extra hydralazine dose for hypertension']","['PAN CULTURE - At [**2146-5-15**] 12:02 AM', ' FEVER - 101.5', 'F - [**2146-5-15**] 12:00 AM']",42811,154794.0
7,2146-05-16 07:13:37,"['SPUTUM CULTURE - At [**2146-5-15**] 10:30 AM', '- when off propofol, no improvement in mental status', '- spiked, tan sputum -> started Vanc/Zosyn for VAP, sputum sent', '- PICC by IR tomorrow', '- Based on ABGs -> decreased FiO2 to 30%, PSV 10/5 (did not tolerate', '[**3-29**])', '- No neuro recs', '- Na 131 -> lytes, osmo and exam consistent with hypervol hypoNa', '(dantrolene mixed in free water)', '- Stopped Dantrolene following discussion with tox']","['SPUTUM CULTURE - At [**2146-5-15**] 10:30 AM', '- when off propofol, no improvement in mental status', '- spiked, tan sputum -> started Vanc/Zosyn for VAP, sputum sent', '- PICC by IR tomorrow', '- Based on ABGs -> decreased FiO2 to 30%, PSV 10/5 (did not tolerate', '[**3-29**])', '- No neuro recs', '- Na 131 -> lytes, osmo and exam consistent with hypervol hypoNa', '(dantrolene mixed in free water)', '- Stopped Dantrolene following discussion with tox']","['- increased metoprolol to 25 PO TID', '- tolerated PS 12/5, off propofol trial', '- CK trending down', '- extra hydralazine dose for hypertension']",42811,154794.0
8,2146-05-16 08:28:09,,"['SPUTUM CULTURE - At [**2146-5-15**] 10:30 AM', '- when off propofol, no improvement in mental status', '- spiked, tan sputum -> started Vanc/Zosyn for VAP, sputum sent', '- PICC by IR tomorrow', '- Based on ABGs -> decreased FiO2 to 30%, PSV 10/5 (did not tolerate', '[**3-29**])', '- No neuro recs', '- Na 131 -> lytes, osmo and exam consistent with hypervol hypoNa', '(dantrolene mixed in free water)', '- Stopped Dantrolene following discussion with tox']",,42811,154794.0
9,2146-05-16 10:46:48,,"['SPUTUM CULTURE - At [**2146-5-15**] 10:30 AM', '- when off propofol, no improvement in mental status', '- spiked, tan sputum -> started Vanc/Zosyn for VAP, sputum sent', '- PICC by IR tomorrow', '- Based on ABGs -> decreased FiO2 to 30%, PSV 10/5 (did not tolerate', '[**3-29**])', '- No neuro recs', '- Na 131 -> lytes, osmo and exam consistent with hypervol hypoNa', '(dantrolene mixed in free water)', '- Stopped Dantrolene following discussion with tox']",,42811,154794.0
10,2146-05-17 06:12:13,"['- became more arrousable, sometimes interactive', '- less movement on left side of body, per neuro will order MRI/MRA head', 'when more stable', '- PICC line will be placed by IR on [**5-17**]', '- plan for extuabtion in AM on [**5-17**], after SBT', '- started back on dantrolene since CK was 1210, then in PM was 724', '- remained off propofol, PRN fentnyl boluses']","['- became more arrousable, sometimes interactive', '- less movement on left side of body, per neuro will order MRI/MRA head', 'when more stable', '- PICC line will be placed by IR on [**5-17**]', '- plan for extuabtion in AM on [**5-17**], after SBT', '- started back on dantrolene since CK was 1210, then in PM was 724', '- remained off propofol, PRN fentnyl boluses']","['SPUTUM CULTURE - At [**2146-5-15**] 10:30 AM', '- when off propofol, no improvement in mental status', '- spiked, tan sputum -> started Vanc/Zosyn for VAP, sputum sent', '- PICC by IR tomorrow', '- Based on ABGs -> decreased FiO2 to 30%, PSV 10/5 (did not tolerate', '[**3-29**])', '- No neuro recs', '- Na 131 -> lytes, osmo and exam consistent with hypervol hypoNa', '(dantrolene mixed in free water)', '- Stopped Dantrolene following discussion with tox']",42811,154794.0
11,2146-05-17 06:13:53,,"['- became more arrousable, sometimes interactive', '- less movement on left side of body, per neuro will order MRI/MRA head', 'when more stable', '- PICC line will be placed by IR on [**5-17**]', '- plan for extuabtion in AM on [**5-17**], after SBT', '- started back on dantrolene since CK was 1210, then in PM was 724', '- remained off propofol, PRN fentnyl boluses']",,42811,154794.0
12,2146-05-17 14:31:54,"['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities']","['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities', '- PICC line will be placed by IR on [**5-17**]', '- started back on dantrolene since CK was 1210, then in PM was 724', '- remained off propofol, PRN fentnyl boluses']","['- became more arrousable, sometimes interactive', '- less movement on left side of body, per neuro will order MRI/MRA head', 'when more stable', '- plan for extuabtion in AM on [**5-17**], after SBT']",42811,154794.0
13,2146-05-17 15:16:10,"['-nurses with difficulty accessing current lines', '-started back on dantrolene since CK was 1210, then in PM was 724', '-remained off propofol, PRN fentanyl boluses']","['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities', '-nurses with difficulty accessing current lines', '-started back on dantrolene since CK was 1210, then in PM was 724', '-remained off propofol, PRN fentanyl boluses']","['- PICC line will be placed by IR on [**5-17**]', '- started back on dantrolene since CK was 1210, then in PM was 724', '- remained off propofol, PRN fentnyl boluses']",42811,154794.0
14,2146-05-17 15:18:40,,"['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities', '-nurses with difficulty accessing current lines', '-started back on dantrolene since CK was 1210, then in PM was 724', '-remained off propofol, PRN fentanyl boluses']",,42811,154794.0
15,2146-05-17 15:45:25,,"['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities', '-nurses with difficulty accessing current lines', '-started back on dantrolene since CK was 1210, then in PM was 724', '-remained off propofol, PRN fentanyl boluses']",,42811,154794.0
16,2146-05-18 05:43:14,"['INVASIVE VENTILATION - STOP [**2146-5-17**] 09:16 AM', ' ANGIOGRAPHY - At [**2146-5-17**] 02:00 PM', 'To IR for PICC insertion.', ' EKG - At [**2146-5-17**] 03:50 PM', ' EKG - At [**2146-5-17**] 03:55 PM', ' PICC LINE - START [**2146-5-17**] 04:23 PM', ' EKG - At [**2146-5-17**] 07:42 PM', ' EKG - At [**2146-5-18**] 03:20 AM', ' ARTERIAL LINE - STOP [**2146-5-18**] 04:48 AM', '[**5-17**]', '-extubated without complication', '-developed afib with RVR prior to picc placement, rate did not respond', 'to metoprolol, therefore started on dilt drip at 10 mg/hr, increased to', '15 mg/hr with no significant response, therefore amiodarone drip', 'started.  Later EKG suggests aflutter.', '-PICC placed', '-tox recommended holding dantrolene given clinical improvement.  Pts', 'weakness improved and CK continues to trend down.', '-sodium stable', '-given additional lopressor 5 mg IV X 1 for HR to 180s at 0300. SBP', '160s, pt assymptomatic. ekg with afib with rvr. started digoxin load.', '-pt pulled art line']","['INVASIVE VENTILATION - STOP [**2146-5-17**] 09:16 AM', ' ANGIOGRAPHY - At [**2146-5-17**] 02:00 PM', 'To IR for PICC insertion.', ' EKG - At [**2146-5-17**] 03:50 PM', ' EKG - At [**2146-5-17**] 03:55 PM', ' PICC LINE - START [**2146-5-17**] 04:23 PM', ' EKG - At [**2146-5-17**] 07:42 PM', ' EKG - At [**2146-5-18**] 03:20 AM', ' ARTERIAL LINE - STOP [**2146-5-18**] 04:48 AM', '[**5-17**]', '-extubated without complication', '-developed afib with RVR prior to picc placement, rate did not respond', 'to metoprolol, therefore started on dilt drip at 10 mg/hr, increased to', '15 mg/hr with no significant response, therefore amiodarone drip', 'started.  Later EKG suggests aflutter.', '-PICC placed', '-tox recommended holding dantrolene given clinical improvement.  Pts', 'weakness improved and CK continues to trend down.', '-sodium stable', '-given additional lopressor 5 mg IV X 1 for HR to 180s at 0300. SBP', '160s, pt assymptomatic. ekg with afib with rvr. started digoxin load.', '-pt pulled art line']","['-pt extubated', '-neuro status improving, pt responsive and able to move all four', 'extremities', '-nurses with difficulty accessing current lines', '-started back on dantrolene since CK was 1210, then in PM was 724', '-remained off propofol, PRN fentanyl boluses']",42811,154794.0
17,2146-05-18 06:35:31,,"['INVASIVE VENTILATION - STOP [**2146-5-17**] 09:16 AM', ' ANGIOGRAPHY - At [**2146-5-17**] 02:00 PM', 'To IR for PICC insertion.', ' EKG - At [**2146-5-17**] 03:50 PM', ' EKG - At [**2146-5-17**] 03:55 PM', ' PICC LINE - START [**2146-5-17**] 04:23 PM', ' EKG - At [**2146-5-17**] 07:42 PM', ' EKG - At [**2146-5-18**] 03:20 AM', ' ARTERIAL LINE - STOP [**2146-5-18**] 04:48 AM', '[**5-17**]', '-extubated without complication', '-developed afib with RVR prior to picc placement, rate did not respond', 'to metoprolol, therefore started on dilt drip at 10 mg/hr, increased to', '15 mg/hr with no significant response, therefore amiodarone drip', 'started.  Later EKG suggests aflutter.', '-PICC placed', '-tox recommended holding dantrolene given clinical improvement.  Pts', 'weakness improved and CK continues to trend down.', '-sodium stable', '-given additional lopressor 5 mg IV X 1 for HR to 180s at 0300. SBP', '160s, pt assymptomatic. ekg with afib with rvr. started digoxin load.', '-pt pulled art line']",,42811,154794.0
18,2146-05-18 15:59:27,"['-extubated without complication [**5-17**]', 'started.  Later EKG suggests aflutter. Given additional lopressor 5 mg', 'IV X 1 for HR to 180s at 0300. SBP 160s, pt assymptomatic. ekg with', 'afib with rvr. started digoxin load.', '-pt agitated with waxing and [**Doctor Last Name 533**] consciousness, pulled art line', '-RU extremity erythema and induration: thrombophlebitis vs. DVT. Assess', 'with RU extremity Doppler', '-Cardiology consulted for possible cardioversion of new onset atrial', 'flutter.  Started on heparin for anticoagulation, stopped digoxin as', 'per cardiology request.  Cardioversion planned for this pm or tomorrow', 'am']","['-extubated without complication [**5-17**]', '-developed afib with RVR prior to picc placement, rate did not respond', 'to metoprolol, therefore started on dilt drip at 10 mg/hr, increased to', '15 mg/hr with no significant response, therefore amiodarone drip', 'started.  Later EKG suggests aflutter. Given additional lopressor 5 mg', 'IV X 1 for HR to 180s at 0300. SBP 160s, pt assymptomatic. ekg with', 'afib with rvr. started digoxin load.', '-PICC placed', '-tox recommended holding dantrolene given clinical improvement.  Pts', 'weakness improved and CK continues to trend down.', '-sodium stable', '-pt agitated with waxing and [**Doctor Last Name 533**] consciousness, pulled art line', '-RU extremity erythema and induration: thrombophlebitis vs. DVT. Assess', 'with RU extremity Doppler', '-Cardiology consulted for possible cardioversion of new onset atrial', 'flutter.  Started on heparin for anticoagulation, stopped digoxin as', 'per cardiology request.  Cardioversion planned for this pm or tomorrow', 'am']","['INVASIVE VENTILATION - STOP [**2146-5-17**] 09:16 AM', ' ANGIOGRAPHY - At [**2146-5-17**] 02:00 PM', 'To IR for PICC insertion.', ' EKG - At [**2146-5-17**] 03:50 PM', ' EKG - At [**2146-5-17**] 03:55 PM', ' PICC LINE - START [**2146-5-17**] 04:23 PM', ' EKG - At [**2146-5-17**] 07:42 PM', ' EKG - At [**2146-5-18**] 03:20 AM', ' ARTERIAL LINE - STOP [**2146-5-18**] 04:48 AM', '[**5-17**]', '-extubated without complication', 'started.  Later EKG suggests aflutter.', '-given additional lopressor 5 mg IV X 1 for HR to 180s at 0300. SBP', '160s, pt assymptomatic. ekg with afib with rvr. started digoxin load.', '-pt pulled art line']",42811,154794.0
19,2146-05-19 06:21:49,"['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. none since.', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']","['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. none since.', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']","['-extubated without complication [**5-17**]', '-developed afib with RVR prior to picc placement, rate did not respond', 'to metoprolol, therefore started on dilt drip at 10 mg/hr, increased to', '15 mg/hr with no significant response, therefore amiodarone drip', 'started.  Later EKG suggests aflutter. Given additional lopressor 5 mg', 'IV X 1 for HR to 180s at 0300. SBP 160s, pt assymptomatic. ekg with', 'afib with rvr. started digoxin load.', '-PICC placed', '-tox recommended holding dantrolene given clinical improvement.  Pts', 'weakness improved and CK continues to trend down.', '-sodium stable', '-pt agitated with waxing and [**Doctor Last Name 533**] consciousness, pulled art line', '-RU extremity erythema and induration: thrombophlebitis vs. DVT. Assess', 'with RU extremity Doppler', '-Cardiology consulted for possible cardioversion of new onset atrial', 'flutter.  Started on heparin for anticoagulation, stopped digoxin as', 'per cardiology request.  Cardioversion planned for this pm or tomorrow', 'am']",42811,154794.0
20,2146-05-19 06:23:26,,"['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. none since.', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']",,42811,154794.0
21,2146-05-19 06:54:09,,"['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. none since.', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']",,42811,154794.0
22,2146-05-19 11:58:55,,"['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. none since.', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']",,42811,154794.0
23,2146-05-19 15:41:16,"['CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 joules with cardiology and ho attending. pt.', 'burst of af (6) beats. Remained in sinus rhythym', '-maintained on heparin and amio drip, to go home on ASA and coumadin', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 2, labetolol IV x 1: patient', 'asymptomatic denied symptoms of end organ dysfunction']","['CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 joules with cardiology and ho attending. pt.', ""converted from atrial flutter to nsr rate in 80's. occ. pac's and 1"", 'burst of af (6) beats. Remained in sinus rhythym', 'pt. given 50mcqs of propofol by anaesthesia. RN in attendance as well.', 'vss.', '-maintained on heparin and amio drip, to go home on ASA and coumadin', '-delerium, restraints ordered', '-swallow study consult placed to eval for aspiration risk, minimal gag', 'reflux', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 2, labetolol IV x 1: patient', 'asymptomatic denied symptoms of end organ dysfunction', '-L wrist cellulitis worsening, painful, blisters.  hot pack attempted,', 'pt not cooperative']","['BLOOD CULTURED - At [**2146-5-18**] 10:00 AM', ' URINE CULTURE - At [**2146-5-18**] 10:30 AM', ' ULTRASOUND - At [**2146-5-18**] 11:15 AM', ' EKG - At [**2146-5-18**] 11:47 AM', ' BLOOD CULTURED - At [**2146-5-18**] 12:12 PM', ' CARDIOVERSION/DEFIBRILLATION - At [**2146-5-18**] 04:15 PM', 'pt. cardiorverted with 200 jewels with cardiology and ho attending. pt.', 'burst of af (6) beats. none since.', ' EKG - At [**2146-5-18**] 05:14 PM', '[**5-18**]', '-cardioverted late afternoon, on heparin and amio drip, to go home on', 'ASA not warfarin [**12-27**] concern of adherance', '-SBP 211 @ 0515, 10 mg Hydralazine IV x 1']",42811,154794.0
0,2143-09-07 06:59:56,,"['BLOOD CULTURED - At [**2143-9-6**] 04:10 PM', ' URINE CULTURE - At [**2143-9-6**] 04:10 PM', 'Patient went for V/Q scan as well as CT scan of chest without', 'contrast.  Patient has been hemodynamically stable saturating well.']",,93893,184199.0
1,2143-09-07 11:06:53,,"['BLOOD CULTURED - At [**2143-9-6**] 04:10 PM', ' URINE CULTURE - At [**2143-9-6**] 04:10 PM', 'Patient went for V/Q scan as well as CT scan of chest without', 'contrast.  Patient has been hemodynamically stable saturating well.']",,93893,184199.0
2,2143-09-08 07:19:14,"['-Tachypneic and tachycardic. Received 05mg Ativan and lasix 20mg IV', 'without improvement. ABGs with [**Last Name (LF) 1183**], [**First Name3 (LF) **] she was placed on BIPAP.', '-Had CT Thorax done yesterday:', '-CT Thorax:', '1. Interval development of bilateral diffuse ground glass and', 'consolidative changes of the lungs with no cavitary lesion. The', 'differential possibilities include atypical pneumonia, non-cardiogenic', 'edema.', '2. Stable bilateral pleural effusion.', '3. Decreasing pneumoperitoneum of the recent surgery.', '4. Prominent right breast tissue.', '-EJ placed for access', '-Multiple bowel movements, large and brown colored, liquid.']","['-Tachypneic and tachycardic. Received 05mg Ativan and lasix 20mg IV', 'without improvement. ABGs with [**Last Name (LF) 1183**], [**First Name3 (LF) **] she was placed on BIPAP.', '-Had CT Thorax done yesterday:', '-CT Thorax:', '1. Interval development of bilateral diffuse ground glass and', 'consolidative changes of the lungs with no cavitary lesion. The', 'differential possibilities include atypical pneumonia, non-cardiogenic', 'edema.', '2. Stable bilateral pleural effusion.', '3. Decreasing pneumoperitoneum of the recent surgery.', '4. Prominent right breast tissue.', '-EJ placed for access', '-Multiple bowel movements, large and brown colored, liquid.']","['BLOOD CULTURED - At [**2143-9-6**] 04:10 PM', ' URINE CULTURE - At [**2143-9-6**] 04:10 PM', 'Patient went for V/Q scan as well as CT scan of chest without', 'contrast.  Patient has been hemodynamically stable saturating well.']",93893,184199.0
3,2143-09-08 07:20:13,,"['-Tachypneic and tachycardic. Received 05mg Ativan and lasix 20mg IV', 'without improvement. ABGs with [**Last Name (LF) 1183**], [**First Name3 (LF) **] she was placed on BIPAP.', '-Had CT Thorax done yesterday:', '-CT Thorax:', '1. Interval development of bilateral diffuse ground glass and', 'consolidative changes of the lungs with no cavitary lesion. The', 'differential possibilities include atypical pneumonia, non-cardiogenic', 'edema.', '2. Stable bilateral pleural effusion.', '3. Decreasing pneumoperitoneum of the recent surgery.', '4. Prominent right breast tissue.', '-EJ placed for access', '-Multiple bowel movements, large and brown colored, liquid.']",,93893,184199.0
4,2143-09-08 18:11:00,,"['-Tachypneic and tachycardic. Received 05mg Ativan and lasix 20mg IV', 'without improvement. ABGs with [**Last Name (LF) 1183**], [**First Name3 (LF) **] she was placed on BIPAP.', '-Had CT Thorax done yesterday:', '-CT Thorax:', '1. Interval development of bilateral diffuse ground glass and', 'consolidative changes of the lungs with no cavitary lesion. The', 'differential possibilities include atypical pneumonia, non-cardiogenic', 'edema.', '2. Stable bilateral pleural effusion.', '3. Decreasing pneumoperitoneum of the recent surgery.', '4. Prominent right breast tissue.', '-EJ placed for access', '-Multiple bowel movements, large and brown colored, liquid.']",,93893,184199.0
5,2143-09-09 07:32:13,"['Vanc/Cefepime stopped for c diff exacerbation and diarrhea', 'No FIbersourse overnight, pt with 600cc liquid stool in 24 hrs', 'Central line placed in right femoral.', 'Pt received bolus of 500cc for low UOP.', 'Patient c/o SOB, but very anxious and looking good. So received ativan', '0.5mg', 'ABG 7.41/47/220s on NRB mask 40%', ' MULTI LUMEN - START [**2143-9-8**] 03:27 PM', 'History obtained from Patient']","['Vanc/Cefepime stopped for c diff exacerbation and diarrhea', 'No FIbersourse overnight, pt with 600cc liquid stool in 24 hrs', 'Central line placed in right femoral.', 'Pt received bolus of 500cc for low UOP.', 'Patient c/o SOB, but very anxious and looking good. So received ativan', '0.5mg', 'ABG 7.41/47/220s on NRB mask 40%', ' MULTI LUMEN - START [**2143-9-8**] 03:27 PM', 'History obtained from Patient']","['-Tachypneic and tachycardic. Received 05mg Ativan and lasix 20mg IV', 'without improvement. ABGs with [**Last Name (LF) 1183**], [**First Name3 (LF) **] she was placed on BIPAP.', '-Had CT Thorax done yesterday:', '-CT Thorax:', '1. Interval development of bilateral diffuse ground glass and', 'consolidative changes of the lungs with no cavitary lesion. The', 'differential possibilities include atypical pneumonia, non-cardiogenic', 'edema.', '2. Stable bilateral pleural effusion.', '3. Decreasing pneumoperitoneum of the recent surgery.', '4. Prominent right breast tissue.', '-EJ placed for access', '-Multiple bowel movements, large and brown colored, liquid.']",93893,184199.0
6,2143-09-09 15:23:45,,"['Vanc/Cefepime stopped for c diff exacerbation and diarrhea', 'No FIbersourse overnight, pt with 600cc liquid stool in 24 hrs', 'Central line placed in right femoral.', 'Pt received bolus of 500cc for low UOP.', 'Patient c/o SOB, but very anxious and looking good. So received ativan', '0.5mg', 'ABG 7.41/47/220s on NRB mask 40%', ' MULTI LUMEN - START [**2143-9-8**] 03:27 PM', 'History obtained from Patient']",,93893,184199.0
7,2143-09-09 15:38:50,,"['Vanc/Cefepime stopped for c diff exacerbation and diarrhea', 'No FIbersourse overnight, pt with 600cc liquid stool in 24 hrs', 'Central line placed in right femoral.', 'Pt received bolus of 500cc for low UOP.', 'Patient c/o SOB, but very anxious and looking good. So received ativan', '0.5mg', 'ABG 7.41/47/220s on NRB mask 40%', ' MULTI LUMEN - START [**2143-9-8**] 03:27 PM', 'History obtained from Patient']",,93893,184199.0
8,2143-09-10 07:43:37,['Pt was intubated because respiratory distress'],['Pt was intubated because respiratory distress'],"['Vanc/Cefepime stopped for c diff exacerbation and diarrhea', 'No FIbersourse overnight, pt with 600cc liquid stool in 24 hrs', 'Central line placed in right femoral.', 'Pt received bolus of 500cc for low UOP.', 'Patient c/o SOB, but very anxious and looking good. So received ativan', '0.5mg', 'ABG 7.41/47/220s on NRB mask 40%', ' MULTI LUMEN - START [**2143-9-8**] 03:27 PM', 'History obtained from Patient']",93893,184199.0
9,2143-09-10 07:55:38,,['Pt was intubated because respiratory distress'],,93893,184199.0
10,2143-09-10 11:19:05,,['Pt was intubated because respiratory distress'],,93893,184199.0
11,2143-09-11 07:52:36,"['ARTERIAL LINE - START [**2143-9-10**] 12:56 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 01:45 PM', ' MULTI LUMEN - STOP [**2143-9-10**] 05:08 PM', ' MULTI LUMEN - START [**2143-9-10**] 05:30 PM', ' EKG - At [**2143-9-10**] 09:00 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 10:00 PM', ' BLOOD CULTURED - At [**2143-9-11**] 05:30 AM', '[**9-10**]', '- Right IJ and aline placed.', '- Patient started on vanco, meropenem, and levofloxacin (continued on', 'po vancomycin and IV flagyl.', '- 9p patient became hypotensive with MAP in 40s on max dose neo and', 'levo with no improvement.  Transfusion halted, triple lumen used for', 'levo, neo, and IVF bolus.  Bladder pressure 17. Patient not', 'dissynchronous, but with prolonged I:E with concern over plugging or', 'ETT obstruction.  ABG similar to prior. Bronch performed demonstrating', 'no obstruction but pus in both airways.  BP then became elevated to', '160s/70s, pressors weaned down (levophed held and neo titrated down).', 'Also sounded a little tight, and so was started on albuterol q4h.', '- 5 am, temp to 100.8, cultures drawn.', 'History obtained from Medical records']","['ARTERIAL LINE - START [**2143-9-10**] 12:56 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 01:45 PM', ' MULTI LUMEN - STOP [**2143-9-10**] 05:08 PM', ' MULTI LUMEN - START [**2143-9-10**] 05:30 PM', ' EKG - At [**2143-9-10**] 09:00 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 10:00 PM', ' BLOOD CULTURED - At [**2143-9-11**] 05:30 AM', '[**9-10**]', '- Right IJ and aline placed.', '- Patient started on vanco, meropenem, and levofloxacin (continued on', 'po vancomycin and IV flagyl.', '- 9p patient became hypotensive with MAP in 40s on max dose neo and', 'levo with no improvement.  Transfusion halted, triple lumen used for', 'levo, neo, and IVF bolus.  Bladder pressure 17. Patient not', 'dissynchronous, but with prolonged I:E with concern over plugging or', 'ETT obstruction.  ABG similar to prior. Bronch performed demonstrating', 'no obstruction but pus in both airways.  BP then became elevated to', '160s/70s, pressors weaned down (levophed held and neo titrated down).', 'Also sounded a little tight, and so was started on albuterol q4h.', '- 5 am, temp to 100.8, cultures drawn.', 'History obtained from Medical records']",['Pt was intubated because respiratory distress'],93893,184199.0
12,2143-09-11 11:36:19,,"['ARTERIAL LINE - START [**2143-9-10**] 12:56 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 01:45 PM', ' MULTI LUMEN - STOP [**2143-9-10**] 05:08 PM', ' MULTI LUMEN - START [**2143-9-10**] 05:30 PM', ' EKG - At [**2143-9-10**] 09:00 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 10:00 PM', ' BLOOD CULTURED - At [**2143-9-11**] 05:30 AM', '[**9-10**]', '- Right IJ and aline placed.', '- Patient started on vanco, meropenem, and levofloxacin (continued on', 'po vancomycin and IV flagyl.', '- 9p patient became hypotensive with MAP in 40s on max dose neo and', 'levo with no improvement.  Transfusion halted, triple lumen used for', 'levo, neo, and IVF bolus.  Bladder pressure 17. Patient not', 'dissynchronous, but with prolonged I:E with concern over plugging or', 'ETT obstruction.  ABG similar to prior. Bronch performed demonstrating', 'no obstruction but pus in both airways.  BP then became elevated to', '160s/70s, pressors weaned down (levophed held and neo titrated down).', 'Also sounded a little tight, and so was started on albuterol q4h.', '- 5 am, temp to 100.8, cultures drawn.', 'History obtained from Medical records']",,93893,184199.0
13,2143-09-11 12:31:40,,"['ARTERIAL LINE - START [**2143-9-10**] 12:56 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 01:45 PM', ' MULTI LUMEN - STOP [**2143-9-10**] 05:08 PM', ' MULTI LUMEN - START [**2143-9-10**] 05:30 PM', ' EKG - At [**2143-9-10**] 09:00 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 10:00 PM', ' BLOOD CULTURED - At [**2143-9-11**] 05:30 AM', '[**9-10**]', '- Right IJ and aline placed.', '- Patient started on vanco, meropenem, and levofloxacin (continued on', 'po vancomycin and IV flagyl.', '- 9p patient became hypotensive with MAP in 40s on max dose neo and', 'levo with no improvement.  Transfusion halted, triple lumen used for', 'levo, neo, and IVF bolus.  Bladder pressure 17. Patient not', 'dissynchronous, but with prolonged I:E with concern over plugging or', 'ETT obstruction.  ABG similar to prior. Bronch performed demonstrating', 'no obstruction but pus in both airways.  BP then became elevated to', '160s/70s, pressors weaned down (levophed held and neo titrated down).', 'Also sounded a little tight, and so was started on albuterol q4h.', '- 5 am, temp to 100.8, cultures drawn.', 'History obtained from Medical records']",,93893,184199.0
14,2143-09-12 07:53:05,"['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased']","['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased', 'History obtained from Medical records']","['ARTERIAL LINE - START [**2143-9-10**] 12:56 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 01:45 PM', ' MULTI LUMEN - STOP [**2143-9-10**] 05:08 PM', ' MULTI LUMEN - START [**2143-9-10**] 05:30 PM', ' EKG - At [**2143-9-10**] 09:00 PM', ' BRONCHOSCOPY - At [**2143-9-10**] 10:00 PM', ' BLOOD CULTURED - At [**2143-9-11**] 05:30 AM', '[**9-10**]', '- Right IJ and aline placed.', '- Patient started on vanco, meropenem, and levofloxacin (continued on', 'po vancomycin and IV flagyl.', '- 9p patient became hypotensive with MAP in 40s on max dose neo and', 'levo with no improvement.  Transfusion halted, triple lumen used for', 'levo, neo, and IVF bolus.  Bladder pressure 17. Patient not', 'dissynchronous, but with prolonged I:E with concern over plugging or', 'ETT obstruction.  ABG similar to prior. Bronch performed demonstrating', 'no obstruction but pus in both airways.  BP then became elevated to', '160s/70s, pressors weaned down (levophed held and neo titrated down).', 'Also sounded a little tight, and so was started on albuterol q4h.', '- 5 am, temp to 100.8, cultures drawn.']",93893,184199.0
15,2143-09-12 14:56:03,,"['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased', 'History obtained from Medical records']",,93893,184199.0
16,2143-09-13 07:00:34,"['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm']","['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm', 'History obtained from Medical records']","['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased']",93893,184199.0
17,2143-09-13 07:08:32,,"['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm', 'History obtained from Medical records']",,93893,184199.0
18,2143-09-13 07:40:26,,"['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm', 'History obtained from Medical records']",,93893,184199.0
19,2143-09-13 07:59:36,"['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased']","['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased', 'History obtained from Medical records']","['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm']",93893,184199.0
20,2143-09-13 11:46:38,"['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm']","['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm', 'History obtained from Medical records']","['ARTERIAL LINE - START [**2143-9-11**] 06:32 PM', ' ARTERIAL LINE - STOP [**2143-9-11**] 06:43 PM', '[**9-11**]', '- A-line replaced', '- Per endocrine recs, decreased insulin regimen to Lantus 3 units [**Hospital1 **]', 'with insulin drip (titrate to blood glucose <150)', 'Glucose=55 at 7:30am. Discontinued insulin drip.', '- CT head, chest, and abdomen without contrast (preliminary report) -', 'Interval worsening of the lung disease suggesting worsening pneumonia', 'or noncardiogenic pulmonary edema.', '- TTE not done', '- Pressors weaned at [**2064**] - MAPs hovering between 65-70. Neo restarted', 'around 2330 for MAPS 55-60, came back quickly on 2. As of 7:30, no', 'pressors.', '- BAL - no growth, PCP negative, AFB negative', '- Blood cultures negative thus far', '- Cortisol stimulation normal (41.6)', '- Repeat ABG at 2300 - given PaO2 trending downwards to 60s, FiO2', 'increased']",93893,184199.0
21,2143-09-14 15:47:15,"[""- dc'd levo/vanco"", '- wrote for TPN to start; TF still on hold per GI', '- got 1uPRBC, started 2uPRBC & pt noted to be dysynchronus w/ vent,', 'increasingly hypoxic.  CXR slightly worse vs unchanged.  Put on', 'pressure support w/ good effect.  Of note, tried lasix gtt, pt on', '2mg/hr, not increasing UOP (over ~1hr), but did drop BP from 120s to', ""80s systolic, so dc'd that.  Went up on sedation to help ventilate."", '- discussed workup for TRALI.  Blood bank fellow, felt unlikely dx.', 'Have not yet sent blood for w/u.', '- 1900, hypotensive with MAP ~60, initially fluid responsive to 500 cc', 'bolus but became hypotensive again and was not fluid responsive (500 cc', 'bolus), restarted levophed', '- Desat this AM with dyssynchrony and increased alertness.  Found to be', 'tight and difficult to ventilate by hand. Received additional boluses', 'of sedation and suctioned out with improvement.']","[""- dc'd levo/vanco"", '- wrote for TPN to start; TF still on hold per GI', '- got 1uPRBC, started 2uPRBC & pt noted to be dysynchronus w/ vent,', 'increasingly hypoxic.  CXR slightly worse vs unchanged.  Put on', 'pressure support w/ good effect.  Of note, tried lasix gtt, pt on', '2mg/hr, not increasing UOP (over ~1hr), but did drop BP from 120s to', ""80s systolic, so dc'd that.  Went up on sedation to help ventilate."", '- discussed workup for TRALI.  Blood bank fellow, felt unlikely dx.', 'Have not yet sent blood for w/u.', '- 1900, hypotensive with MAP ~60, initially fluid responsive to 500 cc', 'bolus but became hypotensive again and was not fluid responsive (500 cc', 'bolus), restarted levophed', '- Desat this AM with dyssynchrony and increased alertness.  Found to be', 'tight and difficult to ventilate by hand. Received additional boluses', 'of sedation and suctioned out with improvement.']","['- Echo was normal with LVEF>55%', '- CT Official Read - Normal', '- Pressures were not hypotensive.', '-Change Vent to Pressure at 4:20pm', 'History obtained from Medical records']",93893,184199.0
22,2143-09-15 07:39:01,"['- Restarted furosemide drip at 15mg/hour with good urine output. Slight', 'creatinine bump, resolved (1.4>1.6>1.4).', '- RR initially increased with improvement in acidosis but increase in', 'PCO2. PEEP decreased from 18 to 15 to increase minute ventilation in', 'hopes of blowing off more CO2 -> 7.31/41/77', '- Spiked fever (to 100.1, then 101.5) - sent blood and urine cultures', ' BLOOD CULTURED - At [**2143-9-15**] 04:43 AM', ' URINE CULTURE - At [**2143-9-15**] 04:43 AM', ' FEVER - 101.5', 'F - [**2143-9-14**] 08:00 PM']","['- Restarted furosemide drip at 15mg/hour with good urine output. Slight', 'creatinine bump, resolved (1.4>1.6>1.4).', '- RR initially increased with improvement in acidosis but increase in', 'PCO2. PEEP decreased from 18 to 15 to increase minute ventilation in', 'hopes of blowing off more CO2 -> 7.31/41/77', '- Spiked fever (to 100.1, then 101.5) - sent blood and urine cultures', ' BLOOD CULTURED - At [**2143-9-15**] 04:43 AM', ' URINE CULTURE - At [**2143-9-15**] 04:43 AM', ' FEVER - 101.5', 'F - [**2143-9-14**] 08:00 PM']","[""- dc'd levo/vanco"", '- wrote for TPN to start; TF still on hold per GI', '- got 1uPRBC, started 2uPRBC & pt noted to be dysynchronus w/ vent,', 'increasingly hypoxic.  CXR slightly worse vs unchanged.  Put on', 'pressure support w/ good effect.  Of note, tried lasix gtt, pt on', '2mg/hr, not increasing UOP (over ~1hr), but did drop BP from 120s to', ""80s systolic, so dc'd that.  Went up on sedation to help ventilate."", '- discussed workup for TRALI.  Blood bank fellow, felt unlikely dx.', 'Have not yet sent blood for w/u.', '- 1900, hypotensive with MAP ~60, initially fluid responsive to 500 cc', 'bolus but became hypotensive again and was not fluid responsive (500 cc', 'bolus), restarted levophed', '- Desat this AM with dyssynchrony and increased alertness.  Found to be', 'tight and difficult to ventilate by hand. Received additional boluses', 'of sedation and suctioned out with improvement.']",93893,184199.0
23,2143-09-15 12:34:48,,"['- Restarted furosemide drip at 15mg/hour with good urine output. Slight', 'creatinine bump, resolved (1.4>1.6>1.4).', '- RR initially increased with improvement in acidosis but increase in', 'PCO2. PEEP decreased from 18 to 15 to increase minute ventilation in', 'hopes of blowing off more CO2 -> 7.31/41/77', '- Spiked fever (to 100.1, then 101.5) - sent blood and urine cultures', ' BLOOD CULTURED - At [**2143-9-15**] 04:43 AM', ' URINE CULTURE - At [**2143-9-15**] 04:43 AM', ' FEVER - 101.5', 'F - [**2143-9-14**] 08:00 PM']",,93893,184199.0
24,2143-09-16 07:52:28,"['MULTI LUMEN - START [**2143-9-15**] 04:36 PM', ' FEVER - 101.3', 'F - [**2143-9-16**] 04:00 AM', ""- pt with intermittent drops in BP (SBP 70's) pt was started on"", 'vasopressin, cont on levophed.  Cont to drop pressures overnight and', 'would increase pressures with increasing levophed.', '- worsening acidosis and [**Month (only) 453**] PaO2 despite FiO2 at 100%. Pt was on', 'pressure support, but plateau pressures elevated.  Pt was was paralyzed', 'with Cisatracurium and changed to Volume control.', 'Assist control (Volume Targeted)']","['MULTI LUMEN - START [**2143-9-15**] 04:36 PM', ' FEVER - 101.3', 'F - [**2143-9-16**] 04:00 AM', ""- pt with intermittent drops in BP (SBP 70's) pt was started on"", 'vasopressin, cont on levophed.  Cont to drop pressures overnight and', 'would increase pressures with increasing levophed.', '- worsening acidosis and [**Month (only) 453**] PaO2 despite FiO2 at 100%. Pt was on', 'pressure support, but plateau pressures elevated.  Pt was was paralyzed', 'with Cisatracurium and changed to Volume control.', 'Assist control (Volume Targeted)']","['- Restarted furosemide drip at 15mg/hour with good urine output. Slight', 'creatinine bump, resolved (1.4>1.6>1.4).', '- RR initially increased with improvement in acidosis but increase in', 'PCO2. PEEP decreased from 18 to 15 to increase minute ventilation in', 'hopes of blowing off more CO2 -> 7.31/41/77', '- Spiked fever (to 100.1, then 101.5) - sent blood and urine cultures', ' BLOOD CULTURED - At [**2143-9-15**] 04:43 AM', ' URINE CULTURE - At [**2143-9-15**] 04:43 AM', ' FEVER - 101.5', 'F - [**2143-9-14**] 08:00 PM']",93893,184199.0
25,2143-09-16 13:11:24,,"['MULTI LUMEN - START [**2143-9-15**] 04:36 PM', ' FEVER - 101.3', 'F - [**2143-9-16**] 04:00 AM', ""- pt with intermittent drops in BP (SBP 70's) pt was started on"", 'vasopressin, cont on levophed.  Cont to drop pressures overnight and', 'would increase pressures with increasing levophed.', '- worsening acidosis and [**Month (only) 453**] PaO2 despite FiO2 at 100%. Pt was on', 'pressure support, but plateau pressures elevated.  Pt was was paralyzed', 'with Cisatracurium and changed to Volume control.', 'Assist control (Volume Targeted)']",,93893,184199.0
0,2154-11-01 05:31:28,,[],,49353,188881.0
1,2154-11-01 05:33:38,,[],,49353,188881.0
2,2154-11-01 12:18:47,,,,49353,188881.0
0,2143-11-19 07:15:47,,"['INDWELLING PORT (PORTACATH) - START [**2143-11-19**] 12:19 AM', ' PAN CULTURE - At [**2143-11-19**] 03:00 AM', ' FEVER - 102.5', 'F - [**2143-11-19**] 02:00 AM']",,59829,147595.0
1,2143-11-19 09:47:38,,"['INDWELLING PORT (PORTACATH) - START [**2143-11-19**] 12:19 AM', ' PAN CULTURE - At [**2143-11-19**] 03:00 AM', ' FEVER - 102.5', 'F - [**2143-11-19**] 02:00 AM']",,59829,147595.0
2,2143-11-19 09:58:17,,"['INDWELLING PORT (PORTACATH) - START [**2143-11-19**] 12:19 AM', ' PAN CULTURE - At [**2143-11-19**] 03:00 AM', ' FEVER - 102.5', 'F - [**2143-11-19**] 02:00 AM']",,59829,147595.0
3,2143-11-19 10:24:07,,"['INDWELLING PORT (PORTACATH) - START [**2143-11-19**] 12:19 AM', ' PAN CULTURE - At [**2143-11-19**] 03:00 AM', ' FEVER - 102.5', 'F - [**2143-11-19**] 02:00 AM']",,59829,147595.0
4,2143-11-20 07:13:45,"['-was on high flow nebs all AM, but arond 1600 was placed on NRB,', 'satting low to mid 90s on it.. lung exam concerning for worsening', 'crackles (sounded very velcro-like on inspiration in AM exam), so got', 'stat CXR, ABG and gave 20mg IV lasix x1', '-stat CXR looks like worsening volume overload- pulmn edema', '-ABG looks ok... but PaO2 94 and should expect better on NRB', '-put out well to lasix, 350cc over 1st hr, then 200cc, then 100cc', '-gave another 10mg IV lasix around 1230am', '-if acutely desats... might have to intubate']","['-was on high flow nebs all AM, but arond 1600 was placed on NRB,', 'satting low to mid 90s on it.. lung exam concerning for worsening', 'crackles (sounded very velcro-like on inspiration in AM exam), so got', 'stat CXR, ABG and gave 20mg IV lasix x1', '-stat CXR looks like worsening volume overload- pulmn edema', '-ABG looks ok... but PaO2 94 and should expect better on NRB', '-put out well to lasix, 350cc over 1st hr, then 200cc, then 100cc', '-gave another 10mg IV lasix around 1230am', '-if acutely desats... might have to intubate']","['INDWELLING PORT (PORTACATH) - START [**2143-11-19**] 12:19 AM', ' PAN CULTURE - At [**2143-11-19**] 03:00 AM', ' FEVER - 102.5', 'F - [**2143-11-19**] 02:00 AM']",59829,147595.0
5,2143-11-20 16:53:28,"['-stat CXR looks like worsening volume overload- pulmonary edema', '- PaO2 94 on NRV, otherwise ABGs OK', '-put out well to lasix, ~650 cc', '-This AM, the patient states that her breathing has improved.', 'Complains of some continues head and neck pain.']","['-was on high flow nebs all AM, but arond 1600 was placed on NRB,', 'satting low to mid 90s on it.. lung exam concerning for worsening', 'crackles (sounded very velcro-like on inspiration in AM exam), so got', 'stat CXR, ABG and gave 20mg IV lasix x1', '-stat CXR looks like worsening volume overload- pulmonary edema', '- PaO2 94 on NRV, otherwise ABGs OK', '-put out well to lasix, ~650 cc', '-gave another 10mg IV lasix around 1230am', '-This AM, the patient states that her breathing has improved.', 'Complains of some continues head and neck pain.']","['-stat CXR looks like worsening volume overload- pulmn edema', '-ABG looks ok... but PaO2 94 and should expect better on NRB', '-put out well to lasix, 350cc over 1st hr, then 200cc, then 100cc', '-if acutely desats... might have to intubate']",59829,147595.0
6,2143-11-21 07:42:06,"['-Changed PO pain regimen to Oxycodone 10mg Q6hrs and Tylenol 650mg', 'Q6hrs standing', '-Updated the patient and family on current treatment', '-Given 20mg IV Lasix x2, still only -300cc, so gave another 40cc Lasix', 'IV in late PM.', '-Stable on NRB satting 98-100%, desats immediately when she takes NRB', 'off.']","['-Changed PO pain regimen to Oxycodone 10mg Q6hrs and Tylenol 650mg', 'Q6hrs standing', '-Updated the patient and family on current treatment', '-Given 20mg IV Lasix x2, still only -300cc, so gave another 40cc Lasix', 'IV in late PM.', '-Stable on NRB satting 98-100%, desats immediately when she takes NRB', 'off.']","['-was on high flow nebs all AM, but arond 1600 was placed on NRB,', 'satting low to mid 90s on it.. lung exam concerning for worsening', 'crackles (sounded very velcro-like on inspiration in AM exam), so got', 'stat CXR, ABG and gave 20mg IV lasix x1', '-stat CXR looks like worsening volume overload- pulmonary edema', '- PaO2 94 on NRV, otherwise ABGs OK', '-put out well to lasix, ~650 cc', '-gave another 10mg IV lasix around 1230am', '-This AM, the patient states that her breathing has improved.', 'Complains of some continues head and neck pain.']",59829,147595.0
7,2143-11-21 11:43:39,,"['-Changed PO pain regimen to Oxycodone 10mg Q6hrs and Tylenol 650mg', 'Q6hrs standing', '-Updated the patient and family on current treatment', '-Given 20mg IV Lasix x2, still only -300cc, so gave another 40cc Lasix', 'IV in late PM.', '-Stable on NRB satting 98-100%, desats immediately when she takes NRB', 'off.']",,59829,147595.0
8,2143-11-22 07:44:40,"['-change steroid dosage to 4mg [**Hospital1 **]', '-needs family mtg w/ Drs [**Name5 (PTitle) 3650**] (primary onc) & [**Doctor Last Name 980**] (neuro-onc)', ""-RT couldn't get induced sputum because she coughed up food when they"", 'tried', '-Have very low urine output so gave 80mg IV lasix at 4pm, after which', 'she started peeing more, then tapered off', '-Was temporarily off nonrebreather but had to be placed back on', 'non-rebreather']","['-change steroid dosage to 4mg [**Hospital1 **]', '-needs family mtg w/ Drs [**Name5 (PTitle) 3650**] (primary onc) & [**Doctor Last Name 980**] (neuro-onc)', ""-RT couldn't get induced sputum because she coughed up food when they"", 'tried', '-Have very low urine output so gave 80mg IV lasix at 4pm, after which', 'she started peeing more, then tapered off', '-Was temporarily off nonrebreather but had to be placed back on', 'non-rebreather']","['-Changed PO pain regimen to Oxycodone 10mg Q6hrs and Tylenol 650mg', 'Q6hrs standing', '-Updated the patient and family on current treatment', '-Given 20mg IV Lasix x2, still only -300cc, so gave another 40cc Lasix', 'IV in late PM.', '-Stable on NRB satting 98-100%, desats immediately when she takes NRB', 'off.']",59829,147595.0
9,2143-11-22 12:03:18,,"['-change steroid dosage to 4mg [**Hospital1 **]', '-needs family mtg w/ Drs [**Name5 (PTitle) 3650**] (primary onc) & [**Doctor Last Name 980**] (neuro-onc)', ""-RT couldn't get induced sputum because she coughed up food when they"", 'tried', '-Have very low urine output so gave 80mg IV lasix at 4pm, after which', 'she started peeing more, then tapered off', '-Was temporarily off nonrebreather but had to be placed back on', 'non-rebreather']",,59829,147595.0
10,2143-11-23 07:17:31,"['[**2143-11-21**]', '-tomorrow change steroid dosage to 4mg [**Hospital1 **]', '[**2143-11-22**]', '- Family meeting today; Husband and Daughter want to keep the patient', 'full code for now.  They understand the risk of intubation and the', 'patient may not be able to be extubated.  They want to keep', 'readdressing code status daily.  They are possibly interested in', 'hospice, either home or inpatient closer to their home, but want to', 'keep going with antibiotics and steroids for now.']","['[**2143-11-21**]', '-tomorrow change steroid dosage to 4mg [**Hospital1 **]', '-needs family mtg w/ Drs [**Name5 (PTitle) 3650**] (primary onc) & [**Doctor Last Name 980**] (neuro-onc)', ""-RT couldn't get induced sputum because she coughed up food when they"", 'tried', '-Have very low urine output so gave 80mg IV lasix at 4pm, after which', 'she started peeing more, then tapered off', '-Was temporarily off nonrebreather but had to be placed back on', 'non-rebreather', '[**2143-11-22**]', '- Family meeting today; Husband and Daughter want to keep the patient', 'full code for now.  They understand the risk of intubation and the', 'patient may not be able to be extubated.  They want to keep', 'readdressing code status daily.  They are possibly interested in', 'hospice, either home or inpatient closer to their home, but want to', 'keep going with antibiotics and steroids for now.']",['-change steroid dosage to 4mg [**Hospital1 **]'],59829,147595.0
11,2143-11-23 10:55:30,"['- Family meeting was held; Husband and Daughter want to keep the', 'patient full code for now.  They understand the risk of intubation and', 'the patient may not be able to be extubated.  They want to keep', '-This AM, the patient is reporting improved breathing on 60% face', 'mask.  She desats to ~90% when sitting up.']","['- Family meeting was held; Husband and Daughter want to keep the', 'patient full code for now.  They understand the risk of intubation and', 'the patient may not be able to be extubated.  They want to keep', 'readdressing code status daily.  They are possibly interested in', 'hospice, either home or inpatient closer to their home, but want to', 'keep going with antibiotics and steroids for now.', '-This AM, the patient is reporting improved breathing on 60% face', 'mask.  She desats to ~90% when sitting up.']","['[**2143-11-21**]', '-tomorrow change steroid dosage to 4mg [**Hospital1 **]', '-needs family mtg w/ Drs [**Name5 (PTitle) 3650**] (primary onc) & [**Doctor Last Name 980**] (neuro-onc)', ""-RT couldn't get induced sputum because she coughed up food when they"", 'tried', '-Have very low urine output so gave 80mg IV lasix at 4pm, after which', 'she started peeing more, then tapered off', '-Was temporarily off nonrebreather but had to be placed back on', 'non-rebreather', '[**2143-11-22**]', '- Family meeting today; Husband and Daughter want to keep the patient', 'full code for now.  They understand the risk of intubation and the', 'patient may not be able to be extubated.  They want to keep']",59829,147595.0
12,2143-11-24 07:48:10,"['-Satting in mid-90s on 60% face mask, but does not tolerate any', 'physical exertion.', ""-Hypotensive (got Atenolol in AM, which was subsequently d/c'd), so we"", 'were unable to diurese further in AM>  Gave 80mg IV Lasix in PM, with', 'good response.  However, positive as was getting extra IVF with Bactrim', '(most concentrated possible).', '-Started on empiric treatment for PCP with IV bactrim (concentrated in', 'order to minimize fluids).', '-The patient fell out of bed and was found on the floor.  She was alert', 'and oriented, but unable to state how she ended up there.  She was', 'returned back to bed. O2 sats returned to high 90s.  Neurological exam', 'was non-focal. She was placed in Posey restraints.  STAT CT head and', 'C-spine were ordered (will be done at 7am) Event note was written.', 'Attending was notified.']","['-Satting in mid-90s on 60% face mask, but does not tolerate any', 'physical exertion.', ""-Hypotensive (got Atenolol in AM, which was subsequently d/c'd), so we"", 'were unable to diurese further in AM>  Gave 80mg IV Lasix in PM, with', 'good response.  However, positive as was getting extra IVF with Bactrim', '(most concentrated possible).', '-Started on empiric treatment for PCP with IV bactrim (concentrated in', 'order to minimize fluids).', '-The patient fell out of bed and was found on the floor.  She was alert', 'and oriented, but unable to state how she ended up there.  She was', 'returned back to bed. O2 sats returned to high 90s.  Neurological exam', 'was non-focal. She was placed in Posey restraints.  STAT CT head and', 'C-spine were ordered (will be done at 7am) Event note was written.', 'Attending was notified.']","['- Family meeting was held; Husband and Daughter want to keep the', 'patient full code for now.  They understand the risk of intubation and', 'the patient may not be able to be extubated.  They want to keep', 'readdressing code status daily.  They are possibly interested in', 'hospice, either home or inpatient closer to their home, but want to', 'keep going with antibiotics and steroids for now.', '-This AM, the patient is reporting improved breathing on 60% face', 'mask.  She desats to ~90% when sitting up.']",59829,147595.0
13,2143-11-24 12:06:13,"['were unable to diurese further in AM.  Gave 80mg IV Lasix in PM, with', '-Started on empiric treatment for PCP with IV Bactrim (concentrated in', 'was non-focal. She was placed in Posey restraints.  [**Location (un) 239**] J collar', 'ordered.  STAT CT head and C-spine were ordered (will be done at 7am)', 'Event note was written.  Attending was notified.', '-Was transiently on 100% [**Last Name (un) 9565**] mask after fall, but is now back on 60%', 'face mask and satting >95%.']","['-Satting in mid-90s on 60% face mask, but does not tolerate any', 'physical exertion.', ""-Hypotensive (got Atenolol in AM, which was subsequently d/c'd), so we"", 'were unable to diurese further in AM.  Gave 80mg IV Lasix in PM, with', 'good response.  However, positive as was getting extra IVF with Bactrim', '(most concentrated possible).', '-Started on empiric treatment for PCP with IV Bactrim (concentrated in', 'order to minimize fluids).', '-The patient fell out of bed and was found on the floor.  She was alert', 'and oriented, but unable to state how she ended up there.  She was', 'returned back to bed. O2 sats returned to high 90s.  Neurological exam', 'was non-focal. She was placed in Posey restraints.  [**Location (un) 239**] J collar', 'ordered.  STAT CT head and C-spine were ordered (will be done at 7am)', 'Event note was written.  Attending was notified.', '-Was transiently on 100% [**Last Name (un) 9565**] mask after fall, but is now back on 60%', 'face mask and satting >95%.']","['were unable to diurese further in AM>  Gave 80mg IV Lasix in PM, with', '-Started on empiric treatment for PCP with IV bactrim (concentrated in', 'was non-focal. She was placed in Posey restraints.  STAT CT head and', 'C-spine were ordered (will be done at 7am) Event note was written.', 'Attending was notified.']",59829,147595.0
14,2143-11-25 07:47:14,"['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']","['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']","['-Satting in mid-90s on 60% face mask, but does not tolerate any', 'physical exertion.', ""-Hypotensive (got Atenolol in AM, which was subsequently d/c'd), so we"", 'were unable to diurese further in AM.  Gave 80mg IV Lasix in PM, with', 'good response.  However, positive as was getting extra IVF with Bactrim', '(most concentrated possible).', '-Started on empiric treatment for PCP with IV Bactrim (concentrated in', 'order to minimize fluids).', '-The patient fell out of bed and was found on the floor.  She was alert', 'and oriented, but unable to state how she ended up there.  She was', 'returned back to bed. O2 sats returned to high 90s.  Neurological exam', 'was non-focal. She was placed in Posey restraints.  [**Location (un) 239**] J collar', 'ordered.  STAT CT head and C-spine were ordered (will be done at 7am)', 'Event note was written.  Attending was notified.', '-Was transiently on 100% [**Last Name (un) 9565**] mask after fall, but is now back on 60%', 'face mask and satting >95%.']",59829,147595.0
15,2143-11-25 07:53:30,,"['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']",,59829,147595.0
16,2143-11-25 13:01:35,,"['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']",,59829,147595.0
17,2143-11-25 13:24:45,,"['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']",,59829,147595.0
18,2143-11-26 07:31:31,"['- Unable wean O2 yesterday', '- I/O: +600 at 2100, gave lasix 80 mg IV', '- Vanc and cefepime stopped', '- Plan for family meeting today at 1630']","['- Unable wean O2 yesterday', '- I/O: +600 at 2100, gave lasix 80 mg IV', '- Vanc and cefepime stopped', '- Plan for family meeting today at 1630']","['- Held family meeting.  Now DNR/DNI.  Plan is to get palliative care', 'team to speak with patient/family tomorrow and initiate movements', 'towards discharge, likely to an LTAC.  Plan to give PCP treatment [**Name Initial (PRE) **] few', 'days to work and likely discharge to facility mid-week.', '- Fluid balance was positive 1.5L at midnight so gave 80mg IV Lasix.']",59829,147595.0
19,2143-11-26 07:50:45,"['- Unable wean O2 yesterday, is now requiring 95% face mask plus 5L NC', '- Vanc and cefepime course completed yesterday']","['- Unable wean O2 yesterday, is now requiring 95% face mask plus 5L NC', '- I/O: +600 at 2100, gave lasix 80 mg IV', '- Vanc and cefepime course completed yesterday', '- Plan for family meeting today at 1630']","['- Unable wean O2 yesterday', '- Vanc and cefepime stopped']",59829,147595.0
20,2143-11-26 12:08:25,"['- Unable wean O2 yesterday, had episode of respiratory distress with', 'desats, now requiring 95% face mask plus 5L NC']","['- Unable wean O2 yesterday, had episode of respiratory distress with', 'desats, now requiring 95% face mask plus 5L NC', '- I/O: +600 at 2100, gave lasix 80 mg IV', '- Vanc and cefepime course completed yesterday', '- Plan for family meeting today at 1630']","['- Unable wean O2 yesterday, is now requiring 95% face mask plus 5L NC']",59829,147595.0
21,2143-11-27 07:03:25,"['- Still has continuous desats on NRB', '- Family meeting held and patient made CMO', '- Plan to stay in ICU for now with possible hospice at home versus', 'hospice facility', '- Changed medications to increase morphine with standing ativan']","['- Still has continuous desats on NRB', '- Family meeting held and patient made CMO', '- Plan to stay in ICU for now with possible hospice at home versus', 'hospice facility', '- Changed medications to increase morphine with standing ativan']","['- Unable wean O2 yesterday, had episode of respiratory distress with', 'desats, now requiring 95% face mask plus 5L NC', '- I/O: +600 at 2100, gave lasix 80 mg IV', '- Vanc and cefepime course completed yesterday', '- Plan for family meeting today at 1630']",59829,147595.0
22,2143-11-27 13:56:06,,"['- Still has continuous desats on NRB', '- Family meeting held and patient made CMO', '- Plan to stay in ICU for now with possible hospice at home versus', 'hospice facility', '- Changed medications to increase morphine with standing ativan']",,59829,147595.0
23,2143-11-28 06:54:48,"['- On morphine gtt', '- Family at bedside entire night, including husband']","['- On morphine gtt', '- Family at bedside entire night, including husband']","['- Still has continuous desats on NRB', '- Family meeting held and patient made CMO', '- Plan to stay in ICU for now with possible hospice at home versus', 'hospice facility', '- Changed medications to increase morphine with standing ativan']",59829,147595.0
24,2143-11-28 10:50:07,,"['- On morphine gtt', '- Family at bedside entire night, including husband']",,59829,147595.0
0,2115-11-24 07:02:30,,[],,60626,171464.0
1,2115-11-24 07:05:52,,[],,60626,171464.0
2,2115-11-24 07:19:35,,[],,60626,171464.0
0,2183-09-22 05:33:35,,"['Off Neosynephrine.', 'Ordered Lasix 20 mg IV for ? fluid overload with elevated BNP, desats', 'mid 80s with agitation in am']",,76921,187904.0
1,2183-09-22 05:43:43,"['Ordered Lasix 20 mg IV for ? fluid overload with elevated BNP but has', 'not received yet [**1-18**] low BP', 'Desats to mid 80s with agitation in am', 'c/o L hand pain, given Tramadol which was on prior to admission']","['Off Neosynephrine.', 'Ordered Lasix 20 mg IV for ? fluid overload with elevated BNP but has', 'not received yet [**1-18**] low BP', 'Desats to mid 80s with agitation in am', 'c/o L hand pain, given Tramadol which was on prior to admission']","['Ordered Lasix 20 mg IV for ? fluid overload with elevated BNP, desats', 'mid 80s with agitation in am']",76921,187904.0
2,2183-09-22 10:40:59,"['Off Neosynephrine since 2 am.', 'Ordered Lasix 20 mg IV for fluid overload, contribution of diastolic', 'CHF with elevated BNP but has not received yet [**1-18**] low BP', 'c/o L hand pain, given Tramadol which she was on prior to admission and', 'had been taking at previous admission']","['Off Neosynephrine since 2 am.', 'Ordered Lasix 20 mg IV for fluid overload, contribution of diastolic', 'CHF with elevated BNP but has not received yet [**1-18**] low BP', 'Desats to mid 80s with agitation in am', 'c/o L hand pain, given Tramadol which she was on prior to admission and', 'had been taking at previous admission']","['Off Neosynephrine.', 'Ordered Lasix 20 mg IV for ? fluid overload with elevated BNP but has', 'not received yet [**1-18**] low BP', 'c/o L hand pain, given Tramadol which was on prior to admission']",76921,187904.0
3,2183-09-23 06:40:13,['CALLED OUT'],['CALLED OUT'],"['Off Neosynephrine since 2 am.', 'Ordered Lasix 20 mg IV for fluid overload, contribution of diastolic', 'CHF with elevated BNP but has not received yet [**1-18**] low BP', 'Desats to mid 80s with agitation in am', 'c/o L hand pain, given Tramadol which she was on prior to admission and', 'had been taking at previous admission']",76921,187904.0
4,2183-09-23 06:41:30,,['CALLED OUT'],,76921,187904.0
5,2183-09-23 16:29:27,"['Patient aspirated with desats overnight. This am, she was reporting', 'slightly worse SOB and was coughing more.', 'Given Haldol x 1 for agitation overnight']","['Patient aspirated with desats overnight. This am, she was reporting', 'slightly worse SOB and was coughing more.', 'Given Haldol x 1 for agitation overnight']",['CALLED OUT'],76921,187904.0
6,2183-09-24 06:17:02,['Diuresed'],['Diuresed'],"['Patient aspirated with desats overnight. This am, she was reporting', 'slightly worse SOB and was coughing more.', 'Given Haldol x 1 for agitation overnight']",76921,187904.0
7,2183-09-24 06:17:39,,['Diuresed'],,76921,187904.0
8,2183-09-24 06:24:01,['Bronchoscopy in AM'],['Bronchoscopy in AM'],['Diuresed'],76921,187904.0
9,2183-09-24 06:26:19,,['Bronchoscopy in AM'],,76921,187904.0
10,2183-09-24 13:08:56,"['Diuresed Overnight', 'Haloperidol given x1 for agitation', ""Decreased 02 Requirement to 4L NC , de-sats to 80's when off NC"", 'Pt went in AF with RVR this AM to 130s, Broken with Metoprolol 2.5mg', 'x2.']","['Diuresed Overnight', 'Haloperidol given x1 for agitation', ""Decreased 02 Requirement to 4L NC , de-sats to 80's when off NC"", 'Pt went in AF with RVR this AM to 130s, Broken with Metoprolol 2.5mg', 'x2.']",['Bronchoscopy in AM'],76921,187904.0
11,2183-09-24 16:43:58,['Pills suctioned from pts oropharynx'],"['Diuresed Overnight', 'Haloperidol given x1 for agitation', ""Decreased 02 Requirement to 4L NC , de-sats to 80's when off NC"", 'Pt went in AF with RVR this AM to 130s, Broken with Metoprolol 2.5mg', 'x2.', 'Pills suctioned from pts oropharynx']",,76921,187904.0
12,2183-09-25 05:42:05,"['EKG - At [**2183-9-24**] 12:00 PM', ' BLOOD CULTURED - At [**2183-9-24**] 05:21 PM', 'x2', ' STOOL CULTURE - At [**2183-9-24**] 05:21 PM', 'Likley aspirated in am with desats', 'Will get S/S re-eval and video swallow tomorrow.', 'Spiked fever 101.1 Added meropenem for coverage']","['EKG - At [**2183-9-24**] 12:00 PM', ' BLOOD CULTURED - At [**2183-9-24**] 05:21 PM', 'x2', ' STOOL CULTURE - At [**2183-9-24**] 05:21 PM', 'Likley aspirated in am with desats', 'Will get S/S re-eval and video swallow tomorrow.', 'Spiked fever 101.1 Added meropenem for coverage']","['Diuresed Overnight', 'Haloperidol given x1 for agitation', ""Decreased 02 Requirement to 4L NC , de-sats to 80's when off NC"", 'Pt went in AF with RVR this AM to 130s, Broken with Metoprolol 2.5mg', 'x2.', 'Pills suctioned from pts oropharynx']",76921,187904.0
13,2183-09-25 05:42:37,,"['EKG - At [**2183-9-24**] 12:00 PM', ' BLOOD CULTURED - At [**2183-9-24**] 05:21 PM', 'x2', ' STOOL CULTURE - At [**2183-9-24**] 05:21 PM', 'Likley aspirated in am with desats', 'Will get S/S re-eval and video swallow tomorrow.', 'Spiked fever 101.1 Added meropenem for coverage']",,76921,187904.0
14,2183-09-25 05:43:07,,"['EKG - At [**2183-9-24**] 12:00 PM', ' BLOOD CULTURED - At [**2183-9-24**] 05:21 PM', 'x2', ' STOOL CULTURE - At [**2183-9-24**] 05:21 PM', 'Likley aspirated in am with desats', 'Will get S/S re-eval and video swallow tomorrow.', 'Spiked fever 101.1 Added meropenem for coverage']",,76921,187904.0
15,2183-09-25 15:18:39,['Spiked fever 101.1 yesterday. Added meropenem for coverage.'],"['EKG - At [**2183-9-24**] 12:00 PM', ' BLOOD CULTURED - At [**2183-9-24**] 05:21 PM', 'x2', ' STOOL CULTURE - At [**2183-9-24**] 05:21 PM', 'Spiked fever 101.1 yesterday. Added meropenem for coverage.']","['Likley aspirated in am with desats', 'Will get S/S re-eval and video swallow tomorrow.', 'Spiked fever 101.1 Added meropenem for coverage']",76921,187904.0
0,2176-01-25 05:20:44,,['Pt. was agitated w/ delirium o/n.  Was given Haldol IV'],,86722,115967.0
0,2161-10-29 07:34:49,,['NASAL SWAB - At [**2161-10-28**] 09:05 PM'],,49081,127653.0
1,2161-10-29 11:43:58,"['- received ativan yesterday with improvement of symptoms', '- CT head done', '- called out to the floor last night, waiting for a bed']","['NASAL SWAB - At [**2161-10-28**] 09:05 PM', '- received ativan yesterday with improvement of symptoms', '- CT head done', '- called out to the floor last night, waiting for a bed']",,49081,127653.0
0,2161-11-10 05:43:01,,[],,49081,140192.0
1,2161-11-10 06:25:12,,[],,49081,140192.0
2,2161-11-10 07:03:40,"['None', 'Patient resting comfortably.']","['None', 'Patient resting comfortably.']",,49081,140192.0
3,2161-11-10 11:26:48,,"['None', 'Patient resting comfortably.']",,49081,140192.0
0,2117-02-15 07:06:47,,"['EKG - At [**2117-2-14**] 11:01 AM', ' EKG - At [**2117-2-14**] 06:18 PM', ' BLOOD CULTURED - At [**2117-2-14**] 07:17 PM']",,73888,144271.0
1,2117-02-15 07:09:00,,"['EKG - At [**2117-2-14**] 11:01 AM', ' EKG - At [**2117-2-14**] 06:18 PM', ' BLOOD CULTURED - At [**2117-2-14**] 07:17 PM']",,73888,144271.0
2,2117-02-15 13:00:24,,"['EKG - At [**2117-2-14**] 11:01 AM', ' EKG - At [**2117-2-14**] 06:18 PM', ' BLOOD CULTURED - At [**2117-2-14**] 07:17 PM']",,73888,144271.0
3,2117-02-16 07:09:54,"['EKG - At [**2117-2-15**] 07:30 PM', ' EKG - At [**2117-2-15**] 08:15 PM', ' SPUTUM CULTURE - At [**2117-2-16**] 02:50 AM', '[**2117-2-15**]', '-had another episode of SVT, BP transiently in 70s, resolved without', 'intervention, ECG unchanged', '-given additional 10mg lasix, negative 1.1L as of 2300', '-SVT again x2, BPs in 50sm resolved with carotid massage, started', 'metoprolol 12.5 Q6, also given 5 IV for SVT again', 'History obtained from Patient']","['EKG - At [**2117-2-15**] 07:30 PM', ' EKG - At [**2117-2-15**] 08:15 PM', ' SPUTUM CULTURE - At [**2117-2-16**] 02:50 AM', '[**2117-2-15**]', '-had another episode of SVT, BP transiently in 70s, resolved without', 'intervention, ECG unchanged', '-given additional 10mg lasix, negative 1.1L as of 2300', '-SVT again x2, BPs in 50sm resolved with carotid massage, started', 'metoprolol 12.5 Q6, also given 5 IV for SVT again', 'History obtained from Patient']","['EKG - At [**2117-2-14**] 11:01 AM', ' EKG - At [**2117-2-14**] 06:18 PM', ' BLOOD CULTURED - At [**2117-2-14**] 07:17 PM']",73888,144271.0
4,2117-02-16 07:11:08,,"['EKG - At [**2117-2-15**] 07:30 PM', ' EKG - At [**2117-2-15**] 08:15 PM', ' SPUTUM CULTURE - At [**2117-2-16**] 02:50 AM', '[**2117-2-15**]', '-had another episode of SVT, BP transiently in 70s, resolved without', 'intervention, ECG unchanged', '-given additional 10mg lasix, negative 1.1L as of 2300', '-SVT again x2, BPs in 50sm resolved with carotid massage, started', 'metoprolol 12.5 Q6, also given 5 IV for SVT again', 'History obtained from Patient']",,73888,144271.0
5,2117-02-16 07:28:10,,"['EKG - At [**2117-2-15**] 07:30 PM', ' EKG - At [**2117-2-15**] 08:15 PM', ' SPUTUM CULTURE - At [**2117-2-16**] 02:50 AM', '[**2117-2-15**]', '-had another episode of SVT, BP transiently in 70s, resolved without', 'intervention, ECG unchanged', '-given additional 10mg lasix, negative 1.1L as of 2300', '-SVT again x2, BPs in 50sm resolved with carotid massage, started', 'metoprolol 12.5 Q6, also given 5 IV for SVT again', 'History obtained from Patient']",,73888,144271.0
6,2117-02-17 08:03:24,['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM'],['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM'],"['EKG - At [**2117-2-15**] 07:30 PM', ' EKG - At [**2117-2-15**] 08:15 PM', ' SPUTUM CULTURE - At [**2117-2-16**] 02:50 AM', '[**2117-2-15**]', '-had another episode of SVT, BP transiently in 70s, resolved without', 'intervention, ECG unchanged', '-given additional 10mg lasix, negative 1.1L as of 2300', '-SVT again x2, BPs in 50sm resolved with carotid massage, started', 'metoprolol 12.5 Q6, also given 5 IV for SVT again', 'History obtained from Patient']",73888,144271.0
7,2117-02-17 08:04:36,,['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM'],,73888,144271.0
8,2117-02-17 14:08:16,"['[**2117-2-16**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.']","['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM', '[**2117-2-16**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.']",,73888,144271.0
9,2117-02-17 14:42:09,,"['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM', '[**2117-2-16**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.']",,73888,144271.0
10,2117-02-17 14:45:31,,"['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM', '[**2117-2-16**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.']",,73888,144271.0
11,2117-02-18 07:27:38,"['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'History obtained from [**Hospital 31**] Medical records']","['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'History obtained from [**Hospital 31**] Medical records']","['TRANSTHORACIC ECHO - At [**2117-2-16**] 11:42 AM', '[**2117-2-16**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.']",73888,144271.0
12,2117-02-18 07:30:44,,"['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'History obtained from [**Hospital 31**] Medical records']",,73888,144271.0
13,2117-02-18 12:14:48,,"['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'History obtained from [**Hospital 31**] Medical records']",,73888,144271.0
14,2117-02-18 14:20:10,['Loving the chocolate shakes'],"['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'Loving the chocolate shakes', 'History obtained from [**Hospital 31**] Medical records']",,73888,144271.0
15,2117-02-19 08:01:55,"['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'History obtained from Patient']","['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'History obtained from Patient']","['-CT chest final read: hypersensitivity pneumonitis vs pulmonary edema', '-started ensure shakes QID', '-Tried to wean O2 unfortunately became more hypoxic with coughing', 'spells had to go from 60-80% FiO2', '-Pt was still even as per goal at 0100', 'Loving the chocolate shakes', 'History obtained from [**Hospital 31**] Medical records']",73888,144271.0
16,2117-02-19 08:03:17,,"['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'History obtained from Patient']",,73888,144271.0
17,2117-02-19 11:18:50,"['Switched to nasal cannula overnight', 'Worked with PT this am. They did not get him standing [**2-9**] BP 80.', 'Recommend OOB to chair with nursing over weekend.']","['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'Switched to nasal cannula overnight', 'Worked with PT this am. They did not get him standing [**2-9**] BP 80.', 'Recommend OOB to chair with nursing over weekend.', 'History obtained from Patient']",,73888,144271.0
18,2117-02-19 11:25:24,,"['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'Switched to nasal cannula overnight', 'Worked with PT this am. They did not get him standing [**2-9**] BP 80.', 'Recommend OOB to chair with nursing over weekend.', 'History obtained from Patient']",,73888,144271.0
19,2117-02-20 08:30:14,"['CALLED OUT', '[**2-19**]', '- Became hypotensive and desated with PT, so held diuresis', '- Changed iv steroids to 60mg po prednisone for NSIP', '- Added bactrim for ppx', '- Unasyn switched to augmentin']","['CALLED OUT', '[**2-19**]', '- Became hypotensive and desated with PT, so held diuresis', '- Changed iv steroids to 60mg po prednisone for NSIP', '- Added bactrim for ppx', '- Unasyn switched to augmentin', 'History obtained from Patient']","['- No new culture data.', '- Steroids decreased.', '- Patient received 10mg IV lasix twice', 'Enjoyed chocolate shakes', 'Switched to nasal cannula overnight', 'Worked with PT this am. They did not get him standing [**2-9**] BP 80.', 'Recommend OOB to chair with nursing over weekend.']",73888,144271.0
20,2117-02-20 08:30:40,,"['CALLED OUT', '[**2-19**]', '- Became hypotensive and desated with PT, so held diuresis', '- Changed iv steroids to 60mg po prednisone for NSIP', '- Added bactrim for ppx', '- Unasyn switched to augmentin', 'History obtained from Patient']",,73888,144271.0
21,2117-02-20 18:10:21,,"['CALLED OUT', '[**2-19**]', '- Became hypotensive and desated with PT, so held diuresis', '- Changed iv steroids to 60mg po prednisone for NSIP', '- Added bactrim for ppx', '- Unasyn switched to augmentin', 'History obtained from Patient']",,73888,144271.0
22,2117-02-20 18:19:06,,"['CALLED OUT', '[**2-19**]', '- Became hypotensive and desated with PT, so held diuresis', '- Changed iv steroids to 60mg po prednisone for NSIP', '- Added bactrim for ppx', '- Unasyn switched to augmentin', 'History obtained from Patient']",,73888,144271.0
0,2170-10-09 07:52:13,,"['MULTI LUMEN - START [**2170-10-8**] 11:48 PM', '- Methemoglobin level 10%']",,52831,106939.0
1,2170-10-09 07:52:46,,"['MULTI LUMEN - START [**2170-10-8**] 11:48 PM', '- Methemoglobin level 10%']",,52831,106939.0
2,2170-10-09 10:46:11,,"['MULTI LUMEN - START [**2170-10-8**] 11:48 PM', '- Methemoglobin level 10%']",,52831,106939.0
3,2170-10-10 07:00:43,"['OR SENT - At [**2170-10-9**] 10:32 AM', ' OR RECEIVED - At [**2170-10-9**] 11:59 AM', ' INVASIVE VENTILATION - START [**2170-10-9**] 12:00 PM', ""- Biopsy shows lymphoma - plasmablastic vs. Burkitt's lymphoma (less"", 'likely); hem/onc will wait to treat once diagnosis finalized', '- Given patient has lymphoma, ID recommends treating with HAART (HIV', 'with lymphoma has survival benefit, whereas HIV with TB alone does not)', '- ID - Atovaquone for PCP prophylaxis', '[**Name Initial (PRE) **] Sputum cx (ETT) - GRAM STAIN [**10-27**] PMNs, <10 epithelial cells, 1+', 'GRAM NEGATIVE ROD(S), 1+ GRAM POSITIVE COCCI IN PAIRS.', '- G6PD pending', '- No TTE today', '- Bone marrow biopsy results pending', '- BNP 1615', '- Tumor lysis labs - Checked q6 hours. Low/normal Ca, normal K, low', 'uric acid, low phos.']","['OR SENT - At [**2170-10-9**] 10:32 AM', ' OR RECEIVED - At [**2170-10-9**] 11:59 AM', ' INVASIVE VENTILATION - START [**2170-10-9**] 12:00 PM', ""- Biopsy shows lymphoma - plasmablastic vs. Burkitt's lymphoma (less"", 'likely); hem/onc will wait to treat once diagnosis finalized', '- Given patient has lymphoma, ID recommends treating with HAART (HIV', 'with lymphoma has survival benefit, whereas HIV with TB alone does not)', '- ID - Atovaquone for PCP prophylaxis', '[**Name Initial (PRE) **] Sputum cx (ETT) - GRAM STAIN [**10-27**] PMNs, <10 epithelial cells, 1+', 'GRAM NEGATIVE ROD(S), 1+ GRAM POSITIVE COCCI IN PAIRS.', '- G6PD pending', '- No TTE today', '- Bone marrow biopsy results pending', '- BNP 1615', '- Tumor lysis labs - Checked q6 hours. Low/normal Ca, normal K, low', 'uric acid, low phos.']","['MULTI LUMEN - START [**2170-10-8**] 11:48 PM', '- Methemoglobin level 10%']",52831,106939.0
4,2170-10-10 07:02:12,,"['OR SENT - At [**2170-10-9**] 10:32 AM', ' OR RECEIVED - At [**2170-10-9**] 11:59 AM', ' INVASIVE VENTILATION - START [**2170-10-9**] 12:00 PM', ""- Biopsy shows lymphoma - plasmablastic vs. Burkitt's lymphoma (less"", 'likely); hem/onc will wait to treat once diagnosis finalized', '- Given patient has lymphoma, ID recommends treating with HAART (HIV', 'with lymphoma has survival benefit, whereas HIV with TB alone does not)', '- ID - Atovaquone for PCP prophylaxis', '[**Name Initial (PRE) **] Sputum cx (ETT) - GRAM STAIN [**10-27**] PMNs, <10 epithelial cells, 1+', 'GRAM NEGATIVE ROD(S), 1+ GRAM POSITIVE COCCI IN PAIRS.', '- G6PD pending', '- No TTE today', '- Bone marrow biopsy results pending', '- BNP 1615', '- Tumor lysis labs - Checked q6 hours. Low/normal Ca, normal K, low', 'uric acid, low phos.']",,52831,106939.0
5,2170-10-10 14:23:34,,"['OR SENT - At [**2170-10-9**] 10:32 AM', ' OR RECEIVED - At [**2170-10-9**] 11:59 AM', ' INVASIVE VENTILATION - START [**2170-10-9**] 12:00 PM', ""- Biopsy shows lymphoma - plasmablastic vs. Burkitt's lymphoma (less"", 'likely); hem/onc will wait to treat once diagnosis finalized', '- Given patient has lymphoma, ID recommends treating with HAART (HIV', 'with lymphoma has survival benefit, whereas HIV with TB alone does not)', '- ID - Atovaquone for PCP prophylaxis', '[**Name Initial (PRE) **] Sputum cx (ETT) - GRAM STAIN [**10-27**] PMNs, <10 epithelial cells, 1+', 'GRAM NEGATIVE ROD(S), 1+ GRAM POSITIVE COCCI IN PAIRS.', '- G6PD pending', '- No TTE today', '- Bone marrow biopsy results pending', '- BNP 1615', '- Tumor lysis labs - Checked q6 hours. Low/normal Ca, normal K, low', 'uric acid, low phos.']",,52831,106939.0
0,2124-02-01 05:24:48,,['EKG - At [**2124-1-31**] 09:58 PM'],,57437,158857.0
1,2124-02-01 05:32:23,"['- pt agitated throughout the night - ? encephalopathy vs withdrawl from', 'ETOH benzos?', '- admin', 'd two rounds of 1mg Ativan and 2mg Haldol with little effect', '- admin', 'd 2 addt', 'l mg of Ativan prior to these episodes']","['EKG - At [**2124-1-31**] 09:58 PM', '- pt agitated throughout the night - ? encephalopathy vs withdrawl from', 'ETOH benzos?', '- admin', 'd two rounds of 1mg Ativan and 2mg Haldol with little effect', '- admin', 'd 2 addt', 'l mg of Ativan prior to these episodes']",,57437,158857.0
2,2124-02-01 06:31:46,"['d 2mg of Ativan for sedation, ? withdrawl', '- passed NGT, secured into place, CXR pending', '- Pox and BP difficult to assess, but when checked pt saturating in the', 'high 90s and BPs in the 130-150s systolic with doppler']","['EKG - At [**2124-1-31**] 09:58 PM', '- pt agitated throughout the night - ? encephalopathy vs withdrawl from', 'ETOH benzos?', '- admin', 'd 2mg of Ativan for sedation, ? withdrawl', '- admin', 'd two rounds of 1mg Ativan and 2mg Haldol with little effect', '- passed NGT, secured into place, CXR pending', '- Pox and BP difficult to assess, but when checked pt saturating in the', 'high 90s and BPs in the 130-150s systolic with doppler']","['d 2 addt', 'l mg of Ativan prior to these episodes']",57437,158857.0
3,2124-02-01 15:39:10,,"['EKG - At [**2124-1-31**] 09:58 PM', '- pt agitated throughout the night - ? encephalopathy vs withdrawl from', 'ETOH benzos?', '- admin', 'd 2mg of Ativan for sedation, ? withdrawl', '- admin', 'd two rounds of 1mg Ativan and 2mg Haldol with little effect', '- passed NGT, secured into place, CXR pending', '- Pox and BP difficult to assess, but when checked pt saturating in the', 'high 90s and BPs in the 130-150s systolic with doppler']",,57437,158857.0
4,2124-02-02 06:23:22,"['TRANSTHORACIC ECHO - At [**2124-2-1**] 09:42 AM', ' INVASIVE VENTILATION - START [**2124-2-1**] 10:50 AM', ' MULTI LUMEN - START [**2124-2-1**] 12:49 PM', ' ARTERIAL LINE - START [**2124-2-1**] 12:50 PM', ' ULTRASOUND - At [**2124-2-1**] 02:39 PM', ' PARACENTESIS - At [**2124-2-1**] 04:02 PM', '-TTE: The left atrium is moderately dilated. The right atrium is', 'moderately dilated. No atrial septal defect or patent foramen ovale is', 'seen by 2D, color Doppler or saline contrast with maneuvers. There is', 'mild symmetric left ventricular hypertrophy. The left ventricular', 'cavity size is normal. Overall left ventricular systolic function is', 'low normal (LVEF 50-55%). The right ventricular cavity is dilated with', 'moderate global free wall hypokinesis. There is abnormal septal', 'motion/position consistent with right ventricular pressure/volume', 'overload. The ascending aorta is mildly dilated. The aortic valve', 'leaflets are moderately thickened. No aortic regurgitation is seen. The', 'mitral valve leaflets are mildly thickened. Mild to moderate ([**2-10**]+)', 'mitral regurgitation is seen. The tricuspid valve leaflets are', 'moderately thickened. Moderate [2+] tricuspid regurgitation is seen.', 'The pulmonary artery pressure was not adequately determined . There is', 'no pericardial effusion.', '-intubated, Aline, CVL placed', '-paracentesis- no evidence of SBP', '-bladder pressure 20', '-? liver will place NG via scope', '-painful RUE w/BP measurements, US RUE to r/o DVT. Also dilated RV on', 'echo, concern for PEs. LENIs pending', '-decreased UOP o/n- increased pressors, NS bolus']","['TRANSTHORACIC ECHO - At [**2124-2-1**] 09:42 AM', ' INVASIVE VENTILATION - START [**2124-2-1**] 10:50 AM', ' MULTI LUMEN - START [**2124-2-1**] 12:49 PM', ' ARTERIAL LINE - START [**2124-2-1**] 12:50 PM', ' ULTRASOUND - At [**2124-2-1**] 02:39 PM', ' PARACENTESIS - At [**2124-2-1**] 04:02 PM', '-TTE: The left atrium is moderately dilated. The right atrium is', 'moderately dilated. No atrial septal defect or patent foramen ovale is', 'seen by 2D, color Doppler or saline contrast with maneuvers. There is', 'mild symmetric left ventricular hypertrophy. The left ventricular', 'cavity size is normal. Overall left ventricular systolic function is', 'low normal (LVEF 50-55%). The right ventricular cavity is dilated with', 'moderate global free wall hypokinesis. There is abnormal septal', 'motion/position consistent with right ventricular pressure/volume', 'overload. The ascending aorta is mildly dilated. The aortic valve', 'leaflets are moderately thickened. No aortic regurgitation is seen. The', 'mitral valve leaflets are mildly thickened. Mild to moderate ([**2-10**]+)', 'mitral regurgitation is seen. The tricuspid valve leaflets are', 'moderately thickened. Moderate [2+] tricuspid regurgitation is seen.', 'The pulmonary artery pressure was not adequately determined . There is', 'no pericardial effusion.', '-intubated, Aline, CVL placed', '-paracentesis- no evidence of SBP', '-bladder pressure 20', '-? liver will place NG via scope', '-painful RUE w/BP measurements, US RUE to r/o DVT. Also dilated RV on', 'echo, concern for PEs. LENIs pending', '-decreased UOP o/n- increased pressors, NS bolus']","['EKG - At [**2124-1-31**] 09:58 PM', '- pt agitated throughout the night - ? encephalopathy vs withdrawl from', 'ETOH benzos?', '- admin', 'd 2mg of Ativan for sedation, ? withdrawl', '- admin', 'd two rounds of 1mg Ativan and 2mg Haldol with little effect', '- passed NGT, secured into place, CXR pending', '- Pox and BP difficult to assess, but when checked pt saturating in the', 'high 90s and BPs in the 130-150s systolic with doppler']",57437,158857.0
5,2124-02-02 06:25:00,,"['TRANSTHORACIC ECHO - At [**2124-2-1**] 09:42 AM', ' INVASIVE VENTILATION - START [**2124-2-1**] 10:50 AM', ' MULTI LUMEN - START [**2124-2-1**] 12:49 PM', ' ARTERIAL LINE - START [**2124-2-1**] 12:50 PM', ' ULTRASOUND - At [**2124-2-1**] 02:39 PM', ' PARACENTESIS - At [**2124-2-1**] 04:02 PM', '-TTE: The left atrium is moderately dilated. The right atrium is', 'moderately dilated. No atrial septal defect or patent foramen ovale is', 'seen by 2D, color Doppler or saline contrast with maneuvers. There is', 'mild symmetric left ventricular hypertrophy. The left ventricular', 'cavity size is normal. Overall left ventricular systolic function is', 'low normal (LVEF 50-55%). The right ventricular cavity is dilated with', 'moderate global free wall hypokinesis. There is abnormal septal', 'motion/position consistent with right ventricular pressure/volume', 'overload. The ascending aorta is mildly dilated. The aortic valve', 'leaflets are moderately thickened. No aortic regurgitation is seen. The', 'mitral valve leaflets are mildly thickened. Mild to moderate ([**2-10**]+)', 'mitral regurgitation is seen. The tricuspid valve leaflets are', 'moderately thickened. Moderate [2+] tricuspid regurgitation is seen.', 'The pulmonary artery pressure was not adequately determined . There is', 'no pericardial effusion.', '-intubated, Aline, CVL placed', '-paracentesis- no evidence of SBP', '-bladder pressure 20', '-? liver will place NG via scope', '-painful RUE w/BP measurements, US RUE to r/o DVT. Also dilated RV on', 'echo, concern for PEs. LENIs pending', '-decreased UOP o/n- increased pressors, NS bolus']",,57437,158857.0
6,2124-02-02 13:50:10,"['-intubated, Aline and CVL placed', '-Dilated RV on echo with global free wall hypokinesis, concern for PEs.', 'LENIs pending']","['-intubated, Aline and CVL placed', '-paracentesis- no evidence of SBP', '-bladder pressure 20', '-? liver will place NG via scope', '-Dilated RV on echo with global free wall hypokinesis, concern for PEs.', 'LENIs pending', '-decreased UOP o/n- increased pressors, NS bolus']","['TRANSTHORACIC ECHO - At [**2124-2-1**] 09:42 AM', ' INVASIVE VENTILATION - START [**2124-2-1**] 10:50 AM', ' MULTI LUMEN - START [**2124-2-1**] 12:49 PM', ' ARTERIAL LINE - START [**2124-2-1**] 12:50 PM', ' ULTRASOUND - At [**2124-2-1**] 02:39 PM', ' PARACENTESIS - At [**2124-2-1**] 04:02 PM', '-TTE: The left atrium is moderately dilated. The right atrium is', 'moderately dilated. No atrial septal defect or patent foramen ovale is', 'seen by 2D, color Doppler or saline contrast with maneuvers. There is', 'mild symmetric left ventricular hypertrophy. The left ventricular', 'cavity size is normal. Overall left ventricular systolic function is', 'low normal (LVEF 50-55%). The right ventricular cavity is dilated with', 'moderate global free wall hypokinesis. There is abnormal septal', 'motion/position consistent with right ventricular pressure/volume', 'overload. The ascending aorta is mildly dilated. The aortic valve', 'leaflets are moderately thickened. No aortic regurgitation is seen. The', 'mitral valve leaflets are mildly thickened. Mild to moderate ([**2-10**]+)', 'mitral regurgitation is seen. The tricuspid valve leaflets are', 'moderately thickened. Moderate [2+] tricuspid regurgitation is seen.', 'The pulmonary artery pressure was not adequately determined . There is', 'no pericardial effusion.', '-intubated, Aline, CVL placed', '-painful RUE w/BP measurements, US RUE to r/o DVT. Also dilated RV on', 'echo, concern for PEs. LENIs pending']",57437,158857.0
7,2124-02-03 04:43:38,"['DNR per family', 'No further invasive procedures', 'Did not have NGT placed secondary to family request', 'Decreased PEEP to 5', 'CTA neg for PE', 'LENIS neg UE/LE B/L', 'SBP 70s with 15cc/hr Levophed around 2 am. Bolused 500cc, with UOP 40', 'cc/hr SBP 80-90s']","['DNR per family', 'No further invasive procedures', 'Did not have NGT placed secondary to family request', 'Decreased PEEP to 5', 'CTA neg for PE', 'LENIS neg UE/LE B/L', 'SBP 70s with 15cc/hr Levophed around 2 am. Bolused 500cc, with UOP 40', 'cc/hr SBP 80-90s']","['-intubated, Aline and CVL placed', '-paracentesis- no evidence of SBP', '-bladder pressure 20', '-? liver will place NG via scope', '-Dilated RV on echo with global free wall hypokinesis, concern for PEs.', 'LENIs pending', '-decreased UOP o/n- increased pressors, NS bolus']",57437,158857.0
8,2124-02-03 04:46:15,,"['DNR per family', 'No further invasive procedures', 'Did not have NGT placed secondary to family request', 'Decreased PEEP to 5', 'CTA neg for PE', 'LENIS neg UE/LE B/L', 'SBP 70s with 15cc/hr Levophed around 2 am. Bolused 500cc, with UOP 40', 'cc/hr SBP 80-90s']",,57437,158857.0
9,2124-02-03 10:26:43,"['Pt made DNR per family and requested no further invasive procedures or', 'escalation of care', 'cc/hr SBP 80-90s, bolused 500cc again this am', 'Developed new rash on abdomen']","['Pt made DNR per family and requested no further invasive procedures or', 'escalation of care', 'Did not have NGT placed secondary to family request', 'Decreased PEEP to 5', 'CTA neg for PE', 'LENIS neg UE/LE B/L', 'SBP 70s with 15cc/hr Levophed around 2 am. Bolused 500cc, with UOP 40', 'cc/hr SBP 80-90s, bolused 500cc again this am', 'Developed new rash on abdomen']","['DNR per family', 'No further invasive procedures', 'cc/hr SBP 80-90s']",57437,158857.0
10,2124-02-04 05:43:10,"['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']","['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']","['Pt made DNR per family and requested no further invasive procedures or', 'escalation of care', 'Did not have NGT placed secondary to family request', 'Decreased PEEP to 5', 'CTA neg for PE', 'LENIS neg UE/LE B/L', 'SBP 70s with 15cc/hr Levophed around 2 am. Bolused 500cc, with UOP 40', 'cc/hr SBP 80-90s, bolused 500cc again this am', 'Developed new rash on abdomen']",57437,158857.0
11,2124-02-04 05:44:28,,"['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']",,57437,158857.0
12,2124-02-04 12:42:32,,"['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']",,57437,158857.0
13,2124-02-04 13:01:39,,"['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']",,57437,158857.0
14,2124-02-05 05:59:08,"['INVASIVE VENTILATION - STOP [**2124-2-4**] 03:30 PM', 'made CMO by family']","['INVASIVE VENTILATION - STOP [**2124-2-4**] 03:30 PM', 'made CMO by family']","['ARTERIAL LINE - STOP [**2124-2-4**] 12:00 AM', 'Made DNR yesterday. No more invasive procedures. Family considering', 'CMO.']",57437,158857.0
15,2124-02-05 05:59:54,,"['INVASIVE VENTILATION - STOP [**2124-2-4**] 03:30 PM', 'made CMO by family']",,57437,158857.0
16,2124-02-05 07:47:07,['Patient made CMO by family. Extubated. Family at bedside'],"['INVASIVE VENTILATION - STOP [**2124-2-4**] 03:30 PM', 'Patient made CMO by family. Extubated. Family at bedside']",['made CMO by family'],57437,158857.0
0,2163-05-16 06:47:13,,"['-pt extubated, very anxious', '-reports taking ativan in AM, and having ""a few"" cocktails afterwork in', 'PM, does not remember getting in car', '-c-collar removed by pt, neck non-tender; c-spine film prelim with', 'degeneration of C5-6, has some mild numbness in right thumb (on side', 'with handcuffs)', '-intoxicated', '-only wants sister [**Name (NI) 1850**] in Emergency (number on ICU consent)', '-police at bedside', '-had HA, tried tylenol, then gave dose of ibuprofen']",,91453,146698.0
1,2163-05-16 11:24:43,"['- Extubated, very anxious', '- reports taking ativan in AM, and having ""a few"" cocktails afterwork', 'in PM, does not remember getting in car', '- c-collar removed by pt, neck non-tender; c-spine film prelim with']","['- Extubated, very anxious', '- reports taking ativan in AM, and having ""a few"" cocktails afterwork', 'in PM, does not remember getting in car', '- c-collar removed by pt, neck non-tender; c-spine film prelim with', 'degeneration of C5-6, has some mild numbness in right thumb (on side', 'with handcuffs)', '-intoxicated', '-only wants sister [**Name (NI) 1850**] in Emergency (number on ICU consent)', '-police at bedside', '-had HA, tried tylenol, then gave dose of ibuprofen']","['-pt extubated, very anxious', '-reports taking ativan in AM, and having ""a few"" cocktails afterwork in', 'PM, does not remember getting in car', '-c-collar removed by pt, neck non-tender; c-spine film prelim with']",91453,146698.0
2,2163-05-16 11:36:27,"['- Diazepam 10mg x 2 overnight (5pm, 1am)']","['- Extubated, very anxious', '- reports taking ativan in AM, and having ""a few"" cocktails afterwork', 'in PM, does not remember getting in car', '- c-collar removed by pt, neck non-tender; c-spine film prelim with', 'degeneration of C5-6, has some mild numbness in right thumb (on side', 'with handcuffs)', '-intoxicated', '-only wants sister [**Name (NI) 1850**] in Emergency (number on ICU consent)', '-police at bedside', '-had HA, tried tylenol, then gave dose of ibuprofen', '- Diazepam 10mg x 2 overnight (5pm, 1am)']",,91453,146698.0
3,2163-05-16 13:40:30,"['- C-Collar removed by pt, neck non-tender; c-spine film prelim with']","['- Extubated, very anxious', '- reports taking ativan in AM, and having ""a few"" cocktails afterwork', 'in PM, does not remember getting in car', '- C-Collar removed by pt, neck non-tender; c-spine film prelim with', 'degeneration of C5-6, has some mild numbness in right thumb (on side', 'with handcuffs)', '-intoxicated', '-only wants sister [**Name (NI) 1850**] in Emergency (number on ICU consent)', '-police at bedside', '-had HA, tried tylenol, then gave dose of ibuprofen', '- Diazepam 10mg x 2 overnight (5pm, 1am)']","['- c-collar removed by pt, neck non-tender; c-spine film prelim with']",91453,146698.0
0,2120-02-20 06:48:40,,"['Patient has received 7 doses of Valium PO since yesterday morning along', 'with 3 doses of Haldol PO.']",,68392,161941.0
1,2120-02-20 06:49:49,,"['Patient has received 7 doses of Valium PO since yesterday morning along', 'with 3 doses of Haldol PO.']",,68392,161941.0
2,2120-02-20 11:12:19,,"['Patient has received 7 doses of Valium PO since yesterday morning along', 'with 3 doses of Haldol PO.']",,68392,161941.0
3,2120-02-20 11:13:36,,"['Patient has received 7 doses of Valium PO since yesterday morning along', 'with 3 doses of Haldol PO.']",,68392,161941.0
4,2120-02-21 07:01:54,"['Kept overnight for agitation, frequent medication dosing and', 'tachycardia. Given 1L NS bolus without effect.', 'Psych recs for direct from ICU admission to [**Hospital1 **] 4.', '1mg ativan IV x2 for acute anxiety']","['Kept overnight for agitation, frequent medication dosing and', 'tachycardia. Given 1L NS bolus without effect.', 'Psych recs for direct from ICU admission to [**Hospital1 **] 4.', '1mg ativan IV x2 for acute anxiety']","['Patient has received 7 doses of Valium PO since yesterday morning along', 'with 3 doses of Haldol PO.']",68392,161941.0
5,2120-02-21 07:55:41,,"['Kept overnight for agitation, frequent medication dosing and', 'tachycardia. Given 1L NS bolus without effect.', 'Psych recs for direct from ICU admission to [**Hospital1 **] 4.', '1mg ativan IV x2 for acute anxiety']",,68392,161941.0
6,2120-02-21 13:46:19,,"['Kept overnight for agitation, frequent medication dosing and', 'tachycardia. Given 1L NS bolus without effect.', 'Psych recs for direct from ICU admission to [**Hospital1 **] 4.', '1mg ativan IV x2 for acute anxiety']",,68392,161941.0
7,2120-02-21 13:47:54,,"['Kept overnight for agitation, frequent medication dosing and', 'tachycardia. Given 1L NS bolus without effect.', 'Psych recs for direct from ICU admission to [**Hospital1 **] 4.', '1mg ativan IV x2 for acute anxiety']",,68392,161941.0
0,2137-05-01 07:38:31,,"['Confusion overnight. Pulled Swan back to RV and caused VT. Swan pulled', 'back to Rv.', 'Restarted Heparin gtt']",,44486,178101.0
1,2137-05-01 07:40:53,,"['Confusion overnight. Pulled Swan back to RV and caused VT. Swan pulled', 'back to Rv.', 'Restarted Heparin gtt']",,44486,178101.0
2,2137-05-01 12:46:43,,"['Confusion overnight. Pulled Swan back to RV and caused VT. Swan pulled', 'back to Rv.']",['Restarted Heparin gtt'],44486,178101.0
0,2196-01-28 07:36:15,,"['admitted for airway monitoring', 'No acute events O/N']",,27960,179767.0
1,2196-01-28 07:52:38,,"['admitted for airway monitoring', 'No acute events O/N']",,27960,179767.0
2,2196-01-28 10:15:25,,"['admitted for airway monitoring', 'No acute events O/N']",,27960,179767.0
0,2167-04-23 07:24:26,,"['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of worsening hypotension, fever']",,89119,187268.0
1,2167-04-23 07:36:20,,"['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of worsening hypotension, fever']",,89119,187268.0
2,2167-04-23 08:05:44,,"['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of worsening hypotension, fever']",,89119,187268.0
3,2167-04-23 08:54:37,,"['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of worsening hypotension, fever']",,89119,187268.0
4,2167-04-23 09:56:49,"['- re-started on pressors in setting of fever and worsening hypotension', 'several hours after dialysis ended']","['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of fever and worsening hypotension', 'several hours after dialysis ended']","['- re-started on pressors in setting of worsening hypotension, fever']",89119,187268.0
5,2167-04-24 06:28:55,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']","['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']","['TUNNELED (HICKMAN) LINE - START [**2167-4-22**] 01:10 PM', ' MULTI LUMEN - START [**2167-4-22**] 01:12 PM', ' EKG - At [**2167-4-22**] 01:45 PM', ' BLOOD CULTURED - At [**2167-4-22**] 03:06 PM', 'HD line', 'venipuncture', ' NASAL SWAB - At [**2167-4-22**] 03:06 PM', ' FEVER - 101.3', 'F - [**2167-4-23**] 04:00 AM', '[**2167-4-22**]:', '- Patient underwent HD', '- IR contact[**Name (NI) **] to pull tunnelled HD catheter, will perform this morning', 'and likely will place a temporary HD catheter.', '- seen by ID, no recs yet.', '- patient spiked fever to 101.3 this morning; lactate and cultures', 'sent.', '- re-started on pressors in setting of fever and worsening hypotension', 'several hours after dialysis ended']",89119,187268.0
6,2167-04-24 06:36:33,,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",,89119,187268.0
7,2167-04-24 07:04:08,,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",,89119,187268.0
8,2167-04-24 08:57:47,,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",,89119,187268.0
9,2167-04-24 08:58:44,,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",,89119,187268.0
10,2167-04-24 10:58:42,,"['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",,89119,187268.0
11,2167-04-25 07:49:59,"['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured']","['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured']","['TUNNELED (HICKMAN) LINE - STOP [**2167-4-23**] 09:10 AM', ' BLOOD CULTURED - At [**2167-4-23**] 09:39 AM', 'HD line tip', ' ULTRASOUND - At [**2167-4-23**] 10:40 AM', 'pacer pocket', ' BLOOD CULTURED - At [**2167-4-23**] 01:06 PM', 'R Fem MLC', ' BLOOD CULTURED - At [**2167-4-23**] 03:30 PM', 'REJ line tip', '[**2167-4-23**]:', '- HD catheter line pulled and tip cultured', '- EJ pulled and cultured', '- femoral line remains as still pressor requirement', '- GNR in aerobic bottle from [**4-22**] (not yet speciated)']",89119,187268.0
12,2167-04-25 08:14:30,,"['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured']",,89119,187268.0
13,2167-04-25 10:08:00,"['- pt found to be hypotensive to systolic 76-80s at 7am-10am; got 250 cc', 'bolus IVF; ? slightly sleepy.']","['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured', '- pt found to be hypotensive to systolic 76-80s at 7am-10am; got 250 cc', 'bolus IVF; ? slightly sleepy.']",,89119,187268.0
14,2167-04-25 14:24:24,,"['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured', '- pt found to be hypotensive to systolic 76-80s at 7am-10am; got 250 cc', 'bolus IVF; ? slightly sleepy.']",,89119,187268.0
15,2167-04-26 07:51:08,"['TRANSTHORACIC ECHO - At [**2167-4-25**] 09:27 AM', '- Patient became hypotensive into 60s (asymptomatic). Vasopressin', 'started.', '- CT abd/pelvis non-contrast looking for abdominal source: New small to', 'moderate bilateral pleural effusions with simple fluid attenuation,', 'there is associate compressive atelectasis.  There has been prior', 'mediastinotomy.  Pacer wires seen.  Coronary artery calcifications.', 'Large stones in gallbladder (unchanged).  Cystic lesions in pancreas.', 'Left upper pole mass, left lower pole cyst, right heterogeneous lower', 'pole lesions are poorly evaluated.', 'No free air in abdomen.  Mild diffuse mesenteric stranding and', 'anasarca. No RP lymphadenopathy.', '1. no acute intraabdominal/pelvic process to explain symptoms', '2. multiple pancreatic/renal lesions', '3. cholelithiasis without cholecystitis.', '4. new small to moderate bilateral pleural effusions']","['TRANSTHORACIC ECHO - At [**2167-4-25**] 09:27 AM', '- Patient became hypotensive into 60s (asymptomatic). Vasopressin', 'started.', '- CT abd/pelvis non-contrast looking for abdominal source: New small to', 'moderate bilateral pleural effusions with simple fluid attenuation,', 'there is associate compressive atelectasis.  There has been prior', 'mediastinotomy.  Pacer wires seen.  Coronary artery calcifications.', 'Large stones in gallbladder (unchanged).  Cystic lesions in pancreas.', 'Left upper pole mass, left lower pole cyst, right heterogeneous lower', 'pole lesions are poorly evaluated.', 'No free air in abdomen.  Mild diffuse mesenteric stranding and', 'anasarca. No RP lymphadenopathy.', '1. no acute intraabdominal/pelvic process to explain symptoms', '2. multiple pancreatic/renal lesions', '3. cholelithiasis without cholecystitis.', '4. new small to moderate bilateral pleural effusions']","['PICC LINE - START [**2167-4-24**] 06:30 PM', ' MULTI LUMEN - STOP [**2167-4-24**] 10:17 PM', '- catheter tip: growing GNR', '- ABX - changed to meropenem (from ceftaz for non-HD dosing) and', 'continued on gentamycin for pseudomonas, Flagyl PO for C. Diff', '- Pain service - no change in pain regimen', '- Renal: no need for HD today, will eval daily - may need tomorrow, ok', 'for abdominal CT if ID wants it', '- Ordered for TTE and TEE to evaluate for endocarditis', '- PICC line placed (could not advance any further and tip read as', 'ending in brachiocephalic not distal SVC). Recommmendation was that if', 'needs ABX for longer than mid-week next week then have IR place another', 'PICC so can get tip in distal SVC.', '- Femoral line pulled and catheter tip cultured', '- pt found to be hypotensive to systolic 76-80s at 7am-10am; got 250 cc', 'bolus IVF; ? slightly sleepy.']",89119,187268.0
16,2167-04-26 09:52:46,,"['TRANSTHORACIC ECHO - At [**2167-4-25**] 09:27 AM', '- Patient became hypotensive into 60s (asymptomatic). Vasopressin', 'started.', '- CT abd/pelvis non-contrast looking for abdominal source: New small to', 'moderate bilateral pleural effusions with simple fluid attenuation,', 'there is associate compressive atelectasis.  There has been prior', 'mediastinotomy.  Pacer wires seen.  Coronary artery calcifications.', 'Large stones in gallbladder (unchanged).  Cystic lesions in pancreas.', 'Left upper pole mass, left lower pole cyst, right heterogeneous lower', 'pole lesions are poorly evaluated.', 'No free air in abdomen.  Mild diffuse mesenteric stranding and', 'anasarca. No RP lymphadenopathy.', '1. no acute intraabdominal/pelvic process to explain symptoms', '2. multiple pancreatic/renal lesions', '3. cholelithiasis without cholecystitis.', '4. new small to moderate bilateral pleural effusions']",,89119,187268.0
17,2167-04-27 06:43:25,['BLOOD CULTURED - At [**2167-4-26**] 03:17 PM'],['BLOOD CULTURED - At [**2167-4-26**] 03:17 PM'],"['TRANSTHORACIC ECHO - At [**2167-4-25**] 09:27 AM', '- Patient became hypotensive into 60s (asymptomatic). Vasopressin', 'started.', '- CT abd/pelvis non-contrast looking for abdominal source: New small to', 'moderate bilateral pleural effusions with simple fluid attenuation,', 'there is associate compressive atelectasis.  There has been prior', 'mediastinotomy.  Pacer wires seen.  Coronary artery calcifications.', 'Large stones in gallbladder (unchanged).  Cystic lesions in pancreas.', 'Left upper pole mass, left lower pole cyst, right heterogeneous lower', 'pole lesions are poorly evaluated.', 'No free air in abdomen.  Mild diffuse mesenteric stranding and', 'anasarca. No RP lymphadenopathy.', '1. no acute intraabdominal/pelvic process to explain symptoms', '2. multiple pancreatic/renal lesions', '3. cholelithiasis without cholecystitis.', '4. new small to moderate bilateral pleural effusions']",89119,187268.0
18,2167-04-27 06:43:59,,['BLOOD CULTURED - At [**2167-4-26**] 03:17 PM'],,89119,187268.0
19,2167-04-27 06:58:05,,['BLOOD CULTURED - At [**2167-4-26**] 03:17 PM'],,89119,187268.0
20,2167-04-27 10:15:24,,['BLOOD CULTURED - At [**2167-4-26**] 03:17 PM'],,89119,187268.0
0,2142-06-03 06:53:24,,"['- C collar placed for ?trauma; consider C-spine xray and CT head when', 'more stable. Hip xray without fx.', '- TTE showed worsened LVEF 20-25% with hypokinetic RV with e/o elevated', 'RV pressures.', '- Versed/fentanyl weaned to prn boluses. Started amiodarone with', 'improved HR control. Levophed dependent with drop in SBP to 40s when', 'off pressors transiently for blood draw but tachycardic when too high.', '- Agitated and tried to pull out ETT so switched from fentanyl/versed', 'bolus to gtt.', '- Able to wean off AC to PS.', '- Started tube feeds']",,10134,156534.0
1,2142-06-03 06:57:49,,"['- C collar placed for ?trauma; consider C-spine xray and CT head when', 'more stable. Hip xray without fx.', '- TTE showed worsened LVEF 20-25% with hypokinetic RV with e/o elevated', 'RV pressures.', '- Versed/fentanyl weaned to prn boluses. Started amiodarone with', 'improved HR control. Levophed dependent with drop in SBP to 40s when', 'off pressors transiently for blood draw but tachycardic when too high.', '- Agitated and tried to pull out ETT so switched from fentanyl/versed', 'bolus to gtt.', '- Able to wean off AC to PS.', '- Started tube feeds']",,10134,156534.0
2,2142-06-03 11:44:02,"['- C collar placed for ?trauma. Hip x-ray without fx.', '- Started amiodarone with improved HR control. Levophed dependent with', 'drop in SBP to 40s when off pressors transiently for blood draw but', 'tachycardic when too high.', '- Able to wean off AC to PS; now on SBT']","['- C collar placed for ?trauma. Hip x-ray without fx.', '- Started tube feeds', '- TTE showed worsened LVEF 20-25% with hypokinetic RV with e/o elevated', 'RV pressures.', '- Started amiodarone with improved HR control. Levophed dependent with', 'drop in SBP to 40s when off pressors transiently for blood draw but', 'tachycardic when too high.', '- Able to wean off AC to PS; now on SBT']","['- C collar placed for ?trauma; consider C-spine xray and CT head when', 'more stable. Hip xray without fx.', '- Versed/fentanyl weaned to prn boluses. Started amiodarone with', 'improved HR control. Levophed dependent with drop in SBP to 40s when', 'off pressors transiently for blood draw but tachycardic when too high.', '- Agitated and tried to pull out ETT so switched from fentanyl/versed', 'bolus to gtt.', '- Able to wean off AC to PS.']",10134,156534.0
3,2142-06-04 07:06:32,"['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']","['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']","['- C collar placed for ?trauma. Hip x-ray without fx.', '- Started tube feeds', '- TTE showed worsened LVEF 20-25% with hypokinetic RV with e/o elevated', 'RV pressures.', '- Started amiodarone with improved HR control. Levophed dependent with', 'drop in SBP to 40s when off pressors transiently for blood draw but', 'tachycardic when too high.', '- Able to wean off AC to PS; now on SBT']",10134,156534.0
4,2142-06-04 07:08:28,,"['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']",,10134,156534.0
5,2142-06-04 07:12:07,,"['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']",,10134,156534.0
6,2142-06-04 12:34:21,,"['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']",,10134,156534.0
7,2142-06-05 06:49:50,"['- CMO - kept norepinephrine going at this time to allow family to come', 'see patient. Palliative care aware.', '- Pressors discontinued in evening. Patient maintaining MAP 50s off of', 'pressors.']","['- CMO - kept norepinephrine going at this time to allow family to come', 'see patient. Palliative care aware.', '- Pressors discontinued in evening. Patient maintaining MAP 50s off of', 'pressors.']","['C-SPINE CLEARANCE - At [**2142-6-3**] 04:40 PM', ' INVASIVE VENTILATION - STOP [**2142-6-3**] 04:45 PM', ' ARTERIAL LINE - STOP [**2142-6-4**] 12:19 AM', '[**2142-6-3**]', '- Dr. [**Last Name (STitle) **] recommended continuing amio gtt for 24 hr until AM of [**2142-6-4**]', 'and wanted her to be full code.', '- CT head and neck without fracture.  Sedation was lightened and', 'C-spine was cleared.', '- Patient was extubated without trouble, but was delerious and', 'uncomfortable.', ""- In the evening, we were approached by the patient's family who wanted"", 'to speak to palleative care/hospice and wanted her to be DNR/DNI.  Dr.', '[**Last Name (STitle) **] was made aware of the change in her code status and spoke with her', 'family about the decision.', '- She was given morphine for pain and discomfort as well as lorazepam', 'for agitation.']",10134,156534.0
8,2142-06-05 06:52:06,,"['- CMO - kept norepinephrine going at this time to allow family to come', 'see patient. Palliative care aware.', '- Pressors discontinued in evening. Patient maintaining MAP 50s off of', 'pressors.']",,10134,156534.0
9,2142-06-05 10:51:00,,"['- CMO - kept norepinephrine going at this time to allow family to come', 'see patient. Palliative care aware.', '- Pressors discontinued in evening. Patient maintaining MAP 50s off of', 'pressors.']",,10134,156534.0
0,2178-08-21 08:20:18,,['INVASIVE VENTILATION - START [**2178-8-21**] 04:00 AM'],,69578,181308.0
1,2178-08-21 08:20:56,,['INVASIVE VENTILATION - START [**2178-8-21**] 04:00 AM'],,69578,181308.0
2,2178-08-21 09:35:25,,,,69578,181308.0
3,2178-08-21 22:43:23,,,,69578,181308.0
4,2178-08-22 02:03:44,,,,69578,181308.0
5,2178-08-22 07:13:46,"['EKG - At [**2178-8-21**] 08:08 AM', ' PICC LINE - START [**2178-8-21**] 03:55 PM', 'ERCP yesterday; retreived stone and sphincterotomy.', 'Vent settings improved']",,"['INVASIVE VENTILATION - START [**2178-8-21**] 04:00 AM', ""39M with Duchenne's muscular dystrophy, chronic vent dependency, with 3"", 'days RUQ pain, nausea originally admitted to MICU Green on the night of', '[**8-20**].  Left-sided PICC was placed in ICU on [**8-21**] [**1-3**] poor access and', 'inability to draw labs.  Patient was seen by general surgery and ERCP.', 'It was decided that patient should have ERCP.', 'Patient was stable overnight and transferred East on [**8-21**] for ERCP.', 'ERCP performed under MAC anesthesia.  ERCP significant for a filling', 'defect that appeared like a stone in the lower [**12-4**] of the CBD.', 'Sphincterotomy was performed, the stone along with some sludge was', 'extracted.  The patient was stable post-procedure and transferred to', 'the [**Hospital Unit Name 1**] as he is ventilator-dependent [**1-3**] muscular dystrophy.', '.', 'In the [**Hospital Unit Name 1**], 87 111/72 15 98%.  Patient denies any pain.  ROS', 'significant for constipation, last BM Monday and increased secretions', 'around his trach.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",69578,181308.0
6,2178-08-22 07:14:41,,,,69578,181308.0
7,2178-08-22 07:21:36,,,,69578,181308.0
8,2178-08-22 08:00:02,,,,69578,181308.0
9,2178-08-22 08:19:45,,,,69578,181308.0
10,2178-08-22 10:44:38,,,,69578,181308.0
11,2178-08-23 06:42:18,"['-BP in 70s overnight, bolus 500cc, d/c lisinopril']",,"['EKG - At [**2178-8-21**] 08:08 AM', ' PICC LINE - START [**2178-8-21**] 03:55 PM', 'ERCP yesterday; retreived stone and sphincterotomy.', 'Vent settings improved']",69578,181308.0
12,2178-08-23 07:15:02,,,,69578,181308.0
13,2178-08-23 12:23:38,,,,69578,181308.0
0,2129-04-04 06:28:00,,['-received Haldol (total 3.5 mg) overnight for agitation'],,69776,117902.0
1,2129-04-04 10:12:00,,['-received Haldol (total 3.5 mg) overnight for agitation'],,69776,117902.0
2,2129-04-04 21:18:23,,['-received Haldol (total 3.5 mg) overnight for agitation'],,69776,117902.0
3,2129-04-07 07:34:34,"['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']","['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']",['-received Haldol (total 3.5 mg) overnight for agitation'],69776,117902.0
4,2129-04-07 14:52:24,,"['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']",,69776,117902.0
5,2129-04-07 20:50:25,,"['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']",,69776,117902.0
6,2129-04-08 07:13:40,"['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']","['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']","['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']",69776,117902.0
7,2129-04-08 16:01:14,"['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']","['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']","['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']",69776,117902.0
8,2129-04-08 20:22:50,"['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']","['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']","['- Was to be called out to floor, family concerned, so stayed overnight', '- Pt became agitated, took off o2 and desated to mid 80s. Nursing able', 'to calm him down and replace O2 without using haldol or restraints', '- [**Last Name (un) **]-[**Doctor Last Name **] respirations continue']",69776,117902.0
9,2129-04-09 07:06:08,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']","['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']","['-', 'Did better overnight with less agitation', '-', 'Able to take PO (2 ensure shakes) yesterday', '-', 'Continues to [**Last Name (un) **] stoke breathe']",69776,117902.0
10,2129-04-09 07:11:33,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
11,2129-04-09 16:54:22,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
12,2129-04-09 17:01:52,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
13,2129-04-09 17:32:25,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
14,2129-04-09 17:33:56,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
15,2129-04-09 18:11:53,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
16,2129-04-09 18:40:42,,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",,69776,117902.0
17,2129-04-10 07:24:50,"['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",69776,117902.0
18,2129-04-10 07:26:07,,"['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']",,69776,117902.0
19,2129-04-10 08:30:44,"['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']","['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']",69776,117902.0
20,2129-04-10 14:00:07,"['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['[**4-8**]', '- Is/Os check put out 1-1.5 L from lasix dose so no extra pm diuretics']",69776,117902.0
21,2129-04-11 06:42:52,"['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']","['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']",69776,117902.0
22,2129-04-11 06:44:48,,"['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']",,69776,117902.0
23,2129-04-11 10:51:35,,"['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']",,69776,117902.0
24,2129-04-11 13:25:41,"['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']","['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']",69776,117902.0
25,2129-04-11 13:26:23,"['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']","['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']","['FEVER - 101.2', 'F - [**2129-4-9**] 08:00 PM', '[**4-9**]', '- Had HCT drop from hematoma on R flank, extraperitoneal, CT confirms,', 'IR recommended transfusing and correcting coagulopathy, if still', 'unstable, then will intervene', '- Transfused 2 units PRBCs with Hct increase from 21.7 to 28.3', '- HR increased from 60 to 76, SBP stayed 100s-120s']",69776,117902.0
26,2129-04-12 07:46:37,"['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']","['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']","['BLOOD CULTURED - At [**2129-4-10**] 03:06 PM', ' URINE CULTURE - At [**2129-4-10**] 03:09 PM', ' FEVER - 101.8', 'F - [**2129-4-10**] 08:00 PM', '- Pharmacy - vancomycin 24 on a.m. of [**4-10**]. Dose not given. Vanco level', 'requested for [**4-11**] and pharmacy recommend changing dose to 750 mg IV QD,', 'based on level.', '- per Dr. [**Last Name (STitle) 5279**], patient NOT going for right-heart cath given clinical', 'instability', '- got 80 mg IV Lasix', '- patient felt better in evening, ate some pudding, tolerated well', '- overnight transfused 1u PRBCs for hct 25.7']",69776,117902.0
27,2129-04-12 07:52:07,,"['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']",,69776,117902.0
28,2129-04-12 15:44:06,,"['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']",,69776,117902.0
29,2129-04-13 07:34:51,"['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']","['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']","['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']",69776,117902.0
30,2129-04-13 07:41:19,,"['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']",,69776,117902.0
31,2129-04-13 09:49:27,,"['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']",,69776,117902.0
32,2129-04-13 14:40:21,,"['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']",,69776,117902.0
33,2129-04-13 14:41:18,"['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']","['[**4-11**]- [**4-12**]', '- [**Doctor First Name 2554**] spoke with wife about not doing catheterization', '- family requested to speak with Dr. [**Last Name (STitle) 5279**]', '- did not give dose of lasix given hypernatremia', '- pm sodium was 150 so gave 500 cc D5W over 4 hrs...(FYI free water', 'defecit around 3 L)']","['SPUTUM CULTURE - At [**2129-4-12**] 12:30 PM', ' URINE CULTURE - At [**2129-4-12**] 12:30 PM', ' BLOOD CULTURED - At [**2129-4-12**] 01:00 PM', '[**Date range (1) 5235**]', '-Was transfused 1 unit PRBCs', '-Family meeting with [**Doctor First Name 2554**], Dr. [**Last Name (STitle) **], and [**Doctor Last Name 366**], it was decided to', 'try a R heart cath if medically feasible on [**2129-4-13**] to ascertain R sided', 'pressures and determine if pt wet/dry or euvolemic. No dilator trials', 'to be done.']",69776,117902.0
0,2176-06-04 06:29:19,,"['-Patient admited overnight.', '-5am increase in abdominal pain, tachycardic tachypneic', ' urology', 'called and reported he will be going to the OR in the morning.', '-Started on IV morphine for pain control.']",,28043,149969.0
1,2176-06-05 06:30:54,"['-urology- s/p OR to close anterior perf, unable to reach posterior', 'perforation, still with necrosis. Thought [**3-4**] foley malpositioning; has', 'foley, suprapubic cath, jp tube near perforation for urine output; may', 'need b/l nephrostomy tube, urinary diversion if not improving, JP to', 'bulb suction, foley to gravity, broad spectrum antibx', '-peritoneal fluid- 4+ polys, 1+ GNR', '-urine culture- >100,000/mL GNR', '-cont cefepime, gentamicin spec/[**Last Name (un) **] pending', '-cont vancomycin', '-nutrition- clear sips', '-pain: morphine IV and Ditropan for bladder spasm', '-3PM gas- 7.29/36/143, lactate 4.8 (previous 4.5)', '-bolused 1L NS over 1 hr', '-transfused 2 units PRBCs at request of urology', '-6PM gas- 7.34/35/93, lactate 2.3', '-morphine changed to dilaudid (c/w urology) for better pain control', '-hypotensive overnight (?narcotics vs sepsis?)- gave 1.5L IVF in 500cc', 'boluses, no need for pressors, to maintain MAP above 65']","['-urology- s/p OR to close anterior perf, unable to reach posterior', 'perforation, still with necrosis. Thought [**3-4**] foley malpositioning; has', 'foley, suprapubic cath, jp tube near perforation for urine output; may', 'need b/l nephrostomy tube, urinary diversion if not improving, JP to', 'bulb suction, foley to gravity, broad spectrum antibx', '-peritoneal fluid- 4+ polys, 1+ GNR', '-urine culture- >100,000/mL GNR', '-cont cefepime, gentamicin spec/[**Last Name (un) **] pending', '-cont vancomycin', '-nutrition- clear sips', '-pain: morphine IV and Ditropan for bladder spasm', '-3PM gas- 7.29/36/143, lactate 4.8 (previous 4.5)', '-bolused 1L NS over 1 hr', '-transfused 2 units PRBCs at request of urology', '-6PM gas- 7.34/35/93, lactate 2.3', '-morphine changed to dilaudid (c/w urology) for better pain control', '-hypotensive overnight (?narcotics vs sepsis?)- gave 1.5L IVF in 500cc', 'boluses, no need for pressors, to maintain MAP above 65']","['-Patient admited overnight.', '-5am increase in abdominal pain, tachycardic tachypneic', ' urology', 'called and reported he will be going to the OR in the morning.', '-Started on IV morphine for pain control.']",28043,149969.0
2,2176-06-05 12:15:34,"['-this morning, patient is disoriented and agitated, requiring two-point', 'restraints']","['-urology- s/p OR to close anterior perf, unable to reach posterior', 'perforation, still with necrosis. Thought [**3-4**] foley malpositioning; has', 'foley, suprapubic cath, jp tube near perforation for urine output; may', 'need b/l nephrostomy tube, urinary diversion if not improving, JP to', 'bulb suction, foley to gravity, broad spectrum antibx', '-peritoneal fluid- 4+ polys, 1+ GNR', '-urine culture- >100,000/mL GNR', '-cont cefepime, gentamicin spec/[**Last Name (un) **] pending', '-cont vancomycin', '-nutrition- clear sips', '-pain: morphine IV and Ditropan for bladder spasm', '-3PM gas- 7.29/36/143, lactate 4.8 (previous 4.5)', '-bolused 1L NS over 1 hr', '-transfused 2 units PRBCs at request of urology', '-6PM gas- 7.34/35/93, lactate 2.3', '-morphine changed to dilaudid (c/w urology) for better pain control', '-hypotensive overnight (?narcotics vs sepsis?)- gave 1.5L IVF in 500cc', 'boluses, no need for pressors, to maintain MAP above 65', '-this morning, patient is disoriented and agitated, requiring two-point', 'restraints']",,28043,149969.0
3,2176-06-06 06:18:26,"['-Started metoprolol 12.5 tid for AF w/ RVR (on bisoprolol 5mg daily at', 'home)', '-BP low; given dextrose for FSG in 50s with improvement', '-CXR for low grade fevers, increased cough and coarse rales, CVP stable', '[**10-11**]: given lasix 10mg IV for evidence of fluid overload.', ""-Vigileo d/c'd"", '-NGT placed and tube feeds started per Nutrition recs. While awaiting', 'initiation of tube feeds, glucoses noted to be low-running in 50s-70s.', 'Given dextrose prn. Had 180 cc residuals from tube (10cc/h feed, with', 'q4h 150cc flush)', '-Increased confusion/mild agitation -> xyprexa 2.5 with good effect', '-[**Hospital1 **] lytes/CBC, urine creat check per Uro. CBC notable for decrease in', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct 28', 'No evidence of hemolysis.', '-Gent trough 2.5 today']","['-Started metoprolol 12.5 tid for AF w/ RVR (on bisoprolol 5mg daily at', 'home)', '-BP low; given dextrose for FSG in 50s with improvement', '-CXR for low grade fevers, increased cough and coarse rales, CVP stable', '[**10-11**]: given lasix 10mg IV for evidence of fluid overload.', ""-Vigileo d/c'd"", '-NGT placed and tube feeds started per Nutrition recs. While awaiting', 'initiation of tube feeds, glucoses noted to be low-running in 50s-70s.', 'Given dextrose prn. Had 180 cc residuals from tube (10cc/h feed, with', 'q4h 150cc flush)', '-Increased confusion/mild agitation -> xyprexa 2.5 with good effect', '-[**Hospital1 **] lytes/CBC, urine creat check per Uro. CBC notable for decrease in', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct 28', 'No evidence of hemolysis.', '-Gent trough 2.5 today']","['-urology- s/p OR to close anterior perf, unable to reach posterior', 'perforation, still with necrosis. Thought [**3-4**] foley malpositioning; has', 'foley, suprapubic cath, jp tube near perforation for urine output; may', 'need b/l nephrostomy tube, urinary diversion if not improving, JP to', 'bulb suction, foley to gravity, broad spectrum antibx', '-peritoneal fluid- 4+ polys, 1+ GNR', '-urine culture- >100,000/mL GNR', '-cont cefepime, gentamicin spec/[**Last Name (un) **] pending', '-cont vancomycin', '-nutrition- clear sips', '-pain: morphine IV and Ditropan for bladder spasm', '-3PM gas- 7.29/36/143, lactate 4.8 (previous 4.5)', '-bolused 1L NS over 1 hr', '-transfused 2 units PRBCs at request of urology', '-6PM gas- 7.34/35/93, lactate 2.3', '-morphine changed to dilaudid (c/w urology) for better pain control', '-hypotensive overnight (?narcotics vs sepsis?)- gave 1.5L IVF in 500cc', 'boluses, no need for pressors, to maintain MAP above 65', '-this morning, patient is disoriented and agitated, requiring two-point', 'restraints']",28043,149969.0
4,2176-06-06 06:50:31,"['-Increased confusion/mild agitation -> Zyprexa 2.5 with good effect', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct', '28. No evidence of hemolysis.']","['-Started metoprolol 12.5 tid for AF w/ RVR (on bisoprolol 5mg daily at', 'home)', '-BP low; given dextrose for FSG in 50s with improvement', '-CXR for low grade fevers, increased cough and coarse rales, CVP stable', '[**10-11**]: given lasix 10mg IV for evidence of fluid overload.', ""-Vigileo d/c'd"", '-NGT placed and tube feeds started per Nutrition recs. While awaiting', 'initiation of tube feeds, glucoses noted to be low-running in 50s-70s.', 'Given dextrose prn. Had 180 cc residuals from tube (10cc/h feed, with', 'q4h 150cc flush)', '-Increased confusion/mild agitation -> Zyprexa 2.5 with good effect', '-[**Hospital1 **] lytes/CBC, urine creat check per Uro. CBC notable for decrease in', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct', '28. No evidence of hemolysis.', '-Gent trough 2.5 today']","['-Increased confusion/mild agitation -> xyprexa 2.5 with good effect', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct 28', 'No evidence of hemolysis.']",28043,149969.0
5,2176-06-06 11:24:37,,"['-Started metoprolol 12.5 tid for AF w/ RVR (on bisoprolol 5mg daily at', 'home)', '-BP low; given dextrose for FSG in 50s with improvement', '-CXR for low grade fevers, increased cough and coarse rales, CVP stable', '[**10-11**]: given lasix 10mg IV for evidence of fluid overload.', ""-Vigileo d/c'd"", '-NGT placed and tube feeds started per Nutrition recs. While awaiting', 'initiation of tube feeds, glucoses noted to be low-running in 50s-70s.', 'Given dextrose prn. Had 180 cc residuals from tube (10cc/h feed, with', 'q4h 150cc flush)', '-Increased confusion/mild agitation -> Zyprexa 2.5 with good effect', '-[**Hospital1 **] lytes/CBC, urine creat check per Uro. CBC notable for decrease in', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct', '28. No evidence of hemolysis.', '-Gent trough 2.5 today']",,28043,149969.0
6,2176-06-07 07:09:43,"['-metoprolol 25 PO bid for AF', '-hypertensive to SBP 200s so restarted home amlodipine (with holding', 'parameters), gave dilaudid for pain.', '-micro data: pseudomonas (sensitivities pending)']","['-metoprolol 25 PO bid for AF', '-hypertensive to SBP 200s so restarted home amlodipine (with holding', 'parameters), gave dilaudid for pain.', '-micro data: pseudomonas (sensitivities pending)']","['-Started metoprolol 12.5 tid for AF w/ RVR (on bisoprolol 5mg daily at', 'home)', '-BP low; given dextrose for FSG in 50s with improvement', '-CXR for low grade fevers, increased cough and coarse rales, CVP stable', '[**10-11**]: given lasix 10mg IV for evidence of fluid overload.', ""-Vigileo d/c'd"", '-NGT placed and tube feeds started per Nutrition recs. While awaiting', 'initiation of tube feeds, glucoses noted to be low-running in 50s-70s.', 'Given dextrose prn. Had 180 cc residuals from tube (10cc/h feed, with', 'q4h 150cc flush)', '-Increased confusion/mild agitation -> Zyprexa 2.5 with good effect', '-[**Hospital1 **] lytes/CBC, urine creat check per Uro. CBC notable for decrease in', 'Hct to 27 (pre-transfusion level) but remained HD stable with AM Hct', '28. No evidence of hemolysis.', '-Gent trough 2.5 today']",28043,149969.0
7,2176-06-07 07:25:26,"['-in morning: oriented to person, still with abdominal pain but does not', 'appear to be as severe as previous days; interactive but difficult to', 'understand speech; not aphasic; less confused than previous days']","['-metoprolol 25 PO bid for AF', '-hypertensive to SBP 200s so restarted home amlodipine (with holding', 'parameters), gave dilaudid for pain.', '-micro data: pseudomonas (sensitivities pending)', '-in morning: oriented to person, still with abdominal pain but does not', 'appear to be as severe as previous days; interactive but difficult to', 'understand speech; not aphasic; less confused than previous days']",,28043,149969.0
8,2176-06-07 12:03:22,,"['-metoprolol 25 PO bid for AF', '-hypertensive to SBP 200s so restarted home amlodipine (with holding', 'parameters), gave dilaudid for pain.', '-micro data: pseudomonas (sensitivities pending)', '-in morning: oriented to person, still with abdominal pain but does not', 'appear to be as severe as previous days; interactive but difficult to', 'understand speech; not aphasic; less confused than previous days']",,28043,149969.0
9,2176-06-07 12:38:28,,"['-metoprolol 25 PO bid for AF', '-hypertensive to SBP 200s so restarted home amlodipine (with holding', 'parameters), gave dilaudid for pain.', '-micro data: pseudomonas (sensitivities pending)', '-in morning: oriented to person, still with abdominal pain but does not', 'appear to be as severe as previous days; interactive but difficult to', 'understand speech; not aphasic; less confused than previous days']",,28043,149969.0
0,2176-06-18 07:27:09,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
1,2176-06-18 07:44:16,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
2,2176-06-18 08:02:10,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
3,2176-06-18 08:04:09,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
4,2176-06-18 09:24:07,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
5,2176-06-18 09:44:56,,"['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",,28043,135417.0
6,2176-06-19 07:03:48,"['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']","['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']","['- changed from cefepime to ceftriaxone at meningitis dosing per', 'neuro/ID recs', '- EEG w/o seizure activity', '- urology recs: NTD, consider cystogram if increased abdominal pain,', 'sutures need to be removed 2-3 weeks after surgery']",28043,135417.0
7,2176-06-19 07:13:48,,"['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']",,28043,135417.0
8,2176-06-19 08:02:33,,"['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']",,28043,135417.0
9,2176-06-19 09:55:56,,"['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']",,28043,135417.0
10,2176-06-20 07:23:00,"['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC', 'History obtained from Medical records']","['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC', 'History obtained from Medical records']","['[**6-18**]', '- ABG stable on CPAP+  PS 7.44/31/259', '- Neuro: findings consistent with myoclonus, and EEG with seizure', 'activity.  Started acyclovir pending HSV PCR', '- Hct slow downtrend to 26.8 -> added on iron studies, hemolysis labs', '- Tube feeds held past midnight for potential extubation', ""- Started dilantin, became unresponsive and hypotensive to 90's. given"", 'ativan 2mg for concern for recurrent seizure activity. developed afib', 'with RVR. no response to 1L of fluid, started on levophed, now weaning', 'down. dilantin now DCd.', '- A line placed']",28043,135417.0
11,2176-06-20 07:30:26,,"['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC', 'History obtained from Medical records']",,28043,135417.0
12,2176-06-20 07:38:14,,"['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC', 'History obtained from Medical records']",,28043,135417.0
13,2176-06-20 11:06:17,,"['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC', 'History obtained from Medical records']",,28043,135417.0
14,2176-06-21 07:18:29,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP']","['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']","['STOOL CULTURE - At [**2176-6-19**] 08:00 PM', ' BLOOD CULTURED - At [**2176-6-20**] 04:07 AM', '- changed to fosphenytoin per neuro recs', '- pulled off azithro, added TMPSMX for listeria coverage (pt is pcn', 'allergic)', '- repeated pan cx given hypotension', '- HSV PCR returned negative, DCd acyclovir', ""- TPA'd PICC (discussed with attending), kept old PICC in place"", '- Echo done EF 50-55%, moderate AS moderate MR', '- had bursts of afib with rvr overnight, resumed metoprolol TID', 'PICC']",28043,135417.0
15,2176-06-21 07:19:11,,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",,28043,135417.0
16,2176-06-21 07:22:12,,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",,28043,135417.0
17,2176-06-21 07:57:39,,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",,28043,135417.0
18,2176-06-21 11:33:55,,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",,28043,135417.0
19,2176-06-21 12:45:37,,"['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",,28043,135417.0
20,2176-06-22 07:44:06,"['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']","['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']","['- given additional dose of 5 mg/kg of phosphenytoin', '- neuro did not recommend any additional imaging or repeat LP', 'History obtained from Medical records']",28043,135417.0
21,2176-06-22 07:44:53,,"['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']",,28043,135417.0
22,2176-06-22 07:51:12,,"['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']",,28043,135417.0
23,2176-06-22 11:19:45,,"['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']",,28043,135417.0
24,2176-06-23 06:11:29,"['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']","['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']","['- Updated family', '- Continued to monitor mental status', '- Tolerating PSV 5/5 with ABG: 7.44/26/171']",28043,135417.0
25,2176-06-23 06:12:21,,"['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']",,28043,135417.0
26,2176-06-23 07:56:08,,"['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']",,28043,135417.0
27,2176-06-23 08:00:53,,"['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']",,28043,135417.0
28,2176-06-23 08:46:31,,"['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']",,28043,135417.0
29,2176-06-24 07:19:16,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']","['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']","['ULTRASOUND - At [**2176-6-22**] 06:20 PM', 'LUE', '- updated family', '- left upper extremity swelling noted and left upper extremity', 'ultrasound negative', '- doing well on PS 5/5', '- ETT advanced']",28043,135417.0
30,2176-06-24 07:22:29,,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",,28043,135417.0
31,2176-06-24 07:25:32,,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",,28043,135417.0
32,2176-06-24 08:04:21,,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",,28043,135417.0
33,2176-06-24 09:34:56,,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",,28043,135417.0
34,2176-06-24 09:35:31,,"['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",,28043,135417.0
35,2176-06-25 07:29:29,"['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']","['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']","['PICC LINE - START [**2176-6-23**] 02:16 PM', ' PICC LINE - STOP [**2176-6-23**] 04:01 PM', '- New PICC placed, old PICC pulled', '- chose not to extubate as appeared to be tiring late in the day after', 'PICC placment.  will plan to extubate in am.', '- Spoke w/ wife.', '- Periods of apnea noted, MRI ordered to r/o new intra-cranial', 'pathology', 'History obtained from Medical records']",28043,135417.0
36,2176-06-25 07:31:08,,"['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']",,28043,135417.0
37,2176-06-25 07:50:55,,"['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']",,28043,135417.0
38,2176-06-25 07:52:18,,"['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']",,28043,135417.0
39,2176-06-25 09:55:32,,"['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']",,28043,135417.0
40,2176-06-26 07:34:51,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']","['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']","['- MRI no acute processes', '- Vanco level 45 -> held vanco', '- Tolerated SBT well post MRI -> extubated successfully']",28043,135417.0
41,2176-06-26 07:36:43,,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",,28043,135417.0
42,2176-06-26 07:37:55,,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",,28043,135417.0
43,2176-06-26 07:39:41,,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",,28043,135417.0
44,2176-06-26 07:57:30,,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",,28043,135417.0
45,2176-06-26 11:14:10,,"['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",,28043,135417.0
46,2176-06-27 07:52:16,"['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']","['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']","['- dophoff placed (in stomache)', ""- rapid afib to 120's in afternoon while on IV metoprolol only,"", 'restarted TID metoprolol tartarte with improvement in HR', '- no further clinical seizure activity', '- given 20mg IV lasix as running evening late in the evening', '- PICC pulled back']",28043,135417.0
47,2176-06-27 07:53:41,,"['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']",,28043,135417.0
48,2176-06-27 07:56:09,,"['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']",,28043,135417.0
49,2176-06-27 08:34:24,,"['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']",,28043,135417.0
50,2176-06-27 10:31:37,,"['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']",,28043,135417.0
51,2176-06-28 06:55:37,"['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']","['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']","['ARTERIAL LINE - STOP [**2176-6-26**] 08:01 PM', '- intermittently rate-controlled', '- switched to po bactrim', '- changed from phosphenytoin to phenytoin 100 tid w/ extra 200 mg as', 'level was low']",28043,135417.0
52,2176-06-28 06:56:19,,"['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']",,28043,135417.0
53,2176-06-28 06:58:14,,"['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']",,28043,135417.0
54,2176-06-28 10:23:13,,"['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']",,28043,135417.0
55,2176-06-28 10:32:04,,"['- tachycardic to 120s in am and amio loaded with HR 60s-90s', '- MS [**First Name (Titles) 4073**] [**Last Name (Titles) 2840**]', '- dilantin held given free level >2', '- diuresed with lasix 20mg IV x2']",,28043,135417.0
0,2176-08-02 06:12:20,,"['PICC LINE - START [**2176-8-1**] 01:59 PM', ' FEVER - 101.3', 'F - [**2176-8-1**] 04:00 PM', '- admitted from ER', '- started on vancomycin, meropenem, PO vancomycin', '- pancultured', '- started on diltiazem drip and PO diltiazem for atrial fibrillation', 'with rapid ventricular response.  Diltiazem drip now discontinued for', 'hypotension.']",,28043,127710.0
1,2176-08-02 06:13:40,,"['PICC LINE - START [**2176-8-1**] 01:59 PM', ' FEVER - 101.3', 'F - [**2176-8-1**] 04:00 PM', '- admitted from ER', '- started on vancomycin, meropenem, PO vancomycin', '- pancultured', '- started on diltiazem drip and PO diltiazem for atrial fibrillation', 'with rapid ventricular response.  Diltiazem drip now discontinued for', 'hypotension.']",,28043,127710.0
2,2176-08-02 06:39:04,,"['PICC LINE - START [**2176-8-1**] 01:59 PM', ' FEVER - 101.3', 'F - [**2176-8-1**] 04:00 PM', '- admitted from ER', '- started on vancomycin, meropenem, PO vancomycin', '- pancultured', '- started on diltiazem drip and PO diltiazem for atrial fibrillation', 'with rapid ventricular response.  Diltiazem drip now discontinued for', 'hypotension.']",,28043,127710.0
3,2176-08-02 08:32:01,,"['PICC LINE - START [**2176-8-1**] 01:59 PM', ' FEVER - 101.3', 'F - [**2176-8-1**] 04:00 PM', '- admitted from ER', '- started on vancomycin, meropenem, PO vancomycin', '- pancultured', '- started on diltiazem drip and PO diltiazem for atrial fibrillation', 'with rapid ventricular response.  Diltiazem drip now discontinued for', 'hypotension.']",,28043,127710.0
4,2176-08-03 05:57:10,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']","['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']","['PICC LINE - START [**2176-8-1**] 01:59 PM', ' FEVER - 101.3', 'F - [**2176-8-1**] 04:00 PM', '- admitted from ER', '- started on vancomycin, meropenem, PO vancomycin', '- pancultured', '- started on diltiazem drip and PO diltiazem for atrial fibrillation', 'with rapid ventricular response.  Diltiazem drip now discontinued for', 'hypotension.']",28043,127710.0
5,2176-08-03 05:57:49,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
6,2176-08-03 06:00:45,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
7,2176-08-03 06:12:18,['- RUQ U/S with gall stones but without acute cholecystitis.'],"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
8,2176-08-03 06:45:28,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
9,2176-08-03 07:15:12,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
10,2176-08-03 07:26:21,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
11,2176-08-03 07:40:21,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
12,2176-08-03 08:02:09,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
13,2176-08-03 09:10:17,,"['ULTRASOUND - At [**2176-8-2**] 09:24 AM', ' SPUTUM CULTURE - At [**2176-8-2**] 12:00 PM', ' STOOL CULTURE - At [**2176-8-2**] 12:00 PM', '- Loaded with digoxin for a-fib with RVR (dose per pharmacy should be', '0.25 x 3 doses) -> rates came down to 90-100s but tachy again in', 'evening, so Dilt increased to 60 mg QID.', '- RUQ U/S with gall stones but without acute cholecystitis.', '- Urine cx with >100,000 yeast. Given significant bladder history,', 'would prefer to call urology for foley and suprapubic cath change.', '- Hct 25.8 -> 24.9', '- Wound care recs put in POE and say to consider Surgical consult for', 'debridement of sacral ulcer.', '- [**Hospital 12**] rehab MACU (for culture data) [**Telephone/Fax (1) 1959**]: Blood Cx Collected', '[**2176-7-31**] with GPC in cluster 2/2 bottles', '- C diff positive']",,28043,127710.0
0,2180-01-05 06:55:09,,['-'],,13305,106092.0
1,2180-01-05 13:42:04,"['- No N/V or hematemesis', '- feels well']","['- No N/V or hematemesis', '- feels well']",['-'],13305,106092.0
0,2123-12-12 08:10:52,,"['Admitted for alcohol/opiate withdrawal/DTs', '- CIWA scale upped to 10-20mg due to progressive agitation', '- Not calmed/responsive to repeat IV/PO valium.', '- 0.1 clonidine for SBP>170 q4, repeat 0.1 given']",,91092,103998.0
1,2123-12-12 10:48:33,,"['Admitted for alcohol/opiate withdrawal/DTs', '- CIWA scale upped to 10-20mg due to progressive agitation', '- Not calmed/responsive to repeat IV/PO valium.', '- 0.1 clonidine for SBP>170 q4, repeat 0.1 given']",,91092,103998.0
2,2123-12-13 06:43:43,"['- Increasingly paranoid and demanding.  Gave additional dose of', 'methadone and one time dose of ativan.  Started on nicotine patch.', '- Consulted psych for additional recs:  Robaxin for muscle cramps,', 'motrin for pain, bentyl for abd pain, imodium for diarrhea, clonidine', 'TID, valium 10mg per CIWA, vistaril for anxiety.  They recommended', 'haldol and cogentin for acute agitation.  They determined that the', 'patient does not have capacity to leave AMA.', '- Continued 1:1 sitter', '- Pt received motrin X2, vistaril X1, methocarbamol X1, and valium X2', 'overnight']","['- Increasingly paranoid and demanding.  Gave additional dose of', 'methadone and one time dose of ativan.  Started on nicotine patch.', '- Consulted psych for additional recs:  Robaxin for muscle cramps,', 'motrin for pain, bentyl for abd pain, imodium for diarrhea, clonidine', 'TID, valium 10mg per CIWA, vistaril for anxiety.  They recommended', 'haldol and cogentin for acute agitation.  They determined that the', 'patient does not have capacity to leave AMA.', '- Continued 1:1 sitter', '- Pt received motrin X2, vistaril X1, methocarbamol X1, and valium X2', 'overnight']","['Admitted for alcohol/opiate withdrawal/DTs', '- CIWA scale upped to 10-20mg due to progressive agitation', '- Not calmed/responsive to repeat IV/PO valium.', '- 0.1 clonidine for SBP>170 q4, repeat 0.1 given']",91092,103998.0
3,2123-12-13 06:45:32,,"['- Increasingly paranoid and demanding.  Gave additional dose of', 'methadone and one time dose of ativan.  Started on nicotine patch.', '- Consulted psych for additional recs:  Robaxin for muscle cramps,', 'motrin for pain, bentyl for abd pain, imodium for diarrhea, clonidine', 'TID, valium 10mg per CIWA, vistaril for anxiety.  They recommended', 'haldol and cogentin for acute agitation.  They determined that the', 'patient does not have capacity to leave AMA.', '- Continued 1:1 sitter', '- Pt received motrin X2, vistaril X1, methocarbamol X1, and valium X2', 'overnight']",,91092,103998.0
4,2123-12-13 13:05:33,,"['- Increasingly paranoid and demanding.  Gave additional dose of', 'methadone and one time dose of ativan.  Started on nicotine patch.', '- Consulted psych for additional recs:  Robaxin for muscle cramps,', 'motrin for pain, bentyl for abd pain, imodium for diarrhea, clonidine', 'TID, valium 10mg per CIWA, vistaril for anxiety.  They recommended', 'haldol and cogentin for acute agitation.  They determined that the', 'patient does not have capacity to leave AMA.', '- Continued 1:1 sitter', '- Pt received motrin X2, vistaril X1, methocarbamol X1, and valium X2', 'overnight']",,91092,103998.0
0,2190-09-04 07:16:51,,"['ENDOSCOPY - At [**2190-9-3**] 01:45 PM', 'EGD done, visualized blood in stomach, but no active source of', 'bleeding. Given Fent/Midaz, 25mcg, 1mg.  VS remain stable.']",,43456,147366.0
1,2190-09-04 08:07:20,,"['ENDOSCOPY - At [**2190-9-3**] 01:45 PM', 'EGD done, visualized blood in stomach, but no active source of', 'bleeding. Given Fent/Midaz, 25mcg, 1mg.  VS remain stable.']",,43456,147366.0
2,2190-09-04 12:31:33,"['EGD done yesterday, visualized blood in stomach, but no active source', 'of bleeding. VS remain stable.', '- Has been oozing small amounts of bright blood per rectum.']","['EGD done yesterday, visualized blood in stomach, but no active source', 'of bleeding. VS remain stable.', '- Has been oozing small amounts of bright blood per rectum.']","['ENDOSCOPY - At [**2190-9-3**] 01:45 PM', 'EGD done, visualized blood in stomach, but no active source of', 'bleeding. Given Fent/Midaz, 25mcg, 1mg.  VS remain stable.']",43456,147366.0
3,2190-09-05 07:21:05,"['TRANSTHORACIC ECHO - At [**2190-9-4**] 02:00 PM , hyperdynamic small LV', ""Yesterday's am HCT continued to drop (total down 10pts in 24 hours),"", 'kept in ICU to have documented stable hcts.  Next Hct 30.3 (from 29.7)', 'Small melanotic stool x 1 yesterday', 'Remained HD stable, quiet overnight']","['TRANSTHORACIC ECHO - At [**2190-9-4**] 02:00 PM , hyperdynamic small LV', ""Yesterday's am HCT continued to drop (total down 10pts in 24 hours),"", 'kept in ICU to have documented stable hcts.  Next Hct 30.3 (from 29.7)', 'Small melanotic stool x 1 yesterday', 'Remained HD stable, quiet overnight']","['EGD done yesterday, visualized blood in stomach, but no active source', 'of bleeding. VS remain stable.', '- Has been oozing small amounts of bright blood per rectum.']",43456,147366.0
4,2190-09-05 07:38:26,,"['TRANSTHORACIC ECHO - At [**2190-9-4**] 02:00 PM , hyperdynamic small LV', ""Yesterday's am HCT continued to drop (total down 10pts in 24 hours),"", 'kept in ICU to have documented stable hcts.  Next Hct 30.3 (from 29.7)', 'Small melanotic stool x 1 yesterday', 'Remained HD stable, quiet overnight']",,43456,147366.0
5,2190-09-05 10:20:37,,"['TRANSTHORACIC ECHO - At [**2190-9-4**] 02:00 PM , hyperdynamic small LV', ""Yesterday's am HCT continued to drop (total down 10pts in 24 hours),"", 'kept in ICU to have documented stable hcts.  Next Hct 30.3 (from 29.7)', 'Small melanotic stool x 1 yesterday', 'Remained HD stable, quiet overnight']",,43456,147366.0
6,2190-09-05 14:39:17,,"['TRANSTHORACIC ECHO - At [**2190-9-4**] 02:00 PM , hyperdynamic small LV', ""Yesterday's am HCT continued to drop (total down 10pts in 24 hours),"", 'kept in ICU to have documented stable hcts.  Next Hct 30.3 (from 29.7)', 'Small melanotic stool x 1 yesterday', 'Remained HD stable, quiet overnight']",,43456,147366.0
0,2103-10-11 06:22:43,,"['EKG - At [**2103-10-11**] 12:30 AM', ' CHEST PAIN - At [**2103-10-11**] 12:30 AM', ' INVASIVE VENTILATION - START [**2103-10-11**] 02:23 AM', ' MULTI LUMEN - START [**2103-10-11**] 02:27 AM', ' ARTERIAL LINE - START [**2103-10-11**] 02:56 AM', 'Pt stable throughout day after arrival to floor.  Called to bedside at', 'MN for acute distress. Pt found to be tachypneic, 02 sats high 90s.', 'Very cold and clammy.  Slightly altered. BP initially stable. Unable to', 'get oral temperature, rectal temp 98. Given Nebs, 02. c/o chest pain.', 'Given 0.5mg morphine. ECG unchanged/uninterpretable in setting of known', 'LBBB.  CXR unchanged. BPs erratic, unable to measure pressure or 02 sat', 'as pt became more clamped down.  Became more obtunded.  Initial labs', 'notable for neg CEs, Hct increased to 50, persistent leukocytosis.', 'Right femoral access was obtained. Initial attempts to place a-line', 'unsuccsesful due to absence of peripheral pulses. Pt bolused 3L,', 'started on pressors, initially dopamine, then levo added once CVL', 'placed.', 'Due to obtundation, inability to monitor 02 sat and', 'difficulty acquiring information from arterial blood gas, anaesthesia', 'was called and emergent intubation was performed with etomidate.', 'Anaesthesia able to place femoral arterial line.  Pt had emergent TTE', 'that showed new global hypokinesis with EF ~10% (last [**3-23**] was', '40-50%).  Initial ABG after intubation: 7.12/42/341, lactate 7.7 up', 'from 2.8 at time of admission.  Pt transitioned to dobutamine, RR', 'increased.  Skin perfusion improved, however repeat ABG worse at', '7.06/44/251 lactate 8.  Vent settings changed to CPAP.  Zosyn started.', 'Bicarb gtt started.  Pt hyperkalemic to 6, given insulin/D5, ca', 'gluconate. [**Name (NI) **] brother [**Name (NI) **] [**Name (NI) 4803**] was called and notified of', ""patient's status.  Dopamine added back on.  LFTs continue to rise.  Pt"", 'headed to CT for CT with gastrograffin contrast only.  Oliguric.']",,30678,197019.0
1,2103-10-11 07:58:41,,"['EKG - At [**2103-10-11**] 12:30 AM', ' CHEST PAIN - At [**2103-10-11**] 12:30 AM', ' INVASIVE VENTILATION - START [**2103-10-11**] 02:23 AM', ' MULTI LUMEN - START [**2103-10-11**] 02:27 AM', ' ARTERIAL LINE - START [**2103-10-11**] 02:56 AM', 'Pt stable throughout day after arrival to floor.  Called to bedside at', 'MN for acute distress. Pt found to be tachypneic, 02 sats high 90s.', 'Very cold and clammy.  Slightly altered. BP initially stable. Unable to', 'get oral temperature, rectal temp 98. Given Nebs, 02. c/o chest pain.', 'Given 0.5mg morphine. ECG unchanged/uninterpretable in setting of known', 'LBBB.  CXR unchanged. BPs erratic, unable to measure pressure or 02 sat', 'as pt became more clamped down.  Became more obtunded.  Initial labs', 'notable for neg CEs, Hct increased to 50, persistent leukocytosis.', 'Right femoral access was obtained. Initial attempts to place a-line', 'unsuccsesful due to absence of peripheral pulses. Pt bolused 3L,', 'started on pressors, initially dopamine, then levo added once CVL', 'placed.', 'Due to obtundation, inability to monitor 02 sat and', 'difficulty acquiring information from arterial blood gas, anaesthesia', 'was called and emergent intubation was performed with etomidate.', 'Anaesthesia able to place femoral arterial line.  Pt had emergent TTE', 'that showed new global hypokinesis with EF ~10% (last [**3-23**] was', '40-50%).  Initial ABG after intubation: 7.12/42/341, lactate 7.7 up', 'from 2.8 at time of admission.  Pt transitioned to dobutamine, RR', 'increased.  Skin perfusion improved, however repeat ABG worse at', '7.06/44/251 lactate 8.  Vent settings changed to CPAP.  Zosyn started.', 'Bicarb gtt started.  Pt hyperkalemic to 6, given insulin/D5, ca', 'gluconate. [**Name (NI) **] brother [**Name (NI) **] [**Name (NI) 4803**] was called and notified of', ""patient's status.  Dopamine added back on.  LFTs continue to rise.  Pt"", 'headed to CT for CT with gastrograffin contrast only.  Oliguric.']",,30678,197019.0
2,2103-10-11 10:21:26,,"['EKG - At [**2103-10-11**] 12:30 AM', ' CHEST PAIN - At [**2103-10-11**] 12:30 AM', ' INVASIVE VENTILATION - START [**2103-10-11**] 02:23 AM', ' MULTI LUMEN - START [**2103-10-11**] 02:27 AM', ' ARTERIAL LINE - START [**2103-10-11**] 02:56 AM', 'Pt stable throughout day after arrival to floor.  Called to bedside at', 'MN for acute distress. Pt found to be tachypneic, 02 sats high 90s.', 'Very cold and clammy.  Slightly altered. BP initially stable. Unable to', 'get oral temperature, rectal temp 98. Given Nebs, 02. c/o chest pain.', 'Given 0.5mg morphine. ECG unchanged/uninterpretable in setting of known', 'LBBB.  CXR unchanged. BPs erratic, unable to measure pressure or 02 sat', 'as pt became more clamped down.  Became more obtunded.  Initial labs', 'notable for neg CEs, Hct increased to 50, persistent leukocytosis.', 'Right femoral access was obtained. Initial attempts to place a-line', 'unsuccsesful due to absence of peripheral pulses. Pt bolused 3L,', 'started on pressors, initially dopamine, then levo added once CVL', 'placed.', 'Due to obtundation, inability to monitor 02 sat and', 'difficulty acquiring information from arterial blood gas, anaesthesia', 'was called and emergent intubation was performed with etomidate.', 'Anaesthesia able to place femoral arterial line.  Pt had emergent TTE', 'that showed new global hypokinesis with EF ~10% (last [**3-23**] was', '40-50%).  Initial ABG after intubation: 7.12/42/341, lactate 7.7 up', 'from 2.8 at time of admission.  Pt transitioned to dobutamine, RR', 'increased.  Skin perfusion improved, however repeat ABG worse at', '7.06/44/251 lactate 8.  Vent settings changed to CPAP.  Zosyn started.', 'Bicarb gtt started.  Pt hyperkalemic to 6, given insulin/D5, ca', 'gluconate. [**Name (NI) **] brother [**Name (NI) **] [**Name (NI) 4803**] was called and notified of', ""patient's status.  Dopamine added back on.  LFTs continue to rise.  Pt"", 'headed to CT for CT with gastrograffin contrast only.  Oliguric.']",,30678,197019.0
3,2103-10-11 10:33:36,,"['EKG - At [**2103-10-11**] 12:30 AM', ' CHEST PAIN - At [**2103-10-11**] 12:30 AM', ' INVASIVE VENTILATION - START [**2103-10-11**] 02:23 AM', ' MULTI LUMEN - START [**2103-10-11**] 02:27 AM', ' ARTERIAL LINE - START [**2103-10-11**] 02:56 AM', 'Pt stable throughout day after arrival to floor.  Called to bedside at', 'MN for acute distress. Pt found to be tachypneic, 02 sats high 90s.', 'Very cold and clammy.  Slightly altered. BP initially stable. Unable to', 'get oral temperature, rectal temp 98. Given Nebs, 02. c/o chest pain.', 'Given 0.5mg morphine. ECG unchanged/uninterpretable in setting of known', 'LBBB.  CXR unchanged. BPs erratic, unable to measure pressure or 02 sat', 'as pt became more clamped down.  Became more obtunded.  Initial labs', 'notable for neg CEs, Hct increased to 50, persistent leukocytosis.', 'Right femoral access was obtained. Initial attempts to place a-line', 'unsuccsesful due to absence of peripheral pulses. Pt bolused 3L,', 'started on pressors, initially dopamine, then levo added once CVL', 'placed.', 'Due to obtundation, inability to monitor 02 sat and', 'difficulty acquiring information from arterial blood gas, anaesthesia', 'was called and emergent intubation was performed with etomidate.', 'Anaesthesia able to place femoral arterial line.  Pt had emergent TTE', 'that showed new global hypokinesis with EF ~10% (last [**3-23**] was', '40-50%).  Initial ABG after intubation: 7.12/42/341, lactate 7.7 up', 'from 2.8 at time of admission.  Pt transitioned to dobutamine, RR', 'increased.  Skin perfusion improved, however repeat ABG worse at', '7.06/44/251 lactate 8.  Vent settings changed to CPAP.  Zosyn started.', 'Bicarb gtt started.  Pt hyperkalemic to 6, given insulin/D5, ca', 'gluconate. [**Name (NI) **] brother [**Name (NI) **] [**Name (NI) 4803**] was called and notified of', ""patient's status.  Dopamine added back on.  LFTs continue to rise.  Pt"", 'headed to CT for CT with gastrograffin contrast only.  Oliguric.']",,30678,197019.0
4,2103-10-12 07:46:27,"['ULTRASOUND Abd - At [**2103-10-11**] 09:00 AM', 'patient', 's vascular grafts', 'appeared patent', ' NUCLEAR MEDICINE - At [**2103-10-11**] 10:00 AM', 'HIDA showed lack of flow', 'into the duodendum, which was thought to be due to the fentanyl pt is', 'on.  It also showed delayed filling of the GB, likely from chronic', 'cholecystitis', ' SPUTUM CULTURE - At [**2103-10-11**] 01:25 PM', ' EKG - At [**2103-10-11**] 02:26 PM', ' MULTI LUMEN - START [**2103-10-11**] 05:23 PM', 'RIJ placed', ' TRANS ESOPHAGEAL ECHO - At [**2103-10-11**] 06:00 PM-->did not show aortic', 'dissection', ' MULTI LUMEN - STOP [**2103-10-11**] 10:45 PM', 'Femoral line removed', '- Pressors weaned--on dobutamine & dopa', '- Heparin started for psossible PE vs MI']","['ULTRASOUND Abd - At [**2103-10-11**] 09:00 AM', 'patient', 's vascular grafts', 'appeared patent', ' NUCLEAR MEDICINE - At [**2103-10-11**] 10:00 AM', 'HIDA showed lack of flow', 'into the duodendum, which was thought to be due to the fentanyl pt is', 'on.  It also showed delayed filling of the GB, likely from chronic', 'cholecystitis', ' SPUTUM CULTURE - At [**2103-10-11**] 01:25 PM', ' EKG - At [**2103-10-11**] 02:26 PM', ' MULTI LUMEN - START [**2103-10-11**] 05:23 PM', 'RIJ placed', ' TRANS ESOPHAGEAL ECHO - At [**2103-10-11**] 06:00 PM-->did not show aortic', 'dissection', ' MULTI LUMEN - STOP [**2103-10-11**] 10:45 PM', 'Femoral line removed', '- Pressors weaned--on dobutamine & dopa', '- Heparin started for psossible PE vs MI']","['EKG - At [**2103-10-11**] 12:30 AM', ' CHEST PAIN - At [**2103-10-11**] 12:30 AM', ' INVASIVE VENTILATION - START [**2103-10-11**] 02:23 AM', ' MULTI LUMEN - START [**2103-10-11**] 02:27 AM', ' ARTERIAL LINE - START [**2103-10-11**] 02:56 AM', 'Pt stable throughout day after arrival to floor.  Called to bedside at', 'MN for acute distress. Pt found to be tachypneic, 02 sats high 90s.', 'Very cold and clammy.  Slightly altered. BP initially stable. Unable to', 'get oral temperature, rectal temp 98. Given Nebs, 02. c/o chest pain.', 'Given 0.5mg morphine. ECG unchanged/uninterpretable in setting of known', 'LBBB.  CXR unchanged. BPs erratic, unable to measure pressure or 02 sat', 'as pt became more clamped down.  Became more obtunded.  Initial labs', 'notable for neg CEs, Hct increased to 50, persistent leukocytosis.', 'Right femoral access was obtained. Initial attempts to place a-line', 'unsuccsesful due to absence of peripheral pulses. Pt bolused 3L,', 'started on pressors, initially dopamine, then levo added once CVL', 'placed.', 'Due to obtundation, inability to monitor 02 sat and', 'difficulty acquiring information from arterial blood gas, anaesthesia', 'was called and emergent intubation was performed with etomidate.', 'Anaesthesia able to place femoral arterial line.  Pt had emergent TTE', 'that showed new global hypokinesis with EF ~10% (last [**3-23**] was', '40-50%).  Initial ABG after intubation: 7.12/42/341, lactate 7.7 up', 'from 2.8 at time of admission.  Pt transitioned to dobutamine, RR', 'increased.  Skin perfusion improved, however repeat ABG worse at', '7.06/44/251 lactate 8.  Vent settings changed to CPAP.  Zosyn started.', 'Bicarb gtt started.  Pt hyperkalemic to 6, given insulin/D5, ca', 'gluconate. [**Name (NI) **] brother [**Name (NI) **] [**Name (NI) 4803**] was called and notified of', ""patient's status.  Dopamine added back on.  LFTs continue to rise.  Pt"", 'headed to CT for CT with gastrograffin contrast only.  Oliguric.']",30678,197019.0
5,2103-10-12 08:05:36,,"['ULTRASOUND Abd - At [**2103-10-11**] 09:00 AM', 'patient', 's vascular grafts', 'appeared patent', ' NUCLEAR MEDICINE - At [**2103-10-11**] 10:00 AM', 'HIDA showed lack of flow', 'into the duodendum, which was thought to be due to the fentanyl pt is', 'on.  It also showed delayed filling of the GB, likely from chronic', 'cholecystitis', ' SPUTUM CULTURE - At [**2103-10-11**] 01:25 PM', ' EKG - At [**2103-10-11**] 02:26 PM', ' MULTI LUMEN - START [**2103-10-11**] 05:23 PM', 'RIJ placed', ' TRANS ESOPHAGEAL ECHO - At [**2103-10-11**] 06:00 PM-->did not show aortic', 'dissection', ' MULTI LUMEN - STOP [**2103-10-11**] 10:45 PM', 'Femoral line removed', '- Pressors weaned--on dobutamine & dopa', '- Heparin started for psossible PE vs MI']",,30678,197019.0
6,2103-10-13 01:17:22,"['- Dopamine weaned off, still on dobutamine', '- Heparin started for possible PE vs MI; however, pt having some', 'hemoptysis this AM (non-massive).']","['ULTRASOUND Abd - At [**2103-10-11**] 09:00 AM', 'patient', 's vascular grafts', 'appeared patent', ' NUCLEAR MEDICINE - At [**2103-10-11**] 10:00 AM', 'HIDA showed lack of flow', 'into the duodendum, which was thought to be due to the fentanyl pt is', 'on.  It also showed delayed filling of the GB, likely from chronic', 'cholecystitis', ' MULTI LUMEN - START [**2103-10-11**] 05:23 PM', 'RIJ placed', ' TRANS ESOPHAGEAL ECHO - At [**2103-10-11**] 06:00 PM-->did not show aortic', 'dissection', ' MULTI LUMEN - STOP [**2103-10-11**] 10:45 PM', 'Femoral line removed', '- Dopamine weaned off, still on dobutamine', '- Heparin started for possible PE vs MI; however, pt having some', 'hemoptysis this AM (non-massive).']","[' SPUTUM CULTURE - At [**2103-10-11**] 01:25 PM', ' EKG - At [**2103-10-11**] 02:26 PM', '- Pressors weaned--on dobutamine & dopa', '- Heparin started for psossible PE vs MI']",30678,197019.0
7,2103-10-13 07:30:05,"['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after getting protamine, ffp & plt"", 'b/c of hemoptysis.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)']","['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after getting protamine, ffp & plt"", 'b/c of hemoptysis.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)']","['ULTRASOUND Abd - At [**2103-10-11**] 09:00 AM', 'patient', 's vascular grafts', 'appeared patent', ' NUCLEAR MEDICINE - At [**2103-10-11**] 10:00 AM', 'HIDA showed lack of flow', 'into the duodendum, which was thought to be due to the fentanyl pt is', 'on.  It also showed delayed filling of the GB, likely from chronic', 'cholecystitis', ' MULTI LUMEN - START [**2103-10-11**] 05:23 PM', 'RIJ placed', ' TRANS ESOPHAGEAL ECHO - At [**2103-10-11**] 06:00 PM-->did not show aortic', 'dissection', ' MULTI LUMEN - STOP [**2103-10-11**] 10:45 PM', 'Femoral line removed', '- Dopamine weaned off, still on dobutamine', '- Heparin started for possible PE vs MI; however, pt having some', 'hemoptysis this AM (non-massive).']",30678,197019.0
8,2103-10-13 07:33:45,"[""- Remained off of heparin gtt y'day after having hemoptysis; got"", 'protamine, ffp & plt.  Still small amount of bright red blood on', '- Poor UOP y', 'day ~5-15CC/HR.', 'Given 500cc NS bolus ON w/o significant', 'change in UOP.']","['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after having hemoptysis; got"", 'protamine, ffp & plt.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)', '- Poor UOP y', 'day ~5-15CC/HR.', 'Given 500cc NS bolus ON w/o significant', 'change in UOP.']","[""- Remained off of heparin gtt y'day after getting protamine, ffp & plt"", 'b/c of hemoptysis.  Still small amount of bright red blood on']",30678,197019.0
9,2103-10-13 07:57:13,,"['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after having hemoptysis; got"", 'protamine, ffp & plt.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)', '- Poor UOP y', 'day ~5-15CC/HR.', 'Given 500cc NS bolus ON w/o significant', 'change in UOP.']",,30678,197019.0
10,2103-10-13 14:20:17,,"['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after having hemoptysis; got"", 'protamine, ffp & plt.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)', '- Poor UOP y', 'day ~5-15CC/HR.', 'Given 500cc NS bolus ON w/o significant', 'change in UOP.']",,30678,197019.0
11,2103-10-14 07:52:34,"['Hypotensive in afternoon yesterday, hct stable, CEs still trending', 'down. ECG unchanged. Still with sl hemoptysis in ET tube but CXR', 'unchanged.  Restarted dopamine.  A-line left in overnight given ongoing', 'need for pressors. Lactate normal. SV02 69%', 'Renal consulted, recommended HD, will place L femoral temporary access', 'and dialyze today vs tomorrow.', 'Talked with brother, gave update.']","['Hypotensive in afternoon yesterday, hct stable, CEs still trending', 'down. ECG unchanged. Still with sl hemoptysis in ET tube but CXR', 'unchanged.  Restarted dopamine.  A-line left in overnight given ongoing', 'need for pressors. Lactate normal. SV02 69%', 'Renal consulted, recommended HD, will place L femoral temporary access', 'and dialyze today vs tomorrow.', 'Talked with brother, gave update.']","['- Remained off of dopamine, weaned down dobutamine.', ""- Remained off of heparin gtt y'day after having hemoptysis; got"", 'protamine, ffp & plt.  Still small amount of bright red blood on', 'suctioning overnight.', '- Hct up 32-->34', '- Repeat TTE shows EF 20%, up from 10%.  RV still dilated & severely', 'hypokinetic.  No focal WMA seen', '- CE trending down', '- RUQ US w/o portal vein thrombosis.  GB shows improvement in wall', 'edema.', '- LENIs negative for DVT', '- Pt still on vent; ETT advanced (~6cm from carina now)', '- Poor UOP y', 'day ~5-15CC/HR.', 'Given 500cc NS bolus ON w/o significant', 'change in UOP.']",30678,197019.0
12,2103-10-14 07:53:42,,"['Hypotensive in afternoon yesterday, hct stable, CEs still trending', 'down. ECG unchanged. Still with sl hemoptysis in ET tube but CXR', 'unchanged.  Restarted dopamine.  A-line left in overnight given ongoing', 'need for pressors. Lactate normal. SV02 69%', 'Renal consulted, recommended HD, will place L femoral temporary access', 'and dialyze today vs tomorrow.', 'Talked with brother, gave update.']",,30678,197019.0
13,2103-10-14 11:49:24,,"['Hypotensive in afternoon yesterday, hct stable, CEs still trending', 'down. ECG unchanged. Still with sl hemoptysis in ET tube but CXR', 'unchanged.  Restarted dopamine.  A-line left in overnight given ongoing', 'need for pressors. Lactate normal. SV02 69%', 'Renal consulted, recommended HD, will place L femoral temporary access', 'and dialyze today vs tomorrow.', 'Talked with brother, gave update.']",,30678,197019.0
14,2103-10-15 06:07:02,"['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to develope hematoma at left HD line site with associated drop', 'in HCT of several points']","['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to develope hematoma at left HD line site with associated drop', 'in HCT of several points']","['Hypotensive in afternoon yesterday, hct stable, CEs still trending', 'down. ECG unchanged. Still with sl hemoptysis in ET tube but CXR', 'unchanged.  Restarted dopamine.  A-line left in overnight given ongoing', 'need for pressors. Lactate normal. SV02 69%', 'Renal consulted, recommended HD, will place L femoral temporary access', 'and dialyze today vs tomorrow.', 'Talked with brother, gave update.']",30678,197019.0
15,2103-10-15 07:45:59,"[' noted to developed hematoma at left HD line site with associated drop', 'Persistent pressor requirement']","['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to developed hematoma at left HD line site with associated drop', 'in HCT of several points', 'Persistent pressor requirement']",[' noted to develope hematoma at left HD line site with associated drop'],30678,197019.0
16,2103-10-15 07:47:27,,"['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to developed hematoma at left HD line site with associated drop', 'in HCT of several points', 'Persistent pressor requirement']",,30678,197019.0
17,2103-10-15 12:33:53,,"['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to developed hematoma at left HD line site with associated drop', 'in HCT of several points', 'Persistent pressor requirement']",,30678,197019.0
18,2103-10-16 06:42:50,"['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4']","['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4']","['ARTERIAL LINE - STOP [**2103-10-14**] 02:58 PM', ' DIALYSIS CATHETER - START [**2103-10-14**] 06:59 PM', ' noted to developed hematoma at left HD line site with associated drop', 'in HCT of several points', 'Persistent pressor requirement']",30678,197019.0
19,2103-10-16 06:53:00,"['- SBT in the 30s this AM.', '- TF off since MN (for possible extubation)']","['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4', '- SBT in the 30s this AM.', '- TF off since MN (for possible extubation)']",,30678,197019.0
20,2103-10-16 07:53:55,,"['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4', '- SBT in the 30s this AM.', '- TF off since MN (for possible extubation)']",,30678,197019.0
21,2103-10-16 09:18:40,"['- 02 sats dropped to 88% on Fi02 0.4, was titrated up to 0.5.', '-s/p HD yesterday with 1.5L removed']","['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4, was titrated up to 0.5.', '- SBT in the 30s this AM.', '- TF off since MN (for possible extubation)', '-s/p HD yesterday with 1.5L removed']",['- 02 sats dropped to 88% on Fi02 0.4'],30678,197019.0
22,2103-10-17 07:10:10,"['CTA - No PE', 'Had HD']","['CTA - No PE', 'Had HD']","['- Pt tolerated two hour SBT (5/0); however, he had significant', 'secretions (blood tinged).  He was put back on PS [**9-21**] overnight.', '- 02 sats dropped to 88% on Fi02 0.4, was titrated up to 0.5.', '- SBT in the 30s this AM.', '- TF off since MN (for possible extubation)', '-s/p HD yesterday with 1.5L removed']",30678,197019.0
23,2103-10-17 07:16:06,,"['CTA - No PE', 'Had HD']",,30678,197019.0
24,2103-10-17 07:45:54,,[],"['CTA - No PE', 'Had HD']",30678,197019.0
25,2103-10-17 09:32:06,,[],,30678,197019.0
26,2103-10-17 11:35:27,,[],,30678,197019.0
27,2103-10-18 06:50:54,"['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '- Patient', 's tube feeds stopped at midnight, had SBT this AM with RSBI', 'of 26 (fentanyl still at 25mcg/hr)']","['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '- Patient', 's tube feeds stopped at midnight, had SBT this AM with RSBI', 'of 26 (fentanyl still at 25mcg/hr)']",,30678,197019.0
28,2103-10-18 07:58:54,,"['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '- Patient', 's tube feeds stopped at midnight, had SBT this AM with RSBI', 'of 26 (fentanyl still at 25mcg/hr)']",,30678,197019.0
29,2103-10-18 12:15:39,"['-', 'Patient', 's tube feeds stopped at midnight, had SBT this AM', 'with RSBI of 26 (fentanyl still at 25mcg/hr)']","['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '-', 'Patient', 's tube feeds stopped at midnight, had SBT this AM', 'with RSBI of 26 (fentanyl still at 25mcg/hr)']","['- Patient', 's tube feeds stopped at midnight, had SBT this AM with RSBI', 'of 26 (fentanyl still at 25mcg/hr)']",30678,197019.0
30,2103-10-18 13:13:40,,"['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '-', 'Patient', 's tube feeds stopped at midnight, had SBT this AM', 'with RSBI of 26 (fentanyl still at 25mcg/hr)']",,30678,197019.0
31,2103-10-19 06:58:22,"['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']","['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']","['ULTRASOUND - At [**2103-10-18**] 06:02 AM', 'right femoral ultrasound of lrg hematoma', '- Patient with new left groin hematoma at old site of left femoral line', '(removed at 2pm on [**2103-10-14**]). Hct decreased overnight from 31.6 -> 26.9.', 'Patient ordered for right femoral ultrasound to evaluate', '-', 'Patient', 's tube feeds stopped at midnight, had SBT this AM', 'with RSBI of 26 (fentanyl still at 25mcg/hr)']",30678,197019.0
32,2103-10-19 07:46:12,['Carvedilol dose lowered and BP is currently stable.'],"['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', 'Carvedilol dose lowered and BP is currently stable.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']",,30678,197019.0
33,2103-10-19 12:40:57,,"['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', 'Carvedilol dose lowered and BP is currently stable.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']",,30678,197019.0
34,2103-10-19 13:05:35,,"['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', 'Carvedilol dose lowered and BP is currently stable.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']",,30678,197019.0
35,2103-10-19 13:07:26,,"['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', 'Carvedilol dose lowered and BP is currently stable.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']",,30678,197019.0
36,2103-10-20 06:54:46,"['- Patient extubated.  Brother and patient in agreement not to', 're-intubate.  Patient weaned to 6L nasal canulla, but has difficulty', 'clearing secretions so requires intermittent suctioning', '- dialysied 1 kg yesterday']","['- Patient extubated.  Brother and patient in agreement not to', 're-intubate.  Patient weaned to 6L nasal canulla, but has difficulty', 'clearing secretions so requires intermittent suctioning', '- dialysied 1 kg yesterday']","['Dialyzed.', 'Transfused 1 unit PRBCs, 1 unit platelets', 'Give PO Vitamin K', 'Cefepime started for VAP, Ceftriaxone discontinued.', 'Carvedilol dose lowered and BP is currently stable.', ' BLOOD CULTURED - At [**2103-10-18**] 05:28 PM', ' BLOOD CULTURED - At [**2103-10-19**] 04:48 AM', 'History obtained from [**Hospital 85**] Medical records']",30678,197019.0
37,2103-10-20 07:46:55,,"['- Patient extubated.  Brother and patient in agreement not to', 're-intubate.  Patient weaned to 6L nasal canulla, but has difficulty', 'clearing secretions so requires intermittent suctioning', '- dialysied 1 kg yesterday']",,30678,197019.0
38,2103-10-20 12:02:19,['- dialyzed 1 kg yesterday'],"['- Patient extubated.  Brother and patient in agreement not to', 're-intubate.  Patient weaned to 6L nasal canulla, but has difficulty', 'clearing secretions so requires intermittent suctioning', '- dialyzed 1 kg yesterday']",['- dialysied 1 kg yesterday'],30678,197019.0
39,2103-10-20 12:22:17,"['- Dialyzed 1 kg yesterday', '- This AM, had conversation with HCP regarding patient', 's current', 'situation and goals of care, and patient made CMO at noon today.']","['- Patient extubated.  Brother and patient in agreement not to', 're-intubate.  Patient weaned to 6L nasal canulla, but has difficulty', 'clearing secretions so requires intermittent suctioning', '- Dialyzed 1 kg yesterday', '- This AM, had conversation with HCP regarding patient', 's current', 'situation and goals of care, and patient made CMO at noon today.']",['- dialyzed 1 kg yesterday'],30678,197019.0
0,2173-11-20 06:27:38,,"['-ABGs: A/C, 100% Fi02: 7.30/47/240->7.41/37/147/', '-Attempted Aline, multiple times, did not get. difficulty with', 'advancing wire with arrow kit. no long 20G angiocaths in unit.', '-1.5L NS to keep MAPs >65 all before 6pm', '-sputum culture 2+GPCs in pairs,clusters and chains. Added Vanco', '-started tube feeds']",,61259,148966.0
1,2173-11-20 06:29:44,,"['-ABGs: A/C, 100% Fi02: 7.30/47/240->7.41/37/147/', '-Attempted Aline, multiple times, did not get. difficulty with', 'advancing wire with arrow kit. no long 20G angiocaths in unit.', '-1.5L NS to keep MAPs >65 all before 6pm', '-sputum culture 2+GPCs in pairs,clusters and chains. Added Vanco', '-started tube feeds']",,61259,148966.0
2,2173-11-20 10:53:14,,"['-ABGs: A/C, 100% Fi02: 7.30/47/240->7.41/37/147/', '-Attempted Aline, multiple times, did not get. difficulty with', 'advancing wire with arrow kit. no long 20G angiocaths in unit.', '-1.5L NS to keep MAPs >65 all before 6pm', '-sputum culture 2+GPCs in pairs,clusters and chains. Added Vanco', '-started tube feeds']",,61259,148966.0
3,2173-11-20 14:40:28,,"['-ABGs: A/C, 100% Fi02: 7.30/47/240->7.41/37/147/', '-Attempted Aline, multiple times, did not get. difficulty with', 'advancing wire with arrow kit. no long 20G angiocaths in unit.', '-1.5L NS to keep MAPs >65 all before 6pm', '-sputum culture 2+GPCs in pairs,clusters and chains. Added Vanco', '-started tube feeds']",,61259,148966.0
4,2173-11-21 07:17:23,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']","['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']","['-ABGs: A/C, 100% Fi02: 7.30/47/240->7.41/37/147/', '-Attempted Aline, multiple times, did not get. difficulty with', 'advancing wire with arrow kit. no long 20G angiocaths in unit.', '-1.5L NS to keep MAPs >65 all before 6pm', '-sputum culture 2+GPCs in pairs,clusters and chains. Added Vanco', '-started tube feeds']",61259,148966.0
5,2173-11-21 07:22:23,,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",,61259,148966.0
6,2173-11-21 10:18:31,,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",,61259,148966.0
7,2173-11-21 10:19:14,,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",,61259,148966.0
8,2173-11-21 10:29:45,,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",,61259,148966.0
9,2173-11-21 13:54:10,,"['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",,61259,148966.0
10,2173-11-22 07:49:23,"['SPUTUM CULTURE - At [**2173-11-21**] 10:16 AM', ' INVASIVE VENTILATION - STOP [**2173-11-21**] 11:01 AM', '-Successfully extubated on [**11-21**] AM rounds and doing well on face mask', 'all day', '-MRSA swab negative', '-Plan to guaiac stools but none yet', '-Speech and swallow consult pending for this AM', '-Iron studies consistent with anemia of chronic disease', '-PPi discontinued now that patient extubated', '-[**11-21**] sputum growing GNR, [**11-19**] sputum growing GPC', '-[**11-21**] PM Hct stable at 34']","['SPUTUM CULTURE - At [**2173-11-21**] 10:16 AM', ' INVASIVE VENTILATION - STOP [**2173-11-21**] 11:01 AM', '-Successfully extubated on [**11-21**] AM rounds and doing well on face mask', 'all day', '-MRSA swab negative', '-Plan to guaiac stools but none yet', '-Speech and swallow consult pending for this AM', '-Iron studies consistent with anemia of chronic disease', '-PPi discontinued now that patient extubated', '-[**11-21**] sputum growing GNR, [**11-19**] sputum growing GPC', '-[**11-21**] PM Hct stable at 34']","['- CBC with elevated leukocytosis, diff shows 9% bands (down from 10%)', '- unable to draw ABG (bad PVD)', '- on PS, not being extubated tonight.', '- sputum cx with sparse OP growth', '- MAPS remained > 85, no IVFs given', '- got PICC o/n (may need long term abx + for sedative meds)']",61259,148966.0
11,2173-11-22 13:34:36,"['INVASIVE VENTILATION - STOP [**2173-11-21**] 11:01 AM', '-PPI discontinued now that patient extubated', '-[**11-21**] sputum gram stain shows GNR, [**11-19**] sputum gram stain shows GPC']","['INVASIVE VENTILATION - STOP [**2173-11-21**] 11:01 AM', '-Successfully extubated on [**11-21**] AM rounds and doing well on face mask', 'all day', '-MRSA swab negative', '-Plan to guaiac stools but none yet', '-Speech and swallow consult pending for this AM', '-Iron studies consistent with anemia of chronic disease', '-PPI discontinued now that patient extubated', '-[**11-21**] sputum gram stain shows GNR, [**11-19**] sputum gram stain shows GPC', '-[**11-21**] PM Hct stable at 34']","['SPUTUM CULTURE - At [**2173-11-21**] 10:16 AM', ' INVASIVE VENTILATION - STOP [**2173-11-21**] 11:01 AM', '-PPi discontinued now that patient extubated', '-[**11-21**] sputum growing GNR, [**11-19**] sputum growing GPC']",61259,148966.0
0,2155-06-11 07:57:32,,"['- Patient having some increase in diarrhea, C. diff sent.', '- remained stable overnight.']",,76078,128376.0
1,2155-06-11 10:44:43,,"['- Patient having some increase in diarrhea, C. diff sent.', '- remained stable overnight.']",,76078,128376.0
2,2155-06-12 07:03:00,"['- plastics consult: likely not sick from decub; stage IV decubitus', 'tracks to bone. Debrided wound but would prefer for lower INR into', 'therapeutic range before further debridement (OR versus bedside).', ""Consider Zn and vit C supplements. Recc'd for dakins (and papain/urea"", 'ointment that needs to be followed up with pharm on [**6-12**].)', '- gave 1 mg IV vitamin K', '- blood cultures: GNR and GPR in [**3-18**] bottles [**6-10**]', '- blood cultures: [**6-11**] NGTD x2 bottles', '- urine culture: GNR 10-100,000 colonies', '- continued vanc/Zosyn', '- C dif: negative', '- CXR: No acute cardiopulmonary process. Left 9th rib posterolateral', 'old rib fracture, accurate age indeterminant.', '- noted to be in AF in the evening, rate in 90s --> no intervention', '- frequent ventricular bigeminy in AM, sleeping, BP stable, repleted', ""'lytes""]","['- plastics consult: likely not sick from decub; stage IV decubitus', 'tracks to bone. Debrided wound but would prefer for lower INR into', 'therapeutic range before further debridement (OR versus bedside).', ""Consider Zn and vit C supplements. Recc'd for dakins (and papain/urea"", 'ointment that needs to be followed up with pharm on [**6-12**].)', '- gave 1 mg IV vitamin K', '- blood cultures: GNR and GPR in [**3-18**] bottles [**6-10**]', '- blood cultures: [**6-11**] NGTD x2 bottles', '- urine culture: GNR 10-100,000 colonies', '- continued vanc/Zosyn', '- C dif: negative', '- CXR: No acute cardiopulmonary process. Left 9th rib posterolateral', 'old rib fracture, accurate age indeterminant.', '- noted to be in AF in the evening, rate in 90s --> no intervention', '- frequent ventricular bigeminy in AM, sleeping, BP stable, repleted', ""'lytes""]","['- Patient having some increase in diarrhea, C. diff sent.', '- remained stable overnight.']",76078,128376.0
3,2155-06-12 11:58:46,,"['- plastics consult: likely not sick from decub; stage IV decubitus', 'tracks to bone. Debrided wound but would prefer for lower INR into', 'therapeutic range before further debridement (OR versus bedside).', ""Consider Zn and vit C supplements. Recc'd for dakins (and papain/urea"", 'ointment that needs to be followed up with pharm on [**6-12**].)', '- gave 1 mg IV vitamin K', '- blood cultures: GNR and GPR in [**3-18**] bottles [**6-10**]', '- blood cultures: [**6-11**] NGTD x2 bottles', '- urine culture: GNR 10-100,000 colonies', '- continued vanc/Zosyn', '- C dif: negative', '- CXR: No acute cardiopulmonary process. Left 9th rib posterolateral', 'old rib fracture, accurate age indeterminant.', '- noted to be in AF in the evening, rate in 90s --> no intervention', '- frequent ventricular bigeminy in AM, sleeping, BP stable, repleted', ""'lytes""]",,76078,128376.0
4,2155-06-12 12:20:44,,"['- plastics consult: likely not sick from decub; stage IV decubitus', 'tracks to bone. Debrided wound but would prefer for lower INR into', 'therapeutic range before further debridement (OR versus bedside).', ""Consider Zn and vit C supplements. Recc'd for dakins (and papain/urea"", 'ointment that needs to be followed up with pharm on [**6-12**].)', '- gave 1 mg IV vitamin K', '- blood cultures: GNR and GPR in [**3-18**] bottles [**6-10**]', '- blood cultures: [**6-11**] NGTD x2 bottles', '- urine culture: GNR 10-100,000 colonies', '- continued vanc/Zosyn', '- C dif: negative', '- CXR: No acute cardiopulmonary process. Left 9th rib posterolateral', 'old rib fracture, accurate age indeterminant.', '- noted to be in AF in the evening, rate in 90s --> no intervention', '- frequent ventricular bigeminy in AM, sleeping, BP stable, repleted', ""'lytes""]",,76078,128376.0
0,2167-01-14 06:45:18,,"['PICC LINE - START [**2167-1-13**] 07:56 PM', 'new PICC placed today [**2167-1-13**]', ' MULTI LUMEN - START [**2167-1-13**] 07:57 PM', 'placed on admission to the  ICU', 'CVP was 3.  Pt recieved 2.6L NS with increased to 6.']",,50490,115121.0
1,2167-01-15 07:10:14,"['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- cx data - nothing new', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']","['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- cx data - nothing new', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']","['PICC LINE - START [**2167-1-13**] 07:56 PM', 'new PICC placed today [**2167-1-13**]', ' MULTI LUMEN - START [**2167-1-13**] 07:57 PM', 'placed on admission to the  ICU', 'CVP was 3.  Pt recieved 2.6L NS with increased to 6.']",50490,115121.0
2,2167-01-15 07:40:33,"['PICC LINE - START [**2167-1-13**] 07:56 PM', 'new PICC placed today [**2167-1-13**]', ' MULTI LUMEN - START [**2167-1-13**] 07:57 PM', 'placed on admission to the  ICU', 'CVP was 3.  Pt recieved 2.6L NS with increased to 6.']","['PICC LINE - START [**2167-1-13**] 07:56 PM', 'new PICC placed today [**2167-1-13**]', ' MULTI LUMEN - START [**2167-1-13**] 07:57 PM', 'placed on admission to the  ICU', 'CVP was 3.  Pt recieved 2.6L NS with increased to 6.']","['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- cx data - nothing new', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']",50490,115121.0
3,2167-01-15 07:55:28,"['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']","['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']","['PICC LINE - START [**2167-1-13**] 07:56 PM', 'new PICC placed today [**2167-1-13**]', ' MULTI LUMEN - START [**2167-1-13**] 07:57 PM', 'placed on admission to the  ICU', 'CVP was 3.  Pt recieved 2.6L NS with increased to 6.']",50490,115121.0
4,2167-01-15 11:36:39,,"['- Added Azithromycin ([**1-14**]-); Continued vanco/[**Last Name (un) **]/flagyl', '- Continued nystatin, acyclovir and fluconazole for mucositis', '- Transfused 1 u prbc - 20 > 23.1', '- BMT reccs - continue azithro/flagyl/fluc/vanco/[**Last Name (un) **]; family meeting']",,50490,115121.0
0,2147-01-06 07:47:33,,"['ULTRASOUND - At [**2147-1-5**] 09:11 PM', 'gallbladder and liver', ' SPUTUM CULTURE - At [**2147-1-6**] 03:15 AM', '- spike to 100.6 axillary.  Cultured,  no abx started.', '- psych c/s recommend continuing CIWA scale as patient appeared to be', 'w/d from EtOH and not in acute psychosis', '- delirum improved significantly with valium']",,55413,174852.0
1,2147-01-06 09:54:13,,"['ULTRASOUND - At [**2147-1-5**] 09:11 PM', 'gallbladder and liver', ' SPUTUM CULTURE - At [**2147-1-6**] 03:15 AM', '- spike to 100.6 axillary.  Cultured,  no abx started.', '- psych c/s recommend continuing CIWA scale as patient appeared to be', 'w/d from EtOH and not in acute psychosis', '- delirum improved significantly with valium']",,55413,174852.0
2,2147-01-06 10:21:29,,"['ULTRASOUND - At [**2147-1-5**] 09:11 PM', 'gallbladder and liver', ' SPUTUM CULTURE - At [**2147-1-6**] 03:15 AM', '- spike to 100.6 axillary.  Cultured,  no abx started.', '- psych c/s recommend continuing CIWA scale as patient appeared to be', 'w/d from EtOH and not in acute psychosis', '- delirum improved significantly with valium']",,55413,174852.0
3,2147-01-07 07:13:04,"['- trialed pt on IV haldol per Psych recs as Psych were concerned about', 'Benzo intoxication, no improvement pt very agitated. Psych consulted', 'again recommended changing to CIWA scale with Haldol for EtoH', 'withdrawal. Pt required large amounts of Benzos was agitated until 0130']","['- trialed pt on IV haldol per Psych recs as Psych were concerned about', 'Benzo intoxication, no improvement pt very agitated. Psych consulted', 'again recommended changing to CIWA scale with Haldol for EtoH', 'withdrawal. Pt required large amounts of Benzos was agitated until 0130']","['ULTRASOUND - At [**2147-1-5**] 09:11 PM', 'gallbladder and liver', ' SPUTUM CULTURE - At [**2147-1-6**] 03:15 AM', '- spike to 100.6 axillary.  Cultured,  no abx started.', '- psych c/s recommend continuing CIWA scale as patient appeared to be', 'w/d from EtOH and not in acute psychosis', '- delirum improved significantly with valium']",55413,174852.0
4,2147-01-07 11:02:01,"['withdrawal. Pt required large amounts of Benzos (approx 600mg) and', 'still was very agitated even with 10mg IV Haldol q1hr']","['- trialed pt on IV haldol per Psych recs as Psych were concerned about', 'Benzo intoxication, no improvement pt very agitated. Psych consulted', 'again recommended changing to CIWA scale with Haldol for EtoH', 'withdrawal. Pt required large amounts of Benzos (approx 600mg) and', 'still was very agitated even with 10mg IV Haldol q1hr']",['withdrawal. Pt required large amounts of Benzos was agitated until 0130'],55413,174852.0
5,2147-01-08 07:03:40,"['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']","['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']","['- trialed pt on IV haldol per Psych recs as Psych were concerned about', 'Benzo intoxication, no improvement pt very agitated. Psych consulted', 'again recommended changing to CIWA scale with Haldol for EtoH', 'withdrawal. Pt required large amounts of Benzos (approx 600mg) and', 'still was very agitated even with 10mg IV Haldol q1hr']",55413,174852.0
6,2147-01-08 08:20:32,,"['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']",,55413,174852.0
7,2147-01-08 11:46:44,,"['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']",,55413,174852.0
8,2147-01-08 12:24:11,,"['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']",,55413,174852.0
9,2147-01-09 06:40:39,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to [**Last Name (un) **] and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.']","['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to [**Last Name (un) **] and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.']","['- The patient remained very agitated during the day.  She had received', '~ 620 mg of valium total yesterday and this am, so psych recommended', 'using haldol instead of valium as she was likely valium intoxicated.', 'She got 10 mg of po haldol x 2, then 30 mg IV valium x 1, then 5 mg of', 'zyprexa x 1 and continued to have agitation.  She then received another', '10 mg IV valium.  Psych was recontacted and recommended giving 5 mg IV', 'haldol q1h prn.  She became so agitated that security had to be called', 'non-urgently to place leather restraints as she was almost climbing out', 'of bed with the cloth restraints in place.  She continued to receive', 'haldol q1h, but her agitation grew and psych had to come and reevalute', 'her.  They felt her agitation was consistent with delirium and', 'continued to recommend avoid benzos and giving haldol 5-10 mg q1h prn.', 'As her QTc was becoming getting longer (up to 466) they stated if it', 'became > 500, she could be loaded with depakote orally.  Also wanted to', 'check an EKG after each haldol dose.', '- TSH, Vit B12, folate, haptoglobin, and thiamine was ordered.  TSH,', 'Vit B12, and folate were WNL.  haptoglobin < 20.', 'History obtained from Patient']",55413,174852.0
10,2147-01-09 07:12:31,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to [**Last Name (un) **] and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.']",,55413,174852.0
11,2147-01-09 07:21:31,"['-significantly less agitated, now consistenly oriented to person and', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']","['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']","['-significantly less agitated, now consistenly oriented to [**Last Name (un) **] and']",55413,174852.0
12,2147-01-09 07:34:35,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']",,55413,174852.0
13,2147-01-09 07:44:35,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']",,55413,174852.0
14,2147-01-09 07:52:27,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']",,55413,174852.0
15,2147-01-09 10:40:57,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']",,55413,174852.0
16,2147-01-09 12:21:41,,"['- started haldol 5mg po q4h standing', '-significantly less agitated, now consistenly oriented to person and', 'place.  Able to state the name/number of her HCP.', '- pysch rec to continue current management.  There was concern over', 'needing a valium taper, but felt that she will autotaper as she', 'received a significant amount of iv valium which accumulates in adipose', 'tissue and will slowly decrease over time.  However, need to watch for', 'benzo withdrawal.', 'This am she is oriented x 3 and admits to pain in her lower back and', 'abdomen.']",,55413,174852.0
0,2178-04-10 06:55:07,,[],,94404,107454.0
1,2178-04-10 15:31:03,"['Patient required one dose of diazepam at midnight. Has not required', 'benzodiazepines since then.']","['Patient required one dose of diazepam at midnight. Has not required', 'benzodiazepines since then.']",,94404,107454.0
0,2108-01-24 07:29:55,,"['Prepped for Colonoscopy today.', 'Remained hemodynamically stable', 'Hct dropped to 27 with IVF']",,93632,159011.0
1,2108-01-24 11:07:59,,"['Prepped for Colonoscopy today.', 'Remained hemodynamically stable', 'Hct dropped to 27 with IVF']",,93632,159011.0
2,2108-01-25 06:32:01,"['CALLED OUT', 'HCT stable yesterday, no further GI bleeding', 'Pt deferred colonoscopy, health care proxy was [**Name (NI) 1850**] by GI and she', 'also deferred scope.']","['CALLED OUT', 'HCT stable yesterday, no further GI bleeding', 'Pt deferred colonoscopy, health care proxy was [**Name (NI) 1850**] by GI and she', 'also deferred scope.']","['Prepped for Colonoscopy today.', 'Remained hemodynamically stable', 'Hct dropped to 27 with IVF']",93632,159011.0
0,2151-10-08 08:48:30,,[],,45219,187810.0
1,2151-10-08 12:14:34,,[],,45219,187810.0
0,2133-08-28 08:47:13,,['EKG - At [**2133-8-28**] 01:45 AM'],,6901,198044.0
1,2133-08-28 12:10:18,,['EKG - At [**2133-8-28**] 01:45 AM'],,6901,198044.0
2,2133-08-29 07:54:39,['MULTI LUMEN - START [**2133-8-28**] 05:39 PM'],['MULTI LUMEN - START [**2133-8-28**] 05:39 PM'],['EKG - At [**2133-8-28**] 01:45 AM'],6901,198044.0
3,2133-08-29 08:04:42,,['MULTI LUMEN - START [**2133-8-28**] 05:39 PM'],,6901,198044.0
4,2133-08-29 15:31:15,['-1L bolus for hypotension'],"['MULTI LUMEN - START [**2133-8-28**] 05:39 PM', '-1L bolus for hypotension']",,6901,198044.0
5,2133-08-30 07:32:55,"['Dopamine weaned to 2mc/kg', 'Increased pain regimen for pain control']","['Dopamine weaned to 2mc/kg', 'Increased pain regimen for pain control']","['MULTI LUMEN - START [**2133-8-28**] 05:39 PM', '-1L bolus for hypotension']",6901,198044.0
6,2133-08-30 07:33:41,,"['Dopamine weaned to 2mc/kg', 'Increased pain regimen for pain control']",,6901,198044.0
7,2133-08-30 19:00:40,,"['Dopamine weaned to 2mc/kg', 'Increased pain regimen for pain control']",,6901,198044.0
8,2133-08-31 07:45:07,"['RBC transfusion.', 'CVP goal [**3-8**]', 'Try to wean him off pressors.', 'Stopped opioids; tylenol standing for pain control (at baseline due to', 'OA)', 'Coumadin increased to 10mg (home dose 8, during last 3 days and INR', 'still low)']","['RBC transfusion.', 'CVP goal [**3-8**]', 'Try to wean him off pressors.', 'Stopped opioids; tylenol standing for pain control (at baseline due to', 'OA)', 'Coumadin increased to 10mg (home dose 8, during last 3 days and INR', 'still low)']","['Dopamine weaned to 2mc/kg', 'Increased pain regimen for pain control']",6901,198044.0
9,2133-08-31 21:42:41,['weaned him off pressors.'],"['RBC transfusion.', 'CVP goal [**3-8**]', 'weaned him off pressors.', 'Stopped opioids; tylenol standing for pain control (at baseline due to', 'OA)', 'Coumadin increased to 10mg (home dose 8, during last 3 days and INR', 'still low)']",['Try to wean him off pressors.'],6901,198044.0
0,2202-01-28 07:47:00,,"['EKG - At [**2202-1-27**] 02:00 PM', 'c/o abdominal pain but uninmpressive exam, treated only with valium', '22 gauge in hand', 'Hard stick', 'PICC placed today']",,76134,110727.0
1,2202-01-28 10:05:25,,"['EKG - At [**2202-1-27**] 02:00 PM', 'c/o abdominal pain but uninmpressive exam, treated only with valium', '22 gauge in hand', 'Hard stick', 'PICC placed today']",,76134,110727.0
0,2202-06-05 08:05:09,,['PICC LINE - START [**2202-6-5**] 02:13 AM'],,46057,188769.0
1,2202-06-05 11:32:26,,['PICC LINE - START [**2202-6-5**] 02:13 AM'],,46057,188769.0
2,2202-06-05 12:00:07,,['PICC LINE - START [**2202-6-5**] 02:13 AM'],,46057,188769.0
3,2202-06-09 06:34:11,"['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']","['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",['PICC LINE - START [**2202-6-5**] 02:13 AM'],46057,188769.0
4,2202-06-09 06:35:33,,"['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",,46057,188769.0
5,2202-06-09 10:29:45,,"['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",,46057,188769.0
6,2202-06-09 10:34:58,,"['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",,46057,188769.0
7,2202-06-09 11:47:19,,"['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",,46057,188769.0
8,2202-06-10 06:49:16,"['NON-INVASIVE VENTILATION - START [**2202-6-9**] 08:00 AM', ' ARTERIAL LINE - START [**2202-6-9**] 11:00 AM', ' NON-INVASIVE VENTILATION - STOP [**2202-6-9**] 11:15 AM', ' INVASIVE VENTILATION - START [**2202-6-9**] 11:15 AM', ' CARDIAC ARREST - At [**2202-6-9**] 10:02 PM', '.', '-intubated', '-axillary a-line placed', '-renal c/s called.', 'TTE-The left atrium is moderately dilated. No atrial septal defect is', 'seen by 2D or color Doppler. Left ventricular wall thicknesses are', 'normal. The left ventricular cavity size is normal. Overall left', 'ventricular systolic function is moderately depressed (LVEF= 30-35 %)', 'with global hypokinesis and akinesis the infero-lateral wall. There is', 'no ventricular septal defect. with moderate global free wall', 'hypokinesis. The ascending aorta is mildly dilated. A bioprosthetic', 'aortic valve prosthesis is present. The aortic valve prosthesis appears', 'well seated, with normal leaflet/disc motion and transvalvular', 'gradients. No masses or vegetations are seen on the aortic valve, but', 'cannot be fully excluded due to suboptimal image quality. No aortic', 'regurgitation is seen. The mitral valve leaflets are mildly thickened.', 'No mass or vegetation is seen on the mitral valve. Mild (1+) mitral', 'regurgitation is seen. The tricuspid valve leaflets are mildly', 'thickened. There is moderate pulmonary artery systolic hypertension.', 'There is no pericardial effusion.', '-levophed added, unable to wean off neo as pt with increased', 'tachy-brady and dropped pressures.', '-awaiting stability for CT torso. added CT head given ?asym pupils.', '-awaiting [**Last Name (un) **] stim', '-IVF', '-guaiac +stools, brown noted', '-given 2 amps of bicarb', '-oliguric', '-abx renally dosed, allopurinol dcd', '.', 'Coded around 930pm, dropped pressure, became bradycardic. PEA', 'given 1mg epi x2, 1mg atropine, bicarb, calcium. ABG pH 7.34/46/380.']","['NON-INVASIVE VENTILATION - START [**2202-6-9**] 08:00 AM', ' ARTERIAL LINE - START [**2202-6-9**] 11:00 AM', ' NON-INVASIVE VENTILATION - STOP [**2202-6-9**] 11:15 AM', ' INVASIVE VENTILATION - START [**2202-6-9**] 11:15 AM', ' CARDIAC ARREST - At [**2202-6-9**] 10:02 PM', '.', '-intubated', '-axillary a-line placed', '-renal c/s called.', 'TTE-The left atrium is moderately dilated. No atrial septal defect is', 'seen by 2D or color Doppler. Left ventricular wall thicknesses are', 'normal. The left ventricular cavity size is normal. Overall left', 'ventricular systolic function is moderately depressed (LVEF= 30-35 %)', 'with global hypokinesis and akinesis the infero-lateral wall. There is', 'no ventricular septal defect. with moderate global free wall', 'hypokinesis. The ascending aorta is mildly dilated. A bioprosthetic', 'aortic valve prosthesis is present. The aortic valve prosthesis appears', 'well seated, with normal leaflet/disc motion and transvalvular', 'gradients. No masses or vegetations are seen on the aortic valve, but', 'cannot be fully excluded due to suboptimal image quality. No aortic', 'regurgitation is seen. The mitral valve leaflets are mildly thickened.', 'No mass or vegetation is seen on the mitral valve. Mild (1+) mitral', 'regurgitation is seen. The tricuspid valve leaflets are mildly', 'thickened. There is moderate pulmonary artery systolic hypertension.', 'There is no pericardial effusion.', '-levophed added, unable to wean off neo as pt with increased', 'tachy-brady and dropped pressures.', '-awaiting stability for CT torso. added CT head given ?asym pupils.', '-awaiting [**Last Name (un) **] stim', '-IVF', '-guaiac +stools, brown noted', '-given 2 amps of bicarb', '-oliguric', '-abx renally dosed, allopurinol dcd', '.', 'Coded around 930pm, dropped pressure, became bradycardic. PEA', 'given 1mg epi x2, 1mg atropine, bicarb, calcium. ABG pH 7.34/46/380.']","['PICC LINE - START [**2202-6-8**] 12:00 PM', 'SINGLE LUMEN', ' EKG - At [**2202-6-8**] 12:30 PM', ' MULTI LUMEN - START [**2202-6-8**] 04:55 PM', ' PICC LINE - STOP [**2202-6-8**] 06:35 PM', 'SINGLE LUMEN']",46057,188769.0
9,2202-06-10 06:53:58,,"['NON-INVASIVE VENTILATION - START [**2202-6-9**] 08:00 AM', ' ARTERIAL LINE - START [**2202-6-9**] 11:00 AM', ' NON-INVASIVE VENTILATION - STOP [**2202-6-9**] 11:15 AM', ' INVASIVE VENTILATION - START [**2202-6-9**] 11:15 AM', ' CARDIAC ARREST - At [**2202-6-9**] 10:02 PM', '.', '-intubated', '-axillary a-line placed', '-renal c/s called.', 'TTE-The left atrium is moderately dilated. No atrial septal defect is', 'seen by 2D or color Doppler. Left ventricular wall thicknesses are', 'normal. The left ventricular cavity size is normal. Overall left', 'ventricular systolic function is moderately depressed (LVEF= 30-35 %)', 'with global hypokinesis and akinesis the infero-lateral wall. There is', 'no ventricular septal defect. with moderate global free wall', 'hypokinesis. The ascending aorta is mildly dilated. A bioprosthetic', 'aortic valve prosthesis is present. The aortic valve prosthesis appears', 'well seated, with normal leaflet/disc motion and transvalvular', 'gradients. No masses or vegetations are seen on the aortic valve, but', 'cannot be fully excluded due to suboptimal image quality. No aortic', 'regurgitation is seen. The mitral valve leaflets are mildly thickened.', 'No mass or vegetation is seen on the mitral valve. Mild (1+) mitral', 'regurgitation is seen. The tricuspid valve leaflets are mildly', 'thickened. There is moderate pulmonary artery systolic hypertension.', 'There is no pericardial effusion.', '-levophed added, unable to wean off neo as pt with increased', 'tachy-brady and dropped pressures.', '-awaiting stability for CT torso. added CT head given ?asym pupils.', '-awaiting [**Last Name (un) **] stim', '-IVF', '-guaiac +stools, brown noted', '-given 2 amps of bicarb', '-oliguric', '-abx renally dosed, allopurinol dcd', '.', 'Coded around 930pm, dropped pressure, became bradycardic. PEA', 'given 1mg epi x2, 1mg atropine, bicarb, calcium. ABG pH 7.34/46/380.']",,46057,188769.0
10,2202-06-10 10:40:13,,"['NON-INVASIVE VENTILATION - START [**2202-6-9**] 08:00 AM', ' ARTERIAL LINE - START [**2202-6-9**] 11:00 AM', ' NON-INVASIVE VENTILATION - STOP [**2202-6-9**] 11:15 AM', ' INVASIVE VENTILATION - START [**2202-6-9**] 11:15 AM', ' CARDIAC ARREST - At [**2202-6-9**] 10:02 PM', '.', '-intubated', '-axillary a-line placed', '-renal c/s called.', 'TTE-The left atrium is moderately dilated. No atrial septal defect is', 'seen by 2D or color Doppler. Left ventricular wall thicknesses are', 'normal. The left ventricular cavity size is normal. Overall left', 'ventricular systolic function is moderately depressed (LVEF= 30-35 %)', 'with global hypokinesis and akinesis the infero-lateral wall. There is', 'no ventricular septal defect. with moderate global free wall', 'hypokinesis. The ascending aorta is mildly dilated. A bioprosthetic', 'aortic valve prosthesis is present. The aortic valve prosthesis appears', 'well seated, with normal leaflet/disc motion and transvalvular', 'gradients. No masses or vegetations are seen on the aortic valve, but', 'cannot be fully excluded due to suboptimal image quality. No aortic', 'regurgitation is seen. The mitral valve leaflets are mildly thickened.', 'No mass or vegetation is seen on the mitral valve. Mild (1+) mitral', 'regurgitation is seen. The tricuspid valve leaflets are mildly', 'thickened. There is moderate pulmonary artery systolic hypertension.', 'There is no pericardial effusion.', '-levophed added, unable to wean off neo as pt with increased', 'tachy-brady and dropped pressures.', '-awaiting stability for CT torso. added CT head given ?asym pupils.', '-awaiting [**Last Name (un) **] stim', '-IVF', '-guaiac +stools, brown noted', '-given 2 amps of bicarb', '-oliguric', '-abx renally dosed, allopurinol dcd', '.', 'Coded around 930pm, dropped pressure, became bradycardic. PEA', 'given 1mg epi x2, 1mg atropine, bicarb, calcium. ABG pH 7.34/46/380.']",,46057,188769.0
0,2129-10-21 07:48:26,,"['Patient received 3 units PRBCs during ICU stay', 'Hemodynamically stable', 'Intermittent rectal pain spasms', 'History obtained from Patient']",,52107,136570.0
1,2129-10-21 07:49:27,,"['Patient received 3 units PRBCs during ICU stay', 'Hemodynamically stable', 'Intermittent rectal pain spasms', 'History obtained from Patient']",,52107,136570.0
2,2129-10-21 10:34:39,,"['Patient received 3 units PRBCs during ICU stay', 'Hemodynamically stable', 'Intermittent rectal pain spasms', 'History obtained from Patient']",,52107,136570.0
0,2191-04-19 06:34:58,,"['INVASIVE VENTILATION - START [**2191-4-19**] 01:30 AM', ' BLOOD CULTURED - At [**2191-4-19**] 03:25 AM', ' EKG - At [**2191-4-19**] 03:25 AM', 'Per nursing, when sedation reduced patient is arousable and follows', 'commands.', 'RSBI of 60 this AM']",,45598,109727.0
1,2191-04-19 07:25:45,,"['INVASIVE VENTILATION - START [**2191-4-19**] 01:30 AM', ' BLOOD CULTURED - At [**2191-4-19**] 03:25 AM', ' EKG - At [**2191-4-19**] 03:25 AM', 'Per nursing, when sedation reduced patient is arousable and follows', 'commands.', 'RSBI of 60 this AM']",,45598,109727.0
2,2191-04-19 10:39:39,,"['INVASIVE VENTILATION - START [**2191-4-19**] 01:30 AM', ' BLOOD CULTURED - At [**2191-4-19**] 03:25 AM', ' EKG - At [**2191-4-19**] 03:25 AM', 'Per nursing, when sedation reduced patient is arousable and follows', 'commands.', 'RSBI of 60 this AM']",,45598,109727.0
3,2191-04-20 07:40:40,"['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']","['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']","['INVASIVE VENTILATION - START [**2191-4-19**] 01:30 AM', ' BLOOD CULTURED - At [**2191-4-19**] 03:25 AM', ' EKG - At [**2191-4-19**] 03:25 AM', 'Per nursing, when sedation reduced patient is arousable and follows', 'commands.', 'RSBI of 60 this AM']",45598,109727.0
4,2191-04-20 07:41:31,,"['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']",,45598,109727.0
5,2191-04-20 07:59:15,,"['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']",,45598,109727.0
6,2191-04-20 15:00:24,,"['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']",,45598,109727.0
7,2191-04-20 15:36:24,,"['INVASIVE VENTILATION - STOP [**2191-4-19**] 01:16 PM', ' EKG - At [**2191-4-19**] 08:19 PM', '- Extubated', '- Toxicology saw, pt. does not fit profile of any known toxin', '- Psychiatry saw, recommended pt. should adhere to current medications', 'without starting and stopping', '- Given 2 tabs percocet for back pain']",,45598,109727.0
0,2169-11-08 12:42:33,,"['No event since admission earlier this morning. Patient slept well. Seen', 'by Surgery.']",,42013,131114.0
0,2143-04-06 07:29:26,,"['remained hypertensive, restarted home meds (toprol xl 200, amlodipine', '10) and prn hydralazine', 'fever 100.6-> cultured', 'reglan + simethicone for gastroparesis', ""UA w/ blood, consistent w/ ua's from past""]",,23657,164590.0
1,2143-04-06 11:40:06,,"['remained hypertensive, restarted home meds (toprol xl 200, amlodipine', '10) and prn hydralazine', 'fever 100.6-> cultured', 'reglan + simethicone for gastroparesis', ""UA w/ blood, consistent w/ ua's from past""]",,23657,164590.0
0,2145-02-20 07:02:10,,"['NASAL SWAB - At [**2145-2-19**] 04:56 PM', ' PICC LINE - START [**2145-2-19**] 05:02 PM', '- Got 2L D51/2NS, then D5W w/ 3 amps bicarb X1L, finally D5NS with K', '- Insulin gtt', '- AG 21 by 11pm (has uremia, CKD at baseline)', '- pRBC X1 given Hct 20', '- Metoprolol 10mg q6 IV started given unable to take PO antihtn meds', '- HD tomorrow', '.', 'Feeling much better this morning - would like to try PO and lantus.', 'Then consider discontinuing insulin gtt']",,23657,125544.0
1,2145-02-20 07:05:40,,"['NASAL SWAB - At [**2145-2-19**] 04:56 PM', ' PICC LINE - START [**2145-2-19**] 05:02 PM', '- Got 2L D51/2NS, then D5W w/ 3 amps bicarb X1L, finally D5NS with K', '- Insulin gtt', '- AG 21 by 11pm (has uremia, CKD at baseline)', '- pRBC X1 given Hct 20', '- Metoprolol 10mg q6 IV started given unable to take PO antihtn meds', '- HD tomorrow', '.', 'Feeling much better this morning - would like to try PO and lantus.', 'Then consider discontinuing insulin gtt']",,23657,125544.0
2,2145-02-20 12:10:31,"['Had episode of hypertensive urgency to SBP230s. Responded to home PO', 'medications + 20mg IV Hydralazine and 10mg IV Lopressor']","['NASAL SWAB - At [**2145-2-19**] 04:56 PM', ' PICC LINE - START [**2145-2-19**] 05:02 PM', '- Got 2L D51/2NS, then D5W w/ 3 amps bicarb X1L, finally D5NS with K', '- Insulin gtt', '- AG 21 by 11pm (has uremia, CKD at baseline)', '- pRBC X1 given Hct 20', '- Metoprolol 10mg q6 IV started given unable to take PO antihtn meds', '- HD tomorrow', '.', 'Feeling much better this morning - would like to try PO and lantus.', 'Then consider discontinuing insulin gtt', '.', 'Had episode of hypertensive urgency to SBP230s. Responded to home PO', 'medications + 20mg IV Hydralazine and 10mg IV Lopressor']",,23657,125544.0
3,2145-02-20 12:35:18,,"['NASAL SWAB - At [**2145-2-19**] 04:56 PM', ' PICC LINE - START [**2145-2-19**] 05:02 PM', '- Got 2L D51/2NS, then D5W w/ 3 amps bicarb X1L, finally D5NS with K', '- Insulin gtt', '- AG 21 by 11pm (has uremia, CKD at baseline)', '- pRBC X1 given Hct 20', '- Metoprolol 10mg q6 IV started given unable to take PO antihtn meds', '- HD tomorrow', '.', 'Feeling much better this morning - would like to try PO and lantus.', 'Then consider discontinuing insulin gtt', '.', 'Had episode of hypertensive urgency to SBP230s. Responded to home PO', 'medications + 20mg IV Hydralazine and 10mg IV Lopressor']",,23657,125544.0
4,2145-02-21 07:34:04,"['EKG - At [**2145-2-20**] 09:45 AM', ' EKG - At [**2145-2-21**] 06:05 AM', '[**2-21**]:', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big']","['EKG - At [**2145-2-20**] 09:45 AM', ' EKG - At [**2145-2-21**] 06:05 AM', '[**2-21**]:', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big']","['NASAL SWAB - At [**2145-2-19**] 04:56 PM', ' PICC LINE - START [**2145-2-19**] 05:02 PM', '- Got 2L D51/2NS, then D5W w/ 3 amps bicarb X1L, finally D5NS with K', '- Insulin gtt', '- AG 21 by 11pm (has uremia, CKD at baseline)', '- pRBC X1 given Hct 20', '- Metoprolol 10mg q6 IV started given unable to take PO antihtn meds', '- HD tomorrow', '.', 'Feeling much better this morning - would like to try PO and lantus.', 'Then consider discontinuing insulin gtt', '.', 'Had episode of hypertensive urgency to SBP230s. Responded to home PO', 'medications + 20mg IV Hydralazine and 10mg IV Lopressor']",23657,125544.0
5,2145-02-21 11:15:29,"['- For BS 436 at 0600 had insulin 14 units plus his lantus 14 units', '- FS 492 at 07:30, received repeat insulin 14 units, then put on 2', 'unit/hr Insulin gtt']","['[**2-21**]:', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 at 0600 had insulin 14 units plus his lantus 14 units', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- FS 492 at 07:30, received repeat insulin 14 units, then put on 2', 'unit/hr Insulin gtt']","['EKG - At [**2145-2-20**] 09:45 AM', ' EKG - At [**2145-2-21**] 06:05 AM', '- For BS 436 had insulin 14 units plus his lantus 14 units']",23657,125544.0
6,2145-02-22 07:24:13,"['- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him pizza at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']","['- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him pizza at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']","['[**2-21**]:', '- For BS 436 at 0600 had insulin 14 units plus his lantus 14 units', '- FS 492 at 07:30, received repeat insulin 14 units, then put on 2', 'unit/hr Insulin gtt']",23657,125544.0
7,2145-02-22 07:28:37,,"['- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him pizza at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']",,23657,125544.0
8,2145-02-22 15:14:16,['- Upset this morning regarding starting dialysis without breakfast'],"['- Upset this morning regarding starting dialysis without breakfast', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him pizza at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']",,23657,125544.0
9,2145-02-22 15:27:19,"['- Did not want dinner, then girlfriend requesting to get him [**Hospital1 11622**] at']","['- Upset this morning regarding starting dialysis without breakfast', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him [**Hospital1 11622**] at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']","['- Did not want dinner, then girlfriend requesting to get him pizza at']",23657,125544.0
10,2145-02-25 06:27:05,"['PICC LINE - START [**2145-2-24**] 01:38 PM', ' NASAL SWAB - At [**2145-2-24**] 04:31 PM', '- trazodone x 1', '- Fingersticks trended down to < 100. Given food with glucose,', 'transitioned from insulin gtt to boluses', '- Nausea/vomiting o/n -> low fingersticks -> given [**1-9**] amp D50', '- insulin gtt turned down to 0.5 units/hr']","['PICC LINE - START [**2145-2-24**] 01:38 PM', ' NASAL SWAB - At [**2145-2-24**] 04:31 PM', '- trazodone x 1', '- Fingersticks trended down to < 100. Given food with glucose,', 'transitioned from insulin gtt to boluses', '- Nausea/vomiting o/n -> low fingersticks -> given [**1-9**] amp D50', '- insulin gtt turned down to 0.5 units/hr']","['- Upset this morning regarding starting dialysis without breakfast', '- Had anti-HTNives pushed up at 0200, 0300 for SBPs > 190', '- For abdominal pain: Had EKG (no ischemia), morphine', '- For BS 436 had insulin 14 units plus his lantus 14 units, placed on', 'insulin gtt, then BS to 130s so [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] the drip was stopped', '- [**Last Name (un) 276**] recs- stop gtt, increase SSI by 2 units (except bedtime', 'scale), use dinner scale if pt eats at bedtime', '- SBP again above 200 at 0730', '- Refusing Calcium capsules b/c too big', '- renal recs- Metoprolol 100mg [**Hospital1 **], no extra IVF, HD tomorrow, check', 'cxr, given lasix 80mg IV x 1', '- Did not want dinner, then girlfriend requesting to get him [**Hospital1 11622**] at', '2100. Suggested she give him more bland food such as apple sauce or', '[**Location (un) **] crackers instead. Evening fingersticks between 66-219', '- C. Diff sent']",23657,125544.0
11,2145-02-25 10:50:39,,"['PICC LINE - START [**2145-2-24**] 01:38 PM', ' NASAL SWAB - At [**2145-2-24**] 04:31 PM', '- trazodone x 1', '- Fingersticks trended down to < 100. Given food with glucose,', 'transitioned from insulin gtt to boluses', '- Nausea/vomiting o/n -> low fingersticks -> given [**1-9**] amp D50', '- insulin gtt turned down to 0.5 units/hr']",,23657,125544.0
12,2145-02-26 07:12:51,"['EKG - At [**2145-2-25**] 09:53 AM', '- Required Dextrose gtt in the morning for low BS', ""- D/c'd Insulin gtt, started Glargine 15 and ISS [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] Recs"", '- Renal recs: Got 4th session today, d/c calcitriol, starting EPO', '- BPs responded well to HD and labetalol', '- Blood/urine/stool cx NGTD', '- Wanted to leave AMA this PM (loss of freedom, wants to get life', 'together); convinced him to stay but does NOT want call out to floor']","['EKG - At [**2145-2-25**] 09:53 AM', '- Required Dextrose gtt in the morning for low BS', ""- D/c'd Insulin gtt, started Glargine 15 and ISS [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] Recs"", '- Renal recs: Got 4th session today, d/c calcitriol, starting EPO', '- BPs responded well to HD and labetalol', '- Blood/urine/stool cx NGTD', '- Wanted to leave AMA this PM (loss of freedom, wants to get life', 'together); convinced him to stay but does NOT want call out to floor']","['PICC LINE - START [**2145-2-24**] 01:38 PM', ' NASAL SWAB - At [**2145-2-24**] 04:31 PM', '- trazodone x 1', '- Fingersticks trended down to < 100. Given food with glucose,', 'transitioned from insulin gtt to boluses', '- Nausea/vomiting o/n -> low fingersticks -> given [**1-9**] amp D50', '- insulin gtt turned down to 0.5 units/hr']",23657,125544.0
13,2145-02-26 10:58:13,,"['EKG - At [**2145-2-25**] 09:53 AM', '- Required Dextrose gtt in the morning for low BS', ""- D/c'd Insulin gtt, started Glargine 15 and ISS [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] Recs"", '- Renal recs: Got 4th session today, d/c calcitriol, starting EPO', '- BPs responded well to HD and labetalol', '- Blood/urine/stool cx NGTD', '- Wanted to leave AMA this PM (loss of freedom, wants to get life', 'together); convinced him to stay but does NOT want call out to floor']",,23657,125544.0
0,2145-04-17 07:10:10,,"['[**2145-4-16**]:', '- Episode of CP in the early PM, pleuritic in nature. This occurred', 'within a few hours of chest CTA, so was not possible to repeat study.', 'CE flat (troponin elevated, but pt in ESRD).', '- Underwent HD today', '- Initially on NRB but weaned to 5L -> down', '- BPs trended down to SBPs 120s-140s overnight, but high read again', 'this AM']",,23657,176997.0
1,2145-04-17 15:44:47,,"['[**2145-4-16**]:', '- Episode of CP in the early PM, pleuritic in nature. This occurred', 'within a few hours of chest CTA, so was not possible to repeat study.', 'CE flat (troponin elevated, but pt in ESRD).', '- Underwent HD today', '- Initially on NRB but weaned to 5L -> down', '- BPs trended down to SBPs 120s-140s overnight, but high read again', 'this AM']",,23657,176997.0
0,2144-01-13 06:30:59,,['- Failed Femoral Line Placement secondary to positioning'],,47726,137085.0
1,2144-01-13 10:32:02,,['- Failed Femoral Line Placement secondary to positioning'],,47726,137085.0
0,2161-06-08 07:09:13,,['Diarrhea has resolved'],,7187,175644.0
1,2161-06-08 13:19:32,"['Received 2 units pRBC in ED yesterday ([**2161-6-7**])', 'Diarrhea has resolved.  No bleeding this am.']","['Received 2 units pRBC in ED yesterday ([**2161-6-7**])', 'Diarrhea has resolved.  No bleeding this am.']",['Diarrhea has resolved'],7187,175644.0
0,2114-04-17 07:51:15,,[],,98309,168521.0
1,2114-04-17 10:16:42,,[],,98309,168521.0
2,2114-04-17 10:41:28,,[],,98309,168521.0
3,2114-04-17 10:54:28,"['Pt admitted overnight, remained afebrile and hemodynamically stable', 'with a benign belly exam.', 'CXR demonstrated marked cardiomegaly w/o evidence of edema.', 'Pt has been tolerating IVF w/o signs of volume overload.']","['Pt admitted overnight, remained afebrile and hemodynamically stable', 'with a benign belly exam.', 'CXR demonstrated marked cardiomegaly w/o evidence of edema.', 'Pt has been tolerating IVF w/o signs of volume overload.']",,98309,168521.0
4,2114-04-17 11:17:08,,"['Pt admitted overnight, remained afebrile and hemodynamically stable', 'with a benign belly exam.', 'CXR demonstrated marked cardiomegaly w/o evidence of edema.', 'Pt has been tolerating IVF w/o signs of volume overload.']",,98309,168521.0
5,2114-04-18 06:59:50,"['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']","['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']","['Pt admitted overnight, remained afebrile and hemodynamically stable', 'with a benign belly exam.', 'CXR demonstrated marked cardiomegaly w/o evidence of edema.', 'Pt has been tolerating IVF w/o signs of volume overload.']",98309,168521.0
6,2114-04-18 07:14:11,,"['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']",,98309,168521.0
7,2114-04-18 07:37:09,"['ERCP -->', 'TTE -->', 'A-Fib with RVR this morning']","['ERCP -->', 'TTE -->', 'A-Fib with RVR this morning']","['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']",98309,168521.0
8,2114-04-18 07:49:29,,['ERCP -->'],"['TTE -->', 'A-Fib with RVR this morning']",98309,168521.0
9,2114-04-18 08:06:48,"['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']","['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation.']",['ERCP -->'],98309,168521.0
10,2114-04-18 12:33:36,"['- ERCP performed - patient noted to have a dilated CBD, sphincterotomy', 'performed with stone removal. Pancreatic duct also cannulated with', 'sphincterotomy and stent placement.', 'suggests impaired relaxation. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7027**] dilated. AV leaflets mildly', 'thickened w/o AS.', '-Pt flipped back into A-Fib with RVR at 3am.  Max HR 130. Pt asx, BP', 'stable. Back into SR at 8am.']","['- ERCP performed - patient noted to have a dilated CBD, sphincterotomy', 'performed with stone removal. Pancreatic duct also cannulated with', 'sphincterotomy and stent placement.', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7027**] dilated. AV leaflets mildly', 'thickened w/o AS.', '-Pt flipped back into A-Fib with RVR at 3am.  Max HR 130. Pt asx, BP', 'stable. Back into SR at 8am.']","['- ERCP performed - patient noted to have a dilated duct, sphincterotomy', 'performed with stone removal.', '- Continue Unasyn and Cipro', 'suggests impaired relaxation.']",98309,168521.0
11,2114-04-18 15:30:07,,"['- ERCP performed - patient noted to have a dilated CBD, sphincterotomy', 'performed with stone removal. Pancreatic duct also cannulated with', 'sphincterotomy and stent placement.', '- ECHO performed: Mild LVH, EF 70-80%, increased left ventricular', 'filling pressure (PCWP>18mmHg). The left ventricular inflow pattern', 'suggests impaired relaxation. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7027**] dilated. AV leaflets mildly', 'thickened w/o AS.', '-Pt flipped back into A-Fib with RVR at 3am.  Max HR 130. Pt asx, BP', 'stable. Back into SR at 8am.']",,98309,168521.0
0,2112-09-16 07:48:54,,"['ERCP - At [**2112-9-15**] 08:14 PM', 'returned to room at [**2102**]', 'S/P stent placement', 'Overnight no significant events. Did continue to have RUQ burning', 'discomfort.', 'No n/v/d.']",,46668,177510.0
1,2112-09-16 11:28:00,,"['ERCP - At [**2112-9-15**] 08:14 PM', 'returned to room at [**2102**]', 'S/P stent placement', 'Overnight no significant events. Did continue to have RUQ burning', 'discomfort.', 'No n/v/d.']",,46668,177510.0
2,2112-09-16 12:55:16,,"['ERCP - At [**2112-9-15**] 08:14 PM', 'returned to room at [**2102**]', 'S/P stent placement', 'Overnight no significant events. Did continue to have RUQ burning', 'discomfort.', 'No n/v/d.']",,46668,177510.0
0,2111-03-20 06:51:37,,"['ARTERIAL LINE - START [**2111-3-19**] 10:04 PM', ' ARTERIAL LINE - START [**2111-3-19**] 10:05 PM']",,66555,124440.0
1,2111-03-20 11:06:10,,"['ARTERIAL LINE - START [**2111-3-19**] 10:04 PM', ' ARTERIAL LINE - START [**2111-3-19**] 10:05 PM']",,66555,124440.0
2,2111-03-21 07:24:32,"['ARTERIAL LINE - STOP [**2111-3-20**] 04:30 PM', ""- Pt's Hct stable at 27.6"", '- IR removed femoral sheeth', '- Urology - rec Daily KUB, (and other things we are doing - cipro 500', 'q12, renacidin infusion, 2units PRBC given, CT abd/pelvis done)']","['ARTERIAL LINE - STOP [**2111-3-20**] 04:30 PM', ""- Pt's Hct stable at 27.6"", '- IR removed femoral sheeth', '- Urology - rec Daily KUB, (and other things we are doing - cipro 500', 'q12, renacidin infusion, 2units PRBC given, CT abd/pelvis done)']","['ARTERIAL LINE - START [**2111-3-19**] 10:04 PM', ' ARTERIAL LINE - START [**2111-3-19**] 10:05 PM']",66555,124440.0
3,2111-03-21 13:31:34,,"['ARTERIAL LINE - STOP [**2111-3-20**] 04:30 PM', ""- Pt's Hct stable at 27.6"", '- IR removed femoral sheeth', '- Urology - rec Daily KUB, (and other things we are doing - cipro 500', 'q12, renacidin infusion, 2units PRBC given, CT abd/pelvis done)']",,66555,124440.0
0,2149-03-18 06:20:03,,"['Had [**4-5**] left-sided chest pressure at 3 a.m. that responded to NTG SL x', '2. EKG showed new TWI in V2-V4. Trop 3.95 CK']",,87236,127056.0
1,2149-03-18 06:55:51,,"['Had [**4-5**] left-sided chest pressure at 3 a.m. that responded to NTG SL x', '2. EKG showed new TWI in V2-V4. Trop 3.95 CK']",,87236,127056.0
2,2149-03-18 11:37:53,['2. EKG showed new TWI in V2-V4. Trop 3.95.'],"['Had [**4-5**] left-sided chest pressure at 3 a.m. that responded to NTG SL x', '2. EKG showed new TWI in V2-V4. Trop 3.95.']",['2. EKG showed new TWI in V2-V4. Trop 3.95 CK'],87236,127056.0
3,2149-03-18 14:37:35,,"['Had [**4-5**] left-sided chest pressure at 3 a.m. that responded to NTG SL x', '2. EKG showed new TWI in V2-V4. Trop 3.95.']",,87236,127056.0
4,2149-03-19 07:44:42,"['Pre dinner GFS 188, nurse [**First Name (Titles) **] [**Last Name (Titles) **] 8U.', 'Started on sliding scale. Hemoglobin A1C 6.4.', 'CE trending down.', 'Echo showed Moderate regional left ventricular systolic dysfunction,', 'c/w CAD. Mild mitral regurgitation. There is moderate regional left', 'ventricular systolic dysfunction with edema and akinesis of the mid-', 'and distal anterior wall, anterior septum and apex (mid-LAD territory),', 'most c/w recent infarction.', 'd/c nitro drip, SLNTG prn, could consider long acting nitrate.', 'started on metoprolol 12.[**Hospital1 7**] (may need [**Last Name (LF) 14143**], [**First Name3 (LF) **] need ace in', 'future)', '-ordered for PT consult for tomorrow', '-Med rec with ENT RE keflex.', ""-PCP confirmed pt's dose of terazosin (hytrin): 2mg before bed."", '-call out to [**Hospital Ward Name 289**] 3.']","['Pre dinner GFS 188, nurse [**First Name (Titles) **] [**Last Name (Titles) **] 8U.', 'Started on sliding scale. Hemoglobin A1C 6.4.', 'CE trending down.', 'Echo showed Moderate regional left ventricular systolic dysfunction,', 'c/w CAD. Mild mitral regurgitation. There is moderate regional left', 'ventricular systolic dysfunction with edema and akinesis of the mid-', 'and distal anterior wall, anterior septum and apex (mid-LAD territory),', 'most c/w recent infarction.', 'd/c nitro drip, SLNTG prn, could consider long acting nitrate.', 'started on metoprolol 12.[**Hospital1 7**] (may need [**Last Name (LF) 14143**], [**First Name3 (LF) **] need ace in', 'future)', '-ordered for PT consult for tomorrow', '-Med rec with ENT RE keflex.', ""-PCP confirmed pt's dose of terazosin (hytrin): 2mg before bed."", '-call out to [**Hospital Ward Name 289**] 3.']","['Had [**4-5**] left-sided chest pressure at 3 a.m. that responded to NTG SL x', '2. EKG showed new TWI in V2-V4. Trop 3.95.']",87236,127056.0
5,2149-03-19 16:23:16,,"['Pre dinner GFS 188, nurse [**First Name (Titles) **] [**Last Name (Titles) **] 8U.', 'Started on sliding scale. Hemoglobin A1C 6.4.', 'CE trending down.', 'Echo showed Moderate regional left ventricular systolic dysfunction,', 'c/w CAD. Mild mitral regurgitation. There is moderate regional left', 'ventricular systolic dysfunction with edema and akinesis of the mid-', 'and distal anterior wall, anterior septum and apex (mid-LAD territory),', 'most c/w recent infarction.', 'd/c nitro drip, SLNTG prn, could consider long acting nitrate.', 'started on metoprolol 12.[**Hospital1 7**] (may need [**Last Name (LF) 14143**], [**First Name3 (LF) **] need ace in', 'future)', '-ordered for PT consult for tomorrow', '-Med rec with ENT RE keflex.', ""-PCP confirmed pt's dose of terazosin (hytrin): 2mg before bed."", '-call out to [**Hospital Ward Name 289**] 3.']",,87236,127056.0
0,2122-03-29 06:34:07,,"['MIDLINE - START [**2122-3-28**] 08:00 PM', ' MIDLINE - STOP [**2122-3-28**] 09:30 PM', '-started lasix gtt', '-weaned off nonrebreather']",,16975,100446.0
1,2122-03-29 10:08:20,,"['MIDLINE - START [**2122-3-28**] 08:00 PM', ' MIDLINE - STOP [**2122-3-28**] 09:30 PM', '-started lasix gtt', '-weaned off nonrebreather']",,16975,100446.0
2,2122-03-29 11:40:47,,"['MIDLINE - START [**2122-3-28**] 08:00 PM', ' MIDLINE - STOP [**2122-3-28**] 09:30 PM', '-started lasix gtt', '-weaned off nonrebreather']",,16975,100446.0
3,2122-03-30 05:50:32,['Had LENIS. No DVT. Discontinued heparin gtt'],['Had LENIS. No DVT. Discontinued heparin gtt'],"['MIDLINE - START [**2122-3-28**] 08:00 PM', ' MIDLINE - STOP [**2122-3-28**] 09:30 PM', '-started lasix gtt', '-weaned off nonrebreather']",16975,100446.0
4,2122-03-30 05:51:53,,['Had LENIS. No DVT. Discontinued heparin gtt'],,16975,100446.0
5,2122-03-30 10:12:38,,['Had LENIS. No DVT. Discontinued heparin gtt'],,16975,100446.0
6,2122-03-31 09:25:49,,['Had LENIS. No DVT. Discontinued heparin gtt'],,16975,100446.0
0,2141-09-22 04:45:20,,"['Temp 102.  Cultured and started Abx, Renal agreed with not starting IP', 'antibiotics given peritoneal fluid']",,109,172335.0
1,2141-09-22 14:57:09,"['antibiotics given peritoneal fluid clarity', 'Had PD (2 dwells) 200 +; tolerated well without abdominal pain']","['Temp 102.  Cultured and started Abx, Renal agreed with not starting IP', 'antibiotics given peritoneal fluid clarity', 'Had PD (2 dwells) 200 +; tolerated well without abdominal pain']",['antibiotics given peritoneal fluid'],109,172335.0
0,2141-10-15 05:36:06,,"['Pt started her PO BP meds, with good effect.', 'Her diet was advanced to regular, and her abdominal pain was stable', 'overnight.', 'She had a 3 point HCT drop from 24.5 to 21.4 overnight.']",,109,126055.0
1,2141-10-15 05:37:30,,"['Pt started her PO BP meds, with good effect.', 'Her diet was advanced to regular, and her abdominal pain was stable', 'overnight.', 'She had a 3 point HCT drop from 24.5 to 21.4 overnight.']",,109,126055.0
2,2141-10-15 07:11:56,,[],"['Pt started her PO BP meds, with good effect.', 'Her diet was advanced to regular, and her abdominal pain was stable', 'overnight.', 'She had a 3 point HCT drop from 24.5 to 21.4 overnight.']",109,126055.0
3,2141-10-15 07:51:28,,[],,109,126055.0
4,2141-10-15 08:18:51,,[],,109,126055.0
5,2141-10-15 11:51:22,,[],,109,126055.0
6,2141-10-15 12:25:47,,[],,109,126055.0
7,2141-10-15 12:32:56,,[],,109,126055.0
8,2141-10-15 14:22:53,,[],,109,126055.0
9,2141-10-16 05:00:00,,[],,109,126055.0
10,2141-10-16 05:01:59,,[],,109,126055.0
11,2141-10-16 07:21:51,,[],,109,126055.0
12,2141-10-16 08:03:46,,[],,109,126055.0
13,2141-10-16 13:09:38,,[],,109,126055.0
14,2141-10-16 13:18:31,,[],,109,126055.0
15,2141-10-16 13:19:20,,[],,109,126055.0
16,2141-10-17 05:51:27,['MIDLINE - START [**2141-10-16**] 08:36 AM'],['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
17,2141-10-17 07:07:47,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
18,2141-10-17 07:09:44,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
19,2141-10-17 07:24:39,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
20,2141-10-17 07:38:26,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
21,2141-10-17 15:26:22,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
22,2141-10-17 16:32:42,,[],['MIDLINE - START [**2141-10-16**] 08:36 AM'],109,126055.0
23,2141-10-17 16:45:38,['MIDLINE - START [**2141-10-16**] 08:36 AM'],['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
24,2141-10-17 16:48:36,,['MIDLINE - START [**2141-10-16**] 08:36 AM'],,109,126055.0
25,2141-10-18 05:50:31,"['Pt had HCT drop to 18.', 'Transfused 1unit PRBCs HCT bumped to 24', 'NPO at midnight and stop heparin at 5am.', 'GI will scope in am.', 'Pt to receive DDAVP before procedure.']","['Pt had HCT drop to 18.', 'Transfused 1unit PRBCs HCT bumped to 24', 'NPO at midnight and stop heparin at 5am.', 'GI will scope in am.', 'Pt to receive DDAVP before procedure.']",['MIDLINE - START [**2141-10-16**] 08:36 AM'],109,126055.0
26,2141-10-18 05:51:16,,"['Pt had HCT drop to 18.', 'Transfused 1unit PRBCs HCT bumped to 24', 'NPO at midnight and stop heparin at 5am.', 'GI will scope in am.', 'Pt to receive DDAVP before procedure.']",,109,126055.0
27,2141-10-18 06:37:23,"['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']","['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']","['Pt had HCT drop to 18.', 'Transfused 1unit PRBCs HCT bumped to 24', 'NPO at midnight and stop heparin at 5am.', 'GI will scope in am.', 'Pt to receive DDAVP before procedure.']",109,126055.0
28,2141-10-18 06:40:11,,"['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']",,109,126055.0
29,2141-10-18 08:10:20,['23.4'],"['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', '23.4', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']",,109,126055.0
30,2141-10-18 17:15:27,,"['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', '23.4', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']",,109,126055.0
31,2141-10-18 21:19:08,,"['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', '23.4', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']",,109,126055.0
32,2141-10-20 06:02:46,"['Peritoneal Dialysis and fluid sent for cell count', ' ULTRASOUND - At [**2141-10-19**] 08:47 AM', 'cardiac echo', ' CALLED OUT']","['Peritoneal Dialysis and fluid sent for cell count', ' ULTRASOUND - At [**2141-10-19**] 08:47 AM', 'cardiac echo', ' CALLED OUT']","['Pt had HCT drop to 18 yesterday', ' Transfused 1unit PRBCs HCT bumped to', '24', '23.4', 'GI will scope in am', ' NPO at midnight and heparin stopped at about 6am,', 'DDAVP 30min before procedure.']",109,126055.0
33,2141-10-20 16:04:09,,"['Peritoneal Dialysis and fluid sent for cell count', ' ULTRASOUND - At [**2141-10-19**] 08:47 AM', 'cardiac echo']",[' CALLED OUT'],109,126055.0
34,2141-10-22 05:32:04,"['EKG - At [**2141-10-21**] 09:00 AM', 'Changed HTN regimen so decreased pill burden.', 'Changed to Toprol XL 200, Amlodipine 120, Hydral q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain, needs better PO pain', 'regimen, reports MSIR not helping', 'Sarna lotion for pruritus.']","['EKG - At [**2141-10-21**] 09:00 AM', 'Changed HTN regimen so decreased pill burden.', 'Changed to Toprol XL 200, Amlodipine 120, Hydral q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain, needs better PO pain', 'regimen, reports MSIR not helping', 'Sarna lotion for pruritus.']","['Peritoneal Dialysis and fluid sent for cell count', ' ULTRASOUND - At [**2141-10-19**] 08:47 AM', 'cardiac echo']",109,126055.0
35,2141-10-22 05:33:42,,"['EKG - At [**2141-10-21**] 09:00 AM', 'Changed HTN regimen so decreased pill burden.', 'Changed to Toprol XL 200, Amlodipine 120, Hydral q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain, needs better PO pain', 'regimen, reports MSIR not helping', 'Sarna lotion for pruritus.']",,109,126055.0
36,2141-10-22 14:20:18,"['Changed HTN regimen to  decrease pill burden and keep increased basal', 'levels of anti-HTNs', 'Changed to Toprol XL 200, Amlodipine 120, Hydral 50mg q8', 'Given morphine IV x 2 for breakthrough pain,']","['Changed HTN regimen to  decrease pill burden and keep increased basal', 'levels of anti-HTNs', 'Changed to Toprol XL 200, Amlodipine 120, Hydral 50mg q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain,', 'Sarna lotion for pruritus.']","['EKG - At [**2141-10-21**] 09:00 AM', 'Changed HTN regimen so decreased pill burden.', 'Changed to Toprol XL 200, Amlodipine 120, Hydral q8', 'Given morphine IV x 2 for breakthrough pain, needs better PO pain', 'regimen, reports MSIR not helping']",109,126055.0
37,2141-10-22 14:34:57,,"['Changed HTN regimen to  decrease pill burden and keep increased basal', 'levels of anti-HTNs', 'Changed to Toprol XL 200, Amlodipine 120, Hydral 50mg q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain,', 'Sarna lotion for pruritus.']",,109,126055.0
38,2141-10-22 18:10:01,,"['Changed HTN regimen to  decrease pill burden and keep increased basal', 'levels of anti-HTNs', 'Changed to Toprol XL 200, Amlodipine 120, Hydral 50mg q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain,', 'Sarna lotion for pruritus.']",,109,126055.0
39,2141-10-23 07:43:12,"[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.']","[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.']","['Changed HTN regimen to  decrease pill burden and keep increased basal', 'levels of anti-HTNs', 'Changed to Toprol XL 200, Amlodipine 120, Hydral 50mg q8', 'SBP 130s-180s', 'Given morphine IV x 2 for breakthrough pain,', 'Sarna lotion for pruritus.']",109,126055.0
40,2141-10-23 07:45:46,"['In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']","[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",,109,126055.0
41,2141-10-23 07:56:57,,"[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",,109,126055.0
42,2141-10-23 15:15:28,"['Asymptomatic.', '1 BM over past 24hrs.']","[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Asymptomatic.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', '1 BM over past 24hrs.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",,109,126055.0
43,2141-10-23 15:50:11,,"[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Asymptomatic.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', '1 BM over past 24hrs.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",,109,126055.0
44,2141-10-23 16:48:15,,"[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Asymptomatic.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', '1 BM over past 24hrs.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",,109,126055.0
45,2141-10-24 05:45:17,"['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, in the setting of burping acidic', 'material.  EKG obtained and cardiac enzymes were cycled. GI cocktail', 'ordered.', '-Repleted calcium', '-Labile HTN to 200', 's at 1700, started on labetalol gtt.', '-Danzinger: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.']","['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, in the setting of burping acidic', 'material.  EKG obtained and cardiac enzymes were cycled. GI cocktail', 'ordered.', '-Repleted calcium', '-Labile HTN to 200', 's at 1700, started on labetalol gtt.', '-Danzinger: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.']","[""Hypertensive O/N with SBP into 250-260's. Given extra hydralazine 50mg"", 'PO, Labetalol IV 20mg x2, and started on labetalol gtt with some', 'improvement in SBP. Off labetalol gtt now. Nifedipime given early.', 'Asymptomatic.', 'Pt also had episodex1 N/V during PD, zofran given with relief.', 's/p PDx4 over last 24hrs; pt did not complete final PD cycle [**2-11**]', 'abdominal discomfort.', '1 BM over past 24hrs.', 'In follow up to Dr. [**Last Name (STitle) 5951**]', 's Sexual History from yest, the patient also', 'reports that she has a h/o', 'cysts', ' on her ovaries; seen on U/S two', 'years ago in ER after pt reports having abdominal pain.']",109,126055.0
46,2141-10-24 05:47:08,,"['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, in the setting of burping acidic', 'material.  EKG obtained and cardiac enzymes were cycled. GI cocktail', 'ordered.', '-Repleted calcium', '-Labile HTN to 200', 's at 1700, started on labetalol gtt.', '-Danzinger: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.']",,109,126055.0
47,2141-10-24 05:48:51,,"['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, in the setting of burping acidic', 'material.  EKG obtained and cardiac enzymes were cycled. GI cocktail', 'ordered.', '-Repleted calcium', '-Labile HTN to 200', 's at 1700, started on labetalol gtt.', '-Danzinger: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.']",,109,126055.0
48,2141-10-24 06:58:45,"['character in sternal/epigastric areas, non-radiating, in the setting of', 'burping acidic material.  Otherwise, asymptomatic. EKG obtained and', 'cardiac enzymes were cycled. GI cocktail ordered.', 's at 1700, started on labetalol gtt', ' stopped at', '12am; gave nifedipime early', '-[**Doctor Last Name 3006**]: Outpatient oral hydralazine sliding scale (', '-s/p PD x4 yesterday']","['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, non-radiating, in the setting of', 'burping acidic material.  Otherwise, asymptomatic. EKG obtained and', 'cardiac enzymes were cycled. GI cocktail ordered.', '-Repleted calcium', '-Labile HTN to 200', 's at 1700, started on labetalol gtt', ' stopped at', '12am; gave nifedipime early', '-[**Doctor Last Name 3006**]: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.', '-s/p PD x4 yesterday']","['character in sternal/epigastric areas, in the setting of burping acidic', 'material.  EKG obtained and cardiac enzymes were cycled. GI cocktail', 'ordered.', 's at 1700, started on labetalol gtt.', '-Danzinger: Outpatient oral hydralazine sliding scale (']",109,126055.0
49,2141-10-24 13:29:48,"['Held coumadin.', '- Reported a period of Chest Pain last night - constant and cramp like', 'in character in sternal/epigastric areas, non-radiating, in the setting', 'of burping acidic material.  Otherwise, asymptomatic. Serial EKG', 'obtained and cardiac enzymes negative. GI cocktail ordered with relief', 'of pain.', '-This am HCT 26', '20, relative decrease in BP, no more hematemesis,', 'guaiac stool negative, placed PIV-20gauge, started IV ppi [**Hospital1 **], NPO. D/w', 'GI, no scope as patient ate food before NPO order given.', '12am; gave nifedipime early. [**Doctor Last Name 3006**]: Rec start outpatient oral', 'hydralazine sliding']","['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin.', '- Reported a period of Chest Pain last night - constant and cramp like', 'in character in sternal/epigastric areas, non-radiating, in the setting', 'of burping acidic material.  Otherwise, asymptomatic. Serial EKG', 'obtained and cardiac enzymes negative. GI cocktail ordered with relief', 'of pain.', '-This am HCT 26', '20, relative decrease in BP, no more hematemesis,', 'guaiac stool negative, placed PIV-20gauge, started IV ppi [**Hospital1 **], NPO. D/w', 'GI, no scope as patient ate food before NPO order given.', '-Labile HTN to 200', 's at 1700, started on labetalol gtt', ' stopped at', '12am; gave nifedipime early. [**Doctor Last Name 3006**]: Rec start outpatient oral', 'hydralazine sliding', '-s/p PD x4 yesterday']","['Held coumadin, will f/u HCT and INR in am.', '- Reported a period of Chest Pain - constant and cramp like in', 'character in sternal/epigastric areas, non-radiating, in the setting of', 'burping acidic material.  Otherwise, asymptomatic. EKG obtained and', 'cardiac enzymes were cycled. GI cocktail ordered.', '-Repleted calcium', '12am; gave nifedipime early', '-[**Doctor Last Name 3006**]: Outpatient oral hydralazine sliding scale (', 'for sbp > 170,', 'take 25 mg po hydralazine as needed, every 20 minutes or so, until her', 'bps improve a bit', '). Will f/u on [**10-24**] with visit.']",109,126055.0
50,2141-10-24 16:13:45,,"['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin.', '- Reported a period of Chest Pain last night - constant and cramp like', 'in character in sternal/epigastric areas, non-radiating, in the setting', 'of burping acidic material.  Otherwise, asymptomatic. Serial EKG', 'obtained and cardiac enzymes negative. GI cocktail ordered with relief', 'of pain.', '-This am HCT 26', '20, relative decrease in BP, no more hematemesis,', 'guaiac stool negative, placed PIV-20gauge, started IV ppi [**Hospital1 **], NPO. D/w', 'GI, no scope as patient ate food before NPO order given.', '-Labile HTN to 200', 's at 1700, started on labetalol gtt', ' stopped at', '12am; gave nifedipime early. [**Doctor Last Name 3006**]: Rec start outpatient oral', 'hydralazine sliding', '-s/p PD x4 yesterday']",,109,126055.0
51,2141-10-25 05:22:05,"['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, no', 'need to change PD', 'BP better controlled overnight. HCT bumped appropriately 20->26 after 2', 'units.', 'NPO for planned EGD']","['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, no', 'need to change PD', 'BP better controlled overnight. HCT bumped appropriately 20->26 after 2', 'units.', 'NPO for planned EGD']","['-Emesisx4 at 1500; 500cc total, trace pos gastroccult; borderline', 'tachy; per renal, considering uremic bleeding/platelets? Started DDAVP.', 'Held coumadin.', '- Reported a period of Chest Pain last night - constant and cramp like', 'in character in sternal/epigastric areas, non-radiating, in the setting', 'of burping acidic material.  Otherwise, asymptomatic. Serial EKG', 'obtained and cardiac enzymes negative. GI cocktail ordered with relief', 'of pain.', '-This am HCT 26', '20, relative decrease in BP, no more hematemesis,', 'guaiac stool negative, placed PIV-20gauge, started IV ppi [**Hospital1 **], NPO. D/w', 'GI, no scope as patient ate food before NPO order given.', '-Labile HTN to 200', 's at 1700, started on labetalol gtt', ' stopped at', '12am; gave nifedipime early. [**Doctor Last Name 3006**]: Rec start outpatient oral', 'hydralazine sliding', '-s/p PD x4 yesterday']",109,126055.0
52,2141-10-25 05:23:30,,"['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, no', 'need to change PD', 'BP better controlled overnight. HCT bumped appropriately 20->26 after 2', 'units.', 'NPO for planned EGD']",,109,126055.0
53,2141-10-25 07:02:41,"['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, BP', 'better controlled overnight; also increased PD fluid from 1L to 1.2L', 'per exchange which will begin morning of [**10-25**].', 'HCT bumped appropriately 20->26 after 2 units. Some', 'epigastric/midsternal discomfort with reflux', 'given GI cocktail with', 'relief. NPO for planned EGD']","['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, BP', 'better controlled overnight; also increased PD fluid from 1L to 1.2L', 'per exchange which will begin morning of [**10-25**].', 'HCT bumped appropriately 20->26 after 2 units. Some', 'epigastric/midsternal discomfort with reflux', 'given GI cocktail with', 'relief. NPO for planned EGD']","['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, no', 'need to change PD', 'BP better controlled overnight. HCT bumped appropriately 20->26 after 2', 'units.', 'NPO for planned EGD']",109,126055.0
54,2141-10-25 16:22:13,"['relief. NPO for planned EGD.', 'Tmax at 102 this am (800); Blood, Urine, and PD cultures sent; end of', 'last transfusion was at 1840 yesterday evening.']","['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, BP', 'better controlled overnight; also increased PD fluid from 1L to 1.2L', 'per exchange which will begin morning of [**10-25**].', 'HCT bumped appropriately 20->26 after 2 units. Some', 'epigastric/midsternal discomfort with reflux', 'given GI cocktail with', 'relief. NPO for planned EGD.', 'Tmax at 102 this am (800); Blood, Urine, and PD cultures sent; end of', 'last transfusion was at 1840 yesterday evening.']",['relief. NPO for planned EGD'],109,126055.0
55,2141-10-25 16:29:28,,"['Per renal attg Dr. [**Last Name (STitle) 3006**], changed HTN regimen to home regimen, BP', 'better controlled overnight; also increased PD fluid from 1L to 1.2L', 'per exchange which will begin morning of [**10-25**].', 'HCT bumped appropriately 20->26 after 2 units. Some', 'epigastric/midsternal discomfort with reflux', 'given GI cocktail with', 'relief. NPO for planned EGD.', 'Tmax at 102 this am (800); Blood, Urine, and PD cultures sent; end of', 'last transfusion was at 1840 yesterday evening.']",,109,126055.0
0,2141-11-19 07:33:05,,"['DIALYSIS CATHETER - START [**2141-11-19**] 01:25 AM', 'IV labetalol pushes used overnight for SBPs>200, po labetalol 300mg x1', 'Peritoneal fluid sent for cell count and gram stain', 'Ascites', 'WBC 1265', 'RBC 1680', 'Poly 43', 'Lymph 1', 'Mono 2', 'EOs']",,109,125288.0
1,2141-11-19 07:34:13,,"['DIALYSIS CATHETER - START [**2141-11-19**] 01:25 AM', 'IV labetalol pushes used overnight for SBPs>200, po labetalol 300mg x1', 'Peritoneal fluid sent for cell count and gram stain', 'Ascites', 'WBC 1265', 'RBC 1680', 'Poly 43', 'Lymph 1', 'Mono 2', 'EOs']",,109,125288.0
2,2141-11-19 10:50:12,,"['DIALYSIS CATHETER - START [**2141-11-19**] 01:25 AM', 'IV labetalol pushes used overnight for SBPs>200, po labetalol 300mg x1', 'Peritoneal fluid sent for cell count and gram stain', 'Ascites', 'WBC 1265', 'RBC 1680', 'Poly 43', 'Lymph 1', 'Mono 2', 'EOs']",,109,125288.0
3,2141-11-19 12:37:50,,"['DIALYSIS CATHETER - START [**2141-11-19**] 01:25 AM', 'IV labetalol pushes used overnight for SBPs>200, po labetalol 300mg x1', 'Peritoneal fluid sent for cell count and gram stain', 'Ascites', 'WBC 1265', 'RBC 1680', 'Poly 43', 'Lymph 1', 'Mono 2', 'EOs']",,109,125288.0
0,2141-11-25 05:39:20,,"['DIALYSIS CATHETER - START [**2141-11-24**] 10:24 PM', 'on arrival', ' DIALYSIS CATHETER - START [**2141-11-24**] 10:26 PM', 'left abd peritoneal diaysis catheter', 'Received 10mg IV Hydralazine X 3 to keep BPs <200.']",,109,161950.0
1,2141-11-25 13:26:45,"['Had fleeting episode of chest pain last night, lasting <10 seconds.', 'ECG was obtained which showed no change.', 'Received 10mg IV Hydralazine X 3 to keep BPs <200.  Otherwise pt denies', 'abdominal pain this morning, continues to have headaches but these have', 'subsided. Denies fever/chills/night sweats.']","['DIALYSIS CATHETER - START [**2141-11-24**] 10:24 PM', 'on arrival', ' DIALYSIS CATHETER - START [**2141-11-24**] 10:26 PM', 'left abd peritoneal diaysis catheter', 'Had fleeting episode of chest pain last night, lasting <10 seconds.', 'ECG was obtained which showed no change.', 'Received 10mg IV Hydralazine X 3 to keep BPs <200.  Otherwise pt denies', 'abdominal pain this morning, continues to have headaches but these have', 'subsided. Denies fever/chills/night sweats.']",['Received 10mg IV Hydralazine X 3 to keep BPs <200.'],109,161950.0
2,2141-11-26 07:06:41,"['* no treatment for SBP at this time as per renal', '* patient given 1x IV dilaudid for HA, after that was given PO', 'dilaudid only.', ""* BP controlled: 150's - 160's/80's - 100's"", '* needs to be done: psych consult, pull PD cath, aliskerin, call-out']","['* no treatment for SBP at this time as per renal', '* patient given 1x IV dilaudid for HA, after that was given PO', 'dilaudid only.', ""* BP controlled: 150's - 160's/80's - 100's"", '* needs to be done: psych consult, pull PD cath, aliskerin, call-out']","['DIALYSIS CATHETER - START [**2141-11-24**] 10:24 PM', 'on arrival', ' DIALYSIS CATHETER - START [**2141-11-24**] 10:26 PM', 'left abd peritoneal diaysis catheter', 'Had fleeting episode of chest pain last night, lasting <10 seconds.', 'ECG was obtained which showed no change.', 'Received 10mg IV Hydralazine X 3 to keep BPs <200.  Otherwise pt denies', 'abdominal pain this morning, continues to have headaches but these have', 'subsided. Denies fever/chills/night sweats.']",109,161950.0
3,2141-11-26 07:08:22,,"['* no treatment for SBP at this time as per renal', '* patient given 1x IV dilaudid for HA, after that was given PO', 'dilaudid only.', ""* BP controlled: 150's - 160's/80's - 100's"", '* needs to be done: psych consult, pull PD cath, aliskerin, call-out']",,109,161950.0
4,2141-11-26 13:00:02,"['* HD yesterday', '* needs to be done: psych consult']","['* HD yesterday', '* no treatment for SBP at this time as per renal', '* patient given 1x IV dilaudid for HA, after that was given PO', 'dilaudid only.', ""* BP controlled: 150's - 160's/80's - 100's"", '* needs to be done: psych consult']","['* needs to be done: psych consult, pull PD cath, aliskerin, call-out']",109,161950.0
0,2141-12-08 10:42:31,,"['Since admission, weaned off labetalol drip and started home PO BP', 'meds.  Abdominal pain still present but no worse.  Patient otherwise', 'resting comfortably.  Still having loose stools.']",,109,173633.0
1,2141-12-08 10:46:00,,"['Since admission, weaned off labetalol drip and started home PO BP', 'meds.  Abdominal pain still present but no worse.  Patient otherwise', 'resting comfortably.  Still having loose stools.']",,109,173633.0
2,2141-12-08 10:47:21,,"['Since admission, weaned off labetalol drip and started home PO BP', 'meds.  Abdominal pain still present but no worse.  Patient otherwise', 'resting comfortably.  Still having loose stools.']",,109,173633.0
3,2141-12-09 08:13:19,"['EKG - At [**2141-12-8**] 08:22 AM', 'Hypertensive on modified medication regimen and kept for close', 'observation and blood pressure control']","['EKG - At [**2141-12-8**] 08:22 AM', 'Hypertensive on modified medication regimen and kept for close', 'observation and blood pressure control']","['Since admission, weaned off labetalol drip and started home PO BP', 'meds.  Abdominal pain still present but no worse.  Patient otherwise', 'resting comfortably.  Still having loose stools.']",109,173633.0
4,2141-12-09 13:04:27,,"['EKG - At [**2141-12-8**] 08:22 AM', 'Hypertensive on modified medication regimen and kept for close', 'observation and blood pressure control']",,109,173633.0
0,2141-12-19 06:07:21,,"['ULTRASOUND - At [**2141-12-18**] 11:08 AM', 'PD cath to come out Th per transplant', '-HD tomorrow', '-Echo:  ? ASD septum secundum']",,109,140167.0
1,2141-12-19 06:08:23,,"['ULTRASOUND - At [**2141-12-18**] 11:08 AM', 'PD cath to come out Th per transplant', '-HD tomorrow', '-Echo:  ? ASD septum secundum']",,109,140167.0
2,2141-12-19 15:12:36,"['-per transplant PD cath to come out Thurs', ' needs pre-op labs, stop', 'heparin on wed night, NPO after midnight', '-HD today', '-Echo:  ? ASD septum secundum, LVH - > nl function, mild aortic regurg,', 'small circumferential pericardial effusion, no tamponade, mild', 'pulmonary systolic hypertension']","['ULTRASOUND - At [**2141-12-18**] 11:08 AM', '-per transplant PD cath to come out Thurs', ' needs pre-op labs, stop', 'heparin on wed night, NPO after midnight', '-HD today', '-Echo:  ? ASD septum secundum, LVH - > nl function, mild aortic regurg,', 'small circumferential pericardial effusion, no tamponade, mild', 'pulmonary systolic hypertension']","['PD cath to come out Th per transplant', '-HD tomorrow', '-Echo:  ? ASD septum secundum']",109,140167.0
3,2141-12-19 15:19:51,,"['ULTRASOUND - At [**2141-12-18**] 11:08 AM', '-per transplant PD cath to come out Thurs', ' needs pre-op labs, stop', 'heparin on wed night, NPO after midnight', '-HD today', '-Echo:  ? ASD septum secundum, LVH - > nl function, mild aortic regurg,', 'small circumferential pericardial effusion, no tamponade, mild', 'pulmonary systolic hypertension']",,109,140167.0
4,2141-12-21 07:51:34,"['DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', ' DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', 'PD cath noted left abd.', ' MAGNETIC RESONANCE IMAGING - At [**2141-12-20**] 09:00 PM', 'MRI of head and neck', 'Very upset pre-MRV that was not getting fed, bargained PBJ [**Location (un) 316**] vs', 'leaving AMA', 'Required ativan for MRV x2 2mg doses, then was sleepy but breathing', 'comfortably thereafter']","['DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', ' DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', 'PD cath noted left abd.', ' MAGNETIC RESONANCE IMAGING - At [**2141-12-20**] 09:00 PM', 'MRI of head and neck', 'Very upset pre-MRV that was not getting fed, bargained PBJ [**Location (un) 316**] vs', 'leaving AMA', 'Required ativan for MRV x2 2mg doses, then was sleepy but breathing', 'comfortably thereafter']","['ULTRASOUND - At [**2141-12-18**] 11:08 AM', '-per transplant PD cath to come out Thurs', ' needs pre-op labs, stop', 'heparin on wed night, NPO after midnight', '-HD today', '-Echo:  ? ASD septum secundum, LVH - > nl function, mild aortic regurg,', 'small circumferential pericardial effusion, no tamponade, mild', 'pulmonary systolic hypertension']",109,140167.0
5,2141-12-21 07:58:17,,"['DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', ' DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', 'PD cath noted left abd.', ' MAGNETIC RESONANCE IMAGING - At [**2141-12-20**] 09:00 PM', 'MRI of head and neck', 'Very upset pre-MRV that was not getting fed, bargained PBJ [**Location (un) 316**] vs', 'leaving AMA', 'Required ativan for MRV x2 2mg doses, then was sleepy but breathing', 'comfortably thereafter']",,109,140167.0
6,2141-12-21 09:01:46,"['Temporary Femoral Dialysis Catheter inserted yesterday and Old', 'tunnelled line that had cuff out was removed']","['Temporary Femoral Dialysis Catheter inserted yesterday and Old', 'tunnelled line that had cuff out was removed']","['DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', ' DIALYSIS CATHETER - START [**2141-12-20**] 10:00 AM', 'PD cath noted left abd.', ' MAGNETIC RESONANCE IMAGING - At [**2141-12-20**] 09:00 PM', 'MRI of head and neck', 'Very upset pre-MRV that was not getting fed, bargained PBJ [**Location (un) 316**] vs', 'leaving AMA', 'Required ativan for MRV x2 2mg doses, then was sleepy but breathing', 'comfortably thereafter']",109,140167.0
0,2142-01-09 07:33:18,,"['DIALYSIS CATHETER - START [**2142-1-8**] 08:34 AM', '[**2142-1-9**] Events:', '- SBP up to 213, restarted nicardipine drip at 0.1mcg with initially', ""good response down to 130's.  Then back up to 215, increased drip to"", '0.5mcg']",,109,135923.0
1,2142-01-09 07:35:21,,"['DIALYSIS CATHETER - START [**2142-1-8**] 08:34 AM', '[**2142-1-9**] Events:', '- SBP up to 213, restarted nicardipine drip at 0.1mcg with initially', ""good response down to 130's.  Then back up to 215, increased drip to"", '0.5mcg']",,109,135923.0
2,2142-01-09 11:53:28,"[""good response down to 130's.  Then SBP back up to 215, increased drip"", 'to 0.5mcg. Off drip this am with SBP 130s-150s..', 'Did not have CPAP last night since machine not in room. Headache', 'resolved this am. Still c/o unchanged pain at  left anterior wall', 'abdominal wall hematoma.  Had HD yesterday.']","['DIALYSIS CATHETER - START [**2142-1-8**] 08:34 AM', '[**2142-1-9**] Events:', '- SBP up to 213, restarted nicardipine drip at 0.1mcg with initially', ""good response down to 130's.  Then SBP back up to 215, increased drip"", 'to 0.5mcg. Off drip this am with SBP 130s-150s..', 'Did not have CPAP last night since machine not in room. Headache', 'resolved this am. Still c/o unchanged pain at  left anterior wall', 'abdominal wall hematoma.  Had HD yesterday.']","[""good response down to 130's.  Then back up to 215, increased drip to"", '0.5mcg']",109,135923.0
0,2142-01-15 06:50:43,,"['TUNNELED (HICKMAN) LINE - START [**2142-1-14**] 07:31 PM', '[**2142-1-14**] Events:', '- Maintained on Nicardipine drip with improvement of blood pressures']",,109,124657.0
1,2142-01-15 06:51:24,,"['TUNNELED (HICKMAN) LINE - START [**2142-1-14**] 07:31 PM', '[**2142-1-14**] Events:', '- Maintained on Nicardipine drip with improvement of blood pressures']",,109,124657.0
2,2142-01-15 12:12:17,['Pt currently has no complaints.'],"['TUNNELED (HICKMAN) LINE - START [**2142-1-14**] 07:31 PM', '[**2142-1-14**] Events:', '- Maintained on Nicardipine drip with improvement of blood pressures', 'Pt currently has no complaints.']",,109,124657.0
3,2142-01-16 07:08:05,"['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']","['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']","['TUNNELED (HICKMAN) LINE - START [**2142-1-14**] 07:31 PM', '[**2142-1-14**] Events:', '- Maintained on Nicardipine drip with improvement of blood pressures', 'Pt currently has no complaints.']",109,124657.0
4,2142-01-16 07:09:06,,"['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']",,109,124657.0
5,2142-01-16 08:02:23,,"['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']",,109,124657.0
6,2142-01-16 12:53:53,,"['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']",,109,124657.0
7,2142-01-17 06:28:47,"['CALLED OUT', 'Called out but hypertensive to 180s, kept overnight.']","['CALLED OUT', 'Called out but hypertensive to 180s, kept overnight.']","['[**1-15**] Events:', '-Underwent dialysis early due to elevated K, EKG showed peaked T waves,', 'otherwise unremarkable.  Got 15 mg Kayexalate', '-PM HCT stable 24.8', '-Received extra 30 mg of Nicardipine at 2 AM for pressure of 230/129', 'while asleep', '-c/o abdominal pain overnight-states morphine not helpful, given 0.5 mg', 'dilaudid IV once']",109,124657.0
8,2142-01-17 06:31:04,,"['CALLED OUT', 'Called out but hypertensive to 180s, kept overnight.']",,109,124657.0
9,2142-01-17 13:58:42,,"['CALLED OUT', 'Called out but hypertensive to 180s, kept overnight.']",,109,124657.0
10,2142-01-18 07:00:24,"[""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight', '- Plan to call out to the floor in AM.']","['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight', '- Plan to call out to the floor in AM.']","['Called out but hypertensive to 180s, kept overnight.']",109,124657.0
11,2142-01-18 07:02:01,,"['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight', '- Plan to call out to the floor in AM.']",,109,124657.0
12,2142-01-18 07:04:11,,"['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight', '- Plan to call out to the floor in AM.']",,109,124657.0
13,2142-01-18 11:50:04,"[""pressure decreased to 100's-120's systolic.""]","['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's-120's systolic."", '- Plan to call out to the floor in AM.']","[""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight']",109,124657.0
14,2142-01-18 11:55:25,,"['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's-120's systolic."", '- Plan to call out to the floor in AM.']",,109,124657.0
15,2142-01-18 11:55:55,"[""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight']","['CALLED OUT', ""- Pt became very hypertensive during the day up to 230's systolic.  She"", 'was switched from nicardipine to nifedipine CR per renal.  She also', 'received an extra dose of hydralazine 100mg PO.  After which her blood', ""pressure decreased to 100's - 120's systolic, remained normotensive"", 'overnight', '- Plan to call out to the floor in AM.']","[""pressure decreased to 100's-120's systolic.""]",109,124657.0
0,2142-01-22 06:42:38,,"['DIALYSIS CATHETER - START [**2142-1-21**] 12:00 PM', '[**2142-1-21**] events', '-BP 101 systolic-possibly not taking BP meds at home, but got all meds', 'at once in ICU', '-SW consulted', '-CXR showed: no change from previous-continued vanc in setting of', 'HD(line inf vs. thrombophlebitis)', '-L wrist I and D-gram stain with GPC in pairs and clusters, covered', 'with vanc.']",,109,176760.0
1,2142-01-22 06:44:15,,"['DIALYSIS CATHETER - START [**2142-1-21**] 12:00 PM', '[**2142-1-21**] events', '-BP 101 systolic-possibly not taking BP meds at home, but got all meds', 'at once in ICU', '-SW consulted', '-CXR showed: no change from previous-continued vanc in setting of', 'HD(line inf vs. thrombophlebitis)', '-L wrist I and D-gram stain with GPC in pairs and clusters, covered', 'with vanc.']",,109,176760.0
2,2142-01-22 11:47:10,,"['DIALYSIS CATHETER - START [**2142-1-21**] 12:00 PM', '[**2142-1-21**] events', '-BP 101 systolic-possibly not taking BP meds at home, but got all meds', 'at once in ICU', '-SW consulted', '-CXR showed: no change from previous-continued vanc in setting of', 'HD(line inf vs. thrombophlebitis)', '-L wrist I and D-gram stain with GPC in pairs and clusters, covered', 'with vanc.']",,109,176760.0
0,2142-02-15 06:54:46,,"['Pt received hydral IV X4 followed by restarting home BP meds.', 'BP 100s-110s systolic over the evening, pt asymptomatic', 'History obtained from [**Hospital 85**] Medical records']",,109,113189.0
0,2142-02-26 06:43:26,,"['did not give narcotics, hypotension resolved', 'resumed anti-htn meds', 'pressors 140/85', 'used CPAP overnight']",,109,158995.0
1,2142-02-26 06:44:43,,"['did not give narcotics, hypotension resolved', 'resumed anti-htn meds', 'pressors 140/85', 'used CPAP overnight']",,109,158995.0
2,2142-02-26 06:48:32,,"['did not give narcotics, hypotension resolved', 'resumed anti-htn meds', 'pressors 140/85', 'used CPAP overnight']",,109,158995.0
3,2142-02-26 09:29:48,,"['did not give narcotics, hypotension resolved', 'resumed anti-htn meds', 'pressors 140/85', 'used CPAP overnight']",,109,158995.0
0,2142-03-22 07:54:50,,"['DIALYSIS CATHETER - START [**2142-3-21**] 11:08 AM', '- Nicardipine gtt, weaned off but back on for SBP>180, DBP>100', '- Ruled out with enzymes', '- Tolerated food', '- Dialyzed 1 L off', '- Transfused 1 unit pRBCs per Renal', '- Low grade temp <100.5', '- RUQ us: No evidence of cholecystitis. No biliary dilatation', '- Increased Labetaolol from 900 to 1000 TID']",,109,158943.0
1,2142-03-22 12:49:06,,"['DIALYSIS CATHETER - START [**2142-3-21**] 11:08 AM', '- Nicardipine gtt, weaned off but back on for SBP>180, DBP>100', '- Ruled out with enzymes', '- Tolerated food', '- Dialyzed 1 L off', '- Transfused 1 unit pRBCs per Renal', '- Low grade temp <100.5', '- RUQ us: No evidence of cholecystitis. No biliary dilatation', '- Increased Labetaolol from 900 to 1000 TID']",,109,158943.0
2,2142-03-22 12:53:38,,"['DIALYSIS CATHETER - START [**2142-3-21**] 11:08 AM', '- Nicardipine gtt, weaned off but back on for SBP>180, DBP>100', '- Ruled out with enzymes', '- Tolerated food', '- Dialyzed 1 L off', '- Transfused 1 unit pRBCs per Renal', '- Low grade temp <100.5', '- RUQ us: No evidence of cholecystitis. No biliary dilatation', '- Increased Labetaolol from 900 to 1000 TID']",,109,158943.0
0,2142-04-21 07:05:56,,"['- transitioned to PO home regimen', '- called out to floor', ' DIALYSIS CATHETER - START [**2142-4-20**] 03:00 PM']",,109,137510.0
1,2142-04-21 07:08:07,,"['- transitioned to PO home regimen', '- called out to floor', ' DIALYSIS CATHETER - START [**2142-4-20**] 03:00 PM']",,109,137510.0
2,2142-04-21 10:59:47,,"['- transitioned to PO home regimen', '- called out to floor', ' DIALYSIS CATHETER - START [**2142-4-20**] 03:00 PM']",,109,137510.0
0,2119-02-26 07:18:59,,['- One episode of emesis this morning'],,665,152089.0
1,2119-02-26 07:25:35,,['- One episode of emesis this morning'],,665,152089.0
2,2119-02-26 10:11:45,['No acute events except for 1 spell of minimal emesis in AM'],['No acute events except for 1 spell of minimal emesis in AM'],['- One episode of emesis this morning'],665,152089.0
0,2106-10-04 08:01:48,,['ARTERIAL LINE - START [**2106-10-3**] 09:47 PM'],,64911,103718.0
1,2106-10-04 13:17:44,"['- A-line placed', ""- BIPAP'ed overnight, AM ABG 7.35/35/168/20"", '- O/N continued to receive IVF at 250cc, switched to LR for', 'hyperchloremia', '- Score 3 on admission (ransons)', '- AG closed, Bicarb 20->17 with coincident hyperchloremia, pH 7.35', '- Cr trending down, 1.0, WBC trending down', '- LDH trending up 221 -> 349, AST/ALT trending down, bili stable', '- Labetolol weaned off then back on at low dose.']","['ARTERIAL LINE - START [**2106-10-3**] 09:47 PM', '- A-line placed', ""- BIPAP'ed overnight, AM ABG 7.35/35/168/20"", '- O/N continued to receive IVF at 250cc, switched to LR for', 'hyperchloremia', '- Score 3 on admission (ransons)', '- AG closed, Bicarb 20->17 with coincident hyperchloremia, pH 7.35', '- Cr trending down, 1.0, WBC trending down', '- LDH trending up 221 -> 349, AST/ALT trending down, bili stable', '- Labetolol weaned off then back on at low dose.']",,64911,103718.0
2,2106-10-05 08:11:49,['ULTRASOUND - At [**2106-10-4**] 12:08 PM'],['ULTRASOUND - At [**2106-10-4**] 12:08 PM'],"['ARTERIAL LINE - START [**2106-10-3**] 09:47 PM', '- A-line placed', ""- BIPAP'ed overnight, AM ABG 7.35/35/168/20"", '- O/N continued to receive IVF at 250cc, switched to LR for', 'hyperchloremia', '- Score 3 on admission (ransons)', '- AG closed, Bicarb 20->17 with coincident hyperchloremia, pH 7.35', '- Cr trending down, 1.0, WBC trending down', '- LDH trending up 221 -> 349, AST/ALT trending down, bili stable', '- Labetolol weaned off then back on at low dose.']",64911,103718.0
3,2106-10-05 08:12:53,,['ULTRASOUND - At [**2106-10-4**] 12:08 PM'],,64911,103718.0
4,2106-10-05 12:02:54,"['- RUQ U/S with cholelithiasis, bile ducts WNL.', '- Haldol added to regimen', '- Persistently hypertensive, metoprolol 5 mg x 1, labetalol gtt back', 'on.', '- Phos 1.2 on PM check, repleted.', '- Total Ativan: ?14 mg over last 24hrs, ?5 haldol.']","['- RUQ U/S with cholelithiasis, bile ducts WNL.', '- Haldol added to regimen', '- Persistently hypertensive, metoprolol 5 mg x 1, labetalol gtt back', 'on.', '- Phos 1.2 on PM check, repleted.', '- Total Ativan: ?14 mg over last 24hrs, ?5 haldol.']",['ULTRASOUND - At [**2106-10-4**] 12:08 PM'],64911,103718.0
5,2106-10-05 12:27:22,,"['- RUQ U/S with cholelithiasis, bile ducts WNL.', '- Haldol added to regimen', '- Persistently hypertensive, metoprolol 5 mg x 1, labetalol gtt back', 'on.', '- Phos 1.2 on PM check, repleted.', '- Total Ativan: ?14 mg over last 24hrs, ?5 haldol.']",,64911,103718.0
6,2106-10-06 07:37:02,"['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']","['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']","['- RUQ U/S with cholelithiasis, bile ducts WNL.', '- Haldol added to regimen', '- Persistently hypertensive, metoprolol 5 mg x 1, labetalol gtt back', 'on.', '- Phos 1.2 on PM check, repleted.', '- Total Ativan: ?14 mg over last 24hrs, ?5 haldol.']",64911,103718.0
7,2106-10-06 07:43:37,,"['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']",,64911,103718.0
8,2106-10-06 08:24:44,"['- continues to withdraw with high benzo and haldol requirements (total', '~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).']","['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements (total', '~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']",['- continues to withdraw with high benzo and haldol requirements'],64911,103718.0
9,2106-10-06 08:26:35,,"['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements (total', '~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']",,64911,103718.0
10,2106-10-06 11:19:38,"['~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).  Unable to get', 'ECG thus far.']","['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements (total', '~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).  Unable to get', 'ECG thus far.', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']","['~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).']",64911,103718.0
11,2106-10-07 08:01:08,"['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.']","['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.']","['PAN CULTURE - At [**2106-10-5**] 01:18 PM', '- continues to withdraw with high benzo and haldol requirements (total', '~28 mg IV Ativan, 5 mg IV haldol since 6 am yesterday).  Unable to get', 'ECG thus far.', '- febrile to 100.2 axillary  --> got cultured', '- got lasix 20 x 2 with good effect', '- intermittently on BIPAP, but satting well on nasal cannula']",64911,103718.0
12,2106-10-07 08:02:51,,"['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.']",,64911,103718.0
13,2106-10-07 08:30:45,"['- continues to withdraw with high benzo and haldol requirements: total', '6 mg IV haldol. 16 mg IV lorazepam, 10 mg IV diazepam.']","['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements: total', '6 mg IV haldol. 16 mg IV lorazepam, 10 mg IV diazepam.', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.']",['- continues to withdraw with high benzo and haldol requirements'],64911,103718.0
14,2106-10-07 11:35:02,['- 1mg MR1 IV morphine overnight'],"['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements: total', '6 mg IV haldol. 16 mg IV lorazepam, 10 mg IV diazepam.', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.', '- 1mg MR1 IV morphine overnight']",,64911,103718.0
15,2106-10-08 07:49:32,"['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']","['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']","['EKG - At [**2106-10-6**] 10:00 AM', 'QTC .447', ' NON-INVASIVE VENTILATION - START [**2106-10-6**] 11:35 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 01:00 AM', '- [**10-6**] switched to bipap for tachypnea, then to facemask overnight', '- continues to withdraw with high benzo and haldol requirements: total', '6 mg IV haldol. 16 mg IV lorazepam, 10 mg IV diazepam.', '- intermittent agitation in bed - attempted valium', '- re-sited A-line over wire', '- BPs controlled with labetalol bolus, not gtt, due to poor iv access.', '2nd pIV placed overnight.', '- 1mg MR1 IV morphine overnight']",64911,103718.0
16,2106-10-08 07:50:45,,"['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']",,64911,103718.0
17,2106-10-08 11:13:17,,"['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']",,64911,103718.0
18,2106-10-08 11:28:31,,"['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']",,64911,103718.0
19,2106-10-09 07:47:07,"['BLOOD CULTURED - At [**2106-10-8**] 12:19 PM', ' FEVER - 101.5', 'F - [**2106-10-8**] 11:00 PM', 'Surgery did recommend feeding with clears as soon as patient is able.', 'If unable to take POs for a few more days, then would recommend TPN.', 'They recommend  follow up MRCP in [**1-3**] weeks to evaluate pancreatic', 'duct.', 'More alert and complaining of pain --> morphine 2 mg x 2', 'Remained off bipap']","['BLOOD CULTURED - At [**2106-10-8**] 12:19 PM', ' FEVER - 101.5', 'F - [**2106-10-8**] 11:00 PM', 'Surgery did recommend feeding with clears as soon as patient is able.', 'If unable to take POs for a few more days, then would recommend TPN.', 'They recommend  follow up MRCP in [**1-3**] weeks to evaluate pancreatic', 'duct.', 'More alert and complaining of pain --> morphine 2 mg x 2', 'Remained off bipap']","['EKG - At [**2106-10-7**] 08:22 AM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:30 AM', ' NON-INVASIVE VENTILATION - STOP [**2106-10-7**] 08:05 PM', ' NON-INVASIVE VENTILATION - START [**2106-10-7**] 11:00 PM', ' ARTERIAL LINE - STOP [**2106-10-8**] 06:41 AM', ' FEVER - 101.4', 'F - [**2106-10-7**] 11:00 AM', '- On bipap during most of daytime/nighttime', '- Vanc/zosyn started; T 101.4 and cultured.', '- Haldol and diazepam requirements:', '- I/O: lasix 20 IV x2', '- More lethargy; no hypercarbia - head CT normal.  Improved and back to', 'more agitated.', ""- CT chest and abdomen while getting CT'ed to eval pancreas, source of"", 'fever.  Prelim: ?RUL infiltrate, pancreas with area of probable', 'necrosis ~3x3 cm.']",64911,103718.0
20,2106-10-09 07:48:06,,"['BLOOD CULTURED - At [**2106-10-8**] 12:19 PM', ' FEVER - 101.5', 'F - [**2106-10-8**] 11:00 PM', 'Surgery did recommend feeding with clears as soon as patient is able.', 'If unable to take POs for a few more days, then would recommend TPN.', 'They recommend  follow up MRCP in [**1-3**] weeks to evaluate pancreatic', 'duct.', 'More alert and complaining of pain --> morphine 2 mg x 2', 'Remained off bipap']",,64911,103718.0
21,2106-10-09 11:37:26,,"['BLOOD CULTURED - At [**2106-10-8**] 12:19 PM', ' FEVER - 101.5', 'F - [**2106-10-8**] 11:00 PM', 'Surgery did recommend feeding with clears as soon as patient is able.', 'If unable to take POs for a few more days, then would recommend TPN.', 'They recommend  follow up MRCP in [**1-3**] weeks to evaluate pancreatic', 'duct.', 'More alert and complaining of pain --> morphine 2 mg x 2', 'Remained off bipap']",,64911,103718.0
22,2106-10-10 07:40:20,['STOOL CULTURE - At [**2106-10-9**] 04:00 PM'],['STOOL CULTURE - At [**2106-10-9**] 04:00 PM'],"['BLOOD CULTURED - At [**2106-10-8**] 12:19 PM', ' FEVER - 101.5', 'F - [**2106-10-8**] 11:00 PM', 'Surgery did recommend feeding with clears as soon as patient is able.', 'If unable to take POs for a few more days, then would recommend TPN.', 'They recommend  follow up MRCP in [**1-3**] weeks to evaluate pancreatic', 'duct.', 'More alert and complaining of pain --> morphine 2 mg x 2', 'Remained off bipap']",64911,103718.0
23,2106-10-10 07:42:18,"['NGT placed, tube feeds started and lactulose started - pt pulled, tube', 'replaced, pt removed 2nd time', 'Now <60hrs without bipap', 'More alert throughout day and night, responsive to commands - one dose', 'of valium', 'Given 20mg iv lasix for goal net negative 4am']","['STOOL CULTURE - At [**2106-10-9**] 04:00 PM', 'NGT placed, tube feeds started and lactulose started - pt pulled, tube', 'replaced, pt removed 2nd time', 'Now <60hrs without bipap', 'More alert throughout day and night, responsive to commands - one dose', 'of valium', 'Given 20mg iv lasix for goal net negative 4am']",,64911,103718.0
24,2106-10-10 14:26:09,"['replaced, pt removed 2nd time.  No NGT currently.', 'Now ~60hrs without bipap', 'of valium overnight as became more confused/agitated.', 'Given 20mg iv lasix for goal net negative 4am.', 'Denies current abdominal pain.']","['STOOL CULTURE - At [**2106-10-9**] 04:00 PM', 'NGT placed, tube feeds started and lactulose started - pt pulled, tube', 'replaced, pt removed 2nd time.  No NGT currently.', 'Now ~60hrs without bipap', 'More alert throughout day and night, responsive to commands - one dose', 'of valium overnight as became more confused/agitated.', 'Given 20mg iv lasix for goal net negative 4am.', 'Denies current abdominal pain.']","['replaced, pt removed 2nd time', 'Now <60hrs without bipap', 'of valium', 'Given 20mg iv lasix for goal net negative 4am']",64911,103718.0
25,2106-10-11 07:50:23,"['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']","['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']","['STOOL CULTURE - At [**2106-10-9**] 04:00 PM', 'NGT placed, tube feeds started and lactulose started - pt pulled, tube', 'replaced, pt removed 2nd time.  No NGT currently.', 'Now ~60hrs without bipap', 'More alert throughout day and night, responsive to commands - one dose', 'of valium overnight as became more confused/agitated.', 'Given 20mg iv lasix for goal net negative 4am.', 'Denies current abdominal pain.']",64911,103718.0
26,2106-10-11 07:51:13,,"['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']",,64911,103718.0
27,2106-10-11 07:53:44,,"['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']",,64911,103718.0
28,2106-10-11 15:14:01,,"['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']",,64911,103718.0
29,2106-10-11 15:21:53,,"['- During day with significantly improved mental status,', 'conversant/appropriate.  Swallowing soft diet without issue.', 'Overnight more confused, trying to get out of bed and pull out lines.', '- T max:', '- LENIs negative for clot (fever workup)', '- R knee filmed given s/p fall and complained of pain.  No fracture.', 'Patient tender over patella and mildly warm focally - ?bursitis.  No', 'significant effusion.  Patient reports history of gout in past but knee', 'not erythematous and inflamed.']",,64911,103718.0
0,2207-03-01 07:02:18,,"['EKG - At [**2207-2-28**] 11:30 PM', 'admit @ [**2126**]', ' FEVER - 101.3', 'F - [**2207-3-1**] 12:00 AM', ' blood culture sent, urine', 'sent', 'Pt. received glucagon and calcium without much effect.  BP was stable', 'in low 100s, but d/t poor urine output she was started on dopamine to', 'see if this would increase.']",,4843,187638.0
1,2207-03-01 09:21:39,,"['EKG - At [**2207-2-28**] 11:30 PM', 'admit @ [**2126**]', ' FEVER - 101.3', 'F - [**2207-3-1**] 12:00 AM', ' blood culture sent, urine', 'sent', 'Pt. received glucagon and calcium without much effect.  BP was stable', 'in low 100s, but d/t poor urine output she was started on dopamine to', 'see if this would increase.']",,4843,187638.0
2,2207-03-01 12:33:29,,"['EKG - At [**2207-2-28**] 11:30 PM', 'admit @ [**2126**]', ' FEVER - 101.3', 'F - [**2207-3-1**] 12:00 AM', ' blood culture sent, urine', 'sent', 'Pt. received glucagon and calcium without much effect.  BP was stable', 'in low 100s, but d/t poor urine output she was started on dopamine to', 'see if this would increase.']",,4843,187638.0
3,2207-03-02 07:02:50,"['Dopamine turned off yesterday evening, maintained adequate MAPs.']","['Dopamine turned off yesterday evening, maintained adequate MAPs.']","['EKG - At [**2207-2-28**] 11:30 PM', 'admit @ [**2126**]', ' FEVER - 101.3', 'F - [**2207-3-1**] 12:00 AM', ' blood culture sent, urine', 'sent', 'Pt. received glucagon and calcium without much effect.  BP was stable', 'in low 100s, but d/t poor urine output she was started on dopamine to', 'see if this would increase.']",4843,187638.0
4,2207-03-02 10:11:58,,"['Dopamine turned off yesterday evening, maintained adequate MAPs.']",,4843,187638.0
5,2207-03-02 12:49:06,,"['Dopamine turned off yesterday evening, maintained adequate MAPs.']",,4843,187638.0
6,2207-03-09 07:27:23,"['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']","['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']","['Dopamine turned off yesterday evening, maintained adequate MAPs.']",4843,187638.0
7,2207-03-09 07:29:13,,"['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']",,4843,187638.0
8,2207-03-09 07:31:33,,"['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']",,4843,187638.0
9,2207-03-09 08:48:32,,"['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']",,4843,187638.0
10,2207-03-09 14:24:31,,"['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']",,4843,187638.0
11,2207-03-10 07:48:31,"['[**2207-3-9**]', 'Hct checked q4h', '22 --> 26.1 --> 24.7 at 1730, she was given 2 more units at this point', 'and her Hct was', 'GI wants to hold off to scope tomorrow and just wanted to transfuse to', 'keep Ht 25-30 or above.']","['[**2207-3-9**]', 'Hct checked q4h', '22 --> 26.1 --> 24.7 at 1730, she was given 2 more units at this point', 'and her Hct was', 'GI wants to hold off to scope tomorrow and just wanted to transfuse to', 'keep Ht 25-30 or above.']","['Hct 17 --> 21 after 4 units, scoped, then 3 more units, hct 25, scoped', 'again with intubation, intra-scope hct 25, receiving 2 more units', '--> 21, then scoped, scope showed large clot in stomach but unable to', ""intervene, planned for repeat scope tomorrow, f/u hct 21, rec'd another"", 'unit, became HTN to 190s around 7pm, hands puffy and SBP 190/100, gave', '20 IV lasix, receiving 2 more units', '-10pm, husband came in, agreed to intubate and scope', '-11pm, attempted intubation, desats to 50s, code blue', '-MN, to OR for fiber optic intubation followed by EGD, able to', 'cauterize lesion', '-250mg erythromycin', '-propafol gtt']",4843,187638.0
12,2207-03-10 07:51:25,,"['[**2207-3-9**]', 'Hct checked q4h', '22 --> 26.1 --> 24.7 at 1730, she was given 2 more units at this point', 'and her Hct was', 'GI wants to hold off to scope tomorrow and just wanted to transfuse to', 'keep Ht 25-30 or above.']",,4843,187638.0
13,2207-03-10 09:09:30,"['and her Hct  bumped', '28.6', ' 30.0', ' 27.8', ' 28.1']","['[**2207-3-9**]', 'Hct checked q4h', '22 --> 26.1 --> 24.7 at 1730, she was given 2 more units at this point', 'and her Hct  bumped', '28.6', ' 30.0', ' 27.8', ' 28.1', 'GI wants to hold off to scope tomorrow and just wanted to transfuse to', 'keep Ht 25-30 or above.']",['and her Hct was'],4843,187638.0
14,2207-03-11 07:46:47,"['Scoped by GI. Had stable clot, that they did not want to mess around', 'with. They discussed the case with surgery. Surgery is following along', 'but no immediate plans to take to OR while Hct, and hemodynamics are', 'stable given that Pt is not ideal surgical candidate. They will be', 'following and will continue to re-evaluate as things go on.', 'Spoke with Dr. [**Last Name (STitle) 11890**] from ID who mentioned that high dose', 'nafcillin can lead to platelet dysfunction. In this setting, nafcillin', 'was d/c and started vanco. CT scan of LE done, no final read back yet,', 'but per nursing, podiatry had come by and said the scan looked OK. PM', 'Hcts stable.']","['Scoped by GI. Had stable clot, that they did not want to mess around', 'with. They discussed the case with surgery. Surgery is following along', 'but no immediate plans to take to OR while Hct, and hemodynamics are', 'stable given that Pt is not ideal surgical candidate. They will be', 'following and will continue to re-evaluate as things go on.', 'Spoke with Dr. [**Last Name (STitle) 11890**] from ID who mentioned that high dose', 'nafcillin can lead to platelet dysfunction. In this setting, nafcillin', 'was d/c and started vanco. CT scan of LE done, no final read back yet,', 'but per nursing, podiatry had come by and said the scan looked OK. PM', 'Hcts stable.']","['[**2207-3-9**]', 'Hct checked q4h', '22 --> 26.1 --> 24.7 at 1730, she was given 2 more units at this point', 'and her Hct  bumped', '28.6', ' 30.0', ' 27.8', ' 28.1', 'GI wants to hold off to scope tomorrow and just wanted to transfuse to', 'keep Ht 25-30 or above.']",4843,187638.0
15,2207-03-11 08:02:04,,"['Scoped by GI. Had stable clot, that they did not want to mess around', 'with. They discussed the case with surgery. Surgery is following along', 'but no immediate plans to take to OR while Hct, and hemodynamics are', 'stable given that Pt is not ideal surgical candidate. They will be', 'following and will continue to re-evaluate as things go on.', 'Spoke with Dr. [**Last Name (STitle) 11890**] from ID who mentioned that high dose', 'nafcillin can lead to platelet dysfunction. In this setting, nafcillin', 'was d/c and started vanco. CT scan of LE done, no final read back yet,', 'but per nursing, podiatry had come by and said the scan looked OK. PM', 'Hcts stable.']",,4843,187638.0
16,2207-03-11 09:48:11,,"['Scoped by GI. Had stable clot, that they did not want to mess around', 'with. They discussed the case with surgery. Surgery is following along', 'but no immediate plans to take to OR while Hct, and hemodynamics are', 'stable given that Pt is not ideal surgical candidate. They will be', 'following and will continue to re-evaluate as things go on.', 'Spoke with Dr. [**Last Name (STitle) 11890**] from ID who mentioned that high dose', 'nafcillin can lead to platelet dysfunction. In this setting, nafcillin', 'was d/c and started vanco. CT scan of LE done, no final read back yet,', 'but per nursing, podiatry had come by and said the scan looked OK. PM', 'Hcts stable.']",,4843,187638.0
17,2207-03-12 07:03:53,"['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']","['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']","['Scoped by GI. Had stable clot, that they did not want to mess around', 'with. They discussed the case with surgery. Surgery is following along', 'but no immediate plans to take to OR while Hct, and hemodynamics are', 'stable given that Pt is not ideal surgical candidate. They will be', 'following and will continue to re-evaluate as things go on.', 'Spoke with Dr. [**Last Name (STitle) 11890**] from ID who mentioned that high dose', 'nafcillin can lead to platelet dysfunction. In this setting, nafcillin', 'was d/c and started vanco. CT scan of LE done, no final read back yet,', 'but per nursing, podiatry had come by and said the scan looked OK. PM', 'Hcts stable.']",4843,187638.0
18,2207-03-12 07:04:59,,"['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']",,4843,187638.0
19,2207-03-12 07:58:57,,"['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']",,4843,187638.0
20,2207-03-12 10:12:22,,"['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']",,4843,187638.0
21,2207-03-13 06:50:27,"['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']","['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']","['Hcts stable. Started diuresing in evening; put out ~800cc with 20 IV', 'Lasix. Lowish blood sugars so gave only 10 of lantus; reduced regular', 'dose from 40 -> 20 -> 16. Phosphate rising.']",4843,187638.0
22,2207-03-13 06:51:16,,"['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']",,4843,187638.0
23,2207-03-13 08:42:58,,"['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']",,4843,187638.0
24,2207-03-13 12:00:33,,"['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']",,4843,187638.0
25,2207-03-14 04:25:43,"['Pt was initially scheduled to go to OR for podiatric procedure,', 'however, surgery recommended deferring until Pt more stable. Pt', 's Hct', 'remained stable throughout the day. Pt HD stable, husband at the', 'bedside. Plan for c/o to floor today.']","['Pt was initially scheduled to go to OR for podiatric procedure,', 'however, surgery recommended deferring until Pt more stable. Pt', 's Hct', 'remained stable throughout the day. Pt HD stable, husband at the', 'bedside. Plan for c/o to floor today.']","['Pt. extubated yesterday and did well.  Hct has been stable.', 'Plan to go to the OR today with orthopedics.']",4843,187638.0
26,2207-03-14 04:30:33,,"['Pt was initially scheduled to go to OR for podiatric procedure,', 'however, surgery recommended deferring until Pt more stable. Pt', 's Hct', 'remained stable throughout the day. Pt HD stable, husband at the', 'bedside. Plan for c/o to floor today.']",,4843,187638.0
27,2207-03-14 07:56:07,,"['Pt was initially scheduled to go to OR for podiatric procedure,', 'however, surgery recommended deferring until Pt more stable. Pt', 's Hct', 'remained stable throughout the day. Pt HD stable, husband at the', 'bedside. Plan for c/o to floor today.']",,4843,187638.0
28,2207-03-14 10:53:57,,"['Pt was initially scheduled to go to OR for podiatric procedure,', 'however, surgery recommended deferring until Pt more stable. Pt', 's Hct', 'remained stable throughout the day. Pt HD stable, husband at the', 'bedside. Plan for c/o to floor today.']",,4843,187638.0
0,2142-03-21 07:11:57,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
1,2142-03-21 07:13:42,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
2,2142-03-21 07:14:36,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
3,2142-03-21 08:39:37,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
4,2142-03-21 08:49:31,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
5,2142-03-21 09:27:56,,"['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",,99346,143984.0
6,2142-03-22 06:25:18,"['repeat echo demonstrated no acute change from prior', '- called EP to come interogate pacemaker and also to increase basal', 'rate, EP said that biV is not working and impedence higher in the', 'setting of increased diuresis, did not want to increase basal rate so', 'dr. [**Last Name (STitle) **] and dr. [**Last Name (STitle) **] will have to figure it out', '- called out awaiting transfer', '- decreased glargine and decreased sliding scale in the setting of low', 'glucose', '- restarted on levoquin in the setting of RLL infiltrate', '- also some concern on chest x-ray as per radiology that sternal wifes', 'were fractured appears for years with posible lowest sternal wire', 'migrating to right?', '- called CT surgery to eval: awaiting final recs', '- patient got 40 IV lasix this morning, only 1.2 liter negative however', 'increase in Cr and BUN so did not give additional diuresis', '- restarted eplerenone on transfer orders for am']","['repeat echo demonstrated no acute change from prior', '- called EP to come interogate pacemaker and also to increase basal', 'rate, EP said that biV is not working and impedence higher in the', 'setting of increased diuresis, did not want to increase basal rate so', 'dr. [**Last Name (STitle) **] and dr. [**Last Name (STitle) **] will have to figure it out', '- called out awaiting transfer', '- decreased glargine and decreased sliding scale in the setting of low', 'glucose', '- restarted on levoquin in the setting of RLL infiltrate', '- also some concern on chest x-ray as per radiology that sternal wifes', 'were fractured appears for years with posible lowest sternal wire', 'migrating to right?', '- called CT surgery to eval: awaiting final recs', '- patient got 40 IV lasix this morning, only 1.2 liter negative however', 'increase in Cr and BUN so did not give additional diuresis', '- restarted eplerenone on transfer orders for am']","['- Pt admitted to CCU', '- Received additional Lasix 30mg IV x 1 last night, now net -2.1 L (had', 'gotten 250cc boluses x 2 in ED, not recorded). UOP now decreased over', 'past few hrs from 180/hr after Lasix to 30-45/hr.', '- Called overnight as pt noticed to be diaphoretic, systolic BP up to', '130s. BS found to be 54, improved to 103 after juice. Pt otherwise', 'denied CP, SOB. Was wheezy on exam, so gave duonebs x 1.']",99346,143984.0
7,2142-03-22 07:52:47,"['- repeat echo demonstrated no acute change from prior with EF 25%,', 'severe MR, dilated RA with low filling pressures.', '- also some concern on chest x-ray as per radiology that sternal wires', 'were fractured appears for years with possible lowest sternal wire']","['- repeat echo demonstrated no acute change from prior with EF 25%,', 'severe MR, dilated RA with low filling pressures.', '- called EP to come interogate pacemaker and also to increase basal', 'rate, EP said that biV is not working and impedence higher in the', 'setting of increased diuresis, did not want to increase basal rate so', 'dr. [**Last Name (STitle) **] and dr. [**Last Name (STitle) **] will have to figure it out', '- called out awaiting transfer', '- decreased glargine and decreased sliding scale in the setting of low', 'glucose', '- restarted on levoquin in the setting of RLL infiltrate', '- also some concern on chest x-ray as per radiology that sternal wires', 'were fractured appears for years with possible lowest sternal wire', 'migrating to right?', '- called CT surgery to eval: awaiting final recs', '- patient got 40 IV lasix this morning, only 1.2 liter negative however', 'increase in Cr and BUN so did not give additional diuresis', '- restarted eplerenone on transfer orders for am']","['repeat echo demonstrated no acute change from prior', '- also some concern on chest x-ray as per radiology that sternal wifes', 'were fractured appears for years with posible lowest sternal wire']",99346,143984.0
8,2142-03-22 10:31:26,"['rate, EP said that biV is not working and impedence improved in setting', 'of diuresis, did not want to increase basal rate so dr. [**Last Name (STitle) **] and dr.', '[**Last Name (STitle) **] will have to figure it out', ' nothing further to', 'do.  Ok per CT [**Doctor First Name 91**].']","['- repeat echo demonstrated no acute change from prior with EF 25%,', 'severe MR, dilated RA with low filling pressures.', '- called EP to come interogate pacemaker and also to increase basal', 'rate, EP said that biV is not working and impedence improved in setting', 'of diuresis, did not want to increase basal rate so dr. [**Last Name (STitle) **] and dr.', '[**Last Name (STitle) **] will have to figure it out', '- called out awaiting transfer', '- decreased glargine and decreased sliding scale in the setting of low', 'glucose', '- restarted on levoquin in the setting of RLL infiltrate', '- also some concern on chest x-ray as per radiology that sternal wires', 'were fractured appears for years with possible lowest sternal wire', 'migrating to right?', '- called CT surgery to eval: awaiting final recs', ' nothing further to', 'do.  Ok per CT [**Doctor First Name 91**].', '- patient got 40 IV lasix this morning, only 1.2 liter negative however', 'increase in Cr and BUN so did not give additional diuresis', '- restarted eplerenone on transfer orders for am']","['rate, EP said that biV is not working and impedence higher in the', 'setting of increased diuresis, did not want to increase basal rate so', 'dr. [**Last Name (STitle) **] and dr. [**Last Name (STitle) **] will have to figure it out']",99346,143984.0
9,2142-03-22 10:32:37,,"['- repeat echo demonstrated no acute change from prior with EF 25%,', 'severe MR, dilated RA with low filling pressures.', '- called EP to come interogate pacemaker and also to increase basal', 'rate, EP said that biV is not working and impedence improved in setting', 'of diuresis, did not want to increase basal rate so dr. [**Last Name (STitle) **] and dr.', '[**Last Name (STitle) **] will have to figure it out', '- called out awaiting transfer', '- decreased glargine and decreased sliding scale in the setting of low', 'glucose', '- restarted on levoquin in the setting of RLL infiltrate', '- also some concern on chest x-ray as per radiology that sternal wires', 'were fractured appears for years with possible lowest sternal wire', 'migrating to right?', '- called CT surgery to eval: awaiting final recs', ' nothing further to', 'do.  Ok per CT [**Doctor First Name 91**].', '- patient got 40 IV lasix this morning, only 1.2 liter negative however', 'increase in Cr and BUN so did not give additional diuresis', '- restarted eplerenone on transfer orders for am']",,99346,143984.0
0,2156-12-19 07:41:28,,"['NASAL SWAB - At [**2156-12-18**] 05:52 PM', ' EKG - At [**2156-12-18**] 06:14 PM', ' PICC LINE - START [**2156-12-18**] 09:02 PM', '-', 'started on milrinone gtt + lasix gtt', '-', 'downtitrated lasix gtt overnight', '-', 'this morning stopped lasix gtt altogether']",,73837,171994.0
1,2156-12-19 09:24:41,,"['NASAL SWAB - At [**2156-12-18**] 05:52 PM', ' EKG - At [**2156-12-18**] 06:14 PM', ' PICC LINE - START [**2156-12-18**] 09:02 PM', '-', 'started on milrinone gtt + lasix gtt', '-', 'downtitrated lasix gtt overnight', '-', 'this morning stopped lasix gtt altogether']",,73837,171994.0
2,2156-12-19 09:33:40,,"['NASAL SWAB - At [**2156-12-18**] 05:52 PM', ' EKG - At [**2156-12-18**] 06:14 PM', ' PICC LINE - START [**2156-12-18**] 09:02 PM', '-', 'started on milrinone gtt + lasix gtt', '-', 'downtitrated lasix gtt overnight', '-', 'this morning stopped lasix gtt altogether']",,73837,171994.0
3,2156-12-19 10:39:37,,"['NASAL SWAB - At [**2156-12-18**] 05:52 PM', ' EKG - At [**2156-12-18**] 06:14 PM', ' PICC LINE - START [**2156-12-18**] 09:02 PM', '-', 'started on milrinone gtt + lasix gtt', '-', 'downtitrated lasix gtt overnight', '-', 'this morning stopped lasix gtt altogether']",,73837,171994.0
4,2156-12-20 07:04:10,"['- cath in am', '- off lasix gtt, -2L.']","['- cath in am', '- off lasix gtt, -2L.']","['NASAL SWAB - At [**2156-12-18**] 05:52 PM', ' EKG - At [**2156-12-18**] 06:14 PM', ' PICC LINE - START [**2156-12-18**] 09:02 PM', '-', 'started on milrinone gtt + lasix gtt', '-', 'downtitrated lasix gtt overnight', '-', 'this morning stopped lasix gtt altogether']",73837,171994.0
5,2156-12-20 09:30:28,,"['- cath in am', '- off lasix gtt, -2L.']",,73837,171994.0
6,2156-12-20 09:59:20,,"['- cath in am', '- off lasix gtt, -2L.']",,73837,171994.0
7,2156-12-20 13:43:14,,"['- cath in am', '- off lasix gtt, -2L.']",,73837,171994.0
8,2156-12-21 07:33:07,"['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, DES to RCA deployed']","['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, DES to RCA deployed']","['- cath in am', '- off lasix gtt, -2L.']",73837,171994.0
9,2156-12-21 10:30:38,,"['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, DES to RCA deployed']",,73837,171994.0
10,2156-12-21 10:42:03,,"['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, DES to RCA deployed']",,73837,171994.0
11,2156-12-21 10:59:09,"['severely elevated wedge, [**Year (4 digits) **] to RCA deployed']","['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, [**Year (4 digits) **] to RCA deployed']","['severely elevated wedge, DES to RCA deployed']",73837,171994.0
12,2156-12-21 11:30:59,,"['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, [**Year (4 digits) **] to RCA deployed']",,73837,171994.0
13,2156-12-22 07:41:41,"['- got cardiac MR today', '- 8 beat run of NSVT @ 1410, while sleeping', '- EP: f/u as outpatient in [**3-9**] mos., will re-eval today as patient had', 'NSVT but likely no changes in recs', '- continued good diuresis on lasix gtt alone', '- tried to call out to [**Hospital1 1896**] but no beds available']","['- got cardiac MR today', '- 8 beat run of NSVT @ 1410, while sleeping', '- EP: f/u as outpatient in [**3-9**] mos., will re-eval today as patient had', 'NSVT but likely no changes in recs', '- continued good diuresis on lasix gtt alone', '- tried to call out to [**Hospital1 1896**] but no beds available']","['CARDIAC CATH - At [**2156-12-20**] 11:15 AM', ' URINE CULTURE - At [**2156-12-20**] 07:30 PM', '- Cath revealed RCA, LAD disease, severe pulmonary artery hypertension,', 'severely elevated wedge, [**Year (4 digits) **] to RCA deployed']",73837,171994.0
14,2156-12-22 10:27:48,,"['- got cardiac MR today', '- 8 beat run of NSVT @ 1410, while sleeping', '- EP: f/u as outpatient in [**3-9**] mos., will re-eval today as patient had', 'NSVT but likely no changes in recs', '- continued good diuresis on lasix gtt alone', '- tried to call out to [**Hospital1 1896**] but no beds available']",,73837,171994.0
0,2112-02-13 06:51:00,,"['- Transferred yesterday from VICU after runs of NSVT', '- Started on amio gtt', '- Telemetry events: episodes of apnea with desats, frequent PVCs, one', 'episode of ?SVT. Otherwise, no NSVT']",,94847,162559.0
1,2112-02-13 06:52:33,,"['- Transferred yesterday from VICU after runs of NSVT', '- Started on amio gtt', '- Telemetry events: episodes of apnea with desats, frequent PVCs, one', 'episode of ?SVT. Otherwise, no NSVT']",,94847,162559.0
2,2112-02-13 06:53:15,,"['- Transferred yesterday from VICU after runs of NSVT', '- Started on amio gtt', '- Telemetry events: episodes of apnea with desats, frequent PVCs, one', 'episode of ?SVT. Otherwise, no NSVT']",,94847,162559.0
3,2112-02-13 09:18:24,,"['- Transferred yesterday from VICU after runs of NSVT', '- Started on amio gtt', '- Telemetry events: episodes of apnea with desats, frequent PVCs, one', 'episode of ?SVT. Otherwise, no NSVT']",,94847,162559.0
4,2112-02-13 09:19:52,,"['- Transferred yesterday from VICU after runs of NSVT', '- Started on amio gtt', '- Telemetry events: episodes of apnea with desats, frequent PVCs, one', 'episode of ?SVT. Otherwise, no NSVT']",,94847,162559.0
0,2132-12-02 05:36:13,,['SHEATH - START [**2132-12-1**] 06:45 PM'],,75315,113802.0
1,2132-12-02 05:45:00,,['SHEATH - START [**2132-12-1**] 06:45 PM'],,75315,113802.0
2,2132-12-02 07:52:37,"['No events following initiation of TPA', 'Q3H Fibrinogen checks']","['No events following initiation of TPA', 'Q3H Fibrinogen checks']",['SHEATH - START [**2132-12-1**] 06:45 PM'],75315,113802.0
0,2134-04-24 07:40:04,,"['- given 10U regular for BS 404 --> 275', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to 500 cc NS bolus', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- EGD showed diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- In total, received 2 units PRBCs, 2 units FFP', '- febrile to 100.9', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']",,75315,106015.0
1,2134-04-24 07:43:02,,"['- given 10U regular for BS 404 --> 275', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to 500 cc NS bolus', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- EGD showed diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- In total, received 2 units PRBCs, 2 units FFP', '- febrile to 100.9', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']",,75315,106015.0
2,2134-04-24 08:30:04,,"['- given 10U regular for BS 404 --> 275', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to 500 cc NS bolus', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- EGD showed diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- In total, received 2 units PRBCs, 2 units FFP', '- febrile to 100.9', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']",,75315,106015.0
3,2134-04-24 09:24:43,"['- GI performed EGD: diffuse erythema/ulceration, in esophagus, stomach,', 'it reached 100) --> responed to NS boluses', '- Also received 2 units FFP', '- febrile to 100.9, blood cultures sent']","['- GI performed EGD: diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to NS boluses', '- given 10U regular for BS 404 --> 275', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- Also received 2 units FFP', '- febrile to 100.9, blood cultures sent', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']","['it reached 100) --> responed to 500 cc NS bolus', '- EGD showed diffuse erythema/ulceration, in esophagus, stomach,', '- In total, received 2 units PRBCs, 2 units FFP', '- febrile to 100.9']",75315,106015.0
4,2134-04-24 13:30:37,,"['- GI performed EGD: diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to NS boluses', '- given 10U regular for BS 404 --> 275', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- Also received 2 units FFP', '- febrile to 100.9, blood cultures sent', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']",,75315,106015.0
5,2134-04-25 07:07:52,"['PICC LINE - START [**2134-4-24**] 10:31 AM', ' BLOOD CULTURED - At [**2134-4-24**] 02:40 PM', 'from POC', ' BLOOD CULTURED - At [**2134-4-24**] 02:57 PM', 'from PICC', '- Restarted bblocker: Metoprolol Tartrate 25 mg TID', '- PICC placed', '- per GI - Colonoscopy monday to r/o process at anastamosis site.', '- Per micro lab, pt growing [**3-2**] GPCs in clusters from portacath from', '[**4-23**] blood cultures. Started vancomycin through PICC line and portacath', '(alternating doses)', '- TPN held', '- lovenox held since [**4-22**] in setting of bleeding', '- 500cc bolus for SBP 90s, pt was asymptomatic', '- one small maroon stool overnight']","['PICC LINE - START [**2134-4-24**] 10:31 AM', ' BLOOD CULTURED - At [**2134-4-24**] 02:40 PM', 'from POC', ' BLOOD CULTURED - At [**2134-4-24**] 02:57 PM', 'from PICC', '- Restarted bblocker: Metoprolol Tartrate 25 mg TID', '- PICC placed', '- per GI - Colonoscopy monday to r/o process at anastamosis site.', '- Per micro lab, pt growing [**3-2**] GPCs in clusters from portacath from', '[**4-23**] blood cultures. Started vancomycin through PICC line and portacath', '(alternating doses)', '- TPN held', '- lovenox held since [**4-22**] in setting of bleeding', '- 500cc bolus for SBP 90s, pt was asymptomatic', '- one small maroon stool overnight']","['- GI performed EGD: diffuse erythema/ulceration, in esophagus, stomach,', 'duodenum.  Recommended PPI, carafate slurry.  They are suspicious that', ""patient's whole GI tract is diffusely inflamed as was seen on EGD."", 'Given that there is not tracer available for bleeding scan, they would', 'recommend angio if briskly bleeding', '- HR was in the 130s-140s (was 60s-80s on floor until last night when', 'it reached 100) --> responed to NS boluses', '- given 10U regular for BS 404 --> 275', '- insulin changed from RISS to HISS', '- GI recs: EGD now, bleeding scan later', '- FeNa 0.2% -> prerenal.  Got IVF boluses and PRBCs', '- wrote for sq vitamin k for three more days', '- Hct 31.7 -->  30.7 --> 1 unit PRBC --> 30.7 --> 1 unit --> 30.5 -->', '29.8', '- Also received 2 units FFP', '- febrile to 100.9, blood cultures sent', '- Last dose of lovenox was 120 mg sq (1.5 mg/kg) on AM of [**4-22**]', '- [**4-1**] epidoses of loose mucous with blood and stool overnight', ' INDWELLING PORT (PORTACATH) - START [**2134-4-23**] 10:45 AM', ' ENDOSCOPY - At [**2134-4-23**] 04:10 PM', 'History obtained from Patient']",75315,106015.0
6,2134-04-25 12:05:23,"['- pt states that he feels', 'pretty damn good']","['PICC LINE - START [**2134-4-24**] 10:31 AM', ' BLOOD CULTURED - At [**2134-4-24**] 02:40 PM', 'from POC', ' BLOOD CULTURED - At [**2134-4-24**] 02:57 PM', 'from PICC', '- Restarted bblocker: Metoprolol Tartrate 25 mg TID', '- PICC placed', '- per GI - Colonoscopy monday to r/o process at anastamosis site.', '- Per micro lab, pt growing [**3-2**] GPCs in clusters from portacath from', '[**4-23**] blood cultures. Started vancomycin through PICC line and portacath', '(alternating doses)', '- TPN held', '- lovenox held since [**4-22**] in setting of bleeding', '- 500cc bolus for SBP 90s, pt was asymptomatic', '- one small maroon stool overnight', '- pt states that he feels', 'pretty damn good']",,75315,106015.0
7,2134-04-25 12:28:16,,"['PICC LINE - START [**2134-4-24**] 10:31 AM', ' BLOOD CULTURED - At [**2134-4-24**] 02:40 PM', 'from POC', ' BLOOD CULTURED - At [**2134-4-24**] 02:57 PM', 'from PICC', '- Restarted bblocker: Metoprolol Tartrate 25 mg TID', '- PICC placed', '- per GI - Colonoscopy monday to r/o process at anastamosis site.', '- Per micro lab, pt growing [**3-2**] GPCs in clusters from portacath from', '[**4-23**] blood cultures. Started vancomycin through PICC line and portacath', '(alternating doses)', '- TPN held', '- lovenox held since [**4-22**] in setting of bleeding', '- 500cc bolus for SBP 90s, pt was asymptomatic', '- one small maroon stool overnight', '- pt states that he feels', 'pretty damn good']",,75315,106015.0
0,2135-03-05 07:24:37,,"[""- ordered for 1u pRBC's --> post Hct 27.9 from 22.9"", '- PM tumor lysis/lytes: looked good, no tumor lysis', '- TTE: degree of TR seen has increased. Moderate pulmonary hypertension', 'is now detected from [**12/2134**]', '- received chemo', ' TRANSTHORACIC ECHO - At [**2135-3-4**] 09:59 AM']",,9403,175096.0
1,2135-03-05 07:28:02,,"[""- ordered for 1u pRBC's --> post Hct 27.9 from 22.9"", '- PM tumor lysis/lytes: looked good, no tumor lysis', '- TTE: degree of TR seen has increased. Moderate pulmonary hypertension', 'is now detected from [**12/2134**]', '- received chemo', ' TRANSTHORACIC ECHO - At [**2135-3-4**] 09:59 AM']",,9403,175096.0
2,2135-03-05 19:27:26,,"[""- ordered for 1u pRBC's --> post Hct 27.9 from 22.9"", '- PM tumor lysis/lytes: looked good, no tumor lysis', '- TTE: degree of TR seen has increased. Moderate pulmonary hypertension', 'is now detected from [**12/2134**]', '- received chemo', ' TRANSTHORACIC ECHO - At [**2135-3-4**] 09:59 AM']",,9403,175096.0
0,2162-12-03 07:29:09,,"['- Patient with frank hemoptysis yesterday that stopped about 4PM', '- AFB ordered x 3, HIV sent', '- Given Cough suppressant (codeine), azithro, and ceftriaxone', '- Plan for Bronchoscopy in AM.', '- SW consult as patient with finacial stressors and boyfriend with', 'recent family deaths.']",,54794,135513.0
1,2162-12-03 08:07:09,['recent family deaths.  Patient wants to leave due to this.'],"['- Patient with frank hemoptysis yesterday that stopped about 4PM', '- AFB ordered x 3, HIV sent', '- Given Cough suppressant (codeine), azithro, and ceftriaxone', '- Plan for Bronchoscopy in AM.', '- SW consult as patient with finacial stressors and boyfriend with', 'recent family deaths.  Patient wants to leave due to this.']",['recent family deaths.'],54794,135513.0
2,2162-12-04 07:12:45,"['OSH records and CT obtained', '- HIV Negative', '- Learned that patient provided additional sputums at [**Company 2301**]. These grew MSSA', '- Started on Naficllin', '- Nauseous overnight after recieving codeine, received Maalox w/', 'subsequent vomitting x1 and nausea resolved.', 'History obtained from Patient']","['OSH records and CT obtained', '- HIV Negative', '- Learned that patient provided additional sputums at [**Company 2301**]. These grew MSSA', '- Started on Naficllin', '- Nauseous overnight after recieving codeine, received Maalox w/', 'subsequent vomitting x1 and nausea resolved.', 'History obtained from Patient']","['- Patient with frank hemoptysis yesterday that stopped about 4PM', '- AFB ordered x 3, HIV sent', '- Given Cough suppressant (codeine), azithro, and ceftriaxone', '- Plan for Bronchoscopy in AM.', '- SW consult as patient with finacial stressors and boyfriend with', 'recent family deaths.  Patient wants to leave due to this.']",54794,135513.0
0,2146-03-04 07:03:34,,"['ULTRASOUND - At [**2146-3-3**] 09:30 AM', 'ABD', ' PARACENTESIS - At [**2146-3-3**] 09:30 AM', 'attempted', ' INVASIVE VENTILATION - START [**2146-3-3**] 10:25 AM', ' MULTI LUMEN - START [**2146-3-3**] 10:57 AM', ' ARTERIAL LINE - START [**2146-3-3**] 04:12 PM', ' PARACENTESIS - At [**2146-3-3**] 04:18 PM', '5L diagnostic paracenesis performed, Fluid consistent with SBP.', 'Patient became hypotensive in the late afternoon with SBP in 80s.  She', 'was given 500cc IVF bolus with no response.  3rd Albumin bag hung.', '1uPRBC also running but still remained with SBP in low 80s.', ""Vasopressin started at 1.2 and increased to 2.4.  MAP's remained at"", '60.  Levophed then started at low dose and patient has remained with', 'MAP of 65.', 'HCT at 8pm came back at 22 which was down from 24 despite 4uPRBCs.  DIC', 'and Hemolysis labs sent.  1uPRBC was ordered and hung.  STAT CT scan of', 'abdomen was ordered for evaluation of possible hemoperitoneum s/p', 'paracentesis.  CT scan was negative for intraperitoneal bleed.  Repeat', 'HCT overnight increased to 28.  D-dimer extremely elevated to [**Numeric Identifier 6835**]', 'which suggests DIC.']",,30659,123675.0
1,2146-03-04 07:04:30,,"['ULTRASOUND - At [**2146-3-3**] 09:30 AM', 'ABD', ' PARACENTESIS - At [**2146-3-3**] 09:30 AM', 'attempted', ' INVASIVE VENTILATION - START [**2146-3-3**] 10:25 AM', ' MULTI LUMEN - START [**2146-3-3**] 10:57 AM', ' ARTERIAL LINE - START [**2146-3-3**] 04:12 PM', ' PARACENTESIS - At [**2146-3-3**] 04:18 PM', '5L diagnostic paracenesis performed, Fluid consistent with SBP.', 'Patient became hypotensive in the late afternoon with SBP in 80s.  She', 'was given 500cc IVF bolus with no response.  3rd Albumin bag hung.', '1uPRBC also running but still remained with SBP in low 80s.', ""Vasopressin started at 1.2 and increased to 2.4.  MAP's remained at"", '60.  Levophed then started at low dose and patient has remained with', 'MAP of 65.', 'HCT at 8pm came back at 22 which was down from 24 despite 4uPRBCs.  DIC', 'and Hemolysis labs sent.  1uPRBC was ordered and hung.  STAT CT scan of', 'abdomen was ordered for evaluation of possible hemoperitoneum s/p', 'paracentesis.  CT scan was negative for intraperitoneal bleed.  Repeat', 'HCT overnight increased to 28.  D-dimer extremely elevated to [**Numeric Identifier 6835**]', 'which suggests DIC.']",,30659,123675.0
2,2146-03-04 10:36:10,,"['ULTRASOUND - At [**2146-3-3**] 09:30 AM', 'ABD', ' PARACENTESIS - At [**2146-3-3**] 09:30 AM', 'attempted', ' INVASIVE VENTILATION - START [**2146-3-3**] 10:25 AM', ' MULTI LUMEN - START [**2146-3-3**] 10:57 AM', ' ARTERIAL LINE - START [**2146-3-3**] 04:12 PM', ' PARACENTESIS - At [**2146-3-3**] 04:18 PM', '5L diagnostic paracenesis performed, Fluid consistent with SBP.', 'Patient became hypotensive in the late afternoon with SBP in 80s.  She', 'was given 500cc IVF bolus with no response.  3rd Albumin bag hung.', '1uPRBC also running but still remained with SBP in low 80s.', ""Vasopressin started at 1.2 and increased to 2.4.  MAP's remained at"", '60.  Levophed then started at low dose and patient has remained with', 'MAP of 65.', 'HCT at 8pm came back at 22 which was down from 24 despite 4uPRBCs.  DIC', 'and Hemolysis labs sent.  1uPRBC was ordered and hung.  STAT CT scan of', 'abdomen was ordered for evaluation of possible hemoperitoneum s/p', 'paracentesis.  CT scan was negative for intraperitoneal bleed.  Repeat', 'HCT overnight increased to 28.  D-dimer extremely elevated to [**Numeric Identifier 6835**]', 'which suggests DIC.']",,30659,123675.0
3,2146-03-05 07:40:50,"['Levophed off at 3pm yesterday. Vasopressin off at 6am this morning.', ""Family mtg yesterday, patient's family agreed that patient would want"", 'to keep going with aggressive care for now.', 'Renal will consider RRT today.', ""Followed DIC labs overnight - pt received: 5 units FFP, 3 units pRBC's"", 'and 1 unit platelets. Fibrinogen remained above 100.']","['Levophed off at 3pm yesterday. Vasopressin off at 6am this morning.', ""Family mtg yesterday, patient's family agreed that patient would want"", 'to keep going with aggressive care for now.', 'Renal will consider RRT today.', ""Followed DIC labs overnight - pt received: 5 units FFP, 3 units pRBC's"", 'and 1 unit platelets. Fibrinogen remained above 100.']","['ULTRASOUND - At [**2146-3-3**] 09:30 AM', 'ABD', ' PARACENTESIS - At [**2146-3-3**] 09:30 AM', 'attempted', ' INVASIVE VENTILATION - START [**2146-3-3**] 10:25 AM', ' MULTI LUMEN - START [**2146-3-3**] 10:57 AM', ' ARTERIAL LINE - START [**2146-3-3**] 04:12 PM', ' PARACENTESIS - At [**2146-3-3**] 04:18 PM', '5L diagnostic paracenesis performed, Fluid consistent with SBP.', 'Patient became hypotensive in the late afternoon with SBP in 80s.  She', 'was given 500cc IVF bolus with no response.  3rd Albumin bag hung.', '1uPRBC also running but still remained with SBP in low 80s.', ""Vasopressin started at 1.2 and increased to 2.4.  MAP's remained at"", '60.  Levophed then started at low dose and patient has remained with', 'MAP of 65.', 'HCT at 8pm came back at 22 which was down from 24 despite 4uPRBCs.  DIC', 'and Hemolysis labs sent.  1uPRBC was ordered and hung.  STAT CT scan of', 'abdomen was ordered for evaluation of possible hemoperitoneum s/p', 'paracentesis.  CT scan was negative for intraperitoneal bleed.  Repeat', 'HCT overnight increased to 28.  D-dimer extremely elevated to [**Numeric Identifier 6835**]', 'which suggests DIC.']",30659,123675.0
4,2146-03-05 12:13:22,,"['Levophed off at 3pm yesterday. Vasopressin off at 6am this morning.', ""Family mtg yesterday, patient's family agreed that patient would want"", 'to keep going with aggressive care for now.', 'Renal will consider RRT today.', ""Followed DIC labs overnight - pt received: 5 units FFP, 3 units pRBC's"", 'and 1 unit platelets. Fibrinogen remained above 100.']",,30659,123675.0
5,2146-03-05 12:15:47,,"['Levophed off at 3pm yesterday. Vasopressin off at 6am this morning.', ""Family mtg yesterday, patient's family agreed that patient would want"", 'to keep going with aggressive care for now.', 'Renal will consider RRT today.', ""Followed DIC labs overnight - pt received: 5 units FFP, 3 units pRBC's"", 'and 1 unit platelets. Fibrinogen remained above 100.']",,30659,123675.0
6,2146-03-06 07:53:42,"['DIALYSIS CATHETER - START [**2146-3-5**] 05:30 PM', 'Pt started on CVVH last pm', 'Remained off pressors', 'Still with significant NGT output, po meds not restarted']","['DIALYSIS CATHETER - START [**2146-3-5**] 05:30 PM', 'Pt started on CVVH last pm', 'Remained off pressors', 'Still with significant NGT output, po meds not restarted']","['Levophed off at 3pm yesterday. Vasopressin off at 6am this morning.', ""Family mtg yesterday, patient's family agreed that patient would want"", 'to keep going with aggressive care for now.', 'Renal will consider RRT today.', ""Followed DIC labs overnight - pt received: 5 units FFP, 3 units pRBC's"", 'and 1 unit platelets. Fibrinogen remained above 100.']",30659,123675.0
7,2146-03-06 16:02:26,,"['DIALYSIS CATHETER - START [**2146-3-5**] 05:30 PM', 'Pt started on CVVH last pm', 'Remained off pressors', 'Still with significant NGT output, po meds not restarted']",,30659,123675.0
8,2146-03-07 07:31:28,"['Vanc level low, gave Vanco 500mg IV x 1.', 'Therapeutic Para done yesterday 3.5 L taken off.  WBC count now', 'decreased, no SBP.  Resent cultures. ?bubbles from tubing during', 'paracentesis.  CXR done and showed no signs of', 'perforation/pneumoperitoneum.', 'Platelets < 30, gave 1u Platelets overnight.', 'Patient has not stooled overnight.']","['Vanc level low, gave Vanco 500mg IV x 1.', 'Therapeutic Para done yesterday 3.5 L taken off.  WBC count now', 'decreased, no SBP.  Resent cultures. ?bubbles from tubing during', 'paracentesis.  CXR done and showed no signs of', 'perforation/pneumoperitoneum.', 'Platelets < 30, gave 1u Platelets overnight.', 'Patient has not stooled overnight.']","['DIALYSIS CATHETER - START [**2146-3-5**] 05:30 PM', 'Pt started on CVVH last pm', 'Remained off pressors', 'Still with significant NGT output, po meds not restarted']",30659,123675.0
9,2146-03-07 07:32:13,,"['Vanc level low, gave Vanco 500mg IV x 1.', 'Therapeutic Para done yesterday 3.5 L taken off.  WBC count now', 'decreased, no SBP.  Resent cultures. ?bubbles from tubing during', 'paracentesis.  CXR done and showed no signs of', 'perforation/pneumoperitoneum.', 'Platelets < 30, gave 1u Platelets overnight.', 'Patient has not stooled overnight.']",,30659,123675.0
10,2146-03-07 11:28:14,"['Patient has not stooled overnight, but began this morning.']","['Vanc level low, gave Vanco 500mg IV x 1.', 'Therapeutic Para done yesterday 3.5 L taken off.  WBC count now', 'decreased, no SBP.  Resent cultures. ?bubbles from tubing during', 'paracentesis.  CXR done and showed no signs of', 'perforation/pneumoperitoneum.', 'Platelets < 30, gave 1u Platelets overnight.', 'Patient has not stooled overnight, but began this morning.']",['Patient has not stooled overnight.'],30659,123675.0
11,2146-03-08 06:21:51,"['ARTERIAL LINE - STOP [**2146-3-7**] 01:00 PM', ' BLOOD CULTURED - At [**2146-3-7**] 09:00 PM', 'Patient put on propofol overnight for restlessness, hypertension.', 'Reglan increased, continued lactulose/rifaxamine - stooling well', 'Still no urine output', 'DIC labs were wnl last night']","['ARTERIAL LINE - STOP [**2146-3-7**] 01:00 PM', ' BLOOD CULTURED - At [**2146-3-7**] 09:00 PM', 'Patient put on propofol overnight for restlessness, hypertension.', 'Reglan increased, continued lactulose/rifaxamine - stooling well', 'Still no urine output', 'DIC labs were wnl last night']","['Vanc level low, gave Vanco 500mg IV x 1.', 'Therapeutic Para done yesterday 3.5 L taken off.  WBC count now', 'decreased, no SBP.  Resent cultures. ?bubbles from tubing during', 'paracentesis.  CXR done and showed no signs of', 'perforation/pneumoperitoneum.', 'Platelets < 30, gave 1u Platelets overnight.', 'Patient has not stooled overnight, but began this morning.']",30659,123675.0
12,2146-03-08 12:30:17,,"['ARTERIAL LINE - STOP [**2146-3-7**] 01:00 PM', ' BLOOD CULTURED - At [**2146-3-7**] 09:00 PM', 'Patient put on propofol overnight for restlessness, hypertension.', 'Reglan increased, continued lactulose/rifaxamine - stooling well', 'Still no urine output', 'DIC labs were wnl last night']",,30659,123675.0
13,2146-03-08 19:09:12,,"['ARTERIAL LINE - STOP [**2146-3-7**] 01:00 PM', ' BLOOD CULTURED - At [**2146-3-7**] 09:00 PM', 'Patient put on propofol overnight for restlessness, hypertension.', 'Reglan increased, continued lactulose/rifaxamine - stooling well', 'Still no urine output', 'DIC labs were wnl last night']",,30659,123675.0
14,2146-03-09 07:04:15,"['PARACENTESIS - At [**2146-3-8**] 12:55 PM', 'Post procedure the pt developed hypotension with HCT drop from 29 to', '22. She received 3U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Surgery consultation was', 'obtained, with recommendation for continued medical management. She', 'received 4 U PRBC and 2 U Plt with rise in HCT for 25. Plt 53. Pt', 'required levophed for BP support, weaned off since 2100. An additional', '2 U PRBC given this am']","['PARACENTESIS - At [**2146-3-8**] 12:55 PM', 'Post procedure the pt developed hypotension with HCT drop from 29 to', '22. She received 3U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Surgery consultation was', 'obtained, with recommendation for continued medical management. She', 'received 4 U PRBC and 2 U Plt with rise in HCT for 25. Plt 53. Pt', 'required levophed for BP support, weaned off since 2100. An additional', '2 U PRBC given this am']","['ARTERIAL LINE - STOP [**2146-3-7**] 01:00 PM', ' BLOOD CULTURED - At [**2146-3-7**] 09:00 PM', 'Patient put on propofol overnight for restlessness, hypertension.', 'Reglan increased, continued lactulose/rifaxamine - stooling well', 'Still no urine output', 'DIC labs were wnl last night']",30659,123675.0
15,2146-03-09 07:06:56,"['22. She received 2U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Fibrinogen up from 63 to 162.', 'Surgery consultation was obtained, with recommendation for continued', 'medical management. She received 4 U PRBC and 2 U Plt with rise in HCT', 'for 25. Plt 53. Pt required levophed for BP support, weaned off since', '2100. An additional 2 U PRBC given this am']","['PARACENTESIS - At [**2146-3-8**] 12:55 PM', 'Post procedure the pt developed hypotension with HCT drop from 29 to', '22. She received 2U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Fibrinogen up from 63 to 162.', 'Surgery consultation was obtained, with recommendation for continued', 'medical management. She received 4 U PRBC and 2 U Plt with rise in HCT', 'for 25. Plt 53. Pt required levophed for BP support, weaned off since', '2100. An additional 2 U PRBC given this am']","['22. She received 3U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Surgery consultation was', 'obtained, with recommendation for continued medical management. She', 'received 4 U PRBC and 2 U Plt with rise in HCT for 25. Plt 53. Pt', 'required levophed for BP support, weaned off since 2100. An additional', '2 U PRBC given this am']",30659,123675.0
16,2146-03-09 11:37:49,,"['PARACENTESIS - At [**2146-3-8**] 12:55 PM', 'Post procedure the pt developed hypotension with HCT drop from 29 to', '22. She received 2U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Fibrinogen up from 63 to 162.', 'Surgery consultation was obtained, with recommendation for continued', 'medical management. She received 4 U PRBC and 2 U Plt with rise in HCT', 'for 25. Plt 53. Pt required levophed for BP support, weaned off since', '2100. An additional 2 U PRBC given this am']",,30659,123675.0
17,2146-03-10 07:28:11,"['HCT stable overnight.  PLT decreased to < 30, so patient was given 1u', 'Platelets.', 'Patient did not tolerate RSBI trial, became tachypneic to RR 40s.  No', 'SBT done.', 'HD done yesterday with removal of 1L fluid.']","['HCT stable overnight.  PLT decreased to < 30, so patient was given 1u', 'Platelets.', 'Patient did not tolerate RSBI trial, became tachypneic to RR 40s.  No', 'SBT done.', 'HD done yesterday with removal of 1L fluid.']","['PARACENTESIS - At [**2146-3-8**] 12:55 PM', 'Post procedure the pt developed hypotension with HCT drop from 29 to', '22. She received 2U PRBC, 3 U FFP and 2 U Cryoprecipitate with a repeat', 'HCT of 15, INR improved from 2.9 to 2.0. Fibrinogen up from 63 to 162.', 'Surgery consultation was obtained, with recommendation for continued', 'medical management. She received 4 U PRBC and 2 U Plt with rise in HCT', 'for 25. Plt 53. Pt required levophed for BP support, weaned off since', '2100. An additional 2 U PRBC given this am']",30659,123675.0
18,2146-03-10 07:30:41,,"['HCT stable overnight.  PLT decreased to < 30, so patient was given 1u', 'Platelets.', 'Patient did not tolerate RSBI trial, became tachypneic to RR 40s.  No', 'SBT done.', 'HD done yesterday with removal of 1L fluid.']",,30659,123675.0
19,2146-03-10 14:09:09,,"['HCT stable overnight.  PLT decreased to < 30, so patient was given 1u', 'Platelets.', 'Patient did not tolerate RSBI trial, became tachypneic to RR 40s.  No', 'SBT done.', 'HD done yesterday with removal of 1L fluid.']",,30659,123675.0
20,2146-03-11 07:30:09,"['PARACENTESIS - At [**2146-3-10**] 03:50 PM', 'Pigtail drain placed.', '2L drained at the time of placement, then 600cc/3hours were drained (2x', 'overnight)', 'Received 50g albumin IV x 1 last night, and another dose this morning.', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2146-3-11**] 12:24 AM', 'pt pulled out ett and ngt', ""Received 4 units platelets, 1 unit pRBC's overnight; with pigtail,"", 'received 2 units FFP, 1 unit platelets and ddAVP.']","['PARACENTESIS - At [**2146-3-10**] 03:50 PM', 'Pigtail drain placed.', '2L drained at the time of placement, then 600cc/3hours were drained (2x', 'overnight)', 'Received 50g albumin IV x 1 last night, and another dose this morning.', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2146-3-11**] 12:24 AM', 'pt pulled out ett and ngt', ""Received 4 units platelets, 1 unit pRBC's overnight; with pigtail,"", 'received 2 units FFP, 1 unit platelets and ddAVP.']","['HCT stable overnight.  PLT decreased to < 30, so patient was given 1u', 'Platelets.', 'Patient did not tolerate RSBI trial, became tachypneic to RR 40s.  No', 'SBT done.', 'HD done yesterday with removal of 1L fluid.']",30659,123675.0
21,2146-03-11 20:38:34,,"['PARACENTESIS - At [**2146-3-10**] 03:50 PM', 'Pigtail drain placed.', '2L drained at the time of placement, then 600cc/3hours were drained (2x', 'overnight)', 'Received 50g albumin IV x 1 last night, and another dose this morning.', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2146-3-11**] 12:24 AM', 'pt pulled out ett and ngt', ""Received 4 units platelets, 1 unit pRBC's overnight; with pigtail,"", 'received 2 units FFP, 1 unit platelets and ddAVP.']",,30659,123675.0
22,2146-03-12 07:53:03,['History obtained from [**Hospital 85**] Medical records'],['History obtained from [**Hospital 85**] Medical records'],"['PARACENTESIS - At [**2146-3-10**] 03:50 PM', 'Pigtail drain placed.', '2L drained at the time of placement, then 600cc/3hours were drained (2x', 'overnight)', 'Received 50g albumin IV x 1 last night, and another dose this morning.', ' UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2146-3-11**] 12:24 AM', 'pt pulled out ett and ngt', ""Received 4 units platelets, 1 unit pRBC's overnight; with pigtail,"", 'received 2 units FFP, 1 unit platelets and ddAVP.']",30659,123675.0
23,2146-03-12 08:01:03,"['HCT stable overnight. Pigtail catheter removed. Pt had NG placed', 'yesterday am but pt self-dc', 'd it last pm. Over course of yesterday', 'received 2 PRBC, 2 FFP, 4 Plt', 'Mental status overall improved']","['HCT stable overnight. Pigtail catheter removed. Pt had NG placed', 'yesterday am but pt self-dc', 'd it last pm. Over course of yesterday', 'received 2 PRBC, 2 FFP, 4 Plt', 'Mental status overall improved', 'History obtained from [**Hospital 85**] Medical records']",,30659,123675.0
24,2146-03-12 11:14:08,,"['HCT stable overnight. Pigtail catheter removed. Pt had NG placed', 'yesterday am but pt self-dc', 'd it last pm. Over course of yesterday', 'received 2 PRBC, 2 FFP, 4 Plt', 'Mental status overall improved', 'History obtained from [**Hospital 85**] Medical records']",,30659,123675.0
25,2146-03-12 12:53:10,,"['HCT stable overnight. Pigtail catheter removed. Pt had NG placed', 'yesterday am but pt self-dc', 'd it last pm. Over course of yesterday', 'received 2 PRBC, 2 FFP, 4 Plt', 'Mental status overall improved', 'History obtained from [**Hospital 85**] Medical records']",,30659,123675.0
26,2146-03-13 07:32:07,"['NGT placed yesterday with no complication - restarted lactulose.', 'HCT, PLT, INR stable overnight']","['NGT placed yesterday with no complication - restarted lactulose.', 'HCT, PLT, INR stable overnight']","['HCT stable overnight. Pigtail catheter removed. Pt had NG placed', 'yesterday am but pt self-dc', 'd it last pm. Over course of yesterday', 'received 2 PRBC, 2 FFP, 4 Plt', 'Mental status overall improved', 'History obtained from [**Hospital 85**] Medical records']",30659,123675.0
27,2146-03-13 12:55:24,,"['NGT placed yesterday with no complication - restarted lactulose.', 'HCT, PLT, INR stable overnight']",,30659,123675.0
28,2146-03-14 07:07:05,"['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']","['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']","['NGT placed yesterday with no complication - restarted lactulose.', 'HCT, PLT, INR stable overnight']",30659,123675.0
29,2146-03-14 07:08:16,,"['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']",,30659,123675.0
30,2146-03-14 07:10:55,"['NGT in place, tolerate TF', 's until the evening yesterday, then had high', 'residuals']","['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", 'NGT in place, tolerate TF', 's until the evening yesterday, then had high', 'residuals', ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']",,30659,123675.0
31,2146-03-14 12:00:13,,"['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", 'NGT in place, tolerate TF', 's until the evening yesterday, then had high', 'residuals', ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']",,30659,123675.0
32,2146-03-14 12:06:09,,"['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", 'NGT in place, tolerate TF', 's until the evening yesterday, then had high', 'residuals', ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']",,30659,123675.0
33,2146-03-15 07:32:42,"['BLOOD CULTURED - At [**2146-3-14**] 11:30 AM', 'peripheral stick.', ' STOOL CULTURE - At [**2146-3-14**] 11:30 AM', ' ULTRASOUND - At [**2146-3-14**] 02:00 PM', 'Off unit to US for US guided paracentesis.  Ascites fluid sent for', 'cx/labs.', ' BLOOD CULTURED - At [**2146-3-14**] 03:30 PM', 'including fungal and x2bottles. Drawn from HD line.', 'The patient underwent US guided paracentesis yest with 3L taken off', 'Received HD last pm', 'HCT stable', 'Started on caspofungin/vanc/meropenem for fever spike']","['BLOOD CULTURED - At [**2146-3-14**] 11:30 AM', 'peripheral stick.', ' STOOL CULTURE - At [**2146-3-14**] 11:30 AM', ' ULTRASOUND - At [**2146-3-14**] 02:00 PM', 'Off unit to US for US guided paracentesis.  Ascites fluid sent for', 'cx/labs.', ' BLOOD CULTURED - At [**2146-3-14**] 03:30 PM', 'including fungal and x2bottles. Drawn from HD line.', 'The patient underwent US guided paracentesis yest with 3L taken off', 'Received HD last pm', 'HCT stable', 'Started on caspofungin/vanc/meropenem for fever spike']","['patient spiked to 101 overnight. Sampled ascites (from drain, not new', 'puncture), blood, urine. CXR this AM. Started vanco yesterday before', 'spike, out of concern of open para sites; meropenem started overnight', 'for empiric coverage of aspiration pna vs. GI source.', 'Growing budding yeast from ascites - but will likely need new sterile', ""paracentesis to be sure that that's not a contaminant."", 'NGT in place, tolerate TF', 's until the evening yesterday, then had high', 'residuals', ' BLOOD CULTURED - At [**2146-3-13**] 08:23 PM', 'RIJ CVL', ' URINE CULTURE - At [**2146-3-13**] 09:00 PM']",30659,123675.0
34,2146-03-15 12:58:04,,"['BLOOD CULTURED - At [**2146-3-14**] 11:30 AM', 'peripheral stick.', ' STOOL CULTURE - At [**2146-3-14**] 11:30 AM', ' ULTRASOUND - At [**2146-3-14**] 02:00 PM', 'Off unit to US for US guided paracentesis.  Ascites fluid sent for', 'cx/labs.', ' BLOOD CULTURED - At [**2146-3-14**] 03:30 PM', 'including fungal and x2bottles. Drawn from HD line.', 'The patient underwent US guided paracentesis yest with 3L taken off', 'Received HD last pm', 'HCT stable', 'Started on caspofungin/vanc/meropenem for fever spike']",,30659,123675.0
35,2146-03-24 06:52:55,"['[**3-23**] Events:', '- lactulose PR and PO started', '- art line placed with mod low SBPs in 80s-90s', '- continues to have severe AMS, responds to simple commands only', ' DIALYSIS CATHETER - START [**2146-3-23**] 01:30 PM', ' BLOOD CULTURED - At [**2146-3-23**] 03:20 PM', ' NASAL SWAB - At [**2146-3-23**] 03:20 PM', ' ARTERIAL LINE - START [**2146-3-23**] 11:31 PM']","['[**3-23**] Events:', '- lactulose PR and PO started', '- art line placed with mod low SBPs in 80s-90s', '- continues to have severe AMS, responds to simple commands only', ' DIALYSIS CATHETER - START [**2146-3-23**] 01:30 PM', ' BLOOD CULTURED - At [**2146-3-23**] 03:20 PM', ' NASAL SWAB - At [**2146-3-23**] 03:20 PM', ' ARTERIAL LINE - START [**2146-3-23**] 11:31 PM']","['BLOOD CULTURED - At [**2146-3-14**] 11:30 AM', 'peripheral stick.', ' STOOL CULTURE - At [**2146-3-14**] 11:30 AM', ' ULTRASOUND - At [**2146-3-14**] 02:00 PM', 'Off unit to US for US guided paracentesis.  Ascites fluid sent for', 'cx/labs.', ' BLOOD CULTURED - At [**2146-3-14**] 03:30 PM', 'including fungal and x2bottles. Drawn from HD line.', 'The patient underwent US guided paracentesis yest with 3L taken off', 'Received HD last pm', 'HCT stable', 'Started on caspofungin/vanc/meropenem for fever spike']",30659,123675.0
36,2146-03-24 06:56:45,,"['[**3-23**] Events:', '- lactulose PR and PO started', '- art line placed with mod low SBPs in 80s-90s', '- continues to have severe AMS, responds to simple commands only', ' DIALYSIS CATHETER - START [**2146-3-23**] 01:30 PM', ' BLOOD CULTURED - At [**2146-3-23**] 03:20 PM', ' NASAL SWAB - At [**2146-3-23**] 03:20 PM', ' ARTERIAL LINE - START [**2146-3-23**] 11:31 PM']",,30659,123675.0
37,2146-03-24 10:46:07,,"['[**3-23**] Events:', '- lactulose PR and PO started', '- art line placed with mod low SBPs in 80s-90s', '- continues to have severe AMS, responds to simple commands only', ' DIALYSIS CATHETER - START [**2146-3-23**] 01:30 PM', ' BLOOD CULTURED - At [**2146-3-23**] 03:20 PM', ' NASAL SWAB - At [**2146-3-23**] 03:20 PM', ' ARTERIAL LINE - START [**2146-3-23**] 11:31 PM']",,30659,123675.0
38,2146-03-25 07:18:30,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt', '- ascites fluid c/w SBP by PMNs but gram stain negative', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']","['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt', '- ascites fluid c/w SBP by PMNs but gram stain negative', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']","['[**3-23**] Events:', '- lactulose PR and PO started', '- art line placed with mod low SBPs in 80s-90s', '- continues to have severe AMS, responds to simple commands only', ' DIALYSIS CATHETER - START [**2146-3-23**] 01:30 PM', ' BLOOD CULTURED - At [**2146-3-23**] 03:20 PM', ' NASAL SWAB - At [**2146-3-23**] 03:20 PM', ' ARTERIAL LINE - START [**2146-3-23**] 11:31 PM']",30659,123675.0
39,2146-03-25 07:18:57,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt', '- ascites fluid c/w SBP by PMNs but gram stain negative', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
40,2146-03-25 07:19:26,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt', '- ascites fluid c/w SBP by PMNs but gram stain negative', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
41,2146-03-25 14:19:31,"['required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine']","['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']","['required small dose neo gtt', '- ascites fluid c/w SBP by PMNs but gram stain negative']",30659,123675.0
42,2146-03-25 16:49:09,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
43,2146-03-25 17:09:17,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
44,2146-03-25 17:33:36,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
45,2146-03-25 18:31:57,,"['PAN CULTURE - At [**2146-3-24**] 09:50 AM', ' PARACENTESIS - At [**2146-3-24**] 04:24 PM', ' MULTI LUMEN - START [**2146-3-24**] 05:05 PM', ' BLOOD CULTURED - At [**2146-3-25**] 03:55 AM', '[**3-24**] Events:', '- diagnostic and therapeutic para -> 4L off, given 30g albumin,', 'required small dose neo gtt (bladder pressures from 30 to 23)', 'Gave lactulose edema, now having bowel movements', '- ascites fluid c/w SBP by PMNs but gram stain negative, increased dose', 'of mitrodrine', '- placed R IJ', '- intermittently hypotensive (fluid responsive) overnight', '- CVP and central venous O2 adequate', '- remained anuric']",,30659,123675.0
0,2191-11-18 07:31:28,,"['Continues to have frequent PVCs, in ventricular bigemeny on tele.']",,11538,198510.0
1,2191-11-18 11:19:29,,"['Continues to have frequent PVCs, in ventricular bigemeny on tele.']",,11538,198510.0
2,2191-11-19 07:15:36,"['- ECHO: EF 20%, severe global LV hypokinesis', '- Amio gtt switched to 400mg PO TID (received 555mg IV)', '- started Metoprolol 25mg PO TID', '- 12p mildly hypotensive with mild lightheadedness: 250cc bolus NS', '- hold on EP studies for now']","['- ECHO: EF 20%, severe global LV hypokinesis', '- Amio gtt switched to 400mg PO TID (received 555mg IV)', '- started Metoprolol 25mg PO TID', '- 12p mildly hypotensive with mild lightheadedness: 250cc bolus NS', '- hold on EP studies for now']","['Continues to have frequent PVCs, in ventricular bigemeny on tele.']",11538,198510.0
3,2191-11-19 10:24:34,,"['- ECHO: EF 20%, severe global LV hypokinesis', '- Amio gtt switched to 400mg PO TID (received 555mg IV)', '- started Metoprolol 25mg PO TID', '- 12p mildly hypotensive with mild lightheadedness: 250cc bolus NS', '- hold on EP studies for now']",,11538,198510.0
0,2139-03-04 07:09:10,,"['History obtained from Patient, Family / [**Hospital 75**] Medical records']",,66069,165068.0
1,2139-03-04 07:11:34,,"['History obtained from Patient, Family / [**Hospital 75**] Medical records']",,66069,165068.0
2,2139-03-04 11:27:52,['No overnight events.'],"['No overnight events.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",,66069,165068.0
3,2139-03-04 13:34:43,,"['No overnight events.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",,66069,165068.0
4,2139-03-04 20:33:24,,"['No overnight events.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",,66069,165068.0
5,2139-03-05 07:28:16,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']","['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']","['No overnight events.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",66069,165068.0
6,2139-03-05 07:31:02,,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']",,66069,165068.0
7,2139-03-05 07:40:52,,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']",,66069,165068.0
8,2139-03-05 07:56:01,,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']",,66069,165068.0
9,2139-03-05 12:40:49,,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']",,66069,165068.0
10,2139-03-05 12:57:16,,"['EKG - At [**2139-3-4**] 02:51 PM', ' URINE CULTURE - At [**2139-3-4**] 09:14 PM', '[**3-4**]', '- EGD on [**3-5**], NPO pm', '- hct stable']",,66069,165068.0
0,2172-10-23 07:15:18,,"['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",,55575,108289.0
1,2172-10-23 07:16:22,,"['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",,55575,108289.0
2,2172-10-23 12:18:40,,"['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",,55575,108289.0
3,2172-10-23 12:45:58,,"['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",,55575,108289.0
4,2172-10-23 12:53:57,,"['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",,55575,108289.0
5,2172-10-24 07:47:02,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']","['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']","['-EGD showed friability at site of anastamosis which was injected and', 'blood in stomach.  Varices were noted in the lower third of the', 'esophagus.', '- GI recommending repeat EGD with EUS when bleeding stops to evaluate', 'for ulcers', '- could not get PICC due to long line for PICC', '- octreotide drip stopped because there was no evidence of bleeding', 'varices', '- GI recommended checking a gastrin level', '- Hct 31.1 --> 28.8 --> 1 unit PRBCs --> 30.5 --> 29.0 --> 1 unit PRBCs', '- Hypernatremia improved with D5W 151 --> 147', '- Echo performed: Normal global biventricular systolic function.', 'Limited study', '- iron studies show iron deficiency anemia so started on iron', 'supplements', '*will need PICC placement or Left IJ today *']",55575,108289.0
6,2172-10-24 07:48:09,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
7,2172-10-24 07:59:08,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
8,2172-10-24 09:19:37,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
9,2172-10-24 09:22:50,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
10,2172-10-24 12:39:42,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
11,2172-10-24 12:51:36,,"['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",,55575,108289.0
12,2172-10-25 07:34:20,"['- Surgery: no plan for surgical intervention, likely trauma from first', 'EGD.  Rec fluconazole and zosyn (continued).', '- Hct stable 32.1 --> 32.3 -->  32.6', '- Na improved 146 --> 143 --> 142', '- PPI changed from gtt to bolus IV BID.', '- PIVs: 18g x 2 in right arm placed and blown', '- UE ultrasound for LUE swelling: extensive clot burden including R SC', 'clot, bilat brachial clots.  OSH Right RIJ still in place.']","['- Surgery: no plan for surgical intervention, likely trauma from first', 'EGD.  Rec fluconazole and zosyn (continued).', '- Hct stable 32.1 --> 32.3 -->  32.6', '- Na improved 146 --> 143 --> 142', '- PPI changed from gtt to bolus IV BID.', '- PIVs: 18g x 2 in right arm placed and blown', '- UE ultrasound for LUE swelling: extensive clot burden including R SC', 'clot, bilat brachial clots.  OSH Right RIJ still in place.']","['Bedside PICC could not be placed', 'Attempted LIJ without success, would not thread, kept OSH RIJ, PICC to', 'be placed over weekend into Monday', 'KUB did not show free air', 'CT abd with PO contrast - ""free air in mesentary"" - called surgery', 'consult, started iv fluc and zosyn for possible extravasation of PO', 'contrast into abdomen', 'Sent off SPEP/UPEP for low anion gap', 'OSH ct scan taken down to radiology, logged into computer', 'HCT stable at 32 --> 30 --> 32 PM of [**10-23**] into am [**10-24**]']",55575,108289.0
13,2172-10-25 07:37:07,,"['- Surgery: no plan for surgical intervention, likely trauma from first', 'EGD.  Rec fluconazole and zosyn (continued).', '- Hct stable 32.1 --> 32.3 -->  32.6', '- Na improved 146 --> 143 --> 142', '- PPI changed from gtt to bolus IV BID.', '- PIVs: 18g x 2 in right arm placed and blown', '- UE ultrasound for LUE swelling: extensive clot burden including R SC', 'clot, bilat brachial clots.  OSH Right RIJ still in place.']",,55575,108289.0
14,2172-10-25 12:22:59,,"['- Surgery: no plan for surgical intervention, likely trauma from first', 'EGD.  Rec fluconazole and zosyn (continued).', '- Hct stable 32.1 --> 32.3 -->  32.6', '- Na improved 146 --> 143 --> 142', '- PPI changed from gtt to bolus IV BID.', '- PIVs: 18g x 2 in right arm placed and blown', '- UE ultrasound for LUE swelling: extensive clot burden including R SC', 'clot, bilat brachial clots.  OSH Right RIJ still in place.']",,55575,108289.0
15,2172-10-27 10:16:56,"['Code blue called at 930am after patient experienced substernal chest', 'pain, [**4-18**], was diaphoretic, sweaty, and clammy, sbp 140/90, hr 180.']","['Code blue called at 930am after patient experienced substernal chest', 'pain, [**4-18**], was diaphoretic, sweaty, and clammy, sbp 140/90, hr 180.']","['- Surgery: no plan for surgical intervention, likely trauma from first', 'EGD.  Rec fluconazole and zosyn (continued).', '- Hct stable 32.1 --> 32.3 -->  32.6', '- Na improved 146 --> 143 --> 142', '- PPI changed from gtt to bolus IV BID.', '- PIVs: 18g x 2 in right arm placed and blown', '- UE ultrasound for LUE swelling: extensive clot burden including R SC', 'clot, bilat brachial clots.  OSH Right RIJ still in place.']",55575,108289.0
16,2172-10-27 10:36:08,"['Patient was given 5 of lopressor IV and nitroglycerin x 2.  Chest pain', 'resolved and HR timproved to 70s.', 'Since discharge from MICU, patient had PICC placed.  Right IJ was', 'pulled.  Hct was stable.  He was not started on TPN.']","['Code blue called at 930am after patient experienced substernal chest', 'pain, [**4-18**], was diaphoretic, sweaty, and clammy, sbp 140/90, hr 180.', 'Patient was given 5 of lopressor IV and nitroglycerin x 2.  Chest pain', 'resolved and HR timproved to 70s.', 'Since discharge from MICU, patient had PICC placed.  Right IJ was', 'pulled.  Hct was stable.  He was not started on TPN.']",,55575,108289.0
17,2172-10-27 10:56:27,"['Mr. [**Known lastname 2275**] is well known to the MICU green team.  He was admitted', 'initially for GI bleed at anastamosis site of prior Bilroth surgery.', 'He required 3 units PRBCs but remained hemodynamically stable.  He was', 'called out to CC7 two days ago. Since discharge from MICU, patient had', 'PICC placed.  Right IJ was pulled.  Hct was stable.  He was not started', 'on TPN.', 'Prior to Code Blue, patient was lying in bed.  He developed sudden', 'substernal crushing chest pain and was noted to be diaphoretic, cool.', 'He was noted to have A. fib with RVR.  A code blue was called at 9:30', 'AM.  He was given NGLx2 with improvement of chest pain.  He was given', 'Lopressor 5 IV x 1 and HR improved to 70s.', 'He remained', 'hemodynamically stable and did not loose a pulse during the event.', 'When patient was asked about his code status, he reversed his DNR/DNI.']","['Mr. [**Known lastname 2275**] is well known to the MICU green team.  He was admitted', 'initially for GI bleed at anastamosis site of prior Bilroth surgery.', 'He required 3 units PRBCs but remained hemodynamically stable.  He was', 'called out to CC7 two days ago. Since discharge from MICU, patient had', 'PICC placed.  Right IJ was pulled.  Hct was stable.  He was not started', 'on TPN.', 'Prior to Code Blue, patient was lying in bed.  He developed sudden', 'substernal crushing chest pain and was noted to be diaphoretic, cool.', 'He was noted to have A. fib with RVR.  A code blue was called at 9:30', 'AM.  He was given NGLx2 with improvement of chest pain.  He was given', 'Lopressor 5 IV x 1 and HR improved to 70s.', 'He remained', 'hemodynamically stable and did not loose a pulse during the event.', 'When patient was asked about his code status, he reversed his DNR/DNI.']","['Code blue called at 930am after patient experienced substernal chest', 'pain, [**4-18**], was diaphoretic, sweaty, and clammy, sbp 140/90, hr 180.', 'Patient was given 5 of lopressor IV and nitroglycerin x 2.  Chest pain', 'resolved and HR timproved to 70s.', 'Since discharge from MICU, patient had PICC placed.  Right IJ was', 'pulled.  Hct was stable.  He was not started on TPN.']",55575,108289.0
18,2172-10-27 13:14:46,,"['Mr. [**Known lastname 2275**] is well known to the MICU green team.  He was admitted', 'initially for GI bleed at anastamosis site of prior Bilroth surgery.', 'He required 3 units PRBCs but remained hemodynamically stable.  He was', 'called out to CC7 two days ago. Since discharge from MICU, patient had', 'PICC placed.  Right IJ was pulled.  Hct was stable.  He was not started', 'on TPN.', 'Prior to Code Blue, patient was lying in bed.  He developed sudden', 'substernal crushing chest pain and was noted to be diaphoretic, cool.', 'He was noted to have A. fib with RVR.  A code blue was called at 9:30', 'AM.  He was given NGLx2 with improvement of chest pain.  He was given', 'Lopressor 5 IV x 1 and HR improved to 70s.', 'He remained', 'hemodynamically stable and did not loose a pulse during the event.', 'When patient was asked about his code status, he reversed his DNR/DNI.']",,55575,108289.0
19,2172-10-27 15:45:32,,"['Mr. [**Known lastname 2275**] is well known to the MICU green team.  He was admitted', 'initially for GI bleed at anastamosis site of prior Bilroth surgery.', 'He required 3 units PRBCs but remained hemodynamically stable.  He was', 'called out to CC7 two days ago. Since discharge from MICU, patient had', 'PICC placed.  Right IJ was pulled.  Hct was stable.  He was not started', 'on TPN.', 'Prior to Code Blue, patient was lying in bed.  He developed sudden', 'substernal crushing chest pain and was noted to be diaphoretic, cool.', 'He was noted to have A. fib with RVR.  A code blue was called at 9:30', 'AM.  He was given NGLx2 with improvement of chest pain.  He was given', 'Lopressor 5 IV x 1 and HR improved to 70s.', 'He remained', 'hemodynamically stable and did not loose a pulse during the event.', 'When patient was asked about his code status, he reversed his DNR/DNI.']",,55575,108289.0
20,2172-10-28 07:53:51,"['- Access nightmare.', '- After much to-do, had PICC exchanged for a neater one with peripheral', 'port.', '- CTA prelim read with small subsegmental bilateral PEs; also some', 'peripheral parenchymal opacities, unclear etiology.', '- SVC filter placed.  No heparin gtt.', ""- Enzymes flat thus far; this AM's pending."", '- Weaned off nitro.', '- Actually brady to high 40s while asleep.']","['- Access nightmare.', '- After much to-do, had PICC exchanged for a neater one with peripheral', 'port.', '- CTA prelim read with small subsegmental bilateral PEs; also some', 'peripheral parenchymal opacities, unclear etiology.', '- SVC filter placed.  No heparin gtt.', ""- Enzymes flat thus far; this AM's pending."", '- Weaned off nitro.', '- Actually brady to high 40s while asleep.']","['Mr. [**Known lastname 2275**] is well known to the MICU green team.  He was admitted', 'initially for GI bleed at anastamosis site of prior Bilroth surgery.', 'He required 3 units PRBCs but remained hemodynamically stable.  He was', 'called out to CC7 two days ago. Since discharge from MICU, patient had', 'PICC placed.  Right IJ was pulled.  Hct was stable.  He was not started', 'on TPN.', 'Prior to Code Blue, patient was lying in bed.  He developed sudden', 'substernal crushing chest pain and was noted to be diaphoretic, cool.', 'He was noted to have A. fib with RVR.  A code blue was called at 9:30', 'AM.  He was given NGLx2 with improvement of chest pain.  He was given', 'Lopressor 5 IV x 1 and HR improved to 70s.', 'He remained', 'hemodynamically stable and did not loose a pulse during the event.', 'When patient was asked about his code status, he reversed his DNR/DNI.']",55575,108289.0
21,2172-10-28 07:54:57,,"['- Access nightmare.', '- After much to-do, had PICC exchanged for a neater one with peripheral', 'port.', '- CTA prelim read with small subsegmental bilateral PEs; also some', 'peripheral parenchymal opacities, unclear etiology.', '- SVC filter placed.  No heparin gtt.', ""- Enzymes flat thus far; this AM's pending."", '- Weaned off nitro.', '- Actually brady to high 40s while asleep.']",,55575,108289.0
22,2172-10-28 14:09:44,['- had PICC exchanged for a power picc'],"['- had PICC exchanged for a power picc', '- CTA prelim read with small subsegmental bilateral PEs; also some', 'peripheral parenchymal opacities, unclear etiology.', '- SVC filter placed.  No heparin gtt.', ""- Enzymes flat thus far; this AM's pending."", '- Weaned off nitro.', '- Actually brady to high 40s while asleep.']","['- Access nightmare.', '- After much to-do, had PICC exchanged for a neater one with peripheral', 'port.']",55575,108289.0
23,2172-10-29 08:07:37,"['Had maroon colored stools and hct drop, so i kept him for the night.', 'Repeat Hct was not significantly down.']","['Had maroon colored stools and hct drop, so i kept him for the night.', 'Repeat Hct was not significantly down.']","['- had PICC exchanged for a power picc', '- CTA prelim read with small subsegmental bilateral PEs; also some', 'peripheral parenchymal opacities, unclear etiology.', '- SVC filter placed.  No heparin gtt.', ""- Enzymes flat thus far; this AM's pending."", '- Weaned off nitro.', '- Actually brady to high 40s while asleep.']",55575,108289.0
24,2172-10-29 08:08:34,,"['Had maroon colored stools and hct drop, so i kept him for the night.', 'Repeat Hct was not significantly down.']",,55575,108289.0
25,2172-10-29 11:49:25,,"['Had maroon colored stools and hct drop, so i kept him for the night.', 'Repeat Hct was not significantly down.']",,55575,108289.0
26,2172-10-30 07:52:30,"['ENDOSCOPY - At [**2172-10-29**] 06:04 PM', '- EGD by GI for assessment of GIB - no varices identified, otherwise', 'clean scope.  Plan for c-scope within next two days.', '- hct trend 26.9 --> scope --> 26 --> 29']","['ENDOSCOPY - At [**2172-10-29**] 06:04 PM', '- EGD by GI for assessment of GIB - no varices identified, otherwise', 'clean scope.  Plan for c-scope within next two days.', '- hct trend 26.9 --> scope --> 26 --> 29']","['Had maroon colored stools and hct drop, so i kept him for the night.', 'Repeat Hct was not significantly down.']",55575,108289.0
27,2172-10-30 07:53:12,,"['ENDOSCOPY - At [**2172-10-29**] 06:04 PM', '- EGD by GI for assessment of GIB - no varices identified, otherwise', 'clean scope.  Plan for c-scope within next two days.', '- hct trend 26.9 --> scope --> 26 --> 29']",,55575,108289.0
28,2172-10-30 08:08:35,,"['ENDOSCOPY - At [**2172-10-29**] 06:04 PM', '- EGD by GI for assessment of GIB - no varices identified, otherwise', 'clean scope.  Plan for c-scope within next two days.', '- hct trend 26.9 --> scope --> 26 --> 29']",,55575,108289.0
29,2172-10-30 11:45:07,"['Feels well, no complaints.  Denies abdominal, chest pain.']","['ENDOSCOPY - At [**2172-10-29**] 06:04 PM', '- EGD by GI for assessment of GIB - no varices identified, otherwise', 'clean scope.  Plan for c-scope within next two days.', '- hct trend 26.9 --> scope --> 26 --> 29', 'Feels well, no complaints.  Denies abdominal, chest pain.']",,55575,108289.0
0,2163-03-10 08:02:48,,"['Continued to have retching overnight; put in restraints b/c pulling at', 'NG tube', 'Labetalol gtt stopped b/c BP down to 130s']",,384,122988.0
1,2163-03-10 10:30:01,,"['Continued to have retching overnight; put in restraints b/c pulling at', 'NG tube', 'Labetalol gtt stopped b/c BP down to 130s']",,384,122988.0
0,2161-02-02 06:47:42,,"['ENDOSCOPY - At [**2161-2-1**] 08:00 PM', 'received  a total of 5mcg fentanyl and 1mg versed', 'found visible vessel / DuelaFoy lesion - clipped.', 'Transfused a total of 5 units overnight', 'Currently feels much improved,', 'had a great night.', ' No LH, dizziness,', 'no SOB. No abd pain. Still having melena.']",,76932,172163.0
0,2108-08-13 06:48:25,,"['URINE CULTURE - At [**2108-8-12**] 11:05 PM', 'newly inserted foley', ' PHERESIS CATHETER - START [**2108-8-13**] 12:53 AM', 'placed with ultrasound, xray verified', 'Patient had plasmapheresis overnight.']",,58357,111327.0
1,2108-08-13 10:59:19,['Received first treatment of hydroxyurea overnight.'],"['URINE CULTURE - At [**2108-8-12**] 11:05 PM', 'newly inserted foley', ' PHERESIS CATHETER - START [**2108-8-13**] 12:53 AM', 'placed with ultrasound, xray verified', 'Patient had plasmapheresis overnight.', 'Received first treatment of hydroxyurea overnight.']",,58357,111327.0
2,2108-08-14 07:05:55,"['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx', '- received 1 unit of cryo']","['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx', '- received 1 unit of cryo']","['URINE CULTURE - At [**2108-8-12**] 11:05 PM', 'newly inserted foley', ' PHERESIS CATHETER - START [**2108-8-13**] 12:53 AM', 'placed with ultrasound, xray verified', 'Patient had plasmapheresis overnight.', 'Received first treatment of hydroxyurea overnight.']",58357,111327.0
3,2108-08-14 07:06:59,,"['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx', '- received 1 unit of cryo']",,58357,111327.0
4,2108-08-14 07:16:40,,"['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx', '- received 1 unit of cryo']",,58357,111327.0
5,2108-08-14 15:34:44,"['- spiked to 101 while receiving 2 units FFP, was panCx, then received 1', 'unit of cryo', '- patient complains of a sore throat']","['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx, then received 1', 'unit of cryo', '- patient complains of a sore throat']","['- spiked to 101 while receiving 2 units FFP, was panCx', '- received 1 unit of cryo']",58357,111327.0
6,2108-08-15 07:16:48,['No overnight events'],['No overnight events'],"['EKG - At [**2108-8-13**] 10:09 AM', ' BLOOD CULTURED - At [**2108-8-13**] 11:33 PM', ' URINE CULTURE - At [**2108-8-13**] 11:33 PM', ' FEVER - 101.6', 'F - [**2108-8-14**] 12:00 AM', '- received Hydroxyurea 3000 mg PO TID x 1 day (total 9000mg)', '- spiked to 101 while receiving 2 units FFP, was panCx, then received 1', 'unit of cryo', '- patient complains of a sore throat']",58357,111327.0
7,2108-08-15 14:37:10,"['This morning, the patient complains of confusion at times.', 'The patient also complains of a non-productive cough with a tingling in', 'the back of his throat.', 'Has had a poor appetite with low PO intake.', 'No n/v/chest pain/reports of SOB/dizziness.']","['No overnight events', 'This morning, the patient complains of confusion at times.', 'The patient also complains of a non-productive cough with a tingling in', 'the back of his throat.', 'Has had a poor appetite with low PO intake.', 'No n/v/chest pain/reports of SOB/dizziness.']",,58357,111327.0
8,2108-08-15 14:38:17,,"['No overnight events', 'This morning, the patient complains of confusion at times.', 'The patient also complains of a non-productive cough with a tingling in', 'the back of his throat.', 'Has had a poor appetite with low PO intake.', 'No n/v/chest pain/reports of SOB/dizziness.']",,58357,111327.0
9,2108-08-15 15:02:30,,"['No overnight events', 'This morning, the patient complains of confusion at times.', 'The patient also complains of a non-productive cough with a tingling in', 'the back of his throat.', 'Has had a poor appetite with low PO intake.', 'No n/v/chest pain/reports of SOB/dizziness.']",,58357,111327.0
0,2169-11-24 06:36:27,,[],,66256,166051.0
0,2169-11-30 06:55:49,,['No overnight events.'],,66256,187869.0
1,2169-11-30 07:38:52,"['The patient was weaned off the dilt gtt and remained in NSR.', 'This am she continues to have [**4-25**] pleuritic back and rib pain,', 'epecially with coughing.  Denies SOB.']","['The patient was weaned off the dilt gtt and remained in NSR.', 'This am she continues to have [**4-25**] pleuritic back and rib pain,', 'epecially with coughing.  Denies SOB.']",['No overnight events.'],66256,187869.0
2,2169-11-30 07:52:20,,"['The patient was weaned off the dilt gtt and remained in NSR.', 'This am she continues to have [**4-25**] pleuritic back and rib pain,', 'epecially with coughing.  Denies SOB.']",,66256,187869.0
3,2169-11-30 09:11:22,,"['The patient was weaned off the dilt gtt and remained in NSR.', 'This am she continues to have [**4-25**] pleuritic back and rib pain,', 'epecially with coughing.  Denies SOB.']",,66256,187869.0
0,2103-01-18 07:13:23,,"['EKG - At [**2103-1-17**] 07:45 PM', ' EKG - At [**2103-1-18**] 04:00 AM', '- two episodes of chest pain 1 am and 4am. To [**6-21**], down to 3/10 with', '1mg morphine. EKG at 0419 essentially unchanged with improved TWI in', 'V1/V2 and marginal deepening of TWI in V4', '- 1mg morphine given prn and patient  requesting q3-4 hours', '- patient had one dose of xanax 0.5mg to little effect, also very', 'anxious', 'History obtained from [**Hospital 31**] Medical records']",,53341,158856.0
1,2103-01-18 08:42:43,,"['EKG - At [**2103-1-17**] 07:45 PM', ' EKG - At [**2103-1-18**] 04:00 AM', '- two episodes of chest pain 1 am and 4am. To [**6-21**], down to 3/10 with', '1mg morphine. EKG at 0419 essentially unchanged with improved TWI in', 'V1/V2 and marginal deepening of TWI in V4', '- 1mg morphine given prn and patient  requesting q3-4 hours', '- patient had one dose of xanax 0.5mg to little effect, also very', 'anxious', 'History obtained from [**Hospital 31**] Medical records']",,53341,158856.0
2,2103-01-19 06:36:30,"['CARDIAC CATH - At [**2103-1-18**] 12:00 PM', ' EKG - At [**2103-1-18**] 03:45 PM', 'with 4/10 CP-CCU Team aware', '- cath showed stable coronary disease, no intervention', '- has persistent chest pain, no EKG changes, non-cardiac in nature.', 'given morphine', '- started on Atorvastatin 80mg daily, Dr. [**Last Name (STitle) 10288**] put her on simva 20,', 'no h/o myositis or muscle weakness on statin.  will d/c home with home', 'dose of simva 20 as lipid profile looking great', ""- nitro gtt d/c'd after cath, outpatient imdur and ramipril restarted"", '- Dow recs: can go home today, but if pt wants to stay, it is fine.', 'give PPI. --- gave pt zantac given she is on plavix.', ""- pt didn't want to leave today, so kept her, will d/c tomorrow""]","['CARDIAC CATH - At [**2103-1-18**] 12:00 PM', ' EKG - At [**2103-1-18**] 03:45 PM', 'with 4/10 CP-CCU Team aware', '- cath showed stable coronary disease, no intervention', '- has persistent chest pain, no EKG changes, non-cardiac in nature.', 'given morphine', '- started on Atorvastatin 80mg daily, Dr. [**Last Name (STitle) 10288**] put her on simva 20,', 'no h/o myositis or muscle weakness on statin.  will d/c home with home', 'dose of simva 20 as lipid profile looking great', ""- nitro gtt d/c'd after cath, outpatient imdur and ramipril restarted"", '- Dow recs: can go home today, but if pt wants to stay, it is fine.', 'give PPI. --- gave pt zantac given she is on plavix.', ""- pt didn't want to leave today, so kept her, will d/c tomorrow""]","['EKG - At [**2103-1-17**] 07:45 PM', ' EKG - At [**2103-1-18**] 04:00 AM', '- two episodes of chest pain 1 am and 4am. To [**6-21**], down to 3/10 with', '1mg morphine. EKG at 0419 essentially unchanged with improved TWI in', 'V1/V2 and marginal deepening of TWI in V4', '- 1mg morphine given prn and patient  requesting q3-4 hours', '- patient had one dose of xanax 0.5mg to little effect, also very', 'anxious', 'History obtained from [**Hospital 31**] Medical records']",53341,158856.0
3,2103-01-19 07:06:04,,"['CARDIAC CATH - At [**2103-1-18**] 12:00 PM', ' EKG - At [**2103-1-18**] 03:45 PM', 'with 4/10 CP-CCU Team aware', '- cath showed stable coronary disease, no intervention', '- has persistent chest pain, no EKG changes, non-cardiac in nature.', 'given morphine', '- started on Atorvastatin 80mg daily, Dr. [**Last Name (STitle) 10288**] put her on simva 20,', 'no h/o myositis or muscle weakness on statin.  will d/c home with home', 'dose of simva 20 as lipid profile looking great', ""- nitro gtt d/c'd after cath, outpatient imdur and ramipril restarted"", '- Dow recs: can go home today, but if pt wants to stay, it is fine.', 'give PPI. --- gave pt zantac given she is on plavix.', ""- pt didn't want to leave today, so kept her, will d/c tomorrow""]",,53341,158856.0
4,2103-01-19 11:36:47,,"['CARDIAC CATH - At [**2103-1-18**] 12:00 PM', ' EKG - At [**2103-1-18**] 03:45 PM', 'with 4/10 CP-CCU Team aware', '- cath showed stable coronary disease, no intervention', '- has persistent chest pain, no EKG changes, non-cardiac in nature.', 'given morphine', '- started on Atorvastatin 80mg daily, Dr. [**Last Name (STitle) 10288**] put her on simva 20,', 'no h/o myositis or muscle weakness on statin.  will d/c home with home', 'dose of simva 20 as lipid profile looking great', ""- nitro gtt d/c'd after cath, outpatient imdur and ramipril restarted"", '- Dow recs: can go home today, but if pt wants to stay, it is fine.', 'give PPI. --- gave pt zantac given she is on plavix.', ""- pt didn't want to leave today, so kept her, will d/c tomorrow""]",,53341,158856.0
0,2104-01-17 07:17:51,,"['- FS 206 after initiating insulin gtt => started on D5 1/2 NS at 200', 'ccs/hr, FS in 100s.', '- restarted 18 U Lantus + HISS at 9 pm w/ q2 FS', '- q4 lyte checks (gap 16, 15, 23) with FS < 200 => changed back to', 'insulin gtt', '- advance diet', '- sent serum urine tox due to continue lethargy', 'History obtained from Patient']",,86754,165305.0
1,2104-01-17 07:19:45,,"['- FS 206 after initiating insulin gtt => started on D5 1/2 NS at 200', 'ccs/hr, FS in 100s.', '- restarted 18 U Lantus + HISS at 9 pm w/ q2 FS', '- q4 lyte checks (gap 16, 15, 23) with FS < 200 => changed back to', 'insulin gtt', '- advance diet', '- sent serum urine tox due to continue lethargy', 'History obtained from Patient']",,86754,165305.0
2,2104-01-17 10:42:16,"['- tolerating POs', '- sent serum urine tox due to continue lethargy, which was negative']","['- FS 206 after initiating insulin gtt => started on D5 1/2 NS at 200', 'ccs/hr, FS in 100s.', '- restarted 18 U Lantus + HISS at 9 pm w/ q2 FS', '- q4 lyte checks (gap 16, 15, 23) with FS < 200 => changed back to', 'insulin gtt', '- tolerating POs', '- sent serum urine tox due to continue lethargy, which was negative', 'History obtained from Patient']","['- advance diet', '- sent serum urine tox due to continue lethargy']",86754,165305.0
3,2104-01-17 10:48:55,,"['- FS 206 after initiating insulin gtt => started on D5 1/2 NS at 200', 'ccs/hr, FS in 100s.', '- restarted 18 U Lantus + HISS at 9 pm w/ q2 FS', '- q4 lyte checks (gap 16, 15, 23) with FS < 200 => changed back to', 'insulin gtt', '- tolerating POs', '- sent serum urine tox due to continue lethargy, which was negative', 'History obtained from Patient']",,86754,165305.0
4,2104-01-17 10:50:06,,"['- FS 206 after initiating insulin gtt => started on D5 1/2 NS at 200', 'ccs/hr, FS in 100s.', '- restarted 18 U Lantus + HISS at 9 pm w/ q2 FS', '- q4 lyte checks (gap 16, 15, 23) with FS < 200 => changed back to', 'insulin gtt', '- tolerating POs', '- sent serum urine tox due to continue lethargy, which was negative', 'History obtained from Patient']",,86754,165305.0
0,2183-03-24 06:26:19,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
1,2183-03-24 06:27:15,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
2,2183-03-24 06:30:29,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
3,2183-03-24 06:34:45,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
4,2183-03-24 06:41:19,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
5,2183-03-24 11:00:41,,"['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",,58947,100037.0
6,2183-03-25 07:26:06,"['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']","['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']","['-received 2 units of platelets and 2 units of PRBCs', '-neuro exam stable']",58947,100037.0
7,2183-03-25 07:27:33,,"['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']",,58947,100037.0
8,2183-03-25 07:28:47,,"['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']",,58947,100037.0
9,2183-03-25 07:35:22,,"['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']",,58947,100037.0
10,2183-03-25 10:57:16,,"['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']",,58947,100037.0
11,2183-04-21 07:37:03,"['URINE CULTURE - At [**2183-4-20**] 09:09 PM', ' STOOL CULTURE - At [**2183-4-20**] 09:09 PM', ' EKG - At [**2183-4-21**] 06:20 AM']","['URINE CULTURE - At [**2183-4-20**] 09:09 PM', ' STOOL CULTURE - At [**2183-4-20**] 09:09 PM', ' EKG - At [**2183-4-21**] 06:20 AM']","['- spoke to hem-onc, prelim results look like APML, continuing ATRA', '- following DIC labs Q4H and maintaining platelets >80k bc head bleed', '- CT head: Interval increase in multicompartment hemorrhages with no', 'midline shift and no evidence of acute infarction.', '- MRI L spine: No evidence of acute spine injury within the cervical,', 'thoracic or lumbar spine. Note is made of a fluid level within the', 'lower lumbar spine, most consistent with layering subarachnoid blood.', '- send blood cultures', '- transfused platlets and blood (4 plts, 1 PRBC, 1 FFP)', '- neurosurg following']",58947,100037.0
12,2183-04-21 07:39:56,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative', '-Hct remained at 22 despite transfusion, transfused 1U PRBC', '-Narrow complex tachycardia, patient stable. Diltiazem 15mg IV']","['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative', '-Hct remained at 22 despite transfusion, transfused 1U PRBC', '-Narrow complex tachycardia, patient stable. Diltiazem 15mg IV']","['URINE CULTURE - At [**2183-4-20**] 09:09 PM', ' STOOL CULTURE - At [**2183-4-20**] 09:09 PM', ' EKG - At [**2183-4-21**] 06:20 AM']",58947,100037.0
13,2183-04-21 10:09:23,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']","['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']","['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative', '-Hct remained at 22 despite transfusion, transfused 1U PRBC', '-Narrow complex tachycardia, patient stable. Diltiazem 15mg IV']",58947,100037.0
14,2183-04-21 10:13:09,,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",,58947,100037.0
15,2183-04-21 10:15:51,,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",,58947,100037.0
16,2183-04-21 10:31:29,,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",,58947,100037.0
17,2183-04-21 11:38:04,,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",,58947,100037.0
18,2183-04-21 12:54:58,,"['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",,58947,100037.0
19,2183-04-23 07:54:02,"['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']","['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']","['-Hct decreased to 22, transfused 1U PRBC, DIC labs negative.', '-Hct remained at 22 despite transfusion, transfused 1U PRBC, repeat Hct', '26.', '-Narrow complex tachycardia from 140-160bpm concerning for afib vs MAT,', 'patient hemodynamically stable. Diltiazam 5mg then 10mg pushed.', 'Decreased to 120. Metoprolol 5mg IV pushed, return to NSR.']",58947,100037.0
20,2183-04-23 08:01:59,,"['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']",,58947,100037.0
21,2183-04-23 13:29:59,,"['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']",,58947,100037.0
22,2183-04-23 16:10:01,,"['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']",,58947,100037.0
23,2183-04-23 18:16:39,,"['PICC LINE - START [**2183-4-22**] 12:09 PM', ' Afib with RVR to 130s, stable hemodynamics']",,58947,100037.0
0,2120-05-15 06:57:25,,['No overnight events'],,61033,116966.0
1,2120-05-15 07:29:11,,['No overnight events'],,61033,116966.0
2,2120-05-15 07:44:56,,['No overnight events'],,61033,116966.0
3,2120-05-15 10:17:45,,['No overnight events'],,61033,116966.0
0,2161-03-16 07:35:40,,"['BLOOD CULTURED - At [**2161-3-15**] 10:44 AM', ' SPUTUM CULTURE - At [**2161-3-15**] 10:44 AM', ' URINE CULTURE - At [**2161-3-15**] 10:45 AM', ' BLOOD CULTURED - At [**2161-3-15**] 11:24 AM', ' MULTI LUMEN - START [**2161-3-15**] 01:38 PM', ' EKG - At [**2161-3-15**] 02:44 PM', ' EKG - At [**2161-3-15**] 04:39 PM', ' ARTERIAL LINE - STOP [**2161-3-15**] 05:00 PM', ' ARTERIAL LINE - START [**2161-3-16**] 02:02 AM', '- Q4 HCT - 30.9 - 28.2- (1unit pRBCs) - 28.6- (1 unit pRBCs) - 31.8 -', '32.2', '- urine sed - 3 hyaline casts', '- urine lytes -', '- family meeting - full code', '- cardiac [**Last Name (un) **] - flat', '- left IJ placed', '- cards -', ""- GI no new rec's""]",,32443,184083.0
1,2161-03-16 07:37:01,,"['BLOOD CULTURED - At [**2161-3-15**] 10:44 AM', ' SPUTUM CULTURE - At [**2161-3-15**] 10:44 AM', ' URINE CULTURE - At [**2161-3-15**] 10:45 AM', ' BLOOD CULTURED - At [**2161-3-15**] 11:24 AM', ' MULTI LUMEN - START [**2161-3-15**] 01:38 PM', ' EKG - At [**2161-3-15**] 02:44 PM', ' EKG - At [**2161-3-15**] 04:39 PM', ' ARTERIAL LINE - STOP [**2161-3-15**] 05:00 PM', ' ARTERIAL LINE - START [**2161-3-16**] 02:02 AM', '- Q4 HCT - 30.9 - 28.2- (1unit pRBCs) - 28.6- (1 unit pRBCs) - 31.8 -', '32.2', '- urine sed - 3 hyaline casts', '- urine lytes -', '- family meeting - full code', '- cardiac [**Last Name (un) **] - flat', '- left IJ placed', '- cards -', ""- GI no new rec's""]",,32443,184083.0
2,2161-03-16 10:46:49,"['- acutely hypotensive and febrile to 100.8, extremities cool, cyanotic', 'and mottled', '> vanc and zosyn started, central line placed, pan cx', 'd, bolused', '- urine lytes', ' FeNa 1.6, anion gap 44', '- cardiac [**Last Name (un) **]', ' flat', '- cards', ' afib with ectopy, pacer appeared to be functioning', 'appropriately']","['BLOOD CULTURED - At [**2161-3-15**] 10:44 AM', ' SPUTUM CULTURE - At [**2161-3-15**] 10:44 AM', ' URINE CULTURE - At [**2161-3-15**] 10:45 AM', ' BLOOD CULTURED - At [**2161-3-15**] 11:24 AM', ' MULTI LUMEN - START [**2161-3-15**] 01:38 PM', ' EKG - At [**2161-3-15**] 02:44 PM', ' EKG - At [**2161-3-15**] 04:39 PM', ' ARTERIAL LINE - STOP [**2161-3-15**] 05:00 PM', ' ARTERIAL LINE - START [**2161-3-16**] 02:02 AM', '- acutely hypotensive and febrile to 100.8, extremities cool, cyanotic', 'and mottled', '> vanc and zosyn started, central line placed, pan cx', 'd, bolused', '- Q4 HCT - 30.9 - 28.2- (1unit pRBCs) - 28.6- (1 unit pRBCs) - 31.8 -', '32.2', '- urine sed - 3 hyaline casts', '- urine lytes', ' FeNa 1.6, anion gap 44', '- family meeting - full code', '- cardiac [**Last Name (un) **]', ' flat', '- cards', ' afib with ectopy, pacer appeared to be functioning', 'appropriately', ""- GI no new rec's""]","['- urine lytes -', '- cardiac [**Last Name (un) **] - flat', '- left IJ placed', '- cards -']",32443,184083.0
3,2161-03-17 07:56:16,"['- Q4 HCTs have been stable ( 30-28.8-29 )', '- resp alkalosis, overbreathing vent, increased sedation', '- hemodynamically stable']","['- Q4 HCTs have been stable ( 30-28.8-29 )', '- resp alkalosis, overbreathing vent, increased sedation', '- hemodynamically stable']","['BLOOD CULTURED - At [**2161-3-15**] 10:44 AM', ' SPUTUM CULTURE - At [**2161-3-15**] 10:44 AM', ' URINE CULTURE - At [**2161-3-15**] 10:45 AM', ' BLOOD CULTURED - At [**2161-3-15**] 11:24 AM', ' MULTI LUMEN - START [**2161-3-15**] 01:38 PM', ' EKG - At [**2161-3-15**] 02:44 PM', ' EKG - At [**2161-3-15**] 04:39 PM', ' ARTERIAL LINE - STOP [**2161-3-15**] 05:00 PM', ' ARTERIAL LINE - START [**2161-3-16**] 02:02 AM', '- acutely hypotensive and febrile to 100.8, extremities cool, cyanotic', 'and mottled', '> vanc and zosyn started, central line placed, pan cx', 'd, bolused', '- Q4 HCT - 30.9 - 28.2- (1unit pRBCs) - 28.6- (1 unit pRBCs) - 31.8 -', '32.2', '- urine sed - 3 hyaline casts', '- urine lytes', ' FeNa 1.6, anion gap 44', '- family meeting - full code', '- cardiac [**Last Name (un) **]', ' flat', '- cards', ' afib with ectopy, pacer appeared to be functioning', 'appropriately', ""- GI no new rec's""]",32443,184083.0
4,2161-03-18 01:35:06,,"['- Q4 HCTs have been stable ( 30-28.8-29 )', '- resp alkalosis, overbreathing vent, increased sedation', '- hemodynamically stable']",,32443,184083.0
5,2161-03-18 07:13:31,"['-- patient started on TF', ""-- cordis d/c'd; tip sent for culture"", '-- CT scan showed perforation of duodenal ulcer w/ free air in the', 'peritoneum', '-- Gen surgery c/s, family wanted everything done, patient taken to OR', 'emergently', '-- NG tube found to have threaded through perforated small bowel, w/', 'significant leakage of GI contents', '-- patient quickly became hypotensive after the surgery to SBP of 78,', 'aggressivly resusitated w/ fluids receiving 6L.  Had a pH of 7.14,', 'lactate of 2.4, improved w/ fluids.', '-- decreased steroids as part of taper, received stress dose in OR']","['-- patient started on TF', ""-- cordis d/c'd; tip sent for culture"", '-- CT scan showed perforation of duodenal ulcer w/ free air in the', 'peritoneum', '-- Gen surgery c/s, family wanted everything done, patient taken to OR', 'emergently', '-- NG tube found to have threaded through perforated small bowel, w/', 'significant leakage of GI contents', '-- patient quickly became hypotensive after the surgery to SBP of 78,', 'aggressivly resusitated w/ fluids receiving 6L.  Had a pH of 7.14,', 'lactate of 2.4, improved w/ fluids.', '-- decreased steroids as part of taper, received stress dose in OR']","['- Q4 HCTs have been stable ( 30-28.8-29 )', '- resp alkalosis, overbreathing vent, increased sedation', '- hemodynamically stable']",32443,184083.0
6,2161-03-18 11:03:20,"['significant leakage of GI contents.  Patch procedure was performed,', 'peritoneal washout, placement of J and G tubes.  Stress dose steroids', 'and pressors were given during the procedure.']","['-- patient started on TF', ""-- cordis d/c'd; tip sent for culture"", '-- CT scan showed perforation of duodenal ulcer w/ free air in the', 'peritoneum', '-- Gen surgery c/s, family wanted everything done, patient taken to OR', 'emergently', '-- NG tube found to have threaded through perforated small bowel, w/', 'significant leakage of GI contents.  Patch procedure was performed,', 'peritoneal washout, placement of J and G tubes.  Stress dose steroids', 'and pressors were given during the procedure.', '-- patient quickly became hypotensive after the surgery to SBP of 78,', 'aggressivly resusitated w/ fluids receiving 6L.  Had a pH of 7.14,', 'lactate of 2.4, improved w/ fluids.', '-- decreased steroids as part of taper, received stress dose in OR']",['significant leakage of GI contents'],32443,184083.0
0,2162-02-18 06:18:14,,"['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held overnight', '- Pressors off since 5am']",,25256,170994.0
1,2162-02-18 06:21:07,,"['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held overnight', '- Pressors off since 5am']",,25256,170994.0
2,2162-02-18 07:50:53,"['- Temp to 100.9', '- TF have been held']","['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- Temp to 100.9', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held', '- Pressors off since 5am']",['- TF have been held overnight'],25256,170994.0
3,2162-02-18 09:35:11,,"['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- Temp to 100.9', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held', '- Pressors off since 5am']",,25256,170994.0
4,2162-02-18 11:02:30,,"['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- Temp to 100.9', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held', '- Pressors off since 5am']",,25256,170994.0
5,2162-02-19 07:53:37,"['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM', '- ECHO: Vigorous biventircular systolic function. No', 'clinically-significant valvular disease seen. Normal estimated', 'intracardiac filling pressures.', '- BMT recs: check IgG (and extubate)', '- SBT performed for about 15-20 minutes w/ an increase in HR and RR w/', 'an erratic breathing pattern. Placed back on the AC mode/ re-sedated', 'and will repeat SBT in the AM.', '- Tried to reduce rate again after PM ABG', '- did not tolerate pressure support this am', 'History obtained from Medical records']","['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM', '- ECHO: Vigorous biventircular systolic function. No', 'clinically-significant valvular disease seen. Normal estimated', 'intracardiac filling pressures.', '- BMT recs: check IgG (and extubate)', '- SBT performed for about 15-20 minutes w/ an increase in HR and RR w/', 'an erratic breathing pattern. Placed back on the AC mode/ re-sedated', 'and will repeat SBT in the AM.', '- Tried to reduce rate again after PM ABG', '- did not tolerate pressure support this am', 'History obtained from Medical records']","['PICC LINE - START [**2162-2-17**] 12:02 PM', ' INVASIVE VENTILATION - START [**2162-2-17**] 12:04 PM', ' ARTERIAL LINE - START [**2162-2-17**] 05:08 PM', ' BRONCHOSCOPY - At [**2162-2-17**] 06:15 PM', '- Temp to 100.9', '- CTA: no evidence of PE, but did show LLL consolidation and abdominal', 'ascites', '- Head CT: negative for bleed', '- Patient had bronch; fluid evident for mucus plugs; cx sent and are', 'pending', '- He was hypotensive after intubation, started on pressors.  Got 1L NS', 'bolus x2 overnight.', '- A-line placed.', ""- Repeat CXR didn't look like pneumothorax"", '- RISBI 135, but patient agitated once sedation off', '- TF have been held', '- Pressors off since 5am']",25256,170994.0
6,2162-02-19 07:58:27,"['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM: Vigorous biventircular', 'systolic function. No clinically-significant valvular disease seen.', 'Normal estimated intracardiac filling pressures.', '- Attempted PSV but pt had apneic periods and placed back on AC.']","['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM: Vigorous biventircular', 'systolic function. No clinically-significant valvular disease seen.', 'Normal estimated intracardiac filling pressures.', '- SBT performed for about 15-20 minutes w/ an increase in HR and RR w/', 'an erratic breathing pattern. Placed back on the AC mode/ re-sedated', 'and will repeat SBT in the AM.', '- Attempted PSV but pt had apneic periods and placed back on AC.', 'History obtained from Medical records']","['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM', '- ECHO: Vigorous biventircular systolic function. No', 'clinically-significant valvular disease seen. Normal estimated', 'intracardiac filling pressures.', '- BMT recs: check IgG (and extubate)', '- Tried to reduce rate again after PM ABG', '- did not tolerate pressure support this am']",25256,170994.0
7,2162-02-19 13:33:23,,"['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM: Vigorous biventircular', 'systolic function. No clinically-significant valvular disease seen.', 'Normal estimated intracardiac filling pressures.', '- SBT performed for about 15-20 minutes w/ an increase in HR and RR w/', 'an erratic breathing pattern. Placed back on the AC mode/ re-sedated', 'and will repeat SBT in the AM.', '- Attempted PSV but pt had apneic periods and placed back on AC.', 'History obtained from Medical records']",,25256,170994.0
8,2162-02-20 08:13:41,"['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']","['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']","['TRANSTHORACIC ECHO - At [**2162-2-18**] 08:21 AM: Vigorous biventircular', 'systolic function. No clinically-significant valvular disease seen.', 'Normal estimated intracardiac filling pressures.', '- SBT performed for about 15-20 minutes w/ an increase in HR and RR w/', 'an erratic breathing pattern. Placed back on the AC mode/ re-sedated', 'and will repeat SBT in the AM.', '- Attempted PSV but pt had apneic periods and placed back on AC.', 'History obtained from Medical records']",25256,170994.0
9,2162-02-20 08:15:26,,"['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']",,25256,170994.0
10,2162-02-20 11:06:54,,"['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']",,25256,170994.0
11,2162-02-20 11:57:44,,"['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']",,25256,170994.0
12,2162-02-21 08:03:20,"['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-NIF was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']","['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-NIF was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']","['- BAL without any growth - discussed with BMT and started steroids', '- started more agressive bowel regimen', '- some asictes on US but defer tap until have shown that no improvement', 'with BMs', 'History obtained from [**Hospital 85**] Medical records']",25256,170994.0
13,2162-02-21 08:09:29,"['[**2-20**]', '-INR goal is 2.5 - 3.5 for mechanical valve', '-increased redness seen in lower extremities so TEDs were removed to', 'ensure that he was not extravasating given rising INR', '-switched to pressure support in the morning and he tolerated SBT; was', 'extubated w/ no complications', '-urine lytes were:  FeNA 0.2% suggestive of prerenal etiology', '-order placed for echo', 'History obtained from Patient']","['[**2-20**]', '-INR goal is 2.5 - 3.5 for mechanical valve', '-increased redness seen in lower extremities so TEDs were removed to', 'ensure that he was not extravasating given rising INR', '-switched to pressure support in the morning and he tolerated SBT; was', 'extubated w/ no complications', '-urine lytes were:  FeNA 0.2% suggestive of prerenal etiology', '-order placed for echo', 'History obtained from Patient']","['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-NIF was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']",25256,170994.0
14,2162-02-21 10:58:53,"['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-NIF was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']","['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-NIF was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']","['[**2-20**]', '-INR goal is 2.5 - 3.5 for mechanical valve', '-increased redness seen in lower extremities so TEDs were removed to', 'ensure that he was not extravasating given rising INR', '-switched to pressure support in the morning and he tolerated SBT; was', 'extubated w/ no complications', '-urine lytes were:  FeNA 0.2% suggestive of prerenal etiology', '-order placed for echo', 'History obtained from Patient']",25256,170994.0
15,2162-02-21 14:10:08,['-[** **] was only -20 (should be at least 25) suggesting there is some'],"['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-[** **] was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']",['-NIF was only -20 (should be at least 25) suggesting there is some'],25256,170994.0
16,2162-02-22 07:45:13,"['[**2-21**]', '-Today again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention after', 'several hours and did better than yesterday overall', '-As got closer to bedtime, tidal volumes started getting smaller and', 'smaller, therefore was switched back to AC until AM when we plan to', 'switch him back to PSV.', ""-DC'd famotidine given persistent thrombocytopenia"", '-BMT was again pushing for extubation']","['[**2-21**]', '-Today again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention after', 'several hours and did better than yesterday overall', '-As got closer to bedtime, tidal volumes started getting smaller and', 'smaller, therefore was switched back to AC until AM when we plan to', 'switch him back to PSV.', ""-DC'd famotidine given persistent thrombocytopenia"", '-BMT was again pushing for extubation']","['-metoprolol restarted at 12.5 mg PO BID', '-lactulose given to encourage bowel movements', '-[** **] was only -20 (should be at least 25) suggesting there is some', 'restrictive defect preventing normal inspiratory pressures (perhaps', 'combination of deconditioning, tight abdomen secondary to constipation,', 'and some intrinsic lung defect)', '-Platelets on lower side, if continue to drop consider d/c vanc', '-clarify with GI about whether they want to do imaging study prior to', 'extubation (last week they may have wanted ? MR enterography to', 'evaluate small bowel) - hem onc feels it would be better to get such a', 'study done before extubation b/c it was tricky for him to do it', 'previously (couldnt lie still, trouble swallowing contrast)', '-At around 6 pm, started tiring:']",25256,170994.0
17,2162-02-22 07:51:39,,"['[**2-21**]', '-Today again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention after', 'several hours and did better than yesterday overall', '-As got closer to bedtime, tidal volumes started getting smaller and', 'smaller, therefore was switched back to AC until AM when we plan to', 'switch him back to PSV.', ""-DC'd famotidine given persistent thrombocytopenia"", '-BMT was again pushing for extubation']",,25256,170994.0
18,2162-02-22 15:27:45,"['-Yesterday again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention', 'after several hours and did better than yesterday overall']","['-Yesterday again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention', 'after several hours and did better than yesterday overall', '-As got closer to bedtime, tidal volumes started getting smaller and', 'smaller, therefore was switched back to AC until AM when we plan to', 'switch him back to PSV.', ""-DC'd famotidine given persistent thrombocytopenia"", '-BMT was again pushing for extubation']","['[**2-21**]', '-Today again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention after', 'several hours and did better than yesterday overall']",25256,170994.0
19,2162-02-23 06:59:45,"['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection']","['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection']","['-Yesterday again placed on PSV 14/10 FIO2 .40 w/ less CO2 retention', 'after several hours and did better than yesterday overall', '-As got closer to bedtime, tidal volumes started getting smaller and', 'smaller, therefore was switched back to AC until AM when we plan to', 'switch him back to PSV.', ""-DC'd famotidine given persistent thrombocytopenia"", '-BMT was again pushing for extubation']",25256,170994.0
20,2162-02-23 07:02:08,,"['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection']",,25256,170994.0
21,2162-02-23 07:16:04,['- off TPN on full tube feeds'],"['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection', '- off TPN on full tube feeds']",,25256,170994.0
22,2162-02-23 07:58:08,,"['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection', '- off TPN on full tube feeds']",,25256,170994.0
23,2162-02-23 12:12:41,"['- off TPN, on full tube feeds']","['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection', '- off TPN, on full tube feeds']",['- off TPN on full tube feeds'],25256,170994.0
24,2162-02-24 07:23:21,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]","['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]","['- discussion with BMT: asked us to consult CT [**Doctor First Name 458**] for trach later this', 'week', '- e-mailed GI [**Doctor Last Name **] re: placing peg tube at the same time & he said', 'that CT surgery can do the PEG and the trach', '- plan to ask neuromuscular to see patient in re: inability to wean', 'from vent', '- nursing concerned for some hematuria, but repeat Hct stable', '- also ordered U/A, urine culture & urine bk --> U/A with large amount', 'of blood, no infection', '- off TPN, on full tube feeds']",25256,170994.0
25,2162-02-24 07:32:34,,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]",,25256,170994.0
26,2162-02-24 07:34:54,,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]",,25256,170994.0
27,2162-02-24 07:55:25,,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]",,25256,170994.0
28,2162-02-24 07:58:38,"['- Diuresed with Lasix 20mg IV', '- Patient request that GI/hepatology physicians be updated about his', 'status']","['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Diuresed with Lasix 20mg IV', '- Patient request that GI/hepatology physicians be updated about his', 'status']","['- Gave Lasix 20mg IV', ""- Patient's GI/hepatogy physicians were updated at his request""]",25256,170994.0
29,2162-02-24 11:25:30,,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Diuresed with Lasix 20mg IV', '- Patient request that GI/hepatology physicians be updated about his', 'status']",,25256,170994.0
30,2162-02-24 11:27:04,,"['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Diuresed with Lasix 20mg IV', '- Patient request that GI/hepatology physicians be updated about his', 'status']",,25256,170994.0
31,2162-02-25 07:19:02,"['-plan to trach and PEG Friday by thoracic sx', '- stopped all antibiotics', '- doing well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- repeat CXR ordered for AM to assess interval change.', '- Continue diuresis with goal -500cc daily', '- SW c/s for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '-started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']","['-plan to trach and PEG Friday by thoracic sx', '- stopped all antibiotics', '- doing well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- repeat CXR ordered for AM to assess interval change.', '- Continue diuresis with goal -500cc daily', '- SW c/s for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '-started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']","['- plan for tracheostomy and PEG Friday by Thoracic surgery', '- Family mtg held for update/questions', '- Antibiotics continued (today was due to be last day of course) given', 'CXR findings and increasing WBC', '- Sent sputum culture', '- Methyprednisolone decreased to 30mg IV q12', '- Diuresed with Lasix 20mg IV', '- Patient request that GI/hepatology physicians be updated about his', 'status']",25256,170994.0
32,2162-02-25 07:29:43,,"['-plan to trach and PEG Friday by thoracic sx', '- stopped all antibiotics', '- doing well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- repeat CXR ordered for AM to assess interval change.', '- Continue diuresis with goal -500cc daily', '- SW c/s for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '-started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']",,25256,170994.0
33,2162-02-25 07:30:47,"['- plan to trach and PEG Friday by thoracic sx', '- stopped antibiotics', '- did well on PSV 10/5 overnight initially then some periods of apnea']","['- plan to trach and PEG Friday by thoracic sx', '- stopped antibiotics', '- did well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- repeat CXR ordered for AM to assess interval change.', '- Continue diuresis with goal -500cc daily', '- SW c/s for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '-started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']","['-plan to trach and PEG Friday by thoracic sx', '- stopped all antibiotics', '- doing well on PSV 10/5 overnight initially then some periods of apnea']",25256,170994.0
34,2162-02-25 14:18:22,"['- SW consulted for patient/family coping', '- started on robinul as scopolamine TD not effective']","['- stopped antibiotics', '- did well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- SW consulted for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '- started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']","['- plan to trach and PEG Friday by thoracic sx', '- repeat CXR ordered for AM to assess interval change.', '- Continue diuresis with goal -500cc daily', '- SW c/s for patient/family coping', '-started on robinul as scopolamine TD not effective']",25256,170994.0
35,2162-02-25 16:11:11,,"['- stopped antibiotics', '- did well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- SW consulted for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '- started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.', 'History obtained from Patient']",,25256,170994.0
36,2162-02-26 07:08:47,"['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', ""- hold TF's in AM"", ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM']","['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', ""- hold TF's in AM"", ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM', 'History obtained from Patient']","['- stopped antibiotics', '- did well on PSV 10/5 overnight initially then some periods of apnea', ""that were disruptive to pt's sleep so changed to CMV overnight for"", 'comfort.', '- repeat ABG at 8 PM: 7.44/ 55 /155 /39', '- SW consulted for patient/family coping', '- anemia: trend HCT, repeat iron and folate studies', '- started on robinul as scopolamine TD not effective', '- A line noted to be kinked. Using BP cuff for BP monitoring, still', 'able to draw off line so not changed.', '- Paged by Dr. [**Last Name (STitle) 2233**] that PEG tube would ideally be avoided given', 'portal HTN.']",25256,170994.0
37,2162-02-26 07:16:15,,"['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', ""- hold TF's in AM"", ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM', 'History obtained from Patient']",,25256,170994.0
38,2162-02-26 13:15:14,['- Tube feeds held for possible extubation'],"['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', '- Tube feeds held for possible extubation', ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM', 'History obtained from Patient']","[""- hold TF's in AM""]",25256,170994.0
39,2162-02-26 13:18:54,,"['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', '- Tube feeds held for possible extubation', ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM', 'History obtained from Patient']",,25256,170994.0
40,2162-02-27 08:05:11,"['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']","['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']","['- On PSV from 11:00 to 22:00 yesterday with PSof 18/12 -> [**9-28**], then', 'put back on AC as TV in 200s.', '- 9PM ABG: 7.40/65/93/42/11', '- goal negative 0.5L --> negative 410 cc over past 24 hours', '- final sputum cx: OP flora', '- tapered prednisone to 20mg PO BID, will discuss goal', 'immunosuppression with dr. [**Last Name (STitle) **]', '- d/w dr. [**Last Name (STitle) **] about plan for nutrition ongoing', '- d/w dr. [**Last Name (STitle) **] about ? dobhoff', '- mildly iron deficient, no supplementation for now', '- vitamin d levels pending', '- Tube feeds held for possible extubation', ' ARTERIAL LINE - STOP [**2162-2-25**] 01:00 PM', 'History obtained from Patient']",25256,170994.0
41,2162-02-27 08:18:12,,"['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']",,25256,170994.0
42,2162-02-27 12:42:35,,"['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']",,25256,170994.0
43,2162-02-27 13:04:14,,"['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']",,25256,170994.0
44,2162-02-28 07:43:38,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']","['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']","['- extubated in AM, had some fatigue with breathing around 3PM, ABG', '7.31/ 81/ 96, put on NIPPV for for ~2 hrs, felt better.', '- will hold off on daubhoff for now.', '- per dr. [**Last Name (STitle) **], earlier CXR if persistent fatigue with breathing to', 'see if RLL process worsened now off antibiotics.', '- ordered CXR for am', '- continued prednisone at 20mg PO bid, per BMT']",25256,170994.0
45,2162-02-28 07:44:54,,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",,25256,170994.0
46,2162-02-28 07:45:53,,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",,25256,170994.0
47,2162-02-28 08:09:29,,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",,25256,170994.0
48,2162-02-28 08:11:41,,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",,25256,170994.0
49,2162-02-28 11:08:41,,"['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",,25256,170994.0
50,2162-03-01 07:33:26,"['- ativan held, trazodone written for sleep given agitation with ativan', '- calorie counts added to assess PO intake', '- AM VBG 7.35/80/47/46/13', '- repeat U/A, C. diff sent for leukocytosis/left shift', ""- @1300, patient noted to be tachy to the 140's & tachypneic to mid"", ""30's, put on BiPAP for short period, switched to CPAP which was better"", 'tolerated and patient able to sleep for ~2 hours']","['- ativan held, trazodone written for sleep given agitation with ativan', '- calorie counts added to assess PO intake', '- AM VBG 7.35/80/47/46/13', '- repeat U/A, C. diff sent for leukocytosis/left shift', ""- @1300, patient noted to be tachy to the 140's & tachypneic to mid"", ""30's, put on BiPAP for short period, switched to CPAP which was better"", 'tolerated and patient able to sleep for ~2 hours']","['- Using BiPAP intermittently when feeling respiratory fatigue.', '- pH 7.36 pCO2 81 on VBG at 5 PM', '- Trying to supplement with ensure puddings and encourage good po', 'intake to match his caloric demands.', '- Added guaifenisin to help with mucous/sputum']",25256,170994.0
51,2162-03-01 10:54:19,,"['- ativan held, trazodone written for sleep given agitation with ativan', '- calorie counts added to assess PO intake', '- AM VBG 7.35/80/47/46/13', '- repeat U/A, C. diff sent for leukocytosis/left shift', ""- @1300, patient noted to be tachy to the 140's & tachypneic to mid"", ""30's, put on BiPAP for short period, switched to CPAP which was better"", 'tolerated and patient able to sleep for ~2 hours']",,25256,170994.0
52,2162-03-02 06:47:46,"['- PA/LAT cxr - no change', '- PT seen, walked around unit.', '- U/A/C pending', '- C. diff pending', '- Diff: 96% PMN, 2% bands', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- [**Doctor Last Name 1750**] recommended starting voriconazole/fluconazole for fungal', 'prophylaxis, started fluconazole 200mg PO daily']","['- PA/LAT cxr - no change', '- PT seen, walked around unit.', '- U/A/C pending', '- C. diff pending', '- Diff: 96% PMN, 2% bands', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- [**Doctor Last Name 1750**] recommended starting voriconazole/fluconazole for fungal', 'prophylaxis, started fluconazole 200mg PO daily']","['- ativan held, trazodone written for sleep given agitation with ativan', '- calorie counts added to assess PO intake', '- AM VBG 7.35/80/47/46/13', '- repeat U/A, C. diff sent for leukocytosis/left shift', ""- @1300, patient noted to be tachy to the 140's & tachypneic to mid"", ""30's, put on BiPAP for short period, switched to CPAP which was better"", 'tolerated and patient able to sleep for ~2 hours']",25256,170994.0
53,2162-03-02 07:02:24,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- started fluconazole 200mg PO daily per BMT recs']","['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']","['- PA/LAT cxr - no change', '- PT seen, walked around unit.', '- U/A/C pending', '- C. diff pending', '- Diff: 96% PMN, 2% bands', '- [**Doctor Last Name 1750**] recommended starting voriconazole/fluconazole for fungal', 'prophylaxis, started fluconazole 200mg PO daily']",25256,170994.0
54,2162-03-02 07:48:24,,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",,25256,170994.0
55,2162-03-02 07:50:47,,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",,25256,170994.0
56,2162-03-02 07:52:35,,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",,25256,170994.0
57,2162-03-02 07:55:24,,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",,25256,170994.0
58,2162-03-02 08:01:35,,"['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",,25256,170994.0
59,2162-03-03 07:21:11,"['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']","['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']","['- PA/LAT CXR obtained', '- PT seen, walked around unit', '- U/A/C ordered', '- C. diff ordered', '- LENI negative for DVT', '- changed diet from Kosher to regular', '- started fluconazole 200mg PO daily per BMT recs']",25256,170994.0
60,2162-03-03 07:32:19,,"['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']",,25256,170994.0
61,2162-03-03 07:44:07,,"['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']",,25256,170994.0
62,2162-03-03 10:06:44,,"['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']",,25256,170994.0
63,2162-03-04 06:58:24,"['- Urine culture negative', '- dr. [**Last Name (STitle) **] ok with voriconazole (patient now taking it)', ""- at 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after 30mg IV', 'Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']","['- Urine culture negative', '- dr. [**Last Name (STitle) **] ok with voriconazole (patient now taking it)', ""- at 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after 30mg IV', 'Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']","['- BMT recommended checking CT sinus and CT chest and to start empiric', 'Cefepime, but continue steroids at 20mg [**Hospital1 **] Prednisone', '-CT sinus: wet read: Mucosal thickening with aerosolized secretions in', 'the sphenoid sinus, ethmoid air cells and minimal in the maxillary', 'sinus, an acute component is possible given aerosolized secretions. New', 'from the study of [**2162-8-20**].', '-Chest CT seemed to have increased LLL consolidation, started on', 'vanc/cefepime/vori for broad coverage per BMT recs.', '-Ordered b-d-glucan and galactomannan', '-Tachycardia to the 170s (looked like premature atrial contractions on', 'EKG, no other acute changes)-given 25 mg metoprolol po x1. Persisted', 'with tachy to the 120s. VBG showed: 7.26/116/57. Convinced pt to use', 'CPAP.  O2 sats stable at 99-100%.']",25256,170994.0
64,2162-03-04 06:59:39,,"['- Urine culture negative', '- dr. [**Last Name (STitle) **] ok with voriconazole (patient now taking it)', ""- at 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after 30mg IV', 'Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
65,2162-03-04 07:16:55,"['- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", 'recommended additional nodal agents, but more Lopressor did not slow', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor']","['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']","['- dr. [**Last Name (STitle) **] ok with voriconazole (patient now taking it)', ""- at 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", 'recommended additional nodal agents, but more lopressor did not slow', 'reported that he was tiring out, still no response after 30mg IV', 'Lopressor']",25256,170994.0
66,2162-03-04 07:24:49,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
67,2162-03-04 07:28:46,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
68,2162-03-04 07:37:22,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
69,2162-03-04 07:40:39,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
70,2162-03-04 07:41:31,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
71,2162-03-04 10:30:56,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
72,2162-03-04 10:32:48,,"['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",,25256,170994.0
73,2162-03-05 09:01:34,"['- CTA -> No PE, worsening LLL and RLL PNA, increased L pleural effusion', 'and new R pleural effusion', '- Bronch-> 3+ PMN', 's, no organisms. ABG after bronch: 7.42/57/108', '- TTE-> normal, EF 55%']","['- CTA -> No PE, worsening LLL and RLL PNA, increased L pleural effusion', 'and new R pleural effusion', '- Bronch-> 3+ PMN', 's, no organisms. ABG after bronch: 7.42/57/108', '- TTE-> normal, EF 55%']","['- Urine culture negative', '- Dr. [**Last Name (STitle) **] ok with Voriconazole', ""- At 6pm, patient tachy from 110's to 230's, frequent changes in hr,"", ""with sbp's in the 90's - placed on BiPAP, received IVF's & lopressor IV"", 'without a response', '- EKG demonstrated atrial tach vs. AVNRT per cardiology fellow,', 'recommended additional nodal agents, but more Lopressor did not slow', 'his hr', '- A-line placed, ABG 7.45/53/39/38/10, patient very uncomfortable', 'reported that he was tiring out, still no response after a total of', '30mg IV Lopressor', '- intubated at 11PM, received 10mg IV Diltiazem, hr dropped to', ""110-140's, sbp's initially in the 100's, but quickly dropped to 70's"", ""- gave more IVF boluses with improvement in sbp to 100's"", '- CTA chest ordered --> no PE, but new consolidation in right base', 'suggestive of aspiration', '- Dobhoff placed', '- Phenylephrine gtt started at 0.3mcg/kg/min for goal MAP >65']",25256,170994.0
74,2162-03-05 09:27:17,['- Pressors stopped yesterday'],"['- CTA -> No PE, worsening LLL and RLL PNA, increased L pleural effusion', 'and new R pleural effusion', '- Bronch-> 3+ PMN', 's, no organisms. ABG after bronch: 7.42/57/108', '- TTE-> normal, EF 55%', '- Pressors stopped yesterday']",,25256,170994.0
75,2162-03-05 14:52:14,,"['- CTA -> No PE, worsening LLL and RLL PNA, increased L pleural effusion', 'and new R pleural effusion', '- Bronch-> 3+ PMN', 's, no organisms. ABG after bronch: 7.42/57/108', '- TTE-> normal, EF 55%']",['- Pressors stopped yesterday'],25256,170994.0
76,2162-03-06 08:09:50,,[],"['- CTA -> No PE, worsening LLL and RLL PNA, increased L pleural effusion', 'and new R pleural effusion', '- Bronch-> 3+ PMN', 's, no organisms. ABG after bronch: 7.42/57/108', '- TTE-> normal, EF 55%']",25256,170994.0
77,2162-03-06 08:27:20,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']","['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
78,2162-03-06 09:06:07,,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
79,2162-03-06 09:18:27,,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
80,2162-03-06 09:58:08,,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
81,2162-03-06 12:22:48,,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
82,2162-03-06 12:31:36,,"['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",,25256,170994.0
83,2162-03-07 07:10:04,"['-was getting more hypoxic despite going up on FIO2 and was bronched,', 'BAL sent', '-lasix gtt was stopped as he was already -2L in the am and had some', 'signs of contraction alkalosis', '-prednisone was changed to 30mg in am so he could sleep', '- able to decrease FiO2 to 50% at 2300', ' BRONCHOSCOPY - At [**2162-3-6**] 02:51 PM']","['-was getting more hypoxic despite going up on FIO2 and was bronched,', 'BAL sent', '-lasix gtt was stopped as he was already -2L in the am and had some', 'signs of contraction alkalosis', '-prednisone was changed to 30mg in am so he could sleep', '- able to decrease FiO2 to 50% at 2300', ' BRONCHOSCOPY - At [**2162-3-6**] 02:51 PM']","['- Pt found to have GNRs in BAL culture', '- Pt started on a lasix gtt yesterday due to fluid overload', '- Started to wean sedtion as tolerated']",25256,170994.0
84,2162-03-07 07:31:33,,"['-was getting more hypoxic despite going up on FIO2 and was bronched,', 'BAL sent', '-lasix gtt was stopped as he was already -2L in the am and had some', 'signs of contraction alkalosis', '-prednisone was changed to 30mg in am so he could sleep', '- able to decrease FiO2 to 50% at 2300', ' BRONCHOSCOPY - At [**2162-3-6**] 02:51 PM']",,25256,170994.0
85,2162-03-07 16:16:50,,"['-was getting more hypoxic despite going up on FIO2 and was bronched,', 'BAL sent', '-lasix gtt was stopped as he was already -2L in the am and had some', 'signs of contraction alkalosis', '-prednisone was changed to 30mg in am so he could sleep', '- able to decrease FiO2 to 50% at 2300', ' BRONCHOSCOPY - At [**2162-3-6**] 02:51 PM']",,25256,170994.0
86,2162-03-08 07:56:31,"['- Plan for bedside trach this AM by thoracics.', '- ESBL Klebs in sputum, so switched from cefepime/flagyl to meropenem', '- oxygenating well, so weaned PEEP to 5']","['- Plan for bedside trach this AM by thoracics.', '- ESBL Klebs in sputum, so switched from cefepime/flagyl to meropenem', '- oxygenating well, so weaned PEEP to 5']","['-was getting more hypoxic despite going up on FIO2 and was bronched,', 'BAL sent', '-lasix gtt was stopped as he was already -2L in the am and had some', 'signs of contraction alkalosis', '-prednisone was changed to 30mg in am so he could sleep', '- able to decrease FiO2 to 50% at 2300', ' BRONCHOSCOPY - At [**2162-3-6**] 02:51 PM']",25256,170994.0
87,2162-03-08 08:03:10,,"['- Plan for bedside trach this AM by thoracics.', '- ESBL Klebs in sputum, so switched from cefepime/flagyl to meropenem', '- oxygenating well, so weaned PEEP to 5']",,25256,170994.0
88,2162-03-09 07:14:23,"['-discontinued vanco after checking with BMT. They recommend continuing', 'voriconazole given immunosuppression', '-Trach placed at bedside. CXR read states ?trach sitting low, but', 'thoracics stated nothing to do, will leave it as is.', '- minute ventilation noted to decrease over early evening. ABG showed', 'some increase in PCO2. Pt was put on A/C overnight for respiratory', 'rest. Will restart PSV at 4 AM.', '- Thoracic surgery post-op check said continue trach care and signed', 'off', '- Being screened for trach rehab', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 01:51 PM', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 02:13 PM']","['-discontinued vanco after checking with BMT. They recommend continuing', 'voriconazole given immunosuppression', '-Trach placed at bedside. CXR read states ?trach sitting low, but', 'thoracics stated nothing to do, will leave it as is.', '- minute ventilation noted to decrease over early evening. ABG showed', 'some increase in PCO2. Pt was put on A/C overnight for respiratory', 'rest. Will restart PSV at 4 AM.', '- Thoracic surgery post-op check said continue trach care and signed', 'off', '- Being screened for trach rehab', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 01:51 PM', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 02:13 PM']","['- Plan for bedside trach this AM by thoracics.', '- ESBL Klebs in sputum, so switched from cefepime/flagyl to meropenem', '- oxygenating well, so weaned PEEP to 5']",25256,170994.0
89,2162-03-09 11:33:01,['thoracics stated nothing to do'],"['-discontinued vanco after checking with BMT. They recommend continuing', 'voriconazole given immunosuppression', '-Trach placed at bedside. CXR read states ?trach sitting low, but', 'thoracics stated nothing to do', '- minute ventilation noted to decrease over early evening. ABG showed', 'some increase in PCO2. Pt was put on A/C overnight for respiratory', 'rest. Will restart PSV at 4 AM.', '- Thoracic surgery post-op check said continue trach care and signed', 'off', '- Being screened for trach rehab', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 01:51 PM']","['thoracics stated nothing to do, will leave it as is.', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 02:13 PM']",25256,170994.0
90,2162-03-10 07:27:02,"[""- dc'ed A line"", '- case manager talked with patient and wife yesterday afternoon and', 'deferred making a decision about placement until speaking to  Dr.', '[**Last Name (STitle) 1750**].', '- Restarted tube feeds']","[""- dc'ed A line"", '- case manager talked with patient and wife yesterday afternoon and', 'deferred making a decision about placement until speaking to  Dr.', '[**Last Name (STitle) 1750**].', '- Restarted tube feeds']","['-discontinued vanco after checking with BMT. They recommend continuing', 'voriconazole given immunosuppression', '-Trach placed at bedside. CXR read states ?trach sitting low, but', 'thoracics stated nothing to do', '- minute ventilation noted to decrease over early evening. ABG showed', 'some increase in PCO2. Pt was put on A/C overnight for respiratory', 'rest. Will restart PSV at 4 AM.', '- Thoracic surgery post-op check said continue trach care and signed', 'off', '- Being screened for trach rehab', ' PERCUTANEOUS TRACHEOSTOMY - At [**2162-3-8**] 01:51 PM']",25256,170994.0
91,2162-03-10 07:29:58,,"[""- dc'ed A line"", '- case manager talked with patient and wife yesterday afternoon and', 'deferred making a decision about placement until speaking to  Dr.', '[**Last Name (STitle) 1750**].', '- Restarted tube feeds']",,25256,170994.0
92,2162-03-11 06:58:58,"['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on vanco due to temperature to 100.7', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting palcement at [**Hospital1 **]']","['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on vanco due to temperature to 100.7', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting palcement at [**Hospital1 **]']","[""- dc'ed A line"", '- case manager talked with patient and wife yesterday afternoon and', 'deferred making a decision about placement until speaking to  Dr.', '[**Last Name (STitle) 1750**].', '- Restarted tube feeds']",25256,170994.0
93,2162-03-11 07:27:01,"['- started on Vanco due to temperature to 100.7', '- S&S deferred PMV evaluation until patient can tolerate PS 8/5', '- S&S evaluation of swallow deferred until off vent', '- awaiting placement at [**Hospital1 **]']","['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on Vanco due to temperature to 100.7', '- S&S deferred PMV evaluation until patient can tolerate PS 8/5', '- S&S evaluation of swallow deferred until off vent', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting placement at [**Hospital1 **]']","['- started on vanco due to temperature to 100.7', '- awaiting palcement at [**Hospital1 **]']",25256,170994.0
94,2162-03-11 07:39:06,,"['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on Vanco due to temperature to 100.7', '- S&S deferred PMV evaluation until patient can tolerate PS 8/5', '- S&S evaluation of swallow deferred until off vent', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting placement at [**Hospital1 **]']",,25256,170994.0
95,2162-03-11 11:50:12,,"['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on Vanco due to temperature to 100.7', '- S&S deferred PMV evaluation until patient can tolerate PS 8/5', '- S&S evaluation of swallow deferred until off vent', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting placement at [**Hospital1 **]']",,25256,170994.0
96,2162-03-12 07:50:22,"['- KUB (our read): wnl, no dilated loops of bowel.', '- C. diff sent given new loose BMs.', '-per BMT will keep vanco. Repeat sputum sent. If afebrile thru [**3-12**],', 'can re-attempt dcing vanc.', '- [**Name6 (MD) **] IV RN, okay for PICC line to stay in place for 3-6 months so will', 'not replace/remove prior to d/c', '-low UOP in evening, up >5L LOS, given 40 mg IV lasix x 1.']","['- KUB (our read): wnl, no dilated loops of bowel.', '- C. diff sent given new loose BMs.', '-per BMT will keep vanco. Repeat sputum sent. If afebrile thru [**3-12**],', 'can re-attempt dcing vanc.', '- [**Name6 (MD) **] IV RN, okay for PICC line to stay in place for 3-6 months so will', 'not replace/remove prior to d/c', '-low UOP in evening, up >5L LOS, given 40 mg IV lasix x 1.']","['- patient reported aspiration with accidental removal of NGT', '- post pyloric NGT placed by IR', '- repeat CXR is unchanged', '- started on Vanco due to temperature to 100.7', '- S&S deferred PMV evaluation until patient can tolerate PS 8/5', '- S&S evaluation of swallow deferred until off vent', '- Prednisone decreased to 20mg PO daily per BMT recs', '- awaiting placement at [**Hospital1 **]']",25256,170994.0
97,2162-03-12 07:52:28,,"['- KUB (our read): wnl, no dilated loops of bowel.', '- C. diff sent given new loose BMs.', '-per BMT will keep vanco. Repeat sputum sent. If afebrile thru [**3-12**],', 'can re-attempt dcing vanc.', '- [**Name6 (MD) **] IV RN, okay for PICC line to stay in place for 3-6 months so will', 'not replace/remove prior to d/c', '-low UOP in evening, up >5L LOS, given 40 mg IV lasix x 1.']",,25256,170994.0
98,2162-03-12 14:20:47,['- did well with Passy-Muir valve trial yesterday'],"['- KUB (our read): wnl, no dilated loops of bowel.', '- C. diff sent given new loose BMs.', '-per BMT will keep vanco. Repeat sputum sent. If afebrile thru [**3-12**],', 'can re-attempt dcing vanc.', '- [**Name6 (MD) **] IV RN, okay for PICC line to stay in place for 3-6 months so will', 'not replace/remove prior to d/c', '-low UOP in evening, up >5L LOS, given 40 mg IV lasix x 1.', '- did well with Passy-Muir valve trial yesterday']",,25256,170994.0
99,2162-03-13 07:38:28,"['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT wants to start rituxan Saturday', '- trach collar for an hour in the AM', '- discussing possible IVIg for GVHD (patient has received in past)']","['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT wants to start rituxan Saturday', '- trach collar for an hour in the AM', '- discussing possible IVIg for GVHD (patient has received in past)']","['- KUB (our read): wnl, no dilated loops of bowel.', '- C. diff sent given new loose BMs.', '-per BMT will keep vanco. Repeat sputum sent. If afebrile thru [**3-12**],', 'can re-attempt dcing vanc.', '- [**Name6 (MD) **] IV RN, okay for PICC line to stay in place for 3-6 months so will', 'not replace/remove prior to d/c', '-low UOP in evening, up >5L LOS, given 40 mg IV lasix x 1.', '- did well with Passy-Muir valve trial yesterday']",25256,170994.0
100,2162-03-13 07:40:44,,"['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT wants to start rituxan Saturday', '- trach collar for an hour in the AM', '- discussing possible IVIg for GVHD (patient has received in past)']",,25256,170994.0
101,2162-03-13 08:16:46,,"['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT wants to start rituxan Saturday', '- trach collar for an hour in the AM', '- discussing possible IVIg for GVHD (patient has received in past)']",,25256,170994.0
102,2162-03-13 13:33:50,"['- BMT recs: ? rituxan, IVIG for GVHD']","['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT recs: ? rituxan, IVIG for GVHD', '- trach collar for an hour in the AM']","['- BMT wants to start rituxan Saturday', '- discussing possible IVIg for GVHD (patient has received in past)']",25256,170994.0
103,2162-03-14 07:39:58,"['- rituximab for GVHD per BMT', '- walking around the unit']","['- rituximab for GVHD per BMT', '- walking around the unit']","['- restarted MVI', '- no bed at [**Hospital1 **] --> probably bed on Monday', '- BMT recs: ? rituxan, IVIG for GVHD', '- trach collar for an hour in the AM']",25256,170994.0
104,2162-03-14 07:43:09,,"['- rituximab for GVHD per BMT', '- walking around the unit']",,25256,170994.0
105,2162-03-14 12:41:58,,"['- rituximab for GVHD per BMT', '- walking around the unit']",,25256,170994.0
106,2162-03-15 06:45:37,"['PRESEP CATHETER - START [**2162-3-14**] 09:32 PM', '- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon']","['PRESEP CATHETER - START [**2162-3-14**] 09:32 PM', '- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon']","['- rituximab for GVHD per BMT', '- walking around the unit']",25256,170994.0
107,2162-03-15 06:54:41,['- Abdominal U/S ordered per BMT'],"['PRESEP CATHETER - START [**2162-3-14**] 09:32 PM', '- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon', '- Abdominal U/S ordered per BMT']",,25256,170994.0
108,2162-03-15 07:57:08,,"['PRESEP CATHETER - START [**2162-3-14**] 09:32 PM', '- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon', '- Abdominal U/S ordered per BMT']",,25256,170994.0
109,2162-03-15 12:07:27,,"['- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon', '- Abdominal U/S ordered per BMT']",['PRESEP CATHETER - START [**2162-3-14**] 09:32 PM'],25256,170994.0
110,2162-03-16 07:11:35,"['- Per BMT, wanted diagnostic para prior to d/c, but not enough fluid to', 'safely tap, so they said ok to discharge', '- will need to return to [**Hospital Unit Name 44**] for outpatient appt with Dr. [**Last Name (STitle) 1750**] on', 'Friday', '- [**Hospital1 632**] agreed to take [**Known lastname 11922**] tomorrow, Tuesday, as long as he is on', '40% FiO2, paperwork complete & ambulance booked for 11AM', ""- [**Last Name (un) **] d/c'd as he completed 8 day course"", ""- Will be d/c'd on Spironolactone 50mg [**Hospital1 **] with f/u on Friday in the"", '[**Hospital Unit Name 11945**] - At [**2162-3-15**] 09:23 AM', 'abdominal', 'History obtained from Patient']","['- Per BMT, wanted diagnostic para prior to d/c, but not enough fluid to', 'safely tap, so they said ok to discharge', '- will need to return to [**Hospital Unit Name 44**] for outpatient appt with Dr. [**Last Name (STitle) 1750**] on', 'Friday', '- [**Hospital1 632**] agreed to take [**Known lastname 11922**] tomorrow, Tuesday, as long as he is on', '40% FiO2, paperwork complete & ambulance booked for 11AM', ""- [**Last Name (un) **] d/c'd as he completed 8 day course"", ""- Will be d/c'd on Spironolactone 50mg [**Hospital1 **] with f/u on Friday in the"", '[**Hospital Unit Name 11945**] - At [**2162-3-15**] 09:23 AM', 'abdominal', 'History obtained from Patient']","['- Patient with increased work of breathing, concerned that Rituxan was', 'infused too quickly, but improved on albuterol nebs and BMT thinks', 'interstitial pneumonitis unlikely', '- Patient on trach collar off vent for 1.5 hours in the afternoon', '- Abdominal U/S ordered per BMT']",25256,170994.0
111,2162-03-16 07:19:56,,"['- Per BMT, wanted diagnostic para prior to d/c, but not enough fluid to', 'safely tap, so they said ok to discharge', '- will need to return to [**Hospital Unit Name 44**] for outpatient appt with Dr. [**Last Name (STitle) 1750**] on', 'Friday', '- [**Hospital1 632**] agreed to take [**Known lastname 11922**] tomorrow, Tuesday, as long as he is on', '40% FiO2, paperwork complete & ambulance booked for 11AM', ""- [**Last Name (un) **] d/c'd as he completed 8 day course"", ""- Will be d/c'd on Spironolactone 50mg [**Hospital1 **] with f/u on Friday in the"", '[**Hospital Unit Name 11945**] - At [**2162-3-15**] 09:23 AM', 'abdominal', 'History obtained from Patient']",,25256,170994.0
0,2162-03-23 06:28:09,,"['- IgG level low, will need IVIG', '- per BMT attg, plan for nutrition consult for elemental tube feeds as', 'patient may have impaired absorption [**1-26**] pancreatic dmg from GVHD', '- transfused 1 unit pRBCs']",,25256,144551.0
1,2162-03-23 06:51:04,,"['- IgG level low, will need IVIG', '- per BMT attg, plan for nutrition consult for elemental tube feeds as', 'patient may have impaired absorption [**1-26**] pancreatic dmg from GVHD', '- transfused 1 unit pRBCs']",,25256,144551.0
2,2162-03-23 06:51:54,"['- IgG level low, may need IVIG', '- BCx, sputum cx returned positive (see micro data)']","['- IgG level low, may need IVIG', '- per BMT attg, plan for nutrition consult for elemental tube feeds as', 'patient may have impaired absorption [**1-26**] pancreatic dmg from GVHD', '- transfused 1 unit pRBCs', '- BCx, sputum cx returned positive (see micro data)']","['- IgG level low, will need IVIG']",25256,144551.0
3,2162-03-23 10:53:34,,"['- IgG level low, may need IVIG', '- per BMT attg, plan for nutrition consult for elemental tube feeds as', 'patient may have impaired absorption [**1-26**] pancreatic dmg from GVHD', '- transfused 1 unit pRBCs', '- BCx, sputum cx returned positive (see micro data)']",,25256,144551.0
4,2162-03-24 07:45:34,"['[**3-23**]', '- IgG level low, s/p giving IVIG', '- nutrition consult for elemental tube feeds', '- transfused 1 unit PRBCs, bumped appropriately, IRON studies (anemia', 'of chronic disease), hapto elevated likely due to acute phase, however,', 'given changes in hct were recently, will need to talk to BMT regarding', 'possible causes for the anemia.', '- cultures:  BCx: GRAM NEGATIVE ROD(S); sputum Cx:GRAM NEGATIVE ROD(S).', 'GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. currently on Meropenem 500', 'mg IV Q6H, Voriconazole 200 mg PO Q12H', '- PICC line needed today, follow up cultures and watch fever curve']","['[**3-23**]', '- IgG level low, s/p giving IVIG', '- nutrition consult for elemental tube feeds', '- transfused 1 unit PRBCs, bumped appropriately, IRON studies (anemia', 'of chronic disease), hapto elevated likely due to acute phase, however,', 'given changes in hct were recently, will need to talk to BMT regarding', 'possible causes for the anemia.', '- cultures:  BCx: GRAM NEGATIVE ROD(S); sputum Cx:GRAM NEGATIVE ROD(S).', 'GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. currently on Meropenem 500', 'mg IV Q6H, Voriconazole 200 mg PO Q12H', '- PICC line needed today, follow up cultures and watch fever curve']","['- IgG level low, may need IVIG', '- per BMT attg, plan for nutrition consult for elemental tube feeds as', 'patient may have impaired absorption [**1-26**] pancreatic dmg from GVHD', '- transfused 1 unit pRBCs', '- BCx, sputum cx returned positive (see micro data)']",25256,144551.0
5,2162-03-24 10:06:00,,"['[**3-23**]', '- IgG level low, s/p giving IVIG', '- nutrition consult for elemental tube feeds', '- transfused 1 unit PRBCs, bumped appropriately, IRON studies (anemia', 'of chronic disease), hapto elevated likely due to acute phase, however,', 'given changes in hct were recently, will need to talk to BMT regarding', 'possible causes for the anemia.', '- cultures:  BCx: GRAM NEGATIVE ROD(S); sputum Cx:GRAM NEGATIVE ROD(S).', 'GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. currently on Meropenem 500', 'mg IV Q6H, Voriconazole 200 mg PO Q12H', '- PICC line needed today, follow up cultures and watch fever curve']",,25256,144551.0
6,2162-03-24 12:41:37,,"['[**3-23**]', '- IgG level low, s/p giving IVIG', '- nutrition consult for elemental tube feeds', '- transfused 1 unit PRBCs, bumped appropriately, IRON studies (anemia', 'of chronic disease), hapto elevated likely due to acute phase, however,', 'given changes in hct were recently, will need to talk to BMT regarding', 'possible causes for the anemia.', '- cultures:  BCx: GRAM NEGATIVE ROD(S); sputum Cx:GRAM NEGATIVE ROD(S).', 'GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. currently on Meropenem 500', 'mg IV Q6H, Voriconazole 200 mg PO Q12H', '- PICC line needed today, follow up cultures and watch fever curve']",,25256,144551.0
7,2162-03-25 07:08:48,"['FEVER - 101.4', 'F - [**2162-3-24**] 09:00 AM', '- [**Doctor Last Name **] rec: use tobra, IV or nebulized, for the ESBL klebs', ""- ID consult:  This might be stenotrophomonas (it's a non-fermenter),"", 'so we added Bactrim 130 mg IV q8 and D/c his PPX dose (Bactrim DS TIW)', '- OSH records: same ESBL Klebs in sputum on [**3-21**]', '- Limiting early morning interruptions']","['FEVER - 101.4', 'F - [**2162-3-24**] 09:00 AM', '- [**Doctor Last Name **] rec: use tobra, IV or nebulized, for the ESBL klebs', ""- ID consult:  This might be stenotrophomonas (it's a non-fermenter),"", 'so we added Bactrim 130 mg IV q8 and D/c his PPX dose (Bactrim DS TIW)', '- OSH records: same ESBL Klebs in sputum on [**3-21**]', '- Limiting early morning interruptions']","['[**3-23**]', '- IgG level low, s/p giving IVIG', '- nutrition consult for elemental tube feeds', '- transfused 1 unit PRBCs, bumped appropriately, IRON studies (anemia', 'of chronic disease), hapto elevated likely due to acute phase, however,', 'given changes in hct were recently, will need to talk to BMT regarding', 'possible causes for the anemia.', '- cultures:  BCx: GRAM NEGATIVE ROD(S); sputum Cx:GRAM NEGATIVE ROD(S).', 'GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. currently on Meropenem 500', 'mg IV Q6H, Voriconazole 200 mg PO Q12H', '- PICC line needed today, follow up cultures and watch fever curve']",25256,144551.0
8,2162-03-25 11:21:29,,"['FEVER - 101.4', 'F - [**2162-3-24**] 09:00 AM', '- [**Doctor Last Name **] rec: use tobra, IV or nebulized, for the ESBL klebs', ""- ID consult:  This might be stenotrophomonas (it's a non-fermenter),"", 'so we added Bactrim 130 mg IV q8 and D/c his PPX dose (Bactrim DS TIW)', '- OSH records: same ESBL Klebs in sputum on [**3-21**]', '- Limiting early morning interruptions']",,25256,144551.0
9,2162-03-26 07:32:44,"['- placed back on pressure support in order to raise bicarbonate', '(relatively overventilated)', '- fever to 100.8, picc deferred', '- ID consult: Since BCx grew out Klebsiella, d/c bactrim, vancomycin.', 'IV Tobramycin if patient decompensates.', '- Notified CM about plan for possible d/c back to [**Hospital1 **] tomorrow or', 'more likely Saturday', '- glucan was both negative and greater than assay on the same day.', 'Unclear significance.  Glucan will be resent with AM labs tomorrow.  ID', 'aware and agrees with this plan.', '- Vitamin D level is 26 (insufficiency), he gets repletion already', '- got OOB --> Chair', ""- BMT: didn't see them or any recs in chart"", '- nurse felt that Dobhoff got pulled out a bit and may no longer be', 'post-pyloric; ordered CXR and KUB for tomorrow PM rounds']","['- placed back on pressure support in order to raise bicarbonate', '(relatively overventilated)', '- fever to 100.8, picc deferred', '- ID consult: Since BCx grew out Klebsiella, d/c bactrim, vancomycin.', 'IV Tobramycin if patient decompensates.', '- Notified CM about plan for possible d/c back to [**Hospital1 **] tomorrow or', 'more likely Saturday', '- glucan was both negative and greater than assay on the same day.', 'Unclear significance.  Glucan will be resent with AM labs tomorrow.  ID', 'aware and agrees with this plan.', '- Vitamin D level is 26 (insufficiency), he gets repletion already', '- got OOB --> Chair', ""- BMT: didn't see them or any recs in chart"", '- nurse felt that Dobhoff got pulled out a bit and may no longer be', 'post-pyloric; ordered CXR and KUB for tomorrow PM rounds']","['FEVER - 101.4', 'F - [**2162-3-24**] 09:00 AM', '- [**Doctor Last Name **] rec: use tobra, IV or nebulized, for the ESBL klebs', ""- ID consult:  This might be stenotrophomonas (it's a non-fermenter),"", 'so we added Bactrim 130 mg IV q8 and D/c his PPX dose (Bactrim DS TIW)', '- OSH records: same ESBL Klebs in sputum on [**3-21**]', '- Limiting early morning interruptions']",25256,144551.0
10,2162-03-26 12:15:07,,"['- placed back on pressure support in order to raise bicarbonate', '(relatively overventilated)', '- fever to 100.8, picc deferred', '- ID consult: Since BCx grew out Klebsiella, d/c bactrim, vancomycin.', 'IV Tobramycin if patient decompensates.', '- Notified CM about plan for possible d/c back to [**Hospital1 **] tomorrow or', 'more likely Saturday', '- glucan was both negative and greater than assay on the same day.', 'Unclear significance.  Glucan will be resent with AM labs tomorrow.  ID', 'aware and agrees with this plan.', '- Vitamin D level is 26 (insufficiency), he gets repletion already', '- got OOB --> Chair', ""- BMT: didn't see them or any recs in chart"", '- nurse felt that Dobhoff got pulled out a bit and may no longer be', 'post-pyloric; ordered CXR and KUB for tomorrow PM rounds']",,25256,144551.0
11,2162-03-26 12:55:00,,"['- placed back on pressure support in order to raise bicarbonate', '(relatively overventilated)', '- fever to 100.8, picc deferred', '- ID consult: Since BCx grew out Klebsiella, d/c bactrim, vancomycin.', 'IV Tobramycin if patient decompensates.', '- Notified CM about plan for possible d/c back to [**Hospital1 **] tomorrow or', 'more likely Saturday', '- glucan was both negative and greater than assay on the same day.', 'Unclear significance.  Glucan will be resent with AM labs tomorrow.  ID', 'aware and agrees with this plan.', '- Vitamin D level is 26 (insufficiency), he gets repletion already', '- got OOB --> Chair', ""- BMT: didn't see them or any recs in chart"", '- nurse felt that Dobhoff got pulled out a bit and may no longer be', 'post-pyloric; ordered CXR and KUB for tomorrow PM rounds']",,25256,144551.0
12,2162-03-27 07:00:46,"['- PICC held off due to spike fever.', '- BMT recs: check tobramycin in am.', '- IR replated doboff tube, location is appropriate.', '- Got 500 cc bolus due to thirst, HR elevated, and low BP, responded', 'appropriately', '- sputum culture, tobramycin started (getting trough level tomorrow', 'am).', '- f/u repeat sputum cultures, glucan/galacto', '- [**Last Name (un) 12035**] sputum culture sensitivity.', 'AMPICILLIN/SULBACTAM--  =>32 R', 'CEFAZOLIN-------------  =>64 R', 'CEFEPIME--------------', '<=1 S', 'CEFTAZIDIME-----------', '<=1 S', 'CEFTRIAXONE-----------', '<=1 S', 'CIPROFLOXACIN---------', '=>4 R', 'GENTAMICIN------------', '<=1 S', 'MEROPENEM-------------<=0.25 S', 'PIPERACILLIN/TAZO----- =>128 R', 'TOBRAMYCIN------------', '<=1 S', 'TRIMETHOPRIM/SULFA----  =>16 R']","['- PICC held off due to spike fever.', '- BMT recs: check tobramycin in am.', '- IR replated doboff tube, location is appropriate.', '- Got 500 cc bolus due to thirst, HR elevated, and low BP, responded', 'appropriately', '- sputum culture, tobramycin started (getting trough level tomorrow', 'am).', '- f/u repeat sputum cultures, glucan/galacto', '- [**Last Name (un) 12035**] sputum culture sensitivity.', 'AMPICILLIN/SULBACTAM--  =>32 R', 'CEFAZOLIN-------------  =>64 R', 'CEFEPIME--------------', '<=1 S', 'CEFTAZIDIME-----------', '<=1 S', 'CEFTRIAXONE-----------', '<=1 S', 'CIPROFLOXACIN---------', '=>4 R', 'GENTAMICIN------------', '<=1 S', 'MEROPENEM-------------<=0.25 S', 'PIPERACILLIN/TAZO----- =>128 R', 'TOBRAMYCIN------------', '<=1 S', 'TRIMETHOPRIM/SULFA----  =>16 R']","['- placed back on pressure support in order to raise bicarbonate', '(relatively overventilated)', '- fever to 100.8, picc deferred', '- ID consult: Since BCx grew out Klebsiella, d/c bactrim, vancomycin.', 'IV Tobramycin if patient decompensates.', '- Notified CM about plan for possible d/c back to [**Hospital1 **] tomorrow or', 'more likely Saturday', '- glucan was both negative and greater than assay on the same day.', 'Unclear significance.  Glucan will be resent with AM labs tomorrow.  ID', 'aware and agrees with this plan.', '- Vitamin D level is 26 (insufficiency), he gets repletion already', '- got OOB --> Chair', ""- BMT: didn't see them or any recs in chart"", '- nurse felt that Dobhoff got pulled out a bit and may no longer be', 'post-pyloric; ordered CXR and KUB for tomorrow PM rounds']",25256,144551.0
13,2162-03-27 15:37:59,,"['- PICC held off due to spike fever.', '- BMT recs: check tobramycin in am.', '- IR replated doboff tube, location is appropriate.', '- Got 500 cc bolus due to thirst, HR elevated, and low BP, responded', 'appropriately', '- sputum culture, tobramycin started (getting trough level tomorrow', 'am).', '- f/u repeat sputum cultures, glucan/galacto', '- [**Last Name (un) 12035**] sputum culture sensitivity.', 'AMPICILLIN/SULBACTAM--  =>32 R', 'CEFAZOLIN-------------  =>64 R', 'CEFEPIME--------------', '<=1 S', 'CEFTAZIDIME-----------', '<=1 S', 'CEFTRIAXONE-----------', '<=1 S', 'CIPROFLOXACIN---------', '=>4 R', 'GENTAMICIN------------', '<=1 S', 'MEROPENEM-------------<=0.25 S', 'PIPERACILLIN/TAZO----- =>128 R', 'TOBRAMYCIN------------', '<=1 S', 'TRIMETHOPRIM/SULFA----  =>16 R']",,25256,144551.0
14,2162-03-28 07:12:23,"['- Tobra level 0.4 --> low. Gave 240 mg', '- had c-diffy BM, started flagyl. Patient refused until C-diff positive']","['- Tobra level 0.4 --> low. Gave 240 mg', '- had c-diffy BM, started flagyl. Patient refused until C-diff positive']","['- PICC held off due to spike fever.', '- BMT recs: check tobramycin in am.', '- IR replated doboff tube, location is appropriate.', '- Got 500 cc bolus due to thirst, HR elevated, and low BP, responded', 'appropriately', '- sputum culture, tobramycin started (getting trough level tomorrow', 'am).', '- f/u repeat sputum cultures, glucan/galacto', '- [**Last Name (un) 12035**] sputum culture sensitivity.', 'AMPICILLIN/SULBACTAM--  =>32 R', 'CEFAZOLIN-------------  =>64 R', 'CEFEPIME--------------', '<=1 S', 'CEFTAZIDIME-----------', '<=1 S', 'CEFTRIAXONE-----------', '<=1 S', 'CIPROFLOXACIN---------', '=>4 R', 'GENTAMICIN------------', '<=1 S', 'MEROPENEM-------------<=0.25 S', 'PIPERACILLIN/TAZO----- =>128 R', 'TOBRAMYCIN------------', '<=1 S', 'TRIMETHOPRIM/SULFA----  =>16 R']",25256,144551.0
15,2162-03-28 14:23:50,,"['- Tobra level 0.4 --> low. Gave 240 mg', '- had c-diffy BM, started flagyl. Patient refused until C-diff positive']",,25256,144551.0
16,2162-03-29 07:18:30,"['- [**Known firstname 11704**] celebrated his 39th birthday', '- C. diff on [**3-27**] was negative', '- Klebsiella is not esbl (CTX, CTZ, cefepime sensitive)', '- ID: consider transition to CTX monotherapy if remains stable', '- Tolerated PS 5/5 and patient would like trach collar trial tomorrow', '- Tmax 100.4 at noon']","['- [**Known firstname 11704**] celebrated his 39th birthday', '- C. diff on [**3-27**] was negative', '- Klebsiella is not esbl (CTX, CTZ, cefepime sensitive)', '- ID: consider transition to CTX monotherapy if remains stable', '- Tolerated PS 5/5 and patient would like trach collar trial tomorrow', '- Tmax 100.4 at noon']","['- Tobra level 0.4 --> low. Gave 240 mg', '- had c-diffy BM, started flagyl. Patient refused until C-diff positive']",25256,144551.0
17,2162-03-29 12:05:41,,"['- [**Known firstname 11704**] celebrated his 39th birthday', '- C. diff on [**3-27**] was negative', '- Klebsiella is not esbl (CTX, CTZ, cefepime sensitive)', '- ID: consider transition to CTX monotherapy if remains stable', '- Tolerated PS 5/5 and patient would like trach collar trial tomorrow', '- Tmax 100.4 at noon']",,25256,144551.0
18,2162-03-29 13:37:09,,"['- [**Known firstname 11704**] celebrated his 39th birthday', '- C. diff on [**3-27**] was negative', '- Klebsiella is not esbl (CTX, CTZ, cefepime sensitive)', '- ID: consider transition to CTX monotherapy if remains stable', '- Tolerated PS 5/5 and patient would like trach collar trial tomorrow', '- Tmax 100.4 at noon']",,25256,144551.0
19,2162-03-30 07:45:52,"['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, after D7 of tobra, check audiogram', 'for ototoxicity and renal tox, if positive then d/c tobra.', '- respiratory support - did not do trach collar', '- had hematuria overnight.']","['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, after D7 of tobra, check audiogram', 'for ototoxicity and renal tox, if positive then d/c tobra.', '- respiratory support - did not do trach collar', '- had hematuria overnight.']","['- [**Known firstname 11704**] celebrated his 39th birthday', '- C. diff on [**3-27**] was negative', '- Klebsiella is not esbl (CTX, CTZ, cefepime sensitive)', '- ID: consider transition to CTX monotherapy if remains stable', '- Tolerated PS 5/5 and patient would like trach collar trial tomorrow', '- Tmax 100.4 at noon']",25256,144551.0
20,2162-03-30 11:48:28,,"['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, after D7 of tobra, check audiogram', 'for ototoxicity and renal tox, if positive then d/c tobra.', '- respiratory support - did not do trach collar', '- had hematuria overnight.']",,25256,144551.0
21,2162-03-30 12:35:52,"['- ID rec: start CTX, d/c meropenem, d/c tobra']","['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, d/c tobra', '- respiratory support - did not do trach collar', '- had hematuria overnight.']","['- ID rec: start CTX, d/c meropenem, after D7 of tobra, check audiogram', 'for ototoxicity and renal tox, if positive then d/c tobra.']",25256,144551.0
22,2162-03-30 13:39:02,,"['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, d/c tobra', '- respiratory support - did not do trach collar', '- had hematuria overnight.']",,25256,144551.0
23,2162-03-31 07:38:36,"['- PICC: patient refused [**1-26**] 99.5 temp', '- Creon changed to Viokase', '- Patient still refusing trach collar', '- ID: re-B-Glucan--> check in a week, repeat Chest CT if indicated', '- Dobhoff Clogged --> converted Vori, Mycophenalate to IV; Was also due', 'for simva (no IV equivalent) and acyclovir ppx (held due to renal', 'toxicity of IV preparation)']","['- PICC: patient refused [**1-26**] 99.5 temp', '- Creon changed to Viokase', '- Patient still refusing trach collar', '- ID: re-B-Glucan--> check in a week, repeat Chest CT if indicated', '- Dobhoff Clogged --> converted Vori, Mycophenalate to IV; Was also due', 'for simva (no IV equivalent) and acyclovir ppx (held due to renal', 'toxicity of IV preparation)']","['- refused PICC, like to have one more day prior to placement of PICC', '- tobramycin lvl ordered for the am.', '- ID rec: start CTX, d/c meropenem, d/c tobra', '- respiratory support - did not do trach collar', '- had hematuria overnight.']",25256,144551.0
24,2162-03-31 15:36:53,,"['- PICC: patient refused [**1-26**] 99.5 temp', '- Creon changed to Viokase', '- Patient still refusing trach collar', '- ID: re-B-Glucan--> check in a week, repeat Chest CT if indicated', '- Dobhoff Clogged --> converted Vori, Mycophenalate to IV; Was also due', 'for simva (no IV equivalent) and acyclovir ppx (held due to renal', 'toxicity of IV preparation)']",,25256,144551.0
25,2162-04-01 07:01:09,"['FLUOROSCOPY - At [**2162-3-31**] 04:45 PM', ' PICC LINE - START [**2162-3-31**] 04:53 PM', '- PICC successfully placed by IV team', '- Dobhoff replaced', '- switched IV meds back to PO']","['FLUOROSCOPY - At [**2162-3-31**] 04:45 PM', ' PICC LINE - START [**2162-3-31**] 04:53 PM', '- PICC successfully placed by IV team', '- Dobhoff replaced', '- switched IV meds back to PO']","['- PICC: patient refused [**1-26**] 99.5 temp', '- Creon changed to Viokase', '- Patient still refusing trach collar', '- ID: re-B-Glucan--> check in a week, repeat Chest CT if indicated', '- Dobhoff Clogged --> converted Vori, Mycophenalate to IV; Was also due', 'for simva (no IV equivalent) and acyclovir ppx (held due to renal', 'toxicity of IV preparation)']",25256,144551.0
26,2162-04-01 11:26:05,,"['FLUOROSCOPY - At [**2162-3-31**] 04:45 PM', ' PICC LINE - START [**2162-3-31**] 04:53 PM', '- PICC successfully placed by IV team', '- Dobhoff replaced', '- switched IV meds back to PO']",,25256,144551.0
27,2162-04-01 20:53:08,,"['FLUOROSCOPY - At [**2162-3-31**] 04:45 PM', ' PICC LINE - START [**2162-3-31**] 04:53 PM', '- PICC successfully placed by IV team', '- Dobhoff replaced', '- switched IV meds back to PO']",,25256,144551.0
28,2162-04-02 07:40:25,"['alk phos down trending.', 'PT eval okay to go', 'd/c tomorrow if spaudling has a bed.']","['alk phos down trending.', 'PT eval okay to go', 'd/c tomorrow if spaudling has a bed.']","['FLUOROSCOPY - At [**2162-3-31**] 04:45 PM', ' PICC LINE - START [**2162-3-31**] 04:53 PM', '- PICC successfully placed by IV team', '- Dobhoff replaced', '- switched IV meds back to PO']",25256,144551.0
29,2162-04-02 11:51:13,,"['alk phos down trending.', 'PT eval okay to go', 'd/c tomorrow if spaudling has a bed.']",,25256,144551.0
30,2162-04-02 14:57:28,,"['alk phos down trending.', 'PT eval okay to go', 'd/c tomorrow if spaudling has a bed.']",,25256,144551.0
0,2185-12-22 07:12:20,,"['Pt had some stretch pain overnight, relieved with Morphine.', 'Non-sustained runs of Vtach.']",,47795,120186.0
1,2185-12-22 12:02:40,,"['Pt had some stretch pain overnight, relieved with Morphine.', 'Non-sustained runs of Vtach.']",,47795,120186.0
2,2185-12-22 15:15:19,,"['Pt had some stretch pain overnight, relieved with Morphine.', 'Non-sustained runs of Vtach.']",,47795,120186.0
0,2195-08-16 06:04:21,,[],,64270,187496.0
1,2195-08-16 07:00:23,,[],,64270,187496.0
2,2195-08-16 07:07:13,"['-several episodes of tachycardia overnight to 120s, EKG unchanged.']","['-several episodes of tachycardia overnight to 120s, EKG unchanged.']",,64270,187496.0
3,2195-08-16 09:56:34,,"['-several episodes of tachycardia overnight to 120s, EKG unchanged.']",,64270,187496.0
4,2195-08-16 10:22:46,,"['-several episodes of tachycardia overnight to 120s, EKG unchanged.']",,64270,187496.0
5,2195-08-17 06:46:28,"['EKG - At [**2195-8-16**] 12:00 PM', ' EKG - At [**2195-8-16**] 05:48 PM', ' EKG - At [**2195-8-16**] 07:45 PM', '[**8-16**]']","['EKG - At [**2195-8-16**] 12:00 PM', ' EKG - At [**2195-8-16**] 05:48 PM', ' EKG - At [**2195-8-16**] 07:45 PM', '[**8-16**]']","['-several episodes of tachycardia overnight to 120s, EKG unchanged.']",64270,187496.0
6,2195-08-17 07:15:31,,"['EKG - At [**2195-8-16**] 12:00 PM', ' EKG - At [**2195-8-16**] 05:48 PM', ' EKG - At [**2195-8-16**] 07:45 PM', '[**8-16**]']",,64270,187496.0
7,2195-08-17 15:28:34,,"['EKG - At [**2195-8-16**] 12:00 PM', ' EKG - At [**2195-8-16**] 05:48 PM', ' EKG - At [**2195-8-16**] 07:45 PM', '[**8-16**]']",,64270,187496.0
0,2196-06-05 07:33:33,,"['INVASIVE VENTILATION - START [**2196-6-4**] 05:55 PM', ' ARTERIAL LINE - START [**2196-6-4**] 07:30 PM', ' MULTI LUMEN - START [**2196-6-4**] 07:48 PM', ' BLOOD CULTURED - At [**2196-6-4**] 08:00 PM', ' ULTRASOUND - At [**2196-6-4**] 10:23 PM', 'Gall blader and liver', ' EKG - At [**2196-6-5**] 03:00 AM', ' BLOOD CULTURED - At [**2196-6-5**] 04:44 AM', '- transiently off neo, but had to be restarted to maintain MAP above 60', '- given 3L <D5W w/3 amp bicarb>']",,65650,164885.0
1,2196-06-05 07:34:45,,"['INVASIVE VENTILATION - START [**2196-6-4**] 05:55 PM', ' ARTERIAL LINE - START [**2196-6-4**] 07:30 PM', ' MULTI LUMEN - START [**2196-6-4**] 07:48 PM', ' BLOOD CULTURED - At [**2196-6-4**] 08:00 PM', ' ULTRASOUND - At [**2196-6-4**] 10:23 PM', 'Gall blader and liver', ' EKG - At [**2196-6-5**] 03:00 AM', ' BLOOD CULTURED - At [**2196-6-5**] 04:44 AM', '- transiently off neo, but had to be restarted to maintain MAP above 60', '- given 3L <D5W w/3 amp bicarb>']",,65650,164885.0
2,2196-06-05 12:33:14,,"['INVASIVE VENTILATION - START [**2196-6-4**] 05:55 PM', ' ARTERIAL LINE - START [**2196-6-4**] 07:30 PM', ' MULTI LUMEN - START [**2196-6-4**] 07:48 PM', ' BLOOD CULTURED - At [**2196-6-4**] 08:00 PM', ' ULTRASOUND - At [**2196-6-4**] 10:23 PM', 'Gall blader and liver', ' EKG - At [**2196-6-5**] 03:00 AM', ' BLOOD CULTURED - At [**2196-6-5**] 04:44 AM', '- transiently off neo, but had to be restarted to maintain MAP above 60', '- given 3L <D5W w/3 amp bicarb>']",,65650,164885.0
3,2196-06-05 14:50:05,,"['INVASIVE VENTILATION - START [**2196-6-4**] 05:55 PM', ' ARTERIAL LINE - START [**2196-6-4**] 07:30 PM', ' MULTI LUMEN - START [**2196-6-4**] 07:48 PM', ' BLOOD CULTURED - At [**2196-6-4**] 08:00 PM', ' ULTRASOUND - At [**2196-6-4**] 10:23 PM', 'Gall blader and liver', ' EKG - At [**2196-6-5**] 03:00 AM', ' BLOOD CULTURED - At [**2196-6-5**] 04:44 AM', '- transiently off neo, but had to be restarted to maintain MAP above 60', '- given 3L <D5W w/3 amp bicarb>']",,65650,164885.0
4,2196-06-06 06:38:03,"['EKG - At [**2196-6-5**] 08:00 AM', '- ID:  started treatment for M Bovis INH, rifampin + vanc/zosyn for', 'broad coverage', '- TTE:  trivial effusion, no tamponade', '- d/w ERCP:  no need for ERCP currently', '- d/w renal:  need to start FFP for INR <2, platelets >50 for HD line', 'for likely CVVH tomorrow', '- aiming for MAP ~100 because mental status seems to improve with that,', 'also lactate improving', '- got 1 unit platelets', '- following DIC labs', '- lactate (peaked at 5.3) now falling', '- started insulin SS for FS 200s', '- ABG still looks bad:  increasing FiO2 and PEEP-->now on 60% FiO2,', 'PEEP 15', '- esophageal balloon pressure to tailor PEEP', 'did compliance curve and', 'found that optimal PEEP was actually 10']","['EKG - At [**2196-6-5**] 08:00 AM', '- ID:  started treatment for M Bovis INH, rifampin + vanc/zosyn for', 'broad coverage', '- TTE:  trivial effusion, no tamponade', '- d/w ERCP:  no need for ERCP currently', '- d/w renal:  need to start FFP for INR <2, platelets >50 for HD line', 'for likely CVVH tomorrow', '- aiming for MAP ~100 because mental status seems to improve with that,', 'also lactate improving', '- got 1 unit platelets', '- following DIC labs', '- lactate (peaked at 5.3) now falling', '- started insulin SS for FS 200s', '- ABG still looks bad:  increasing FiO2 and PEEP-->now on 60% FiO2,', 'PEEP 15', '- esophageal balloon pressure to tailor PEEP', 'did compliance curve and', 'found that optimal PEEP was actually 10']","['INVASIVE VENTILATION - START [**2196-6-4**] 05:55 PM', ' ARTERIAL LINE - START [**2196-6-4**] 07:30 PM', ' MULTI LUMEN - START [**2196-6-4**] 07:48 PM', ' BLOOD CULTURED - At [**2196-6-4**] 08:00 PM', ' ULTRASOUND - At [**2196-6-4**] 10:23 PM', 'Gall blader and liver', ' EKG - At [**2196-6-5**] 03:00 AM', ' BLOOD CULTURED - At [**2196-6-5**] 04:44 AM', '- transiently off neo, but had to be restarted to maintain MAP above 60', '- given 3L <D5W w/3 amp bicarb>']",65650,164885.0
5,2196-06-06 12:22:25,,"['EKG - At [**2196-6-5**] 08:00 AM', '- ID:  started treatment for M Bovis INH, rifampin + vanc/zosyn for', 'broad coverage', '- TTE:  trivial effusion, no tamponade', '- d/w ERCP:  no need for ERCP currently', '- d/w renal:  need to start FFP for INR <2, platelets >50 for HD line', 'for likely CVVH tomorrow', '- aiming for MAP ~100 because mental status seems to improve with that,', 'also lactate improving', '- got 1 unit platelets', '- following DIC labs', '- lactate (peaked at 5.3) now falling', '- started insulin SS for FS 200s', '- ABG still looks bad:  increasing FiO2 and PEEP-->now on 60% FiO2,', 'PEEP 15', '- esophageal balloon pressure to tailor PEEP', 'did compliance curve and', 'found that optimal PEEP was actually 10']",,65650,164885.0
6,2196-06-06 12:26:00,,"['EKG - At [**2196-6-5**] 08:00 AM', '- ID:  started treatment for M Bovis INH, rifampin + vanc/zosyn for', 'broad coverage', '- TTE:  trivial effusion, no tamponade', '- d/w ERCP:  no need for ERCP currently', '- d/w renal:  need to start FFP for INR <2, platelets >50 for HD line', 'for likely CVVH tomorrow', '- aiming for MAP ~100 because mental status seems to improve with that,', 'also lactate improving', '- got 1 unit platelets', '- following DIC labs', '- lactate (peaked at 5.3) now falling', '- started insulin SS for FS 200s', '- ABG still looks bad:  increasing FiO2 and PEEP-->now on 60% FiO2,', 'PEEP 15', '- esophageal balloon pressure to tailor PEEP', 'did compliance curve and', 'found that optimal PEEP was actually 10']",,65650,164885.0
7,2196-06-07 06:25:16,"['DIALYSIS CATHETER - START [**2196-6-6**] 12:00 PM', ' ARTERIAL LINE - STOP [**2196-6-7**] 12:00 AM', '- Surgery consulted for ? ischemic colitis given rising lactate,', 'abdominal tenderness.  D/w family and surgery led to decline of any', 'surgical intervention', '- Started on CVVH']","['DIALYSIS CATHETER - START [**2196-6-6**] 12:00 PM', ' ARTERIAL LINE - STOP [**2196-6-7**] 12:00 AM', '- Surgery consulted for ? ischemic colitis given rising lactate,', 'abdominal tenderness.  D/w family and surgery led to decline of any', 'surgical intervention', '- Started on CVVH']","['EKG - At [**2196-6-5**] 08:00 AM', '- ID:  started treatment for M Bovis INH, rifampin + vanc/zosyn for', 'broad coverage', '- TTE:  trivial effusion, no tamponade', '- d/w ERCP:  no need for ERCP currently', '- d/w renal:  need to start FFP for INR <2, platelets >50 for HD line', 'for likely CVVH tomorrow', '- aiming for MAP ~100 because mental status seems to improve with that,', 'also lactate improving', '- got 1 unit platelets', '- following DIC labs', '- lactate (peaked at 5.3) now falling', '- started insulin SS for FS 200s', '- ABG still looks bad:  increasing FiO2 and PEEP-->now on 60% FiO2,', 'PEEP 15', '- esophageal balloon pressure to tailor PEEP', 'did compliance curve and', 'found that optimal PEEP was actually 10']",65650,164885.0
8,2196-06-07 06:27:36,"['- Lost A-line, could not replace due to edema']","['DIALYSIS CATHETER - START [**2196-6-6**] 12:00 PM', ' ARTERIAL LINE - STOP [**2196-6-7**] 12:00 AM', '- Surgery consulted for ? ischemic colitis given rising lactate,', 'abdominal tenderness.  D/w family and surgery led to decline of any', 'surgical intervention', '- Started on CVVH', '- Lost A-line, could not replace due to edema']",,65650,164885.0
9,2196-06-07 07:56:53,"['SCROTAL ULTRASOUND', 'Hypoechoic nodules in the upper pole of the right testicle.', 'Differential includes tumor or phlegmon. No evidence of epididymitis.', 'Bilateral hydroceles.']","['DIALYSIS CATHETER - START [**2196-6-6**] 12:00 PM', ' ARTERIAL LINE - STOP [**2196-6-7**] 12:00 AM', '- Surgery consulted for ? ischemic colitis given rising lactate,', 'abdominal tenderness.  D/w family and surgery led to decline of any', 'surgical intervention', '- Started on CVVH', '- Lost A-line, could not replace due to edema', 'SCROTAL ULTRASOUND', 'Hypoechoic nodules in the upper pole of the right testicle.', 'Differential includes tumor or phlegmon. No evidence of epididymitis.', 'Bilateral hydroceles.']",,65650,164885.0
10,2196-06-07 08:41:18,"['surgical intervention and imaging', '- Temporary dialysis line placed on [**6-6**]', '- Had to go up on pressors briefly (but at same level as was at', 'yesterday)', '- PEEP went up from 10 to 12 (improvement in paO2 to 90', 's from 60', '- Cultures remain negative', '- CVVP running even currently (unable to take anything off)']","['DIALYSIS CATHETER - START [**2196-6-6**] 12:00 PM', ' ARTERIAL LINE - STOP [**2196-6-7**] 12:00 AM', '- Surgery consulted for ? ischemic colitis given rising lactate,', 'abdominal tenderness.  D/w family and surgery led to decline of any', 'surgical intervention and imaging', '- Temporary dialysis line placed on [**6-6**]', '- Started on CVVH', '- Lost A-line, could not replace due to edema', '- Had to go up on pressors briefly (but at same level as was at', 'yesterday)', '- PEEP went up from 10 to 12 (improvement in paO2 to 90', 's from 60', '- Cultures remain negative', '- CVVP running even currently (unable to take anything off)', 'SCROTAL ULTRASOUND', 'Hypoechoic nodules in the upper pole of the right testicle.', 'Differential includes tumor or phlegmon. No evidence of epididymitis.', 'Bilateral hydroceles.']",['surgical intervention'],65650,164885.0
11,2196-06-08 06:18:19,,,,65650,164885.0
12,2196-06-08 07:11:58,,,,65650,164885.0
13,2196-06-08 07:24:02,,,,65650,164885.0
14,2196-06-08 09:41:11,,,,65650,164885.0
15,2196-06-08 09:42:07,,,,65650,164885.0
16,2196-06-09 07:23:43,,,,65650,164885.0
17,2196-06-09 07:27:05,,,,65650,164885.0
18,2196-06-09 15:31:12,,,,65650,164885.0
19,2196-06-09 15:32:30,,,,65650,164885.0
20,2196-06-10 07:15:57,"['- Amio stopped after converted to sinus brady', '- Difficulty with CVVH o/n, had to change machines, not fluid down']",,"['- [**Hospital 327**] Hospital without growth on cultures', '- Started pyridoxine 10mg IV daily', '- Changed INH/rifampin PO to levoflox/rifampin IV', '- Decreased FiO2 to 40%, PEEP to 10, RR to 16', '- Became transiently hypertensive/bradycardic with cryo (given for', 'fibrinogen 101)', '- Family decided not to change subclavian line', '- New afib, with RVR in the early evening. Initially gave back fluids,', 'later loaded with amio']",65650,164885.0
21,2196-06-10 07:17:20,,,,65650,164885.0
22,2196-06-10 11:57:00,,,,65650,164885.0
23,2196-06-11 07:57:56,"['DIALYSIS CATHETER - START [**2196-6-10**] 08:00 PM', ' MULTI LUMEN - START [**2196-6-10**] 08:00 PM', 'new line placed in ir . all lines and solutsions new to infuse into new', 'line', ' MULTI LUMEN - STOP [**2196-6-10**] 10:03 PM', '- dialysis line changed', '- central access changed', '- pressors off and pt hypertensive--> thus able to achieve greater', 'volume removal']",,"['- Amio stopped after converted to sinus brady', '- Difficulty with CVVH o/n, had to change machines, not fluid down']",65650,164885.0
24,2196-06-11 16:09:04,,,,65650,164885.0
25,2196-06-12 07:32:10,"['DIALYSIS CATHETER - STOP [**2196-6-11**] 04:15 PM', '- pulled femoral HD line', ""- Rec'd 1 unit platelets prior to line pull, received unit of cryo"", 'without reaction', '- holding TF for high residuals']",,"['DIALYSIS CATHETER - START [**2196-6-10**] 08:00 PM', ' MULTI LUMEN - START [**2196-6-10**] 08:00 PM', 'new line placed in ir . all lines and solutsions new to infuse into new', 'line', ' MULTI LUMEN - STOP [**2196-6-10**] 10:03 PM', '- dialysis line changed', '- central access changed', '- pressors off and pt hypertensive--> thus able to achieve greater', 'volume removal']",65650,164885.0
26,2196-06-12 07:43:39,,,,65650,164885.0
27,2196-06-12 07:45:11,,,,65650,164885.0
28,2196-06-12 13:47:13,,,,65650,164885.0
29,2196-06-13 07:19:44,"['STOOL CULTURE - At [**2196-6-12**] 02:12 PM', ' BLOOD CULTURED - At [**2196-6-12**] 02:55 PM', 'drawn from central line', ' BLOOD CULTURED - At [**2196-6-12**] 03:44 PM', 'drawn from central line', '- Tube feeds held for high residuals', '- Unable to change a-line over a wire', '- Transient hypotension (while in NSR, afebrile, resp fine) after', 'stopping CVVH.  As levo was about to drip in, BP restored.  Labs sent', 'stat but no significant change.']",,"['DIALYSIS CATHETER - STOP [**2196-6-11**] 04:15 PM', '- pulled femoral HD line', ""- Rec'd 1 unit platelets prior to line pull, received unit of cryo"", 'without reaction', '- holding TF for high residuals']",65650,164885.0
30,2196-06-13 07:22:04,,,,65650,164885.0
31,2196-06-13 10:16:49,,,,65650,164885.0
32,2196-06-15 07:06:51,"['No acute events overnight', 'Not Dialyzed yesterday']",,"['STOOL CULTURE - At [**2196-6-12**] 02:12 PM', ' BLOOD CULTURED - At [**2196-6-12**] 02:55 PM', 'drawn from central line', ' BLOOD CULTURED - At [**2196-6-12**] 03:44 PM', 'drawn from central line', '- Tube feeds held for high residuals', '- Unable to change a-line over a wire', '- Transient hypotension (while in NSR, afebrile, resp fine) after', 'stopping CVVH.  As levo was about to drip in, BP restored.  Labs sent', 'stat but no significant change.']",65650,164885.0
33,2196-06-15 07:11:24,,,,65650,164885.0
34,2196-06-15 14:45:50,,,,65650,164885.0
35,2196-06-16 07:02:10,"['- No acute events o/n', '- UF:  remove 4.5 L with stable BP']",,"['No acute events overnight', 'Not Dialyzed yesterday']",65650,164885.0
36,2196-06-16 07:59:00,,,,65650,164885.0
37,2196-06-16 14:54:28,['- got ultrafiltration with removal of 4.5 L with stable BP'],,"['- No acute events o/n', '- UF:  remove 4.5 L with stable BP']",65650,164885.0
38,2196-06-17 07:29:43,"['- trial of PSV but patient with cheye-[**Doctor Last Name **] breathing', '- ID says no PCP [**Name9 (PRE) 1694**] but attending may be re-considering']",,['- got ultrafiltration with removal of 4.5 L with stable BP'],65650,164885.0
39,2196-06-17 13:09:02,"['- lightened sedation; patient became hypertensive and agitated', '- trial of PSV but patient inconsistently breathing']",,['- trial of PSV but patient with cheye-[**Doctor Last Name **] breathing'],65650,164885.0
40,2196-06-17 13:40:00,,,,65650,164885.0
41,2196-06-17 15:08:23,,,,65650,164885.0
42,2196-06-18 07:37:34,['Tunnelled line pushed back to Monday'],,"['- lightened sedation; patient became hypertensive and agitated', '- trial of PSV but patient inconsistently breathing', '- ID says no PCP [**Name9 (PRE) 1694**] but attending may be re-considering']",65650,164885.0
43,2196-06-18 07:42:42,,,,65650,164885.0
44,2196-06-18 14:49:45,,,,65650,164885.0
45,2196-06-19 07:36:02,"['ARTERIAL LINE - START [**2196-6-18**] 07:00 PM', ' ARTERIAL LINE - STOP [**2196-6-18**] 10:00 PM', ' ARTERIAL LINE - START [**2196-6-19**] 06:40 AM', '[**First Name8 (NamePattern2) **] [**Location (un) 103**] sbp in 170s, noninvasive cuff [**Location (un) 103**] sbp in 130s. abg', 'sent.', '--Significant improvement in removal of volume yesterday.']",,['Tunnelled line pushed back to Monday'],65650,164885.0
46,2196-06-19 07:38:29,,,,65650,164885.0
47,2196-06-19 19:33:30,['--unable to get HD or UF today b/c of dialysis nurse staffing issues'],,,65650,164885.0
48,2196-06-20 07:28:55,['No acute events or changes in mgt overnight'],,"['ARTERIAL LINE - START [**2196-6-18**] 07:00 PM', ' ARTERIAL LINE - STOP [**2196-6-18**] 10:00 PM', ' ARTERIAL LINE - START [**2196-6-19**] 06:40 AM', '[**First Name8 (NamePattern2) **] [**Location (un) 103**] sbp in 170s, noninvasive cuff [**Location (un) 103**] sbp in 130s. abg', 'sent.', '--Significant improvement in removal of volume yesterday.', '--unable to get HD or UF today b/c of dialysis nurse staffing issues']",65650,164885.0
49,2196-06-20 07:30:07,,,,65650,164885.0
50,2196-06-20 13:05:58,,,,65650,164885.0
51,2196-06-21 07:19:27,"['- 4.2L taken on w/ HD', '- spoke to ID about tx for bcg ""months and months""', '- attempted NIF but pt would bite down on ET tube']",,['No acute events or changes in mgt overnight'],65650,164885.0
52,2196-06-21 08:21:19,,,,65650,164885.0
53,2196-06-21 09:35:11,,,,65650,164885.0
54,2196-06-21 15:04:37,,,,65650,164885.0
55,2196-06-22 07:26:52,"['- A-line taken out', '- Sputum sample obtained by RT', '- switched to Levofloxacin po', '- transfused 2 units pRBC for HCT 20', '- family meeting w Ms [**Known lastname 5999**] yesterday', ' continue current measures']",,"['- 4.2L taken on w/ HD', '- spoke to ID about tx for bcg ""months and months""', '- attempted NIF but pt would bite down on ET tube']",65650,164885.0
56,2196-06-22 12:46:10,,,,65650,164885.0
57,2196-06-22 14:09:42,,,,65650,164885.0
58,2196-06-23 08:03:27,"['- PS trial unsuccessful - pt w intermittent apnea', '- HD today w removal of 2.7L of fluid, wgt 11kgs decrease since [**6-19**]', '- spiked a fever to 101.1 @ 8pm --> pancultured/CXR, given vanc 1gm x1', 'for possible line infection', '- 2 episodes of SVT, hemodynamically stable']",,"['- A-line taken out', '- Sputum sample obtained by RT', '- switched to Levofloxacin po', '- transfused 2 units pRBC for HCT 20', '- family meeting w Ms [**Known lastname 5999**] yesterday', ' continue current measures']",65650,164885.0
59,2196-06-23 10:09:11,,,,65650,164885.0
60,2196-06-24 07:38:02,"['BLOOD CULTURED - At [**2196-6-23**] 11:45 AM', 'fungal', ' URINE CULTURE - At [**2196-6-23**] 04:34 PM']",,"['- PS trial unsuccessful - pt w intermittent apnea', '- HD today w removal of 2.7L of fluid, wgt 11kgs decrease since [**6-19**]', '- spiked a fever to 101.1 @ 8pm --> pancultured/CXR, given vanc 1gm x1', 'for possible line infection', '- 2 episodes of SVT, hemodynamically stable']",65650,164885.0
61,2196-06-24 08:03:53,"['- Blood culture grew gram + cocci in pairs and clusters, antibiotic', 'coverage changed in include zosyn', '- Central line removed, 2 PIV placed', '- Repeat UA showed no yeast', '- Phosphate binder stopped for P of 1.9', '- C. diff negative x 3']",,"['BLOOD CULTURED - At [**2196-6-23**] 11:45 AM', 'fungal', ' URINE CULTURE - At [**2196-6-23**] 04:34 PM']",65650,164885.0
62,2196-06-24 16:18:21,,,,65650,164885.0
63,2196-06-24 17:03:24,,,,65650,164885.0
64,2196-06-24 19:30:26,,,,65650,164885.0
65,2196-06-25 07:41:00,"['- 2 liters removed during HD', '- After HD patient tolerated PS x 12 hours, repeat ABG showed', '7.33/57/129.  Patient placed back on AC early this am.', '- Had preliminary discussion with family re: goals of care.  For now', 'the plan is aggressive diuresis to optimize medical condition for', 'possible attempted extubation early next week.  Will need to clarify', 'whether they would desire re-intubation in event of failure.']",,"['- Blood culture grew gram + cocci in pairs and clusters, antibiotic', 'coverage changed in include zosyn', '- Central line removed, 2 PIV placed', '- Repeat UA showed no yeast', '- Phosphate binder stopped for P of 1.9', '- C. diff negative x 3']",65650,164885.0
66,2196-06-25 08:02:10,['- 2 liters removed during HD for LOS fluid balance now +18 L'],,['- 2 liters removed during HD'],65650,164885.0
67,2196-06-25 11:04:51,,,,65650,164885.0
68,2196-06-25 11:29:20,,,,65650,164885.0
69,2196-06-26 06:57:01,"['- ID - d/c zosyn, cont vanc for 14-d total, signed off', '- renal - HD monday', '- PSV all day [**12-24**]', '- cath tip grew --> coag neg Staph']",,"['- 2 liters removed during HD for LOS fluid balance now +18 L', '- After HD patient tolerated PS x 12 hours, repeat ABG showed', '7.33/57/129.  Patient placed back on AC early this am.', '- Had preliminary discussion with family re: goals of care.  For now', 'the plan is aggressive diuresis to optimize medical condition for', 'possible attempted extubation early next week.  Will need to clarify', 'whether they would desire re-intubation in event of failure.']",65650,164885.0
70,2196-06-26 10:37:30,,,,65650,164885.0
71,2196-06-27 07:22:37,"['BLOOD CULTURED - At [**2196-6-26**] 12:37 PM', '[**6-26**]', '-family want to meet on Monday at 3pm, with team member, and Dr. [**First Name (STitle) **],', 'she will bring her pastor', '-renal recs to continue HD', '-blood cx to be collected with HD on Monday', '-G6PD- still pending', '-check vanco [**6-27**] trough']",,"['- ID - d/c zosyn, cont vanc for 14-d total, signed off', '- renal - HD monday', '- PSV all day [**12-24**]', '- cath tip grew --> coag neg Staph']",65650,164885.0
72,2196-06-27 07:23:44,,,,65650,164885.0
73,2196-06-27 12:55:55,,,,65650,164885.0
74,2196-06-28 07:14:14,"['SPUTUM CULTURE - At [**2196-6-27**] 02:16 PM', '[**6-27**]', '- family meeting', '- Pt made CMO, extubated and placed on Morphine gtt']",,"['BLOOD CULTURED - At [**2196-6-26**] 12:37 PM', '[**6-26**]', '-family want to meet on Monday at 3pm, with team member, and Dr. [**First Name (STitle) **],', 'she will bring her pastor', '-renal recs to continue HD', '-blood cx to be collected with HD on Monday', '-G6PD- still pending', '-check vanco [**6-27**] trough']",65650,164885.0
75,2196-06-28 14:59:15,,,,65650,164885.0
0,2154-06-16 07:12:42,,"['- Hemodynamically stable', '- c/o severe back pain and discomfort; relieved by percocet', '- received trazodone for sleep and ativan for anxiety during the night']",,42405,106980.0
1,2154-06-16 07:49:25,"['- remains very agitated in AM, wants to get OOB', '- No BM yet']","['- Hemodynamically stable', '- c/o severe back pain and discomfort; relieved by percocet', '- received trazodone for sleep and ativan for anxiety during the night', '- remains very agitated in AM, wants to get OOB', '- No BM yet']",,42405,106980.0
2,2154-06-16 09:31:25,,"['- Hemodynamically stable', '- c/o severe back pain and discomfort; relieved by percocet', '- received trazodone for sleep and ativan for anxiety during the night', '- remains very agitated in AM, wants to get OOB', '- No BM yet']",,42405,106980.0
3,2154-06-16 10:06:40,,"['- Hemodynamically stable', '- c/o severe back pain and discomfort; relieved by percocet', '- received trazodone for sleep and ativan for anxiety during the night', '- remains very agitated in AM, wants to get OOB', '- No BM yet']",,42405,106980.0
4,2154-06-17 07:11:06,"[""- Spoke to OSH surgeon - cefazolin was only to be 24h ->d/c'd, recom to"", 'start ASA 81, start SQH on day#5 (currently POD#2), activity as', 'tolerated', '- EP rec- NPO, Vanc at bedside -> on schedule for late tomorrow to give', 'family time to decide about pacer']","[""- Spoke to OSH surgeon - cefazolin was only to be 24h ->d/c'd, recom to"", 'start ASA 81, start SQH on day#5 (currently POD#2), activity as', 'tolerated', '- EP rec- NPO, Vanc at bedside -> on schedule for late tomorrow to give', 'family time to decide about pacer']","['- Hemodynamically stable', '- c/o severe back pain and discomfort; relieved by percocet', '- received trazodone for sleep and ativan for anxiety during the night', '- remains very agitated in AM, wants to get OOB', '- No BM yet']",42405,106980.0
5,2154-06-17 09:47:41,,"[""- Spoke to OSH surgeon - cefazolin was only to be 24h ->d/c'd, recom to"", 'start ASA 81, start SQH on day#5 (currently POD#2), activity as', 'tolerated', '- EP rec- NPO, Vanc at bedside -> on schedule for late tomorrow to give', 'family time to decide about pacer']",,42405,106980.0
0,2122-01-17 08:06:51,,"['EKG - At [**2122-1-16**] 09:09 AM', ' MAGNETIC RESONANCE IMAGING - At [**2122-1-16**] 03:10 PM', 'total body', ' BLOOD CULTURED - At [**2122-1-16**] 03:10 PM', ' URINE CULTURE - At [**2122-1-16**] 03:10 PM', ' LUMBAR PUNCTURE - At [**2122-1-16**] 04:08 PM', '[**1-16**] Events:', '- MRI showed no evidence of cord compression or other pathology', '- tox screen negative for cocaine', '- LP -> awaiting cultures/VDRL/Lyme', '- CT -> no evidence of dissection', '- CKs trending down', '- Switched from insulin gtt to lantus 15 units at bedtime -> pt with', 'increased FSBS over 350s after insulin gtt stopped ([**12-29**] pt eating large', 'meal), insulin gtt re-started this AM']",,42948,178084.0
1,2122-01-17 08:07:39,,"['EKG - At [**2122-1-16**] 09:09 AM', ' MAGNETIC RESONANCE IMAGING - At [**2122-1-16**] 03:10 PM', 'total body', ' BLOOD CULTURED - At [**2122-1-16**] 03:10 PM', ' URINE CULTURE - At [**2122-1-16**] 03:10 PM', ' LUMBAR PUNCTURE - At [**2122-1-16**] 04:08 PM', '[**1-16**] Events:', '- MRI showed no evidence of cord compression or other pathology', '- tox screen negative for cocaine', '- LP -> awaiting cultures/VDRL/Lyme', '- CT -> no evidence of dissection', '- CKs trending down', '- Switched from insulin gtt to lantus 15 units at bedtime -> pt with', 'increased FSBS over 350s after insulin gtt stopped ([**12-29**] pt eating large', 'meal), insulin gtt re-started this AM']",,42948,178084.0
2,2122-01-17 08:08:21,,"['EKG - At [**2122-1-16**] 09:09 AM', ' MAGNETIC RESONANCE IMAGING - At [**2122-1-16**] 03:10 PM', 'total body', ' BLOOD CULTURED - At [**2122-1-16**] 03:10 PM', ' URINE CULTURE - At [**2122-1-16**] 03:10 PM', ' LUMBAR PUNCTURE - At [**2122-1-16**] 04:08 PM', '[**1-16**] Events:', '- MRI showed no evidence of cord compression or other pathology', '- tox screen negative for cocaine', '- LP -> awaiting cultures/VDRL/Lyme', '- CT -> no evidence of dissection', '- CKs trending down', '- Switched from insulin gtt to lantus 15 units at bedtime -> pt with', 'increased FSBS over 350s after insulin gtt stopped ([**12-29**] pt eating large', 'meal), insulin gtt re-started this AM']",,42948,178084.0
3,2122-01-17 12:18:44,"['- CTA -> no evidence of dissection', '- had lower extremity pain responded to 1mg dilaudid']","['EKG - At [**2122-1-16**] 09:09 AM', ' MAGNETIC RESONANCE IMAGING - At [**2122-1-16**] 03:10 PM', 'total body', ' BLOOD CULTURED - At [**2122-1-16**] 03:10 PM', ' URINE CULTURE - At [**2122-1-16**] 03:10 PM', ' LUMBAR PUNCTURE - At [**2122-1-16**] 04:08 PM', '[**1-16**] Events:', '- MRI showed no evidence of cord compression or other pathology', '- tox screen negative for cocaine', '- LP -> awaiting cultures/VDRL/Lyme', '- CTA -> no evidence of dissection', '- CKs trending down', '- Switched from insulin gtt to lantus 15 units at bedtime -> pt with', 'increased FSBS over 350s after insulin gtt stopped ([**12-29**] pt eating large', 'meal), insulin gtt re-started this AM', '- had lower extremity pain responded to 1mg dilaudid']",['- CT -> no evidence of dissection'],42948,178084.0
0,2125-06-12 07:12:43,,"['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well.', '-Heparin gtt started this am giving CE cont to trend up']",,72790,138635.0
1,2125-06-12 07:14:52,"['Considered giving lasix but pt autodiuresing well, now -800 mL.']","['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well, now -800 mL.', '-Heparin gtt started this am giving CE cont to trend up']",['Considered giving lasix but pt autodiuresing well.'],72790,138635.0
2,2125-06-12 07:28:14,,"['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well, now -800 mL.', '-Heparin gtt started this am giving CE cont to trend up']",,72790,138635.0
3,2125-06-12 10:01:53,,"['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well, now -800 mL.', '-Heparin gtt started this am giving CE cont to trend up']",,72790,138635.0
4,2125-06-12 10:08:17,,"['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well, now -800 mL.', '-Heparin gtt started this am giving CE cont to trend up']",,72790,138635.0
5,2125-06-13 07:51:32,"['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']","['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']","['-Hypertensive on admission, nitro gtt and labetolol gtt started.', ""labetolol dc'd and nifedipine started. Pressure responded"", '-Patient started on hypothermic protocol', '-Subclavian line placed', '-Amio gtt started', '-CXR showed widened mediastinum felt to be [**2-5**] engorged vasculature.', 'Considered giving lasix but pt autodiuresing well, now -800 mL.', '-Heparin gtt started this am giving CE cont to trend up']",72790,138635.0
6,2125-06-13 09:34:36,,"['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']",,72790,138635.0
7,2125-06-13 09:46:33,,"['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']",,72790,138635.0
8,2125-06-13 18:08:23,,"['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']",,72790,138635.0
9,2125-06-13 18:09:14,,"['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']",,72790,138635.0
10,2125-06-14 07:25:32,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']","['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']","['TRANSTHORACIC ECHO - At [**2125-6-12**] 10:00 AM', ' SHEATH - STOP [**2125-6-12**] 03:07 PM', ' ARTERIAL LINE - STOP [**2125-6-12**] 03:30 PM', '- completed cooling protocol, rewarming started 8pm', '- sheath pulled, post-sheath check at 9pm no complications', '- A-line pulled', '- d/c amio, heparin gtt and nitro gtt; d/c cisatracurium at midnight', '- FiO2 was decreased to 40% at noon (ABG: 7.43/40/74/27), and switched']",72790,138635.0
11,2125-06-14 07:30:06,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
12,2125-06-14 07:39:31,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
13,2125-06-14 07:54:07,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
14,2125-06-14 09:14:15,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
15,2125-06-14 09:26:42,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
16,2125-06-14 14:44:36,,"['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",,72790,138635.0
17,2125-06-15 08:05:29,"['MAGNETIC RESONANCE IMAGING - At [**2125-6-14**] 01:00 PM', '24-hr Events:', '- Abd CT- neg for RP bleed', '- Pt episode of HR 120 (a-flutter/SR). Titrated metoprolol to 25mg [**Hospital1 **]', '- Per EP: restart heparin gtt when able, will need long-term anticoag.', 'Obtain records from [**Hospital1 632**]', '- 12:00pmHct 36 (33)---> 28 (8:45pm) --> 10:20PM 35', '- Cardiac MRI:read pending', ""- Gave another dose of metop 12.5mg since HR in 120's"", '- -600 cc at 3pm, no lasix given']","['MAGNETIC RESONANCE IMAGING - At [**2125-6-14**] 01:00 PM', '24-hr Events:', '- Abd CT- neg for RP bleed', '- Pt episode of HR 120 (a-flutter/SR). Titrated metoprolol to 25mg [**Hospital1 **]', '- Per EP: restart heparin gtt when able, will need long-term anticoag.', 'Obtain records from [**Hospital1 632**]', '- 12:00pmHct 36 (33)---> 28 (8:45pm) --> 10:20PM 35', '- Cardiac MRI:read pending', ""- Gave another dose of metop 12.5mg since HR in 120's"", '- -600 cc at 3pm, no lasix given']","['INVASIVE VENTILATION - STOP [**2125-6-13**] 10:30 AM', '- Extubated, C-spine cleared', '- EEG results: no issues', '- Neuro: will arrange long-term follow-up for remaining mild neuro', 'deficits (clumsiness, memory, cognitive)', '- I/O check (goal -500 cc): +300 at MN', '- Around 2am pt was complaining of mild CP [**2-13**]. EKG showed frequent', 'PVCs and more prominent RBBB, no new ST changes. Since pt was', 'previously CP free, and no invervention was done on cath (2VD LAD,Lcx', 'nearly completly occluded) restarted pt on NTG gtt and heparin gtt,', 'sent new CE on AM labs to trend.', '- CK 144 -> 298', '- Hct 38 -> 33.8']",72790,138635.0
18,2125-06-15 09:51:47,,"['MAGNETIC RESONANCE IMAGING - At [**2125-6-14**] 01:00 PM', '24-hr Events:', '- Abd CT- neg for RP bleed', '- Pt episode of HR 120 (a-flutter/SR). Titrated metoprolol to 25mg [**Hospital1 **]', '- Per EP: restart heparin gtt when able, will need long-term anticoag.', 'Obtain records from [**Hospital1 632**]', '- 12:00pmHct 36 (33)---> 28 (8:45pm) --> 10:20PM 35', '- Cardiac MRI:read pending', ""- Gave another dose of metop 12.5mg since HR in 120's"", '- -600 cc at 3pm, no lasix given']",,72790,138635.0
19,2125-06-15 11:16:35,,"['MAGNETIC RESONANCE IMAGING - At [**2125-6-14**] 01:00 PM', '24-hr Events:', '- Abd CT- neg for RP bleed', '- Pt episode of HR 120 (a-flutter/SR). Titrated metoprolol to 25mg [**Hospital1 **]', '- Per EP: restart heparin gtt when able, will need long-term anticoag.', 'Obtain records from [**Hospital1 632**]', '- 12:00pmHct 36 (33)---> 28 (8:45pm) --> 10:20PM 35', '- Cardiac MRI:read pending', ""- Gave another dose of metop 12.5mg since HR in 120's"", '- -600 cc at 3pm, no lasix given']",,72790,138635.0
0,2187-06-21 07:09:10,,"['FEVER - 103.1', 'F - [**2187-6-20**] 04:00 PM  - sent Blood Cx.', 'In order to keep BP under control yesterday, increased Metoprolol to 50', 'PO BID and titrated Captopril up to 75 mg PO TID.  Also on clonidine.', ""Patient's BP was somewhat low overnight - hung around 20cc/hr.""]",,31664,160571.0
1,2187-06-21 11:35:07,"['Patient continues to have dyspnea', ' appears to have worsened overnight', 'though patient will state that she feels better.  O2 sat dropped to low', '90s on 4L.  O2 inc to 4.5 L and sats returned to high 90s.  She was', 'given IV lasix 20 x1 and a sputum cx was ordered.', 'Patient denies pain and other complaints.']","['FEVER - 103.1', 'F - [**2187-6-20**] 04:00 PM  - sent Blood Cx.', 'In order to keep BP under control yesterday, increased Metoprolol to 50', 'PO BID and titrated Captopril up to 75 mg PO TID.  Also on clonidine.', ""Patient's BP was somewhat low overnight - hung around 20cc/hr."", 'Patient continues to have dyspnea', ' appears to have worsened overnight', 'though patient will state that she feels better.  O2 sat dropped to low', '90s on 4L.  O2 inc to 4.5 L and sats returned to high 90s.  She was', 'given IV lasix 20 x1 and a sputum cx was ordered.', 'Patient denies pain and other complaints.']",,31664,160571.0
2,2187-06-22 07:03:13,"['THORACENTESIS - At [**2187-6-21**] 04:03 PM', 'It revealed straw colored fluid.  Gram stain negative.', 'Patient was found to have a resistant strain of E coli in her urine and', 'she was switched to meropenum.', 'She had a Hct drop for unknown reasons and was transfused one unit of', 'PRBCs -- Hct went from 23.3->23.7 after one unit.  It is stable this', 'morning.', 'Monitoring creatinine and giving gentle diuresis.']","['THORACENTESIS - At [**2187-6-21**] 04:03 PM', 'It revealed straw colored fluid.  Gram stain negative.', 'Patient was found to have a resistant strain of E coli in her urine and', 'she was switched to meropenum.', 'She had a Hct drop for unknown reasons and was transfused one unit of', 'PRBCs -- Hct went from 23.3->23.7 after one unit.  It is stable this', 'morning.', 'Monitoring creatinine and giving gentle diuresis.']","['FEVER - 103.1', 'F - [**2187-6-20**] 04:00 PM  - sent Blood Cx.', 'In order to keep BP under control yesterday, increased Metoprolol to 50', 'PO BID and titrated Captopril up to 75 mg PO TID.  Also on clonidine.', ""Patient's BP was somewhat low overnight - hung around 20cc/hr."", 'Patient continues to have dyspnea', ' appears to have worsened overnight', 'though patient will state that she feels better.  O2 sat dropped to low', '90s on 4L.  O2 inc to 4.5 L and sats returned to high 90s.  She was', 'given IV lasix 20 x1 and a sputum cx was ordered.', 'Patient denies pain and other complaints.']",31664,160571.0
3,2187-06-22 14:43:23,"['It revealed straw colored fluid.  Gram stain negative. Transudate by', 'Light', 's criteria', '--Patient was found to have a resistant strain of E coli in her urine', 'and she was switched to meropenum.', '--She had a Hct drop for unknown reasons and was transfused one unit of', 'PRBCs --- Hct went from 23.3->23.7 after one unit.  It is stable this', 'morning.  Her lovenox and coumadin were held', '--Monitoring creatinine and giving gentle diuresis.  Increased to 2.0', 'last night back down today.']","['THORACENTESIS - At [**2187-6-21**] 04:03 PM', 'It revealed straw colored fluid.  Gram stain negative. Transudate by', 'Light', 's criteria', '--Patient was found to have a resistant strain of E coli in her urine', 'and she was switched to meropenum.', '--She had a Hct drop for unknown reasons and was transfused one unit of', 'PRBCs --- Hct went from 23.3->23.7 after one unit.  It is stable this', 'morning.  Her lovenox and coumadin were held', '--Monitoring creatinine and giving gentle diuresis.  Increased to 2.0', 'last night back down today.']","['It revealed straw colored fluid.  Gram stain negative.', 'Patient was found to have a resistant strain of E coli in her urine and', 'she was switched to meropenum.', 'She had a Hct drop for unknown reasons and was transfused one unit of', 'PRBCs -- Hct went from 23.3->23.7 after one unit.  It is stable this', 'morning.', 'Monitoring creatinine and giving gentle diuresis.']",31664,160571.0
0,2127-03-05 07:11:40,,"['SPUTUM CULTURE - At [**2127-3-4**] 11:46 AM', ' BRONCHOSCOPY - At [**2127-3-4**] 12:22 PM', ' ARTERIAL LINE - STOP [**2127-3-4**] 06:18 PM', ' STOOL CULTURE - At [**2127-3-4**] 10:00 PM', 'c. diff', ' EKG - At [**2127-3-5**] 03:30 AM', 'tachycardia w/?raf', '- 2L LR given, low UOP', '- Bronch - friable R bronchi/bronchioles, L appear pristine - BAL sent', '- Off pressors', '- Min sedation', '- Metoprolol 25mg OG x1 given for HR up to 130s and SBP > 130']",,43147,161625.0
1,2127-03-05 14:08:56,,"['SPUTUM CULTURE - At [**2127-3-4**] 11:46 AM', ' BRONCHOSCOPY - At [**2127-3-4**] 12:22 PM', ' ARTERIAL LINE - STOP [**2127-3-4**] 06:18 PM', ' STOOL CULTURE - At [**2127-3-4**] 10:00 PM', 'c. diff', ' EKG - At [**2127-3-5**] 03:30 AM', 'tachycardia w/?raf', '- 2L LR given, low UOP', '- Bronch - friable R bronchi/bronchioles, L appear pristine - BAL sent', '- Off pressors', '- Min sedation', '- Metoprolol 25mg OG x1 given for HR up to 130s and SBP > 130']",,43147,161625.0
2,2127-03-06 07:38:41,"['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']","['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']","['SPUTUM CULTURE - At [**2127-3-4**] 11:46 AM', ' BRONCHOSCOPY - At [**2127-3-4**] 12:22 PM', ' ARTERIAL LINE - STOP [**2127-3-4**] 06:18 PM', ' STOOL CULTURE - At [**2127-3-4**] 10:00 PM', 'c. diff', ' EKG - At [**2127-3-5**] 03:30 AM', 'tachycardia w/?raf', '- 2L LR given, low UOP', '- Bronch - friable R bronchi/bronchioles, L appear pristine - BAL sent', '- Off pressors', '- Min sedation', '- Metoprolol 25mg OG x1 given for HR up to 130s and SBP > 130']",43147,161625.0
3,2127-03-06 07:40:10,,"['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']",,43147,161625.0
4,2127-03-06 07:41:07,,"['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']",,43147,161625.0
5,2127-03-06 07:45:10,,"['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']",,43147,161625.0
6,2127-03-06 16:04:39,,"['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']",,43147,161625.0
7,2127-03-07 07:26:21,"['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']","['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']","['- CT head - cont. evolution of R ACA infarct, stable sellar mass, no', 'acute process', '- A-line placed', '- PSV trial 7.4/35/116/22', '- Spiked fever to 100.7, pan-cultured, UA with mod bacteria, restarted', 'on vanc & zosyn on [**3-3**]', '- HTN to 170s resting (210 with movement), given lasix 20 mg IV']",43147,161625.0
8,2127-03-07 07:27:02,,"['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']",,43147,161625.0
9,2127-03-07 07:27:44,,"['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']",,43147,161625.0
10,2127-03-07 07:47:01,,"['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']",,43147,161625.0
11,2127-03-07 13:23:31,,"['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']",,43147,161625.0
12,2127-03-08 07:11:44,"['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']","['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']","['- RSBI and SBT excellent, extubated- prior to extubation:', '7.39/42/102--> after extubation:  7.49/38/56', '- ABG at 9 pm 7.55/32/55.  acetazolamide 250 mg Q 12 h x 2 doses']",43147,161625.0
13,2127-03-08 07:13:18,,"['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']",,43147,161625.0
14,2127-03-08 07:23:06,,"['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']",,43147,161625.0
15,2127-03-08 11:58:22,,"['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']",,43147,161625.0
16,2127-03-09 06:03:49,"['INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', '- ID consult for Bld Cx pos (Enterococcus and Clostridium): needs ABD', 'CT to rule out abscess; stop vanc; continue zosyn in house and switch', 'to moxifloxacin 400 mg daily on discharge for total of 14 day course', '- CT abd/pelvis performed (non-contrast as no peripheral access) -', 'dictated read no intra-abdominal air or fluid collections, no', 'lymphadenopathy']","['INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', '- ID consult for Bld Cx pos (Enterococcus and Clostridium): needs ABD', 'CT to rule out abscess; stop vanc; continue zosyn in house and switch', 'to moxifloxacin 400 mg daily on discharge for total of 14 day course', '- CT abd/pelvis performed (non-contrast as no peripheral access) -', 'dictated read no intra-abdominal air or fluid collections, no', 'lymphadenopathy']","['- PICC placed', '- Got Lasix 40mg IV x1 w/ UOP 400-600cc/hour', '- Has bed at [**Hospital 858**] Rehab, family has concerns about discharge from', 'MICU']",43147,161625.0
17,2127-03-09 07:40:11,,"['INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', '- ID consult for Bld Cx pos (Enterococcus and Clostridium): needs ABD', 'CT to rule out abscess; stop vanc; continue zosyn in house and switch', 'to moxifloxacin 400 mg daily on discharge for total of 14 day course', '- CT abd/pelvis performed (non-contrast as no peripheral access) -', 'dictated read no intra-abdominal air or fluid collections, no', 'lymphadenopathy']",,43147,161625.0
18,2127-03-09 14:30:29,,"['INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2127-3-8**] 07:00 PM', '- ID consult for Bld Cx pos (Enterococcus and Clostridium): needs ABD', 'CT to rule out abscess; stop vanc; continue zosyn in house and switch', 'to moxifloxacin 400 mg daily on discharge for total of 14 day course', '- CT abd/pelvis performed (non-contrast as no peripheral access) -', 'dictated read no intra-abdominal air or fluid collections, no', 'lymphadenopathy']",,43147,161625.0
0,2127-03-19 06:39:58,,['PICC LINE - START [**2127-3-19**] 12:14 AM'],,43147,180640.0
1,2127-03-19 11:40:45,"['Lasix 20 IV x1', ' now 2L neg', 'On pressure support [**5-6**]']","['PICC LINE - START [**2127-3-19**] 12:14 AM', 'Lasix 20 IV x1', ' now 2L neg', 'On pressure support [**5-6**]']",,43147,180640.0
2,2127-03-20 07:34:05,"['- Talked with grandson (who is not HCP but speaks English better than', 'his mother who IS HCP). Grandson said that HCP was coming in later but', 'I did not see her. Unable to talk about whether or not they would want', 'pt reintubated.', '- Autodiuresing (-2.5L at the end of [**3-19**], pm lytes fine)', '- Not any more awake', '- Holding TF as possibly extubatable in am']","['- Talked with grandson (who is not HCP but speaks English better than', 'his mother who IS HCP). Grandson said that HCP was coming in later but', 'I did not see her. Unable to talk about whether or not they would want', 'pt reintubated.', '- Autodiuresing (-2.5L at the end of [**3-19**], pm lytes fine)', '- Not any more awake', '- Holding TF as possibly extubatable in am']","['PICC LINE - START [**2127-3-19**] 12:14 AM', 'Lasix 20 IV x1', ' now 2L neg', 'On pressure support [**5-6**]']",43147,180640.0
3,2127-03-20 12:50:21,,"['- Talked with grandson (who is not HCP but speaks English better than', 'his mother who IS HCP). Grandson said that HCP was coming in later but', 'I did not see her. Unable to talk about whether or not they would want', 'pt reintubated.', '- Autodiuresing (-2.5L at the end of [**3-19**], pm lytes fine)', '- Not any more awake', '- Holding TF as possibly extubatable in am']",,43147,180640.0
4,2127-03-21 07:45:40,"['- continues to autodiurese until dropped urine output.', '- started antibiotics', '- got tube feeds during the day, held overnight for planned extubation', '- code: DNR ok to intubate']","['- continues to autodiurese until dropped urine output.', '- started antibiotics', '- got tube feeds during the day, held overnight for planned extubation', '- code: DNR ok to intubate']","['- Talked with grandson (who is not HCP but speaks English better than', 'his mother who IS HCP). Grandson said that HCP was coming in later but', 'I did not see her. Unable to talk about whether or not they would want', 'pt reintubated.', '- Autodiuresing (-2.5L at the end of [**3-19**], pm lytes fine)', '- Not any more awake', '- Holding TF as possibly extubatable in am']",43147,180640.0
5,2127-03-21 14:51:37,,"['- continues to autodiurese until dropped urine output.', '- started antibiotics', '- got tube feeds during the day, held overnight for planned extubation', '- code: DNR ok to intubate']",,43147,180640.0
6,2127-03-22 07:43:48,"['SPUTUM CULTURE - At [**2127-3-21**] 12:08 PM', '- pt extubated and tolerating well on shovel mask 02 sat 100%', '- started on Vanco/Cefepime for worsening CXR and WBC 12']","['SPUTUM CULTURE - At [**2127-3-21**] 12:08 PM', '- pt extubated and tolerating well on shovel mask 02 sat 100%', '- started on Vanco/Cefepime for worsening CXR and WBC 12']","['- continues to autodiurese until dropped urine output.', '- started antibiotics', '- got tube feeds during the day, held overnight for planned extubation', '- code: DNR ok to intubate']",43147,180640.0
7,2127-03-22 13:50:41,,"['SPUTUM CULTURE - At [**2127-3-21**] 12:08 PM', '- pt extubated and tolerating well on shovel mask 02 sat 100%', '- started on Vanco/Cefepime for worsening CXR and WBC 12']",,43147,180640.0
0,2120-11-16 07:30:54,,[],,86580,145497.0
1,2120-11-16 07:35:06,['None.'],['None.'],,86580,145497.0
2,2120-11-16 13:38:54,['- pericardial drain continues to put out ~25cc/hr of sanguine fluid'],['- pericardial drain continues to put out ~25cc/hr of sanguine fluid'],['None.'],86580,145497.0
3,2120-11-17 06:59:35,"['[**11-16**]:', '- Output pericardial drain - unable to flush the line. Interventional']","['[**11-16**]:', '- Output pericardial drain - unable to flush the line. Interventional']",['- pericardial drain continues to put out ~25cc/hr of sanguine fluid'],86580,145497.0
4,2120-11-17 16:00:33,,"['[**11-16**]:', '- Output pericardial drain - unable to flush the line. Interventional']",,86580,145497.0
5,2120-11-18 07:33:48,"['[**11-17**]:', '- Right pleural effusion drained roughly 1100 serous fluid.  Sent for', 'cytology and culture c/w exudative effusion (fluid LDH of 290 with', 'serum of 281)', '- Post procedure XR with no evidence of pneumothorax', '- Bedside echo revealed mild increase in effusion with no tamponade', 'physiology able to flush, no return', '- received 1L NS [**2-19**] poor UOP']","['[**11-17**]:', '- Right pleural effusion drained roughly 1100 serous fluid.  Sent for', 'cytology and culture c/w exudative effusion (fluid LDH of 290 with', 'serum of 281)', '- Post procedure XR with no evidence of pneumothorax', '- Bedside echo revealed mild increase in effusion with no tamponade', 'physiology able to flush, no return', '- received 1L NS [**2-19**] poor UOP']","['[**11-16**]:', '- Output pericardial drain - unable to flush the line. Interventional']",86580,145497.0
6,2120-11-18 07:43:00,,"['[**11-17**]:', '- Right pleural effusion drained roughly 1100 serous fluid.  Sent for', 'cytology and culture c/w exudative effusion (fluid LDH of 290 with', 'serum of 281)', '- Post procedure XR with no evidence of pneumothorax', '- Bedside echo revealed mild increase in effusion with no tamponade', 'physiology able to flush, no return', '- received 1L NS [**2-19**] poor UOP']",,86580,145497.0
7,2120-11-18 11:03:01,,"['[**11-17**]:', '- Right pleural effusion drained roughly 1100 serous fluid.  Sent for', 'cytology and culture c/w exudative effusion (fluid LDH of 290 with', 'serum of 281)', '- Post procedure XR with no evidence of pneumothorax', '- Bedside echo revealed mild increase in effusion with no tamponade', 'physiology able to flush, no return', '- received 1L NS [**2-19**] poor UOP']",,86580,145497.0
8,2120-11-19 06:18:37,"['TRANS ESOPHAGEAL ECHO - At [**2120-11-18**] 09:10 AM', '- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for VATS pericardial', 'window + L pleural effusion drainage', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']","['TRANS ESOPHAGEAL ECHO - At [**2120-11-18**] 09:10 AM', '- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for VATS pericardial', 'window + L pleural effusion drainage', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']","['[**11-17**]:', '- Right pleural effusion drained roughly 1100 serous fluid.  Sent for', 'cytology and culture c/w exudative effusion (fluid LDH of 290 with', 'serum of 281)', '- Post procedure XR with no evidence of pneumothorax', '- Bedside echo revealed mild increase in effusion with no tamponade', 'physiology able to flush, no return', '- received 1L NS [**2-19**] poor UOP']",86580,145497.0
9,2120-11-19 07:28:43,,"['TRANS ESOPHAGEAL ECHO - At [**2120-11-18**] 09:10 AM', '- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for VATS pericardial', 'window + L pleural effusion drainage', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']",,86580,145497.0
10,2120-11-19 09:13:45,"['- thoracic surgery planning to take patient to OR for pericardial', 'window.']","['- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for pericardial', 'window.', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']","['TRANS ESOPHAGEAL ECHO - At [**2120-11-18**] 09:10 AM', '- thoracic surgery planning to take patient to OR for VATS pericardial', 'window + L pleural effusion drainage']",86580,145497.0
11,2120-11-19 10:37:05,,"['- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for pericardial', 'window.', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']",,86580,145497.0
12,2120-11-19 11:19:30,,"['- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for pericardial', 'window.', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']",,86580,145497.0
13,2120-11-20 06:16:30,"['ARTERIAL LINE - START [**2120-11-19**] 10:00 AM placed in OR', ' OR RECEIVED - At [**2120-11-19**] 10:00 AM', ' ULTRASOUND - At [**2120-11-19**] 11:21 AM thoracic US at bedside', ' ARTERIAL LINE - STOP [**2120-11-20**] 05:15 AM placed in OR', '- s/p vats and pericardial window with chest tube placement on -20, on', 'pca dilaudid.', ""- presistently tachycardiac, was hypotensive to 90's (SBP), given 1 L"", 'of LR bolus.', '- repleted ca gluconate 2g x1 and 500 NS bolus.', '- advanced diet to full liquid']","['ARTERIAL LINE - START [**2120-11-19**] 10:00 AM placed in OR', ' OR RECEIVED - At [**2120-11-19**] 10:00 AM', ' ULTRASOUND - At [**2120-11-19**] 11:21 AM thoracic US at bedside', ' ARTERIAL LINE - STOP [**2120-11-20**] 05:15 AM placed in OR', '- s/p vats and pericardial window with chest tube placement on -20, on', 'pca dilaudid.', ""- presistently tachycardiac, was hypotensive to 90's (SBP), given 1 L"", 'of LR bolus.', '- repleted ca gluconate 2g x1 and 500 NS bolus.', '- advanced diet to full liquid']","['- pericardial drain pulled', '- TTE showed recurrence of effusion (moderate to large in size)', '- thoracic surgery planning to take patient to OR for pericardial', 'window.', '- per cytology, report should be available end of Wednesday', '- per Heme/Onc, patient has had good response to salvage therapy in the', 'past and last treatment was several months ago.  Should be able to', 'restart treatment as outpatient.']",86580,145497.0
14,2120-11-20 10:01:31,,"['ARTERIAL LINE - START [**2120-11-19**] 10:00 AM placed in OR', ' OR RECEIVED - At [**2120-11-19**] 10:00 AM', ' ULTRASOUND - At [**2120-11-19**] 11:21 AM thoracic US at bedside', ' ARTERIAL LINE - STOP [**2120-11-20**] 05:15 AM placed in OR', '- s/p vats and pericardial window with chest tube placement on -20, on', 'pca dilaudid.', ""- presistently tachycardiac, was hypotensive to 90's (SBP), given 1 L"", 'of LR bolus.', '- repleted ca gluconate 2g x1 and 500 NS bolus.', '- advanced diet to full liquid']",,86580,145497.0
15,2120-11-20 17:49:40,,"['ARTERIAL LINE - START [**2120-11-19**] 10:00 AM placed in OR', ' OR RECEIVED - At [**2120-11-19**] 10:00 AM', ' ULTRASOUND - At [**2120-11-19**] 11:21 AM thoracic US at bedside', ' ARTERIAL LINE - STOP [**2120-11-20**] 05:15 AM placed in OR', '- s/p vats and pericardial window with chest tube placement on -20, on', 'pca dilaudid.', ""- presistently tachycardiac, was hypotensive to 90's (SBP), given 1 L"", 'of LR bolus.', '- repleted ca gluconate 2g x1 and 500 NS bolus.', '- advanced diet to full liquid']",,86580,145497.0
0,2131-12-11 07:55:27,,['No overnight events'],,60436,189140.0
1,2131-12-11 11:10:37,"['Pt is comfortable this AM, no SOB, CP, lightheadedness.']","['No overnight events', 'Pt is comfortable this AM, no SOB, CP, lightheadedness.']",,60436,189140.0
2,2131-12-11 14:44:53,,"['No overnight events', 'Pt is comfortable this AM, no SOB, CP, lightheadedness.']",,60436,189140.0
0,2107-03-30 11:24:35,,"['PRESEP CATHETER - START [**2107-3-30**] 12:09 AM', ' ARTERIAL LINE - START [**2107-3-30**] 12:10 AM', ' SPUTUM CULTURE - At [**2107-3-30**] 01:54 AM', ' URINE CULTURE - At [**2107-3-30**] 01:54 AM', ' BLOOD CULTURED - At [**2107-3-30**] 04:42 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:00 AM', 'Resburicase given', 'IVFs provided', 'Vent settings manipulated to lower tidal volumes']",,32060,117616.0
1,2107-03-31 06:51:35,"['TRANS thoracic ECHO - At [**2107-3-30**] 10:17 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:17 PM', 'to replace earlier speciemen sent w/o proper label', ' FEVER - 104.2', 'F - [**2107-3-30**] 07:00 AM', '- ECHO : No evidence of endocarditis or abscess seen. Dilated,', 'hypokinetic right ventricle with pressure/volume overload. Mild mitral', 'regurgitation. moderate aortic valve stenosis (area 1.0-1.2cm2), EF', '50-55%,', '- FiO2 decreased to 50% in AM with ABG 7.24/47/103 then FiO2 decreased', 'to 40%', '- Urine sediment: bland (per Renal)', '- renal recs: avoid IR, give bicarb boluses after NS.', '- started on insulin Gtt', '- TRALI workup being sent per blood bank, and blood and platelets given', 'to him will be rechecked.', '- Off pressors since  3pm-ish', '- patient doing well on AC, switched to Pressues support [**5-9**], 40%. Gas', 'on this in the AM 7.37/43/74/26.']","['TRANS thoracic ECHO - At [**2107-3-30**] 10:17 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:17 PM', 'to replace earlier speciemen sent w/o proper label', ' FEVER - 104.2', 'F - [**2107-3-30**] 07:00 AM', '- ECHO : No evidence of endocarditis or abscess seen. Dilated,', 'hypokinetic right ventricle with pressure/volume overload. Mild mitral', 'regurgitation. moderate aortic valve stenosis (area 1.0-1.2cm2), EF', '50-55%,', '- FiO2 decreased to 50% in AM with ABG 7.24/47/103 then FiO2 decreased', 'to 40%', '- Urine sediment: bland (per Renal)', '- renal recs: avoid IR, give bicarb boluses after NS.', '- started on insulin Gtt', '- TRALI workup being sent per blood bank, and blood and platelets given', 'to him will be rechecked.', '- Off pressors since  3pm-ish', '- patient doing well on AC, switched to Pressues support [**5-9**], 40%. Gas', 'on this in the AM 7.37/43/74/26.']","['PRESEP CATHETER - START [**2107-3-30**] 12:09 AM', ' ARTERIAL LINE - START [**2107-3-30**] 12:10 AM', ' SPUTUM CULTURE - At [**2107-3-30**] 01:54 AM', ' URINE CULTURE - At [**2107-3-30**] 01:54 AM', ' BLOOD CULTURED - At [**2107-3-30**] 04:42 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:00 AM', 'Resburicase given', 'IVFs provided', 'Vent settings manipulated to lower tidal volumes']",32060,117616.0
2,2107-03-31 11:03:33,"['- Off pressors since  1pm, readded temporarily overnight from 9pm to', '1am.']","['TRANS thoracic ECHO - At [**2107-3-30**] 10:17 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:17 PM', 'to replace earlier speciemen sent w/o proper label', ' FEVER - 104.2', 'F - [**2107-3-30**] 07:00 AM', '- ECHO : No evidence of endocarditis or abscess seen. Dilated,', 'hypokinetic right ventricle with pressure/volume overload. Mild mitral', 'regurgitation. moderate aortic valve stenosis (area 1.0-1.2cm2), EF', '50-55%,', '- FiO2 decreased to 50% in AM with ABG 7.24/47/103 then FiO2 decreased', 'to 40%', '- Urine sediment: bland (per Renal)', '- renal recs: avoid IR, give bicarb boluses after NS.', '- started on insulin Gtt', '- TRALI workup being sent per blood bank, and blood and platelets given', 'to him will be rechecked.', '- Off pressors since  1pm, readded temporarily overnight from 9pm to', '1am.', '- patient doing well on AC, switched to Pressues support [**5-9**], 40%. Gas', 'on this in the AM 7.37/43/74/26.']",['- Off pressors since  3pm-ish'],32060,117616.0
3,2107-04-01 06:31:02,,[],"['TRANS thoracic ECHO - At [**2107-3-30**] 10:17 AM', ' BLOOD CULTURED - At [**2107-3-30**] 05:17 PM', 'to replace earlier speciemen sent w/o proper label', ' FEVER - 104.2', 'F - [**2107-3-30**] 07:00 AM', '- ECHO : No evidence of endocarditis or abscess seen. Dilated,', 'hypokinetic right ventricle with pressure/volume overload. Mild mitral', 'regurgitation. moderate aortic valve stenosis (area 1.0-1.2cm2), EF', '50-55%,', '- FiO2 decreased to 50% in AM with ABG 7.24/47/103 then FiO2 decreased', 'to 40%', '- Urine sediment: bland (per Renal)', '- renal recs: avoid IR, give bicarb boluses after NS.', '- started on insulin Gtt', '- TRALI workup being sent per blood bank, and blood and platelets given', 'to him will be rechecked.', '- Off pressors since  1pm, readded temporarily overnight from 9pm to', '1am.', '- patient doing well on AC, switched to Pressues support [**5-9**], 40%. Gas', 'on this in the AM 7.37/43/74/26.']",32060,117616.0
4,2107-04-01 13:34:00,"['sedation weaned', 'vent weaned to PS 5/5', 'extubated this morning', ""neurologic exam - > was not moving UE's as well as legs, so CT head /"", 'c-spine to seek out source of compression, weakness, bleeding; CTH', 'without bleed', 'started w/ beta blocker regarding NSTEMI']","['sedation weaned', 'vent weaned to PS 5/5', 'extubated this morning', ""neurologic exam - > was not moving UE's as well as legs, so CT head /"", 'c-spine to seek out source of compression, weakness, bleeding; CTH', 'without bleed', 'started w/ beta blocker regarding NSTEMI']",,32060,117616.0
5,2107-04-02 07:10:13,"['- extuated at 11am yesterday', 'need to follow up OSH blood bank for infection', 'renal- follow na w/ auto / uric acid diuresis', 'changed levoflox to renal dosing', 'vanc needs to be done by level', 'afrin / nasal washes for sinusitis by ct scan', 'bmt - allopurinol, qod cbc w/ diff, d/c to bmt service.c', 'spoke w/ wife about re-intubation...if for clearly reversible causes', 'can intubate for short time period.', 'Na increasing, given 1L D5W for osmotic diuresis.']","['- extuated at 11am yesterday', 'need to follow up OSH blood bank for infection', 'renal- follow na w/ auto / uric acid diuresis', 'changed levoflox to renal dosing', 'vanc needs to be done by level', 'afrin / nasal washes for sinusitis by ct scan', 'bmt - allopurinol, qod cbc w/ diff, d/c to bmt service.c', 'spoke w/ wife about re-intubation...if for clearly reversible causes', 'can intubate for short time period.', 'Na increasing, given 1L D5W for osmotic diuresis.']","['sedation weaned', 'vent weaned to PS 5/5', 'extubated this morning', ""neurologic exam - > was not moving UE's as well as legs, so CT head /"", 'c-spine to seek out source of compression, weakness, bleeding; CTH', 'without bleed', 'started w/ beta blocker regarding NSTEMI']",32060,117616.0
6,2107-04-02 19:36:08,,"['- extuated at 11am yesterday', 'need to follow up OSH blood bank for infection', 'renal- follow na w/ auto / uric acid diuresis', 'changed levoflox to renal dosing', 'vanc needs to be done by level', 'afrin / nasal washes for sinusitis by ct scan', 'bmt - allopurinol, qod cbc w/ diff, d/c to bmt service.c', 'spoke w/ wife about re-intubation...if for clearly reversible causes', 'can intubate for short time period.', 'Na increasing, given 1L D5W for osmotic diuresis.']",,32060,117616.0
7,2107-04-03 06:49:15,"['- abg, not hypercarbic, but somewhat hypoxic (po2 61), recheck was 57,', 'put shovel mask on better, and up to 92%', '- started morphine 0.5 mg 2 doses because seemed like might be in pain', '(Oww.. oww)', '- no BM since tuesday. suppository didnt work, will try enema next', '- spiked temp to 100.8 axillary at 4am, blood cultures sent', '- Ectopy --> K 2.9 --> repleted']","['- abg, not hypercarbic, but somewhat hypoxic (po2 61), recheck was 57,', 'put shovel mask on better, and up to 92%', '- started morphine 0.5 mg 2 doses because seemed like might be in pain', '(Oww.. oww)', '- no BM since tuesday. suppository didnt work, will try enema next', '- spiked temp to 100.8 axillary at 4am, blood cultures sent', '- Ectopy --> K 2.9 --> repleted']","['- extuated at 11am yesterday', 'need to follow up OSH blood bank for infection', 'renal- follow na w/ auto / uric acid diuresis', 'changed levoflox to renal dosing', 'vanc needs to be done by level', 'afrin / nasal washes for sinusitis by ct scan', 'bmt - allopurinol, qod cbc w/ diff, d/c to bmt service.c', 'spoke w/ wife about re-intubation...if for clearly reversible causes', 'can intubate for short time period.', 'Na increasing, given 1L D5W for osmotic diuresis.']",32060,117616.0
8,2107-04-03 06:51:27,,"['- abg, not hypercarbic, but somewhat hypoxic (po2 61), recheck was 57,', 'put shovel mask on better, and up to 92%', '- started morphine 0.5 mg 2 doses because seemed like might be in pain', '(Oww.. oww)', '- no BM since tuesday. suppository didnt work, will try enema next', '- spiked temp to 100.8 axillary at 4am, blood cultures sent', '- Ectopy --> K 2.9 --> repleted']",,32060,117616.0
9,2107-04-03 12:59:41,"['- Oxygenation improved on face mask', '- Morphine 0.5 mg x 2 doses for pain', '- More assertive bowel regimen for constipation', '- Temp 100.8 axillary @ 4am:  Blood cultures sent']","['- Oxygenation improved on face mask', '- Morphine 0.5 mg x 2 doses for pain', '- More assertive bowel regimen for constipation', '- Temp 100.8 axillary @ 4am:  Blood cultures sent', '- Ectopy --> K 2.9 --> repleted']","['- abg, not hypercarbic, but somewhat hypoxic (po2 61), recheck was 57,', 'put shovel mask on better, and up to 92%', '- started morphine 0.5 mg 2 doses because seemed like might be in pain', '(Oww.. oww)', '- no BM since tuesday. suppository didnt work, will try enema next', '- spiked temp to 100.8 axillary at 4am, blood cultures sent']",32060,117616.0
0,2138-03-26 07:40:51,,['CALLED OUT'],,28887,183614.0
1,2138-03-26 07:51:10,"['No acute events overnight.', 'Pt comfortable this morning, denying pain, asking for lotion for his', 'skin.']","['CALLED OUT', 'No acute events overnight.', 'Pt comfortable this morning, denying pain, asking for lotion for his', 'skin.']",,28887,183614.0
2,2138-03-26 08:11:40,,"['CALLED OUT', 'No acute events overnight.', 'Pt comfortable this morning, denying pain, asking for lotion for his', 'skin.']",,28887,183614.0
3,2138-03-26 12:19:42,"['Pt comfortable this morning, denying pain.']","['CALLED OUT', 'No acute events overnight.', 'Pt comfortable this morning, denying pain.']","['Pt comfortable this morning, denying pain, asking for lotion for his', 'skin.']",28887,183614.0
0,2193-09-13 00:01:31,,"['FEVER - 103.0', 'F - [**2193-9-12**] 04:00 AM']",,31783,144368.0
1,2193-09-13 06:19:47,"['EKG - At [**2193-9-12**] 10:00 AM', ' ULTRASOUND - At [**2193-9-12**] 12:08 PM', 'Echo', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER - 103.0', 'F - [**2193-9-12**] 09:00 PM', 'ID recommended continuing current abx and no platelet transfusions.', 'Urine lytes suggestive of SIADH likely from pulm pathology.', 'Serum sodium trending down o/n 130->126.', 'Platelets stable at ~20.', 'Tachycardic with MAP 64 and UOP decreased to 20mL/hour when lasix wore', 'off.']","['EKG - At [**2193-9-12**] 10:00 AM', ' ULTRASOUND - At [**2193-9-12**] 12:08 PM', 'Echo', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER - 103.0', 'F - [**2193-9-12**] 09:00 PM', 'ID recommended continuing current abx and no platelet transfusions.', 'Urine lytes suggestive of SIADH likely from pulm pathology.', 'Serum sodium trending down o/n 130->126.', 'Platelets stable at ~20.', 'Tachycardic with MAP 64 and UOP decreased to 20mL/hour when lasix wore', 'off.']","['FEVER - 103.0', 'F - [**2193-9-12**] 04:00 AM']",31783,144368.0
2,2193-09-13 06:20:54,,"['EKG - At [**2193-9-12**] 10:00 AM', ' ULTRASOUND - At [**2193-9-12**] 12:08 PM', 'Echo', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER - 103.0', 'F - [**2193-9-12**] 09:00 PM', 'ID recommended continuing current abx and no platelet transfusions.', 'Urine lytes suggestive of SIADH likely from pulm pathology.', 'Serum sodium trending down o/n 130->126.', 'Platelets stable at ~20.', 'Tachycardic with MAP 64 and UOP decreased to 20mL/hour when lasix wore', 'off.']",,31783,144368.0
3,2193-09-13 07:26:40,"[' ECHO ULTRASOUND - At [**2193-9-12**] 12:08 PM', ' FEVER throughout much of the day yesterday to high of 103.0', 'F at']","['EKG - At [**2193-9-12**] 10:00 AM', ' ECHO ULTRASOUND - At [**2193-9-12**] 12:08 PM', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER throughout much of the day yesterday to high of 103.0', 'F at']","[' ULTRASOUND - At [**2193-9-12**] 12:08 PM', 'Echo', ' FEVER - 103.0', 'F - [**2193-9-12**] 09:00 PM', 'ID recommended continuing current abx and no platelet transfusions.', 'Urine lytes suggestive of SIADH likely from pulm pathology.', 'Serum sodium trending down o/n 130->126.', 'Platelets stable at ~20.', 'Tachycardic with MAP 64 and UOP decreased to 20mL/hour when lasix wore', 'off.']",31783,144368.0
4,2193-09-13 07:38:35,,"['EKG - At [**2193-9-12**] 10:00 AM', ' ECHO ULTRASOUND - At [**2193-9-12**] 12:08 PM', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER throughout much of the day yesterday to high of 103.0', 'F at']",,31783,144368.0
5,2193-09-13 07:55:35,,"['EKG - At [**2193-9-12**] 10:00 AM', ' ECHO ULTRASOUND - At [**2193-9-12**] 12:08 PM', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER throughout much of the day yesterday to high of 103.0', 'F at']",,31783,144368.0
6,2193-09-13 12:54:39,,"['EKG - At [**2193-9-12**] 10:00 AM', ' ECHO ULTRASOUND - At [**2193-9-12**] 12:08 PM', ' EKG - At [**2193-9-12**] 01:44 PM: slightly inc QTc and sinus tachycardia', 'at rate of 100.', ' FEVER throughout much of the day yesterday to high of 103.0', 'F at']",,31783,144368.0
0,2159-07-17 06:10:11,,"['BLOOD CULTURED - At [**2159-7-16**] 10:30 PM', ' URINE CULTURE - At [**2159-7-16**] 10:30 PM', ' FEVER - 101.3', 'F - [**2159-7-16**] 07:00 PM', '- pt had head CT without acute bleed on prelim read', '- started on heparin gtt', 'History obtained from Patient']",,61932,165934.0
1,2159-07-17 10:22:29,,"['BLOOD CULTURED - At [**2159-7-16**] 10:30 PM', ' URINE CULTURE - At [**2159-7-16**] 10:30 PM', ' FEVER - 101.3', 'F - [**2159-7-16**] 07:00 PM', '- pt had head CT without acute bleed on prelim read', '- started on heparin gtt', 'History obtained from Patient']",,61932,165934.0
2,2159-07-17 15:13:22,,"['BLOOD CULTURED - At [**2159-7-16**] 10:30 PM', ' URINE CULTURE - At [**2159-7-16**] 10:30 PM', ' FEVER - 101.3', 'F - [**2159-7-16**] 07:00 PM', '- pt had head CT without acute bleed on prelim read', '- started on heparin gtt', 'History obtained from Patient']",,61932,165934.0
3,2159-07-17 15:34:43,,"['BLOOD CULTURED - At [**2159-7-16**] 10:30 PM', ' URINE CULTURE - At [**2159-7-16**] 10:30 PM', ' FEVER - 101.3', 'F - [**2159-7-16**] 07:00 PM', '- pt had head CT without acute bleed on prelim read', '- started on heparin gtt', 'History obtained from Patient']",,61932,165934.0
0,2118-04-24 06:19:07,,"['MULTI LUMEN - START [**2118-4-23**] 07:59 PM', 'placed in ED', ' BLOOD CULTURED - At [**2118-4-24**] 12:12 AM', 'Still requiring low dose levophed']",,23666,134984.0
1,2118-04-24 09:53:38,"['Weaned off levophed overnight. Patient more interactable this AM. Had', 'acute onset respiratory distress, increased crackles and wheezing', 'around 9am.']","['MULTI LUMEN - START [**2118-4-23**] 07:59 PM', 'placed in ED', ' BLOOD CULTURED - At [**2118-4-24**] 12:12 AM', 'Weaned off levophed overnight. Patient more interactable this AM. Had', 'acute onset respiratory distress, increased crackles and wheezing', 'around 9am.']",['Still requiring low dose levophed'],23666,134984.0
2,2118-04-24 09:57:36,,"['MULTI LUMEN - START [**2118-4-23**] 07:59 PM', 'placed in ED', ' BLOOD CULTURED - At [**2118-4-24**] 12:12 AM', 'Weaned off levophed overnight. Patient more interactable this AM. Had', 'acute onset respiratory distress, increased crackles and wheezing', 'around 9am.']",,23666,134984.0
3,2118-04-25 07:02:21,"['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']","['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']","['MULTI LUMEN - START [**2118-4-23**] 07:59 PM', 'placed in ED', ' BLOOD CULTURED - At [**2118-4-24**] 12:12 AM', 'Weaned off levophed overnight. Patient more interactable this AM. Had', 'acute onset respiratory distress, increased crackles and wheezing', 'around 9am.']",23666,134984.0
4,2118-04-25 07:03:16,,"['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']",,23666,134984.0
5,2118-04-25 07:04:26,,"['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']",,23666,134984.0
6,2118-04-25 07:49:47,,"['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']",,23666,134984.0
7,2118-04-25 12:50:26,,"['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']",,23666,134984.0
8,2118-04-26 06:57:06,"['- got Vit K 5mg PO', '- spoke with family and they want to escalation of care, if patient', 'worsens comfort care measures', '- metoprolol 5 mg IV x 1 for rate control']","['- got Vit K 5mg PO', '- spoke with family and they want to escalation of care, if patient', 'worsens comfort care measures', '- metoprolol 5 mg IV x 1 for rate control']","['[**Age over 90 382**] yo F with a history of stroke, Atrial fibrillation on coumadin, CHF,', ""COPD, Crohn's disease, and uterine cancer sent in from [**Hospital 12**] rehab for"", 'BP of 70/40, HR 65 (on digoxin), 92% on RA.', '- Gave patient 40mg IV lasix in AM and placed patient on BiPap, patient', ""net negative 600 cc at 7pm, comfortable breaths.  Patient's younger"", 'brother, [**Name (NI) **], updated.', '- BiPap down to 50% at 7pm, satting 99 to 100.', '- Some lower sternal, mid chest chest pain, dull, [**4-24**].  Pt. mentions', 'it has come and gone for months.  EKG unchanged from previous.  CE &', 'trops sent, pain went away during physical exam, would give 1mg', 'morphine if recurs.']",23666,134984.0
9,2118-04-26 06:57:50,,"['- got Vit K 5mg PO', '- spoke with family and they want to escalation of care, if patient', 'worsens comfort care measures', '- metoprolol 5 mg IV x 1 for rate control']",,23666,134984.0
10,2118-04-26 14:21:37,,"['- got Vit K 5mg PO', '- spoke with family and they want to escalation of care, if patient', 'worsens comfort care measures', '- metoprolol 5 mg IV x 1 for rate control']",,23666,134984.0
11,2118-04-27 07:24:45,"['- iv lasix, -1200 overall, contraction by bicarb and BP in mid 80s.', 'held evening metoprolol, monitor', '- dc dig', '- INR at 1.7']","['- iv lasix, -1200 overall, contraction by bicarb and BP in mid 80s.', 'held evening metoprolol, monitor', '- dc dig', '- INR at 1.7']","['- got Vit K 5mg PO', '- spoke with family and they want to escalation of care, if patient', 'worsens comfort care measures', '- metoprolol 5 mg IV x 1 for rate control']",23666,134984.0
12,2118-04-27 07:25:36,,"['- iv lasix, -1200 overall, contraction by bicarb and BP in mid 80s.', 'held evening metoprolol, monitor', '- dc dig', '- INR at 1.7']",,23666,134984.0
13,2118-04-27 07:39:19,,"['- iv lasix, -1200 overall, contraction by bicarb and BP in mid 80s.', 'held evening metoprolol, monitor', '- dc dig', '- INR at 1.7']",,23666,134984.0
14,2118-04-27 10:26:13,,"['- iv lasix, -1200 overall, contraction by bicarb and BP in mid 80s.', 'held evening metoprolol, monitor', '- dc dig', '- INR at 1.7']",,23666,134984.0
0,2172-04-01 06:22:36,,"['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction']",,52228,155354.0
1,2172-04-01 07:02:29,['Continued with heavy menstrual bleeding'],"['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction', 'Continued with heavy menstrual bleeding']",,52228,155354.0
2,2172-04-01 08:00:03,"['This morning, denies any SOB, nausea, or bleeding. Handling secretions', 'without problem.']","['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction', 'Continued with heavy menstrual bleeding', 'This morning, denies any SOB, nausea, or bleeding. Handling secretions', 'without problem.']",,52228,155354.0
3,2172-04-01 10:21:03,,"['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction', 'Continued with heavy menstrual bleeding', 'This morning, denies any SOB, nausea, or bleeding. Handling secretions', 'without problem.']",,52228,155354.0
4,2172-04-01 11:40:32,,"['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction', 'Continued with heavy menstrual bleeding', 'This morning, denies any SOB, nausea, or bleeding. Handling secretions', 'without problem.']",,52228,155354.0
5,2172-04-02 07:19:52,"['- overnight neuro exam unchanged', '- ? bleeding with BM', '- d/w heme --> plan was to only transfuse blood/plts for active bleed', 'or acute changes']","['- overnight neuro exam unchanged', '- ? bleeding with BM', '- d/w heme --> plan was to only transfuse blood/plts for active bleed', 'or acute changes']","['Discussed with bloodbank - felt c/w anaphylactic transfusion reaction.', 'Should get only washed products', 'No evidence of IgA deficiency to explain reaction', 'Continued with heavy menstrual bleeding', 'This morning, denies any SOB, nausea, or bleeding. Handling secretions', 'without problem.']",52228,155354.0
6,2172-04-02 07:21:17,,"['- overnight neuro exam unchanged', '- ? bleeding with BM', '- d/w heme --> plan was to only transfuse blood/plts for active bleed', 'or acute changes']",,52228,155354.0
7,2172-04-02 11:15:40,,"['- overnight neuro exam unchanged', '- ? bleeding with BM', '- d/w heme --> plan was to only transfuse blood/plts for active bleed', 'or acute changes']",,52228,155354.0
8,2172-04-03 06:12:54,['History obtained from Patient'],['History obtained from Patient'],"['- overnight neuro exam unchanged', '- ? bleeding with BM', '- d/w heme --> plan was to only transfuse blood/plts for active bleed', 'or acute changes']",52228,155354.0
9,2172-04-03 06:15:27,"[""- Patient's platelets decreased to <5, spoke to both hematology and"", 'blood bank and decision to transfuse 1 bag of washed platelets', 'monitoring closely for anaphylactic reaction', '- Platelets running in at 5am']","[""- Patient's platelets decreased to <5, spoke to both hematology and"", 'blood bank and decision to transfuse 1 bag of washed platelets', 'monitoring closely for anaphylactic reaction', '- Platelets running in at 5am', 'History obtained from Patient']",,52228,155354.0
10,2172-04-03 08:26:31,"['- One bag of washed platelets ran in this AM at 5am without any', 'reactions']","[""- Patient's platelets decreased to <5, spoke to both hematology and"", 'blood bank and decision to transfuse 1 bag of washed platelets', 'monitoring closely for anaphylactic reaction', '- One bag of washed platelets ran in this AM at 5am without any', 'reactions', 'History obtained from Patient']",['- Platelets running in at 5am'],52228,155354.0
11,2172-04-03 08:57:18,"['- Continued heavy menstrual bleeding, occasional clots from nose']","[""- Patient's platelets decreased to <5, spoke to both hematology and"", 'blood bank and decision to transfuse 1 bag of washed platelets', 'monitoring closely for anaphylactic reaction', '- One bag of washed platelets ran in this AM at 5am without any', 'reactions', '- Continued heavy menstrual bleeding, occasional clots from nose', 'History obtained from Patient']",,52228,155354.0
12,2172-04-03 11:09:01,,"[""- Patient's platelets decreased to <5, spoke to both hematology and"", 'blood bank and decision to transfuse 1 bag of washed platelets', 'monitoring closely for anaphylactic reaction', '- One bag of washed platelets ran in this AM at 5am without any', 'reactions', '- Continued heavy menstrual bleeding, occasional clots from nose', 'History obtained from Patient']",,52228,155354.0
0,2156-02-25 06:43:38,,"['-Attempts to place Right A-line bilaterally, unable to feed wire', '-Unable to thread wire in R subclavian despite multiple attempts at', 'repositioning.', '-Unable to tolerate decrease in tidal volum on CMV [**3-6**] increased work', 'of breathing/dysynchrony', ' MULTI LUMEN - START [**2156-2-24**] 11:30 AM']",,18082,181163.0
1,2156-02-25 10:53:42,"['-Total boluses overnight of 2.75L', '-decrease in hemoptysis; minimal bloody secretions since admission']","['-Attempts to place Right A-line bilaterally, unable to feed wire', '-Unable to thread wire in R subclavian despite multiple attempts at', 'repositioning.', '-Unable to tolerate decrease in tidal volum on CMV [**3-6**] increased work', 'of breathing/dysynchrony', '-Total boluses overnight of 2.75L', '-decrease in hemoptysis; minimal bloody secretions since admission', ' MULTI LUMEN - START [**2156-2-24**] 11:30 AM']",,18082,181163.0
2,2156-02-25 11:20:13,['-Unable to tolerate decrease in tidal volume on CMV [**3-6**] increased work'],"['-Attempts to place Right A-line bilaterally, unable to feed wire', '-Unable to thread wire in R subclavian despite multiple attempts at', 'repositioning.', '-Unable to tolerate decrease in tidal volume on CMV [**3-6**] increased work', 'of breathing/dysynchrony', '-Total boluses overnight of 2.75L', '-decrease in hemoptysis; minimal bloody secretions since admission', ' MULTI LUMEN - START [**2156-2-24**] 11:30 AM']",['-Unable to tolerate decrease in tidal volum on CMV [**3-6**] increased work'],18082,181163.0
3,2156-02-26 06:38:22,"['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage sicne covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']","['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage sicne covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']","['-Attempts to place Right A-line bilaterally, unable to feed wire', '-Unable to thread wire in R subclavian despite multiple attempts at', 'repositioning.', '-Unable to tolerate decrease in tidal volume on CMV [**3-6**] increased work', 'of breathing/dysynchrony', '-Total boluses overnight of 2.75L', '-decrease in hemoptysis; minimal bloody secretions since admission', ' MULTI LUMEN - START [**2156-2-24**] 11:30 AM']",18082,181163.0
4,2156-02-26 08:07:13,,"['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage sicne covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']",,18082,181163.0
5,2156-02-26 14:51:08,,"['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage sicne covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']",,18082,181163.0
6,2156-02-26 15:08:23,,"['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage sicne covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']",,18082,181163.0
7,2156-02-26 15:13:16,['kept on broad ABX coverage since covering for aspiration PNA.'],"['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage since covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']",['kept on broad ABX coverage sicne covering for aspiration PNA.'],18082,181163.0
8,2156-02-27 06:44:04,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']","['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']","['-Urine micro shoed Kleb. Pneumoniae R to Cipro and Nitrofuratoin, but', 'kept on broad ABX coverage since covering for aspiration PNA.', '-LENIs performed, but were unread', '-CXR obtained and showed some improvement in pulm edema and RLL opacity', 'which is c/w diagnosis of aspiration', '-LIJ central line was placed', '-Bolused 3 L NS for CVP < 12 and transient UOP of 25 cc/hr.  With', 'boluses pt maintained UOP of 40-80 cc/hr', '- plan for SBT this AM']",18082,181163.0
9,2156-02-27 06:46:18,,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",,18082,181163.0
10,2156-02-27 12:44:53,,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",,18082,181163.0
11,2156-02-27 18:03:25,,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",,18082,181163.0
12,2156-02-27 18:05:45,,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",,18082,181163.0
13,2156-02-27 18:24:02,,"['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",,18082,181163.0
14,2156-02-28 07:16:38,"['-extubated yesterday to BIPAP, daughter decided that she would want', 're-intubation if necessary', '-given Lasix 40IV x2 (last dose yest AM) prior to extubation, continued', 'to autodiurese throughout the day to -4.5L yesterday', '-metoprolol increased to home dose of 25mg [**Hospital1 **], continued to be', 'borderline tachycardic, with good BP', ""-LENI's were negative for DVT"", ' INVASIVE VENTILATION - STOP [**2156-2-27**] 02:00 PM', ' NON-INVASIVE VENTILATION - START [**2156-2-27**] 02:45 PM']","['-extubated yesterday to BIPAP, daughter decided that she would want', 're-intubation if necessary', '-given Lasix 40IV x2 (last dose yest AM) prior to extubation, continued', 'to autodiurese throughout the day to -4.5L yesterday', '-metoprolol increased to home dose of 25mg [**Hospital1 **], continued to be', 'borderline tachycardic, with good BP', ""-LENI's were negative for DVT"", ' INVASIVE VENTILATION - STOP [**2156-2-27**] 02:00 PM', ' NON-INVASIVE VENTILATION - START [**2156-2-27**] 02:45 PM']","['LENIs--read still pending', '1L+, got lasix 20 IV+40 IV', 'Started trial of metoprolol IV; was fine; started half her home dose of', 'PO metoprolol', 'Hct was 22.2, got 1 U PRBCs', 'FiO2 went from 0.5 to 0.6, trying to go down to 0.5 again']",18082,181163.0
15,2156-02-29 02:14:53,,"['-extubated yesterday to BIPAP, daughter decided that she would want', 're-intubation if necessary', '-given Lasix 40IV x2 (last dose yest AM) prior to extubation, continued', 'to autodiurese throughout the day to -4.5L yesterday', '-metoprolol increased to home dose of 25mg [**Hospital1 **], continued to be', 'borderline tachycardic, with good BP', ""-LENI's were negative for DVT"", ' INVASIVE VENTILATION - STOP [**2156-2-27**] 02:00 PM', ' NON-INVASIVE VENTILATION - START [**2156-2-27**] 02:45 PM']",,18082,181163.0
16,2156-02-29 09:19:29,"['- Goal negative 1L, after Lasix 20 mg IV x2 pt was -103 @ MN, and', 'negative 439 @ 5AM', '- F/U CXR obtained yesterday afternoon showed interval improvement on', 'the left, post-extubation.', '- Developed afib with RVR with rates to 140s.  Responded to Lopressor 5', 'mg IV x2 with rates coming down to 90-100.', '- At 1 AM in the setting of RVR developed respiroatory distress on high', 'flow O2 facemask with tachypnea to the 30s and sating 88%.  ABG']","['- Goal negative 1L, after Lasix 20 mg IV x2 pt was -103 @ MN, and', 'negative 439 @ 5AM', '- F/U CXR obtained yesterday afternoon showed interval improvement on', 'the left, post-extubation.', '- Developed afib with RVR with rates to 140s.  Responded to Lopressor 5', 'mg IV x2 with rates coming down to 90-100.', '- At 1 AM in the setting of RVR developed respiroatory distress on high', 'flow O2 facemask with tachypnea to the 30s and sating 88%.  ABG']","['-extubated yesterday to BIPAP, daughter decided that she would want', 're-intubation if necessary', '-given Lasix 40IV x2 (last dose yest AM) prior to extubation, continued', 'to autodiurese throughout the day to -4.5L yesterday', '-metoprolol increased to home dose of 25mg [**Hospital1 **], continued to be', 'borderline tachycardic, with good BP', ""-LENI's were negative for DVT"", ' INVASIVE VENTILATION - STOP [**2156-2-27**] 02:00 PM', ' NON-INVASIVE VENTILATION - START [**2156-2-27**] 02:45 PM']",18082,181163.0
17,2156-03-01 02:07:52,,"['- Goal negative 1L, after Lasix 20 mg IV x2 pt was -103 @ MN, and', 'negative 439 @ 5AM', '- F/U CXR obtained yesterday afternoon showed interval improvement on', 'the left, post-extubation.', '- Developed afib with RVR with rates to 140s.  Responded to Lopressor 5', 'mg IV x2 with rates coming down to 90-100.', '- At 1 AM in the setting of RVR developed respiroatory distress on high', 'flow O2 facemask with tachypnea to the 30s and sating 88%.  ABG']",,18082,181163.0
18,2156-03-01 07:56:30,"['NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', ' EKG - At [**2156-2-29**] 12:44 PM', ' NON-INVASIVE VENTILATION - STOP [**2156-2-29**] 01:12 PM', 'Attg met with daughter who affirmed still going forward w aggressive', 'intervention including intubation if needed', 'Metoprolol increased to TID dosing after RVR of prior night', '20 lasix IV x2, negative 1L today', 'History obtained from Medical records']","['NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', ' EKG - At [**2156-2-29**] 12:44 PM', ' NON-INVASIVE VENTILATION - STOP [**2156-2-29**] 01:12 PM', 'Attg met with daughter who affirmed still going forward w aggressive', 'intervention including intubation if needed', 'Metoprolol increased to TID dosing after RVR of prior night', '20 lasix IV x2, negative 1L today', 'History obtained from Medical records']","['- Goal negative 1L, after Lasix 20 mg IV x2 pt was -103 @ MN, and', 'negative 439 @ 5AM', '- F/U CXR obtained yesterday afternoon showed interval improvement on', 'the left, post-extubation.', '- Developed afib with RVR with rates to 140s.  Responded to Lopressor 5', 'mg IV x2 with rates coming down to 90-100.', '- At 1 AM in the setting of RVR developed respiroatory distress on high', 'flow O2 facemask with tachypnea to the 30s and sating 88%.  ABG']",18082,181163.0
19,2156-03-01 16:02:44,"['Metoprolol increased to TID dosing [**3-6**] RVR', 'Placed on BiPAP briefly', ' NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', 'Subjective Nonverbal']","['Attg met with daughter who affirmed still going forward w aggressive', 'intervention including intubation if needed', 'Metoprolol increased to TID dosing [**3-6**] RVR', 'Placed on BiPAP briefly', '20 lasix IV x2, negative 1L today', ' NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', ' EKG - At [**2156-2-29**] 12:44 PM', ' NON-INVASIVE VENTILATION - STOP [**2156-2-29**] 01:12 PM', 'Subjective Nonverbal', 'History obtained from Medical records']","['NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', 'Metoprolol increased to TID dosing after RVR of prior night']",18082,181163.0
20,2156-03-01 17:39:49,,"['Attg met with daughter who affirmed still going forward w aggressive', 'intervention including intubation if needed', 'Metoprolol increased to TID dosing [**3-6**] RVR', 'Placed on BiPAP briefly', '20 lasix IV x2, negative 1L today', ' NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', ' EKG - At [**2156-2-29**] 12:44 PM', ' NON-INVASIVE VENTILATION - STOP [**2156-2-29**] 01:12 PM', 'Subjective Nonverbal', 'History obtained from Medical records']",,18082,181163.0
21,2156-03-02 07:03:15,"['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM']","['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM']","['Attg met with daughter who affirmed still going forward w aggressive', 'intervention including intubation if needed', 'Metoprolol increased to TID dosing [**3-6**] RVR', 'Placed on BiPAP briefly', '20 lasix IV x2, negative 1L today', ' NON-INVASIVE VENTILATION - START [**2156-2-29**] 08:30 AM', ' EKG - At [**2156-2-29**] 12:44 PM', ' NON-INVASIVE VENTILATION - STOP [**2156-2-29**] 01:12 PM', 'Subjective Nonverbal', 'History obtained from Medical records']",18082,181163.0
22,2156-03-02 07:15:00,,"['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM']",,18082,181163.0
23,2156-03-02 07:18:04,,"['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM']",,18082,181163.0
24,2156-03-02 12:58:26,"['SUBJECTIVE', 'Nonverbal.', 'No diarrhea [**Name8 (MD) **] RN.']","['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM', 'SUBJECTIVE', 'Nonverbal.', 'No diarrhea [**Name8 (MD) **] RN.']",,18082,181163.0
25,2156-03-02 13:00:35,,"['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM', 'SUBJECTIVE', 'Nonverbal.', 'No diarrhea [**Name8 (MD) **] RN.']",,18082,181163.0
26,2156-03-02 13:05:48,,"['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM', 'SUBJECTIVE', 'Nonverbal.', 'No diarrhea [**Name8 (MD) **] RN.']",,18082,181163.0
27,2156-03-03 07:44:13,"['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates, morphine with good effect']","['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates, morphine with good effect']","['Attending discussed goals of care with daughter [**Doctor First Name 397**] to', 'continue aggressive care.', ""Patient's other daughter also wants aggressive care for now."", 'Febrile in AM with leukocytosis; cultured and cefepime changed to', 'meropenem; fevers resolved in PM', 'Decreased dose of metoprolol', 'Urine output very poor despite IV fluids', ' URINE CULTURE - At [**2156-3-1**] 11:00 AM', ' BLOOD CULTURED - At [**2156-3-1**] 11:15 AM', ' BLOOD CULTURED - At [**2156-3-1**] 12:15 PM', ' SPUTUM CULTURE - At [**2156-3-1**] 01:19 PM', ' FEVER - 101.6', 'F - [**2156-3-1**] 09:00 AM', 'SUBJECTIVE', 'Nonverbal.', 'No diarrhea [**Name8 (MD) **] RN.']",18082,181163.0
28,2156-03-03 07:47:40,,"['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates, morphine with good effect']",,18082,181163.0
29,2156-03-03 08:08:38,,"['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates, morphine with good effect']",,18082,181163.0
30,2156-03-03 11:50:00,"['given lasix, nitrates with good effect']","['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates with good effect']","['given lasix, nitrates, morphine with good effect']",18082,181163.0
31,2156-03-04 07:31:33,"['- IR changed G tube to G-J tube, feeds restarted', '- family never showed up']","['- IR changed G tube to G-J tube, feeds restarted', '- family never showed up']","['PICC LINE - START [**2156-3-2**] 12:00 PM', ' SPUTUM CULTURE - At [**2156-3-2**] 01:10 PM', ' MULTI LUMEN - STOP [**2156-3-2**] 10:30 PM', 'site cleaned and dressing changed.', 'screened for MACU - transfer depends on big picture for her care', 'PICC placed, LIJ pulled', 'urine output remained borderline, given 500cc NS bolus x1 without great', 'effect', 'tube feeds were planned to restart, but TF not flushing', 'family meeting needed wednesday to discuss ?trach and dispo', ""~4am episode of ?flash pulmonary edema in setting of BP'd to 190's"", 'given lasix, nitrates with good effect']",18082,181163.0
32,2156-03-04 08:04:35,,"['- IR changed G tube to G-J tube, feeds restarted', '- family never showed up']",,18082,181163.0
33,2156-03-04 10:18:11,,"['- IR changed G tube to G-J tube, feeds restarted', '- family never showed up']",,18082,181163.0
34,2156-03-04 13:15:49,"['- family didn', 't visit yesterday']","['- IR changed G tube to G-J tube, feeds restarted', '- family didn', 't visit yesterday']",['- family never showed up'],18082,181163.0
35,2156-03-05 07:15:41,,"['- IR changed G tube to G-J tube, feeds restarted', '- family didn', 't visit yesterday']",,18082,181163.0
36,2156-03-05 07:30:35,"['Spoke with daughters; both are clear about wanting to continue full', 'care for [**Known firstname 548**]', '[**Last Name (NamePattern1) 549**] daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']","['Spoke with daughters; both are clear about wanting to continue full', 'care for [**Known firstname 548**]', '[**Last Name (NamePattern1) 549**] daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']","['- IR changed G tube to G-J tube, feeds restarted', '- family didn', 't visit yesterday']",18082,181163.0
37,2156-03-05 07:34:50,,"['Spoke with daughters; both are clear about wanting to continue full', 'care for [**Known firstname 548**]', '[**Last Name (NamePattern1) 549**] daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']",,18082,181163.0
38,2156-03-05 13:29:44,"['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care']","['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']","['Spoke with daughters; both are clear about wanting to continue full', 'care for [**Known firstname 548**]', '[**Last Name (NamePattern1) 549**] daughters coming in in the morning to talk with palliative care']",18082,181163.0
39,2156-03-05 13:59:34,,"['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']",,18082,181163.0
40,2156-03-05 14:03:07,,"['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']",,18082,181163.0
41,2156-03-05 14:08:57,,"['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']",,18082,181163.0
42,2156-03-06 07:29:48,"['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'decided not to call out [**3-6**] frequent suctioning requirements', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']","['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'decided not to call out [**3-6**] frequent suctioning requirements', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']","['Spoke with daughters; both are clear about wanting to continue', 'aggressive care for Ms. [**Known lastname 103**]', 'Both daughters coming in in the morning to talk with palliative care', 'team (10-11am)', 'Being screened for [**Hospital1 82**] given that daughters feel she did not do', 'well at [**Hospital 12**] Rehab', 'Febrile to 101F last night -- blood cultures sent', 'RN reports need for frequent suctioning, thick tan secretions', ' BLOOD CULTURED - At [**2156-3-4**] 11:49 PM', ' URINE CULTURE - At [**2156-3-5**] 12:02 AM', ' CALLED OUT', 'History obtained from Medical records']",18082,181163.0
43,2156-03-06 07:43:37,['did not require suctioning overnight'],"['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'did not require suctioning overnight', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']",['decided not to call out [**3-6**] frequent suctioning requirements'],18082,181163.0
44,2156-03-06 08:38:41,,"['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'did not require suctioning overnight', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']",,18082,181163.0
45,2156-03-06 10:40:49,,"['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'did not require suctioning overnight', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']",,18082,181163.0
46,2156-03-12 07:43:03,"['PICC LINE - START [**2156-3-11**] 08:29 PM', ' EKG - At [**2156-3-11**] 11:16 PM', 'History obtained from Medical records']","['PICC LINE - START [**2156-3-11**] 08:29 PM', ' EKG - At [**2156-3-11**] 11:16 PM', 'History obtained from Medical records']","['case manager spoke with family, plan for meeting saturday', 'diuresed with lasix', 'did not require suctioning overnight', ' SPUTUM CULTURE - At [**2156-3-5**] 12:02 PM']",18082,181163.0
47,2156-03-12 07:44:33,,"['PICC LINE - START [**2156-3-11**] 08:29 PM', ' EKG - At [**2156-3-11**] 11:16 PM', 'History obtained from Medical records']",,18082,181163.0
48,2156-03-12 10:52:55,"['Transferred to [**Hospital Unit Name 44**], quiet night.']","['Transferred to [**Hospital Unit Name 44**], quiet night.', 'History obtained from Medical records']","['PICC LINE - START [**2156-3-11**] 08:29 PM', ' EKG - At [**2156-3-11**] 11:16 PM']",18082,181163.0
0,2141-02-10 07:06:51,,"['URINE CULTURE - At [**2141-2-9**] 10:22 PM', ' NASAL SWAB - At [**2141-2-9**] 10:22 PM', ' EKG - At [**2141-2-9**] 10:46 PM', '-weaned off nitro drip']",,78015,184837.0
1,2141-02-10 10:23:27,,"['URINE CULTURE - At [**2141-2-9**] 10:22 PM', ' NASAL SWAB - At [**2141-2-9**] 10:22 PM', ' EKG - At [**2141-2-9**] 10:46 PM', '-weaned off nitro drip']",,78015,184837.0
0,2155-02-12 06:21:18,,['URINE CULTURE - At [**2155-2-12**] 06:00 AM'],,25332,129798.0
1,2155-02-12 07:00:13,,['URINE CULTURE - At [**2155-2-12**] 06:00 AM'],,25332,129798.0
2,2155-02-12 11:53:16,['no events o/n'],['no events o/n'],['URINE CULTURE - At [**2155-2-12**] 06:00 AM'],25332,129798.0
3,2155-02-13 07:12:54,"['MIDLINE - START [**2155-2-12**] 10:30 AM', ' INVASIVE VENTILATION - START [**2155-2-12**] 01:00 PM', ' ARTERIAL LINE - START [**2155-2-12**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2155-2-12**] 10:00 PM', 'brain with contrast']","['MIDLINE - START [**2155-2-12**] 10:30 AM', ' INVASIVE VENTILATION - START [**2155-2-12**] 01:00 PM', ' ARTERIAL LINE - START [**2155-2-12**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2155-2-12**] 10:00 PM', 'brain with contrast']",['no events o/n'],25332,129798.0
4,2155-02-13 07:40:48,,"['MIDLINE - START [**2155-2-12**] 10:30 AM', ' INVASIVE VENTILATION - START [**2155-2-12**] 01:00 PM', ' ARTERIAL LINE - START [**2155-2-12**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2155-2-12**] 10:00 PM', 'brain with contrast']",,25332,129798.0
5,2155-02-13 07:41:36,"['[**2155-2-12**]:', '- tachypnic to 50s, intubated electively for MRI (had to be nasally b/c', 'has radiation damage to jaw)', '- dropped pressures at MRI (SBP 60s despite IVF), needed pressors', '- EEG diffuse slowing, no e/o status epilepticus', '- sent toxo titers', '- will attempt repeat MRI']","['[**2155-2-12**]:', '- tachypnic to 50s, intubated electively for MRI (had to be nasally b/c', 'has radiation damage to jaw)', '- dropped pressures at MRI (SBP 60s despite IVF), needed pressors', '- EEG diffuse slowing, no e/o status epilepticus', '- sent toxo titers', '- will attempt repeat MRI']","['MIDLINE - START [**2155-2-12**] 10:30 AM', ' INVASIVE VENTILATION - START [**2155-2-12**] 01:00 PM', ' ARTERIAL LINE - START [**2155-2-12**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2155-2-12**] 10:00 PM', 'brain with contrast']",25332,129798.0
6,2155-02-13 13:39:33,,"['[**2155-2-12**]:', '- tachypnic to 50s, intubated electively for MRI (had to be nasally b/c', 'has radiation damage to jaw)', '- dropped pressures at MRI (SBP 60s despite IVF), needed pressors', '- EEG diffuse slowing, no e/o status epilepticus', '- sent toxo titers', '- will attempt repeat MRI']",,25332,129798.0
7,2155-02-14 07:03:10,"['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']","['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']","['[**2155-2-12**]:', '- tachypnic to 50s, intubated electively for MRI (had to be nasally b/c', 'has radiation damage to jaw)', '- dropped pressures at MRI (SBP 60s despite IVF), needed pressors', '- EEG diffuse slowing, no e/o status epilepticus', '- sent toxo titers', '- will attempt repeat MRI']",25332,129798.0
8,2155-02-14 07:14:54,,"['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']",,25332,129798.0
9,2155-02-15 00:19:39,,"['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']",,25332,129798.0
10,2155-02-15 00:37:29,,"['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']",,25332,129798.0
11,2155-02-15 07:47:20,"['[**2154-2-14**]:', '- Lots of conversations between various teams:  As it stands now, [**Location **] MRI is down for ASL MRI.  If the water is fixed tomorrow we need', 'to page the [**Hospital Ward Name 247**] MRI tech -[**Numeric Identifier 11346**] and [**First Name8 (NamePattern2) 831**] [**Last Name (NamePattern1) 11347**]- [**Numeric Identifier 11348**] to get', 'these studies done.', '- Dr. [**First Name (STitle) **] (NSG) to discuss patient at tumor board on Monday, possible', 'bx, Tuesday or wednesday.', '- Dr. [**Last Name (STitle) 11349**] preference is to extubate with anesthesia on hand durring', 'the day, after the MRI, as he does not want pt to remain intubated', 'until tuesday with underlying sinus disease.']","['[**2154-2-14**]:', '- Lots of conversations between various teams:  As it stands now, [**Location **] MRI is down for ASL MRI.  If the water is fixed tomorrow we need', 'to page the [**Hospital Ward Name 247**] MRI tech -[**Numeric Identifier 11346**] and [**First Name8 (NamePattern2) 831**] [**Last Name (NamePattern1) 11347**]- [**Numeric Identifier 11348**] to get', 'these studies done.', '- Dr. [**First Name (STitle) **] (NSG) to discuss patient at tumor board on Monday, possible', 'bx, Tuesday or wednesday.', '- Dr. [**Last Name (STitle) 11349**] preference is to extubate with anesthesia on hand durring', 'the day, after the MRI, as he does not want pt to remain intubated', 'until tuesday with underlying sinus disease.']","['- initial MR head suggested Toxo, also post-radiation change,', 'superimposed infection, metastatic disease or a graft-versus-host', 'disease, thus held off empiric therapy for toxomplasmosis; ? glioma', '- problems include hyponatremia, drop in plts', '- per wife, pt does not take lorazepam at home', '- sputum cx -> GRAM STAIN [**2155-2-13**]', '<10 PMNs and <10 epithelial cells/100X field.', '3+  (5-10 per 1000X FIELD):', 'BUDDING YEAST ? [**Female First Name (un) **] vs', 'Cryptococcus', '1+', '(<1 per 1000X FIELD):', 'GRAM POSITIVE COCCI.', 'IN PAIRS.', '- Neurosurg, Neuro-onc consulted', '- vent changed to CPAP, tolerated well']",25332,129798.0
12,2155-02-15 08:30:21,,"['[**2154-2-14**]:', '- Lots of conversations between various teams:  As it stands now, [**Location **] MRI is down for ASL MRI.  If the water is fixed tomorrow we need', 'to page the [**Hospital Ward Name 247**] MRI tech -[**Numeric Identifier 11346**] and [**First Name8 (NamePattern2) 831**] [**Last Name (NamePattern1) 11347**]- [**Numeric Identifier 11348**] to get', 'these studies done.', '- Dr. [**First Name (STitle) **] (NSG) to discuss patient at tumor board on Monday, possible', 'bx, Tuesday or wednesday.', '- Dr. [**Last Name (STitle) 11349**] preference is to extubate with anesthesia on hand durring', 'the day, after the MRI, as he does not want pt to remain intubated', 'until tuesday with underlying sinus disease.']",,25332,129798.0
13,2155-02-15 12:01:39,,"['[**2154-2-14**]:', '- Lots of conversations between various teams:  As it stands now, [**Location **] MRI is down for ASL MRI.  If the water is fixed tomorrow we need', 'to page the [**Hospital Ward Name 247**] MRI tech -[**Numeric Identifier 11346**] and [**First Name8 (NamePattern2) 831**] [**Last Name (NamePattern1) 11347**]- [**Numeric Identifier 11348**] to get', 'these studies done.', '- Dr. [**First Name (STitle) **] (NSG) to discuss patient at tumor board on Monday, possible', 'bx, Tuesday or wednesday.', '- Dr. [**Last Name (STitle) 11349**] preference is to extubate with anesthesia on hand durring', 'the day, after the MRI, as he does not want pt to remain intubated', 'until tuesday with underlying sinus disease.']",,25332,129798.0
14,2155-02-16 07:46:53,"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']","['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']","['[**2154-2-14**]:', '- Lots of conversations between various teams:  As it stands now, [**Location **] MRI is down for ASL MRI.  If the water is fixed tomorrow we need', 'to page the [**Hospital Ward Name 247**] MRI tech -[**Numeric Identifier 11346**] and [**First Name8 (NamePattern2) 831**] [**Last Name (NamePattern1) 11347**]- [**Numeric Identifier 11348**] to get', 'these studies done.', '- Dr. [**First Name (STitle) **] (NSG) to discuss patient at tumor board on Monday, possible', 'bx, Tuesday or wednesday.', '- Dr. [**Last Name (STitle) 11349**] preference is to extubate with anesthesia on hand durring', 'the day, after the MRI, as he does not want pt to remain intubated', 'until tuesday with underlying sinus disease.']",25332,129798.0
15,2155-02-16 07:47:47,,"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
16,2155-02-16 12:36:15,,"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
17,2155-02-16 12:51:22,,"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
18,2155-02-16 12:55:30,,"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
19,2155-02-17 07:19:42,,[],"['MAGNETIC RESONANCE IMAGING - At [**2155-2-15**] 11:45 AM', '- got ASL MRI', '- had hypotensive episode after receiving IV labetalol, propofol and IV', 'Bactrim around same time, SBP dropped to 30s, came back quickly with', 'IVF wide open and pressors on for 2 minutes only', '- PSV trial --> agitated, hypoxic --> back on AC', ""- on AC 7.43/43/136, pc02 goal 50's so decreased RR"", '- ENT attg Dr. [**Last Name (STitle) 11353**] emailed saying OGT OK, but could not pass', '(pt kept biting even though increased sedation)', '- received IVF to maintain UOP', '- no neurosurg recs', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
20,2155-02-17 07:35:23,"['- per BMT, no indication for [**Last Name (LF) 2643**], [**First Name3 (LF) 178**] attempt to advance mid-line to', 'PICC tomorrow', '- contact[**Name (NI) **] [**Name (NI) **] re: ASL MRI and quality of study, will need to', 'discuss with Neuro-onc tomorrow, may need repeat with IV contrast', '- vent -> [**11-11**] all day, tolerated well, likely remain intubated pending', 'possible biopsy']","['- per BMT, no indication for [**Last Name (LF) 2643**], [**First Name3 (LF) 178**] attempt to advance mid-line to', 'PICC tomorrow', '- contact[**Name (NI) **] [**Name (NI) **] re: ASL MRI and quality of study, will need to', 'discuss with Neuro-onc tomorrow, may need repeat with IV contrast', '- vent -> [**11-11**] all day, tolerated well, likely remain intubated pending', 'possible biopsy']",,25332,129798.0
21,2155-02-17 22:47:39,,"['- per BMT, no indication for [**Last Name (LF) 2643**], [**First Name3 (LF) 178**] attempt to advance mid-line to', 'PICC tomorrow', '- contact[**Name (NI) **] [**Name (NI) **] re: ASL MRI and quality of study, will need to', 'discuss with Neuro-onc tomorrow, may need repeat with IV contrast', '- vent -> [**11-11**] all day, tolerated well, likely remain intubated pending', 'possible biopsy']",,25332,129798.0
22,2155-02-18 07:43:00,"['[**2155-2-17**]:', '- PET scan was negative for tumor, NSG is not going to biopsy', '- Had limited overall fluid status to 20mg IV lasix x3, started drip']","['[**2155-2-17**]:', '- PET scan was negative for tumor, NSG is not going to biopsy', '- Had limited overall fluid status to 20mg IV lasix x3, started drip']","['- per BMT, no indication for [**Last Name (LF) 2643**], [**First Name3 (LF) 178**] attempt to advance mid-line to', 'PICC tomorrow', '- contact[**Name (NI) **] [**Name (NI) **] re: ASL MRI and quality of study, will need to', 'discuss with Neuro-onc tomorrow, may need repeat with IV contrast', '- vent -> [**11-11**] all day, tolerated well, likely remain intubated pending', 'possible biopsy']",25332,129798.0
23,2155-02-18 11:37:08,,"['[**2155-2-17**]:', '- PET scan was negative for tumor, NSG is not going to biopsy', '- Had limited overall fluid status to 20mg IV lasix x3, started drip']",,25332,129798.0
24,2155-02-18 11:51:12,,"['[**2155-2-17**]:', '- PET scan was negative for tumor, NSG is not going to biopsy', '- Had limited overall fluid status to 20mg IV lasix x3, started drip']",,25332,129798.0
25,2155-02-19 07:05:52,"['- family updated re: plan for EEG, diuresis before extubation', '- D/Ced phenytoin and bolused sedation in preparation for EEG', '- Lasix gtt titrated for goal 2L neg (on 10/hr)']","['- family updated re: plan for EEG, diuresis before extubation', '- D/Ced phenytoin and bolused sedation in preparation for EEG', '- Lasix gtt titrated for goal 2L neg (on 10/hr)']","['[**2155-2-17**]:', '- PET scan was negative for tumor, NSG is not going to biopsy', '- Had limited overall fluid status to 20mg IV lasix x3, started drip']",25332,129798.0
26,2155-02-19 12:42:28,,"['- family updated re: plan for EEG, diuresis before extubation', '- D/Ced phenytoin and bolused sedation in preparation for EEG', '- Lasix gtt titrated for goal 2L neg (on 10/hr)']",,25332,129798.0
27,2155-02-20 07:41:27,"['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']","['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']","['- family updated re: plan for EEG, diuresis before extubation', '- D/Ced phenytoin and bolused sedation in preparation for EEG', '- Lasix gtt titrated for goal 2L neg (on 10/hr)']",25332,129798.0
28,2155-02-20 07:42:34,,"['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']",,25332,129798.0
29,2155-02-20 20:01:13,,"['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']",,25332,129798.0
30,2155-02-21 00:24:27,,"['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']",,25332,129798.0
31,2155-02-21 06:56:09,"['Extubated, did extremely well']","['Extubated, did extremely well']","['- meeting with patient, family, Dr. [**Last Name (STitle) 1750**], and Dr. [**First Name (STitle) 116**] ->', 'considering extubation tomorrow, with possible no re-intubation if', 'fails', '- continued to aggressively diurese with electrolyte repletion']",25332,129798.0
32,2155-02-21 07:18:27,,"['Extubated, did extremely well']",,25332,129798.0
33,2155-02-21 07:21:17,,"['Extubated, did extremely well']",,25332,129798.0
34,2155-02-21 09:30:24,,"['Extubated, did extremely well']",,25332,129798.0
35,2155-02-21 09:41:08,,"['Extubated, did extremely well']",,25332,129798.0
36,2155-02-21 10:56:48,,"['Extubated, did extremely well']",,25332,129798.0
37,2155-02-22 07:26:11,"['- diuresing well and extubated, pC02 and bicarb started to climb again', 'but improved mental status', '- started Keppra solution for sz ppx', '- taking thickened liquids', '- decreased lasix gtt overnight, will convert to IV bolus dosing in AM', 'so can go to floor', 'History obtained from [**Hospital 85**] Medical records']","['- diuresing well and extubated, pC02 and bicarb started to climb again', 'but improved mental status', '- started Keppra solution for sz ppx', '- taking thickened liquids', '- decreased lasix gtt overnight, will convert to IV bolus dosing in AM', 'so can go to floor', 'History obtained from [**Hospital 85**] Medical records']","['Extubated, did extremely well']",25332,129798.0
38,2155-02-22 07:31:32,,"['- diuresing well and extubated, pC02 and bicarb started to climb again', 'but improved mental status', '- started Keppra solution for sz ppx', '- taking thickened liquids', '- decreased lasix gtt overnight, will convert to IV bolus dosing in AM', 'so can go to floor', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
39,2155-02-22 15:12:04,,"['- diuresing well and extubated, pC02 and bicarb started to climb again', 'but improved mental status', '- started Keppra solution for sz ppx', '- taking thickened liquids', '- decreased lasix gtt overnight, will convert to IV bolus dosing in AM', 'so can go to floor', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
40,2155-02-26 07:04:35,"['- placed foley', '- concern for aspiration pneumonitis vs. pneumonia, will cover if', 'spikes -> added sputum cx', '- cont dilt gtt']","['- placed foley', '- concern for aspiration pneumonitis vs. pneumonia, will cover if', 'spikes -> added sputum cx', '- cont dilt gtt']","['- diuresing well and extubated, pC02 and bicarb started to climb again', 'but improved mental status', '- started Keppra solution for sz ppx', '- taking thickened liquids', '- decreased lasix gtt overnight, will convert to IV bolus dosing in AM', 'so can go to floor', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
41,2155-02-26 14:05:00,,"['- placed foley', '- concern for aspiration pneumonitis vs. pneumonia, will cover if', 'spikes -> added sputum cx', '- cont dilt gtt']",,25332,129798.0
42,2155-02-26 14:12:36,,"['- placed foley', '- concern for aspiration pneumonitis vs. pneumonia, will cover if', 'spikes -> added sputum cx', '- cont dilt gtt']",,25332,129798.0
43,2155-02-27 07:29:39,"['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM.', 'History obtained from [**Hospital 85**] Medical records']","['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM.', 'History obtained from [**Hospital 85**] Medical records']","['- placed foley', '- concern for aspiration pneumonitis vs. pneumonia, will cover if', 'spikes -> added sputum cx', '- cont dilt gtt']",25332,129798.0
44,2155-02-27 07:30:58,,"['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM.', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
45,2155-02-27 07:37:24,,"['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM.', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
46,2155-02-27 09:27:18,"['- S+S couldnt do a bedside, plan for video swallow in AM', '- received 1.5 liters total of bolus yesterday for marginal UOP']","['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM', '- received 1.5 liters total of bolus yesterday for marginal UOP', 'History obtained from [**Hospital 85**] Medical records']","['- S+S couldnt do a bedside, plan for video swallow in AM.']",25332,129798.0
47,2155-02-28 07:23:01,"['- after extensive discussions all around, no ablation, did not give', 'argatroban', '- failed video swallow [**3-11**] diffuse muscle weakness and delayed all', 'phases of swallowing, thought is this represents general deconditioning', '(per [**Doctor Last Name 1750**], not really asked to S&S) and maybe giving temporary', 'nutrition could bridge to improved swallowing', '- [**Doctor Last Name 1750**] discussed G-tube as this ""bridge,"" pt just wants to', 'eat..unclear what will happen but gen [**Doctor First Name 458**] to see pt and eval if even', 'decent PEG candidate given skin issues', '- held off Lasix since pt very dry and thirsty, extremely uncomfortable', 'all day with diffuse pain requiring frequent morphine', '- titrated up metoprolol, 2.5 to 5 to 10, minimal response, at 15,', 'dropped pressures and UOP, got 250cc bolus', '- [**Doctor Last Name 1750**] discussed PEG']","['- after extensive discussions all around, no ablation, did not give', 'argatroban', '- failed video swallow [**3-11**] diffuse muscle weakness and delayed all', 'phases of swallowing, thought is this represents general deconditioning', '(per [**Doctor Last Name 1750**], not really asked to S&S) and maybe giving temporary', 'nutrition could bridge to improved swallowing', '- [**Doctor Last Name 1750**] discussed G-tube as this ""bridge,"" pt just wants to', 'eat..unclear what will happen but gen [**Doctor First Name 458**] to see pt and eval if even', 'decent PEG candidate given skin issues', '- held off Lasix since pt very dry and thirsty, extremely uncomfortable', 'all day with diffuse pain requiring frequent morphine', '- titrated up metoprolol, 2.5 to 5 to 10, minimal response, at 15,', 'dropped pressures and UOP, got 250cc bolus', '- [**Doctor Last Name 1750**] discussed PEG']","['- Dr [**Last Name (STitle) 1750**] discussing flutter ablation with patient, [**Doctor Last Name **]', '- wants us to start bival/argatroban to buy time', '- S+S couldnt do a bedside, plan for video swallow in AM', '- received 1.5 liters total of bolus yesterday for marginal UOP', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
48,2155-02-28 13:00:03,,"['- after extensive discussions all around, no ablation, did not give', 'argatroban', '- failed video swallow [**3-11**] diffuse muscle weakness and delayed all', 'phases of swallowing, thought is this represents general deconditioning', '(per [**Doctor Last Name 1750**], not really asked to S&S) and maybe giving temporary', 'nutrition could bridge to improved swallowing', '- [**Doctor Last Name 1750**] discussed G-tube as this ""bridge,"" pt just wants to', 'eat..unclear what will happen but gen [**Doctor First Name 458**] to see pt and eval if even', 'decent PEG candidate given skin issues', '- held off Lasix since pt very dry and thirsty, extremely uncomfortable', 'all day with diffuse pain requiring frequent morphine', '- titrated up metoprolol, 2.5 to 5 to 10, minimal response, at 15,', 'dropped pressures and UOP, got 250cc bolus', '- [**Doctor Last Name 1750**] discussed PEG']",,25332,129798.0
49,2155-03-01 07:32:09,"['- nasally re-intubated for resp distress/hypercarbic resp failure this', 'morning', '- repeat ABG showed improved ventilation', '- continued empiric treatment for aspiration/HAP', '- Dr. [**Last Name (STitle) 2045**] and Dr. [**Last Name (STitle) 619**] discussed pulmonary prognosis with wife']","['- nasally re-intubated for resp distress/hypercarbic resp failure this', 'morning', '- repeat ABG showed improved ventilation', '- continued empiric treatment for aspiration/HAP', '- Dr. [**Last Name (STitle) 2045**] and Dr. [**Last Name (STitle) 619**] discussed pulmonary prognosis with wife']","['- after extensive discussions all around, no ablation, did not give', 'argatroban', '- failed video swallow [**3-11**] diffuse muscle weakness and delayed all', 'phases of swallowing, thought is this represents general deconditioning', '(per [**Doctor Last Name 1750**], not really asked to S&S) and maybe giving temporary', 'nutrition could bridge to improved swallowing', '- [**Doctor Last Name 1750**] discussed G-tube as this ""bridge,"" pt just wants to', 'eat..unclear what will happen but gen [**Doctor First Name 458**] to see pt and eval if even', 'decent PEG candidate given skin issues', '- held off Lasix since pt very dry and thirsty, extremely uncomfortable', 'all day with diffuse pain requiring frequent morphine', '- titrated up metoprolol, 2.5 to 5 to 10, minimal response, at 15,', 'dropped pressures and UOP, got 250cc bolus', '- [**Doctor Last Name 1750**] discussed PEG']",25332,129798.0
50,2155-03-01 21:52:25,,"['- nasally re-intubated for resp distress/hypercarbic resp failure this', 'morning', '- repeat ABG showed improved ventilation', '- continued empiric treatment for aspiration/HAP', '- Dr. [**Last Name (STitle) 2045**] and Dr. [**Last Name (STitle) 619**] discussed pulmonary prognosis with wife']",,25332,129798.0
51,2155-03-02 07:39:47,['ARTERIAL LINE - START [**2155-3-1**] 02:30 PM'],['ARTERIAL LINE - START [**2155-3-1**] 02:30 PM'],"['- nasally re-intubated for resp distress/hypercarbic resp failure this', 'morning', '- repeat ABG showed improved ventilation', '- continued empiric treatment for aspiration/HAP', '- Dr. [**Last Name (STitle) 2045**] and Dr. [**Last Name (STitle) 619**] discussed pulmonary prognosis with wife']",25332,129798.0
52,2155-03-02 11:52:29,,['ARTERIAL LINE - START [**2155-3-1**] 02:30 PM'],,25332,129798.0
53,2155-03-03 07:18:27,"['- gave Lasix 40, 60', '- KUB for firm abdomen, no e/o obstruction, gave lactulose', '- PSV trial, did well on [**1-11**]', 'History obtained from [**Hospital 85**] Medical records']","['- gave Lasix 40, 60', '- KUB for firm abdomen, no e/o obstruction, gave lactulose', '- PSV trial, did well on [**1-11**]', 'History obtained from [**Hospital 85**] Medical records']",['ARTERIAL LINE - START [**2155-3-1**] 02:30 PM'],25332,129798.0
54,2155-03-03 07:27:12,,"['- gave Lasix 40, 60', '- KUB for firm abdomen, no e/o obstruction, gave lactulose', '- PSV trial, did well on [**1-11**]', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
55,2155-03-03 14:02:35,,"['- gave Lasix 40, 60', '- KUB for firm abdomen, no e/o obstruction, gave lactulose', '- PSV trial, did well on [**1-11**]', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
56,2155-03-04 07:32:29,,[],"['- gave Lasix 40, 60', '- KUB for firm abdomen, no e/o obstruction, gave lactulose', '- PSV trial, did well on [**1-11**]', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
57,2155-03-04 13:50:23,,[],,25332,129798.0
58,2155-03-05 07:34:20,,[],,25332,129798.0
59,2155-03-05 13:32:06,['started lasix gtt'],['started lasix gtt'],,25332,129798.0
60,2155-03-06 07:47:25,"['- SBT- RSBI 81 but RR30, VT high 200s', '- Hct dropped in AM, but stable at PM check', '- BUN/Cr starting to bump with lasix gtt', '- a-line failed', 'History obtained from [**Hospital 85**] Medical records']","['- SBT- RSBI 81 but RR30, VT high 200s', '- Hct dropped in AM, but stable at PM check', '- BUN/Cr starting to bump with lasix gtt', '- a-line failed', 'History obtained from [**Hospital 85**] Medical records']",['started lasix gtt'],25332,129798.0
61,2155-03-06 07:48:11,,"['- SBT- RSBI 81 but RR30, VT high 200s', '- Hct dropped in AM, but stable at PM check', '- BUN/Cr starting to bump with lasix gtt', '- a-line failed', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
62,2155-03-06 16:23:21,,"['- SBT- RSBI 81 but RR30, VT high 200s', '- Hct dropped in AM, but stable at PM check', '- BUN/Cr starting to bump with lasix gtt', '- a-line failed', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
63,2155-03-07 06:59:38,"['- cont diuresis, treatment for aspiration', '- pt refused one unit PRBC, repeat Hct stable', '- added VBG to morning labs', '- Dr. [**Last Name (STitle) 1750**] met with family in evening, [**Hospital Unit Name 44**] team did not speak with', 'him, [**Female First Name (un) 11483**] emailed him to set up meeting tomorrow RE: goals of care']","['- cont diuresis, treatment for aspiration', '- pt refused one unit PRBC, repeat Hct stable', '- added VBG to morning labs', '- Dr. [**Last Name (STitle) 1750**] met with family in evening, [**Hospital Unit Name 44**] team did not speak with', 'him, [**Female First Name (un) 11483**] emailed him to set up meeting tomorrow RE: goals of care']","['- SBT- RSBI 81 but RR30, VT high 200s', '- Hct dropped in AM, but stable at PM check', '- BUN/Cr starting to bump with lasix gtt', '- a-line failed', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
64,2155-03-07 16:31:26,,"['- cont diuresis, treatment for aspiration', '- pt refused one unit PRBC, repeat Hct stable', '- added VBG to morning labs', '- Dr. [**Last Name (STitle) 1750**] met with family in evening, [**Hospital Unit Name 44**] team did not speak with', 'him, [**Female First Name (un) 11483**] emailed him to set up meeting tomorrow RE: goals of care']",,25332,129798.0
65,2155-03-08 07:10:58,,[],"['- cont diuresis, treatment for aspiration', '- pt refused one unit PRBC, repeat Hct stable', '- added VBG to morning labs', '- Dr. [**Last Name (STitle) 1750**] met with family in evening, [**Hospital Unit Name 44**] team did not speak with', 'him, [**Female First Name (un) 11483**] emailed him to set up meeting tomorrow RE: goals of care']",25332,129798.0
66,2155-03-08 11:34:07,"['O/N bolused 1 L for low UOP, responded', 'This AM, had episode tachycardia 170s, desat to 85%', 'Gave IV dilt and lasix, CXR looked unchanged']","['O/N bolused 1 L for low UOP, responded', 'This AM, had episode tachycardia 170s, desat to 85%', 'Gave IV dilt and lasix, CXR looked unchanged']",,25332,129798.0
67,2155-03-09 07:50:14,"['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']","['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']","['O/N bolused 1 L for low UOP, responded', 'This AM, had episode tachycardia 170s, desat to 85%', 'Gave IV dilt and lasix, CXR looked unchanged']",25332,129798.0
68,2155-03-09 07:51:56,,"['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
69,2155-03-09 08:18:54,,"['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
70,2155-03-09 12:41:32,,"['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
71,2155-03-10 07:33:53,"['[**2155-3-9**]:', '- creatinine rising, sent u/a, cx, lytes, eos; urine lytes consistent', 'with pre-renal physiology (FeNa 0.7, FeUrea 33.5)', '- received 2 units PRBCs for drifting Hct', '- NS 500 cc x 1 for marginal UOP', '- converting midaz, fent to propofol for easy on/off tomorrow during', 'family meeting/goals of care', '- completed course of antibiotics for aspiration pneumonia', ""- d/c'd prophylactic bactrim and acyclovir given renal failure"", '- Haldol PRN for agitation, QTc okay 0.4 sec']","['[**2155-3-9**]:', '- creatinine rising, sent u/a, cx, lytes, eos; urine lytes consistent', 'with pre-renal physiology (FeNa 0.7, FeUrea 33.5)', '- received 2 units PRBCs for drifting Hct', '- NS 500 cc x 1 for marginal UOP', '- converting midaz, fent to propofol for easy on/off tomorrow during', 'family meeting/goals of care', '- completed course of antibiotics for aspiration pneumonia', ""- d/c'd prophylactic bactrim and acyclovir given renal failure"", '- Haldol PRN for agitation, QTc okay 0.4 sec']","['- bolused 500cc for UOP with no effect, UOP remained poor', '- sent U lytes', '- IP team would be able to do percut trach in OR if that is decision', '- plan is switch to propofol Sunday and allow [**Doctor First Name 831**] to clear so that he', 'may be involved in decision for mtg Monday', '- agitated overnight, HR 140s, wants us to call 911, gave haldol', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
72,2155-03-10 07:35:21,,"['[**2155-3-9**]:', '- creatinine rising, sent u/a, cx, lytes, eos; urine lytes consistent', 'with pre-renal physiology (FeNa 0.7, FeUrea 33.5)', '- received 2 units PRBCs for drifting Hct', '- NS 500 cc x 1 for marginal UOP', '- converting midaz, fent to propofol for easy on/off tomorrow during', 'family meeting/goals of care', '- completed course of antibiotics for aspiration pneumonia', ""- d/c'd prophylactic bactrim and acyclovir given renal failure"", '- Haldol PRN for agitation, QTc okay 0.4 sec']",,25332,129798.0
73,2155-03-10 15:45:18,,"['[**2155-3-9**]:', '- creatinine rising, sent u/a, cx, lytes, eos; urine lytes consistent', 'with pre-renal physiology (FeNa 0.7, FeUrea 33.5)', '- received 2 units PRBCs for drifting Hct', '- NS 500 cc x 1 for marginal UOP', '- converting midaz, fent to propofol for easy on/off tomorrow during', 'family meeting/goals of care', '- completed course of antibiotics for aspiration pneumonia', ""- d/c'd prophylactic bactrim and acyclovir given renal failure"", '- Haldol PRN for agitation, QTc okay 0.4 sec']",,25332,129798.0
74,2155-03-11 07:39:51,"['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', '[**2155-3-10**]:', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what."" Abigan believes pt is competent, will need psych consult to', 'evaluate competency', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']","['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', '[**2155-3-10**]:', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what."" Abigan believes pt is competent, will need psych consult to', 'evaluate competency', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']","['[**2155-3-9**]:', '- creatinine rising, sent u/a, cx, lytes, eos; urine lytes consistent', 'with pre-renal physiology (FeNa 0.7, FeUrea 33.5)', '- received 2 units PRBCs for drifting Hct', '- NS 500 cc x 1 for marginal UOP', '- converting midaz, fent to propofol for easy on/off tomorrow during', 'family meeting/goals of care', '- completed course of antibiotics for aspiration pneumonia', ""- d/c'd prophylactic bactrim and acyclovir given renal failure"", '- Haldol PRN for agitation, QTc okay 0.4 sec']",25332,129798.0
75,2155-03-11 07:41:30,,"['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', '[**2155-3-10**]:', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what."" Abigan believes pt is competent, will need psych consult to', 'evaluate competency', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']",,25332,129798.0
76,2155-03-11 15:31:26,"['Overnight', 'what.""']","['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', 'Overnight', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what.""', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']","['[**2155-3-10**]:', 'what."" Abigan believes pt is competent, will need psych consult to', 'evaluate competency']",25332,129798.0
77,2155-03-11 15:53:45,,"['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', 'Overnight', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what.""', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']",,25332,129798.0
78,2155-03-12 07:03:05,"['[**3-11**]', '-started on klonipim and haldol', '-writing sample in chart', '-trach and peg by IP tomorrow', '-if needes fentanyl boluses or having pain, consider methadone', '-family meeting had, status quo']","['[**3-11**]', '-started on klonipim and haldol', '-writing sample in chart', '-trach and peg by IP tomorrow', '-if needes fentanyl boluses or having pain, consider methadone', '-family meeting had, status quo']","['ULTRASOUND - At [**2155-3-10**] 05:05 PM', 'Renal', 'Overnight', '- Family meeting: Pt adamant ""I want a trach, I want to live no matter', 'what.""', '- Vanc level 94, repeat 89.', '- Renal u/s ordered per renal recs']",25332,129798.0
79,2155-03-12 07:04:54,,"['[**3-11**]', '-started on klonipim and haldol', '-writing sample in chart', '-trach and peg by IP tomorrow', '-if needes fentanyl boluses or having pain, consider methadone', '-family meeting had, status quo']",,25332,129798.0
80,2155-03-12 07:05:43,,"['[**3-11**]', '-started on klonipim and haldol', '-writing sample in chart', '-trach and peg by IP tomorrow', '-if needes fentanyl boluses or having pain, consider methadone', '-family meeting had, status quo']",,25332,129798.0
81,2155-03-12 14:33:00,"['Overnight, patient had family meeting and expressed continued desire', 'for trach.  Received haldol prn for agitation x2.']","['Overnight, patient had family meeting and expressed continued desire', 'for trach.  Received haldol prn for agitation x2.']","['[**3-11**]', '-started on klonipim and haldol', '-writing sample in chart', '-trach and peg by IP tomorrow', '-if needes fentanyl boluses or having pain, consider methadone', '-family meeting had, status quo']",25332,129798.0
82,2155-03-13 07:57:28,"['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', ""-Spoke with pt's nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 223**] [**Hospital 258**] Healthcare ([**Telephone/Fax (1) 11525**]) Blood"", 'culture [**2-10**] GPC ([**2155-3-9**]) speciation pending, [**2155-3-11**] pending. Urine', 'culture on [**2155-3-7**] grew Proteus >100,000 sensitivities: aztreonam,', 'ceftazadime, cefepime, cefoxitin, cefuroxime, cefotetan, gentamicin,', 'imipenem, levofloxacin, pipericillin, bactrim. Resistant to', 'tetracycline. The nurse says that the pt did not have a fever or any', 'focal signs of infection. The only concern was increased abdominal', 'distension.', '-BNP checked [**Numeric Identifier 11526**] (no baseline)', '-bladder pressure 14', '-GPC in blood cx', '-US showed sludge/GB thickening, CBD not elevated', '-Echo: worsening 4+ TR/RV dysfunction', '-Liver saw pt, want to repeat tap (are confused by SAAG bc not', 'consistent w/ portal hypertension/cardiac/etc...transudative process)', 'History obtained from Medical records']","['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', ""-Spoke with pt's nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 223**] [**Hospital 258**] Healthcare ([**Telephone/Fax (1) 11525**]) Blood"", 'culture [**2-10**] GPC ([**2155-3-9**]) speciation pending, [**2155-3-11**] pending. Urine', 'culture on [**2155-3-7**] grew Proteus >100,000 sensitivities: aztreonam,', 'ceftazadime, cefepime, cefoxitin, cefuroxime, cefotetan, gentamicin,', 'imipenem, levofloxacin, pipericillin, bactrim. Resistant to', 'tetracycline. The nurse says that the pt did not have a fever or any', 'focal signs of infection. The only concern was increased abdominal', 'distension.', '-BNP checked [**Numeric Identifier 11526**] (no baseline)', '-bladder pressure 14', '-GPC in blood cx', '-US showed sludge/GB thickening, CBD not elevated', '-Echo: worsening 4+ TR/RV dysfunction', '-Liver saw pt, want to repeat tap (are confused by SAAG bc not', 'consistent w/ portal hypertension/cardiac/etc...transudative process)', 'History obtained from Medical records']","['Overnight, patient had family meeting and expressed continued desire', 'for trach.  Received haldol prn for agitation x2.']",25332,129798.0
83,2155-03-13 07:58:32,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', ""-Spoke with pt's nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 223**] [**Hospital 258**] Healthcare ([**Telephone/Fax (1) 11525**]) Blood"", 'culture [**2-10**] GPC ([**2155-3-9**]) speciation pending, [**2155-3-11**] pending. Urine', 'culture on [**2155-3-7**] grew Proteus >100,000 sensitivities: aztreonam,', 'ceftazadime, cefepime, cefoxitin, cefuroxime, cefotetan, gentamicin,', 'imipenem, levofloxacin, pipericillin, bactrim. Resistant to', 'tetracycline. The nurse says that the pt did not have a fever or any', 'focal signs of infection. The only concern was increased abdominal', 'distension.', '-BNP checked [**Numeric Identifier 11526**] (no baseline)', '-bladder pressure 14', '-GPC in blood cx', '-US showed sludge/GB thickening, CBD not elevated', '-Echo: worsening 4+ TR/RV dysfunction', '-Liver saw pt, want to repeat tap (are confused by SAAG bc not', 'consistent w/ portal hypertension/cardiac/etc...transudative process)', 'History obtained from Medical records']",,25332,129798.0
84,2155-03-13 07:59:54,"['[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow']","['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', '[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow', 'History obtained from Medical records']","[""-Spoke with pt's nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 223**] [**Hospital 258**] Healthcare ([**Telephone/Fax (1) 11525**]) Blood"", 'culture [**2-10**] GPC ([**2155-3-9**]) speciation pending, [**2155-3-11**] pending. Urine', 'culture on [**2155-3-7**] grew Proteus >100,000 sensitivities: aztreonam,', 'ceftazadime, cefepime, cefoxitin, cefuroxime, cefotetan, gentamicin,', 'imipenem, levofloxacin, pipericillin, bactrim. Resistant to', 'tetracycline. The nurse says that the pt did not have a fever or any', 'focal signs of infection. The only concern was increased abdominal', 'distension.', '-BNP checked [**Numeric Identifier 11526**] (no baseline)', '-bladder pressure 14', '-GPC in blood cx', '-US showed sludge/GB thickening, CBD not elevated', '-Echo: worsening 4+ TR/RV dysfunction', '-Liver saw pt, want to repeat tap (are confused by SAAG bc not', 'consistent w/ portal hypertension/cardiac/etc...transudative process)']",25332,129798.0
85,2155-03-13 14:34:15,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', '[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow', 'History obtained from Medical records']",,25332,129798.0
86,2155-03-13 14:40:53,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', '[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow', 'History obtained from Medical records']",,25332,129798.0
87,2155-03-13 15:13:29,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', '[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow', 'History obtained from Medical records']",,25332,129798.0
88,2155-03-14 07:53:14,"['EKG - At [**2155-3-13**] 05:25 PM', '-A flutter RVR in 160s (asymptomatic), required dilt IV pushes, + PO,', 'no success, pt started on dilt drip with fair success (still in 115s by', 'am)', '-Complaining of persistent pain from skin breakdown, started on', 'fentanyl patch', '-Failed PSV 8/8 got tachypneic now back to 15/8', 'History obtained from [**Hospital 85**] Medical records']","['EKG - At [**2155-3-13**] 05:25 PM', '-A flutter RVR in 160s (asymptomatic), required dilt IV pushes, + PO,', 'no success, pt started on dilt drip with fair success (still in 115s by', 'am)', '-Complaining of persistent pain from skin breakdown, started on', 'fentanyl patch', '-Failed PSV 8/8 got tachypneic now back to 15/8', 'History obtained from [**Hospital 85**] Medical records']","['PERCUTANEOUS TRACHEOSTOMY - At [**2155-3-12**] 02:00 PM', '[**3-12**]', '-got trach, was unable to get peg', '-IR for HD line, got HD overnight, if vanc trough >40 then will do hd', 'tomorrow', 'History obtained from Medical records']",25332,129798.0
89,2155-03-14 08:01:38,"['RSBI = 108 on 0-PEEP and 5 cm PSV.  N.B.: RR was slowly increasing per', 'unit time.  Failed RSBI.']","['EKG - At [**2155-3-13**] 05:25 PM', '-A flutter RVR in 160s (asymptomatic), required dilt IV pushes, + PO,', 'no success, pt started on dilt drip with fair success (still in 115s by', 'am)', '-Complaining of persistent pain from skin breakdown, started on', 'fentanyl patch', '-Failed PSV 8/8 got tachypneic now back to 15/8', 'RSBI = 108 on 0-PEEP and 5 cm PSV.  N.B.: RR was slowly increasing per', 'unit time.  Failed RSBI.', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
90,2155-03-14 15:55:04,,"['EKG - At [**2155-3-13**] 05:25 PM', '-A flutter RVR in 160s (asymptomatic), required dilt IV pushes, + PO,', 'no success, pt started on dilt drip with fair success (still in 115s by', 'am)', '-Complaining of persistent pain from skin breakdown, started on', 'fentanyl patch', '-Failed PSV 8/8 got tachypneic now back to 15/8', 'RSBI = 108 on 0-PEEP and 5 cm PSV.  N.B.: RR was slowly increasing per', 'unit time.  Failed RSBI.', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
91,2155-03-15 07:36:19,['EKG - At [**2155-3-14**] 10:01 AM'],['EKG - At [**2155-3-14**] 10:01 AM'],"['EKG - At [**2155-3-13**] 05:25 PM', '-A flutter RVR in 160s (asymptomatic), required dilt IV pushes, + PO,', 'no success, pt started on dilt drip with fair success (still in 115s by', 'am)', '-Complaining of persistent pain from skin breakdown, started on', 'fentanyl patch', '-Failed PSV 8/8 got tachypneic now back to 15/8', 'RSBI = 108 on 0-PEEP and 5 cm PSV.  N.B.: RR was slowly increasing per', 'unit time.  Failed RSBI.', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
92,2155-03-15 11:33:52,,['EKG - At [**2155-3-14**] 10:01 AM'],,25332,129798.0
93,2155-03-15 11:39:15,,['EKG - At [**2155-3-14**] 10:01 AM'],,25332,129798.0
94,2155-03-15 11:46:12,,['EKG - At [**2155-3-14**] 10:01 AM'],,25332,129798.0
95,2155-03-15 12:39:14,,['EKG - At [**2155-3-14**] 10:01 AM'],,25332,129798.0
96,2155-03-16 07:03:30,"['- getting free water through tube feed', '- ordered ir guided g tube not done', '- Passed PSV 5/5, put back to [**11-11**] overnight will trach collar in AM', 'History obtained from [**Hospital 85**] Medical records']","['- getting free water through tube feed', '- ordered ir guided g tube not done', '- Passed PSV 5/5, put back to [**11-11**] overnight will trach collar in AM', 'History obtained from [**Hospital 85**] Medical records']",['EKG - At [**2155-3-14**] 10:01 AM'],25332,129798.0
97,2155-03-16 07:05:53,,"['- getting free water through tube feed', '- ordered ir guided g tube not done', '- Passed PSV 5/5, put back to [**11-11**] overnight will trach collar in AM', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
98,2155-03-16 15:43:32,,"['- getting free water through tube feed', '- ordered ir guided g tube not done', '- Passed PSV 5/5, put back to [**11-11**] overnight will trach collar in AM', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
99,2155-03-17 07:50:46,"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today']","['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today', 'History obtained from [**Hospital 85**] Medical records']","['- getting free water through tube feed', '- ordered ir guided g tube not done', '- Passed PSV 5/5, put back to [**11-11**] overnight will trach collar in AM']",25332,129798.0
100,2155-03-17 07:54:20,,"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
101,2155-03-17 07:56:05,,"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
102,2155-03-17 07:57:43,,[],"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
103,2155-03-17 07:59:51,"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today']","['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today']",,25332,129798.0
104,2155-03-17 08:03:52,['History obtained from [**Hospital 85**] Medical records'],"['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today', 'History obtained from [**Hospital 85**] Medical records']",,25332,129798.0
105,2155-03-17 12:30:58,"['- Pt did not do well with trach mask trial', '- Tube feeds held at MN in anticipation for PEG tube placement today,', 'which wont happen until tomorrow']","['- Pt did not do well with trach mask trial', '- Tube feeds held at MN in anticipation for PEG tube placement today,', 'which wont happen until tomorrow', 'History obtained from [**Hospital 85**] Medical records']","['- Pt did not do well with taking away PSV', '- Tube feeds held at MN in anticipation for PEG tube placement today']",25332,129798.0
106,2155-03-18 07:25:01,"['DIALYSIS CATHETER - START [**2155-3-17**] 07:00 PM', 'right', ' URINE CULTURE - At [**2155-3-17**] 09:00 PM', ' BLOOD CULTURED - At [**2155-3-17**] 10:30 PM', 'peripheral', ' MIDLINE - STOP [**2155-3-17**] 10:49 PM']","['DIALYSIS CATHETER - START [**2155-3-17**] 07:00 PM', 'right', ' URINE CULTURE - At [**2155-3-17**] 09:00 PM', ' BLOOD CULTURED - At [**2155-3-17**] 10:30 PM', 'peripheral', ' MIDLINE - STOP [**2155-3-17**] 10:49 PM']","['- Pt did not do well with trach mask trial', '- Tube feeds held at MN in anticipation for PEG tube placement today,', 'which wont happen until tomorrow', 'History obtained from [**Hospital 85**] Medical records']",25332,129798.0
107,2155-03-18 07:27:09,,"['DIALYSIS CATHETER - START [**2155-3-17**] 07:00 PM', 'right', ' URINE CULTURE - At [**2155-3-17**] 09:00 PM', ' BLOOD CULTURED - At [**2155-3-17**] 10:30 PM', 'peripheral', ' MIDLINE - STOP [**2155-3-17**] 10:49 PM']",,25332,129798.0
108,2155-03-18 13:11:32,"['-cultures sent for rising WBC', '-Fungal proph added per onc recs', '-keppra changed to HD dosing']","['DIALYSIS CATHETER - START [**2155-3-17**] 07:00 PM', 'right', ' URINE CULTURE - At [**2155-3-17**] 09:00 PM', ' BLOOD CULTURED - At [**2155-3-17**] 10:30 PM', 'peripheral', ' MIDLINE - STOP [**2155-3-17**] 10:49 PM', '-cultures sent for rising WBC', '-Fungal proph added per onc recs', '-keppra changed to HD dosing']",,25332,129798.0
109,2155-03-19 07:57:14,"['FLUOROSCOPY - At [**2155-3-18**] 03:25 PM', 'G-tube placement.', ' BRONCHOSCOPY - At [**2155-3-18**] 06:25 PM', '[**2155-3-18**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.', 'History obtained from Patient']","['FLUOROSCOPY - At [**2155-3-18**] 03:25 PM', 'G-tube placement.', ' BRONCHOSCOPY - At [**2155-3-18**] 06:25 PM', '[**2155-3-18**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.', 'History obtained from Patient']","['DIALYSIS CATHETER - START [**2155-3-17**] 07:00 PM', 'right', ' URINE CULTURE - At [**2155-3-17**] 09:00 PM', ' BLOOD CULTURED - At [**2155-3-17**] 10:30 PM', 'peripheral', ' MIDLINE - STOP [**2155-3-17**] 10:49 PM', '-cultures sent for rising WBC', '-Fungal proph added per onc recs', '-keppra changed to HD dosing']",25332,129798.0
110,2155-03-19 07:58:55,,"['FLUOROSCOPY - At [**2155-3-18**] 03:25 PM', 'G-tube placement.', ' BRONCHOSCOPY - At [**2155-3-18**] 06:25 PM', '[**2155-3-18**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.', 'History obtained from Patient']",,25332,129798.0
111,2155-03-19 14:00:05,,"['FLUOROSCOPY - At [**2155-3-18**] 03:25 PM', 'G-tube placement.', ' BRONCHOSCOPY - At [**2155-3-18**] 06:25 PM', '[**2155-3-18**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.', 'History obtained from Patient']",,25332,129798.0
112,2155-03-20 07:38:09,"['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']","['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']","['FLUOROSCOPY - At [**2155-3-18**] 03:25 PM', 'G-tube placement.', ' BRONCHOSCOPY - At [**2155-3-18**] 06:25 PM', '[**2155-3-18**]:', '-PEG placed.', '-Bleeding around trach.  IP came to evaluate: saw a clot in the', 'suprastomal area which was suctioned with no residual active bleeding', 'between 2nd/3rd ring during bronch.  Applied lidocain/epi.', '-There was a concern for tracheal innominate fistula.  Had a long', 'discussion between IP, heme/onc, radiology, surgery regarding MRA vs', 'CTA (given his renal failure).  Ultimately, he needed stat CTA neck.', 'Discussed this with patient and his wife to great depths.  He was', 'premedicated with sodium bicarb, famotidine, benadryl, and zofran.', 'History obtained from Patient']",25332,129798.0
113,2155-03-20 07:41:09,,"['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']",,25332,129798.0
114,2155-03-20 11:52:49,,"['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']",,25332,129798.0
115,2155-03-20 14:52:17,,"['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']",,25332,129798.0
116,2155-03-21 07:00:32,,[],"['-CTA neck prelim negative for innominate artery', '-No episodes of bleeding', ""-DC'd cefazolin"", '-IP saw pt said trach looks good, other IP atg to come tonight or', 'tomorrow for [**Female First Name (un) **] bc they are very busy', '-Got HD from 1-2pm and renal asking whether he needs a tunneled line']",25332,129798.0
117,2155-03-21 07:01:56,,[],,25332,129798.0
118,2155-03-21 12:56:28,,,,25332,129798.0
0,2151-10-25 06:22:15,,"['BLOOD CULTURED - At [**2151-10-24**] 03:35 PM', ' URINE CULTURE - At [**2151-10-24**] 03:35 PM', ' FEVER - 101.4', 'F - [**2151-10-24**] 03:00 PM', '- Advanced diet to regular', '- Urology recommended MRI urogram and Renal Scan per Nuc med (both to', 'be done Monday)', '- Per Urology, hydronephrosis is of unclear clinical significance', '- [**Name (NI) 6320**] Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 1859**] (outpatient onc fellow and', ""attending) about patient's status"", '- Spiked fever to 101, pan cultured']",,9725,165189.0
1,2151-10-25 08:14:26,,"['BLOOD CULTURED - At [**2151-10-24**] 03:35 PM', ' URINE CULTURE - At [**2151-10-24**] 03:35 PM', ' FEVER - 101.4', 'F - [**2151-10-24**] 03:00 PM', '- Advanced diet to regular', '- Urology recommended MRI urogram and Renal Scan per Nuc med (both to', 'be done Monday)', '- Per Urology, hydronephrosis is of unclear clinical significance', '- [**Name (NI) 6320**] Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 1859**] (outpatient onc fellow and', ""attending) about patient's status"", '- Spiked fever to 101, pan cultured']",,9725,165189.0
0,2166-05-23 12:02:36,,"['EKG - At [**2166-5-22**] 11:43 PM', ' NASAL SWAB - At [**2166-5-23**] 12:37 AM']",,10686,125238.0
1,2166-05-23 12:18:36,,"['EKG - At [**2166-5-22**] 11:43 PM', ' NASAL SWAB - At [**2166-5-23**] 12:37 AM']",,10686,125238.0
0,2154-01-16 07:19:25,,"['PICC LINE - START [**2154-1-15**] 09:42 PM', '- admitted to ICU for somnolence']",,80799,171120.0
1,2154-01-16 16:51:35,,['- admitted to ICU for somnolence'],['PICC LINE - START [**2154-1-15**] 09:42 PM'],80799,171120.0
0,2169-10-20 07:39:20,,['- no events'],,85575,169008.0
1,2169-10-20 10:10:38,,['- no events'],,85575,169008.0
2,2169-10-21 07:22:15,"['EKG - At [**2169-10-20**] 08:16 AM', ' Pacemaker Placement - At [**2169-10-20**] 10:00 AM', '- pacemaker placement - no complications, CXR and EKG in AM, Vanc given', 'x1, Clinda starting in AM x3d']","['EKG - At [**2169-10-20**] 08:16 AM', ' Pacemaker Placement - At [**2169-10-20**] 10:00 AM', '- pacemaker placement - no complications, CXR and EKG in AM, Vanc given', 'x1, Clinda starting in AM x3d']",['- no events'],85575,169008.0
3,2169-10-21 11:08:25,,"['EKG - At [**2169-10-20**] 08:16 AM', ' Pacemaker Placement - At [**2169-10-20**] 10:00 AM', '- pacemaker placement - no complications, CXR and EKG in AM, Vanc given', 'x1, Clinda starting in AM x3d']",,85575,169008.0
0,2151-10-31 07:34:10,,"[""Patient's vent settings were changed from the following:"", 'pH 7.23 pCO2 54 pO2  70 HCO3 24 BaseXS -5']",,59765,141920.0
1,2151-10-31 09:57:41,"['CMV/Assist; FiO2%:100; ; TV:450; PEEP:12; Temp:37.6 Lactate:2.3', 'CMV/Assist; FiO2%:100; AADO2:607; Req:99; TV:400; PEEP:12;', 'pH7.32 pCO2 49 pO2 60 HCO3 26', 'to the ARDSnet protocol as below to prevent lung overexpansion.', 'FiO2%:100; AADO2:592; Req:97; Rate:/22; TV:280; Temp:38.2', 'pH 7.28 pCO2 54 pO2 70 HCO326 BaseXS -1', 'She began to drop her O2 sats on the vent settings so multiple vent', 'adjustments were made to bring up her O2 sats.  The following vent', 'settings allowed her to stablilize at 85% and she was kept on these the', 'remainder of the evening.', 'CMV/Assist; FiO2%:100; AADO2:618; Req:98; TV:350; PEEP:12;', 'pH 7.29 pCO2 52 pO2 65 HCO3 26 BaseXS -1']","[""Patient's vent settings were changed from the following:"", 'CMV/Assist; FiO2%:100; ; TV:450; PEEP:12; Temp:37.6 Lactate:2.3', 'pH 7.23 pCO2 54 pO2  70 HCO3 24 BaseXS -5', 'CMV/Assist; FiO2%:100; AADO2:607; Req:99; TV:400; PEEP:12;', 'pH7.32 pCO2 49 pO2 60 HCO3 26', 'to the ARDSnet protocol as below to prevent lung overexpansion.', 'FiO2%:100; AADO2:592; Req:97; Rate:/22; TV:280; Temp:38.2', 'pH 7.28 pCO2 54 pO2 70 HCO326 BaseXS -1', 'She began to drop her O2 sats on the vent settings so multiple vent', 'adjustments were made to bring up her O2 sats.  The following vent', 'settings allowed her to stablilize at 85% and she was kept on these the', 'remainder of the evening.', 'CMV/Assist; FiO2%:100; AADO2:618; Req:98; TV:350; PEEP:12;', 'pH 7.29 pCO2 52 pO2 65 HCO3 26 BaseXS -1']",,59765,141920.0
2,2151-10-31 09:59:32,,"[""Patient's vent settings were changed from the following:"", 'CMV/Assist; FiO2%:100; ; TV:450; PEEP:12; Temp:37.6 Lactate:2.3', 'pH 7.23 pCO2 54 pO2  70 HCO3 24 BaseXS -5', 'CMV/Assist; FiO2%:100; AADO2:607; Req:99; TV:400; PEEP:12;', 'pH7.32 pCO2 49 pO2 60 HCO3 26', 'to the ARDSnet protocol as below to prevent lung overexpansion.', 'FiO2%:100; AADO2:592; Req:97; Rate:/22; TV:280; Temp:38.2', 'pH 7.28 pCO2 54 pO2 70 HCO326 BaseXS -1', 'She began to drop her O2 sats on the vent settings so multiple vent', 'adjustments were made to bring up her O2 sats.  The following vent', 'settings allowed her to stablilize at 85% and she was kept on these the', 'remainder of the evening.', 'CMV/Assist; FiO2%:100; AADO2:618; Req:98; TV:350; PEEP:12;', 'pH 7.29 pCO2 52 pO2 65 HCO3 26 BaseXS -1']",,59765,141920.0
3,2151-11-01 06:41:50,"['EKG - At [**2151-10-31**] 10:00 AM', ' MULTI LUMEN - START [**2151-10-31**] 04:30 PM', ' MULTI LUMEN - STOP [**2151-10-31**] 06:30 PM', ' BLOOD CULTURED - At [**2151-11-1**] 12:00 AM', 'x 2 from new lines central and art', ' EKG - At [**2151-11-1**] 12:38 AM', ' URINE CULTURE - At [**2151-11-1**] 12:40 AM', ' STOOL CULTURE - At [**2151-11-1**] 12:40 AM', ' EKG - At [**2151-11-1**] 01:38 AM', ' ARTERIAL LINE - STOP [**2151-11-1**] 02:43 AM', 'started in ER', ' ARTERIAL LINE - START [**2151-11-1**] 04:07 AM', ""- Tried NO and had some improved sats temporarily from high 80's -->"", ""mid 90's."", '- Tried PRVC and APRV today', '- Around 2200: unstable, hypoTN and started on Levophed, evolving', 'lactic acidosis', '- Got 3L D5W with 3 amps HCO3', '- New Aline placed on R', '- started on flagyl for empiric c. diff coverage', '- CXR without free air, pneumothorax', '- KUB pending', '- Ordered Peramivir', '- Tylenol absorption test', '- ID recs: Reasonable to get IV Peramivir. Change Ceftriaxone to', 'Cefepime for better Staph coverage (done). Send urine Legionella', '(ordered).', '- Goal is fluid even for the day --> stopping Lasix though', '- Flu sample sent to state lab for PCR', ""- 1U PRBC's today for some volume"", 'Hct 24.5  --> 27.8', '- Need to change groin line for an IJ --> DONE', ""- Start TF's"", ""- 6pm started NO and sats from high 80's --> mid 90's""]","['EKG - At [**2151-10-31**] 10:00 AM', ' MULTI LUMEN - START [**2151-10-31**] 04:30 PM', ' MULTI LUMEN - STOP [**2151-10-31**] 06:30 PM', ' BLOOD CULTURED - At [**2151-11-1**] 12:00 AM', 'x 2 from new lines central and art', ' EKG - At [**2151-11-1**] 12:38 AM', ' URINE CULTURE - At [**2151-11-1**] 12:40 AM', ' STOOL CULTURE - At [**2151-11-1**] 12:40 AM', ' EKG - At [**2151-11-1**] 01:38 AM', ' ARTERIAL LINE - STOP [**2151-11-1**] 02:43 AM', 'started in ER', ' ARTERIAL LINE - START [**2151-11-1**] 04:07 AM', ""- Tried NO and had some improved sats temporarily from high 80's -->"", ""mid 90's."", '- Tried PRVC and APRV today', '- Around 2200: unstable, hypoTN and started on Levophed, evolving', 'lactic acidosis', '- Got 3L D5W with 3 amps HCO3', '- New Aline placed on R', '- started on flagyl for empiric c. diff coverage', '- CXR without free air, pneumothorax', '- KUB pending', '- Ordered Peramivir', '- Tylenol absorption test', '- ID recs: Reasonable to get IV Peramivir. Change Ceftriaxone to', 'Cefepime for better Staph coverage (done). Send urine Legionella', '(ordered).', '- Goal is fluid even for the day --> stopping Lasix though', '- Flu sample sent to state lab for PCR', ""- 1U PRBC's today for some volume"", 'Hct 24.5  --> 27.8', '- Need to change groin line for an IJ --> DONE', ""- Start TF's"", ""- 6pm started NO and sats from high 80's --> mid 90's""]","[""Patient's vent settings were changed from the following:"", 'CMV/Assist; FiO2%:100; ; TV:450; PEEP:12; Temp:37.6 Lactate:2.3', 'pH 7.23 pCO2 54 pO2  70 HCO3 24 BaseXS -5', 'CMV/Assist; FiO2%:100; AADO2:607; Req:99; TV:400; PEEP:12;', 'pH7.32 pCO2 49 pO2 60 HCO3 26', 'to the ARDSnet protocol as below to prevent lung overexpansion.', 'FiO2%:100; AADO2:592; Req:97; Rate:/22; TV:280; Temp:38.2', 'pH 7.28 pCO2 54 pO2 70 HCO326 BaseXS -1', 'She began to drop her O2 sats on the vent settings so multiple vent', 'adjustments were made to bring up her O2 sats.  The following vent', 'settings allowed her to stablilize at 85% and she was kept on these the', 'remainder of the evening.', 'CMV/Assist; FiO2%:100; AADO2:618; Req:98; TV:350; PEEP:12;', 'pH 7.29 pCO2 52 pO2 65 HCO3 26 BaseXS -1']",59765,141920.0
4,2151-11-01 12:04:33,"['- New Aline placed on L, got triple lumen CVL on R, and fem line was', 'pulled']","['EKG - At [**2151-10-31**] 10:00 AM', ' MULTI LUMEN - START [**2151-10-31**] 04:30 PM', ' MULTI LUMEN - STOP [**2151-10-31**] 06:30 PM', ' BLOOD CULTURED - At [**2151-11-1**] 12:00 AM', 'x 2 from new lines central and art', ' EKG - At [**2151-11-1**] 12:38 AM', ' URINE CULTURE - At [**2151-11-1**] 12:40 AM', ' STOOL CULTURE - At [**2151-11-1**] 12:40 AM', ' EKG - At [**2151-11-1**] 01:38 AM', ' ARTERIAL LINE - STOP [**2151-11-1**] 02:43 AM', 'started in ER', ' ARTERIAL LINE - START [**2151-11-1**] 04:07 AM', ""- Tried NO and had some improved sats temporarily from high 80's -->"", ""mid 90's."", '- Tried PRVC and APRV today', '- Around 2200: unstable, hypoTN and started on Levophed, evolving', 'lactic acidosis', '- Got 3L D5W with 3 amps HCO3', '- New Aline placed on L, got triple lumen CVL on R, and fem line was', 'pulled', '- started on flagyl for empiric c. diff coverage', '- CXR without free air, pneumothorax', '- KUB pending', '- Ordered Peramivir', '- Tylenol absorption test', '- ID recs: Reasonable to get IV Peramivir. Change Ceftriaxone to', 'Cefepime for better Staph coverage (done). Send urine Legionella', '(ordered).', '- Goal is fluid even for the day --> stopping Lasix though', '- Flu sample sent to state lab for PCR', ""- 1U PRBC's today for some volume"", 'Hct 24.5  --> 27.8', ""- Start TF's""]","['- New Aline placed on R', '- Need to change groin line for an IJ --> DONE', ""- 6pm started NO and sats from high 80's --> mid 90's""]",59765,141920.0
5,2151-11-02 07:09:31,"['BLOOD CULTURED - At [**2151-11-1**] 08:00 AM another set from the arterial', 'line (peripheral stick x2 was unsuccessful)', ' BLOOD CULTURED - At [**2151-11-1**] 10:00 AM another set from the central', 'line', ' EKG - At [**2151-11-1**] 03:25 PM', ' SPUTUM CULTURE - At [**2151-11-1**] 06:19 PM', ' CARDIAC ARREST - At [**2151-11-1**] 06:45 PM', 'PEA arrest in the setting of hypoxia. pt was pulseless and cpr was', 'initated briefly. she received 1mg ivp epinephrine and rapidly became', ""hyptensive (sbp ~295) and more tachycardic (hr 130's). a ntg drip was"", 'then initiated to reduce hypertension and was eventually weaned off.', ' CARDIAC ARREST - At [**2151-11-1**] 07:05 PM', 'PEA ? due to hypoxia. 0.5 mg of epi given and pulse returned along with', 'severe hypertension.', '- echo: mild LVH w/ EF>75$, mildly dilated/hypokinetic RV, moderate', 'pulmonary HTN.', '- PM trop continues to rise. ECG reassuring as ST changes from night', 'before corrected.', '- KUB: no obstruction', '- respiratory viral culture negative - ? stop flu precautions.', '- solumedrol dose cut in half', '- stopped bicarb drip', '- vanco changed to Q48hr']","['BLOOD CULTURED - At [**2151-11-1**] 08:00 AM another set from the arterial', 'line (peripheral stick x2 was unsuccessful)', ' BLOOD CULTURED - At [**2151-11-1**] 10:00 AM another set from the central', 'line', ' EKG - At [**2151-11-1**] 03:25 PM', ' SPUTUM CULTURE - At [**2151-11-1**] 06:19 PM', ' CARDIAC ARREST - At [**2151-11-1**] 06:45 PM', 'PEA arrest in the setting of hypoxia. pt was pulseless and cpr was', 'initated briefly. she received 1mg ivp epinephrine and rapidly became', ""hyptensive (sbp ~295) and more tachycardic (hr 130's). a ntg drip was"", 'then initiated to reduce hypertension and was eventually weaned off.', ' CARDIAC ARREST - At [**2151-11-1**] 07:05 PM', 'PEA ? due to hypoxia. 0.5 mg of epi given and pulse returned along with', 'severe hypertension.', '- echo: mild LVH w/ EF>75$, mildly dilated/hypokinetic RV, moderate', 'pulmonary HTN.', '- PM trop continues to rise. ECG reassuring as ST changes from night', 'before corrected.', '- KUB: no obstruction', '- respiratory viral culture negative - ? stop flu precautions.', '- solumedrol dose cut in half', '- stopped bicarb drip', '- vanco changed to Q48hr']","['EKG - At [**2151-10-31**] 10:00 AM', ' MULTI LUMEN - START [**2151-10-31**] 04:30 PM', ' MULTI LUMEN - STOP [**2151-10-31**] 06:30 PM', ' BLOOD CULTURED - At [**2151-11-1**] 12:00 AM', 'x 2 from new lines central and art', ' EKG - At [**2151-11-1**] 12:38 AM', ' URINE CULTURE - At [**2151-11-1**] 12:40 AM', ' STOOL CULTURE - At [**2151-11-1**] 12:40 AM', ' EKG - At [**2151-11-1**] 01:38 AM', ' ARTERIAL LINE - STOP [**2151-11-1**] 02:43 AM', 'started in ER', ' ARTERIAL LINE - START [**2151-11-1**] 04:07 AM', ""- Tried NO and had some improved sats temporarily from high 80's -->"", ""mid 90's."", '- Tried PRVC and APRV today', '- Around 2200: unstable, hypoTN and started on Levophed, evolving', 'lactic acidosis', '- Got 3L D5W with 3 amps HCO3', '- New Aline placed on L, got triple lumen CVL on R, and fem line was', 'pulled', '- started on flagyl for empiric c. diff coverage', '- CXR without free air, pneumothorax', '- KUB pending', '- Ordered Peramivir', '- Tylenol absorption test', '- ID recs: Reasonable to get IV Peramivir. Change Ceftriaxone to', 'Cefepime for better Staph coverage (done). Send urine Legionella', '(ordered).', '- Goal is fluid even for the day --> stopping Lasix though', '- Flu sample sent to state lab for PCR', ""- 1U PRBC's today for some volume"", 'Hct 24.5  --> 27.8', ""- Start TF's""]",59765,141920.0
6,2151-11-02 11:39:25,,"['BLOOD CULTURED - At [**2151-11-1**] 08:00 AM another set from the arterial', 'line (peripheral stick x2 was unsuccessful)', ' BLOOD CULTURED - At [**2151-11-1**] 10:00 AM another set from the central', 'line', ' EKG - At [**2151-11-1**] 03:25 PM', ' SPUTUM CULTURE - At [**2151-11-1**] 06:19 PM', ' CARDIAC ARREST - At [**2151-11-1**] 06:45 PM', 'PEA arrest in the setting of hypoxia. pt was pulseless and cpr was', 'initated briefly. she received 1mg ivp epinephrine and rapidly became', ""hyptensive (sbp ~295) and more tachycardic (hr 130's). a ntg drip was"", 'then initiated to reduce hypertension and was eventually weaned off.', ' CARDIAC ARREST - At [**2151-11-1**] 07:05 PM', 'PEA ? due to hypoxia. 0.5 mg of epi given and pulse returned along with', 'severe hypertension.', '- echo: mild LVH w/ EF>75$, mildly dilated/hypokinetic RV, moderate', 'pulmonary HTN.', '- PM trop continues to rise. ECG reassuring as ST changes from night', 'before corrected.', '- KUB: no obstruction', '- respiratory viral culture negative - ? stop flu precautions.', '- solumedrol dose cut in half', '- stopped bicarb drip', '- vanco changed to Q48hr']",,59765,141920.0
7,2151-11-03 06:59:04,"['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']","['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']","['BLOOD CULTURED - At [**2151-11-1**] 08:00 AM another set from the arterial', 'line (peripheral stick x2 was unsuccessful)', ' BLOOD CULTURED - At [**2151-11-1**] 10:00 AM another set from the central', 'line', ' EKG - At [**2151-11-1**] 03:25 PM', ' SPUTUM CULTURE - At [**2151-11-1**] 06:19 PM', ' CARDIAC ARREST - At [**2151-11-1**] 06:45 PM', 'PEA arrest in the setting of hypoxia. pt was pulseless and cpr was', 'initated briefly. she received 1mg ivp epinephrine and rapidly became', ""hyptensive (sbp ~295) and more tachycardic (hr 130's). a ntg drip was"", 'then initiated to reduce hypertension and was eventually weaned off.', ' CARDIAC ARREST - At [**2151-11-1**] 07:05 PM', 'PEA ? due to hypoxia. 0.5 mg of epi given and pulse returned along with', 'severe hypertension.', '- echo: mild LVH w/ EF>75$, mildly dilated/hypokinetic RV, moderate', 'pulmonary HTN.', '- PM trop continues to rise. ECG reassuring as ST changes from night', 'before corrected.', '- KUB: no obstruction', '- respiratory viral culture negative - ? stop flu precautions.', '- solumedrol dose cut in half', '- stopped bicarb drip', '- vanco changed to Q48hr']",59765,141920.0
8,2151-11-03 10:51:30,,"['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']",,59765,141920.0
9,2151-11-04 07:08:50,"['EKG - At [**2151-11-3**] 09:04 PM', 'arrythmias', ' FEVER - 101.9', 'F - [**2151-11-3**] 06:00 PM', '- Plan through yesterday had been to decrease NO, try to diurese the pt', 'with lasix, then increase the PEEP in an attempt to wean FiO2.', '- Diuresed well', '- In the evening, shut off NO --> sats from 94 to 90, Ppeak 37,', 'Pplateau 34 increased PEEP to 15. Plan was: if better, then go down on', 'FiO2. If worse, back on NO --> repeat O2 slightly lower, so getting', 'repeat and then will decide']","['EKG - At [**2151-11-3**] 09:04 PM', 'arrythmias', ' FEVER - 101.9', 'F - [**2151-11-3**] 06:00 PM', '- Plan through yesterday had been to decrease NO, try to diurese the pt', 'with lasix, then increase the PEEP in an attempt to wean FiO2.', '- Diuresed well', '- In the evening, shut off NO --> sats from 94 to 90, Ppeak 37,', 'Pplateau 34 increased PEEP to 15. Plan was: if better, then go down on', 'FiO2. If worse, back on NO --> repeat O2 slightly lower, so getting', 'repeat and then will decide']","['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']",59765,141920.0
10,2151-11-04 09:26:02,,"['EKG - At [**2151-11-3**] 09:04 PM', 'arrythmias', ' FEVER - 101.9', 'F - [**2151-11-3**] 06:00 PM', '- Plan through yesterday had been to decrease NO, try to diurese the pt', 'with lasix, then increase the PEEP in an attempt to wean FiO2.', '- Diuresed well', '- In the evening, shut off NO --> sats from 94 to 90, Ppeak 37,', 'Pplateau 34 increased PEEP to 15. Plan was: if better, then go down on', 'FiO2. If worse, back on NO --> repeat O2 slightly lower, so getting', 'repeat and then will decide']",,59765,141920.0
11,2151-11-04 11:01:09,,"['EKG - At [**2151-11-3**] 09:04 PM', 'arrythmias', ' FEVER - 101.9', 'F - [**2151-11-3**] 06:00 PM', '- Plan through yesterday had been to decrease NO, try to diurese the pt', 'with lasix, then increase the PEEP in an attempt to wean FiO2.', '- Diuresed well', '- In the evening, shut off NO --> sats from 94 to 90, Ppeak 37,', 'Pplateau 34 increased PEEP to 15. Plan was: if better, then go down on', 'FiO2. If worse, back on NO --> repeat O2 slightly lower, so getting', 'repeat and then will decide']",,59765,141920.0
12,2151-11-04 11:04:14,"['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic /', 'dyssynchronous', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']","['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic /', 'dyssynchronous', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']","['EKG - At [**2151-11-3**] 09:04 PM', 'arrythmias', ' FEVER - 101.9', 'F - [**2151-11-3**] 06:00 PM', '- Plan through yesterday had been to decrease NO, try to diurese the pt', 'with lasix, then increase the PEEP in an attempt to wean FiO2.', '- Diuresed well', '- In the evening, shut off NO --> sats from 94 to 90, Ppeak 37,', 'Pplateau 34 increased PEEP to 15. Plan was: if better, then go down on', 'FiO2. If worse, back on NO --> repeat O2 slightly lower, so getting', 'repeat and then will decide']",59765,141920.0
13,2151-11-05 07:36:48,"['BLOOD CULTURED - At [**2151-11-4**] 10:30 AM', ' BLOOD CULTURED - At [**2151-11-4**] 10:45 AM', ' URINE CULTURE - At [**2151-11-4**] 10:45 AM', '- ABG stable after vent weaning.', '- CT torso: Large right and small left basal effusions with atelectasis', 'and enlarged heart suggest CHF.  Fatty liver and small ascites. No', 'abscess.', '- Patient diuresing spontaneously to about -300cc, but gave 40mg IV', 'lasix ordered this morning.', '- pan culture all pending.', '- patient continued to be hypertensive to 170s/80s so we tried IV', 'hydral 10mg Q6hrs PRN.', '- paralysis stopped around 2am.']","['BLOOD CULTURED - At [**2151-11-4**] 10:30 AM', ' BLOOD CULTURED - At [**2151-11-4**] 10:45 AM', ' URINE CULTURE - At [**2151-11-4**] 10:45 AM', '- ABG stable after vent weaning.', '- CT torso: Large right and small left basal effusions with atelectasis', 'and enlarged heart suggest CHF.  Fatty liver and small ascites. No', 'abscess.', '- Patient diuresing spontaneously to about -300cc, but gave 40mg IV', 'lasix ordered this morning.', '- pan culture all pending.', '- patient continued to be hypertensive to 170s/80s so we tried IV', 'hydral 10mg Q6hrs PRN.', '- paralysis stopped around 2am.']","['BLOOD CULTURED - At [**2151-11-2**] 05:00 PM', 'central line', ' URINE CULTURE - At [**2151-11-2**] 05:00 PM', ' BLOOD CULTURED - At [**2151-11-2**] 05:15 PM', 'arterial line', ' CARDIOVERSION/DEFIBRILLATION - At [**2151-11-2**] 08:00 PM', '200j 300j', ' CARDIAC ARREST - At [**2151-11-2**] 08:00 PM', '.25mg epi given', ' EKG - At [**2151-11-2**] 08:27 PM', ' FEVER - 101.2', 'F - [**2151-11-3**] 12:00 AM', '- Steroids cut in half', '- Paralytics off at 1730 --> not initiating own breaths off paralytic /', 'dyssynchronous', '- 8pm Desat on vent --> bradycardia and hypoTN --> bag mask ventilation', ""and norepi --> then developed HTN, tachy to 250's and sbp 300's --> 200"", 'J shock. Lopressor 2.5mg x1 given. Normalized, then began to desat,', 'then bradycardic and hypoTN. Levo restarted, up to 0.3 without much', ""response.  Epi 0.25mg given, pt again tachy to 250's and sbp 250's."", 'Shocked at 300J with slowing of rate to 150 bpm and normalization of', 'HR. Stabilized on vent with just Levo.', '- Family [**Name (NI) 161**], they still want all measures.', '- Temp curve continues upward, without any relief from PR Tylenol', '- Continues currently on Levo, Cisatra']",59765,141920.0
14,2151-11-05 11:11:22,,"['BLOOD CULTURED - At [**2151-11-4**] 10:30 AM', ' BLOOD CULTURED - At [**2151-11-4**] 10:45 AM', ' URINE CULTURE - At [**2151-11-4**] 10:45 AM', '- ABG stable after vent weaning.', '- CT torso: Large right and small left basal effusions with atelectasis', 'and enlarged heart suggest CHF.  Fatty liver and small ascites. No', 'abscess.', '- Patient diuresing spontaneously to about -300cc, but gave 40mg IV', 'lasix ordered this morning.', '- pan culture all pending.', '- patient continued to be hypertensive to 170s/80s so we tried IV', 'hydral 10mg Q6hrs PRN.', '- paralysis stopped around 2am.']",,59765,141920.0
15,2151-11-06 07:51:42,"[""This morning became tachycardic to 130-140 and had PVC's.  Blood"", 'pressure was stable at SBP 110, but low for her.  Had a call from micro', 'lab that she is growing gram variable rods in one blood culture.  Was', ""given a fluid bolus and responded with HR to 120's and SBP to 120.""]","[""This morning became tachycardic to 130-140 and had PVC's.  Blood"", 'pressure was stable at SBP 110, but low for her.  Had a call from micro', 'lab that she is growing gram variable rods in one blood culture.  Was', ""given a fluid bolus and responded with HR to 120's and SBP to 120.""]","['BLOOD CULTURED - At [**2151-11-4**] 10:30 AM', ' BLOOD CULTURED - At [**2151-11-4**] 10:45 AM', ' URINE CULTURE - At [**2151-11-4**] 10:45 AM', '- ABG stable after vent weaning.', '- CT torso: Large right and small left basal effusions with atelectasis', 'and enlarged heart suggest CHF.  Fatty liver and small ascites. No', 'abscess.', '- Patient diuresing spontaneously to about -300cc, but gave 40mg IV', 'lasix ordered this morning.', '- pan culture all pending.', '- patient continued to be hypertensive to 170s/80s so we tried IV', 'hydral 10mg Q6hrs PRN.', '- paralysis stopped around 2am.']",59765,141920.0
16,2151-11-06 10:55:36,,"[""This morning became tachycardic to 130-140 and had PVC's.  Blood"", 'pressure was stable at SBP 110, but low for her.  Had a call from micro', 'lab that she is growing gram variable rods in one blood culture.  Was', ""given a fluid bolus and responded with HR to 120's and SBP to 120.""]",,59765,141920.0
17,2151-11-07 11:31:20,"['BLOOD CULTURED - At [**2151-11-6**] 01:18 PM', 'repeated from central line', '- replaced foley (had yeast)', '- 1/2 NS 1 L bolus (hypernatremic) --> f/u UOP: good through the night.', '- Started Merrem for Gram variable from CVL', '- Had gone down on FiO2 60 --> 50, then down on PEEP, then desatted', '--> did recruitment maneuvers --> back now to 50%, PEEP 15 --> weaned', 'down to 14, was doing well --> tried down to 13 but ABG showing', 'decreased O2 7.44/44/66 (down from 85) --> back to PEEP 14, still 50%', '- 3pm chem: HCO3 went down from 33 --> 31, Cr 1.6 --> 1.7, otherwise', 'same.', '- Vanc trough 18.8']","['BLOOD CULTURED - At [**2151-11-6**] 01:18 PM', 'repeated from central line', '- replaced foley (had yeast)', '- 1/2 NS 1 L bolus (hypernatremic) --> f/u UOP: good through the night.', '- Started Merrem for Gram variable from CVL', '- Had gone down on FiO2 60 --> 50, then down on PEEP, then desatted', '--> did recruitment maneuvers --> back now to 50%, PEEP 15 --> weaned', 'down to 14, was doing well --> tried down to 13 but ABG showing', 'decreased O2 7.44/44/66 (down from 85) --> back to PEEP 14, still 50%', '- 3pm chem: HCO3 went down from 33 --> 31, Cr 1.6 --> 1.7, otherwise', 'same.', '- Vanc trough 18.8']","[""This morning became tachycardic to 130-140 and had PVC's.  Blood"", 'pressure was stable at SBP 110, but low for her.  Had a call from micro', 'lab that she is growing gram variable rods in one blood culture.  Was', ""given a fluid bolus and responded with HR to 120's and SBP to 120.""]",59765,141920.0
18,2151-11-07 13:26:11,"['- During rounds, pt was becoming more dysynchronous with the vent,', 'hypertensive and tachycardic. Got Hydral prn without good response.']","['BLOOD CULTURED - At [**2151-11-6**] 01:18 PM', 'repeated from central line', '- replaced foley (had yeast)', '- 1/2 NS 1 L bolus (hypernatremic) --> f/u UOP: good through the night.', '- Started Merrem for Gram variable from CVL', '- Had gone down on FiO2 60 --> 50, then down on PEEP, then desatted', '--> did recruitment maneuvers --> back now to 50%, PEEP 15 --> weaned', 'down to 14, was doing well --> tried down to 13 but ABG showing', 'decreased O2 7.44/44/66 (down from 85) --> back to PEEP 14, still 50%', '- 3pm chem: HCO3 went down from 33 --> 31, Cr 1.6 --> 1.7, otherwise', 'same.', '- Vanc trough 18.8', '- During rounds, pt was becoming more dysynchronous with the vent,', 'hypertensive and tachycardic. Got Hydral prn without good response.']",,59765,141920.0
19,2151-11-08 07:41:31,"['BLOOD CULTURED - At [**2151-11-7**] 12:00 PM', '1 set from the arterial line', ' BLOOD CULTURED - At [**2151-11-7**] 12:10 PM', '1 set from the central line', '- hypertensive; added labetalol PO and increased dose of prn hydral.', '-cxr: no significant change', '-per ID: daily blood cultures, keep antibiotics as they are', '-40 IV lasix given at 1pm and again at 11pm with good responses both', 'times.', '- showing paradoxical breathing around 10pm, worry that she is tiring', 'out on pressure support, put back on assist control overnight.', '- hypertensive again late in the day, added PO amlodipine (on', 'nifedipine at home), but gave hydral as amlodipine will take some time', 'to work.']","['BLOOD CULTURED - At [**2151-11-7**] 12:00 PM', '1 set from the arterial line', ' BLOOD CULTURED - At [**2151-11-7**] 12:10 PM', '1 set from the central line', '- hypertensive; added labetalol PO and increased dose of prn hydral.', '-cxr: no significant change', '-per ID: daily blood cultures, keep antibiotics as they are', '-40 IV lasix given at 1pm and again at 11pm with good responses both', 'times.', '- showing paradoxical breathing around 10pm, worry that she is tiring', 'out on pressure support, put back on assist control overnight.', '- hypertensive again late in the day, added PO amlodipine (on', 'nifedipine at home), but gave hydral as amlodipine will take some time', 'to work.']","['BLOOD CULTURED - At [**2151-11-6**] 01:18 PM', 'repeated from central line', '- replaced foley (had yeast)', '- 1/2 NS 1 L bolus (hypernatremic) --> f/u UOP: good through the night.', '- Started Merrem for Gram variable from CVL', '- Had gone down on FiO2 60 --> 50, then down on PEEP, then desatted', '--> did recruitment maneuvers --> back now to 50%, PEEP 15 --> weaned', 'down to 14, was doing well --> tried down to 13 but ABG showing', 'decreased O2 7.44/44/66 (down from 85) --> back to PEEP 14, still 50%', '- 3pm chem: HCO3 went down from 33 --> 31, Cr 1.6 --> 1.7, otherwise', 'same.', '- Vanc trough 18.8', '- During rounds, pt was becoming more dysynchronous with the vent,', 'hypertensive and tachycardic. Got Hydral prn without good response.']",59765,141920.0
20,2151-11-08 19:04:53,,"['BLOOD CULTURED - At [**2151-11-7**] 12:00 PM', '1 set from the arterial line', ' BLOOD CULTURED - At [**2151-11-7**] 12:10 PM', '1 set from the central line', '- hypertensive; added labetalol PO and increased dose of prn hydral.', '-cxr: no significant change', '-per ID: daily blood cultures, keep antibiotics as they are', '-40 IV lasix given at 1pm and again at 11pm with good responses both', 'times.', '- showing paradoxical breathing around 10pm, worry that she is tiring', 'out on pressure support, put back on assist control overnight.', '- hypertensive again late in the day, added PO amlodipine (on', 'nifedipine at home), but gave hydral as amlodipine will take some time', 'to work.']",,59765,141920.0
21,2151-11-09 06:56:20,"['- 60 IV lasix given with a goal of 1L off', '- weaned to PSV 12 and 12- let rest at this', '- kept insulin drip because much better controlled with drip and still', 'critically ill', '- ID recs: no abio changes, UA and Ucx b/c of yeast, renal u/s', '- Had to go back on CMV because hypertensive and low sats.  Went back', 'to pressure support in the morning (5am).  Can recheck gas in the am.']","['- 60 IV lasix given with a goal of 1L off', '- weaned to PSV 12 and 12- let rest at this', '- kept insulin drip because much better controlled with drip and still', 'critically ill', '- ID recs: no abio changes, UA and Ucx b/c of yeast, renal u/s', '- Had to go back on CMV because hypertensive and low sats.  Went back', 'to pressure support in the morning (5am).  Can recheck gas in the am.']","['BLOOD CULTURED - At [**2151-11-7**] 12:00 PM', '1 set from the arterial line', ' BLOOD CULTURED - At [**2151-11-7**] 12:10 PM', '1 set from the central line', '- hypertensive; added labetalol PO and increased dose of prn hydral.', '-cxr: no significant change', '-per ID: daily blood cultures, keep antibiotics as they are', '-40 IV lasix given at 1pm and again at 11pm with good responses both', 'times.', '- showing paradoxical breathing around 10pm, worry that she is tiring', 'out on pressure support, put back on assist control overnight.', '- hypertensive again late in the day, added PO amlodipine (on', 'nifedipine at home), but gave hydral as amlodipine will take some time', 'to work.']",59765,141920.0
22,2151-11-09 10:32:29,,"['- 60 IV lasix given with a goal of 1L off', '- weaned to PSV 12 and 12- let rest at this', '- kept insulin drip because much better controlled with drip and still', 'critically ill', '- ID recs: no abio changes, UA and Ucx b/c of yeast, renal u/s', '- Had to go back on CMV because hypertensive and low sats.  Went back', 'to pressure support in the morning (5am).  Can recheck gas in the am.']",,59765,141920.0
23,2151-11-10 09:01:43,"['- Lasix 40mg IV given, no UOP response (net positive) so gave another', '80mg IV Lasix.', '- Call ID re: cefepime, stopping [**Last Name (un) **]', '- PICC ordered']","['- Lasix 40mg IV given, no UOP response (net positive) so gave another', '80mg IV Lasix.', '- Call ID re: cefepime, stopping [**Last Name (un) **]', '- PICC ordered']","['- 60 IV lasix given with a goal of 1L off', '- weaned to PSV 12 and 12- let rest at this', '- kept insulin drip because much better controlled with drip and still', 'critically ill', '- ID recs: no abio changes, UA and Ucx b/c of yeast, renal u/s', '- Had to go back on CMV because hypertensive and low sats.  Went back', 'to pressure support in the morning (5am).  Can recheck gas in the am.']",59765,141920.0
24,2151-11-10 15:54:09,,"['- Lasix 40mg IV given, no UOP response (net positive) so gave another', '80mg IV Lasix.', '- PICC ordered']","['- Call ID re: cefepime, stopping [**Last Name (un) **]']",59765,141920.0
25,2151-11-11 06:39:25,"['-Fever of 101.3', '-successfully weaned PEEP to 8', '- diuresed 1.2L']","['-Fever of 101.3', '-successfully weaned PEEP to 8', '- diuresed 1.2L']","['- Lasix 40mg IV given, no UOP response (net positive) so gave another', '80mg IV Lasix.', '- PICC ordered']",59765,141920.0
26,2151-11-11 14:18:36,,"['-Fever of 101.3', '-successfully weaned PEEP to 8', '- diuresed 1.2L']",,59765,141920.0
27,2151-11-12 06:32:27,,,,59765,141920.0
28,2151-11-12 06:32:56,,,,59765,141920.0
29,2151-11-12 11:44:55,,,,59765,141920.0
30,2151-11-13 07:46:52,"['- d/c Levaquin [**11-13**], d/c Vanc [**11-14**], d/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 350**] [**11-15**]', '- monostat written', '- plan to extubate tomorrow, make anesthesia aware bc difficult', 'airway.  if not successful, consider trach monday', '- change foley today', '- lasix drip']",,"['- d/c Levaquin tomorrow, d/c other abx after 15 day course', '- consulted IP re: trach and PEG Monday if not able to wean from vent', '- Glargine dose given and kept on insulin drip.  Will consider starting', 'sliding scale tomorrow.', '- started on Zyprexa and seems to be doing well with it.', '- 1 uPRBC', '- Acetazolamide started d/t alkalosis and diuresis', '- increased free H20 flushes for hypernatremia']",59765,141920.0
31,2151-11-13 23:48:11,"['- monostat written for vaginal infection', '- lasix drip on board', '- on SBT this morning', '- this morning with white secretions']",,"['- monostat written', '- plan to extubate tomorrow, make anesthesia aware bc difficult', 'airway.  if not successful, consider trach monday', '- change foley today', '- lasix drip']",59765,141920.0
32,2151-11-14 08:08:19,['No acute events'],,"['- d/c Levaquin [**11-13**], d/c Vanc [**11-14**], d/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 350**] [**11-15**]', '- monostat written for vaginal infection', '- lasix drip on board', '- on SBT this morning', '- this morning with white secretions']",59765,141920.0
33,2151-11-14 17:32:59,,,,59765,141920.0
34,2151-11-15 06:25:32,"['- patient extubated', '- passed nursing bedside swallow exam and diet progressed to clear', 'liquids.  Will wait for PO meds for now.', '- diuresed with 40mg lasix w/ adequate output in pm']",,['No acute events'],59765,141920.0
35,2151-11-15 15:55:52,,,,59765,141920.0
36,2151-11-16 06:20:26,"['- pt doing well post-extubation (day 2 off vent)', '- advanced diet to soft-mechanical; pt taking PO meds', '- diuresed w. Lasix 60mg IV am w. -- output in the pm.', '- Received Lasix 60mg again in PM to keep up with goal -1-']",,"['- patient extubated', '- passed nursing bedside swallow exam and diet progressed to clear', 'liquids.  Will wait for PO meds for now.', '- diuresed with 40mg lasix w/ adequate output in pm']",59765,141920.0
37,2151-11-16 12:06:18,"['- diuresed w. Lasix 60mg IV am and received Lasix 60mg again in PM to', 'keep up with goal 1-1.5 negative']",,"['- diuresed w. Lasix 60mg IV am w. -- output in the pm.', '- Received Lasix 60mg again in PM to keep up with goal -1-']",59765,141920.0
38,2151-11-16 13:13:16,,,,59765,141920.0
0,2105-03-01 07:49:57,,"['Overnight, pt slept with intermittent pain, nausea', 'History obtained from Patient']",,49247,114517.0
1,2105-03-01 12:13:13,,"['Overnight, pt slept with intermittent pain, nausea', 'History obtained from Patient']",,49247,114517.0
0,2185-05-24 07:20:04,,"['MULTI LUMEN - START [**2185-5-23**] 02:39 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 06:19 PM', ' NASAL SWAB - At [**2185-5-23**] 06:19 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 10:16 PM', '- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levaphed for hypotension', '- Started insulin gtt for persistant hyperglycemia']",,58105,129914.0
1,2185-05-24 07:22:42,,"['MULTI LUMEN - START [**2185-5-23**] 02:39 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 06:19 PM', ' NASAL SWAB - At [**2185-5-23**] 06:19 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 10:16 PM', '- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levaphed for hypotension', '- Started insulin gtt for persistant hyperglycemia']",,58105,129914.0
2,2185-05-24 07:29:21,,"['- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levaphed for hypotension', '- Started insulin gtt for persistant hyperglycemia']","['MULTI LUMEN - START [**2185-5-23**] 02:39 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 06:19 PM', ' NASAL SWAB - At [**2185-5-23**] 06:19 PM', ' SPUTUM CULTURE - At [**2185-5-23**] 10:16 PM']",58105,129914.0
3,2185-05-24 09:45:48,,"['- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levaphed for hypotension', '- Started insulin gtt for persistant hyperglycemia']",,58105,129914.0
4,2185-05-24 09:48:52,['- Started levophed for hypotension'],"['- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levophed for hypotension', '- Started insulin gtt for persistant hyperglycemia']",['- Started levaphed for hypotension'],58105,129914.0
5,2185-05-25 06:53:20,"['- Extubated', '- D5 1/2 NS decreased to 150 cc/h as Na correcting slightly faster than', '0.5 mEq/h', '- Weaned off levophed', '- Pt resisted NG tube. Placed on aspiration precautions. Bedside', 'swallow trial unsuccessful [**12-20**] AMS.', '- PM Na 150. At goal for day, so d/c D5 1/2NS with plan to restart if', 'FSG <200 on insulin gtt. Insulin gtt stopped as FSG <100.', '- [**2185-5-23**] 1 of 2 sets Aerobic bottle: GPC in pairs and clusters']","['- Extubated', '- D5 1/2 NS decreased to 150 cc/h as Na correcting slightly faster than', '0.5 mEq/h', '- Weaned off levophed', '- Pt resisted NG tube. Placed on aspiration precautions. Bedside', 'swallow trial unsuccessful [**12-20**] AMS.', '- PM Na 150. At goal for day, so d/c D5 1/2NS with plan to restart if', 'FSG <200 on insulin gtt. Insulin gtt stopped as FSG <100.', '- [**2185-5-23**] 1 of 2 sets Aerobic bottle: GPC in pairs and clusters']","['- Admitted from ED with CVL and intubated.', '- Required several boluses of IVF', '- Started levophed for hypotension', '- Started insulin gtt for persistant hyperglycemia']",58105,129914.0
6,2185-05-25 07:48:15,,"['- Extubated', '- Weaned off levophed', '- Pt resisted NG tube. Placed on aspiration precautions. Bedside', 'swallow trial unsuccessful [**12-20**] AMS.', '- PM Na 150. At goal for day, so d/c D5 1/2NS with plan to restart if', 'FSG <200 on insulin gtt. Insulin gtt stopped as FSG <100.', '- [**2185-5-23**] 1 of 2 sets Aerobic bottle: GPC in pairs and clusters']","['- D5 1/2 NS decreased to 150 cc/h as Na correcting slightly faster than', '0.5 mEq/h']",58105,129914.0
7,2185-05-25 07:49:55,,"['- Extubated', '- Weaned off levophed', '- Pt resisted NG tube. Placed on aspiration precautions. Bedside', 'swallow trial unsuccessful [**12-20**] AMS.', '- PM Na 150. At goal for day, so d/c D5 1/2NS with plan to restart if', 'FSG <200 on insulin gtt. Insulin gtt stopped as FSG <100.', '- [**2185-5-23**] 1 of 2 sets Aerobic bottle: GPC in pairs and clusters']",,58105,129914.0
8,2185-05-25 11:45:52,,"['- Extubated', '- Weaned off levophed', '- Pt resisted NG tube. Placed on aspiration precautions. Bedside', 'swallow trial unsuccessful [**12-20**] AMS.', '- PM Na 150. At goal for day, so d/c D5 1/2NS with plan to restart if', 'FSG <200 on insulin gtt. Insulin gtt stopped as FSG <100.', '- [**2185-5-23**] 1 of 2 sets Aerobic bottle: GPC in pairs and clusters']",,58105,129914.0
0,2177-03-29 07:39:20,,"['FEVER - 102.0', 'F - [**2177-3-28**] 02:00 PM', '.', '- Patient confirmed DNR/DNI and would like to go home ASAP', ""- Likely not candidate for chemo or aggressive treatments, and not pt's""]",,49510,171334.0
1,2177-03-29 07:43:16,,"['FEVER - 102.0', 'F - [**2177-3-28**] 02:00 PM', '.', '- Patient confirmed DNR/DNI and would like to go home ASAP', ""- Likely not candidate for chemo or aggressive treatments, and not pt's""]",,49510,171334.0
2,2177-03-29 12:20:01,,"['FEVER - 102.0', 'F - [**2177-3-28**] 02:00 PM', '.', '- Patient confirmed DNR/DNI and would like to go home ASAP', ""- Likely not candidate for chemo or aggressive treatments, and not pt's""]",,49510,171334.0
3,2177-03-29 12:38:24,,"['FEVER - 102.0', 'F - [**2177-3-28**] 02:00 PM', '.', '- Patient confirmed DNR/DNI and would like to go home ASAP', ""- Likely not candidate for chemo or aggressive treatments, and not pt's""]",,49510,171334.0
0,2166-12-08 07:27:18,,"['- Had multiple seizures during the day (3), gave IV Ativan with the', 'last one, consulted neurology who recommended loading with 10mg/kg IV', 'Depakote load and if he seizes again, give 2mg IV Ativan and then start', '1mg po TID standing', '- Mag low in the morning, repleted', '- Ate full lunch and ate dinner', '- Got records from [**Hospital1 587**], just showed he had a few ED visits in [**2161**] for', 'seizures, treated with Ativan, and sent out']",,83514,102212.0
1,2166-12-08 07:48:03,,"['- Had multiple seizures during the day (3), gave IV Ativan with the', 'last one, consulted neurology who recommended loading with 10mg/kg IV', 'Depakote load and if he seizes again, give 2mg IV Ativan and then start', '1mg po TID standing', '- Mag low in the morning, repleted', '- Ate full lunch and ate dinner', '- Got records from [**Hospital1 587**], just showed he had a few ED visits in [**2161**] for', 'seizures, treated with Ativan, and sent out']",,83514,102212.0
2,2166-12-08 14:04:44,['- had another seizure during rounds which self-resolved'],"['- Had multiple seizures during the day (3), gave IV Ativan with the', 'last one, consulted neurology who recommended loading with 10mg/kg IV', 'Depakote load and if he seizes again, give 2mg IV Ativan and then start', '1mg po TID standing', '- Mag low in the morning, repleted', '- Ate full lunch and ate dinner', '- Got records from [**Hospital1 587**], just showed he had a few ED visits in [**2161**] for', 'seizures, treated with Ativan, and sent out', '- had another seizure during rounds which self-resolved']",,83514,102212.0
3,2166-12-09 07:21:16,"['-phenytoin low, but pharmacy said this could be false because assay', 'measures bound phenytoin.  Sent free phenytoin level -> plan to give', 'extra dose of 150 if <0.5.', '-seizure during rounds in AM, resolved with ativan', '-Neuro recs: tried to get patient transferred west to neuro floor, but', 'west attending said no.  Patient has focal neuro deficits including', 'left pronator drift on exam.  Ordered MRI, bedside 24 hour EEG and', 'morning levels of dilantin and phenytoin.', '-went for MRI overnight', ' MAGNETIC RESONANCE IMAGING - At [**2166-12-8**] 10:02 PM', 'returned from MRI head']","['-phenytoin low, but pharmacy said this could be false because assay', 'measures bound phenytoin.  Sent free phenytoin level -> plan to give', 'extra dose of 150 if <0.5.', '-seizure during rounds in AM, resolved with ativan', '-Neuro recs: tried to get patient transferred west to neuro floor, but', 'west attending said no.  Patient has focal neuro deficits including', 'left pronator drift on exam.  Ordered MRI, bedside 24 hour EEG and', 'morning levels of dilantin and phenytoin.', '-went for MRI overnight', ' MAGNETIC RESONANCE IMAGING - At [**2166-12-8**] 10:02 PM', 'returned from MRI head']","['- Had multiple seizures during the day (3), gave IV Ativan with the', 'last one, consulted neurology who recommended loading with 10mg/kg IV', 'Depakote load and if he seizes again, give 2mg IV Ativan and then start', '1mg po TID standing', '- Mag low in the morning, repleted', '- Ate full lunch and ate dinner', '- Got records from [**Hospital1 587**], just showed he had a few ED visits in [**2161**] for', 'seizures, treated with Ativan, and sent out', '- had another seizure during rounds which self-resolved']",83514,102212.0
4,2166-12-09 14:04:35,,"['-phenytoin low, but pharmacy said this could be false because assay', 'measures bound phenytoin.  Sent free phenytoin level -> plan to give', 'extra dose of 150 if <0.5.', '-seizure during rounds in AM, resolved with ativan', '-Neuro recs: tried to get patient transferred west to neuro floor, but', 'west attending said no.  Patient has focal neuro deficits including', 'left pronator drift on exam.  Ordered MRI, bedside 24 hour EEG and', 'morning levels of dilantin and phenytoin.', '-went for MRI overnight', ' MAGNETIC RESONANCE IMAGING - At [**2166-12-8**] 10:02 PM', 'returned from MRI head']",,83514,102212.0
0,2192-09-22 06:26:18,,"['BAL FLUID CULTURE - At [**2192-9-21**] 10:30 AM', ' MAGNETIC RESONANCE IMAGING - At [**2192-9-21**] 01:00 PM', ' INVASIVE VENTILATION - STOP [**2192-9-21**] 06:30 PM', '- ISS started, cont D5', '- MRI: No evidence of acute hemorrhage or infarction, hyperintense foci', 'within the left thalamus and left pons on FLAIR - focal', 'encephalomalacia?', '- Extubated', '- Agitated, first given 2mg ativan, then two hours later 2mg haldol.', ""Disoriented, doesn't remember coming here.  Is able to count down from"", '10, unable to do MOYB.  Denies drugs other than marijuana.', '- HSV added on to CSF from [**Location (un) 196**], lab req faxed, f/u if received', '(lab: [**Telephone/Fax (1) 9676**], fax [**Telephone/Fax (1) 9677**])']",,86621,161367.0
1,2192-09-22 07:52:42,['- CSF at outside hospital unremarkable.'],"['BAL FLUID CULTURE - At [**2192-9-21**] 10:30 AM', ' MAGNETIC RESONANCE IMAGING - At [**2192-9-21**] 01:00 PM', ' INVASIVE VENTILATION - STOP [**2192-9-21**] 06:30 PM', '- ISS started, cont D5', '- MRI: No evidence of acute hemorrhage or infarction, hyperintense foci', 'within the left thalamus and left pons on FLAIR - focal', 'encephalomalacia?', '- Extubated', '- Agitated, first given 2mg ativan, then two hours later 2mg haldol.', ""Disoriented, doesn't remember coming here.  Is able to count down from"", '10, unable to do MOYB.  Denies drugs other than marijuana.', '- CSF at outside hospital unremarkable.', '- HSV added on to CSF from [**Location (un) 196**], lab req faxed, f/u if received', '(lab: [**Telephone/Fax (1) 9676**], fax [**Telephone/Fax (1) 9677**])']",,86621,161367.0
2,2192-09-22 08:26:35,,"['BAL FLUID CULTURE - At [**2192-9-21**] 10:30 AM', ' MAGNETIC RESONANCE IMAGING - At [**2192-9-21**] 01:00 PM', ' INVASIVE VENTILATION - STOP [**2192-9-21**] 06:30 PM', '- ISS started, cont D5', '- MRI: No evidence of acute hemorrhage or infarction, hyperintense foci', 'within the left thalamus and left pons on FLAIR - focal', 'encephalomalacia?', '- Extubated', '- Agitated, first given 2mg ativan, then two hours later 2mg haldol.', ""Disoriented, doesn't remember coming here.  Is able to count down from"", '10, unable to do MOYB.  Denies drugs other than marijuana.', '- CSF at outside hospital unremarkable.', '- HSV added on to CSF from [**Location (un) 196**], lab req faxed, f/u if received', '(lab: [**Telephone/Fax (1) 9676**], fax [**Telephone/Fax (1) 9677**])']",,86621,161367.0
3,2192-09-22 11:29:11,,"['BAL FLUID CULTURE - At [**2192-9-21**] 10:30 AM', ' MAGNETIC RESONANCE IMAGING - At [**2192-9-21**] 01:00 PM', ' INVASIVE VENTILATION - STOP [**2192-9-21**] 06:30 PM', '- ISS started, cont D5', '- MRI: No evidence of acute hemorrhage or infarction, hyperintense foci', 'within the left thalamus and left pons on FLAIR - focal', 'encephalomalacia?', '- Extubated', '- Agitated, first given 2mg ativan, then two hours later 2mg haldol.', ""Disoriented, doesn't remember coming here.  Is able to count down from"", '10, unable to do MOYB.  Denies drugs other than marijuana.', '- CSF at outside hospital unremarkable.', '- HSV added on to CSF from [**Location (un) 196**], lab req faxed, f/u if received', '(lab: [**Telephone/Fax (1) 9676**], fax [**Telephone/Fax (1) 9677**])']",,86621,161367.0
0,2169-04-03 06:59:54,,"['DIALYSIS CATHETER - START [**2169-4-2**] 10:20 AM', ' EKG - At [**2169-4-2**] 10:30 AM', ' INVASIVE VENTILATION - START [**2169-4-2**] 10:40 AM', ' ARTERIAL LINE - START [**2169-4-2**] 11:41 AM', ' NASAL SWAB - At [**2169-4-2**] 12:06 PM', ' SPUTUM CULTURE - At [**2169-4-2**] 01:30 PM', ' BLOOD CULTURED - At [**2169-4-2**] 02:06 PM', ' URINE CULTURE - At [**2169-4-2**] 02:06 PM', ' BLOOD CULTURED - At [**2169-4-2**] 03:27 PM', ' INVASIVE VENTILATION - STOP [**2169-4-3**] 12:15 AM', '[**4-2**] Events:', '- intially closed gap from 26 to 12, then 9, now 13', '- gave D10 with insulin drip since FS low', '- off insulin drip since 2:30am', '- FS in 80s and stable, given Glargine 25u at 11pm', '- patient given 2L of fluid to maintain pressures, patient now', 'hypertensive since meds held']",,95339,175410.0
1,2169-04-03 07:00:39,,"['DIALYSIS CATHETER - START [**2169-4-2**] 10:20 AM', ' EKG - At [**2169-4-2**] 10:30 AM', ' INVASIVE VENTILATION - START [**2169-4-2**] 10:40 AM', ' ARTERIAL LINE - START [**2169-4-2**] 11:41 AM', ' NASAL SWAB - At [**2169-4-2**] 12:06 PM', ' SPUTUM CULTURE - At [**2169-4-2**] 01:30 PM', ' BLOOD CULTURED - At [**2169-4-2**] 02:06 PM', ' URINE CULTURE - At [**2169-4-2**] 02:06 PM', ' BLOOD CULTURED - At [**2169-4-2**] 03:27 PM', ' INVASIVE VENTILATION - STOP [**2169-4-3**] 12:15 AM', '[**4-2**] Events:', '- intially closed gap from 26 to 12, then 9, now 13', '- gave D10 with insulin drip since FS low', '- off insulin drip since 2:30am', '- FS in 80s and stable, given Glargine 25u at 11pm', '- patient given 2L of fluid to maintain pressures, patient now', 'hypertensive since meds held']",,95339,175410.0
2,2169-04-03 07:01:45,,"['DIALYSIS CATHETER - START [**2169-4-2**] 10:20 AM', ' EKG - At [**2169-4-2**] 10:30 AM', ' INVASIVE VENTILATION - START [**2169-4-2**] 10:40 AM', ' ARTERIAL LINE - START [**2169-4-2**] 11:41 AM', ' NASAL SWAB - At [**2169-4-2**] 12:06 PM', ' SPUTUM CULTURE - At [**2169-4-2**] 01:30 PM', ' BLOOD CULTURED - At [**2169-4-2**] 02:06 PM', ' URINE CULTURE - At [**2169-4-2**] 02:06 PM', ' BLOOD CULTURED - At [**2169-4-2**] 03:27 PM', ' INVASIVE VENTILATION - STOP [**2169-4-3**] 12:15 AM', '[**4-2**] Events:', '- intially closed gap from 26 to 12, then 9, now 13', '- gave D10 with insulin drip since FS low', '- off insulin drip since 2:30am', '- FS in 80s and stable, given Glargine 25u at 11pm', '- patient given 2L of fluid to maintain pressures, patient now', 'hypertensive since meds held']",,95339,175410.0
3,2169-04-03 08:37:36,,"['DIALYSIS CATHETER - START [**2169-4-2**] 10:20 AM', ' EKG - At [**2169-4-2**] 10:30 AM', ' INVASIVE VENTILATION - START [**2169-4-2**] 10:40 AM', ' ARTERIAL LINE - START [**2169-4-2**] 11:41 AM', ' NASAL SWAB - At [**2169-4-2**] 12:06 PM', ' SPUTUM CULTURE - At [**2169-4-2**] 01:30 PM', ' BLOOD CULTURED - At [**2169-4-2**] 02:06 PM', ' URINE CULTURE - At [**2169-4-2**] 02:06 PM', ' BLOOD CULTURED - At [**2169-4-2**] 03:27 PM', ' INVASIVE VENTILATION - STOP [**2169-4-3**] 12:15 AM', '[**4-2**] Events:', '- intially closed gap from 26 to 12, then 9, now 13', '- gave D10 with insulin drip since FS low', '- off insulin drip since 2:30am', '- FS in 80s and stable, given Glargine 25u at 11pm', '- patient given 2L of fluid to maintain pressures, patient now', 'hypertensive since meds held']",,95339,175410.0
4,2169-04-03 08:48:41,,"['DIALYSIS CATHETER - START [**2169-4-2**] 10:20 AM', ' EKG - At [**2169-4-2**] 10:30 AM', ' INVASIVE VENTILATION - START [**2169-4-2**] 10:40 AM', ' ARTERIAL LINE - START [**2169-4-2**] 11:41 AM', ' NASAL SWAB - At [**2169-4-2**] 12:06 PM', ' SPUTUM CULTURE - At [**2169-4-2**] 01:30 PM', ' BLOOD CULTURED - At [**2169-4-2**] 02:06 PM', ' URINE CULTURE - At [**2169-4-2**] 02:06 PM', ' BLOOD CULTURED - At [**2169-4-2**] 03:27 PM', ' INVASIVE VENTILATION - STOP [**2169-4-3**] 12:15 AM', '[**4-2**] Events:', '- intially closed gap from 26 to 12, then 9, now 13', '- gave D10 with insulin drip since FS low', '- off insulin drip since 2:30am', '- FS in 80s and stable, given Glargine 25u at 11pm', '- patient given 2L of fluid to maintain pressures, patient now', 'hypertensive since meds held']",,95339,175410.0
0,2164-02-18 13:43:24,,"['62-year-old man quadraplegic s/p transverse myelitis, h/o asthma,', 'multiple pnas, initially admitted on [**2163-2-14**] for hypoxia, concerning', 'for pna, temporarily in ICU on [**2164-2-15**] for hypoxia, now transferred', 'back to ICU from floor for frequent hypoxic episodes.']",,3623,178444.0
1,2164-02-19 08:01:55,"['Transferred back to ICU for frequent desating to 60s requiring NRB, no', 'fever, persistent leukocytosis, on broad-spectrum abx', '- monitor for now; will not electively intubate for bronch (for now)', '- talked to GI re: possible esophageal pH probe; GI recommended upper', 'GI series first and then endoscopy', 'History obtained from [**Hospital 85**] Medical records']","['Transferred back to ICU for frequent desating to 60s requiring NRB, no', 'fever, persistent leukocytosis, on broad-spectrum abx', '- monitor for now; will not electively intubate for bronch (for now)', '- talked to GI re: possible esophageal pH probe; GI recommended upper', 'GI series first and then endoscopy', 'History obtained from [**Hospital 85**] Medical records']","['62-year-old man quadraplegic s/p transverse myelitis, h/o asthma,', 'multiple pnas, initially admitted on [**2163-2-14**] for hypoxia, concerning', 'for pna, temporarily in ICU on [**2164-2-15**] for hypoxia, now transferred', 'back to ICU from floor for frequent hypoxic episodes.']",3623,178444.0
2,2164-02-19 08:03:14,,"['Transferred back to ICU for frequent desating to 60s requiring NRB, no', 'fever, persistent leukocytosis, on broad-spectrum abx', '- monitor for now; will not electively intubate for bronch (for now)', '- talked to GI re: possible esophageal pH probe; GI recommended upper', 'GI series first and then endoscopy', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
3,2164-02-19 09:59:42,,"['Transferred back to ICU for frequent desating to 60s requiring NRB, no', 'fever, persistent leukocytosis, on broad-spectrum abx', '- monitor for now; will not electively intubate for bronch (for now)', '- talked to GI re: possible esophageal pH probe; GI recommended upper', 'GI series first and then endoscopy', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
4,2164-02-20 07:39:54,"['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice']","['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice', 'History obtained from [**Hospital 85**] Medical records']","['Transferred back to ICU for frequent desating to 60s requiring NRB, no', 'fever, persistent leukocytosis, on broad-spectrum abx', '- monitor for now; will not electively intubate for bronch (for now)', '- talked to GI re: possible esophageal pH probe; GI recommended upper', 'GI series first and then endoscopy']",3623,178444.0
5,2164-02-20 07:41:07,,"['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
6,2164-02-20 11:09:09,,"['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
7,2164-02-20 11:41:34,,"['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
8,2164-02-21 07:48:35,"['- [**Female First Name (un) **] recs: Remeron solutab 15mg PO qHS', '- Met with PCP [**Name Initial (PRE) **]: start Haldol', '- Nutrition plan: wife OK with TPN if needed, no PEG, no NGT', '- Vanco trough 21 at 3 AM and dosed at 8 & 8, gave Vanco 750 x 1,', 'trough at 7 AM', '- Watch creatinine, slowly trending up', '- ANCA, [**Doctor First Name 1205**], UPEP: neg', '- SPEP, IGE, ACE, anti-GBM: P']","['- [**Female First Name (un) **] recs: Remeron solutab 15mg PO qHS', '- Met with PCP [**Name Initial (PRE) **]: start Haldol', '- Nutrition plan: wife OK with TPN if needed, no PEG, no NGT', '- Vanco trough 21 at 3 AM and dosed at 8 & 8, gave Vanco 750 x 1,', 'trough at 7 AM', '- Watch creatinine, slowly trending up', '- ANCA, [**Doctor First Name 1205**], UPEP: neg', '- SPEP, IGE, ACE, anti-GBM: P', 'History obtained from [**Hospital 85**] Medical records']","['- PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] called: suggests CPAP trial if possible but thinks', 'patient will be unlikely to tolerate mask unless Clonazepam loaded (pt', ""states he's tolerated in the past for approximately 30 seconds); agrees"", 'that intubation may not be helpful for longterm goals but thinks PEG', 'may be necessary and that family would agree', '- Palliative / Pain consult: suggest scheduled Alprazolam 0.125 Q4H (pt', 'may refuse); Fentanyl 12.5-25mcg IV q4H (pt may refuse); contact Dr.', '[**Last Name (STitle) **] and see if he will be able to visit patient in hospital, also need', 'to clarify if longterm goals have been discussed as outpatient with', 'family', '- Geriatrics consult: Would recommend Celexa instead of Wellbutrin,', 'schedule alprazolam, contact PCP', '[**Name Initial (PRE) **] CBC with diff obtain: no eosiniophilia or significant change', '- NGT not placed given h/o nasal surgery', '- PEG not pursued given tenuous respiratory status', '- Anti-GBM, SPEP, UPEP sent', '- Pt taking minimal pos, changed po Alprazolam to IV Ativan', '- Medications changed to IV for less po dosing: Synthroid, PPI', '- Started refusing po anxiolytics; given Ativan 0.5mg IV x 2', '- Per discussion with family & patient, will change code status to', 'DNR/DNI as patient would never want a trach and his functional status', 'is already poor; if no hope for improved functional status, would', 'prefer home with hospice']",3623,178444.0
9,2164-02-21 07:52:18,['trough 7 AM'],"['- [**Female First Name (un) **] recs: Remeron solutab 15mg PO qHS', '- Met with PCP [**Name Initial (PRE) **]: start Haldol', '- Nutrition plan: wife OK with TPN if needed, no PEG, no NGT', '- Vanco trough 21 at 3 AM and dosed at 8 & 8, gave Vanco 750 x 1,', 'trough 7 AM', '- Watch creatinine, slowly trending up', '- ANCA, [**Doctor First Name 1205**], UPEP: neg', '- SPEP, IGE, ACE, anti-GBM: P', 'History obtained from [**Hospital 85**] Medical records']",['trough at 7 AM'],3623,178444.0
10,2164-02-21 11:08:50,,"['- [**Female First Name (un) **] recs: Remeron solutab 15mg PO qHS', '- Met with PCP [**Name Initial (PRE) **]: start Haldol', '- Nutrition plan: wife OK with TPN if needed, no PEG, no NGT', '- Vanco trough 21 at 3 AM and dosed at 8 & 8, gave Vanco 750 x 1,', 'trough 7 AM', '- Watch creatinine, slowly trending up', '- ANCA, [**Doctor First Name 1205**], UPEP: neg', '- SPEP, IGE, ACE, anti-GBM: P', 'History obtained from [**Hospital 85**] Medical records']",,3623,178444.0
11,2164-02-22 07:47:59,"['- CXR: Interval worsening', '- Goal to wean FiO2 if possible, not attained', '- Discontinued all oral medications patient is repeatedly refusing']","['- CXR: Interval worsening', '- Goal to wean FiO2 if possible, not attained', '- Discontinued all oral medications patient is repeatedly refusing']","['- [**Female First Name (un) **] recs: Remeron solutab 15mg PO qHS', '- Met with PCP [**Name Initial (PRE) **]: start Haldol', '- Nutrition plan: wife OK with TPN if needed, no PEG, no NGT', '- Vanco trough 21 at 3 AM and dosed at 8 & 8, gave Vanco 750 x 1,', 'trough 7 AM', '- Watch creatinine, slowly trending up', '- ANCA, [**Doctor First Name 1205**], UPEP: neg', '- SPEP, IGE, ACE, anti-GBM: P', 'History obtained from [**Hospital 85**] Medical records']",3623,178444.0
12,2164-02-22 07:55:23,,"['- CXR: Interval worsening', '- Goal to wean FiO2 if possible, not attained', '- Discontinued all oral medications patient is repeatedly refusing']",,3623,178444.0
13,2164-02-22 11:13:20,,"['- CXR: Interval worsening', '- Goal to wean FiO2 if possible, not attained', '- Discontinued all oral medications patient is repeatedly refusing']",,3623,178444.0
0,2176-10-06 06:09:03,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
1,2176-10-06 06:16:53,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
2,2176-10-06 06:31:44,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
3,2176-10-06 06:55:28,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
4,2176-10-06 09:03:15,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
5,2176-10-06 09:17:05,,"['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",,74674,194853.0
6,2176-10-07 07:15:10,"['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']","['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']","['EKG - At [**2176-10-5**] 07:59 PM', '[**2176-10-5**]: Started Metoprolol 25 TID. Around 8pm Pt tacchy to 130s,', 'dyspeneic. O2 requirement increased from 2 to 4L. EKG obtained showed', 'afib. Given 50 of metoprolol. Ordered 15 IV Dilt but held it as HR came', 'down to 80s.  CXR shows increased pulmonary edema. Pt urinating well so', 'held off on diuretics.']",74674,194853.0
7,2176-10-07 07:16:01,,"['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']",,74674,194853.0
8,2176-10-07 07:22:20,,"['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']",,74674,194853.0
9,2176-10-07 10:26:44,,"['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']",,74674,194853.0
10,2176-10-07 17:18:31,,"['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']",,74674,194853.0
11,2176-10-08 07:24:46,"['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']","['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']","['Remained asymptomatic.  Tolerated lying flat well without diuresis.  No', 'events overnight.  Scheduled for cath today, heparin discontinued at', 'midnight.', 'This AM, patient reports ongoing fatigue but denies other symptoms.', 'Specifically, no CP, palpitations, SOB, dizziness or other pain.']",74674,194853.0
12,2176-10-08 07:46:21,,"['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']",,74674,194853.0
13,2176-10-08 07:49:13,,"['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']",,74674,194853.0
14,2176-10-08 10:07:46,,"['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']",,74674,194853.0
15,2176-10-08 11:23:44,,"['[**2176-10-7**]: Cath showed three vessel coronary artery disease with several', 'stents in place, severe aortic stenosis and elevated left- and', 'right-sided filling pressures. Abd US showed AAA measuring 4.1 cm at', 'the widest diameter, slight interval increase from the ultrasound of', '[**2173-10-24**] No hydronephrosis. Bilateral renal cysts. No evidence of', 'renal artery stenosis.', 'Post cath check wnl.', 'Sotalol 80 [**Hospital1 **] started - check ECGs after each dose', 'restarted heparin']",,74674,194853.0
0,2176-10-24 06:46:05,,"['CHEST PAIN - At [**2176-10-24**] 02:00 AM', 'Substernal CP, EKG obtained, given 1 tab SL nitro. CP resolved after 1', 'ntg tab.']",,74674,160180.0
1,2176-10-24 10:12:06,,"['CHEST PAIN - At [**2176-10-24**] 02:00 AM', 'Substernal CP, EKG obtained, given 1 tab SL nitro. CP resolved after 1', 'ntg tab.']",,74674,160180.0
2,2176-10-24 12:07:26,"['Substernal CP, EKG obtained, given 1 tab SL nitro with resolution of', 'CP.']","['CHEST PAIN - At [**2176-10-24**] 02:00 AM', 'Substernal CP, EKG obtained, given 1 tab SL nitro with resolution of', 'CP.']","['Substernal CP, EKG obtained, given 1 tab SL nitro. CP resolved after 1', 'ntg tab.']",74674,160180.0
0,2199-08-21 07:52:14,,"['- ordered strongyloides Ab and strongyloides stool for AM', '- CTA completed: no PE (wet read)', '- psych consulted for withdrawal symptoms (opiate, benzo) but did not', 'see yesterday', '- started clonidine 0.1 mg po BID and gave 4 mg po ativan during the', 'day, then started CIWA 10 mg valium po q2 hour prn with HR in 90s, BPs', 'in 100-110s, did not get additional meds overnight', '- serum tox/urine tox sent']",,87111,155958.0
0,2188-09-27 06:34:20,,['ARTERIAL LINE - START [**2188-9-26**] 04:00'],,28259,111485.0
1,2188-09-27 11:25:22,,['ARTERIAL LINE - START [**2188-9-26**] 04:00'],,28259,111485.0
0,2123-02-12 06:36:08,,"['FEVER - 102.9', 'F - [**2123-2-11**] 12:00 PM', '- IP removed about 700cc of pleural fluid and left catheter in place;', 'fluid studies suggest exudate, concerning for empyema', '- flu negative', '- OSH hospitalist called and shared that his sputum was positive for', 'group A strep', '- vancomycin was discontinued; continued on pip-tazo and levoflox', '- awaiting chest CT', '- able to wean FiO2 to 40% and PEEP to 8', '- TF started']",,50911,180602.0
1,2123-02-12 07:30:03,"['group A strep -Shivraman [**Telephone/Fax (1) 13460**].  Need to get final report from', 'lab @ [**Hospital1 608**].', '- able to wean FiO2 to 40% and PEEP to 8-->PSV 8/5']","['FEVER - 102.9', 'F - [**2123-2-11**] 12:00 PM', '- IP removed about 700cc of pleural fluid and left catheter in place;', 'fluid studies suggest exudate, concerning for empyema', '- flu negative', '- OSH hospitalist called and shared that his sputum was positive for', 'group A strep -Shivraman [**Telephone/Fax (1) 13460**].  Need to get final report from', 'lab @ [**Hospital1 608**].', '- vancomycin was discontinued; continued on pip-tazo and levoflox', '- awaiting chest CT', '- able to wean FiO2 to 40% and PEEP to 8-->PSV 8/5', '- TF started']","['group A strep', '- able to wean FiO2 to 40% and PEEP to 8']",50911,180602.0
2,2123-02-12 07:36:02,,"['FEVER - 102.9', 'F - [**2123-2-11**] 12:00 PM', '- IP removed about 700cc of pleural fluid and left catheter in place;', 'fluid studies suggest exudate, concerning for empyema', '- flu negative', '- OSH hospitalist called and shared that his sputum was positive for', 'group A strep -Shivraman [**Telephone/Fax (1) 13460**].  Need to get final report from', 'lab @ [**Hospital1 608**].', '- vancomycin was discontinued; continued on pip-tazo and levoflox', '- awaiting chest CT', '- able to wean FiO2 to 40% and PEEP to 8-->PSV 8/5', '- TF started']",,50911,180602.0
3,2123-02-12 09:52:15,,"['FEVER - 102.9', 'F - [**2123-2-11**] 12:00 PM', '- IP removed about 700cc of pleural fluid and left catheter in place;', 'fluid studies suggest exudate, concerning for empyema', '- flu negative', '- OSH hospitalist called and shared that his sputum was positive for', 'group A strep -Shivraman [**Telephone/Fax (1) 13460**].  Need to get final report from', 'lab @ [**Hospital1 608**].', '- vancomycin was discontinued; continued on pip-tazo and levoflox', '- awaiting chest CT', '- able to wean FiO2 to 40% and PEEP to 8-->PSV 8/5', '- TF started']",,50911,180602.0
4,2123-02-12 09:53:41,,,,50911,180602.0
5,2123-02-13 07:12:52,,,,50911,180602.0
6,2123-02-13 07:14:13,,,,50911,180602.0
7,2123-02-13 08:35:10,,,,50911,180602.0
8,2123-02-14 06:55:16,"['BLOOD CULTURED - At [**2123-2-13**] 09:20 AM', ' FEVER - 102.6', 'F - [**2123-2-13**] 09:00 AM', '- considered CVL but got good PIVs', '- abx changed back to Zosyn becasue patient febrile again, not looking', 'good', '- Chest tube to remain in for now per IP, Repeat Non-con Chest in am to', 'eval, IP will reassess after', '- not really waking up despite off all sedatives, ongoing fever --> LP', 'without any evidence of infection (briefly on acyclovir, stopped when', 'CSF with 1 RBC only)', '- continues to oxygenate well, mildly hypertensive, febrile, awake but', 'without coherent communication, intermittently following commands']",,"['INVASIVE VENTILATION - STOP [**2123-2-12**] 01:45 PM', ' NON-INVASIVE VENTILATION - START [**2123-2-13**] 05:00 AM', ' FEVER - 101.1', 'F - [**2123-2-13**] 04:00 AM', '- Extubated to NC, continued to be confused, tachypnic.  Settled with', 'ativan, multiple episodes of hypertension and tachypnea overnight,', 'gasses stable', '- Trial of Bipap']",50911,180602.0
9,2123-02-14 06:58:09,,,,50911,180602.0
10,2123-02-14 09:55:17,,,,50911,180602.0
11,2123-02-14 10:05:41,,,,50911,180602.0
0,2162-03-16 07:01:43,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
1,2162-03-16 07:03:24,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
2,2162-03-16 07:19:25,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
3,2162-03-16 07:19:58,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
4,2162-03-16 09:43:04,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
5,2162-03-16 11:53:21,,"['[**2162-3-15**]', '- IR placed bedside perc chole drain', '- cultures of bile sent', '- pain controlled better with morphine', '- BP stable overnight', ' PERCUTANEOUS DRAIN INSERTION - At [**2162-3-15**] 10:44 PM', 'percutaneous drain placed into gallbladder area by Interventional', 'Radiology attending.  Procedure done at bedside under local anesthetic']",,54857,101988.0
0,2159-07-03 07:36:50,,"['- Completed ASA desensitization protocol specific for pt', 's asthma hx', '(last dose of 325 mg at MN)', '- Peak flow 140-180. No w/r/r; no edema, rash or other symptoms of', 'allergic response', '- New onset Afib (HR80-90s) starting 10pm and persisting into the AM.', 'EKG done. Pt continued on home Carvedilol and Heparin gtt for now', ' EKG - At [**2159-7-2**] 10:00 PM']",,86402,168718.0
1,2159-07-03 10:40:36,,"['- Completed ASA desensitization protocol specific for pt', 's asthma hx', '(last dose of 325 mg at MN)', '- Peak flow 140-180. No w/r/r; no edema, rash or other symptoms of', 'allergic response', '- New onset Afib (HR80-90s) starting 10pm and persisting into the AM.', 'EKG done. Pt continued on home Carvedilol and Heparin gtt for now']",[' EKG - At [**2159-7-2**] 10:00 PM'],86402,168718.0
2,2159-07-04 08:12:27,,"['- Completed ASA desensitization protocol specific for pt', 's asthma hx', '(last dose of 325 mg at MN)', '- Peak flow 140-180. No w/r/r; no edema, rash or other symptoms of', 'allergic response', '- New onset Afib (HR80-90s) starting 10pm and persisting into the AM.', 'EKG done. Pt continued on home Carvedilol and Heparin gtt for now']",,86402,168718.0
0,2170-12-20 07:54:31,,['EKG - At [**2170-12-20**] 01:34 AM'],,61450,153185.0
1,2170-12-20 12:15:32,,['EKG - At [**2170-12-20**] 01:34 AM'],,61450,153185.0
0,2112-02-29 07:31:07,,"['EKG - At [**2112-2-28**] 10:39 PM', 'History obtained from Patient']",,94321,117033.0
1,2112-02-29 07:35:20,,"['EKG - At [**2112-2-28**] 10:39 PM', 'History obtained from Patient']",,94321,117033.0
2,2112-02-29 10:42:28,['-[**2112-2-29**] Lasix gtt stopped at 6am'],"['EKG - At [**2112-2-28**] 10:39 PM', '-[**2112-2-29**] Lasix gtt stopped at 6am', 'History obtained from Patient']",,94321,117033.0
0,2189-07-17 07:35:14,,"['BLOOD CULTURED - At [**2189-7-16**] 08:31 PM', ' NASAL SWAB - At [**2189-7-16**] 08:31 PM', ' URINE CULTURE - At [**2189-7-16**] 08:32 PM', '-Continued requiring high flow O2 o/n.', ""-desaturations to low 80's with change to NC"", '-Sips of clears only while high O2 requirements persist', '-some productive cough with sputum']",,69380,124616.0
1,2189-07-17 10:21:59,"['-daughter concerned about nutrition status, calling Dr. [**Last Name (STitle) 7513**], and', 'starting home cardiac meds']","['BLOOD CULTURED - At [**2189-7-16**] 08:31 PM', ' NASAL SWAB - At [**2189-7-16**] 08:31 PM', ' URINE CULTURE - At [**2189-7-16**] 08:32 PM', '-Continued requiring high flow O2 o/n.', ""-desaturations to low 80's with change to NC"", '-Sips of clears only while high O2 requirements persist', '-some productive cough with sputum', '-daughter concerned about nutrition status, calling Dr. [**Last Name (STitle) 7513**], and', 'starting home cardiac meds']",,69380,124616.0
2,2189-07-18 07:08:45,"['ULTRASOUND - At [**2189-7-17**] 10:10 AM', ' ARTERIAL LINE - START [**2189-7-18**] 12:19 AM', '-When pt would get up to urinate, he would desat to high 60s. However,', 'around 2200 got up to urinate and desated to 40s. Patient was intubated', 'and OG tube placed.', '- Art line was placed', '- Family called', '- BLE U/S showed no DVT', '- Extensive discussion with interpreter about [**Company 157**] and goals of care.', 'ICU consent signed in afternoon.']","['ULTRASOUND - At [**2189-7-17**] 10:10 AM', ' ARTERIAL LINE - START [**2189-7-18**] 12:19 AM', '-When pt would get up to urinate, he would desat to high 60s. However,', 'around 2200 got up to urinate and desated to 40s. Patient was intubated', 'and OG tube placed.', '- Art line was placed', '- Family called', '- BLE U/S showed no DVT', '- Extensive discussion with interpreter about [**Company 157**] and goals of care.', 'ICU consent signed in afternoon.']","['BLOOD CULTURED - At [**2189-7-16**] 08:31 PM', ' NASAL SWAB - At [**2189-7-16**] 08:31 PM', ' URINE CULTURE - At [**2189-7-16**] 08:32 PM', '-Continued requiring high flow O2 o/n.', ""-desaturations to low 80's with change to NC"", '-Sips of clears only while high O2 requirements persist', '-some productive cough with sputum', '-daughter concerned about nutrition status, calling Dr. [**Last Name (STitle) 7513**], and', 'starting home cardiac meds']",69380,124616.0
3,2189-07-18 08:20:19,,"['ULTRASOUND - At [**2189-7-17**] 10:10 AM', ' ARTERIAL LINE - START [**2189-7-18**] 12:19 AM', '-When pt would get up to urinate, he would desat to high 60s. However,', 'around 2200 got up to urinate and desated to 40s. Patient was intubated', 'and OG tube placed.', '- Art line was placed', '- Family called', '- BLE U/S showed no DVT', '- Extensive discussion with interpreter about [**Company 157**] and goals of care.', 'ICU consent signed in afternoon.']",,69380,124616.0
4,2189-07-18 09:56:48,,"['ULTRASOUND - At [**2189-7-17**] 10:10 AM', ' ARTERIAL LINE - START [**2189-7-18**] 12:19 AM', '-When pt would get up to urinate, he would desat to high 60s. However,', 'around 2200 got up to urinate and desated to 40s. Patient was intubated', 'and OG tube placed.', '- Art line was placed', '- Family called', '- BLE U/S showed no DVT', '- Extensive discussion with interpreter about [**Company 157**] and goals of care.', 'ICU consent signed in afternoon.']",,69380,124616.0
5,2189-07-19 07:47:27,"['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65; sats decreased', 'to 91% in am after repositioning, resent gas']","['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65; sats decreased', 'to 91% in am after repositioning, resent gas']","['ULTRASOUND - At [**2189-7-17**] 10:10 AM', ' ARTERIAL LINE - START [**2189-7-18**] 12:19 AM', '-When pt would get up to urinate, he would desat to high 60s. However,', 'around 2200 got up to urinate and desated to 40s. Patient was intubated', 'and OG tube placed.', '- Art line was placed', '- Family called', '- BLE U/S showed no DVT', '- Extensive discussion with interpreter about [**Company 157**] and goals of care.', 'ICU consent signed in afternoon.']",69380,124616.0
6,2189-07-19 08:08:42,,"['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65; sats decreased', 'to 91% in am after repositioning, resent gas']",,69380,124616.0
7,2189-07-19 08:26:36,,"['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65; sats decreased', 'to 91% in am after repositioning, resent gas']",,69380,124616.0
8,2189-07-19 10:37:32,"['-doing well on PCV; increased fi02 to 60% for PO2 at 65 and increased', 'to 90', '7.36/43/90 most recent ABG']","['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65 and increased', 'to 90', '7.36/43/90 most recent ABG']","['-doing well on PCV; increased fi02 to 60% for PO2 at 65; sats decreased', 'to 91% in am after repositioning, resent gas']",69380,124616.0
9,2189-07-20 07:11:51,"[""Mini BAl collected. paralytics d/c'd, continued with fentanyl/versed"", 'sedation.  UOP remained >30, so no fluid boluses required. ABGs', 'consistent. No acute events.']","[""Mini BAl collected. paralytics d/c'd, continued with fentanyl/versed"", 'sedation.  UOP remained >30, so no fluid boluses required. ABGs', 'consistent. No acute events.']","['MULTI LUMEN - START [**2189-7-18**] 02:50 PM', ""-d/c'd propfol"", '-changed PPI to H2B', '-dysynchronous with vent even when maximally sedated, so started', 'parlytics', '-given 2.5L NS for hypotension; HR low and poor UOP; so put in left IJ', 'line for better monitoring and access', '-sent UA for pink sediment, also sent Ulytes', '-put in for consult for tube feeds-recs received', '-high residuals >200, changed important meds to IV or PR, except Plavix', '(discuss on rounds)', '-good UOP >30cc/hr until this am, gave 500cc bolus', '-long discussion with family on seriousness of current condition', '-doing well on PCV; increased fi02 to 60% for PO2 at 65 and increased', 'to 90', '7.36/43/90 most recent ABG']",69380,124616.0
10,2189-07-20 16:07:18,,"[""Mini BAl collected. paralytics d/c'd, continued with fentanyl/versed"", 'sedation.  UOP remained >30, so no fluid boluses required. ABGs', 'consistent. No acute events.']",,69380,124616.0
11,2189-07-20 20:24:55,,"[""Mini BAl collected. paralytics d/c'd, continued with fentanyl/versed"", 'sedation.  UOP remained >30, so no fluid boluses required. ABGs', 'consistent. No acute events.']",,69380,124616.0
12,2189-07-21 07:21:23,"['FiO2 weaned, ABG stable, tube feeds residuals 200 got KUB - no', 'obstruction, decreased fentanyl due to bradycardia']","['FiO2 weaned, ABG stable, tube feeds residuals 200 got KUB - no', 'obstruction, decreased fentanyl due to bradycardia']","[""Mini BAl collected. paralytics d/c'd, continued with fentanyl/versed"", 'sedation.  UOP remained >30, so no fluid boluses required. ABGs', 'consistent. No acute events.']",69380,124616.0
13,2189-07-21 10:50:26,,"['FiO2 weaned, ABG stable, tube feeds residuals 200 got KUB - no', 'obstruction, decreased fentanyl due to bradycardia']",,69380,124616.0
14,2189-07-22 08:03:20,"['-Weaned to pressure-supported ventilation, with stable ABG but', 'development of apnea. Switched to manditory minute ventilation/pressure', 'support ventilation, with continuted stable ABG. Switched back to CPAP', 'overnight.', '-Sedation weaned but increased again due to agitation yesterday.', 'Increased again overnight due to significant agitation (100 mcg/hr', 'Fentanyl, 8 mg/hr Versed)', '-UOP remained >30 mL/hr.', '-Bowel regimen initiated for increased tube feed residuals and', 'decreased bowel movements. No bowel movements occurrred. No tube feed', 'residuals.', '-Persistent bradycardia despite decreased Fentanyl.', '-Family meeting with social work tomorrow, 1PM.', '-PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7579**] updated via email but she is on maternity leave.']","['-Weaned to pressure-supported ventilation, with stable ABG but', 'development of apnea. Switched to manditory minute ventilation/pressure', 'support ventilation, with continuted stable ABG. Switched back to CPAP', 'overnight.', '-Sedation weaned but increased again due to agitation yesterday.', 'Increased again overnight due to significant agitation (100 mcg/hr', 'Fentanyl, 8 mg/hr Versed)', '-UOP remained >30 mL/hr.', '-Bowel regimen initiated for increased tube feed residuals and', 'decreased bowel movements. No bowel movements occurrred. No tube feed', 'residuals.', '-Persistent bradycardia despite decreased Fentanyl.', '-Family meeting with social work tomorrow, 1PM.', '-PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7579**] updated via email but she is on maternity leave.']","['FiO2 weaned, ABG stable, tube feeds residuals 200 got KUB - no', 'obstruction, decreased fentanyl due to bradycardia']",69380,124616.0
15,2189-07-22 11:29:49,"['-Weaned from pressure control to pressure-support ventilation, with', 'stable ABG but development of apnea. Switched to mandatory minute', 'ventilation/pressure support ventilation, with continued stable ABG.', 'Switched back to CPAP overnight.', '-Sedation weaned (Versed as low as 2 mg/hr) but increased again due to', 'agitation yesterday. Increased again overnight due to significant', 'agitation (100 mcg/hr Fentanyl, 8 mg/hr Versed). Yesterday spoke with', 'nurse [**First Name (Titles) **] [**Last Name (Titles) 7581**] interpreter; he was able to nod his head but', 'occasionally answered inappropriately.', 'decreased bowel movements. No bowel movements occurrred. Tube feed', 'residuals present (amt not recorded).', '-Family meeting with social work today, 1PM.']","['-Weaned from pressure control to pressure-support ventilation, with', 'stable ABG but development of apnea. Switched to mandatory minute', 'ventilation/pressure support ventilation, with continued stable ABG.', 'Switched back to CPAP overnight.', '-Sedation weaned (Versed as low as 2 mg/hr) but increased again due to', 'agitation yesterday. Increased again overnight due to significant', 'agitation (100 mcg/hr Fentanyl, 8 mg/hr Versed). Yesterday spoke with', 'nurse [**First Name (Titles) **] [**Last Name (Titles) 7581**] interpreter; he was able to nod his head but', 'occasionally answered inappropriately.', '-UOP remained >30 mL/hr.', '-Bowel regimen initiated for increased tube feed residuals and', 'decreased bowel movements. No bowel movements occurrred. Tube feed', 'residuals present (amt not recorded).', '-Persistent bradycardia despite decreased Fentanyl.', '-Family meeting with social work today, 1PM.', '-PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7579**] updated via email but she is on maternity leave.']","['-Weaned to pressure-supported ventilation, with stable ABG but', 'development of apnea. Switched to manditory minute ventilation/pressure', 'support ventilation, with continuted stable ABG. Switched back to CPAP', 'overnight.', '-Sedation weaned but increased again due to agitation yesterday.', 'Increased again overnight due to significant agitation (100 mcg/hr', 'Fentanyl, 8 mg/hr Versed)', 'decreased bowel movements. No bowel movements occurrred. No tube feed', 'residuals.', '-Family meeting with social work tomorrow, 1PM.']",69380,124616.0
16,2189-07-22 12:22:10,,"['-Weaned from pressure control to pressure-support ventilation, with', 'stable ABG but development of apnea. Switched to mandatory minute', 'ventilation/pressure support ventilation, with continued stable ABG.', 'Switched back to CPAP overnight.', '-Sedation weaned (Versed as low as 2 mg/hr) but increased again due to', 'agitation yesterday. Increased again overnight due to significant', 'agitation (100 mcg/hr Fentanyl, 8 mg/hr Versed). Yesterday spoke with', 'nurse [**First Name (Titles) **] [**Last Name (Titles) 7581**] interpreter; he was able to nod his head but', 'occasionally answered inappropriately.', '-UOP remained >30 mL/hr.', '-Bowel regimen initiated for increased tube feed residuals and', 'decreased bowel movements. No bowel movements occurrred. Tube feed', 'residuals present (amt not recorded).', '-Persistent bradycardia despite decreased Fentanyl.', '-Family meeting with social work today, 1PM.', '-PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7579**] updated via email but she is on maternity leave.']",,69380,124616.0
17,2189-07-23 07:19:06,"['Sedation decreased and seen with Farsi interpretor.  Following', 'commands, MS appears appropriate.  Farsi interpretor available on page', 'in the afternoon, and can be here around 1:30pm if we would like to', 'extubate.  Dr. [**Last Name (STitle) 7597**] advised a steroid taper(150, 120, 100 QD) and', 'advised Bactrim prophylaxis for .  UOP adequate all day.']","['Sedation decreased and seen with Farsi interpretor.  Following', 'commands, MS appears appropriate.  Farsi interpretor available on page', 'in the afternoon, and can be here around 1:30pm if we would like to', 'extubate.  Dr. [**Last Name (STitle) 7597**] advised a steroid taper(150, 120, 100 QD) and', 'advised Bactrim prophylaxis for .  UOP adequate all day.']","['-Weaned from pressure control to pressure-support ventilation, with', 'stable ABG but development of apnea. Switched to mandatory minute', 'ventilation/pressure support ventilation, with continued stable ABG.', 'Switched back to CPAP overnight.', '-Sedation weaned (Versed as low as 2 mg/hr) but increased again due to', 'agitation yesterday. Increased again overnight due to significant', 'agitation (100 mcg/hr Fentanyl, 8 mg/hr Versed). Yesterday spoke with', 'nurse [**First Name (Titles) **] [**Last Name (Titles) 7581**] interpreter; he was able to nod his head but', 'occasionally answered inappropriately.', '-UOP remained >30 mL/hr.', '-Bowel regimen initiated for increased tube feed residuals and', 'decreased bowel movements. No bowel movements occurrred. Tube feed', 'residuals present (amt not recorded).', '-Persistent bradycardia despite decreased Fentanyl.', '-Family meeting with social work today, 1PM.', '-PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7579**] updated via email but she is on maternity leave.']",69380,124616.0
18,2189-07-23 07:56:41,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']","['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']","['Sedation decreased and seen with Farsi interpretor.  Following', 'commands, MS appears appropriate.  Farsi interpretor available on page', 'in the afternoon, and can be here around 1:30pm if we would like to', 'extubate.  Dr. [**Last Name (STitle) 7597**] advised a steroid taper(150, 120, 100 QD) and', 'advised Bactrim prophylaxis for .  UOP adequate all day.']",69380,124616.0
19,2189-07-23 07:58:11,,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",,69380,124616.0
20,2189-07-23 11:37:35,,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",,69380,124616.0
21,2189-07-23 14:07:17,,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",,69380,124616.0
22,2189-07-23 14:08:52,,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",,69380,124616.0
23,2189-07-23 19:29:55,,"['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",,69380,124616.0
24,2189-07-24 07:35:46,"['INVASIVE VENTILATION - STOP [**2189-7-23**] 03:45 PM', 'Decreased sedation. Only -950 out with 20 IV lasix. Decreased steroids', 'by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim. Daughter', 'informed about extubation. Pt extubated SpO2 95%, ABG Stable, on', 'facemask 100%. Attempt to ween to 80% O2 lead to desaturation.', 'Gave zofran for nausea, 5mg hydralazine for HTN, haldol', 'Had some blood-tinged urine.', 'If failing consider diuresis and noninvasive ventilation. Held', 'atorvastatin, PO acetylcysteine.']","['INVASIVE VENTILATION - STOP [**2189-7-23**] 03:45 PM', 'Decreased sedation. Only -950 out with 20 IV lasix. Decreased steroids', 'by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim. Daughter', 'informed about extubation. Pt extubated SpO2 95%, ABG Stable, on', 'facemask 100%. Attempt to ween to 80% O2 lead to desaturation.', 'Gave zofran for nausea, 5mg hydralazine for HTN, haldol', 'Had some blood-tinged urine.', 'If failing consider diuresis and noninvasive ventilation. Held', 'atorvastatin, PO acetylcysteine.']","['Ventilator weaned with stable ABG. Sedation decreased and was seen with', 'Farsi interpreter', 'he was following commands, MS appears appropriate.', 'Farsi interpreter available on page in the afternoon, and can be here']",69380,124616.0
25,2189-07-24 07:59:46,"['by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim.', 'Pt extubated SpO2 95%, ABG Stable, on facemask 100%. Attempt to wean to', '80% O2 lead to ABG PaO2 of 60.', 'Gave zofran for nausea, 5mg hydralazine for HTN, Haldol.']","['INVASIVE VENTILATION - STOP [**2189-7-23**] 03:45 PM', 'Decreased sedation. Only -950 out with 20 IV lasix. Decreased steroids', 'by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim.', 'Pt extubated SpO2 95%, ABG Stable, on facemask 100%. Attempt to wean to', '80% O2 lead to ABG PaO2 of 60.', 'Gave zofran for nausea, 5mg hydralazine for HTN, Haldol.', 'Had some blood-tinged urine.']","['by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim. Daughter', 'informed about extubation. Pt extubated SpO2 95%, ABG Stable, on', 'facemask 100%. Attempt to ween to 80% O2 lead to desaturation.', 'Gave zofran for nausea, 5mg hydralazine for HTN, haldol', 'If failing consider diuresis and noninvasive ventilation. Held', 'atorvastatin, PO acetylcysteine.']",69380,124616.0
26,2189-07-24 13:22:57,"['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']","['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']","['INVASIVE VENTILATION - STOP [**2189-7-23**] 03:45 PM', 'Decreased sedation. Only -950 out with 20 IV lasix. Decreased steroids', 'by 10 per Dr.[**Name (NI) 7618**] suggestion. Started bactrim.', 'Pt extubated SpO2 95%, ABG Stable, on facemask 100%. Attempt to wean to', '80% O2 lead to ABG PaO2 of 60.', 'Gave zofran for nausea, 5mg hydralazine for HTN, Haldol.', 'Had some blood-tinged urine.']",69380,124616.0
27,2189-07-24 13:24:21,,"['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']",,69380,124616.0
28,2189-07-24 13:25:41,,"['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']",,69380,124616.0
29,2189-07-24 16:29:12,,"['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']",,69380,124616.0
30,2189-07-25 07:57:34,"['--Weaned to 60% O2 with 02 sat generally >/=90%. Desaturation with', 'repositioning to 85%.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. To take PR lactulose when wakes', 'up.']","['--Weaned to 60% O2 with 02 sat generally >/=90%. Desaturation with', 'repositioning to 85%.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. To take PR lactulose when wakes', 'up.']","['Pt  weaned of sedation and extubated SpO2 95%, ABG stable, on facemask', '100%. Initial attempt to wean to 80% FiO2 lead to ABG PaO2 of 60.', 'Weaned to 60% this AM, with O2 sat 95%, ABG pending.', 'Received Lasix 20 mL IV. Decreased steroids by 10mg per Dr.[**Name (NI) 7618**]', 'suggestion. Started bactrim.', 'Received Zofran for nausea, 5mg hydralazine for HTN, Haldol for', 'agitation.', 'Has blood-tinged urine.']",69380,124616.0
31,2189-07-25 08:34:57,['throughout indicating no obstruction. Large BM this AM.'],"['--Weaned to 60% O2 with 02 sat generally >/=90%. Desaturation with', 'repositioning to 85%.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM this AM.']","['throughout indicating no obstruction. To take PR lactulose when wakes', 'up.']",69380,124616.0
32,2189-07-25 15:27:55,"['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.']","['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']","['--Weaned to 60% O2 with 02 sat generally >/=90%. Desaturation with', 'repositioning to 85%.', 'throughout indicating no obstruction. Large BM this AM.']",69380,124616.0
33,2189-07-26 00:28:46,,"['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']",,69380,124616.0
34,2189-07-26 07:33:05,"['-O2 sat >/=95% on FiO2 60 by face mask.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Overnight, tachypnic with crackles at lung bases; required Lasix 20 mg', 'IV and 100% FiO2 with resolution of acute tachypnea and clearing of', 'lungs.', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN.', '-NAC restarted (held for NPO).', '-Hct down from 36.5 to 33.1. B12/folate/LFTs to be collected tomorrow.', '-Has required only 4 units of ISS during stay. Decreased fingersticks', 'to bedtime and fasting QAM.']","['-O2 sat >/=95% on FiO2 60 by face mask.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Overnight, tachypnic with crackles at lung bases; required Lasix 20 mg', 'IV and 100% FiO2 with resolution of acute tachypnea and clearing of', 'lungs.', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN.', '-NAC restarted (held for NPO).', '-Hct down from 36.5 to 33.1. B12/folate/LFTs to be collected tomorrow.', '-Has required only 4 units of ISS during stay. Decreased fingersticks', 'to bedtime and fasting QAM.']","['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']",69380,124616.0
35,2189-07-26 11:35:33,"['-O2 sat >/=95% on FiO2 60 by face mask. However, overnight, he had a', 'tachypneic with crackles at lung bases; required Lasix 20 mg IV and', 'FiO2 100 with resolution of acute tachypnea and clearing of lungs.', 'Sense weaned down to FiO2 60 with stable SpO2.', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN; will receive']","['-O2 sat >/=95% on FiO2 60 by face mask. However, overnight, he had a', 'tachypneic with crackles at lung bases; required Lasix 20 mg IV and', 'FiO2 100 with resolution of acute tachypnea and clearing of lungs.', 'Sense weaned down to FiO2 60 with stable SpO2.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN; will receive']","['-O2 sat >/=95% on FiO2 60 by face mask.', '-Overnight, tachypnic with crackles at lung bases; required Lasix 20 mg', 'IV and 100% FiO2 with resolution of acute tachypnea and clearing of', 'lungs.', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN.', '-NAC restarted (held for NPO).', '-Hct down from 36.5 to 33.1. B12/folate/LFTs to be collected tomorrow.', '-Has required only 4 units of ISS during stay. Decreased fingersticks', 'to bedtime and fasting QAM.']",69380,124616.0
36,2189-07-26 13:10:37,,"['-O2 sat >/=95% on FiO2 60 by face mask. However, overnight, he had a', 'tachypneic with crackles at lung bases; required Lasix 20 mg IV and', 'FiO2 100 with resolution of acute tachypnea and clearing of lungs.', 'Sense weaned down to FiO2 60 with stable SpO2.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN; will receive']",,69380,124616.0
37,2189-07-26 19:34:07,,"['-O2 sat >/=95% on FiO2 60 by face mask. However, overnight, he had a', 'tachypneic with crackles at lung bases; required Lasix 20 mg IV and', 'FiO2 100 with resolution of acute tachypnea and clearing of lungs.', 'Sense weaned down to FiO2 60 with stable SpO2.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN; will receive']",,69380,124616.0
38,2189-07-27 05:52:02,"[""Desat to high 60's after taking PO NAC, did not initially go up with"", ""high flow, given albuterol with increase in sats. D/C'ed NAC. CXR"", ""ordered - unchanged, ABG ordered - PaO2 in 30's. Nasal canula 4L and 6L"", 'O2 sats to 85.', 'Peripheral IV placed, IJ pulled.', ' MULTI LUMEN - STOP [**2189-7-26**] 07:22 PM']","[""Desat to high 60's after taking PO NAC, did not initially go up with"", ""high flow, given albuterol with increase in sats. D/C'ed NAC. CXR"", ""ordered - unchanged, ABG ordered - PaO2 in 30's. Nasal canula 4L and 6L"", 'O2 sats to 85.', 'Peripheral IV placed, IJ pulled.', ' MULTI LUMEN - STOP [**2189-7-26**] 07:22 PM']","['-O2 sat >/=95% on FiO2 60 by face mask. However, overnight, he had a', 'tachypneic with crackles at lung bases; required Lasix 20 mg IV and', 'FiO2 100 with resolution of acute tachypnea and clearing of lungs.', 'Sense weaned down to FiO2 60 with stable SpO2.', '-BM x2 (guaiac negative)', '-UOP adequate; goal 30 cc/hr', '-Diet advanced to dysphagia diet.', ""-D/C'd abx for HCAP (cefepime, vanco, cipro). Continued Bactrim for PCP"", '[**Name Initial (PRE) 3261**].', '-Imdur increased to 60 mg PO QD (outpatient dose) for HTN; will receive']",69380,124616.0
39,2189-07-27 11:48:53,"[""ordered - unchanged, ABG ordered - PaO2 in 30's."", 'Nasal canula 4L and 6L O2 sats to 85.']","[""Desat to high 60's after taking PO NAC, did not initially go up with"", ""high flow, given albuterol with increase in sats. D/C'ed NAC. CXR"", ""ordered - unchanged, ABG ordered - PaO2 in 30's."", 'Nasal canula 4L and 6L O2 sats to 85.', 'Peripheral IV placed, IJ pulled.', ' MULTI LUMEN - STOP [**2189-7-26**] 07:22 PM']","[""ordered - unchanged, ABG ordered - PaO2 in 30's. Nasal canula 4L and 6L"", 'O2 sats to 85.']",69380,124616.0
40,2189-07-28 07:31:00,"['Methyl pred now 20 q8, passed swallow eval, diet is thickened liquids', 'but O2 sats worse so holding PO.', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Plan for family meeting today, 2PM.']","['Methyl pred now 20 q8, passed swallow eval, diet is thickened liquids', 'but O2 sats worse so holding PO.', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Plan for family meeting today, 2PM.']","[""Desat to high 60's after taking PO NAC, did not initially go up with"", ""high flow, given albuterol with increase in sats. D/C'ed NAC. CXR"", ""ordered - unchanged, ABG ordered - PaO2 in 30's."", 'Nasal canula 4L and 6L O2 sats to 85.', 'Peripheral IV placed, IJ pulled.', ' MULTI LUMEN - STOP [**2189-7-26**] 07:22 PM']",69380,124616.0
41,2189-07-28 07:50:34,['Cough improved per nursing on hydrocodone.'],"['Methyl pred now 20 q8, passed swallow eval, diet is thickened liquids', 'but O2 sats worse so holding PO.', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 2PM.']",,69380,124616.0
42,2189-07-28 14:03:38,"['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Got Fluid bolus, improved BPs. Hct stable.', 'Methylprednisolone taper now at 20 mg IV TID', 'Plan for family meeting today, 3PM.']","['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']","['Methyl pred now 20 q8, passed swallow eval, diet is thickened liquids', 'but O2 sats worse so holding PO.', 'Got Fluid bolus, improved BPs.', 'Plan for family meeting today, 2PM.']",69380,124616.0
43,2189-07-28 14:08:29,,"['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']",,69380,124616.0
44,2189-07-29 07:42:51,"['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Desaturation with exertion and with anxiety, which', 'resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg hydrocodone, which was an', 'improvement.']","['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Desaturation with exertion and with anxiety, which', 'resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg hydrocodone, which was an', 'improvement.']","['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']",69380,124616.0
45,2189-07-29 09:01:09,,"['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Desaturation with exertion and with anxiety, which', 'resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg hydrocodone, which was an', 'improvement.']",,69380,124616.0
46,2189-07-29 09:10:20,,"['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Desaturation with exertion and with anxiety, which', 'resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg hydrocodone, which was an', 'improvement.']",,69380,124616.0
47,2189-07-29 12:36:46,"['80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']","['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']","['80 to 90 overnight. Desaturation with exertion and with anxiety, which', 'resolves without intervention.', 'Slept for 5 hours last night after 10 mg hydrocodone, which was an', 'improvement.']",69380,124616.0
48,2189-07-29 12:39:47,,"['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']",,69380,124616.0
49,2189-07-30 07:29:39,"['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers Sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evalution at rehab before advancing', 'diet.', 'Trial of ativan added for anxiety.', 'CXR no evidence of pneumonia', 'U/A pending']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers Sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evalution at rehab before advancing', 'diet.', 'Trial of ativan added for anxiety.', 'CXR no evidence of pneumonia', 'U/A pending']","['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']",69380,124616.0
50,2189-07-30 10:52:23,"['Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers Sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evalution at rehab before advancing', 'diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['Trial of ativan added for anxiety.', 'U/A pending']",69380,124616.0
51,2189-07-30 10:53:12,"['overnight. Continues to desat to 80s with any activity---recovers sats', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['overnight. Continues to desat to 80s with any activity---recovers Sats', 'purees, 1:1 supervision, swallow re-evalution at rehab before advancing', 'diet.']",69380,124616.0
52,2189-07-30 11:13:15,,"['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']",,69380,124616.0
53,2189-07-31 07:17:29,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']",69380,124616.0
54,2189-07-31 07:28:50,,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']",,69380,124616.0
55,2189-07-31 07:29:52,"['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']",69380,124616.0
56,2189-07-31 12:43:32,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']",69380,124616.0
57,2189-07-31 13:18:05,"['eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']","['eating. Producing moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on zosyn, cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety.', '1 large bowel movement. Daughter seeking second opinion.']",69380,124616.0
58,2189-07-31 13:43:57,,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']",,69380,124616.0
59,2189-07-31 14:55:18,,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']",,69380,124616.0
60,2189-07-31 15:30:13,"['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']","['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']",69380,124616.0
61,2189-07-31 15:30:47,"['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']","['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']","['--Weaned to 60% O2 with 02 sat generally >/=92%. Desaturation with', 'repositioning to 85% with resolution not without intervention.', '--Speech and swallow recommended that he remain NPO at this time, with', 'alternate means of nutrition, hydration, and medications over the', 'weekend. Essential meds may be given crushed with puree, strictly NPO', 'if status worsens. Speech and swallow will re-evaluate next week. His', 'nurse said that he is more alert than when evaluated by speech and', 'swallow this AM and tolerated meds crushed in thick', 'liquid/puree--suggested team re-evaluate this PM whether he needs an NG', 'tube placement vs. can tolerate slow advancement of diet.', '--Started Imdur 30 mg PO yesterday with improvement to hypertension.', '--Received Zofran for nausea. Overnight, developed cramping abdominal', 'pain without tenderness to palpation after several hours dry heaves.', 'Also has not had BM in 10days. KUB showed stool in rectal vault, air', 'throughout indicating no obstruction. Large BM (guaiac negative) this', 'AM. No abdominal pain this AM.', '--Continues with blood-tinged urine by Foley.', '--Exceeded I/O goal of net -1L without need for Lasix, with stable BUN', 'and Cr.']",69380,124616.0
62,2189-07-31 15:31:14,"['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']","['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']","['Passed swallow eval, diet is thickened liquids but O2 sats worse so', 'holding PO. O2 requirement 6L NC + non-rebreather yesterday. Weaned', 'this AM to 80% high flow, with SpO2 >/=90-95%', 'Diuresed, became hypotensive, tachycardic with increased 02', 'requirement.', 'Got Fluid bolus, improved BPs. Hct stable.', 'Spoke with him/daughter about reintubating if 02 sat continues to get', 'worse, agreed with plan.', 'Methylprednisolone taper now at 20 mg IV TID', 'Cough improved per nursing on hydrocodone.', 'Plan for family meeting today, 3PM.']",69380,124616.0
63,2189-07-31 15:34:09,"['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']","['Weaned to FiO2 high flow mask yesterday but required FiO2 increase from', '80 to 90 overnight. Switched to FiO2 95 this AM in anticipation of', 'desat while moving to chair. Desaturation with exertion and with', 'anxiety, which otherwise resolves without intervention.', 'Tolerated advancement of diet to thickened liquids, and PO meds were', 'restarted.', 'UOP >30 cc/hr.', 'NAC restarted.', 'Family meeting with Farsi interpreter today, with extensive discussion', 'regarding the nature of IPF and the goal to wean O2 requirement to', 'permit transfer to rehab.', 'Slept for 5 hours last night after 10 mg guaifenesin-codeine, which was', 'an improvement.', 'No BM since [**2189-7-25**], at which point he had BM x 4.']",69380,124616.0
64,2189-07-31 15:35:11,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']","['ARTERIAL LINE - STOP [**2189-7-29**] 06:07 PM', 'Weaned to FiO2 60 high flow mask yesterday but increased to 95%', 'overnight. Continues to desat to 80s with any activity---recovers sats', 'with slow deep breathing exercises.', 'Speech and swallow recommended continuing thickened liquids, meds in', 'purees, 1:1 supervision, swallow re-evaluation at rehab before', 'advancing diet.', 'Trial of Ativan 0.25 mg for anxiety with little effect.', 'He did not sleep overnight and anxiety persists.', 'No BM for 5 days.', 'Increased sputum production.', 'CXR no evidence of pneumonia', 'U/A with persistent RBC, WBC, bacteria improved from [**2189-7-25**], negative', 'for leuk and nitrite.', 'A-line and Foley discontinued.']",69380,124616.0
65,2189-07-31 15:35:40,,"['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']",,69380,124616.0
66,2189-08-01 07:24:56,"['The family wants to be transfered to [**Hospital6 870**] for second', 'opinion. [**Hospital3 **] agreed to take him today. Family is aware.', 'PICC was scheduled for yesterday, refused by patient - want to get done', 'at [**Hospital3 **]', 'O2 sats remain generally >95% on FiO2 95 high flow mask, with 6L NC', 'when eating.', 'ISS restarted given glucose >150.']","['The family wants to be transfered to [**Hospital6 870**] for second', 'opinion. [**Hospital3 **] agreed to take him today. Family is aware.', 'PICC was scheduled for yesterday, refused by patient - want to get done', 'at [**Hospital3 **]', 'O2 sats remain generally >95% on FiO2 95 high flow mask, with 6L NC', 'when eating.', 'ISS restarted given glucose >150.']","['O2 requirement remains FiO2 95 on high flow mask, with 6L NC while', 'eating. Continues to desaturate to 80s with any exertion. Producing', 'moderate to large amounts of white sputum.', 'Sputum culture collected, empirically started on Zosyn, Cipro.', 'Lorazepam increased from 0.25 to 0.5 for anxiety, seemingly with good', 'effect.', '1 large bowel movement.', 'Slept for 4 hours last night, which is an improvement.', 'Daughter seeking second opinion/possible transfer to [**Hospital3 7727**].']",69380,124616.0
67,2189-08-01 21:42:15,,"['The family wants to be transfered to [**Hospital6 870**] for second', 'opinion. [**Hospital3 **] agreed to take him today. Family is aware.', 'PICC was scheduled for yesterday, refused by patient - want to get done', 'at [**Hospital3 **]', 'O2 sats remain generally >95% on FiO2 95 high flow mask, with 6L NC', 'when eating.', 'ISS restarted given glucose >150.']",,69380,124616.0
0,2199-03-13 07:50:39,,"['NON-INVASIVE VENTILATION - START [**2199-3-12**] 10:43 PM', '- admitted with resp distress', '- positive pressure ventilation with goals sats of low 90s given high', 'CO2 retention', '- WOB decreased', '- RT had difficulty titrating CPAP/BiPAP & maintaining sats, pt was', 'switched to NC with face tent of 60%, sats stable in low 90s now', 'Pt doing well this am, denies SOB/cough/CP.  Pt has some abd', 'pain/distension & needs to have a BM.']",,3070,171863.0
1,2199-03-13 13:09:02,,"['NON-INVASIVE VENTILATION - START [**2199-3-12**] 10:43 PM', '- admitted with resp distress', '- positive pressure ventilation with goals sats of low 90s given high', 'CO2 retention', '- WOB decreased', '- RT had difficulty titrating CPAP/BiPAP & maintaining sats, pt was', 'switched to NC with face tent of 60%, sats stable in low 90s now', 'Pt doing well this am, denies SOB/cough/CP.  Pt has some abd', 'pain/distension & needs to have a BM.']",,3070,171863.0
2,2199-03-14 07:01:06,"['URINE CULTURE - At [**2199-3-13**] 08:15 AM', ' NON-INVASIVE VENTILATION - STOP [**2199-3-13**] 07:02 PM', ' NON-INVASIVE VENTILATION - START [**2199-3-13**] 11:05 PM', ' CALLED OUT', '-- began steroid taper', '-- pt comfortable throughout day, but w/ thick, congestive cough.', 'Desats to low 80s w/ chest PT', '-- repeat ABGs c/w with baseline, improved pH to 7.39 but continued', 'hypercapnea', '-- decreased neb frequency to see if could tolerate for floor', '-- ordered for HS BIPAP at home settings']","['URINE CULTURE - At [**2199-3-13**] 08:15 AM', ' NON-INVASIVE VENTILATION - STOP [**2199-3-13**] 07:02 PM', ' NON-INVASIVE VENTILATION - START [**2199-3-13**] 11:05 PM', ' CALLED OUT', '-- began steroid taper', '-- pt comfortable throughout day, but w/ thick, congestive cough.', 'Desats to low 80s w/ chest PT', '-- repeat ABGs c/w with baseline, improved pH to 7.39 but continued', 'hypercapnea', '-- decreased neb frequency to see if could tolerate for floor', '-- ordered for HS BIPAP at home settings']","['NON-INVASIVE VENTILATION - START [**2199-3-12**] 10:43 PM', '- admitted with resp distress', '- positive pressure ventilation with goals sats of low 90s given high', 'CO2 retention', '- WOB decreased', '- RT had difficulty titrating CPAP/BiPAP & maintaining sats, pt was', 'switched to NC with face tent of 60%, sats stable in low 90s now', 'Pt doing well this am, denies SOB/cough/CP.  Pt has some abd', 'pain/distension & needs to have a BM.']",3070,171863.0
3,2199-03-14 07:40:09,"['-- called out to floor', 'Pt was seen while taking a nebulizer treatment.  He was feeling SOB,', 'unable to bring up secretions while coughing.  Denies CP/ABD pain']","['-- began steroid taper', '-- pt comfortable throughout day, but w/ thick, congestive cough.', 'Desats to low 80s w/ chest PT', '-- repeat ABGs c/w with baseline, improved pH to 7.39 but continued', 'hypercapnea', '-- decreased neb frequency to see if could tolerate for floor', '-- ordered for HS BIPAP at home settings', '-- called out to floor', 'Pt was seen while taking a nebulizer treatment.  He was feeling SOB,', 'unable to bring up secretions while coughing.  Denies CP/ABD pain']","['URINE CULTURE - At [**2199-3-13**] 08:15 AM', ' NON-INVASIVE VENTILATION - STOP [**2199-3-13**] 07:02 PM', ' NON-INVASIVE VENTILATION - START [**2199-3-13**] 11:05 PM', ' CALLED OUT']",3070,171863.0
4,2199-03-14 16:02:34,,"['-- began steroid taper', '-- pt comfortable throughout day, but w/ thick, congestive cough.', 'Desats to low 80s w/ chest PT', '-- repeat ABGs c/w with baseline, improved pH to 7.39 but continued', 'hypercapnea', '-- decreased neb frequency to see if could tolerate for floor', '-- ordered for HS BIPAP at home settings', '-- called out to floor', 'Pt was seen while taking a nebulizer treatment.  He was feeling SOB,', 'unable to bring up secretions while coughing.  Denies CP/ABD pain']",,3070,171863.0
5,2199-03-15 07:33:24,"['NON-INVASIVE VENTILATION - STOP [**2199-3-14**] 07:24 PM', '- increased steroids to methylpred 60mg tid', '- tried to space out nebs to q4h prn overnight with bipap but pt', 'desatted and was switched back to face mask with nebs, restarted nebs', 'at q4h', 'Pt feeling SOB this am, still with non-productive cough.  No CP/ABD', 'pain, tolerating po.']","['NON-INVASIVE VENTILATION - STOP [**2199-3-14**] 07:24 PM', '- increased steroids to methylpred 60mg tid', '- tried to space out nebs to q4h prn overnight with bipap but pt', 'desatted and was switched back to face mask with nebs, restarted nebs', 'at q4h', 'Pt feeling SOB this am, still with non-productive cough.  No CP/ABD', 'pain, tolerating po.']","['-- began steroid taper', '-- pt comfortable throughout day, but w/ thick, congestive cough.', 'Desats to low 80s w/ chest PT', '-- repeat ABGs c/w with baseline, improved pH to 7.39 but continued', 'hypercapnea', '-- decreased neb frequency to see if could tolerate for floor', '-- ordered for HS BIPAP at home settings', '-- called out to floor', 'Pt was seen while taking a nebulizer treatment.  He was feeling SOB,', 'unable to bring up secretions while coughing.  Denies CP/ABD pain']",3070,171863.0
6,2199-03-15 15:43:30,"['- pt desatted & was switched back to face mask with nebs, restarted', 'nebs at q4h']","['NON-INVASIVE VENTILATION - STOP [**2199-3-14**] 07:24 PM', '- increased steroids to methylpred 60mg tid', '- pt desatted & was switched back to face mask with nebs, restarted', 'nebs at q4h', 'Pt feeling SOB this am, still with non-productive cough.  No CP/ABD', 'pain, tolerating po.']","['- tried to space out nebs to q4h prn overnight with bipap but pt', 'desatted and was switched back to face mask with nebs, restarted nebs', 'at q4h']",3070,171863.0
0,2114-04-01 07:35:22,,"['INVASIVE VENTILATION - START [**2114-3-31**] 06:53 PM', ' PRESEP CATHETER - START [**2114-3-31**] 07:00 PM', '- persistently hypotensive, 2L bolus with short-lived response,', 're-started dopamine 7am', '- failed am RSBI, no spontaneous breaths', 'History obtained from Medical records']",,28484,166083.0
1,2114-04-01 10:50:02,,"['INVASIVE VENTILATION - START [**2114-3-31**] 06:53 PM', ' PRESEP CATHETER - START [**2114-3-31**] 07:00 PM', '- persistently hypotensive, 2L bolus with short-lived response,', 're-started dopamine 7am', '- failed am RSBI, no spontaneous breaths', 'History obtained from Medical records']",,28484,166083.0
2,2114-04-02 08:01:44,"['- having increased yellow sputum secretion from ETT', '- pt oxygenating well on minimal vent settings (plan to extubate in am)', '- non gap acidosis likely [**2-24**] to NS resussitation']","['- having increased yellow sputum secretion from ETT', '- pt oxygenating well on minimal vent settings (plan to extubate in am)', '- non gap acidosis likely [**2-24**] to NS resussitation']","['INVASIVE VENTILATION - START [**2114-3-31**] 06:53 PM', ' PRESEP CATHETER - START [**2114-3-31**] 07:00 PM', '- persistently hypotensive, 2L bolus with short-lived response,', 're-started dopamine 7am', '- failed am RSBI, no spontaneous breaths', 'History obtained from Medical records']",28484,166083.0
3,2114-04-02 08:03:46,,"['- having increased yellow sputum secretion from ETT', '- pt oxygenating well on minimal vent settings (plan to extubate in am)', '- non gap acidosis likely [**2-24**] to NS resussitation']",,28484,166083.0
4,2114-04-03 07:26:58,,"['- having increased yellow sputum secretion from ETT', '- pt oxygenating well on minimal vent settings (plan to extubate in am)', '- non gap acidosis likely [**2-24**] to NS resussitation']",,28484,166083.0
5,2114-04-03 07:42:18,"['TRANSTHORACIC ECHO - At [**2114-4-2**] 11:25 AM', ' INVASIVE VENTILATION - STOP [**2114-4-2**] 02:40 PM', '-- extubated w/o difficulty', '-- TTE showed sever AS w/ [**Location (un) **] of 0.5.  Was discussed w/ PCP, [**Name10 (NameIs) **]', 'has long refused valve surgery.', '-- CT of head negative', '-- > 2L negative to lasix']","['TRANSTHORACIC ECHO - At [**2114-4-2**] 11:25 AM', ' INVASIVE VENTILATION - STOP [**2114-4-2**] 02:40 PM', '-- extubated w/o difficulty', '-- TTE showed sever AS w/ [**Location (un) **] of 0.5.  Was discussed w/ PCP, [**Name10 (NameIs) **]', 'has long refused valve surgery.', '-- CT of head negative', '-- > 2L negative to lasix']","['- having increased yellow sputum secretion from ETT', '- pt oxygenating well on minimal vent settings (plan to extubate in am)', '- non gap acidosis likely [**2-24**] to NS resussitation']",28484,166083.0
6,2114-04-03 22:12:37,,"['TRANSTHORACIC ECHO - At [**2114-4-2**] 11:25 AM', ' INVASIVE VENTILATION - STOP [**2114-4-2**] 02:40 PM', '-- extubated w/o difficulty', '-- TTE showed sever AS w/ [**Location (un) **] of 0.5.  Was discussed w/ PCP, [**Name10 (NameIs) **]', 'has long refused valve surgery.', '-- CT of head negative', '-- > 2L negative to lasix']",,28484,166083.0
7,2114-04-04 07:24:09,"['CALLED OUT', '- MRSA in sputum', '- switched to ceftriaxone for duration of 7 day course', '- restarted home lasix']","['CALLED OUT', '- MRSA in sputum', '- switched to ceftriaxone for duration of 7 day course', '- restarted home lasix']","['TRANSTHORACIC ECHO - At [**2114-4-2**] 11:25 AM', ' INVASIVE VENTILATION - STOP [**2114-4-2**] 02:40 PM', '-- extubated w/o difficulty', '-- TTE showed sever AS w/ [**Location (un) **] of 0.5.  Was discussed w/ PCP, [**Name10 (NameIs) **]', 'has long refused valve surgery.', '-- CT of head negative', '-- > 2L negative to lasix']",28484,166083.0
8,2114-04-04 10:31:34,,"['CALLED OUT', '- MRSA in sputum', '- switched to ceftriaxone for duration of 7 day course', '- restarted home lasix']",,28484,166083.0
0,2170-10-16 07:14:33,,"['BLOOD CULTURED - At [**2170-10-15**] 11:00 AM', ' URINE CULTURE - At [**2170-10-15**] 11:00 AM', ' MULTI LUMEN - START [**2170-10-15**] 12:45 PM', ' PICC LINE - START [**2170-10-15**] 01:35 PM', ' ARTERIAL LINE - START [**2170-10-15**] 01:38 PM', ' ULTRASOUND - At [**2170-10-15**] 04:00 PM', 'right upper quadrant ultrasound', '- Transfused 3 units PRBC with appropriate bump in hct, platelets x1,', 'FFP x1, cryoprecipitate x1.', '- RUQ US: No evidence of cholecystitis, innumerable hepatic mets', '- Low hapto, unchanged LDH. Smear from this AM did not show', 'schistocytes', '- Renal function improving', '- RIJ placed. As patient was hemodynamically stable without fever or', 'change in mental status, PICC left in place for now.']",,25696,188176.0
1,2170-10-16 18:31:48,['- Unable to pass NGT this morning'],"['BLOOD CULTURED - At [**2170-10-15**] 11:00 AM', ' URINE CULTURE - At [**2170-10-15**] 11:00 AM', ' MULTI LUMEN - START [**2170-10-15**] 12:45 PM', ' PICC LINE - START [**2170-10-15**] 01:35 PM', ' ARTERIAL LINE - START [**2170-10-15**] 01:38 PM', ' ULTRASOUND - At [**2170-10-15**] 04:00 PM', 'right upper quadrant ultrasound', '- Transfused 3 units PRBC with appropriate bump in hct, platelets x1,', 'FFP x1, cryoprecipitate x1.', '- RUQ US: No evidence of cholecystitis, innumerable hepatic mets', '- Low hapto, unchanged LDH. Smear from this AM did not show', 'schistocytes', '- Renal function improving', '- RIJ placed. As patient was hemodynamically stable without fever or', 'change in mental status, PICC left in place for now.', '- Unable to pass NGT this morning']",,25696,188176.0
2,2170-10-17 10:47:46,"['- No urology recs', ""- Spoke with Dr. [**Last Name (STitle) 5889**], patient's oncologist. Anemia/thrombocytopenia"", 'likely [**2-10**] bone mets from prostate CA + hematuria. No recommendations', 'at this time.', '- On [**2170-10-17**], needs type and screen reordered', '- Received 4U pRBCs, 1U platelets, and 500ml bolus x1', '- Guiac(+) stool, no melena or BRBPR', '- CT abdomen/pelvis - No RP or intraabdominal bleed', '- Sent off Coombs - pending', '- Hct: 23.0>20.6>23.2>23.6', '- Peripheral smear with occasional schistocytes', 'History obtained from Patient']","['- No urology recs', ""- Spoke with Dr. [**Last Name (STitle) 5889**], patient's oncologist. Anemia/thrombocytopenia"", 'likely [**2-10**] bone mets from prostate CA + hematuria. No recommendations', 'at this time.', '- On [**2170-10-17**], needs type and screen reordered', '- Received 4U pRBCs, 1U platelets, and 500ml bolus x1', '- Guiac(+) stool, no melena or BRBPR', '- CT abdomen/pelvis - No RP or intraabdominal bleed', '- Sent off Coombs - pending', '- Hct: 23.0>20.6>23.2>23.6', '- Peripheral smear with occasional schistocytes', 'History obtained from Patient']","['BLOOD CULTURED - At [**2170-10-15**] 11:00 AM', ' URINE CULTURE - At [**2170-10-15**] 11:00 AM', ' MULTI LUMEN - START [**2170-10-15**] 12:45 PM', ' PICC LINE - START [**2170-10-15**] 01:35 PM', ' ARTERIAL LINE - START [**2170-10-15**] 01:38 PM', ' ULTRASOUND - At [**2170-10-15**] 04:00 PM', 'right upper quadrant ultrasound', '- Transfused 3 units PRBC with appropriate bump in hct, platelets x1,', 'FFP x1, cryoprecipitate x1.', '- RUQ US: No evidence of cholecystitis, innumerable hepatic mets', '- Low hapto, unchanged LDH. Smear from this AM did not show', 'schistocytes', '- Renal function improving', '- RIJ placed. As patient was hemodynamically stable without fever or', 'change in mental status, PICC left in place for now.', '- Unable to pass NGT this morning']",25696,188176.0
3,2170-10-17 11:03:40,,"['- No urology recs', ""- Spoke with Dr. [**Last Name (STitle) 5889**], patient's oncologist. Anemia/thrombocytopenia"", 'likely [**2-10**] bone mets from prostate CA + hematuria. No recommendations', 'at this time.', '- On [**2170-10-17**], needs type and screen reordered', '- Received 4U pRBCs, 1U platelets, and 500ml bolus x1', '- Guiac(+) stool, no melena or BRBPR', '- CT abdomen/pelvis - No RP or intraabdominal bleed', '- Sent off Coombs - pending', '- Hct: 23.0>20.6>23.2>23.6', '- Peripheral smear with occasional schistocytes', 'History obtained from Patient']",,25696,188176.0
4,2170-10-17 18:19:34,,"['- No urology recs', ""- Spoke with Dr. [**Last Name (STitle) 5889**], patient's oncologist. Anemia/thrombocytopenia"", 'likely [**2-10**] bone mets from prostate CA + hematuria. No recommendations', 'at this time.', '- On [**2170-10-17**], needs type and screen reordered', '- Received 4U pRBCs, 1U platelets, and 500ml bolus x1', '- Guiac(+) stool, no melena or BRBPR', '- CT abdomen/pelvis - No RP or intraabdominal bleed', '- Sent off Coombs - pending', '- Hct: 23.0>20.6>23.2>23.6', '- Peripheral smear with occasional schistocytes', 'History obtained from Patient']",,25696,188176.0
5,2170-10-18 06:29:57,"['- Pt given 2U FFP and 2U pRBC --> Hct: 26.6 --> 27.0', '- Coombs was negative', '- Urology: may consider formalin']","['- Pt given 2U FFP and 2U pRBC --> Hct: 26.6 --> 27.0', '- Coombs was negative', '- Urology: may consider formalin']","['- No urology recs', ""- Spoke with Dr. [**Last Name (STitle) 5889**], patient's oncologist. Anemia/thrombocytopenia"", 'likely [**2-10**] bone mets from prostate CA + hematuria. No recommendations', 'at this time.', '- On [**2170-10-17**], needs type and screen reordered', '- Received 4U pRBCs, 1U platelets, and 500ml bolus x1', '- Guiac(+) stool, no melena or BRBPR', '- CT abdomen/pelvis - No RP or intraabdominal bleed', '- Sent off Coombs - pending', '- Hct: 23.0>20.6>23.2>23.6', '- Peripheral smear with occasional schistocytes', 'History obtained from Patient']",25696,188176.0
6,2170-10-18 14:47:56,,"['- Pt given 2U FFP and 2U pRBC --> Hct: 26.6 --> 27.0', '- Coombs was negative', '- Urology: may consider formalin']",,25696,188176.0
7,2170-10-19 06:28:06,"['- Hct 25, transfused 1unit PRBC', '- 11p: MAP ~60 and hct 22.5, transfused 2u PRBC', 'Received total 3U pRBCs and 1U platelets', '- Per urology, plan for OR this afternoon for formulin in bladder - NPO', 'after midnight', '- Sacral and heel decubitus ulcers. Bed ordered, nutrition and wound', 'care consults placed.']","['- Hct 25, transfused 1unit PRBC', '- 11p: MAP ~60 and hct 22.5, transfused 2u PRBC', 'Received total 3U pRBCs and 1U platelets', '- Per urology, plan for OR this afternoon for formulin in bladder - NPO', 'after midnight', '- Sacral and heel decubitus ulcers. Bed ordered, nutrition and wound', 'care consults placed.']","['- Pt given 2U FFP and 2U pRBC --> Hct: 26.6 --> 27.0', '- Coombs was negative', '- Urology: may consider formalin']",25696,188176.0
8,2170-10-19 12:56:58,,"['- Hct 25, transfused 1unit PRBC', '- 11p: MAP ~60 and hct 22.5, transfused 2u PRBC', 'Received total 3U pRBCs and 1U platelets', '- Per urology, plan for OR this afternoon for formulin in bladder - NPO', 'after midnight', '- Sacral and heel decubitus ulcers. Bed ordered, nutrition and wound', 'care consults placed.']",,25696,188176.0
9,2170-10-20 07:18:16,"['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120', '- Went to OR for formalin procedure; soft Foley placed; per urology,', 'will take 3-5 days for formalin to fully take effect']","['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120', '- Went to OR for formalin procedure; soft Foley placed; per urology,', 'will take 3-5 days for formalin to fully take effect']","['- Hct 25, transfused 1unit PRBC', '- 11p: MAP ~60 and hct 22.5, transfused 2u PRBC', 'Received total 3U pRBCs and 1U platelets', '- Per urology, plan for OR this afternoon for formulin in bladder - NPO', 'after midnight', '- Sacral and heel decubitus ulcers. Bed ordered, nutrition and wound', 'care consults placed.']",25696,188176.0
10,2170-10-20 11:16:27,"['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120;', 'also given one unit of platelets']","['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120;', 'also given one unit of platelets', '- Went to OR for formalin procedure; soft Foley placed; per urology,', 'will take 3-5 days for formalin to fully take effect']",['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120'],25696,188176.0
11,2170-10-27 07:46:49,"['MULTI LUMEN - START [**2170-10-26**] 03:59 PM', ' PICC LINE - STOP [**2170-10-26**] 06:19 PM', '- CVL placed and PICC line pulled', '- pt given 1U pRBC --> Hct 28.2', '- UA showed >1000 RBC', '- Pt started on hydrocort 50mg Q6', '- d/c Zosyn and cont Vanco', '- Micro 1 set only (coag neg staph)']","['MULTI LUMEN - START [**2170-10-26**] 03:59 PM', ' PICC LINE - STOP [**2170-10-26**] 06:19 PM', '- CVL placed and PICC line pulled', '- pt given 1U pRBC --> Hct 28.2', '- UA showed >1000 RBC', '- Pt started on hydrocort 50mg Q6', '- d/c Zosyn and cont Vanco', '- Micro 1 set only (coag neg staph)']","['- Transfused 2U pRBCs prior to urology procedure > hct 31.7 at 2120;', 'also given one unit of platelets', '- Went to OR for formalin procedure; soft Foley placed; per urology,', 'will take 3-5 days for formalin to fully take effect']",25696,188176.0
12,2170-10-27 07:48:38,,"['MULTI LUMEN - START [**2170-10-26**] 03:59 PM', ' PICC LINE - STOP [**2170-10-26**] 06:19 PM', '- CVL placed and PICC line pulled', '- pt given 1U pRBC --> Hct 28.2', '- UA showed >1000 RBC', '- Pt started on hydrocort 50mg Q6', '- Micro 1 set only (coag neg staph)']",['- d/c Zosyn and cont Vanco'],25696,188176.0
13,2170-10-27 12:51:19,,"['MULTI LUMEN - START [**2170-10-26**] 03:59 PM', ' PICC LINE - STOP [**2170-10-26**] 06:19 PM', '- CVL placed and PICC line pulled', '- pt given 1U pRBC --> Hct 28.2', '- UA showed >1000 RBC', '- Pt started on hydrocort 50mg Q6', '- Micro 1 set only (coag neg staph)']",,25696,188176.0
14,2170-10-28 06:27:36,"['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']","['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']","['MULTI LUMEN - START [**2170-10-26**] 03:59 PM', ' PICC LINE - STOP [**2170-10-26**] 06:19 PM', '- CVL placed and PICC line pulled', '- pt given 1U pRBC --> Hct 28.2', '- UA showed >1000 RBC', '- Pt started on hydrocort 50mg Q6', '- Micro 1 set only (coag neg staph)']",25696,188176.0
15,2170-10-28 06:29:30,,"['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']",,25696,188176.0
16,2170-10-28 16:09:17,,"['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']",,25696,188176.0
17,2170-10-28 16:20:02,,"['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']",,25696,188176.0
18,2170-10-29 07:04:45,"['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']","['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']","['BLOOD CULTURED - At [**2170-10-27**] 05:10 PM', 'from his aline and central line', ' CALLED OUT', '- Stopped vancomycin', '- Gave 1u PRBC', '- HCT 28.6, Platelets=22 at 4:45pm. Nothing done.', '- Lethargic during the day']",25696,188176.0
19,2170-10-29 07:12:20,,"['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']",,25696,188176.0
20,2170-10-29 07:18:09,,"['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']",,25696,188176.0
21,2170-10-29 09:32:06,,"['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']",,25696,188176.0
22,2170-11-02 13:10:15,"['Escalating pressor needs in the setting of ongoing hypotension, rising', 'lactate, and poor urine ouput. Currently on levo, neo, and vasopressin.', 'HR improved from 140s to 100s overnight.', 'Received a total of 4 units PRBCs s/p procedure. Hcts bumping', 'appropriately. Received ~4 L IVF boluses.', 'IR attending in touch many times over the night to discuss case.', 'Sedation changed from Propofol to Versed/Fentanyl with hopes for', 'improved hemodynamic status.', 'History obtained from Family / [**Hospital 56**] Medical records']","['Escalating pressor needs in the setting of ongoing hypotension, rising', 'lactate, and poor urine ouput. Currently on levo, neo, and vasopressin.', 'HR improved from 140s to 100s overnight.', 'Received a total of 4 units PRBCs s/p procedure. Hcts bumping', 'appropriately. Received ~4 L IVF boluses.', 'IR attending in touch many times over the night to discuss case.', 'Sedation changed from Propofol to Versed/Fentanyl with hopes for', 'improved hemodynamic status.', 'History obtained from Family / [**Hospital 56**] Medical records']","['CALLED OUT', '- Tapered steroid dose', '- 5pm hematocrit -> 30.1']",25696,188176.0
23,2170-11-02 14:34:29,,"['Escalating pressor needs in the setting of ongoing hypotension, rising', 'lactate, and poor urine ouput. Currently on levo, neo, and vasopressin.', 'HR improved from 140s to 100s overnight.', 'Received a total of 4 units PRBCs s/p procedure. Hcts bumping', 'appropriately. Received ~4 L IVF boluses.', 'IR attending in touch many times over the night to discuss case.', 'Sedation changed from Propofol to Versed/Fentanyl with hopes for', 'improved hemodynamic status.', 'History obtained from Family / [**Hospital 56**] Medical records']",,25696,188176.0
24,2170-11-03 05:42:28,"['ULTRASOUND - At [**2170-11-2**] 08:00 AM', 'renal ultrasound', ' BLOOD CULTURED - At [**2170-11-3**] 04:06 AM', 'temp 102', ' FEVER - 103.0', 'F - [**2170-11-2**] 06:00 PM', 'FiO2 weaned', 'Bolus 500NS cc x1', 'Large Posterior Hematoma appreciated on exam, CT Thorax performed', 'Decision made by IR not to take pt back for procedure overnight given', 'that he was hemodynamically stable with stable Hcts.', 'BCx grew GPCs and GNRs']","['ULTRASOUND - At [**2170-11-2**] 08:00 AM', 'renal ultrasound', ' BLOOD CULTURED - At [**2170-11-3**] 04:06 AM', 'temp 102', ' FEVER - 103.0', 'F - [**2170-11-2**] 06:00 PM', 'FiO2 weaned', 'Bolus 500NS cc x1', 'Large Posterior Hematoma appreciated on exam, CT Thorax performed', 'Decision made by IR not to take pt back for procedure overnight given', 'that he was hemodynamically stable with stable Hcts.', 'BCx grew GPCs and GNRs']","['Escalating pressor needs in the setting of ongoing hypotension, rising', 'lactate, and poor urine ouput. Currently on levo, neo, and vasopressin.', 'HR improved from 140s to 100s overnight.', 'Received a total of 4 units PRBCs s/p procedure. Hcts bumping', 'appropriately. Received ~4 L IVF boluses.', 'IR attending in touch many times over the night to discuss case.', 'Sedation changed from Propofol to Versed/Fentanyl with hopes for', 'improved hemodynamic status.', 'History obtained from Family / [**Hospital 56**] Medical records']",25696,188176.0
25,2170-11-03 06:45:45,[' ULTRASOUND - At [**2170-11-2**] 08:00 AM'],"['FiO2 weaned', 'Bolus 500NS cc x1', 'Large Posterior Hematoma appreciated on exam, CT Thorax performed', 'Decision made by IR not to take pt back for procedure overnight given', 'that he was hemodynamically stable with stable Hcts.', 'BCx grew GPCs and GNRs', ' ULTRASOUND - At [**2170-11-2**] 08:00 AM', 'renal ultrasound', ' BLOOD CULTURED - At [**2170-11-3**] 04:06 AM', 'temp 102', ' FEVER - 103.0', 'F - [**2170-11-2**] 06:00 PM']",['ULTRASOUND - At [**2170-11-2**] 08:00 AM'],25696,188176.0
26,2170-11-03 19:17:32,['500ccs of coffee ground emesis.'],"['BCx grew GPCs and GNRs', 'Large Posterior Hematoma appreciated on exam, CT Thorax performed', '500ccs of coffee ground emesis.', 'FiO2 weaned', 'Bolus 500NS cc x1', 'Decision made by IR not to take pt back for procedure overnight given', 'that he was hemodynamically stable with stable Hcts.', ' ULTRASOUND - At [**2170-11-2**] 08:00 AM', 'renal ultrasound', ' BLOOD CULTURED - At [**2170-11-3**] 04:06 AM', 'temp 102', ' FEVER - 103.0', 'F - [**2170-11-2**] 06:00 PM']",,25696,188176.0
27,2170-11-04 05:29:29,"['- BP somewhat tenuous at 90s/60s.', '- HCT trend: 27.5 -> 25.1 -> 26.7', '- Started Aztreonam for double coverage of GNR', '- ?extuate today', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM']","['- BP somewhat tenuous at 90s/60s.', '- HCT trend: 27.5 -> 25.1 -> 26.7', '- Started Aztreonam for double coverage of GNR', '- ?extuate today', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM']","['BCx grew GPCs and GNRs', 'Large Posterior Hematoma appreciated on exam, CT Thorax performed', '500ccs of coffee ground emesis.', 'FiO2 weaned', 'Bolus 500NS cc x1', 'Decision made by IR not to take pt back for procedure overnight given', 'that he was hemodynamically stable with stable Hcts.', ' ULTRASOUND - At [**2170-11-2**] 08:00 AM', 'renal ultrasound', ' BLOOD CULTURED - At [**2170-11-3**] 04:06 AM', 'temp 102', ' FEVER - 103.0', 'F - [**2170-11-2**] 06:00 PM']",25696,188176.0
28,2170-11-04 05:30:32,,"['- BP somewhat tenuous at 90s/60s.', '- HCT trend: 27.5 -> 25.1 -> 26.7', '- Started Aztreonam for double coverage of GNR', '- ?extuate today', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM']",,25696,188176.0
29,2170-11-04 06:42:50,['Persistently bacteremic with GPC'],"['- BP somewhat tenuous at 90s/60s.', '- HCT trend: 27.5 -> 25.1 -> 26.7', '- Started Aztreonam for double coverage of GNR', '- ?extuate today', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM', 'Persistently bacteremic with GPC']",,25696,188176.0
30,2170-11-04 15:49:44,"['- Remains on Levophed, weaning off', '- HCT stable', 'Persistently bacteremic GPC']","['- Remains on Levophed, weaning off', '- HCT stable', '- Started Aztreonam for double coverage of GNR', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM', 'Persistently bacteremic GPC']","['- BP somewhat tenuous at 90s/60s.', '- HCT trend: 27.5 -> 25.1 -> 26.7', '- ?extuate today', 'Persistently bacteremic with GPC']",25696,188176.0
31,2170-11-05 05:40:57,"['FEVER - 101.5', 'F - [**2170-11-4**] 12:00 PM', '- Blood cx VRE and Klebsiella. Changed Abx from Vanc/Zosyn/Aztreonam to', 'Dapto/CTX', '- ? Stool coming out around foley catheter. Was small amounts and no', 'further episodes', '- Still on Levophed, unable to diurese [**2-10**] hypotension but grossly', 'fluid overloaded', '- Lactate 3.0, trended down from 3.8', '- Echo ordered due to persistent bacteremia']","['FEVER - 101.5', 'F - [**2170-11-4**] 12:00 PM', '- Blood cx VRE and Klebsiella. Changed Abx from Vanc/Zosyn/Aztreonam to', 'Dapto/CTX', '- ? Stool coming out around foley catheter. Was small amounts and no', 'further episodes', '- Still on Levophed, unable to diurese [**2-10**] hypotension but grossly', 'fluid overloaded', '- Lactate 3.0, trended down from 3.8', '- Echo ordered due to persistent bacteremia']","['- Remains on Levophed, weaning off', '- HCT stable', '- Started Aztreonam for double coverage of GNR', '- Failed trial to discontinue CBI - began urinating frank blood.', ' FEVER - 101.3', 'F - [**2170-11-4**] 04:00 AM', 'Persistently bacteremic GPC']",25696,188176.0
32,2170-11-05 05:42:26,['- Ordered Platelets [**11-5**] am for <50'],"['FEVER - 101.5', 'F - [**2170-11-4**] 12:00 PM', '- Blood cx VRE and Klebsiella. Changed Abx from Vanc/Zosyn/Aztreonam to', 'Dapto/CTX', '- ? Stool coming out around foley catheter. Was small amounts and no', 'further episodes', '- Still on Levophed, unable to diurese [**2-10**] hypotension but grossly', 'fluid overloaded', '- Lactate 3.0, trended down from 3.8', '- Echo ordered due to persistent bacteremia', '- Ordered Platelets [**11-5**] am for <50']",,25696,188176.0
33,2170-11-05 12:29:39,,"['FEVER - 101.5', 'F - [**2170-11-4**] 12:00 PM', '- Blood cx VRE and Klebsiella. Changed Abx from Vanc/Zosyn/Aztreonam to', 'Dapto/CTX', '- ? Stool coming out around foley catheter. Was small amounts and no', 'further episodes', '- Still on Levophed, unable to diurese [**2-10**] hypotension but grossly', 'fluid overloaded', '- Lactate 3.0, trended down from 3.8', '- Echo ordered due to persistent bacteremia', '- Ordered Platelets [**11-5**] am for <50']",,25696,188176.0
34,2170-11-06 05:28:48,"['Methadone stopped yesterday', 'Had echo without vegetations', 'Tube feeds started', 'Spoke w/family, will be here at 4pm today for family meeting']","['Methadone stopped yesterday', 'Had echo without vegetations', 'Tube feeds started', 'Spoke w/family, will be here at 4pm today for family meeting']","['FEVER - 101.5', 'F - [**2170-11-4**] 12:00 PM', '- Blood cx VRE and Klebsiella. Changed Abx from Vanc/Zosyn/Aztreonam to', 'Dapto/CTX', '- ? Stool coming out around foley catheter. Was small amounts and no', 'further episodes', '- Still on Levophed, unable to diurese [**2-10**] hypotension but grossly', 'fluid overloaded', '- Lactate 3.0, trended down from 3.8', '- Echo ordered due to persistent bacteremia', '- Ordered Platelets [**11-5**] am for <50']",25696,188176.0
35,2170-11-06 12:43:51,,"['Methadone stopped yesterday', 'Had echo without vegetations', 'Tube feeds started', 'Spoke w/family, will be here at 4pm today for family meeting']",,25696,188176.0
36,2170-11-06 12:57:08,,"['Methadone stopped yesterday', 'Had echo without vegetations', 'Tube feeds started', 'Spoke w/family, will be here at 4pm today for family meeting']",,25696,188176.0
37,2170-11-07 05:51:37,"['- NGT placed, D/C OG', '- SBT x 2 hours - did okay, but rather than extubate now, plan is to', 'extubate when family arrives if they can arrive within 24-48 hours.', '- ? remove nephrostomy tube for comfort - follow up with IR.', '- Family meeting occurred and patient = DNR, but obviously intubated.', ' FEVER - 101.3', 'F - [**2170-11-6**] 06:00 PM']","['- NGT placed, D/C OG', '- SBT x 2 hours - did okay, but rather than extubate now, plan is to', 'extubate when family arrives if they can arrive within 24-48 hours.', '- ? remove nephrostomy tube for comfort - follow up with IR.', '- Family meeting occurred and patient = DNR, but obviously intubated.', ' FEVER - 101.3', 'F - [**2170-11-6**] 06:00 PM']","['Methadone stopped yesterday', 'Had echo without vegetations', 'Tube feeds started', 'Spoke w/family, will be here at 4pm today for family meeting']",25696,188176.0
38,2170-11-07 05:55:27,,"['- NGT placed, D/C OG', '- SBT x 2 hours - did okay, but rather than extubate now, plan is to', 'extubate when family arrives if they can arrive within 24-48 hours.', '- ? remove nephrostomy tube for comfort - follow up with IR.', '- Family meeting occurred and patient = DNR, but obviously intubated.', ' FEVER - 101.3', 'F - [**2170-11-6**] 06:00 PM']",,25696,188176.0
39,2170-11-07 14:17:51,"['NGT placed, OG removed.  Pt had SBT X 2 hours yesterday and did well.', 'Per discussion with family, would like to be present for extubation,', 'therefore waiting 24 hours.  Discussed removing nephrostomy tube,', 'however IR is reluctant given bleeding risk.  During family meeting, pt', 'was made DNR status.']","['NGT placed, OG removed.  Pt had SBT X 2 hours yesterday and did well.', 'Per discussion with family, would like to be present for extubation,', 'therefore waiting 24 hours.  Discussed removing nephrostomy tube,', 'however IR is reluctant given bleeding risk.  During family meeting, pt', 'was made DNR status.', ' FEVER - 101.3', 'F - [**2170-11-6**] 06:00 PM']","['- NGT placed, D/C OG', '- SBT x 2 hours - did okay, but rather than extubate now, plan is to', 'extubate when family arrives if they can arrive within 24-48 hours.', '- ? remove nephrostomy tube for comfort - follow up with IR.', '- Family meeting occurred and patient = DNR, but obviously intubated.']",25696,188176.0
40,2170-11-08 05:40:42,"['ARTERIAL LINE - STOP [**2170-11-7**] 08:28 PM', '- weaning levophed', '- HR up to 130s; given 250cc x 2 w/o improvement; afebrile; sedation', 'increased', '- hct & plt cont to drop & pt. with bloody BM --> transfused 1 unit', 'PRBCs & 1 pk platelets']","['ARTERIAL LINE - STOP [**2170-11-7**] 08:28 PM', '- weaning levophed', '- HR up to 130s; given 250cc x 2 w/o improvement; afebrile; sedation', 'increased', '- hct & plt cont to drop & pt. with bloody BM --> transfused 1 unit', 'PRBCs & 1 pk platelets']","['NGT placed, OG removed.  Pt had SBT X 2 hours yesterday and did well.', 'Per discussion with family, would like to be present for extubation,', 'therefore waiting 24 hours.  Discussed removing nephrostomy tube,', 'however IR is reluctant given bleeding risk.  During family meeting, pt', 'was made DNR status.', ' FEVER - 101.3', 'F - [**2170-11-6**] 06:00 PM']",25696,188176.0
41,2170-11-08 13:06:14,"['- Pt. passed a large cranberry colored fecal clot: hct & plt cont to', 'drop & pt. with bloody BM.  Subsequently transfused 1 unit pRBCs & 1', 'unit of platelets.', 'increased.', '- Weaning levophed.', '- Hypoactive bowel sounds.']","['ARTERIAL LINE - STOP [**2170-11-7**] 08:28 PM', '- Pt. passed a large cranberry colored fecal clot: hct & plt cont to', 'drop & pt. with bloody BM.  Subsequently transfused 1 unit pRBCs & 1', 'unit of platelets.', '- HR up to 130s; given 250cc x 2 w/o improvement; afebrile; sedation', 'increased.', '- Weaning levophed.', '- Hypoactive bowel sounds.']","['- weaning levophed', 'increased', '- hct & plt cont to drop & pt. with bloody BM --> transfused 1 unit', 'PRBCs & 1 pk platelets']",25696,188176.0
42,2170-11-09 05:38:37,"['Extubated successfully', 'CBC continues to trend down']","['Extubated successfully', 'CBC continues to trend down']","['ARTERIAL LINE - STOP [**2170-11-7**] 08:28 PM', '- Pt. passed a large cranberry colored fecal clot: hct & plt cont to', 'drop & pt. with bloody BM.  Subsequently transfused 1 unit pRBCs & 1', 'unit of platelets.', '- HR up to 130s; given 250cc x 2 w/o improvement; afebrile; sedation', 'increased.', '- Weaning levophed.', '- Hypoactive bowel sounds.']",25696,188176.0
43,2170-11-09 13:22:23,['Able to wean final pressor.'],"['Extubated successfully', 'Able to wean final pressor.', 'CBC continues to trend down']",,25696,188176.0
44,2170-11-10 05:29:51,"['- Familiy meeting- still DNR-DNI, no escalation of care. Would', 'appreciate priest or [**Name2 (NI) **].', '- Emailed Dr. [**Last Name (STitle) 5889**]', '- Transfused 1unit PRBCs; postT HCT:']","['- Familiy meeting- still DNR-DNI, no escalation of care. Would', 'appreciate priest or [**Name2 (NI) **].', '- Emailed Dr. [**Last Name (STitle) 5889**]', '- Transfused 1unit PRBCs; postT HCT:']","['Extubated successfully', 'Able to wean final pressor.', 'CBC continues to trend down']",25696,188176.0
45,2170-11-10 05:30:37,,"['- Familiy meeting- still DNR-DNI, no escalation of care. Would', 'appreciate priest or [**Name2 (NI) **].', '- Emailed Dr. [**Last Name (STitle) 5889**]', '- Transfused 1unit PRBCs; postT HCT:']",,25696,188176.0
46,2170-11-11 05:37:57,"['- transfused platelets', '- fentanyl patch increased from 25 to 50', '- family mtg: family still requesting medical interventions, will give', 'IVF but not pressors to maintain BP while trying to keep pt.', 'comfortable with narcotics']","['- transfused platelets', '- fentanyl patch increased from 25 to 50', '- family mtg: family still requesting medical interventions, will give', 'IVF but not pressors to maintain BP while trying to keep pt.', 'comfortable with narcotics']","['- Familiy meeting- still DNR-DNI, no escalation of care. Would', 'appreciate priest or [**Name2 (NI) **].', '- Emailed Dr. [**Last Name (STitle) 5889**]', '- Transfused 1unit PRBCs; postT HCT:']",25696,188176.0
47,2170-11-11 10:31:33,"['- family coming today around noon to discuss patient', 's care.']","['- transfused platelets', '- fentanyl patch increased from 25 to 50', '- family mtg: family still requesting medical interventions, will give', 'IVF but not pressors to maintain BP while trying to keep pt.', 'comfortable with narcotics', '- family coming today around noon to discuss patient', 's care.']",,25696,188176.0
48,2170-11-12 05:57:00,"['Discussed with family and would like to make patient as comfortable as', 'possible.  Started Morpine gtt.']","['Discussed with family and would like to make patient as comfortable as', 'possible.  Started Morpine gtt.']","['- transfused platelets', '- fentanyl patch increased from 25 to 50', '- family mtg: family still requesting medical interventions, will give', 'IVF but not pressors to maintain BP while trying to keep pt.', 'comfortable with narcotics', '- family coming today around noon to discuss patient', 's care.']",25696,188176.0
0,2163-02-20 07:44:42,,"['- spiked to 101.3', '- CTA-> R subsegmental PE (maybe chronic)', ""- LENI's-> no DVT""]",,98604,102658.0
1,2163-02-20 08:03:36,,"['- spiked to 101.3', '- CTA-> R subsegmental PE (maybe chronic)', ""- LENI's-> no DVT""]",,98604,102658.0
2,2163-02-20 10:36:06,,"['- spiked to 101.3', '- CTA-> R subsegmental PE (maybe chronic)', ""- LENI's-> no DVT""]",,98604,102658.0
3,2163-02-20 10:42:04,,"['- spiked to 101.3', '- CTA-> R subsegmental PE (maybe chronic)', ""- LENI's-> no DVT""]",,98604,102658.0
0,2108-04-10 08:04:58,,"['WOUND CULTURE - At [**2108-4-9**] 11:00 AM', 'Culture from pleural fluid (pleuredex drain).', ' NASAL SWAB - At [**2108-4-9**] 11:00 AM', ' MULTI LUMEN - STOP [**2108-4-9**] 09:00 PM']",,92625,194695.0
1,2108-04-10 10:01:08,,"['WOUND CULTURE - At [**2108-4-9**] 11:00 AM', 'Culture from pleural fluid (pleuredex drain).', ' NASAL SWAB - At [**2108-4-9**] 11:00 AM', ' MULTI LUMEN - STOP [**2108-4-9**] 09:00 PM']",,92625,194695.0
2,2108-04-10 10:15:04,['- UOP very poor'],"['WOUND CULTURE - At [**2108-4-9**] 11:00 AM', 'Culture from pleural fluid (pleuredex drain).', ' NASAL SWAB - At [**2108-4-9**] 11:00 AM', ' MULTI LUMEN - STOP [**2108-4-9**] 09:00 PM', '- UOP very poor']",,92625,194695.0
0,2159-09-25 05:37:11,,[],,72350,166834.0
1,2159-09-25 06:23:51,['No overnight events'],['No overnight events'],,72350,166834.0
2,2159-09-25 07:09:44,['Remained sinus tachycardic and O2 sats are 99-100% on 2 Liters.'],"['No overnight events', 'Remained sinus tachycardic and O2 sats are 99-100% on 2 Liters.']",,72350,166834.0
3,2159-09-25 11:21:22,['Received 1 unit of PRBC over night for low Hct'],"['No overnight events', 'Remained sinus tachycardic and O2 sats are 99-100% on 2 Liters.', 'Received 1 unit of PRBC over night for low Hct']",,72350,166834.0
0,2180-03-29 06:50:00,,['MULTI LUMEN - START [**2180-3-29**] 12:54 AM'],,50055,104964.0
1,2180-03-29 11:01:51,,,,50055,104964.0
2,2180-03-29 11:02:16,,,,50055,104964.0
3,2180-03-30 06:21:10,,,,50055,104964.0
4,2180-03-30 14:07:55,,,,50055,104964.0
0,2155-11-09 06:31:02,,"['-transfused 2U for hct 22.7', '-CT A/P to r/o RP bleed prelim- negative', '10mg Po hydral for sbps to 180s']",,20536,139765.0
1,2155-11-09 06:31:42,,"['-transfused 2U for hct 22.7', '-CT A/P to r/o RP bleed prelim- negative', '10mg Po hydral for sbps to 180s']",,20536,139765.0
2,2155-11-09 10:51:02,,"['-transfused 2U for hct 22.7', '-CT A/P to r/o RP bleed prelim- negative', '10mg Po hydral for sbps to 180s']",,20536,139765.0
3,2155-11-09 11:08:22,,"['-transfused 2U for hct 22.7', '-CT A/P to r/o RP bleed prelim- negative', '10mg Po hydral for sbps to 180s']",,20536,139765.0
0,2184-09-07 07:20:43,,"['FEVER - 101.3', 'F - [**2184-9-6**] 10:00 PM', '-received pain meds over night for sore throat']",,29991,169310.0
1,2184-09-07 07:23:14,,"['FEVER - 101.3', 'F - [**2184-9-6**] 10:00 PM', '-received pain meds over night for sore throat']",,29991,169310.0
2,2184-09-07 10:31:40,,"['FEVER - 101.3', 'F - [**2184-9-6**] 10:00 PM', '-received pain meds over night for sore throat']",,29991,169310.0
3,2184-09-07 10:33:02,,"['FEVER - 101.3', 'F - [**2184-9-6**] 10:00 PM', '-received pain meds over night for sore throat']",,29991,169310.0
0,2108-03-26 05:38:29,,['No events'],,42455,173960.0
1,2108-03-26 05:41:49,,['No events'],,42455,173960.0
2,2108-03-26 09:03:59,,['No events'],,42455,173960.0
3,2108-03-26 11:08:55,,['No events'],,42455,173960.0
0,2184-02-11 06:19:32,,"['ANGIOGRAPHY - At [**2184-2-10**] 06:00 PM', 'Hct30', '27.5, hemodynamically stable']",,67006,107482.0
1,2184-02-11 09:19:30,,"['ANGIOGRAPHY - At [**2184-2-10**] 06:00 PM', 'Hct30', '27.5, hemodynamically stable']",,67006,107482.0
0,2125-09-12 07:43:30,,"['CT surgery came by to see patient. RN noticed that pt', 'orthostatic (HR inc 10 points, SBP down 15 points)', ' gave 500 cc bolus', 'NS. Patietn responded appropriately, remained asymptomatic and', 'maintained appropriate mentation.', 'This AM patient has no complaints. Denies chest pain, SOB,', 'palpitations, dizziness.']",,56790,126309.0
1,2125-09-12 08:39:47,,"['CT surgery came by to see patient. RN noticed that pt', 'orthostatic (HR inc 10 points, SBP down 15 points)', ' gave 500 cc bolus', 'NS. Patietn responded appropriately, remained asymptomatic and', 'maintained appropriate mentation.', 'This AM patient has no complaints. Denies chest pain, SOB,', 'palpitations, dizziness.']",,56790,126309.0
2,2125-09-12 19:56:40,,"['CT surgery came by to see patient. RN noticed that pt', 'orthostatic (HR inc 10 points, SBP down 15 points)', ' gave 500 cc bolus', 'NS. Patietn responded appropriately, remained asymptomatic and', 'maintained appropriate mentation.', 'This AM patient has no complaints. Denies chest pain, SOB,', 'palpitations, dizziness.']",,56790,126309.0
3,2125-09-13 04:10:20,"['ULTRASOUND - At [**2125-9-12**] 09:30 AM', 'bilateral carotids and LE vein mapping', ' TRANSTHORACIC ECHO - At [**2125-9-12**] 11:30 AM']","['ULTRASOUND - At [**2125-9-12**] 09:30 AM', 'bilateral carotids and LE vein mapping', ' TRANSTHORACIC ECHO - At [**2125-9-12**] 11:30 AM']","['CT surgery came by to see patient. RN noticed that pt', 'orthostatic (HR inc 10 points, SBP down 15 points)', ' gave 500 cc bolus', 'NS. Patietn responded appropriately, remained asymptomatic and', 'maintained appropriate mentation.', 'This AM patient has no complaints. Denies chest pain, SOB,', 'palpitations, dizziness.']",56790,126309.0
4,2125-09-13 07:17:52,"['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.']","['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.']","['ULTRASOUND - At [**2125-9-12**] 09:30 AM', 'bilateral carotids and LE vein mapping', ' TRANSTHORACIC ECHO - At [**2125-9-12**] 11:30 AM']",56790,126309.0
5,2125-09-13 07:33:46,,"['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.']",,56790,126309.0
6,2125-09-13 07:56:49,"['Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']","['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']",,56790,126309.0
7,2125-09-13 09:18:02,,"['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']",,56790,126309.0
8,2125-09-13 09:27:54,,"['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']",,56790,126309.0
9,2125-09-14 07:50:20,"['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']","['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']","['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']",56790,126309.0
10,2125-09-14 07:51:19,,"['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']",,56790,126309.0
11,2125-09-14 07:54:09,,"['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']",,56790,126309.0
12,2125-09-14 09:35:05,,"['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']",,56790,126309.0
13,2125-09-14 09:37:33,"['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']","['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']","['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']",56790,126309.0
14,2125-09-14 09:39:15,"['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']","['- CT Abd ordered but for some reason did not occur.', '- Will call radiology first thing in AM to schedule this exam needed', 'for pre-op clearance by CT surgery for CABG on [**9-26**].', '- Patient still anxious over the course of the day.', '- Was explained all results obtained so far and was told that she would', 'not be kept out of the loop.  She was relieved after that discussion', 'and appreciated our time.']","['- Echo, carotid US, vein mapping completed', '- CT surgery recs -> can continue antibiotics to treat potential', 'infection, call heme consult for eval of splenic calcification (CT vs', 'MRI).', '- planned surgery on her originally scheduled date of [**2125-9-26**]', '- SW consult called, as pt concerned about making it through procedure', 'and very anxious regarding prognosis.', 'Patient denies CP, SOB, dysuria, N/V. She reports about 3 BMs', 'yesterday, 1 of which was watery, denies abdominal pain.']",56790,126309.0
0,2111-01-25 08:15:16,,"['MULTI LUMEN - START [**2111-1-24**] 03:18 PM', ' MULTI LUMEN - STOP [**2111-1-24**] 06:41 PM', ' FEVER - 103.9', 'F - [**2111-1-24**] 07:00 AM', '- attempted CVVH; but BPs very low once initiated so stopped, will', 'retry in AM', '- RIJ placed, but on CXR was in subclavian so it was pulled']",,55180,158604.0
1,2111-01-25 12:44:31,,"['MULTI LUMEN - START [**2111-1-24**] 03:18 PM', ' MULTI LUMEN - STOP [**2111-1-24**] 06:41 PM', ' FEVER - 103.9', 'F - [**2111-1-24**] 07:00 AM', '- attempted CVVH; but BPs very low once initiated so stopped, will', 'retry in AM', '- RIJ placed, but on CXR was in subclavian so it was pulled']",,55180,158604.0
2,2111-01-26 08:02:31,"['-- miserable failed attempt at placing brachial a-line', '-- patient underwent CVVH throughout day w/o need for pressors, but', 'nothing was taken off', '-- talked to renal, okay to run neg 100cc/hr, has been tolerating last', 'few hrs', ""-- left of PSV as didn't change fluid status""]","['-- miserable failed attempt at placing brachial a-line', '-- patient underwent CVVH throughout day w/o need for pressors, but', 'nothing was taken off', '-- talked to renal, okay to run neg 100cc/hr, has been tolerating last', 'few hrs', ""-- left of PSV as didn't change fluid status""]","['MULTI LUMEN - START [**2111-1-24**] 03:18 PM', ' MULTI LUMEN - STOP [**2111-1-24**] 06:41 PM', ' FEVER - 103.9', 'F - [**2111-1-24**] 07:00 AM', '- attempted CVVH; but BPs very low once initiated so stopped, will', 'retry in AM', '- RIJ placed, but on CXR was in subclavian so it was pulled']",55180,158604.0
3,2111-01-26 11:17:16,,"['-- miserable failed attempt at placing brachial a-line', '-- patient underwent CVVH throughout day w/o need for pressors, but', 'nothing was taken off', '-- talked to renal, okay to run neg 100cc/hr, has been tolerating last', 'few hrs', ""-- left of PSV as didn't change fluid status""]",,55180,158604.0
4,2111-01-27 07:47:23,"['- on levophed in morning but off for rest of day', '- a lot of fluid removed with cvvh', '- went down on ps 15 -> 10, did well']","['- on levophed in morning but off for rest of day', '- a lot of fluid removed with cvvh', '- went down on ps 15 -> 10, did well']","['-- miserable failed attempt at placing brachial a-line', '-- patient underwent CVVH throughout day w/o need for pressors, but', 'nothing was taken off', '-- talked to renal, okay to run neg 100cc/hr, has been tolerating last', 'few hrs', ""-- left of PSV as didn't change fluid status""]",55180,158604.0
5,2111-01-27 07:51:56,,"['- on levophed in morning but off for rest of day', '- a lot of fluid removed with cvvh', '- went down on ps 15 -> 10, did well']",,55180,158604.0
6,2111-01-27 11:42:10,,"['- on levophed in morning but off for rest of day', '- a lot of fluid removed with cvvh', '- went down on ps 15 -> 10, did well']",,55180,158604.0
7,2111-01-28 07:52:01,"['- extubated, doing great on nasal cannula', '- was off pressors all day, taken off CVVH', '- BP dropped at around 8 PM, was given 25 gm albumin without much', 'improvement, started back on levophed and attempted to wean down, no', 'mental status changes with low BPs']","['- extubated, doing great on nasal cannula', '- was off pressors all day, taken off CVVH', '- BP dropped at around 8 PM, was given 25 gm albumin without much', 'improvement, started back on levophed and attempted to wean down, no', 'mental status changes with low BPs']","['- on levophed in morning but off for rest of day', '- a lot of fluid removed with cvvh', '- went down on ps 15 -> 10, did well']",55180,158604.0
8,2111-01-28 07:54:24,,"['- extubated, doing great on nasal cannula', '- was off pressors all day, taken off CVVH', '- BP dropped at around 8 PM, was given 25 gm albumin without much', 'improvement, started back on levophed and attempted to wean down, no', 'mental status changes with low BPs']",,55180,158604.0
9,2111-01-29 07:36:14,"['PICC LINE - START [**2111-1-28**] 10:44 AM', ' MULTI LUMEN - STOP [**2111-1-28**] 01:00 PM', ' ARTERIAL LINE - START [**2111-1-28**] 02:09 PM', ' ARTERIAL LINE - STOP [**2111-1-28**] 04:23 PM', '-- hepatology rec repeat para to confirm resolusion of leukocytosis in', 'next few days', ""-- had PICC placed, and could't assess BPs with ongoing levophed."", 'Placed axillary a-line, which ultimatly was lost a few hours later.', 'Now able to assess BP w/ pedi cuff on wrist.', '-- still with ongoing levophed requirement.  I initiated midodrine as', 'well to help w/ weening.  He is asx to lower BPs.']","['PICC LINE - START [**2111-1-28**] 10:44 AM', ' MULTI LUMEN - STOP [**2111-1-28**] 01:00 PM', ' ARTERIAL LINE - START [**2111-1-28**] 02:09 PM', ' ARTERIAL LINE - STOP [**2111-1-28**] 04:23 PM', '-- hepatology rec repeat para to confirm resolusion of leukocytosis in', 'next few days', ""-- had PICC placed, and could't assess BPs with ongoing levophed."", 'Placed axillary a-line, which ultimatly was lost a few hours later.', 'Now able to assess BP w/ pedi cuff on wrist.', '-- still with ongoing levophed requirement.  I initiated midodrine as', 'well to help w/ weening.  He is asx to lower BPs.']","['- extubated, doing great on nasal cannula', '- was off pressors all day, taken off CVVH', '- BP dropped at around 8 PM, was given 25 gm albumin without much', 'improvement, started back on levophed and attempted to wean down, no', 'mental status changes with low BPs']",55180,158604.0
10,2111-01-29 10:19:47,,"['PICC LINE - START [**2111-1-28**] 10:44 AM', ' MULTI LUMEN - STOP [**2111-1-28**] 01:00 PM', ' ARTERIAL LINE - START [**2111-1-28**] 02:09 PM', ' ARTERIAL LINE - STOP [**2111-1-28**] 04:23 PM', '-- hepatology rec repeat para to confirm resolusion of leukocytosis in', 'next few days', ""-- had PICC placed, and could't assess BPs with ongoing levophed."", 'Placed axillary a-line, which ultimatly was lost a few hours later.', 'Now able to assess BP w/ pedi cuff on wrist.', '-- still with ongoing levophed requirement.  I initiated midodrine as', 'well to help w/ weening.  He is asx to lower BPs.']",,55180,158604.0
11,2111-01-30 07:57:12,"['PARACENTESIS - At [**2111-1-29**] 01:50 PM', ' ARTERIAL LINE - START [**2111-1-29**] 02:27 PM', ' MULTI LUMEN - START [**2111-1-29**] 02:27 PM', ' INVASIVE VENTILATION - START [**2111-1-29**] 02:32 PM', ' EKG - At [**2111-1-29**] 07:19 PM']","['PARACENTESIS - At [**2111-1-29**] 01:50 PM', ' ARTERIAL LINE - START [**2111-1-29**] 02:27 PM', ' MULTI LUMEN - START [**2111-1-29**] 02:27 PM', ' INVASIVE VENTILATION - START [**2111-1-29**] 02:32 PM', ' EKG - At [**2111-1-29**] 07:19 PM']","['PICC LINE - START [**2111-1-28**] 10:44 AM', ' MULTI LUMEN - STOP [**2111-1-28**] 01:00 PM', ' ARTERIAL LINE - START [**2111-1-28**] 02:09 PM', ' ARTERIAL LINE - STOP [**2111-1-28**] 04:23 PM', '-- hepatology rec repeat para to confirm resolusion of leukocytosis in', 'next few days', ""-- had PICC placed, and could't assess BPs with ongoing levophed."", 'Placed axillary a-line, which ultimatly was lost a few hours later.', 'Now able to assess BP w/ pedi cuff on wrist.', '-- still with ongoing levophed requirement.  I initiated midodrine as', 'well to help w/ weening.  He is asx to lower BPs.']",55180,158604.0
12,2111-01-30 11:05:44,,"['PARACENTESIS - At [**2111-1-29**] 01:50 PM', ' ARTERIAL LINE - START [**2111-1-29**] 02:27 PM', ' MULTI LUMEN - START [**2111-1-29**] 02:27 PM', ' INVASIVE VENTILATION - START [**2111-1-29**] 02:32 PM', ' EKG - At [**2111-1-29**] 07:19 PM']",,55180,158604.0
13,2111-01-31 08:01:57,"['- continued on PS', '- CVVH continued; still pressor requirement for BP', '- cultures still no new growth; maintained on same abx', '- talked to sister; family meeting monday afternoon.  will have goals', 'of care discussion though per sister, patient is quite scared of dying', '- liver recommended starting rifaximin, checking LFTs, and goals of', 'care discussion']","['- continued on PS', '- CVVH continued; still pressor requirement for BP', '- cultures still no new growth; maintained on same abx', '- talked to sister; family meeting monday afternoon.  will have goals', 'of care discussion though per sister, patient is quite scared of dying', '- liver recommended starting rifaximin, checking LFTs, and goals of', 'care discussion']","['PARACENTESIS - At [**2111-1-29**] 01:50 PM', ' ARTERIAL LINE - START [**2111-1-29**] 02:27 PM', ' MULTI LUMEN - START [**2111-1-29**] 02:27 PM', ' INVASIVE VENTILATION - START [**2111-1-29**] 02:32 PM', ' EKG - At [**2111-1-29**] 07:19 PM']",55180,158604.0
14,2111-01-31 09:58:27,,"['- continued on PS', '- CVVH continued; still pressor requirement for BP', '- cultures still no new growth; maintained on same abx', '- talked to sister; family meeting monday afternoon.  will have goals', 'of care discussion though per sister, patient is quite scared of dying', '- liver recommended starting rifaximin, checking LFTs, and goals of', 'care discussion']",,55180,158604.0
15,2111-02-01 08:27:04,"['-- Continued to address hemodynamics throughout the day.  Svo2 from the', 'femoral line was 33%.  In order to evaluate for cardiogenic', 'underfilling in the setting of abdominal expansion, performed para with', 'removal of 5L of straw colored fluid.', '- Able to ween off pressors', '- Had been off sedation for most of the day, cooperative and following', 'commands. Even with para, patient with sub-optimal tidal volumes of 7.', 'Unable to extubate.', '- PICC with functioning difficulties, PICC nurse will need to address', 'today.', '- complaining of increasing arm pain now that sedation off.  No change', 'in exam.  Requiring pain meds throughout the night.']","['-- Continued to address hemodynamics throughout the day.  Svo2 from the', 'femoral line was 33%.  In order to evaluate for cardiogenic', 'underfilling in the setting of abdominal expansion, performed para with', 'removal of 5L of straw colored fluid.', '- Able to ween off pressors', '- Had been off sedation for most of the day, cooperative and following', 'commands. Even with para, patient with sub-optimal tidal volumes of 7.', 'Unable to extubate.', '- PICC with functioning difficulties, PICC nurse will need to address', 'today.', '- complaining of increasing arm pain now that sedation off.  No change', 'in exam.  Requiring pain meds throughout the night.']","['- continued on PS', '- CVVH continued; still pressor requirement for BP', '- cultures still no new growth; maintained on same abx', '- talked to sister; family meeting monday afternoon.  will have goals', 'of care discussion though per sister, patient is quite scared of dying', '- liver recommended starting rifaximin, checking LFTs, and goals of', 'care discussion']",55180,158604.0
16,2111-02-01 08:45:42,,"['-- Continued to address hemodynamics throughout the day.  Svo2 from the', 'femoral line was 33%.  In order to evaluate for cardiogenic', 'underfilling in the setting of abdominal expansion, performed para with', 'removal of 5L of straw colored fluid.', '- Able to ween off pressors', '- Had been off sedation for most of the day, cooperative and following', 'commands. Even with para, patient with sub-optimal tidal volumes of 7.', 'Unable to extubate.', '- PICC with functioning difficulties, PICC nurse will need to address', 'today.', '- complaining of increasing arm pain now that sedation off.  No change', 'in exam.  Requiring pain meds throughout the night.']",,55180,158604.0
17,2111-02-02 07:46:25,"['- extubated in a.m.', '- fam meeting regarding goals of care.  laid out hospice vs continued', 'invasive treatments in setting of terminal disease (liver, kidney,', 'cardiac, likely recurrent resp failure).  also got SW involved. patient', 'initially thought he could be on hospice with dialysis but clarified', 'later. family understands the choices in front of him. patient wants to', 'think about overnight.', ""- on auto-set bipap o/n (couldn't tolerate [**10-20**]) and did well"", '- got fentanyl boluses for left arm pain w/o resp compromise', '- 14 beat run of NSVT -> ekg stable']","['- extubated in a.m.', '- fam meeting regarding goals of care.  laid out hospice vs continued', 'invasive treatments in setting of terminal disease (liver, kidney,', 'cardiac, likely recurrent resp failure).  also got SW involved. patient', 'initially thought he could be on hospice with dialysis but clarified', 'later. family understands the choices in front of him. patient wants to', 'think about overnight.', ""- on auto-set bipap o/n (couldn't tolerate [**10-20**]) and did well"", '- got fentanyl boluses for left arm pain w/o resp compromise', '- 14 beat run of NSVT -> ekg stable']","['-- Continued to address hemodynamics throughout the day.  Svo2 from the', 'femoral line was 33%.  In order to evaluate for cardiogenic', 'underfilling in the setting of abdominal expansion, performed para with', 'removal of 5L of straw colored fluid.', '- Able to ween off pressors', '- Had been off sedation for most of the day, cooperative and following', 'commands. Even with para, patient with sub-optimal tidal volumes of 7.', 'Unable to extubate.', '- PICC with functioning difficulties, PICC nurse will need to address', 'today.', '- complaining of increasing arm pain now that sedation off.  No change', 'in exam.  Requiring pain meds throughout the night.']",55180,158604.0
18,2111-02-02 07:52:45,,"['- extubated in a.m.', '- fam meeting regarding goals of care.  laid out hospice vs continued', 'invasive treatments in setting of terminal disease (liver, kidney,', 'cardiac, likely recurrent resp failure).  also got SW involved. patient', 'initially thought he could be on hospice with dialysis but clarified', 'later. family understands the choices in front of him. patient wants to', 'think about overnight.', ""- on auto-set bipap o/n (couldn't tolerate [**10-20**]) and did well"", '- got fentanyl boluses for left arm pain w/o resp compromise', '- 14 beat run of NSVT -> ekg stable']",,55180,158604.0
19,2111-02-02 09:45:12,,"['- extubated in a.m.', '- fam meeting regarding goals of care.  laid out hospice vs continued', 'invasive treatments in setting of terminal disease (liver, kidney,', 'cardiac, likely recurrent resp failure).  also got SW involved. patient', 'initially thought he could be on hospice with dialysis but clarified', 'later. family understands the choices in front of him. patient wants to', 'think about overnight.', ""- on auto-set bipap o/n (couldn't tolerate [**10-20**]) and did well"", '- got fentanyl boluses for left arm pain w/o resp compromise', '- 14 beat run of NSVT -> ekg stable']",,55180,158604.0
20,2111-02-03 07:34:56,"['- family meeting: discussed all of his options, not really much left.', 'going to talk to his family re going home with hospice vs doing', 'everything.  may need to consider trach then to avoid repeat', 'intubations.  will also need to discuss whether peritoneal drain is', 'appropriate', '- did not get HD today; will get on Tuesday']","['- family meeting: discussed all of his options, not really much left.', 'going to talk to his family re going home with hospice vs doing', 'everything.  may need to consider trach then to avoid repeat', 'intubations.  will also need to discuss whether peritoneal drain is', 'appropriate', '- did not get HD today; will get on Tuesday']","['- extubated in a.m.', '- fam meeting regarding goals of care.  laid out hospice vs continued', 'invasive treatments in setting of terminal disease (liver, kidney,', 'cardiac, likely recurrent resp failure).  also got SW involved. patient', 'initially thought he could be on hospice with dialysis but clarified', 'later. family understands the choices in front of him. patient wants to', 'think about overnight.', ""- on auto-set bipap o/n (couldn't tolerate [**10-20**]) and did well"", '- got fentanyl boluses for left arm pain w/o resp compromise', '- 14 beat run of NSVT -> ekg stable']",55180,158604.0
21,2111-02-03 07:35:18,,"['- family meeting: discussed all of his options, not really much left.', 'going to talk to his family re going home with hospice vs doing', 'everything.  may need to consider trach then to avoid repeat', 'intubations.  will also need to discuss whether peritoneal drain is', 'appropriate', '- did not get HD today; will get on Tuesday']",,55180,158604.0
22,2111-02-03 07:40:09,,"['- family meeting: discussed all of his options, not really much left.', 'going to talk to his family re going home with hospice vs doing', 'everything.  may need to consider trach then to avoid repeat', 'intubations.  will also need to discuss whether peritoneal drain is', 'appropriate', '- did not get HD today; will get on Tuesday']",,55180,158604.0
23,2111-02-03 10:45:13,,"['- family meeting: discussed all of his options, not really much left.', 'going to talk to his family re going home with hospice vs doing', 'everything.  may need to consider trach then to avoid repeat', 'intubations.  will also need to discuss whether peritoneal drain is', 'appropriate', '- did not get HD today; will get on Tuesday']",,55180,158604.0
0,2133-05-07 06:40:55,,"[""SBP 90's"", 'CXR showed ?retrocardiac opacity, given leukocytosis, chills and', 'hypotension started levofloxacin overnight', 'Foley was d/c']",,90484,147829.0
1,2133-05-07 08:03:40,['Pt became N/V after miralax this AM'],"[""SBP 90's"", 'CXR showed ?retrocardiac opacity, given leukocytosis, chills and', 'hypotension started levofloxacin overnight', 'Foley was d/c', 'Pt became N/V after miralax this AM']",,90484,147829.0
2,2133-05-07 08:37:40,,"[""SBP 90's"", 'CXR showed ?retrocardiac opacity, given leukocytosis, chills and', 'hypotension started levofloxacin overnight', 'Foley was d/c', 'Pt became N/V after miralax this AM']",,90484,147829.0
3,2133-05-07 08:41:13,,"[""SBP 90's"", 'CXR showed ?retrocardiac opacity, given leukocytosis, chills and', 'hypotension started levofloxacin overnight', 'Foley was d/c', 'Pt became N/V after miralax this AM']",,90484,147829.0
4,2133-05-08 14:06:36,"['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care. Repeat 12-lead EKG shows continued ST depressions in', 'the same distribution as prior.  Bedside TTE showed no change or new', 'WMA.  ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', 'History obtained from Medical records']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care. Repeat 12-lead EKG shows continued ST depressions in', 'the same distribution as prior.  Bedside TTE showed no change or new', 'WMA.  ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', 'History obtained from Medical records']","[""SBP 90's"", 'CXR showed ?retrocardiac opacity, given leukocytosis, chills and', 'hypotension started levofloxacin overnight', 'Foley was d/c', 'Pt became N/V after miralax this AM']",90484,147829.0
5,2133-05-08 14:08:21,"['for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed no change or new WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '-Bilateral LE dopplers showed:', '-CXR showed:']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed no change or new WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-Bilateral LE dopplers showed:', '-CXR showed:', 'History obtained from Medical records']","['for further care. Repeat 12-lead EKG shows continued ST depressions in', 'the same distribution as prior.  Bedside TTE showed no change or new', 'WMA.  ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K']",90484,147829.0
6,2133-05-08 15:49:06,"['-Bedside TTE showed new, worsened inferior/posterior WMA.', '-CXR showed: pulmonary edema, no obvious infiltrates, and borderline', 'widened mediastinum.']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: pulmonary edema, no obvious infiltrates, and borderline', 'widened mediastinum.', '-Bilateral LE dopplers showed:', 'History obtained from Medical records']","['-Bedside TTE showed no change or new WMA.', '-CXR showed:']",90484,147829.0
7,2133-05-09 07:42:54,,"['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: pulmonary edema, no obvious infiltrates, and borderline', 'widened mediastinum.', '-Bilateral LE dopplers showed:', 'History obtained from Medical records']",,90484,147829.0
8,2133-05-09 07:44:32,"['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '-Received lasix 20 mg IV:', '-Plan is for ccath on Mon', '- Self extubated, resp status remained stable', '- Started on Heparin gtt']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '-Received lasix 20 mg IV:', '-Plan is for ccath on Mon', '- Self extubated, resp status remained stable', '- Started on Heparin gtt']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: pulmonary edema, no obvious infiltrates, and borderline', 'widened mediastinum.', '-Bilateral LE dopplers showed:', 'History obtained from Medical records']",90484,147829.0
9,2133-05-09 07:49:33,"['- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Desats when NRB comes off']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']","['-Received lasix 20 mg IV:', '-Plan is for ccath on Mon', '- Self extubated, resp status remained stable']",90484,147829.0
10,2133-05-09 07:59:12,"['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']",90484,147829.0
11,2133-05-09 08:11:46,,"['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']",,90484,147829.0
12,2133-05-09 08:15:09,"['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']",90484,147829.0
13,2133-05-09 08:26:13,"['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']",90484,147829.0
14,2133-05-09 09:09:58,"['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']","['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']","['CALLED OUT', '-Patient initially transferred to on the evening of [**5-6**] for hypotension', 'to the 80s that was initially responsive to IVF, following IVF, SBP', ""then dropped to the high 70's despite NS boluses.  EKG appeared"", 'unchanged from prior but did show stable diffuse ST depressions in', 'V3-V6, I, II, aVL, aVF.', 'Repeat TTE while in the CCU showed focal', 'basal inferior hypokinesis, mild-mod TR & MR, trivial/physiologic', 'pericardial effusion. Adjustment to meds: Lopressor decreased to 12.5', ""mg TID, imdur d/c'd.  SBP imprpoved and remained in 90's during CCU"", 'course without need for vasopressor therapy.  CXR demonstrated possible', 'retrocardiac opacity and patient started levofloxacin for possible', ""PNA.  Given patient's improvement in BP, pt was transferred to"", 'cardiology floor for continued care.', '-At ~ noon on [**5-8**], patient was found down on the ground by nursing', 'staff, and was reported in the restroom just prior to being found', 'unresponsive.  No pulse was palpable and telemetry strip demonstrated a', 'slow, possible junctional rhythm.  Chest compressions were initiated,', 'and shortly thereafter the patient was noted to be in sinus', 'tachycardia.  No shocks or intravenous medications were administered.', 'The patient was intubated for airway protection, and brought to the CCU', 'for further care.', '-Repeat 12-lead EKG shows continued ST depressions in the same', 'distribution as prior.', '-Bedside TTE showed new, worsened inferior/posterior WMA.', '-ABG on arrival was: 7.4/40/65 on AC 16/550/5/100%, Lactate 4.3, K', '4.4.', '-CXR showed: prelim read - pulmonary edema, no obvious infiltrates, and', 'borderline widened mediastinum.', '-Bilateral LE dopplers ordered', 'History obtained from Medical records']",90484,147829.0
15,2133-05-09 09:11:21,,"['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']",,90484,147829.0
16,2133-05-10 06:22:41,['ECG performed improved ST-depressions'],['ECG performed improved ST-depressions'],"['[**2133-5-8**]:', '-ECHO showed extensive inferior and posterior wall contractile', 'dysfunction.  This better explains pulm edema on CXR.', '- CXR: pulm edema, widened mediastinum which rads felt could be due to', 'plump veins in setting of poor systolic output', '- Received 20 IV lasix o/n: neg 1L as of this am. Given another dose of', 'lasix 60 mg at 0600', '- Plan is for ccath on Mon', '- Self extubated, resp status remained stable on NRB', '- Started on Heparin gtt', '- Desats when NRB comes off']",90484,147829.0
17,2133-05-10 08:38:30,,['ECG performed improved ST-depressions'],,90484,147829.0
18,2133-05-10 10:02:38,,['ECG performed improved ST-depressions'],,90484,147829.0
19,2133-05-11 06:40:46,['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],['ECG performed improved ST-depressions'],90484,147829.0
20,2133-05-11 08:15:57,,['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],,90484,147829.0
21,2133-05-11 08:22:13,,['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],,90484,147829.0
22,2133-05-11 09:38:04,,['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],,90484,147829.0
23,2133-05-12 07:03:09,"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', 'c.cath: multivessel disease, CT [**Doctor First Name **] contact[**Name (NI) **] via email']","['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', 'c.cath: multivessel disease, CT [**Doctor First Name **] contact[**Name (NI) **] via email']",['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],90484,147829.0
24,2133-05-12 07:08:17,"['- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']","['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']","['c.cath: multivessel disease, CT [**Doctor First Name **] contact[**Name (NI) **] via email']",90484,147829.0
25,2133-05-12 07:58:14,,"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",,90484,147829.0
26,2133-05-12 10:11:09,['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",90484,147829.0
27,2133-05-12 10:23:10,"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']","['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",['- Pt had small episode of hemoptysis w/ sputum - repeated CXR -'],90484,147829.0
28,2133-05-12 10:45:20,,"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",,90484,147829.0
29,2133-05-12 10:48:05,,"['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",,90484,147829.0
30,2133-05-14 07:27:16,"['Please see admission and transfer H&Ps and detailed daily notes from', 'the CCU and [**Hospital Unit Name 2852**] teams. The patient is well-known to the CCU team.', 'While on the floor, the patient was auto-diuresing while awaiting CABG', 'planned for Friday [**2133-5-14**]. He had intermittent chest pain over the', 'course of the day yesterday and overnight, and was triggered for this', 'indication this morning. The interventional fellow and attending were', 'made aware and the patient was taken to the cath lab for IABP', 'placement, but he ultimately refused this and is transferred to the CCU', 'for further care while awaiting CABG.', '.', 'On arrival to the CCU, the patient denies any chest pain. He attributes', 'his episode of chest pain today to moving around in bed and not to his', 'cardiac status.', 'History obtained from [**Hospital 31**] Medical records']","['Please see admission and transfer H&Ps and detailed daily notes from', 'the CCU and [**Hospital Unit Name 2852**] teams. The patient is well-known to the CCU team.', 'While on the floor, the patient was auto-diuresing while awaiting CABG', 'planned for Friday [**2133-5-14**]. He had intermittent chest pain over the', 'course of the day yesterday and overnight, and was triggered for this', 'indication this morning. The interventional fellow and attending were', 'made aware and the patient was taken to the cath lab for IABP', 'placement, but he ultimately refused this and is transferred to the CCU', 'for further care while awaiting CABG.', '.', 'On arrival to the CCU, the patient denies any chest pain. He attributes', 'his episode of chest pain today to moving around in bed and not to his', 'cardiac status.', 'History obtained from [**Hospital 31**] Medical records']","['CARDIAC CATH - At [**2133-5-11**] 03:00 PM', 'returned from diagnostic cath', '- C.cath: 3V disease,', 'LCMA no dz,', 'LAD 90% stenosis at proximal and mid-vessel.', 'LCx has 90% ostial stenosis and 95% at mid segment.', 'RCA total occlusion. Distal RCA fill by collateralls', '- CT [**Doctor First Name **] contact[**Name (NI) **] via email']",90484,147829.0
31,2133-05-14 09:41:46,,"['Please see admission and transfer H&Ps and detailed daily notes from', 'the CCU and [**Hospital Unit Name 2852**] teams. The patient is well-known to the CCU team.', 'While on the floor, the patient was auto-diuresing while awaiting CABG', 'planned for Friday [**2133-5-14**]. He had intermittent chest pain over the', 'course of the day yesterday and overnight, and was triggered for this', 'indication this morning. The interventional fellow and attending were', 'made aware and the patient was taken to the cath lab for IABP', 'placement, but he ultimately refused this and is transferred to the CCU', 'for further care while awaiting CABG.', '.', 'On arrival to the CCU, the patient denies any chest pain. He attributes', 'his episode of chest pain today to moving around in bed and not to his', 'cardiac status.', 'History obtained from [**Hospital 31**] Medical records']",,90484,147829.0
0,2183-09-13 06:55:56,,"['1L NS bolus x2 given. 1unit FFP and 1unit platelets given at MN, plt ck', 'post transfusion. Additional 3units FFPs and 1unit Plts given to', 'maintain plt count >50 for procedure.', '-Cipro started for double coverage as patient has GNRs', '-Started tramadol b/c would not cause spasms of gallbladder sphincter', 'for HIDA scan. Will give dilaudid after if he needs.', '- Hida scan showed a gallbladder that would not fill. IR would not do', 'cholecystostomy b/c of coags and low platelets. Gave a 6 pack of plts.', 'and 4 units of FFP. INR 2.5->2.2; Plts 47->55. Not a good response. So,', 'IR would not do the procedure Friday. Agreed to re-assess Saturday', 'morning. (spoke with [**Doctor Last Name 9186**]) He will get 4 units of ffp and 6', 'pack of plts prior to lab draw in AM. Will likely need more after, so', 'will have this order ready and hold prn. IR number [**Serial Number 9187**]']",,52919,132862.0
1,2183-09-13 11:08:19,,"['1L NS bolus x2 given. 1unit FFP and 1unit platelets given at MN, plt ck', 'post transfusion. Additional 3units FFPs and 1unit Plts given to', 'maintain plt count >50 for procedure.', '-Cipro started for double coverage as patient has GNRs', '-Started tramadol b/c would not cause spasms of gallbladder sphincter', 'for HIDA scan. Will give dilaudid after if he needs.', '- Hida scan showed a gallbladder that would not fill. IR would not do', 'cholecystostomy b/c of coags and low platelets. Gave a 6 pack of plts.', 'and 4 units of FFP. INR 2.5->2.2; Plts 47->55. Not a good response. So,', 'IR would not do the procedure Friday. Agreed to re-assess Saturday', 'morning. (spoke with [**Doctor Last Name 9186**]) He will get 4 units of ffp and 6', 'pack of plts prior to lab draw in AM. Will likely need more after, so', 'will have this order ready and hold prn. IR number [**Serial Number 9187**]']",,52919,132862.0
2,2183-09-14 07:54:13,"['PARACENTESIS - At [**2183-9-13**] 01:41 PM', ' EKG - At [**2183-9-14**] 06:06 AM', '- s/p cholecystostomy by IR-currently draining brown sludge', '- on cipro/vanc/zosyn Day#3 (but had received a dose of zosyn the day', 'previously in addition)', '- ascites and chole drainage (+) GNR.', '- s/p paracentesis with removal of 2L of fluid', '- PRN morphine in case dropping Sp02 and new tachycardia to the 100', 'might have been related to pain level.', '- Started on 200 cc/hr IVF maintenance for dropping SBP to low 90', 's and', 'persistant tachycardia in the low 100', ' 500 cc of maintenance + 500', 'cc bolus for dropping Urine Output and persistant tachycardia.', '- pt. weaned off pressors, remained afebrile', '- Sp02 94% on 6 L NC']","['PARACENTESIS - At [**2183-9-13**] 01:41 PM', ' EKG - At [**2183-9-14**] 06:06 AM', '- s/p cholecystostomy by IR-currently draining brown sludge', '- on cipro/vanc/zosyn Day#3 (but had received a dose of zosyn the day', 'previously in addition)', '- ascites and chole drainage (+) GNR.', '- s/p paracentesis with removal of 2L of fluid', '- PRN morphine in case dropping Sp02 and new tachycardia to the 100', 'might have been related to pain level.', '- Started on 200 cc/hr IVF maintenance for dropping SBP to low 90', 's and', 'persistant tachycardia in the low 100', ' 500 cc of maintenance + 500', 'cc bolus for dropping Urine Output and persistant tachycardia.', '- pt. weaned off pressors, remained afebrile', '- Sp02 94% on 6 L NC']","['1L NS bolus x2 given. 1unit FFP and 1unit platelets given at MN, plt ck', 'post transfusion. Additional 3units FFPs and 1unit Plts given to', 'maintain plt count >50 for procedure.', '-Cipro started for double coverage as patient has GNRs', '-Started tramadol b/c would not cause spasms of gallbladder sphincter', 'for HIDA scan. Will give dilaudid after if he needs.', '- Hida scan showed a gallbladder that would not fill. IR would not do', 'cholecystostomy b/c of coags and low platelets. Gave a 6 pack of plts.', 'and 4 units of FFP. INR 2.5->2.2; Plts 47->55. Not a good response. So,', 'IR would not do the procedure Friday. Agreed to re-assess Saturday', 'morning. (spoke with [**Doctor Last Name 9186**]) He will get 4 units of ffp and 6', 'pack of plts prior to lab draw in AM. Will likely need more after, so', 'will have this order ready and hold prn. IR number [**Serial Number 9187**]']",52919,132862.0
3,2183-09-14 13:07:24,"['- Afib overnight w rates 90s-100s, nadolol restarted bringing ventric', 'rate into 80s', '- Sp02 94% on 6 L NC- increasing O2 requirement', '- No BM since [**9-13**] morning']","['PARACENTESIS - At [**2183-9-13**] 01:41 PM', ' EKG - At [**2183-9-14**] 06:06 AM', '- s/p cholecystostomy by IR-currently draining brown sludge', '- on cipro/vanc/zosyn Day#3 (but had received a dose of zosyn the day', 'previously in addition)', '- ascites and chole drainage (+) GNR.', '- s/p paracentesis with removal of 2L of fluid', '- PRN morphine in case dropping Sp02 and new tachycardia to the 100', 'might have been related to pain level.', '- Started on 200 cc/hr IVF maintenance for dropping SBP to low 90', 's and', 'persistant tachycardia in the low 100', ' 500 cc of maintenance + 500', 'cc bolus for dropping Urine Output and persistant tachycardia.', '- pt. weaned off pressors, remained afebrile', '- Afib overnight w rates 90s-100s, nadolol restarted bringing ventric', 'rate into 80s', '- Sp02 94% on 6 L NC- increasing O2 requirement', '- No BM since [**9-13**] morning']",['- Sp02 94% on 6 L NC'],52919,132862.0
4,2183-09-14 13:27:32,,"['PARACENTESIS - At [**2183-9-13**] 01:41 PM', ' EKG - At [**2183-9-14**] 06:06 AM', '- s/p cholecystostomy by IR-currently draining brown sludge', '- on cipro/vanc/zosyn Day#3 (but had received a dose of zosyn the day', 'previously in addition)', '- ascites and chole drainage (+) GNR.', '- s/p paracentesis with removal of 2L of fluid', '- PRN morphine in case dropping Sp02 and new tachycardia to the 100', 'might have been related to pain level.', '- Started on 200 cc/hr IVF maintenance for dropping SBP to low 90', 's and', 'persistant tachycardia in the low 100', ' 500 cc of maintenance + 500', 'cc bolus for dropping Urine Output and persistant tachycardia.', '- pt. weaned off pressors, remained afebrile', '- Afib overnight w rates 90s-100s, nadolol restarted bringing ventric', 'rate into 80s', '- Sp02 94% on 6 L NC- increasing O2 requirement', '- No BM since [**9-13**] morning']",,52919,132862.0
5,2183-09-15 06:39:03,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']","['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']","['PARACENTESIS - At [**2183-9-13**] 01:41 PM', ' EKG - At [**2183-9-14**] 06:06 AM', '- s/p cholecystostomy by IR-currently draining brown sludge', '- on cipro/vanc/zosyn Day#3 (but had received a dose of zosyn the day', 'previously in addition)', '- ascites and chole drainage (+) GNR.', '- s/p paracentesis with removal of 2L of fluid', '- PRN morphine in case dropping Sp02 and new tachycardia to the 100', 'might have been related to pain level.', '- Started on 200 cc/hr IVF maintenance for dropping SBP to low 90', 's and', 'persistant tachycardia in the low 100', ' 500 cc of maintenance + 500', 'cc bolus for dropping Urine Output and persistant tachycardia.', '- pt. weaned off pressors, remained afebrile', '- Afib overnight w rates 90s-100s, nadolol restarted bringing ventric', 'rate into 80s', '- Sp02 94% on 6 L NC- increasing O2 requirement', '- No BM since [**9-13**] morning']",52919,132862.0
6,2183-09-15 12:35:07,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
7,2183-09-15 12:46:04,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
8,2183-09-15 12:50:07,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
9,2183-09-15 12:55:22,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
10,2183-09-15 15:08:24,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
11,2183-09-15 18:35:19,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
12,2183-09-16 00:09:57,,"['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",,52919,132862.0
13,2183-09-16 06:29:42,"['BLOOD CULTURED - At [**2183-9-15**] 12:15 PM', 'from aline', ' BLOOD CULTURED - At [**2183-9-15**] 12:30 PM', 'from R  IJ', ' SPUTUM CULTURE - At [**2183-9-15**] 03:00 PM', ' PARACENTESIS - At [**2183-9-15**] 06:00 PM']","['BLOOD CULTURED - At [**2183-9-15**] 12:15 PM', 'from aline', ' BLOOD CULTURED - At [**2183-9-15**] 12:30 PM', 'from R  IJ', ' SPUTUM CULTURE - At [**2183-9-15**] 03:00 PM', ' PARACENTESIS - At [**2183-9-15**] 06:00 PM']","['[**9-14**]:', '- ABG (w non-rebreather): 7.33/54/107', '- had been lying on his left side, so much of abdominal fluids probably', 'shifted into left pleural cavity; also had received 14L? extra in last', 'couple of days', ""- didn't respond to lasix 20mg IV, so tried 40mg IV lasix"", '- ABG: with non-invasive ventilation BIPAP for 1.5 hrs-- 7.36/52/95', '- switched back to non-rebreather for comfort', '- switched back to Bipap for a couple of hours', '- A-line placed right radial, ABG 21:00 unchanged, pt feels', 'subjectively more difficulty breathing-->  INTUBATED at 21:50 by', 'anesthesia, placed on AC w tidal volumes 450cc', '-> Intubation done w intention of improving respiratory status to buy', 'us more time to get the fluid out of his chest cavity -- thought to be', 'positional from belly; will likely tap 5-6L [**9-15**] to help', '- OG tube placed for tube feeds', '- started on phenylephrine pressor to maintain BP, likely because of', 'increased sedation from intubation procedure,  hopefully can be weaned', 'once extra intubation sedation wears off by morning; on midaz and', 'fentanyl currently for sedation, did get some propofol during', 'intubation procedure', '-Chole draining putting out brown liquid']",52919,132862.0
14,2183-09-16 06:33:56,,"['BLOOD CULTURED - At [**2183-9-15**] 12:15 PM', 'from aline', ' BLOOD CULTURED - At [**2183-9-15**] 12:30 PM', 'from R  IJ', ' SPUTUM CULTURE - At [**2183-9-15**] 03:00 PM', ' PARACENTESIS - At [**2183-9-15**] 06:00 PM']",,52919,132862.0
15,2183-09-16 06:37:56,"['-pleural pressure 12/0 inspiraton/end-expiration by esophageal balloon.', 'Changed PEEP to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by blood and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap', '- Esophageal Balloon done again overnight. Expiratory transpulmonary', 'pressure was 0. Inspiratory Transmural pressure was 7. at a PEEP of 15.', 'ABG showed a PaO2 of 97 so PEEP was decreased to 12.']","['-pleural pressure 12/0 inspiraton/end-expiration by esophageal balloon.', 'Changed PEEP to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by blood and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap', '- Esophageal Balloon done again overnight. Expiratory transpulmonary', 'pressure was 0. Inspiratory Transmural pressure was 7. at a PEEP of 15.', 'ABG showed a PaO2 of 97 so PEEP was decreased to 12.']","['BLOOD CULTURED - At [**2183-9-15**] 12:15 PM', 'from aline', ' BLOOD CULTURED - At [**2183-9-15**] 12:30 PM', 'from R  IJ', ' SPUTUM CULTURE - At [**2183-9-15**] 03:00 PM', ' PARACENTESIS - At [**2183-9-15**] 06:00 PM']",52919,132862.0
16,2183-09-16 09:27:46,"['-pleural pressure 12/0 inspiraton/end-expiration by esophageal', 'balloon.  Changed PEEP to 15.']","['-pleural pressure 12/0 inspiraton/end-expiration by esophageal', 'balloon.  Changed PEEP to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by blood and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap', '- Esophageal Balloon done again overnight. Expiratory transpulmonary', 'pressure was 0. Inspiratory Transmural pressure was 7. at a PEEP of 15.', 'ABG showed a PaO2 of 97 so PEEP was decreased to 12.']","['-pleural pressure 12/0 inspiraton/end-expiration by esophageal balloon.', 'Changed PEEP to 15.']",52919,132862.0
17,2183-09-16 10:55:52,"['-pleural pressure 12/0 by esophageal balloon.  Changed PEEP to 15.  7/0', 's/p tap', ' changed PEEP to 12.  Repeat pressure 7/-2.5-3', ' changed PEEP', 'back to 15.', '- d/c cipro/vanc; e. coli by bile and peritoneal cultures; continue', '- switch to levo/vaso from phenylephrine.  Levo d/c', 'd today with', 'pressures OK.']","['-pleural pressure 12/0 by esophageal balloon.  Changed PEEP to 15.  7/0', 's/p tap', ' changed PEEP to 12.  Repeat pressure 7/-2.5-3', ' changed PEEP', 'back to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by bile and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.  Levo d/c', 'd today with', 'pressures OK.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap']","['-pleural pressure 12/0 inspiraton/end-expiration by esophageal', 'balloon.  Changed PEEP to 15.', '- d/c cipro/vanc; e. coli by blood and peritoneal cultures; continue', '- switch to levo/vaso from phenylephrine.', '- Esophageal Balloon done again overnight. Expiratory transpulmonary', 'pressure was 0. Inspiratory Transmural pressure was 7. at a PEEP of 15.', 'ABG showed a PaO2 of 97 so PEEP was decreased to 12.']",52919,132862.0
18,2183-09-16 11:12:48,,"['-pleural pressure 12/0 by esophageal balloon.  Changed PEEP to 15.  7/0', 's/p tap', ' changed PEEP to 12.  Repeat pressure 7/-2.5-3', ' changed PEEP', 'back to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by bile and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.  Levo d/c', 'd today with', 'pressures OK.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap']",,52919,132862.0
19,2183-09-16 15:53:25,,"['-pleural pressure 12/0 by esophageal balloon.  Changed PEEP to 15.  7/0', 's/p tap', ' changed PEEP to 12.  Repeat pressure 7/-2.5-3', ' changed PEEP', 'back to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by bile and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.  Levo d/c', 'd today with', 'pressures OK.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap']",,52919,132862.0
20,2183-09-17 07:03:17,"['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']","['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']","['-pleural pressure 12/0 by esophageal balloon.  Changed PEEP to 15.  7/0', 's/p tap', ' changed PEEP to 12.  Repeat pressure 7/-2.5-3', ' changed PEEP', 'back to 15.', '- bladder pressure 21, then 19 s/p tap. to assess abdominal pressures', 'with concern for abdominal compartment syndrome and compression of', 'renal arteries', '- sent sputum cultures (?aspiration PNA?)', '- d/c cipro/vanc; e. coli by bile and peritoneal cultures; continue', 'zosyn', '- therapeutic paracentesis with 4 L amber fluid removed.  Sent for gram', 'stain and culture.  Tolerated procedure well.  100 g albumin given', 'immediately after procedure.', '- KUB done, non-diagnostic given large amount of ascites.  Surgery', 'signed off.', '- d/c nadolol', '- switch to levo/vaso from phenylephrine.  Levo d/c', 'd today with', 'pressures OK.', '- received 1 L NS bolus s/p tap to maintain u/o > 30 ml/hr.  U/O', 'increased to 50-75 ml/hr s/p tap']",52919,132862.0
21,2183-09-17 12:01:38,,"['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']",,52919,132862.0
22,2183-09-17 12:15:33,,"['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']",,52919,132862.0
23,2183-09-17 12:24:16,,"['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']",,52919,132862.0
24,2183-09-17 13:23:03,,"['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']",,52919,132862.0
25,2183-09-18 07:12:10,"['- turned down to 50% FiO2', '- likely paracentesis tomorrow, but will need platelets first', '- urine output picked up overnight, stable at 40ccs/hr', '- started insulin drip for sugars >400 and multiple high sugars not', 'easy to control so far today with plan of using it for 24 hours to', 'adjust his subq regimen ; holding subq regimen for now', '- bladder pressure could not be measured accurately at night because', 'urine leaking out around foley', '- HR elevated into low 100s-110s, appears as if he may be breaking into', 'afib when rate briefly goes into 120s', '- urine output 40-50cc/hr']","['- turned down to 50% FiO2', '- likely paracentesis tomorrow, but will need platelets first', '- urine output picked up overnight, stable at 40ccs/hr', '- started insulin drip for sugars >400 and multiple high sugars not', 'easy to control so far today with plan of using it for 24 hours to', 'adjust his subq regimen ; holding subq regimen for now', '- bladder pressure could not be measured accurately at night because', 'urine leaking out around foley', '- HR elevated into low 100s-110s, appears as if he may be breaking into', 'afib when rate briefly goes into 120s', '- urine output 40-50cc/hr']","['[**9-16**]:', '-bile/peritoneal cx: E.coli', '-still on 15 of PEEP due high pleural pressures', '-only on vasopressin-leave on for 24 hours post levophed d/c', '-CVP: [**5-24**]', '-during the day yesterday had difficulty weaning FiO2 to 40%, was', 'increased back to 80%, then weaned back down to 50%', '-hyperglycemic to 400s overnight, received additional 20 units humolog', 'on top of standing glargine.']",52919,132862.0
26,2183-09-18 13:15:09,"['- urine output picked up overnight, was stable at 40ccs/hr, now', 'decreasing', 'urine leaking out around foley, estimated at 25', '- vasopressin turned off with good BPs', '- reported leakage around cholecystostomy tube']","['- turned down to 50% FiO2', '- likely paracentesis tomorrow, but will need platelets first', '- urine output picked up overnight, was stable at 40ccs/hr, now', 'decreasing', '- started insulin drip for sugars >400 and multiple high sugars not', 'easy to control so far today with plan of using it for 24 hours to', 'adjust his subq regimen ; holding subq regimen for now', '- bladder pressure could not be measured accurately at night because', 'urine leaking out around foley, estimated at 25', '- HR elevated into low 100s-110s, appears as if he may be breaking into', 'afib when rate briefly goes into 120s', '- vasopressin turned off with good BPs', '- reported leakage around cholecystostomy tube']","['- urine output picked up overnight, stable at 40ccs/hr', 'urine leaking out around foley', '- urine output 40-50cc/hr']",52919,132862.0
27,2183-09-18 18:50:25,,"['- turned down to 50% FiO2', '- likely paracentesis tomorrow, but will need platelets first', '- urine output picked up overnight, was stable at 40ccs/hr, now', 'decreasing', '- started insulin drip for sugars >400 and multiple high sugars not', 'easy to control so far today with plan of using it for 24 hours to', 'adjust his subq regimen ; holding subq regimen for now', '- bladder pressure could not be measured accurately at night because', 'urine leaking out around foley, estimated at 25', '- HR elevated into low 100s-110s, appears as if he may be breaking into', 'afib when rate briefly goes into 120s', '- vasopressin turned off with good BPs', '- reported leakage around cholecystostomy tube']",,52919,132862.0
28,2183-09-19 06:36:03,"['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased in response', 'to lasix.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.']","['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased in response', 'to lasix.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.']","['- turned down to 50% FiO2', '- likely paracentesis tomorrow, but will need platelets first', '- urine output picked up overnight, was stable at 40ccs/hr, now', 'decreasing', '- started insulin drip for sugars >400 and multiple high sugars not', 'easy to control so far today with plan of using it for 24 hours to', 'adjust his subq regimen ; holding subq regimen for now', '- bladder pressure could not be measured accurately at night because', 'urine leaking out around foley, estimated at 25', '- HR elevated into low 100s-110s, appears as if he may be breaking into', 'afib when rate briefly goes into 120s', '- vasopressin turned off with good BPs', '- reported leakage around cholecystostomy tube']",52919,132862.0
29,2183-09-19 11:42:55,"['systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.']","['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased in response', 'to lasix.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.']",['systolic.  HR increased back to 120s.  Amiodarone given.'],52919,132862.0
30,2183-09-19 12:04:10,"['- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']","['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']","['- received albumin 10g/L and lasix 20 mg IV.  U/O increased in response', 'to lasix.']",52919,132862.0
31,2183-09-19 12:16:42,,"['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']",,52919,132862.0
32,2183-09-19 12:24:28,,"['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']",,52919,132862.0
33,2183-09-19 12:42:11,,"['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']",,52919,132862.0
34,2183-09-20 07:07:13,"['EKG - At [**2183-9-20**] 01:02 AM', 'rate appeared in sinus rhythm with questionable pwaves. 12 lead ekg', 'revealed afib.', '- A.Fib with RVR o/n, lopressor IV x3 decreased HR but dropped SBP to', '70s', '- Amio loaded and now on infusion, infusion continued o/n b/c patient', 'remained tachycardic, repeat EKG showed pt was in A. flutter so less', 'likely to break, also pt became hypotensive with decreased HR', '- tried 500cc fluid bolus, but no decrease in HR, tried lasix b/c', 'unsure if patient is possibly in heart failure, has pulmonary edema on', ""CXR, gave 40mg IV-->put out 60cc's, gave 80mg IV--> unclear urine"", 'output b/c had leaked around foley site', '- continued fever, currently attributing it to less than 24 hours on', 'meropenem, but may need repeat imaging', '- continues on insulin gtt--> difficult to assess 24 hours insulin', 'needs, insulin requirement has decreased, looks like the pump may not', 'have been working properly and since that change, needs have decreased', 'from 24units per hour to 4units per hour', '- Pt. with decreased urine output overnight, inspite of lasix, but', 'renal function improving, his foley was leaking onto the bed.', '- Had a few episodes of desaturation, FiO2 increased back to 50%']","['EKG - At [**2183-9-20**] 01:02 AM', 'rate appeared in sinus rhythm with questionable pwaves. 12 lead ekg', 'revealed afib.', '- A.Fib with RVR o/n, lopressor IV x3 decreased HR but dropped SBP to', '70s', '- Amio loaded and now on infusion, infusion continued o/n b/c patient', 'remained tachycardic, repeat EKG showed pt was in A. flutter so less', 'likely to break, also pt became hypotensive with decreased HR', '- tried 500cc fluid bolus, but no decrease in HR, tried lasix b/c', 'unsure if patient is possibly in heart failure, has pulmonary edema on', ""CXR, gave 40mg IV-->put out 60cc's, gave 80mg IV--> unclear urine"", 'output b/c had leaked around foley site', '- continued fever, currently attributing it to less than 24 hours on', 'meropenem, but may need repeat imaging', '- continues on insulin gtt--> difficult to assess 24 hours insulin', 'needs, insulin requirement has decreased, looks like the pump may not', 'have been working properly and since that change, needs have decreased', 'from 24units per hour to 4units per hour', '- Pt. with decreased urine output overnight, inspite of lasix, but', 'renal function improving, his foley was leaking onto the bed.', '- Had a few episodes of desaturation, FiO2 increased back to 50%']","['- 5 L paracentesis done, cultures sent', '- received albumin 10g/L and lasix 20 mg IV.  U/O increased from', '30cc/hr to 70cc/hr in response to lasix, maintained u/o > 50cc/hr', 'overnight.', '- BPs down to 90s systolic with HR 120s to 130s, so further diuresis', 'held', '- ABG in AM showed 7.47/39/89 on 50% FiO2.  FiO2 decreased to 40%', '- in A-fib with ventricular rates to 140s yesterday.  Metoprolol 5mg IV', 'x 3 given with some response, HR to the 110s.  BP dropped to 90s', 'systolic.  HR increased back to 120s.  Amiodarone given with no', 'response in HR / BP.', '- on insulin drip given BS 300s-400s, goal glucose < 150.  Required', 'approx 270 units over 24 hours.', '- fever to 102 at midnight', '- abdominal US non-diagnostic yesterday.  IR believes leakage around', 'cholecystostomy drain could be [**1-13**] increased intra-abdominal pressure']",52919,132862.0
35,2183-09-20 14:31:02,,"['EKG - At [**2183-9-20**] 01:02 AM', 'rate appeared in sinus rhythm with questionable pwaves. 12 lead ekg', 'revealed afib.', '- A.Fib with RVR o/n, lopressor IV x3 decreased HR but dropped SBP to', '70s', '- Amio loaded and now on infusion, infusion continued o/n b/c patient', 'remained tachycardic, repeat EKG showed pt was in A. flutter so less', 'likely to break, also pt became hypotensive with decreased HR', '- tried 500cc fluid bolus, but no decrease in HR, tried lasix b/c', 'unsure if patient is possibly in heart failure, has pulmonary edema on', ""CXR, gave 40mg IV-->put out 60cc's, gave 80mg IV--> unclear urine"", 'output b/c had leaked around foley site', '- continued fever, currently attributing it to less than 24 hours on', 'meropenem, but may need repeat imaging', '- continues on insulin gtt--> difficult to assess 24 hours insulin', 'needs, insulin requirement has decreased, looks like the pump may not', 'have been working properly and since that change, needs have decreased', 'from 24units per hour to 4units per hour', '- Pt. with decreased urine output overnight, inspite of lasix, but', 'renal function improving, his foley was leaking onto the bed.', '- Had a few episodes of desaturation, FiO2 increased back to 50%']",,52919,132862.0
36,2183-09-20 15:23:37,,"['EKG - At [**2183-9-20**] 01:02 AM', 'rate appeared in sinus rhythm with questionable pwaves. 12 lead ekg', 'revealed afib.', '- A.Fib with RVR o/n, lopressor IV x3 decreased HR but dropped SBP to', '70s', '- Amio loaded and now on infusion, infusion continued o/n b/c patient', 'remained tachycardic, repeat EKG showed pt was in A. flutter so less', 'likely to break, also pt became hypotensive with decreased HR', '- tried 500cc fluid bolus, but no decrease in HR, tried lasix b/c', 'unsure if patient is possibly in heart failure, has pulmonary edema on', ""CXR, gave 40mg IV-->put out 60cc's, gave 80mg IV--> unclear urine"", 'output b/c had leaked around foley site', '- continued fever, currently attributing it to less than 24 hours on', 'meropenem, but may need repeat imaging', '- continues on insulin gtt--> difficult to assess 24 hours insulin', 'needs, insulin requirement has decreased, looks like the pump may not', 'have been working properly and since that change, needs have decreased', 'from 24units per hour to 4units per hour', '- Pt. with decreased urine output overnight, inspite of lasix, but', 'renal function improving, his foley was leaking onto the bed.', '- Had a few episodes of desaturation, FiO2 increased back to 50%']",,52919,132862.0
37,2183-09-21 07:58:09,"['- CT abd/chest--> cancelled for now bc pt not stable enough', '- decr PEEP 15-->12--> 10', '- transition from IV to PO amiodarone--> switched back to IV amiodarone']","['- CT abd/chest--> cancelled for now bc pt not stable enough', '- decr PEEP 15-->12--> 10', '- transition from IV to PO amiodarone--> switched back to IV amiodarone']","['EKG - At [**2183-9-20**] 01:02 AM', 'rate appeared in sinus rhythm with questionable pwaves. 12 lead ekg', 'revealed afib.', '- A.Fib with RVR o/n, lopressor IV x3 decreased HR but dropped SBP to', '70s', '- Amio loaded and now on infusion, infusion continued o/n b/c patient', 'remained tachycardic, repeat EKG showed pt was in A. flutter so less', 'likely to break, also pt became hypotensive with decreased HR', '- tried 500cc fluid bolus, but no decrease in HR, tried lasix b/c', 'unsure if patient is possibly in heart failure, has pulmonary edema on', ""CXR, gave 40mg IV-->put out 60cc's, gave 80mg IV--> unclear urine"", 'output b/c had leaked around foley site', '- continued fever, currently attributing it to less than 24 hours on', 'meropenem, but may need repeat imaging', '- continues on insulin gtt--> difficult to assess 24 hours insulin', 'needs, insulin requirement has decreased, looks like the pump may not', 'have been working properly and since that change, needs have decreased', 'from 24units per hour to 4units per hour', '- Pt. with decreased urine output overnight, inspite of lasix, but', 'renal function improving, his foley was leaking onto the bed.', '- Had a few episodes of desaturation, FiO2 increased back to 50%']",52919,132862.0
38,2183-09-21 14:30:18,,"['- CT abd/chest--> cancelled for now bc pt not stable enough', '- decr PEEP 15-->12--> 10', '- transition from IV to PO amiodarone--> switched back to IV amiodarone']",,52919,132862.0
39,2183-09-21 20:32:42,,"['- CT abd/chest--> cancelled for now bc pt not stable enough', '- decr PEEP 15-->12--> 10', '- transition from IV to PO amiodarone--> switched back to IV amiodarone']",,52919,132862.0
40,2183-09-22 07:14:24,"['- Renal following', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.', '- Patient with significant leaking around his cholecystostomy... deeply', 'saturating the sheets and bed and dripping onto floor. Tried to change', 'bandage and tube fell out...it was only in about 2 inches.', '- IR came by in the evening to place another tube, but thought the', 'gallbladder may be perforated. Did not want to do it under CT b/c INR', 'was high', '- Got a CT torso overnight b/c of concern for perf. Read shows', 'distended gall bladder']","['- Renal following', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.', '- Patient with significant leaking around his cholecystostomy... deeply', 'saturating the sheets and bed and dripping onto floor. Tried to change', 'bandage and tube fell out...it was only in about 2 inches.', '- IR came by in the evening to place another tube, but thought the', 'gallbladder may be perforated. Did not want to do it under CT b/c INR', 'was high', '- Got a CT torso overnight b/c of concern for perf. Read shows', 'distended gall bladder']","['- CT abd/chest--> cancelled for now bc pt not stable enough', '- decr PEEP 15-->12--> 10', '- transition from IV to PO amiodarone--> switched back to IV amiodarone']",52919,132862.0
41,2183-09-22 09:14:13,"['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr']","['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.', '- IR came by in the evening to place another tube, but thought the', 'gallbladder may be perforated. Did not want to do it under CT b/c INR', 'was high', '- Got a CT torso overnight b/c of concern for perf. Read shows', 'distended gall bladder']","['- Renal following', '- Patient with significant leaking around his cholecystostomy... deeply', 'saturating the sheets and bed and dripping onto floor. Tried to change', 'bandage and tube fell out...it was only in about 2 inches.']",52919,132862.0
42,2183-09-22 09:50:40,,"['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.']","['- IR came by in the evening to place another tube, but thought the', 'gallbladder may be perforated. Did not want to do it under CT b/c INR', 'was high', '- Got a CT torso overnight b/c of concern for perf. Read shows', 'distended gall bladder']",52919,132862.0
43,2183-09-22 10:10:33,,"['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.']",,52919,132862.0
44,2183-09-22 10:22:19,,"['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.']",,52919,132862.0
45,2183-09-22 14:55:33,,"['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.']",,52919,132862.0
46,2183-09-23 07:07:34,"['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control']","['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control']","['- Patient with significant leakage of peritoneal fluid around', 'cholecystostomy, dressings changed, tube fell out and was noted to be', 'in only approx 2 inches.  IR was called, US was done and showed', 'distended gall bladder.', 'Reluctant to replace tube with INR >3 and', 'PLTs 60.  CT was done and shows distended gall bladder.', '- Renal following for worsening BUN and Cr', '- not on sedation, not responsive to verbal commands', '- appears to be in Aflutter rather than Afib, which may be why amio', 'drip not working initially, then throughout day HR decreased to the', ""90's."", '-  Desatted twice in AM to 80s--> first time PEEP increased from 10 to', '12 ; second time increased PEEP to 14 and increased FiO2 from 50% to', '60%; eventually weaned back down to PEEP 14 and FiO2 to 50%', '-  gave 1 liter bolus of NS b/c likely intravascular depleted, and did', ""not increase uop; gave another 500 cc bolus b/c bp's were going down"", 'and did not help much. Started levophed.', '- Started octreotide and albumin for possible hepatorenal failure; did', 'not start midodrine b/c had to be placed back on levophed for low maps', '- goals of care: family meeting and daughter will discuss with rest of', 'family whether to make patient DNR or not. He is currently full code.']",52919,132862.0
47,2183-09-23 10:43:05,,"['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control']",,52919,132862.0
48,2183-09-23 10:54:53,,"['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control']",,52919,132862.0
49,2183-09-23 11:12:56,"['- tube feeds changed to renal', '- new murmur on exam, ECHO shows moderate MR', '- u/o decreasing, now 2.5 ml / hr']","['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control', '- tube feeds changed to renal', '- new murmur on exam, ECHO shows moderate MR', '- u/o decreasing, now 2.5 ml / hr']",,52919,132862.0
50,2183-09-23 11:38:39,,"['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control', '- tube feeds changed to renal', '- new murmur on exam, ECHO shows moderate MR', '- u/o decreasing, now 2.5 ml / hr']",,52919,132862.0
51,2183-09-24 05:57:52,"['- Renal may consider CVVH to get some volume off if oxygenation gets', 'worse and there are no other options, but not likely because he may not', 'tolerate especially w hypotension and on levophed; we should readdress', 'goals of care w family today', '- DCed vancomycin b/c has had full 8 day course (and level is so high', 'that he wont need anymore dosing to last for a while); vanc was started', ""to cover Gm+ cocci in sputum which didn't grow out in cultures"", '- continues with increased FiO2 requirement at 70%--> decreased to 60%', 'FiO2, tolerated well in evening (O2sat 94%)', '- want to keep tidal volumes down to fit w ARDS protocol (b/c his p:f', 'ratios suggest ARDS)', '- PM Hct showed Hct drop from 26--> 22', '- s/p Diagnostic tap -- peritoneal fluid grossly bloody, so volume tap', 'aborted --> fluid shows Hct 3% and WBC 333.', '- 1u pRBCs transfused', '- family updated by [**First Name8 (NamePattern2) 5027**] [**Last Name (NamePattern1) 9173**].  overnight, we promised to call', 'daughter [**Name (NI) 284**] if pressor requirement increases or if pt needing lots of', 'transfusions, or if respiratory status declining quickly.', '- DIC labs sent -- fibrinogen low at 77, D-dimer high --> checking Q6h', 'DIC labs.  1bag Cryo transfused.', '- post-transfusion Hct: bumped from 22--> 23.9 , not quite appropriate', '- 10pm Fibrinogen = 102 (UpToDate says to give cryo if <50 to keep', 'fibrinogen >100, so did not give cryo at this time)', '- 1am fibrinogen = 103  ; 3:30am fibrinogen  = 92  ;', '- pending 8am fibrinogen = ?', '- A-line not [**Location (un) 118**] accurate BPs; per, nursing on day and night shift,', 'it is dampened and not working well.  may need another A-line']","['- Renal may consider CVVH to get some volume off if oxygenation gets', 'worse and there are no other options, but not likely because he may not', 'tolerate especially w hypotension and on levophed; we should readdress', 'goals of care w family today', '- DCed vancomycin b/c has had full 8 day course (and level is so high', 'that he wont need anymore dosing to last for a while); vanc was started', ""to cover Gm+ cocci in sputum which didn't grow out in cultures"", '- continues with increased FiO2 requirement at 70%--> decreased to 60%', 'FiO2, tolerated well in evening (O2sat 94%)', '- want to keep tidal volumes down to fit w ARDS protocol (b/c his p:f', 'ratios suggest ARDS)', '- PM Hct showed Hct drop from 26--> 22', '- s/p Diagnostic tap -- peritoneal fluid grossly bloody, so volume tap', 'aborted --> fluid shows Hct 3% and WBC 333.', '- 1u pRBCs transfused', '- family updated by [**First Name8 (NamePattern2) 5027**] [**Last Name (NamePattern1) 9173**].  overnight, we promised to call', 'daughter [**Name (NI) 284**] if pressor requirement increases or if pt needing lots of', 'transfusions, or if respiratory status declining quickly.', '- DIC labs sent -- fibrinogen low at 77, D-dimer high --> checking Q6h', 'DIC labs.  1bag Cryo transfused.', '- post-transfusion Hct: bumped from 22--> 23.9 , not quite appropriate', '- 10pm Fibrinogen = 102 (UpToDate says to give cryo if <50 to keep', 'fibrinogen >100, so did not give cryo at this time)', '- 1am fibrinogen = 103  ; 3:30am fibrinogen  = 92  ;', '- pending 8am fibrinogen = ?', '- A-line not [**Location (un) 118**] accurate BPs; per, nursing on day and night shift,', 'it is dampened and not working well.  may need another A-line']","['- new cholecystostomy tube placed by IR in afternoon.  Required 3', 'passes.', '- de-satted into upper 80s overnight with PaO2 into 60s, FiO2 increased', 'to 100%, now at 70% with PEEP 14', '- norepinephrine weaned downed to 0.05 mcg/kg/min yesterday, increased', 'to 0.07 mcg/kg/min to maintain MAP > 60.', '- family meeting conducted yesterday, no change in code status', '- continued on insulin drip for blood sugar control', '- tube feeds changed to renal', '- new murmur on exam, ECHO shows moderate MR', '- u/o decreasing, now 2.5 ml / hr']",52919,132862.0
52,2183-09-24 07:14:46,"['tolerate especially w hypotension and on levophed', '- DCed vancomycin', '- 1u pRBCs transfused with 2 pt bump in HCT', 'DIC labs.  1bag Cryo transfused', ' 10 pm fibrinogen 102', ' 1 am 103, 3:30', 'am 92', ' 8am pending', '- per up to date, will plan to give cryo for fibrinogen < 50 with goal', '> 100.', 'it is dampened and not working well.']","['- Renal may consider CVVH to get some volume off if oxygenation gets', 'worse and there are no other options, but not likely because he may not', 'tolerate especially w hypotension and on levophed', '- DCed vancomycin', '- continues with increased FiO2 requirement at 70%--> decreased to 60%', 'FiO2, tolerated well in evening (O2sat 94%)', '- want to keep tidal volumes down to fit w ARDS protocol (b/c his p:f', 'ratios suggest ARDS)', '- PM Hct showed Hct drop from 26--> 22', '- s/p Diagnostic tap -- peritoneal fluid grossly bloody, so volume tap', 'aborted --> fluid shows Hct 3% and WBC 333.', '- 1u pRBCs transfused with 2 pt bump in HCT', '- family updated by [**First Name8 (NamePattern2) 5027**] [**Last Name (NamePattern1) 9173**].  overnight, we promised to call', 'daughter [**Name (NI) 284**] if pressor requirement increases or if pt needing lots of', 'transfusions, or if respiratory status declining quickly.', '- DIC labs sent -- fibrinogen low at 77, D-dimer high --> checking Q6h', 'DIC labs.  1bag Cryo transfused', ' 10 pm fibrinogen 102', ' 1 am 103, 3:30', 'am 92', ' 8am pending', '- per up to date, will plan to give cryo for fibrinogen < 50 with goal', '> 100.', '- A-line not [**Location (un) 118**] accurate BPs; per, nursing on day and night shift,', 'it is dampened and not working well.']","['tolerate especially w hypotension and on levophed; we should readdress', 'goals of care w family today', '- DCed vancomycin b/c has had full 8 day course (and level is so high', 'that he wont need anymore dosing to last for a while); vanc was started', ""to cover Gm+ cocci in sputum which didn't grow out in cultures"", '- 1u pRBCs transfused', 'DIC labs.  1bag Cryo transfused.', '- post-transfusion Hct: bumped from 22--> 23.9 , not quite appropriate', '- 10pm Fibrinogen = 102 (UpToDate says to give cryo if <50 to keep', 'fibrinogen >100, so did not give cryo at this time)', '- 1am fibrinogen = 103  ; 3:30am fibrinogen  = 92  ;', '- pending 8am fibrinogen = ?', 'it is dampened and not working well.  may need another A-line']",52919,132862.0
53,2183-09-24 10:33:39,"['tolerate especially w hypotension and on levophed, difficult canulation', 'and coagulation issues', '- PM Hct showed Hct drop from 26--> 22, transfused with bump to 24, now', 'stable']","['- Renal may consider CVVH to get some volume off if oxygenation gets', 'worse and there are no other options, but not likely because he may not', 'tolerate especially w hypotension and on levophed, difficult canulation', 'and coagulation issues', '- DCed vancomycin', '- continues with increased FiO2 requirement at 70%--> decreased to 60%', 'FiO2, tolerated well in evening (O2sat 94%)', '- want to keep tidal volumes down to fit w ARDS protocol (b/c his p:f', 'ratios suggest ARDS)', '- PM Hct showed Hct drop from 26--> 22, transfused with bump to 24, now', 'stable', '- s/p Diagnostic tap -- peritoneal fluid grossly bloody, so volume tap', 'aborted --> fluid shows Hct 3% and WBC 333.', '- DIC labs sent -- fibrinogen low at 77, D-dimer high --> checking Q6h', 'DIC labs.  1bag Cryo transfused', ' 10 pm fibrinogen 102', ' 1 am 103, 3:30', 'am 92', ' 8am pending', '- family updated by [**First Name8 (NamePattern2) 5027**] [**Last Name (NamePattern1) 9173**].  overnight, we promised to call', 'daughter [**Name (NI) 284**] if pressor requirement increases or if pt needing lots of', 'transfusions, or if respiratory status declining quickly.', '- per up to date, will plan to give cryo for fibrinogen < 50 with goal', '> 100.', '- A-line not [**Location (un) 118**] accurate BPs; per, nursing on day and night shift,', 'it is dampened and not working well.']","['tolerate especially w hypotension and on levophed', '- PM Hct showed Hct drop from 26--> 22', '- 1u pRBCs transfused with 2 pt bump in HCT']",52919,132862.0
54,2183-09-24 11:29:50,,"['- Renal may consider CVVH to get some volume off if oxygenation gets', 'worse and there are no other options, but not likely because he may not', 'tolerate especially w hypotension and on levophed, difficult canulation', 'and coagulation issues', '- DCed vancomycin', '- continues with increased FiO2 requirement at 70%--> decreased to 60%', 'FiO2, tolerated well in evening (O2sat 94%)', '- want to keep tidal volumes down to fit w ARDS protocol (b/c his p:f', 'ratios suggest ARDS)', '- PM Hct showed Hct drop from 26--> 22, transfused with bump to 24, now', 'stable', '- s/p Diagnostic tap -- peritoneal fluid grossly bloody, so volume tap', 'aborted --> fluid shows Hct 3% and WBC 333.', '- DIC labs sent -- fibrinogen low at 77, D-dimer high --> checking Q6h', 'DIC labs.  1bag Cryo transfused', ' 10 pm fibrinogen 102', ' 1 am 103, 3:30', 'am 92', ' 8am pending', '- family updated by [**First Name8 (NamePattern2) 5027**] [**Last Name (NamePattern1) 9173**].  overnight, we promised to call', 'daughter [**Name (NI) 284**] if pressor requirement increases or if pt needing lots of', 'transfusions, or if respiratory status declining quickly.', '- per up to date, will plan to give cryo for fibrinogen < 50 with goal', '> 100.', '- A-line not [**Location (un) 118**] accurate BPs; per, nursing on day and night shift,', 'it is dampened and not working well.']",,52919,132862.0
0,2141-04-08 07:27:07,,[],,32673,151884.0
1,2141-04-09 08:00:20,"['[**Known lastname 661**]- 68M with PMH GAVE and ampullary adenomas who was admitted', 'with melena and BRBPR 10 days s/p endoscopy.  On a PPI  and octreotide', 'gtt, will get endoscopy with GI tomorrow.', '-Serial HCT stable']","['[**Known lastname 661**]- 68M with PMH GAVE and ampullary adenomas who was admitted', 'with melena and BRBPR 10 days s/p endoscopy.  On a PPI  and octreotide', 'gtt, will get endoscopy with GI tomorrow.', '-Serial HCT stable']",,32673,151884.0
2,2141-04-09 16:12:09,,"['[**Known lastname 661**]- 68M with PMH GAVE and ampullary adenomas who was admitted', 'with melena and BRBPR 10 days s/p endoscopy.  On a PPI  and octreotide', 'gtt, will get endoscopy with GI tomorrow.', '-Serial HCT stable']",,32673,151884.0
0,2165-07-11 06:53:37,,"['Pt with dark red stool this am. HCT bumped appropriately to 24 with 1U', 'PRBC. Pt receieved 2nd unit overnight. HD stable.', 'History obtained from [**Hospital 85**] Medical records']",,27450,152177.0
1,2165-07-11 11:21:15,,"['Pt with dark red stool this am. HCT bumped appropriately to 24 with 1U', 'PRBC. Pt receieved 2nd unit overnight. HD stable.', 'History obtained from [**Hospital 85**] Medical records']",,27450,152177.0
0,2106-01-19 08:23:21,,"['- ENT: leave packing in until thursday (placed on saturday), use', 'humified oxygen after extubation, avoid nasal cannula, cefazolin until', 'packing removed', '- Dr. [**Last Name (STitle) **]: dig was for rate control (checking dig level), please', 'c/s cards (will call in morning), will drop by wednesday or thursday', '- heme/onc: requested we send several labs and urine studies', '- extubated, did well', '- ECHO: dCHF,  mild aortic stenosis', '-S&S c/s', '- started d5w for hypernatrem']",,56478,171250.0
1,2106-01-19 08:28:08,"['- Heme recs:', 'differential diagnosis for Mr. [**Known lastname 10368**] coagulopathy includes', 'multiple factor deficiencies caused by either severe', 'malnutrition, protein-losing enteropathy, or nephrotic syndrome (all consistent', 'with his low albumin), heparin use (unlikely given current medication list), dys', 'fibrinogenemia (qualitative defect given normal fibrinogen level), or an acquire', 'd inhibitor of a clotting factor (e.g. thrombin, factor X, or [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**]', 'factor).', 'urine analysis to r/o proteinuria.', '[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] disease screen:  factor VIII', 'activity, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] antigen, and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] activity (ristocetin cofact', 'SPEP and UPEP.', '- thrombin time and inhibitor screen', '-reptilase time to evaluate for possible fibrinogen', 'abnormality']","['- ENT: leave packing in until thursday (placed on saturday), use', 'humified oxygen after extubation, avoid nasal cannula, cefazolin until', 'packing removed', '- Dr. [**Last Name (STitle) **]: dig was for rate control (checking dig level), please', 'c/s cards (will call in morning), will drop by wednesday or thursday', '- heme/onc: requested we send several labs and urine studies', '- extubated, did well', '- ECHO: dCHF,  mild aortic stenosis', '-S&S c/s', '- started d5w for hypernatrem', '- Heme recs:', 'differential diagnosis for Mr. [**Known lastname 10368**] coagulopathy includes', 'multiple factor deficiencies caused by either severe', 'malnutrition, protein-losing enteropathy, or nephrotic syndrome (all consistent', 'with his low albumin), heparin use (unlikely given current medication list), dys', 'fibrinogenemia (qualitative defect given normal fibrinogen level), or an acquire', 'd inhibitor of a clotting factor (e.g. thrombin, factor X, or [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**]', 'factor).', 'urine analysis to r/o proteinuria.', '[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] disease screen:  factor VIII', 'activity, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] antigen, and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] activity (ristocetin cofact', 'SPEP and UPEP.', '- thrombin time and inhibitor screen', '-reptilase time to evaluate for possible fibrinogen', 'abnormality']",,56478,171250.0
2,2106-01-19 09:33:07,,"['- ENT: leave packing in until thursday (placed on saturday), use', 'humified oxygen after extubation, avoid nasal cannula, cefazolin until', 'packing removed', '- Dr. [**Last Name (STitle) **]: dig was for rate control (checking dig level), please', 'c/s cards (will call in morning), will drop by wednesday or thursday', '- heme/onc: requested we send several labs and urine studies', '- extubated, did well', '- ECHO: dCHF,  mild aortic stenosis', '-S&S c/s', '- started d5w for hypernatrem', '- Heme recs:', 'differential diagnosis for Mr. [**Known lastname 10368**] coagulopathy includes', 'multiple factor deficiencies caused by either severe', 'malnutrition, protein-losing enteropathy, or nephrotic syndrome (all consistent', 'with his low albumin), heparin use (unlikely given current medication list), dys', 'fibrinogenemia (qualitative defect given normal fibrinogen level), or an acquire', 'd inhibitor of a clotting factor (e.g. thrombin, factor X, or [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**]', 'factor).', 'urine analysis to r/o proteinuria.', '[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] disease screen:  factor VIII', 'activity, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] antigen, and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] activity (ristocetin cofact', 'SPEP and UPEP.', '- thrombin time and inhibitor screen', '-reptilase time to evaluate for possible fibrinogen', 'abnormality']",,56478,171250.0
3,2106-01-19 09:36:30,,"['- ENT: leave packing in until thursday (placed on saturday), use', 'humified oxygen after extubation, avoid nasal cannula, cefazolin until', 'packing removed', '- Dr. [**Last Name (STitle) **]: dig was for rate control (checking dig level), please', 'c/s cards (will call in morning), will drop by wednesday or thursday', '- heme/onc: requested we send several labs and urine studies', '- extubated, did well', '- ECHO: dCHF,  mild aortic stenosis', '-S&S c/s', '- started d5w for hypernatrem', '- Heme recs:', 'differential diagnosis for Mr. [**Known lastname 10368**] coagulopathy includes', 'multiple factor deficiencies caused by either severe', 'malnutrition, protein-losing enteropathy, or nephrotic syndrome (all consistent', 'with his low albumin), heparin use (unlikely given current medication list), dys', 'fibrinogenemia (qualitative defect given normal fibrinogen level), or an acquire', 'd inhibitor of a clotting factor (e.g. thrombin, factor X, or [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**]', 'factor).', 'urine analysis to r/o proteinuria.', '[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] disease screen:  factor VIII', 'activity, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] antigen, and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] activity (ristocetin cofact', 'SPEP and UPEP.', '- thrombin time and inhibitor screen', '-reptilase time to evaluate for possible fibrinogen', 'abnormality']",,56478,171250.0
4,2106-01-28 07:33:23,"['- [**Doctor First Name **] placed strong dobhoff, started TFs', '- was not responding to lasix, tried higher doses to 160 mg iv,', 'chlorothiazide + metolazone; wrote for albumin (thought he was getting', ""it already but he wasn't)"", ""- couldn't lie flat and dropped sats to 80s when supine so didn't get"", 'CT', '- had delerium overnight, was calling for his mother and father', '- [**Name (NI) **] 7.23/76 this a.m. -> abg', ""- told me and nurse that he didn't want the treatments/needle sticks,"", 'instead wanted to be made comfortable, ""let me go."", understand that', 'this would mean that he would die, was appropriate and A/O to person,', 'year, ~location (rehab),', ' PICC LINE - START [**2106-1-27**] 08:19 AM', ' BLOOD CULTURED - At [**2106-1-27**] 06:00 PM', 'X1', ' BLOOD CULTURED - At [**2106-1-28**] 01:30 AM', 'X1']","['- [**Doctor First Name **] placed strong dobhoff, started TFs', '- was not responding to lasix, tried higher doses to 160 mg iv,', 'chlorothiazide + metolazone; wrote for albumin (thought he was getting', ""it already but he wasn't)"", ""- couldn't lie flat and dropped sats to 80s when supine so didn't get"", 'CT', '- had delerium overnight, was calling for his mother and father', '- [**Name (NI) **] 7.23/76 this a.m. -> abg', ""- told me and nurse that he didn't want the treatments/needle sticks,"", 'instead wanted to be made comfortable, ""let me go."", understand that', 'this would mean that he would die, was appropriate and A/O to person,', 'year, ~location (rehab),', ' PICC LINE - START [**2106-1-27**] 08:19 AM', ' BLOOD CULTURED - At [**2106-1-27**] 06:00 PM', 'X1', ' BLOOD CULTURED - At [**2106-1-28**] 01:30 AM', 'X1']","['- ENT: leave packing in until thursday (placed on saturday), use', 'humified oxygen after extubation, avoid nasal cannula, cefazolin until', 'packing removed', '- Dr. [**Last Name (STitle) **]: dig was for rate control (checking dig level), please', 'c/s cards (will call in morning), will drop by wednesday or thursday', '- heme/onc: requested we send several labs and urine studies', '- extubated, did well', '- ECHO: dCHF,  mild aortic stenosis', '-S&S c/s', '- started d5w for hypernatrem', '- Heme recs:', 'differential diagnosis for Mr. [**Known lastname 10368**] coagulopathy includes', 'multiple factor deficiencies caused by either severe', 'malnutrition, protein-losing enteropathy, or nephrotic syndrome (all consistent', 'with his low albumin), heparin use (unlikely given current medication list), dys', 'fibrinogenemia (qualitative defect given normal fibrinogen level), or an acquire', 'd inhibitor of a clotting factor (e.g. thrombin, factor X, or [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**]', 'factor).', 'urine analysis to r/o proteinuria.', '[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] disease screen:  factor VIII', 'activity, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] antigen, and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10369**] activity (ristocetin cofact', 'SPEP and UPEP.', '- thrombin time and inhibitor screen', '-reptilase time to evaluate for possible fibrinogen', 'abnormality']",56478,171250.0
5,2106-01-28 07:35:14,,"['- [**Doctor First Name **] placed strong dobhoff, started TFs', '- was not responding to lasix, tried higher doses to 160 mg iv,', 'chlorothiazide + metolazone; wrote for albumin (thought he was getting', ""it already but he wasn't)"", ""- couldn't lie flat and dropped sats to 80s when supine so didn't get"", 'CT', '- had delerium overnight, was calling for his mother and father', '- [**Name (NI) **] 7.23/76 this a.m. -> abg', ""- told me and nurse that he didn't want the treatments/needle sticks,"", 'instead wanted to be made comfortable, ""let me go."", understand that', 'this would mean that he would die, was appropriate and A/O to person,', 'year, ~location (rehab),', ' PICC LINE - START [**2106-1-27**] 08:19 AM', ' BLOOD CULTURED - At [**2106-1-27**] 06:00 PM', 'X1', ' BLOOD CULTURED - At [**2106-1-28**] 01:30 AM', 'X1']",,56478,171250.0
6,2106-01-29 07:48:49,"['-- further disucssion with family regarding prognosis and goals of', 'care; they want CMO, but to try to maintain holding pattern until', 'daughter can come in at 4P on Friday', '-- cont on BiPAP throughout the day; having signficant secretions;', 'given 0.5 of morphine and scopalamine patch overnight', '-- BPs low, started on levophed overnight to maintain MAP>55', '-- diuretics stopped; despite max doses, patient only made about', '10cc/hr', '-- TPN stopped; all IV meds transitioned to PO if possible', ' NON-INVASIVE VENTILATION - START [**2106-1-28**] 08:10 AM']","['-- further disucssion with family regarding prognosis and goals of', 'care; they want CMO, but to try to maintain holding pattern until', 'daughter can come in at 4P on Friday', '-- cont on BiPAP throughout the day; having signficant secretions;', 'given 0.5 of morphine and scopalamine patch overnight', '-- BPs low, started on levophed overnight to maintain MAP>55', '-- diuretics stopped; despite max doses, patient only made about', '10cc/hr', '-- TPN stopped; all IV meds transitioned to PO if possible', ' NON-INVASIVE VENTILATION - START [**2106-1-28**] 08:10 AM']","['- [**Doctor First Name **] placed strong dobhoff, started TFs', '- was not responding to lasix, tried higher doses to 160 mg iv,', 'chlorothiazide + metolazone; wrote for albumin (thought he was getting', ""it already but he wasn't)"", ""- couldn't lie flat and dropped sats to 80s when supine so didn't get"", 'CT', '- had delerium overnight, was calling for his mother and father', '- [**Name (NI) **] 7.23/76 this a.m. -> abg', ""- told me and nurse that he didn't want the treatments/needle sticks,"", 'instead wanted to be made comfortable, ""let me go."", understand that', 'this would mean that he would die, was appropriate and A/O to person,', 'year, ~location (rehab),', ' PICC LINE - START [**2106-1-27**] 08:19 AM', ' BLOOD CULTURED - At [**2106-1-27**] 06:00 PM', 'X1', ' BLOOD CULTURED - At [**2106-1-28**] 01:30 AM', 'X1']",56478,171250.0
7,2106-01-29 08:02:44,,"['-- further disucssion with family regarding prognosis and goals of', 'care; they want CMO, but to try to maintain holding pattern until', 'daughter can come in at 4P on Friday', '-- cont on BiPAP throughout the day; having signficant secretions;', 'given 0.5 of morphine and scopalamine patch overnight', '-- BPs low, started on levophed overnight to maintain MAP>55', '-- diuretics stopped; despite max doses, patient only made about', '10cc/hr', '-- TPN stopped; all IV meds transitioned to PO if possible', ' NON-INVASIVE VENTILATION - START [**2106-1-28**] 08:10 AM']",,56478,171250.0
8,2106-01-30 08:10:25,"['[**1-28**]', '*******************************************************', '[**1-29**]', '-- Daughter arrived at 4pm, patient taken off BIPAP and pressors', ""d/c'd.  All non-essential meds stopped.  Patient did well throughout"", 'night.']","['[**1-28**]', '-- further disucssion with family regarding prognosis and goals of', 'care; they want CMO, but to try to maintain holding pattern until', 'daughter can come in at 4P on Friday', '-- cont on BiPAP throughout the day; having signficant secretions;', 'given 0.5 of morphine and scopalamine patch overnight', '-- BPs low, started on levophed overnight to maintain MAP>55', '-- diuretics stopped; despite max doses, patient only made about', '10cc/hr', '-- TPN stopped; all IV meds transitioned to PO if possible', '*******************************************************', '[**1-29**]', '-- Daughter arrived at 4pm, patient taken off BIPAP and pressors', ""d/c'd.  All non-essential meds stopped.  Patient did well throughout"", 'night.']",[' NON-INVASIVE VENTILATION - START [**2106-1-28**] 08:10 AM'],56478,171250.0
9,2106-01-30 11:48:07,,"['[**1-28**]', '-- further disucssion with family regarding prognosis and goals of', 'care; they want CMO, but to try to maintain holding pattern until', 'daughter can come in at 4P on Friday', '-- cont on BiPAP throughout the day; having signficant secretions;', 'given 0.5 of morphine and scopalamine patch overnight', '-- BPs low, started on levophed overnight to maintain MAP>55', '-- diuretics stopped; despite max doses, patient only made about', '10cc/hr', '-- TPN stopped; all IV meds transitioned to PO if possible', '*******************************************************', '[**1-29**]', '-- Daughter arrived at 4pm, patient taken off BIPAP and pressors', ""d/c'd.  All non-essential meds stopped.  Patient did well throughout"", 'night.']",,56478,171250.0
0,2191-08-18 07:21:10,,"['PICC LINE - START [**2191-8-17**] 11:47 AM', ' BLOOD CULTURED - At [**2191-8-17**] 01:04 PM', 'PICC', ' BLOOD CULTURED - At [**2191-8-18**] 04:37 AM', '-moaned overnight, thought [**12-20**] pain, given 0.5mg morphine', '-able to say yes and no and repeat my name', '-moved all extremities except RUE', '-Right picc u/s with nonoccluding clot', '-Tm 100.5', '-NG tube removed bc could not identify below the diaphragm, then', 'replaced, shot 2 films but then looked to be in good place but nurse', 'found it coiled in his mouth so it was removed', '-free phenytoin level pending, neuro would like for us to discuss', 'dosing with them', '-held off on MRI brain to see if neuro really wants it']",,54229,165594.0
1,2191-08-18 07:22:54,,"['PICC LINE - START [**2191-8-17**] 11:47 AM', ' BLOOD CULTURED - At [**2191-8-17**] 01:04 PM', 'PICC', ' BLOOD CULTURED - At [**2191-8-18**] 04:37 AM', '-moaned overnight, thought [**12-20**] pain, given 0.5mg morphine', '-able to say yes and no and repeat my name', '-moved all extremities except RUE', '-Right picc u/s with nonoccluding clot', '-Tm 100.5', '-NG tube removed bc could not identify below the diaphragm, then', 'replaced, shot 2 films but then looked to be in good place but nurse', 'found it coiled in his mouth so it was removed', '-free phenytoin level pending, neuro would like for us to discuss', 'dosing with them', '-held off on MRI brain to see if neuro really wants it']",,54229,165594.0
2,2191-08-18 10:06:14,,"['PICC LINE - START [**2191-8-17**] 11:47 AM', ' BLOOD CULTURED - At [**2191-8-17**] 01:04 PM', 'PICC', ' BLOOD CULTURED - At [**2191-8-18**] 04:37 AM', '-moaned overnight, thought [**12-20**] pain, given 0.5mg morphine', '-able to say yes and no and repeat my name', '-moved all extremities except RUE', '-Right picc u/s with nonoccluding clot', '-Tm 100.5', '-NG tube removed bc could not identify below the diaphragm, then', 'replaced, shot 2 films but then looked to be in good place but nurse', 'found it coiled in his mouth so it was removed', '-free phenytoin level pending, neuro would like for us to discuss', 'dosing with them', '-held off on MRI brain to see if neuro really wants it']",,54229,165594.0
3,2191-08-22 07:48:51,"['FEVER - 102.4', 'F - [**2191-8-21**] 08:00 AM', '- patient now covered with vancomycin and cefepime, gentamicin', 'discontinued', '- persistent large volumes of bilous return from NGT (it is properly', 'placed in stomach), patient is passing flatus and has ABS (no ileus)']","['FEVER - 102.4', 'F - [**2191-8-21**] 08:00 AM', '- patient now covered with vancomycin and cefepime, gentamicin', 'discontinued', '- persistent large volumes of bilous return from NGT (it is properly', 'placed in stomach), patient is passing flatus and has ABS (no ileus)']","['PICC LINE - START [**2191-8-17**] 11:47 AM', ' BLOOD CULTURED - At [**2191-8-17**] 01:04 PM', 'PICC', ' BLOOD CULTURED - At [**2191-8-18**] 04:37 AM', '-moaned overnight, thought [**12-20**] pain, given 0.5mg morphine', '-able to say yes and no and repeat my name', '-moved all extremities except RUE', '-Right picc u/s with nonoccluding clot', '-Tm 100.5', '-NG tube removed bc could not identify below the diaphragm, then', 'replaced, shot 2 films but then looked to be in good place but nurse', 'found it coiled in his mouth so it was removed', '-free phenytoin level pending, neuro would like for us to discuss', 'dosing with them', '-held off on MRI brain to see if neuro really wants it']",54229,165594.0
4,2191-08-22 14:11:19,,"['FEVER - 102.4', 'F - [**2191-8-21**] 08:00 AM', '- patient now covered with vancomycin and cefepime, gentamicin', 'discontinued', '- persistent large volumes of bilous return from NGT (it is properly', 'placed in stomach), patient is passing flatus and has ABS (no ileus)']",,54229,165594.0
5,2191-08-23 07:33:33,"['SPUTUM CULTURE - At [**2191-8-22**] 12:00 PM', 'culture repeated', ' ANGIOGRAPHY - At [**2191-8-22**] 03:00 PM', 'temporary dialysis line placement.', ' DIALYSIS CATHETER - START [**2191-8-22**] 04:10 PM', 'sideport', '-Renal: tunneled line okay, check vanco trough daily, if trough between', '15-20 give 500mg IV Vanco, if < 15 give 1gm.', '-lipase mildly elevated, AST, alk phos very mildly elevated; holding', 'off on RUQ US', '-prelim read of KUB does not show any obstruction', '- sputum cultures -  positive for GNR and G+ Cocci in Pairs']","['SPUTUM CULTURE - At [**2191-8-22**] 12:00 PM', 'culture repeated', ' ANGIOGRAPHY - At [**2191-8-22**] 03:00 PM', 'temporary dialysis line placement.', ' DIALYSIS CATHETER - START [**2191-8-22**] 04:10 PM', 'sideport', '-Renal: tunneled line okay, check vanco trough daily, if trough between', '15-20 give 500mg IV Vanco, if < 15 give 1gm.', '-lipase mildly elevated, AST, alk phos very mildly elevated; holding', 'off on RUQ US', '-prelim read of KUB does not show any obstruction', '- sputum cultures -  positive for GNR and G+ Cocci in Pairs']","['FEVER - 102.4', 'F - [**2191-8-21**] 08:00 AM', '- patient now covered with vancomycin and cefepime, gentamicin', 'discontinued', '- persistent large volumes of bilous return from NGT (it is properly', 'placed in stomach), patient is passing flatus and has ABS (no ileus)']",54229,165594.0
6,2191-08-23 22:22:15,,"['SPUTUM CULTURE - At [**2191-8-22**] 12:00 PM', 'culture repeated', ' ANGIOGRAPHY - At [**2191-8-22**] 03:00 PM', 'temporary dialysis line placement.', ' DIALYSIS CATHETER - START [**2191-8-22**] 04:10 PM', 'sideport', '-Renal: tunneled line okay, check vanco trough daily, if trough between', '15-20 give 500mg IV Vanco, if < 15 give 1gm.', '-lipase mildly elevated, AST, alk phos very mildly elevated; holding', 'off on RUQ US', '-prelim read of KUB does not show any obstruction', '- sputum cultures -  positive for GNR and G+ Cocci in Pairs']",,54229,165594.0
7,2191-08-24 06:56:37,"['- axillary arterial line placed showing pressures higher than measured', 'by non-invassive', '- CVVH started but was stopped prematurely because of line difficulties', '- clots in temporay line', '- Pharmacy dosing: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro dosing: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Neuro consulted re: prognosis and could not elaborate do to co-morbid', 'illnesses', '- Total HD output 60 cc']","['- axillary arterial line placed showing pressures higher than measured', 'by non-invassive', '- CVVH started but was stopped prematurely because of line difficulties', '- clots in temporay line', '- Pharmacy dosing: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro dosing: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Neuro consulted re: prognosis and could not elaborate do to co-morbid', 'illnesses', '- Total HD output 60 cc']","['SPUTUM CULTURE - At [**2191-8-22**] 12:00 PM', 'culture repeated', ' ANGIOGRAPHY - At [**2191-8-22**] 03:00 PM', 'temporary dialysis line placement.', ' DIALYSIS CATHETER - START [**2191-8-22**] 04:10 PM', 'sideport', '-Renal: tunneled line okay, check vanco trough daily, if trough between', '15-20 give 500mg IV Vanco, if < 15 give 1gm.', '-lipase mildly elevated, AST, alk phos very mildly elevated; holding', 'off on RUQ US', '-prelim read of KUB does not show any obstruction', '- sputum cultures -  positive for GNR and G+ Cocci in Pairs']",54229,165594.0
8,2191-08-24 08:17:32,"['- axillary a-line placed showing pressures higher than measured by', 'non-invasive', '- CVVH started but stopped prematurely because of line difficulties', 'clots', '- Pharmacy: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro:: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Total CVVH output 60 cc', '- NG aspirate now green again']","['- axillary a-line placed showing pressures higher than measured by', 'non-invasive', '- CVVH started but stopped prematurely because of line difficulties', 'clots', '- Pharmacy: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro:: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Neuro consulted re: prognosis and could not elaborate do to co-morbid', 'illnesses', '- Total CVVH output 60 cc', '- NG aspirate now green again']","['- axillary arterial line placed showing pressures higher than measured', 'by non-invassive', '- CVVH started but was stopped prematurely because of line difficulties', '- clots in temporay line', '- Pharmacy dosing: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro dosing: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Total HD output 60 cc']",54229,165594.0
9,2191-08-24 18:16:33,,"['- axillary a-line placed showing pressures higher than measured by', 'non-invasive', '- CVVH started but stopped prematurely because of line difficulties', 'clots', '- Pharmacy: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro:: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Neuro consulted re: prognosis and could not elaborate do to co-morbid', 'illnesses', '- Total CVVH output 60 cc', '- NG aspirate now green again']",,54229,165594.0
10,2191-08-25 07:25:29,"['- duplex US of RUEx: non-occlusive thrombus along PICC in the right', 'axillary vein, with peripheral flow noted, does not propagate centrally', 'into SCV, brachial veins are patent', '- PICC pulled and temporary line placed by IR and HD initiated with 2L', 'taken off', '- sedation discontinued but patient remains unresponsive, no withdrawal', 'of upper extremities', '- neuro: SDH alone likely not sole cause of altered MS, likely', 'multifactorial secondary to infection, uremia, seizures - check daily', 'dilantin levels']","['- duplex US of RUEx: non-occlusive thrombus along PICC in the right', 'axillary vein, with peripheral flow noted, does not propagate centrally', 'into SCV, brachial veins are patent', '- PICC pulled and temporary line placed by IR and HD initiated with 2L', 'taken off', '- sedation discontinued but patient remains unresponsive, no withdrawal', 'of upper extremities', '- neuro: SDH alone likely not sole cause of altered MS, likely', 'multifactorial secondary to infection, uremia, seizures - check daily', 'dilantin levels']","['- axillary a-line placed showing pressures higher than measured by', 'non-invasive', '- CVVH started but stopped prematurely because of line difficulties', 'clots', '- Pharmacy: Vancomycin 1gm q 24 and cefepime 1 gm q 12', '- Neuro:: fosphenytoin dosing 200 AM/100 PM/100 HS', '- Neuro consulted re: prognosis and could not elaborate do to co-morbid', 'illnesses', '- Total CVVH output 60 cc', '- NG aspirate now green again']",54229,165594.0
11,2191-08-25 14:40:51,['- temporary line replaced by IR and HD initiated with 2L taken off'],"['- duplex US of RUEx: non-occlusive thrombus along PICC in the right', 'axillary vein, with peripheral flow noted, does not propagate centrally', 'into SCV, brachial veins are patent', '- temporary line replaced by IR and HD initiated with 2L taken off', '- sedation discontinued but patient remains unresponsive, no withdrawal', 'of upper extremities', '- neuro: SDH alone likely not sole cause of altered MS, likely', 'multifactorial secondary to infection, uremia, seizures - check daily', 'dilantin levels']","['- PICC pulled and temporary line placed by IR and HD initiated with 2L', 'taken off']",54229,165594.0
12,2191-08-26 07:19:23,"['FEVER - 102.3', 'F - [**2191-8-25**] 08:00 PM', '-dilantin level within normal ranges after adjusting for low albumin', '(14)', '-sputum cultures show 2+ gram - and 1+ gram positive consistent with', 'MRSA', '-no neuro recs left', '-nutrition consulted but did not leave TPN recs yet', '-fever spiked to 102.4 around 8 pm and was re-pancultured', '-around 1 AM BP fell to 70s systolic when nursing turned patient; after', 'repositioning, BP failed to improve, was given a 500 cc NS bolus.  Pt', 'was restarted on levo to maintain pressures.']","['FEVER - 102.3', 'F - [**2191-8-25**] 08:00 PM', '-dilantin level within normal ranges after adjusting for low albumin', '(14)', '-sputum cultures show 2+ gram - and 1+ gram positive consistent with', 'MRSA', '-no neuro recs left', '-nutrition consulted but did not leave TPN recs yet', '-fever spiked to 102.4 around 8 pm and was re-pancultured', '-around 1 AM BP fell to 70s systolic when nursing turned patient; after', 'repositioning, BP failed to improve, was given a 500 cc NS bolus.  Pt', 'was restarted on levo to maintain pressures.']","['- duplex US of RUEx: non-occlusive thrombus along PICC in the right', 'axillary vein, with peripheral flow noted, does not propagate centrally', 'into SCV, brachial veins are patent', '- temporary line replaced by IR and HD initiated with 2L taken off', '- sedation discontinued but patient remains unresponsive, no withdrawal', 'of upper extremities', '- neuro: SDH alone likely not sole cause of altered MS, likely', 'multifactorial secondary to infection, uremia, seizures - check daily', 'dilantin levels']",54229,165594.0
13,2191-08-26 07:25:00,,"['FEVER - 102.3', 'F - [**2191-8-25**] 08:00 PM', '-dilantin level within normal ranges after adjusting for low albumin', '(14)', '-sputum cultures show 2+ gram - and 1+ gram positive consistent with', 'MRSA', '-no neuro recs left', '-nutrition consulted but did not leave TPN recs yet', '-fever spiked to 102.4 around 8 pm and was re-pancultured', '-around 1 AM BP fell to 70s systolic when nursing turned patient; after', 'repositioning, BP failed to improve, was given a 500 cc NS bolus.  Pt', 'was restarted on levo to maintain pressures.']",,54229,165594.0
14,2191-08-26 19:44:18,"['- episode of aberrancy on telemetry lasting one minute, unable to', 'assess on ECG.  Following ECG was unchanged from prior.']","['FEVER - 102.3', 'F - [**2191-8-25**] 08:00 PM', '-dilantin level within normal ranges after adjusting for low albumin', '(14)', '-sputum cultures show 2+ gram - and 1+ gram positive consistent with', 'MRSA', '-no neuro recs left', '-nutrition consulted but did not leave TPN recs yet', '-fever spiked to 102.4 around 8 pm and was re-pancultured', '-around 1 AM BP fell to 70s systolic when nursing turned patient; after', 'repositioning, BP failed to improve, was given a 500 cc NS bolus.  Pt', 'was restarted on levo to maintain pressures.', '- episode of aberrancy on telemetry lasting one minute, unable to', 'assess on ECG.  Following ECG was unchanged from prior.']",,54229,165594.0
15,2191-08-27 08:29:07,"['FEVER - 101.4', 'F - [**2191-8-26**] 04:00 PM', '-No bands in diff, but given hypotension, fever and elevated white', 'count, recultured and broadened coverage to meropenem, Gentamycin and', 'Vanco.', '- CT head - results pending', ""- Hold off on LP, neuro doesn't think this is neurological as symptoms"", 'are improving', ""- spoke with daughter: she's seen him like this before when he's"", 'azotemic. waiting for a few more cycles of dialysis to see if he', 'improves.', '- HD or CVVH tomorrow as pt can tolerate.', '- neurology thinks he will improve with tx of infection', '- TPN started']","['FEVER - 101.4', 'F - [**2191-8-26**] 04:00 PM', '-No bands in diff, but given hypotension, fever and elevated white', 'count, recultured and broadened coverage to meropenem, Gentamycin and', 'Vanco.', '- CT head - results pending', ""- Hold off on LP, neuro doesn't think this is neurological as symptoms"", 'are improving', ""- spoke with daughter: she's seen him like this before when he's"", 'azotemic. waiting for a few more cycles of dialysis to see if he', 'improves.', '- HD or CVVH tomorrow as pt can tolerate.', '- neurology thinks he will improve with tx of infection', '- TPN started']","['FEVER - 102.3', 'F - [**2191-8-25**] 08:00 PM', '-dilantin level within normal ranges after adjusting for low albumin', '(14)', '-sputum cultures show 2+ gram - and 1+ gram positive consistent with', 'MRSA', '-no neuro recs left', '-nutrition consulted but did not leave TPN recs yet', '-fever spiked to 102.4 around 8 pm and was re-pancultured', '-around 1 AM BP fell to 70s systolic when nursing turned patient; after', 'repositioning, BP failed to improve, was given a 500 cc NS bolus.  Pt', 'was restarted on levo to maintain pressures.', '- episode of aberrancy on telemetry lasting one minute, unable to', 'assess on ECG.  Following ECG was unchanged from prior.']",54229,165594.0
16,2191-08-27 11:28:29,,"['FEVER - 101.4', 'F - [**2191-8-26**] 04:00 PM', '-No bands in diff, but given hypotension, fever and elevated white', 'count, recultured and broadened coverage to meropenem, Gentamycin and', 'Vanco.', '- CT head - results pending', ""- Hold off on LP, neuro doesn't think this is neurological as symptoms"", 'are improving', ""- spoke with daughter: she's seen him like this before when he's"", 'azotemic. waiting for a few more cycles of dialysis to see if he', 'improves.', '- HD or CVVH tomorrow as pt can tolerate.', '- neurology thinks he will improve with tx of infection', '- TPN started']",,54229,165594.0
17,2191-08-28 07:43:08,"['[**8-26**]', '[**8-27**]', '-Insulin at 420 - 450 in morning, given 10 units insulin, then 15,', 'without significant effect.  Blood sugar likely due to starting TPN', 'yesterday.', '-Started glargine 12 QHS (first dose given now, will hold tonight).', '-Sliding scale increased.', '-nutrition recommended goal tube feeds of 60 ml/hr.', '-insulin drip started, after BS unresponsive to sliding scale.']","['[**8-26**]', '-No bands in diff, but given hypotension, fever and elevated white', 'count, recultured and broadened coverage to meropenem, Gentamycin and', 'Vanco.', '- CT head - results pending', ""- Hold off on LP, neuro doesn't think this is neurological as symptoms"", 'are improving', ""- spoke with daughter: she's seen him like this before when he's"", 'azotemic. waiting for a few more cycles of dialysis to see if he', 'improves.', '- HD or CVVH tomorrow as pt can tolerate.', '- neurology thinks he will improve with tx of infection', '- TPN started', '[**8-27**]', '-Insulin at 420 - 450 in morning, given 10 units insulin, then 15,', 'without significant effect.  Blood sugar likely due to starting TPN', 'yesterday.', '-Started glargine 12 QHS (first dose given now, will hold tonight).', '-Sliding scale increased.', '-nutrition recommended goal tube feeds of 60 ml/hr.', '-insulin drip started, after BS unresponsive to sliding scale.']","['FEVER - 101.4', 'F - [**2191-8-26**] 04:00 PM']",54229,165594.0
18,2191-08-29 07:57:42,"['FEVER - 101.1', 'F - [**2191-8-28**] 04:00 PM', '-CVVH filter clotted for unclear reasons; re-ordered repeat Rt upper', 'extremity US (initially had clot in PICC on rt) to ensure no further', 'extension however by evening still not done/no read on it', '-pressures in the AM initially low in the 80s; has not required', 'levophed however as pressures rose spontaneously to 110s - 120s', '-tolerating tube feeds with normal residuals/ no biliary output', 'anylonger']","['FEVER - 101.1', 'F - [**2191-8-28**] 04:00 PM', '-CVVH filter clotted for unclear reasons; re-ordered repeat Rt upper', 'extremity US (initially had clot in PICC on rt) to ensure no further', 'extension however by evening still not done/no read on it', '-pressures in the AM initially low in the 80s; has not required', 'levophed however as pressures rose spontaneously to 110s - 120s', '-tolerating tube feeds with normal residuals/ no biliary output', 'anylonger']","['[**8-26**]', '-No bands in diff, but given hypotension, fever and elevated white', 'count, recultured and broadened coverage to meropenem, Gentamycin and', 'Vanco.', '- CT head - results pending', ""- Hold off on LP, neuro doesn't think this is neurological as symptoms"", 'are improving', ""- spoke with daughter: she's seen him like this before when he's"", 'azotemic. waiting for a few more cycles of dialysis to see if he', 'improves.', '- HD or CVVH tomorrow as pt can tolerate.', '- neurology thinks he will improve with tx of infection', '- TPN started', '[**8-27**]', '-Insulin at 420 - 450 in morning, given 10 units insulin, then 15,', 'without significant effect.  Blood sugar likely due to starting TPN', 'yesterday.', '-Started glargine 12 QHS (first dose given now, will hold tonight).', '-Sliding scale increased.', '-nutrition recommended goal tube feeds of 60 ml/hr.', '-insulin drip started, after BS unresponsive to sliding scale.']",54229,165594.0
19,2191-08-29 16:46:16,,"['FEVER - 101.1', 'F - [**2191-8-28**] 04:00 PM', '-CVVH filter clotted for unclear reasons; re-ordered repeat Rt upper', 'extremity US (initially had clot in PICC on rt) to ensure no further', 'extension however by evening still not done/no read on it', '-pressures in the AM initially low in the 80s; has not required', 'levophed however as pressures rose spontaneously to 110s - 120s', '-tolerating tube feeds with normal residuals/ no biliary output', 'anylonger']",,54229,165594.0
20,2191-08-30 07:13:46,"['- RUQ u/s - Prelim read - Stable appearance since [**8-24**] with non', 'occlusive thrombus in nid axillary vein.', '- HD after CVVH filter clotted', '- Trial of PSV to 5, but was tachypneic.', '- Spiking fevers 101.3 at 4pm [**8-29**], again at 8pm']","['- RUQ u/s - Prelim read - Stable appearance since [**8-24**] with non', 'occlusive thrombus in nid axillary vein.', '- HD after CVVH filter clotted', '- Trial of PSV to 5, but was tachypneic.', '- Spiking fevers 101.3 at 4pm [**8-29**], again at 8pm']","['FEVER - 101.1', 'F - [**2191-8-28**] 04:00 PM', '-CVVH filter clotted for unclear reasons; re-ordered repeat Rt upper', 'extremity US (initially had clot in PICC on rt) to ensure no further', 'extension however by evening still not done/no read on it', '-pressures in the AM initially low in the 80s; has not required', 'levophed however as pressures rose spontaneously to 110s - 120s', '-tolerating tube feeds with normal residuals/ no biliary output', 'anylonger']",54229,165594.0
21,2191-08-30 13:52:07,['- RUE u/s - Prelim read - Stable appearance since [**8-24**] with non'],"['- RUE u/s - Prelim read - Stable appearance since [**8-24**] with non', 'occlusive thrombus in nid axillary vein.', '- HD after CVVH filter clotted', '- Trial of PSV to 5, but was tachypneic.', '- Spiking fevers 101.3 at 4pm [**8-29**], again at 8pm']",['- RUQ u/s - Prelim read - Stable appearance since [**8-24**] with non'],54229,165594.0
22,2191-08-31 07:51:39,"['ULTRASOUND - At [**2191-8-30**] 11:14 AM', 'abd CT to search for infection', ' PICC LINE - STOP [**2191-8-30**] 04:53 PM', '- Renal recs: concern for SVC syndrome given UE>LE edema, recommend', ""MRV, however, not urgent because it won't change management"", '- PICC pulled, catheter tip sent for cultures', '- Abdominal u/s done, pending.', '- HD tomorrow, none today']","['ULTRASOUND - At [**2191-8-30**] 11:14 AM', 'abd CT to search for infection', ' PICC LINE - STOP [**2191-8-30**] 04:53 PM', '- Renal recs: concern for SVC syndrome given UE>LE edema, recommend', ""MRV, however, not urgent because it won't change management"", '- PICC pulled, catheter tip sent for cultures', '- Abdominal u/s done, pending.', '- HD tomorrow, none today']","['- RUE u/s - Prelim read - Stable appearance since [**8-24**] with non', 'occlusive thrombus in nid axillary vein.', '- HD after CVVH filter clotted', '- Trial of PSV to 5, but was tachypneic.', '- Spiking fevers 101.3 at 4pm [**8-29**], again at 8pm']",54229,165594.0
23,2191-08-31 13:29:25,"['- Abdominal u/s done', '- HD planned for today']","['ULTRASOUND - At [**2191-8-30**] 11:14 AM', 'abd CT to search for infection', ' PICC LINE - STOP [**2191-8-30**] 04:53 PM', '- Renal recs: concern for SVC syndrome given UE>LE edema, recommend', ""MRV, however, not urgent because it won't change management"", '- PICC pulled, catheter tip sent for cultures', '- Abdominal u/s done', '- HD planned for today']","['- Abdominal u/s done, pending.', '- HD tomorrow, none today']",54229,165594.0
24,2191-09-01 06:51:21,"['STOOL CULTURE - At [**2191-8-31**] 10:43 AM', 'c. diff', ' INVASIVE VENTILATION - STOP [**2191-8-31**] 04:33 PM', ' INVASIVE VENTILATION - START [**2191-8-31**] 10:20 PM', '- readjusted sliding scale (cut in half) b/c now NPO after OG tube', 'removed following extubation; continued on 40 of lantus standing', '-extubated post HD; was respirating on shovel mask at 35 - 40 / min,', 'abdominal breathing persistent, tiring out, respiratory distress, was']","['STOOL CULTURE - At [**2191-8-31**] 10:43 AM', 'c. diff', ' INVASIVE VENTILATION - STOP [**2191-8-31**] 04:33 PM', ' INVASIVE VENTILATION - START [**2191-8-31**] 10:20 PM', '- readjusted sliding scale (cut in half) b/c now NPO after OG tube', 'removed following extubation; continued on 40 of lantus standing', '-extubated post HD; was respirating on shovel mask at 35 - 40 / min,', 'abdominal breathing persistent, tiring out, respiratory distress, was']","['ULTRASOUND - At [**2191-8-30**] 11:14 AM', 'abd CT to search for infection', ' PICC LINE - STOP [**2191-8-30**] 04:53 PM', '- Renal recs: concern for SVC syndrome given UE>LE edema, recommend', ""MRV, however, not urgent because it won't change management"", '- PICC pulled, catheter tip sent for cultures', '- Abdominal u/s done', '- HD planned for today']",54229,165594.0
25,2191-09-01 06:54:20,,"['STOOL CULTURE - At [**2191-8-31**] 10:43 AM', 'c. diff', ' INVASIVE VENTILATION - STOP [**2191-8-31**] 04:33 PM', ' INVASIVE VENTILATION - START [**2191-8-31**] 10:20 PM', '- readjusted sliding scale (cut in half) b/c now NPO after OG tube', 'removed following extubation; continued on 40 of lantus standing', '-extubated post HD; was respirating on shovel mask at 35 - 40 / min,', 'abdominal breathing persistent, tiring out, respiratory distress, was']",,54229,165594.0
26,2191-09-01 19:30:08,,"['STOOL CULTURE - At [**2191-8-31**] 10:43 AM', 'c. diff', ' INVASIVE VENTILATION - STOP [**2191-8-31**] 04:33 PM', ' INVASIVE VENTILATION - START [**2191-8-31**] 10:20 PM', '- readjusted sliding scale (cut in half) b/c now NPO after OG tube', 'removed following extubation; continued on 40 of lantus standing', '-extubated post HD; was respirating on shovel mask at 35 - 40 / min,', 'abdominal breathing persistent, tiring out, respiratory distress, was']",,54229,165594.0
27,2191-09-02 06:39:18,"['- Bolused IV phenytoin 300mg and check free dilantin in AM', '- Pt started on midodrine', '- MRV - narrowing of R Subclav and R Brachiocephalic.  Narrowing of L', 'subclavian and L IJ.  Patent SVC and RIJ.  Enlarged mediastinal LN', 'unchanged from prior.']","['- Bolused IV phenytoin 300mg and check free dilantin in AM', '- Pt started on midodrine', '- MRV - narrowing of R Subclav and R Brachiocephalic.  Narrowing of L', 'subclavian and L IJ.  Patent SVC and RIJ.  Enlarged mediastinal LN', 'unchanged from prior.']","['STOOL CULTURE - At [**2191-8-31**] 10:43 AM', 'c. diff', ' INVASIVE VENTILATION - STOP [**2191-8-31**] 04:33 PM', ' INVASIVE VENTILATION - START [**2191-8-31**] 10:20 PM', '- readjusted sliding scale (cut in half) b/c now NPO after OG tube', 'removed following extubation; continued on 40 of lantus standing', '-extubated post HD; was respirating on shovel mask at 35 - 40 / min,', 'abdominal breathing persistent, tiring out, respiratory distress, was']",54229,165594.0
28,2191-09-02 13:16:05,,"['- Bolused IV phenytoin 300mg and check free dilantin in AM', '- Pt started on midodrine', '- MRV - narrowing of R Subclav and R Brachiocephalic.  Narrowing of L', 'subclavian and L IJ.  Patent SVC and RIJ.  Enlarged mediastinal LN', 'unchanged from prior.']",,54229,165594.0
29,2191-09-02 13:45:51,,"['- Bolused IV phenytoin 300mg and check free dilantin in AM', '- Pt started on midodrine', '- MRV - narrowing of R Subclav and R Brachiocephalic.  Narrowing of L', 'subclavian and L IJ.  Patent SVC and RIJ.  Enlarged mediastinal LN', 'unchanged from prior.']",,54229,165594.0
30,2191-09-03 08:34:31,"['- Neuro recs: fosphenytoin 200mg TID, check daily levels, q3-4d check', ""free level (doesn't need to be daily)"", '- Midodrine increased to 15mg TID', '- Family informed of possibility of trach/peg', '- HSV DFA sample done from sacral wound']","['- Neuro recs: fosphenytoin 200mg TID, check daily levels, q3-4d check', ""free level (doesn't need to be daily)"", '- Midodrine increased to 15mg TID', '- Family informed of possibility of trach/peg', '- HSV DFA sample done from sacral wound']","['- Bolused IV phenytoin 300mg and check free dilantin in AM', '- Pt started on midodrine', '- MRV - narrowing of R Subclav and R Brachiocephalic.  Narrowing of L', 'subclavian and L IJ.  Patent SVC and RIJ.  Enlarged mediastinal LN', 'unchanged from prior.']",54229,165594.0
31,2191-09-03 16:24:00,,"['- Neuro recs: fosphenytoin 200mg TID, check daily levels, q3-4d check', ""free level (doesn't need to be daily)"", '- Midodrine increased to 15mg TID', '- Family informed of possibility of trach/peg', '- HSV DFA sample done from sacral wound']",,54229,165594.0
32,2191-09-04 07:00:45,"['BLOOD CULTURED - At [**2191-9-3**] 10:00 PM', '1st of 2 blood cultures', ' BLOOD CULTURED - At [**2191-9-4**] 12:30 AM', '2nd of 2 blood cultures', '-phenytoin level was 3.4 this AM; free phenyotin/phenytoin level was', 'checked this PM prior to afternoon dose; given low total phenytoin, he', 'got 300 mg IV X 1 of phenytoin this evening at 8 PM in addition to his', 'usual TID phenytoin', '-starting fluorinef for pressure support', '-changed ventilator settings to PSV and repeat blood gas was 7.4  47', '127', '-attempted to pull off pressors... No overnight pressor requirement.', '-renal recs: next HD will be on Monday; would use free phenytoin as a', 'guide to dose (2.7 - 3 per neurology)']","['BLOOD CULTURED - At [**2191-9-3**] 10:00 PM', '1st of 2 blood cultures', ' BLOOD CULTURED - At [**2191-9-4**] 12:30 AM', '2nd of 2 blood cultures', '-phenytoin level was 3.4 this AM; free phenyotin/phenytoin level was', 'checked this PM prior to afternoon dose; given low total phenytoin, he', 'got 300 mg IV X 1 of phenytoin this evening at 8 PM in addition to his', 'usual TID phenytoin', '-starting fluorinef for pressure support', '-changed ventilator settings to PSV and repeat blood gas was 7.4  47', '127', '-attempted to pull off pressors... No overnight pressor requirement.', '-renal recs: next HD will be on Monday; would use free phenytoin as a', 'guide to dose (2.7 - 3 per neurology)']","['- Neuro recs: fosphenytoin 200mg TID, check daily levels, q3-4d check', ""free level (doesn't need to be daily)"", '- Midodrine increased to 15mg TID', '- Family informed of possibility of trach/peg', '- HSV DFA sample done from sacral wound']",54229,165594.0
33,2191-09-05 07:33:24,,"['BLOOD CULTURED - At [**2191-9-3**] 10:00 PM', '1st of 2 blood cultures', ' BLOOD CULTURED - At [**2191-9-4**] 12:30 AM', '2nd of 2 blood cultures', '-phenytoin level was 3.4 this AM; free phenyotin/phenytoin level was', 'checked this PM prior to afternoon dose; given low total phenytoin, he', 'got 300 mg IV X 1 of phenytoin this evening at 8 PM in addition to his', 'usual TID phenytoin', '-starting fluorinef for pressure support', '-changed ventilator settings to PSV and repeat blood gas was 7.4  47', '127', '-attempted to pull off pressors... No overnight pressor requirement.', '-renal recs: next HD will be on Monday; would use free phenytoin as a', 'guide to dose (2.7 - 3 per neurology)']",,54229,165594.0
34,2191-09-05 07:51:29,"['BLOOD CULTURED - At [**2191-9-4**] 09:57 PM', 'C&S drawn/sent from RUE & RSC HD side ports.', ' SPUTUM CULTURE - At [**2191-9-4**] 09:58 PM', ' FEVER - 102.4', 'F - [**2191-9-5**] 01:00 AM']","['BLOOD CULTURED - At [**2191-9-4**] 09:57 PM', 'C&S drawn/sent from RUE & RSC HD side ports.', ' SPUTUM CULTURE - At [**2191-9-4**] 09:58 PM', ' FEVER - 102.4', 'F - [**2191-9-5**] 01:00 AM']","['BLOOD CULTURED - At [**2191-9-3**] 10:00 PM', '1st of 2 blood cultures', ' BLOOD CULTURED - At [**2191-9-4**] 12:30 AM', '2nd of 2 blood cultures', '-phenytoin level was 3.4 this AM; free phenyotin/phenytoin level was', 'checked this PM prior to afternoon dose; given low total phenytoin, he', 'got 300 mg IV X 1 of phenytoin this evening at 8 PM in addition to his', 'usual TID phenytoin', '-starting fluorinef for pressure support', '-changed ventilator settings to PSV and repeat blood gas was 7.4  47', '127', '-attempted to pull off pressors... No overnight pressor requirement.', '-renal recs: next HD will be on Monday; would use free phenytoin as a', 'guide to dose (2.7 - 3 per neurology)']",54229,165594.0
35,2191-09-05 09:29:23,"['- Off pressors for most of the day, restarted briefly for BP in 80s.', '- Spiked temp to 101.3  Blood and urine cultured', '- Continued to have hiccoughs.', '- Contact[**Name (NI) **] IR re: placing a temp line.  NPO after MN for placement of', 'femoral temp line with side port for access.  Infected HD line should', 'be pulled afterward.']","['BLOOD CULTURED - At [**2191-9-4**] 09:57 PM', 'C&S drawn/sent from RUE & RSC HD side ports.', ' SPUTUM CULTURE - At [**2191-9-4**] 09:58 PM', ' FEVER - 102.4', 'F - [**2191-9-5**] 01:00 AM', '- Off pressors for most of the day, restarted briefly for BP in 80s.', '- Spiked temp to 101.3  Blood and urine cultured', '- Continued to have hiccoughs.', '- Contact[**Name (NI) **] IR re: placing a temp line.  NPO after MN for placement of', 'femoral temp line with side port for access.  Infected HD line should', 'be pulled afterward.']",,54229,165594.0
36,2191-09-06 07:25:10,"['DIALYSIS CATHETER - START [**2191-9-5**] 10:30 AM', ' DIALYSIS CATHETER - STOP [**2191-9-5**] 11:00 AM', 'sideport', ' ARTERIAL LINE - STOP [**2191-9-6**] 05:05 AM', '- renal recs: zosyn after HD today', '- temporary R femoral line placed in IR', '- Wife is concerned pt is not getting his enough fiber in diet', 'requesting nutirition consult, also ask if can add probiotics from', 'home, also with h/o recent eye surgery that has been monitored qwk for', 'adjustment, consider opthomology c/s', '- Wife aware that next step is extubation and if fails, then trach', '- unable to tolerate fully weaning levo']","['DIALYSIS CATHETER - START [**2191-9-5**] 10:30 AM', ' DIALYSIS CATHETER - STOP [**2191-9-5**] 11:00 AM', 'sideport', ' ARTERIAL LINE - STOP [**2191-9-6**] 05:05 AM', '- renal recs: zosyn after HD today', '- temporary R femoral line placed in IR', '- Wife is concerned pt is not getting his enough fiber in diet', 'requesting nutirition consult, also ask if can add probiotics from', 'home, also with h/o recent eye surgery that has been monitored qwk for', 'adjustment, consider opthomology c/s', '- Wife aware that next step is extubation and if fails, then trach', '- unable to tolerate fully weaning levo']","['BLOOD CULTURED - At [**2191-9-4**] 09:57 PM', 'C&S drawn/sent from RUE & RSC HD side ports.', ' SPUTUM CULTURE - At [**2191-9-4**] 09:58 PM', ' FEVER - 102.4', 'F - [**2191-9-5**] 01:00 AM', '- Off pressors for most of the day, restarted briefly for BP in 80s.', '- Spiked temp to 101.3  Blood and urine cultured', '- Continued to have hiccoughs.', '- Contact[**Name (NI) **] IR re: placing a temp line.  NPO after MN for placement of', 'femoral temp line with side port for access.  Infected HD line should', 'be pulled afterward.']",54229,165594.0
37,2191-09-06 12:13:56,['- ECHO this AM'],"['DIALYSIS CATHETER - START [**2191-9-5**] 10:30 AM', ' DIALYSIS CATHETER - STOP [**2191-9-5**] 11:00 AM', 'sideport', ' ARTERIAL LINE - STOP [**2191-9-6**] 05:05 AM', '- renal recs: zosyn after HD today', '- temporary R femoral line placed in IR', '- Wife is concerned pt is not getting his enough fiber in diet', 'requesting nutirition consult, also ask if can add probiotics from', 'home, also with h/o recent eye surgery that has been monitored qwk for', 'adjustment, consider opthomology c/s', '- Wife aware that next step is extubation and if fails, then trach', '- unable to tolerate fully weaning levo', '- ECHO this AM']",,54229,165594.0
38,2191-09-07 08:18:23,"['-IP consulted for trach/PEG placement; they will place him tomorrow; is', 'NPO after midnight and will receive ddAVP 30 min prior to procedure', 'given low platelets', '-optho consulted:  felt that no acute management was necessary, that if', 'his hospital course is only days more, then he could see an optho as', 'outpatient.  If going to have continued prolonged hospital course, can', 'consult optho formally.', '-CT abd/pelvis: lumbar spine at level of L2-L4 suggestive of', 'osteomyelitis, although findings are nonspecific, MRI lumbar obtained', 'tonight for further evaluation; final read of CT is still pending']","['-IP consulted for trach/PEG placement; they will place him tomorrow; is', 'NPO after midnight and will receive ddAVP 30 min prior to procedure', 'given low platelets', '-optho consulted:  felt that no acute management was necessary, that if', 'his hospital course is only days more, then he could see an optho as', 'outpatient.  If going to have continued prolonged hospital course, can', 'consult optho formally.', '-CT abd/pelvis: lumbar spine at level of L2-L4 suggestive of', 'osteomyelitis, although findings are nonspecific, MRI lumbar obtained', 'tonight for further evaluation; final read of CT is still pending']","['DIALYSIS CATHETER - START [**2191-9-5**] 10:30 AM', ' DIALYSIS CATHETER - STOP [**2191-9-5**] 11:00 AM', 'sideport', ' ARTERIAL LINE - STOP [**2191-9-6**] 05:05 AM', '- renal recs: zosyn after HD today', '- temporary R femoral line placed in IR', '- Wife is concerned pt is not getting his enough fiber in diet', 'requesting nutirition consult, also ask if can add probiotics from', 'home, also with h/o recent eye surgery that has been monitored qwk for', 'adjustment, consider opthomology c/s', '- Wife aware that next step is extubation and if fails, then trach', '- unable to tolerate fully weaning levo', '- ECHO this AM']",54229,165594.0
39,2191-09-07 09:55:44,,"['-IP consulted for trach/PEG placement; they will place him tomorrow; is', 'NPO after midnight and will receive ddAVP 30 min prior to procedure', 'given low platelets', '-optho consulted:  felt that no acute management was necessary, that if', 'his hospital course is only days more, then he could see an optho as', 'outpatient.  If going to have continued prolonged hospital course, can', 'consult optho formally.', '-CT abd/pelvis: lumbar spine at level of L2-L4 suggestive of', 'osteomyelitis, although findings are nonspecific, MRI lumbar obtained', 'tonight for further evaluation; final read of CT is still pending']",,54229,165594.0
40,2191-09-08 07:48:38,"['- trach from IP - a little bit of oozing at the site, which improved.', 'He became agitated afterwards and tachypneic. Confirmed trach', 'placement, and no PNX with radiology.  Concerned about pain, increased', 'his sedation.  Still tachypneic, switched to AC to further increase', 'sedation.  Stopped overbreathing, pH improved.  He continued to remain', 'agitated throughout the night.', '- MRI spine: no osteo', ""- CT abd:  Schmorl's nodes/?osteo. Prominent mediastinal LN"", '- sputum cx [**9-6**]: sparse MRSA, sparse GNR.', ""- Renal believes clotting of lines may be [**12-20**] dilantin, don't have a"", 'lot of other suggestions regarding HD access at this time', '- fever 101.5F']","['- trach from IP - a little bit of oozing at the site, which improved.', 'He became agitated afterwards and tachypneic. Confirmed trach', 'placement, and no PNX with radiology.  Concerned about pain, increased', 'his sedation.  Still tachypneic, switched to AC to further increase', 'sedation.  Stopped overbreathing, pH improved.  He continued to remain', 'agitated throughout the night.', '- MRI spine: no osteo', ""- CT abd:  Schmorl's nodes/?osteo. Prominent mediastinal LN"", '- sputum cx [**9-6**]: sparse MRSA, sparse GNR.', ""- Renal believes clotting of lines may be [**12-20**] dilantin, don't have a"", 'lot of other suggestions regarding HD access at this time', '- fever 101.5F']","['-IP consulted for trach/PEG placement; they will place him tomorrow; is', 'NPO after midnight and will receive ddAVP 30 min prior to procedure', 'given low platelets', '-optho consulted:  felt that no acute management was necessary, that if', 'his hospital course is only days more, then he could see an optho as', 'outpatient.  If going to have continued prolonged hospital course, can', 'consult optho formally.', '-CT abd/pelvis: lumbar spine at level of L2-L4 suggestive of', 'osteomyelitis, although findings are nonspecific, MRI lumbar obtained', 'tonight for further evaluation; final read of CT is still pending']",54229,165594.0
41,2191-09-08 15:50:09,,"['- trach from IP - a little bit of oozing at the site, which improved.', 'He became agitated afterwards and tachypneic. Confirmed trach', 'placement, and no PNX with radiology.  Concerned about pain, increased', 'his sedation.  Still tachypneic, switched to AC to further increase', 'sedation.  Stopped overbreathing, pH improved.  He continued to remain', 'agitated throughout the night.', '- MRI spine: no osteo', ""- CT abd:  Schmorl's nodes/?osteo. Prominent mediastinal LN"", '- sputum cx [**9-6**]: sparse MRSA, sparse GNR.', ""- Renal believes clotting of lines may be [**12-20**] dilantin, don't have a"", 'lot of other suggestions regarding HD access at this time', '- fever 101.5F']",,54229,165594.0
42,2191-09-09 08:08:27,"['- spoke with daughter about current situation, did not seem to be ready', 'for backing off care, wants to reeval mental status after HD', ""- Dilatin d/c'd, neuro to make recs tomorrow re different antiepileptic"", '- renal recs: d/c dilantin']","['- spoke with daughter about current situation, did not seem to be ready', 'for backing off care, wants to reeval mental status after HD', ""- Dilatin d/c'd, neuro to make recs tomorrow re different antiepileptic"", '- renal recs: d/c dilantin']","['- trach from IP - a little bit of oozing at the site, which improved.', 'He became agitated afterwards and tachypneic. Confirmed trach', 'placement, and no PNX with radiology.  Concerned about pain, increased', 'his sedation.  Still tachypneic, switched to AC to further increase', 'sedation.  Stopped overbreathing, pH improved.  He continued to remain', 'agitated throughout the night.', '- MRI spine: no osteo', ""- CT abd:  Schmorl's nodes/?osteo. Prominent mediastinal LN"", '- sputum cx [**9-6**]: sparse MRSA, sparse GNR.', ""- Renal believes clotting of lines may be [**12-20**] dilantin, don't have a"", 'lot of other suggestions regarding HD access at this time', '- fever 101.5F']",54229,165594.0
43,2191-09-09 14:21:17,,"['- spoke with daughter about current situation, did not seem to be ready', 'for backing off care, wants to reeval mental status after HD', ""- Dilatin d/c'd, neuro to make recs tomorrow re different antiepileptic"", '- renal recs: d/c dilantin']",,54229,165594.0
44,2191-09-10 06:50:16,"['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']","['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']","['- spoke with daughter about current situation, did not seem to be ready', 'for backing off care, wants to reeval mental status after HD', ""- Dilatin d/c'd, neuro to make recs tomorrow re different antiepileptic"", '- renal recs: d/c dilantin']",54229,165594.0
45,2191-09-10 18:09:22,,"['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']",,54229,165594.0
46,2191-09-10 18:17:09,,"['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']",,54229,165594.0
47,2191-09-10 19:41:07,,"['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']",,54229,165594.0
48,2191-09-11 07:57:05,"['- [**Last Name (un) 1398**] Stim 16.9 --> 31.7 --> 36.5, adequate', '- increased free water flushes', '- trial on vent mask, unsuccessful after 2.5 hrs, back on PS 10/5.']","['- [**Last Name (un) 1398**] Stim 16.9 --> 31.7 --> 36.5, adequate', '- increased free water flushes', '- trial on vent mask, unsuccessful after 2.5 hrs, back on PS 10/5.']","['ULTRASOUND - At [**2191-9-9**] 05:30 PM', '-obtained lower extremity US to assess for DVT given persistent fevers:', 'none seen', '-dilantin on 200 [**Hospital1 **] X 2 days, will taper down to 100 [**Hospital1 **] X 2 days', 'thereafter, then D/c', '-on keppra 250 [**Hospital1 **] X 3 days, then keppra 500 qam 250 qpm', '-[**Last Name (un) **] stim test in PM given hypotension , results pending']",54229,165594.0
49,2191-09-11 07:58:51,,"['- [**Last Name (un) 1398**] Stim 16.9 --> 31.7 --> 36.5, adequate', '- increased free water flushes', '- trial on vent mask, unsuccessful after 2.5 hrs, back on PS 10/5.']",,54229,165594.0
50,2191-09-11 13:45:15,,"['- [**Last Name (un) 1398**] Stim 16.9 --> 31.7 --> 36.5, adequate', '- increased free water flushes', '- trial on vent mask, unsuccessful after 2.5 hrs, back on PS 10/5.']",,54229,165594.0
51,2191-09-12 07:15:40,"['BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' SPUTUM CULTURE - At [**2191-9-11**] 04:31 PM']","['BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' SPUTUM CULTURE - At [**2191-9-11**] 04:31 PM']","['- [**Last Name (un) 1398**] Stim 16.9 --> 31.7 --> 36.5, adequate', '- increased free water flushes', '- trial on vent mask, unsuccessful after 2.5 hrs, back on PS 10/5.']",54229,165594.0
52,2191-09-12 07:20:36,,"['BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' SPUTUM CULTURE - At [**2191-9-11**] 04:31 PM']",,54229,165594.0
53,2191-09-12 07:34:25,"['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR']","['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR']","['BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' BLOOD CULTURED - At [**2191-9-11**] 04:31 PM', ' SPUTUM CULTURE - At [**2191-9-11**] 04:31 PM']",54229,165594.0
54,2191-09-12 07:35:23,,"['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR']",,54229,165594.0
55,2191-09-12 12:55:15,"['s. Then febrile this am while on rounds up to', '102.']","['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR', 's. Then febrile this am while on rounds up to', '102.']",,54229,165594.0
56,2191-09-12 15:26:12,,"['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR', 's. Then febrile this am while on rounds up to', '102.']",,54229,165594.0
57,2191-09-13 06:59:45,"['--Febrile to 102 this am, re-BCx and Myco/lytic Cx', '--HD yesterday', '--EEG', ""--BP's increasing and Fluoronef and Midodrine tapered"", '--Head CT with opacification of mastoids, sinus mucosal thickening;', 'ethmoidal, L maxillary, and sphenoidal sinuses with hyperdense material', 'in L sphenoid sinus, could be inspissated mucus vs fungal infection in', 'sphenoid sinus  --> NGT removed', '--Held all sedating/pain meds']","['--Febrile to 102 this am, re-BCx and Myco/lytic Cx', '--HD yesterday', '--EEG', ""--BP's increasing and Fluoronef and Midodrine tapered"", '--Head CT with opacification of mastoids, sinus mucosal thickening;', 'ethmoidal, L maxillary, and sphenoidal sinuses with hyperdense material', 'in L sphenoid sinus, could be inspissated mucus vs fungal infection in', 'sphenoid sinus  --> NGT removed', '--Held all sedating/pain meds']","['Low grade fever to 100.1 at 3pm and 6pm, was BCx', 'd x2 and sputum Cx', 'with 2+ GPC', 's and 2+ GNR', 's. Then febrile this am while on rounds up to', '102.']",54229,165594.0
58,2191-09-13 07:02:16,,"['--Febrile to 102 this am, re-BCx and Myco/lytic Cx', '--HD yesterday', '--EEG', ""--BP's increasing and Fluoronef and Midodrine tapered"", '--Head CT with opacification of mastoids, sinus mucosal thickening;', 'ethmoidal, L maxillary, and sphenoidal sinuses with hyperdense material', 'in L sphenoid sinus, could be inspissated mucus vs fungal infection in', 'sphenoid sinus  --> NGT removed', '--Held all sedating/pain meds']",,54229,165594.0
59,2191-09-13 13:35:06,,"['--Febrile to 102 this am, re-BCx and Myco/lytic Cx', '--HD yesterday', '--EEG', ""--BP's increasing and Fluoronef and Midodrine tapered"", '--Head CT with opacification of mastoids, sinus mucosal thickening;', 'ethmoidal, L maxillary, and sphenoidal sinuses with hyperdense material', 'in L sphenoid sinus, could be inspissated mucus vs fungal infection in', 'sphenoid sinus  --> NGT removed', '--Held all sedating/pain meds']",,54229,165594.0
60,2191-09-14 07:35:20,"['Pt received tunneled HD line,  PICC line, and PEG tube all yesterday.', 'PEG tube draining dark bilious material when set to drainage', 'ENT consulted for sinusitis seen on CT scan, nasal steroids,', 'neosynephrine spray, and ABx started.', 'Continues only on Keppra, no Dilantin', 'Afebrile through yesterday', 'RSBI 69 this am', 'Transiently hypotense when PEG tube placed, received fluid bolus, but', 'otherwise normotensive through day and Midodrine set to lower', 'parameters', '7.38/50/70  on T piece 12L and FiO2 50%  but put back on vent overnight', 'due to sedation from procedures yesterday, but back to T piece this am', 'ENT feels that sinusitis on CT scan is due to obstruction by chronic NG', 'tube and that this will clear once NG tube is out.  They recommended', 'saline wash, nasal steroids, augmentin and re-image in 4 to 7 days.']","['Pt received tunneled HD line,  PICC line, and PEG tube all yesterday.', 'PEG tube draining dark bilious material when set to drainage', 'ENT consulted for sinusitis seen on CT scan, nasal steroids,', 'neosynephrine spray, and ABx started.', 'Continues only on Keppra, no Dilantin', 'Afebrile through yesterday', 'RSBI 69 this am', 'Transiently hypotense when PEG tube placed, received fluid bolus, but', 'otherwise normotensive through day and Midodrine set to lower', 'parameters', '7.38/50/70  on T piece 12L and FiO2 50%  but put back on vent overnight', 'due to sedation from procedures yesterday, but back to T piece this am', 'ENT feels that sinusitis on CT scan is due to obstruction by chronic NG', 'tube and that this will clear once NG tube is out.  They recommended', 'saline wash, nasal steroids, augmentin and re-image in 4 to 7 days.']","['--Febrile to 102 this am, re-BCx and Myco/lytic Cx', '--HD yesterday', '--EEG', ""--BP's increasing and Fluoronef and Midodrine tapered"", '--Head CT with opacification of mastoids, sinus mucosal thickening;', 'ethmoidal, L maxillary, and sphenoidal sinuses with hyperdense material', 'in L sphenoid sinus, could be inspissated mucus vs fungal infection in', 'sphenoid sinus  --> NGT removed', '--Held all sedating/pain meds']",54229,165594.0
61,2191-09-14 13:18:25,,"['Pt received tunneled HD line,  PICC line, and PEG tube all yesterday.', 'PEG tube draining dark bilious material when set to drainage', 'ENT consulted for sinusitis seen on CT scan, nasal steroids,', 'neosynephrine spray, and ABx started.', 'Continues only on Keppra, no Dilantin', 'Afebrile through yesterday', 'RSBI 69 this am', 'Transiently hypotense when PEG tube placed, received fluid bolus, but', 'otherwise normotensive through day and Midodrine set to lower', 'parameters', '7.38/50/70  on T piece 12L and FiO2 50%  but put back on vent overnight', 'due to sedation from procedures yesterday, but back to T piece this am', 'ENT feels that sinusitis on CT scan is due to obstruction by chronic NG', 'tube and that this will clear once NG tube is out.  They recommended', 'saline wash, nasal steroids, augmentin and re-image in 4 to 7 days.']",,54229,165594.0
0,2153-11-20 07:09:22,,"['EKG - At [**2153-11-19**] 09:10 PM', ' NASAL SWAB - At [**2153-11-19**] 09:10 PM', '- Cath sites were intact, neg groin check.', '- started heparin gtt for afib.']",,48463,173608.0
1,2153-11-20 07:12:59,,"['EKG - At [**2153-11-19**] 09:10 PM', ' NASAL SWAB - At [**2153-11-19**] 09:10 PM', '- Cath sites were intact, neg groin check.', '- started heparin gtt for afib.']",,48463,173608.0
2,2153-11-20 11:10:25,['- held heparin gtt for afib.'],"['EKG - At [**2153-11-19**] 09:10 PM', ' NASAL SWAB - At [**2153-11-19**] 09:10 PM', '- Cath sites were intact, neg groin check.', '- held heparin gtt for afib.']",['- started heparin gtt for afib.'],48463,173608.0
0,2151-09-24 08:02:54,,"['- KUB performed:', '- CVP to 9 from [**10-11**] at midnight - treated with fluids only, off', 'pressors', '- Bronchoscopy performed, Axillary arterial line placed and lost,', 'Central line placed', '- + stools, guiac possitive but likely from Fe based medications']",,32790,113032.0
1,2151-09-24 14:05:43,,"['- KUB performed:', '- CVP to 9 from [**10-11**] at midnight - treated with fluids only, off', 'pressors', '- Bronchoscopy performed, Axillary arterial line placed and lost,', 'Central line placed', '- + stools, guiac possitive but likely from Fe based medications']",,32790,113032.0
2,2151-09-25 08:13:47,"['-blood Cx with GPC in clusters', '-called to patient bedside at 15:51 for concern of increased', '""twitching"" since decr. sedation, patient somewhat more arousable with', 'marked tremor of upper extremities with any movement, did not appear', 'like seizure, coming out of sedation', '-lasix challenge to mobilize fluids off lungs - 200 cc/hr outs']","['-blood Cx with GPC in clusters', '-called to patient bedside at 15:51 for concern of increased', '""twitching"" since decr. sedation, patient somewhat more arousable with', 'marked tremor of upper extremities with any movement, did not appear', 'like seizure, coming out of sedation', '-lasix challenge to mobilize fluids off lungs - 200 cc/hr outs']","['- KUB performed:', '- CVP to 9 from [**10-11**] at midnight - treated with fluids only, off', 'pressors', '- Bronchoscopy performed, Axillary arterial line placed and lost,', 'Central line placed', '- + stools, guiac possitive but likely from Fe based medications']",32790,113032.0
3,2151-09-25 08:20:34,['-blood Cx w/ GPC in clusters'],"['-blood Cx w/ GPC in clusters', '-lasix challenge to mobilize fluids off lungs - 200 cc/hr outs']","['-blood Cx with GPC in clusters', '-called to patient bedside at 15:51 for concern of increased', '""twitching"" since decr. sedation, patient somewhat more arousable with', 'marked tremor of upper extremities with any movement, did not appear', 'like seizure, coming out of sedation']",32790,113032.0
4,2151-09-25 11:58:21,,"['-blood Cx w/ GPC in clusters', '-lasix challenge to mobilize fluids off lungs - 200 cc/hr outs']",,32790,113032.0
5,2151-09-26 06:52:04,"['-goal for 1L negative. gave 20mg IV lasix x 2', ""-major barrier to extubation seems to be sedation. stopping TF's if"", 'wakes up more and attempting to do SBT', '-RSBI: 91, sedated, lots of secretions; will try SBT today']","['-goal for 1L negative. gave 20mg IV lasix x 2', ""-major barrier to extubation seems to be sedation. stopping TF's if"", 'wakes up more and attempting to do SBT', '-RSBI: 91, sedated, lots of secretions; will try SBT today']","['-blood Cx w/ GPC in clusters', '-lasix challenge to mobilize fluids off lungs - 200 cc/hr outs']",32790,113032.0
6,2151-09-26 20:38:07,,"['-goal for 1L negative. gave 20mg IV lasix x 2', ""-major barrier to extubation seems to be sedation. stopping TF's if"", 'wakes up more and attempting to do SBT', '-RSBI: 91, sedated, lots of secretions; will try SBT today']",,32790,113032.0
7,2151-09-27 16:48:17,"['-CT head reassuring (got head CT as somnolent on exam this am)', '-TBB neg 2.5L at midnight.', '-started low dose metop tartrate for afib in 110s c plenty of bp room.']","['-CT head reassuring (got head CT as somnolent on exam this am)', '-TBB neg 2.5L at midnight.', '-started low dose metop tartrate for afib in 110s c plenty of bp room.']","['-goal for 1L negative. gave 20mg IV lasix x 2', ""-major barrier to extubation seems to be sedation. stopping TF's if"", 'wakes up more and attempting to do SBT', '-RSBI: 91, sedated, lots of secretions; will try SBT today']",32790,113032.0
8,2151-09-28 07:58:07,"['-Spotaneous breathing trial: TV 308 / RR 19 / I:E 1:6.5 / SpO2 100%;', '- Was on assist all night; currently on 8 of pressure support and 5 of', 'PEEP', '-Lasix 20 mg IV bolus with goal of(-)1.5 L, initially put out 20 cc/hr,', 'given second 20 mg IV bolus with substantial urine output; over last 24', 'is -1.6 :', '-overnight was a little agitated, was climbing out of bed; was started', 'on light Propofol drip at 5cc/hr for light sedation']","['-Spotaneous breathing trial: TV 308 / RR 19 / I:E 1:6.5 / SpO2 100%;', '- Was on assist all night; currently on 8 of pressure support and 5 of', 'PEEP', '-Lasix 20 mg IV bolus with goal of(-)1.5 L, initially put out 20 cc/hr,', 'given second 20 mg IV bolus with substantial urine output; over last 24', 'is -1.6 :', '-overnight was a little agitated, was climbing out of bed; was started', 'on light Propofol drip at 5cc/hr for light sedation']","['-CT head reassuring (got head CT as somnolent on exam this am)', '-TBB neg 2.5L at midnight.', '-started low dose metop tartrate for afib in 110s c plenty of bp room.']",32790,113032.0
9,2151-09-28 19:53:30,,"['-Spotaneous breathing trial: TV 308 / RR 19 / I:E 1:6.5 / SpO2 100%;', '- Was on assist all night; currently on 8 of pressure support and 5 of', 'PEEP', '-Lasix 20 mg IV bolus with goal of(-)1.5 L, initially put out 20 cc/hr,', 'given second 20 mg IV bolus with substantial urine output; over last 24', 'is -1.6 :', '-overnight was a little agitated, was climbing out of bed; was started', 'on light Propofol drip at 5cc/hr for light sedation']",,32790,113032.0
10,2151-09-29 07:28:14,"['- patient successfully extubated, now on face mask and tolerating well', '- tube feeds restarted', '- got 1 dose of IV lasix 40 mg; diuresing and was -1.5 L by evening', '- meropenem was discontinued after course for VAP complete', '- repeat sputum gram stain and culture pending']","['- patient successfully extubated, now on face mask and tolerating well', '- tube feeds restarted', '- got 1 dose of IV lasix 40 mg; diuresing and was -1.5 L by evening', '- meropenem was discontinued after course for VAP complete', '- repeat sputum gram stain and culture pending']","['-Spotaneous breathing trial: TV 308 / RR 19 / I:E 1:6.5 / SpO2 100%;', '- Was on assist all night; currently on 8 of pressure support and 5 of', 'PEEP', '-Lasix 20 mg IV bolus with goal of(-)1.5 L, initially put out 20 cc/hr,', 'given second 20 mg IV bolus with substantial urine output; over last 24', 'is -1.6 :', '-overnight was a little agitated, was climbing out of bed; was started', 'on light Propofol drip at 5cc/hr for light sedation']",32790,113032.0
11,2151-09-29 07:38:28,,"['- patient successfully extubated, now on face mask and tolerating well', '- tube feeds restarted', '- got 1 dose of IV lasix 40 mg; diuresing and was -1.5 L by evening', '- meropenem was discontinued after course for VAP complete', '- repeat sputum gram stain and culture pending']",,32790,113032.0
12,2151-09-29 07:39:29,,"['- patient successfully extubated, now on face mask and tolerating well', '- tube feeds restarted', '- got 1 dose of IV lasix 40 mg; diuresing and was -1.5 L by evening', '- meropenem was discontinued after course for VAP complete', '- repeat sputum gram stain and culture pending']",,32790,113032.0
13,2151-09-29 14:01:47,,"['- patient successfully extubated, now on face mask and tolerating well', '- tube feeds restarted', '- got 1 dose of IV lasix 40 mg; diuresing and was -1.5 L by evening', '- meropenem was discontinued after course for VAP complete', '- repeat sputum gram stain and culture pending']",,32790,113032.0
0,2157-02-27 07:21:31,,"['EKG - At [**2157-2-26**] 07:30 PM', ' EKG - At [**2157-2-26**] 09:42 PM', '- HR in 60s all night']",,20536,163417.0
1,2157-02-27 09:05:28,,"['EKG - At [**2157-2-26**] 07:30 PM', ' EKG - At [**2157-2-26**] 09:42 PM', '- HR in 60s all night']",,20536,163417.0
2,2157-02-27 10:31:51,,"['EKG - At [**2157-2-26**] 07:30 PM', ' EKG - At [**2157-2-26**] 09:42 PM', '- HR in 60s all night']",,20536,163417.0
0,2148-01-09 06:55:04,,"['62yo w/ known CAD,MI, CABGx2, HTN, cardiomyopathy 30-40%EF - presented', 'to OSH [**2148-1-6**] w/ DOE + light headedness - found to be in CHB w/', 'escape 30-40s, stable BP. Echo 30%. [**2148-1-8**] pt had VF arrest, pads on,', 'shocked 200J and went back into CHB, not intubated, oriented. Tx to', '[**Hospital1 54**] this evening for plans of PPM + AICD placement in am. Temp wire', 'VVI rate 80.']",,25178,169461.0
1,2148-01-09 12:33:51,"['- Pt transferred to CCU from OSH s/p polymorphic VT arrest', '- Remained stable on temporary wire pacing', '- Feels ok, no complaints']","['- Pt transferred to CCU from OSH s/p polymorphic VT arrest', '- Remained stable on temporary wire pacing', '- Feels ok, no complaints']","['62yo w/ known CAD,MI, CABGx2, HTN, cardiomyopathy 30-40%EF - presented', 'to OSH [**2148-1-6**] w/ DOE + light headedness - found to be in CHB w/', 'escape 30-40s, stable BP. Echo 30%. [**2148-1-8**] pt had VF arrest, pads on,', 'shocked 200J and went back into CHB, not intubated, oriented. Tx to', '[**Hospital1 54**] this evening for plans of PPM + AICD placement in am. Temp wire', 'VVI rate 80.']",25178,169461.0
0,2106-10-29 07:16:04,,"['PICC LINE - START [**2106-10-29**] 12:00 AM', '-GI c/s (A&P not done yet)', '-Derm c/s thought rash unlikely vasculitis, called it eczema, suggested', 'use hydrocort', '-Renal c/s thought increasing Cr (repeat 3.2->3.5) [**1-18**] AIN from Abx,', '(cipro) or PPI. saw WBC casts in sediment', ""- d/c'd cipro and changed pantoprazole to famotidine"", '- around 1830 patient was noted to be increasingly somnolent,', 'unresponsive to verbal stimuli and pain- but grimaced with sternal rub.', 'Pupils were pinpoint but reactive.', 'ABG showed pH 7.23/ 49/110/22, revealing metabolic and respiratory', 'acidosis.', '-Narcan pushed with excellent response, patient woke up immediately and', 'became agitated', '- had PICC line placed, CXR confirmed']",,58193,133164.0
1,2106-10-29 07:29:56,"['- she had pills in her purse and security was called (looked them up on', 'online drug formulary and it was a narcotic based bowel medication,', 'phenergan, gabapentin and seroquel)']","['PICC LINE - START [**2106-10-29**] 12:00 AM', '- around 1830 patient was noted to be increasingly somnolent,', 'unresponsive to verbal stimuli and pain- but grimaced with sternal rub.', 'Pupils were pinpoint but reactive.', 'ABG showed pH 7.23/ 49/110/22, revealing metabolic and respiratory', 'acidosis.', '-Narcan pushed with excellent response, patient woke up immediately and', 'became agitated', '- she had pills in her purse and security was called (looked them up on', 'online drug formulary and it was a narcotic based bowel medication,', 'phenergan, gabapentin and seroquel)', '- had PICC line placed, CXR confirmed']","['-GI c/s (A&P not done yet)', '-Derm c/s thought rash unlikely vasculitis, called it eczema, suggested', 'use hydrocort', '-Renal c/s thought increasing Cr (repeat 3.2->3.5) [**1-18**] AIN from Abx,', '(cipro) or PPI. saw WBC casts in sediment', ""- d/c'd cipro and changed pantoprazole to famotidine""]",58193,133164.0
2,2106-10-29 10:46:59,"['- had PICC line placed around 2300, CXR confirmed']","['PICC LINE - START [**2106-10-29**] 12:00 AM', '- around 1830 patient was noted to be increasingly somnolent,', 'unresponsive to verbal stimuli and pain- but grimaced with sternal rub.', 'Pupils were pinpoint but reactive.', 'ABG showed pH 7.23/ 49/110/22, revealing metabolic and respiratory', 'acidosis.', '-Narcan pushed with excellent response, patient woke up immediately and', 'became agitated', '- she had pills in her purse and security was called (looked them up on', 'online drug formulary and it was a narcotic based bowel medication,', 'phenergan, gabapentin and seroquel)', '- had PICC line placed around 2300, CXR confirmed']","['- had PICC line placed, CXR confirmed']",58193,133164.0
0,2162-03-22 05:50:02,,['History obtained from Medical records'],,74562,138356.0
1,2162-03-22 12:04:12,['Admitted with COPD flair vs aspiration PNA'],"['Admitted with COPD flair vs aspiration PNA', 'History obtained from Medical records']",,74562,138356.0
0,2162-11-15 07:33:45,,"['INVASIVE VENTILATION - START [**2162-11-15**] 04:00 AM', '- patient had increasing respiratory difficulty and was intubated.', '- arterial line placed.']",,74562,133835.0
1,2162-11-15 12:10:27,,"['INVASIVE VENTILATION - START [**2162-11-15**] 04:00 AM', '- patient had increasing respiratory difficulty and was intubated.', '- arterial line placed.']",,74562,133835.0
2,2162-11-16 07:06:05,"['ULTRASOUND - At [**2162-11-15**] 09:02 AM', ' URINE CULTURE - At [**2162-11-15**] 01:02 PM', 'Weaned from AC to PS down to 5/5 but pH 7.23 so upped back to [**10-11**]', 'Converted to sinus rhythm', 'Hypothermic to 95.6 at midnight, put on bair hugger, then normothermic', 'at 4am', ""5am SBP drop to 70's, IV bolus given, increased to 100 with MAP >65""]","['ULTRASOUND - At [**2162-11-15**] 09:02 AM', ' URINE CULTURE - At [**2162-11-15**] 01:02 PM', 'Weaned from AC to PS down to 5/5 but pH 7.23 so upped back to [**10-11**]', 'Converted to sinus rhythm', 'Hypothermic to 95.6 at midnight, put on bair hugger, then normothermic', 'at 4am', ""5am SBP drop to 70's, IV bolus given, increased to 100 with MAP >65""]","['INVASIVE VENTILATION - START [**2162-11-15**] 04:00 AM', '- patient had increasing respiratory difficulty and was intubated.', '- arterial line placed.']",74562,133835.0
3,2162-11-16 07:12:40,,"['ULTRASOUND - At [**2162-11-15**] 09:02 AM', ' URINE CULTURE - At [**2162-11-15**] 01:02 PM', 'Weaned from AC to PS down to 5/5 but pH 7.23 so upped back to [**10-11**]', 'Converted to sinus rhythm', 'Hypothermic to 95.6 at midnight, put on bair hugger, then normothermic', 'at 4am', ""5am SBP drop to 70's, IV bolus given, increased to 100 with MAP >65""]",,74562,133835.0
4,2162-11-16 17:39:02,,"['ULTRASOUND - At [**2162-11-15**] 09:02 AM', ' URINE CULTURE - At [**2162-11-15**] 01:02 PM', 'Weaned from AC to PS down to 5/5 but pH 7.23 so upped back to [**10-11**]', 'Converted to sinus rhythm', 'Hypothermic to 95.6 at midnight, put on bair hugger, then normothermic', 'at 4am', ""5am SBP drop to 70's, IV bolus given, increased to 100 with MAP >65""]",,74562,133835.0
5,2162-11-17 07:13:54,"['BRONCHOSCOPY - At [**2162-11-16**] 08:15 AM diagnostic', ""- SBT --> wasn't doing well on [**5-11**] so didn't get SBT"", '- started tamiflu, f/u flu swab', '- steroids to prednisone 40mg daily', '- Vanc trough 6.9, changed to Q8hrs.', '- BAL in the am --> resp viral Ag screen negative, negative Gstain,', 'negative PCP.', '[**Name Initial (NameIs) 429**]:', 'No Known Drug [**Name Initial (NameIs) 429**]']","['BRONCHOSCOPY - At [**2162-11-16**] 08:15 AM diagnostic', ""- SBT --> wasn't doing well on [**5-11**] so didn't get SBT"", '- started tamiflu, f/u flu swab', '- steroids to prednisone 40mg daily', '- Vanc trough 6.9, changed to Q8hrs.', '- BAL in the am --> resp viral Ag screen negative, negative Gstain,', 'negative PCP.', '[**Name Initial (NameIs) 429**]:', 'No Known Drug [**Name Initial (NameIs) 429**]']","['ULTRASOUND - At [**2162-11-15**] 09:02 AM', ' URINE CULTURE - At [**2162-11-15**] 01:02 PM', 'Weaned from AC to PS down to 5/5 but pH 7.23 so upped back to [**10-11**]', 'Converted to sinus rhythm', 'Hypothermic to 95.6 at midnight, put on bair hugger, then normothermic', 'at 4am', ""5am SBP drop to 70's, IV bolus given, increased to 100 with MAP >65""]",74562,133835.0
6,2162-11-18 00:08:33,,"['BRONCHOSCOPY - At [**2162-11-16**] 08:15 AM diagnostic', ""- SBT --> wasn't doing well on [**5-11**] so didn't get SBT"", '- started tamiflu, f/u flu swab', '- steroids to prednisone 40mg daily', '- Vanc trough 6.9, changed to Q8hrs.', '- BAL in the am --> resp viral Ag screen negative, negative Gstain,', 'negative PCP.', '[**Name Initial (NameIs) 429**]:', 'No Known Drug [**Name Initial (NameIs) 429**]']",,74562,133835.0
7,2162-11-18 00:34:30,,"['BRONCHOSCOPY - At [**2162-11-16**] 08:15 AM diagnostic', ""- SBT --> wasn't doing well on [**5-11**] so didn't get SBT"", '- started tamiflu, f/u flu swab', '- steroids to prednisone 40mg daily', '- Vanc trough 6.9, changed to Q8hrs.', '- BAL in the am --> resp viral Ag screen negative, negative Gstain,', 'negative PCP.', '[**Name Initial (NameIs) 429**]:', 'No Known Drug [**Name Initial (NameIs) 429**]']",,74562,133835.0
8,2162-11-18 07:19:52,"['INVASIVE VENTILATION - STOP [**2162-11-17**] 09:45 AM', '- extubated', '- viral DFA from BAL negative, but we are waiting for culture to clear', 'precautions and stop tamiflu.', '- prednisone taper - two days 20mg, two days 10mg, then off.', '- Seen by speech and swallow', '- ABG extubaed 7.44/44/99']","['INVASIVE VENTILATION - STOP [**2162-11-17**] 09:45 AM', '- extubated', '- viral DFA from BAL negative, but we are waiting for culture to clear', 'precautions and stop tamiflu.', '- prednisone taper - two days 20mg, two days 10mg, then off.', '- Seen by speech and swallow', '- ABG extubaed 7.44/44/99']","['BRONCHOSCOPY - At [**2162-11-16**] 08:15 AM diagnostic', ""- SBT --> wasn't doing well on [**5-11**] so didn't get SBT"", '- started tamiflu, f/u flu swab', '- steroids to prednisone 40mg daily', '- Vanc trough 6.9, changed to Q8hrs.', '- BAL in the am --> resp viral Ag screen negative, negative Gstain,', 'negative PCP.', '[**Name Initial (NameIs) 429**]:', 'No Known Drug [**Name Initial (NameIs) 429**]']",74562,133835.0
9,2162-11-18 15:40:55,"['- prednisone taper - two days 20mg ([**11-17**] and [**11-18**]), two days 10mg,', 'then off.']","['INVASIVE VENTILATION - STOP [**2162-11-17**] 09:45 AM', '- extubated', '- viral DFA from BAL negative, but we are waiting for culture to clear', 'precautions and stop tamiflu.', '- prednisone taper - two days 20mg ([**11-17**] and [**11-18**]), two days 10mg,', 'then off.', '- Seen by speech and swallow', '- ABG extubaed 7.44/44/99']","['- prednisone taper - two days 20mg, two days 10mg, then off.']",74562,133835.0
0,2184-03-19 05:43:48,,"['ARTERIAL LINE - START [**2184-3-18**] 01:11 PM', ' TRANSTHORACIC ECHO - At [**2184-3-18**] 03:48 PM', ' URINE CULTURE - At [**2184-3-18**] 03:48 PM', ' NASAL SWAB - At [**2184-3-18**] 03:48 PM', ' BLOOD CULTURED - At [**2184-3-19**] 04:00 AM', '1 set bld cx drawn from aline at 4am, 2nd set bld cx drawn from hickman']",,19569,197451.0
1,2184-03-19 08:23:53,,"['ARTERIAL LINE - START [**2184-3-18**] 01:11 PM', ' TRANSTHORACIC ECHO - At [**2184-3-18**] 03:48 PM', ' URINE CULTURE - At [**2184-3-18**] 03:48 PM', ' NASAL SWAB - At [**2184-3-18**] 03:48 PM', ' BLOOD CULTURED - At [**2184-3-19**] 04:00 AM', '1 set bld cx drawn from aline at 4am, 2nd set bld cx drawn from hickman']",,19569,197451.0
2,2184-03-19 11:02:41,,"['ARTERIAL LINE - START [**2184-3-18**] 01:11 PM', ' TRANSTHORACIC ECHO - At [**2184-3-18**] 03:48 PM', ' URINE CULTURE - At [**2184-3-18**] 03:48 PM', ' NASAL SWAB - At [**2184-3-18**] 03:48 PM', ' BLOOD CULTURED - At [**2184-3-19**] 04:00 AM', '1 set bld cx drawn from aline at 4am, 2nd set bld cx drawn from hickman']",,19569,197451.0
3,2184-03-19 11:38:35,,"['ARTERIAL LINE - START [**2184-3-18**] 01:11 PM', ' TRANSTHORACIC ECHO - At [**2184-3-18**] 03:48 PM', ' URINE CULTURE - At [**2184-3-18**] 03:48 PM', ' NASAL SWAB - At [**2184-3-18**] 03:48 PM', ' BLOOD CULTURED - At [**2184-3-19**] 04:00 AM', '1 set bld cx drawn from aline at 4am, 2nd set bld cx drawn from hickman']",,19569,197451.0
4,2184-03-20 08:24:00,"['-- Cyclosporine levels at toxic levels, afternoon dose was held, at', 'dose lowered to 25mg IV BID starting this am', '-- Patient underwent bronchoscopy, microbiology pending', '-- had to go up on PEEP to 15 following bronch', '-- patient w/ improved blood sugars after tightenting SS', '-- has had high TF residuals of 200-300, and concern of needing not', 'absorbing PO meds with illeus']","['-- Cyclosporine levels at toxic levels, afternoon dose was held, at', 'dose lowered to 25mg IV BID starting this am', '-- Patient underwent bronchoscopy, microbiology pending', '-- had to go up on PEEP to 15 following bronch', '-- patient w/ improved blood sugars after tightenting SS', '-- has had high TF residuals of 200-300, and concern of needing not', 'absorbing PO meds with illeus']","['ARTERIAL LINE - START [**2184-3-18**] 01:11 PM', ' TRANSTHORACIC ECHO - At [**2184-3-18**] 03:48 PM', ' URINE CULTURE - At [**2184-3-18**] 03:48 PM', ' NASAL SWAB - At [**2184-3-18**] 03:48 PM', ' BLOOD CULTURED - At [**2184-3-19**] 04:00 AM', '1 set bld cx drawn from aline at 4am, 2nd set bld cx drawn from hickman']",19569,197451.0
5,2184-03-20 11:03:46,['absorbing PO meds with [** 1462**]'],"['-- Cyclosporine levels at toxic levels, afternoon dose was held, at', 'dose lowered to 25mg IV BID starting this am', '-- Patient underwent bronchoscopy, microbiology pending', '-- had to go up on PEEP to 15 following bronch', '-- patient w/ improved blood sugars after tightenting SS', '-- has had high TF residuals of 200-300, and concern of needing not', 'absorbing PO meds with [** 1462**]']",['absorbing PO meds with illeus'],19569,197451.0
6,2184-03-21 07:27:51,"['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd""]","['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd""]","['-- Cyclosporine levels at toxic levels, afternoon dose was held, at', 'dose lowered to 25mg IV BID starting this am', '-- Patient underwent bronchoscopy, microbiology pending', '-- had to go up on PEEP to 15 following bronch', '-- patient w/ improved blood sugars after tightenting SS', '-- has had high TF residuals of 200-300, and concern of needing not', 'absorbing PO meds with [** 1462**]']",19569,197451.0
7,2184-03-21 07:54:31,,"['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd""]",,19569,197451.0
8,2184-03-21 07:55:38,,"['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd""]",,19569,197451.0
9,2184-03-21 08:33:29,"['Pt opening eyes, but not responding to commands, denies abd pain']","['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd"", 'Pt opening eyes, but not responding to commands, denies abd pain']",,19569,197451.0
10,2184-03-21 16:44:48,,"['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd"", 'Pt opening eyes, but not responding to commands, denies abd pain']",,19569,197451.0
11,2184-03-22 07:06:53,"['- metabolic acidosis persists despite 3amps of bicarb', '- potassium was rising at 5.4, renal consulted for am', '- started chlorthiazide & lasix gtt, having good uop & K coming down', '- weaning fiO2 & PEEP overnight', '- KUB showed non specific bowel gas pattern, still holding TFs, gave', 'kayexalate and pt had a large BM this am', '- PCP aspirate negative [**Name Initial (PRE) **] 1, per ID still getting one more day of', 'Bactrim', 'Pt opening eyes, but otherwise, not responding.']","['- metabolic acidosis persists despite 3amps of bicarb', '- potassium was rising at 5.4, renal consulted for am', '- started chlorthiazide & lasix gtt, having good uop & K coming down', '- weaning fiO2 & PEEP overnight', '- KUB showed non specific bowel gas pattern, still holding TFs, gave', 'kayexalate and pt had a large BM this am', '- PCP aspirate negative [**Name Initial (PRE) **] 1, per ID still getting one more day of', 'Bactrim', 'Pt opening eyes, but otherwise, not responding.']","['- volume overload, renal failure with elev K & phos, per renal, OK to', 'diurese, giving higher entry level dose of lasix, 80-100mg', '- per renal, 3 amps bicarb', '- tube feeds held [**2-14**] high residuals', ""- SC heparin d/c'd"", 'Pt opening eyes, but not responding to commands, denies abd pain']",19569,197451.0
12,2184-03-22 12:31:36,,"['- metabolic acidosis persists despite 3amps of bicarb', '- potassium was rising at 5.4, renal consulted for am', '- started chlorthiazide & lasix gtt, having good uop & K coming down', '- weaning fiO2 & PEEP overnight', '- KUB showed non specific bowel gas pattern, still holding TFs, gave', 'kayexalate and pt had a large BM this am', '- PCP aspirate negative [**Name Initial (PRE) **] 1, per ID still getting one more day of', 'Bactrim', 'Pt opening eyes, but otherwise, not responding.']",,19569,197451.0
13,2184-03-23 08:05:42,"['-- renal to see in AM, renal u/s ordred', '-- cyclosporine at therapeutic level', '-- continue on lasix gtt w/ thiazide --> was > negative 3L', ""-- d/c'd bactrim --> started on PCP [**Name9 (PRE) **] [**Name Initial (PRE) **]/ atorvaquone"", '-- Increased FiO2 to 60% 2/2 to low PO2.  PO2 w/ some improvement, O2', 'sats up from 90 to 95%']","['-- renal to see in AM, renal u/s ordred', '-- cyclosporine at therapeutic level', '-- continue on lasix gtt w/ thiazide --> was > negative 3L', ""-- d/c'd bactrim --> started on PCP [**Name9 (PRE) **] [**Name Initial (PRE) **]/ atorvaquone"", '-- Increased FiO2 to 60% 2/2 to low PO2.  PO2 w/ some improvement, O2', 'sats up from 90 to 95%']","['- metabolic acidosis persists despite 3amps of bicarb', '- potassium was rising at 5.4, renal consulted for am', '- started chlorthiazide & lasix gtt, having good uop & K coming down', '- weaning fiO2 & PEEP overnight', '- KUB showed non specific bowel gas pattern, still holding TFs, gave', 'kayexalate and pt had a large BM this am', '- PCP aspirate negative [**Name Initial (PRE) **] 1, per ID still getting one more day of', 'Bactrim', 'Pt opening eyes, but otherwise, not responding.']",19569,197451.0
14,2184-03-23 10:20:29,,"['-- renal to see in AM, renal u/s ordred', '-- cyclosporine at therapeutic level', '-- continue on lasix gtt w/ thiazide --> was > negative 3L', ""-- d/c'd bactrim --> started on PCP [**Name9 (PRE) **] [**Name Initial (PRE) **]/ atorvaquone"", '-- Increased FiO2 to 60% 2/2 to low PO2.  PO2 w/ some improvement, O2', 'sats up from 90 to 95%']",,19569,197451.0
15,2184-03-24 08:04:03,"['- renal US - no hydro', '- FeUrea - 50%', '- steroid taper', 'Pt opening eyes but not responding to commands']","['- renal US - no hydro', '- FeUrea - 50%', '- steroid taper', 'Pt opening eyes but not responding to commands']","['-- renal to see in AM, renal u/s ordred', '-- cyclosporine at therapeutic level', '-- continue on lasix gtt w/ thiazide --> was > negative 3L', ""-- d/c'd bactrim --> started on PCP [**Name9 (PRE) **] [**Name Initial (PRE) **]/ atorvaquone"", '-- Increased FiO2 to 60% 2/2 to low PO2.  PO2 w/ some improvement, O2', 'sats up from 90 to 95%']",19569,197451.0
16,2184-03-24 18:09:16,,"['- renal US - no hydro', '- FeUrea - 50%', '- steroid taper', 'Pt opening eyes but not responding to commands']",,19569,197451.0
17,2184-03-24 18:21:50,,"['- renal US - no hydro', '- FeUrea - 50%', '- steroid taper', 'Pt opening eyes but not responding to commands']",,19569,197451.0
18,2184-03-25 07:18:08,"['BLOOD CULTURED - At [**2184-3-24**] 01:39 PM', ' URINE CULTURE - At [**2184-3-24**] 01:39 PM', ' SPUTUM CULTURE - At [**2184-3-24**] 01:40 PM', '- negative 2.5L & lasix gtt was decreased to 3cc/hr', '- weaned down to PEEP of 10 & FiO2 at 40%', '- pm lytes showed rise in Na & Cl, started free water boluses with TF', '- sbp dipped to low 90s in am, Lasix gtt stopped & 250cc bolus given,', 'BP came up to 120/60']","['BLOOD CULTURED - At [**2184-3-24**] 01:39 PM', ' URINE CULTURE - At [**2184-3-24**] 01:39 PM', ' SPUTUM CULTURE - At [**2184-3-24**] 01:40 PM', '- negative 2.5L & lasix gtt was decreased to 3cc/hr', '- weaned down to PEEP of 10 & FiO2 at 40%', '- pm lytes showed rise in Na & Cl, started free water boluses with TF', '- sbp dipped to low 90s in am, Lasix gtt stopped & 250cc bolus given,', 'BP came up to 120/60']","['- renal US - no hydro', '- FeUrea - 50%', '- steroid taper', 'Pt opening eyes but not responding to commands']",19569,197451.0
19,2184-03-25 12:59:56,,"['BLOOD CULTURED - At [**2184-3-24**] 01:39 PM', ' URINE CULTURE - At [**2184-3-24**] 01:39 PM', ' SPUTUM CULTURE - At [**2184-3-24**] 01:40 PM', '- negative 2.5L & lasix gtt was decreased to 3cc/hr', '- weaned down to PEEP of 10 & FiO2 at 40%', '- pm lytes showed rise in Na & Cl, started free water boluses with TF', '- sbp dipped to low 90s in am, Lasix gtt stopped & 250cc bolus given,', 'BP came up to 120/60']",,19569,197451.0
20,2184-03-26 08:06:43,"['FEVER - 102.0', 'F - [**2184-3-25**] 09:00 PM', '-- have decreased PEEP over course of day from 10 to 8 to 5 and has', 'tolerated well.', '-- subtherapeutic on cyclosporine, increased PM dose per BMT', '-- pan cultured again this am']","['FEVER - 102.0', 'F - [**2184-3-25**] 09:00 PM', '-- have decreased PEEP over course of day from 10 to 8 to 5 and has', 'tolerated well.', '-- subtherapeutic on cyclosporine, increased PM dose per BMT', '-- pan cultured again this am']","['BLOOD CULTURED - At [**2184-3-24**] 01:39 PM', ' URINE CULTURE - At [**2184-3-24**] 01:39 PM', ' SPUTUM CULTURE - At [**2184-3-24**] 01:40 PM', '- negative 2.5L & lasix gtt was decreased to 3cc/hr', '- weaned down to PEEP of 10 & FiO2 at 40%', '- pm lytes showed rise in Na & Cl, started free water boluses with TF', '- sbp dipped to low 90s in am, Lasix gtt stopped & 250cc bolus given,', 'BP came up to 120/60']",19569,197451.0
21,2184-03-26 08:44:01,,"['FEVER - 102.0', 'F - [**2184-3-25**] 09:00 PM', '-- have decreased PEEP over course of day from 10 to 8 to 5 and has', 'tolerated well.', '-- subtherapeutic on cyclosporine, increased PM dose per BMT', '-- pan cultured again this am']",,19569,197451.0
22,2184-03-26 17:07:41,,"['FEVER - 102.0', 'F - [**2184-3-25**] 09:00 PM', '-- have decreased PEEP over course of day from 10 to 8 to 5 and has', 'tolerated well.', '-- subtherapeutic on cyclosporine, increased PM dose per BMT', '-- pan cultured again this am']",,19569,197451.0
23,2184-03-27 07:15:20,"['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]']","['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]']","['FEVER - 102.0', 'F - [**2184-3-25**] 09:00 PM', '-- have decreased PEEP over course of day from 10 to 8 to 5 and has', 'tolerated well.', '-- subtherapeutic on cyclosporine, increased PM dose per BMT', '-- pan cultured again this am']",19569,197451.0
24,2184-03-27 07:31:11,,"['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]']",,19569,197451.0
25,2184-03-27 07:54:52,,"['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]']",,19569,197451.0
26,2184-03-27 20:50:41,['Pt opening eyes & responding to commands today'],"['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]', 'Pt opening eyes & responding to commands today']",,19569,197451.0
27,2184-03-28 08:07:10,"['- cyclosporine level low at 129, increased to 75mcg [**Hospital1 **]', '- desatted briefly ?possibly due to mucus plugging', '- bronchoscopy revealed normal airways, BAL sent', '- continued low grade fevers, pancultured', '- C.diff neg, stool Cx neg to date']","['- cyclosporine level low at 129, increased to 75mcg [**Hospital1 **]', '- desatted briefly ?possibly due to mucus plugging', '- bronchoscopy revealed normal airways, BAL sent', '- continued low grade fevers, pancultured', '- C.diff neg, stool Cx neg to date']","['BLOOD CULTURED - At [**2184-3-26**] 09:59 AM', ' FEVER - 101.6', 'F - [**2184-3-26**] 12:00 PM', '- started on flagyl and Levaquin for persistent fevers', '- Head CT showed evidence of sinusitis', '- Chest CT showed evidence of multifocal PNA', ""- LENI's negative for DVT"", '- given 100mg IV lasix x1', '- cyclosporine level 110 so dose increased to 50mg [**Hospital1 **]', 'Pt opening eyes & responding to commands today']",19569,197451.0
28,2184-03-29 05:26:06,,"['- cyclosporine level low at 129, increased to 75mcg [**Hospital1 **]', '- desatted briefly ?possibly due to mucus plugging', '- bronchoscopy revealed normal airways, BAL sent', '- continued low grade fevers, pancultured', '- C.diff neg, stool Cx neg to date']",,19569,197451.0
29,2184-03-29 07:19:05,"['BLOOD CULTURED - At [**2184-3-29**] 06:17 AM', '- Decreased PEEP to 8, but did not tolerated, increased back to 10', '- BMT concerned that ARDS may be secondary to cyclosporine, and', 'decreased dose to 50 q12 w/ plans of tapering off and switching to', 'either predisone or FK', '- patinet short of I/Os goal this evening, wanted to give lasix, but', 'SBP < 100, so deffered.', '- BAL specimen poor quality, not enough specimen for viral culture']","['BLOOD CULTURED - At [**2184-3-29**] 06:17 AM', '- Decreased PEEP to 8, but did not tolerated, increased back to 10', '- BMT concerned that ARDS may be secondary to cyclosporine, and', 'decreased dose to 50 q12 w/ plans of tapering off and switching to', 'either predisone or FK', '- patinet short of I/Os goal this evening, wanted to give lasix, but', 'SBP < 100, so deffered.', '- BAL specimen poor quality, not enough specimen for viral culture']","['- cyclosporine level low at 129, increased to 75mcg [**Hospital1 **]', '- desatted briefly ?possibly due to mucus plugging', '- bronchoscopy revealed normal airways, BAL sent', '- continued low grade fevers, pancultured', '- C.diff neg, stool Cx neg to date']",19569,197451.0
30,2184-03-29 20:35:36,,"['BLOOD CULTURED - At [**2184-3-29**] 06:17 AM', '- Decreased PEEP to 8, but did not tolerated, increased back to 10', '- BMT concerned that ARDS may be secondary to cyclosporine, and', 'decreased dose to 50 q12 w/ plans of tapering off and switching to', 'either predisone or FK', '- patinet short of I/Os goal this evening, wanted to give lasix, but', 'SBP < 100, so deffered.', '- BAL specimen poor quality, not enough specimen for viral culture']",,19569,197451.0
31,2184-03-30 07:56:25,"['- tried to wean vent, pCO2 increased, pt look as though he were tiring', 'so switched back to AC for rest overnight', ""- per BMT, cyclosporine d/c'd as possible culprit for ARDS,"", '- I/O goal even', 'Day 13 Vanc/Meropenem', 'Day 5 Levofloxacin & Flagyl', 'home reg Acyclovir & Atovaquone, Voriconazole']","['- tried to wean vent, pCO2 increased, pt look as though he were tiring', 'so switched back to AC for rest overnight', ""- per BMT, cyclosporine d/c'd as possible culprit for ARDS,"", '- I/O goal even', 'Day 13 Vanc/Meropenem', 'Day 5 Levofloxacin & Flagyl', 'home reg Acyclovir & Atovaquone, Voriconazole']","['BLOOD CULTURED - At [**2184-3-29**] 06:17 AM', '- Decreased PEEP to 8, but did not tolerated, increased back to 10', '- BMT concerned that ARDS may be secondary to cyclosporine, and', 'decreased dose to 50 q12 w/ plans of tapering off and switching to', 'either predisone or FK', '- patinet short of I/Os goal this evening, wanted to give lasix, but', 'SBP < 100, so deffered.', '- BAL specimen poor quality, not enough specimen for viral culture']",19569,197451.0
32,2184-03-30 07:57:26,,"['- tried to wean vent, pCO2 increased, pt look as though he were tiring', 'so switched back to AC for rest overnight', ""- per BMT, cyclosporine d/c'd as possible culprit for ARDS,"", '- I/O goal even', 'Day 13 Vanc/Meropenem', 'Day 5 Levofloxacin & Flagyl', 'home reg Acyclovir & Atovaquone, Voriconazole']",,19569,197451.0
33,2184-03-30 20:01:37,,"['- tried to wean vent, pCO2 increased, pt look as though he were tiring', 'so switched back to AC for rest overnight', ""- per BMT, cyclosporine d/c'd as possible culprit for ARDS,"", '- I/O goal even', 'Day 13 Vanc/Meropenem', 'Day 5 Levofloxacin & Flagyl', 'home reg Acyclovir & Atovaquone, Voriconazole']",,19569,197451.0
34,2184-03-31 06:41:33,"['- extubated successfully, sating 93% on fact tent', '- developped urethral pain & grossly bloody urine', '- foley was changed out & received 6L of CBI, hct stable x 3', ""- pain worse in am, no UOP for 2 hrs likely [**2-14**] clot, foley was d/c'd,"", 'pt had >300cc UOP', '- per BMT, pt will need to start Tacrolimus [**3-31**] am (replacement for', 'cyclosporine)']","['- extubated successfully, sating 93% on fact tent', '- developped urethral pain & grossly bloody urine', '- foley was changed out & received 6L of CBI, hct stable x 3', ""- pain worse in am, no UOP for 2 hrs likely [**2-14**] clot, foley was d/c'd,"", 'pt had >300cc UOP', '- per BMT, pt will need to start Tacrolimus [**3-31**] am (replacement for', 'cyclosporine)']","['- tried to wean vent, pCO2 increased, pt look as though he were tiring', 'so switched back to AC for rest overnight', ""- per BMT, cyclosporine d/c'd as possible culprit for ARDS,"", '- I/O goal even', 'Day 13 Vanc/Meropenem', 'Day 5 Levofloxacin & Flagyl', 'home reg Acyclovir & Atovaquone, Voriconazole']",19569,197451.0
35,2184-03-31 06:58:17,,"['- extubated successfully, sating 93% on fact tent', '- developped urethral pain & grossly bloody urine', '- foley was changed out & received 6L of CBI, hct stable x 3', ""- pain worse in am, no UOP for 2 hrs likely [**2-14**] clot, foley was d/c'd,"", 'pt had >300cc UOP', '- per BMT, pt will need to start Tacrolimus [**3-31**] am (replacement for', 'cyclosporine)']",,19569,197451.0
36,2184-04-14 06:34:03,"['TUNNELED (HICKMAN) LINE - START [**2184-4-13**] 10:46 AM', '- started on BiPAP 12/4, repeat gas on this 7.20/111/44/45, then', '7.18/121/61/47', '- on noninvasive assist control-- not ideal, but mental status improved', 'on this.']","['TUNNELED (HICKMAN) LINE - START [**2184-4-13**] 10:46 AM', '- started on BiPAP 12/4, repeat gas on this 7.20/111/44/45, then', '7.18/121/61/47', '- on noninvasive assist control-- not ideal, but mental status improved', 'on this.']","['- extubated successfully, sating 93% on fact tent', '- developped urethral pain & grossly bloody urine', '- foley was changed out & received 6L of CBI, hct stable x 3', ""- pain worse in am, no UOP for 2 hrs likely [**2-14**] clot, foley was d/c'd,"", 'pt had >300cc UOP', '- per BMT, pt will need to start Tacrolimus [**3-31**] am (replacement for', 'cyclosporine)']",19569,197451.0
37,2184-04-14 06:37:25,,"['TUNNELED (HICKMAN) LINE - START [**2184-4-13**] 10:46 AM', '- started on BiPAP 12/4, repeat gas on this 7.20/111/44/45, then', '7.18/121/61/47', '- on noninvasive assist control-- not ideal, but mental status improved', 'on this.']",,19569,197451.0
38,2184-04-14 10:53:36,"['-', 'on 50% mask, weaned down to nasal cannula', '-', 'diuresed well overnight.']","['TUNNELED (HICKMAN) LINE - START [**2184-4-13**] 10:46 AM', '-', 'on 50% mask, weaned down to nasal cannula', '-', 'diuresed well overnight.']","['- started on BiPAP 12/4, repeat gas on this 7.20/111/44/45, then', '7.18/121/61/47', '- on noninvasive assist control-- not ideal, but mental status improved', 'on this.']",19569,197451.0
39,2184-04-15 07:45:33,"['- Cards: [**Hospital 1954**] medical mgt with BB and ACEI, no dobutamine MIBI.', 'Will need to ask operative risk for thoracotomy/VATS.  Increased', 'metoprolol to 25mg TID given HR 110s.', '- BMT: Hold VATS, hold steroids, hold ganciclovir', '- ID: Continue atovaquone, acyclovir, voriconazole ppx', ""- Med changes: D/c'd levofloxacin"", '- Labs: Sent for stool OP given concern for strongyloides']","['- Cards: [**Hospital 1954**] medical mgt with BB and ACEI, no dobutamine MIBI.', 'Will need to ask operative risk for thoracotomy/VATS.  Increased', 'metoprolol to 25mg TID given HR 110s.', '- BMT: Hold VATS, hold steroids, hold ganciclovir', '- ID: Continue atovaquone, acyclovir, voriconazole ppx', ""- Med changes: D/c'd levofloxacin"", '- Labs: Sent for stool OP given concern for strongyloides']","['TUNNELED (HICKMAN) LINE - START [**2184-4-13**] 10:46 AM', '-', 'on 50% mask, weaned down to nasal cannula', '-', 'diuresed well overnight.']",19569,197451.0
40,2184-04-15 07:47:07,,"['- Cards: [**Hospital 1954**] medical mgt with BB and ACEI, no dobutamine MIBI.', 'Will need to ask operative risk for thoracotomy/VATS.  Increased', 'metoprolol to 25mg TID given HR 110s.', '- BMT: Hold VATS, hold steroids, hold ganciclovir', '- ID: Continue atovaquone, acyclovir, voriconazole ppx', ""- Med changes: D/c'd levofloxacin"", '- Labs: Sent for stool OP given concern for strongyloides']",,19569,197451.0
41,2184-04-15 15:00:34,"['- [**Hospital 503**]: Sent for stool OP given concern for strongyloides', '- Resp: nasal cannula to facemask overnight for hypoxia while sleeping']","['- Cards: [**Hospital 1954**] medical mgt with BB and ACEI, no dobutamine MIBI.', 'Will need to ask operative risk for thoracotomy/VATS.  Increased', 'metoprolol to 25mg TID given HR 110s.', '- BMT: Hold VATS, hold steroids, hold ganciclovir', '- ID: Continue atovaquone, acyclovir, voriconazole ppx', ""- Med changes: D/c'd levofloxacin"", '- [**Hospital 503**]: Sent for stool OP given concern for strongyloides', '- Resp: nasal cannula to facemask overnight for hypoxia while sleeping']",['- Labs: Sent for stool OP given concern for strongyloides'],19569,197451.0
42,2184-04-16 06:49:18,"['O+P sent', 'metop increased to 125 mg tid, prn iv metoprolol for HR', 'd/c captopril (get more room on BP, also can cause aplastic anemia)', 'asa 81 QOD started']","['O+P sent', 'metop increased to 125 mg tid, prn iv metoprolol for HR', 'd/c captopril (get more room on BP, also can cause aplastic anemia)', 'asa 81 QOD started']","['- Cards: [**Hospital 1954**] medical mgt with BB and ACEI, no dobutamine MIBI.', 'Will need to ask operative risk for thoracotomy/VATS.  Increased', 'metoprolol to 25mg TID given HR 110s.', '- BMT: Hold VATS, hold steroids, hold ganciclovir', '- ID: Continue atovaquone, acyclovir, voriconazole ppx', ""- Med changes: D/c'd levofloxacin"", '- [**Hospital 503**]: Sent for stool OP given concern for strongyloides', '- Resp: nasal cannula to facemask overnight for hypoxia while sleeping']",19569,197451.0
43,2184-04-16 11:59:24,,"['O+P sent', 'metop increased to 125 mg tid, prn iv metoprolol for HR', 'd/c captopril (get more room on BP, also can cause aplastic anemia)', 'asa 81 QOD started']",,19569,197451.0
44,2184-04-17 07:56:11,"['- CT chest: Likely BOOP', '- BOOP: Started methylprednisolone 125mg Q6H x3 days with long taper', '- Tacrolimus dosing per BMT, currently being held', '- Enterococci UTI: Repeat UA, cx before starting vancomycin', '- CP: Resolved with SLNTG + nitro paste, morphine, no EKG changes, ABG', 'normal (on O2)']","['- CT chest: Likely BOOP', '- BOOP: Started methylprednisolone 125mg Q6H x3 days with long taper', '- Tacrolimus dosing per BMT, currently being held', '- Enterococci UTI: Repeat UA, cx before starting vancomycin', '- CP: Resolved with SLNTG + nitro paste, morphine, no EKG changes, ABG', 'normal (on O2)']","['O+P sent', 'metop increased to 125 mg tid, prn iv metoprolol for HR', 'd/c captopril (get more room on BP, also can cause aplastic anemia)', 'asa 81 QOD started']",19569,197451.0
45,2184-04-17 18:58:47,,"['- CT chest: Likely BOOP', '- BOOP: Started methylprednisolone 125mg Q6H x3 days with long taper', '- Tacrolimus dosing per BMT, currently being held', '- Enterococci UTI: Repeat UA, cx before starting vancomycin', '- CP: Resolved with SLNTG + nitro paste, morphine, no EKG changes, ABG', 'normal (on O2)']",,19569,197451.0
46,2184-04-18 06:45:11,"['- CP: Standing nitro paste; still no EKG changes noted', '- Metoprolol changed from 125mg TID to 100 mg PO QID']","['- CP: Standing nitro paste; still no EKG changes noted', '- Metoprolol changed from 125mg TID to 100 mg PO QID']","['- CT chest: Likely BOOP', '- BOOP: Started methylprednisolone 125mg Q6H x3 days with long taper', '- Tacrolimus dosing per BMT, currently being held', '- Enterococci UTI: Repeat UA, cx before starting vancomycin', '- CP: Resolved with SLNTG + nitro paste, morphine, no EKG changes, ABG', 'normal (on O2)']",19569,197451.0
47,2184-04-18 06:48:47,,"['- CP: Standing nitro paste; still no EKG changes noted', '- Metoprolol changed from 125mg TID to 100 mg PO QID']",,19569,197451.0
48,2184-04-18 11:37:27,,"['- CP: Standing nitro paste; still no EKG changes noted', '- Metoprolol changed from 125mg TID to 100 mg PO QID']",,19569,197451.0
49,2184-04-19 07:38:01,"['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for ?', 'overnight desats', 'Trying nasal mask at this time', 'VRE positive urine this am']","['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for ?', 'overnight desats', 'Trying nasal mask at this time', 'VRE positive urine this am']","['- CP: Standing nitro paste; still no EKG changes noted', '- Metoprolol changed from 125mg TID to 100 mg PO QID']",19569,197451.0
50,2184-04-19 15:26:48,"['Did not tolerate face mask CPAP overnight which was started for', 'Nasal mask at this time']","['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for', 'overnight desats', 'Nasal mask at this time']","['Did not tolerate face mask CPAP overnight which was started for ?', 'Trying nasal mask at this time', 'VRE positive urine this am']",19569,197451.0
51,2184-04-19 16:09:21,,"['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for', 'overnight desats', 'Nasal mask at this time']",,19569,197451.0
52,2184-04-19 16:14:07,,"['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for', 'overnight desats', 'Nasal mask at this time']",,19569,197451.0
53,2184-04-20 06:50:35,"['-Tolerated NC at 5L during the day', '- No desats overnight', '- Variable FSBG during the day, was hypoglycemic requiring D50 x1 per', 'protocol, insulin gtt decreased', '- OOB to chair for 2 hours which patient tolerated.']","['-Tolerated NC at 5L during the day', '- No desats overnight', '- Variable FSBG during the day, was hypoglycemic requiring D50 x1 per', 'protocol, insulin gtt decreased', '- OOB to chair for 2 hours which patient tolerated.']","['O2 weaned', 'Insulin gtt started for FS in the 500s', 'Did not tolerate face mask CPAP overnight which was started for', 'overnight desats', 'Nasal mask at this time']",19569,197451.0
54,2184-04-20 14:23:17,,"['-Tolerated NC at 5L during the day', '- No desats overnight', '- Variable FSBG during the day, was hypoglycemic requiring D50 x1 per', 'protocol, insulin gtt decreased', '- OOB to chair for 2 hours which patient tolerated.']",,19569,197451.0
55,2184-04-20 14:39:22,,"['-Tolerated NC at 5L during the day', '- No desats overnight', '- Variable FSBG during the day, was hypoglycemic requiring D50 x1 per', 'protocol, insulin gtt decreased', '- OOB to chair for 2 hours which patient tolerated.']",,19569,197451.0
56,2184-04-21 07:30:23,"['-changed steroids to 60mg [**Hospital1 **] prednisone per BMT recs', '-repeat CBC showed WBC return to baseline, likely elevation was', 'spurious', '-increasing insulin requirement during day, FSBS 91-264 today, mostly', '>200,  required 12.5 units per hour with improved control. Hypoglycemic', 'to 62 overnight, off gtt for now.', '-Sats 88-98% on 50% FiO2 face mask.  Desat to 85% on 5LNC', ' switched to', 'face mask.  Upon exertion, pt desats to 80', 's however recovers quickly.', 'Currently on 50% FiO2 with cool mist face mask', '-fluid even']","['-changed steroids to 60mg [**Hospital1 **] prednisone per BMT recs', '-repeat CBC showed WBC return to baseline, likely elevation was', 'spurious', '-increasing insulin requirement during day, FSBS 91-264 today, mostly', '>200,  required 12.5 units per hour with improved control. Hypoglycemic', 'to 62 overnight, off gtt for now.', '-Sats 88-98% on 50% FiO2 face mask.  Desat to 85% on 5LNC', ' switched to', 'face mask.  Upon exertion, pt desats to 80', 's however recovers quickly.', 'Currently on 50% FiO2 with cool mist face mask', '-fluid even']","['-Tolerated NC at 5L during the day', '- No desats overnight', '- Variable FSBG during the day, was hypoglycemic requiring D50 x1 per', 'protocol, insulin gtt decreased', '- OOB to chair for 2 hours which patient tolerated.']",19569,197451.0
57,2184-04-21 17:03:44,,"['-changed steroids to 60mg [**Hospital1 **] prednisone per BMT recs', '-repeat CBC showed WBC return to baseline, likely elevation was', 'spurious', '-increasing insulin requirement during day, FSBS 91-264 today, mostly', '>200,  required 12.5 units per hour with improved control. Hypoglycemic', 'to 62 overnight, off gtt for now.', '-Sats 88-98% on 50% FiO2 face mask.  Desat to 85% on 5LNC', ' switched to', 'face mask.  Upon exertion, pt desats to 80', 's however recovers quickly.', 'Currently on 50% FiO2 with cool mist face mask', '-fluid even']",,19569,197451.0
58,2184-04-22 14:32:07,,[],"['-changed steroids to 60mg [**Hospital1 **] prednisone per BMT recs', '-repeat CBC showed WBC return to baseline, likely elevation was', 'spurious', '-increasing insulin requirement during day, FSBS 91-264 today, mostly', '>200,  required 12.5 units per hour with improved control. Hypoglycemic', 'to 62 overnight, off gtt for now.', '-Sats 88-98% on 50% FiO2 face mask.  Desat to 85% on 5LNC', ' switched to', 'face mask.  Upon exertion, pt desats to 80', 's however recovers quickly.', 'Currently on 50% FiO2 with cool mist face mask', '-fluid even']",19569,197451.0
59,2184-04-22 14:43:15,,[],,19569,197451.0
60,2184-04-22 16:06:22,,[],,19569,197451.0
61,2184-04-23 07:36:16,"['- good UOP. was >-1L by 10 pm (on his own)', '- K improved after kayexalate to 4.4', ""- did not tolerate nasal bipap- used for 2 hours, couldn't sleep.  sats"", 'were still in the low 90s with it on.']","['- good UOP. was >-1L by 10 pm (on his own)', '- K improved after kayexalate to 4.4', ""- did not tolerate nasal bipap- used for 2 hours, couldn't sleep.  sats"", 'were still in the low 90s with it on.']",,19569,197451.0
62,2184-04-23 07:38:31,"['-Insulin increased', '-steroids decreased']","['- good UOP. was >-1L by 10 pm (on his own)', '- K improved after kayexalate to 4.4', ""- did not tolerate nasal bipap- used for 2 hours, couldn't sleep.  sats"", 'were still in the low 90s with it on.', '-Insulin increased', '-steroids decreased']",,19569,197451.0
63,2184-04-23 15:25:06,"['were still in the low 90s with it on. Did not desat overnight', '-02 sats overall improved.  Decreased to 88% on 4L with PT ambulating', '4', ' to chair.  Otherwise was high 90s this am on 4-5L NC.']","['- good UOP. was >-1L by 10 pm (on his own)', '- K improved after kayexalate to 4.4', ""- did not tolerate nasal bipap- used for 2 hours, couldn't sleep.  sats"", 'were still in the low 90s with it on. Did not desat overnight', '-Insulin increased', '-steroids decreased', '-02 sats overall improved.  Decreased to 88% on 4L with PT ambulating', '4', ' to chair.  Otherwise was high 90s this am on 4-5L NC.']",['were still in the low 90s with it on.'],19569,197451.0
64,2184-04-23 18:09:25,,"['- good UOP. was >-1L by 10 pm (on his own)', '- K improved after kayexalate to 4.4', ""- did not tolerate nasal bipap- used for 2 hours, couldn't sleep.  sats"", 'were still in the low 90s with it on. Did not desat overnight', '-Insulin increased', '-steroids decreased', '-02 sats overall improved.  Decreased to 88% on 4L with PT ambulating', '4', ' to chair.  Otherwise was high 90s this am on 4-5L NC.']",,19569,197451.0
0,2185-04-21 07:33:24,,['EKG - At [**2185-4-20**] 07:30 PM'],,19569,115191.0
1,2185-04-21 11:26:44,['None'],['None'],['EKG - At [**2185-4-20**] 07:30 PM'],19569,115191.0
2,2185-04-21 11:42:34,"['Non-contrast Head CT obtained', ' prelim negative', 'Kayxalate administered']","['Non-contrast Head CT obtained', ' prelim negative', 'Kayxalate administered']",['None'],19569,115191.0
3,2185-04-21 11:49:16,,"['Non-contrast Head CT obtained', ' prelim negative', 'Kayxalate administered']",,19569,115191.0
4,2185-04-22 06:11:01,"['-f/u K+ 5.6-> 5.7', '-final head CT neg', '-neg 1.7 L', '-restarted PO lasix', '-called out to BMT but no bed on BMT floor']","['-f/u K+ 5.6-> 5.7', '-final head CT neg', '-neg 1.7 L', '-restarted PO lasix', '-called out to BMT but no bed on BMT floor']","['Non-contrast Head CT obtained', ' prelim negative', 'Kayxalate administered']",19569,115191.0
0,2190-08-31 09:46:09,,"['INVASIVE VENTILATION - START [**2190-8-30**] 04:05 PM', ' ARTERIAL LINE - START [**2190-8-30**] 05:30 PM', ' BLOOD CULTURED - At [**2190-8-31**] 12:15 AM', 'art line', ' BLOOD CULTURED - At [**2190-8-31**] 12:30 AM', 'venipuncture', 'Arterial line placed on [**8-30**] (right radial)', '3 RBC & 4 FFPs']",,28223,121068.0
1,2190-08-31 11:56:47,,"['INVASIVE VENTILATION - START [**2190-8-30**] 04:05 PM', ' ARTERIAL LINE - START [**2190-8-30**] 05:30 PM', ' BLOOD CULTURED - At [**2190-8-31**] 12:15 AM', 'art line', ' BLOOD CULTURED - At [**2190-8-31**] 12:30 AM', 'venipuncture', 'Arterial line placed on [**8-30**] (right radial)', '3 RBC & 4 FFPs']",,28223,121068.0
2,2190-09-01 07:21:53,"['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']","['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']","['INVASIVE VENTILATION - START [**2190-8-30**] 04:05 PM', ' ARTERIAL LINE - START [**2190-8-30**] 05:30 PM', ' BLOOD CULTURED - At [**2190-8-31**] 12:15 AM', 'art line', ' BLOOD CULTURED - At [**2190-8-31**] 12:30 AM', 'venipuncture', 'Arterial line placed on [**8-30**] (right radial)', '3 RBC & 4 FFPs']",28223,121068.0
3,2190-09-01 07:32:10,,"['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']",,28223,121068.0
4,2190-09-01 12:03:20,,"['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']",,28223,121068.0
5,2190-09-01 12:45:34,,"['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']",,28223,121068.0
6,2190-09-02 07:28:24,"['INVASIVE VENTILATION - STOP [**2190-9-1**] 09:00 AM', 'Patient was extubated yesterday. on shovel mask with FiO2 40%. Failed', 'speech and swallow yesterday. got ng tube which he pulled out', 'overnight.  speech and swallow has seen patient before, apparently high', 'risk for aspiration.  Has swollen left arm on exam. LUE us shows', 'nonocclusive thrombus wihtin one of the paired left bracial vein.', 'Given possible gi bleed cannot anti-coagulate at this point.  Also', 'given IV lopressor 5 mg x1 for PVCs as on metaprolol at home.']","['INVASIVE VENTILATION - STOP [**2190-9-1**] 09:00 AM', 'Patient was extubated yesterday. on shovel mask with FiO2 40%. Failed', 'speech and swallow yesterday. got ng tube which he pulled out', 'overnight.  speech and swallow has seen patient before, apparently high', 'risk for aspiration.  Has swollen left arm on exam. LUE us shows', 'nonocclusive thrombus wihtin one of the paired left bracial vein.', 'Given possible gi bleed cannot anti-coagulate at this point.  Also', 'given IV lopressor 5 mg x1 for PVCs as on metaprolol at home.']","['WOUND CULTURE - At [**2190-8-31**] 08:00 AM', ' ENDOSCOPY - At [**2190-8-31**] 10:10 AM: EGD showed coffee ground emesis', 'mixed with food in stomach, non-bleeding ulcer in the cardia, otherwise', 'normal EGD to duodenum. GI recs to continue PPI [**Hospital1 **], repeat EGD or', 'colonoscopy later this admission', '-Vascular surgery consult: wet to dry dressings [**Hospital1 **]', '-Last hct 31 (s/p 4U PRBC, 4U FFP total)']",28223,121068.0
7,2190-09-02 07:54:56,,"['INVASIVE VENTILATION - STOP [**2190-9-1**] 09:00 AM', 'Patient was extubated yesterday. on shovel mask with FiO2 40%. Failed', 'speech and swallow yesterday. got ng tube which he pulled out', 'overnight.  speech and swallow has seen patient before, apparently high', 'risk for aspiration.  Has swollen left arm on exam. LUE us shows', 'nonocclusive thrombus wihtin one of the paired left bracial vein.', 'Given possible gi bleed cannot anti-coagulate at this point.  Also', 'given IV lopressor 5 mg x1 for PVCs as on metaprolol at home.']",,28223,121068.0
8,2190-09-02 11:27:34,"['given IV lopressor 5 mg x1 for PVCs as on metaprolol at home. Coughing', 'up big plugs.']","['INVASIVE VENTILATION - STOP [**2190-9-1**] 09:00 AM', 'Patient was extubated yesterday. on shovel mask with FiO2 40%. Failed', 'speech and swallow yesterday. got ng tube which he pulled out', 'overnight.  speech and swallow has seen patient before, apparently high', 'risk for aspiration.  Has swollen left arm on exam. LUE us shows', 'nonocclusive thrombus wihtin one of the paired left bracial vein.', 'Given possible gi bleed cannot anti-coagulate at this point.  Also', 'given IV lopressor 5 mg x1 for PVCs as on metaprolol at home. Coughing', 'up big plugs.']",['given IV lopressor 5 mg x1 for PVCs as on metaprolol at home.'],28223,121068.0
0,2141-12-15 10:15:14,,"['BLOOD CULTURED - At [**2141-12-14**] 11:00 PM', 'ADMITTED']",,19493,155882.0
1,2141-12-15 10:18:19,,"['BLOOD CULTURED - At [**2141-12-14**] 11:00 PM', 'ADMITTED']",,19493,155882.0
2,2141-12-15 10:19:39,,"['BLOOD CULTURED - At [**2141-12-14**] 11:00 PM', 'ADMITTED']",,19493,155882.0
0,2193-12-30 07:46:44,,"['ULTRASOUND - At [**2193-12-29**] 02:00 PM', ""LE's"", '- Patient brought to floor', '- Given 5 mg lopressor in TSICU then another 10 mg on floor - helped to', 'rate control from ~ 140 to 100s.', '- Started diltiazem 30 mg QID', '- Sedation (propofol and lorazepam) stopped at about 11:30 a.m. and', 'patient still not to baseline by evening.', '- Per family, patient can follow commands (such as squeeze hand) and', 'will look around meaningfully at baseline, but can neither speak nor', 'move.', '- EEG electrodes removed this a.m. for MRI', '- Neurology suggested MRI as soon as hemodynamically stable (we should', 'get this in a.m.', '- Let SBP run 120s-150s if possible given possible stroke', '- EEG electrodes can be replaced after MRI if Neuro/we like.', '- BP quite labile, particularly when patient being passively moved', 'around']",,6533,152972.0
1,2193-12-30 12:04:07,['- Neurology suggested MRI as soon as [**Year (4 digits) 11359**] stable (we should'],"['ULTRASOUND - At [**2193-12-29**] 02:00 PM', ""LE's"", '- Patient brought to floor', '- Given 5 mg lopressor in TSICU then another 10 mg on floor - helped to', 'rate control from ~ 140 to 100s.', '- Started diltiazem 30 mg QID', '- Sedation (propofol and lorazepam) stopped at about 11:30 a.m. and', 'patient still not to baseline by evening.', '- Per family, patient can follow commands (such as squeeze hand) and', 'will look around meaningfully at baseline, but can neither speak nor', 'move.', '- EEG electrodes removed this a.m. for MRI', '- Neurology suggested MRI as soon as [**Year (4 digits) 11359**] stable (we should', 'get this in a.m.', '- Let SBP run 120s-150s if possible given possible stroke', '- EEG electrodes can be replaced after MRI if Neuro/we like.', '- BP quite labile, particularly when patient being passively moved', 'around']",['- Neurology suggested MRI as soon as hemodynamically stable (we should'],6533,152972.0
2,2193-12-31 07:06:38,"['MAGNETIC RESONANCE IMAGING - At [**2193-12-30**] 10:30 AM', '- MRI with acute infarct involving the entire right MCA territory with', 'small amount of hemorrhage in the right temporal lobe, mass effect on', 'right lateral ventricle and 4mm right to left midline shift with near', 'complete occlusion of the right ICA.', '- Heparin, plavix discontinued based on MRI findings', '- Palliative care consulted and noted that they briefly met with', 'family, that the is family overwhelmed with rapid turn of events, and', 'that they are available tomorrow to assit with care', '- Stroke team consulted and recommending allowing BP to autoregulate', '(can treat SBP > 200 with hydralazine 10mg IV), continue tegretol as', 'seizure ppx', '- Patient will likely be made CMO in the morning']","['MAGNETIC RESONANCE IMAGING - At [**2193-12-30**] 10:30 AM', '- MRI with acute infarct involving the entire right MCA territory with', 'small amount of hemorrhage in the right temporal lobe, mass effect on', 'right lateral ventricle and 4mm right to left midline shift with near', 'complete occlusion of the right ICA.', '- Heparin, plavix discontinued based on MRI findings', '- Palliative care consulted and noted that they briefly met with', 'family, that the is family overwhelmed with rapid turn of events, and', 'that they are available tomorrow to assit with care', '- Stroke team consulted and recommending allowing BP to autoregulate', '(can treat SBP > 200 with hydralazine 10mg IV), continue tegretol as', 'seizure ppx', '- Patient will likely be made CMO in the morning']","['ULTRASOUND - At [**2193-12-29**] 02:00 PM', ""LE's"", '- Patient brought to floor', '- Given 5 mg lopressor in TSICU then another 10 mg on floor - helped to', 'rate control from ~ 140 to 100s.', '- Started diltiazem 30 mg QID', '- Sedation (propofol and lorazepam) stopped at about 11:30 a.m. and', 'patient still not to baseline by evening.', '- Per family, patient can follow commands (such as squeeze hand) and', 'will look around meaningfully at baseline, but can neither speak nor', 'move.', '- EEG electrodes removed this a.m. for MRI', '- Neurology suggested MRI as soon as [**Year (4 digits) 11359**] stable (we should', 'get this in a.m.', '- Let SBP run 120s-150s if possible given possible stroke', '- EEG electrodes can be replaced after MRI if Neuro/we like.', '- BP quite labile, particularly when patient being passively moved', 'around']",6533,152972.0
3,2193-12-31 07:21:19,['that they are available tomorrow to assist with care'],"['MAGNETIC RESONANCE IMAGING - At [**2193-12-30**] 10:30 AM', '- MRI with acute infarct involving the entire right MCA territory with', 'small amount of hemorrhage in the right temporal lobe, mass effect on', 'right lateral ventricle and 4mm right to left midline shift with near', 'complete occlusion of the right ICA.', '- Heparin, plavix discontinued based on MRI findings', '- Palliative care consulted and noted that they briefly met with', 'family, that the is family overwhelmed with rapid turn of events, and', 'that they are available tomorrow to assist with care', '- Stroke team consulted and recommending allowing BP to autoregulate', '(can treat SBP > 200 with hydralazine 10mg IV), continue tegretol as', 'seizure ppx', '- Patient will likely be made CMO in the morning']",['that they are available tomorrow to assit with care'],6533,152972.0
4,2194-01-01 07:25:15,"['- Family Meeting: Awaiting family from out of town. Would like to plan', 'for extubation in the morning [**1-1**].', '- Neuro recs: Comfort measures.', '- Palliative care recs: Nothing new.', '- Patient hypotensive during the afternoon, bolused 500cc with good', 'response. However continued to have lability of blood pressure during', 'the afternoon/evening', '- Went into A. fib with RVR (150s). Gave 5mg Lopressor with rate to', '100s, blood pressure 80s/40s during so bolused 500cc. Pressures/rate', 'stabilized.']","['- Family Meeting: Awaiting family from out of town. Would like to plan', 'for extubation in the morning [**1-1**].', '- Neuro recs: Comfort measures.', '- Palliative care recs: Nothing new.', '- Patient hypotensive during the afternoon, bolused 500cc with good', 'response. However continued to have lability of blood pressure during', 'the afternoon/evening', '- Went into A. fib with RVR (150s). Gave 5mg Lopressor with rate to', '100s, blood pressure 80s/40s during so bolused 500cc. Pressures/rate', 'stabilized.']","['MAGNETIC RESONANCE IMAGING - At [**2193-12-30**] 10:30 AM', '- MRI with acute infarct involving the entire right MCA territory with', 'small amount of hemorrhage in the right temporal lobe, mass effect on', 'right lateral ventricle and 4mm right to left midline shift with near', 'complete occlusion of the right ICA.', '- Heparin, plavix discontinued based on MRI findings', '- Palliative care consulted and noted that they briefly met with', 'family, that the is family overwhelmed with rapid turn of events, and', 'that they are available tomorrow to assist with care', '- Stroke team consulted and recommending allowing BP to autoregulate', '(can treat SBP > 200 with hydralazine 10mg IV), continue tegretol as', 'seizure ppx', '- Patient will likely be made CMO in the morning']",6533,152972.0
5,2194-01-01 13:01:00,,"['- Family Meeting: Awaiting family from out of town. Would like to plan', 'for extubation in the morning [**1-1**].', '- Neuro recs: Comfort measures.', '- Palliative care recs: Nothing new.', '- Patient hypotensive during the afternoon, bolused 500cc with good', 'response. However continued to have lability of blood pressure during', 'the afternoon/evening', '- Went into A. fib with RVR (150s). Gave 5mg Lopressor with rate to', '100s, blood pressure 80s/40s during so bolused 500cc. Pressures/rate', 'stabilized.']",,6533,152972.0
6,2194-01-02 07:01:41,"['- Extubated', '- Made CMO', '- Morphine drip; scopolamine patch', '- Became tachycardic again to 130s in the evening.', '- RVR later yesterday, but with good pressures.']","['- Extubated', '- Made CMO', '- Morphine drip; scopolamine patch', '- Became tachycardic again to 130s in the evening.', '- RVR later yesterday, but with good pressures.']","['- Family Meeting: Awaiting family from out of town. Would like to plan', 'for extubation in the morning [**1-1**].', '- Neuro recs: Comfort measures.', '- Palliative care recs: Nothing new.', '- Patient hypotensive during the afternoon, bolused 500cc with good', 'response. However continued to have lability of blood pressure during', 'the afternoon/evening', '- Went into A. fib with RVR (150s). Gave 5mg Lopressor with rate to', '100s, blood pressure 80s/40s during so bolused 500cc. Pressures/rate', 'stabilized.']",6533,152972.0
7,2194-01-02 11:52:44,,"['- Extubated', '- Made CMO', '- Morphine drip; scopolamine patch', '- Became tachycardic again to 130s in the evening.', '- RVR later yesterday, but with good pressures.']",,6533,152972.0
0,2194-10-30 06:22:12,,"[""Patient received 3 units platelets and 2 units PRBC's overnight"", 'Neurosurgery recs include BP < 140, repeat head CT today and q2 hr', 'neurochecks']",,63687,147677.0
1,2194-10-30 09:55:21,,"[""Patient received 3 units platelets and 2 units PRBC's overnight"", 'Neurosurgery recs include BP < 140, repeat head CT today and q2 hr', 'neurochecks']",,63687,147677.0
2,2194-10-30 11:26:39,,"[""Patient received 3 units platelets and 2 units PRBC's overnight"", 'Neurosurgery recs include BP < 140, repeat head CT today and q2 hr', 'neurochecks']",,63687,147677.0
3,2194-10-31 06:35:50,"['-bone marrow bx c/w possible aplastic anemia. Stopped allopurinol.', '-repeat Hct 19. transfused another unit']","['-bone marrow bx c/w possible aplastic anemia. Stopped allopurinol.', '-repeat Hct 19. transfused another unit']","[""Patient received 3 units platelets and 2 units PRBC's overnight"", 'Neurosurgery recs include BP < 140, repeat head CT today and q2 hr', 'neurochecks']",63687,147677.0
4,2194-10-31 13:32:56,,"['-bone marrow bx c/w possible aplastic anemia. Stopped allopurinol.', '-repeat Hct 19. transfused another unit']",,63687,147677.0
5,2194-12-08 06:56:26,"['PICC LINE - START [**2194-12-7**] 07:03 PM', 'This is a 64 yo male with history of gout and post-polio syndrome who', 'initially presented with fatigue and dyspnea, as well as bloody BMs,', 'increased bruising, and epistaxis, and was found to have aplastic', 'anemia. He was treated with ATG, and remains on prednisone and', 'cyclosporine. His course has been complicated by acute SAH on CT head,', 'that was followed with serial scans and has since resolved. Also, he', 'has had persistent abdominal pain, s/p ERCP and stent placement without', 'resolution. He underwent CT abdomen this evening to further evaluate', 'his pain.', '.', 'After the scan, the patient noted feeling flushed over his head and', 'neck, with some shortness of breath and throat tightness. Hives were', 'noted, but the patient denies pruritus. He was given 50mg benadryl,', '125mg solumedrol and 20mg famotidine. His symptoms improved greatly,', 'although he was noted to still have mild stridor. He was transferred to', 'the ICU for monitoring overnight. Prior to transfer, his vitals were:', 'afebrile 125/70 94 16 99%,3L FM.', '.', 'In the ICU, the patient feels well and denies CP, dyspnea, chest', 'tightness, cough, wheeze, pruritus. He does confirm HA and mild', 'epigastric abdominal pain, neither of which are new or acutely changed.']","['PICC LINE - START [**2194-12-7**] 07:03 PM', 'This is a 64 yo male with history of gout and post-polio syndrome who', 'initially presented with fatigue and dyspnea, as well as bloody BMs,', 'increased bruising, and epistaxis, and was found to have aplastic', 'anemia. He was treated with ATG, and remains on prednisone and', 'cyclosporine. His course has been complicated by acute SAH on CT head,', 'that was followed with serial scans and has since resolved. Also, he', 'has had persistent abdominal pain, s/p ERCP and stent placement without', 'resolution. He underwent CT abdomen this evening to further evaluate', 'his pain.', '.', 'After the scan, the patient noted feeling flushed over his head and', 'neck, with some shortness of breath and throat tightness. Hives were', 'noted, but the patient denies pruritus. He was given 50mg benadryl,', '125mg solumedrol and 20mg famotidine. His symptoms improved greatly,', 'although he was noted to still have mild stridor. He was transferred to', 'the ICU for monitoring overnight. Prior to transfer, his vitals were:', 'afebrile 125/70 94 16 99%,3L FM.', '.', 'In the ICU, the patient feels well and denies CP, dyspnea, chest', 'tightness, cough, wheeze, pruritus. He does confirm HA and mild', 'epigastric abdominal pain, neither of which are new or acutely changed.']","['-bone marrow bx c/w possible aplastic anemia. Stopped allopurinol.', '-repeat Hct 19. transfused another unit']",63687,147677.0
6,2194-12-08 07:14:25,,"['PICC LINE - START [**2194-12-7**] 07:03 PM', 'This is a 64 yo male with history of gout and post-polio syndrome who', 'initially presented with fatigue and dyspnea, as well as bloody BMs,', 'increased bruising, and epistaxis, and was found to have aplastic', 'anemia. He was treated with ATG, and remains on prednisone and', 'cyclosporine. His course has been complicated by acute SAH on CT head,', 'that was followed with serial scans and has since resolved. Also, he', 'has had persistent abdominal pain, s/p ERCP and stent placement without', 'resolution. He underwent CT abdomen this evening to further evaluate', 'his pain.', '.', 'After the scan, the patient noted feeling flushed over his head and', 'neck, with some shortness of breath and throat tightness. Hives were', 'noted, but the patient denies pruritus. He was given 50mg benadryl,', '125mg solumedrol and 20mg famotidine. His symptoms improved greatly,', 'although he was noted to still have mild stridor. He was transferred to', 'the ICU for monitoring overnight. Prior to transfer, his vitals were:', 'afebrile 125/70 94 16 99%,3L FM.', '.', 'In the ICU, the patient feels well and denies CP, dyspnea, chest', 'tightness, cough, wheeze, pruritus. He does confirm HA and mild', 'epigastric abdominal pain, neither of which are new or acutely changed.']",,63687,147677.0
7,2194-12-08 17:31:58,"['No events overnight.  The patient remained free of symptoms of allergic', 'reaction / anaphylaxis since arrival in [**Hospital Unit Name 10**].  This AM the pt. denies', 'flushing, SOB, wheezing, pruritus.  At this time, he continues to', 'complain of mild abdominal pain 3.5-4/10 and stable frontal headache,', 'which are both not new.']","['No events overnight.  The patient remained free of symptoms of allergic', 'reaction / anaphylaxis since arrival in [**Hospital Unit Name 10**].  This AM the pt. denies', 'flushing, SOB, wheezing, pruritus.  At this time, he continues to', 'complain of mild abdominal pain 3.5-4/10 and stable frontal headache,', 'which are both not new.']","['PICC LINE - START [**2194-12-7**] 07:03 PM', 'This is a 64 yo male with history of gout and post-polio syndrome who', 'initially presented with fatigue and dyspnea, as well as bloody BMs,', 'increased bruising, and epistaxis, and was found to have aplastic', 'anemia. He was treated with ATG, and remains on prednisone and', 'cyclosporine. His course has been complicated by acute SAH on CT head,', 'that was followed with serial scans and has since resolved. Also, he', 'has had persistent abdominal pain, s/p ERCP and stent placement without', 'resolution. He underwent CT abdomen this evening to further evaluate', 'his pain.', '.', 'After the scan, the patient noted feeling flushed over his head and', 'neck, with some shortness of breath and throat tightness. Hives were', 'noted, but the patient denies pruritus. He was given 50mg benadryl,', '125mg solumedrol and 20mg famotidine. His symptoms improved greatly,', 'although he was noted to still have mild stridor. He was transferred to', 'the ICU for monitoring overnight. Prior to transfer, his vitals were:', 'afebrile 125/70 94 16 99%,3L FM.', '.', 'In the ICU, the patient feels well and denies CP, dyspnea, chest', 'tightness, cough, wheeze, pruritus. He does confirm HA and mild', 'epigastric abdominal pain, neither of which are new or acutely changed.']",63687,147677.0
8,2194-12-08 18:17:57,,"['No events overnight.  The patient remained free of symptoms of allergic', 'reaction / anaphylaxis since arrival in [**Hospital Unit Name 10**].  This AM the pt. denies', 'flushing, SOB, wheezing, pruritus.  At this time, he continues to', 'complain of mild abdominal pain 3.5-4/10 and stable frontal headache,', 'which are both not new.']",,63687,147677.0
0,2112-02-16 07:46:36,,"['NASAL SWAB - At [**2112-2-15**] 04:52 PM', '- Head CT: Extensive hypodensity in R, temporal/parietal lobes. No', 'midline shift, no acute bleed, ischemia', '- Ab CT: No evidence of obstruction, free air, stool impaction']",,84437,131503.0
1,2112-02-16 07:48:42,,"['NASAL SWAB - At [**2112-2-15**] 04:52 PM', '- Head CT: Extensive hypodensity in R, temporal/parietal lobes. No', 'midline shift, no acute bleed, ischemia', '- Ab CT: No evidence of obstruction, free air, stool impaction']",,84437,131503.0
2,2112-02-16 09:27:39,,"['NASAL SWAB - At [**2112-2-15**] 04:52 PM', '- Head CT: Extensive hypodensity in R, temporal/parietal lobes. No', 'midline shift, no acute bleed, ischemia', '- Ab CT: No evidence of obstruction, free air, stool impaction']",,84437,131503.0
0,2169-04-27 07:19:06,,"['PARACENTESIS - At [**2169-4-26**] 09:20 AM', ' EKG - At [**2169-4-26**] 01:00 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:20 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:25 PM', ' NUCLEAR MEDICINE - At [**2169-4-26**] 11:39 PM', 'HIDA scan', '- transplant surgery eval and recommending percutaneous cholecystostomy', 'tube placement by IR.  IR not sure that this is cholecystitis and', 'recommending HIDA scan first.  Ordered for HIDA, will need to correct', 'coagulopathy in the morning with FFP/platelets so patient can go to IR', 'likely will get paracentesis and perc ccy at that time.', '- Patient had HIDA overnight that was reportedly normal (called by', 'radiology); he will no longer be traveling for perc cholecystostomy.', '- No official read on CT of abdomen yet, but now new ? of right sided', 'colitis.']",,54788,123083.0
1,2169-04-27 08:58:35,,"['PARACENTESIS - At [**2169-4-26**] 09:20 AM', ' EKG - At [**2169-4-26**] 01:00 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:20 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:25 PM', ' NUCLEAR MEDICINE - At [**2169-4-26**] 11:39 PM', 'HIDA scan', '- transplant surgery eval and recommending percutaneous cholecystostomy', 'tube placement by IR.  IR not sure that this is cholecystitis and', 'recommending HIDA scan first.  Ordered for HIDA, will need to correct', 'coagulopathy in the morning with FFP/platelets so patient can go to IR', 'likely will get paracentesis and perc ccy at that time.', '- Patient had HIDA overnight that was reportedly normal (called by', 'radiology); he will no longer be traveling for perc cholecystostomy.', '- No official read on CT of abdomen yet, but now new ? of right sided', 'colitis.']",,54788,123083.0
2,2169-04-27 10:57:32,,"['PARACENTESIS - At [**2169-4-26**] 09:20 AM', ' EKG - At [**2169-4-26**] 01:00 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:20 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:25 PM', ' NUCLEAR MEDICINE - At [**2169-4-26**] 11:39 PM', 'HIDA scan', '- transplant surgery eval and recommending percutaneous cholecystostomy', 'tube placement by IR.  IR not sure that this is cholecystitis and', 'recommending HIDA scan first.  Ordered for HIDA, will need to correct', 'coagulopathy in the morning with FFP/platelets so patient can go to IR', 'likely will get paracentesis and perc ccy at that time.', '- Patient had HIDA overnight that was reportedly normal (called by', 'radiology); he will no longer be traveling for perc cholecystostomy.', '- No official read on CT of abdomen yet, but now new ? of right sided', 'colitis.']",,54788,123083.0
3,2169-04-28 07:30:12,"['BLOOD CULTURED - At [**2169-4-27**] 04:15 PM', '2 sets', ' URINE CULTURE - At [**2169-4-27**] 04:15 PM', ' STOOL CULTURE - At [**2169-4-27**] 08:50 PM', '- ID now consulting', '- Transplant [**Doctor First Name 213**]: rec colonoscopy, reverse INR', '- Liver: no colonoscopy for now, vitamin K', '- Peritoneal fluid & blood cx growing group B strep.', '- TTE to r/o endocarditis']","['BLOOD CULTURED - At [**2169-4-27**] 04:15 PM', '2 sets', ' URINE CULTURE - At [**2169-4-27**] 04:15 PM', ' STOOL CULTURE - At [**2169-4-27**] 08:50 PM', '- ID now consulting', '- Transplant [**Doctor First Name 213**]: rec colonoscopy, reverse INR', '- Liver: no colonoscopy for now, vitamin K', '- Peritoneal fluid & blood cx growing group B strep.', '- TTE to r/o endocarditis']","['PARACENTESIS - At [**2169-4-26**] 09:20 AM', ' EKG - At [**2169-4-26**] 01:00 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:20 PM', ' BLOOD CULTURED - At [**2169-4-26**] 01:25 PM', ' NUCLEAR MEDICINE - At [**2169-4-26**] 11:39 PM', 'HIDA scan', '- transplant surgery eval and recommending percutaneous cholecystostomy', 'tube placement by IR.  IR not sure that this is cholecystitis and', 'recommending HIDA scan first.  Ordered for HIDA, will need to correct', 'coagulopathy in the morning with FFP/platelets so patient can go to IR', 'likely will get paracentesis and perc ccy at that time.', '- Patient had HIDA overnight that was reportedly normal (called by', 'radiology); he will no longer be traveling for perc cholecystostomy.', '- No official read on CT of abdomen yet, but now new ? of right sided', 'colitis.']",54788,123083.0
4,2169-04-28 07:37:45,"['1. Would switch antibiotics to ceftriaxone 2gm IV daily for GBSperitonitis and b', 'acteremia', '2. F/u surveillance blood cultures', '3. Please send two additional stool samples for C. diff testing', '4. Please send stool for bacterial culture, Yersinia, O&P,cryptosporidium/Giardi', 'a DFA, as well as cyclospora andmicrosporidium.', '5. Consider repeat colonoscopy with intubation of terminal ileumfor direct visua', 'lization and repeat biopsies for pathology and viral culture to r/o CMV.']","['BLOOD CULTURED - At [**2169-4-27**] 04:15 PM', '2 sets', ' URINE CULTURE - At [**2169-4-27**] 04:15 PM', ' STOOL CULTURE - At [**2169-4-27**] 08:50 PM', '- ID now consulting', '1. Would switch antibiotics to ceftriaxone 2gm IV daily for GBSperitonitis and b', 'acteremia', '2. F/u surveillance blood cultures', '3. Please send two additional stool samples for C. diff testing', '4. Please send stool for bacterial culture, Yersinia, O&P,cryptosporidium/Giardi', 'a DFA, as well as cyclospora andmicrosporidium.', '5. Consider repeat colonoscopy with intubation of terminal ileumfor direct visua', 'lization and repeat biopsies for pathology and viral culture to r/o CMV.', '- Transplant [**Doctor First Name 213**]: rec colonoscopy, reverse INR', '- Liver: no colonoscopy for now, vitamin K', '- Peritoneal fluid & blood cx growing group B strep.', '- TTE to r/o endocarditis']",,54788,123083.0
5,2169-04-28 11:37:16,,"['BLOOD CULTURED - At [**2169-4-27**] 04:15 PM', '2 sets', ' URINE CULTURE - At [**2169-4-27**] 04:15 PM', ' STOOL CULTURE - At [**2169-4-27**] 08:50 PM', '- ID now consulting', '1. Would switch antibiotics to ceftriaxone 2gm IV daily for GBSperitonitis and b', 'acteremia', '2. F/u surveillance blood cultures', '3. Please send two additional stool samples for C. diff testing', '4. Please send stool for bacterial culture, Yersinia, O&P,cryptosporidium/Giardi', 'a DFA, as well as cyclospora andmicrosporidium.', '5. Consider repeat colonoscopy with intubation of terminal ileumfor direct visua', 'lization and repeat biopsies for pathology and viral culture to r/o CMV.', '- Transplant [**Doctor First Name 213**]: rec colonoscopy, reverse INR', '- Liver: no colonoscopy for now, vitamin K', '- Peritoneal fluid & blood cx growing group B strep.', '- TTE to r/o endocarditis']",,54788,123083.0
6,2169-04-29 07:44:25,"['TRANSTHORACIC ECHO - At [**2169-4-28**] 11:47 AM', ' STOOL CULTURE - At [**2169-4-29**] 05:11 AM', ' BLOOD CULTURED - At [**2169-4-29**] 05:18 AM', '- ID recs: continue ceftriaxone, consider CT chest given O2 req', '- CXR c/w pulm edema & atelectasis, but opacities could be infectious', '- Got lasix 20IV x2 but just net even by end of day', '- tell team that need to pull abdominal sutures in [**7-22**] days']","['TRANSTHORACIC ECHO - At [**2169-4-28**] 11:47 AM', ' STOOL CULTURE - At [**2169-4-29**] 05:11 AM', ' BLOOD CULTURED - At [**2169-4-29**] 05:18 AM', '- ID recs: continue ceftriaxone, consider CT chest given O2 req', '- CXR c/w pulm edema & atelectasis, but opacities could be infectious', '- Got lasix 20IV x2 but just net even by end of day', '- tell team that need to pull abdominal sutures in [**7-22**] days']","['BLOOD CULTURED - At [**2169-4-27**] 04:15 PM', '2 sets', ' URINE CULTURE - At [**2169-4-27**] 04:15 PM', ' STOOL CULTURE - At [**2169-4-27**] 08:50 PM', '- ID now consulting', '1. Would switch antibiotics to ceftriaxone 2gm IV daily for GBSperitonitis and b', 'acteremia', '2. F/u surveillance blood cultures', '3. Please send two additional stool samples for C. diff testing', '4. Please send stool for bacterial culture, Yersinia, O&P,cryptosporidium/Giardi', 'a DFA, as well as cyclospora andmicrosporidium.', '5. Consider repeat colonoscopy with intubation of terminal ileumfor direct visua', 'lization and repeat biopsies for pathology and viral culture to r/o CMV.', '- Transplant [**Doctor First Name 213**]: rec colonoscopy, reverse INR', '- Liver: no colonoscopy for now, vitamin K', '- Peritoneal fluid & blood cx growing group B strep.', '- TTE to r/o endocarditis']",54788,123083.0
0,2130-11-11 08:06:22,,"['INVASIVE VENTILATION - START [**2130-11-11**] 12:00 AM', ' MULTI LUMEN - START [**2130-11-11**] 12:30 AM', ' INDWELLING PORT (PORTACATH) - START [**2130-11-11**] 12:30 AM', 'Pt had this recently placed. Accessed @ [**Hospital1 5**] in ED', ' BLOOD CULTURED - At [**2130-11-11**] 03:00 AM', ' URINE CULTURE - At [**2130-11-11**] 03:00 AM', ' SPUTUM CULTURE - At [**2130-11-11**] 04:10 AM']",,48660,184168.0
1,2130-11-11 12:13:17,,"['INVASIVE VENTILATION - START [**2130-11-11**] 12:00 AM', ' MULTI LUMEN - START [**2130-11-11**] 12:30 AM', ' INDWELLING PORT (PORTACATH) - START [**2130-11-11**] 12:30 AM', 'Pt had this recently placed. Accessed @ [**Hospital1 5**] in ED', ' BLOOD CULTURED - At [**2130-11-11**] 03:00 AM', ' URINE CULTURE - At [**2130-11-11**] 03:00 AM', ' SPUTUM CULTURE - At [**2130-11-11**] 04:10 AM']",,48660,184168.0
2,2130-11-12 08:36:15,"['MULTI LUMEN - START [**2130-11-11**] 04:32 PM', ' MULTI LUMEN - STOP [**2130-11-11**] 10:00 PM', ' FEVER - 101.5', 'F - [**2130-11-12**] 04:00 AM']","['MULTI LUMEN - START [**2130-11-11**] 04:32 PM', ' MULTI LUMEN - STOP [**2130-11-11**] 10:00 PM', ' FEVER - 101.5', 'F - [**2130-11-12**] 04:00 AM']","['INVASIVE VENTILATION - START [**2130-11-11**] 12:00 AM', ' MULTI LUMEN - START [**2130-11-11**] 12:30 AM', ' INDWELLING PORT (PORTACATH) - START [**2130-11-11**] 12:30 AM', 'Pt had this recently placed. Accessed @ [**Hospital1 5**] in ED', ' BLOOD CULTURED - At [**2130-11-11**] 03:00 AM', ' URINE CULTURE - At [**2130-11-11**] 03:00 AM', ' SPUTUM CULTURE - At [**2130-11-11**] 04:10 AM']",48660,184168.0
3,2130-11-12 09:42:14,"[' L IJ', ' Right Femoral', '2 units FFP for coagulopathy', 'Conjunctivitis - written for erythromycin eye ointment (per wife was', 'using gel at home to help treat)', 'Held tube feeds because free water residuals > 200 ml', 'Increased lactulose to help stimulate bowel movement', 'Wildy variable HCT, Hgb on CBC', 'Copious secretions']","['MULTI LUMEN - START [**2130-11-11**] 04:32 PM', ' L IJ', ' MULTI LUMEN - STOP [**2130-11-11**] 10:00 PM', ' Right Femoral', ' FEVER - 101.5', 'F - [**2130-11-12**] 04:00 AM', '2 units FFP for coagulopathy', 'Conjunctivitis - written for erythromycin eye ointment (per wife was', 'using gel at home to help treat)', 'Held tube feeds because free water residuals > 200 ml', 'Increased lactulose to help stimulate bowel movement', 'Wildy variable HCT, Hgb on CBC', 'Copious secretions']",,48660,184168.0
4,2130-11-12 12:08:00,"['Wildly variable HCT, Hgb on CBC', 'Patient discovered to be impacted', ' tar hard stones that are guaiac', 'negative.']","['MULTI LUMEN - START [**2130-11-11**] 04:32 PM', ' L IJ', ' MULTI LUMEN - STOP [**2130-11-11**] 10:00 PM', ' Right Femoral', ' FEVER - 101.5', 'F - [**2130-11-12**] 04:00 AM', '2 units FFP for coagulopathy', 'Conjunctivitis - written for erythromycin eye ointment (per wife was', 'using gel at home to help treat)', 'Held tube feeds because free water residuals > 200 ml', 'Increased lactulose to help stimulate bowel movement', 'Wildly variable HCT, Hgb on CBC', 'Copious secretions', 'Patient discovered to be impacted', ' tar hard stones that are guaiac', 'negative.']","['Wildy variable HCT, Hgb on CBC']",48660,184168.0
5,2130-11-13 11:46:40,"['SPUTUM CULTURE - At [**2130-11-12**] 10:00 PM', ' FEVER - 101.8', 'F - [**2130-11-12**] 04:00 PM']","['SPUTUM CULTURE - At [**2130-11-12**] 10:00 PM', ' FEVER - 101.8', 'F - [**2130-11-12**] 04:00 PM']","['MULTI LUMEN - START [**2130-11-11**] 04:32 PM', ' L IJ', ' MULTI LUMEN - STOP [**2130-11-11**] 10:00 PM', ' Right Femoral', ' FEVER - 101.5', 'F - [**2130-11-12**] 04:00 AM', '2 units FFP for coagulopathy', 'Conjunctivitis - written for erythromycin eye ointment (per wife was', 'using gel at home to help treat)', 'Held tube feeds because free water residuals > 200 ml', 'Increased lactulose to help stimulate bowel movement', 'Wildly variable HCT, Hgb on CBC', 'Copious secretions', 'Patient discovered to be impacted', ' tar hard stones that are guaiac', 'negative.']",48660,184168.0
6,2130-11-13 11:58:04,"['- adjusted antibiotic dosing due to improved GFR', '- required cooling blanket and prn acetaminophen to defervesce; HR', 'improved with defervescence', '- successfully [**Name6 (MD) 2975**] by RN with copious Guaiac negative liquid', 'stool output following disimpaction; OGT residuals much improved', 'following disimpaction', '- serum Na improved with D5W and free water boluses', '- in afternoon, SBP in 90s with CVP 2-3; 3 liter LR boluses given with', 'good effect on SBP and CVP', '- 3AM, became acutely tachypneic, tachycardic, agitated, and hypoxic in', 'setting of fever spike; increased sedation and FiO2 with good effect;', 'additional LR boluses given; FiO2 decreased this morning with good', 'effect']","['- adjusted antibiotic dosing due to improved GFR', '- required cooling blanket and prn acetaminophen to defervesce; HR', 'improved with defervescence', '- successfully [**Name6 (MD) 2975**] by RN with copious Guaiac negative liquid', 'stool output following disimpaction; OGT residuals much improved', 'following disimpaction', '- serum Na improved with D5W and free water boluses', '- in afternoon, SBP in 90s with CVP 2-3; 3 liter LR boluses given with', 'good effect on SBP and CVP', '- 3AM, became acutely tachypneic, tachycardic, agitated, and hypoxic in', 'setting of fever spike; increased sedation and FiO2 with good effect;', 'additional LR boluses given; FiO2 decreased this morning with good', 'effect']","['SPUTUM CULTURE - At [**2130-11-12**] 10:00 PM', ' FEVER - 101.8', 'F - [**2130-11-12**] 04:00 PM']",48660,184168.0
7,2130-11-13 12:00:20,,"['- adjusted antibiotic dosing due to improved GFR', '- required cooling blanket and prn acetaminophen to defervesce; HR', 'improved with defervescence', '- successfully [**Name6 (MD) 2975**] by RN with copious Guaiac negative liquid', 'stool output following disimpaction; OGT residuals much improved', 'following disimpaction', '- serum Na improved with D5W and free water boluses', '- in afternoon, SBP in 90s with CVP 2-3; 3 liter LR boluses given with', 'good effect on SBP and CVP', '- 3AM, became acutely tachypneic, tachycardic, agitated, and hypoxic in', 'setting of fever spike; increased sedation and FiO2 with good effect;', 'additional LR boluses given; FiO2 decreased this morning with good', 'effect']",,48660,184168.0
8,2130-11-14 08:02:23,"['BLOOD CULTURED - At [**2130-11-13**] 09:08 AM', ' ULTRASOUND - At [**2130-11-13**] 10:03 AM', ' ARTERIAL LINE - START [**2130-11-13**] 05:26 PM', ' FEVER - 101.1', 'F - [**2130-11-14**] 04:00 AM', 'Continued to stool', 'Placed a-line', 'Backed off NG tube again as residuals increased; trial of increasing', 'again overnight', 'Tachy, ongoing but basically stable levophed requirement', 'Changed sedation from versed to propofol', 'Repeated ABGs overnight showed evolving acidosis; worsening CXR appears', 'to show diffuse PNA vs additional fluid overload']","['BLOOD CULTURED - At [**2130-11-13**] 09:08 AM', ' ULTRASOUND - At [**2130-11-13**] 10:03 AM', ' ARTERIAL LINE - START [**2130-11-13**] 05:26 PM', ' FEVER - 101.1', 'F - [**2130-11-14**] 04:00 AM', 'Continued to stool', 'Placed a-line', 'Backed off NG tube again as residuals increased; trial of increasing', 'again overnight', 'Tachy, ongoing but basically stable levophed requirement', 'Changed sedation from versed to propofol', 'Repeated ABGs overnight showed evolving acidosis; worsening CXR appears', 'to show diffuse PNA vs additional fluid overload']","['- adjusted antibiotic dosing due to improved GFR', '- required cooling blanket and prn acetaminophen to defervesce; HR', 'improved with defervescence', '- successfully [**Name6 (MD) 2975**] by RN with copious Guaiac negative liquid', 'stool output following disimpaction; OGT residuals much improved', 'following disimpaction', '- serum Na improved with D5W and free water boluses', '- in afternoon, SBP in 90s with CVP 2-3; 3 liter LR boluses given with', 'good effect on SBP and CVP', '- 3AM, became acutely tachypneic, tachycardic, agitated, and hypoxic in', 'setting of fever spike; increased sedation and FiO2 with good effect;', 'additional LR boluses given; FiO2 decreased this morning with good', 'effect']",48660,184168.0
9,2130-11-14 09:09:57,"['Placed a-line, Tachy, ongoing but basically stable levophed requirement', 'Gave 25 gm of albumin yesterday with minimal improvement in', 'hemodynamics']","['BLOOD CULTURED - At [**2130-11-13**] 09:08 AM', ' ULTRASOUND - At [**2130-11-13**] 10:03 AM', ' ARTERIAL LINE - START [**2130-11-13**] 05:26 PM', ' FEVER - 101.1', 'F - [**2130-11-14**] 04:00 AM', 'Continued to stool', 'Placed a-line, Tachy, ongoing but basically stable levophed requirement', 'Backed off NG tube again as residuals increased; trial of increasing', 'again overnight', 'Changed sedation from versed to propofol', 'Repeated ABGs overnight showed evolving acidosis; worsening CXR appears', 'to show diffuse PNA vs additional fluid overload', 'Gave 25 gm of albumin yesterday with minimal improvement in', 'hemodynamics']","['Placed a-line', 'Tachy, ongoing but basically stable levophed requirement']",48660,184168.0
10,2130-11-15 07:38:02,"['- Increased rifaximin to 400 mg TID', '- Removed left IJ, placed R IJ', '- IR consulted to remove Right Subclavian Port', '- Copious stool > 1liter, decreased lactulose to 30ml QID']","['- Increased rifaximin to 400 mg TID', '- Removed left IJ, placed R IJ', '- IR consulted to remove Right Subclavian Port', '- Copious stool > 1liter, decreased lactulose to 30ml QID']","['BLOOD CULTURED - At [**2130-11-13**] 09:08 AM', ' ULTRASOUND - At [**2130-11-13**] 10:03 AM', ' ARTERIAL LINE - START [**2130-11-13**] 05:26 PM', ' FEVER - 101.1', 'F - [**2130-11-14**] 04:00 AM', 'Continued to stool', 'Placed a-line, Tachy, ongoing but basically stable levophed requirement', 'Backed off NG tube again as residuals increased; trial of increasing', 'again overnight', 'Changed sedation from versed to propofol', 'Repeated ABGs overnight showed evolving acidosis; worsening CXR appears', 'to show diffuse PNA vs additional fluid overload', 'Gave 25 gm of albumin yesterday with minimal improvement in', 'hemodynamics']",48660,184168.0
11,2130-11-15 07:39:54,,"['- Increased rifaximin to 400 mg TID', '- Removed left IJ, placed R IJ', '- IR consulted to remove Right Subclavian Port', '- Copious stool > 1liter, decreased lactulose to 30ml QID']",,48660,184168.0
12,2130-11-15 13:15:44,"['- Now [**1-14**] (1 set) blood cultures positive from left IJ [**11-12**]', 'subsequent cultures remain negative', '- IR and Surgery consulted to remove right subclavian port', ' will draw', 'blood cultures now and hold on removal', '- Copious stool > 1liter, decreased lactulose to 30 ml QID']","['- Now [**1-14**] (1 set) blood cultures positive from left IJ [**11-12**]', 'subsequent cultures remain negative', '- Removed left IJ, placed R IJ', '- IR and Surgery consulted to remove right subclavian port', ' will draw', 'blood cultures now and hold on removal', '- Copious stool > 1liter, decreased lactulose to 30 ml QID', '- Increased rifaximin to 400 mg TID']","['- IR consulted to remove Right Subclavian Port', '- Copious stool > 1liter, decreased lactulose to 30ml QID']",48660,184168.0
13,2130-11-15 13:23:14,,"['- Now [**1-14**] (1 set) blood cultures positive from left IJ [**11-12**]', 'subsequent cultures remain negative', '- Removed left IJ, placed R IJ', '- IR and Surgery consulted to remove right subclavian port', ' will draw', 'blood cultures now and hold on removal', '- Copious stool > 1liter, decreased lactulose to 30 ml QID', '- Increased rifaximin to 400 mg TID']",,48660,184168.0
14,2130-11-16 07:56:23,"['BLOOD CULTURED - At [**2130-11-15**] 01:00 PM', 'Started vasopressin, but still needed levophed increases', 'Stopped TFs due to high residuals and decreased free water flushes']","['BLOOD CULTURED - At [**2130-11-15**] 01:00 PM', 'Started vasopressin, but still needed levophed increases', 'Stopped TFs due to high residuals and decreased free water flushes']","['- Now [**1-14**] (1 set) blood cultures positive from left IJ [**11-12**]', 'subsequent cultures remain negative', '- Removed left IJ, placed R IJ', '- IR and Surgery consulted to remove right subclavian port', ' will draw', 'blood cultures now and hold on removal', '- Copious stool > 1liter, decreased lactulose to 30 ml QID', '- Increased rifaximin to 400 mg TID']",48660,184168.0
15,2130-11-16 12:05:50,"['- CvO2 85%', 'Stopped Tube Feeds due to high residuals and decreased free water', 'flushes', 'Attempted to decrease PEEP but resulted in decreased PaO2 and returned', 'back to PEEP 12', 'Stopped Aztreonam']","['BLOOD CULTURED - At [**2130-11-15**] 01:00 PM', 'Started vasopressin, but still needed levophed increases', '- CvO2 85%', 'Stopped Tube Feeds due to high residuals and decreased free water', 'flushes', 'Attempted to decrease PEEP but resulted in decreased PaO2 and returned', 'back to PEEP 12', 'Stopped Aztreonam']",['Stopped TFs due to high residuals and decreased free water flushes'],48660,184168.0
16,2130-11-16 12:16:15,,"['BLOOD CULTURED - At [**2130-11-15**] 01:00 PM', 'Started vasopressin, but still needed levophed increases', '- CvO2 85%', 'Stopped Tube Feeds due to high residuals and decreased free water', 'flushes', 'Attempted to decrease PEEP but resulted in decreased PaO2 and returned', 'back to PEEP 12', 'Stopped Aztreonam']",,48660,184168.0
17,2130-11-17 07:48:25,"['TRANSTHORACIC ECHO - At [**2130-11-16**] 12:00 PM', 'Some desaturations with turning--overnight had to go up on FiO2 and', 'PEEP to recover from acute desat, which was then resolved more', 'completely --it was noticed that turning to the right-side down', 'resulted in worsening desaturations.']","['TRANSTHORACIC ECHO - At [**2130-11-16**] 12:00 PM', 'Some desaturations with turning--overnight had to go up on FiO2 and', 'PEEP to recover from acute desat, which was then resolved more', 'completely --it was noticed that turning to the right-side down', 'resulted in worsening desaturations.']","['BLOOD CULTURED - At [**2130-11-15**] 01:00 PM', 'Started vasopressin, but still needed levophed increases', '- CvO2 85%', 'Stopped Tube Feeds due to high residuals and decreased free water', 'flushes', 'Attempted to decrease PEEP but resulted in decreased PaO2 and returned', 'back to PEEP 12', 'Stopped Aztreonam']",48660,184168.0
18,2130-11-17 16:54:32,,"['TRANSTHORACIC ECHO - At [**2130-11-16**] 12:00 PM', 'Some desaturations with turning--overnight had to go up on FiO2 and', 'PEEP to recover from acute desat, which was then resolved more', 'completely --it was noticed that turning to the right-side down', 'resulted in worsening desaturations.']",,48660,184168.0
19,2130-11-18 12:48:17,"['FEVER - 101.6', 'F - [**2130-11-18**] 04:00 AM', '- given albumin to help with diuresis', '- meropenem added as he was persistently febrile to cover', 'ESBL/klebsiella', '- erythromycin added for motility', 'History obtained from Medical records']","['FEVER - 101.6', 'F - [**2130-11-18**] 04:00 AM', '- given albumin to help with diuresis', '- meropenem added as he was persistently febrile to cover', 'ESBL/klebsiella', '- erythromycin added for motility', 'History obtained from Medical records']","['TRANSTHORACIC ECHO - At [**2130-11-16**] 12:00 PM', 'Some desaturations with turning--overnight had to go up on FiO2 and', 'PEEP to recover from acute desat, which was then resolved more', 'completely --it was noticed that turning to the right-side down', 'resulted in worsening desaturations.']",48660,184168.0
20,2130-11-19 08:40:43,"['Norepi weaned', 'Vasopression transiently weaned but then re-started for decrease in UOP', 'and SBP in the 80s', 'Ammonia re-checked and was found still to be 74', 'Transfused 2 U PRBC for hct 20 and hct now 27']","['Norepi weaned', 'Vasopression transiently weaned but then re-started for decrease in UOP', 'and SBP in the 80s', 'Ammonia re-checked and was found still to be 74', 'Transfused 2 U PRBC for hct 20 and hct now 27', 'History obtained from Medical records']","['FEVER - 101.6', 'F - [**2130-11-18**] 04:00 AM', '- given albumin to help with diuresis', '- meropenem added as he was persistently febrile to cover', 'ESBL/klebsiella', '- erythromycin added for motility']",48660,184168.0
21,2130-11-19 08:42:23,,"['Norepi weaned', 'Vasopression transiently weaned but then re-started for decrease in UOP', 'and SBP in the 80s', 'Ammonia re-checked and was found still to be 74', 'Transfused 2 U PRBC for hct 20 and hct now 27', 'History obtained from Medical records']",,48660,184168.0
22,2130-11-19 10:23:04,,"['Norepi weaned', 'Vasopression transiently weaned but then re-started for decrease in UOP', 'and SBP in the 80s', 'Ammonia re-checked and was found still to be 74', 'Transfused 2 U PRBC for hct 20 and hct now 27', 'History obtained from Medical records']",,48660,184168.0
23,2130-11-20 07:55:45,"['periodic episodes of open eyes (but non-interactive), high BP, high HR;', 'restarted seroquel (home med); ativan boluses only temporarily helpful;', 'had to restart propofol as sedation, then w/fentanyl and propofol had', 'to restart vasopressin for low BP. Stopped vasopressin this am.']","['periodic episodes of open eyes (but non-interactive), high BP, high HR;', 'restarted seroquel (home med); ativan boluses only temporarily helpful;', 'had to restart propofol as sedation, then w/fentanyl and propofol had', 'to restart vasopressin for low BP. Stopped vasopressin this am.']","['Norepi weaned', 'Vasopression transiently weaned but then re-started for decrease in UOP', 'and SBP in the 80s', 'Ammonia re-checked and was found still to be 74', 'Transfused 2 U PRBC for hct 20 and hct now 27', 'History obtained from Medical records']",48660,184168.0
24,2130-11-20 11:49:31,['to restart vasopressin for low BP.'],"['periodic episodes of open eyes (but non-interactive), high BP, high HR;', 'restarted seroquel (home med); ativan boluses only temporarily helpful;', 'had to restart propofol as sedation, then w/fentanyl and propofol had', 'to restart vasopressin for low BP.']",['to restart vasopressin for low BP. Stopped vasopressin this am.'],48660,184168.0
25,2130-11-21 07:28:05,"['- Weaned off levophed', '- Diuresed to 20 iv lasix *3, last dose given this am', '- Stopped fentanyl patient became very restless restarted low dose', 'fentanyl, and continued patient on  propofol', '- Vancomycin level 28.5 at 3 am', ' rechecking at 7 am today']","['- Weaned off levophed', '- Diuresed to 20 iv lasix *3, last dose given this am', '- Stopped fentanyl patient became very restless restarted low dose', 'fentanyl, and continued patient on  propofol', '- Vancomycin level 28.5 at 3 am', ' rechecking at 7 am today']","['periodic episodes of open eyes (but non-interactive), high BP, high HR;', 'restarted seroquel (home med); ativan boluses only temporarily helpful;', 'had to restart propofol as sedation, then w/fentanyl and propofol had', 'to restart vasopressin for low BP.']",48660,184168.0
26,2130-11-21 07:32:08,,"['- Weaned off levophed', '- Diuresed to 20 iv lasix *3, last dose given this am', '- Stopped fentanyl patient became very restless restarted low dose', 'fentanyl, and continued patient on  propofol', '- Vancomycin level 28.5 at 3 am', ' rechecking at 7 am today']",,48660,184168.0
27,2130-11-21 07:40:11,"['Weaned off propofol, patient tracked with eyes, restlessly moved limbs,', 'tachycardic, hypertensive. Restarted low dose propofol. Given', 'hematocrit drop did not attempt PS O/N.', 'On Heparin hematocrit drop 25.5-22.3 and increase in pulmonary bloody', 'secretions, stopped heparin. Patient received one unit pRBCs and 2', 'units FFP', 'Converted medications to PO given gut working', 'Started captopril and uptitrated for BP control', 'Stopped nitro drip', 'Na fell 121 in setting volume increasing on schedule for early am HD to', 'remove fluid']","['Weaned off propofol, patient tracked with eyes, restlessly moved limbs,', 'tachycardic, hypertensive. Restarted low dose propofol. Given', 'hematocrit drop did not attempt PS O/N.', 'On Heparin hematocrit drop 25.5-22.3 and increase in pulmonary bloody', 'secretions, stopped heparin. Patient received one unit pRBCs and 2', 'units FFP', 'Converted medications to PO given gut working', 'Started captopril and uptitrated for BP control', 'Stopped nitro drip', 'Na fell 121 in setting volume increasing on schedule for early am HD to', 'remove fluid']","['- Weaned off levophed', '- Diuresed to 20 iv lasix *3, last dose given this am', '- Stopped fentanyl patient became very restless restarted low dose', 'fentanyl, and continued patient on  propofol', '- Vancomycin level 28.5 at 3 am', ' rechecking at 7 am today']",48660,184168.0
28,2130-11-21 07:42:48,,"['Weaned off propofol, patient tracked with eyes, restlessly moved limbs,', 'tachycardic, hypertensive. Restarted low dose propofol. Given', 'hematocrit drop did not attempt PS O/N.', 'On Heparin hematocrit drop 25.5-22.3 and increase in pulmonary bloody', 'secretions, stopped heparin. Patient received one unit pRBCs and 2', 'units FFP', 'Converted medications to PO given gut working', 'Started captopril and uptitrated for BP control', 'Stopped nitro drip', 'Na fell 121 in setting volume increasing on schedule for early am HD to', 'remove fluid']",,48660,184168.0
29,2130-11-21 07:54:16,"['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']","['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']","['Weaned off propofol, patient tracked with eyes, restlessly moved limbs,', 'tachycardic, hypertensive. Restarted low dose propofol. Given', 'hematocrit drop did not attempt PS O/N.', 'On Heparin hematocrit drop 25.5-22.3 and increase in pulmonary bloody', 'secretions, stopped heparin. Patient received one unit pRBCs and 2', 'units FFP', 'Converted medications to PO given gut working', 'Started captopril and uptitrated for BP control', 'Stopped nitro drip', 'Na fell 121 in setting volume increasing on schedule for early am HD to', 'remove fluid']",48660,184168.0
30,2130-11-21 07:54:47,,"['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']",,48660,184168.0
31,2130-11-21 15:03:42,,"['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']",,48660,184168.0
32,2130-11-21 15:11:36,,"['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']",,48660,184168.0
33,2130-11-22 07:54:32,"['URINE CULTURE - At [**2130-11-21**] 01:08 PM', ' EKG - At [**2130-11-21**] 02:00 PM', '- Diuresed -2L yesterday', '- Changed levophed to neosynephrine', '- Increased seroquel from 200 mg [**Hospital1 **] to 300 mg [**Hospital1 **]', '- Attempted to wean PEEP but blood pressure dropped', '- Discontinued vancomycin', '- Changed the Foley and resent urine culture']","['URINE CULTURE - At [**2130-11-21**] 01:08 PM', ' EKG - At [**2130-11-21**] 02:00 PM', '- Diuresed -2L yesterday', '- Changed levophed to neosynephrine', '- Increased seroquel from 200 mg [**Hospital1 **] to 300 mg [**Hospital1 **]', '- Attempted to wean PEEP but blood pressure dropped', '- Discontinued vancomycin', '- Changed the Foley and resent urine culture']","['- Weaned off levophed', ' back on low dose for diuresis', '- Diuresed to lasix 20 mg IV  x 3, last dose given this morning', '- Fentanyl off briefly but patient became very restless and restarted', 'low dose (continued patient on propofol)', '- Vancomycin trough 28.4 this morning and decreased dose']",48660,184168.0
34,2130-11-22 07:57:17,,"['URINE CULTURE - At [**2130-11-21**] 01:08 PM', ' EKG - At [**2130-11-21**] 02:00 PM', '- Diuresed -2L yesterday', '- Changed levophed to neosynephrine', '- Increased seroquel from 200 mg [**Hospital1 **] to 300 mg [**Hospital1 **]', '- Attempted to wean PEEP but blood pressure dropped', '- Discontinued vancomycin', '- Changed the Foley and resent urine culture']",,48660,184168.0
35,2130-11-22 14:39:57,['- Diuresed -1.3L yesterday'],"['URINE CULTURE - At [**2130-11-21**] 01:08 PM', ' EKG - At [**2130-11-21**] 02:00 PM', '- Diuresed -1.3L yesterday', '- Changed levophed to neosynephrine', '- Increased seroquel from 200 mg [**Hospital1 **] to 300 mg [**Hospital1 **]', '- Attempted to wean PEEP but blood pressure dropped', '- Discontinued vancomycin', '- Changed the Foley and resent urine culture']",['- Diuresed -2L yesterday'],48660,184168.0
36,2130-11-23 08:01:06,"['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed']","['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed']","['URINE CULTURE - At [**2130-11-21**] 01:08 PM', ' EKG - At [**2130-11-21**] 02:00 PM', '- Diuresed -1.3L yesterday', '- Changed levophed to neosynephrine', '- Increased seroquel from 200 mg [**Hospital1 **] to 300 mg [**Hospital1 **]', '- Attempted to wean PEEP but blood pressure dropped', '- Discontinued vancomycin', '- Changed the Foley and resent urine culture']",48660,184168.0
37,2130-11-23 08:36:40,,"['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed']",,48660,184168.0
38,2130-11-23 09:42:48,['Diuresed negative 4 liters'],"['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed negative 4 liters']",['Diuresed'],48660,184168.0
39,2130-11-23 11:07:56,,"['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed negative 4 liters']",,48660,184168.0
40,2130-11-24 08:02:15,"['BLOOD CULTURED - At [**2130-11-23**] 09:18 PM', ' URINE CULTURE - At [**2130-11-23**] 09:18 PM', ' SPUTUM CULTURE - At [**2130-11-24**] 12:16 AM', 'Weaned PEEP to 5', 'Weaned sedation', 'ABG 7.58/33/96 gave 500,g iv acetazolamide', 'Repleted K', 'Febrile O/N 100.8 and cultured']","['BLOOD CULTURED - At [**2130-11-23**] 09:18 PM', ' URINE CULTURE - At [**2130-11-23**] 09:18 PM', ' SPUTUM CULTURE - At [**2130-11-24**] 12:16 AM', 'Weaned PEEP to 5', 'Weaned sedation', 'ABG 7.58/33/96 gave 500,g iv acetazolamide', 'Repleted K', 'Febrile O/N 100.8 and cultured']","['BLOOD CULTURED - At [**2130-11-22**] 01:02 PM', ' SPUTUM CULTURE - At [**2130-11-22**] 01:02 PM', ' ULTRASOUND - At [**2130-11-22**] 02:04 PM', ' PARACENTESIS - At [**2130-11-22**] 04:04 PM -- took off 2L', 'Diuresed negative 4 liters']",48660,184168.0
41,2130-11-24 11:46:35,"[' gram stain negative', 'ABG 7.58/33/96 gave 500mg iv acetazolamide']","['BLOOD CULTURED - At [**2130-11-23**] 09:18 PM', ' URINE CULTURE - At [**2130-11-23**] 09:18 PM', ' SPUTUM CULTURE - At [**2130-11-24**] 12:16 AM', ' gram stain negative', 'Weaned PEEP to 5', 'Weaned sedation', 'ABG 7.58/33/96 gave 500mg iv acetazolamide', 'Repleted K', 'Febrile O/N 100.8 and cultured']","['ABG 7.58/33/96 gave 500,g iv acetazolamide']",48660,184168.0
42,2130-11-25 08:13:07,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']","['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']","['BLOOD CULTURED - At [**2130-11-23**] 09:18 PM', ' URINE CULTURE - At [**2130-11-23**] 09:18 PM', ' SPUTUM CULTURE - At [**2130-11-24**] 12:16 AM', ' gram stain negative', 'Weaned PEEP to 5', 'Weaned sedation', 'ABG 7.58/33/96 gave 500mg iv acetazolamide', 'Repleted K', 'Febrile O/N 100.8 and cultured']",48660,184168.0
43,2130-11-25 09:28:13,,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",,48660,184168.0
44,2130-11-25 18:11:39,,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",,48660,184168.0
45,2130-11-25 18:21:01,,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",,48660,184168.0
46,2130-11-25 18:31:04,,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",,48660,184168.0
47,2130-11-25 18:54:52,,"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",,48660,184168.0
48,2130-11-26 07:25:44,,[],"['BLOOD CULTURED - At [**2130-11-24**] 09:29 PM', 'x2', ' URINE CULTURE - At [**2130-11-24**] 09:30 PM', ' STOOL CULTURE - At [**2130-11-24**] 09:30 PM', ' BAL FLUID CULTURE - At [**2130-11-24**] 09:30 PM', '- Albumin 75 gm x 1', '- Neosynephrine off since [**11-24**] 17:00', '- Spiked temperature to 100.8 and pan-cultured', '- Blood culture from [**11-23**] positive for GPC -> started vancomycin', 'History obtained from Medical records']",48660,184168.0
49,2130-11-26 07:57:52,"['Diuresed gently (goal -1L)', 'Held tube feeds in anticipation of possible extubation', 'Continued to do well on PS']","['Diuresed gently (goal -1L)', 'Held tube feeds in anticipation of possible extubation', 'Continued to do well on PS']",,48660,184168.0
50,2130-11-26 10:45:24,,"['Diuresed gently (goal -1L)', 'Held tube feeds in anticipation of possible extubation', 'Continued to do well on PS']",,48660,184168.0
51,2130-11-27 07:36:43,"['- Extubated', '- A-Line removed', '- Failed Speech and Swallow evaluation']","['- Extubated', '- A-Line removed', '- Failed Speech and Swallow evaluation']","['Diuresed gently (goal -1L)', 'Held tube feeds in anticipation of possible extubation', 'Continued to do well on PS']",48660,184168.0
52,2130-11-27 07:37:15,,"['- Extubated', '- A-Line removed', '- Failed Speech and Swallow evaluation']",,48660,184168.0
53,2130-11-27 14:31:35,,"['- Extubated', '- A-Line removed', '- Failed Speech and Swallow evaluation']",,48660,184168.0
54,2130-11-27 15:06:46,['- A-line removed'],"['- Extubated', '- A-line removed', '- Failed Speech and Swallow evaluation']",['- A-Line removed'],48660,184168.0
55,2130-11-28 08:00:16,"['MULTI LUMEN - STOP [**2130-11-27**] 05:46 PM', '- RIJ removed', '- Noted to aspirate with pills and prethickened liquids -> will repeat', 'Speech & Swallow evaluation', '- Zydis 5 mg x 1 overnight as could not receive seroquel', '- Erythromycin PO discontinued', 'History obtained from Patient']","['MULTI LUMEN - STOP [**2130-11-27**] 05:46 PM', '- RIJ removed', '- Noted to aspirate with pills and prethickened liquids -> will repeat', 'Speech & Swallow evaluation', '- Zydis 5 mg x 1 overnight as could not receive seroquel', '- Erythromycin PO discontinued', 'History obtained from Patient']","['- Extubated', '- A-line removed', '- Failed Speech and Swallow evaluation']",48660,184168.0
56,2130-11-28 09:02:51,,"['MULTI LUMEN - STOP [**2130-11-27**] 05:46 PM', '- RIJ removed', '- Noted to aspirate with pills and prethickened liquids -> will repeat', 'Speech & Swallow evaluation', '- Zydis 5 mg x 1 overnight as could not receive seroquel', '- Erythromycin PO discontinued', 'History obtained from Patient']",,48660,184168.0
57,2130-11-28 09:08:06,,"['MULTI LUMEN - STOP [**2130-11-27**] 05:46 PM', '- RIJ removed', '- Noted to aspirate with pills and prethickened liquids -> will repeat', 'Speech & Swallow evaluation', '- Zydis 5 mg x 1 overnight as could not receive seroquel', '- Erythromycin PO discontinued', 'History obtained from Patient']",,48660,184168.0
58,2130-11-29 09:00:10,"['LUMBAR PUNCTURE - At [**2130-11-28**] 12:19 PM', ' MAGNETIC RESONANCE IMAGING - At [**2130-11-28**] 08:00 PM', 'PT GOT .5MG IV ATIVAN FOR PROCEDURE DUE TO EXCESSIVE MOVEMENT IN', 'SCANNER . bp DOWN TO 93/45, BUT PT AWAKE AND ASKING FOR JUICE', ' FEVER - 101.3', 'F - [**2130-11-28**] 04:00 PM', 'Apparent seizure event in AM during rounds, got 2 mg ativan for this', 'EEG done, read pending', 'CT head negative', 'MRI done; got 0.5 mg ativan for this b/c of movement', 'Seroquel taken off', 'Continued to be encephalopathic/sedated-appearing, but interactive', '2x restraints for trying to pull NG tube', 'Otherwise stable', 'History obtained from [**Hospital 19**] Medical records']","['LUMBAR PUNCTURE - At [**2130-11-28**] 12:19 PM', ' MAGNETIC RESONANCE IMAGING - At [**2130-11-28**] 08:00 PM', 'PT GOT .5MG IV ATIVAN FOR PROCEDURE DUE TO EXCESSIVE MOVEMENT IN', 'SCANNER . bp DOWN TO 93/45, BUT PT AWAKE AND ASKING FOR JUICE', ' FEVER - 101.3', 'F - [**2130-11-28**] 04:00 PM', 'Apparent seizure event in AM during rounds, got 2 mg ativan for this', 'EEG done, read pending', 'CT head negative', 'MRI done; got 0.5 mg ativan for this b/c of movement', 'Seroquel taken off', 'Continued to be encephalopathic/sedated-appearing, but interactive', '2x restraints for trying to pull NG tube', 'Otherwise stable', 'History obtained from [**Hospital 19**] Medical records']","['MULTI LUMEN - STOP [**2130-11-27**] 05:46 PM', '- RIJ removed', '- Noted to aspirate with pills and prethickened liquids -> will repeat', 'Speech & Swallow evaluation', '- Zydis 5 mg x 1 overnight as could not receive seroquel', '- Erythromycin PO discontinued', 'History obtained from Patient']",48660,184168.0
59,2130-11-29 09:04:13,['Continued vanco; started ceftaz and flagyl'],"['LUMBAR PUNCTURE - At [**2130-11-28**] 12:19 PM', ' MAGNETIC RESONANCE IMAGING - At [**2130-11-28**] 08:00 PM', 'PT GOT .5MG IV ATIVAN FOR PROCEDURE DUE TO EXCESSIVE MOVEMENT IN', 'SCANNER . bp DOWN TO 93/45, BUT PT AWAKE AND ASKING FOR JUICE', ' FEVER - 101.3', 'F - [**2130-11-28**] 04:00 PM', 'Apparent seizure event in AM during rounds, got 2 mg ativan for this', 'EEG done, read pending', 'CT head negative', 'MRI done; got 0.5 mg ativan for this b/c of movement', 'Seroquel taken off', 'Continued to be encephalopathic/sedated-appearing, but interactive', '2x restraints for trying to pull NG tube', 'Continued vanco; started ceftaz and flagyl', 'History obtained from [**Hospital 19**] Medical records']",['Otherwise stable'],48660,184168.0
60,2130-11-29 13:39:07,"['2x restraints for trying to pull NG tube; ultimately succeeded in', 'pulling tube']","['LUMBAR PUNCTURE - At [**2130-11-28**] 12:19 PM', ' MAGNETIC RESONANCE IMAGING - At [**2130-11-28**] 08:00 PM', 'PT GOT .5MG IV ATIVAN FOR PROCEDURE DUE TO EXCESSIVE MOVEMENT IN', 'SCANNER . bp DOWN TO 93/45, BUT PT AWAKE AND ASKING FOR JUICE', ' FEVER - 101.3', 'F - [**2130-11-28**] 04:00 PM', 'Apparent seizure event in AM during rounds, got 2 mg ativan for this', 'EEG done, read pending', 'CT head negative', 'MRI done; got 0.5 mg ativan for this b/c of movement', 'Seroquel taken off', 'Continued to be encephalopathic/sedated-appearing, but interactive', '2x restraints for trying to pull NG tube; ultimately succeeded in', 'pulling tube', 'Continued vanco; started ceftaz and flagyl', 'History obtained from [**Hospital 19**] Medical records']",['2x restraints for trying to pull NG tube'],48660,184168.0
61,2130-11-30 08:53:17,"['ULTRASOUND - At [**2130-11-29**] 04:40 PM', ""Pt had Dobhoff placed it and then self-d/c'ed it"", 'Had neurology evaluation for ? seizure- per neuro MRI with sig. brain', 'atrophy - ALS vs hep C neuropathy', 'EMG for today', 'EEG no seizure activity', 'Abd Ultrasound not enough to ascites tap', 'Failed speech/swallow plan for video swallow today', 'Patient confused, thinks he is at ""[**State 621**] Fire Department"",', 'convinced team has been comparing him to [**Doctor First Name 3337**] Hitler (apparent', 'confusion w recent news item on TV)']","['ULTRASOUND - At [**2130-11-29**] 04:40 PM', ""Pt had Dobhoff placed it and then self-d/c'ed it"", 'Had neurology evaluation for ? seizure- per neuro MRI with sig. brain', 'atrophy - ALS vs hep C neuropathy', 'EMG for today', 'EEG no seizure activity', 'Abd Ultrasound not enough to ascites tap', 'Failed speech/swallow plan for video swallow today', 'Patient confused, thinks he is at ""[**State 621**] Fire Department"",', 'convinced team has been comparing him to [**Doctor First Name 3337**] Hitler (apparent', 'confusion w recent news item on TV)']","['LUMBAR PUNCTURE - At [**2130-11-28**] 12:19 PM', ' MAGNETIC RESONANCE IMAGING - At [**2130-11-28**] 08:00 PM', 'PT GOT .5MG IV ATIVAN FOR PROCEDURE DUE TO EXCESSIVE MOVEMENT IN', 'SCANNER . bp DOWN TO 93/45, BUT PT AWAKE AND ASKING FOR JUICE', ' FEVER - 101.3', 'F - [**2130-11-28**] 04:00 PM', 'Apparent seizure event in AM during rounds, got 2 mg ativan for this', 'EEG done, read pending', 'CT head negative', 'MRI done; got 0.5 mg ativan for this b/c of movement', 'Seroquel taken off', 'Continued to be encephalopathic/sedated-appearing, but interactive', '2x restraints for trying to pull NG tube; ultimately succeeded in', 'pulling tube', 'Continued vanco; started ceftaz and flagyl', 'History obtained from [**Hospital 19**] Medical records']",48660,184168.0
62,2130-11-30 11:22:54,"[""Pt had Dobhoff placed and then self-d/c'ed it""]","['ULTRASOUND - At [**2130-11-29**] 04:40 PM', ""Pt had Dobhoff placed and then self-d/c'ed it"", 'Had neurology evaluation for ? seizure- per neuro MRI with sig. brain', 'atrophy - ALS vs hep C neuropathy', 'EMG for today', 'EEG no seizure activity', 'Abd Ultrasound not enough to ascites tap', 'Failed speech/swallow plan for video swallow today', 'Patient confused, thinks he is at ""[**State 621**] Fire Department"",', 'convinced team has been comparing him to [**Doctor First Name 3337**] Hitler (apparent', 'confusion w recent news item on TV)']","[""Pt had Dobhoff placed it and then self-d/c'ed it""]",48660,184168.0
63,2130-11-30 11:43:02,,"['ULTRASOUND - At [**2130-11-29**] 04:40 PM', ""Pt had Dobhoff placed and then self-d/c'ed it"", 'Had neurology evaluation for ? seizure- per neuro MRI with sig. brain', 'atrophy - ALS vs hep C neuropathy', 'EMG for today', 'EEG no seizure activity', 'Abd Ultrasound not enough to ascites tap', 'Failed speech/swallow plan for video swallow today', 'Patient confused, thinks he is at ""[**State 621**] Fire Department"",', 'convinced team has been comparing him to [**Doctor First Name 3337**] Hitler (apparent', 'confusion w recent news item on TV)']",,48660,184168.0
64,2130-12-01 08:49:04,"['CALLED OUT --but stayed in ICU [**1-14**] high anxiety reaction', '- Advanced diet', '- EMG showed likely critical illness polymyoneuropathy', '- Discontinued ceftazidine', '- Discontinued erythromycin drops', 'History obtained from [**Hospital 19**] Medical records']","['CALLED OUT --but stayed in ICU [**1-14**] high anxiety reaction', '- Advanced diet', '- EMG showed likely critical illness polymyoneuropathy', '- Discontinued ceftazidine', '- Discontinued erythromycin drops', 'History obtained from [**Hospital 19**] Medical records']","['ULTRASOUND - At [**2130-11-29**] 04:40 PM', ""Pt had Dobhoff placed and then self-d/c'ed it"", 'Had neurology evaluation for ? seizure- per neuro MRI with sig. brain', 'atrophy - ALS vs hep C neuropathy', 'EMG for today', 'EEG no seizure activity', 'Abd Ultrasound not enough to ascites tap', 'Failed speech/swallow plan for video swallow today', 'Patient confused, thinks he is at ""[**State 621**] Fire Department"",', 'convinced team has been comparing him to [**Doctor First Name 3337**] Hitler (apparent', 'confusion w recent news item on TV)']",48660,184168.0
65,2130-12-01 08:50:29,,"['CALLED OUT --but stayed in ICU [**1-14**] high anxiety reaction', '- Advanced diet', '- EMG showed likely critical illness polymyoneuropathy', '- Discontinued ceftazidine', '- Discontinued erythromycin drops', 'History obtained from [**Hospital 19**] Medical records']",,48660,184168.0
66,2130-12-01 15:34:56,,"['CALLED OUT --but stayed in ICU [**1-14**] high anxiety reaction', '- Advanced diet', '- EMG showed likely critical illness polymyoneuropathy', '- Discontinued ceftazidine', '- Discontinued erythromycin drops', 'History obtained from [**Hospital 19**] Medical records']",,48660,184168.0
0,2194-11-20 07:08:21,,"['- advanced et tube 2 cm', '- repeat labs inr 1.1 ptt 31.3 ; plts 137 (155); fibrinogen 372 (390);', 'fdp 10-40 (80-60)', '- Hct with AMLs --> 19.6 --> wrote u u prbc', '- Abg 7.46/44/142/32 on ac 500 x12 0.4 peep 5 --> 7.44/45/151/32 on ac', '500 x14 0.4 on peep 5 --> 7.48/42/160/32 changed to 5/5 @0630', '- RSBI < 20 at 0400 with 0/5 trial, but pt still somewhat somnolent so', 'sedation turned down', '- ob/gyb pager [**Numeric Identifier 3191**] would like to know when pt called out']",,50997,145271.0
1,2194-11-20 07:10:19,,"['- advanced et tube 2 cm', '- repeat labs inr 1.1 ptt 31.3 ; plts 137 (155); fibrinogen 372 (390);', 'fdp 10-40 (80-60)', '- Hct with AMLs --> 19.6 --> wrote u u prbc', '- Abg 7.46/44/142/32 on ac 500 x12 0.4 peep 5 --> 7.44/45/151/32 on ac', '500 x14 0.4 on peep 5 --> 7.48/42/160/32 changed to 5/5 @0630', '- RSBI < 20 at 0400 with 0/5 trial, but pt still somewhat somnolent so', 'sedation turned down', '- ob/gyb pager [**Numeric Identifier 3191**] would like to know when pt called out']",,50997,145271.0
2,2194-11-20 10:18:05,,"['- advanced et tube 2 cm', '- repeat labs inr 1.1 ptt 31.3 ; plts 137 (155); fibrinogen 372 (390);', 'fdp 10-40 (80-60)', '- Hct with AMLs --> 19.6 --> wrote u u prbc', '- Abg 7.46/44/142/32 on ac 500 x12 0.4 peep 5 --> 7.44/45/151/32 on ac', '500 x14 0.4 on peep 5 --> 7.48/42/160/32 changed to 5/5 @0630', '- RSBI < 20 at 0400 with 0/5 trial, but pt still somewhat somnolent so', 'sedation turned down', '- ob/gyb pager [**Numeric Identifier 3191**] would like to know when pt called out']",,50997,145271.0
0,2132-07-25 06:28:43,,"['PARACENTESIS - At [**2132-7-24**] 02:30 PM', 'start', ' PARACENTESIS - At [**2132-7-24**] 04:00 PM', 'end - removed 1250 ml', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am. No frank blood, no melena,', 'green stools.']",,28271,170516.0
1,2132-07-25 06:29:49,,"['PARACENTESIS - At [**2132-7-24**] 02:30 PM', 'start', ' PARACENTESIS - At [**2132-7-24**] 04:00 PM', 'end - removed 1250 ml', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am. No frank blood, no melena,', 'green stools.']",,28271,170516.0
2,2132-07-25 06:30:40,,"['PARACENTESIS - At [**2132-7-24**] 02:30 PM', 'start', ' PARACENTESIS - At [**2132-7-24**] 04:00 PM', 'end - removed 1250 ml', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am. No frank blood, no melena,', 'green stools.']",,28271,170516.0
3,2132-07-25 07:04:28,"['10.5L fluid taken off. Given 100mg Albumin in divided doses of 25mg', '(received 3 so far)', 'SAAG >2.1', 'Morning Hct was 27.5. In for Hct at 10am and 4pm. No frank blood, no', 'melena, green stools.']","['PARACENTESIS - At [**2132-7-24**] 02:30 PM', '10.5L fluid taken off. Given 100mg Albumin in divided doses of 25mg', '(received 3 so far)', 'SAAG >2.1', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am and 4pm. No frank blood, no', 'melena, green stools.']","['start', ' PARACENTESIS - At [**2132-7-24**] 04:00 PM', 'end - removed 1250 ml', 'Morning Hct was 27.5. In for Hct at 10am. No frank blood, no melena,', 'green stools.']",28271,170516.0
4,2132-07-25 16:30:27,,"['PARACENTESIS - At [**2132-7-24**] 02:30 PM', '10.5L fluid taken off. Given 100mg Albumin in divided doses of 25mg', '(received 3 so far)', 'SAAG >2.1', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am and 4pm. No frank blood, no', 'melena, green stools.']",,28271,170516.0
5,2132-07-26 06:39:46,"['Cultures grew GNR and budding yeast. Started empirically on capsofungin', 'and ceftriaxone', 'Ascites re-accumulating', 'HCT stabilized', 'CT abdomen showed ascites and possible small amount of blood', 'heavy diarrhea o/n']","['Cultures grew GNR and budding yeast. Started empirically on capsofungin', 'and ceftriaxone', 'Ascites re-accumulating', 'HCT stabilized', 'CT abdomen showed ascites and possible small amount of blood', 'heavy diarrhea o/n']","['PARACENTESIS - At [**2132-7-24**] 02:30 PM', '10.5L fluid taken off. Given 100mg Albumin in divided doses of 25mg', '(received 3 so far)', 'SAAG >2.1', ' CALLED OUT then called back in for SBPs in 80s.', 'Paracentesis labs consistent with SBP. Started on ceftriaxone.', 'Liver team requested corticotropin stim test for ?AI. Had random [**Last Name (un) 45**]', 'of 37.7 -> 45.2 -> 50.8 with high dose ACTH indicating no AI and no', 'steroids were started.', 'BP decreased to 70s/40s. 500NS and albumin (2nd dose) were given and', 'SBPs up to 80s. UOP throughout was 30mL/hour and pt was asymptomatic.', 'Morning Hct was 27.5. In for Hct at 10am and 4pm. No frank blood, no', 'melena, green stools.']",28271,170516.0
6,2132-07-26 08:27:23,['heavy diarrhea overnight; checking c. diff toxins'],"['Cultures grew GNR and budding yeast. Started empirically on capsofungin', 'and ceftriaxone', 'Ascites re-accumulating', 'HCT stabilized', 'CT abdomen showed ascites and possible small amount of blood', 'heavy diarrhea overnight; checking c. diff toxins']",['heavy diarrhea o/n'],28271,170516.0
7,2132-07-26 08:34:53,,"['Cultures grew GNR and budding yeast. Started empirically on capsofungin', 'and ceftriaxone', 'Ascites re-accumulating', 'HCT stabilized', 'CT abdomen showed ascites and possible small amount of blood', 'heavy diarrhea overnight; checking c. diff toxins']",,28271,170516.0
8,2132-07-26 13:13:03,"['heavy diarrhea overnight, most likely [**1-5**] lactulose']","['Cultures grew GNR and budding yeast. Started empirically on capsofungin', 'and ceftriaxone', 'Ascites re-accumulating', 'HCT stabilized', 'CT abdomen showed ascites and possible small amount of blood', 'heavy diarrhea overnight, most likely [**1-5**] lactulose']",['heavy diarrhea overnight; checking c. diff toxins'],28271,170516.0
0,2197-03-06 07:52:49,,"['URINE CULTURE - At [**2197-3-6**] 12:52 AM', 'Did not diurese as BPs have been low, 70s.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,67306,142980.0
1,2197-03-06 08:06:23,,"['URINE CULTURE - At [**2197-3-6**] 12:52 AM', 'Did not diurese as BPs have been low, 70s.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,67306,142980.0
2,2197-03-06 08:59:58,,"['URINE CULTURE - At [**2197-3-6**] 12:52 AM', 'Did not diurese as BPs have been low, 70s.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,67306,142980.0
3,2197-03-06 11:02:41,,"['URINE CULTURE - At [**2197-3-6**] 12:52 AM', 'Did not diurese as BPs have been low, 70s.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,67306,142980.0
4,2197-03-07 07:02:56,"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx']","['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx']","['URINE CULTURE - At [**2197-3-6**] 12:52 AM', 'Did not diurese as BPs have been low, 70s.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",67306,142980.0
5,2197-03-07 07:13:26,,"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx']",,67306,142980.0
6,2197-03-07 07:51:37,,"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx']",,67306,142980.0
7,2197-03-07 10:20:06,['- Hem/onc recommending diuresis'],"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx', '- Hem/onc recommending diuresis']",,67306,142980.0
8,2197-03-07 10:50:55,,"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx', '- Hem/onc recommending diuresis']",,67306,142980.0
9,2197-03-07 10:54:47,,"['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx', '- Hem/onc recommending diuresis']",,67306,142980.0
10,2197-03-08 07:28:34,"['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']","['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']","['FEVER - 101.2', 'F - [**2197-3-6**] 11:46 PM', '[**3-6**]', '- Added levo for atypical coverage', '- CT head: No acute intracranial abnormalities. Hypodensities in', 'bilateral PCA and left MCA regions, compatible with chronic infarcts at', 'these sites. Age-related parenchymal atrophy. Extensive paranasal sinus', 'mucosal thickening.', '- CT chest - radiologists concerned new bl diffuse ground glass', 'opacities and patchy consolidations concern for massive infection, ddx', 'includes ARDS or massive hemorrhage', '- Flu swab positive for RSV per virology', '- Discussed w/ ID re: monoclonal abx, efficacy unproven in this setting', 'also has high sorbitol load concerning given his renal failure.', 'Continued abx regimen (levo/vanc/cefepime) and held off on monoclonoal', 'abs', '- Spiked to 101, pan-cultured, remained on 5L w/ sats mid 90s so', 'continued abx', '- Hem/onc recommending diuresis']",67306,142980.0
11,2197-03-08 07:53:30,,"['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']",,67306,142980.0
12,2197-03-08 11:47:19,,"['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']",,67306,142980.0
13,2197-03-08 11:49:56,,"['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']",,67306,142980.0
14,2197-03-08 13:27:10,,"['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']",,67306,142980.0
15,2197-03-09 06:51:33,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']","['PICC LINE - START [**2197-3-8**] 03:00 PM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']","['TRANSTHORACIC ECHO - At [**2197-3-7**] 10:39 AM', '- TTE: Compared with the prior study LV cavity is slightly smaller and', 'the severity of mitral regurgitation and pulmonary artery systolic', 'pressure are slightly reduced. Regional left ventricular systolic', 'function is similar (30%).', '- Repeating BNP to see if changed', '- Gave a second shot of lasix 40mg IV ONCE at 1830', '- ID recommended giving anti-RSV antibody', ""- DC'd valgan and levoflox per ID recs"", '- Explained the risks of ab to wife and pt who decided to think about', 'it. They had questions about the procedure they wanted to talk to Dr.', '[**Last Name (STitle) 11599**] about. They also wanted to know if the insurance company', 'would pay for it since it costs 15,000 dollars.', '- Drug check: Neither valcyte or voriconazole cause pneumonitis', 'History obtained from [**Hospital 19**] Medical records']",67306,142980.0
16,2197-03-09 06:53:40,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
17,2197-03-09 10:14:24,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
18,2197-03-09 10:39:24,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
19,2197-03-09 11:02:28,['- Overnight received 40mg iv lasix at 0200AM'],"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
20,2197-03-09 11:08:59,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
21,2197-03-09 12:03:16,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
22,2197-03-09 12:49:24,"['- Overnight received 40mg iv lasix at 0200AM for worsening hypoxia and', 'increased O2 requirement']","['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM for worsening hypoxia and', 'increased O2 requirement', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",['- Overnight received 40mg iv lasix at 0200AM'],67306,142980.0
23,2197-03-09 12:56:36,,"['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM for worsening hypoxia and', 'increased O2 requirement', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",,67306,142980.0
24,2197-03-10 07:28:39,"['BLOOD CULTURED - At [**2197-3-10**] 06:11 AM', ' URINE CULTURE - At [**2197-3-10**] 06:11 AM', '[**3-9**]', '- Did not start mirtazapine', '- XRay showed PICC line tip at level of low SVC without kinking.', '- Increased leukocytosis: so sent off second sputum, stool, urine, got', 'CXR, checked LFTs', '- Met w/ heme/onc and wife: Wanted to continue with treatment', '- O2 weaned down to 50% fio2 and 4L nc; put out net 200cc earlier in', 'the day but then 700cc net in; however, his sbp was persistently in the', '70s and as he was sating well on less oxygen did not give lasix.', 'History obtained from Patient, Family / Friend']","['BLOOD CULTURED - At [**2197-3-10**] 06:11 AM', ' URINE CULTURE - At [**2197-3-10**] 06:11 AM', '[**3-9**]', '- Did not start mirtazapine', '- XRay showed PICC line tip at level of low SVC without kinking.', '- Increased leukocytosis: so sent off second sputum, stool, urine, got', 'CXR, checked LFTs', '- Met w/ heme/onc and wife: Wanted to continue with treatment', '- O2 weaned down to 50% fio2 and 4L nc; put out net 200cc earlier in', 'the day but then 700cc net in; however, his sbp was persistently in the', '70s and as he was sating well on less oxygen did not give lasix.', 'History obtained from Patient, Family / Friend']","['PICC LINE - START [**2197-3-8**] 03:00 PM', '- Overnight received 40mg iv lasix at 0200AM for worsening hypoxia and', 'increased O2 requirement', '- I/O - 535 + large amount inc from condom cath', '- PICC placed', '- c/o vision changes. may be [**2-21**] codeine, monitoring for now']",67306,142980.0
25,2197-03-10 07:40:31,,"['BLOOD CULTURED - At [**2197-3-10**] 06:11 AM', ' URINE CULTURE - At [**2197-3-10**] 06:11 AM', '[**3-9**]', '- Did not start mirtazapine', '- XRay showed PICC line tip at level of low SVC without kinking.', '- Increased leukocytosis: so sent off second sputum, stool, urine, got', 'CXR, checked LFTs', '- Met w/ heme/onc and wife: Wanted to continue with treatment', '- O2 weaned down to 50% fio2 and 4L nc; put out net 200cc earlier in', 'the day but then 700cc net in; however, his sbp was persistently in the', '70s and as he was sating well on less oxygen did not give lasix.', 'History obtained from Patient, Family / Friend']",,67306,142980.0
26,2197-03-10 09:16:13,,"['BLOOD CULTURED - At [**2197-3-10**] 06:11 AM', ' URINE CULTURE - At [**2197-3-10**] 06:11 AM', '[**3-9**]', '- Did not start mirtazapine', '- XRay showed PICC line tip at level of low SVC without kinking.', '- Increased leukocytosis: so sent off second sputum, stool, urine, got', 'CXR, checked LFTs', '- Met w/ heme/onc and wife: Wanted to continue with treatment', '- O2 weaned down to 50% fio2 and 4L nc; put out net 200cc earlier in', 'the day but then 700cc net in; however, his sbp was persistently in the', '70s and as he was sating well on less oxygen did not give lasix.', 'History obtained from Patient, Family / Friend']",,67306,142980.0
27,2197-03-10 14:28:05,,"['BLOOD CULTURED - At [**2197-3-10**] 06:11 AM', ' URINE CULTURE - At [**2197-3-10**] 06:11 AM', '[**3-9**]', '- Did not start mirtazapine', '- XRay showed PICC line tip at level of low SVC without kinking.', '- Increased leukocytosis: so sent off second sputum, stool, urine, got', 'CXR, checked LFTs', '- Met w/ heme/onc and wife: Wanted to continue with treatment', '- O2 weaned down to 50% fio2 and 4L nc; put out net 200cc earlier in', 'the day but then 700cc net in; however, his sbp was persistently in the', '70s and as he was sating well on less oxygen did not give lasix.', 'History obtained from Patient, Family / Friend']",,67306,142980.0
0,2121-01-31 07:04:50,,"['-Axillary Aline placed', '-3sets of CE done; remained flat; cardiology consulted given ? evolving', 'EKG changes and ECHO done with EF 20%', '-Evidence of pancreatitis Amylase 109, Lipase 374', '-Cards felt respiratory failure due to HTN causing flash pulmonary', 'edema in setting of depressed EF and that hypotension not likely', 'cardiogenic shock given HTN on initial admission and no evidence of RV', 'dilation on TTE.  Suggested trial of diuresis if need to improve', 'oxygenation.  Felt hypotension could be [**1-28**] pancreatitis vs hemorrhagic', 'shock; did not feel ACS but did agree w/statin, aspirin. Did think', 'patient may benefit from eventual cath vs stress AND may benefit from', 'swan pending what other results return', '-Patient noted to have pulsatile mass and given 10pt Hct drop-->ordered', 'CT torso to evalute for pancreatitis, dissecting aneurysm and PE; held', 'heparin that was initially started given Hct drop', '-Prelim CT Read:', 'Bilateral pleural effusions and associated bibasilar atelectasis.', 'Diffuse ground glass opacification scattered throughout both lung', 'fields, non-specific could relate to edema, infection or inflammation.', 'No CT evidence of pancreatitis, can correlate with labs. No evidence of', 'pulmonary embolism to the subsegmental levels and no evidence of', 'abdominal aortic aneurysm. Status post gastric banding.', '-Looked through old records and clean cath [**2110**]', '-Sent TSH, thiamine for nutritional deficiencies given lap band and', 'cardiomyopathy', '-D-dimer 1861', '-Repeat lactate 2.1-->1.0 this AM', '-Temp 100.1 at MN', '-Weaned off dobutamine, on Levo .08', '-On PSV 8/8', '-Hct 52->47->40->37.9', ' INVASIVE VENTILATION - START [**2121-1-30**] 12:00 PM', ' MULTI LUMEN - START [**2121-1-30**] 01:24 PM', ' BLOOD CULTURED - At [**2121-1-30**] 02:37 PM', 'TLCL', ' SPUTUM CULTURE - At [**2121-1-30**] 02:37 PM', ' URINE CULTURE - At [**2121-1-30**] 02:38 PM', ' TRANSTHORACIC ECHO - At [**2121-1-30**] 04:11 PM', ' ARTERIAL LINE - START [**2121-1-30**] 06:00 PM']",,95495,134287.0
1,2121-01-31 07:45:59,,"['-Axillary Aline placed', '-3sets of CE done; remained flat; cardiology consulted given ? evolving', 'EKG changes and ECHO done with EF 20%', '-Evidence of pancreatitis Amylase 109, Lipase 374', '-Cards felt respiratory failure due to HTN causing flash pulmonary', 'edema in setting of depressed EF and that hypotension not likely', 'cardiogenic shock given HTN on initial admission and no evidence of RV', 'dilation on TTE.  Suggested trial of diuresis if need to improve', 'oxygenation.  Felt hypotension could be [**1-28**] pancreatitis vs hemorrhagic', 'shock; did not feel ACS but did agree w/statin, aspirin. Did think', 'patient may benefit from eventual cath vs stress AND may benefit from', 'swan pending what other results return', '-Patient noted to have pulsatile mass and given 10pt Hct drop-->ordered', 'CT torso to evalute for pancreatitis, dissecting aneurysm and PE; held', 'heparin that was initially started given Hct drop', '-Prelim CT Read:', 'Bilateral pleural effusions and associated bibasilar atelectasis.', 'Diffuse ground glass opacification scattered throughout both lung', 'fields, non-specific could relate to edema, infection or inflammation.', 'No CT evidence of pancreatitis, can correlate with labs. No evidence of', 'pulmonary embolism to the subsegmental levels and no evidence of', 'abdominal aortic aneurysm. Status post gastric banding.', '-Looked through old records and clean cath [**2110**]', '-Sent TSH, thiamine for nutritional deficiencies given lap band and', 'cardiomyopathy', '-D-dimer 1861', '-Repeat lactate 2.1-->1.0 this AM', '-Temp 100.1 at MN', '-Weaned off dobutamine, on Levo .08', '-On PSV 8/8', '-Hct 52->47->40->37.9', ' INVASIVE VENTILATION - START [**2121-1-30**] 12:00 PM', ' MULTI LUMEN - START [**2121-1-30**] 01:24 PM', ' BLOOD CULTURED - At [**2121-1-30**] 02:37 PM', 'TLCL', ' SPUTUM CULTURE - At [**2121-1-30**] 02:37 PM', ' URINE CULTURE - At [**2121-1-30**] 02:38 PM', ' TRANSTHORACIC ECHO - At [**2121-1-30**] 04:11 PM', ' ARTERIAL LINE - START [**2121-1-30**] 06:00 PM']",,95495,134287.0
2,2121-01-31 09:07:40,,"['-Axillary Aline placed', '-3sets of CE done; remained flat; cardiology consulted given ? evolving', 'EKG changes and ECHO done with EF 20%', '-Evidence of pancreatitis Amylase 109, Lipase 374', '-Cards felt respiratory failure due to HTN causing flash pulmonary', 'edema in setting of depressed EF and that hypotension not likely', 'cardiogenic shock given HTN on initial admission and no evidence of RV', 'dilation on TTE.  Suggested trial of diuresis if need to improve', 'oxygenation.  Felt hypotension could be [**1-28**] pancreatitis vs hemorrhagic', 'shock; did not feel ACS but did agree w/statin, aspirin. Did think', 'patient may benefit from eventual cath vs stress AND may benefit from', 'swan pending what other results return', '-Patient noted to have pulsatile mass and given 10pt Hct drop-->ordered', 'CT torso to evalute for pancreatitis, dissecting aneurysm and PE; held', 'heparin that was initially started given Hct drop', '-Prelim CT Read:', 'Bilateral pleural effusions and associated bibasilar atelectasis.', 'Diffuse ground glass opacification scattered throughout both lung', 'fields, non-specific could relate to edema, infection or inflammation.', 'No CT evidence of pancreatitis, can correlate with labs. No evidence of', 'pulmonary embolism to the subsegmental levels and no evidence of', 'abdominal aortic aneurysm. Status post gastric banding.', '-Looked through old records and clean cath [**2110**]', '-Sent TSH, thiamine for nutritional deficiencies given lap band and', 'cardiomyopathy', '-D-dimer 1861', '-Repeat lactate 2.1-->1.0 this AM', '-Temp 100.1 at MN', '-Weaned off dobutamine, on Levo .08', '-On PSV 8/8', '-Hct 52->47->40->37.9', ' INVASIVE VENTILATION - START [**2121-1-30**] 12:00 PM', ' MULTI LUMEN - START [**2121-1-30**] 01:24 PM', ' BLOOD CULTURED - At [**2121-1-30**] 02:37 PM', 'TLCL', ' SPUTUM CULTURE - At [**2121-1-30**] 02:37 PM', ' URINE CULTURE - At [**2121-1-30**] 02:38 PM', ' TRANSTHORACIC ECHO - At [**2121-1-30**] 04:11 PM', ' ARTERIAL LINE - START [**2121-1-30**] 06:00 PM']",,95495,134287.0
3,2121-02-01 10:27:19,"['SPUTUM CULTURE - At [**2121-1-31**] 12:00 PM', ' ULTRASOUND - At [**2121-1-31**] 01:00 PM', 'R lower extremity (inner thigh) for ? abcess/cellulitis.', ' NASAL SWAB - At [**2121-1-31**] 01:15 PM', 'flu swab resent d/t insufficient cells from previous sample.', ' INVASIVE VENTILATION - STOP [**2121-1-31**] 03:13 PM', ' EKG - At [**2121-1-31**] 10:20 PM']","['SPUTUM CULTURE - At [**2121-1-31**] 12:00 PM', ' ULTRASOUND - At [**2121-1-31**] 01:00 PM', 'R lower extremity (inner thigh) for ? abcess/cellulitis.', ' NASAL SWAB - At [**2121-1-31**] 01:15 PM', 'flu swab resent d/t insufficient cells from previous sample.', ' INVASIVE VENTILATION - STOP [**2121-1-31**] 03:13 PM', ' EKG - At [**2121-1-31**] 10:20 PM']","['-Axillary Aline placed', '-3sets of CE done; remained flat; cardiology consulted given ? evolving', 'EKG changes and ECHO done with EF 20%', '-Evidence of pancreatitis Amylase 109, Lipase 374', '-Cards felt respiratory failure due to HTN causing flash pulmonary', 'edema in setting of depressed EF and that hypotension not likely', 'cardiogenic shock given HTN on initial admission and no evidence of RV', 'dilation on TTE.  Suggested trial of diuresis if need to improve', 'oxygenation.  Felt hypotension could be [**1-28**] pancreatitis vs hemorrhagic', 'shock; did not feel ACS but did agree w/statin, aspirin. Did think', 'patient may benefit from eventual cath vs stress AND may benefit from', 'swan pending what other results return', '-Patient noted to have pulsatile mass and given 10pt Hct drop-->ordered', 'CT torso to evalute for pancreatitis, dissecting aneurysm and PE; held', 'heparin that was initially started given Hct drop', '-Prelim CT Read:', 'Bilateral pleural effusions and associated bibasilar atelectasis.', 'Diffuse ground glass opacification scattered throughout both lung', 'fields, non-specific could relate to edema, infection or inflammation.', 'No CT evidence of pancreatitis, can correlate with labs. No evidence of', 'pulmonary embolism to the subsegmental levels and no evidence of', 'abdominal aortic aneurysm. Status post gastric banding.', '-Looked through old records and clean cath [**2110**]', '-Sent TSH, thiamine for nutritional deficiencies given lap band and', 'cardiomyopathy', '-D-dimer 1861', '-Repeat lactate 2.1-->1.0 this AM', '-Temp 100.1 at MN', '-Weaned off dobutamine, on Levo .08', '-On PSV 8/8', '-Hct 52->47->40->37.9', ' INVASIVE VENTILATION - START [**2121-1-30**] 12:00 PM', ' MULTI LUMEN - START [**2121-1-30**] 01:24 PM', ' BLOOD CULTURED - At [**2121-1-30**] 02:37 PM', 'TLCL', ' SPUTUM CULTURE - At [**2121-1-30**] 02:37 PM', ' URINE CULTURE - At [**2121-1-30**] 02:38 PM', ' TRANSTHORACIC ECHO - At [**2121-1-30**] 04:11 PM', ' ARTERIAL LINE - START [**2121-1-30**] 06:00 PM']",95495,134287.0
4,2121-02-01 10:28:30,"['- Extubated without complication', '- Cardiology consult recommended cardiac MRI, will need to have MRI', 'checklist filled ahead of time, plan for scan Tues/Wed, will require 1', 'to 1.5hrs flat', '- RN pointed out area of thigh redness / fullness on right medial', 'thigh, US odered (pending)', '- Received Lasix 40mg [**Hospital1 **]']","['SPUTUM CULTURE - At [**2121-1-31**] 12:00 PM', ' ULTRASOUND - At [**2121-1-31**] 01:00 PM', 'R lower extremity (inner thigh) for ? abcess/cellulitis.', ' NASAL SWAB - At [**2121-1-31**] 01:15 PM', 'flu swab resent d/t insufficient cells from previous sample.', ' INVASIVE VENTILATION - STOP [**2121-1-31**] 03:13 PM', ' EKG - At [**2121-1-31**] 10:20 PM', '- Extubated without complication', '- Cardiology consult recommended cardiac MRI, will need to have MRI', 'checklist filled ahead of time, plan for scan Tues/Wed, will require 1', 'to 1.5hrs flat', '- RN pointed out area of thigh redness / fullness on right medial', 'thigh, US odered (pending)', '- Received Lasix 40mg [**Hospital1 **]']",,95495,134287.0
5,2121-02-01 10:55:14,,"['SPUTUM CULTURE - At [**2121-1-31**] 12:00 PM', ' ULTRASOUND - At [**2121-1-31**] 01:00 PM', 'R lower extremity (inner thigh) for ? abcess/cellulitis.', ' NASAL SWAB - At [**2121-1-31**] 01:15 PM', 'flu swab resent d/t insufficient cells from previous sample.', ' INVASIVE VENTILATION - STOP [**2121-1-31**] 03:13 PM', ' EKG - At [**2121-1-31**] 10:20 PM', '- Extubated without complication', '- Cardiology consult recommended cardiac MRI, will need to have MRI', 'checklist filled ahead of time, plan for scan Tues/Wed, will require 1', 'to 1.5hrs flat', '- RN pointed out area of thigh redness / fullness on right medial', 'thigh, US odered (pending)', '- Received Lasix 40mg [**Hospital1 **]']",,95495,134287.0
6,2121-02-02 07:39:24,"['ARTERIAL LINE - STOP [**2121-2-1**] 02:33 PM', '-- Patient given 40mg IV lasix and -800 at midnight. Gave another 40mg', 'IV lasix.', '-- pt was leaking urine around foley, so it was d/c', '-- respiratory screen negative', '-- sputum cx growing coag positive staph (d/c vanco earlier in the', 'day), restarted vanco']","['ARTERIAL LINE - STOP [**2121-2-1**] 02:33 PM', '-- Patient given 40mg IV lasix and -800 at midnight. Gave another 40mg', 'IV lasix.', '-- pt was leaking urine around foley, so it was d/c', '-- respiratory screen negative', '-- sputum cx growing coag positive staph (d/c vanco earlier in the', 'day), restarted vanco']","['SPUTUM CULTURE - At [**2121-1-31**] 12:00 PM', ' ULTRASOUND - At [**2121-1-31**] 01:00 PM', 'R lower extremity (inner thigh) for ? abcess/cellulitis.', ' NASAL SWAB - At [**2121-1-31**] 01:15 PM', 'flu swab resent d/t insufficient cells from previous sample.', ' INVASIVE VENTILATION - STOP [**2121-1-31**] 03:13 PM', ' EKG - At [**2121-1-31**] 10:20 PM', '- Extubated without complication', '- Cardiology consult recommended cardiac MRI, will need to have MRI', 'checklist filled ahead of time, plan for scan Tues/Wed, will require 1', 'to 1.5hrs flat', '- RN pointed out area of thigh redness / fullness on right medial', 'thigh, US odered (pending)', '- Received Lasix 40mg [**Hospital1 **]']",95495,134287.0
7,2121-02-02 10:05:47,,"['ARTERIAL LINE - STOP [**2121-2-1**] 02:33 PM', '-- Patient given 40mg IV lasix and -800 at midnight. Gave another 40mg', 'IV lasix.', '-- pt was leaking urine around foley, so it was d/c', '-- respiratory screen negative', '-- sputum cx growing coag positive staph (d/c vanco earlier in the', 'day), restarted vanco']",,95495,134287.0
0,2153-07-29 07:27:55,,"['MULTI LUMEN - START [**2153-7-28**] 12:08 PM', ' MULTI LUMEN - STOP [**2153-7-28**] 02:30 PM', ' MULTI LUMEN - START [**2153-7-28**] 03:00 PM', '-UOP remains marginal 10, 40, 25cc/hr around 19:35', '- per surgical team feel very strongly about perioperative beta blocker', 'despite hypotension and bradycardia.  Advised to switch to short acting', 'to maintain cardioprotective effect but they wanted to double dose in', 'that case.  Compromise stay with long acting Toprol XL at home dose.']",,63407,189576.0
1,2153-07-29 13:06:31,"['- surgical team feels very strongly about perioperative beta blocker', 'to maintain cardioprotective effect but surgery wanted to double dose', 'in that case, so instead continuing pt on home dose of Toprol XL']","['MULTI LUMEN - START [**2153-7-28**] 12:08 PM', ' MULTI LUMEN - STOP [**2153-7-28**] 02:30 PM', ' MULTI LUMEN - START [**2153-7-28**] 03:00 PM', '-UOP remains marginal 10, 40, 25cc/hr around 19:35', '- surgical team feels very strongly about perioperative beta blocker', 'despite hypotension and bradycardia.  Advised to switch to short acting', 'to maintain cardioprotective effect but surgery wanted to double dose', 'in that case, so instead continuing pt on home dose of Toprol XL']","['- per surgical team feel very strongly about perioperative beta blocker', 'to maintain cardioprotective effect but they wanted to double dose in', 'that case.  Compromise stay with long acting Toprol XL at home dose.']",63407,189576.0
0,2168-10-12 07:04:53,,"['EKG - At [**2168-10-11**] 06:12 PM', ' EKG - At [**2168-10-11**] 06:12 PM', ' NASAL SWAB - At [**2168-10-11**] 06:40 PM', ' URINE CULTURE - At [**2168-10-11**] 06:40 PM', ' BLOOD CULTURED - At [**2168-10-11**] 06:40 PM', '.', 'Tox recs q4h chem 10 and EKG', 'bicarb gtt', 'Renal said no bicarb unless arrhythmia', 'Gave MS contin 30mg x1 (normal dose is 60mg tid)', 'FENA 1.6']",,88350,119602.0
1,2168-10-12 07:05:53,,"['EKG - At [**2168-10-11**] 06:12 PM', ' EKG - At [**2168-10-11**] 06:12 PM', ' NASAL SWAB - At [**2168-10-11**] 06:40 PM', ' URINE CULTURE - At [**2168-10-11**] 06:40 PM', ' BLOOD CULTURED - At [**2168-10-11**] 06:40 PM', '.', 'Tox recs q4h chem 10 and EKG', 'bicarb gtt', 'Renal said no bicarb unless arrhythmia', 'Gave MS contin 30mg x1 (normal dose is 60mg tid)', 'FENA 1.6']",,88350,119602.0
2,2168-10-12 10:10:29,,"['EKG - At [**2168-10-11**] 06:12 PM', ' EKG - At [**2168-10-11**] 06:12 PM', ' NASAL SWAB - At [**2168-10-11**] 06:40 PM', ' URINE CULTURE - At [**2168-10-11**] 06:40 PM', ' BLOOD CULTURED - At [**2168-10-11**] 06:40 PM', '.', 'Tox recs q4h chem 10 and EKG', 'bicarb gtt', 'Renal said no bicarb unless arrhythmia', 'Gave MS contin 30mg x1 (normal dose is 60mg tid)', 'FENA 1.6']",,88350,119602.0
3,2168-10-13 07:47:32,['CALLED OUT yesterday morning'],['CALLED OUT yesterday morning'],"['EKG - At [**2168-10-11**] 06:12 PM', ' EKG - At [**2168-10-11**] 06:12 PM', ' NASAL SWAB - At [**2168-10-11**] 06:40 PM', ' URINE CULTURE - At [**2168-10-11**] 06:40 PM', ' BLOOD CULTURED - At [**2168-10-11**] 06:40 PM', '.', 'Tox recs q4h chem 10 and EKG', 'bicarb gtt', 'Renal said no bicarb unless arrhythmia', 'Gave MS contin 30mg x1 (normal dose is 60mg tid)', 'FENA 1.6']",88350,119602.0
4,2168-10-13 07:48:19,,['CALLED OUT yesterday morning'],,88350,119602.0
5,2168-10-13 10:54:12,,['CALLED OUT yesterday morning'],,88350,119602.0
0,2196-10-08 07:09:47,,"['NASAL SWAB - At [**2196-10-8**] 01:22 AM', '- Weaned to 50% FM']",,93104,171431.0
1,2196-10-08 10:52:12,,"['NASAL SWAB - At [**2196-10-8**] 01:22 AM', '- Weaned to 50% FM']",,93104,171431.0
2,2196-10-09 07:01:19,"['- O2 sats remained greater than 92%', '- fu cultures: pending', '- fu sputum cultures: pending', '- viral nasal swab: pending', '- spaced out her nebulizer treatments to q6 hours.', '- ciprofloxacin changed to levofloxacin (day 1: [**10-8**])', '- advanced diet to clears']","['- O2 sats remained greater than 92%', '- fu cultures: pending', '- fu sputum cultures: pending', '- viral nasal swab: pending', '- spaced out her nebulizer treatments to q6 hours.', '- ciprofloxacin changed to levofloxacin (day 1: [**10-8**])', '- advanced diet to clears']","['NASAL SWAB - At [**2196-10-8**] 01:22 AM', '- Weaned to 50% FM']",93104,171431.0
3,2196-10-09 13:01:09,,"['- O2 sats remained greater than 92%', '- fu cultures: pending', '- fu sputum cultures: pending', '- viral nasal swab: pending', '- spaced out her nebulizer treatments to q6 hours.', '- ciprofloxacin changed to levofloxacin (day 1: [**10-8**])', '- advanced diet to clears']",,93104,171431.0
4,2196-10-09 13:02:37,,"['- O2 sats remained greater than 92%', '- fu cultures: pending', '- fu sputum cultures: pending', '- viral nasal swab: pending', '- spaced out her nebulizer treatments to q6 hours.', '- ciprofloxacin changed to levofloxacin (day 1: [**10-8**])', '- advanced diet to clears']",,93104,171431.0
5,2196-10-10 06:24:03,"['- added singulair', '- changed MethylPREDNISolone Sodium Succ from 100mg q6h to 80 mg IV Q8', '- increased the frequency of beta-blocker, Xopenex Neb *NF* 0.63 mg', 'Other q3H dyspnea/wheezing but per RT Xopenex is long-acting so changed', 'to q4-6h', '- continued atrovent Neb Q6H, flovent 110mcg 2 PUFF [**Hospital1 **], advair(250/50)', '1 INH [**Hospital1 **]', '- continued on Levoquin for possible CAP vs atypical pna', '- URINE CULTURE from [**10-7**] showed GRAM POSITIVE BACTERIA.', '10,000-100,000 ORGANISMS/ML..  Alpha hemolytic colonies consistent with', 'alpha streptococcus or Lactobacillus sp.', '- pt reported to nurse that she was found to have a pituitary mass and', 'thyroid dysfunction in the past, gained lots of wt despite small PO', 'intakes, was seen by endocrinologist but had no regular followup. TSH', 'and T4 were added to morning lab, but one month ago TSH was normal at', '1.4']","['- added singulair', '- changed MethylPREDNISolone Sodium Succ from 100mg q6h to 80 mg IV Q8', '- increased the frequency of beta-blocker, Xopenex Neb *NF* 0.63 mg', 'Other q3H dyspnea/wheezing but per RT Xopenex is long-acting so changed', 'to q4-6h', '- continued atrovent Neb Q6H, flovent 110mcg 2 PUFF [**Hospital1 **], advair(250/50)', '1 INH [**Hospital1 **]', '- continued on Levoquin for possible CAP vs atypical pna', '- URINE CULTURE from [**10-7**] showed GRAM POSITIVE BACTERIA.', '10,000-100,000 ORGANISMS/ML..  Alpha hemolytic colonies consistent with', 'alpha streptococcus or Lactobacillus sp.', '- pt reported to nurse that she was found to have a pituitary mass and', 'thyroid dysfunction in the past, gained lots of wt despite small PO', 'intakes, was seen by endocrinologist but had no regular followup. TSH', 'and T4 were added to morning lab, but one month ago TSH was normal at', '1.4']","['- O2 sats remained greater than 92%', '- fu cultures: pending', '- fu sputum cultures: pending', '- viral nasal swab: pending', '- spaced out her nebulizer treatments to q6 hours.', '- ciprofloxacin changed to levofloxacin (day 1: [**10-8**])', '- advanced diet to clears']",93104,171431.0
6,2196-10-10 11:57:07,,"['- added singulair', '- changed MethylPREDNISolone Sodium Succ from 100mg q6h to 80 mg IV Q8', '- increased the frequency of beta-blocker, Xopenex Neb *NF* 0.63 mg', 'Other q3H dyspnea/wheezing but per RT Xopenex is long-acting so changed', 'to q4-6h', '- continued atrovent Neb Q6H, flovent 110mcg 2 PUFF [**Hospital1 **], advair(250/50)', '1 INH [**Hospital1 **]', '- continued on Levoquin for possible CAP vs atypical pna', '- URINE CULTURE from [**10-7**] showed GRAM POSITIVE BACTERIA.', '10,000-100,000 ORGANISMS/ML..  Alpha hemolytic colonies consistent with', 'alpha streptococcus or Lactobacillus sp.', '- pt reported to nurse that she was found to have a pituitary mass and', 'thyroid dysfunction in the past, gained lots of wt despite small PO', 'intakes, was seen by endocrinologist but had no regular followup. TSH', 'and T4 were added to morning lab, but one month ago TSH was normal at', '1.4']",,93104,171431.0
7,2196-10-12 07:51:03,"['MIDLINE - START [**2196-10-11**] 09:16 AM', ' CALLED OUT', '- c/o to floor today', '- f/u blood, sputum, viral culture: all pending.', '- per pharm team, decrease steroids as follow: IV methylprednisolone', '40mg X 2 more doses on [**10-11**].  Tomorrow AM, switch to 50mg PO', 'prednisone.']","['MIDLINE - START [**2196-10-11**] 09:16 AM', ' CALLED OUT', '- c/o to floor today', '- f/u blood, sputum, viral culture: all pending.', '- per pharm team, decrease steroids as follow: IV methylprednisolone', '40mg X 2 more doses on [**10-11**].  Tomorrow AM, switch to 50mg PO', 'prednisone.']","['- added singulair', '- changed MethylPREDNISolone Sodium Succ from 100mg q6h to 80 mg IV Q8', '- increased the frequency of beta-blocker, Xopenex Neb *NF* 0.63 mg', 'Other q3H dyspnea/wheezing but per RT Xopenex is long-acting so changed', 'to q4-6h', '- continued atrovent Neb Q6H, flovent 110mcg 2 PUFF [**Hospital1 **], advair(250/50)', '1 INH [**Hospital1 **]', '- continued on Levoquin for possible CAP vs atypical pna', '- URINE CULTURE from [**10-7**] showed GRAM POSITIVE BACTERIA.', '10,000-100,000 ORGANISMS/ML..  Alpha hemolytic colonies consistent with', 'alpha streptococcus or Lactobacillus sp.', '- pt reported to nurse that she was found to have a pituitary mass and', 'thyroid dysfunction in the past, gained lots of wt despite small PO', 'intakes, was seen by endocrinologist but had no regular followup. TSH', 'and T4 were added to morning lab, but one month ago TSH was normal at', '1.4']",93104,171431.0
8,2196-10-12 09:32:20,,"['MIDLINE - START [**2196-10-11**] 09:16 AM', ' CALLED OUT', '- c/o to floor today', '- f/u blood, sputum, viral culture: all pending.', '- per pharm team, decrease steroids as follow: IV methylprednisolone', '40mg X 2 more doses on [**10-11**].  Tomorrow AM, switch to 50mg PO', 'prednisone.']",,93104,171431.0
0,2173-01-20 07:38:59,,"['-K remained low at 2.9, repleted with K through PEG, will likely need K', 'added to IVFs', '-Na, Cre improved with IVFs']",,74016,112955.0
1,2173-01-20 07:42:00,['- Insulin gtt decreased to 10 U/hr'],"['-K remained low at 2.9, repleted with K through PEG, will likely need K', 'added to IVFs', '-Na, Cre improved with IVFs', '- Insulin gtt decreased to 10 U/hr']",,74016,112955.0
2,2173-01-20 07:47:31,,"['-K remained low at 2.9, repleted with K through PEG, will likely need K', 'added to IVFs', '-Na, Cre improved with IVFs', '- Insulin gtt decreased to 10 U/hr']",,74016,112955.0
3,2173-01-20 12:27:51,"['- started ppx abx and antiviral for presumed meningitis', '- fluids changed to D5']","['-K remained low at 2.9, repleted with K through PEG, will likely need K', 'added to IVFs', '-Na, Cre improved with IVFs', '- Insulin gtt decreased to 10 U/hr', '- started ppx abx and antiviral for presumed meningitis', '- fluids changed to D5']",,74016,112955.0
4,2173-01-21 07:57:28,"['PICC LINE - START [**2173-1-20**] 11:24 AM', '- Urine and blood cultures pending', '- Family refused LP', '- C diff ordered', '- CXR with ? interstitial edema', '- 6p Na 162 from 169 at 1a- correcting w/ 250 cc Q 4 plus', '- D5 1/2 NS plus 40 K at 200cc/hr for the night', '- Phenytoin level 7.9 ([**11-9**] therapeutic at 6p)', '- CK continueds to trend up to 6733 in evening. Trop flat', '-Fingersticks trended down to nadir 47 then fluids back to D5 1/2 NS', 'from 1/2 NS at midnight', '-PICC successfully placed']","['PICC LINE - START [**2173-1-20**] 11:24 AM', '- Urine and blood cultures pending', '- Family refused LP', '- C diff ordered', '- CXR with ? interstitial edema', '- 6p Na 162 from 169 at 1a- correcting w/ 250 cc Q 4 plus', '- D5 1/2 NS plus 40 K at 200cc/hr for the night', '- Phenytoin level 7.9 ([**11-9**] therapeutic at 6p)', '- CK continueds to trend up to 6733 in evening. Trop flat', '-Fingersticks trended down to nadir 47 then fluids back to D5 1/2 NS', 'from 1/2 NS at midnight', '-PICC successfully placed']","['-K remained low at 2.9, repleted with K through PEG, will likely need K', 'added to IVFs', '-Na, Cre improved with IVFs', '- Insulin gtt decreased to 10 U/hr', '- started ppx abx and antiviral for presumed meningitis', '- fluids changed to D5']",74016,112955.0
5,2173-01-21 12:23:56,,"['PICC LINE - START [**2173-1-20**] 11:24 AM', '- Urine and blood cultures pending', '- Family refused LP', '- C diff ordered', '- CXR with ? interstitial edema', '- 6p Na 162 from 169 at 1a- correcting w/ 250 cc Q 4 plus', '- D5 1/2 NS plus 40 K at 200cc/hr for the night', '- Phenytoin level 7.9 ([**11-9**] therapeutic at 6p)', '- CK continueds to trend up to 6733 in evening. Trop flat', '-Fingersticks trended down to nadir 47 then fluids back to D5 1/2 NS', 'from 1/2 NS at midnight', '-PICC successfully placed']",,74016,112955.0
6,2173-01-21 12:31:58,,"['PICC LINE - START [**2173-1-20**] 11:24 AM', '- Urine and blood cultures pending', '- Family refused LP', '- C diff ordered', '- CXR with ? interstitial edema', '- 6p Na 162 from 169 at 1a- correcting w/ 250 cc Q 4 plus', '- D5 1/2 NS plus 40 K at 200cc/hr for the night', '- Phenytoin level 7.9 ([**11-9**] therapeutic at 6p)', '- CK continueds to trend up to 6733 in evening. Trop flat', '-Fingersticks trended down to nadir 47 then fluids back to D5 1/2 NS', 'from 1/2 NS at midnight', '-PICC successfully placed']",,74016,112955.0
7,2173-01-22 07:51:45,"['- Discontinued ampicillin and vancomycin', '- Discontinued IVF', ""- Patient's insulin drip was stopped and glarine + HISS was started"", '- Attempted [**Last Name (un) 72**] consult; however, they were not reachable', '- Sodium check at 1700 was 150 (was 162 24 hours prior)', '- Sodium check at 2300 was 149']","['- Discontinued ampicillin and vancomycin', '- Discontinued IVF', ""- Patient's insulin drip was stopped and glarine + HISS was started"", '- Attempted [**Last Name (un) 72**] consult; however, they were not reachable', '- Sodium check at 1700 was 150 (was 162 24 hours prior)', '- Sodium check at 2300 was 149']","['PICC LINE - START [**2173-1-20**] 11:24 AM', '- Urine and blood cultures pending', '- Family refused LP', '- C diff ordered', '- CXR with ? interstitial edema', '- 6p Na 162 from 169 at 1a- correcting w/ 250 cc Q 4 plus', '- D5 1/2 NS plus 40 K at 200cc/hr for the night', '- Phenytoin level 7.9 ([**11-9**] therapeutic at 6p)', '- CK continueds to trend up to 6733 in evening. Trop flat', '-Fingersticks trended down to nadir 47 then fluids back to D5 1/2 NS', 'from 1/2 NS at midnight', '-PICC successfully placed']",74016,112955.0
8,2173-01-22 15:14:13,,"['- Discontinued ampicillin and vancomycin', '- Discontinued IVF', ""- Patient's insulin drip was stopped and glarine + HISS was started"", '- Attempted [**Last Name (un) 72**] consult; however, they were not reachable', '- Sodium check at 1700 was 150 (was 162 24 hours prior)', '- Sodium check at 2300 was 149']",,74016,112955.0
0,2141-06-12 06:36:00,,"['2 episodes of 20cc bloody BMs', 'hemodynamically stable, good UOP', 'repeat hct stable, s/p 1 uPRBC tx in ER', 'C diff ordered', 'Cipro / Flagyl started for low grade temp 100.2', 'worsening abdominal cramping- pain medication']",,109,147469.0
1,2141-06-12 06:54:00,"['A line- unable to flush, attempt at replacement over wire failed,', 'removed, cuff pressures', 'BP near goal of SBP 200.', 'Labetaolol drip re ordered to titrate to SBP 180', 'hyperkalemia resolved', 'MRI/MRA/MRV without contrast of head ordered, unable to adequately', 'perform given motion artifact of head during respiration', 'Neuro consult done- will staff in a.m.', 'Coumadin Held']","['A line- unable to flush, attempt at replacement over wire failed,', 'removed, cuff pressures', 'BP near goal of SBP 200.', 'Labetaolol drip re ordered to titrate to SBP 180', 'hyperkalemia resolved', 'MRI/MRA/MRV without contrast of head ordered, unable to adequately', 'perform given motion artifact of head during respiration', 'Neuro consult done- will staff in a.m.', 'Coumadin Held']","['2 episodes of 20cc bloody BMs', 'hemodynamically stable, good UOP', 'repeat hct stable, s/p 1 uPRBC tx in ER', 'C diff ordered', 'Cipro / Flagyl started for low grade temp 100.2', 'worsening abdominal cramping- pain medication']",109,147469.0
2,2141-06-12 11:31:29,,"['A line- unable to flush, attempt at replacement over wire failed,', 'removed, cuff pressures', 'BP near goal of SBP 200.', 'Labetaolol drip re ordered to titrate to SBP 180', 'hyperkalemia resolved', 'MRI/MRA/MRV without contrast of head ordered, unable to adequately', 'perform given motion artifact of head during respiration', 'Neuro consult done- will staff in a.m.', 'Coumadin Held']",,109,147469.0
3,2141-06-13 08:10:45,"['Labetalol gtt off as pt dropped bp to 120s following addition of po', 'meds', 'titrating po meds', 'Neuro recs - consider repeat MRV, Started keppra for seizure prophy', 'Renal wants to start a direct renin inhibitor ASAP - will have to', 'discuss w/ pharmacy in am - non-formulary', 'Unable to trial CPAP o/n - CPAP in use by next door neighbor']","['Labetalol gtt off as pt dropped bp to 120s following addition of po', 'meds', 'titrating po meds', 'Neuro recs - consider repeat MRV, Started keppra for seizure prophy', 'Renal wants to start a direct renin inhibitor ASAP - will have to', 'discuss w/ pharmacy in am - non-formulary', 'Unable to trial CPAP o/n - CPAP in use by next door neighbor']","['A line- unable to flush, attempt at replacement over wire failed,', 'removed, cuff pressures', 'BP near goal of SBP 200.', 'Labetaolol drip re ordered to titrate to SBP 180', 'hyperkalemia resolved', 'MRI/MRA/MRV without contrast of head ordered, unable to adequately', 'perform given motion artifact of head during respiration', 'Neuro consult done- will staff in a.m.', 'Coumadin Held']",109,147469.0
4,2141-06-13 12:22:22,,"['Labetalol gtt off as pt dropped bp to 120s following addition of po', 'meds', 'titrating po meds', 'Neuro recs - consider repeat MRV, Started keppra for seizure prophy', 'Renal wants to start a direct renin inhibitor ASAP - will have to', 'discuss w/ pharmacy in am - non-formulary', 'Unable to trial CPAP o/n - CPAP in use by next door neighbor']",,109,147469.0
5,2141-06-14 07:44:25,"['Did not receive direct renin inhibitor as pharmacy had to order  med.', '[**Month (only) 60**] arrive this AM', 'Increased dose of nifedipine and added back labetalol as persistently', 'hypertensive', 'K of 5.1 in PM  - gave kayexelate', 'Did not get peritoneal dialysis as PD catheter clogged - got AXR to', 'check placement.']","['Did not receive direct renin inhibitor as pharmacy had to order  med.', '[**Month (only) 60**] arrive this AM', 'Increased dose of nifedipine and added back labetalol as persistently', 'hypertensive', 'K of 5.1 in PM  - gave kayexelate', 'Did not get peritoneal dialysis as PD catheter clogged - got AXR to', 'check placement.']","['Labetalol gtt off as pt dropped bp to 120s following addition of po', 'meds', 'titrating po meds', 'Neuro recs - consider repeat MRV, Started keppra for seizure prophy', 'Renal wants to start a direct renin inhibitor ASAP - will have to', 'discuss w/ pharmacy in am - non-formulary', 'Unable to trial CPAP o/n - CPAP in use by next door neighbor']",109,147469.0
6,2141-06-14 10:09:52,,"['Did not receive direct renin inhibitor as pharmacy had to order  med.', '[**Month (only) 60**] arrive this AM', 'Increased dose of nifedipine and added back labetalol as persistently', 'hypertensive', 'K of 5.1 in PM  - gave kayexelate', 'Did not get peritoneal dialysis as PD catheter clogged - got AXR to', 'check placement.']",,109,147469.0
7,2141-06-15 07:27:02,,[],"['Did not receive direct renin inhibitor as pharmacy had to order  med.', '[**Month (only) 60**] arrive this AM', 'Increased dose of nifedipine and added back labetalol as persistently', 'hypertensive', 'K of 5.1 in PM  - gave kayexelate', 'Did not get peritoneal dialysis as PD catheter clogged - got AXR to', 'check placement.']",109,147469.0
8,2141-06-15 13:03:31,"['increased nifedipine to home dose of 90mg [**Hospital1 **]', 'labetalol to home dose of 900mg tid', 'started renin inhibitor at starting dose', 'PD cathter in wrong place, repeat upright KUB performed', 'lactulose written until two soft BMs to help w/ PD catheter placement.', 'direct renin inhibitor started', 'per renal start prn hydral.  25mg po hydral q8hrs started for SBP >', '160.  Patient ideally will continue this sliding scale at home.', '11 p.m. BP 220/120- given 25mg po hydral prn dose x 1 and gave', 'additional 20mg IV labetalol']","['increased nifedipine to home dose of 90mg [**Hospital1 **]', 'labetalol to home dose of 900mg tid', 'started renin inhibitor at starting dose', 'PD cathter in wrong place, repeat upright KUB performed', 'lactulose written until two soft BMs to help w/ PD catheter placement.', 'direct renin inhibitor started', 'per renal start prn hydral.  25mg po hydral q8hrs started for SBP >', '160.  Patient ideally will continue this sliding scale at home.', '11 p.m. BP 220/120- given 25mg po hydral prn dose x 1 and gave', 'additional 20mg IV labetalol']",,109,147469.0
9,2141-06-15 13:07:18,,"['increased nifedipine to home dose of 90mg [**Hospital1 **]', 'labetalol to home dose of 900mg tid', 'started renin inhibitor at starting dose', 'PD cathter in wrong place, repeat upright KUB performed', 'lactulose written until two soft BMs to help w/ PD catheter placement.', 'direct renin inhibitor started', 'per renal start prn hydral.  25mg po hydral q8hrs started for SBP >', '160.  Patient ideally will continue this sliding scale at home.', '11 p.m. BP 220/120- given 25mg po hydral prn dose x 1 and gave', 'additional 20mg IV labetalol']",,109,147469.0
0,2141-09-06 07:11:20,,"['- Pt took morning and noon meds prior to arrival.  Gave night time', 'doses with some decrease in BPs']",,109,131345.0
1,2141-09-06 07:46:06,"['- Due for am meds', ' will eval need for labetalol drip at that time']","['- Pt took morning and noon meds prior to arrival.  Gave night time', 'doses with some decrease in BPs', '- Due for am meds', ' will eval need for labetalol drip at that time']",,109,131345.0
2,2141-09-06 09:58:15,"['doses with some decrease in BPs.  Goal SBP <200', '- HCT decreased to 18.6.  Might req transfusion however the volume may', 'be too much.  Will wait until renal evals need for perit dialysis.']","['- Pt took morning and noon meds prior to arrival.  Gave night time', 'doses with some decrease in BPs.  Goal SBP <200', '- Due for am meds', ' will eval need for labetalol drip at that time', '- HCT decreased to 18.6.  Might req transfusion however the volume may', 'be too much.  Will wait until renal evals need for perit dialysis.']",['doses with some decrease in BPs'],109,131345.0
0,2155-03-02 07:55:09,,"['- LIJ central line placed for access', '- serial troponin stable at 0.03', '- After FS <200 pt was given 15 Lantus and Insulin gtt was titrated', 'down and eventually transitioned to SC insulin', '- UOP 50-100cc/hr throughout the night', '- repleted K and Phos']",,5247,103106.0
1,2155-03-02 10:53:57,,"['- LIJ central line placed for access', '- serial troponin stable at 0.03', '- After FS <200 pt was given 15 Lantus and Insulin gtt was titrated', 'down and eventually transitioned to SC insulin', '- UOP 50-100cc/hr throughout the night', '- repleted K and Phos']",,5247,103106.0
0,2160-12-17 07:17:28,,"['- Patient given extra dose of 12.5 mg of metoprolol for HR in 110', 'with improvement to 90', 's-100', '- Attempted to wean off 35% shovel mask a number of times, but patient', 'de-saturated with attempts at this.', '- Put out about 500 cc to 20 mg IV lasix, given 2^nd dose of 20 mg IV', 'lasix for further diuresis given BP was stable.', '- Repeat ABG with improved pH, minimally improved Co2']",,42346,180391.0
1,2160-12-17 07:33:02,,"['- Patient given extra dose of 12.5 mg of metoprolol for HR in 110', 'with improvement to 90', 's-100', '- Attempted to wean off 35% shovel mask a number of times, but patient', 'de-saturated with attempts at this.', '- Put out about 500 cc to 20 mg IV lasix, given 2^nd dose of 20 mg IV', 'lasix for further diuresis given BP was stable.', '- Repeat ABG with improved pH, minimally improved Co2']",,42346,180391.0
2,2160-12-17 11:12:19,"['- Repeat ABG with improved pH, minimally improved Co2 (facemask was off', 'face at time)', 'Patient reports that she feels well this morning. Her breathing is', 'improved. No dyspnea, chest pain, or other complaints.']","['- Patient given extra dose of 12.5 mg of metoprolol for HR in 110', 'with improvement to 90', 's-100', '- Attempted to wean off 35% shovel mask a number of times, but patient', 'de-saturated with attempts at this.', '- Put out about 500 cc to 20 mg IV lasix, given 2^nd dose of 20 mg IV', 'lasix for further diuresis given BP was stable.', '- Repeat ABG with improved pH, minimally improved Co2 (facemask was off', 'face at time)', 'Patient reports that she feels well this morning. Her breathing is', 'improved. No dyspnea, chest pain, or other complaints.']","['- Repeat ABG with improved pH, minimally improved Co2']",42346,180391.0
3,2160-12-17 11:31:52,,"['- Patient given extra dose of 12.5 mg of metoprolol for HR in 110', 'with improvement to 90', 's-100', '- Attempted to wean off 35% shovel mask a number of times, but patient', 'de-saturated with attempts at this.', '- Put out about 500 cc to 20 mg IV lasix, given 2^nd dose of 20 mg IV', 'lasix for further diuresis given BP was stable.', '- Repeat ABG with improved pH, minimally improved Co2 (facemask was off', 'face at time)', 'Patient reports that she feels well this morning. Her breathing is', 'improved. No dyspnea, chest pain, or other complaints.']",,42346,180391.0
0,2169-12-27 07:48:31,,"['- HD x 2L', '- UF x 2L', '- Weaned Vent to 40% Peep 5 TV 500x 16, pH 7.45 / 44 /113', '- Family came, will try to extubate in AM, they will be in at 9am', '- Became very agitated at ~ 4am, required several proprofol boluses and', '[**1-25**] person restraint. Diaphoretic / tachypneic / tachycardic in A fib', 'wit aberrant conduction.', '- Responded to sedation, no further weaning attempt']",,64407,175035.0
1,2169-12-27 08:04:39,,"['- HD x 2L', '- UF x 2L', '- Weaned Vent to 40% Peep 5 TV 500x 16, pH 7.45 / 44 /113', '- Family came, will try to extubate in AM, they will be in at 9am', '- Became very agitated at ~ 4am, required several proprofol boluses and', '[**1-25**] person restraint. Diaphoretic / tachypneic / tachycardic in A fib', 'wit aberrant conduction.', '- Responded to sedation, no further weaning attempt']",,64407,175035.0
2,2169-12-27 10:16:06,"['wit aberrant conduction.- attempted to increase BB but BP wouldn', 'tolerate']","['- HD x 2L', '- UF x 2L', '- Weaned Vent to 40% Peep 5 TV 500x 16, pH 7.45 / 44 /113', '- Family came, will try to extubate in AM, they will be in at 9am', '- Became very agitated at ~ 4am, required several proprofol boluses and', '[**1-25**] person restraint. Diaphoretic / tachypneic / tachycardic in A fib', 'wit aberrant conduction.- attempted to increase BB but BP wouldn', 'tolerate', '- Responded to sedation, no further weaning attempt']",['wit aberrant conduction.'],64407,175035.0
3,2169-12-28 07:50:38,"['[**12-27**]', '- tolerated HD, but persistant agitation and a-fib w/ RVR during', 'dialysis. Required metoprolol 10mg x2 and dilt 10mg. Converted after', 'dialysis was stopped', '- pt extubated', '- severe, severe, severe agitation requiring 6mg ativan, 5mg valium,', '4mg morphine and 17mg haldol. Still agitated at times. Called PCP and', 'patient takes oxycodone/percocet at home. ~30mg daily.', '- pt improved and slept after getting 22mg IV haldol, 6mg ativan, 5mg', 'valium, 4mg morphine.', '- pt agitated again at 2am given 10mg haldol x2 and 6mg ativan over 2', 'hours. Calmed down and slept afterwards', ' EKG - At [**2169-12-27**] 10:30 AM', ' BLOOD CULTURED - At [**2169-12-27**] 11:08 AM', '2 sets one from HD line one one from a-line', ' INVASIVE VENTILATION - STOP [**2169-12-27**] 02:00 PM', ' ARTERIAL LINE - STOP [**2169-12-27**] 03:08 PM']","['[**12-27**]', '- tolerated HD, but persistant agitation and a-fib w/ RVR during', 'dialysis. Required metoprolol 10mg x2 and dilt 10mg. Converted after', 'dialysis was stopped', '- pt extubated', '- severe, severe, severe agitation requiring 6mg ativan, 5mg valium,', '4mg morphine and 17mg haldol. Still agitated at times. Called PCP and', 'patient takes oxycodone/percocet at home. ~30mg daily.', '- pt improved and slept after getting 22mg IV haldol, 6mg ativan, 5mg', 'valium, 4mg morphine.', '- pt agitated again at 2am given 10mg haldol x2 and 6mg ativan over 2', 'hours. Calmed down and slept afterwards', ' EKG - At [**2169-12-27**] 10:30 AM', ' BLOOD CULTURED - At [**2169-12-27**] 11:08 AM', '2 sets one from HD line one one from a-line', ' INVASIVE VENTILATION - STOP [**2169-12-27**] 02:00 PM', ' ARTERIAL LINE - STOP [**2169-12-27**] 03:08 PM']","['- HD x 2L', '- UF x 2L', '- Weaned Vent to 40% Peep 5 TV 500x 16, pH 7.45 / 44 /113', '- Family came, will try to extubate in AM, they will be in at 9am', '- Became very agitated at ~ 4am, required several proprofol boluses and', '[**1-25**] person restraint. Diaphoretic / tachypneic / tachycardic in A fib', 'wit aberrant conduction.- attempted to increase BB but BP wouldn', 'tolerate', '- Responded to sedation, no further weaning attempt']",64407,175035.0
4,2169-12-28 11:29:41,,"['[**12-27**]', '- tolerated HD, but persistant agitation and a-fib w/ RVR during', 'dialysis. Required metoprolol 10mg x2 and dilt 10mg. Converted after', 'dialysis was stopped', '- pt extubated', '- severe, severe, severe agitation requiring 6mg ativan, 5mg valium,', '4mg morphine and 17mg haldol. Still agitated at times. Called PCP and', 'patient takes oxycodone/percocet at home. ~30mg daily.', '- pt improved and slept after getting 22mg IV haldol, 6mg ativan, 5mg', 'valium, 4mg morphine.', '- pt agitated again at 2am given 10mg haldol x2 and 6mg ativan over 2', 'hours. Calmed down and slept afterwards', ' EKG - At [**2169-12-27**] 10:30 AM', ' BLOOD CULTURED - At [**2169-12-27**] 11:08 AM', '2 sets one from HD line one one from a-line', ' INVASIVE VENTILATION - STOP [**2169-12-27**] 02:00 PM', ' ARTERIAL LINE - STOP [**2169-12-27**] 03:08 PM']",,64407,175035.0
5,2169-12-29 07:12:12,"['-Extreme agitation; pulled IV; could not manage thus intubated/sedated', 'with propofol, fentanyl', '-Psych consulted- recommended Haldol QID and Haldol qid prn; could', 'switch to zyprexa if needed; also recommended considering MRI-->however', 'pt did okay and  was able to be on proprofol only', '-CT head- No acute intracranial process seen on non-contrast CT. If', 'clinically warranted, MI would be recommended for more sensitive', 'assessment of more subtle processes.', '-CXR s/p line placement:', 'New Rt IJ CVL tip in mid-SVC. no PTX. increased ill-defined density in', 'infrahilar Rt lower lung ?aspiration or developing consolidation-->no', ""fever and WBC has been coming down so didn't start abx based on CXR"", 'finding', '-Renal to do HD today', '-Currently tolerating CPAP', ' TRANSTHORACIC ECHO - At [**2169-12-28**] 10:26 AM', ' INVASIVE VENTILATION - START [**2169-12-28**] 03:00 PM', ' MULTI LUMEN - START [**2169-12-28**] 06:45 PM']","['-Extreme agitation; pulled IV; could not manage thus intubated/sedated', 'with propofol, fentanyl', '-Psych consulted- recommended Haldol QID and Haldol qid prn; could', 'switch to zyprexa if needed; also recommended considering MRI-->however', 'pt did okay and  was able to be on proprofol only', '-CT head- No acute intracranial process seen on non-contrast CT. If', 'clinically warranted, MI would be recommended for more sensitive', 'assessment of more subtle processes.', '-CXR s/p line placement:', 'New Rt IJ CVL tip in mid-SVC. no PTX. increased ill-defined density in', 'infrahilar Rt lower lung ?aspiration or developing consolidation-->no', ""fever and WBC has been coming down so didn't start abx based on CXR"", 'finding', '-Renal to do HD today', '-Currently tolerating CPAP', ' TRANSTHORACIC ECHO - At [**2169-12-28**] 10:26 AM', ' INVASIVE VENTILATION - START [**2169-12-28**] 03:00 PM', ' MULTI LUMEN - START [**2169-12-28**] 06:45 PM']","['[**12-27**]', '- tolerated HD, but persistant agitation and a-fib w/ RVR during', 'dialysis. Required metoprolol 10mg x2 and dilt 10mg. Converted after', 'dialysis was stopped', '- pt extubated', '- severe, severe, severe agitation requiring 6mg ativan, 5mg valium,', '4mg morphine and 17mg haldol. Still agitated at times. Called PCP and', 'patient takes oxycodone/percocet at home. ~30mg daily.', '- pt improved and slept after getting 22mg IV haldol, 6mg ativan, 5mg', 'valium, 4mg morphine.', '- pt agitated again at 2am given 10mg haldol x2 and 6mg ativan over 2', 'hours. Calmed down and slept afterwards', ' EKG - At [**2169-12-27**] 10:30 AM', ' BLOOD CULTURED - At [**2169-12-27**] 11:08 AM', '2 sets one from HD line one one from a-line', ' INVASIVE VENTILATION - STOP [**2169-12-27**] 02:00 PM', ' ARTERIAL LINE - STOP [**2169-12-27**] 03:08 PM']",64407,175035.0
6,2169-12-29 09:44:19,,"['-Extreme agitation; pulled IV; could not manage thus intubated/sedated', 'with propofol, fentanyl', '-Psych consulted- recommended Haldol QID and Haldol qid prn; could', 'switch to zyprexa if needed; also recommended considering MRI-->however', 'pt did okay and  was able to be on proprofol only', '-CT head- No acute intracranial process seen on non-contrast CT. If', 'clinically warranted, MI would be recommended for more sensitive', 'assessment of more subtle processes.', '-CXR s/p line placement:', 'New Rt IJ CVL tip in mid-SVC. no PTX. increased ill-defined density in', 'infrahilar Rt lower lung ?aspiration or developing consolidation-->no', ""fever and WBC has been coming down so didn't start abx based on CXR"", 'finding', '-Renal to do HD today', '-Currently tolerating CPAP', ' TRANSTHORACIC ECHO - At [**2169-12-28**] 10:26 AM', ' INVASIVE VENTILATION - START [**2169-12-28**] 03:00 PM', ' MULTI LUMEN - START [**2169-12-28**] 06:45 PM']",,64407,175035.0
7,2169-12-30 07:50:28,"['EKG - At [**2169-12-29**] 09:59 AM', ' LUMBAR PUNCTURE - At [**2169-12-29**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-12-29**] 09:02 PM', '[**12-29**]', '- Continues to be agitated, requiring large amount of sedation', '- ECG with a fib with RVR', '- Started Diltiazem 90mg PO QID for rate control, Dilt gtt for RVR', '- LP performed, 1WBC, 1RBC, Protein', 'Protein 41/Glucose 68/WBC 2/RBC 1/ Poly 4 /Lymph  33/Mono 63/', '- MRI obtained', '- Started Heparin gtt for a fib', '- Given Haldol this AM, will continue to schedule', '- Family continued to call through the night for MD discussion in spite', 'of 6pm meeting']","['EKG - At [**2169-12-29**] 09:59 AM', ' LUMBAR PUNCTURE - At [**2169-12-29**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-12-29**] 09:02 PM', '[**12-29**]', '- Continues to be agitated, requiring large amount of sedation', '- ECG with a fib with RVR', '- Started Diltiazem 90mg PO QID for rate control, Dilt gtt for RVR', '- LP performed, 1WBC, 1RBC, Protein', 'Protein 41/Glucose 68/WBC 2/RBC 1/ Poly 4 /Lymph  33/Mono 63/', '- MRI obtained', '- Started Heparin gtt for a fib', '- Given Haldol this AM, will continue to schedule', '- Family continued to call through the night for MD discussion in spite', 'of 6pm meeting']","['-Extreme agitation; pulled IV; could not manage thus intubated/sedated', 'with propofol, fentanyl', '-Psych consulted- recommended Haldol QID and Haldol qid prn; could', 'switch to zyprexa if needed; also recommended considering MRI-->however', 'pt did okay and  was able to be on proprofol only', '-CT head- No acute intracranial process seen on non-contrast CT. If', 'clinically warranted, MI would be recommended for more sensitive', 'assessment of more subtle processes.', '-CXR s/p line placement:', 'New Rt IJ CVL tip in mid-SVC. no PTX. increased ill-defined density in', 'infrahilar Rt lower lung ?aspiration or developing consolidation-->no', ""fever and WBC has been coming down so didn't start abx based on CXR"", 'finding', '-Renal to do HD today', '-Currently tolerating CPAP', ' TRANSTHORACIC ECHO - At [**2169-12-28**] 10:26 AM', ' INVASIVE VENTILATION - START [**2169-12-28**] 03:00 PM', ' MULTI LUMEN - START [**2169-12-28**] 06:45 PM']",64407,175035.0
8,2169-12-30 07:57:59,"['- Received 2x 500ml boluses for hypotension in setting of profound', 'sedation']","['EKG - At [**2169-12-29**] 09:59 AM', ' LUMBAR PUNCTURE - At [**2169-12-29**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-12-29**] 09:02 PM', '[**12-29**]', '- Continues to be agitated, requiring large amount of sedation', '- ECG with a fib with RVR', '- Received 2x 500ml boluses for hypotension in setting of profound', 'sedation', '- Started Diltiazem 90mg PO QID for rate control, Dilt gtt for RVR', '- LP performed, 1WBC, 1RBC, Protein', 'Protein 41/Glucose 68/WBC 2/RBC 1/ Poly 4 /Lymph  33/Mono 63/', '- MRI obtained', '- Started Heparin gtt for a fib', '- Given Haldol this AM, will continue to schedule', '- Family continued to call through the night for MD discussion in spite', 'of 6pm meeting']",,64407,175035.0
9,2169-12-30 09:29:31,,"['EKG - At [**2169-12-29**] 09:59 AM', ' LUMBAR PUNCTURE - At [**2169-12-29**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-12-29**] 09:02 PM', '[**12-29**]', '- Continues to be agitated, requiring large amount of sedation', '- ECG with a fib with RVR', '- Received 2x 500ml boluses for hypotension in setting of profound', 'sedation', '- Started Diltiazem 90mg PO QID for rate control, Dilt gtt for RVR', '- LP performed, 1WBC, 1RBC, Protein', 'Protein 41/Glucose 68/WBC 2/RBC 1/ Poly 4 /Lymph  33/Mono 63/', '- MRI obtained', '- Started Heparin gtt for a fib', '- Given Haldol this AM, will continue to schedule', '- Family continued to call through the night for MD discussion in spite', 'of 6pm meeting']",,64407,175035.0
10,2169-12-31 07:15:57,"['EKG - At [**2169-12-30**] 09:00 PM', ' EKG - At [**2169-12-31**] 12:00 AM', '- Continues to be agitated', '- MRI No evidence of acute infarct, mass effect, or hydrocephalus', 'identified.', '- CSF culture and HSV PCR still pending', '- Standing haldol, difficult to wean propofol (although gtt was', 'miscalculated on metavision, actually only on 45 (not 90).', '- started dilt gtt because persistant RVR despite IV pushes. Titrated', 'down to 5mg/hr']","['EKG - At [**2169-12-30**] 09:00 PM', ' EKG - At [**2169-12-31**] 12:00 AM', '- Continues to be agitated', '- MRI No evidence of acute infarct, mass effect, or hydrocephalus', 'identified.', '- CSF culture and HSV PCR still pending', '- Standing haldol, difficult to wean propofol (although gtt was', 'miscalculated on metavision, actually only on 45 (not 90).', '- started dilt gtt because persistant RVR despite IV pushes. Titrated', 'down to 5mg/hr']","['EKG - At [**2169-12-29**] 09:59 AM', ' LUMBAR PUNCTURE - At [**2169-12-29**] 02:00 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-12-29**] 09:02 PM', '[**12-29**]', '- Continues to be agitated, requiring large amount of sedation', '- ECG with a fib with RVR', '- Received 2x 500ml boluses for hypotension in setting of profound', 'sedation', '- Started Diltiazem 90mg PO QID for rate control, Dilt gtt for RVR', '- LP performed, 1WBC, 1RBC, Protein', 'Protein 41/Glucose 68/WBC 2/RBC 1/ Poly 4 /Lymph  33/Mono 63/', '- MRI obtained', '- Started Heparin gtt for a fib', '- Given Haldol this AM, will continue to schedule', '- Family continued to call through the night for MD discussion in spite', 'of 6pm meeting']",64407,175035.0
11,2169-12-31 09:49:24,,"['EKG - At [**2169-12-30**] 09:00 PM', ' EKG - At [**2169-12-31**] 12:00 AM', '- Continues to be agitated', '- MRI No evidence of acute infarct, mass effect, or hydrocephalus', 'identified.', '- CSF culture and HSV PCR still pending', '- Standing haldol, difficult to wean propofol (although gtt was', 'miscalculated on metavision, actually only on 45 (not 90).', '- started dilt gtt because persistant RVR despite IV pushes. Titrated', 'down to 5mg/hr']",,64407,175035.0
12,2170-01-01 07:10:45,"['-Added Metoprolol 12.5mg TID', '-Weaning diltizem gtt', '-Started Precedex', '-Renal: if plan to resume feeding consider Sevelamer for phosphate', 'control, check albumin and/or ICa to monitor hypercalcemia', '-Off dilt gtt', '-still getting Propofol but weaned down', 'History obtained from Family / [**Hospital 380**] Medical records']","['-Added Metoprolol 12.5mg TID', '-Weaning diltizem gtt', '-Started Precedex', '-Renal: if plan to resume feeding consider Sevelamer for phosphate', 'control, check albumin and/or ICa to monitor hypercalcemia', '-Off dilt gtt', '-still getting Propofol but weaned down', 'History obtained from Family / [**Hospital 380**] Medical records']","['EKG - At [**2169-12-30**] 09:00 PM', ' EKG - At [**2169-12-31**] 12:00 AM', '- Continues to be agitated', '- MRI No evidence of acute infarct, mass effect, or hydrocephalus', 'identified.', '- CSF culture and HSV PCR still pending', '- Standing haldol, difficult to wean propofol (although gtt was', 'miscalculated on metavision, actually only on 45 (not 90).', '- started dilt gtt because persistant RVR despite IV pushes. Titrated', 'down to 5mg/hr']",64407,175035.0
13,2170-01-01 10:41:04,,"['-Added Metoprolol 12.5mg TID', '-Weaning diltizem gtt', '-Started Precedex', '-Renal: if plan to resume feeding consider Sevelamer for phosphate', 'control, check albumin and/or ICa to monitor hypercalcemia', '-Off dilt gtt', '-still getting Propofol but weaned down', 'History obtained from Family / [**Hospital 380**] Medical records']",,64407,175035.0
14,2170-01-02 07:50:14,"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2170-1-1**] 09:50 AM', ' INVASIVE VENTILATION - STOP [**2170-1-1**] 09:50 AM', '- Self extubated during rounds', '- Required some precedex after extubation, weaned off however and quiet', 'on zyprexa']","['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2170-1-1**] 09:50 AM', ' INVASIVE VENTILATION - STOP [**2170-1-1**] 09:50 AM', '- Self extubated during rounds', '- Required some precedex after extubation, weaned off however and quiet', 'on zyprexa']","['-Added Metoprolol 12.5mg TID', '-Weaning diltizem gtt', '-Started Precedex', '-Renal: if plan to resume feeding consider Sevelamer for phosphate', 'control, check albumin and/or ICa to monitor hypercalcemia', '-Off dilt gtt', '-still getting Propofol but weaned down', 'History obtained from Family / [**Hospital 380**] Medical records']",64407,175035.0
15,2170-01-02 07:51:06,,"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2170-1-1**] 09:50 AM', ' INVASIVE VENTILATION - STOP [**2170-1-1**] 09:50 AM', '- Self extubated during rounds', '- Required some precedex after extubation, weaned off however and quiet', 'on zyprexa']",,64407,175035.0
16,2170-01-02 11:06:26,,"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2170-1-1**] 09:50 AM', ' INVASIVE VENTILATION - STOP [**2170-1-1**] 09:50 AM', '- Self extubated during rounds', '- Required some precedex after extubation, weaned off however and quiet', 'on zyprexa']",,64407,175035.0
17,2170-01-03 07:56:30,['- Updated family: were concerned that he is still confused.'],['- Updated family: were concerned that he is still confused.'],"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2170-1-1**] 09:50 AM', ' INVASIVE VENTILATION - STOP [**2170-1-1**] 09:50 AM', '- Self extubated during rounds', '- Required some precedex after extubation, weaned off however and quiet', 'on zyprexa']",64407,175035.0
18,2170-01-03 11:37:40,,['- Updated family: were concerned that he is still confused.'],,64407,175035.0
0,2182-10-11 07:46:31,,"['NASAL SWAB - At [**2182-10-10**] 11:29 PM', 'MRSA screening', 'Received valium 5mg PO x 1 at 11pm', 'History obtained from [**Hospital 85**] Medical records']",,5060,193317.0
1,2182-10-11 09:19:15,"['Received valium1 5mg PO  total since in ICU, had 50mg in ER', 'Tx with for scabies with cream']","['NASAL SWAB - At [**2182-10-10**] 11:29 PM', 'MRSA screening', 'Received valium1 5mg PO  total since in ICU, had 50mg in ER', 'Tx with for scabies with cream', 'History obtained from [**Hospital 85**] Medical records']",['Received valium 5mg PO x 1 at 11pm'],5060,193317.0
2,2182-10-11 09:47:47,,"['NASAL SWAB - At [**2182-10-10**] 11:29 PM', 'MRSA screening', 'Received valium1 5mg PO  total since in ICU, had 50mg in ER', 'Tx with for scabies with cream', 'History obtained from [**Hospital 85**] Medical records']",,5060,193317.0
0,2182-12-11 07:43:15,,"['MULTI LUMEN - START [**2182-12-10**] 07:28 PM', ' EKG - At [**2182-12-10**] 08:00 PM', 'o/n, nurse reported that pt got 40mg valium and became apenic w sats', '(reportedly) as low as 40', 's. He was easily arousable and sats quickly', 'recovered, he slept well the rest of the night w/o incident.']",,5060,119255.0
1,2182-12-11 11:01:11,,"['MULTI LUMEN - START [**2182-12-10**] 07:28 PM', ' EKG - At [**2182-12-10**] 08:00 PM', 'o/n, nurse reported that pt got 40mg valium and became apenic w sats', '(reportedly) as low as 40', 's. He was easily arousable and sats quickly', 'recovered, he slept well the rest of the night w/o incident.']",,5060,119255.0
2,2182-12-12 07:25:47,"['-Per psych recs, a decision was made to put the patient on standing', 'Valium 5mg q6hrs and d/c CIWA scale.  The patient continued to ask for', 'more benzos.', '- Pt. was switched to Thiamine IV 100mg daily']","['-Per psych recs, a decision was made to put the patient on standing', 'Valium 5mg q6hrs and d/c CIWA scale.  The patient continued to ask for', 'more benzos.', '- Pt. was switched to Thiamine IV 100mg daily']","['MULTI LUMEN - START [**2182-12-10**] 07:28 PM', ' EKG - At [**2182-12-10**] 08:00 PM', 'o/n, nurse reported that pt got 40mg valium and became apenic w sats', '(reportedly) as low as 40', 's. He was easily arousable and sats quickly', 'recovered, he slept well the rest of the night w/o incident.']",5060,119255.0
3,2182-12-12 15:16:42,"['- Per psych recs, a decision was made to put the patient on standing', '- Pt had intermittent apnea yesterday, attributed to Valium']","['- Per psych recs, a decision was made to put the patient on standing', 'Valium 5mg q6hrs and d/c CIWA scale.  The patient continued to ask for', 'more benzos.', '- Pt. was switched to Thiamine IV 100mg daily', '- Pt had intermittent apnea yesterday, attributed to Valium']","['-Per psych recs, a decision was made to put the patient on standing']",5060,119255.0
0,2183-01-30 08:09:14,,['MULTI LUMEN - START [**2183-1-30**] 12:38 AM'],,5060,148207.0
1,2183-01-30 09:30:28,,['MULTI LUMEN - START [**2183-1-30**] 12:38 AM'],,5060,148207.0
2,2183-01-30 11:36:42,"['Complained of pain and withdrawal.  Threatened to leave AMA, but ended', 'up staying.']","['Complained of pain and withdrawal.  Threatened to leave AMA, but ended', 'up staying.']",['MULTI LUMEN - START [**2183-1-30**] 12:38 AM'],5060,148207.0
3,2183-01-30 17:11:19,,"['Complained of pain and withdrawal.  Threatened to leave AMA, but ended', 'up staying.']",,5060,148207.0
0,2190-08-20 06:52:52,,"['ULTRASOUND - At [**2190-8-19**] 09:30 AM', 'renal. Radiology called to reenforce it was a limited study and that', 'renal hypodensities seen on CT showed be f/u later or further', 'investigation with MR. [**Name13 (STitle) **] as NL appearing kidneys BL, One -2mm', 'hypodensity on CT unable to be indentified by US, likely small cyst.', ' SPUTUM CULTURE - At [**2190-8-19**] 11:00 AM', ' MULTI LUMEN - START [**2190-8-19**] 05:00 PM RIJ', ' INDWELLING PORT (PORTACATH) - STOP [**2190-8-19**] 06:10 PM', 'intraosseus iv inserted in R tibia, inserted in [**Hospital1 54**] ER at 1727  on', '[**8-18**]', '-CT abd final - tree in [**Male First Name (un) 667**] opacities in lung bases suggestive of', 'aspiration, hypodensitities in L kidney, no acute bowel process, VP', 'shunt catheter in R hemiabd.', 'Urine cult positive > 100,000 GNR', '- hypotensive to SBP 80 overnight got 1 L bolus and maintainance fluid', '-tachy, partially resonded  to fluid, increased BB to 25mg']",,2208,162248.0
1,2190-08-20 20:06:55,,"['ULTRASOUND - At [**2190-8-19**] 09:30 AM', 'renal. Radiology called to reenforce it was a limited study and that', 'renal hypodensities seen on CT showed be f/u later or further', 'investigation with MR. [**Name13 (STitle) **] as NL appearing kidneys BL, One -2mm', 'hypodensity on CT unable to be indentified by US, likely small cyst.', ' SPUTUM CULTURE - At [**2190-8-19**] 11:00 AM', ' MULTI LUMEN - START [**2190-8-19**] 05:00 PM RIJ', ' INDWELLING PORT (PORTACATH) - STOP [**2190-8-19**] 06:10 PM', 'intraosseus iv inserted in R tibia, inserted in [**Hospital1 54**] ER at 1727  on', '[**8-18**]', '-CT abd final - tree in [**Male First Name (un) 667**] opacities in lung bases suggestive of', 'aspiration, hypodensitities in L kidney, no acute bowel process, VP', 'shunt catheter in R hemiabd.', 'Urine cult positive > 100,000 GNR', '- hypotensive to SBP 80 overnight got 1 L bolus and maintainance fluid', '-tachy, partially resonded  to fluid, increased BB to 25mg']",,2208,162248.0
2,2190-08-21 06:49:57,"['INVASIVE VENTILATION - STOP [**2190-8-20**] 01:37 PM (Extubated)- no', 'issues overnight except required intermittent nasotracheal suctioning', 'Residuals from tube feeds 60 mL after 2 hrs, started Reglan', 'Discussed case with family, understands liklihood of recurrence,', 'interested in rehab facility before return to NH', 'Tube feeds not at goal, started LR IV at 75 mL/hr']","['INVASIVE VENTILATION - STOP [**2190-8-20**] 01:37 PM (Extubated)- no', 'issues overnight except required intermittent nasotracheal suctioning', 'Residuals from tube feeds 60 mL after 2 hrs, started Reglan', 'Discussed case with family, understands liklihood of recurrence,', 'interested in rehab facility before return to NH', 'Tube feeds not at goal, started LR IV at 75 mL/hr']","['ULTRASOUND - At [**2190-8-19**] 09:30 AM', 'renal. Radiology called to reenforce it was a limited study and that', 'renal hypodensities seen on CT showed be f/u later or further', 'investigation with MR. [**Name13 (STitle) **] as NL appearing kidneys BL, One -2mm', 'hypodensity on CT unable to be indentified by US, likely small cyst.', ' SPUTUM CULTURE - At [**2190-8-19**] 11:00 AM', ' MULTI LUMEN - START [**2190-8-19**] 05:00 PM RIJ', ' INDWELLING PORT (PORTACATH) - STOP [**2190-8-19**] 06:10 PM', 'intraosseus iv inserted in R tibia, inserted in [**Hospital1 54**] ER at 1727  on', '[**8-18**]', '-CT abd final - tree in [**Male First Name (un) 667**] opacities in lung bases suggestive of', 'aspiration, hypodensitities in L kidney, no acute bowel process, VP', 'shunt catheter in R hemiabd.', 'Urine cult positive > 100,000 GNR', '- hypotensive to SBP 80 overnight got 1 L bolus and maintainance fluid', '-tachy, partially resonded  to fluid, increased BB to 25mg']",2208,162248.0
3,2190-08-21 06:50:57,,"['INVASIVE VENTILATION - STOP [**2190-8-20**] 01:37 PM (Extubated)- no', 'issues overnight except required intermittent nasotracheal suctioning', 'Residuals from tube feeds 60 mL after 2 hrs, started Reglan', 'Discussed case with family, understands liklihood of recurrence,', 'interested in rehab facility before return to NH', 'Tube feeds not at goal, started LR IV at 75 mL/hr']",,2208,162248.0
4,2190-08-21 14:05:54,,"['INVASIVE VENTILATION - STOP [**2190-8-20**] 01:37 PM (Extubated)- no', 'issues overnight except required intermittent nasotracheal suctioning', 'Residuals from tube feeds 60 mL after 2 hrs, started Reglan', 'Discussed case with family, understands liklihood of recurrence,', 'interested in rehab facility before return to NH', 'Tube feeds not at goal, started LR IV at 75 mL/hr']",,2208,162248.0
0,2190-09-24 05:27:22,,"['IVF boluses for presure.  Pt continued to call out ""agua""', 'Heparin gtt started.  Cards consulted']",,2208,144187.0
1,2190-09-24 10:05:12,,"['IVF boluses for presure.  Pt continued to call out ""agua""', 'Heparin gtt started.  Cards consulted']",,2208,144187.0
0,2191-10-07 07:23:19,,"['MULTI LUMEN - START [**2191-10-6**] 05:55 PM', '-patient received 2L NS overnight, still hadSBP in the 70s, levofed', 'turned on 0.05mcg for goal MAP>55']",,2208,166923.0
1,2191-10-07 07:29:19,,"['MULTI LUMEN - START [**2191-10-6**] 05:55 PM', '-patient received 2L NS overnight, still hadSBP in the 70s, levofed', 'turned on 0.05mcg for goal MAP>55']",,2208,166923.0
2,2191-10-07 07:31:21,,"['MULTI LUMEN - START [**2191-10-6**] 05:55 PM', '-patient received 2L NS overnight, still hadSBP in the 70s, levofed', 'turned on 0.05mcg for goal MAP>55']",,2208,166923.0
3,2191-10-07 10:05:51,"['-patient received 2L NS overnight, still hadSBP in the 70s, levophed', '- during rounds, pt SBP dropped to 60-70s and HR down to 40s, atropine', 'x 1 and bicarb x 1 given', '- attempted a-line']","['MULTI LUMEN - START [**2191-10-6**] 05:55 PM', '-patient received 2L NS overnight, still hadSBP in the 70s, levophed', 'turned on 0.05mcg for goal MAP>55', '- during rounds, pt SBP dropped to 60-70s and HR down to 40s, atropine', 'x 1 and bicarb x 1 given', '- attempted a-line']","['-patient received 2L NS overnight, still hadSBP in the 70s, levofed']",2208,166923.0
4,2191-10-08 07:48:51,"['PERI-CODE - At [**2191-10-7**] 10:46 AM', ""sbp 65/ HR 30's pt unresponsive given 1 amp of atropine and 1 amp na"", 'bicarb. levophed was turned up to .5mcg/kg/min patient responded he was', 'also given 2l NS bolus, 4gm caliciu gluconate and 20 meq kcl. levophed', 'weaned per bp blood glucose 364', '- had bradycardic event yesterday requiring 1mg atropine, sodium', 'bicarb.', '- levophed was increased in the morning to 0.7; though with fluid', 'boluses and time was able to be weaned off', '- Sodium managed with increasing free water boluses and 1/2NS', '- Tube feeds restarted', '- family met and updated. Decision for full code reviewed and', 'confirmed.']","['PERI-CODE - At [**2191-10-7**] 10:46 AM', ""sbp 65/ HR 30's pt unresponsive given 1 amp of atropine and 1 amp na"", 'bicarb. levophed was turned up to .5mcg/kg/min patient responded he was', 'also given 2l NS bolus, 4gm caliciu gluconate and 20 meq kcl. levophed', 'weaned per bp blood glucose 364', '- had bradycardic event yesterday requiring 1mg atropine, sodium', 'bicarb.', '- levophed was increased in the morning to 0.7; though with fluid', 'boluses and time was able to be weaned off', '- Sodium managed with increasing free water boluses and 1/2NS', '- Tube feeds restarted', '- family met and updated. Decision for full code reviewed and', 'confirmed.']","['MULTI LUMEN - START [**2191-10-6**] 05:55 PM', '-patient received 2L NS overnight, still hadSBP in the 70s, levophed', 'turned on 0.05mcg for goal MAP>55', '- during rounds, pt SBP dropped to 60-70s and HR down to 40s, atropine', 'x 1 and bicarb x 1 given', '- attempted a-line']",2208,166923.0
5,2191-10-08 08:02:04,,"['PERI-CODE - At [**2191-10-7**] 10:46 AM', ""sbp 65/ HR 30's pt unresponsive given 1 amp of atropine and 1 amp na"", 'bicarb. levophed was turned up to .5mcg/kg/min patient responded he was', 'also given 2l NS bolus, 4gm caliciu gluconate and 20 meq kcl. levophed', 'weaned per bp blood glucose 364', '- had bradycardic event yesterday requiring 1mg atropine, sodium', 'bicarb.', '- levophed was increased in the morning to 0.7; though with fluid', 'boluses and time was able to be weaned off', '- Sodium managed with increasing free water boluses and 1/2NS', '- Tube feeds restarted', '- family met and updated. Decision for full code reviewed and', 'confirmed.']",,2208,166923.0
6,2191-10-08 10:51:29,,"['PERI-CODE - At [**2191-10-7**] 10:46 AM', ""sbp 65/ HR 30's pt unresponsive given 1 amp of atropine and 1 amp na"", 'bicarb. levophed was turned up to .5mcg/kg/min patient responded he was', 'also given 2l NS bolus, 4gm caliciu gluconate and 20 meq kcl. levophed', 'weaned per bp blood glucose 364', '- had bradycardic event yesterday requiring 1mg atropine, sodium', 'bicarb.', '- levophed was increased in the morning to 0.7; though with fluid', 'boluses and time was able to be weaned off', '- Sodium managed with increasing free water boluses and 1/2NS', '- Tube feeds restarted', '- family met and updated. Decision for full code reviewed and', 'confirmed.']",,2208,166923.0
0,2107-01-09 06:29:49,,"['Pt. was weaned off levophed, and increased w/ dopamine to 7.5mcg/kg/hr', 'w/ MAPs > 70.  Pt. was also weaned off PEEP to 5cm and FiO2 to 60% o/n.', 'Pt. is sedated and unarousable.  BCx and Urine Cx were obtained.']",,28423,130855.0
1,2107-01-09 11:40:05,"['w/ MAPs > 70.  Pt. was also weaned off PEEP to 5cm and FiO2 to 60%', 'o/n.  Pt. is sedated and arousable, denies pain and follows simple', 'commands.  BCx and Urine Cx were obtained.', 'This am, pt was found to be agitated, biting on ETT, with eventual', 'desaturations to 80s and self extubation.  He required immediate', 're-intuabation and received atomidate, succinylcholine and additional', 'doses of fentanyl and Midazolam.']","['Pt. was weaned off levophed, and increased w/ dopamine to 7.5mcg/kg/hr', 'w/ MAPs > 70.  Pt. was also weaned off PEEP to 5cm and FiO2 to 60%', 'o/n.  Pt. is sedated and arousable, denies pain and follows simple', 'commands.  BCx and Urine Cx were obtained.', 'This am, pt was found to be agitated, biting on ETT, with eventual', 'desaturations to 80s and self extubation.  He required immediate', 're-intuabation and received atomidate, succinylcholine and additional', 'doses of fentanyl and Midazolam.']","['w/ MAPs > 70.  Pt. was also weaned off PEEP to 5cm and FiO2 to 60% o/n.', 'Pt. is sedated and unarousable.  BCx and Urine Cx were obtained.']",28423,130855.0
2,2107-01-10 06:26:25,"[""The patient's levophed was weaned off overnight and his dopamine was"", 'increased.  He self-extubated himself this am and was reintubated after', ""he desated to the 80's.  He was started on a lasix gtt (with a goal of"", '[**1-27**] L negative) and has been on a heparin gtt given the balloon pump.', 'His balloon pump was advanced slightly today.  Fluconazole started per', 'transplant surgery.  Patient getting an abdominal US to evaluate for', 'fluid collection which showed (via prelim read) no large perihepatic', 'fluid collection and a small right pleural effusion.  He woke up from', 'sedation (although the sedation was unchanged) and tried to sit up', 'during the day so his sedation was increased and he was placed in', 'restraints given his groin lines.  His Hct check in the afternoon', 'showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to transfuse', 'him a unit of PRBC, however he did not have a blood consent on the', 'chart and his health care proxy could not be reached by phone.  On', 'recheck it was 23.1, so it was decided that as he was stable to defer', 'blood transfusion until consent could be received.']","[""The patient's levophed was weaned off overnight and his dopamine was"", 'increased.  He self-extubated himself this am and was reintubated after', ""he desated to the 80's.  He was started on a lasix gtt (with a goal of"", '[**1-27**] L negative) and has been on a heparin gtt given the balloon pump.', 'His balloon pump was advanced slightly today.  Fluconazole started per', 'transplant surgery.  Patient getting an abdominal US to evaluate for', 'fluid collection which showed (via prelim read) no large perihepatic', 'fluid collection and a small right pleural effusion.  He woke up from', 'sedation (although the sedation was unchanged) and tried to sit up', 'during the day so his sedation was increased and he was placed in', 'restraints given his groin lines.  His Hct check in the afternoon', 'showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to transfuse', 'him a unit of PRBC, however he did not have a blood consent on the', 'chart and his health care proxy could not be reached by phone.  On', 'recheck it was 23.1, so it was decided that as he was stable to defer', 'blood transfusion until consent could be received.']","['Pt. was weaned off levophed, and increased w/ dopamine to 7.5mcg/kg/hr', 'w/ MAPs > 70.  Pt. was also weaned off PEEP to 5cm and FiO2 to 60%', 'o/n.  Pt. is sedated and arousable, denies pain and follows simple', 'commands.  BCx and Urine Cx were obtained.', 'This am, pt was found to be agitated, biting on ETT, with eventual', 'desaturations to 80s and self extubation.  He required immediate', 're-intuabation and received atomidate, succinylcholine and additional', 'doses of fentanyl and Midazolam.']",28423,130855.0
3,2107-01-10 07:57:06,"['He received a dose of 5 mg metolazone overnight and his lasix gtt was', 'increased to 15 mg/hr.  His balloon pump was advanced slightly today.', 'Fluconazole started per transplant surgery.  Patient had an abdominal', 'US to evaluate for fluid collection which showed no large perihepatic', 'This am the patient had a short episode of hypotension so his balloon']","[""The patient's levophed was weaned off overnight and his dopamine was"", 'increased.  He self-extubated himself this am and was reintubated after', ""he desated to the 80's.  He was started on a lasix gtt (with a goal of"", '[**1-27**] L negative) and has been on a heparin gtt given the balloon pump.', 'He received a dose of 5 mg metolazone overnight and his lasix gtt was', 'increased to 15 mg/hr.  His balloon pump was advanced slightly today.', 'Fluconazole started per transplant surgery.  Patient had an abdominal', 'US to evaluate for fluid collection which showed no large perihepatic', 'fluid collection and a small right pleural effusion.  He woke up from', 'sedation (although the sedation was unchanged) and tried to sit up', 'during the day so his sedation was increased and he was placed in', 'restraints given his groin lines.  His Hct check in the afternoon', 'showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to transfuse', 'him a unit of PRBC, however he did not have a blood consent on the', 'chart and his health care proxy could not be reached by phone.  On', 'recheck it was 23.1, so it was decided that as he was stable to defer', 'blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension so his balloon']","['His balloon pump was advanced slightly today.  Fluconazole started per', 'transplant surgery.  Patient getting an abdominal US to evaluate for', 'fluid collection which showed (via prelim read) no large perihepatic']",28423,130855.0
4,2107-01-10 09:38:22,"[""The patient's levophed was weaned off off two nights ago and his"", 'dopamine was increased.  He self-extubated himself yesterday am and was', ""reintubated after he desated to the 80's.  He was started on a lasix"", 'gtt (with a goal of [**1-27**] L negative) and has been on a heparin gtt given', 'the balloon pump.  He received a dose of 5 mg metolazone overnight and', 'his lasix gtt was increased to 15 mg/hr with good response.  His', 'balloon pump was advanced slightly yesterday now with better wave', 'forms.  Fluconazole was started per transplant surgery.  Patient had an', 'abdominal US to evaluate for fluid collection which showed no large', 'perihepatic fluid collection and a small right pleural effusion.  He', 'woke up from sedation (although the sedation was unchanged) and tried', 'to sit up during the day so his sedation was increased and he was', 'placed in restraints given his groin lines.  His Hct check in the', 'afternoon showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to', 'transfuse him a unit of PRBC, however he did not have a blood consent', 'on the chart and his health care proxy could not be reached by phone.', 'On recheck it was 23.1, so it was decided that as he was stable to', 'defer blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension this am so his']","[""The patient's levophed was weaned off off two nights ago and his"", 'dopamine was increased.  He self-extubated himself yesterday am and was', ""reintubated after he desated to the 80's.  He was started on a lasix"", 'gtt (with a goal of [**1-27**] L negative) and has been on a heparin gtt given', 'the balloon pump.  He received a dose of 5 mg metolazone overnight and', 'his lasix gtt was increased to 15 mg/hr with good response.  His', 'balloon pump was advanced slightly yesterday now with better wave', 'forms.  Fluconazole was started per transplant surgery.  Patient had an', 'abdominal US to evaluate for fluid collection which showed no large', 'perihepatic fluid collection and a small right pleural effusion.  He', 'woke up from sedation (although the sedation was unchanged) and tried', 'to sit up during the day so his sedation was increased and he was', 'placed in restraints given his groin lines.  His Hct check in the', 'afternoon showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to', 'transfuse him a unit of PRBC, however he did not have a blood consent', 'on the chart and his health care proxy could not be reached by phone.', 'On recheck it was 23.1, so it was decided that as he was stable to', 'defer blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension this am so his']","[""The patient's levophed was weaned off overnight and his dopamine was"", 'increased.  He self-extubated himself this am and was reintubated after', ""he desated to the 80's.  He was started on a lasix gtt (with a goal of"", '[**1-27**] L negative) and has been on a heparin gtt given the balloon pump.', 'He received a dose of 5 mg metolazone overnight and his lasix gtt was', 'increased to 15 mg/hr.  His balloon pump was advanced slightly today.', 'Fluconazole started per transplant surgery.  Patient had an abdominal', 'US to evaluate for fluid collection which showed no large perihepatic', 'fluid collection and a small right pleural effusion.  He woke up from', 'sedation (although the sedation was unchanged) and tried to sit up', 'during the day so his sedation was increased and he was placed in', 'restraints given his groin lines.  His Hct check in the afternoon', 'showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to transfuse', 'him a unit of PRBC, however he did not have a blood consent on the', 'chart and his health care proxy could not be reached by phone.  On', 'recheck it was 23.1, so it was decided that as he was stable to defer', 'blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension so his balloon']",28423,130855.0
5,2107-01-10 09:50:39,,"[""The patient's levophed was weaned off off two nights ago and his"", 'dopamine was increased.  He self-extubated himself yesterday am and was', ""reintubated after he desated to the 80's.  He was started on a lasix"", 'gtt (with a goal of [**1-27**] L negative) and has been on a heparin gtt given', 'the balloon pump.  He received a dose of 5 mg metolazone overnight and', 'his lasix gtt was increased to 15 mg/hr with good response.  His', 'balloon pump was advanced slightly yesterday now with better wave', 'forms.  Fluconazole was started per transplant surgery.  Patient had an', 'abdominal US to evaluate for fluid collection which showed no large', 'perihepatic fluid collection and a small right pleural effusion.  He', 'woke up from sedation (although the sedation was unchanged) and tried', 'to sit up during the day so his sedation was increased and he was', 'placed in restraints given his groin lines.  His Hct check in the', 'afternoon showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to', 'transfuse him a unit of PRBC, however he did not have a blood consent', 'on the chart and his health care proxy could not be reached by phone.', 'On recheck it was 23.1, so it was decided that as he was stable to', 'defer blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension this am so his']",,28423,130855.0
6,2107-01-11 06:31:14,"['EKG - At [**2107-1-10**] 08:00 AM', ' TRANSTHORACIC ECHO - At [**2107-1-10**] 02:19 PM', ' IABP LINE - STOP [**2107-1-10**] 07:00 PM', ' PA CATHETER - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - START [**2107-1-10**] 09:00 PM', 'TTE done on and off pump shows improved systolic function but continues', 'to have distal inferior wall hypokinesis and distal septal', 'hypokinesis.  Received 2 units PRBCs yesterday and HCT improved from 23', ""to 33.  Tacro was d/c'd due to high morning level and AM level checked"", ""today.  Balloon pump d/c'd at 5pm and pt changed from dopamine to"", 'levophed.  Femoral lines removed and L radial a-line placed.']","['EKG - At [**2107-1-10**] 08:00 AM', ' TRANSTHORACIC ECHO - At [**2107-1-10**] 02:19 PM', ' IABP LINE - STOP [**2107-1-10**] 07:00 PM', ' PA CATHETER - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - START [**2107-1-10**] 09:00 PM', 'TTE done on and off pump shows improved systolic function but continues', 'to have distal inferior wall hypokinesis and distal septal', 'hypokinesis.  Received 2 units PRBCs yesterday and HCT improved from 23', ""to 33.  Tacro was d/c'd due to high morning level and AM level checked"", ""today.  Balloon pump d/c'd at 5pm and pt changed from dopamine to"", 'levophed.  Femoral lines removed and L radial a-line placed.']","[""The patient's levophed was weaned off off two nights ago and his"", 'dopamine was increased.  He self-extubated himself yesterday am and was', ""reintubated after he desated to the 80's.  He was started on a lasix"", 'gtt (with a goal of [**1-27**] L negative) and has been on a heparin gtt given', 'the balloon pump.  He received a dose of 5 mg metolazone overnight and', 'his lasix gtt was increased to 15 mg/hr with good response.  His', 'balloon pump was advanced slightly yesterday now with better wave', 'forms.  Fluconazole was started per transplant surgery.  Patient had an', 'abdominal US to evaluate for fluid collection which showed no large', 'perihepatic fluid collection and a small right pleural effusion.  He', 'woke up from sedation (although the sedation was unchanged) and tried', 'to sit up during the day so his sedation was increased and he was', 'placed in restraints given his groin lines.  His Hct check in the', 'afternoon showed a 3 point Hct drop from 26.2 to 23.1.  We wanted to', 'transfuse him a unit of PRBC, however he did not have a blood consent', 'on the chart and his health care proxy could not be reached by phone.', 'On recheck it was 23.1, so it was decided that as he was stable to', 'defer blood transfusion until consent could be received.', 'This am the patient had a short episode of hypotension this am so his']",28423,130855.0
7,2107-01-11 10:42:47,"['levophed.  Femoral lines removed and R radial a-line placed.', 'Vent settings weaned to [**5-31**] this morning, 40% FiO2 with RSBI of 29.']","['EKG - At [**2107-1-10**] 08:00 AM', ' TRANSTHORACIC ECHO - At [**2107-1-10**] 02:19 PM', ' IABP LINE - STOP [**2107-1-10**] 07:00 PM', ' PA CATHETER - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - START [**2107-1-10**] 09:00 PM', 'TTE done on and off pump shows improved systolic function but continues', 'to have distal inferior wall hypokinesis and distal septal', 'hypokinesis.  Received 2 units PRBCs yesterday and HCT improved from 23', ""to 33.  Tacro was d/c'd due to high morning level and AM level checked"", ""today.  Balloon pump d/c'd at 5pm and pt changed from dopamine to"", 'levophed.  Femoral lines removed and R radial a-line placed.', 'Vent settings weaned to [**5-31**] this morning, 40% FiO2 with RSBI of 29.']",['levophed.  Femoral lines removed and L radial a-line placed.'],28423,130855.0
8,2107-01-12 06:15:44,"['Extubated successfully in AM.  Off levophed at noon, BPs maintained', 'well until 6pm, when SBP < 80.  I/Os were even, but NPO.', 'Gave 250cc', 'NS bolus as CVP 6 at the time, BP responded to 110s.  Cx data negative', 'to date, Vanco level 21, but Vanc dosing 1g [**Hospital1 **].  A-line removed as was', 'cracked.', 'Per Transplant, holding Tacrolimus, will PTC tomorrow, NP', 'past MN.  Transplant wanted to keep IJ for at least one more day.', 'Patient was agitated early in am, was oriented x1, received zydis 5mg', 'x1 w/ good effect.  On exam has myoclonic jerks, asterexis, and was', 'later A&Ox0, w/ loss of immediate recall.  Started lactulose 30mg Q4h', 'PO prn for 3-4BMs, NPO for PTC, so only received 2 doses, nonetheless,', 'stooled Q1-2hrs, guiac positive.  Received an additional IVF bolus 250', 'for SBP maintenance w/ BMs.']","['Extubated successfully in AM.  Off levophed at noon, BPs maintained', 'well until 6pm, when SBP < 80.  I/Os were even, but NPO.', 'Gave 250cc', 'NS bolus as CVP 6 at the time, BP responded to 110s.  Cx data negative', 'to date, Vanco level 21, but Vanc dosing 1g [**Hospital1 **].  A-line removed as was', 'cracked.', 'Per Transplant, holding Tacrolimus, will PTC tomorrow, NP', 'past MN.  Transplant wanted to keep IJ for at least one more day.', 'Patient was agitated early in am, was oriented x1, received zydis 5mg', 'x1 w/ good effect.  On exam has myoclonic jerks, asterexis, and was', 'later A&Ox0, w/ loss of immediate recall.  Started lactulose 30mg Q4h', 'PO prn for 3-4BMs, NPO for PTC, so only received 2 doses, nonetheless,', 'stooled Q1-2hrs, guiac positive.  Received an additional IVF bolus 250', 'for SBP maintenance w/ BMs.']","['EKG - At [**2107-1-10**] 08:00 AM', ' TRANSTHORACIC ECHO - At [**2107-1-10**] 02:19 PM', ' IABP LINE - STOP [**2107-1-10**] 07:00 PM', ' PA CATHETER - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - STOP [**2107-1-10**] 07:00 PM', ' ARTERIAL LINE - START [**2107-1-10**] 09:00 PM', 'TTE done on and off pump shows improved systolic function but continues', 'to have distal inferior wall hypokinesis and distal septal', 'hypokinesis.  Received 2 units PRBCs yesterday and HCT improved from 23', ""to 33.  Tacro was d/c'd due to high morning level and AM level checked"", ""today.  Balloon pump d/c'd at 5pm and pt changed from dopamine to"", 'levophed.  Femoral lines removed and R radial a-line placed.', 'Vent settings weaned to [**5-31**] this morning, 40% FiO2 with RSBI of 29.']",28423,130855.0
9,2107-01-12 10:48:32,,"['Extubated successfully in AM.  Off levophed at noon, BPs maintained', 'well until 6pm, when SBP < 80.  I/Os were even, but NPO.', 'Gave 250cc', 'NS bolus as CVP 6 at the time, BP responded to 110s.  Cx data negative', 'to date, Vanco level 21, but Vanc dosing 1g [**Hospital1 **].  A-line removed as was', 'cracked.', 'Per Transplant, holding Tacrolimus, will PTC tomorrow, NP', 'past MN.  Transplant wanted to keep IJ for at least one more day.', 'Patient was agitated early in am, was oriented x1, received zydis 5mg', 'x1 w/ good effect.  On exam has myoclonic jerks, asterexis, and was', 'later A&Ox0, w/ loss of immediate recall.  Started lactulose 30mg Q4h', 'PO prn for 3-4BMs, NPO for PTC, so only received 2 doses, nonetheless,', 'stooled Q1-2hrs, guiac positive.  Received an additional IVF bolus 250', 'for SBP maintenance w/ BMs.']",,28423,130855.0
0,2103-12-11 07:11:20,,[],,64893,106250.0
1,2103-12-11 07:12:53,,[],,64893,106250.0
2,2103-12-12 07:25:49,"['1 Unit pRBC with appropriate bump from 22.7 to 28.9', 'Cardiac echo', ' Normal. LVEF was > 55% with no structural wall', 'abnormalities', 'LE Doppler', ' No evidence of DVT', 'Renal U/S', ' No abscesses, unable to see ureters but no signs of', 'hydronephrosis.', 'Furosemide per OB recs @ 5:30 last night. Sats improved from 91% to', '97-99%']","['1 Unit pRBC with appropriate bump from 22.7 to 28.9', 'Cardiac echo', ' Normal. LVEF was > 55% with no structural wall', 'abnormalities', 'LE Doppler', ' No evidence of DVT', 'Renal U/S', ' No abscesses, unable to see ureters but no signs of', 'hydronephrosis.', 'Furosemide per OB recs @ 5:30 last night. Sats improved from 91% to', '97-99%']",,64893,106250.0
3,2103-12-12 08:08:27,,"['1 Unit pRBC with appropriate bump from 22.7 to 28.9', 'Cardiac echo', ' Normal. LVEF was > 55% with no structural wall', 'abnormalities', 'LE Doppler', ' No evidence of DVT', 'Renal U/S', ' No abscesses, unable to see ureters but no signs of', 'hydronephrosis.', 'Furosemide per OB recs @ 5:30 last night. Sats improved from 91% to', '97-99%']",,64893,106250.0
0,2144-12-18 05:56:31,,"['INVASIVE VENTILATION - START [**2144-12-17**] 04:44 PM', 'intubated in ER', ' NASAL SWAB - At [**2144-12-17**] 06:00 PM', ' PICC LINE - START [**2144-12-17**] 06:00 PM', ' SPUTUM CULTURE - At [**2144-12-17**] 06:30 PM', ' EKG - At [**2144-12-17**] 09:30 PM', ' BLOOD CULTURED - At [**2144-12-17**] 10:34 PM', 'second set ( first set ED)', ' BLOOD CULTURED - At [**2144-12-18**] 02:06 AM', 'temp 102.0', ' SPUTUM CULTURE - At [**2144-12-18**] 03:02 AM', ' URINE CULTURE - At [**2144-12-18**] 03:03 AM', ' FEVER - 102.0', 'F - [**2144-12-18**] 02:00 AM']",,40577,144014.0
1,2144-12-18 11:05:04,"['Overnight was febrile to 102 degrees, received Tylenol X 2.  Cultures', 'sent.  Hemodynamically stable.  Has no complaints this AM.']","['Overnight was febrile to 102 degrees, received Tylenol X 2.  Cultures', 'sent.  Hemodynamically stable.  Has no complaints this AM.', ' NASAL SWAB - At [**2144-12-17**] 06:00 PM', ' PICC LINE - START [**2144-12-17**] 06:00 PM', ' SPUTUM CULTURE - At [**2144-12-17**] 06:30 PM', ' EKG - At [**2144-12-17**] 09:30 PM', ' BLOOD CULTURED - At [**2144-12-17**] 10:34 PM', 'second set ( first set ED)', ' BLOOD CULTURED - At [**2144-12-18**] 02:06 AM', 'temp 102.0', ' SPUTUM CULTURE - At [**2144-12-18**] 03:02 AM', ' URINE CULTURE - At [**2144-12-18**] 03:03 AM', ' FEVER - 102.0', 'F - [**2144-12-18**] 02:00 AM']","['INVASIVE VENTILATION - START [**2144-12-17**] 04:44 PM', 'intubated in ER']",40577,144014.0
2,2144-12-19 05:36:57,"['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM']","['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM']","['Overnight was febrile to 102 degrees, received Tylenol X 2.  Cultures', 'sent.  Hemodynamically stable.  Has no complaints this AM.', ' NASAL SWAB - At [**2144-12-17**] 06:00 PM', ' PICC LINE - START [**2144-12-17**] 06:00 PM', ' SPUTUM CULTURE - At [**2144-12-17**] 06:30 PM', ' EKG - At [**2144-12-17**] 09:30 PM', ' BLOOD CULTURED - At [**2144-12-17**] 10:34 PM', 'second set ( first set ED)', ' BLOOD CULTURED - At [**2144-12-18**] 02:06 AM', 'temp 102.0', ' SPUTUM CULTURE - At [**2144-12-18**] 03:02 AM', ' URINE CULTURE - At [**2144-12-18**] 03:03 AM', ' FEVER - 102.0', 'F - [**2144-12-18**] 02:00 AM']",40577,144014.0
3,2144-12-19 05:40:27,"['- CTA and CT of abd with PO contrast only.', '- Obtained an ECHO', '- Speech and Swallow consult for Passy Miur valve placement: need to', 'f/u', '- Midline placed.', '- Wound care consult: will need to touch base with surgery team.', '- Nephrologist indicated that he will need at least 40 of lasix/day', '(80mg/day at home).', '- ISS and Glargine regimine was up-titrated.', '- ID approved the Zosyn.', '- Culture results + for MRSA', '- Guaiac negative stool', '- Anemia labs sent.', '- Trended HCT:']","['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM', '- CTA and CT of abd with PO contrast only.', '- Obtained an ECHO', '- Speech and Swallow consult for Passy Miur valve placement: need to', 'f/u', '- Midline placed.', '- Wound care consult: will need to touch base with surgery team.', '- Nephrologist indicated that he will need at least 40 of lasix/day', '(80mg/day at home).', '- ISS and Glargine regimine was up-titrated.', '- ID approved the Zosyn.', '- Culture results + for MRSA', '- Guaiac negative stool', '- Anemia labs sent.', '- Trended HCT:']",,40577,144014.0
4,2144-12-19 16:21:49,['- Transfused 2 units for dropping hct'],"['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM', '- CTA and CT of abd with PO contrast only.', '- Obtained an ECHO', '- Speech and Swallow consult for Passy Miur valve placement: need to', 'f/u', '- Midline placed.', '- Wound care consult: will need to touch base with surgery team.', '- Nephrologist indicated that he will need at least 40 of lasix/day', '(80mg/day at home).', '- ISS and Glargine regimine was up-titrated.', '- ID approved the Zosyn.', '- Culture results + for MRSA', '- Guaiac negative stool', '- Anemia labs sent.', '- Transfused 2 units for dropping hct']",['- Trended HCT:'],40577,144014.0
5,2144-12-19 16:38:32,,"['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM', '- CTA and CT of abd with PO contrast only.', '- Obtained an ECHO', '- Speech and Swallow consult for Passy Miur valve placement: need to', 'f/u', '- Midline placed.', '- Wound care consult: will need to touch base with surgery team.', '- Nephrologist indicated that he will need at least 40 of lasix/day', '(80mg/day at home).', '- ISS and Glargine regimine was up-titrated.', '- ID approved the Zosyn.', '- Culture results + for MRSA', '- Guaiac negative stool', '- Anemia labs sent.', '- Transfused 2 units for dropping hct']",,40577,144014.0
6,2144-12-20 05:55:43,"['- Surgery wound recs - damp to dry', '- zosyn stopped', '- pm hct stable (23.3)', '- started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic)', '- AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']","['- Surgery wound recs - damp to dry', '- zosyn stopped', '- pm hct stable (23.3)', '- started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic)', '- AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']","['TRANSTHORACIC ECHO - At [**2144-12-18**] 09:19 AM', ' INVASIVE VENTILATION - STOP [**2144-12-18**] 03:00 PM', 'intubated in ER', ' FEVER - 101.2', 'F - [**2144-12-18**] 11:30 PM', '- CTA and CT of abd with PO contrast only.', '- Obtained an ECHO', '- Speech and Swallow consult for Passy Miur valve placement: need to', 'f/u', '- Midline placed.', '- Wound care consult: will need to touch base with surgery team.', '- Nephrologist indicated that he will need at least 40 of lasix/day', '(80mg/day at home).', '- ISS and Glargine regimine was up-titrated.', '- ID approved the Zosyn.', '- Culture results + for MRSA', '- Guaiac negative stool', '- Anemia labs sent.', '- Transfused 2 units for dropping hct']",40577,144014.0
7,2144-12-20 05:56:52,,"['- Surgery wound recs - damp to dry', '- zosyn stopped', '- pm hct stable (23.3)', '- started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic)', '- AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']",,40577,144014.0
8,2144-12-20 07:01:51,,"['- Surgery wound recs - damp to dry', '- zosyn stopped', '- pm hct stable (23.3)', '- started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic)', '- AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']",,40577,144014.0
9,2144-12-20 15:30:22,"['Surgery wound recommends damp to dry', 'Zosyn stopped', 'Pm [**12-19**] hct stable (23.3), 22.7 in AM of [**12-20**]', 'Started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic on admission)', 'AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']","['Surgery wound recommends damp to dry', 'Zosyn stopped', 'Pm [**12-19**] hct stable (23.3), 22.7 in AM of [**12-20**]', 'Started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic on admission)', 'AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']","['- Surgery wound recs - damp to dry', '- zosyn stopped', '- pm hct stable (23.3)', '- started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic)', '- AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']",40577,144014.0
10,2144-12-21 05:37:31,"['Got 40mg IV lasix X 2, diuresed well', 'Abx stopped', 'Pt tolerated trach mask during day']","['Got 40mg IV lasix X 2, diuresed well', 'Abx stopped', 'Pt tolerated trach mask during day']","['Surgery wound recommends damp to dry', 'Zosyn stopped', 'Pm [**12-19**] hct stable (23.3), 22.7 in AM of [**12-20**]', 'Started on low dose metoprolol (part of outpt regimen, but pt.', 'bradycardic on admission)', 'AM lipid panel ordered (pt. not on home antihyperlipidemia regimen)']",40577,144014.0
11,2144-12-21 14:28:22,,"['Got 40mg IV lasix X 2, diuresed well', 'Abx stopped', 'Pt tolerated trach mask during day']",,40577,144014.0
12,2144-12-22 05:46:24,"['NASAL SWAB - At [**2144-12-22**] 12:00 AM', '[**Known lastname **]:', '- Out pt f/u appointment made for anemia work up.', '- Switch to home dose of PO lasix 80 PO Q-AM', ""- Called out - needs rehab, but doesn't want to go to [**Hospital1 25**].""]","['NASAL SWAB - At [**2144-12-22**] 12:00 AM', '[**Known lastname **]:', '- Out pt f/u appointment made for anemia work up.', '- Switch to home dose of PO lasix 80 PO Q-AM', ""- Called out - needs rehab, but doesn't want to go to [**Hospital1 25**].""]","['Got 40mg IV lasix X 2, diuresed well', 'Abx stopped', 'Pt tolerated trach mask during day']",40577,144014.0
13,2144-12-22 06:37:23,,"['NASAL SWAB - At [**2144-12-22**] 12:00 AM', '[**Known lastname **]:', '- Out pt f/u appointment made for anemia work up.', '- Switch to home dose of PO lasix 80 PO Q-AM', ""- Called out - needs rehab, but doesn't want to go to [**Hospital1 25**].""]",,40577,144014.0
14,2144-12-22 07:13:10,,"['NASAL SWAB - At [**2144-12-22**] 12:00 AM', '[**Known lastname **]:', '- Out pt f/u appointment made for anemia work up.', '- Switch to home dose of PO lasix 80 PO Q-AM', ""- Called out - needs rehab, but doesn't want to go to [**Hospital1 25**].""]",,40577,144014.0
15,2144-12-22 14:27:19,"['Pt was restarted on home dose of Lasix 80mg PO qAM.  Tolerated trach', 'mask overnight and throughout day yesterday.', 'No lightheadedness, dizziness, fatigue.  Complaining of some hip pain', 'this morning on the right side.  Able to walk yesterday without', 'difficulty.  Able to tolerate eating foods.']","['NASAL SWAB - At [**2144-12-22**] 12:00 AM', 'Pt was restarted on home dose of Lasix 80mg PO qAM.  Tolerated trach', 'mask overnight and throughout day yesterday.', 'No lightheadedness, dizziness, fatigue.  Complaining of some hip pain', 'this morning on the right side.  Able to walk yesterday without', 'difficulty.  Able to tolerate eating foods.']","['[**Known lastname **]:', '- Out pt f/u appointment made for anemia work up.', '- Switch to home dose of PO lasix 80 PO Q-AM', ""- Called out - needs rehab, but doesn't want to go to [**Hospital1 25**].""]",40577,144014.0
0,2144-11-03 10:41:11,,"['MULTI LUMEN - START [**2144-11-2**] 10:15 PM', 'initiated in er', ' EKG - At [**2144-11-3**] 01:29 AM', 'repeat', ' BLOOD CULTURED - At [**2144-11-3**] 01:29 AM', 'from new tlc in groin  unable to get second set due to access']",,4962,161129.0
1,2144-11-03 12:57:09,"['This morning, patient complains of severe pain in his lower', 'extremities, particularly his left leg, typical of the lower extremity', 'pain that he experiences on a chronic basis.  However, this is more', 'severe, the patient believes, because of immobilization and', 'pneumoboots.']","['MULTI LUMEN - START [**2144-11-2**] 10:15 PM', 'initiated in er', ' EKG - At [**2144-11-3**] 01:29 AM', 'repeat', ' BLOOD CULTURED - At [**2144-11-3**] 01:29 AM', 'from new tlc in groin  unable to get second set due to access', 'This morning, patient complains of severe pain in his lower', 'extremities, particularly his left leg, typical of the lower extremity', 'pain that he experiences on a chronic basis.  However, this is more', 'severe, the patient believes, because of immobilization and', 'pneumoboots.']",,4962,161129.0
2,2144-11-03 13:03:51,['initiated in ER'],"['MULTI LUMEN - START [**2144-11-2**] 10:15 PM', 'initiated in ER', ' EKG - At [**2144-11-3**] 01:29 AM', 'repeat', ' BLOOD CULTURED - At [**2144-11-3**] 01:29 AM', 'from new tlc in groin  unable to get second set due to access', 'This morning, patient complains of severe pain in his lower', 'extremities, particularly his left leg, typical of the lower extremity', 'pain that he experiences on a chronic basis.  However, this is more', 'severe, the patient believes, because of immobilization and', 'pneumoboots.']",['initiated in er'],4962,161129.0
3,2144-11-03 13:05:35,,"['MULTI LUMEN - START [**2144-11-2**] 10:15 PM', 'initiated in ER', ' EKG - At [**2144-11-3**] 01:29 AM', 'repeat', ' BLOOD CULTURED - At [**2144-11-3**] 01:29 AM', 'from new tlc in groin  unable to get second set due to access', 'This morning, patient complains of severe pain in his lower', 'extremities, particularly his left leg, typical of the lower extremity', 'pain that he experiences on a chronic basis.  However, this is more', 'severe, the patient believes, because of immobilization and', 'pneumoboots.']",,4962,161129.0
4,2144-11-04 05:49:11,"['Insulin gtt stopped', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit']","['Insulin gtt stopped', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit']","['MULTI LUMEN - START [**2144-11-2**] 10:15 PM', 'initiated in ER', ' EKG - At [**2144-11-3**] 01:29 AM', 'repeat', ' BLOOD CULTURED - At [**2144-11-3**] 01:29 AM', 'from new tlc in groin  unable to get second set due to access', 'This morning, patient complains of severe pain in his lower', 'extremities, particularly his left leg, typical of the lower extremity', 'pain that he experiences on a chronic basis.  However, this is more', 'severe, the patient believes, because of immobilization and', 'pneumoboots.']",4962,161129.0
5,2144-11-04 13:09:39,"['Insulin gtt stopped at 2 p.m. on [**2144-11-3**]', 'Had HD yesterday [**11-3**]:  took off 3.5 L', 'Renal recs [**2144-11-3**]:  (1) HD, (2) Ca acetate with meals, (3)', 'paracentesis.', 'GI recs [**2144-11-3**]:  (1) paracentesis, (2) liver/GB US', 'Leg pain improved.  Still with left arm pain.  Tolerating PO with no', 'N/V.  Has not had BM since day prior to admission.  No other', 'complaints.']","['Insulin gtt stopped at 2 p.m. on [**2144-11-3**]', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM', 'Had HD yesterday [**11-3**]:  took off 3.5 L', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit', 'Renal recs [**2144-11-3**]:  (1) HD, (2) Ca acetate with meals, (3)', 'paracentesis.', 'GI recs [**2144-11-3**]:  (1) paracentesis, (2) liver/GB US', 'Leg pain improved.  Still with left arm pain.  Tolerating PO with no', 'N/V.  Has not had BM since day prior to admission.  No other', 'complaints.']",['Insulin gtt stopped'],4962,161129.0
6,2144-11-04 13:17:08,,"['Insulin gtt stopped at 2 p.m. on [**2144-11-3**]', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM', 'Had HD yesterday [**11-3**]:  took off 3.5 L', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit', 'Renal recs [**2144-11-3**]:  (1) HD, (2) Ca acetate with meals, (3)', 'paracentesis.', 'GI recs [**2144-11-3**]:  (1) paracentesis, (2) liver/GB US', 'Leg pain improved.  Still with left arm pain.  Tolerating PO with no', 'N/V.  Has not had BM since day prior to admission.  No other', 'complaints.']",,4962,161129.0
7,2144-11-04 13:43:27,,"['Insulin gtt stopped at 2 p.m. on [**2144-11-3**]', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM', 'Had HD yesterday [**11-3**]:  took off 3.5 L', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit', 'Renal recs [**2144-11-3**]:  (1) HD, (2) Ca acetate with meals, (3)', 'paracentesis.', 'GI recs [**2144-11-3**]:  (1) paracentesis, (2) liver/GB US', 'Leg pain improved.  Still with left arm pain.  Tolerating PO with no', 'N/V.  Has not had BM since day prior to admission.  No other', 'complaints.']",,4962,161129.0
8,2144-11-04 13:50:24,"['[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see this', 'AM']","['Insulin gtt stopped at 2 p.m. on [**2144-11-3**]', '[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see this', 'AM', 'Had HD yesterday [**11-3**]:  took off 3.5 L', 'Advanced diet', 'Paracentesis  [**2144-11-3**] 04:16 PM', 'PCP visit', 'Renal recs [**2144-11-3**]:  (1) HD, (2) Ca acetate with meals, (3)', 'paracentesis.', 'GI recs [**2144-11-3**]:  (1) paracentesis, (2) liver/GB US', 'Leg pain improved.  Still with left arm pain.  Tolerating PO with no', 'N/V.  Has not had BM since day prior to admission.  No other', 'complaints.']",['[**Last Name (un) 276**] consult: started on glargine and sliding scale.  Will see in AM'],4962,161129.0
0,2145-07-11 06:55:46,,['- admitted'],,4962,114707.0
1,2145-07-11 10:47:09,,['- admitted'],,4962,114707.0
0,2185-07-02 07:57:53,,"['- refused foley', '- hypoglycemic following aggressive insulin drip titration soon after', 'arrival to micu']",,26901,160675.0
1,2185-07-02 08:01:39,,"['- refused foley', '- hypoglycemic following aggressive insulin drip titration soon after', 'arrival to micu']",,26901,160675.0
2,2185-07-02 08:06:53,,"['- refused foley', '- hypoglycemic following aggressive insulin drip titration soon after', 'arrival to micu']",,26901,160675.0
3,2185-07-02 10:54:11,,"['- refused foley', '- hypoglycemic following aggressive insulin drip titration soon after', 'arrival to micu']",,26901,160675.0
4,2185-07-03 06:59:35,"['- influenza A positive, sent to state lab', ""- d/c'd CTX"", ""- ate overnight, gave glargine, d/c'd insulin gtt""]","['- influenza A positive, sent to state lab', ""- d/c'd CTX"", ""- ate overnight, gave glargine, d/c'd insulin gtt""]","['- refused foley', '- hypoglycemic following aggressive insulin drip titration soon after', 'arrival to micu']",26901,160675.0
5,2185-07-03 10:19:08,"[""- ate overnight, gave [** 3973**], d/c'd insulin gtt""]","['- influenza A positive, sent to state lab', ""- d/c'd CTX"", ""- ate overnight, gave [** 3973**], d/c'd insulin gtt""]","[""- ate overnight, gave glargine, d/c'd insulin gtt""]",26901,160675.0
0,2185-10-09 07:20:49,,"['LUMBAR PUNCTURE - At [**2185-10-8**] 01:38 PM', 'Opening pressure 16-20 with return of clear CSF. Small hematoma noted', 'at insertion site. Procedure tolerated well.', ' FEVER - 101.8', 'F - [**2185-10-8**] 09:00 AM', '-[**Last Name (un) 276**] consulted. recommended 6units lantus daily, home novolog on our', 'same sliding scale. Our pharmacy [**Last Name (un) 10163**] have novolog on formulary, so', 'continued on humalog overnight. Will start on novolog tomorrow AM when', 'brings in own insulin.', ""-BP goal is 150's systolic. On PO meds in addition to labetalol drip."", '-Neuro said difficult to assess while sedated and intubated. Will', 'reassess after comes off sedation. Also asked to consider EEG if MS', '[**Name13 (STitle) 10163**] clear after sedation weaned.', '-On coverage for meningitis. Got one dose of acyclovir, but not written', 'as standing dose. LP performed. Cell counts unremarkable.', '-Head CT shows no acute process preliminarily']",,26901,179730.0
1,2185-10-09 12:41:20,,"['LUMBAR PUNCTURE - At [**2185-10-8**] 01:38 PM', 'Opening pressure 16-20 with return of clear CSF. Small hematoma noted', 'at insertion site. Procedure tolerated well.', ' FEVER - 101.8', 'F - [**2185-10-8**] 09:00 AM', '-[**Last Name (un) 276**] consulted. recommended 6units lantus daily, home novolog on our', 'same sliding scale. Our pharmacy [**Last Name (un) 10163**] have novolog on formulary, so', 'continued on humalog overnight. Will start on novolog tomorrow AM when', 'brings in own insulin.', ""-BP goal is 150's systolic. On PO meds in addition to labetalol drip."", '-Neuro said difficult to assess while sedated and intubated. Will', 'reassess after comes off sedation. Also asked to consider EEG if MS', '[**Name13 (STitle) 10163**] clear after sedation weaned.', '-On coverage for meningitis. Got one dose of acyclovir, but not written', 'as standing dose. LP performed. Cell counts unremarkable.', '-Head CT shows no acute process preliminarily']",,26901,179730.0
2,2185-10-09 13:13:39,,"['LUMBAR PUNCTURE - At [**2185-10-8**] 01:38 PM', 'Opening pressure 16-20 with return of clear CSF. Small hematoma noted', 'at insertion site. Procedure tolerated well.', ' FEVER - 101.8', 'F - [**2185-10-8**] 09:00 AM', '-[**Last Name (un) 276**] consulted. recommended 6units lantus daily, home novolog on our', 'same sliding scale. Our pharmacy [**Last Name (un) 10163**] have novolog on formulary, so', 'continued on humalog overnight. Will start on novolog tomorrow AM when', 'brings in own insulin.', ""-BP goal is 150's systolic. On PO meds in addition to labetalol drip."", '-Neuro said difficult to assess while sedated and intubated. Will', 'reassess after comes off sedation. Also asked to consider EEG if MS', '[**Name13 (STitle) 10163**] clear after sedation weaned.', '-On coverage for meningitis. Got one dose of acyclovir, but not written', 'as standing dose. LP performed. Cell counts unremarkable.', '-Head CT shows no acute process preliminarily']",,26901,179730.0
3,2185-10-09 15:24:21,,"['LUMBAR PUNCTURE - At [**2185-10-8**] 01:38 PM', 'Opening pressure 16-20 with return of clear CSF. Small hematoma noted', 'at insertion site. Procedure tolerated well.', ' FEVER - 101.8', 'F - [**2185-10-8**] 09:00 AM', '-[**Last Name (un) 276**] consulted. recommended 6units lantus daily, home novolog on our', 'same sliding scale. Our pharmacy [**Last Name (un) 10163**] have novolog on formulary, so', 'continued on humalog overnight. Will start on novolog tomorrow AM when', 'brings in own insulin.', ""-BP goal is 150's systolic. On PO meds in addition to labetalol drip."", '-Neuro said difficult to assess while sedated and intubated. Will', 'reassess after comes off sedation. Also asked to consider EEG if MS', '[**Name13 (STitle) 10163**] clear after sedation weaned.', '-On coverage for meningitis. Got one dose of acyclovir, but not written', 'as standing dose. LP performed. Cell counts unremarkable.', '-Head CT shows no acute process preliminarily']",,26901,179730.0
4,2185-10-10 07:24:58,"['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile']","['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile']","['LUMBAR PUNCTURE - At [**2185-10-8**] 01:38 PM', 'Opening pressure 16-20 with return of clear CSF. Small hematoma noted', 'at insertion site. Procedure tolerated well.', ' FEVER - 101.8', 'F - [**2185-10-8**] 09:00 AM', '-[**Last Name (un) 276**] consulted. recommended 6units lantus daily, home novolog on our', 'same sliding scale. Our pharmacy [**Last Name (un) 10163**] have novolog on formulary, so', 'continued on humalog overnight. Will start on novolog tomorrow AM when', 'brings in own insulin.', ""-BP goal is 150's systolic. On PO meds in addition to labetalol drip."", '-Neuro said difficult to assess while sedated and intubated. Will', 'reassess after comes off sedation. Also asked to consider EEG if MS', '[**Name13 (STitle) 10163**] clear after sedation weaned.', '-On coverage for meningitis. Got one dose of acyclovir, but not written', 'as standing dose. LP performed. Cell counts unremarkable.', '-Head CT shows no acute process preliminarily']",26901,179730.0
5,2185-10-10 15:08:28,['-dialysis today'],"['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile', '-dialysis today']",,26901,179730.0
6,2185-10-10 18:45:19,,"['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile', '-dialysis today']",,26901,179730.0
7,2185-10-10 20:42:18,,"['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile', '-dialysis today']",,26901,179730.0
8,2185-10-11 06:57:29,"[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']","[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']","['BLOOD CULTURED - At [**2185-10-9**] 04:13 PM', ' SPUTUM CULTURE - At [**2185-10-9**] 04:13 PM', ' URINE CULTURE - At [**2185-10-9**] 04:13 PM', 'extubated', '-[**Last Name (un) **] recs decreasing lantus to 4', '-neuro ([**Pager number 10169**]) signed off, will need to reconsult as pt appears to', ""have word finding difficulties, may be useful to d/w family pt's"", 'baseline prior to this', '-transfused 1U for hct of 21, bumped to 23.8', '-no new culture data. resp culture contam of sputum. will reorder if pt', 'coughing sputum now that he is extubated', '-SBPs 140s-150s', '-currently npo as mental status still altered. hopefully can give diet', 'tomorrow', '-blood sugars labile', '-dialysis today']",26901,179730.0
9,2185-10-11 10:46:42,,"[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']",,26901,179730.0
10,2185-10-11 10:48:34,,"[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']",,26901,179730.0
11,2185-10-11 14:33:46,,"[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']",,26901,179730.0
12,2185-10-12 07:36:16,"['EKG - At [**2185-10-12**] 01:00 AM', ""-vanc/ceftriaxone dc'ed; will dc acyclovir pending HSV cultures"", '- neuro said okay to d/c EEG, but would still like MRI brain b/c of', 'right sided weakness. Stroke protocol, no contrast.', ""-EEG d/c'ed"", '- Psych said to give haldol PRN agitation, avoid', ""benzo's/anticholinergics. Page psych if need to determine capacity (as"", 'right now he is amenable to workup)', ""- BP's in the 190's at 10pm. Gave hydralazine 20mg PO (takes this [**Hospital1 **]"", 'at home). put on hydral 10mg IV Q6', ""- Labile blood sugars. at 6am, sugar of 90's, at 10pm, sugar of 417."", 'Gave humalog, lantus as [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs. [**Last Name (un) 276**] also said if not eating', 'well, should consider starting D5NS (did not start tonight).', ""-then pressures still in >200's. labetalol 10mg IV. started on a drip."", ""BUT his pressures came down to 175's. so the nurse never started the"", 'drip.']","['EKG - At [**2185-10-12**] 01:00 AM', ""-vanc/ceftriaxone dc'ed; will dc acyclovir pending HSV cultures"", '- neuro said okay to d/c EEG, but would still like MRI brain b/c of', 'right sided weakness. Stroke protocol, no contrast.', ""-EEG d/c'ed"", '- Psych said to give haldol PRN agitation, avoid', ""benzo's/anticholinergics. Page psych if need to determine capacity (as"", 'right now he is amenable to workup)', ""- BP's in the 190's at 10pm. Gave hydralazine 20mg PO (takes this [**Hospital1 **]"", 'at home). put on hydral 10mg IV Q6', ""- Labile blood sugars. at 6am, sugar of 90's, at 10pm, sugar of 417."", 'Gave humalog, lantus as [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs. [**Last Name (un) 276**] also said if not eating', 'well, should consider starting D5NS (did not start tonight).', ""-then pressures still in >200's. labetalol 10mg IV. started on a drip."", ""BUT his pressures came down to 175's. so the nurse never started the"", 'drip.']","[""-pressures still in 180's, not taking PO meds, started enalapril IV"", '(holding lisinopril)', '-psych consulted, recommended MRI which pt unable to comply with', '-neuro rec eeg, which we did not feel pt could comply with', '-orders written for ativan and haldol prn overnight.', '-ativan increased from Q6 prn to Q4 prn, after nurse reported increased', 'agitation, threatening to pull lines.', '-hematuria this am', '-HD yesterday, took off 800cc', '-renal added sevelamer', '-peripheral smear sent to r/o ttp', '-psych says pt does not have capacitu to refuse mri']",26901,179730.0
13,2185-10-12 10:47:38,"['Ordered for', 'today.', 'Dripped was stopped this morning when pressures came down to 170 with', 'very low dose.', '-PO labetolol started.']","['EKG - At [**2185-10-12**] 01:00 AM', ""-vanc/ceftriaxone dc'ed; will dc acyclovir pending HSV cultures"", '- neuro said okay to d/c EEG, but would still like MRI brain b/c of', 'right sided weakness. Stroke protocol, no contrast.', 'Ordered for', 'today.', ""-EEG d/c'ed"", '- Psych said to give haldol PRN agitation, avoid', ""benzo's/anticholinergics. Page psych if need to determine capacity (as"", 'right now he is amenable to workup)', ""- BP's in the 190's at 10pm. Gave hydralazine 20mg PO (takes this [**Hospital1 **]"", 'at home). put on hydral 10mg IV Q6', ""- Labile blood sugars. at 6am, sugar of 90's, at 10pm, sugar of 417."", 'Gave humalog, lantus as [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs. [**Last Name (un) 276**] also said if not eating', 'well, should consider starting D5NS (did not start tonight).', ""-then pressures still in >200's. labetalol 10mg IV. started on a drip."", 'Dripped was stopped this morning when pressures came down to 170 with', 'very low dose.', '-PO labetolol started.']","[""BUT his pressures came down to 175's. so the nurse never started the"", 'drip.']",26901,179730.0
14,2185-10-12 10:58:58,,"['EKG - At [**2185-10-12**] 01:00 AM', ""-vanc/ceftriaxone dc'ed; will dc acyclovir pending HSV cultures"", '- neuro said okay to d/c EEG, but would still like MRI brain b/c of', 'right sided weakness. Stroke protocol, no contrast.', 'Ordered for', 'today.', ""-EEG d/c'ed"", '- Psych said to give haldol PRN agitation, avoid', ""benzo's/anticholinergics. Page psych if need to determine capacity (as"", 'right now he is amenable to workup)', ""- BP's in the 190's at 10pm. Gave hydralazine 20mg PO (takes this [**Hospital1 **]"", 'at home). put on hydral 10mg IV Q6', ""- Labile blood sugars. at 6am, sugar of 90's, at 10pm, sugar of 417."", 'Gave humalog, lantus as [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs. [**Last Name (un) 276**] also said if not eating', 'well, should consider starting D5NS (did not start tonight).', ""-then pressures still in >200's. labetalol 10mg IV. started on a drip."", 'Dripped was stopped this morning when pressures came down to 170 with', 'very low dose.', '-PO labetolol started.']",,26901,179730.0
15,2185-10-12 13:48:16,,"['EKG - At [**2185-10-12**] 01:00 AM', ""-vanc/ceftriaxone dc'ed; will dc acyclovir pending HSV cultures"", '- neuro said okay to d/c EEG, but would still like MRI brain b/c of', 'right sided weakness. Stroke protocol, no contrast.', 'Ordered for', 'today.', ""-EEG d/c'ed"", '- Psych said to give haldol PRN agitation, avoid', ""benzo's/anticholinergics. Page psych if need to determine capacity (as"", 'right now he is amenable to workup)', ""- BP's in the 190's at 10pm. Gave hydralazine 20mg PO (takes this [**Hospital1 **]"", 'at home). put on hydral 10mg IV Q6', ""- Labile blood sugars. at 6am, sugar of 90's, at 10pm, sugar of 417."", 'Gave humalog, lantus as [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs. [**Last Name (un) 276**] also said if not eating', 'well, should consider starting D5NS (did not start tonight).', ""-then pressures still in >200's. labetalol 10mg IV. started on a drip."", 'Dripped was stopped this morning when pressures came down to 170 with', 'very low dose.', '-PO labetolol started.']",,26901,179730.0
0,2186-05-12 05:11:59,,"['DIALYSIS CATHETER - START [**2186-5-11**] 09:15 AM', ' TRANSTHORACIC ECHO - At [**2186-5-11**] 02:49 PM', ' ARTERIAL LINE - START [**2186-5-11**] 06:30 PM', 'Anion gap closing overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized', '-decreased lantus dose', '- holding coumadin', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so got head CT --> negative prelim', '- got IV ativan and on Haldol for agitation', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",,26901,117444.0
1,2186-05-12 06:53:33,,"['DIALYSIS CATHETER - START [**2186-5-11**] 09:15 AM', ' TRANSTHORACIC ECHO - At [**2186-5-11**] 02:49 PM', ' ARTERIAL LINE - START [**2186-5-11**] 06:30 PM', 'Anion gap closing overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized', '-decreased lantus dose', '- holding coumadin', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so got head CT --> negative prelim', '- got IV ativan and on Haldol for agitation', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",,26901,117444.0
2,2186-05-12 11:32:37,"['- anion gap improved overnight', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '- holding Coumadin, on heparin gtt for pulmonary embolism', 'hypercarbia so proceeded to get head CT  which was  negative prelim', '- got IV ativan and on Haldol for agitation per psych recs', '.']","['- anion gap improved overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '-decreased lantus dose', '- holding Coumadin, on heparin gtt for pulmonary embolism', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so proceeded to get head CT  which was  negative prelim', '- got IV ativan and on Haldol for agitation per psych recs', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '.', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']","['DIALYSIS CATHETER - START [**2186-5-11**] 09:15 AM', ' TRANSTHORACIC ECHO - At [**2186-5-11**] 02:49 PM', ' ARTERIAL LINE - START [**2186-5-11**] 06:30 PM', 'Anion gap closing overnight', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized', '- holding coumadin', 'hypercarbia so got head CT --> negative prelim', '- got IV ativan and on Haldol for agitation']",26901,117444.0
3,2186-05-12 12:26:45,,"['- anion gap improved overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '-decreased lantus dose', '- holding Coumadin, on heparin gtt for pulmonary embolism', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so proceeded to get head CT  which was  negative prelim', '- got IV ativan and on Haldol for agitation per psych recs', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '.', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",,26901,117444.0
4,2186-05-12 12:53:16,,"['- anion gap improved overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '-decreased lantus dose', '- holding Coumadin, on heparin gtt for pulmonary embolism', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so proceeded to get head CT  which was  negative prelim', '- got IV ativan and on Haldol for agitation per psych recs', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '.', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",,26901,117444.0
5,2186-05-12 13:16:09,['hypercarbia so proceeded to get head CT  which was negative (prelim)'],"['- anion gap improved overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '-decreased lantus dose', '- holding Coumadin, on heparin gtt for pulmonary embolism', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so proceeded to get head CT  which was negative (prelim)', '- got IV ativan and on Haldol for agitation per psych recs', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '.', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",['hypercarbia so proceeded to get head CT  which was  negative prelim'],26901,117444.0
6,2186-05-13 06:27:12,"['- Oral BP meds increased to 600mg TID labetalol, added norvasc 10mg', 'daily', '- Patient had 4L off at HD, after which dropped SBP to 120s at 1pm [**5-12**],', 'so labetalol gtt turned off, given 500ml IVF bolus. SBP goal range', '160-180s', '- [**Last Name (un) 276**] consulted for labile BS, lantus decreased to 20units daily,', 'sliding scale adjusted. overnight had one FS 461 -> 10 units humalog', '- Per psych, patient cannot leave AMA today, placed on ativan prn', 'dosing for agitation', 'History obtained from Patient']","['- Oral BP meds increased to 600mg TID labetalol, added norvasc 10mg', 'daily', '- Patient had 4L off at HD, after which dropped SBP to 120s at 1pm [**5-12**],', 'so labetalol gtt turned off, given 500ml IVF bolus. SBP goal range', '160-180s', '- [**Last Name (un) 276**] consulted for labile BS, lantus decreased to 20units daily,', 'sliding scale adjusted. overnight had one FS 461 -> 10 units humalog', '- Per psych, patient cannot leave AMA today, placed on ativan prn', 'dosing for agitation', 'History obtained from Patient']","['- anion gap improved overnight', '- placed on insulin drip for FSGs in 460-480s range, then got', 'hypoglycemic to 30s requiring 1AMP dextrose, FSGs normalized to', '120-130s range', '-decreased lantus dose', '- holding Coumadin, on heparin gtt for pulmonary embolism', '-very somnolent s/p dilaudid/IV Ativan--> ABG without significant', 'hypercarbia so proceeded to get head CT  which was negative (prelim)', '- got IV ativan and on Haldol for agitation per psych recs', '- demanded to see psych overnight, very agitated and getting up/', 'yelling, needed to call security', '.', '- TTE: mild pulm HTN, mild MR, mild MVP and LVH, EF 70%']",26901,117444.0
7,2186-05-13 06:29:35,,"['- Oral BP meds increased to 600mg TID labetalol, added norvasc 10mg', 'daily', '- Patient had 4L off at HD, after which dropped SBP to 120s at 1pm [**5-12**],', 'so labetalol gtt turned off, given 500ml IVF bolus. SBP goal range', '160-180s', '- [**Last Name (un) 276**] consulted for labile BS, lantus decreased to 20units daily,', 'sliding scale adjusted. overnight had one FS 461 -> 10 units humalog', '- Per psych, patient cannot leave AMA today, placed on ativan prn', 'dosing for agitation', 'History obtained from Patient']",,26901,117444.0
8,2186-05-13 10:52:08,,"['- Oral BP meds increased to 600mg TID labetalol, added norvasc 10mg', 'daily', '- Patient had 4L off at HD, after which dropped SBP to 120s at 1pm [**5-12**],', 'so labetalol gtt turned off, given 500ml IVF bolus. SBP goal range', '160-180s', '- [**Last Name (un) 276**] consulted for labile BS, lantus decreased to 20units daily,', 'sliding scale adjusted. overnight had one FS 461 -> 10 units humalog', '- Per psych, patient cannot leave AMA today, placed on ativan prn', 'dosing for agitation', 'History obtained from Patient']",,26901,117444.0
0,2180-11-28 05:33:57,,"['- Patient was to be called out in the am, however she had SBPs in the', ""70's to 80's.  Asymptomatic.  Was given 500 cc IVF bolus x 2 with"", 'slight improvment in her pressures.  Was kept in the ICU overnight for', 'continued monitoring.  States her SBPs at home run in the 100s.  Her', ""BP's came up to the 110's to 120's overnight."", ""- Was asked about her OSA and she states she hasn't used CPAP for the"", 'last 2 years.', '- KUB (prelim) showed no evidence of obstruction or ileus.', '- CXR PA and Lat showed: Opacity adjacent to the right heart border', 'that could represent crowding of normal vasculature, however,', 'atelectasis or pneumonia cannot be excluded.', '- PT stated patient was okay to walk with the knee immobilizer.']",,99973,150202.0
1,2180-11-28 12:15:58,,"['- Patient was to be called out in the am, however she had SBPs in the', ""70's to 80's.  Asymptomatic.  Was given 500 cc IVF bolus x 2 with"", 'slight improvment in her pressures.  Was kept in the ICU overnight for', 'continued monitoring.  States her SBPs at home run in the 100s.  Her', ""BP's came up to the 110's to 120's overnight."", ""- Was asked about her OSA and she states she hasn't used CPAP for the"", 'last 2 years.', '- KUB (prelim) showed no evidence of obstruction or ileus.', '- CXR PA and Lat showed: Opacity adjacent to the right heart border', 'that could represent crowding of normal vasculature, however,', 'atelectasis or pneumonia cannot be excluded.', '- PT stated patient was okay to walk with the knee immobilizer.']",,99973,150202.0
2,2180-11-29 07:06:35,['Pt called out yesterday but no bed available'],['Pt called out yesterday but no bed available'],"['- Patient was to be called out in the am, however she had SBPs in the', ""70's to 80's.  Asymptomatic.  Was given 500 cc IVF bolus x 2 with"", 'slight improvment in her pressures.  Was kept in the ICU overnight for', 'continued monitoring.  States her SBPs at home run in the 100s.  Her', ""BP's came up to the 110's to 120's overnight."", ""- Was asked about her OSA and she states she hasn't used CPAP for the"", 'last 2 years.', '- KUB (prelim) showed no evidence of obstruction or ileus.', '- CXR PA and Lat showed: Opacity adjacent to the right heart border', 'that could represent crowding of normal vasculature, however,', 'atelectasis or pneumonia cannot be excluded.', '- PT stated patient was okay to walk with the knee immobilizer.']",99973,150202.0
3,2180-11-29 07:36:42,,['Pt called out yesterday but no bed available'],,99973,150202.0
4,2180-11-29 14:16:29,,['Pt called out yesterday but no bed available'],,99973,150202.0
5,2180-11-29 14:18:58,,['Pt called out yesterday but no bed available'],,99973,150202.0
0,2120-03-16 07:37:33,,"['A line and CVL placed. Started on CTX, Cipro and Vanc.']",,97769,186629.0
1,2120-03-17 07:29:19,"['- back on levophed early in day, took off around 4am', ""- cx growing G(-)R, pansensitive, d/c'd vanco/ctx only on cipro now"", '- pt became tachycardic to 120s - given 1L bolus returned to 70s', '- later became tachycardic again gave lopressor 5 IV x1']","['- back on levophed early in day, took off around 4am', ""- cx growing G(-)R, pansensitive, d/c'd vanco/ctx only on cipro now"", '- pt became tachycardic to 120s - given 1L bolus returned to 70s', '- later became tachycardic again gave lopressor 5 IV x1']","['A line and CVL placed. Started on CTX, Cipro and Vanc.']",97769,186629.0
2,2120-03-17 13:24:04,,"['- back on levophed early in day, took off around 4am', ""- cx growing G(-)R, pansensitive, d/c'd vanco/ctx only on cipro now"", '- pt became tachycardic to 120s - given 1L bolus returned to 70s', '- later became tachycardic again gave lopressor 5 IV x1']",,97769,186629.0
3,2120-03-18 07:22:45,"['- completed amiodarone loading dose, was adequately rate-controlled so', 'no plan for further amiodarone', '- doing well off pressors, no IVF needs', '- plan to c/o in am']","['- completed amiodarone loading dose, was adequately rate-controlled so', 'no plan for further amiodarone', '- doing well off pressors, no IVF needs', '- plan to c/o in am']","['- back on levophed early in day, took off around 4am', ""- cx growing G(-)R, pansensitive, d/c'd vanco/ctx only on cipro now"", '- pt became tachycardic to 120s - given 1L bolus returned to 70s', '- later became tachycardic again gave lopressor 5 IV x1']",97769,186629.0
4,2120-03-19 07:28:52,"['ARTERIAL LINE - STOP [**2120-3-18**] 08:30 AM', ' ULTRASOUND - At [**2120-3-18**] 05:23 PM', ""LENI's done portable"", '- was called out but then developed tachycardia (afib) into 180s and', 'hypertension']","['ARTERIAL LINE - STOP [**2120-3-18**] 08:30 AM', ' ULTRASOUND - At [**2120-3-18**] 05:23 PM', ""LENI's done portable"", '- was called out but then developed tachycardia (afib) into 180s and', 'hypertension']","['- completed amiodarone loading dose, was adequately rate-controlled so', 'no plan for further amiodarone', '- doing well off pressors, no IVF needs', '- plan to c/o in am']",97769,186629.0
5,2120-03-19 12:35:55,"['- pt also started on heparin gtt', '- LENI negative']","['ARTERIAL LINE - STOP [**2120-3-18**] 08:30 AM', ' ULTRASOUND - At [**2120-3-18**] 05:23 PM', ""LENI's done portable"", '- was called out but then developed tachycardia (afib) into 180s and', 'hypertension', '- pt also started on heparin gtt', '- LENI negative']",,97769,186629.0
6,2120-03-20 07:15:41,"['PICC LINE - START [**2120-3-19**] 11:30 AM', 'dual [**Last Name (un) 3122**] 41 cm', ' BLOOD CULTURED - At [**2120-3-19**] 02:32 PM', 'x2', ' MULTI LUMEN - STOP [**2120-3-19**] 04:35 PM']","['PICC LINE - START [**2120-3-19**] 11:30 AM', 'dual [**Last Name (un) 3122**] 41 cm', ' BLOOD CULTURED - At [**2120-3-19**] 02:32 PM', 'x2', ' MULTI LUMEN - STOP [**2120-3-19**] 04:35 PM']","['ARTERIAL LINE - STOP [**2120-3-18**] 08:30 AM', ' ULTRASOUND - At [**2120-3-18**] 05:23 PM', ""LENI's done portable"", '- was called out but then developed tachycardia (afib) into 180s and', 'hypertension', '- pt also started on heparin gtt', '- LENI negative']",97769,186629.0
7,2120-03-20 11:36:52,,"['PICC LINE - START [**2120-3-19**] 11:30 AM', 'dual [**Last Name (un) 3122**] 41 cm', ' BLOOD CULTURED - At [**2120-3-19**] 02:32 PM', 'x2', ' MULTI LUMEN - STOP [**2120-3-19**] 04:35 PM']",,97769,186629.0
8,2120-03-20 13:41:51,,"['PICC LINE - START [**2120-3-19**] 11:30 AM', 'dual [**Last Name (un) 3122**] 41 cm', ' BLOOD CULTURED - At [**2120-3-19**] 02:32 PM', 'x2', ' MULTI LUMEN - STOP [**2120-3-19**] 04:35 PM']",,97769,186629.0
0,2139-03-16 08:39:56,,"['NASAL SWAB - At [**2139-3-15**] 11:46 PM', 'MRSA screen', ' BLOOD CULTURED - At [**2139-3-16**] 05:33 AM', 'BC x2']",,79349,116517.0
1,2139-03-16 08:47:28,,"['NASAL SWAB - At [**2139-3-15**] 11:46 PM', 'MRSA screen', ' BLOOD CULTURED - At [**2139-3-16**] 05:33 AM', 'BC x2']",,79349,116517.0
2,2139-03-16 09:10:12,,"['NASAL SWAB - At [**2139-3-15**] 11:46 PM', 'MRSA screen', ' BLOOD CULTURED - At [**2139-3-16**] 05:33 AM', 'BC x2']",,79349,116517.0
3,2139-03-17 07:21:10,"['[**3-16**]', '-- Received small 500cc boluses during day to maintain urine output', ""-- Uptitrated betablocker to 25mg TID, BP ~160's /60's"", '-- Ortho to take to OR in the morning around noon', '-- Has active type and cross']","['[**3-16**]', '-- Received small 500cc boluses during day to maintain urine output', ""-- Uptitrated betablocker to 25mg TID, BP ~160's /60's"", '-- Ortho to take to OR in the morning around noon', '-- Has active type and cross']","['NASAL SWAB - At [**2139-3-15**] 11:46 PM', 'MRSA screen', ' BLOOD CULTURED - At [**2139-3-16**] 05:33 AM', 'BC x2']",79349,116517.0
4,2139-03-17 12:16:22,,"['[**3-16**]', '-- Received small 500cc boluses during day to maintain urine output', ""-- Uptitrated betablocker to 25mg TID, BP ~160's /60's"", '-- Ortho to take to OR in the morning around noon', '-- Has active type and cross']",,79349,116517.0
5,2139-03-17 12:30:56,,"['[**3-16**]', '-- Received small 500cc boluses during day to maintain urine output', ""-- Uptitrated betablocker to 25mg TID, BP ~160's /60's"", '-- Ortho to take to OR in the morning around noon', '-- Has active type and cross']",,79349,116517.0
6,2139-03-18 07:46:19,"['OR SENT - At [**2139-3-17**] 03:40 PM', ' INVASIVE VENTILATION - START [**2139-3-17**] 06:37 PM', ' OR RECEIVED - At [**2139-3-17**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2139-3-18**] 12:32 AM', '-- Successful R Hip repair overnight', '-- Transiently hypotensive to 60/40, dopamine peripheral', 'started/sedation weaned.  Able to wean dopamine ~ 10 minutes.', '-- Successful extubation ~ midnight']","['OR SENT - At [**2139-3-17**] 03:40 PM', ' INVASIVE VENTILATION - START [**2139-3-17**] 06:37 PM', ' OR RECEIVED - At [**2139-3-17**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2139-3-18**] 12:32 AM', '-- Successful R Hip repair overnight', '-- Transiently hypotensive to 60/40, dopamine peripheral', 'started/sedation weaned.  Able to wean dopamine ~ 10 minutes.', '-- Successful extubation ~ midnight']","['[**3-16**]', '-- Received small 500cc boluses during day to maintain urine output', ""-- Uptitrated betablocker to 25mg TID, BP ~160's /60's"", '-- Ortho to take to OR in the morning around noon', '-- Has active type and cross']",79349,116517.0
7,2139-03-18 07:47:27,,"['OR SENT - At [**2139-3-17**] 03:40 PM', ' INVASIVE VENTILATION - START [**2139-3-17**] 06:37 PM', ' OR RECEIVED - At [**2139-3-17**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2139-3-18**] 12:32 AM', '-- Successful R Hip repair overnight', '-- Transiently hypotensive to 60/40, dopamine peripheral', 'started/sedation weaned.  Able to wean dopamine ~ 10 minutes.', '-- Successful extubation ~ midnight']",,79349,116517.0
8,2139-03-18 11:15:36,,"['OR SENT - At [**2139-3-17**] 03:40 PM', ' INVASIVE VENTILATION - START [**2139-3-17**] 06:37 PM', ' OR RECEIVED - At [**2139-3-17**] 07:00 PM', ' INVASIVE VENTILATION - STOP [**2139-3-18**] 12:32 AM', '-- Successful R Hip repair overnight', '-- Transiently hypotensive to 60/40, dopamine peripheral', 'started/sedation weaned.  Able to wean dopamine ~ 10 minutes.', '-- Successful extubation ~ midnight']",,79349,116517.0
0,2173-01-15 06:07:07,,"['ON as addon for trach/PEG by IP', '-Lasix 40 mg IV for volume overload', ' INVASIVE VENTILATION - START [**2173-1-14**] 02:27 PM', ' ULTRASOUND - At [**2173-1-14**] 04:26 PM', 'abdominal US', ' PICC LINE - START [**2173-1-14**] 05:17 PM']",,94025,145724.0
1,2173-01-15 06:08:26,,"['ON as addon for trach/PEG by IP', '-Lasix 40 mg IV for volume overload', ' INVASIVE VENTILATION - START [**2173-1-14**] 02:27 PM', ' ULTRASOUND - At [**2173-1-14**] 04:26 PM', 'abdominal US', ' PICC LINE - START [**2173-1-14**] 05:17 PM']",,94025,145724.0
2,2173-01-15 10:46:56,,"['ON as addon for trach/PEG by IP', '-Lasix 40 mg IV for volume overload', ' INVASIVE VENTILATION - START [**2173-1-14**] 02:27 PM', ' ULTRASOUND - At [**2173-1-14**] 04:26 PM', 'abdominal US', ' PICC LINE - START [**2173-1-14**] 05:17 PM']",,94025,145724.0
3,2173-01-16 06:49:47,"['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']","['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']","['ON as addon for trach/PEG by IP', '-Lasix 40 mg IV for volume overload', ' INVASIVE VENTILATION - START [**2173-1-14**] 02:27 PM', ' ULTRASOUND - At [**2173-1-14**] 04:26 PM', 'abdominal US', ' PICC LINE - START [**2173-1-14**] 05:17 PM']",94025,145724.0
4,2173-01-16 06:50:54,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']",,94025,145724.0
5,2173-01-16 08:23:01,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']",,94025,145724.0
6,2173-01-16 12:28:46,,"['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']",,94025,145724.0
7,2173-01-17 06:52:07,"['- Able to discontinue fentanyl and versed, on fentanyl patch only,', 'ativan only as needed for anxiety', '- Diuresed well with 40mg of lasix once', '- Contact[**Name (NI) **] [**Name2 (NI) 2120**] [**Hospital **] hospital at ([**Telephone/Fax (1) 4372**].  Only positive', 'cultures were rare enterococcus in the tissue and wound cultures from', 'the right hip.  Never sent blood cultures.', '- Hypernatremia improved slightly with D5W 1L and free water flushes', '- Switched to MMV overnight given prolonged times of apnea', '- Repeated Lasix 40mg IV at 11:00pm', '- Gave fentanyl IV PRN for pain during movement, d/c in AM', '- Replaced Mag', ' BLOOD CULTURED - At [**2173-1-16**] 12:29 PM']","['- Able to discontinue fentanyl and versed, on fentanyl patch only,', 'ativan only as needed for anxiety', '- Diuresed well with 40mg of lasix once', '- Contact[**Name (NI) **] [**Name2 (NI) 2120**] [**Hospital **] hospital at ([**Telephone/Fax (1) 4372**].  Only positive', 'cultures were rare enterococcus in the tissue and wound cultures from', 'the right hip.  Never sent blood cultures.', '- Hypernatremia improved slightly with D5W 1L and free water flushes', '- Switched to MMV overnight given prolonged times of apnea', '- Repeated Lasix 40mg IV at 11:00pm', '- Gave fentanyl IV PRN for pain during movement, d/c in AM', '- Replaced Mag', ' BLOOD CULTURED - At [**2173-1-16**] 12:29 PM']","['PERCUTANEOUS TRACHEOSTOMY - At [**2173-1-15**] 09:30 AM', ' PEG INSERTION - At [**2173-1-15**] 02:09 PM', '[**2173-1-15**]', '- Trach & G-tube placed, G active 3pm [**1-16**] for feeding & correcting', 'Free Water deficit', '- Echo concerning for PE, CTA pending (prepped with Bicarb/Mucomyst)', '- Fentanyl Patch & Klonipin started with goal to wean gtt [**1-16**]: On long', 'term methadone as best outpatient pain regimen', '- Pressure support trial today', '- Ab U/S: No significant results']",94025,145724.0
8,2173-01-17 06:53:06,,"['- Able to discontinue fentanyl and versed, on fentanyl patch only,', 'ativan only as needed for anxiety', '- Diuresed well with 40mg of lasix once', '- Contact[**Name (NI) **] [**Name2 (NI) 2120**] [**Hospital **] hospital at ([**Telephone/Fax (1) 4372**].  Only positive', 'cultures were rare enterococcus in the tissue and wound cultures from', 'the right hip.  Never sent blood cultures.', '- Hypernatremia improved slightly with D5W 1L and free water flushes', '- Switched to MMV overnight given prolonged times of apnea', '- Repeated Lasix 40mg IV at 11:00pm', '- Gave fentanyl IV PRN for pain during movement, d/c in AM', '- Replaced Mag', ' BLOOD CULTURED - At [**2173-1-16**] 12:29 PM']",,94025,145724.0
9,2173-01-17 15:50:03,['- Switched to [**Telephone/Fax (1) 4377**] overnight given prolonged times of apnea'],"['- Able to discontinue fentanyl and versed, on fentanyl patch only,', 'ativan only as needed for anxiety', '- Diuresed well with 40mg of lasix once', '- Contact[**Name (NI) **] [**Name2 (NI) 2120**] [**Hospital **] hospital at ([**Telephone/Fax (1) 4372**].  Only positive', 'cultures were rare enterococcus in the tissue and wound cultures from', 'the right hip.  Never sent blood cultures.', '- Hypernatremia improved slightly with D5W 1L and free water flushes', '- Switched to [**Telephone/Fax (1) 4377**] overnight given prolonged times of apnea', '- Repeated Lasix 40mg IV at 11:00pm', '- Gave fentanyl IV PRN for pain during movement, d/c in AM', '- Replaced Mag', ' BLOOD CULTURED - At [**2173-1-16**] 12:29 PM']",['- Switched to MMV overnight given prolonged times of apnea'],94025,145724.0
10,2173-01-18 06:49:18,"['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']","['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']","['- Able to discontinue fentanyl and versed, on fentanyl patch only,', 'ativan only as needed for anxiety', '- Diuresed well with 40mg of lasix once', '- Contact[**Name (NI) **] [**Name2 (NI) 2120**] [**Hospital **] hospital at ([**Telephone/Fax (1) 4372**].  Only positive', 'cultures were rare enterococcus in the tissue and wound cultures from', 'the right hip.  Never sent blood cultures.', '- Hypernatremia improved slightly with D5W 1L and free water flushes', '- Switched to [**Telephone/Fax (1) 4377**] overnight given prolonged times of apnea', '- Repeated Lasix 40mg IV at 11:00pm', '- Gave fentanyl IV PRN for pain during movement, d/c in AM', '- Replaced Mag', ' BLOOD CULTURED - At [**2173-1-16**] 12:29 PM']",94025,145724.0
11,2173-01-18 06:50:22,,"['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']",,94025,145724.0
12,2173-01-18 16:37:10,,"['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']",,94025,145724.0
13,2173-01-18 16:57:55,,"['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']",,94025,145724.0
14,2173-01-19 07:02:52,"['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM']","['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM']","['-Per family had broken hand at OSH and was in cast-not tranferred in', 'cast.  Right 5th fracture-destruction of distal and middle phalanx,', 'plastics consulted-recs pending', '-D/c gentamicin as has been on for 10 days', '-Hematoma on Right medial thigh evaluated by ortho-NTD, HCT stable', '-PM lytes-hypernatremia improved on D5W and free water bolus, stopped', 'D5W and continued free water boluses']",94025,145724.0
15,2173-01-19 07:03:47,,"['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM']",,94025,145724.0
16,2173-01-19 07:04:34,,"['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM']",,94025,145724.0
17,2173-01-19 07:06:31,,"['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM']",,94025,145724.0
18,2173-01-19 14:29:29,['No new imaging or micro data.'],"['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM', 'No new imaging or micro data.']",,94025,145724.0
19,2173-01-20 07:05:07,"['- patient was kept on trach mask successfully', '- started Prednisone 20mg PO daily x5 days for gout flare', '- fentanyl discontinued', '- fluid balance +200cc despite lasix 5cc/hr drip']","['- patient was kept on trach mask successfully', '- started Prednisone 20mg PO daily x5 days for gout flare', '- fentanyl discontinued', '- fluid balance +200cc despite lasix 5cc/hr drip']","['[**1-18**] Events:', '- failed trial on TM, RR 36-40, RSBI 130s', '- if MS does not improve in [**12-18**] wks will need EEG, LP, CT, MRI', '- methadone started (will d/c fentanyl once stable)', '- neg 1L on lasix gtt', '- blood culture (from PICC) with gram+ rods, would like to estabilsh', 'PIV access and pull PICC for cx - IV team failed', ' BLOOD CULTURED - At [**2173-1-18**] 03:00 PM', 'No new imaging or micro data.']",94025,145724.0
20,2173-01-20 07:10:14,,"['- patient was kept on trach mask successfully', '- started Prednisone 20mg PO daily x5 days for gout flare', '- fentanyl discontinued', '- fluid balance +200cc despite lasix 5cc/hr drip']",,94025,145724.0
21,2173-01-20 13:04:51,,"['- patient was kept on trach mask successfully', '- started Prednisone 20mg PO daily x5 days for gout flare', '- fentanyl discontinued', '- fluid balance +200cc despite lasix 5cc/hr drip']",,94025,145724.0
22,2173-01-21 06:46:50,"['- more awake and alert', '- continues to do well on trach mask, although has irregular breathing', 'pattern with periods of apnea', '- run of VT on telemetry, lytes OK, ekg unchanged from prior', '- at midnight I/Os approx even so gave extra dose PO 60 mg lasix']","['- more awake and alert', '- continues to do well on trach mask, although has irregular breathing', 'pattern with periods of apnea', '- run of VT on telemetry, lytes OK, ekg unchanged from prior', '- at midnight I/Os approx even so gave extra dose PO 60 mg lasix']","['- patient was kept on trach mask successfully', '- started Prednisone 20mg PO daily x5 days for gout flare', '- fentanyl discontinued', '- fluid balance +200cc despite lasix 5cc/hr drip']",94025,145724.0
23,2173-01-21 06:48:42,,"['- more awake and alert', '- continues to do well on trach mask, although has irregular breathing', 'pattern with periods of apnea', '- run of VT on telemetry, lytes OK, ekg unchanged from prior', '- at midnight I/Os approx even so gave extra dose PO 60 mg lasix']",,94025,145724.0
24,2173-01-21 06:52:08,,"['- more awake and alert', '- continues to do well on trach mask, although has irregular breathing', 'pattern with periods of apnea', '- run of VT on telemetry, lytes OK, ekg unchanged from prior', '- at midnight I/Os approx even so gave extra dose PO 60 mg lasix']",,94025,145724.0
25,2173-01-21 12:59:42,,"['- more awake and alert', '- continues to do well on trach mask, although has irregular breathing', 'pattern with periods of apnea', '- run of VT on telemetry, lytes OK, ekg unchanged from prior', '- at midnight I/Os approx even so gave extra dose PO 60 mg lasix']",,94025,145724.0
0,2194-07-04 07:58:10,,"['ENDOSCOPY - At [**2194-7-3**] 09:30 PM', 'Uneventful scope, Pt. received 3mg versed and 75mcg of Fentanyl. V/S', 'remain stable.']",,60222,144013.0
1,2194-07-04 09:56:20,,"['ENDOSCOPY - At [**2194-7-3**] 09:30 PM', 'Uneventful scope, Pt. received 3mg versed and 75mcg of Fentanyl. V/S', 'remain stable.']",,60222,144013.0
0,2145-04-02 07:29:35,,"['DIALYSIS CATHETER - START [**2145-4-1**] 08:00 PM', 'placed [**4-1**]. vip port.']",,83982,147681.0
1,2145-04-02 10:51:01,"['Dialysis last night', 'Coffee ground material from NGT after epistaxis in setting of dobhoff', 'tube placement', 'Patient removed dobhoff this am.']","['Dialysis last night', 'Coffee ground material from NGT after epistaxis in setting of dobhoff', 'tube placement', 'Patient removed dobhoff this am.']","['DIALYSIS CATHETER - START [**2145-4-1**] 08:00 PM', 'placed [**4-1**]. vip port.']",83982,147681.0
2,2145-04-03 07:39:04,"['ENDOSCOPY - At [**2145-4-2**] 05:50 PM', 'bedside endoscopy and dobhoff placement', '- Hct stable', '- NGT placed', '- HD performed']","['ENDOSCOPY - At [**2145-4-2**] 05:50 PM', 'bedside endoscopy and dobhoff placement', '- Hct stable', '- NGT placed', '- HD performed']","['Dialysis last night', 'Coffee ground material from NGT after epistaxis in setting of dobhoff', 'tube placement', 'Patient removed dobhoff this am.']",83982,147681.0
3,2145-04-03 14:42:28,,"['ENDOSCOPY - At [**2145-4-2**] 05:50 PM', 'bedside endoscopy and dobhoff placement', '- Hct stable', '- NGT placed', '- HD performed']",,83982,147681.0
4,2145-04-04 07:26:38,['STOOL CULTURE - At [**2145-4-4**] 06:00 AM'],['STOOL CULTURE - At [**2145-4-4**] 06:00 AM'],"['ENDOSCOPY - At [**2145-4-2**] 05:50 PM', 'bedside endoscopy and dobhoff placement', '- Hct stable', '- NGT placed', '- HD performed']",83982,147681.0
5,2145-04-04 07:34:48,"['HD [**4-3**]', 'Started on tube feeds', 'Per transplant surgery, patient now listed']","['HD [**4-3**]', 'Started on tube feeds', 'Per transplant surgery, patient now listed']",['STOOL CULTURE - At [**2145-4-4**] 06:00 AM'],83982,147681.0
6,2145-04-04 11:27:24,,"['HD [**4-3**]', 'Started on tube feeds', 'Per transplant surgery, patient now listed']",,83982,147681.0
7,2145-04-04 11:37:09,,"['HD [**4-3**]', 'Started on tube feeds', 'Per transplant surgery, patient now listed']",,83982,147681.0
8,2145-04-05 07:15:41,"['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']","['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']","['HD [**4-3**]', 'Started on tube feeds', 'Per transplant surgery, patient now listed']",83982,147681.0
9,2145-04-05 07:17:38,,"['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']",,83982,147681.0
10,2145-04-05 07:32:44,,"['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']",,83982,147681.0
11,2145-04-05 13:27:35,,"['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']",,83982,147681.0
12,2145-04-06 07:07:54,"['None', 'History obtained from [**Hospital 19**] Medical records']","['None', 'History obtained from [**Hospital 19**] Medical records']","['[**4-3**]', '- TF started', '- Per transplant [**Doctor First Name 91**], patient now listed.', '[**4-4**]', '- ID recommends 2 weeks of abx']",83982,147681.0
13,2145-04-06 07:10:56,,"['None', 'History obtained from [**Hospital 19**] Medical records']",,83982,147681.0
14,2145-04-06 08:12:28,"['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.']","['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'History obtained from [**Hospital 19**] Medical records']",['None'],83982,147681.0
15,2145-04-06 08:24:18,['MELD 48'],"['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'MELD 48', 'History obtained from [**Hospital 19**] Medical records']",,83982,147681.0
16,2145-04-06 08:27:26,,"['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'MELD 48', 'History obtained from [**Hospital 19**] Medical records']",,83982,147681.0
17,2145-04-06 08:29:05,,"['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'MELD 48', 'History obtained from [**Hospital 19**] Medical records']",,83982,147681.0
18,2145-04-06 11:12:09,,"['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'MELD 48', 'History obtained from [**Hospital 19**] Medical records']",,83982,147681.0
19,2145-04-07 07:15:32,"['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']","['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']","['Remains encephalopathic. Otherwise no significant 24 hour events.', 'Subjectively, pt complains of thirst.', 'MELD 48', 'History obtained from [**Hospital 19**] Medical records']",83982,147681.0
20,2145-04-07 07:16:04,,"['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']",,83982,147681.0
21,2145-04-07 07:19:24,,"['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']",,83982,147681.0
22,2145-04-07 07:22:29,,"['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']",,83982,147681.0
23,2145-04-07 11:30:08,,"['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']",,83982,147681.0
24,2145-04-08 07:27:00,"['- spoke to sisters about paracentesis; they demured for now, wanted to', 'see how he did, seemed concerned about how procedure/findings would', 'affect chances of received transplant. Did say it was OK to do', 'procedure emergently if needed.', '- p.m. wbc stable 19.7']","['- spoke to sisters about paracentesis; they demured for now, wanted to', 'see how he did, seemed concerned about how procedure/findings would', 'affect chances of received transplant. Did say it was OK to do', 'procedure emergently if needed.', '- p.m. wbc stable 19.7']","['dialyzed', 'increased free water given sodium', 'needed ivf and albumin for hypotnesion, started neo for map<60, likely', 'in setting starting hd, along with ? brewing infection', 'pan cultured, no paracentesis given info would only adversely affect', 'his transplant status']",83982,147681.0
25,2145-04-08 07:28:04,,"['- spoke to sisters about paracentesis; they demured for now, wanted to', 'see how he did, seemed concerned about how procedure/findings would', 'affect chances of received transplant. Did say it was OK to do', 'procedure emergently if needed.', '- p.m. wbc stable 19.7']",,83982,147681.0
26,2145-04-08 11:44:08,,"['- spoke to sisters about paracentesis; they demured for now, wanted to', 'see how he did, seemed concerned about how procedure/findings would', 'affect chances of received transplant. Did say it was OK to do', 'procedure emergently if needed.', '- p.m. wbc stable 19.7']",,83982,147681.0
27,2145-04-09 06:44:30,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']","['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']","['- spoke to sisters about paracentesis; they demured for now, wanted to', 'see how he did, seemed concerned about how procedure/findings would', 'affect chances of received transplant. Did say it was OK to do', 'procedure emergently if needed.', '- p.m. wbc stable 19.7']",83982,147681.0
28,2145-04-09 06:45:33,,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",,83982,147681.0
29,2145-04-09 06:46:57,,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",,83982,147681.0
30,2145-04-09 06:47:59,,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",,83982,147681.0
31,2145-04-09 06:53:04,,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",,83982,147681.0
32,2145-04-09 11:06:56,,"['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",,83982,147681.0
33,2145-04-10 07:11:32,"['PARACENTESIS - At [**2145-4-9**] 12:50 PM', ' WOUND CULTURE - At [**2145-4-9**] 01:20 PM', 'ascites fluid sent for anaerobic, aerobic, fungal, cx, gram stain', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.']","['PARACENTESIS - At [**2145-4-9**] 12:50 PM', ' WOUND CULTURE - At [**2145-4-9**] 01:20 PM', 'ascites fluid sent for anaerobic, aerobic, fungal, cx, gram stain', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.']","['family declined para/a line', 'cvo2 66, lactate 1.1', 'HD', 'FFP']",83982,147681.0
34,2145-04-10 13:53:11,,"['PARACENTESIS - At [**2145-4-9**] 12:50 PM', ' WOUND CULTURE - At [**2145-4-9**] 01:20 PM', 'ascites fluid sent for anaerobic, aerobic, fungal, cx, gram stain', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.']",,83982,147681.0
35,2145-04-10 14:05:25,,"['PARACENTESIS - At [**2145-4-9**] 12:50 PM', ' WOUND CULTURE - At [**2145-4-9**] 01:20 PM', 'ascites fluid sent for anaerobic, aerobic, fungal, cx, gram stain', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.']",,83982,147681.0
36,2145-04-11 07:21:14,"['BLOOD CULTURED - At [**2145-4-10**] 04:19 PM', 'from HD VIP port', '[**4-9**]:', '[**4-10**]', '- back on transplant list (confirmed with liver attending)', '- stopped vanc/zosyn per ID given neg cultures, improving white count', '- drawing blood cx off HD line and periphery daily per ID', '- stayed on levo', '- changed BP cuff to regular size b/c large cuff seemed to be [**Location (un) 118**]', 'artifically low BPs']","['BLOOD CULTURED - At [**2145-4-10**] 04:19 PM', 'from HD VIP port', '[**4-9**]:', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.', '[**4-10**]', '- back on transplant list (confirmed with liver attending)', '- stopped vanc/zosyn per ID given neg cultures, improving white count', '- drawing blood cx off HD line and periphery daily per ID', '- stayed on levo', '- changed BP cuff to regular size b/c large cuff seemed to be [**Location (un) 118**]', 'artifically low BPs']","['PARACENTESIS - At [**2145-4-9**] 12:50 PM', ' WOUND CULTURE - At [**2145-4-9**] 01:20 PM', 'ascites fluid sent for anaerobic, aerobic, fungal, cx, gram stain']",83982,147681.0
37,2145-04-11 07:21:49,,"['BLOOD CULTURED - At [**2145-4-10**] 04:19 PM', 'from HD VIP port', '[**4-9**]:', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.', '[**4-10**]', '- back on transplant list (confirmed with liver attending)', '- stopped vanc/zosyn per ID given neg cultures, improving white count', '- drawing blood cx off HD line and periphery daily per ID', '- stayed on levo', '- changed BP cuff to regular size b/c large cuff seemed to be [**Location (un) 118**]', 'artifically low BPs']",,83982,147681.0
38,2145-04-11 13:44:36,,"['BLOOD CULTURED - At [**2145-4-10**] 04:19 PM', 'from HD VIP port', '[**4-9**]:', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.', '[**4-10**]', '- back on transplant list (confirmed with liver attending)', '- stopped vanc/zosyn per ID given neg cultures, improving white count', '- drawing blood cx off HD line and periphery daily per ID', '- stayed on levo', '- changed BP cuff to regular size b/c large cuff seemed to be [**Location (un) 118**]', 'artifically low BPs']",,83982,147681.0
39,2145-04-12 07:04:29,"['PICC LINE - START [**2145-4-11**] 09:30 AM', '- Potential donor became available, but pt was deemed poor candidate', 'given low bp.', '- Attempt to wean neo through day; as low as 1.5']","['PICC LINE - START [**2145-4-11**] 09:30 AM', '- Potential donor became available, but pt was deemed poor candidate', 'given low bp.', '- Attempt to wean neo through day; as low as 1.5']","['BLOOD CULTURED - At [**2145-4-10**] 04:19 PM', 'from HD VIP port', '[**4-9**]:', '- Diagnostic para negative.', '- Derm - rash on arm [**12-21**] BP cuff.  If rash starts to spread, would be', 'more concerned for drug (pip/tazo) rash.', '- Per liver fellow note, pt de-listed yesterday.', '[**4-10**]', '- back on transplant list (confirmed with liver attending)', '- stopped vanc/zosyn per ID given neg cultures, improving white count', '- drawing blood cx off HD line and periphery daily per ID', '- stayed on levo', '- changed BP cuff to regular size b/c large cuff seemed to be [**Location (un) 118**]', 'artifically low BPs']",83982,147681.0
40,2145-04-12 07:08:25,,"['PICC LINE - START [**2145-4-11**] 09:30 AM', '- Potential donor became available, but pt was deemed poor candidate', 'given low bp.', '- Attempt to wean neo through day; as low as 1.5']",,83982,147681.0
41,2145-04-12 10:31:47,,"['PICC LINE - START [**2145-4-11**] 09:30 AM', '- Potential donor became available, but pt was deemed poor candidate', 'given low bp.', '- Attempt to wean neo through day; as low as 1.5']",,83982,147681.0
42,2145-04-13 07:14:11,"['- Moved to chair during the day.', '- Attempted to wean neo.']","['- Moved to chair during the day.', '- Attempted to wean neo.']","['PICC LINE - START [**2145-4-11**] 09:30 AM', '- Potential donor became available, but pt was deemed poor candidate', 'given low bp.', '- Attempt to wean neo through day; as low as 1.5']",83982,147681.0
43,2145-04-13 07:14:57,,"['- Moved to chair during the day.', '- Attempted to wean neo.']",,83982,147681.0
44,2145-04-13 07:15:40,,"['- Moved to chair during the day.', '- Attempted to wean neo.']",,83982,147681.0
45,2145-04-13 12:12:07,,"['- Moved to chair during the day.', '- Attempted to wean neo.']",,83982,147681.0
46,2145-04-13 12:13:03,,"['- Moved to chair during the day.', '- Attempted to wean neo.']",,83982,147681.0
47,2145-04-14 07:13:25,['- Tried off of pressors but had to go back on.'],['- Tried off of pressors but had to go back on.'],"['- Moved to chair during the day.', '- Attempted to wean neo.']",83982,147681.0
48,2145-04-14 07:18:03,,['- Tried off of pressors but had to go back on.'],,83982,147681.0
49,2145-04-14 07:19:03,,['- Tried off of pressors but had to go back on.'],,83982,147681.0
50,2145-04-14 13:17:14,,['- Tried off of pressors but had to go back on.'],,83982,147681.0
51,2145-04-15 06:46:51,"['- albumin qid per trasplant service', '- HD done', '- wound care to back']","['- albumin qid per trasplant service', '- HD done', '- wound care to back']",['- Tried off of pressors but had to go back on.'],83982,147681.0
52,2145-04-15 06:52:29,['- Neo at 0.5'],"['- albumin qid per trasplant service', '- HD done', '- wound care to back', '- Neo at 0.5']",,83982,147681.0
53,2145-04-15 12:26:30,,"['- albumin qid per trasplant service', '- HD done', '- wound care to back', '- Neo at 0.5']",,83982,147681.0
54,2145-04-16 06:57:01,"['- Neo turned off', '- Flexiseal with BRBPR']","['- Neo turned off', '- Flexiseal with BRBPR']","['- albumin qid per trasplant service', '- HD done', '- wound care to back', '- Neo at 0.5']",83982,147681.0
55,2145-04-16 21:14:16,,"['- Neo turned off', '- Flexiseal with BRBPR']",,83982,147681.0
56,2145-04-17 07:33:34,"['[**4-15**]', '[**4-16**]', '- flexiseal still with brbpr in mostly brown stool', '- hct 30->28->25. 2 bag platlets and 4 u FPP total given with', 'stabilization, DDAVP', '- liver: hold off on scoping', '- on liver and kidney tx list', '- bleeding from PICC line, resolved with compression']","['[**4-15**]', '- Neo turned off', '- Flexiseal with BRBPR', '[**4-16**]', '- flexiseal still with brbpr in mostly brown stool', '- hct 30->28->25. 2 bag platlets and 4 u FPP total given with', 'stabilization, DDAVP', '- liver: hold off on scoping', '- on liver and kidney tx list', '- bleeding from PICC line, resolved with compression']",,83982,147681.0
57,2145-04-17 07:37:36,,"['[**4-15**]', '- Neo turned off', '- Flexiseal with BRBPR', '[**4-16**]', '- flexiseal still with brbpr in mostly brown stool', '- hct 30->28->25. 2 bag platlets and 4 u FPP total given with', 'stabilization, DDAVP', '- liver: hold off on scoping', '- on liver and kidney tx list', '- bleeding from PICC line, resolved with compression']",,83982,147681.0
58,2145-04-17 11:48:22,,"['[**4-15**]', '- Neo turned off', '- Flexiseal with BRBPR', '[**4-16**]', '- flexiseal still with brbpr in mostly brown stool', '- hct 30->28->25. 2 bag platlets and 4 u FPP total given with', 'stabilization, DDAVP', '- liver: hold off on scoping', '- on liver and kidney tx list', '- bleeding from PICC line, resolved with compression']",,83982,147681.0
59,2145-04-18 06:41:57,['no events'],['no events'],"['[**4-15**]', '- Neo turned off', '- Flexiseal with BRBPR', '[**4-16**]', '- flexiseal still with brbpr in mostly brown stool', '- hct 30->28->25. 2 bag platlets and 4 u FPP total given with', 'stabilization, DDAVP', '- liver: hold off on scoping', '- on liver and kidney tx list', '- bleeding from PICC line, resolved with compression']",83982,147681.0
60,2145-04-18 06:47:15,,['no events'],,83982,147681.0
61,2145-04-18 09:19:49,,['no events'],,83982,147681.0
62,2145-04-19 07:36:44,['none'],['none'],['no events'],83982,147681.0
63,2145-04-19 07:37:50,,['none'],,83982,147681.0
64,2145-04-19 11:23:48,,['none'],,83982,147681.0
65,2145-04-19 17:33:40,,['none'],,83982,147681.0
66,2145-04-20 06:49:05,"['- Remained off pressors', '- Dobhoff clogged; will require new scoping and placement by hepatology']","['- Remained off pressors', '- Dobhoff clogged; will require new scoping and placement by hepatology']",['none'],83982,147681.0
67,2145-04-20 08:16:48,,"['- Remained off pressors', '- Dobhoff clogged; will require new scoping and placement by hepatology']",,83982,147681.0
68,2145-04-20 08:20:54,,"['- Remained off pressors', '- Dobhoff clogged; will require new scoping and placement by hepatology']",,83982,147681.0
69,2145-04-20 08:24:49,,"['- Remained off pressors', '- Dobhoff clogged; will require new scoping and placement by hepatology']",,83982,147681.0
70,2145-04-20 14:53:46,"['- Dobhoff clogged; hepatology to scope and place new Dobhoff', '- No new complaints this AM']","['- Remained off pressors', '- Dobhoff clogged; hepatology to scope and place new Dobhoff', '- No new complaints this AM']",['- Dobhoff clogged; will require new scoping and placement by hepatology'],83982,147681.0
71,2145-04-20 15:22:07,,"['- Remained off pressors', '- Dobhoff clogged; hepatology to scope and place new Dobhoff', '- No new complaints this AM']",,83982,147681.0
72,2145-04-26 06:34:25,"['DIALYSIS CATHETER - START [**2145-4-25**] 06:12 PM', ' PICC LINE - START [**2145-4-25**] 06:12 PM', ' ARTERIAL LINE - START [**2145-4-25**] 10:29 PM']","['DIALYSIS CATHETER - START [**2145-4-25**] 06:12 PM', ' PICC LINE - START [**2145-4-25**] 06:12 PM', ' ARTERIAL LINE - START [**2145-4-25**] 10:29 PM']","['- Remained off pressors', '- Dobhoff clogged; hepatology to scope and place new Dobhoff', '- No new complaints this AM']",83982,147681.0
73,2145-04-26 06:37:05,,"['DIALYSIS CATHETER - START [**2145-4-25**] 06:12 PM', ' PICC LINE - START [**2145-4-25**] 06:12 PM', ' ARTERIAL LINE - START [**2145-4-25**] 10:29 PM']",,83982,147681.0
74,2145-04-26 13:18:05,,"['DIALYSIS CATHETER - START [**2145-4-25**] 06:12 PM', ' PICC LINE - START [**2145-4-25**] 06:12 PM', ' ARTERIAL LINE - START [**2145-4-25**] 10:29 PM']",,83982,147681.0
75,2145-04-27 06:31:47,"['BLOOD CULTURED - At [**2145-4-26**] 12:00 PM', 'from PICC', ' BLOOD CULTURED - At [**2145-4-26**] 06:17 PM', 'from a-line', '- CT abd/pelvis:  Small perihepatic free fluid, new from prior study.', 'No evidence of obstruction, pneumatosis, or free air. Small bilateral', 'pleural effusions with associated atelectasis/consolidation of the', 'adjacent lungs.', '- Endocrine says its okay to get IV contrast load with hyperthyroidism', 'off of methimazole.', '- Intermittent 500ccLR IV boluses for MAP~55 with CVP<12.', '- GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS [**12-21**]', 'GRAM NEGATIVE ROD(S) [**11-20**]', '(appropriate therapy with Flagyl, Zosyn, vancomycin)', 'Vanc trough ordered for Tuesday evening', '- TTE:  Hyperdynamic LV systolic dysfunction with an abnormal systolic', 'flow contour without LVOT gradient. Mild mitral regurgitation. Mild', 'pulmonary artery systolic hypertension', '- Persistent tachycardia (afib), despite coming off of Levophed and', 'fluid boluses - sBP>140s - amiodarone bolus and gtt started', '- LIJ CVL placed, position confirmed, RIJ removed']","['BLOOD CULTURED - At [**2145-4-26**] 12:00 PM', 'from PICC', ' BLOOD CULTURED - At [**2145-4-26**] 06:17 PM', 'from a-line', '- CT abd/pelvis:  Small perihepatic free fluid, new from prior study.', 'No evidence of obstruction, pneumatosis, or free air. Small bilateral', 'pleural effusions with associated atelectasis/consolidation of the', 'adjacent lungs.', '- Endocrine says its okay to get IV contrast load with hyperthyroidism', 'off of methimazole.', '- Intermittent 500ccLR IV boluses for MAP~55 with CVP<12.', '- GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS [**12-21**]', 'GRAM NEGATIVE ROD(S) [**11-20**]', '(appropriate therapy with Flagyl, Zosyn, vancomycin)', 'Vanc trough ordered for Tuesday evening', '- TTE:  Hyperdynamic LV systolic dysfunction with an abnormal systolic', 'flow contour without LVOT gradient. Mild mitral regurgitation. Mild', 'pulmonary artery systolic hypertension', '- Persistent tachycardia (afib), despite coming off of Levophed and', 'fluid boluses - sBP>140s - amiodarone bolus and gtt started', '- LIJ CVL placed, position confirmed, RIJ removed']","['DIALYSIS CATHETER - START [**2145-4-25**] 06:12 PM', ' PICC LINE - START [**2145-4-25**] 06:12 PM', ' ARTERIAL LINE - START [**2145-4-25**] 10:29 PM']",83982,147681.0
76,2145-04-27 06:33:35,,"['BLOOD CULTURED - At [**2145-4-26**] 12:00 PM', 'from PICC', ' BLOOD CULTURED - At [**2145-4-26**] 06:17 PM', 'from a-line', '- CT abd/pelvis:  Small perihepatic free fluid, new from prior study.', 'No evidence of obstruction, pneumatosis, or free air. Small bilateral', 'pleural effusions with associated atelectasis/consolidation of the', 'adjacent lungs.', '- Endocrine says its okay to get IV contrast load with hyperthyroidism', 'off of methimazole.', '- Intermittent 500ccLR IV boluses for MAP~55 with CVP<12.', '- GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS [**12-21**]', 'GRAM NEGATIVE ROD(S) [**11-20**]', '(appropriate therapy with Flagyl, Zosyn, vancomycin)', 'Vanc trough ordered for Tuesday evening', '- TTE:  Hyperdynamic LV systolic dysfunction with an abnormal systolic', 'flow contour without LVOT gradient. Mild mitral regurgitation. Mild', 'pulmonary artery systolic hypertension', '- Persistent tachycardia (afib), despite coming off of Levophed and', 'fluid boluses - sBP>140s - amiodarone bolus and gtt started', '- LIJ CVL placed, position confirmed, RIJ removed']",,83982,147681.0
77,2145-04-27 06:36:38,"['[**2145-4-26**]', '- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']","['BLOOD CULTURED - At [**2145-4-26**] 12:00 PM', 'from PICC', ' BLOOD CULTURED - At [**2145-4-26**] 06:17 PM', 'from a-line', '[**2145-4-26**]', '- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']","['- CT abd/pelvis:  Small perihepatic free fluid, new from prior study.', 'No evidence of obstruction, pneumatosis, or free air. Small bilateral', 'pleural effusions with associated atelectasis/consolidation of the', 'adjacent lungs.', '- Endocrine says its okay to get IV contrast load with hyperthyroidism', 'off of methimazole.', '- Intermittent 500ccLR IV boluses for MAP~55 with CVP<12.', '- GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS [**12-21**]', 'GRAM NEGATIVE ROD(S) [**11-20**]', '(appropriate therapy with Flagyl, Zosyn, vancomycin)', 'Vanc trough ordered for Tuesday evening', '- TTE:  Hyperdynamic LV systolic dysfunction with an abnormal systolic', 'flow contour without LVOT gradient. Mild mitral regurgitation. Mild', 'pulmonary artery systolic hypertension', '- Persistent tachycardia (afib), despite coming off of Levophed and', 'fluid boluses - sBP>140s - amiodarone bolus and gtt started', '- LIJ CVL placed, position confirmed, RIJ removed']",83982,147681.0
78,2145-04-27 11:51:43,,"['- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']","['BLOOD CULTURED - At [**2145-4-26**] 12:00 PM', 'from PICC', ' BLOOD CULTURED - At [**2145-4-26**] 06:17 PM', 'from a-line', '[**2145-4-26**]']",83982,147681.0
79,2145-04-27 13:58:20,,"['- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']",,83982,147681.0
80,2145-04-27 14:00:25,,"['- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']",,83982,147681.0
81,2145-04-28 06:35:07,"['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']","['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']","['- Given rising leukocytosis, pancultured; no clear infiltrate on CXR', ""- Calcium acetate cannot be crushed. Sevelamer can be crushed - he's"", 'already on it.', '- Sliding scale tightened', '- Started CVVH in afternoon; per renal, aiming for negative on [**2145-3-27**]', '- Per hepatology note, patient is active on transplant list']",83982,147681.0
82,2145-04-28 06:35:58,,"['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']",,83982,147681.0
83,2145-04-28 06:43:49,,"['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']",,83982,147681.0
84,2145-04-28 09:19:30,,"['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']",,83982,147681.0
85,2145-04-29 06:44:55,"['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- No diagnostic para as of [**4-28**].', '- Tolerated taking fluid off in evening.']","['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- No diagnostic para as of [**4-28**].', '- Tolerated taking fluid off in evening.']","['[**2145-4-27**]', '- Increased WBC with 1 band', '- Octreotide discontinued', '- Started SQ heparin', '- Per Hep: appears worse with leukocytosis -> broadened abx from cipro', 'to vanc/zosyn. Sisters/HCP refusing paracentesis at this time. Spoke to', 'Hep fellow and attg regarding this. Plan for family mtg around 1-2pm', 'tomorrow.', '- Goal I/O net neg on CVVH but limited by BP. Levophed uptitrated;', 'given fluid back via CVVH. Given 1 unit pRBC for volume expansion as', 'Hct 22. Started on vasopressin. Able to wean off some levophed.']",83982,147681.0
86,2145-04-29 07:09:58,,"['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- No diagnostic para as of [**4-28**].', '- Tolerated taking fluid off in evening.']",,83982,147681.0
87,2145-04-29 09:26:05,,"['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- No diagnostic para as of [**4-28**].', '- Tolerated taking fluid off in evening.']",,83982,147681.0
88,2145-04-29 09:26:49,['- Tolerated taking fluid off in evening but remained on two pressors.'],"['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- Tolerated taking fluid off in evening but remained on two pressors.']","['- No diagnostic para as of [**4-28**].', '- Tolerated taking fluid off in evening.']",83982,147681.0
89,2145-04-29 11:13:43,,"['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- Tolerated taking fluid off in evening but remained on two pressors.']",,83982,147681.0
90,2145-04-30 06:20:31,"['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered lenis.']","['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered lenis.']","['- Family meeting with liver team explained the gravity of his', 'situation.  Ultimately, will give him a couple days and if still not', 'improving, may move toward CMO.  Unclear how much the family agrees', 'with this.', '- Tolerated taking fluid off in evening but remained on two pressors.']",83982,147681.0
91,2145-04-30 06:21:23,,"['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered lenis.']",,83982,147681.0
92,2145-04-30 07:38:20,,"['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered lenis.']",,83982,147681.0
93,2145-04-30 09:52:18,['units. Held sc heparin. Left thigh swollen. Ordered LENIs.'],"['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered LENIs.']",['units. Held sc heparin. Left thigh swollen. Ordered lenis.'],83982,147681.0
94,2145-05-01 06:54:43,"['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request but still required increase of two', 'pressors overnight.']","['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request but still required increase of two', 'pressors overnight.']","['- Family called and will now agree to diagnostic para if we want to do', 'it. Will be here at 4pm tomorrow for family meeting. Emailed liver team', 'to let them know this as well.', '- Re-positioned A-line with better pressure readings so were able to', 'decrease pressor requirement', '- Pressures started to drop overnight. Levo and vasopressin turned up.', 'CVVH run even with no change bps. Am hct lower and ptt higher. Gave 2', 'units. Held sc heparin. Left thigh swollen. Ordered LENIs.']",83982,147681.0
95,2145-05-01 07:00:11,"['- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two']","['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two', 'pressors overnight.']",['- CVVH held per family request but still required increase of two'],83982,147681.0
96,2145-05-01 08:33:53,,"['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two', 'pressors overnight.']",,83982,147681.0
97,2145-05-01 11:07:06,,"['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two', 'pressors overnight.']",,83982,147681.0
98,2145-05-01 11:20:20,,"['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two', 'pressors overnight.']",,83982,147681.0
99,2145-05-02 06:20:11,"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']","['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']","['- Micafungin added.', '- Bcx grew out GPC in pairs and chains; vanco changed to dapto.', '- Made DNR/DNI at family meeting.', '- CVVH held per family request. 3.2 L net positive yesterday and 4.8 L', 'net positive over length of stay. Still required increase of two', 'pressors overnight.']",83982,147681.0
100,2145-05-02 06:22:36,,"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']",,83982,147681.0
101,2145-05-02 06:23:30,,"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']",,83982,147681.0
102,2145-05-02 08:13:48,,"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']",,83982,147681.0
103,2145-05-02 09:41:48,,"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']",,83982,147681.0
104,2145-05-03 06:14:05,['- Family insisted on CVVH so patient was put back on it'],['- Family insisted on CVVH so patient was put back on it'],"['[**2145-5-1**]', '- Renal: Dialysis is not indicated.', ""- Liver: explained to sisters that he won't have dialysis.  They would"", 'like him to receive last rights and have his mother come in [**5-2**] before', 'pressors are stopped.', '- No further labs as intervetions would be futile', '- Budding yeast growing from A-line despite micafungin.']",83982,147681.0
105,2145-05-03 06:14:53,,['- Family insisted on CVVH so patient was put back on it'],,83982,147681.0
106,2145-05-03 06:38:58,,['- Family insisted on CVVH so patient was put back on it'],,83982,147681.0
107,2145-05-03 06:40:57,,['- Family insisted on CVVH so patient was put back on it'],,83982,147681.0
108,2145-05-03 10:46:46,,['- Family insisted on CVVH so patient was put back on it'],,83982,147681.0
109,2145-05-04 07:17:58,"['- Family mtg: No escalation of care. Stop CVVH if BP does not tolerate.', '- CVVH stopped at 4:345 am as MAP unable to tolerate', '- Family notified to come see pt']","['- Family mtg: No escalation of care. Stop CVVH if BP does not tolerate.', '- CVVH stopped at 4:345 am as MAP unable to tolerate', '- Family notified to come see pt']",['- Family insisted on CVVH so patient was put back on it'],83982,147681.0
110,2145-05-04 07:23:58,,"['- Family mtg: No escalation of care. Stop CVVH if BP does not tolerate.', '- CVVH stopped at 4:345 am as MAP unable to tolerate', '- Family notified to come see pt']",,83982,147681.0
0,2159-11-12 07:13:42,,"['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",,91031,135028.0
1,2159-11-12 07:16:36,,"['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",,91031,135028.0
2,2159-11-12 10:31:08,,"['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",,91031,135028.0
3,2159-11-12 10:46:19,,"['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",,91031,135028.0
4,2159-11-12 10:48:55,,"['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",,91031,135028.0
5,2159-11-13 06:27:15,"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-11-12**] 01:50 PM', 'patient tongued out ETT. Reintubated without incident', ' PARACENTESIS - At [**2159-11-12**] 04:09 PM', '- fluid boluses (2 X 500) to bring up UOP', '- paracentesis negative for SBP', '- increased abd distention with no rise in lactate', '- worsening renal fxn Cr up to 3.7 at night', '- check final read of CT for possible MRI -  to discuss on rounds']","['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-11-12**] 01:50 PM', 'patient tongued out ETT. Reintubated without incident', ' PARACENTESIS - At [**2159-11-12**] 04:09 PM', '- fluid boluses (2 X 500) to bring up UOP', '- paracentesis negative for SBP', '- increased abd distention with no rise in lactate', '- worsening renal fxn Cr up to 3.7 at night', '- check final read of CT for possible MRI -  to discuss on rounds']","['PARACENTESIS - At [**2159-11-11**] 10:30 AM', ' MULTI LUMEN - START [**2159-11-11**] 11:42 AM', ' ARTERIAL LINE - START [**2159-11-11**] 12:30 PM', ' URINE CULTURE - At [**2159-11-11**] 02:20 PM', ' INVASIVE VENTILATION - START [**2159-11-11**] 04:36 PM', '- HCT stable']",91031,135028.0
6,2159-11-13 06:28:41,,"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-11-12**] 01:50 PM', 'patient tongued out ETT. Reintubated without incident', ' PARACENTESIS - At [**2159-11-12**] 04:09 PM', '- fluid boluses (2 X 500) to bring up UOP', '- paracentesis negative for SBP', '- increased abd distention with no rise in lactate', '- worsening renal fxn Cr up to 3.7 at night', '- check final read of CT for possible MRI -  to discuss on rounds']",,91031,135028.0
7,2159-11-13 16:10:48,['- planned to get liver transplant this afternoon'],"['UNPLANNED EXTUBATION (PATIENT-INITIATED) - At [**2159-11-12**] 01:50 PM', 'patient tongued out ETT. Reintubated without incident', ' PARACENTESIS - At [**2159-11-12**] 04:09 PM', '- fluid boluses (2 X 500) to bring up UOP', '- paracentesis negative for SBP', '- increased abd distention with no rise in lactate', '- worsening renal fxn Cr up to 3.7 at night', '- planned to get liver transplant this afternoon']",['- check final read of CT for possible MRI -  to discuss on rounds'],91031,135028.0
0,2186-03-11 06:55:12,,"['ARTERIAL LINE - START [**2186-3-10**] 10:47 AM', ' INVASIVE VENTILATION - START [**2186-3-10**] 12:33 PM', ' INVASIVE VENTILATION - STOP [**2186-3-10**] 02:59 PM', '-Extubated', '-CTA negative for PE', '-Cards recs: ECHO in a few days to further eval for wall motion', 'abnormalities, cycle enzymes, monitor Hct; feels this is not likely', 'embolic event or ACS-> likely due to acute blood loss', '-CE: 1st set: CK 89 MB 4 Trop 0.17, 2nd set: CK 217 MB 7 Trop 0.44,', 'next check CK 226 MB 6 Trop 0.21', '-Hct stable over multiple checks, most recent 29.2 stable from 30.2', 'prior.', '-A-line no longer [**Location (un) 308**] accurately']",,26763,146230.0
1,2186-03-11 06:58:12,,"['ARTERIAL LINE - START [**2186-3-10**] 10:47 AM', ' INVASIVE VENTILATION - START [**2186-3-10**] 12:33 PM', ' INVASIVE VENTILATION - STOP [**2186-3-10**] 02:59 PM', '-Extubated', '-CTA negative for PE', '-Cards recs: ECHO in a few days to further eval for wall motion', 'abnormalities, cycle enzymes, monitor Hct; feels this is not likely', 'embolic event or ACS-> likely due to acute blood loss', '-CE: 1st set: CK 89 MB 4 Trop 0.17, 2nd set: CK 217 MB 7 Trop 0.44,', 'next check CK 226 MB 6 Trop 0.21', '-Hct stable over multiple checks, most recent 29.2 stable from 30.2', 'prior.', '-A-line no longer [**Location (un) 308**] accurately']",,26763,146230.0
2,2186-03-11 10:38:36,,"['ARTERIAL LINE - START [**2186-3-10**] 10:47 AM', ' INVASIVE VENTILATION - START [**2186-3-10**] 12:33 PM', ' INVASIVE VENTILATION - STOP [**2186-3-10**] 02:59 PM', '-Extubated', '-CTA negative for PE', '-Cards recs: ECHO in a few days to further eval for wall motion', 'abnormalities, cycle enzymes, monitor Hct; feels this is not likely', 'embolic event or ACS-> likely due to acute blood loss', '-CE: 1st set: CK 89 MB 4 Trop 0.17, 2nd set: CK 217 MB 7 Trop 0.44,', 'next check CK 226 MB 6 Trop 0.21', '-Hct stable over multiple checks, most recent 29.2 stable from 30.2', 'prior.', '-A-line no longer [**Location (un) 308**] accurately']",,26763,146230.0
0,2174-11-30 06:45:29,,"['-  Given metoprolol 5mg, repeat x1 which brought HR down to 100s, also', 'dropped BP and required more pressors', '- 4L IVF, now on levo and neo, trying to switch to neo...', '- Fever, + blood cultures']",,15853,111874.0
1,2174-11-30 11:19:24,,"['-  Given metoprolol 5mg, repeat x1 which brought HR down to 100s, also', 'dropped BP and required more pressors', '- 4L IVF, now on levo and neo, trying to switch to neo...', '- Fever, + blood cultures']",,15853,111874.0
2,2174-12-01 07:13:53,"['SPUTUM CULTURE - At [**2174-11-30**] 08:00 AM', ' BLOOD CULTURED - At [**2174-11-30**] 02:10 PM', ' URINE CULTURE - At [**2174-11-30**] 02:10 PM', ' ARTERIAL LINE - START [**2174-11-30**] 04:06 PM', ' FEVER - 102.6', 'F - [**2174-11-30**] 06:00 PM', ""- Febrile, tachy, bp's 90-110's through the day"", '- On Levo, Neo, Fentanyl, Versed, Vanc, Cefipime, Cipro', '- Up 11L through day but UOP only in 30-40/hr', '- FeUrea 28%', '- Ca is dropping', '- O2 112 on ABG --> FiO2 dropped to 40%', '- 11L up through day but UOP only 30-40cc/hr', '- Lactate coming down', '- Through the night becoming more tachy.', '- Last ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to 20.', '- D/c Versed and start Propofol for increased restlessness']","['SPUTUM CULTURE - At [**2174-11-30**] 08:00 AM', ' BLOOD CULTURED - At [**2174-11-30**] 02:10 PM', ' URINE CULTURE - At [**2174-11-30**] 02:10 PM', ' ARTERIAL LINE - START [**2174-11-30**] 04:06 PM', ' FEVER - 102.6', 'F - [**2174-11-30**] 06:00 PM', ""- Febrile, tachy, bp's 90-110's through the day"", '- On Levo, Neo, Fentanyl, Versed, Vanc, Cefipime, Cipro', '- Up 11L through day but UOP only in 30-40/hr', '- FeUrea 28%', '- Ca is dropping', '- O2 112 on ABG --> FiO2 dropped to 40%', '- 11L up through day but UOP only 30-40cc/hr', '- Lactate coming down', '- Through the night becoming more tachy.', '- Last ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to 20.', '- D/c Versed and start Propofol for increased restlessness']","['-  Given metoprolol 5mg, repeat x1 which brought HR down to 100s, also', 'dropped BP and required more pressors', '- 4L IVF, now on levo and neo, trying to switch to neo...', '- Fever, + blood cultures']",15853,111874.0
3,2174-12-01 16:10:11,"['- Around 4am he became acutely agitated and was fighting the vent.  He', 'was switched to propofol for sedation.', '-  Afterwards ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to', '20.']","['SPUTUM CULTURE - At [**2174-11-30**] 08:00 AM', ' BLOOD CULTURED - At [**2174-11-30**] 02:10 PM', ' URINE CULTURE - At [**2174-11-30**] 02:10 PM', ' ARTERIAL LINE - START [**2174-11-30**] 04:06 PM', ' FEVER - 102.6', 'F - [**2174-11-30**] 06:00 PM', ""- Febrile, tachy, bp's 90-110's through the day"", '- On Levo, Neo, Fentanyl, Versed, Vanc, Cefipime, Cipro', '- Up 11L through day but UOP only in 30-40/hr', '- FeUrea 28%', '- Ca is dropping', '- O2 112 on ABG --> FiO2 dropped to 40%', '- Lactate coming down', '- Around 4am he became acutely agitated and was fighting the vent.  He', 'was switched to propofol for sedation.', '-  Afterwards ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to', '20.']","['- 11L up through day but UOP only 30-40cc/hr', '- Through the night becoming more tachy.', '- Last ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to 20.', '- D/c Versed and start Propofol for increased restlessness']",15853,111874.0
4,2174-12-01 17:24:09,,"['SPUTUM CULTURE - At [**2174-11-30**] 08:00 AM', ' BLOOD CULTURED - At [**2174-11-30**] 02:10 PM', ' URINE CULTURE - At [**2174-11-30**] 02:10 PM', ' ARTERIAL LINE - START [**2174-11-30**] 04:06 PM', ' FEVER - 102.6', 'F - [**2174-11-30**] 06:00 PM', ""- Febrile, tachy, bp's 90-110's through the day"", '- On Levo, Neo, Fentanyl, Versed, Vanc, Cefipime, Cipro', '- Up 11L through day but UOP only in 30-40/hr', '- FeUrea 28%', '- Ca is dropping', '- O2 112 on ABG --> FiO2 dropped to 40%', '- Lactate coming down', '- Around 4am he became acutely agitated and was fighting the vent.  He', 'was switched to propofol for sedation.', '-  Afterwards ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to', '20.']",,15853,111874.0
5,2174-12-02 07:02:58,"['- Antibiotics changed to vanc/cipro from E. Coli in blood', '- Meeting with HCP [**Name (NI) 5463**] [**Name (NI) 10741**].  He agreed to make patient DNR and', 'to not escalate further, but wanted to contact family members before', 'making any final decision.  He will call tomorrow to update us.', '- [**Name (NI) 552**] niece, [**Name (NI) 10773**] [**Name (NI) 10749**], came in.  Understood the situation and', 'wants to support [**Doctor Last Name 5463**] in his decision to withdraw care.  She will', 'contact [**Name (NI) 5463**] in the morning to talk to him.', '- Plan is to check once daily labs only.']","['- Antibiotics changed to vanc/cipro from E. Coli in blood', '- Meeting with HCP [**Name (NI) 5463**] [**Name (NI) 10741**].  He agreed to make patient DNR and', 'to not escalate further, but wanted to contact family members before', 'making any final decision.  He will call tomorrow to update us.', '- [**Name (NI) 552**] niece, [**Name (NI) 10773**] [**Name (NI) 10749**], came in.  Understood the situation and', 'wants to support [**Doctor Last Name 5463**] in his decision to withdraw care.  She will', 'contact [**Name (NI) 5463**] in the morning to talk to him.', '- Plan is to check once daily labs only.']","['SPUTUM CULTURE - At [**2174-11-30**] 08:00 AM', ' BLOOD CULTURED - At [**2174-11-30**] 02:10 PM', ' URINE CULTURE - At [**2174-11-30**] 02:10 PM', ' ARTERIAL LINE - START [**2174-11-30**] 04:06 PM', ' FEVER - 102.6', 'F - [**2174-11-30**] 06:00 PM', ""- Febrile, tachy, bp's 90-110's through the day"", '- On Levo, Neo, Fentanyl, Versed, Vanc, Cefipime, Cipro', '- Up 11L through day but UOP only in 30-40/hr', '- FeUrea 28%', '- Ca is dropping', '- O2 112 on ABG --> FiO2 dropped to 40%', '- Lactate coming down', '- Around 4am he became acutely agitated and was fighting the vent.  He', 'was switched to propofol for sedation.', '-  Afterwards ABG 7.29/41/52/21/-6 so increased FiO2 to 70% and rr to', '20.']",15853,111874.0
6,2174-12-02 14:28:53,,"['- Antibiotics changed to vanc/cipro from E. Coli in blood', '- Meeting with HCP [**Name (NI) 5463**] [**Name (NI) 10741**].  He agreed to make patient DNR and', 'to not escalate further, but wanted to contact family members before', 'making any final decision.  He will call tomorrow to update us.', '- [**Name (NI) 552**] niece, [**Name (NI) 10773**] [**Name (NI) 10749**], came in.  Understood the situation and', 'wants to support [**Doctor Last Name 5463**] in his decision to withdraw care.  She will', 'contact [**Name (NI) 5463**] in the morning to talk to him.', '- Plan is to check once daily labs only.']",,15853,111874.0
0,2150-12-06 08:18:05,,"['EKG - At [**2150-12-5**] 07:30 PM', 'After admission, o/n pt remained stable but with copious secretions.', 'History obtained from Patient']",,29965,101744.0
1,2150-12-07 06:27:31,"['EKG - At [**2150-12-6**] 08:36 AM', ' SPUTUM CULTURE - At [**2150-12-6**] 10:53 AM', '- Patient is DNR/DNI with no lines or pressors', '- Nasotracheal suctioned several times with good mobilization of', 'secretions', '- Ipratroprium nebs ordered standing', '- Patient in A-fib early afternoon requiring 5 mg lopressor and 10 mg', 'IV diltiazem, but converted to NSR at 7 PM.', '- Swallow eval on Monday for concern of aspiration', '- Poor UOP despite bolusses and +5L for length of stay.']","['EKG - At [**2150-12-6**] 08:36 AM', ' SPUTUM CULTURE - At [**2150-12-6**] 10:53 AM', '- Patient is DNR/DNI with no lines or pressors', '- Nasotracheal suctioned several times with good mobilization of', 'secretions', '- Ipratroprium nebs ordered standing', '- Patient in A-fib early afternoon requiring 5 mg lopressor and 10 mg', 'IV diltiazem, but converted to NSR at 7 PM.', '- Swallow eval on Monday for concern of aspiration', '- Poor UOP despite bolusses and +5L for length of stay.']","['EKG - At [**2150-12-5**] 07:30 PM', 'After admission, o/n pt remained stable but with copious secretions.', 'History obtained from Patient']",29965,101744.0
2,2150-12-07 10:52:51,,"['EKG - At [**2150-12-6**] 08:36 AM', ' SPUTUM CULTURE - At [**2150-12-6**] 10:53 AM', '- Patient is DNR/DNI with no lines or pressors', '- Nasotracheal suctioned several times with good mobilization of', 'secretions', '- Ipratroprium nebs ordered standing', '- Patient in A-fib early afternoon requiring 5 mg lopressor and 10 mg', 'IV diltiazem, but converted to NSR at 7 PM.', '- Swallow eval on Monday for concern of aspiration', '- Poor UOP despite bolusses and +5L for length of stay.']",,29965,101744.0
3,2150-12-07 11:02:00,,"['EKG - At [**2150-12-6**] 08:36 AM', ' SPUTUM CULTURE - At [**2150-12-6**] 10:53 AM', '- Patient is DNR/DNI with no lines or pressors', '- Nasotracheal suctioned several times with good mobilization of', 'secretions', '- Ipratroprium nebs ordered standing', '- Patient in A-fib early afternoon requiring 5 mg lopressor and 10 mg', 'IV diltiazem, but converted to NSR at 7 PM.', '- Swallow eval on Monday for concern of aspiration', '- Poor UOP despite bolusses and +5L for length of stay.']",,29965,101744.0
0,2130-03-13 09:57:46,,"['MULTI LUMEN - START [**2130-3-13**] 12:00 AM', 'pt came with site from osh', 'Given 3amps of bicarbonate in D5W']",,1180,131713.0
1,2130-03-14 07:16:32,"['Seen by renal who think mental status changes too acute for uremia', 'OSH nephrologist away but should return [**3-14**]', 'Had multiple trauma films given fall prior to admission. No definite', 'fracuture of left upper or lower extremity but views limited overall', 'Improved mental status with ability to communicate her needs; able to', ""remember nurse's name throughout night""]","['Seen by renal who think mental status changes too acute for uremia', 'OSH nephrologist away but should return [**3-14**]', 'Had multiple trauma films given fall prior to admission. No definite', 'fracuture of left upper or lower extremity but views limited overall', 'Improved mental status with ability to communicate her needs; able to', ""remember nurse's name throughout night""]","['MULTI LUMEN - START [**2130-3-13**] 12:00 AM', 'pt came with site from osh', 'Given 3amps of bicarbonate in D5W']",1180,131713.0
2,2130-03-14 14:20:02,,"['Seen by renal who think mental status changes too acute for uremia', 'OSH nephrologist away but should return [**3-14**]', 'Had multiple trauma films given fall prior to admission. No definite', 'fracuture of left upper or lower extremity but views limited overall', 'Improved mental status with ability to communicate her needs; able to', ""remember nurse's name throughout night""]",,1180,131713.0
0,2176-02-10 07:05:11,,"['-C-spine re-read as large midline protrusion of the intervertebral disk', 'at C4-5 with concern for cord compression', '-MRI C-spine then ordered per NSG recs: showed central disc protrusion', ""at C4-C5 with mild central canal stenosis. Hard collar d/c'd"", '-Cycled Troponins increasing 0.01->0.01->0.05->0.07']",,70252,104511.0
1,2176-02-10 11:50:50,,"['-C-spine re-read as large midline protrusion of the intervertebral disk', 'at C4-5 with concern for cord compression', '-MRI C-spine then ordered per NSG recs: showed central disc protrusion', ""at C4-C5 with mild central canal stenosis. Hard collar d/c'd"", '-Cycled Troponins increasing 0.01->0.01->0.05->0.07']",,70252,104511.0
2,2176-02-10 11:53:19,,"['-C-spine re-read as large midline protrusion of the intervertebral disk', 'at C4-5 with concern for cord compression', '-MRI C-spine then ordered per NSG recs: showed central disc protrusion', ""at C4-C5 with mild central canal stenosis. Hard collar d/c'd"", '-Cycled Troponins increasing 0.01->0.01->0.05->0.07']",,70252,104511.0
3,2176-02-10 13:23:08,,"['-C-spine re-read as large midline protrusion of the intervertebral disk', 'at C4-5 with concern for cord compression', '-MRI C-spine then ordered per NSG recs: showed central disc protrusion', ""at C4-C5 with mild central canal stenosis. Hard collar d/c'd"", '-Cycled Troponins increasing 0.01->0.01->0.05->0.07']",,70252,104511.0
0,2111-12-16 06:40:31,,"['NON-INVASIVE VENTILATION - START [**2111-12-16**] 01:33 AM', ' NASAL SWAB - At [**2111-12-16**] 04:12 AM', 'MRSA swab sent']",,90256,176449.0
1,2111-12-16 06:42:30,,"['NON-INVASIVE VENTILATION - START [**2111-12-16**] 01:33 AM', ' NASAL SWAB - At [**2111-12-16**] 04:12 AM', 'MRSA swab sent']",,90256,176449.0
2,2111-12-16 11:40:36,,"['NON-INVASIVE VENTILATION - START [**2111-12-16**] 01:33 AM', ' NASAL SWAB - At [**2111-12-16**] 04:12 AM', 'MRSA swab sent']",,90256,176449.0
0,2142-02-24 06:17:51,,"['- Patient with HA, examined with neurology PA - pupils asymmetric by', '1mm, brisk response to light, no other symptoms on exam, gave tylenol', '- head CT - no acute change', '- Heparin gtt PTT 55-65']",,51698,190004.0
1,2142-02-24 11:34:15,,"['- Patient with HA, examined with neurology PA - pupils asymmetric by', '1mm, brisk response to light, no other symptoms on exam, gave tylenol', '- head CT - no acute change', '- Heparin gtt PTT 55-65']",,51698,190004.0
2,2142-03-02 06:16:06,"['- Patient trigger - desaturation to 74% on RA, placed on NRB with', 'return of SaO2. Temperature found to be 105. Rigors. CXR with new LLL', 'infiltrate. Started on vanc/cefepime.', '- became relatively hypotensive (SBP 80-90s), gave NS bolus. Nl', 'lactate. Transferred to ICU', '- CTA - bilateral filling defects of R and L pulm arteries - minimally', 'decreased in size, fluid collection in left hip abductor area - may be', 'hematoma or abcess']","['- Patient trigger - desaturation to 74% on RA, placed on NRB with', 'return of SaO2. Temperature found to be 105. Rigors. CXR with new LLL', 'infiltrate. Started on vanc/cefepime.', '- became relatively hypotensive (SBP 80-90s), gave NS bolus. Nl', 'lactate. Transferred to ICU', '- CTA - bilateral filling defects of R and L pulm arteries - minimally', 'decreased in size, fluid collection in left hip abductor area - may be', 'hematoma or abcess']","['- Patient with HA, examined with neurology PA - pupils asymmetric by', '1mm, brisk response to light, no other symptoms on exam, gave tylenol', '- head CT - no acute change', '- Heparin gtt PTT 55-65']",51698,190004.0
3,2142-03-03 06:41:28,"['- Patient developed worsening lt hip/thigh pain.  Ortho consulted due', 'to concern for septic prosthetic joint.', 'Ortho thinks exam is', ""concerning for septic hip.  Rec aspiration by IR (but IR thinks it's"", 'not possible while anticoagulated).  Hip X-rays also obtained.', '- Ultrasound of previous fluid collection obtained and was consistent', 'with hematoma.', '- Patient in the evening had temp up to 102 and was rigoring.  No focal', 'source of infection found with cultures/imaging from morning rigoring', 'session.', '- Flagyl added for aneorobic coverage due to continued fevers.', '- TTE showed improvement in right heart size with EF of 50-55%.', '- making poor urine, bolused 500cc']","['- Patient developed worsening lt hip/thigh pain.  Ortho consulted due', 'to concern for septic prosthetic joint.', 'Ortho thinks exam is', ""concerning for septic hip.  Rec aspiration by IR (but IR thinks it's"", 'not possible while anticoagulated).  Hip X-rays also obtained.', '- Ultrasound of previous fluid collection obtained and was consistent', 'with hematoma.', '- Patient in the evening had temp up to 102 and was rigoring.  No focal', 'source of infection found with cultures/imaging from morning rigoring', 'session.', '- Flagyl added for aneorobic coverage due to continued fevers.', '- TTE showed improvement in right heart size with EF of 50-55%.', '- making poor urine, bolused 500cc']","['- Patient trigger - desaturation to 74% on RA, placed on NRB with', 'return of SaO2. Temperature found to be 105. Rigors. CXR with new LLL', 'infiltrate. Started on vanc/cefepime.', '- became relatively hypotensive (SBP 80-90s), gave NS bolus. Nl', 'lactate. Transferred to ICU', '- CTA - bilateral filling defects of R and L pulm arteries - minimally', 'decreased in size, fluid collection in left hip abductor area - may be', 'hematoma or abcess']",51698,190004.0
4,2142-03-03 11:57:33,,"['- Patient developed worsening lt hip/thigh pain.  Ortho consulted due', 'to concern for septic prosthetic joint.', 'Ortho thinks exam is', ""concerning for septic hip.  Rec aspiration by IR (but IR thinks it's"", 'not possible while anticoagulated).  Hip X-rays also obtained.', '- Ultrasound of previous fluid collection obtained and was consistent', 'with hematoma.', '- Patient in the evening had temp up to 102 and was rigoring.  No focal', 'source of infection found with cultures/imaging from morning rigoring', 'session.', '- Flagyl added for aneorobic coverage due to continued fevers.', '- TTE showed improvement in right heart size with EF of 50-55%.', '- making poor urine, bolused 500cc']",,51698,190004.0
5,2142-03-03 16:03:09,,"['- Patient developed worsening lt hip/thigh pain.  Ortho consulted due', 'to concern for septic prosthetic joint.', 'Ortho thinks exam is', ""concerning for septic hip.  Rec aspiration by IR (but IR thinks it's"", 'not possible while anticoagulated).  Hip X-rays also obtained.', '- Ultrasound of previous fluid collection obtained and was consistent', 'with hematoma.', '- Patient in the evening had temp up to 102 and was rigoring.  No focal', 'source of infection found with cultures/imaging from morning rigoring', 'session.', '- Flagyl added for aneorobic coverage due to continued fevers.', '- TTE showed improvement in right heart size with EF of 50-55%.', '- making poor urine, bolused 500cc']",,51698,190004.0
6,2142-03-04 08:47:29,"['- Patient trigger - desaturation to 74% on RA, placed on NRB with', 'return of SaO2. Temperature found to be 105. Rigors. CXR with new LLL', 'infiltrate. Started on vanc/cefepime.', '- became relatively hypotensive (SBP 80-90s), gave NS bolus. Nl', 'lactate. Transferred to ICU', '- CTA - bilateral filling defects of R and L pulm arteries - minimally', 'decreased in size, fluid collection in left hip abductor area - may be', 'hematoma or abcess']","['- Patient trigger - desaturation to 74% on RA, placed on NRB with', 'return of SaO2. Temperature found to be 105. Rigors. CXR with new LLL', 'infiltrate. Started on vanc/cefepime.', '- became relatively hypotensive (SBP 80-90s), gave NS bolus. Nl', 'lactate. Transferred to ICU', '- CTA - bilateral filling defects of R and L pulm arteries - minimally', 'decreased in size, fluid collection in left hip abductor area - may be', 'hematoma or abcess']","['- Patient developed worsening lt hip/thigh pain.  Ortho consulted due', 'to concern for septic prosthetic joint.', 'Ortho thinks exam is', ""concerning for septic hip.  Rec aspiration by IR (but IR thinks it's"", 'not possible while anticoagulated).  Hip X-rays also obtained.', '- Ultrasound of previous fluid collection obtained and was consistent', 'with hematoma.', '- Patient in the evening had temp up to 102 and was rigoring.  No focal', 'source of infection found with cultures/imaging from morning rigoring', 'session.', '- Flagyl added for aneorobic coverage due to continued fevers.', '- TTE showed improvement in right heart size with EF of 50-55%.', '- making poor urine, bolused 500cc']",51698,190004.0
0,2126-01-23 07:32:00,,"['BLOOD CULTURED - At [**2126-1-22**] 11:01 PM', ' BLOOD CULTURED - At [**2126-1-22**] 11:02 PM', ' MULTI LUMEN - START [**2126-1-22**] 11:22 PM', ' ARTERIAL LINE - START [**2126-1-22**] 11:58 PM', ' FEVER - 102.5', 'F - [**2126-1-22**] 09:50 PM']",,29495,182822.0
1,2126-01-23 11:37:05,"['Arterial line placed', 'Received aggressive fluid resuscitation and placed on levophed and', 'vasopressin, now tapering off of pressors', 'c/o some persistent R sided abdominal/back discomfort today', ' BLOOD CULTURED - At [**2126-1-22**] 11:01 PM']","['Arterial line placed', 'Received aggressive fluid resuscitation and placed on levophed and', 'vasopressin, now tapering off of pressors', 'c/o some persistent R sided abdominal/back discomfort today', ' BLOOD CULTURED - At [**2126-1-22**] 11:01 PM', ' BLOOD CULTURED - At [**2126-1-22**] 11:02 PM', ' MULTI LUMEN - START [**2126-1-22**] 11:22 PM', ' ARTERIAL LINE - START [**2126-1-22**] 11:58 PM', ' FEVER - 102.5', 'F - [**2126-1-22**] 09:50 PM']",['BLOOD CULTURED - At [**2126-1-22**] 11:01 PM'],29495,182822.0
2,2126-01-23 11:43:52,,"['Arterial line placed', 'Received aggressive fluid resuscitation and placed on levophed and', 'vasopressin, now tapering off of pressors', 'c/o some persistent R sided abdominal/back discomfort today', ' BLOOD CULTURED - At [**2126-1-22**] 11:01 PM', ' BLOOD CULTURED - At [**2126-1-22**] 11:02 PM', ' MULTI LUMEN - START [**2126-1-22**] 11:22 PM', ' ARTERIAL LINE - START [**2126-1-22**] 11:58 PM', ' FEVER - 102.5', 'F - [**2126-1-22**] 09:50 PM']",,29495,182822.0
3,2126-01-24 07:35:33,"['- weaned off of levophed, vasopressin remains on per protocol but MAPs', 'have been fine', '- switched to morphine from toradol yesterday with excellent pain', 'control, [**1-3**] this AM', ' EKG - At [**2126-1-23**] 11:23 AM']","['- weaned off of levophed, vasopressin remains on per protocol but MAPs', 'have been fine', '- switched to morphine from toradol yesterday with excellent pain', 'control, [**1-3**] this AM', ' EKG - At [**2126-1-23**] 11:23 AM']","['Arterial line placed', 'Received aggressive fluid resuscitation and placed on levophed and', 'vasopressin, now tapering off of pressors', 'c/o some persistent R sided abdominal/back discomfort today', ' BLOOD CULTURED - At [**2126-1-22**] 11:01 PM', ' BLOOD CULTURED - At [**2126-1-22**] 11:02 PM', ' MULTI LUMEN - START [**2126-1-22**] 11:22 PM', ' ARTERIAL LINE - START [**2126-1-22**] 11:58 PM', ' FEVER - 102.5', 'F - [**2126-1-22**] 09:50 PM']",29495,182822.0
4,2126-01-25 07:55:40,"['Urology came by--cannot be sure stone has resolved, just need to follow', 'her', 'Seen by cardiology and EP for new AFib; pacemaker was firing on the ?T', 'waves and changed to DDI', 'Advised to started amiodarone and metoprolol,  consider ASA.', 'BP labile with episodes of SBP in 80s (not correlated with episodes of', 'AFib), asymptomatic', 'Continued to have brief episodes of AFib overnight', 'Continued to have good urine output but unable to diurese to goal b/c', 'of hypotension']","['Urology came by--cannot be sure stone has resolved, just need to follow', 'her', 'Seen by cardiology and EP for new AFib; pacemaker was firing on the ?T', 'waves and changed to DDI', 'Advised to started amiodarone and metoprolol,  consider ASA.', 'BP labile with episodes of SBP in 80s (not correlated with episodes of', 'AFib), asymptomatic', 'Continued to have brief episodes of AFib overnight', 'Continued to have good urine output but unable to diurese to goal b/c', 'of hypotension']","['- weaned off of levophed, vasopressin remains on per protocol but MAPs', 'have been fine', '- switched to morphine from toradol yesterday with excellent pain', 'control, [**1-3**] this AM', ' EKG - At [**2126-1-23**] 11:23 AM']",29495,182822.0
5,2126-01-25 08:10:08,,"['Urology came by--cannot be sure stone has resolved, just need to follow', 'her', 'Seen by cardiology and EP for new AFib; pacemaker was firing on the ?T', 'waves and changed to DDI', 'Advised to started amiodarone and metoprolol,  consider ASA.', 'BP labile with episodes of SBP in 80s (not correlated with episodes of', 'AFib), asymptomatic', 'Continued to have brief episodes of AFib overnight', 'Continued to have good urine output but unable to diurese to goal b/c', 'of hypotension']",,29495,182822.0
6,2126-01-26 11:11:20,"[""DC'd steroids"", 'CT torso - no evidence of absecess or pneumonia. findings c/w R sided', 'pyelo', ' ARTERIAL LINE - STOP [**2126-1-25**] 08:00 PM', ' CALLED OUT']","[""DC'd steroids"", 'CT torso - no evidence of absecess or pneumonia. findings c/w R sided', 'pyelo', ' ARTERIAL LINE - STOP [**2126-1-25**] 08:00 PM', ' CALLED OUT']","['Urology came by--cannot be sure stone has resolved, just need to follow', 'her', 'Seen by cardiology and EP for new AFib; pacemaker was firing on the ?T', 'waves and changed to DDI', 'Advised to started amiodarone and metoprolol,  consider ASA.', 'BP labile with episodes of SBP in 80s (not correlated with episodes of', 'AFib), asymptomatic', 'Continued to have brief episodes of AFib overnight', 'Continued to have good urine output but unable to diurese to goal b/c', 'of hypotension']",29495,182822.0
7,2126-01-26 11:22:57,"['Patient reports decrease SOB, no CP. Has been in sinus rhythm for 24', 'hours.  Arterial line removed.']","[""DC'd steroids"", 'CT torso - no evidence of absecess or pneumonia. findings c/w R sided', 'pyelo', 'Patient reports decrease SOB, no CP. Has been in sinus rhythm for 24', 'hours.  Arterial line removed.', ' ARTERIAL LINE - STOP [**2126-1-25**] 08:00 PM', ' CALLED OUT']",,29495,182822.0
0,2124-06-16 07:16:48,,"['MIDLINE - START [**2124-6-15**] 08:30 AM', ' MULTI LUMEN - START [**2124-6-15**] 02:33 PM', ' LUMBAR PUNCTURE - At [**2124-6-15**] 06:30 PM', ' MIDLINE - STOP [**2124-6-15**] 10:00 PM', ' ARTERIAL LINE - START [**2124-6-16**] 04:56 AM', '.', '-LP: Opening Pressure 27 / CSF c/w ?aseptic meningitis, numerous', 'studies/cultures pending', '-talked to ID, changed to treatment dose IV acyclovir', ""-midline d/c'd, tip cultured"", '-ABG w/ improved oxygenation, acute resp alk, lactate up to 3.6 then', 'back down to 2.8', '-received 2U plts, 47 -> 87', '-CVP low [**4-23**], given 500cc bolus x3', '-received 1U pRBC overnight HCT 22', '-lactate up to 2.2->3.2', '-CvO2 67', '.']",,43126,124079.0
1,2124-06-16 12:58:44,"['-ABG w/ improved oxygenation, acute resp alk, lactate up to 2.2->3.2', '-CVP low [**4-23**], given 500cc bolus x5']","['MIDLINE - START [**2124-6-15**] 08:30 AM', ' MULTI LUMEN - START [**2124-6-15**] 02:33 PM', ' LUMBAR PUNCTURE - At [**2124-6-15**] 06:30 PM', ' MIDLINE - STOP [**2124-6-15**] 10:00 PM', ' ARTERIAL LINE - START [**2124-6-16**] 04:56 AM', '.', '-LP: Opening Pressure 27 / CSF c/w ?aseptic meningitis, numerous', 'studies/cultures pending', '-talked to ID, changed to treatment dose IV acyclovir', ""-midline d/c'd, tip cultured"", '-ABG w/ improved oxygenation, acute resp alk, lactate up to 2.2->3.2', '-received 2U plts, 47 -> 87', '-CVP low [**4-23**], given 500cc bolus x5', '-received 1U pRBC overnight HCT 22', '-CvO2 67', '.']","['-ABG w/ improved oxygenation, acute resp alk, lactate up to 3.6 then', 'back down to 2.8', '-CVP low [**4-23**], given 500cc bolus x3', '-lactate up to 2.2->3.2']",43126,124079.0
2,2124-06-16 16:29:55,,"['MIDLINE - START [**2124-6-15**] 08:30 AM', ' MULTI LUMEN - START [**2124-6-15**] 02:33 PM', ' LUMBAR PUNCTURE - At [**2124-6-15**] 06:30 PM', ' MIDLINE - STOP [**2124-6-15**] 10:00 PM', ' ARTERIAL LINE - START [**2124-6-16**] 04:56 AM', '.', '-LP: Opening Pressure 27 / CSF c/w ?aseptic meningitis, numerous', 'studies/cultures pending', '-talked to ID, changed to treatment dose IV acyclovir', ""-midline d/c'd, tip cultured"", '-ABG w/ improved oxygenation, acute resp alk, lactate up to 2.2->3.2', '-received 2U plts, 47 -> 87', '-CVP low [**4-23**], given 500cc bolus x5', '-received 1U pRBC overnight HCT 22', '-CvO2 67', '.']",,43126,124079.0
3,2124-06-17 07:36:26,"['-BMT said would look into CSF lymphocytes do not look malignant.', '-ID approved Foscarnet. Will need to give 500 cc boluses before each', 'dose.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']","['-BMT said would look into CSF lymphocytes do not look malignant.', '-ID approved Foscarnet. Will need to give 500 cc boluses before each', 'dose.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']","['MIDLINE - START [**2124-6-15**] 08:30 AM', ' MULTI LUMEN - START [**2124-6-15**] 02:33 PM', ' LUMBAR PUNCTURE - At [**2124-6-15**] 06:30 PM', ' MIDLINE - STOP [**2124-6-15**] 10:00 PM', ' ARTERIAL LINE - START [**2124-6-16**] 04:56 AM', '.', '-LP: Opening Pressure 27 / CSF c/w ?aseptic meningitis, numerous', 'studies/cultures pending', '-talked to ID, changed to treatment dose IV acyclovir', ""-midline d/c'd, tip cultured"", '-ABG w/ improved oxygenation, acute resp alk, lactate up to 2.2->3.2', '-received 2U plts, 47 -> 87', '-CVP low [**4-23**], given 500cc bolus x5', '-received 1U pRBC overnight HCT 22', '-CvO2 67', '.']",43126,124079.0
4,2124-06-17 07:44:39,,"['-BMT said would look into CSF lymphocytes do not look malignant.', '-ID approved Foscarnet. Will need to give 500 cc boluses before each', 'dose.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']",,43126,124079.0
5,2124-06-17 13:19:44,['-transfused 2 units PRBCs overnight because of Hct drop 26 to 22.'],"['-transfused 2 units PRBCs overnight because of Hct drop 26 to 22.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']","['-BMT said would look into CSF lymphocytes do not look malignant.', '-ID approved Foscarnet. Will need to give 500 cc boluses before each', 'dose.']",43126,124079.0
6,2124-06-17 13:22:03,,"['-transfused 2 units PRBCs overnight because of Hct drop 26 to 22.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']",,43126,124079.0
7,2124-06-17 15:10:37,,"['-transfused 2 units PRBCs overnight because of Hct drop 26 to 22.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']",,43126,124079.0
8,2124-06-18 07:51:13,"['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']","['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']","['-transfused 2 units PRBCs overnight because of Hct drop 26 to 22.', '-TTE: No obvious vegetations seen.', '-Given 500 cc bolus of NS because FeNa=0.8.']",43126,124079.0
9,2124-06-18 07:54:14,,"['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']",,43126,124079.0
10,2124-06-18 14:00:41,,"['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']",,43126,124079.0
11,2124-06-18 17:37:24,,"['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']",,43126,124079.0
12,2124-06-19 06:58:21,"['ARTERIAL LINE - STOP [**2124-6-18**] 12:57 PM', ' STOOL CULTURE - At [**2124-6-18**] 01:18 PM', ' LUMBAR PUNCTURE - At [**2124-6-18**] 06:30 PM']","['ARTERIAL LINE - STOP [**2124-6-18**] 12:57 PM', ' STOOL CULTURE - At [**2124-6-18**] 01:18 PM', ' LUMBAR PUNCTURE - At [**2124-6-18**] 06:30 PM']","['-Hct stable 22.6, hapto (-)', '-UCx (-), BCx NGTD, CSFCx NGTD']",43126,124079.0
13,2124-06-19 07:05:19,"['-re-tapped, opening pressure 35, CSF again c/w aseptic meningitis, sent', 'for flow cytometry', '-callout to BMT today']","['ARTERIAL LINE - STOP [**2124-6-18**] 12:57 PM', ' STOOL CULTURE - At [**2124-6-18**] 01:18 PM', ' LUMBAR PUNCTURE - At [**2124-6-18**] 06:30 PM', '-re-tapped, opening pressure 35, CSF again c/w aseptic meningitis, sent', 'for flow cytometry', '-callout to BMT today']",,43126,124079.0
14,2124-06-19 07:32:35,,"['ARTERIAL LINE - STOP [**2124-6-18**] 12:57 PM', ' STOOL CULTURE - At [**2124-6-18**] 01:18 PM', ' LUMBAR PUNCTURE - At [**2124-6-18**] 06:30 PM', '-re-tapped, opening pressure 35, CSF again c/w aseptic meningitis, sent', 'for flow cytometry', '-callout to BMT today']",,43126,124079.0
15,2124-06-19 15:38:18,,"['ARTERIAL LINE - STOP [**2124-6-18**] 12:57 PM', ' STOOL CULTURE - At [**2124-6-18**] 01:18 PM', ' LUMBAR PUNCTURE - At [**2124-6-18**] 06:30 PM', '-re-tapped, opening pressure 35, CSF again c/w aseptic meningitis, sent', 'for flow cytometry']",['-callout to BMT today'],43126,124079.0
0,2124-08-26 07:09:05,,"['Pt. started on standing haldol as per neuroloy recs, but patient had QT', 'prolongation to 0.49, so patient was changed to zyprexa 5mg QID.', 'Treatment with cidofovir was initiated yesterday, with probenecid for', 'renal protection', 'Patient to get an EEG today']",,43126,132026.0
1,2124-08-26 11:38:43,,"['Pt. started on standing haldol as per neuroloy recs, but patient had QT', 'prolongation to 0.49, so patient was changed to zyprexa 5mg QID.', 'Treatment with cidofovir was initiated yesterday, with probenecid for', 'renal protection', 'Patient to get an EEG today']",,43126,132026.0
2,2124-08-26 13:55:49,,"['Pt. started on standing haldol as per neuroloy recs, but patient had QT', 'prolongation to 0.49, so patient was changed to zyprexa 5mg QID.', 'Treatment with cidofovir was initiated yesterday, with probenecid for', 'renal protection', 'Patient to get an EEG today']",,43126,132026.0
3,2124-08-26 15:28:12,,"['Pt. started on standing haldol as per neuroloy recs, but patient had QT', 'prolongation to 0.49, so patient was changed to zyprexa 5mg QID.', 'Treatment with cidofovir was initiated yesterday, with probenecid for', 'renal protection', 'Patient to get an EEG today']",,43126,132026.0
4,2124-08-27 07:00:28,"['- s/p 1u PRBC Hct 19.6 -> 24', '- EEG today  (iv benadryl prior to study to calm him down)', '- needs another dose of cidofovir (w probenecid next friday)- no', 'evidence that it will work even if he were infected in CSF; no evidence', 'yet that his CSF is infected w BK virus', '- keeping immunosuppressants for now, per dr. [**Last Name (STitle) **]']","['- s/p 1u PRBC Hct 19.6 -> 24', '- EEG today  (iv benadryl prior to study to calm him down)', '- needs another dose of cidofovir (w probenecid next friday)- no', 'evidence that it will work even if he were infected in CSF; no evidence', 'yet that his CSF is infected w BK virus', '- keeping immunosuppressants for now, per dr. [**Last Name (STitle) **]']","['Pt. started on standing haldol as per neuroloy recs, but patient had QT', 'prolongation to 0.49, so patient was changed to zyprexa 5mg QID.', 'Treatment with cidofovir was initiated yesterday, with probenecid for', 'renal protection', 'Patient to get an EEG today']",43126,132026.0
5,2124-08-27 14:45:54,,"['- s/p 1u PRBC Hct 19.6 -> 24', '- EEG today  (iv benadryl prior to study to calm him down)', '- needs another dose of cidofovir (w probenecid next friday)- no', 'evidence that it will work even if he were infected in CSF; no evidence', 'yet that his CSF is infected w BK virus', '- keeping immunosuppressants for now, per dr. [**Last Name (STitle) **]']",,43126,132026.0
6,2124-08-27 15:52:07,,"['- s/p 1u PRBC Hct 19.6 -> 24', '- EEG today  (iv benadryl prior to study to calm him down)', '- needs another dose of cidofovir (w probenecid next friday)- no', 'evidence that it will work even if he were infected in CSF; no evidence', 'yet that his CSF is infected w BK virus', '- keeping immunosuppressants for now, per dr. [**Last Name (STitle) **]']",,43126,132026.0
7,2124-08-28 06:52:48,"[""- EEG not done today; neuro never came by and we didn't want to sedate"", 'him as he is slowly waking up.', '- Gave 1 liter of LR b/c appeared volume down and decreased UOP...was', 'ok, then dropped off again so gave another bolus around [**2144**].', '- Gave IVIG per BMT', '- Likely call out in AM, and BMT is ok with this']","[""- EEG not done today; neuro never came by and we didn't want to sedate"", 'him as he is slowly waking up.', '- Gave 1 liter of LR b/c appeared volume down and decreased UOP...was', 'ok, then dropped off again so gave another bolus around [**2144**].', '- Gave IVIG per BMT', '- Likely call out in AM, and BMT is ok with this']","['- s/p 1u PRBC Hct 19.6 -> 24', '- EEG today  (iv benadryl prior to study to calm him down)', '- needs another dose of cidofovir (w probenecid next friday)- no', 'evidence that it will work even if he were infected in CSF; no evidence', 'yet that his CSF is infected w BK virus', '- keeping immunosuppressants for now, per dr. [**Last Name (STitle) **]']",43126,132026.0
8,2124-08-28 12:35:45,,"[""- EEG not done today; neuro never came by and we didn't want to sedate"", 'him as he is slowly waking up.', '- Gave 1 liter of LR b/c appeared volume down and decreased UOP...was', 'ok, then dropped off again so gave another bolus around [**2144**].', '- Gave IVIG per BMT', '- Likely call out in AM, and BMT is ok with this']",,43126,132026.0
9,2124-08-28 14:27:58,,"[""- EEG not done today; neuro never came by and we didn't want to sedate"", 'him as he is slowly waking up.', '- Gave 1 liter of LR b/c appeared volume down and decreased UOP...was', 'ok, then dropped off again so gave another bolus around [**2144**].', '- Gave IVIG per BMT', '- Likely call out in AM, and BMT is ok with this']",,43126,132026.0
10,2124-09-06 06:21:20,"['Appeared agitated with moaning most of night. Given 5 mg olanzapine and', '2 mg of haldol with little effect.']","['Appeared agitated with moaning most of night. Given 5 mg olanzapine and', '2 mg of haldol with little effect.']","[""- EEG not done today; neuro never came by and we didn't want to sedate"", 'him as he is slowly waking up.', '- Gave 1 liter of LR b/c appeared volume down and decreased UOP...was', 'ok, then dropped off again so gave another bolus around [**2144**].', '- Gave IVIG per BMT', '- Likely call out in AM, and BMT is ok with this']",43126,132026.0
11,2124-09-06 10:08:59,['3.5 mg of haldol with little effect.'],"['Appeared agitated with moaning most of night. Given 5 mg olanzapine and', '3.5 mg of haldol with little effect.']",['2 mg of haldol with little effect.'],43126,132026.0
12,2124-09-11 06:45:33,"['ARTERIAL LINE - START [**2124-9-10**] 08:27 AM', ' EKG - At [**2124-9-10**] 03:09 PM', '[**9-10**]:', '- Code Status: intubated, but DNR ; can use pressors but no', 'epi/atropine or compressions in code situation', '- has PICC line for access ; BMT & wife talked and want to hold off on', 'central line another day until dr. [**Last Name (STitle) 21**] back on service (for BMT)', '- bolusing sedation rather than drip b/c of limited access', '- amio drip for afib started in AM--> converted to sinus rhythm in 50s', '(had rate as high as 140s while in Afib)', '- will need to re-write for amio gtt 0.5mg/hr If Needed after the 18hrs', 'is up of the initial loading dose', '- gave 2L IVFs', '- increasing phenylephrine requirement', '- CT Head/chest/abd/pelvis - ?progression of subdural', 'hematomas/?pneumonia', '- limit antipsychotics but monitor QTc if have to use', '- f/u ID recs', '- trend neuro exams b/c of subdural hematomas', '- urine output dropping off around midnight --> gave 500ml LR bolus', '- CT Head -- stable subdural hematomas', '- CT chest- Bilat apices pneumonia; bilat bases pneumonia vs', 'atelectasis; bilat pleural effusions L>R (RIght side is new)', '- CT abd/pelvis - abdom LAD improved; moderate abd ascites; large amt', 'pelvic fluid ; diffuse anasarca']","['ARTERIAL LINE - START [**2124-9-10**] 08:27 AM', ' EKG - At [**2124-9-10**] 03:09 PM', '[**9-10**]:', '- Code Status: intubated, but DNR ; can use pressors but no', 'epi/atropine or compressions in code situation', '- has PICC line for access ; BMT & wife talked and want to hold off on', 'central line another day until dr. [**Last Name (STitle) 21**] back on service (for BMT)', '- bolusing sedation rather than drip b/c of limited access', '- amio drip for afib started in AM--> converted to sinus rhythm in 50s', '(had rate as high as 140s while in Afib)', '- will need to re-write for amio gtt 0.5mg/hr If Needed after the 18hrs', 'is up of the initial loading dose', '- gave 2L IVFs', '- increasing phenylephrine requirement', '- CT Head/chest/abd/pelvis - ?progression of subdural', 'hematomas/?pneumonia', '- limit antipsychotics but monitor QTc if have to use', '- f/u ID recs', '- trend neuro exams b/c of subdural hematomas', '- urine output dropping off around midnight --> gave 500ml LR bolus', '- CT Head -- stable subdural hematomas', '- CT chest- Bilat apices pneumonia; bilat bases pneumonia vs', 'atelectasis; bilat pleural effusions L>R (RIght side is new)', '- CT abd/pelvis - abdom LAD improved; moderate abd ascites; large amt', 'pelvic fluid ; diffuse anasarca']","['Appeared agitated with moaning most of night. Given 5 mg olanzapine and', '3.5 mg of haldol with little effect.']",43126,132026.0
13,2124-09-11 06:49:57,,"['ARTERIAL LINE - START [**2124-9-10**] 08:27 AM', ' EKG - At [**2124-9-10**] 03:09 PM', '[**9-10**]:', '- Code Status: intubated, but DNR ; can use pressors but no', 'epi/atropine or compressions in code situation', '- has PICC line for access ; BMT & wife talked and want to hold off on', 'central line another day until dr. [**Last Name (STitle) 21**] back on service (for BMT)', '- bolusing sedation rather than drip b/c of limited access', '- amio drip for afib started in AM--> converted to sinus rhythm in 50s', '(had rate as high as 140s while in Afib)', '- will need to re-write for amio gtt 0.5mg/hr If Needed after the 18hrs', 'is up of the initial loading dose', '- gave 2L IVFs', '- increasing phenylephrine requirement', '- CT Head/chest/abd/pelvis - ?progression of subdural', 'hematomas/?pneumonia', '- limit antipsychotics but monitor QTc if have to use', '- f/u ID recs', '- trend neuro exams b/c of subdural hematomas', '- urine output dropping off around midnight --> gave 500ml LR bolus', '- CT Head -- stable subdural hematomas', '- CT chest- Bilat apices pneumonia; bilat bases pneumonia vs', 'atelectasis; bilat pleural effusions L>R (RIght side is new)', '- CT abd/pelvis - abdom LAD improved; moderate abd ascites; large amt', 'pelvic fluid ; diffuse anasarca']",,43126,132026.0
14,2124-09-11 17:25:26,,"['ARTERIAL LINE - START [**2124-9-10**] 08:27 AM', ' EKG - At [**2124-9-10**] 03:09 PM', '[**9-10**]:', '- Code Status: intubated, but DNR ; can use pressors but no', 'epi/atropine or compressions in code situation', '- has PICC line for access ; BMT & wife talked and want to hold off on', 'central line another day until dr. [**Last Name (STitle) 21**] back on service (for BMT)', '- bolusing sedation rather than drip b/c of limited access', '- amio drip for afib started in AM--> converted to sinus rhythm in 50s', '(had rate as high as 140s while in Afib)', '- will need to re-write for amio gtt 0.5mg/hr If Needed after the 18hrs', 'is up of the initial loading dose', '- gave 2L IVFs', '- increasing phenylephrine requirement', '- CT Head/chest/abd/pelvis - ?progression of subdural', 'hematomas/?pneumonia', '- limit antipsychotics but monitor QTc if have to use', '- f/u ID recs', '- trend neuro exams b/c of subdural hematomas', '- urine output dropping off around midnight --> gave 500ml LR bolus', '- CT Head -- stable subdural hematomas', '- CT chest- Bilat apices pneumonia; bilat bases pneumonia vs', 'atelectasis; bilat pleural effusions L>R (RIght side is new)', '- CT abd/pelvis - abdom LAD improved; moderate abd ascites; large amt', 'pelvic fluid ; diffuse anasarca']",,43126,132026.0
15,2124-09-12 07:24:47,"['ARTERIAL LINE - STOP [**2124-9-11**] 07:00 PM', '- Goals of care discussed with Dr. [**Last Name (STitle) 21**] as well as family.  The', ""patient's wife signed a new ICU consent which allows for CVL"", 'placement.  Code status switched to FULL CODE', '- on PS 5/5 as of [**9-11**]', '- No growth on any cultures thus far', ""-Midazolam and Fentanyl d/c'd"", '-Nutrition - TPN; family to discuss access with Dr. [**Last Name (STitle) 21**]', '[**Name (STitle) **] off on Amio PO as currently in sinus', '-ID recs: Started on Linezolid in place of Daptomycin on .', '-Heme/Onc recs', '-VBG and ABG to assess CO2 level prior to extubation', ""-Neo weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]","['ARTERIAL LINE - STOP [**2124-9-11**] 07:00 PM', '- Goals of care discussed with Dr. [**Last Name (STitle) 21**] as well as family.  The', ""patient's wife signed a new ICU consent which allows for CVL"", 'placement.  Code status switched to FULL CODE', '- on PS 5/5 as of [**9-11**]', '- No growth on any cultures thus far', ""-Midazolam and Fentanyl d/c'd"", '-Nutrition - TPN; family to discuss access with Dr. [**Last Name (STitle) 21**]', '[**Name (STitle) **] off on Amio PO as currently in sinus', '-ID recs: Started on Linezolid in place of Daptomycin on .', '-Heme/Onc recs', '-VBG and ABG to assess CO2 level prior to extubation', ""-Neo weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]","['ARTERIAL LINE - START [**2124-9-10**] 08:27 AM', ' EKG - At [**2124-9-10**] 03:09 PM', '[**9-10**]:', '- Code Status: intubated, but DNR ; can use pressors but no', 'epi/atropine or compressions in code situation', '- has PICC line for access ; BMT & wife talked and want to hold off on', 'central line another day until dr. [**Last Name (STitle) 21**] back on service (for BMT)', '- bolusing sedation rather than drip b/c of limited access', '- amio drip for afib started in AM--> converted to sinus rhythm in 50s', '(had rate as high as 140s while in Afib)', '- will need to re-write for amio gtt 0.5mg/hr If Needed after the 18hrs', 'is up of the initial loading dose', '- gave 2L IVFs', '- increasing phenylephrine requirement', '- CT Head/chest/abd/pelvis - ?progression of subdural', 'hematomas/?pneumonia', '- limit antipsychotics but monitor QTc if have to use', '- f/u ID recs', '- trend neuro exams b/c of subdural hematomas', '- urine output dropping off around midnight --> gave 500ml LR bolus', '- CT Head -- stable subdural hematomas', '- CT chest- Bilat apices pneumonia; bilat bases pneumonia vs', 'atelectasis; bilat pleural effusions L>R (RIght side is new)', '- CT abd/pelvis - abdom LAD improved; moderate abd ascites; large amt', 'pelvic fluid ; diffuse anasarca']",43126,132026.0
16,2124-09-12 07:33:21,"['ARTERIAL LINE', '(fem) STOP [**2124-9-11**] 07:00 PM', ""[**Name (STitle) 11026**] weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]","['ARTERIAL LINE', '(fem) STOP [**2124-9-11**] 07:00 PM', '- Goals of care discussed with Dr. [**Last Name (STitle) 21**] as well as family.  The', ""patient's wife signed a new ICU consent which allows for CVL"", 'placement.  Code status switched to FULL CODE', '- on PS 5/5 as of [**9-11**]', '-Nutrition - TPN; family to discuss access with Dr. [**Last Name (STitle) 21**]', ""[**Name (STitle) 11026**] weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]","['ARTERIAL LINE - STOP [**2124-9-11**] 07:00 PM', '- No growth on any cultures thus far', ""-Midazolam and Fentanyl d/c'd"", '[**Name (STitle) **] off on Amio PO as currently in sinus', '-ID recs: Started on Linezolid in place of Daptomycin on .', '-Heme/Onc recs', '-VBG and ABG to assess CO2 level prior to extubation', ""-Neo weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]",43126,132026.0
17,2124-09-12 12:51:29,,"['ARTERIAL LINE', '(fem) STOP [**2124-9-11**] 07:00 PM', '- Goals of care discussed with Dr. [**Last Name (STitle) 21**] as well as family.  The', ""patient's wife signed a new ICU consent which allows for CVL"", 'placement.  Code status switched to FULL CODE', '- on PS 5/5 as of [**9-11**]', '-Nutrition - TPN; family to discuss access with Dr. [**Last Name (STitle) 21**]', ""[**Name (STitle) 11026**] weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]",,43126,132026.0
18,2124-09-13 07:26:27,"['-DIC labs negative (fibrinogen 444)', '-changed thiamine and folate to IV', '-transfused of 3 units platelets -> platelets 107 post-transfusion', '-gave 25g albumin', '-ID recs: suggest considering repeat mini-BAL, repeat LP, repeat viral', 'studies', '-sent EBV, CMV', '-mental status still poor off sedation (not responsive to sternal rub)', '-urine lytes: FeUrea 2.99, FeNa 0.51', '-ordered NGT', '-increased ambisome to 400 mg Q24H', '-ordered head CT --> wet read, subdural stable in appearance', '-8 p.m. CBC with stable platelets, Hct 22.8 from 20.6 after 2 units', 'PRBC', '-ordered another unit PRBC at 10:30 p.m.', '-checking DIC labs again in a.m.']","['-DIC labs negative (fibrinogen 444)', '-changed thiamine and folate to IV', '-transfused of 3 units platelets -> platelets 107 post-transfusion', '-gave 25g albumin', '-ID recs: suggest considering repeat mini-BAL, repeat LP, repeat viral', 'studies', '-sent EBV, CMV', '-mental status still poor off sedation (not responsive to sternal rub)', '-urine lytes: FeUrea 2.99, FeNa 0.51', '-ordered NGT', '-increased ambisome to 400 mg Q24H', '-ordered head CT --> wet read, subdural stable in appearance', '-8 p.m. CBC with stable platelets, Hct 22.8 from 20.6 after 2 units', 'PRBC', '-ordered another unit PRBC at 10:30 p.m.', '-checking DIC labs again in a.m.']","['ARTERIAL LINE', '(fem) STOP [**2124-9-11**] 07:00 PM', '- Goals of care discussed with Dr. [**Last Name (STitle) 21**] as well as family.  The', ""patient's wife signed a new ICU consent which allows for CVL"", 'placement.  Code status switched to FULL CODE', '- on PS 5/5 as of [**9-11**]', '-Nutrition - TPN; family to discuss access with Dr. [**Last Name (STitle) 21**]', ""[**Name (STitle) 11026**] weaned off and has been d/c'd since ~8 pm.  MAP holding in low 60s""]",43126,132026.0
19,2124-09-13 15:38:10,"['-mental status improving,  now opens eyes to commands, turns neck to', 'commands and wiggles toes']","['-DIC labs negative (fibrinogen 444)', '-changed thiamine and folate to IV', '-transfused of 3 units platelets -> platelets 107 post-transfusion', '-gave 25g albumin', '-ID recs: suggest considering repeat mini-BAL, repeat LP, repeat viral', 'studies', '-sent EBV, CMV', '-mental status improving,  now opens eyes to commands, turns neck to', 'commands and wiggles toes', '-urine lytes: FeUrea 2.99, FeNa 0.51', '-ordered NGT', '-increased ambisome to 400 mg Q24H', '-ordered head CT --> wet read, subdural stable in appearance', '-8 p.m. CBC with stable platelets, Hct 22.8 from 20.6 after 2 units', 'PRBC', '-ordered another unit PRBC at 10:30 p.m.']","['-mental status still poor off sedation (not responsive to sternal rub)', '-checking DIC labs again in a.m.']",43126,132026.0
20,2124-09-14 07:22:22,"['-Had melana', ""-D/c'ed benzo, olanzapine (has PRN fentanyl available)"", '[ ]p.m. CBC, goal Hct>24, Plt>50 (send platelets in blue top)', '- got PPN today', '(ok to do TPN thru double lumen catheter, no IJ needed)', '- will get TPN tmrw', '- rechecked CBC Hct 24.3, stable so no GI consult done']","['-Had melana', ""-D/c'ed benzo, olanzapine (has PRN fentanyl available)"", '[ ]p.m. CBC, goal Hct>24, Plt>50 (send platelets in blue top)', '- got PPN today', '(ok to do TPN thru double lumen catheter, no IJ needed)', '- will get TPN tmrw', '- rechecked CBC Hct 24.3, stable so no GI consult done']","['-DIC labs negative (fibrinogen 444)', '-changed thiamine and folate to IV', '-transfused of 3 units platelets -> platelets 107 post-transfusion', '-gave 25g albumin', '-ID recs: suggest considering repeat mini-BAL, repeat LP, repeat viral', 'studies', '-sent EBV, CMV', '-mental status improving,  now opens eyes to commands, turns neck to', 'commands and wiggles toes', '-urine lytes: FeUrea 2.99, FeNa 0.51', '-ordered NGT', '-increased ambisome to 400 mg Q24H', '-ordered head CT --> wet read, subdural stable in appearance', '-8 p.m. CBC with stable platelets, Hct 22.8 from 20.6 after 2 units', 'PRBC', '-ordered another unit PRBC at 10:30 p.m.']",43126,132026.0
21,2124-09-14 15:43:34,"['Benzodiazepine and  olanzapine were discontinued yesterday.', 'Last night, the patient was noted to have an episode of melena.', 'Hematocrit remained stable at 24.3.  The patient did not get a  CVL, as', 'it was determined that he can get TPN through his double lumen PICC.', 'The patient got PPN yesterday.', 'This morning the patient was noted to have worsening hematuria with', 'reduced urine output through his catheter.', 'The patient continues to be stably more responsive today, opens eyes to', 'commands and spontaneously moves all extremities.  No significant', 'change in this regard since yesterday.']","['Benzodiazepine and  olanzapine were discontinued yesterday.', 'Last night, the patient was noted to have an episode of melena.', 'Hematocrit remained stable at 24.3.  The patient did not get a  CVL, as', 'it was determined that he can get TPN through his double lumen PICC.', 'The patient got PPN yesterday.', 'This morning the patient was noted to have worsening hematuria with', 'reduced urine output through his catheter.', 'The patient continues to be stably more responsive today, opens eyes to', 'commands and spontaneously moves all extremities.  No significant', 'change in this regard since yesterday.']","['-Had melana', ""-D/c'ed benzo, olanzapine (has PRN fentanyl available)"", '[ ]p.m. CBC, goal Hct>24, Plt>50 (send platelets in blue top)', '- got PPN today', '(ok to do TPN thru double lumen catheter, no IJ needed)', '- will get TPN tmrw', '- rechecked CBC Hct 24.3, stable so no GI consult done']",43126,132026.0
22,2124-09-14 16:26:55,['The patient did not require any Fentanyl O/N.'],"['Benzodiazepine and  olanzapine were discontinued yesterday.', 'Last night, the patient was noted to have an episode of melena.', 'Hematocrit remained stable at 24.3.  The patient did not get a  CVL, as', 'it was determined that he can get TPN through his double lumen PICC.', 'The patient got PPN yesterday.', 'The patient did not require any Fentanyl O/N.', 'This morning the patient was noted to have worsening hematuria with', 'reduced urine output through his catheter.', 'The patient continues to be stably more responsive today, opens eyes to', 'commands and spontaneously moves all extremities.  No significant', 'change in this regard since yesterday.']",,43126,132026.0
23,2124-09-14 16:45:53,,"['Benzodiazepine and  olanzapine were discontinued yesterday.', 'Last night, the patient was noted to have an episode of melena.', 'Hematocrit remained stable at 24.3.  The patient did not get a  CVL, as', 'it was determined that he can get TPN through his double lumen PICC.', 'The patient got PPN yesterday.', 'The patient did not require any Fentanyl O/N.', 'This morning the patient was noted to have worsening hematuria with', 'reduced urine output through his catheter.', 'The patient continues to be stably more responsive today, opens eyes to', 'commands and spontaneously moves all extremities.  No significant', 'change in this regard since yesterday.']",,43126,132026.0
24,2124-09-15 08:23:01,"['INVASIVE VENTILATION - STOP [**2124-9-14**] 05:23 PM', '- recieved 1uPRBC and 1u PLT', '- CBI for hematuria', '- ambisome decresed to 250 q24 (from 400) given concern for hematuria', '- ID: check stool for c diff', '- CXR: Dense right upper lobe consolidation with volume loss, new since', 'the [**2124-9-13**] study.']","['INVASIVE VENTILATION - STOP [**2124-9-14**] 05:23 PM', '- recieved 1uPRBC and 1u PLT', '- CBI for hematuria', '- ambisome decresed to 250 q24 (from 400) given concern for hematuria', '- ID: check stool for c diff', '- CXR: Dense right upper lobe consolidation with volume loss, new since', 'the [**2124-9-13**] study.']","['Benzodiazepine and  olanzapine were discontinued yesterday.', 'Last night, the patient was noted to have an episode of melena.', 'Hematocrit remained stable at 24.3.  The patient did not get a  CVL, as', 'it was determined that he can get TPN through his double lumen PICC.', 'The patient got PPN yesterday.', 'The patient did not require any Fentanyl O/N.', 'This morning the patient was noted to have worsening hematuria with', 'reduced urine output through his catheter.', 'The patient continues to be stably more responsive today, opens eyes to', 'commands and spontaneously moves all extremities.  No significant', 'change in this regard since yesterday.']",43126,132026.0
25,2124-09-15 08:34:23,,"['INVASIVE VENTILATION - STOP [**2124-9-14**] 05:23 PM', '- recieved 1uPRBC and 1u PLT', '- CBI for hematuria', '- ambisome decresed to 250 q24 (from 400) given concern for hematuria', '- ID: check stool for c diff', '- CXR: Dense right upper lobe consolidation with volume loss, new since', 'the [**2124-9-13**] study.']",,43126,132026.0
26,2124-09-15 18:20:13,,"['INVASIVE VENTILATION - STOP [**2124-9-14**] 05:23 PM', '- recieved 1uPRBC and 1u PLT', '- CBI for hematuria', '- ambisome decresed to 250 q24 (from 400) given concern for hematuria', '- ID: check stool for c diff', '- CXR: Dense right upper lobe consolidation with volume loss, new since', 'the [**2124-9-13**] study.']",,43126,132026.0
27,2124-09-16 07:23:06,"['CARDIAC ARREST - At [**2124-9-16**] 12:51 AM', ' INVASIVE VENTILATION - START [**2124-9-16**] 01:00 AM', ' MULTI LUMEN - START [**2124-9-16**] 02:21 AM', ' EKG - At [**2124-9-16**] 03:40 AM', ' BRONCHOSCOPY - At [**2124-9-16**] 04:13 AM', '- 12:48 a.m.: developed progressive bradycardia, followed by PEA', 'arrest, got intubated by anesthesia, who suctioned a mucus plus. After', '1st mg of epinephrine, regained pulse. Arrest thought to be [**12-20**] mucous', 'plugging, although patient had normal O2 sat prior to arrest', '- had episodes of bradycardia throughout the night', 'At 1248 am, Pt noted to be HTN to SBP 190s and bradycardia. Over the', 'period of one minute pt became progressively bradycardic to 20s and', 'then went into pulseless Vtach. Code blue was called. CPR was started.', 'By the time pads were applied to the patient he had transitioned to', 'PEA. 1mg epi was given. IVF were started wide open. Pulse returned and', 'CPR was stoped. Pt was intubated with 8 ET. Femoral line was placed in', 'R groin. During intubation a large quanitiy of mucous / plug was', 'suctioned. BP was undetectable but recoved with MAP > 110 prior', 'begining pressors. CXR was obtained, which showed increased prominance', 'of haziness in Left lung but no edema. lactate 2.6, ABG with metabolic', 'and respiratoy acidosis. Wife was [**Name (NI) 167**] and is on her way to the', 'hospital. Pt stabilzed, likely cause of PEA arrest was aspiration /', 'mucos plugging.  Total time of code approximately 30 min. Total CPR', 'time < 5 minutes']","['CARDIAC ARREST - At [**2124-9-16**] 12:51 AM', ' INVASIVE VENTILATION - START [**2124-9-16**] 01:00 AM', ' MULTI LUMEN - START [**2124-9-16**] 02:21 AM', ' EKG - At [**2124-9-16**] 03:40 AM', ' BRONCHOSCOPY - At [**2124-9-16**] 04:13 AM', '- 12:48 a.m.: developed progressive bradycardia, followed by PEA', 'arrest, got intubated by anesthesia, who suctioned a mucus plus. After', '1st mg of epinephrine, regained pulse. Arrest thought to be [**12-20**] mucous', 'plugging, although patient had normal O2 sat prior to arrest', '- had episodes of bradycardia throughout the night', 'At 1248 am, Pt noted to be HTN to SBP 190s and bradycardia. Over the', 'period of one minute pt became progressively bradycardic to 20s and', 'then went into pulseless Vtach. Code blue was called. CPR was started.', 'By the time pads were applied to the patient he had transitioned to', 'PEA. 1mg epi was given. IVF were started wide open. Pulse returned and', 'CPR was stoped. Pt was intubated with 8 ET. Femoral line was placed in', 'R groin. During intubation a large quanitiy of mucous / plug was', 'suctioned. BP was undetectable but recoved with MAP > 110 prior', 'begining pressors. CXR was obtained, which showed increased prominance', 'of haziness in Left lung but no edema. lactate 2.6, ABG with metabolic', 'and respiratoy acidosis. Wife was [**Name (NI) 167**] and is on her way to the', 'hospital. Pt stabilzed, likely cause of PEA arrest was aspiration /', 'mucos plugging.  Total time of code approximately 30 min. Total CPR', 'time < 5 minutes']","['INVASIVE VENTILATION - STOP [**2124-9-14**] 05:23 PM', '- recieved 1uPRBC and 1u PLT', '- CBI for hematuria', '- ambisome decresed to 250 q24 (from 400) given concern for hematuria', '- ID: check stool for c diff', '- CXR: Dense right upper lobe consolidation with volume loss, new since', 'the [**2124-9-13**] study.']",43126,132026.0
28,2124-09-16 08:03:13,,"['- 12:48 a.m.: developed progressive bradycardia, followed by PEA', 'arrest, got intubated by anesthesia, who suctioned a mucus plus. After', '1st mg of epinephrine, regained pulse. Arrest thought to be [**12-20**] mucous', 'plugging, although patient had normal O2 sat prior to arrest', '- had episodes of bradycardia throughout the night']","['CARDIAC ARREST - At [**2124-9-16**] 12:51 AM', ' INVASIVE VENTILATION - START [**2124-9-16**] 01:00 AM', ' MULTI LUMEN - START [**2124-9-16**] 02:21 AM', ' EKG - At [**2124-9-16**] 03:40 AM', ' BRONCHOSCOPY - At [**2124-9-16**] 04:13 AM', 'At 1248 am, Pt noted to be HTN to SBP 190s and bradycardia. Over the', 'period of one minute pt became progressively bradycardic to 20s and', 'then went into pulseless Vtach. Code blue was called. CPR was started.', 'By the time pads were applied to the patient he had transitioned to', 'PEA. 1mg epi was given. IVF were started wide open. Pulse returned and', 'CPR was stoped. Pt was intubated with 8 ET. Femoral line was placed in', 'R groin. During intubation a large quanitiy of mucous / plug was', 'suctioned. BP was undetectable but recoved with MAP > 110 prior', 'begining pressors. CXR was obtained, which showed increased prominance', 'of haziness in Left lung but no edema. lactate 2.6, ABG with metabolic', 'and respiratoy acidosis. Wife was [**Name (NI) 167**] and is on her way to the', 'hospital. Pt stabilzed, likely cause of PEA arrest was aspiration /', 'mucos plugging.  Total time of code approximately 30 min. Total CPR', 'time < 5 minutes']",43126,132026.0
29,2124-09-16 10:15:53,"['- 12:48 a.m.: developed progressive bradycardia, followed by pulseless', 'V-tach. CPR was initiated.', 'The patient was intubated by anesthesia,', 'who suctioned a large mucus plus.  After 1st mg of epinephrine,', 'regained pulse. Arrest thought to be [**12-20**] mucous plugging, although', 'patient had normal O2 sat prior to arrest']","['- 12:48 a.m.: developed progressive bradycardia, followed by pulseless', 'V-tach. CPR was initiated.', 'The patient was intubated by anesthesia,', 'who suctioned a large mucus plus.  After 1st mg of epinephrine,', 'regained pulse. Arrest thought to be [**12-20**] mucous plugging, although', 'patient had normal O2 sat prior to arrest', '- had episodes of bradycardia throughout the night']","['- 12:48 a.m.: developed progressive bradycardia, followed by PEA', 'arrest, got intubated by anesthesia, who suctioned a mucus plus. After', '1st mg of epinephrine, regained pulse. Arrest thought to be [**12-20**] mucous', 'plugging, although patient had normal O2 sat prior to arrest']",43126,132026.0
30,2124-09-16 10:28:54,"['- 12:48 a.m.: developed progressive bradycardia with normal O2', 'saturations, followed by pulseless V-tach.  CPR was initiated.', 'V-tach', 'became PEA before paddles were in place.  Anethesia placed at ET tube', 'and suctioned a large mucus plus.  The patient received 1 mg of', 'epinephrine before regaining pulse and blood pressure.', '- Following the Code Blue, the patient had recurrent transient', 'bradycardia throughout the night, requiring 0.5 mg of atropine.', 'Bronchoscopy was performed to ensure that there were no residual mucus', 'plugs.']","['- 12:48 a.m.: developed progressive bradycardia with normal O2', 'saturations, followed by pulseless V-tach.  CPR was initiated.', 'V-tach', 'became PEA before paddles were in place.  Anethesia placed at ET tube', 'and suctioned a large mucus plus.  The patient received 1 mg of', 'epinephrine before regaining pulse and blood pressure.', '- Following the Code Blue, the patient had recurrent transient', 'bradycardia throughout the night, requiring 0.5 mg of atropine.', 'Bronchoscopy was performed to ensure that there were no residual mucus', 'plugs.']","['- 12:48 a.m.: developed progressive bradycardia, followed by pulseless', 'V-tach. CPR was initiated.', 'The patient was intubated by anesthesia,', 'who suctioned a large mucus plus.  After 1st mg of epinephrine,', 'regained pulse. Arrest thought to be [**12-20**] mucous plugging, although', 'patient had normal O2 sat prior to arrest', '- had episodes of bradycardia throughout the night']",43126,132026.0
31,2124-09-16 10:45:57,,"['- 12:48 a.m.: developed progressive bradycardia with normal O2', 'saturations, followed by pulseless V-tach.  CPR was initiated.', 'V-tach', 'became PEA before paddles were in place.  Anethesia placed at ET tube', 'and suctioned a large mucus plus.  The patient received 1 mg of', 'epinephrine before regaining pulse and blood pressure.', '- Following the Code Blue, the patient had recurrent transient', 'bradycardia throughout the night, requiring 0.5 mg of atropine.', 'Bronchoscopy was performed to ensure that there were no residual mucus', 'plugs.']",,43126,132026.0
32,2124-09-17 06:56:48,"['[**9-16**]- AM rounds', '- heme/onc HCT goal >25, plt goal > 50', '- getting 1u PRBC & 1 u plt this AM', '- PM CBC check', '- FiO2 100->80, PEEP 5->10', '- ct current abx (though wt treating?)', '- consider repeat head CT when hemo stable', '- has femoral CVL, need to change to IJ??', '- needs A-line (US guided high radial stick)', '- high risk for ARDS want Vt goal 6cc/kg (he is 82 kg- edematous wt?)']","['[**9-16**]- AM rounds', '- heme/onc HCT goal >25, plt goal > 50', '- getting 1u PRBC & 1 u plt this AM', '- PM CBC check', '- FiO2 100->80, PEEP 5->10', '- ct current abx (though wt treating?)', '- consider repeat head CT when hemo stable', '- has femoral CVL, need to change to IJ??', '- needs A-line (US guided high radial stick)', '- high risk for ARDS want Vt goal 6cc/kg (he is 82 kg- edematous wt?)']","['- 12:48 a.m.: developed progressive bradycardia with normal O2', 'saturations, followed by pulseless V-tach.  CPR was initiated.', 'V-tach', 'became PEA before paddles were in place.  Anethesia placed at ET tube', 'and suctioned a large mucus plus.  The patient received 1 mg of', 'epinephrine before regaining pulse and blood pressure.', '- Following the Code Blue, the patient had recurrent transient', 'bradycardia throughout the night, requiring 0.5 mg of atropine.', 'Bronchoscopy was performed to ensure that there were no residual mucus', 'plugs.']",43126,132026.0
33,2124-09-17 18:49:18,"['- Got 2 units of pRBC & 1 u plt this AM based on Transfusion goal Plt >', '50, Hct >25', '- Got A-line (US guided high radial stick)', '- Reieved multiple 500ml NS boluses to keep blood pressure up.', 'This AM, the ptl. Is sedated and unresponsive to voice commands.  BP is', 'are currently stably and he is satting 100% on Control-Assist Tv 400/', 'RR 16']","['- Got 2 units of pRBC & 1 u plt this AM based on Transfusion goal Plt >', '50, Hct >25', '- Got A-line (US guided high radial stick)', '- Reieved multiple 500ml NS boluses to keep blood pressure up.', 'This AM, the ptl. Is sedated and unresponsive to voice commands.  BP is', 'are currently stably and he is satting 100% on Control-Assist Tv 400/', 'RR 16']","['[**9-16**]- AM rounds', '- heme/onc HCT goal >25, plt goal > 50', '- getting 1u PRBC & 1 u plt this AM', '- PM CBC check', '- FiO2 100->80, PEEP 5->10', '- ct current abx (though wt treating?)', '- consider repeat head CT when hemo stable', '- has femoral CVL, need to change to IJ??', '- needs A-line (US guided high radial stick)', '- high risk for ARDS want Vt goal 6cc/kg (he is 82 kg- edematous wt?)']",43126,132026.0
34,2124-09-17 19:24:09,"['- Got 2 units of pRBC & 1 u Platelets yesterday based on Transfusion', 'goal Plt > 50, Hct >25', '- Received multiple 500ml NS boluses (3.5 L IVF total over 24 hours) to', 'keep blood pressure up.', 'are currently stable and he is satting 100%.']","['- Got 2 units of pRBC & 1 u Platelets yesterday based on Transfusion', 'goal Plt > 50, Hct >25', '- Got A-line (US guided high radial stick)', '- Received multiple 500ml NS boluses (3.5 L IVF total over 24 hours) to', 'keep blood pressure up.', 'This AM, the ptl. Is sedated and unresponsive to voice commands.  BP is', 'are currently stable and he is satting 100%.']","['- Got 2 units of pRBC & 1 u plt this AM based on Transfusion goal Plt >', '50, Hct >25', '- Reieved multiple 500ml NS boluses to keep blood pressure up.', 'are currently stably and he is satting 100% on Control-Assist Tv 400/', 'RR 16']",43126,132026.0
35,2124-09-18 07:12:45,"['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']","['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']","['- Got 2 units of pRBC & 1 u Platelets yesterday based on Transfusion', 'goal Plt > 50, Hct >25', '- Got A-line (US guided high radial stick)', '- Received multiple 500ml NS boluses (3.5 L IVF total over 24 hours) to', 'keep blood pressure up.', 'This AM, the ptl. Is sedated and unresponsive to voice commands.  BP is', 'are currently stable and he is satting 100%.']",43126,132026.0
36,2124-09-18 14:39:48,,"['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']",,43126,132026.0
37,2124-09-18 14:44:48,,"['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']",,43126,132026.0
38,2124-09-18 19:28:07,,"['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']",,43126,132026.0
39,2124-09-18 21:35:06,,"['MULTI LUMEN - STOP [**2124-9-18**] 01:03 AM', '-Required 4+ liters of IVF for hypotension, but continues to sat 100%', 'on the vent', '-Started on stress doses of steriods given likely adrenal dysfunction', '-Will receive LR boluses as needed to keep BP up', '-TPN order modified to reduce amt. of acetate pt. receives given', 'alkalosis', ""-Received PIV x1, allowing femoral CVL to be d/c'd"", '-After further discussion with Dr. [**Last Name (STitle) 21**] about goals of care, ordered', 'CTA to r/u PE, CT head performed to assess for extension of subdural.', 'CT head did not reveal any evidence of a rebleed, however CTA chest', 'suboptimal for eval. of PE due to problems with [**Name2 (NI) 11172**] timing on', 'multiple attempts.', '-Started on tube feeds, hold TPN for now.']",,43126,132026.0
40,2124-09-19 15:03:49,,,,43126,132026.0
41,2124-09-20 06:54:29,,,,43126,132026.0
42,2124-09-21 00:58:41,"['-Decreased RR to 10 yesterday, pt. overbreathing more on the vent', '-The patient got head CT to evaluate for subdural re-bleed: no evidence', 'of new re-bleed, final read pending)', '-Per BMT recs, added pyrimethium and leucovorin and clinda for empiric', 'treatment of Toxoplasmosis (already on [**Last Name (un) 614**], ambisome, linezolid)', 'This AM, the pateient appears more comfortable, no spontaneous head', 'movements.']",,"['-got head CT to eval anisocoria (my read no interval change, final read', 'pending)', '-BMT now wants to treat for [**Last Name (LF) 11219**], [**First Name3 (LF) **] added pyrimethium and leucovorin', 'and clinda (already on [**Last Name (un) 614**], ambisome, linezolid)', '- need to have another discussion of goals of care !!']",43126,132026.0
43,2124-09-21 07:11:43,"['MAGNETIC RESONANCE IMAGING - At [**2124-9-20**] 06:09 PM', 'returned to floor [**2114**]', '- Got MRI, results pending', '- Voriconazole dose increased to 400mg Q24h', '- Neurology again strongly argued against EEG (they believe the patient', 'made purposeful movements to grab his tube when off Propofol, had all', 'brain stem reflexes, except for gag).  Said will show nothing but slow', 'brain waves on Propofol. Recommended MRI to look for evidence of anoxic', 'brain injury vs. evidence of infection vs. white matter changed', 'associated with BK viremia.  Also suggested repeating ammonia levels', 'again.', '-This PM, noted to have melonic stools with clots and also blood clots', ""in residual.  Tube feeds were d/c'd, Hct was checked STAT."", '-Nurse noted the patient to be very uncomfortable after MRI, may need', 'to go up on Propafol.', '-Gave 2 units Platelets this AM for Plt 44.', '-ABG 7.28/42/135/21/-6', 'Ammonia 92, Na 132 this AM']",,"['-Decreased RR to 10 yesterday, pt. overbreathing more on the vent', '-The patient got head CT to evaluate for subdural re-bleed: no evidence', 'of new re-bleed, final read pending)', '-Per BMT recs, added pyrimethium and leucovorin and clinda for empiric', 'treatment of Toxoplasmosis (already on [**Last Name (un) 614**], ambisome, linezolid)', 'This AM, the pateient appears more comfortable, no spontaneous head', 'movements.']",43126,132026.0
44,2124-09-21 22:21:09,"['- Got MRI, shows enlarged frontal hygromas', '-This PM, noted to have melanotic stools with clots and also blood', ""clots in residual.  Tube feeds were d/c'd, Hct was checked STAT."", '-Gave 2 units Platelets in AM for [**2124-9-21**] for Plt 44.', '-Ammonia 92, Na 132 this AM']",,"['MAGNETIC RESONANCE IMAGING - At [**2124-9-20**] 06:09 PM', 'returned to floor [**2114**]', '- Got MRI, results pending', '-This PM, noted to have melonic stools with clots and also blood clots', ""in residual.  Tube feeds were d/c'd, Hct was checked STAT."", '-Nurse noted the patient to be very uncomfortable after MRI, may need', 'to go up on Propafol.', '-Gave 2 units Platelets this AM for Plt 44.', '-ABG 7.28/42/135/21/-6', 'Ammonia 92, Na 132 this AM']",43126,132026.0
45,2124-09-22 07:30:15,"['- MRI no acute process, stable SDH', '- EEG pending', '- melanotic stools continue, along with blood in gastric residuals', '- transfused 1 unit PRBC for Hct 23.3 at 10:43 p.m.', '- cross-matched for additional 2 units']",,"['- Got MRI, shows enlarged frontal hygromas', '- Voriconazole dose increased to 400mg Q24h', '- Neurology again strongly argued against EEG (they believe the patient', 'made purposeful movements to grab his tube when off Propofol, had all', 'brain stem reflexes, except for gag).  Said will show nothing but slow', 'brain waves on Propofol. Recommended MRI to look for evidence of anoxic', 'brain injury vs. evidence of infection vs. white matter changed', 'associated with BK viremia.  Also suggested repeating ammonia levels', 'again.', '-This PM, noted to have melanotic stools with clots and also blood', ""clots in residual.  Tube feeds were d/c'd, Hct was checked STAT."", '-Gave 2 units Platelets in AM for [**2124-9-21**] for Plt 44.', '-Ammonia 92, Na 132 this AM']",43126,132026.0
46,2124-09-22 15:25:09,"['- Remains intubated, mechanically ventilated. No change in neuro', 'status. EEG w/o seizure focus (diffuse encephalopathy) Neuro signed', 'off. Neurosurgery- no procedure rec', 'd at time d/t significant surgical', 'risks outweighing benefits']",,['- EEG pending'],43126,132026.0
47,2124-09-22 15:39:54,,,,43126,132026.0
48,2124-09-24 07:28:08,"['-Dr. [**First Name (STitle) **] had a discussion with Ms. [**Known lastname 9130**] from which it was clear', 'that she is moving toward CMO status for the patient.  She did not want', 'a tracheostomy, noting that it will not correct the underlying', 'problems.', '-The importance of keeping the pt. comfortable was stressed in the', 'meantime.  Propofol was re-started.', '-The patient noted to have worsening hematuria and Ambisome dose was', 'decreased to 250 mg IV Q24hours.', '-Methylprednisolone dose was changed from daily to [**Hospital1 **] and the Blood', 'cultures x 2 performed.']",,"['- Remains intubated, mechanically ventilated. No change in neuro', 'status. EEG w/o seizure focus (diffuse encephalopathy) Neuro signed', 'off. Neurosurgery- no procedure rec', 'd at time d/t significant surgical', 'risks outweighing benefits', '- MRI no acute process, stable SDH', '- melanotic stools continue, along with blood in gastric residuals', '- transfused 1 unit PRBC for Hct 23.3 at 10:43 p.m.', '- cross-matched for additional 2 units']",43126,132026.0
49,2124-09-25 03:00:22,,,,43126,132026.0
50,2124-09-25 07:35:31,"['-Gave 1 units PRBC and 1 unit platelets in a.m.', '-Hct was 18.4 at around 8 p.m. (had only gotten 1 unit PRBC by that', 'point) --> called wife to come in --> wife came in with daughter', '-discussed with Dr. [**Last Name (STitle) 21**] --> plan to support with blood transfusions', 'until family got in', '-Transfused 2 more units PRBC overnight, with Hct increase to 25.5', '-Became hypotensive to MAP in 40 at around 5 a.m. --> treated with', 'fluids', '-[**Name (NI) **] sister plans to come in to see patient']",,"['-Dr. [**First Name (STitle) **] had a discussion with Ms. [**Known lastname 9130**] from which it was clear', 'that she is moving toward CMO status for the patient.  She did not want', 'a tracheostomy, noting that it will not correct the underlying', 'problems.', '-The importance of keeping the pt. comfortable was stressed in the', 'meantime.  Propofol was re-started.', '-The patient noted to have worsening hematuria and Ambisome dose was', 'decreased to 250 mg IV Q24hours.', '-Methylprednisolone dose was changed from daily to [**Hospital1 **] and the Blood', 'cultures x 2 performed.']",43126,132026.0
51,2124-09-25 16:14:17,"['-The patient received 1 units PRBC and 1 unit platelets in a.m.', 'point) .  The patient', 's wife was called to come in at that point.  She', 'came in with daughter.', '-Plan was discussed with Dr. [**Last Name (STitle) 21**].', '-The patient was trasnfused 2 more units PRBC overnight, with Hct', 'increase to 25.5', '-Became hypotensive to MAP in 40 at around 5 a.m. and was treated with', 'fluids.', '-[**Name (NI) **] sister came in to see the patient.', 'This AM, the decision was made by family for no escalation of care, no', 'further antimicrobials, blood transfusions, laboratory or imaging', 'studies.  The patient will be kept comfortable with pain control and', 'sedation.  At this point, the patient will remained intubated on', 'mechanical ventilation.']",,"['-Gave 1 units PRBC and 1 unit platelets in a.m.', 'point) --> called wife to come in --> wife came in with daughter', '-discussed with Dr. [**Last Name (STitle) 21**] --> plan to support with blood transfusions', 'until family got in', '-Transfused 2 more units PRBC overnight, with Hct increase to 25.5', '-Became hypotensive to MAP in 40 at around 5 a.m. --> treated with', 'fluids', '-[**Name (NI) **] sister plans to come in to see patient']",43126,132026.0
52,2124-09-25 16:29:47,,,,43126,132026.0
53,2124-09-26 07:15:42,"['CMO no more AM labs', '- off all meds that [**Last Name (un) **] comfort only', '- on prop, fentanyl, started morphine gtt']",,"['-The patient received 1 units PRBC and 1 unit platelets in a.m.', '-Hct was 18.4 at around 8 p.m. (had only gotten 1 unit PRBC by that', 'point) .  The patient', 's wife was called to come in at that point.  She', 'came in with daughter.', '-Plan was discussed with Dr. [**Last Name (STitle) 21**].', '-The patient was trasnfused 2 more units PRBC overnight, with Hct', 'increase to 25.5', '-Became hypotensive to MAP in 40 at around 5 a.m. and was treated with', 'fluids.', '-[**Name (NI) **] sister came in to see the patient.', 'This AM, the decision was made by family for no escalation of care, no', 'further antimicrobials, blood transfusions, laboratory or imaging', 'studies.  The patient will be kept comfortable with pain control and', 'sedation.  At this point, the patient will remained intubated on', 'mechanical ventilation.']",43126,132026.0
54,2124-09-26 14:13:09,['- off all meds that [**Last Name (un) **] [**Last Name (un) **] only'],,['- off all meds that [**Last Name (un) **] comfort only'],43126,132026.0
0,2184-05-30 05:59:19,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
1,2184-05-30 06:00:32,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
2,2184-05-30 06:09:27,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
3,2184-05-30 07:47:44,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
4,2184-05-30 08:06:02,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
5,2184-05-30 09:19:05,,"['[**2184-5-29**]', '- Started on D10 W and encouraged eating for presumed Sulfonylurea', 'overdose.', '- Cr improved with IVF, but still not normalized.', ""- Pt desats to low 80's while sleeping due to OSA (not officially"", 'diagnosed because her insurance will not pay for sleep study per her).', '- Given dilaudid for chronic pain.', '- PA and Lat CXR clear.']",,5710,170047.0
0,2116-03-21 08:29:04,,"['BLOOD CULTURED - At [**2116-3-20**] 05:34 PM', 'of f l aline and r triple lumen', ""- 2/2 blood cultures positive for GNR's (not yet speciated)"", '- Norepinephrine weaned, off at about 17:00, received 1 L NS for', 'hypotension (MAP of 50-60) in context of CVP decreased to 8, briefly', 'responded but then required another liter bolus, considered tx but', ""MVO2>70, persistently hypotensive with MAP's in 50's so restarted on"", 'norepinephrine', '- Surgery and GI recommended continuing supportive care']",,68177,131184.0
1,2116-03-21 17:02:57,,"['BLOOD CULTURED - At [**2116-3-20**] 05:34 PM', 'of f l aline and r triple lumen', ""- 2/2 blood cultures positive for GNR's (not yet speciated)"", '- Norepinephrine weaned, off at about 17:00, received 1 L NS for', 'hypotension (MAP of 50-60) in context of CVP decreased to 8, briefly', 'responded but then required another liter bolus, considered tx but', ""MVO2>70, persistently hypotensive with MAP's in 50's so restarted on"", 'norepinephrine', '- Surgery and GI recommended continuing supportive care']",,68177,131184.0
2,2116-03-22 07:33:54,"['[**2116-3-20**]:', '______________________________________________________', '[**2116-3-21**]', '- Trial of [**Name (NI) 5622**] pt CO2 progressively rose and pH dropped with Minute', 'Ventilation. ? if sedation interfering with resp drive. Expect to d/c', 'sedation in am and retry PS for possible extubation tomorrow', '-Tried to wean levo but still requires between 0.01 and 0.02. Weaned', 'off this a.m.', '- Blood cultures from [**3-19**] growing pan-sensitive GNR.', '-d/c omeprazole- now on IV Famotidine only']","['[**2116-3-20**]:', ""- 2/2 blood cultures positive for GNR's (not yet speciated)"", '- Norepinephrine weaned, off at about 17:00, received 1 L NS for', 'hypotension (MAP of 50-60) in context of CVP decreased to 8, briefly', 'responded but then required another liter bolus, considered tx but', ""MVO2>70, persistently hypotensive with MAP's in 50's so restarted on"", 'norepinephrine', '- Surgery and GI recommended continuing supportive care', '______________________________________________________', '[**2116-3-21**]', '- Trial of [**Name (NI) 5622**] pt CO2 progressively rose and pH dropped with Minute', 'Ventilation. ? if sedation interfering with resp drive. Expect to d/c', 'sedation in am and retry PS for possible extubation tomorrow', '-Tried to wean levo but still requires between 0.01 and 0.02. Weaned', 'off this a.m.', '- Blood cultures from [**3-19**] growing pan-sensitive GNR.', '-d/c omeprazole- now on IV Famotidine only']","['BLOOD CULTURED - At [**2116-3-20**] 05:34 PM', 'of f l aline and r triple lumen']",68177,131184.0
3,2116-03-23 07:51:22,"['BLOOD CULTURED - At [**2116-3-22**] 09:00 AM', ' INVASIVE VENTILATION - STOP [**2116-3-22**] 09:30 AM', ' ARTERIAL LINE - STOP [**2116-3-22**] 10:52 AM', ' EKG - At [**2116-3-22**] 11:00 AM', '-Extubated and did well. Had some hypercapnia (worst ABG 7.28/50/94)', 'but did well afterward with improvement in pH to 7.34/46/83 by 7pm.', '-Did not get PICC b/c waiting for blood cx to be neg x 72hrs', '-Had runs of narrow complex tach, rhythm was re-entrant vs', 'a.fib/flutter.  Also had runs of bradycardia with a few 2 second pauses', 'around 1 a.m.  Started on po metoprolol for tachyarryhthmia but', 'continued without improvement so needed metoprolol 5mg iv three', 'seperate times.', ""-Vanc d/c'd in a.m. but had GPC in chains in [**3-19**] bcx so restarted"", 'overnight']","['BLOOD CULTURED - At [**2116-3-22**] 09:00 AM', ' INVASIVE VENTILATION - STOP [**2116-3-22**] 09:30 AM', ' ARTERIAL LINE - STOP [**2116-3-22**] 10:52 AM', ' EKG - At [**2116-3-22**] 11:00 AM', '-Extubated and did well. Had some hypercapnia (worst ABG 7.28/50/94)', 'but did well afterward with improvement in pH to 7.34/46/83 by 7pm.', '-Did not get PICC b/c waiting for blood cx to be neg x 72hrs', '-Had runs of narrow complex tach, rhythm was re-entrant vs', 'a.fib/flutter.  Also had runs of bradycardia with a few 2 second pauses', 'around 1 a.m.  Started on po metoprolol for tachyarryhthmia but', 'continued without improvement so needed metoprolol 5mg iv three', 'seperate times.', ""-Vanc d/c'd in a.m. but had GPC in chains in [**3-19**] bcx so restarted"", 'overnight']","['[**2116-3-20**]:', ""- 2/2 blood cultures positive for GNR's (not yet speciated)"", '- Norepinephrine weaned, off at about 17:00, received 1 L NS for', 'hypotension (MAP of 50-60) in context of CVP decreased to 8, briefly', 'responded but then required another liter bolus, considered tx but', ""MVO2>70, persistently hypotensive with MAP's in 50's so restarted on"", 'norepinephrine', '- Surgery and GI recommended continuing supportive care', '______________________________________________________', '[**2116-3-21**]', '- Trial of [**Name (NI) 5622**] pt CO2 progressively rose and pH dropped with Minute', 'Ventilation. ? if sedation interfering with resp drive. Expect to d/c', 'sedation in am and retry PS for possible extubation tomorrow', '-Tried to wean levo but still requires between 0.01 and 0.02. Weaned', 'off this a.m.', '- Blood cultures from [**3-19**] growing pan-sensitive GNR.', '-d/c omeprazole- now on IV Famotidine only']",68177,131184.0
4,2116-03-23 14:54:00,,"['BLOOD CULTURED - At [**2116-3-22**] 09:00 AM', ' INVASIVE VENTILATION - STOP [**2116-3-22**] 09:30 AM', ' ARTERIAL LINE - STOP [**2116-3-22**] 10:52 AM', ' EKG - At [**2116-3-22**] 11:00 AM', '-Extubated and did well. Had some hypercapnia (worst ABG 7.28/50/94)', 'but did well afterward with improvement in pH to 7.34/46/83 by 7pm.', '-Did not get PICC b/c waiting for blood cx to be neg x 72hrs', '-Had runs of narrow complex tach, rhythm was re-entrant vs', 'a.fib/flutter.  Also had runs of bradycardia with a few 2 second pauses', 'around 1 a.m.  Started on po metoprolol for tachyarryhthmia but', 'continued without improvement so needed metoprolol 5mg iv three', 'seperate times.', ""-Vanc d/c'd in a.m. but had GPC in chains in [**3-19**] bcx so restarted"", 'overnight']",,68177,131184.0
5,2116-03-23 15:06:30,,"['BLOOD CULTURED - At [**2116-3-22**] 09:00 AM', ' INVASIVE VENTILATION - STOP [**2116-3-22**] 09:30 AM', ' ARTERIAL LINE - STOP [**2116-3-22**] 10:52 AM', ' EKG - At [**2116-3-22**] 11:00 AM', '-Extubated and did well. Had some hypercapnia (worst ABG 7.28/50/94)', 'but did well afterward with improvement in pH to 7.34/46/83 by 7pm.', '-Did not get PICC b/c waiting for blood cx to be neg x 72hrs', '-Had runs of narrow complex tach, rhythm was re-entrant vs', 'a.fib/flutter.  Also had runs of bradycardia with a few 2 second pauses', 'around 1 a.m.  Started on po metoprolol for tachyarryhthmia but', 'continued without improvement so needed metoprolol 5mg iv three', 'seperate times.', ""-Vanc d/c'd in a.m. but had GPC in chains in [**3-19**] bcx so restarted"", 'overnight']",,68177,131184.0
6,2116-03-24 07:18:28,"['[**2116-3-23**]', '-Quiet day, maintained on shovel mask O2 (nasal cannula 3L this a.m.)', 'and mainly had concerns regarding some minor intermittent confusion,', 'presumed post infectious', ""-Attempted nurse [**First Name (Titles) 5674**] [**Last Name (Titles) **] and weren't able to place so ordered for"", 'IR placed', '-Blood Cx finally positive for two isolates of E. Coli (relatively', 'sensitive) and one bottle with Strep angionosus (usually pen', 'sensitive).  Nothing positive since ED blood cx.', '-Agitation at night and received haldol w/ good effect.']","['[**2116-3-23**]', '-Quiet day, maintained on shovel mask O2 (nasal cannula 3L this a.m.)', 'and mainly had concerns regarding some minor intermittent confusion,', 'presumed post infectious', ""-Attempted nurse [**First Name (Titles) 5674**] [**Last Name (Titles) **] and weren't able to place so ordered for"", 'IR placed', '-Blood Cx finally positive for two isolates of E. Coli (relatively', 'sensitive) and one bottle with Strep angionosus (usually pen', 'sensitive).  Nothing positive since ED blood cx.', '-Agitation at night and received haldol w/ good effect.']","['BLOOD CULTURED - At [**2116-3-22**] 09:00 AM', ' INVASIVE VENTILATION - STOP [**2116-3-22**] 09:30 AM', ' ARTERIAL LINE - STOP [**2116-3-22**] 10:52 AM', ' EKG - At [**2116-3-22**] 11:00 AM', '-Extubated and did well. Had some hypercapnia (worst ABG 7.28/50/94)', 'but did well afterward with improvement in pH to 7.34/46/83 by 7pm.', '-Did not get PICC b/c waiting for blood cx to be neg x 72hrs', '-Had runs of narrow complex tach, rhythm was re-entrant vs', 'a.fib/flutter.  Also had runs of bradycardia with a few 2 second pauses', 'around 1 a.m.  Started on po metoprolol for tachyarryhthmia but', 'continued without improvement so needed metoprolol 5mg iv three', 'seperate times.', ""-Vanc d/c'd in a.m. but had GPC in chains in [**3-19**] bcx so restarted"", 'overnight']",68177,131184.0
0,2103-03-10 08:04:15,,"['INVASIVE VENTILATION - START [**2103-3-9**] 08:30 AM', ' NASAL SWAB - At [**2103-3-9**] 10:02 AM', ' BLOOD CULTURED - At [**2103-3-9**] 11:22 AM', ' URINE CULTURE - At [**2103-3-9**] 11:22 AM', ' BLOOD CULTURED - At [**2103-3-9**] 02:03 PM', ' MAGNETIC RESONANCE IMAGING - At [**2103-3-9**] 08:00 PM']",,46340,111666.0
0,2168-04-01 07:44:05,,"['ULTRASOUND - At [**2168-3-31**] 10:30 AM', '- continue to be tremulous and slightly tachycardic overnight; required', 'total of 90 mg of diazepam']",,42410,197017.0
1,2168-04-01 07:45:40,,"['ULTRASOUND - At [**2168-3-31**] 10:30 AM', '- continue to be tremulous and slightly tachycardic overnight; required', 'total of 90 mg of diazepam']",,42410,197017.0
2,2168-04-01 10:26:33,,"['ULTRASOUND - At [**2168-3-31**] 10:30 AM', '- continue to be tremulous and slightly tachycardic overnight; required', 'total of 90 mg of diazepam']",,42410,197017.0
3,2168-04-02 07:25:35,"['-Patient continues to be treated for ETOH w/d given tremor and', 'tachycardia', '-per pscyh if patient is fully treated for withdrawal may not qualify', 'for dual diagnosis inpt program as will not need detox', '-no inpt programs available currently']","['-Patient continues to be treated for ETOH w/d given tremor and', 'tachycardia', '-per pscyh if patient is fully treated for withdrawal may not qualify', 'for dual diagnosis inpt program as will not need detox', '-no inpt programs available currently']","['ULTRASOUND - At [**2168-3-31**] 10:30 AM', '- continue to be tremulous and slightly tachycardic overnight; required', 'total of 90 mg of diazepam']",42410,197017.0
4,2168-04-02 07:30:16,,"['-Patient continues to be treated for ETOH w/d given tremor and', 'tachycardia', '-per pscyh if patient is fully treated for withdrawal may not qualify', 'for dual diagnosis inpt program as will not need detox', '-no inpt programs available currently']",,42410,197017.0
5,2168-04-02 07:38:51,,"['-Patient continues to be treated for ETOH w/d given tremor and', 'tachycardia', '-per pscyh if patient is fully treated for withdrawal may not qualify', 'for dual diagnosis inpt program as will not need detox', '-no inpt programs available currently']",,42410,197017.0
6,2168-04-02 09:49:46,,"['-Patient continues to be treated for ETOH w/d given tremor and', 'tachycardia', '-per pscyh if patient is fully treated for withdrawal may not qualify', 'for dual diagnosis inpt program as will not need detox', '-no inpt programs available currently']",,42410,197017.0
0,2106-10-19 06:53:57,,"['-2U PRBC for hct 25, repeat hct pending']",,58157,173000.0
1,2106-10-19 06:54:46,['-T 100 overnight'],"['-2U PRBC for hct 25, repeat hct pending', '-T 100 overnight']",,58157,173000.0
2,2106-10-19 06:59:12,,"['-2U PRBC for hct 25, repeat hct pending', '-T 100 overnight']",,58157,173000.0
3,2106-10-19 07:32:30,"['-small amt of loose, BRBPR overnight']","['-2U PRBC for hct 25, repeat hct pending', '-T 100 overnight', '-small amt of loose, BRBPR overnight']",,58157,173000.0
4,2106-10-19 10:10:07,"['-small amt of loose, maroon stool overnight']","['-2U PRBC for hct 25, repeat hct pending', '-T 100 overnight', '-small amt of loose, maroon stool overnight']","['-small amt of loose, BRBPR overnight']",58157,173000.0
5,2106-10-20 06:39:37,['-1U PRBC'],['-1U PRBC'],"['-2U PRBC for hct 25, repeat hct pending', '-T 100 overnight', '-small amt of loose, maroon stool overnight']",58157,173000.0
6,2106-10-20 07:04:29,,['-1U PRBC'],,58157,173000.0
7,2106-10-20 13:00:42,"['-maroon stools with decreasing frequency, volume']","['-1U PRBC', '-maroon stools with decreasing frequency, volume']",,58157,173000.0
0,2104-06-15 06:51:57,,"['Admitted overnight. Labs improved, no evidence of encephalopathy.', 'History obtained from Patient']",,63841,109101.0
1,2104-06-15 06:52:50,,"['Admitted overnight. Labs improved, no evidence of encephalopathy.', 'History obtained from Patient']",,63841,109101.0
2,2104-06-15 06:54:14,,"['Admitted overnight. Labs improved, no evidence of encephalopathy.', 'History obtained from Patient']",,63841,109101.0
3,2104-06-15 08:40:16,,"['Admitted overnight. Labs improved, no evidence of encephalopathy.', 'History obtained from Patient']",,63841,109101.0
0,2141-04-17 08:04:30,,"[""- BP dipped to 80's systolic, improved with IVF"", '- Urine output remains limited']",,65502,127178.0
1,2141-04-17 08:07:24,,"[""- BP dipped to 80's systolic, improved with IVF"", '- Urine output remains limited']",,65502,127178.0
2,2141-04-17 08:46:43,,"[""- BP dipped to 80's systolic, improved with IVF"", '- Urine output remains limited']",,65502,127178.0
3,2141-04-17 09:41:07,"[""- BP dipped to 80's systolic, improved with IVF, had been given metop"", '12. 5 X 1']","[""- BP dipped to 80's systolic, improved with IVF, had been given metop"", '12. 5 X 1', '- Urine output remains limited']","[""- BP dipped to 80's systolic, improved with IVF""]",65502,127178.0
4,2141-04-18 07:48:35,"['- urine/serum tox neg', '- added levoflox for possible evolving LLL infiltrate', '- urine osms w/ FeNA < 1% but UOP picking up w/ IVF', '- family brought in correct med list']","['- urine/serum tox neg', '- added levoflox for possible evolving LLL infiltrate', '- urine osms w/ FeNA < 1% but UOP picking up w/ IVF', '- family brought in correct med list']","[""- BP dipped to 80's systolic, improved with IVF, had been given metop"", '12. 5 X 1', '- Urine output remains limited']",65502,127178.0
5,2141-04-18 07:55:50,,"['- urine/serum tox neg', '- added levoflox for possible evolving LLL infiltrate', '- urine osms w/ FeNA < 1% but UOP picking up w/ IVF', '- family brought in correct med list']",,65502,127178.0
6,2141-04-18 10:18:44,,"['- urine/serum tox neg', '- added levoflox for possible evolving LLL infiltrate', '- urine osms w/ FeNA < 1% but UOP picking up w/ IVF', '- family brought in correct med list']",,65502,127178.0
0,2133-07-04 06:32:29,,"['- perc nephrostomy tube placed, good ouptput, cultures obtained', '- GNR bacteremia', '- hct slowly drifting downward- 21 in a.m. on [**7-4**]- ordered 1 uPRBC']",,62227,188061.0
1,2133-07-04 06:33:57,,"['- perc nephrostomy tube placed, good ouptput, cultures obtained', '- GNR bacteremia', '- hct slowly drifting downward- 21 in a.m. on [**7-4**]- ordered 1 uPRBC']",,62227,188061.0
2,2133-07-04 09:50:29,,"['- perc nephrostomy tube placed, good ouptput, cultures obtained', '- GNR bacteremia', '- hct slowly drifting downward- 21 in a.m. on [**7-4**]- ordered 1 uPRBC']",,62227,188061.0
3,2133-07-04 09:59:52,,"['- perc nephrostomy tube placed, good ouptput, cultures obtained', '- GNR bacteremia', '- hct slowly drifting downward- 21 in a.m. on [**7-4**]- ordered 1 uPRBC']",,62227,188061.0
4,2133-07-05 06:34:12,"['MULTI LUMEN - STOP [**2133-7-4**] 10:15 AM', ' BLOOD CULTURED - At [**2133-7-4**] 04:30 PM', ' BLOOD CULTURED - At [**2133-7-4**] 04:35 PM', ' ULTRASOUND - At [**2133-7-4**] 05:30 PM', 'Renal US', '-CVL removed', '-post transfusion HCT improved', '-Was going to be called out. Developed significant rigors ~4 pm,', 'improved with low dose demerol. Given this occured after 3 days of', 'adequate antibiotic therapy, sent for renal ultrasound to rule out', 'absceses--negative', '-Will keep in ICU overnight.']","['MULTI LUMEN - STOP [**2133-7-4**] 10:15 AM', ' BLOOD CULTURED - At [**2133-7-4**] 04:30 PM', ' BLOOD CULTURED - At [**2133-7-4**] 04:35 PM', ' ULTRASOUND - At [**2133-7-4**] 05:30 PM', 'Renal US', '-CVL removed', '-post transfusion HCT improved', '-Was going to be called out. Developed significant rigors ~4 pm,', 'improved with low dose demerol. Given this occured after 3 days of', 'adequate antibiotic therapy, sent for renal ultrasound to rule out', 'absceses--negative', '-Will keep in ICU overnight.']","['- perc nephrostomy tube placed, good ouptput, cultures obtained', '- GNR bacteremia', '- hct slowly drifting downward- 21 in a.m. on [**7-4**]- ordered 1 uPRBC']",62227,188061.0
5,2133-07-05 06:35:24,,"['MULTI LUMEN - STOP [**2133-7-4**] 10:15 AM', ' BLOOD CULTURED - At [**2133-7-4**] 04:30 PM', ' BLOOD CULTURED - At [**2133-7-4**] 04:35 PM', ' ULTRASOUND - At [**2133-7-4**] 05:30 PM', 'Renal US', '-CVL removed', '-post transfusion HCT improved', '-Was going to be called out. Developed significant rigors ~4 pm,', 'improved with low dose demerol. Given this occured after 3 days of', 'adequate antibiotic therapy, sent for renal ultrasound to rule out', 'absceses--negative', '-Will keep in ICU overnight.']",,62227,188061.0
6,2133-07-05 08:53:12,"['-post transfusion HCT improved (got 1 pRBC)', '-Kept in ICU overnight']","['MULTI LUMEN - STOP [**2133-7-4**] 10:15 AM', ' BLOOD CULTURED - At [**2133-7-4**] 04:30 PM', ' BLOOD CULTURED - At [**2133-7-4**] 04:35 PM', ' ULTRASOUND - At [**2133-7-4**] 05:30 PM', 'Renal US', '-CVL removed', '-post transfusion HCT improved (got 1 pRBC)', '-Was going to be called out. Developed significant rigors ~4 pm,', 'improved with low dose demerol. Given this occured after 3 days of', 'adequate antibiotic therapy, sent for renal ultrasound to rule out', 'absceses--negative', '-Kept in ICU overnight']","['-post transfusion HCT improved', '-Will keep in ICU overnight.']",62227,188061.0
0,2141-03-10 06:54:53,,"['- [**Last Name (un) 276**] saw patient. recommended tighter sliding scale and more', 'lantus- ordered', '- [**Last Name (un) 276**] d/w patient regarding psych history.  Family also called to', ""speak to nurse. concerned with patient's Rx drug use.  Apparently has"", 'had teeth pulled to get narcotics from dentist.  Has been admitted 6', 'times, in 3 different hospitals, since [**Month (only) 735**] for DKA.', '- will need psych consult in AM.  either from us, or from accepting', 'team', '- gap improving throughout the day']",,4308,123437.0
1,2141-03-10 06:56:47,,"['- [**Last Name (un) 276**] saw patient. recommended tighter sliding scale and more', 'lantus- ordered', '- [**Last Name (un) 276**] d/w patient regarding psych history.  Family also called to', ""speak to nurse. concerned with patient's Rx drug use.  Apparently has"", 'had teeth pulled to get narcotics from dentist.  Has been admitted 6', 'times, in 3 different hospitals, since [**Month (only) 735**] for DKA.', '- will need psych consult in AM.  either from us, or from accepting', 'team', '- gap improving throughout the day']",,4308,123437.0
2,2141-03-10 15:14:19,,"['- [**Last Name (un) 276**] saw patient. recommended tighter sliding scale and more', 'lantus- ordered', '- [**Last Name (un) 276**] d/w patient regarding psych history.  Family also called to', ""speak to nurse. concerned with patient's Rx drug use.  Apparently has"", 'had teeth pulled to get narcotics from dentist.  Has been admitted 6', 'times, in 3 different hospitals, since [**Month (only) 735**] for DKA.', '- will need psych consult in AM.  either from us, or from accepting', 'team', '- gap improving throughout the day']",,4308,123437.0
3,2141-03-10 18:11:53,,"['- [**Last Name (un) 276**] saw patient. recommended tighter sliding scale and more', 'lantus- ordered', '- [**Last Name (un) 276**] d/w patient regarding psych history.  Family also called to', ""speak to nurse. concerned with patient's Rx drug use.  Apparently has"", 'had teeth pulled to get narcotics from dentist.  Has been admitted 6', 'times, in 3 different hospitals, since [**Month (only) 735**] for DKA.', '- will need psych consult in AM.  either from us, or from accepting', 'team', '- gap improving throughout the day']",,4308,123437.0
0,2113-04-13 06:54:02,,"['- Received 1unit PRBCs', '- HCT did not appropriately increase, likely from volume shifts', '- Patient pulled NG tube out, nothing was being suctioned', '- GI planning for scope today.']",,67481,159620.0
1,2113-04-13 11:13:42,,"['- Received 1unit PRBCs', '- HCT did not appropriately increase, likely from volume shifts', '- Patient pulled NG tube out, nothing was being suctioned', '- GI planning for scope today.']",,67481,159620.0
0,2114-03-08 08:05:10,,"['INVASIVE VENTILATION - START [**2114-3-8**] 12:15 AM', ' FEVER - 101.8', 'F - [**2114-3-8**] 04:00 AM', ""Spoke with patient's sister who is HCP/guardian regarding extubation"", 'and palliative care measures only. Sister aware that she needs to come', 'into hospital to ID patient prior to this being done.']",,67481,186264.0
1,2114-03-08 08:07:21,,"['INVASIVE VENTILATION - START [**2114-3-8**] 12:15 AM', ' FEVER - 101.8', 'F - [**2114-3-8**] 04:00 AM', ""Spoke with patient's sister who is HCP/guardian regarding extubation"", 'and palliative care measures only. Sister aware that she needs to come', 'into hospital to ID patient prior to this being done.']",,67481,186264.0
2,2114-03-08 08:08:54,,"['INVASIVE VENTILATION - START [**2114-3-8**] 12:15 AM', ' FEVER - 101.8', 'F - [**2114-3-8**] 04:00 AM', ""Spoke with patient's sister who is HCP/guardian regarding extubation"", 'and palliative care measures only. Sister aware that she needs to come', 'into hospital to ID patient prior to this being done.']",,67481,186264.0
3,2114-03-08 11:33:57,,"['INVASIVE VENTILATION - START [**2114-3-8**] 12:15 AM', ' FEVER - 101.8', 'F - [**2114-3-8**] 04:00 AM', ""Spoke with patient's sister who is HCP/guardian regarding extubation"", 'and palliative care measures only. Sister aware that she needs to come', 'into hospital to ID patient prior to this being done.']",,67481,186264.0
0,2170-05-19 06:55:20,,"['-extubated', '-CMO', '-ativan started', '-scopolamine started', '-called out']",,88971,123481.0
1,2170-05-19 15:01:21,['-[** 115**]'],"['-extubated', '-[** 115**]', '-ativan started', '-scopolamine started', '-called out']",['-CMO'],88971,123481.0
2,2170-05-19 15:23:32,,"['-extubated', '-[** 115**]', '-ativan started', '-scopolamine started', '-called out']",,88971,123481.0
3,2170-05-20 07:12:05,,[],"['-extubated', '-[** 115**]', '-ativan started', '-scopolamine started', '-called out']",88971,123481.0
4,2170-05-20 08:37:18,"['-pt taking sips', '-restarted glaucoma drops', '-family would prefer for pt to go to facility with hospice although', 'there was some discussion of home with hospice']","['-pt taking sips', '-restarted glaucoma drops', '-family would prefer for pt to go to facility with hospice although', 'there was some discussion of home with hospice']",,88971,123481.0
5,2170-05-20 09:24:05,,"['-pt taking sips', '-restarted glaucoma drops', '-family would prefer for pt to go to facility with hospice although', 'there was some discussion of home with hospice']",,88971,123481.0
0,2123-04-27 07:17:05,,[],,40526,100456.0
1,2123-04-27 07:40:44,"['- Fluid resuscitation overnight, good UOP, pain controlled']","['- Fluid resuscitation overnight, good UOP, pain controlled']",,40526,100456.0
2,2123-04-27 10:23:16,,"['- Fluid resuscitation overnight, good UOP, pain controlled']",,40526,100456.0
0,2123-06-02 07:01:55,,"['INVASIVE VENTILATION - START [**2123-6-1**] 05:42 PM', ' MULTI LUMEN - START [**2123-6-1**] 06:27 PM', 'extubated at 2245, doing ok since.']",,40526,101343.0
1,2123-06-02 07:17:19,"['extubated at 2245, doing ok since on nasal canula. Has some baseline', 'anxiety contributing to SOB.']","['INVASIVE VENTILATION - START [**2123-6-1**] 05:42 PM', ' MULTI LUMEN - START [**2123-6-1**] 06:27 PM', 'extubated at 2245, doing ok since on nasal canula. Has some baseline', 'anxiety contributing to SOB.']","['extubated at 2245, doing ok since.']",40526,101343.0
2,2123-06-02 14:28:43,,"['INVASIVE VENTILATION - START [**2123-6-1**] 05:42 PM', ' MULTI LUMEN - START [**2123-6-1**] 06:27 PM', 'extubated at 2245, doing ok since on nasal canula. Has some baseline', 'anxiety contributing to SOB.']",,40526,101343.0
0,2150-11-30 08:00:53,,"['-intubated for respiratory failure in the setting of tachypnea &', 'profound acidemia', '-L radial A-line placed', '-CT abd/pelvis with PO contrast ordered', '-started stress-dose steroids given h/o panhypopit (random cortisol', '5.6)', '-R IJ CVL placed', '-started on levo gtt', '-PO vanc started for empiric Rx severe c. diff', '-renal deferring RRT at this time but will follow']",,13258,192384.0
1,2150-11-30 09:59:42,,"['-intubated for respiratory failure in the setting of tachypnea &', 'profound acidemia', '-L radial A-line placed', '-CT abd/pelvis with PO contrast ordered', '-started stress-dose steroids given h/o panhypopit (random cortisol', '5.6)', '-R IJ CVL placed', '-started on levo gtt', '-PO vanc started for empiric Rx severe c. diff', '-renal deferring RRT at this time but will follow']",,13258,192384.0
2,2150-12-01 07:18:08,"['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']","['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']","['-intubated for respiratory failure in the setting of tachypnea &', 'profound acidemia', '-L radial A-line placed', '-CT abd/pelvis with PO contrast ordered', '-started stress-dose steroids given h/o panhypopit (random cortisol', '5.6)', '-R IJ CVL placed', '-started on levo gtt', '-PO vanc started for empiric Rx severe c. diff', '-renal deferring RRT at this time but will follow']",13258,192384.0
3,2150-12-01 07:31:04,,"['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']",,13258,192384.0
4,2150-12-01 07:42:31,,"['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']",,13258,192384.0
5,2150-12-01 10:23:21,,"['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']",,13258,192384.0
6,2150-12-02 07:43:17,"['- SBT terminated due to oversedation and periods of apnea, sedation', 'discontinued', ""- cdiff negative x3, d/c'd PO vanc, IV flagyl, contact precautions"", '- endocrine consulted for panhypopituitarism', 'History obtained from [**Hospital 85**] Medical records']","['- SBT terminated due to oversedation and periods of apnea, sedation', 'discontinued', ""- cdiff negative x3, d/c'd PO vanc, IV flagyl, contact precautions"", '- endocrine consulted for panhypopituitarism', 'History obtained from [**Hospital 85**] Medical records']","['- weaned off levophed since 1300', '-fludrocortisone stopped as BP mildly elevated', '-CT abd/pelvis showed LLL consolidation, bilateral effusions, distended', 'GB without e/o inflammation or stones, no biliary duct dilitations,', 'known R adrenal adenoma, stranding around R kidney and small bowel', '(likely chronic inflammation)', '- Abdominal U/S performed, read pending', '- TTE showed EF of >55%, normal biventricular cavity sizes with', 'preserved global and regional biventricular systolic function', '- Influenza DFA returned negative, tamiflu and ramantidine discontinued', 'History obtained from Medical records']",13258,192384.0
7,2150-12-02 09:58:47,,"['- SBT terminated due to oversedation and periods of apnea, sedation', 'discontinued', ""- cdiff negative x3, d/c'd PO vanc, IV flagyl, contact precautions"", '- endocrine consulted for panhypopituitarism', 'History obtained from [**Hospital 85**] Medical records']",,13258,192384.0
8,2150-12-03 07:50:02,"['INVASIVE VENTILATION - STOP [**2150-12-2**] 11:15 AM', ' ARTERIAL LINE - STOP [**2150-12-3**] 01:30 AM', '-extubated', '-started diet', '-restarted coreg, increased to 6.25 mg [**Hospital1 **]', '-labetalol 20 mg IV boluses x 2 for BP 200/100', '-hydral 10 mg IV x2 BP ~200/100', '-per endocrine tapered hydrocort to 50 q8 per endocrine, cont current', 'thyroxine dose, held off on growth hormone', ""-Aline malfunctioning, was d/c'd"", 'History obtained from Patient']","['INVASIVE VENTILATION - STOP [**2150-12-2**] 11:15 AM', ' ARTERIAL LINE - STOP [**2150-12-3**] 01:30 AM', '-extubated', '-started diet', '-restarted coreg, increased to 6.25 mg [**Hospital1 **]', '-labetalol 20 mg IV boluses x 2 for BP 200/100', '-hydral 10 mg IV x2 BP ~200/100', '-per endocrine tapered hydrocort to 50 q8 per endocrine, cont current', 'thyroxine dose, held off on growth hormone', ""-Aline malfunctioning, was d/c'd"", 'History obtained from Patient']","['- SBT terminated due to oversedation and periods of apnea, sedation', 'discontinued', ""- cdiff negative x3, d/c'd PO vanc, IV flagyl, contact precautions"", '- endocrine consulted for panhypopituitarism', 'History obtained from [**Hospital 85**] Medical records']",13258,192384.0
9,2150-12-03 11:01:24,,"['-extubated', '-started diet', '-restarted coreg, increased to 6.25 mg [**Hospital1 **]', '-labetalol 20 mg IV boluses x 2 for BP 200/100', '-hydral 10 mg IV x2 BP ~200/100', '-per endocrine tapered hydrocort to 50 q8 per endocrine, cont current', 'thyroxine dose, held off on growth hormone', ""-Aline malfunctioning, was d/c'd"", 'History obtained from Patient']","['INVASIVE VENTILATION - STOP [**2150-12-2**] 11:15 AM', ' ARTERIAL LINE - STOP [**2150-12-3**] 01:30 AM']",13258,192384.0
0,2196-07-23 07:53:09,,"['FEVER - 102.3', 'F - [**2196-7-22**] 07:32 PM']",,45646,137058.0
1,2196-07-23 10:35:40,,"['FEVER - 102.3', 'F - [**2196-7-22**] 07:32 PM']",,45646,137058.0
2,2196-07-24 07:36:27,"['EKG - At [**2196-7-23**] 09:52 AM', ' TRANSTHORACIC ECHO - At [**2196-7-23**] 12:00 PM', ' FEVER - 102.3', 'F - [**2196-7-23**] 07:00 PM', '[**7-23**]', '- Per ID restarted doxycycline', '- Called out']","['EKG - At [**2196-7-23**] 09:52 AM', ' TRANSTHORACIC ECHO - At [**2196-7-23**] 12:00 PM', ' FEVER - 102.3', 'F - [**2196-7-23**] 07:00 PM', '[**7-23**]', '- Per ID restarted doxycycline', '- Called out']","['FEVER - 102.3', 'F - [**2196-7-22**] 07:32 PM']",45646,137058.0
3,2196-07-24 07:45:56,,"['EKG - At [**2196-7-23**] 09:52 AM', ' TRANSTHORACIC ECHO - At [**2196-7-23**] 12:00 PM', ' FEVER - 102.3', 'F - [**2196-7-23**] 07:00 PM', '[**7-23**]', '- Per ID restarted doxycycline', '- Called out']",,45646,137058.0
4,2196-07-24 09:56:14,,"['EKG - At [**2196-7-23**] 09:52 AM', ' TRANSTHORACIC ECHO - At [**2196-7-23**] 12:00 PM', ' FEVER - 102.3', 'F - [**2196-7-23**] 07:00 PM', '[**7-23**]', '- Per ID restarted doxycycline', '- Called out']",,45646,137058.0
0,2170-04-08 01:10:22,,,,28933,190604.0
1,2170-04-08 01:35:21,,,,28933,190604.0
2,2170-04-08 06:25:52,,,,28933,190604.0
3,2170-04-08 10:45:57,,,,28933,190604.0
4,2170-04-09 07:21:24,"['CHEST PAIN - At [**2170-4-8**] 03:30 PM', 'developed CP , chest pressure and O2 sat dropped to 88-91% on 2L NC', 'after sputum induction.', ' EKG - At [**2170-4-8**] 03:45 PM', '-Micro came back with strep pneumonia bacteremia.  Can likely peel off', 'vancomycin tomorrow if he remains stable.  Sensitivities pending.', '-Caspofungin was discontinued', '-Induced sputum sent: the patient developed pleuritic chest pain,', 'hypoxic and tachycardic.  EKG and CXR is normal.', '-Put in for daily tacrolimus levels', '-No new Heme-onc recs, they wrote for gleevec.']",,"['PICC LINE - START [**2170-4-7**] 05:48 PM', ' MULTI LUMEN - START [**2170-4-8**] 12:09 AM', ' URINE CULTURE - At [**2170-4-8**] 12:36 AM', ' MULTI LUMEN - STOP [**2170-4-8**] 12:37 AM', '- Overnight events-> placed L-IJ w/ difficulty - had trouble passing', 'the guide wire, but clearly in vein w/o difficulty.  Some clot on', 'return of guide wire.  CXR showed IJ to be running up into opposite', 'IJ.  Attempted to reposition but unsuccessful and given r/o clot opted', 'to d/c line altogether - patient to go to IR today for line placement.', ""- Blood cultures returned positive for GPC in pair's and chains""]",28933,190604.0
5,2170-04-09 13:48:21,,,,28933,190604.0
6,2170-04-10 07:11:44,"['- No further episodes of dyspnea. Likely plug. B/L tachycardia.', '- Call out in AM.']",,"['CHEST PAIN - At [**2170-4-8**] 03:30 PM', 'developed CP , chest pressure and O2 sat dropped to 88-91% on 2L NC', 'after sputum induction.', ' EKG - At [**2170-4-8**] 03:45 PM', '-Micro came back with strep pneumonia bacteremia.  Can likely peel off', 'vancomycin tomorrow if he remains stable.  Sensitivities pending.', '-Caspofungin was discontinued', '-Induced sputum sent: the patient developed pleuritic chest pain,', 'hypoxic and tachycardic.  EKG and CXR is normal.', '-Put in for daily tacrolimus levels', '-No new Heme-onc recs, they wrote for gleevec.']",28933,190604.0
7,2170-04-10 15:06:03,,,,28933,190604.0
8,2170-04-11 06:53:08,"['- Holding FK506 - ? dosing, discuss on rounds with pharmacy/BMT.', '- Lateral Decub shows 300-500cc left sided effusion (opposite', 'pneumonia)', '- Called out to floor.', '- Restarted TPN.']",,"['- No further episodes of dyspnea. Likely plug. B/L tachycardia.', '- Call out in AM.']",28933,190604.0
9,2170-04-11 10:47:24,,,,28933,190604.0
10,2170-04-12 07:49:40,"['-No 7 [**Hospital Ward Name 669**] beds', '-Titrated beta blocker to 25 TID', '-Changed abx to ceftriaxone per ID curbside ([**Doctor Last Name 1750**] requested this)', '-FK506 level 7.2,  BMT recommending change to 0.5 as outpatient -', 'changed to 0.5']",,"['- Holding FK506 - ? dosing, discuss on rounds with pharmacy/BMT.', '- Lateral Decub shows 300-500cc left sided effusion (opposite', 'pneumonia)', '- Called out to floor.', '- Restarted TPN.']",28933,190604.0
11,2170-04-12 07:53:16,,,,28933,190604.0
12,2170-04-12 11:28:20,,,,28933,190604.0
13,2170-04-13 07:46:10,"['- heme/onc would like repeat CT chest if patient does not have', 'significant improvement in dyspnea, they also are considering whether', 'this could be related to pulmonary GVHD and may try steroids tomorrow', '- still called out, BMT refuses to let patient go to 11R', '- BMT happy with FK506 level']",,"['-No 7 [**Hospital Ward Name 669**] beds', '-Titrated beta blocker to 25 TID', '-Changed abx to ceftriaxone per ID curbside ([**Doctor Last Name 1750**] requested this)', '-FK506 level 7.2,  BMT recommending change to 0.5 as outpatient -', 'changed to 0.5']",28933,190604.0
14,2170-04-13 17:26:42,,,,28933,190604.0
0,2170-05-21 06:08:50,,"['PICC LINE - STOP [**2170-5-20**] 12:19 PM', ' THORACENTESIS - At [**2170-5-20**] 03:58 PM', 'PICC line discontinued and tip sent for culture', 's/p thoracentesis, fluid- GS negative, no polys.  LDH and T protein', 'boderline between exudative and transudative, pH 7.36, sent for', 'cytology, viral culture, fungal and AFB.']",,28933,118513.0
1,2170-05-21 07:46:40,,"['PICC LINE - STOP [**2170-5-20**] 12:19 PM', ' THORACENTESIS - At [**2170-5-20**] 03:58 PM', 'PICC line discontinued and tip sent for culture', 's/p thoracentesis, fluid- GS negative, no polys.  LDH and T protein', 'boderline between exudative and transudative, pH 7.36, sent for', 'cytology, viral culture, fungal and AFB.']",,28933,118513.0
2,2170-05-21 08:01:40,,"['PICC LINE - STOP [**2170-5-20**] 12:19 PM', ' THORACENTESIS - At [**2170-5-20**] 03:58 PM', 'PICC line discontinued and tip sent for culture', 's/p thoracentesis, fluid- GS negative, no polys.  LDH and T protein', 'boderline between exudative and transudative, pH 7.36, sent for', 'cytology, viral culture, fungal and AFB.']",,28933,118513.0
3,2170-05-21 12:19:52,,"['PICC LINE - STOP [**2170-5-20**] 12:19 PM', ' THORACENTESIS - At [**2170-5-20**] 03:58 PM', 'PICC line discontinued and tip sent for culture', 's/p thoracentesis, fluid- GS negative, no polys.  LDH and T protein', 'boderline between exudative and transudative, pH 7.36, sent for', 'cytology, viral culture, fungal and AFB.']",,28933,118513.0
4,2170-05-22 07:12:56,"['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']","['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']","['PICC LINE - STOP [**2170-5-20**] 12:19 PM', ' THORACENTESIS - At [**2170-5-20**] 03:58 PM', 'PICC line discontinued and tip sent for culture', 's/p thoracentesis, fluid- GS negative, no polys.  LDH and T protein', 'boderline between exudative and transudative, pH 7.36, sent for', 'cytology, viral culture, fungal and AFB.']",28933,118513.0
5,2170-05-22 12:39:12,,"['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']",,28933,118513.0
6,2170-05-22 13:26:37,,"['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']",,28933,118513.0
7,2170-05-22 14:03:54,,"['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']",,28933,118513.0
8,2170-05-23 07:19:24,['BRONCHOSCOPY - At [**2170-5-22**] 02:00 PM'],['BRONCHOSCOPY - At [**2170-5-22**] 02:00 PM'],"['#Patient became hypoxic yesterday and hypoxia was refractory to IV', 'Lasix (X 2) as well as trial of BiPAP. Was eventually intubated around', '[**2161**] yesterday.', '#Initiated TPN therapy yesterday.', '#Bleeding requiring direct pressure for several minutes by nurse', 'following peripheral IV removal. AM lovenox held.']",28933,118513.0
9,2170-05-23 13:51:02,,['BRONCHOSCOPY - At [**2170-5-22**] 02:00 PM'],,28933,118513.0
10,2170-05-24 08:04:17,"['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']","['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']",['BRONCHOSCOPY - At [**2170-5-22**] 02:00 PM'],28933,118513.0
11,2170-05-24 11:07:17,,"['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']",,28933,118513.0
12,2170-05-25 08:08:13,"['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']","['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']","['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']",28933,118513.0
13,2170-05-25 08:10:13,"['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']","['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']","['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']",28933,118513.0
14,2170-05-26 07:15:00,"['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']","['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']","['# PS trial of [**4-2**] and [**4-7**] and lasted only 2 minutes with tidal volumes', 'of ~300 and associated tachypnea to the 30s and pulse to 130. Was put', 'back on VC.', '# BMT consult requested immunoglobulins due to concern for', 'hypogammaglobulinemia. Labs this AM showed low IgG, IgA and IgM levels.', '# Started an insulin infusion due to consistently high blood glucose', 'yesterday (200-300s).']",28933,118513.0
15,2170-05-26 08:12:21,"['# Spontaneous breathing trial tolerated for 2 hours this AM.', '# Attempt to diurese continues with Lasix 20 mg being given twice', 'yesterday.', '# Discovered that patient had not received IVIG yesterday. Was dosed', 'with 25 g IVIG last night, nidicated for hypogammaglobulinemia.', '# Tacrolimus 24-hour trough 1.8; however, no need to check more levels.', ""# Patient's primary oncologist came by to see family yesterday,"", ""specific goals of care were not discussed. No change in patient's code"", 'status or treatment plan at this time.']","['# Spontaneous breathing trial tolerated for 2 hours this AM.', '# Attempt to diurese continues with Lasix 20 mg being given twice', 'yesterday.', '# Discovered that patient had not received IVIG yesterday. Was dosed', 'with 25 g IVIG last night, nidicated for hypogammaglobulinemia.', '# Tacrolimus 24-hour trough 1.8; however, no need to check more levels.', ""# Patient's primary oncologist came by to see family yesterday,"", ""specific goals of care were not discussed. No change in patient's code"", 'status or treatment plan at this time.']","['# Patient doing well on PS ventilation mode of 20/5.', '# Primary oncologist has been emailed to arrange for family meeting', 'today.', '# BP dropped slightly after second lasix dose yesterday.', '# Received IVIG 25g x 1 for hypogammaglobulinemia.']",28933,118513.0
16,2170-05-26 11:46:18,,"['# Spontaneous breathing trial tolerated for 2 hours this AM.', '# Attempt to diurese continues with Lasix 20 mg being given twice', 'yesterday.', '# Discovered that patient had not received IVIG yesterday. Was dosed', 'with 25 g IVIG last night, nidicated for hypogammaglobulinemia.', '# Tacrolimus 24-hour trough 1.8; however, no need to check more levels.', ""# Patient's primary oncologist came by to see family yesterday,"", ""specific goals of care were not discussed. No change in patient's code"", 'status or treatment plan at this time.']",,28933,118513.0
17,2170-05-27 07:22:36,"['#Patient extubated yesterday afternoon.', '#Some episodes of tachycardia to 150s associated with coughing', 'overnight.', '#Trial of clear liquids; however, patient had difficulty swallowing.', ""#Vancomycin D/C'd.""]","['#Patient extubated yesterday afternoon.', '#Some episodes of tachycardia to 150s associated with coughing', 'overnight.', '#Trial of clear liquids; however, patient had difficulty swallowing.', ""#Vancomycin D/C'd.""]","['# Spontaneous breathing trial tolerated for 2 hours this AM.', '# Attempt to diurese continues with Lasix 20 mg being given twice', 'yesterday.', '# Discovered that patient had not received IVIG yesterday. Was dosed', 'with 25 g IVIG last night, nidicated for hypogammaglobulinemia.', '# Tacrolimus 24-hour trough 1.8; however, no need to check more levels.', ""# Patient's primary oncologist came by to see family yesterday,"", ""specific goals of care were not discussed. No change in patient's code"", 'status or treatment plan at this time.']",28933,118513.0
18,2170-05-27 11:54:08,,"['#Patient extubated yesterday afternoon.', '#Some episodes of tachycardia to 150s associated with coughing', 'overnight.', '#Trial of clear liquids; however, patient had difficulty swallowing.', ""#Vancomycin D/C'd.""]",,28933,118513.0
19,2170-05-28 07:25:18,"['- Cannot [**Last Name (LF) 553**], [**First Name3 (LF) **] could not perform tylenol absorption test.', '- Goal was to keep net balance even to negative.  Right now he is XXXL', '- Per, BMT, recheck CMV viral load in the AM.', 'Patient complains of Nausea,', 'Otherwise is well.', 'Denies CP, SOB, fevers, chills, abdominal pain, diarrhea (last bm 2', 'days ago),']","['- Cannot [**Last Name (LF) 553**], [**First Name3 (LF) **] could not perform tylenol absorption test.', '- Goal was to keep net balance even to negative.  Right now he is XXXL', '- Per, BMT, recheck CMV viral load in the AM.', 'Patient complains of Nausea,', 'Otherwise is well.', 'Denies CP, SOB, fevers, chills, abdominal pain, diarrhea (last bm 2', 'days ago),']","['#Patient extubated yesterday afternoon.', '#Some episodes of tachycardia to 150s associated with coughing', 'overnight.', '#Trial of clear liquids; however, patient had difficulty swallowing.', ""#Vancomycin D/C'd.""]",28933,118513.0
20,2170-05-28 12:44:05,['- Extubated yesterday morning. Doing well on 2 L NC.'],"['- Extubated yesterday morning. Doing well on 2 L NC.', '- Cannot [**Last Name (LF) 553**], [**First Name3 (LF) **] could not perform tylenol absorption test.', '- Goal was to keep net balance even to negative.  Right now he is XXXL', '- Per, BMT, recheck CMV viral load in the AM.']","['Patient complains of Nausea,', 'Otherwise is well.', 'Denies CP, SOB, fevers, chills, abdominal pain, diarrhea (last bm 2', 'days ago),']",28933,118513.0
21,2170-07-26 07:37:18,"['Overnight, the patient was tachypenic and serial VBGs showed persistent', 'hypercarbia.  Tried patient on mask ventilation, and at first he did', 'ok.  Then he started stacking breaths and took off the mask.  02', 'saturation remained >95%.', ' PICC LINE - START [**2170-7-25**] 02:25 PM', ' EKG - At [**2170-7-25**] 10:00 PM', 'unchanged.  pt has been in ST t/o shift']","['Overnight, the patient was tachypenic and serial VBGs showed persistent', 'hypercarbia.  Tried patient on mask ventilation, and at first he did', 'ok.  Then he started stacking breaths and took off the mask.  02', 'saturation remained >95%.', ' PICC LINE - START [**2170-7-25**] 02:25 PM', ' EKG - At [**2170-7-25**] 10:00 PM', 'unchanged.  pt has been in ST t/o shift']","['- Extubated yesterday morning. Doing well on 2 L NC.', '- Cannot [**Last Name (LF) 553**], [**First Name3 (LF) **] could not perform tylenol absorption test.', '- Goal was to keep net balance even to negative.  Right now he is XXXL', '- Per, BMT, recheck CMV viral load in the AM.']",28933,118513.0
22,2170-07-26 09:12:36,"['Mental Status unchanged overnight.  Patient is tired this AM and asking', 'to be intubated.']","['Overnight, the patient was tachypenic and serial VBGs showed persistent', 'hypercarbia.  Tried patient on mask ventilation, and at first he did', 'ok.  Then he started stacking breaths and took off the mask.  02', 'saturation remained >95%.', 'Mental Status unchanged overnight.  Patient is tired this AM and asking', 'to be intubated.', ' PICC LINE - START [**2170-7-25**] 02:25 PM', ' EKG - At [**2170-7-25**] 10:00 PM', 'unchanged.  pt has been in ST t/o shift']",,28933,118513.0
23,2170-07-26 10:05:53,,"['Overnight, the patient was tachypenic and serial VBGs showed persistent', 'hypercarbia.  Tried patient on mask ventilation, and at first he did', 'ok.  Then he started stacking breaths and took off the mask.  02', 'saturation remained >95%.', 'Mental Status unchanged overnight.  Patient is tired this AM and asking', 'to be intubated.', ' PICC LINE - START [**2170-7-25**] 02:25 PM', ' EKG - At [**2170-7-25**] 10:00 PM', 'unchanged.  pt has been in ST t/o shift']",,28933,118513.0
24,2170-07-27 06:38:04,['INVASIVE VENTILATION - START [**2170-7-26**] 03:30 PM'],['INVASIVE VENTILATION - START [**2170-7-26**] 03:30 PM'],"['Overnight, the patient was tachypenic and serial VBGs showed persistent', 'hypercarbia.  Tried patient on mask ventilation, and at first he did', 'ok.  Then he started stacking breaths and took off the mask.  02', 'saturation remained >95%.', 'Mental Status unchanged overnight.  Patient is tired this AM and asking', 'to be intubated.', ' PICC LINE - START [**2170-7-25**] 02:25 PM', ' EKG - At [**2170-7-25**] 10:00 PM', 'unchanged.  pt has been in ST t/o shift']",28933,118513.0
25,2170-07-27 07:12:26,"['-patient intubated yesterday afternoon, secondary to hypercarbia (pCO2', '106)', '-A-line attempted, but unable to place', '-SBPs dropped to 80s after sedation. Lasix and Lopressor held.', 'Responsive to IVF.']","['INVASIVE VENTILATION - START [**2170-7-26**] 03:30 PM', '-patient intubated yesterday afternoon, secondary to hypercarbia (pCO2', '106)', '-A-line attempted, but unable to place', '-SBPs dropped to 80s after sedation. Lasix and Lopressor held.', 'Responsive to IVF.']",,28933,118513.0
26,2170-07-27 09:33:09,"['-receiving 1u of PRBCs this AM', '-had 3 BMs last night']","['INVASIVE VENTILATION - START [**2170-7-26**] 03:30 PM', '-patient intubated yesterday afternoon, secondary to hypercarbia (pCO2', '106)', '-SBPs dropped to 80s after sedation. Lasix and Lopressor held.', 'Responsive to IVF.', '-A-line attempted, but unable to place', '-receiving 1u of PRBCs this AM', '-had 3 BMs last night']",,28933,118513.0
27,2170-07-28 07:43:52,"['BRONCHOSCOPY - At [**2170-7-27**] 11:31 AM', ' THORACENTESIS - At [**2170-7-27**] 12:35 PM', ' BLOOD CULTURED - At [**2170-7-27**] 03:21 PM']","['BRONCHOSCOPY - At [**2170-7-27**] 11:31 AM', ' THORACENTESIS - At [**2170-7-27**] 12:35 PM', ' BLOOD CULTURED - At [**2170-7-27**] 03:21 PM']","['INVASIVE VENTILATION - START [**2170-7-26**] 03:30 PM', '-patient intubated yesterday afternoon, secondary to hypercarbia (pCO2', '106)', '-SBPs dropped to 80s after sedation. Lasix and Lopressor held.', 'Responsive to IVF.', '-A-line attempted, but unable to place', '-receiving 1u of PRBCs this AM', '-had 3 BMs last night']",28933,118513.0
28,2170-07-28 11:19:28,"['Patient tolerated [**Female First Name (un) **] well yesterday with 900 cc drained, sent for', 'Cx,', 'Bronch yesterday for washing and to attempt to open atalectatic lung.', 'GM stain with 3+ GPCs in pairs and clusters.', 'Patient with RSBI of 149 this AM but switched to PS 15/5 and tolerated', 'well.']","['BRONCHOSCOPY - At [**2170-7-27**] 11:31 AM', ' THORACENTESIS - At [**2170-7-27**] 12:35 PM', ' BLOOD CULTURED - At [**2170-7-27**] 03:21 PM', 'Patient tolerated [**Female First Name (un) **] well yesterday with 900 cc drained, sent for', 'Cx,', 'Bronch yesterday for washing and to attempt to open atalectatic lung.', 'GM stain with 3+ GPCs in pairs and clusters.', 'Patient with RSBI of 149 this AM but switched to PS 15/5 and tolerated', 'well.']",,28933,118513.0
29,2170-07-29 08:20:19,['EKG - At [**2170-7-28**] 03:40 PM'],['EKG - At [**2170-7-28**] 03:40 PM'],"['BRONCHOSCOPY - At [**2170-7-27**] 11:31 AM', ' THORACENTESIS - At [**2170-7-27**] 12:35 PM', ' BLOOD CULTURED - At [**2170-7-27**] 03:21 PM', 'Patient tolerated [**Female First Name (un) **] well yesterday with 900 cc drained, sent for', 'Cx,', 'Bronch yesterday for washing and to attempt to open atalectatic lung.', 'GM stain with 3+ GPCs in pairs and clusters.', 'Patient with RSBI of 149 this AM but switched to PS 15/5 and tolerated', 'well.']",28933,118513.0
30,2170-07-29 16:05:34,"['-tried to wean yesterday.  PS reduced to [**11-2**], but CO2 went up to 79.', 'Increased to 15/5.', '-became acutely tachycardic last night, given adenosine, looked like', 'aflutter.  Given IV lopressor (5mg once) which controlled rate.', 'CE', 's x2 negative', '4 pm ABG  7.36/76/357/45']","['EKG - At [**2170-7-28**] 03:40 PM', '-tried to wean yesterday.  PS reduced to [**11-2**], but CO2 went up to 79.', 'Increased to 15/5.', '-became acutely tachycardic last night, given adenosine, looked like', 'aflutter.  Given IV lopressor (5mg once) which controlled rate.', 'CE', 's x2 negative', '4 pm ABG  7.36/76/357/45']",,28933,118513.0
31,2170-07-30 06:31:28,,[],"['EKG - At [**2170-7-28**] 03:40 PM', '-tried to wean yesterday.  PS reduced to [**11-2**], but CO2 went up to 79.', 'Increased to 15/5.', '-became acutely tachycardic last night, given adenosine, looked like', 'aflutter.  Given IV lopressor (5mg once) which controlled rate.', 'CE', 's x2 negative', '4 pm ABG  7.36/76/357/45']",28933,118513.0
32,2170-07-30 06:56:58,"['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI but', 'no spontaneous effort', ' per RT']","['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI but', 'no spontaneous effort', ' per RT']",,28933,118513.0
33,2170-07-30 07:22:37,['Vanc trough 7.3'],"['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI but', 'no spontaneous effort', ' per RT', 'Vanc trough 7.3']",,28933,118513.0
34,2170-07-30 08:03:54,"['Attepmted RSBI early this AM but', ' per RT ->', 'likely too sedated as patient was interactive yesterday', '1 lumen of PICC not flushing or Drawing, TPA for catheter flush']","['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI early this AM but', 'no spontaneous effort', ' per RT ->', 'likely too sedated as patient was interactive yesterday', 'Vanc trough 7.3', '1 lumen of PICC not flushing or Drawing, TPA for catheter flush']","['Attepmted RSBI but', ' per RT']",28933,118513.0
35,2170-07-30 10:00:54,"['-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75', 'Vanc trough 7.3, changed to 1gm q8 this am per Pharm.']","['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI early this AM but', 'no spontaneous effort', ' per RT ->', 'likely too sedated as patient was interactive yesterday', '-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75', 'Vanc trough 7.3, changed to 1gm q8 this am per Pharm.', '1 lumen of PICC not flushing or Drawing, TPA for catheter flush']",['Vanc trough 7.3'],28933,118513.0
36,2170-07-30 10:18:23,['-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75/48'],"['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI early this AM but', 'no spontaneous effort', ' per RT ->', 'likely too sedated as patient was interactive yesterday', '-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75/48', 'Vanc trough 7.3, changed to 1gm q8 this am per Pharm.', '1 lumen of PICC not flushing or Drawing, TPA for catheter flush']",['-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75'],28933,118513.0
37,2170-07-31 06:34:00,,[],"['Was on PS from 11 am to 5 PM yesterday with sats >93 and Vt 500-600cc', 'ABG  7.35/75/76/43', 'Switched to AC at 5PM with VBG 7.33/92/36/51 and Sat 95%', 'Attepmted RSBI early this AM but', 'no spontaneous effort', ' per RT ->', 'likely too sedated as patient was interactive yesterday', '-RSBI this AM while off sedation 122.  ABG on PS 15/5 was 7.36/81/75/48', 'Vanc trough 7.3, changed to 1gm q8 this am per Pharm.', '1 lumen of PICC not flushing or Drawing, TPA for catheter flush']",28933,118513.0
38,2170-07-31 07:39:25,,[],,28933,118513.0
39,2170-07-31 15:47:43,,[],,28933,118513.0
40,2170-08-01 06:42:27,"['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']","['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",,28933,118513.0
41,2170-08-01 06:43:22,,"['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",,28933,118513.0
42,2170-08-01 15:58:45,,"['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",,28933,118513.0
43,2170-08-01 16:28:55,,"['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",,28933,118513.0
44,2170-08-02 06:30:10,"['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']","['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']","['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",28933,118513.0
45,2170-08-02 06:31:30,"['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']","['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']","['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']",28933,118513.0
46,2170-08-02 06:32:09,"['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']","['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']","['Vancomycin trough level 19.9; patient redosed', 'Pt vomiting after starting tube feeds; tube feeds stopped.']",28933,118513.0
47,2170-08-02 07:47:17,,"['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']",,28933,118513.0
48,2170-08-02 20:24:51,,"['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']",,28933,118513.0
49,2170-08-03 06:43:07,"['-family meeting: made DNR, considering trach', '-nausea - zydis']","['-family meeting: made DNR, considering trach', '-nausea - zydis']","['Monitoring EKG', 'Methadone increased to 10mg TID for pain control', 'Discussed with Onc attending who knows pt for long time possibility of', 'tracheostomy and pt has always declined. Try to discuss with patiient', 'yesterday, but he did not respond (despite being awake and respond', 'other questions)', 'Vancomycin dosing adjusted yesterday after discussion with ID. Day 1', 'will be [**7-30**] since was the first day that pt was on therapeutic level.', '8 day course.', 'Tacro level for today (pending)', 'Tube feeds were re-started yesterday @ 30cc/hr, but patient got', 'nauseous despite compazine. Tube feeds were stopped again.']",28933,118513.0
50,2170-08-03 13:35:42,"['-nausea', ' zydis, not tolerating TF', '-KUB- no obstruction, some contrast from previous imaging still in', 'bowels']","['-family meeting: made DNR, considering trach', '-nausea', ' zydis, not tolerating TF', '-KUB- no obstruction, some contrast from previous imaging still in', 'bowels']",['-nausea - zydis'],28933,118513.0
51,2170-08-03 13:47:26,,"['-family meeting: made DNR, considering trach', '-nausea', ' zydis, not tolerating TF', '-KUB- no obstruction, some contrast from previous imaging still in', 'bowels']",,28933,118513.0
52,2170-08-04 06:46:08,,[],"['-family meeting: made DNR, considering trach', '-nausea', ' zydis, not tolerating TF', '-KUB- no obstruction, some contrast from previous imaging still in', 'bowels']",28933,118513.0
53,2170-08-04 06:49:12,"['-vanco trough 30.8, held PM dose, rechecked level at 6:30pm and level', 'wwas 23 dose held again. Recheck this AM.', '-unable to tolerate tube feeds (vomiting) and unable to tolerate', 'gleevec. Order for PICC line placed to start TPN. Currently receiving', 'IV maintenance therapy at 125cc/hr.']","['-vanco trough 30.8, held PM dose, rechecked level at 6:30pm and level', 'wwas 23 dose held again. Recheck this AM.', '-unable to tolerate tube feeds (vomiting) and unable to tolerate', 'gleevec. Order for PICC line placed to start TPN. Currently receiving', 'IV maintenance therapy at 125cc/hr.']",,28933,118513.0
54,2170-08-04 15:52:39,['was 23 dose held again.'],"['-vanco trough 30.8, held PM dose, rechecked level at 6:30pm and level', 'was 23 dose held again.', '-unable to tolerate tube feeds (vomiting) and unable to tolerate', 'gleevec. Order for PICC line placed to start TPN. Currently receiving', 'IV maintenance therapy at 125cc/hr.']",['wwas 23 dose held again. Recheck this AM.'],28933,118513.0
55,2170-08-05 07:02:51,"['- vanco trough 13- dosed vanco', '- continues to be unable to tolerate TF, even PO meds are a problem.', 'nutrition consult for TPN. should be able to use PICC since its double', 'lumen, only 1 being used.', '-BMT ok with holding gleevec for a day, restarting at 200 and titrating', 'up to 400 again.', '-continue to give tacrolimus at current dose, no need to increase,', 'check the level again in a couple days (monday)', '-had couple episodes of apnea. ABG done (5:30pm) looked the same as', 'before, FS was 140s, afebrile. Likely etiology is ativan .5 given', 'earlier in the day may not be clearing as quickly. However, concern is', ""for other causes of 'central' apnea such as chronic methadone"", 'treatment, fatigued respiratory muscles and chest wall. He will wake up', 'when he is shaken and his name is called and can respond to questions', 'so unlikely that this is seizure activity.']","['- vanco trough 13- dosed vanco', '- continues to be unable to tolerate TF, even PO meds are a problem.', 'nutrition consult for TPN. should be able to use PICC since its double', 'lumen, only 1 being used.', '-BMT ok with holding gleevec for a day, restarting at 200 and titrating', 'up to 400 again.', '-continue to give tacrolimus at current dose, no need to increase,', 'check the level again in a couple days (monday)', '-had couple episodes of apnea. ABG done (5:30pm) looked the same as', 'before, FS was 140s, afebrile. Likely etiology is ativan .5 given', 'earlier in the day may not be clearing as quickly. However, concern is', ""for other causes of 'central' apnea such as chronic methadone"", 'treatment, fatigued respiratory muscles and chest wall. He will wake up', 'when he is shaken and his name is called and can respond to questions', 'so unlikely that this is seizure activity.']","['-vanco trough 30.8, held PM dose, rechecked level at 6:30pm and level', 'was 23 dose held again.', '-unable to tolerate tube feeds (vomiting) and unable to tolerate', 'gleevec. Order for PICC line placed to start TPN. Currently receiving', 'IV maintenance therapy at 125cc/hr.']",28933,118513.0
56,2170-08-05 07:03:34,,"['- vanco trough 13- dosed vanco', '- continues to be unable to tolerate TF, even PO meds are a problem.', 'nutrition consult for TPN. should be able to use PICC since its double', 'lumen, only 1 being used.', '-BMT ok with holding gleevec for a day, restarting at 200 and titrating', 'up to 400 again.', '-continue to give tacrolimus at current dose, no need to increase,', 'check the level again in a couple days (monday)', '-had couple episodes of apnea. ABG done (5:30pm) looked the same as', 'before, FS was 140s, afebrile. Likely etiology is ativan .5 given', 'earlier in the day may not be clearing as quickly. However, concern is', ""for other causes of 'central' apnea such as chronic methadone"", 'treatment, fatigued respiratory muscles and chest wall. He will wake up', 'when he is shaken and his name is called and can respond to questions', 'so unlikely that this is seizure activity.']",,28933,118513.0
57,2170-08-06 06:59:27,"[""On Saturday night patient's ventilator onf [**9-2**], vent settings changed"", 'yesterday to [**4-2**] all during the day and patient tolerated well.', 'Apparently overnight patient became apneic on these settings, switched', ""back to AC. Discussion with BMT was had yesterday regarding patient's"", 'Gleevac has pt has been off yesterday secondary to nausea/vomiting.', 'Today plan to re-start. Ordered by BMT for 200 mg today.']","[""On Saturday night patient's ventilator onf [**9-2**], vent settings changed"", 'yesterday to [**4-2**] all during the day and patient tolerated well.', 'Apparently overnight patient became apneic on these settings, switched', ""back to AC. Discussion with BMT was had yesterday regarding patient's"", 'Gleevac has pt has been off yesterday secondary to nausea/vomiting.', 'Today plan to re-start. Ordered by BMT for 200 mg today.']","['- vanco trough 13- dosed vanco', '- continues to be unable to tolerate TF, even PO meds are a problem.', 'nutrition consult for TPN. should be able to use PICC since its double', 'lumen, only 1 being used.', '-BMT ok with holding gleevec for a day, restarting at 200 and titrating', 'up to 400 again.', '-continue to give tacrolimus at current dose, no need to increase,', 'check the level again in a couple days (monday)', '-had couple episodes of apnea. ABG done (5:30pm) looked the same as', 'before, FS was 140s, afebrile. Likely etiology is ativan .5 given', 'earlier in the day may not be clearing as quickly. However, concern is', ""for other causes of 'central' apnea such as chronic methadone"", 'treatment, fatigued respiratory muscles and chest wall. He will wake up', 'when he is shaken and his name is called and can respond to questions', 'so unlikely that this is seizure activity.']",28933,118513.0
58,2170-08-06 12:11:53,"['Today plan to re-start. Ordered by BMT for 200 mg today. This morning', 'on T-tube only. Breathing comfortable. Patient stating that he does not', 'want to be re-intubated if fails trail of extubation.']","[""On Saturday night patient's ventilator onf [**9-2**], vent settings changed"", 'yesterday to [**4-2**] all during the day and patient tolerated well.', 'Apparently overnight patient became apneic on these settings, switched', ""back to AC. Discussion with BMT was had yesterday regarding patient's"", 'Gleevac has pt has been off yesterday secondary to nausea/vomiting.', 'Today plan to re-start. Ordered by BMT for 200 mg today. This morning', 'on T-tube only. Breathing comfortable. Patient stating that he does not', 'want to be re-intubated if fails trail of extubation.']",['Today plan to re-start. Ordered by BMT for 200 mg today.'],28933,118513.0
59,2170-08-07 07:52:23,"['INVASIVE VENTILATION - STOP [**2170-8-6**] 11:10 AM', 'Patient did ok on [**4-2**] yesterday so he was switched to T-tube. He was', 'extubated yesterday. Now on shevel mask 15 L', 'Patient c/o pain in his chest. Does not seem cardiac pain. It may be a', 'mix of anxiety and GVHD and restrictive component in his chest. Pt was', 'given IV morphine and IV fentanyl. Was started on standing tylenol and', 'oxycodone PRN. Methadone was stopped.']","['INVASIVE VENTILATION - STOP [**2170-8-6**] 11:10 AM', 'Patient did ok on [**4-2**] yesterday so he was switched to T-tube. He was', 'extubated yesterday. Now on shevel mask 15 L', 'Patient c/o pain in his chest. Does not seem cardiac pain. It may be a', 'mix of anxiety and GVHD and restrictive component in his chest. Pt was', 'given IV morphine and IV fentanyl. Was started on standing tylenol and', 'oxycodone PRN. Methadone was stopped.']","[""On Saturday night patient's ventilator onf [**9-2**], vent settings changed"", 'yesterday to [**4-2**] all during the day and patient tolerated well.', 'Apparently overnight patient became apneic on these settings, switched', ""back to AC. Discussion with BMT was had yesterday regarding patient's"", 'Gleevac has pt has been off yesterday secondary to nausea/vomiting.', 'Today plan to re-start. Ordered by BMT for 200 mg today. This morning', 'on T-tube only. Breathing comfortable. Patient stating that he does not', 'want to be re-intubated if fails trail of extubation.']",28933,118513.0
60,2170-08-07 07:53:24,,"['INVASIVE VENTILATION - STOP [**2170-8-6**] 11:10 AM', 'Patient did ok on [**4-2**] yesterday so he was switched to T-tube. He was', 'extubated yesterday. Now on shevel mask 15 L', 'Patient c/o pain in his chest. Does not seem cardiac pain. It may be a', 'mix of anxiety and GVHD and restrictive component in his chest. Pt was', 'given IV morphine and IV fentanyl. Was started on standing tylenol and', 'oxycodone PRN. Methadone was stopped.']",,28933,118513.0
61,2170-08-07 14:18:48,,"['INVASIVE VENTILATION - STOP [**2170-8-6**] 11:10 AM', 'Patient did ok on [**4-2**] yesterday so he was switched to T-tube. He was', 'extubated yesterday. Now on shevel mask 15 L', 'Patient c/o pain in his chest. Does not seem cardiac pain. It may be a', 'mix of anxiety and GVHD and restrictive component in his chest. Pt was', 'given IV morphine and IV fentanyl. Was started on standing tylenol and', 'oxycodone PRN. Methadone was stopped.']",,28933,118513.0
0,2179-11-09 06:03:50,,"['URINE CULTURE - At [**2179-11-8**] 05:30 PM', 'hct 26.5- transfuse 1U PRBC, repeat hct= 32.3', '-f/u UA', '-GI may want to scope tomorrow/Wed, f/u recs', '-tachycardic, tachypneic o/n w/productive sputum- suction w/significant', 'yellow sputum', '-improved UOP w/1L NS and blood', '-elevated CK']",,26286,150659.0
1,2179-11-09 06:04:41,,"['URINE CULTURE - At [**2179-11-8**] 05:30 PM', 'hct 26.5- transfuse 1U PRBC, repeat hct= 32.3', '-f/u UA', '-GI may want to scope tomorrow/Wed, f/u recs', '-tachycardic, tachypneic o/n w/productive sputum- suction w/significant', 'yellow sputum', '-improved UOP w/1L NS and blood', '-elevated CK']",,26286,150659.0
2,2179-11-09 10:06:35,['-elevated CKs'],"['URINE CULTURE - At [**2179-11-8**] 05:30 PM', 'hct 26.5- transfuse 1U PRBC, repeat hct= 32.3', '-f/u UA', '-GI may want to scope tomorrow/Wed, f/u recs', '-tachycardic, tachypneic o/n w/productive sputum- suction w/significant', 'yellow sputum', '-improved UOP w/1L NS and blood', '-elevated CKs']",['-elevated CK'],26286,150659.0
3,2179-11-09 10:28:39,,"['URINE CULTURE - At [**2179-11-8**] 05:30 PM', 'hct 26.5- transfuse 1U PRBC, repeat hct= 32.3', '-f/u UA', '-GI may want to scope tomorrow/Wed, f/u recs', '-tachycardic, tachypneic o/n w/productive sputum- suction w/significant', 'yellow sputum', '-improved UOP w/1L NS and blood', '-elevated CKs']",,26286,150659.0
4,2179-11-09 13:55:37,,"['URINE CULTURE - At [**2179-11-8**] 05:30 PM', 'hct 26.5- transfuse 1U PRBC, repeat hct= 32.3', '-f/u UA', '-GI may want to scope tomorrow/Wed, f/u recs', '-tachycardic, tachypneic o/n w/productive sputum- suction w/significant', 'yellow sputum', '-improved UOP w/1L NS and blood', '-elevated CKs']",,26286,150659.0
0,2123-01-06 08:20:32,,['DIALYSIS CATHETER - START [**2123-1-5**] 03:48 PM'],,75668,157090.0
1,2123-01-06 11:59:10,,['DIALYSIS CATHETER - START [**2123-1-5**] 03:48 PM'],,75668,157090.0
0,2143-03-29 06:42:46,,"['- Transferred to MICU for mastocytosis flare', '- received benadryl, solumedrol, zofran, phenergan', '- persistently tachy']",,19308,120012.0
1,2143-03-29 12:26:27,,"['- Transferred to MICU for mastocytosis flare', '- received benadryl, solumedrol, zofran, phenergan', '- persistently tachy']",,19308,120012.0
2,2143-03-30 07:57:46,"['- Recommended to retrial ASA 162 mg daily by Allergy consult', '- Patient with recurrent flushig mid-day; refused ASA', '- Steroid dose tapered to Solumedrol 80 mg TID', '- Diet advanced.']","['- Recommended to retrial ASA 162 mg daily by Allergy consult', '- Patient with recurrent flushig mid-day; refused ASA', '- Steroid dose tapered to Solumedrol 80 mg TID', '- Diet advanced.']","['- Transferred to MICU for mastocytosis flare', '- received benadryl, solumedrol, zofran, phenergan', '- persistently tachy']",19308,120012.0
3,2143-03-30 11:02:16,,"['- Recommended to retrial ASA 162 mg daily by Allergy consult', '- Patient with recurrent flushig mid-day; refused ASA', '- Steroid dose tapered to Solumedrol 80 mg TID', '- Diet advanced.']",,19308,120012.0
4,2143-03-30 11:03:48,,"['- Recommended to retrial ASA 162 mg daily by Allergy consult', '- Patient with recurrent flushig mid-day; refused ASA', '- Steroid dose tapered to Solumedrol 80 mg TID', '- Diet advanced.']",,19308,120012.0
5,2143-03-31 07:47:41,"['- Dr.[**Last Name (STitle) 8242**] to see her today to discuss aspirin', '- patient was called out, however had another flare, prednisone was', 'changed back to solumedrol, patient was kept in ICU overnight for close', 'monitoring']","['- Dr.[**Last Name (STitle) 8242**] to see her today to discuss aspirin', '- patient was called out, however had another flare, prednisone was', 'changed back to solumedrol, patient was kept in ICU overnight for close', 'monitoring']","['- Recommended to retrial ASA 162 mg daily by Allergy consult', '- Patient with recurrent flushig mid-day; refused ASA', '- Steroid dose tapered to Solumedrol 80 mg TID', '- Diet advanced.']",19308,120012.0
6,2143-03-31 12:48:29,,"['- Dr.[**Last Name (STitle) 8242**] to see her today to discuss aspirin', '- patient was called out, however had another flare, prednisone was', 'changed back to solumedrol, patient was kept in ICU overnight for close', 'monitoring']",,19308,120012.0
0,2174-08-06 07:04:33,,"['DIALYSIS CATHETER - START [**2174-8-5**] 06:46 PM', ' EKG - At [**2174-8-5**] 08:27 PM', 'No overnight events', 'History obtained from Patient']",,10957,155819.0
1,2174-08-06 10:41:52,,"['DIALYSIS CATHETER - START [**2174-8-5**] 06:46 PM', ' EKG - At [**2174-8-5**] 08:27 PM', 'No overnight events', 'History obtained from Patient']",,10957,155819.0
0,2137-03-10 07:30:19,,"['INVASIVE VENTILATION - START [**2137-3-9**] 03:30 PM', ' ULTRASOUND - At [**2137-3-10**] 12:00 AM']",,70926,112660.0
1,2137-03-10 08:33:50,,"['INVASIVE VENTILATION - START [**2137-3-9**] 03:30 PM', ' ULTRASOUND - At [**2137-3-10**] 12:00 AM']",,70926,112660.0
2,2137-03-11 07:22:54,"['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']","['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']","['INVASIVE VENTILATION - START [**2137-3-9**] 03:30 PM', ' ULTRASOUND - At [**2137-3-10**] 12:00 AM']",70926,112660.0
3,2137-03-11 07:23:29,,"['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']",,70926,112660.0
4,2137-03-11 10:28:36,,"['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']",,70926,112660.0
5,2137-03-11 10:41:47,,"['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']",,70926,112660.0
6,2137-03-12 07:36:25,"['[**3-11**]', 'Per Dr. [**First Name (STitle) 5974**] ([**Telephone/Fax (1) 13571**]):', 'Pt is seen by Dr. [**Last Name (STitle) 10539**].  Known cirrhosis, no focal liver lesion.', 'Recent decompensation, started on lactulose and diuretics (100', 'aldactone/40 lasix). Low lung volumes are new.', '- FENA .1%, Prerenal, hydrated with Albumin/NaHCO3', '- Poor mental status, agitated/tachycardic continued intubation']","['[**3-11**]', 'Per Dr. [**First Name (STitle) 5974**] ([**Telephone/Fax (1) 13571**]):', 'Pt is seen by Dr. [**Last Name (STitle) 10539**].  Known cirrhosis, no focal liver lesion.', 'Recent decompensation, started on lactulose and diuretics (100', 'aldactone/40 lasix). Low lung volumes are new.', '- FENA .1%, Prerenal, hydrated with Albumin/NaHCO3', '- Poor mental status, agitated/tachycardic continued intubation']","['PARACENTESIS - At [**2137-3-10**] 12:20 PM', '- abd/chest CT showed shrunken, cirrhotic liver, ascites, and', 'left-sided pleural effusion with adjacent atelectasis vs. pneumonia', '- diagnostic para was negative for SBP', '- makes stools with lactulose', '- BP trending down slowly overnight, requiring NS boluses']",70926,112660.0
7,2137-03-12 07:39:02,,"['[**3-11**]', 'Per Dr. [**First Name (STitle) 5974**] ([**Telephone/Fax (1) 13571**]):', 'Pt is seen by Dr. [**Last Name (STitle) 10539**].  Known cirrhosis, no focal liver lesion.', 'Recent decompensation, started on lactulose and diuretics (100', 'aldactone/40 lasix). Low lung volumes are new.', '- FENA .1%, Prerenal, hydrated with Albumin/NaHCO3', '- Poor mental status, agitated/tachycardic continued intubation']",,70926,112660.0
8,2137-03-12 10:11:07,,"['[**3-11**]', 'Per Dr. [**First Name (STitle) 5974**] ([**Telephone/Fax (1) 13571**]):', 'Pt is seen by Dr. [**Last Name (STitle) 10539**].  Known cirrhosis, no focal liver lesion.', 'Recent decompensation, started on lactulose and diuretics (100', 'aldactone/40 lasix). Low lung volumes are new.', '- FENA .1%, Prerenal, hydrated with Albumin/NaHCO3', '- Poor mental status, agitated/tachycardic continued intubation']",,70926,112660.0
9,2137-03-13 11:51:48,,[],"['[**3-11**]', 'Per Dr. [**First Name (STitle) 5974**] ([**Telephone/Fax (1) 13571**]):', 'Pt is seen by Dr. [**Last Name (STitle) 10539**].  Known cirrhosis, no focal liver lesion.', 'Recent decompensation, started on lactulose and diuretics (100', 'aldactone/40 lasix). Low lung volumes are new.', '- FENA .1%, Prerenal, hydrated with Albumin/NaHCO3', '- Poor mental status, agitated/tachycardic continued intubation']",70926,112660.0
10,2137-03-13 18:36:49,"['INVASIVE VENTILATION - STOP [**2137-3-12**] 12:15 PM', '- extubated without difficulty', '- face tent weaned to 4LNC', '- intermittently hypotensive, responsive to NS boluses, also got 50g', 'albumin', '- placed NGT', '- started rifaxamin, lactulose, 1 dose PO vitamin K through NGT', '- having slight BRB in stool, likely hemorrhoids']","['INVASIVE VENTILATION - STOP [**2137-3-12**] 12:15 PM', '- extubated without difficulty', '- face tent weaned to 4LNC', '- intermittently hypotensive, responsive to NS boluses, also got 50g', 'albumin', '- placed NGT', '- started rifaxamin, lactulose, 1 dose PO vitamin K through NGT', '- having slight BRB in stool, likely hemorrhoids']",,70926,112660.0
11,2137-03-13 18:37:56,,"['INVASIVE VENTILATION - STOP [**2137-3-12**] 12:15 PM', '- extubated without difficulty', '- face tent weaned to 4LNC', '- intermittently hypotensive, responsive to NS boluses, also got 50g', 'albumin', '- placed NGT', '- started rifaxamin, lactulose, 1 dose PO vitamin K through NGT', '- having slight BRB in stool, likely hemorrhoids']",,70926,112660.0
12,2137-03-13 18:43:52,,"['INVASIVE VENTILATION - STOP [**2137-3-12**] 12:15 PM', '- extubated without difficulty', '- face tent weaned to 4LNC', '- intermittently hypotensive, responsive to NS boluses, also got 50g', 'albumin', '- placed NGT', '- started rifaxamin, lactulose, 1 dose PO vitamin K through NGT', '- having slight BRB in stool, likely hemorrhoids']",,70926,112660.0
13,2137-03-16 07:54:47,"['ARTERIAL LINE - START [**2137-3-15**] 01:16 PM', ' TRANSTHORACIC ECHO - At [**2137-3-15**] 01:30 PM', ' PARACENTESIS - At [**2137-3-15**] 04:30 PM', 'procedure aborted.  Air drawn with needle by MD while seeking fluid', 'pocket.  ? perfed bowel.  KUB ordered.', '- per renal, would not give bicarb (compensator for resp alk)', '- 250 cc FW q4h for 6 doses', '- repeat lactate/ScVo2 after albumin challenge slightly better', '- dx para per liver recs:', '- echo: hyperdynamic heart, needs fluid', '- fibrinogen stabilized after 1 unit cryo overnight', '- breathing at 40, increasing sedation', '- weaning levophed, giving LR', '- O2 Sat fell after fluids, increasing PEEP from 5 to 10', '- goal PaO2 60', '- pH 7.1-->increasing rate from 20 to 25', '- Hct 19-->2units--> appropriate bump', '- pH persistently low, metabolic acidosis, dyssynchronoous with vent,', 'bladder pressure 12-->paralyzing with 10 mg IV vecuronium', '- called son to let him know she may be dying - he would still like', 'full code but may move toward something else tomorrow, wants to talk to', ""patient's husband"", '- dys-synchronous and acidotic, paralyzed with vecuronium (may stick', 'around for a while give ESLD.....) acidosis improved somewhat', '- persistently hypotensive on levophed, started vasopressin as second', '[**Doctor Last Name **]']","['ARTERIAL LINE - START [**2137-3-15**] 01:16 PM', ' TRANSTHORACIC ECHO - At [**2137-3-15**] 01:30 PM', ' PARACENTESIS - At [**2137-3-15**] 04:30 PM', 'procedure aborted.  Air drawn with needle by MD while seeking fluid', 'pocket.  ? perfed bowel.  KUB ordered.', '- per renal, would not give bicarb (compensator for resp alk)', '- 250 cc FW q4h for 6 doses', '- repeat lactate/ScVo2 after albumin challenge slightly better', '- dx para per liver recs:', '- echo: hyperdynamic heart, needs fluid', '- fibrinogen stabilized after 1 unit cryo overnight', '- breathing at 40, increasing sedation', '- weaning levophed, giving LR', '- O2 Sat fell after fluids, increasing PEEP from 5 to 10', '- goal PaO2 60', '- pH 7.1-->increasing rate from 20 to 25', '- Hct 19-->2units--> appropriate bump', '- pH persistently low, metabolic acidosis, dyssynchronoous with vent,', 'bladder pressure 12-->paralyzing with 10 mg IV vecuronium', '- called son to let him know she may be dying - he would still like', 'full code but may move toward something else tomorrow, wants to talk to', ""patient's husband"", '- dys-synchronous and acidotic, paralyzed with vecuronium (may stick', 'around for a while give ESLD.....) acidosis improved somewhat', '- persistently hypotensive on levophed, started vasopressin as second', '[**Doctor Last Name **]']","['INVASIVE VENTILATION - STOP [**2137-3-12**] 12:15 PM', '- extubated without difficulty', '- face tent weaned to 4LNC', '- intermittently hypotensive, responsive to NS boluses, also got 50g', 'albumin', '- placed NGT', '- started rifaxamin, lactulose, 1 dose PO vitamin K through NGT', '- having slight BRB in stool, likely hemorrhoids']",70926,112660.0
14,2137-03-16 07:56:11,,"['ARTERIAL LINE - START [**2137-3-15**] 01:16 PM', ' TRANSTHORACIC ECHO - At [**2137-3-15**] 01:30 PM', ' PARACENTESIS - At [**2137-3-15**] 04:30 PM', 'procedure aborted.  Air drawn with needle by MD while seeking fluid', 'pocket.  ? perfed bowel.  KUB ordered.', '- per renal, would not give bicarb (compensator for resp alk)', '- 250 cc FW q4h for 6 doses', '- repeat lactate/ScVo2 after albumin challenge slightly better', '- dx para per liver recs:', '- echo: hyperdynamic heart, needs fluid', '- fibrinogen stabilized after 1 unit cryo overnight', '- breathing at 40, increasing sedation', '- weaning levophed, giving LR', '- O2 Sat fell after fluids, increasing PEEP from 5 to 10', '- goal PaO2 60', '- pH 7.1-->increasing rate from 20 to 25', '- Hct 19-->2units--> appropriate bump', '- pH persistently low, metabolic acidosis, dyssynchronoous with vent,', 'bladder pressure 12-->paralyzing with 10 mg IV vecuronium', '- called son to let him know she may be dying - he would still like', 'full code but may move toward something else tomorrow, wants to talk to', ""patient's husband"", '- dys-synchronous and acidotic, paralyzed with vecuronium (may stick', 'around for a while give ESLD.....) acidosis improved somewhat', '- persistently hypotensive on levophed, started vasopressin as second', '[**Doctor Last Name **]']",,70926,112660.0
15,2137-03-16 09:49:24,,"['ARTERIAL LINE - START [**2137-3-15**] 01:16 PM', ' TRANSTHORACIC ECHO - At [**2137-3-15**] 01:30 PM', ' PARACENTESIS - At [**2137-3-15**] 04:30 PM', 'procedure aborted.  Air drawn with needle by MD while seeking fluid', 'pocket.  ? perfed bowel.  KUB ordered.', '- per renal, would not give bicarb (compensator for resp alk)', '- 250 cc FW q4h for 6 doses', '- repeat lactate/ScVo2 after albumin challenge slightly better', '- dx para per liver recs:', '- echo: hyperdynamic heart, needs fluid', '- fibrinogen stabilized after 1 unit cryo overnight', '- breathing at 40, increasing sedation', '- weaning levophed, giving LR', '- O2 Sat fell after fluids, increasing PEEP from 5 to 10', '- goal PaO2 60', '- pH 7.1-->increasing rate from 20 to 25', '- Hct 19-->2units--> appropriate bump', '- pH persistently low, metabolic acidosis, dyssynchronoous with vent,', 'bladder pressure 12-->paralyzing with 10 mg IV vecuronium', '- called son to let him know she may be dying - he would still like', 'full code but may move toward something else tomorrow, wants to talk to', ""patient's husband"", '- dys-synchronous and acidotic, paralyzed with vecuronium (may stick', 'around for a while give ESLD.....) acidosis improved somewhat', '- persistently hypotensive on levophed, started vasopressin as second', '[**Doctor Last Name **]']",,70926,112660.0
16,2137-03-17 07:44:24,,[],"['ARTERIAL LINE - START [**2137-3-15**] 01:16 PM', ' TRANSTHORACIC ECHO - At [**2137-3-15**] 01:30 PM', ' PARACENTESIS - At [**2137-3-15**] 04:30 PM', 'procedure aborted.  Air drawn with needle by MD while seeking fluid', 'pocket.  ? perfed bowel.  KUB ordered.', '- per renal, would not give bicarb (compensator for resp alk)', '- 250 cc FW q4h for 6 doses', '- repeat lactate/ScVo2 after albumin challenge slightly better', '- dx para per liver recs:', '- echo: hyperdynamic heart, needs fluid', '- fibrinogen stabilized after 1 unit cryo overnight', '- breathing at 40, increasing sedation', '- weaning levophed, giving LR', '- O2 Sat fell after fluids, increasing PEEP from 5 to 10', '- goal PaO2 60', '- pH 7.1-->increasing rate from 20 to 25', '- Hct 19-->2units--> appropriate bump', '- pH persistently low, metabolic acidosis, dyssynchronoous with vent,', 'bladder pressure 12-->paralyzing with 10 mg IV vecuronium', '- called son to let him know she may be dying - he would still like', 'full code but may move toward something else tomorrow, wants to talk to', ""patient's husband"", '- dys-synchronous and acidotic, paralyzed with vecuronium (may stick', 'around for a while give ESLD.....) acidosis improved somewhat', '- persistently hypotensive on levophed, started vasopressin as second', '[**Doctor Last Name **]']",70926,112660.0
17,2137-03-17 08:40:46,"['- Decision made not to escalate Care', '- Worsening Vent settings, acidosis, Lactate but not pressor', 'requirements']","['- Decision made not to escalate Care', '- Worsening Vent settings, acidosis, Lactate but not pressor', 'requirements']",,70926,112660.0
0,2189-08-21 07:06:08,,"['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.']",,26212,117561.0
1,2189-08-21 07:10:25,,"['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.']",,26212,117561.0
2,2189-08-21 07:23:51,,"['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.']",,26212,117561.0
3,2189-08-21 07:29:14,"['HTN urgency on presentation to ICU.  Started on NTG gtt.  BP well', 'controlled once po medications were restarted.']","['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.  BP well', 'controlled once po medications were restarted.']",['HTN urgency on presentation to ICU.  Started on NTG gtt.'],26212,117561.0
4,2189-08-21 10:41:07,,"['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.  BP well', 'controlled once po medications were restarted.']",,26212,117561.0
5,2189-08-21 10:57:49,"['Desmopressin given in setting of decreasing hct and persistent bleeding', 'at incision site.']","['ARTERIAL LINE - START [**2189-8-20**] 09:33 PM', 'perirectal abscess I/D', 'HTN urgency on presentation to ICU.  Started on NTG gtt.  BP well', 'controlled once po medications were restarted.', 'Desmopressin given in setting of decreasing hct and persistent bleeding', 'at incision site.']",,26212,117561.0
0,2190-01-19 06:48:28,,"['DIALYSIS CATHETER - START [**2190-1-18**] 02:05 PM', 'Complained of Left thigh numbness. Ortho called and evaluated', 'HCT drop to 26 after 1 unit so started additional unit']",,26212,159674.0
1,2190-01-19 06:55:56,,"['DIALYSIS CATHETER - START [**2190-1-18**] 02:05 PM', 'Complained of Left thigh numbness. Ortho called and evaluated', 'HCT drop to 26 after 1 unit so started additional unit']",,26212,159674.0
2,2190-01-19 12:25:39,,"['DIALYSIS CATHETER - START [**2190-1-18**] 02:05 PM', 'Complained of Left thigh numbness. Ortho called and evaluated', 'HCT drop to 26 after 1 unit so started additional unit']",,26212,159674.0
0,2165-03-08 07:16:47,,"['- Has tendency for systolic blood pressure (SBP) to drift in to low', ""80's when asleep, however after waking, goes immediately up to 100."", 'Patient remained asymptommatic overnight.']",,88106,100746.0
1,2165-03-08 07:17:35,,"['- Has tendency for systolic blood pressure (SBP) to drift in to low', ""80's when asleep, however after waking, goes immediately up to 100."", 'Patient remained asymptommatic overnight.']",,88106,100746.0
2,2165-03-08 07:18:20,,"['- Has tendency for systolic blood pressure (SBP) to drift in to low', ""80's when asleep, however after waking, goes immediately up to 100."", 'Patient remained asymptommatic overnight.']",,88106,100746.0
3,2165-03-08 11:24:20,,"['- Has tendency for systolic blood pressure (SBP) to drift in to low', ""80's when asleep, however after waking, goes immediately up to 100."", 'Patient remained asymptommatic overnight.']",,88106,100746.0
0,2134-09-27 07:36:38,,"['EKG - At [**2134-9-27**] 12:40 AM', ' INVASIVE VENTILATION - START [**2134-9-27**] 05:59 AM', ' ARTERIAL LINE - START [**2134-9-27**] 06:44 AM', '--Stopped Citalopram', ""--Afebrile through the day, continued tachy, BP's have trended down"", 'through day, was even hypoTN so received 2L NS boluses', '--Aggressive fluids for pancreatitis --> continued with D5 1/2NS', '--CT abd/pelvis and head showing severe pancreatitis, fluid and', 'stranding in colon.', '--CT head with ventriculomegaly --> central atrophy (EtOH abuse?) vs', 'communicating hydrocephalus', '--Added on RPR and lipase', '--11a labs with Na 156, K 3.2, BUN/Cr 25/1.2, BS 204, free Ca 1.23 nml', '--6p labs with  Na 154, K 3.2, BUN/Cr 21/1.0, BS 119. Also WBC', '16-->14,  Hct 36 --> 28 --> repeat pending, INR also coming down 4.8', '--> 1.9 --> 1.5', '--B12, folate pending', '--UNa 19, Uosm 636', '--Monday consider post pyloric Dobhoff, ID consult for HAART, TPN,', 'pancreas consult']",,98196,184295.0
1,2134-09-27 07:49:03,,"['EKG - At [**2134-9-27**] 12:40 AM', ' INVASIVE VENTILATION - START [**2134-9-27**] 05:59 AM', ' ARTERIAL LINE - START [**2134-9-27**] 06:44 AM', '--Stopped Citalopram', ""--Afebrile through the day, continued tachy, BP's have trended down"", 'through day, was even hypoTN so received 2L NS boluses', '--Aggressive fluids for pancreatitis --> continued with D5 1/2NS', '--CT abd/pelvis and head showing severe pancreatitis, fluid and', 'stranding in colon.', '--CT head with ventriculomegaly --> central atrophy (EtOH abuse?) vs', 'communicating hydrocephalus', '--Added on RPR and lipase', '--11a labs with Na 156, K 3.2, BUN/Cr 25/1.2, BS 204, free Ca 1.23 nml', '--6p labs with  Na 154, K 3.2, BUN/Cr 21/1.0, BS 119. Also WBC', '16-->14,  Hct 36 --> 28 --> repeat pending, INR also coming down 4.8', '--> 1.9 --> 1.5', '--B12, folate pending', '--UNa 19, Uosm 636', '--Monday consider post pyloric Dobhoff, ID consult for HAART, TPN,', 'pancreas consult']",,98196,184295.0
2,2134-09-27 07:56:31,,"['EKG - At [**2134-9-27**] 12:40 AM', ' INVASIVE VENTILATION - START [**2134-9-27**] 05:59 AM', ' ARTERIAL LINE - START [**2134-9-27**] 06:44 AM', '--Stopped Citalopram', ""--Afebrile through the day, continued tachy, BP's have trended down"", 'through day, was even hypoTN so received 2L NS boluses', '--Aggressive fluids for pancreatitis --> continued with D5 1/2NS', '--CT abd/pelvis and head showing severe pancreatitis, fluid and', 'stranding in colon.', '--CT head with ventriculomegaly --> central atrophy (EtOH abuse?) vs', 'communicating hydrocephalus', '--Added on RPR and lipase', '--11a labs with Na 156, K 3.2, BUN/Cr 25/1.2, BS 204, free Ca 1.23 nml', '--6p labs with  Na 154, K 3.2, BUN/Cr 21/1.0, BS 119. Also WBC', '16-->14,  Hct 36 --> 28 --> repeat pending, INR also coming down 4.8', '--> 1.9 --> 1.5', '--B12, folate pending', '--UNa 19, Uosm 636', '--Monday consider post pyloric Dobhoff, ID consult for HAART, TPN,', 'pancreas consult']",,98196,184295.0
3,2134-09-27 14:05:40,,"['EKG - At [**2134-9-27**] 12:40 AM', ' INVASIVE VENTILATION - START [**2134-9-27**] 05:59 AM', ' ARTERIAL LINE - START [**2134-9-27**] 06:44 AM', '--Stopped Citalopram', ""--Afebrile through the day, continued tachy, BP's have trended down"", 'through day, was even hypoTN so received 2L NS boluses', '--Aggressive fluids for pancreatitis --> continued with D5 1/2NS', '--CT abd/pelvis and head showing severe pancreatitis, fluid and', 'stranding in colon.', '--CT head with ventriculomegaly --> central atrophy (EtOH abuse?) vs', 'communicating hydrocephalus', '--Added on RPR and lipase', '--11a labs with Na 156, K 3.2, BUN/Cr 25/1.2, BS 204, free Ca 1.23 nml', '--6p labs with  Na 154, K 3.2, BUN/Cr 21/1.0, BS 119. Also WBC', '16-->14,  Hct 36 --> 28 --> repeat pending, INR also coming down 4.8', '--> 1.9 --> 1.5', '--B12, folate pending', '--UNa 19, Uosm 636', '--Monday consider post pyloric Dobhoff, ID consult for HAART, TPN,', 'pancreas consult']",,98196,184295.0
4,2134-09-28 06:35:05,"['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']","['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']","['EKG - At [**2134-9-27**] 12:40 AM', ' INVASIVE VENTILATION - START [**2134-9-27**] 05:59 AM', ' ARTERIAL LINE - START [**2134-9-27**] 06:44 AM', '--Stopped Citalopram', ""--Afebrile through the day, continued tachy, BP's have trended down"", 'through day, was even hypoTN so received 2L NS boluses', '--Aggressive fluids for pancreatitis --> continued with D5 1/2NS', '--CT abd/pelvis and head showing severe pancreatitis, fluid and', 'stranding in colon.', '--CT head with ventriculomegaly --> central atrophy (EtOH abuse?) vs', 'communicating hydrocephalus', '--Added on RPR and lipase', '--11a labs with Na 156, K 3.2, BUN/Cr 25/1.2, BS 204, free Ca 1.23 nml', '--6p labs with  Na 154, K 3.2, BUN/Cr 21/1.0, BS 119. Also WBC', '16-->14,  Hct 36 --> 28 --> repeat pending, INR also coming down 4.8', '--> 1.9 --> 1.5', '--B12, folate pending', '--UNa 19, Uosm 636', '--Monday consider post pyloric Dobhoff, ID consult for HAART, TPN,', 'pancreas consult']",98196,184295.0
5,2134-09-28 06:37:08,,"['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']",,98196,184295.0
6,2134-09-28 07:08:14,,"['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']",,98196,184295.0
7,2134-09-28 15:28:38,,"['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']",,98196,184295.0
8,2134-09-29 07:05:23,"['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed', 'Delirium / confusion']","['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed', 'Delirium / confusion']","['LUMBAR PUNCTURE - At [**2134-9-27**] 02:03 PM', ' PAN CULTURE - At [**2134-9-27**] 08:41 PM', 'BC x 2-- peripheral and aline', 'sputum', 'urine', '- Per PCP/ID Doc: Referred by previous PCP to [**Name9 (PRE) 11185**] (PCP/ID) in', '[**9-/2123**]: CD4 Count 432 Viral load 79k (Hep A & B Immune), started on', 'Combivir, Sustiva (still on that). Undetectable Viral load since he has', 'been on therapy. Most recent CD4: 1845 ([**2134-9-16**])', 'Atenolol, Lipitor 40, Combivir/Sustiva']",98196,184295.0
9,2134-09-29 07:17:45,"['- pt switched to levophed, currently on  0.05mcg/kg/min']","['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed, currently on  0.05mcg/kg/min']","['- pt switched to levophed', 'Delirium / confusion']",98196,184295.0
10,2134-09-29 07:23:50,,"['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed, currently on  0.05mcg/kg/min']",,98196,184295.0
11,2134-09-30 02:16:22,,"['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed, currently on  0.05mcg/kg/min']",,98196,184295.0
12,2134-09-30 07:34:27,"['--Talked to ID who said contact his ID PCP and ask him to manage HIV', 'meds. Keenholtz cell phone [**Telephone/Fax (1) 11240**]. Said OK to hold off on HAART', 'while critically ill, do whatever we think is appropriate.', '--Got Dobhoff.', '--Repeat pm Hct 24.8 stable from earlier in the morning', '--Family meeting planned for 4pm tomorrow with daughter [**Name (NI) 7402**] and son', '[**Name (NI) 107**] will conf call in.']","['--Talked to ID who said contact his ID PCP and ask him to manage HIV', 'meds. Keenholtz cell phone [**Telephone/Fax (1) 11240**]. Said OK to hold off on HAART', 'while critically ill, do whatever we think is appropriate.', '--Got Dobhoff.', '--Repeat pm Hct 24.8 stable from earlier in the morning', '--Family meeting planned for 4pm tomorrow with daughter [**Name (NI) 7402**] and son', '[**Name (NI) 107**] will conf call in.']","['MULTI LUMEN - START [**2134-9-28**] 04:35 PM', ' PICC LINE - STOP [**2134-9-28**] 07:13 PM', '- IJ placed', '- PICC pulled tip sent', '- Dobhoff placed -> in stomach, to IR tomorrow for post-pyloric', '- Responded to fluid bolus of D5 Bicarb and monitor UOP', '- Na down to 140 after 5L D5W, Cl still high to 112', '- Set up family meeting for goals of care', '- H/o ? mesenteric pseudoaneurysm, now hct dropping --> guiacs negative', '- needs mag, phos', '- pt switched to levophed, currently on  0.05mcg/kg/min']",98196,184295.0
13,2134-09-30 10:40:41,,"['--Talked to ID who said contact his ID PCP and ask him to manage HIV', 'meds. Keenholtz cell phone [**Telephone/Fax (1) 11240**]. Said OK to hold off on HAART', 'while critically ill, do whatever we think is appropriate.', '--Got Dobhoff.', '--Repeat pm Hct 24.8 stable from earlier in the morning', '--Family meeting planned for 4pm tomorrow with daughter [**Name (NI) 7402**] and son', '[**Name (NI) 107**] will conf call in.']",,98196,184295.0
14,2134-10-01 07:19:44,"['- Dr. [**Last Name (STitle) 2269**] re advancing TF: advance as tolerated per nutrition recs.', 'Goal is 60ml/hour.', '- PM Hct stable at 25.0', '- Family meeting with daughter and son (in [**Name (NI) 9091**]): Pt would not want', 'prolonged ventilation or prolonged rehab, but unsure given that this is', 'potentially reversible, they will call back today with a decision for a', 'plan']","['- Dr. [**Last Name (STitle) 2269**] re advancing TF: advance as tolerated per nutrition recs.', 'Goal is 60ml/hour.', '- PM Hct stable at 25.0', '- Family meeting with daughter and son (in [**Name (NI) 9091**]): Pt would not want', 'prolonged ventilation or prolonged rehab, but unsure given that this is', 'potentially reversible, they will call back today with a decision for a', 'plan']","['--Talked to ID who said contact his ID PCP and ask him to manage HIV', 'meds. Keenholtz cell phone [**Telephone/Fax (1) 11240**]. Said OK to hold off on HAART', 'while critically ill, do whatever we think is appropriate.', '--Got Dobhoff.', '--Repeat pm Hct 24.8 stable from earlier in the morning', '--Family meeting planned for 4pm tomorrow with daughter [**Name (NI) 7402**] and son', '[**Name (NI) 107**] will conf call in.']",98196,184295.0
15,2134-10-01 14:38:54,,"['- Dr. [**Last Name (STitle) 2269**] re advancing TF: advance as tolerated per nutrition recs.', 'Goal is 60ml/hour.', '- PM Hct stable at 25.0', '- Family meeting with daughter and son (in [**Name (NI) 9091**]): Pt would not want', 'prolonged ventilation or prolonged rehab, but unsure given that this is', 'potentially reversible, they will call back today with a decision for a', 'plan']",,98196,184295.0
16,2134-10-02 08:17:04,"['[**10-1**]', '- Son is planning on arriving in town on Sunday, agreed not to escalate', 'care, will make CMO when he arrives', '- No more blood draws, no additional pressor support', '- Continue comfort measures']","['[**10-1**]', '- Son is planning on arriving in town on Sunday, agreed not to escalate', 'care, will make CMO when he arrives', '- No more blood draws, no additional pressor support', '- Continue comfort measures']","['- Dr. [**Last Name (STitle) 2269**] re advancing TF: advance as tolerated per nutrition recs.', 'Goal is 60ml/hour.', '- PM Hct stable at 25.0', '- Family meeting with daughter and son (in [**Name (NI) 9091**]): Pt would not want', 'prolonged ventilation or prolonged rehab, but unsure given that this is', 'potentially reversible, they will call back today with a decision for a', 'plan']",98196,184295.0
17,2134-10-02 08:21:39,,"['[**10-1**]', '- Son is planning on arriving in town on Sunday, agreed not to escalate', 'care, will make CMO when he arrives', '- No more blood draws, no additional pressor support', '- Continue comfort measures']",,98196,184295.0
18,2134-10-02 18:53:02,"['- Son is planning on arriving in town on [**Month/Day (4) 1117**], agreed not to escalate']","['[**10-1**]', '- Son is planning on arriving in town on [**Month/Day (4) 1117**], agreed not to escalate', 'care, will make CMO when he arrives', '- No more blood draws, no additional pressor support', '- Continue comfort measures']","['- Son is planning on arriving in town on Sunday, agreed not to escalate']",98196,184295.0
19,2134-10-03 07:07:58,"['FEVER - 102.2', 'F - [**2134-10-3**] 04:00 AM', '- Stopped MV, thiamine, folate, unnecessary meds', '- Continues on pressors and fentanyl/versed', '- Stopped [**Name (NI) 11328**]', '- Son to arrive tomorrow']","['FEVER - 102.2', 'F - [**2134-10-3**] 04:00 AM', '- Stopped MV, thiamine, folate, unnecessary meds', '- Continues on pressors and fentanyl/versed', '- Stopped [**Name (NI) 11328**]', '- Son to arrive tomorrow']","['[**10-1**]', '- Son is planning on arriving in town on [**Month/Day (4) 1117**], agreed not to escalate', 'care, will make CMO when he arrives', '- No more blood draws, no additional pressor support', '- Continue comfort measures']",98196,184295.0
20,2134-10-03 16:56:23,['- Son arrived today.'],"['FEVER - 102.2', 'F - [**2134-10-3**] 04:00 AM', '- Stopped MV, thiamine, folate, unnecessary meds', '- Continues on pressors and fentanyl/versed', '- Stopped [**Name (NI) 11328**]', '- Son arrived today.']",['- Son to arrive tomorrow'],98196,184295.0
0,2195-12-19 07:18:59,,"['MULTI LUMEN - START [**2195-12-18**] 05:25 PM', ' ARTERIAL LINE - START [**2195-12-18**] 05:25 PM', '-Pt did well overnight with reasonable pain control with PCA and', 'morphine boluses prior to movement.  Used PCA 19 times after 24', 'attempts for a total of 28.5mg Morphine delivered', 'History obtained from Patient']",,14738,106243.0
1,2195-12-19 11:03:05,,"['MULTI LUMEN - START [**2195-12-18**] 05:25 PM', ' ARTERIAL LINE - START [**2195-12-18**] 05:25 PM', '-Pt did well overnight with reasonable pain control with PCA and', 'morphine boluses prior to movement.  Used PCA 19 times after 24', 'attempts for a total of 28.5mg Morphine delivered', 'History obtained from Patient']",,14738,106243.0
0,2107-09-20 06:19:01,,"['TRANSTHORACIC ECHO - At [**2107-9-19**] 02:40 PM', 'MR [**First Name (Titles) **] [**Last Name (Titles) 4746**] of the mitral valve', ' ULTRASOUND - At [**2107-9-19**] 03:00 PM', 'abd US', 'TIPS patency is documented. There is no evidence of stenosis,', 'thrombosis or occlusion. A small amount of ascites is present', 'UTI with Staph aureus', 'BCx with Staph aureus', 'Switched to vancomycin only for Abx coverage pending final cultures', 'Yesterday claimed R sided weakness, esp of R arm. CT of the head was', 'unremarkable']",,19398,167309.0
1,2107-09-20 07:53:37,,"['TRANSTHORACIC ECHO - At [**2107-9-19**] 02:40 PM', 'MR [**First Name (Titles) **] [**Last Name (Titles) 4746**] of the mitral valve', ' ULTRASOUND - At [**2107-9-19**] 03:00 PM', 'abd US', 'TIPS patency is documented. There is no evidence of stenosis,', 'thrombosis or occlusion. A small amount of ascites is present', 'UTI with Staph aureus', 'BCx with Staph aureus', 'Switched to vancomycin only for Abx coverage pending final cultures', 'Yesterday claimed R sided weakness, esp of R arm. CT of the head was', 'unremarkable']",,19398,167309.0
2,2107-09-20 08:01:57,,"['TRANSTHORACIC ECHO - At [**2107-9-19**] 02:40 PM', 'MR [**First Name (Titles) **] [**Last Name (Titles) 4746**] of the mitral valve', ' ULTRASOUND - At [**2107-9-19**] 03:00 PM', 'abd US', 'TIPS patency is documented. There is no evidence of stenosis,', 'thrombosis or occlusion. A small amount of ascites is present', 'UTI with Staph aureus', 'BCx with Staph aureus', 'Switched to vancomycin only for Abx coverage pending final cultures', 'Yesterday claimed R sided weakness, esp of R arm. CT of the head was', 'unremarkable']",,19398,167309.0
3,2107-09-20 12:10:49,,"['TRANSTHORACIC ECHO - At [**2107-9-19**] 02:40 PM', 'MR [**First Name (Titles) **] [**Last Name (Titles) 4746**] of the mitral valve', ' ULTRASOUND - At [**2107-9-19**] 03:00 PM', 'abd US', 'TIPS patency is documented. There is no evidence of stenosis,', 'thrombosis or occlusion. A small amount of ascites is present', 'UTI with Staph aureus', 'BCx with Staph aureus', 'Switched to vancomycin only for Abx coverage pending final cultures', 'Yesterday claimed R sided weakness, esp of R arm. CT of the head was', 'unremarkable']",,19398,167309.0
4,2107-09-20 12:29:10,,"['TRANSTHORACIC ECHO - At [**2107-9-19**] 02:40 PM', 'MR [**First Name (Titles) **] [**Last Name (Titles) 4746**] of the mitral valve', ' ULTRASOUND - At [**2107-9-19**] 03:00 PM', 'abd US', 'TIPS patency is documented. There is no evidence of stenosis,', 'thrombosis or occlusion. A small amount of ascites is present', 'UTI with Staph aureus', 'BCx with Staph aureus', 'Switched to vancomycin only for Abx coverage pending final cultures', 'Yesterday claimed R sided weakness, esp of R arm. CT of the head was', 'unremarkable']",,19398,167309.0
0,2186-05-11 10:56:38,,['No overnight events'],,63499,185887.0
1,2186-05-11 11:15:51,,['No overnight events'],,63499,185887.0
2,2186-05-12 06:56:10,"['TRANSTHORACIC ECHO - At [**2186-5-11**] 03:00 PM', '- Impression: severe diastolic left ventricular failure and secondary', 'right ventricular failure. Compared with the findings of the prior', 'study (images reviewed) of [**2185-10-12**], severe tricuspid', 'regurgitation and pulmonary hypertension are now evident.', '- Patient too somnolent for S&S evaluation on first attempt', '- Hypoglyecemic to 59 in afternoon; received [**1-28**] amp dextrose', '- > 1 L negative today already so no PM Lasix']","['TRANSTHORACIC ECHO - At [**2186-5-11**] 03:00 PM', '- Impression: severe diastolic left ventricular failure and secondary', 'right ventricular failure. Compared with the findings of the prior', 'study (images reviewed) of [**2185-10-12**], severe tricuspid', 'regurgitation and pulmonary hypertension are now evident.', '- Patient too somnolent for S&S evaluation on first attempt', '- Hypoglyecemic to 59 in afternoon; received [**1-28**] amp dextrose', '- > 1 L negative today already so no PM Lasix']",['No overnight events'],63499,185887.0
3,2186-05-12 13:29:20,,"['TRANSTHORACIC ECHO - At [**2186-5-11**] 03:00 PM', '- Impression: severe diastolic left ventricular failure and secondary', 'right ventricular failure. Compared with the findings of the prior', 'study (images reviewed) of [**2185-10-12**], severe tricuspid', 'regurgitation and pulmonary hypertension are now evident.', '- Patient too somnolent for S&S evaluation on first attempt', '- Hypoglyecemic to 59 in afternoon; received [**1-28**] amp dextrose', '- > 1 L negative today already so no PM Lasix']",,63499,185887.0
0,2148-01-22 06:49:07,,"['[**1-21**] Events:', '- HCTs stable', '- extubated', '- MS back to baseline per family', '- colonoscopy either Monday PM or Tuesday']",,23390,177693.0
1,2148-01-22 06:49:48,,"['[**1-21**] Events:', '- HCTs stable', '- extubated', '- MS back to baseline per family', '- colonoscopy either Monday PM or Tuesday']",,23390,177693.0
2,2148-01-22 06:50:35,,"['[**1-21**] Events:', '- HCTs stable', '- extubated', '- MS back to baseline per family', '- colonoscopy either Monday PM or Tuesday']",,23390,177693.0
3,2148-01-22 14:25:55,,"['[**1-21**] Events:', '- HCTs stable', '- extubated', '- MS back to baseline per family', '- colonoscopy either Monday PM or Tuesday']",,23390,177693.0
4,2148-01-22 14:42:10,,"['[**1-21**] Events:', '- HCTs stable', '- extubated', '- MS back to baseline per family', '- colonoscopy either Monday PM or Tuesday']",,23390,177693.0
0,2201-01-28 06:32:14,,['Made CMO'],,98299,112205.0
1,2201-01-28 06:33:34,,['Made CMO'],,98299,112205.0
0,2137-12-09 05:30:15,,"['PRESEP CATHETER - START [**2137-12-8**] 09:49 PM', ' EKG - At [**2137-12-9**] 12:09 AM', ' EKG - At [**2137-12-9**] 04:27 AM']",,23161,148180.0
1,2137-12-09 11:03:27,"['Pt c/o CP [**11-15**] last night.  Received SL nitro X 2 without relief.', 'Discussed via interpreter, pt stated that this is similar to prior', 'episodes of heartburn.  ECG done and some flattened T waves laterally,', 'unchanged from admission ECG but changed from prior.  Pt got Maalox', 'without relief.', ' PRESEP CATHETER - START [**2137-12-8**] 09:49 PM']","['Pt c/o CP [**11-15**] last night.  Received SL nitro X 2 without relief.', 'Discussed via interpreter, pt stated that this is similar to prior', 'episodes of heartburn.  ECG done and some flattened T waves laterally,', 'unchanged from admission ECG but changed from prior.  Pt got Maalox', 'without relief.', ' PRESEP CATHETER - START [**2137-12-8**] 09:49 PM', ' EKG - At [**2137-12-9**] 12:09 AM', ' EKG - At [**2137-12-9**] 04:27 AM']",['PRESEP CATHETER - START [**2137-12-8**] 09:49 PM'],23161,148180.0
0,2159-07-07 08:31:23,,"['-Patient on Narcan drip', '-No acute events overnight', '-Patient now arousable, hungry, diet advanced to regular.']",,28233,145308.0
1,2159-07-07 10:33:26,,"['-Patient on Narcan drip', '-No acute events overnight', '-Patient now arousable, hungry, diet advanced to regular.']",,28233,145308.0
0,2143-01-25 08:03:37,,['- Arrived with non-compensated hypoxemia/hypercarbia'],,23028,117744.0
1,2143-01-25 09:05:39,['- Fentanyl patch restarted last night'],"['- Arrived with non-compensated hypoxemia/hypercarbia', '- Fentanyl patch restarted last night']",,23028,117744.0
2,2143-01-25 09:45:05,,"['- Arrived with non-compensated hypoxemia/hypercarbia', '- Fentanyl patch restarted last night']",,23028,117744.0
3,2143-01-25 09:49:45,,"['- Arrived with non-compensated hypoxemia/hypercarbia', '- Fentanyl patch restarted last night']",,23028,117744.0
0,2171-07-06 07:24:34,,"['NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'legs']",,27379,138237.0
1,2171-07-06 07:25:43,,"['NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'legs']",,27379,138237.0
2,2171-07-06 19:20:46,"['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP.', 'Required CPAP overnight. Switched to Face mask in the a.m.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM']","['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP.', 'Required CPAP overnight. Switched to Face mask in the a.m.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'legs']",['NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM'],27379,138237.0
3,2171-07-06 19:28:02,"['Required CPAP overnight for frequent desats. Switched to Face mask in', 'the a.m. Pt c/o discomfort from CPAP mask.', 'Legs', '- Negative for DVT']","['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP.', 'Required CPAP overnight for frequent desats. Switched to Face mask in', 'the a.m. Pt c/o discomfort from CPAP mask.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'Legs', '- Negative for DVT']","['Required CPAP overnight. Switched to Face mask in the a.m.', 'legs']",27379,138237.0
4,2171-07-06 19:46:52,"['response in UOP. Over 2L out over 24 hours. Subjectively, pt feels', 'better this a.m. Breathing more easily.']","['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP. Over 2L out over 24 hours. Subjectively, pt feels', 'better this a.m. Breathing more easily.', 'Required CPAP overnight for frequent desats. Switched to Face mask in', 'the a.m. Pt c/o discomfort from CPAP mask.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'Legs', '- Negative for DVT']",['response in UOP.'],27379,138237.0
5,2171-07-06 20:42:44,,"['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP. Over 2L out over 24 hours. Subjectively, pt feels', 'better this a.m. Breathing more easily.', 'Required CPAP overnight for frequent desats. Switched to Face mask in', 'the a.m. Pt c/o discomfort from CPAP mask.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'Legs', '- Negative for DVT']",,27379,138237.0
6,2171-07-07 07:22:25,"['Pt has remained nsr with hr in the 70', 's with no ectopy. Lungs still', 'have rales', ' way up bil. Sao2 has remained 89-95%. Pt has no resp', 'distress with sao2 88-89%.', 'Pt was changed to n/c 5-6L and tol well for a while then was changed', 'to face tent.  Pt was also started on levoflox yesterday for dx of pna.', 'Has had no c/o sob or dyspnea. Pt was quite talkative in the evening', 'and tol fluids well.', 'Cont with antibiotics and monitor sao2. provide o2 as pt requires and', 'wean as able.', ' BLOOD CULTURED - At [**2171-7-6**] 01:04 PM', ' URINE CULTURE - At [**2171-7-6**] 01:05 PM']","['Pt has remained nsr with hr in the 70', 's with no ectopy. Lungs still', 'have rales', ' way up bil. Sao2 has remained 89-95%. Pt has no resp', 'distress with sao2 88-89%.', 'Pt was changed to n/c 5-6L and tol well for a while then was changed', 'to face tent.  Pt was also started on levoflox yesterday for dx of pna.', 'Has had no c/o sob or dyspnea. Pt was quite talkative in the evening', 'and tol fluids well.', 'Cont with antibiotics and monitor sao2. provide o2 as pt requires and', 'wean as able.', ' BLOOD CULTURED - At [**2171-7-6**] 01:04 PM', ' URINE CULTURE - At [**2171-7-6**] 01:05 PM']","['Pt placed was given Lasix IV PRN yesterday afternoon. Overnight, had', 'drop in UOP to 30cc/hr, given Lasix 80mg IV x 1 at 5am with good', 'response in UOP. Over 2L out over 24 hours. Subjectively, pt feels', 'better this a.m. Breathing more easily.', 'Required CPAP overnight for frequent desats. Switched to Face mask in', 'the a.m. Pt c/o discomfort from CPAP mask.', ' NON-INVASIVE VENTILATION - START [**2171-7-5**] 11:20 AM', ' ULTRASOUND - At [**2171-7-5**] 08:00 PM', 'Legs', '- Negative for DVT']",27379,138237.0
7,2171-07-07 07:23:31,,"['Pt has remained nsr with hr in the 70', 's with no ectopy. Lungs still', 'have rales', ' way up bil. Sao2 has remained 89-95%. Pt has no resp', 'distress with sao2 88-89%.', 'Pt was changed to n/c 5-6L and tol well for a while then was changed', 'to face tent.  Pt was also started on levoflox yesterday for dx of pna.', 'Has had no c/o sob or dyspnea. Pt was quite talkative in the evening', 'and tol fluids well.', 'Cont with antibiotics and monitor sao2. provide o2 as pt requires and', 'wean as able.', ' BLOOD CULTURED - At [**2171-7-6**] 01:04 PM', ' URINE CULTURE - At [**2171-7-6**] 01:05 PM']",,27379,138237.0
8,2171-07-07 18:33:23,"['No acute events overnight. Pt', 's saturation remained in mid-90s with 6L', 'NC and shovel mask.', 'Pt was started on vanc and levofloxacin yesterday for Pna.']","['No acute events overnight. Pt', 's saturation remained in mid-90s with 6L', 'NC and shovel mask.', 'Pt was started on vanc and levofloxacin yesterday for Pna.', ' BLOOD CULTURED - At [**2171-7-6**] 01:04 PM', ' URINE CULTURE - At [**2171-7-6**] 01:05 PM']","['Pt has remained nsr with hr in the 70', 's with no ectopy. Lungs still', 'have rales', ' way up bil. Sao2 has remained 89-95%. Pt has no resp', 'distress with sao2 88-89%.', 'Pt was changed to n/c 5-6L and tol well for a while then was changed', 'to face tent.  Pt was also started on levoflox yesterday for dx of pna.', 'Has had no c/o sob or dyspnea. Pt was quite talkative in the evening', 'and tol fluids well.', 'Cont with antibiotics and monitor sao2. provide o2 as pt requires and', 'wean as able.']",27379,138237.0
9,2171-07-08 13:29:25,"['Patient remained stable on 02 via nasal cannula.  She was diuresed and', 'has been tolerating PO.']","['Patient remained stable on 02 via nasal cannula.  She was diuresed and', 'has been tolerating PO.']","['No acute events overnight. Pt', 's saturation remained in mid-90s with 6L', 'NC and shovel mask.', 'Pt was started on vanc and levofloxacin yesterday for Pna.', ' BLOOD CULTURED - At [**2171-7-6**] 01:04 PM', ' URINE CULTURE - At [**2171-7-6**] 01:05 PM']",27379,138237.0
10,2171-07-09 07:13:32,"['O/N patient desat to 79% on NC, was started on FT 02, given neb', 'treatment and 02 sats back up to 92-95%.  Also given 80 IV lasix for', 'low uop.  Yesterday had renal u/s and Echo. Echo showed diastolic', 'dysfunction with EF >75%.']","['O/N patient desat to 79% on NC, was started on FT 02, given neb', 'treatment and 02 sats back up to 92-95%.  Also given 80 IV lasix for', 'low uop.  Yesterday had renal u/s and Echo. Echo showed diastolic', 'dysfunction with EF >75%.']","['Patient remained stable on 02 via nasal cannula.  She was diuresed and', 'has been tolerating PO.']",27379,138237.0
11,2171-07-09 07:22:59,,"['O/N patient desat to 79% on NC, was started on FT 02, given neb', 'treatment and 02 sats back up to 92-95%.  Also given 80 IV lasix for', 'low uop.  Yesterday had renal u/s and Echo. Echo showed diastolic', 'dysfunction with EF >75%.']",,27379,138237.0
12,2171-07-09 14:24:10,,"['O/N patient desat to 79% on NC, was started on FT 02, given neb', 'treatment and 02 sats back up to 92-95%.  Also given 80 IV lasix for', 'low uop.  Yesterday had renal u/s and Echo. Echo showed diastolic', 'dysfunction with EF >75%.']",,27379,138237.0
13,2171-07-10 06:26:44,"['Patient without desats last PM, continues to do well, diuresed ~1L w/', '80 IV lasix x2.  Repeat renal U/S without interval change.']","['Patient without desats last PM, continues to do well, diuresed ~1L w/', '80 IV lasix x2.  Repeat renal U/S without interval change.']","['O/N patient desat to 79% on NC, was started on FT 02, given neb', 'treatment and 02 sats back up to 92-95%.  Also given 80 IV lasix for', 'low uop.  Yesterday had renal u/s and Echo. Echo showed diastolic', 'dysfunction with EF >75%.']",27379,138237.0
14,2171-07-10 07:11:35,,"['Patient without desats last PM, continues to do well, diuresed ~1L w/', '80 IV lasix x2.  Repeat renal U/S without interval change.']",,27379,138237.0
15,2171-07-10 13:54:53,"['Patient with single desat to 89 at 0300, otherwise satting >93 % on 6L', 'NC.  Diuresed well ~1L with 80 IV lasix x2']","['Patient with single desat to 89 at 0300, otherwise satting >93 % on 6L', 'NC.  Diuresed well ~1L with 80 IV lasix x2']","['Patient without desats last PM, continues to do well, diuresed ~1L w/', '80 IV lasix x2.  Repeat renal U/S without interval change.']",27379,138237.0
16,2171-07-10 13:59:25,,"['Patient with single desat to 89 at 0300, otherwise satting >93 % on 6L', 'NC.  Diuresed well ~1L with 80 IV lasix x2']",,27379,138237.0
17,2171-07-10 14:03:47,,"['Patient with single desat to 89 at 0300, otherwise satting >93 % on 6L', 'NC.  Diuresed well ~1L with 80 IV lasix x2']",,27379,138237.0
18,2171-07-10 14:51:44,,"['Patient with single desat to 89 at 0300, otherwise satting >93 % on 6L', 'NC.  Diuresed well ~1L with 80 IV lasix x2']",,27379,138237.0
0,2173-03-15 07:07:46,,"['URINE CULTURE - At [**2173-3-14**] 10:59 PM', 'Sent from PERC DRAIN', ' BLOOD CULTURED - At [**2173-3-15**] 12:30 AM', 'BC x 2', ' URINE CULTURE - At [**2173-3-15**] 05:49 AM', 'Foley Catheter', ' FEVER - 102.8', 'F - [**2173-3-15**] 12:00 AM']",,27379,190569.0
1,2173-03-15 07:10:15,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']","['URINE CULTURE - At [**2173-3-14**] 10:59 PM', 'Sent from PERC DRAIN', ' BLOOD CULTURED - At [**2173-3-15**] 12:30 AM', 'BC x 2', ' URINE CULTURE - At [**2173-3-15**] 05:49 AM', 'Foley Catheter', ' FEVER - 102.8', 'F - [**2173-3-15**] 12:00 AM', '- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
2,2173-03-15 07:27:34,,"['URINE CULTURE - At [**2173-3-14**] 10:59 PM', 'Sent from PERC DRAIN', ' BLOOD CULTURED - At [**2173-3-15**] 12:30 AM', 'BC x 2', ' URINE CULTURE - At [**2173-3-15**] 05:49 AM', 'Foley Catheter', ' FEVER - 102.8', 'F - [**2173-3-15**] 12:00 AM', '- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
3,2173-03-15 08:47:16,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']","['URINE CULTURE - At [**2173-3-14**] 10:59 PM', 'Sent from PERC DRAIN', ' BLOOD CULTURED - At [**2173-3-15**] 12:30 AM', 'BC x 2', ' URINE CULTURE - At [**2173-3-15**] 05:49 AM', 'Foley Catheter', ' FEVER - 102.8', 'F - [**2173-3-15**] 12:00 AM']",27379,190569.0
4,2173-03-15 08:49:31,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
5,2173-03-15 08:50:57,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
6,2173-03-15 08:52:52,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
7,2173-03-15 08:54:26,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
8,2173-03-15 09:18:45,,"['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",,27379,190569.0
9,2173-03-16 07:40:00,"['- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']","['- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']","['- Overnight with fever spike to 102, cultured, and decreasing fever', 'curve', '- BP slowly normalized with 3 doses of 10mg IV labetalol', '- Weaned down to 2L NC', '- Rectal exam with soft stool in vault']",27379,190569.0
10,2173-03-16 07:42:17,,"['- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']",,27379,190569.0
11,2173-03-16 08:01:26,['- unable to take fluid off during HD yesterday'],"['- unable to take fluid off during HD yesterday', '- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']",,27379,190569.0
12,2173-03-16 11:46:07,,"['- unable to take fluid off during HD yesterday', '- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']",,27379,190569.0
13,2173-03-17 07:14:28,"['- needed to go to IR for PICC placement, bedside unsuccessful', '- urine with E coli, now on TMPSMX']","['- needed to go to IR for PICC placement, bedside unsuccessful', '- urine with E coli, now on TMPSMX']","['- unable to take fluid off during HD yesterday', '- kept in unit as BPs running lower yesterday, improved this AM SBP', '140s', '- nephrostomy tube flushed', '- abx broadened to vanc/meropenem', '- urine growing back E. coli, sensitivies pending']",27379,190569.0
14,2173-03-17 07:18:36,,"['- needed to go to IR for PICC placement, bedside unsuccessful', '- urine with E coli, now on TMPSMX']",,27379,190569.0
15,2173-03-17 07:19:41,"['- needed to go to IR for PICC placement, bedside -> brachiocephalic']","['- needed to go to IR for PICC placement, bedside -> brachiocephalic', '- urine with E coli, now on TMPSMX']","['- needed to go to IR for PICC placement, bedside unsuccessful']",27379,190569.0
16,2173-03-17 08:09:37,,"['- needed to go to IR for PICC placement, bedside -> brachiocephalic', '- urine with E coli, now on TMPSMX']",,27379,190569.0
17,2173-03-17 09:00:54,,"['- needed to go to IR for PICC placement, bedside -> brachiocephalic', '- urine with E coli, now on TMPSMX']",,27379,190569.0
18,2173-03-17 09:13:35,,"['- needed to go to IR for PICC placement, bedside -> brachiocephalic', '- urine with E coli, now on TMPSMX']",,27379,190569.0
0,2102-09-15 06:35:25,,"['C/O increasing pain in lower abdomen. Increased PCA settings. Remained', 'in sinus rhythm with rate in 70s to 80s.']",,95988,155366.0
1,2102-09-15 06:40:10,,"['C/O increasing pain in lower abdomen. Increased PCA settings. Remained', 'in sinus rhythm with rate in 70s to 80s.']",,95988,155366.0
2,2102-09-15 11:02:36,,"['C/O increasing pain in lower abdomen. Increased PCA settings. Remained', 'in sinus rhythm with rate in 70s to 80s.']",,95988,155366.0
3,2102-09-17 07:33:25,"['EKG - At [**2102-9-17**] 01:37 AM', '- got 500cc bolus NS, Dilt IV bolus 10mg', '- Dilt drip started and titrated up to 5mg/hr, HR stable in 70s-80s']","['EKG - At [**2102-9-17**] 01:37 AM', '- got 500cc bolus NS, Dilt IV bolus 10mg', '- Dilt drip started and titrated up to 5mg/hr, HR stable in 70s-80s']","['C/O increasing pain in lower abdomen. Increased PCA settings. Remained', 'in sinus rhythm with rate in 70s to 80s.']",95988,155366.0
4,2102-09-17 07:46:36,,"['EKG - At [**2102-9-17**] 01:37 AM', '- got 500cc bolus NS, Dilt IV bolus 10mg', '- Dilt drip started and titrated up to 5mg/hr, HR stable in 70s-80s']",,95988,155366.0
5,2102-09-17 10:53:27,"['- abdominal pain post-op, improved w po meds', '- erythema on abdomen improving']","['EKG - At [**2102-9-17**] 01:37 AM', '- got 500cc bolus NS, Dilt IV bolus 10mg', '- Dilt drip started and titrated up to 5mg/hr, HR stable in 70s-80s', '- abdominal pain post-op, improved w po meds', '- erythema on abdomen improving']",,95988,155366.0
6,2102-09-17 15:27:13,,"['EKG - At [**2102-9-17**] 01:37 AM', '- got 500cc bolus NS, Dilt IV bolus 10mg', '- Dilt drip started and titrated up to 5mg/hr, HR stable in 70s-80s', '- abdominal pain post-op, improved w po meds', '- erythema on abdomen improving']",,95988,155366.0
0,2181-08-21 07:33:42,,['EKG - At [**2181-8-20**] 09:56 PM'],,5060,194191.0
0,2181-10-24 06:23:17,,['Received total of Valium 80 mg po since transfer to MICU'],,5060,153063.0
1,2181-10-24 06:24:34,,['Received total of Valium 80 mg po since transfer to MICU'],,5060,153063.0
2,2181-10-24 07:47:37,,['Received total of Valium 80 mg po since transfer to MICU'],,5060,153063.0
3,2181-10-24 10:39:48,,['Received total of Valium 80 mg po since transfer to MICU'],,5060,153063.0
0,2181-11-19 07:44:27,,"['MULTI LUMEN - START [**2181-11-18**] 04:50 PM', 'No acute events overnight']",,5060,184857.0
1,2181-11-19 15:33:26,"['Overnight, received 80mg valium total + banana bag', 'CIWA range 9-27']","['MULTI LUMEN - START [**2181-11-18**] 04:50 PM', 'Overnight, received 80mg valium total + banana bag', 'CIWA range 9-27']",['No acute events overnight'],5060,184857.0
2,2181-11-19 15:45:56,,"['MULTI LUMEN - START [**2181-11-18**] 04:50 PM', 'Overnight, received 80mg valium total + banana bag', 'CIWA range 9-27']",,5060,184857.0
3,2181-11-20 07:27:57,"['MULTI LUMEN - STOP [**2181-11-19**] 01:59 PM', ' PICC LINE - START [**2181-11-19**] 03:00 PM', '- Called psychiatry - will come see patient if necessary', ""- PICC placed; femoral line d/c'ed"", '- Diazepam 10mg PO Q6 hours + Q1-2 hour prn + additional 10mg PO x1']","['MULTI LUMEN - STOP [**2181-11-19**] 01:59 PM', ' PICC LINE - START [**2181-11-19**] 03:00 PM', '- Called psychiatry - will come see patient if necessary', ""- PICC placed; femoral line d/c'ed"", '- Diazepam 10mg PO Q6 hours + Q1-2 hour prn + additional 10mg PO x1']","['MULTI LUMEN - START [**2181-11-18**] 04:50 PM', 'Overnight, received 80mg valium total + banana bag', 'CIWA range 9-27']",5060,184857.0
4,2181-11-20 10:51:57,"['- CIWA range 0-19; given total 60mg diazepam (PO and IV) over past 24', 'hours']","['MULTI LUMEN - STOP [**2181-11-19**] 01:59 PM', ' PICC LINE - START [**2181-11-19**] 03:00 PM', '- Called psychiatry - will come see patient if necessary', ""- PICC placed; femoral line d/c'ed"", '- Diazepam 10mg PO Q6 hours + Q1-2 hour prn + additional 10mg PO x1', '- CIWA range 0-19; given total 60mg diazepam (PO and IV) over past 24', 'hours']",,5060,184857.0
0,2181-12-13 07:01:03,,"['Pt slept most of night.', ' EKG - At [**2181-12-12**] 11:49 PM', ' EKG - At [**2181-12-13**] 12:02 AM']",,5060,135773.0
1,2181-12-13 09:38:30,"['Pt slept most of night.  This AM, complaining of abdominal pain', 'diffusely.  Also complains of headache, nausea, shakiness.', 'Unable to draw labs this AM.']","['Pt slept most of night.  This AM, complaining of abdominal pain', 'diffusely.  Also complains of headache, nausea, shakiness.', 'Unable to draw labs this AM.', ' EKG - At [**2181-12-12**] 11:49 PM', ' EKG - At [**2181-12-13**] 12:02 AM']",['Pt slept most of night.'],5060,135773.0
2,2181-12-13 10:26:25,,"['Pt slept most of night.  This AM, complaining of abdominal pain', 'diffusely.  Also complains of headache, nausea, shakiness.', 'Unable to draw labs this AM.', ' EKG - At [**2181-12-12**] 11:49 PM', ' EKG - At [**2181-12-13**] 12:02 AM']",,5060,135773.0
3,2181-12-14 05:29:15,"['- CIWA scale', '- Follow up CT of abd:', '- [**First Name8 (NamePattern2) 2445**] [**Last Name (NamePattern1) 2446**]: social work for substance abuse', '- Attempted to call out, but had breath holding spells and associated', 'tachycardia.', ' EKG - At [**2181-12-13**] 06:00 PM']","['- CIWA scale', '- Follow up CT of abd:', '- [**First Name8 (NamePattern2) 2445**] [**Last Name (NamePattern1) 2446**]: social work for substance abuse', '- Attempted to call out, but had breath holding spells and associated', 'tachycardia.', ' EKG - At [**2181-12-13**] 06:00 PM']","['Pt slept most of night.  This AM, complaining of abdominal pain', 'diffusely.  Also complains of headache, nausea, shakiness.', 'Unable to draw labs this AM.', ' EKG - At [**2181-12-12**] 11:49 PM', ' EKG - At [**2181-12-13**] 12:02 AM']",5060,135773.0
4,2181-12-14 05:29:58,,"['- CIWA scale', '- Follow up CT of abd:', '- [**First Name8 (NamePattern2) 2445**] [**Last Name (NamePattern1) 2446**]: social work for substance abuse', '- Attempted to call out, but had breath holding spells and associated', 'tachycardia.', ' EKG - At [**2181-12-13**] 06:00 PM']",,5060,135773.0
5,2181-12-14 13:01:53,"['Pt required 150-200mg PO valium over 24 hours to control withdrawal.', 'Follow up CT of abd showed no abdominal or pelvic abnormality, no', 'evidence of pancreatitis', 'Social work discussed with patient placement at detox/rehab facility', 'and may be able to place today or Monday.', 'Attempt was made to transfer pt to floor but when pt was made aware of', 'this, he had breath holding spells and O2 sats dropped to 70s with', 'associated tachycardia.', 'Labs were drawn via arterial stick last night, no labs were able to be', 'obtained this AM.', 'Pt continues to complain of pain in his sternum and abdomen, not', 'relieved by Tylenol.']","['Pt required 150-200mg PO valium over 24 hours to control withdrawal.', 'Follow up CT of abd showed no abdominal or pelvic abnormality, no', 'evidence of pancreatitis', 'Social work discussed with patient placement at detox/rehab facility', 'and may be able to place today or Monday.', 'Attempt was made to transfer pt to floor but when pt was made aware of', 'this, he had breath holding spells and O2 sats dropped to 70s with', 'associated tachycardia.', 'Labs were drawn via arterial stick last night, no labs were able to be', 'obtained this AM.', 'Pt continues to complain of pain in his sternum and abdomen, not', 'relieved by Tylenol.', ' EKG - At [**2181-12-13**] 06:00 PM']","['- CIWA scale', '- Follow up CT of abd:', '- [**First Name8 (NamePattern2) 2445**] [**Last Name (NamePattern1) 2446**]: social work for substance abuse', '- Attempted to call out, but had breath holding spells and associated', 'tachycardia.']",5060,135773.0
0,2182-01-06 07:38:15,,"['- Patient without IV access (IV team tried 4 times), but taking good', 'POs.  Can use foot veins for emergencies.', '- Continues to get PO Valium for withdrawal', '- Knee film without fracture.', '- Repleting lytes and giving PO vitamins', '- recieved 120mg of PO valium yesterday']",,5060,196749.0
1,2182-01-06 11:40:53,,"['- Patient without IV access (IV team tried 4 times), but taking good', 'POs.  Can use foot veins for emergencies.', '- Continues to get PO Valium for withdrawal', '- Knee film without fracture.', '- Repleting lytes and giving PO vitamins', '- recieved 120mg of PO valium yesterday']",,5060,196749.0
2,2182-01-07 07:49:31,"['q4 valium.  Social work notified, planning for d/c to', 'dual diagnosis program when stable.']","['q4 valium.  Social work notified, planning for d/c to', 'dual diagnosis program when stable.']","['- Patient without IV access (IV team tried 4 times), but taking good', 'POs.  Can use foot veins for emergencies.', '- Continues to get PO Valium for withdrawal', '- Knee film without fracture.', '- Repleting lytes and giving PO vitamins', '- recieved 120mg of PO valium yesterday']",5060,196749.0
3,2182-01-07 07:54:07,,"['q4 valium.  Social work notified, planning for d/c to', 'dual diagnosis program when stable.']",,5060,196749.0
4,2182-01-07 10:32:05,,"['q4 valium.  Social work notified, planning for d/c to', 'dual diagnosis program when stable.']",,5060,196749.0
5,2182-01-07 16:00:33,"['q2-4 valium yesterday; none between midnight and 8AM', 'needed.  Social work notified, planning for d/c to dual diagnosis', 'program when stable.']","['q2-4 valium yesterday; none between midnight and 8AM', 'needed.  Social work notified, planning for d/c to dual diagnosis', 'program when stable.']","['q4 valium.  Social work notified, planning for d/c to', 'dual diagnosis program when stable.']",5060,196749.0
0,2182-04-05 07:41:34,,"['INVASIVE VENTILATION - START [**2182-4-4**] 03:35 PM', ' MULTI LUMEN - START [**2182-4-4**] 05:15 PM']",,5060,174823.0
1,2182-04-05 12:12:50,,"['INVASIVE VENTILATION - START [**2182-4-4**] 03:35 PM', ' MULTI LUMEN - START [**2182-4-4**] 05:15 PM']",,5060,174823.0
2,2182-04-06 07:49:04,"['INVASIVE VENTILATION - STOP [**2182-4-5**] 11:30 AM', ' MULTI LUMEN - STOP [**2182-4-5**] 06:07 PM', '-Extubated w/o complication', ""-Fem line D/C'd and peripheral IV placed"", '-Got diazepam for objective criteria of withdrawal (tachycardia and', 'diaphoresis)', 'History obtained from Patient']","['INVASIVE VENTILATION - STOP [**2182-4-5**] 11:30 AM', ' MULTI LUMEN - STOP [**2182-4-5**] 06:07 PM', '-Extubated w/o complication', ""-Fem line D/C'd and peripheral IV placed"", '-Got diazepam for objective criteria of withdrawal (tachycardia and', 'diaphoresis)', 'History obtained from Patient']","['INVASIVE VENTILATION - START [**2182-4-4**] 03:35 PM', ' MULTI LUMEN - START [**2182-4-4**] 05:15 PM']",5060,174823.0
3,2182-04-06 13:07:23,,"['INVASIVE VENTILATION - STOP [**2182-4-5**] 11:30 AM', ' MULTI LUMEN - STOP [**2182-4-5**] 06:07 PM', '-Extubated w/o complication', ""-Fem line D/C'd and peripheral IV placed"", '-Got diazepam for objective criteria of withdrawal (tachycardia and', 'diaphoresis)', 'History obtained from Patient']",,5060,174823.0
0,2182-06-15 05:29:37,,['No significant overnight events'],,5060,156497.0
1,2182-06-15 12:22:08,,['No significant overnight events'],,5060,156497.0
2,2182-06-16 08:20:08,"['-Hand: X-ray changes may be old, no splint needed as no tenderness. Can', 'elevate hand for edema.', '-Threatened to leave AMA. Does not qualify for Section 12 per psych but', 'given expressed desire for detox, will try to Section 35 on Monday.', 'Negotiated valium 10-20mg po q2h prn but no change in percocet.', '-Unable to draw labs this AM']","['-Hand: X-ray changes may be old, no splint needed as no tenderness. Can', 'elevate hand for edema.', '-Threatened to leave AMA. Does not qualify for Section 12 per psych but', 'given expressed desire for detox, will try to Section 35 on Monday.', 'Negotiated valium 10-20mg po q2h prn but no change in percocet.', '-Unable to draw labs this AM']",['No significant overnight events'],5060,156497.0
3,2182-06-16 10:41:43,,"['-Hand: X-ray changes may be old, no splint needed as no tenderness. Can', 'elevate hand for edema.', '-Threatened to leave AMA. Does not qualify for Section 12 per psych but', 'given expressed desire for detox, will try to Section 35 on Monday.', 'Negotiated valium 10-20mg po q2h prn but no change in percocet.', '-Unable to draw labs this AM']",,5060,156497.0
4,2182-06-16 12:10:24,"['-Per ortho, hand x-ray changes may be old with no need for intervention', 'given absence of tenderness.', '-Pt threatened multiple times to leave AMA. Evaluated by Psych, does', 'not qualify for section 12 but pt expressed desire to stay for Section', '35 on Monday.', '-Taking frequent valium (10-20mg po q2h) and percocet q6h with no', 'objective evidence of EtOH withdrawal', '-Pt still easily agitated today. Unable to draw labs this AM.']","['-Per ortho, hand x-ray changes may be old with no need for intervention', 'given absence of tenderness.', '-Pt threatened multiple times to leave AMA. Evaluated by Psych, does', 'not qualify for section 12 but pt expressed desire to stay for Section', '35 on Monday.', '-Taking frequent valium (10-20mg po q2h) and percocet q6h with no', 'objective evidence of EtOH withdrawal', '-Pt still easily agitated today. Unable to draw labs this AM.']","['-Hand: X-ray changes may be old, no splint needed as no tenderness. Can', 'elevate hand for edema.', '-Threatened to leave AMA. Does not qualify for Section 12 per psych but', 'given expressed desire for detox, will try to Section 35 on Monday.', 'Negotiated valium 10-20mg po q2h prn but no change in percocet.', '-Unable to draw labs this AM']",5060,156497.0
5,2182-06-17 07:41:52,"['-Stayed on CIWA q2.', '-Psych: Section 35 commitment ordered by Psychiatry']","['-Stayed on CIWA q2.', '-Psych: Section 35 commitment ordered by Psychiatry']","['-Per ortho, hand x-ray changes may be old with no need for intervention', 'given absence of tenderness.', '-Pt threatened multiple times to leave AMA. Evaluated by Psych, does', 'not qualify for section 12 but pt expressed desire to stay for Section', '35 on Monday.', '-Taking frequent valium (10-20mg po q2h) and percocet q6h with no', 'objective evidence of EtOH withdrawal', '-Pt still easily agitated today. Unable to draw labs this AM.']",5060,156497.0
6,2182-06-17 07:42:58,,"['-Stayed on CIWA q2.', '-Psych: Section 35 commitment ordered by Psychiatry']",,5060,156497.0
7,2182-06-17 14:48:20,"['-Psych: Section 35 commitment process organized by social work', 'Patient reports continued R hand pain and chest pain with deep', 'inspiration.  He is requesting Valium.']","['-Stayed on CIWA q2.', '-Psych: Section 35 commitment process organized by social work', 'Patient reports continued R hand pain and chest pain with deep', 'inspiration.  He is requesting Valium.']",['-Psych: Section 35 commitment ordered by Psychiatry'],5060,156497.0
0,2182-10-08 06:59:10,,"['Initially requesting pain medication and valium. Pt refused tylenol.', 'Fell asleep soon afterward with no further events respiratory or', 'otherwise.', 'After airway stabilization, noted diffuse erythematous papular rash and', 'pt has hx of untreated scabies. Spoke with Derm, note in chart from', '[**Month (only) 60**]. Started permethrin. Now on contact precautions.', 'History obtained from Patient']",,5060,143525.0
0,2123-03-04 06:58:38,,['No events since admission.'],,65522,188720.0
1,2123-03-04 07:00:09,,['No events since admission.'],,65522,188720.0
2,2123-03-04 07:01:46,,['No events since admission.'],,65522,188720.0
3,2123-03-04 09:45:55,,['No events since admission.'],,65522,188720.0
0,2129-01-23 03:40:33,,[],,48925,127507.0
1,2129-01-23 06:59:09,"['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM', 'aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM', 'nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM', 'cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM']","['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM', 'aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM', 'nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM', 'cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM']",,48925,127507.0
2,2129-01-23 07:10:56,"[' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM nasopharyngeal', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM cvl', '- Patient intubated in AM for desaturation and tachypnea.', '- RIJ inserted and CXR confirmed placement.', '- Started Cefepime, Flagyl for treatment of aspiration pneumonia.', '- Echo: LVEF > 65%; consistent with Grade II (moderate) left', 'ventricular diastolic dysfunction.', '- Neurosurgery recommended to continue treatment for INR, return to', 'Coumadin in 1 month, and to continue IVF to treat recent dye load.', '- Had episode of tachypnea, desturation to the 80s, and ventilator', 'dyssynchrony during the late evening. Treated with increased Versed,', 'Fentanyl and then added Propofol. Started low dose Levophed as', 'pressures started to come down.']","['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM', '- Patient intubated in AM for desaturation and tachypnea.', '- RIJ inserted and CXR confirmed placement.', '- Started Cefepime, Flagyl for treatment of aspiration pneumonia.', '- Echo: LVEF > 65%; consistent with Grade II (moderate) left', 'ventricular diastolic dysfunction.', '- Neurosurgery recommended to continue treatment for INR, return to', 'Coumadin in 1 month, and to continue IVF to treat recent dye load.', '- Had episode of tachypnea, desturation to the 80s, and ventilator', 'dyssynchrony during the late evening. Treated with increased Versed,', 'Fentanyl and then added Propofol. Started low dose Levophed as', 'pressures started to come down.']","[' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM', 'aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM', 'nasopharyngeal', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM', 'cvl']",48925,127507.0
3,2129-01-23 07:12:03,"['- PaO2 85 on FiO2 of 100%. Increased PEEP in morning and will continue', 'to follow.']","['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM', '- Patient intubated in AM for desaturation and tachypnea.', '- RIJ inserted and CXR confirmed placement.', '- Started Cefepime, Flagyl for treatment of aspiration pneumonia.', '- Echo: LVEF > 65%; consistent with Grade II (moderate) left', 'ventricular diastolic dysfunction.', '- Neurosurgery recommended to continue treatment for INR, return to', 'Coumadin in 1 month, and to continue IVF to treat recent dye load.', '- Had episode of tachypnea, desturation to the 80s, and ventilator', 'dyssynchrony during the late evening. Treated with increased Versed,', 'Fentanyl and then added Propofol. Started low dose Levophed as', 'pressures started to come down.', '- PaO2 85 on FiO2 of 100%. Increased PEEP in morning and will continue', 'to follow.']",,48925,127507.0
4,2129-01-23 11:51:41,,"['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM', '- Patient intubated in AM for desaturation and tachypnea.', '- RIJ inserted and CXR confirmed placement.', '- Started Cefepime, Flagyl for treatment of aspiration pneumonia.', '- Echo: LVEF > 65%; consistent with Grade II (moderate) left', 'ventricular diastolic dysfunction.', '- Neurosurgery recommended to continue treatment for INR, return to', 'Coumadin in 1 month, and to continue IVF to treat recent dye load.', '- Had episode of tachypnea, desturation to the 80s, and ventilator', 'dyssynchrony during the late evening. Treated with increased Versed,', 'Fentanyl and then added Propofol. Started low dose Levophed as', 'pressures started to come down.', '- PaO2 85 on FiO2 of 100%. Increased PEEP in morning and will continue', 'to follow.']",,48925,127507.0
5,2129-01-24 07:55:29,"['EKG - At [**2129-1-23**] 11:19 AM', ' EKG - At [**2129-1-23**] 10:27 PM', ' EKG - At [**2129-1-24**] 06:19 AM', ' FEVER - 101.9', 'F - [**2129-1-23**] 12:00 PM', '- Moving all extremities', '- CT Head: New areas of hypodensity inferior frontal lobes: concerning', 'for infarct vs edema. No mass effect at all.', '- Now withdrawing - diaphoresis, hypertension, tachycardia', '- Changed valium to q1h 10 mg IV for above.', '- Hypertensive to 180s, tachycardic to 120s, with atrial tachycardia.']","['EKG - At [**2129-1-23**] 11:19 AM', ' EKG - At [**2129-1-23**] 10:27 PM', ' EKG - At [**2129-1-24**] 06:19 AM', ' FEVER - 101.9', 'F - [**2129-1-23**] 12:00 PM', '- Moving all extremities', '- CT Head: New areas of hypodensity inferior frontal lobes: concerning', 'for infarct vs edema. No mass effect at all.', '- Now withdrawing - diaphoresis, hypertension, tachycardia', '- Changed valium to q1h 10 mg IV for above.', '- Hypertensive to 180s, tachycardic to 120s, with atrial tachycardia.']","['NASAL SWAB - At [**2129-1-22**] 10:13 AM', ' INVASIVE VENTILATION - START [**2129-1-22**] 11:20 AM', ' SPUTUM CULTURE - At [**2129-1-22**] 11:54 AM', ' BLOOD CULTURED - At [**2129-1-22**] 12:00 PM aline', ' NASAL SWAB - At [**2129-1-22**] 12:02 PM nasopharyngeal', ' ARTERIAL LINE - START [**2129-1-22**] 12:10 PM', ' TRANSTHORACIC ECHO - At [**2129-1-22**] 12:58 PM', ' MULTI LUMEN - START [**2129-1-22**] 03:00 PM', ' BLOOD CULTURED - At [**2129-1-22**] 05:24 PM cvl', ' FEVER - 102.1', 'F - [**2129-1-22**] 06:00 PM', '- Patient intubated in AM for desaturation and tachypnea.', '- RIJ inserted and CXR confirmed placement.', '- Started Cefepime, Flagyl for treatment of aspiration pneumonia.', '- Echo: LVEF > 65%; consistent with Grade II (moderate) left', 'ventricular diastolic dysfunction.', '- Neurosurgery recommended to continue treatment for INR, return to', 'Coumadin in 1 month, and to continue IVF to treat recent dye load.', '- Had episode of tachypnea, desturation to the 80s, and ventilator', 'dyssynchrony during the late evening. Treated with increased Versed,', 'Fentanyl and then added Propofol. Started low dose Levophed as', 'pressures started to come down.', '- PaO2 85 on FiO2 of 100%. Increased PEEP in morning and will continue', 'to follow.']",48925,127507.0
6,2129-01-24 12:52:08,,"['EKG - At [**2129-1-23**] 11:19 AM', ' EKG - At [**2129-1-23**] 10:27 PM', ' EKG - At [**2129-1-24**] 06:19 AM', ' FEVER - 101.9', 'F - [**2129-1-23**] 12:00 PM', '- Moving all extremities', '- CT Head: New areas of hypodensity inferior frontal lobes: concerning', 'for infarct vs edema. No mass effect at all.', '- Now withdrawing - diaphoresis, hypertension, tachycardia', '- Changed valium to q1h 10 mg IV for above.', '- Hypertensive to 180s, tachycardic to 120s, with atrial tachycardia.']",,48925,127507.0
7,2129-01-25 07:57:37,"['- Nicardipine gtt for BP 140s-150s', '- Neurosurgery: INR <1.5, continue freguent neuro exams.', ""- Withdrawal: Valium DC'd, will use propofal"", ""- DC'd Cefepime/Flagyl, Continued Levofloxacin."", ""- Cefepime/Flagyl DC'd"", '- PCP [**Name Initial (PRE) 2057**] ?Olovic [**Telephone/Fax (1) 12855**]: [**Doctor First Name 6987**] spoke with her. No major news.', '- Attempted to wean PEEP - Multiple attempts with PEEP down to 12 ->', 'Pa02 to 60s. PEEP then back to 50%.', 'History obtained from Family / [**Hospital 75**] Medical records']","['- Nicardipine gtt for BP 140s-150s', '- Neurosurgery: INR <1.5, continue freguent neuro exams.', ""- Withdrawal: Valium DC'd, will use propofal"", ""- DC'd Cefepime/Flagyl, Continued Levofloxacin."", ""- Cefepime/Flagyl DC'd"", '- PCP [**Name Initial (PRE) 2057**] ?Olovic [**Telephone/Fax (1) 12855**]: [**Doctor First Name 6987**] spoke with her. No major news.', '- Attempted to wean PEEP - Multiple attempts with PEEP down to 12 ->', 'Pa02 to 60s. PEEP then back to 50%.', 'History obtained from Family / [**Hospital 75**] Medical records']","['EKG - At [**2129-1-23**] 11:19 AM', ' EKG - At [**2129-1-23**] 10:27 PM', ' EKG - At [**2129-1-24**] 06:19 AM', ' FEVER - 101.9', 'F - [**2129-1-23**] 12:00 PM', '- Moving all extremities', '- CT Head: New areas of hypodensity inferior frontal lobes: concerning', 'for infarct vs edema. No mass effect at all.', '- Now withdrawing - diaphoresis, hypertension, tachycardia', '- Changed valium to q1h 10 mg IV for above.', '- Hypertensive to 180s, tachycardic to 120s, with atrial tachycardia.']",48925,127507.0
8,2129-01-25 08:03:21,,"['- Nicardipine gtt for BP 140s-150s', '- Neurosurgery: INR <1.5, continue freguent neuro exams.', ""- Withdrawal: Valium DC'd, will use propofal"", ""- DC'd Cefepime/Flagyl, Continued Levofloxacin."", ""- Cefepime/Flagyl DC'd"", '- PCP [**Name Initial (PRE) 2057**] ?Olovic [**Telephone/Fax (1) 12855**]: [**Doctor First Name 6987**] spoke with her. No major news.', '- Attempted to wean PEEP - Multiple attempts with PEEP down to 12 ->', 'Pa02 to 60s. PEEP then back to 50%.', 'History obtained from Family / [**Hospital 75**] Medical records']",,48925,127507.0
9,2129-01-25 13:17:03,,"['- Nicardipine gtt for BP 140s-150s', '- Neurosurgery: INR <1.5, continue freguent neuro exams.', ""- Withdrawal: Valium DC'd, will use propofal"", ""- DC'd Cefepime/Flagyl, Continued Levofloxacin."", ""- Cefepime/Flagyl DC'd"", '- PCP [**Name Initial (PRE) 2057**] ?Olovic [**Telephone/Fax (1) 12855**]: [**Doctor First Name 6987**] spoke with her. No major news.', '- Attempted to wean PEEP - Multiple attempts with PEEP down to 12 ->', 'Pa02 to 60s. PEEP then back to 50%.', 'History obtained from Family / [**Hospital 75**] Medical records']",,48925,127507.0
10,2129-01-26 07:51:07,"['BLOOD CULTURED - At [**2129-1-26**] 04:13 AM', '- Neurosurgery signed off in the morning.', '- Increased bowel regimen as abdominal distention likely inhibiting', 'successful wean off of the vent. Patient had a bowel movement in the', 'afternoon. KUB was repeated in the evening which showed dilated bowel', 'per my read.', '- Restarted home Lisinopril at half dose (20mg) and will plan to', 'titrate up (40mg). Started Diltiazem drip (home Nifedipine cannot be', 'crushed) for tachycardia and HTN; added Clonidine patch; restarted', 'Nicardipine drip.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']","['BLOOD CULTURED - At [**2129-1-26**] 04:13 AM', '- Neurosurgery signed off in the morning.', '- Increased bowel regimen as abdominal distention likely inhibiting', 'successful wean off of the vent. Patient had a bowel movement in the', 'afternoon. KUB was repeated in the evening which showed dilated bowel', 'per my read.', '- Restarted home Lisinopril at half dose (20mg) and will plan to', 'titrate up (40mg). Started Diltiazem drip (home Nifedipine cannot be', 'crushed) for tachycardia and HTN; added Clonidine patch; restarted', 'Nicardipine drip.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']","['- Nicardipine gtt for BP 140s-150s', '- Neurosurgery: INR <1.5, continue freguent neuro exams.', ""- Withdrawal: Valium DC'd, will use propofal"", ""- DC'd Cefepime/Flagyl, Continued Levofloxacin."", ""- Cefepime/Flagyl DC'd"", '- PCP [**Name Initial (PRE) 2057**] ?Olovic [**Telephone/Fax (1) 12855**]: [**Doctor First Name 6987**] spoke with her. No major news.', '- Attempted to wean PEEP - Multiple attempts with PEEP down to 12 ->', 'Pa02 to 60s. PEEP then back to 50%.', 'History obtained from Family / [**Hospital 75**] Medical records']",48925,127507.0
11,2129-01-26 13:18:52,['- About 1.5 L OG output this a.m.'],"['BLOOD CULTURED - At [**2129-1-26**] 04:13 AM', '- Neurosurgery signed off in the morning.', '- Increased bowel regimen as abdominal distention likely inhibiting', 'successful wean off of the vent. Patient had a bowel movement in the', 'afternoon. KUB was repeated in the evening which showed dilated bowel', 'per my read.', '- Restarted home Lisinopril at half dose (20mg) and will plan to', 'titrate up (40mg). Started Diltiazem drip (home Nifedipine cannot be', 'crushed) for tachycardia and HTN; added Clonidine patch; restarted', 'Nicardipine drip.', '- About 1.5 L OG output this a.m.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",,48925,127507.0
12,2129-01-27 07:50:56,"['- Family updated by [**Doctor First Name 2682**].', '- BM: Nothing after soap suds enema. Nothing in rectum.', '- OG output: 2 liters till 3pm', '- BP/Rate Control: Well rate controlled 90 - low hundreds. BP 140-150s.', 'Systolics to 80s-100s when propofol increased during episode of', 'decreased 02 saturation.', '- Urine Output dropped over the course of the day. Given increased OG', 'output bolused one liter NS', '- Spiked 102.4 overnight. Urine/Blood Cultured. Given concern for', 'aspiration flagyl added to levofloxacin. Endotracheal gram', 'stain/culture sent. This regimen may need to be broadened if patient', 'does not improve - HAP coverage, etc.', '- 02sat dropped to 90s overnight, Recruitment without success, CXR', 'performed given concern for aspiration no major changes, Oxgenation', 'improved with increased PEEP, Fi02 was weaned down.', '- Called this morning with concerns that during wake up patient was', 'posturing with left upper extremity. Decreased propofol, On my exam', 'patient seemed to move right upper/lower extremity. Less movement in', 'left upper extremity. Pupils equal. Propofol increased when patient', 'became dysynchronous with vent, limiting exam. Non Contrast Head CT.', '- Increased distention of abdomen overnight, sent for non contrast CT', 'of thorax (given further hypoxia)']","['- Family updated by [**Doctor First Name 2682**].', '- BM: Nothing after soap suds enema. Nothing in rectum.', '- OG output: 2 liters till 3pm', '- BP/Rate Control: Well rate controlled 90 - low hundreds. BP 140-150s.', 'Systolics to 80s-100s when propofol increased during episode of', 'decreased 02 saturation.', '- Urine Output dropped over the course of the day. Given increased OG', 'output bolused one liter NS', '- Spiked 102.4 overnight. Urine/Blood Cultured. Given concern for', 'aspiration flagyl added to levofloxacin. Endotracheal gram', 'stain/culture sent. This regimen may need to be broadened if patient', 'does not improve - HAP coverage, etc.', '- 02sat dropped to 90s overnight, Recruitment without success, CXR', 'performed given concern for aspiration no major changes, Oxgenation', 'improved with increased PEEP, Fi02 was weaned down.', '- Called this morning with concerns that during wake up patient was', 'posturing with left upper extremity. Decreased propofol, On my exam', 'patient seemed to move right upper/lower extremity. Less movement in', 'left upper extremity. Pupils equal. Propofol increased when patient', 'became dysynchronous with vent, limiting exam. Non Contrast Head CT.', '- Increased distention of abdomen overnight, sent for non contrast CT', 'of thorax (given further hypoxia)']","['BLOOD CULTURED - At [**2129-1-26**] 04:13 AM', '- Neurosurgery signed off in the morning.', '- Increased bowel regimen as abdominal distention likely inhibiting', 'successful wean off of the vent. Patient had a bowel movement in the', 'afternoon. KUB was repeated in the evening which showed dilated bowel', 'per my read.', '- Restarted home Lisinopril at half dose (20mg) and will plan to', 'titrate up (40mg). Started Diltiazem drip (home Nifedipine cannot be', 'crushed) for tachycardia and HTN; added Clonidine patch; restarted', 'Nicardipine drip.', '- About 1.5 L OG output this a.m.', 'History obtained from Patient, Family / [**Hospital 75**] Medical records']",48925,127507.0
13,2129-01-27 10:11:01,,"['- Family updated by [**Doctor First Name 2682**].', '- BM: Nothing after soap suds enema. Nothing in rectum.', '- OG output: 2 liters till 3pm', '- BP/Rate Control: Well rate controlled 90 - low hundreds. BP 140-150s.', 'Systolics to 80s-100s when propofol increased during episode of', 'decreased 02 saturation.', '- Urine Output dropped over the course of the day. Given increased OG', 'output bolused one liter NS', '- Spiked 102.4 overnight. Urine/Blood Cultured. Given concern for', 'aspiration flagyl added to levofloxacin. Endotracheal gram', 'stain/culture sent. This regimen may need to be broadened if patient', 'does not improve - HAP coverage, etc.', '- 02sat dropped to 90s overnight, Recruitment without success, CXR', 'performed given concern for aspiration no major changes, Oxgenation', 'improved with increased PEEP, Fi02 was weaned down.', '- Called this morning with concerns that during wake up patient was', 'posturing with left upper extremity. Decreased propofol, On my exam', 'patient seemed to move right upper/lower extremity. Less movement in', 'left upper extremity. Pupils equal. Propofol increased when patient', 'became dysynchronous with vent, limiting exam. Non Contrast Head CT.', '- Increased distention of abdomen overnight, sent for non contrast CT', 'of thorax (given further hypoxia)']",,48925,127507.0
14,2129-01-28 07:50:18,"['TRANSTHORACIC ECHO - At [**2129-1-27**] 11:54 AM', ' FEVER - 103.4', 'F - [**2129-1-28**] 12:00 AM', '- Radiology called regarding preliminary findings: CT chest', 'unremarkable, small pericardial effusion.  Multiple loops of dilated', 'large and small bowel. No clear transition point, but perhaps at some', 'point in the proximal portion of the decending colon. Small segment of', 'fecalized small bowel upstream to that, and a lot of edema in that', 'area. Fluid collection around spleen. Findings concerning for', 'mesenteric ischemia given diffuse ileus without clear transition.', 'Recommend CTA if clinically worsens.', '- Surgery: Differential includes small bowel obstruction, large bowel', 'obstruction secondary to mass or stricture, or mesenteric ischemia', 'given recent reversal of AC and ablation procedure. Would continue', 'conservative mgt for now as patient is not clinically decompensating;', 'cont NGT to cont med suction, pull back 6-8cm as in too deep; serial', 'abdominal exams, trend lactate, monitor WBC.', '- Updated family in early afternoon.', '- Pulled back NGT as recommended and restarted after placement', 'confirmed.', '- 1L NS at 500 cc/hr then LR for support given obstruction.']","['TRANSTHORACIC ECHO - At [**2129-1-27**] 11:54 AM', ' FEVER - 103.4', 'F - [**2129-1-28**] 12:00 AM', '- Radiology called regarding preliminary findings: CT chest', 'unremarkable, small pericardial effusion.  Multiple loops of dilated', 'large and small bowel. No clear transition point, but perhaps at some', 'point in the proximal portion of the decending colon. Small segment of', 'fecalized small bowel upstream to that, and a lot of edema in that', 'area. Fluid collection around spleen. Findings concerning for', 'mesenteric ischemia given diffuse ileus without clear transition.', 'Recommend CTA if clinically worsens.', '- Surgery: Differential includes small bowel obstruction, large bowel', 'obstruction secondary to mass or stricture, or mesenteric ischemia', 'given recent reversal of AC and ablation procedure. Would continue', 'conservative mgt for now as patient is not clinically decompensating;', 'cont NGT to cont med suction, pull back 6-8cm as in too deep; serial', 'abdominal exams, trend lactate, monitor WBC.', '- Updated family in early afternoon.', '- Pulled back NGT as recommended and restarted after placement', 'confirmed.', '- 1L NS at 500 cc/hr then LR for support given obstruction.']","['- Family updated by [**Doctor First Name 2682**].', '- BM: Nothing after soap suds enema. Nothing in rectum.', '- OG output: 2 liters till 3pm', '- BP/Rate Control: Well rate controlled 90 - low hundreds. BP 140-150s.', 'Systolics to 80s-100s when propofol increased during episode of', 'decreased 02 saturation.', '- Urine Output dropped over the course of the day. Given increased OG', 'output bolused one liter NS', '- Spiked 102.4 overnight. Urine/Blood Cultured. Given concern for', 'aspiration flagyl added to levofloxacin. Endotracheal gram', 'stain/culture sent. This regimen may need to be broadened if patient', 'does not improve - HAP coverage, etc.', '- 02sat dropped to 90s overnight, Recruitment without success, CXR', 'performed given concern for aspiration no major changes, Oxgenation', 'improved with increased PEEP, Fi02 was weaned down.', '- Called this morning with concerns that during wake up patient was', 'posturing with left upper extremity. Decreased propofol, On my exam', 'patient seemed to move right upper/lower extremity. Less movement in', 'left upper extremity. Pupils equal. Propofol increased when patient', 'became dysynchronous with vent, limiting exam. Non Contrast Head CT.', '- Increased distention of abdomen overnight, sent for non contrast CT', 'of thorax (given further hypoxia)']",48925,127507.0
15,2129-01-28 14:10:11,,"['TRANSTHORACIC ECHO - At [**2129-1-27**] 11:54 AM', ' FEVER - 103.4', 'F - [**2129-1-28**] 12:00 AM', '- Radiology called regarding preliminary findings: CT chest', 'unremarkable, small pericardial effusion.  Multiple loops of dilated', 'large and small bowel. No clear transition point, but perhaps at some', 'point in the proximal portion of the decending colon. Small segment of', 'fecalized small bowel upstream to that, and a lot of edema in that', 'area. Fluid collection around spleen. Findings concerning for', 'mesenteric ischemia given diffuse ileus without clear transition.', 'Recommend CTA if clinically worsens.', '- Surgery: Differential includes small bowel obstruction, large bowel', 'obstruction secondary to mass or stricture, or mesenteric ischemia', 'given recent reversal of AC and ablation procedure. Would continue', 'conservative mgt for now as patient is not clinically decompensating;', 'cont NGT to cont med suction, pull back 6-8cm as in too deep; serial', 'abdominal exams, trend lactate, monitor WBC.', '- Updated family in early afternoon.', '- Pulled back NGT as recommended and restarted after placement', 'confirmed.', '- 1L NS at 500 cc/hr then LR for support given obstruction.']",,48925,127507.0
16,2129-01-29 07:51:36,"['- GI performed flex sigmoidoscopy decompression with slight', 'improvement. Recommended evaluation of vasculation with CTA abdomen', 'once creatinine improved.', '- Surgery recommended serial exams and continued NGT decompression.', '- Blood cultures positive for coag negative staph; ID consulted and', 'recommended f/u cultures (RIJ, a-line pulled and tips cultured),', 'vancomycin trough, speciation, and LFTs/pancreatic enzymes (added to', 'morning labs).', '- Left SC line inserted; new arterial line inserted.', '- Patient maintained on pressors throughout day/evening.', '- PM labs Cr 2.2, Vancomycin trough 14.3.', '- Discussed with Dr. [**Last Name (STitle) 2683**] and decided to defer CTA given [**Last Name (un) **] and', 'clinical picture.', '- Lactate: 1.3 > 1.2 > 1.1  > 1.0 > 0.9']","['- GI performed flex sigmoidoscopy decompression with slight', 'improvement. Recommended evaluation of vasculation with CTA abdomen', 'once creatinine improved.', '- Surgery recommended serial exams and continued NGT decompression.', '- Blood cultures positive for coag negative staph; ID consulted and', 'recommended f/u cultures (RIJ, a-line pulled and tips cultured),', 'vancomycin trough, speciation, and LFTs/pancreatic enzymes (added to', 'morning labs).', '- Left SC line inserted; new arterial line inserted.', '- Patient maintained on pressors throughout day/evening.', '- PM labs Cr 2.2, Vancomycin trough 14.3.', '- Discussed with Dr. [**Last Name (STitle) 2683**] and decided to defer CTA given [**Last Name (un) **] and', 'clinical picture.', '- Lactate: 1.3 > 1.2 > 1.1  > 1.0 > 0.9']","['TRANSTHORACIC ECHO - At [**2129-1-27**] 11:54 AM', ' FEVER - 103.4', 'F - [**2129-1-28**] 12:00 AM', '- Radiology called regarding preliminary findings: CT chest', 'unremarkable, small pericardial effusion.  Multiple loops of dilated', 'large and small bowel. No clear transition point, but perhaps at some', 'point in the proximal portion of the decending colon. Small segment of', 'fecalized small bowel upstream to that, and a lot of edema in that', 'area. Fluid collection around spleen. Findings concerning for', 'mesenteric ischemia given diffuse ileus without clear transition.', 'Recommend CTA if clinically worsens.', '- Surgery: Differential includes small bowel obstruction, large bowel', 'obstruction secondary to mass or stricture, or mesenteric ischemia', 'given recent reversal of AC and ablation procedure. Would continue', 'conservative mgt for now as patient is not clinically decompensating;', 'cont NGT to cont med suction, pull back 6-8cm as in too deep; serial', 'abdominal exams, trend lactate, monitor WBC.', '- Updated family in early afternoon.', '- Pulled back NGT as recommended and restarted after placement', 'confirmed.', '- 1L NS at 500 cc/hr then LR for support given obstruction.']",48925,127507.0
17,2129-01-29 14:17:35,,"['- GI performed flex sigmoidoscopy decompression with slight', 'improvement. Recommended evaluation of vasculation with CTA abdomen', 'once creatinine improved.', '- Surgery recommended serial exams and continued NGT decompression.', '- Blood cultures positive for coag negative staph; ID consulted and', 'recommended f/u cultures (RIJ, a-line pulled and tips cultured),', 'vancomycin trough, speciation, and LFTs/pancreatic enzymes (added to', 'morning labs).', '- Left SC line inserted; new arterial line inserted.', '- Patient maintained on pressors throughout day/evening.', '- PM labs Cr 2.2, Vancomycin trough 14.3.', '- Discussed with Dr. [**Last Name (STitle) 2683**] and decided to defer CTA given [**Last Name (un) **] and', 'clinical picture.', '- Lactate: 1.3 > 1.2 > 1.1  > 1.0 > 0.9']",,48925,127507.0
18,2129-01-30 08:31:23,"['BLOOD CULTURED - At [**2129-1-29**] 03:52 PM', 'obtained from the arterial line', ' STOOL CULTURE - At [**2129-1-29**] 04:34 PM', 'c. diff', ' FEVER - 101.4', 'F - [**2129-1-29**] 08:00 AM', '- ID recs- continue current abx, keep vanco level 15-20, check for c.', 'diff, continue to f/u on culture data and monitor lfts and cbc with', 'diff', '- GI: Nothing New', '- Surgery: Nothing New', '- Repeat pH after 3 amps bicarb to 7.27, Given another 3 amps bicarb.', '- NG tube clamped during the morning, opened with no residual. Given', 'dose of lactulose.', '- 7.27/45/100 -> Fi02 to 50%, PEEP stable at 15.', '- Creatinine rising to 3.1, Urine Lytes ordered.', '- Vanc trough: 27.8', '- Urine Lytes: FeNa 1.42%']","['BLOOD CULTURED - At [**2129-1-29**] 03:52 PM', 'obtained from the arterial line', ' STOOL CULTURE - At [**2129-1-29**] 04:34 PM', 'c. diff', ' FEVER - 101.4', 'F - [**2129-1-29**] 08:00 AM', '- ID recs- continue current abx, keep vanco level 15-20, check for c.', 'diff, continue to f/u on culture data and monitor lfts and cbc with', 'diff', '- GI: Nothing New', '- Surgery: Nothing New', '- Repeat pH after 3 amps bicarb to 7.27, Given another 3 amps bicarb.', '- NG tube clamped during the morning, opened with no residual. Given', 'dose of lactulose.', '- 7.27/45/100 -> Fi02 to 50%, PEEP stable at 15.', '- Creatinine rising to 3.1, Urine Lytes ordered.', '- Vanc trough: 27.8', '- Urine Lytes: FeNa 1.42%']","['- GI performed flex sigmoidoscopy decompression with slight', 'improvement. Recommended evaluation of vasculation with CTA abdomen', 'once creatinine improved.', '- Surgery recommended serial exams and continued NGT decompression.', '- Blood cultures positive for coag negative staph; ID consulted and', 'recommended f/u cultures (RIJ, a-line pulled and tips cultured),', 'vancomycin trough, speciation, and LFTs/pancreatic enzymes (added to', 'morning labs).', '- Left SC line inserted; new arterial line inserted.', '- Patient maintained on pressors throughout day/evening.', '- PM labs Cr 2.2, Vancomycin trough 14.3.', '- Discussed with Dr. [**Last Name (STitle) 2683**] and decided to defer CTA given [**Last Name (un) **] and', 'clinical picture.', '- Lactate: 1.3 > 1.2 > 1.1  > 1.0 > 0.9']",48925,127507.0
19,2129-01-30 21:51:51,,"['BLOOD CULTURED - At [**2129-1-29**] 03:52 PM', 'obtained from the arterial line', ' STOOL CULTURE - At [**2129-1-29**] 04:34 PM', 'c. diff', ' FEVER - 101.4', 'F - [**2129-1-29**] 08:00 AM', '- ID recs- continue current abx, keep vanco level 15-20, check for c.', 'diff, continue to f/u on culture data and monitor lfts and cbc with', 'diff', '- GI: Nothing New', '- Surgery: Nothing New', '- Repeat pH after 3 amps bicarb to 7.27, Given another 3 amps bicarb.', '- NG tube clamped during the morning, opened with no residual. Given', 'dose of lactulose.', '- 7.27/45/100 -> Fi02 to 50%, PEEP stable at 15.', '- Creatinine rising to 3.1, Urine Lytes ordered.', '- Vanc trough: 27.8', '- Urine Lytes: FeNa 1.42%']",,48925,127507.0
20,2129-01-30 22:37:08,,"['BLOOD CULTURED - At [**2129-1-29**] 03:52 PM', 'obtained from the arterial line', ' STOOL CULTURE - At [**2129-1-29**] 04:34 PM', 'c. diff', ' FEVER - 101.4', 'F - [**2129-1-29**] 08:00 AM', '- ID recs- continue current abx, keep vanco level 15-20, check for c.', 'diff, continue to f/u on culture data and monitor lfts and cbc with', 'diff', '- GI: Nothing New', '- Surgery: Nothing New', '- Repeat pH after 3 amps bicarb to 7.27, Given another 3 amps bicarb.', '- NG tube clamped during the morning, opened with no residual. Given', 'dose of lactulose.', '- 7.27/45/100 -> Fi02 to 50%, PEEP stable at 15.', '- Creatinine rising to 3.1, Urine Lytes ordered.', '- Vanc trough: 27.8', '- Urine Lytes: FeNa 1.42%']",,48925,127507.0
21,2129-01-31 07:25:31,"['- Vancomycin level 18.6', '- Ordered urine lytes, osms, eos, etc. Given that we will likely', 'consult Renal in the a.m. - particularly if renal function worsens.', '- OG tube output down in a.m. and lactulose given with some stool', 'output also. Later began to put out a lot per OG - 500 cc.', '- Thus still dramatic ileus (with uremia possibly partly responsible).', '- Still essentially non-responsive with eyes opening to name and no', 'attention or following of commands. Diffuse metabolic character and', 'major contributor may be uremia, but PNA and previous sedating', 'medications (more than two days ago) may contribute. No benzos remain', 'in urine, however.', '- Continued with low-grade fever. Gave OG Tylenol but unlikely much', 'absorbed. Temperature was reduced slightly, nonetheless.', '- Urine output quite large: Adequate volume and renal perfusion, but', 'also possible diuresis phase of ATN. Will need to follow CVP/clinical', 'volume status.', '- Accidentally extubated during cleaning at 5 a.m. Re-intubated by', 'Anesthesia without incident.']","['- Vancomycin level 18.6', '- Ordered urine lytes, osms, eos, etc. Given that we will likely', 'consult Renal in the a.m. - particularly if renal function worsens.', '- OG tube output down in a.m. and lactulose given with some stool', 'output also. Later began to put out a lot per OG - 500 cc.', '- Thus still dramatic ileus (with uremia possibly partly responsible).', '- Still essentially non-responsive with eyes opening to name and no', 'attention or following of commands. Diffuse metabolic character and', 'major contributor may be uremia, but PNA and previous sedating', 'medications (more than two days ago) may contribute. No benzos remain', 'in urine, however.', '- Continued with low-grade fever. Gave OG Tylenol but unlikely much', 'absorbed. Temperature was reduced slightly, nonetheless.', '- Urine output quite large: Adequate volume and renal perfusion, but', 'also possible diuresis phase of ATN. Will need to follow CVP/clinical', 'volume status.', '- Accidentally extubated during cleaning at 5 a.m. Re-intubated by', 'Anesthesia without incident.']","['BLOOD CULTURED - At [**2129-1-29**] 03:52 PM', 'obtained from the arterial line', ' STOOL CULTURE - At [**2129-1-29**] 04:34 PM', 'c. diff', ' FEVER - 101.4', 'F - [**2129-1-29**] 08:00 AM', '- ID recs- continue current abx, keep vanco level 15-20, check for c.', 'diff, continue to f/u on culture data and monitor lfts and cbc with', 'diff', '- GI: Nothing New', '- Surgery: Nothing New', '- Repeat pH after 3 amps bicarb to 7.27, Given another 3 amps bicarb.', '- NG tube clamped during the morning, opened with no residual. Given', 'dose of lactulose.', '- 7.27/45/100 -> Fi02 to 50%, PEEP stable at 15.', '- Creatinine rising to 3.1, Urine Lytes ordered.', '- Vanc trough: 27.8', '- Urine Lytes: FeNa 1.42%']",48925,127507.0
22,2129-01-31 16:02:38,,"['- Vancomycin level 18.6', '- Ordered urine lytes, osms, eos, etc. Given that we will likely', 'consult Renal in the a.m. - particularly if renal function worsens.', '- OG tube output down in a.m. and lactulose given with some stool', 'output also. Later began to put out a lot per OG - 500 cc.', '- Thus still dramatic ileus (with uremia possibly partly responsible).', '- Still essentially non-responsive with eyes opening to name and no', 'attention or following of commands. Diffuse metabolic character and', 'major contributor may be uremia, but PNA and previous sedating', 'medications (more than two days ago) may contribute. No benzos remain', 'in urine, however.', '- Continued with low-grade fever. Gave OG Tylenol but unlikely much', 'absorbed. Temperature was reduced slightly, nonetheless.', '- Urine output quite large: Adequate volume and renal perfusion, but', 'also possible diuresis phase of ATN. Will need to follow CVP/clinical', 'volume status.', '- Accidentally extubated during cleaning at 5 a.m. Re-intubated by', 'Anesthesia without incident.']",,48925,127507.0
23,2129-02-01 08:14:52,"['[**1-31**]', '- Rate controlled with Esmolol drip 75 mcg/kg/minute', '- Vanco level 22', ""- Flagyl d/c'd"", '- Final cxs negative for urine ([**1-26**]), catheter tip ([**1-28**])']","['[**1-31**]', '- Rate controlled with Esmolol drip 75 mcg/kg/minute', '- Vanco level 22', ""- Flagyl d/c'd"", '- Final cxs negative for urine ([**1-26**]), catheter tip ([**1-28**])']","['- Vancomycin level 18.6', '- Ordered urine lytes, osms, eos, etc. Given that we will likely', 'consult Renal in the a.m. - particularly if renal function worsens.', '- OG tube output down in a.m. and lactulose given with some stool', 'output also. Later began to put out a lot per OG - 500 cc.', '- Thus still dramatic ileus (with uremia possibly partly responsible).', '- Still essentially non-responsive with eyes opening to name and no', 'attention or following of commands. Diffuse metabolic character and', 'major contributor may be uremia, but PNA and previous sedating', 'medications (more than two days ago) may contribute. No benzos remain', 'in urine, however.', '- Continued with low-grade fever. Gave OG Tylenol but unlikely much', 'absorbed. Temperature was reduced slightly, nonetheless.', '- Urine output quite large: Adequate volume and renal perfusion, but', 'also possible diuresis phase of ATN. Will need to follow CVP/clinical', 'volume status.', '- Accidentally extubated during cleaning at 5 a.m. Re-intubated by', 'Anesthesia without incident.']",48925,127507.0
24,2129-02-01 15:53:58,,"['[**1-31**]', '- Rate controlled with Esmolol drip 75 mcg/kg/minute', '- Vanco level 22', ""- Flagyl d/c'd"", '- Final cxs negative for urine ([**1-26**]), catheter tip ([**1-28**])']",,48925,127507.0
25,2129-02-02 06:45:38,"['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in morning, CT showing', 'evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity tomorrow', '- Gave D5W for hypernatremia']","['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in morning, CT showing', 'evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity tomorrow', '- Gave D5W for hypernatremia']","['[**1-31**]', '- Rate controlled with Esmolol drip 75 mcg/kg/minute', '- Vanco level 22', ""- Flagyl d/c'd"", '- Final cxs negative for urine ([**1-26**]), catheter tip ([**1-28**])']",48925,127507.0
26,2129-02-02 08:00:13,"['- Unresponsive to verbal/painful stimuli in AM', '- CT showing evolving contusion but no new hemorrhage', '- Plan to do EEG to r/o seizure activity today', '- Gave D5W for hypernatremia, Na+ unchanged']","['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in AM', '- CT showing evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity today', '- Gave D5W for hypernatremia, Na+ unchanged']","['- Unresponsive to verbal/painful stimuli in morning, CT showing', 'evolving contusion but no new hemorrhage', '- Plan to do EEG to r/o seizure activity tomorrow', '- Gave D5W for hypernatremia']",48925,127507.0
27,2129-02-02 14:35:46,,"['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in AM', '- CT showing evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity today', '- Gave D5W for hypernatremia, Na+ unchanged']",,48925,127507.0
28,2129-02-02 14:44:42,,"['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in AM', '- CT showing evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity today', '- Gave D5W for hypernatremia, Na+ unchanged']",,48925,127507.0
29,2129-02-03 06:59:17,"['EEG - At [**2129-2-2**] 09:09 AM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 06:54 PM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 07:09 PM', '[**2-2**]:', '- Neurosurg: no structural reason for AMS, consider MRI/MRA', '- MRI/MRA read:', ""- Neuro: Rec'd LP --> prelim fluid WNL, pending cultures; also ordered"", 'B12, folate, TSH, free T4, RPR', '- EEG: pending', '- Sodium trended 149 --> 144', '- Started standing lactulose, senna/colace', '- Started digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']","['EEG - At [**2129-2-2**] 09:09 AM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 06:54 PM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 07:09 PM', '[**2-2**]:', '- Neurosurg: no structural reason for AMS, consider MRI/MRA', '- MRI/MRA read:', ""- Neuro: Rec'd LP --> prelim fluid WNL, pending cultures; also ordered"", 'B12, folate, TSH, free T4, RPR', '- EEG: pending', '- Sodium trended 149 --> 144', '- Started standing lactulose, senna/colace', '- Started digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']","['BLOOD CULTURED - At [**2129-2-1**] 11:21 AM', 'one blood culture from triple lumen line', '[**2-1**]:', '- Unresponsive to verbal/painful stimuli in AM', '- CT showing evolving contusion but no new hemorrhage', '- Started on neo to maintain MAP > 70; mental status improved to', 'partially opening eyes to name, possibly tracking with eyes across room', '- Plan to do EEG to r/o seizure activity today', '- Gave D5W for hypernatremia, Na+ unchanged']",48925,127507.0
30,2129-02-03 07:01:21,,"['EEG - At [**2129-2-2**] 09:09 AM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 06:54 PM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 07:09 PM', '[**2-2**]:', '- Neurosurg: no structural reason for AMS, consider MRI/MRA', '- MRI/MRA read:', ""- Neuro: Rec'd LP --> prelim fluid WNL, pending cultures; also ordered"", 'B12, folate, TSH, free T4, RPR', '- EEG: pending', '- Sodium trended 149 --> 144', '- Started standing lactulose, senna/colace', '- Started digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']",,48925,127507.0
31,2129-02-03 13:11:19,"['- MRI/MRA read: No acute process', 'B12, folate, TSH, free T4, RPR, all wnl; consider 24-hour EEG', '- EEG: encephalopathic', '- Started Digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']","['- Neurosurg: no structural reason for AMS, consider MRI/MRA', '- MRI/MRA read: No acute process', ""- Neuro: Rec'd LP --> prelim fluid WNL, pending cultures; also ordered"", 'B12, folate, TSH, free T4, RPR, all wnl; consider 24-hour EEG', '- EEG: encephalopathic', '- Sodium trended 149 --> 144', '- Started standing lactulose, senna/colace', '- Started Digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']","['EEG - At [**2129-2-2**] 09:09 AM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 06:54 PM', ' LUMBAR PUNCTURE - At [**2129-2-2**] 07:09 PM', '[**2-2**]:', '- MRI/MRA read:', 'B12, folate, TSH, free T4, RPR', '- EEG: pending', '- Started digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']",48925,127507.0
32,2129-02-04 07:22:31,"['- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W']","['- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W']","['- Neurosurg: no structural reason for AMS, consider MRI/MRA', '- MRI/MRA read: No acute process', ""- Neuro: Rec'd LP --> prelim fluid WNL, pending cultures; also ordered"", 'B12, folate, TSH, free T4, RPR, all wnl; consider 24-hour EEG', '- EEG: encephalopathic', '- Sodium trended 149 --> 144', '- Started standing lactulose, senna/colace', '- Started Digoxin for AF, weaning Esmolol; needed Neo for SBP70-80s']",48925,127507.0
33,2129-02-04 14:53:22,,"['- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W']",,48925,127507.0
34,2129-02-05 07:08:17,"['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- Dialed Esmolol up to 200 mcg, better HR and BP control', '[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd""]","['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W', '- Dialed Esmolol up to 200 mcg, better HR and BP control', '[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd""]",,48925,127507.0
35,2129-02-05 07:10:39,,"['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W', '- Dialed Esmolol up to 200 mcg, better HR and BP control', '[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd""]",,48925,127507.0
36,2129-02-05 13:08:50,"['- started daily digoxin 0.125 IV after loading', '- 24 hr EEG not hooked up as patient was down in MR most of the', 'afternoon, will likely happen some time this weekend']","['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', '[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV after loading', '- 24 hr EEG not hooked up as patient was down in MR most of the', 'afternoon, will likely happen some time this weekend', ""- lactulose d/c'd""]","['abd', '- reloaded w/Dig, dig level 1.1, though need to check another tomorrow', '- GI c/s: Get MR Enterography and MRA at same time (they have discussed', 'protocol with [**First Name8 (NamePattern2) 13070**] [**Last Name (NamePattern1) 803**] of rads) to eval for ischemia; get gensurg;', 'consider stop Dilt as constipating.', '- [**Doctor First Name **] re KUB: No SBO. Ileus w/5 cm dilation, gas in colon. After', 'reviewing labs, prior imaging, they feel MRIs ordered excessive,', 'unlikely he has mes ischemia. Continue NG to sx. Note he would be poor', 'op candidate.', ""- Neuro recs: Check ammonia level (it's 9), no Keppra."", '- 24-hour EEG ordered', '- Nsurg recs: MRI c/w cerebral contusions course, does not explain', 'altered MS, they sign off.', '- Curbsided Cards for AF:  No other recommendations for controlling AF', 'other than cardioversion.  Could try verapamil (strongest CCB) but', ""didn't given ileus and concern for ischemia."", '- PM lytes: continued hyperNa+, getting D5W', '- Dialed Esmolol up to 200 mcg, better HR and BP control', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend']",48925,127507.0
37,2129-02-05 13:51:43,"['abd', '- MRI/MRA abdomen: Proximal small bowel distension to 5.7cm but no', 'clear transition point; sigmoid diverticulosis; aperistaltic small', 'bowel; no proximal vessel filling defects, but cannot rule out distal', '- Started daily Digoxin 0.125mg IV', '- 24 hour EEG not hooked up secondary to patient being at MRI all', 'afternoon - will likely happne some time this weekend', '- Lactulose discontinued']","['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- MRI/MRA abdomen: Proximal small bowel distension to 5.7cm but no', 'clear transition point; sigmoid diverticulosis; aperistaltic small', 'bowel; no proximal vessel filling defects, but cannot rule out distal', '- Started daily Digoxin 0.125mg IV', '- 24 hour EEG not hooked up secondary to patient being at MRI all', 'afternoon - will likely happne some time this weekend', '- Lactulose discontinued']","['[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV after loading', '- 24 hr EEG not hooked up as patient was down in MR most of the', 'afternoon, will likely happen some time this weekend', ""- lactulose d/c'd""]",48925,127507.0
38,2129-02-05 13:52:27,,"['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- MRI/MRA abdomen: Proximal small bowel distension to 5.7cm but no', 'clear transition point; sigmoid diverticulosis; aperistaltic small', 'bowel; no proximal vessel filling defects, but cannot rule out distal', '- Started daily Digoxin 0.125mg IV', '- 24 hour EEG not hooked up secondary to patient being at MRI all', 'afternoon - will likely happne some time this weekend', '- Lactulose discontinued']",,48925,127507.0
39,2129-02-05 14:09:49,,"['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- MRI/MRA abdomen: Proximal small bowel distension to 5.7cm but no', 'clear transition point; sigmoid diverticulosis; aperistaltic small', 'bowel; no proximal vessel filling defects, but cannot rule out distal', '- Started daily Digoxin 0.125mg IV', '- 24 hour EEG not hooked up secondary to patient being at MRI all', 'afternoon - will likely happne some time this weekend', '- Lactulose discontinued']",,48925,127507.0
40,2129-02-06 07:21:30,"['EEG - At [**2129-2-5**] 12:02 PM', '[**2-5**]', '- [**Doctor Last Name 37**] spoke with sons yesterday, who felt pt would want trach']","['EEG - At [**2129-2-5**] 12:02 PM', '[**2-5**]', '- [**Doctor Last Name 37**] spoke with sons yesterday, who felt pt would want trach']","['MAGNETIC RESONANCE IMAGING - At [**2129-2-4**] 02:01 PM', 'abd', '- MRI/MRA abdomen: Proximal small bowel distension to 5.7cm but no', 'clear transition point; sigmoid diverticulosis; aperistaltic small', 'bowel; no proximal vessel filling defects, but cannot rule out distal', '- Started daily Digoxin 0.125mg IV', '- 24 hour EEG not hooked up secondary to patient being at MRI all', 'afternoon - will likely happne some time this weekend', '- Lactulose discontinued']",48925,127507.0
41,2129-02-06 07:23:16,"['[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd"", '[**2-5**]:', '- Surgery team signed off since no surgical abdomnial needs', '- Hypertensive today SBP170-180s, responded well to Labetalol IV', '- TPN started today: please add Thiamine and Folate for tomorrow', '- PEEP increased to [**5-9**]', '- 24 hr EEG started', '- Needs family meeting on Monday to discuss likely eventual trach', '- Na 148 --> restarted D5W for 1L, increased free water flushes with TF', 'and got UA to evaluate for Diabetes Insipidus']","['[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd"", '[**2-5**]:', '- Surgery team signed off since no surgical abdomnial needs', '- Hypertensive today SBP170-180s, responded well to Labetalol IV', '- TPN started today: please add Thiamine and Folate for tomorrow', '- PEEP increased to [**5-9**]', '- 24 hr EEG started', '- Needs family meeting on Monday to discuss likely eventual trach', '- Na 148 --> restarted D5W for 1L, increased free water flushes with TF', 'and got UA to evaluate for Diabetes Insipidus']","['EEG - At [**2129-2-5**] 12:02 PM', '[**2-5**]', '- [**Doctor Last Name 37**] spoke with sons yesterday, who felt pt would want trach']",48925,127507.0
42,2129-02-06 08:18:27,"['- BP labile yesterday, on Dig 0.125 and Esmolol, cannot wean Esmolol or', 'spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP x 3 o/n', '- TPNs started yesterday, add Thi/Folate today', '- D5 past 2 nights for Na+ but now has BS, BMs, p', 'haps try some free', 'H2O PO', '- Will have had EEG 24 hours at noon']","['- BP labile yesterday, on Dig 0.125 and Esmolol, cannot wean Esmolol or', 'spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP x 3 o/n', '- TPNs started yesterday, add Thi/Folate today', '- D5 past 2 nights for Na+ but now has BS, BMs, p', 'haps try some free', 'H2O PO', '- Will have had EEG 24 hours at noon', '- PEEP increased to [**5-9**]', '- Needs family meeting on Monday to discuss likely eventual trach', '- Na 148 --> restarted D5W for 1L, increased free water flushes with TF', 'and got UA to evaluate for Diabetes Insipidus']","['[**2-4**]:', '- MRI/MRA Abdomen: Prox small bowel distension to 5.7 cm but no clear', 'transition point; sigmoid diverticulosis; aperistaltic small bowel; no', 'proximal vessel filling defects, but cannot rule out distal', '- started daily digoxin 0.125 IV', '- 24 hr EEG not hooked up, will likely happen some time this weekend', ""- lactulose d/c'd"", '[**2-5**]:', '- Surgery team signed off since no surgical abdomnial needs', '- Hypertensive today SBP170-180s, responded well to Labetalol IV', '- TPN started today: please add Thiamine and Folate for tomorrow', '- 24 hr EEG started']",48925,127507.0
43,2129-02-06 13:35:48,"['- BP labile yesterday and today, on Dig 0.125 and Esmolol, cannot wean', 'Esmolol or spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP', 'x 3 o/n']","['- BP labile yesterday and today, on Dig 0.125 and Esmolol, cannot wean', 'Esmolol or spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP', 'x 3 o/n', '- TPNs started yesterday, add Thi/Folate today', '- D5 past 2 nights for Na+ but now has BS, BMs, p', 'haps try some free', 'H2O PO', '- Will have had EEG 24 hours at noon', '- PEEP increased to [**5-9**]', '- Needs family meeting on Monday to discuss likely eventual trach', '- Na 148 --> restarted D5W for 1L, increased free water flushes with TF', 'and got UA to evaluate for Diabetes Insipidus']","['- BP labile yesterday, on Dig 0.125 and Esmolol, cannot wean Esmolol or', 'spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP x 3 o/n']",48925,127507.0
44,2129-02-07 07:12:05,"['INVASIVE VENTILATION - STOP [**2129-2-6**] 04:45 PM', ' FEVER - 101.2', 'F - [**2129-2-6**] 12:00 PM', '- much more awake and responsive today, looking at us, no hand squeeze', 'though', '- sodium....', '- EEG...', '- extubated', '- OG tube placed, confirmed by CXR', '- Labetolol 200 mg PO BID', '- Esmolol dialed up at midnight, Labetolol IV boluses for hypertension', 'and tachycardia', '- Nifedepine CR 10 mg PO Q8 also added (cannot have Nifedipine CR 90 mg', 'from home med list b/c cannot be crushed; others not added yet, discuss', 'in AM)', '- K+ sliding scale']","['INVASIVE VENTILATION - STOP [**2129-2-6**] 04:45 PM', ' FEVER - 101.2', 'F - [**2129-2-6**] 12:00 PM', '- much more awake and responsive today, looking at us, no hand squeeze', 'though', '- sodium....', '- EEG...', '- extubated', '- OG tube placed, confirmed by CXR', '- Labetolol 200 mg PO BID', '- Esmolol dialed up at midnight, Labetolol IV boluses for hypertension', 'and tachycardia', '- Nifedepine CR 10 mg PO Q8 also added (cannot have Nifedipine CR 90 mg', 'from home med list b/c cannot be crushed; others not added yet, discuss', 'in AM)', '- K+ sliding scale']","['- BP labile yesterday and today, on Dig 0.125 and Esmolol, cannot wean', 'Esmolol or spikes HTN/rate. Responds well to Labetolol, rec', 'd 10 mg IVP', 'x 3 o/n', '- TPNs started yesterday, add Thi/Folate today', '- D5 past 2 nights for Na+ but now has BS, BMs, p', 'haps try some free', 'H2O PO', '- Will have had EEG 24 hours at noon', '- PEEP increased to [**5-9**]', '- Needs family meeting on Monday to discuss likely eventual trach', '- Na 148 --> restarted D5W for 1L, increased free water flushes with TF', 'and got UA to evaluate for Diabetes Insipidus']",48925,127507.0
45,2129-02-07 07:13:36,,"['INVASIVE VENTILATION - STOP [**2129-2-6**] 04:45 PM', ' FEVER - 101.2', 'F - [**2129-2-6**] 12:00 PM', '- much more awake and responsive today, looking at us, no hand squeeze', 'though', '- sodium....', '- EEG...', '- extubated', '- OG tube placed, confirmed by CXR', '- Labetolol 200 mg PO BID', '- Esmolol dialed up at midnight, Labetolol IV boluses for hypertension', 'and tachycardia', '- Nifedepine CR 10 mg PO Q8 also added (cannot have Nifedipine CR 90 mg', 'from home med list b/c cannot be crushed; others not added yet, discuss', 'in AM)', '- K+ sliding scale']",,48925,127507.0
46,2129-02-07 15:30:34,,"['INVASIVE VENTILATION - STOP [**2129-2-6**] 04:45 PM', ' FEVER - 101.2', 'F - [**2129-2-6**] 12:00 PM', '- much more awake and responsive today, looking at us, no hand squeeze', 'though', '- sodium....', '- EEG...', '- extubated', '- OG tube placed, confirmed by CXR', '- Labetolol 200 mg PO BID', '- Esmolol dialed up at midnight, Labetolol IV boluses for hypertension', 'and tachycardia', '- Nifedepine CR 10 mg PO Q8 also added (cannot have Nifedipine CR 90 mg', 'from home med list b/c cannot be crushed; others not added yet, discuss', 'in AM)', '- K+ sliding scale']",,48925,127507.0
47,2129-02-08 07:13:08,"['ULTRASOUND - At [**2129-2-7**] 01:52 PM', ' BLOOD CULTURED - At [**2129-2-7**] 01:52 PM', ' URINE CULTURE - At [**2129-2-7**] 01:52 PM', '- Peripheral smear/haptoglobin sent for steady Hct downward drift:', 'haptoglobin high; smear pending', ""- LFT's normal"", '- LENIs revealed DVT. Started on heparin gtt (no bolus), with neurosurg', 'approval. Should stop heparin gtt immediately if any new neuro findings', 'on exam', '- Dobhoff will be placed in AM', '- vanco increased to 1 gram Q24', '- Increased standing labetalol to 400 mg PO/NG TID', '- Gave labetalol IV boluses for tachycardia/hypertension, with varying', 'success', ""- D/c'd nifedipine immediate release; can cause variety of cardiac"", 'adverse events', '- Added glargine for long-acting coverage to start with breakfast', 'tomorrow']","['ULTRASOUND - At [**2129-2-7**] 01:52 PM', ' BLOOD CULTURED - At [**2129-2-7**] 01:52 PM', ' URINE CULTURE - At [**2129-2-7**] 01:52 PM', '- Peripheral smear/haptoglobin sent for steady Hct downward drift:', 'haptoglobin high; smear pending', ""- LFT's normal"", '- LENIs revealed DVT. Started on heparin gtt (no bolus), with neurosurg', 'approval. Should stop heparin gtt immediately if any new neuro findings', 'on exam', '- Dobhoff will be placed in AM', '- vanco increased to 1 gram Q24', '- Increased standing labetalol to 400 mg PO/NG TID', '- Gave labetalol IV boluses for tachycardia/hypertension, with varying', 'success', ""- D/c'd nifedipine immediate release; can cause variety of cardiac"", 'adverse events', '- Added glargine for long-acting coverage to start with breakfast', 'tomorrow']","['INVASIVE VENTILATION - STOP [**2129-2-6**] 04:45 PM', ' FEVER - 101.2', 'F - [**2129-2-6**] 12:00 PM', '- much more awake and responsive today, looking at us, no hand squeeze', 'though', '- sodium....', '- EEG...', '- extubated', '- OG tube placed, confirmed by CXR', '- Labetolol 200 mg PO BID', '- Esmolol dialed up at midnight, Labetolol IV boluses for hypertension', 'and tachycardia', '- Nifedepine CR 10 mg PO Q8 also added (cannot have Nifedipine CR 90 mg', 'from home med list b/c cannot be crushed; others not added yet, discuss', 'in AM)', '- K+ sliding scale']",48925,127507.0
48,2129-02-08 12:00:07,,"['ULTRASOUND - At [**2129-2-7**] 01:52 PM', ' BLOOD CULTURED - At [**2129-2-7**] 01:52 PM', ' URINE CULTURE - At [**2129-2-7**] 01:52 PM', '- Peripheral smear/haptoglobin sent for steady Hct downward drift:', 'haptoglobin high; smear pending', ""- LFT's normal"", '- LENIs revealed DVT. Started on heparin gtt (no bolus), with neurosurg', 'approval. Should stop heparin gtt immediately if any new neuro findings', 'on exam', '- Dobhoff will be placed in AM', '- vanco increased to 1 gram Q24', '- Increased standing labetalol to 400 mg PO/NG TID', '- Gave labetalol IV boluses for tachycardia/hypertension, with varying', 'success', ""- D/c'd nifedipine immediate release; can cause variety of cardiac"", 'adverse events', '- Added glargine for long-acting coverage to start with breakfast', 'tomorrow']",,48925,127507.0
49,2129-02-08 15:54:09,,"['ULTRASOUND - At [**2129-2-7**] 01:52 PM', ' BLOOD CULTURED - At [**2129-2-7**] 01:52 PM', ' URINE CULTURE - At [**2129-2-7**] 01:52 PM', '- Peripheral smear/haptoglobin sent for steady Hct downward drift:', 'haptoglobin high; smear pending', ""- LFT's normal"", '- LENIs revealed DVT. Started on heparin gtt (no bolus), with neurosurg', 'approval. Should stop heparin gtt immediately if any new neuro findings', 'on exam', '- Dobhoff will be placed in AM', '- vanco increased to 1 gram Q24', '- Increased standing labetalol to 400 mg PO/NG TID', '- Gave labetalol IV boluses for tachycardia/hypertension, with varying', 'success', ""- D/c'd nifedipine immediate release; can cause variety of cardiac"", 'adverse events', '- Added glargine for long-acting coverage to start with breakfast', 'tomorrow']",,48925,127507.0
50,2129-02-09 06:12:17,"['EKG - At [**2129-2-8**] 11:58 AM', ' MULTI LUMEN - STOP [**2129-2-8**] 03:58 PM', ' PICC LINE - START [**2129-2-8**] 04:11 PM', '- ABGs alkalotic, CT head for ?AMS - dictation: No new intracranial', 'hemorrhage, redemonstration of bilateral frontal lobe hypodensities', 'R>L, no midline shift or gyrus/sulci configuration change, no new', 'infarcts, left temporal bone fx (old), evolving frontal contusion', '- EP recommending holding on Sotalol (risk for throwing thrombus with', 'reversed INR and possible converting back to sinus on Sotalol).', 'Discontinue digoxin given small LV (worse not better effect). Repeat', 'ECHO given ?change in quality of pericardial effusion (blood?).', '- upped Labetolol from 400->600 TID', '- Wincing with left elbow/forearm mvmt - XRay: no acute fracture', '- EEG showed slow encephalopathic background throughout (meds vs.', 'metabolic disturbances vs. infxn)', '- Lipase 100, stopped tube feeds (bowel rest) and started IV Dilaudid', 'PRN pain']","['EKG - At [**2129-2-8**] 11:58 AM', ' MULTI LUMEN - STOP [**2129-2-8**] 03:58 PM', ' PICC LINE - START [**2129-2-8**] 04:11 PM', '- ABGs alkalotic, CT head for ?AMS - dictation: No new intracranial', 'hemorrhage, redemonstration of bilateral frontal lobe hypodensities', 'R>L, no midline shift or gyrus/sulci configuration change, no new', 'infarcts, left temporal bone fx (old), evolving frontal contusion', '- EP recommending holding on Sotalol (risk for throwing thrombus with', 'reversed INR and possible converting back to sinus on Sotalol).', 'Discontinue digoxin given small LV (worse not better effect). Repeat', 'ECHO given ?change in quality of pericardial effusion (blood?).', '- upped Labetolol from 400->600 TID', '- Wincing with left elbow/forearm mvmt - XRay: no acute fracture', '- EEG showed slow encephalopathic background throughout (meds vs.', 'metabolic disturbances vs. infxn)', '- Lipase 100, stopped tube feeds (bowel rest) and started IV Dilaudid', 'PRN pain']","['ULTRASOUND - At [**2129-2-7**] 01:52 PM', ' BLOOD CULTURED - At [**2129-2-7**] 01:52 PM', ' URINE CULTURE - At [**2129-2-7**] 01:52 PM', '- Peripheral smear/haptoglobin sent for steady Hct downward drift:', 'haptoglobin high; smear pending', ""- LFT's normal"", '- LENIs revealed DVT. Started on heparin gtt (no bolus), with neurosurg', 'approval. Should stop heparin gtt immediately if any new neuro findings', 'on exam', '- Dobhoff will be placed in AM', '- vanco increased to 1 gram Q24', '- Increased standing labetalol to 400 mg PO/NG TID', '- Gave labetalol IV boluses for tachycardia/hypertension, with varying', 'success', ""- D/c'd nifedipine immediate release; can cause variety of cardiac"", 'adverse events', '- Added glargine for long-acting coverage to start with breakfast', 'tomorrow']",48925,127507.0
51,2129-02-09 06:28:21,,"['EKG - At [**2129-2-8**] 11:58 AM', ' MULTI LUMEN - STOP [**2129-2-8**] 03:58 PM', ' PICC LINE - START [**2129-2-8**] 04:11 PM', '- ABGs alkalotic, CT head for ?AMS - dictation: No new intracranial', 'hemorrhage, redemonstration of bilateral frontal lobe hypodensities', 'R>L, no midline shift or gyrus/sulci configuration change, no new', 'infarcts, left temporal bone fx (old), evolving frontal contusion', '- EP recommending holding on Sotalol (risk for throwing thrombus with', 'reversed INR and possible converting back to sinus on Sotalol).', 'Discontinue digoxin given small LV (worse not better effect). Repeat', 'ECHO given ?change in quality of pericardial effusion (blood?).', '- upped Labetolol from 400->600 TID', '- Wincing with left elbow/forearm mvmt - XRay: no acute fracture', '- EEG showed slow encephalopathic background throughout (meds vs.', 'metabolic disturbances vs. infxn)', '- Lipase 100, stopped tube feeds (bowel rest) and started IV Dilaudid', 'PRN pain']",,48925,127507.0
52,2129-02-09 12:09:01,['- upped Labetolol from 400->800 TID'],"['EKG - At [**2129-2-8**] 11:58 AM', ' MULTI LUMEN - STOP [**2129-2-8**] 03:58 PM', ' PICC LINE - START [**2129-2-8**] 04:11 PM', '- ABGs alkalotic, CT head for ?AMS - dictation: No new intracranial', 'hemorrhage, redemonstration of bilateral frontal lobe hypodensities', 'R>L, no midline shift or gyrus/sulci configuration change, no new', 'infarcts, left temporal bone fx (old), evolving frontal contusion', '- EP recommending holding on Sotalol (risk for throwing thrombus with', 'reversed INR and possible converting back to sinus on Sotalol).', 'Discontinue digoxin given small LV (worse not better effect). Repeat', 'ECHO given ?change in quality of pericardial effusion (blood?).', '- upped Labetolol from 400->800 TID', '- Wincing with left elbow/forearm mvmt - XRay: no acute fracture', '- EEG showed slow encephalopathic background throughout (meds vs.', 'metabolic disturbances vs. infxn)', '- Lipase 100, stopped tube feeds (bowel rest) and started IV Dilaudid', 'PRN pain']",['- upped Labetolol from 400->600 TID'],48925,127507.0
53,2129-02-10 07:44:25,"['EKG - At [**2129-2-9**] 05:00 PM', ' FEVER - 102.0', 'F - [**2129-2-9**] 06:00 PM: Urine and blood cultured', '- Tap elbow with 75K WBC with NEG birefringent crystals --> Gout,', 'started pred 60mg x3d', '- Ortho following but not active now', ""- Rec'd Labetolol 20 mg for hypertension at 0230 and again at 0630"", 'switched back to Labetalol 800mg TID today from metoprolol']","['EKG - At [**2129-2-9**] 05:00 PM', ' FEVER - 102.0', 'F - [**2129-2-9**] 06:00 PM: Urine and blood cultured', '- Tap elbow with 75K WBC with NEG birefringent crystals --> Gout,', 'started pred 60mg x3d', '- Ortho following but not active now', ""- Rec'd Labetolol 20 mg for hypertension at 0230 and again at 0630"", 'switched back to Labetalol 800mg TID today from metoprolol']","['EKG - At [**2129-2-8**] 11:58 AM', ' MULTI LUMEN - STOP [**2129-2-8**] 03:58 PM', ' PICC LINE - START [**2129-2-8**] 04:11 PM', '- ABGs alkalotic, CT head for ?AMS - dictation: No new intracranial', 'hemorrhage, redemonstration of bilateral frontal lobe hypodensities', 'R>L, no midline shift or gyrus/sulci configuration change, no new', 'infarcts, left temporal bone fx (old), evolving frontal contusion', '- EP recommending holding on Sotalol (risk for throwing thrombus with', 'reversed INR and possible converting back to sinus on Sotalol).', 'Discontinue digoxin given small LV (worse not better effect). Repeat', 'ECHO given ?change in quality of pericardial effusion (blood?).', '- upped Labetolol from 400->800 TID', '- Wincing with left elbow/forearm mvmt - XRay: no acute fracture', '- EEG showed slow encephalopathic background throughout (meds vs.', 'metabolic disturbances vs. infxn)', '- Lipase 100, stopped tube feeds (bowel rest) and started IV Dilaudid', 'PRN pain']",48925,127507.0
54,2129-02-10 07:46:38,,"['EKG - At [**2129-2-9**] 05:00 PM', ' FEVER - 102.0', 'F - [**2129-2-9**] 06:00 PM: Urine and blood cultured', '- Tap elbow with 75K WBC with NEG birefringent crystals --> Gout,', 'started pred 60mg x3d', '- Ortho following but not active now', ""- Rec'd Labetolol 20 mg for hypertension at 0230 and again at 0630"", 'switched back to Labetalol 800mg TID today from metoprolol']",,48925,127507.0
55,2129-02-10 14:29:20,,"['EKG - At [**2129-2-9**] 05:00 PM', ' FEVER - 102.0', 'F - [**2129-2-9**] 06:00 PM: Urine and blood cultured', '- Tap elbow with 75K WBC with NEG birefringent crystals --> Gout,', 'started pred 60mg x3d', '- Ortho following but not active now', ""- Rec'd Labetolol 20 mg for hypertension at 0230 and again at 0630"", 'switched back to Labetalol 800mg TID today from metoprolol']",,48925,127507.0
0,2158-01-23 08:10:56,,"['BRONCHOSCOPY - At [**2158-1-22**] 03:00 PM', ""- IP attempted to place pigtail, got some fluid but couldn't place"", 'catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement tomorrow,', 'down the road may consider VATS. No PTX on CXR.', '- bronch showed large amt clear secretions', '- urine remained low, urine lytes showed UNA<10, osm 770, consistent', 'with intravascular depletion. CVP fluctuating so unsure of validity,', 'but [**6-26**] in PM. Pt received 1L boluses x 3 with only minimal urine', 'output response (100-200cc per 1L).', '- marginal BPs overnight 80-90s, with stable but borderline urine', 'output, sent for repeat urine lytes in AM to help assess volume status', 'History obtained from Medical records']",,57615,127312.0
1,2158-01-23 08:16:22,"['catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement, down the', 'road may consider VATS. No PTX on CXR.']","['BRONCHOSCOPY - At [**2158-1-22**] 03:00 PM', ""- IP attempted to place pigtail, got some fluid but couldn't place"", 'catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement, down the', 'road may consider VATS. No PTX on CXR.', '- bronch showed large amt clear secretions', '- urine remained low, urine lytes showed UNA<10, osm 770, consistent', 'with intravascular depletion. CVP fluctuating so unsure of validity,', 'but [**6-26**] in PM. Pt received 1L boluses x 3 with only minimal urine', 'output response (100-200cc per 1L).', '- marginal BPs overnight 80-90s, with stable but borderline urine', 'output, sent for repeat urine lytes in AM to help assess volume status', 'History obtained from Medical records']","['catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement tomorrow,', 'down the road may consider VATS. No PTX on CXR.']",57615,127312.0
2,2158-01-23 16:22:15,,"['BRONCHOSCOPY - At [**2158-1-22**] 03:00 PM', ""- IP attempted to place pigtail, got some fluid but couldn't place"", 'catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement, down the', 'road may consider VATS. No PTX on CXR.', '- bronch showed large amt clear secretions', '- urine remained low, urine lytes showed UNA<10, osm 770, consistent', 'with intravascular depletion. CVP fluctuating so unsure of validity,', 'but [**6-26**] in PM. Pt received 1L boluses x 3 with only minimal urine', 'output response (100-200cc per 1L).', '- marginal BPs overnight 80-90s, with stable but borderline urine', 'output, sent for repeat urine lytes in AM to help assess volume status', 'History obtained from Medical records']",,57615,127312.0
3,2158-01-24 07:23:18,"['TRANSTHORACIC ECHO - At [**2158-1-23**] 08:45 AM', ' THORACENTESIS - At [**2158-1-23**] 01:41 PM']","['TRANSTHORACIC ECHO - At [**2158-1-23**] 08:45 AM', ' THORACENTESIS - At [**2158-1-23**] 01:41 PM']","['BRONCHOSCOPY - At [**2158-1-22**] 03:00 PM', ""- IP attempted to place pigtail, got some fluid but couldn't place"", 'catheter. Plan is CT-guided [**Female First Name (un) **] and pigtail drain placement, down the', 'road may consider VATS. No PTX on CXR.', '- bronch showed large amt clear secretions', '- urine remained low, urine lytes showed UNA<10, osm 770, consistent', 'with intravascular depletion. CVP fluctuating so unsure of validity,', 'but [**6-26**] in PM. Pt received 1L boluses x 3 with only minimal urine', 'output response (100-200cc per 1L).', '- marginal BPs overnight 80-90s, with stable but borderline urine', 'output, sent for repeat urine lytes in AM to help assess volume status', 'History obtained from Medical records']",57615,127312.0
4,2158-01-24 11:55:49,,"['TRANSTHORACIC ECHO - At [**2158-1-23**] 08:45 AM', ' THORACENTESIS - At [**2158-1-23**] 01:41 PM']",,57615,127312.0
5,2158-01-25 07:43:28,['EKG - At [**2158-1-24**] 11:23 PM'],['EKG - At [**2158-1-24**] 11:23 PM'],"['TRANSTHORACIC ECHO - At [**2158-1-23**] 08:45 AM', ' THORACENTESIS - At [**2158-1-23**] 01:41 PM']",57615,127312.0
6,2158-01-25 14:40:15,,['EKG - At [**2158-1-24**] 11:23 PM'],,57615,127312.0
7,2158-01-26 07:43:49,"['- AF with RVR, poorly rate controlled (150-160s) on dilt drip', '- bolused amio and started drip, still not rate controlled, re-bolused', 'amio 150 mg --> rate 140-150s with BP 70/50 (MAP 60)', '- EP curbside rec DC cardioversion and continuing amiodarone to', 'maintain sinus afterwards, held off until AM and rates stayed 120-130s', 'with decent MAPs', '- received 500cc NS and 1 U PRBC to keep up pressures (Hct 26 to 23)', '- fam mtg: would not want trach or CPR, pressors OK, will continue to', 'attempt optimization for [**2-22**] d then extubate', '- cont on Zosyn for enterococcus UTI (day 7/10-14d course)', '- neuromusc attg consulted --> rec MRI C, T spine to evaluate cord', 'compression in setting of recent compression fractures, EMG to r/o ALS', 'only if patient stable for transport since will not affect outcome', 'History obtained from [**Hospital 19**] Medical records']","['- AF with RVR, poorly rate controlled (150-160s) on dilt drip', '- bolused amio and started drip, still not rate controlled, re-bolused', 'amio 150 mg --> rate 140-150s with BP 70/50 (MAP 60)', '- EP curbside rec DC cardioversion and continuing amiodarone to', 'maintain sinus afterwards, held off until AM and rates stayed 120-130s', 'with decent MAPs', '- received 500cc NS and 1 U PRBC to keep up pressures (Hct 26 to 23)', '- fam mtg: would not want trach or CPR, pressors OK, will continue to', 'attempt optimization for [**2-22**] d then extubate', '- cont on Zosyn for enterococcus UTI (day 7/10-14d course)', '- neuromusc attg consulted --> rec MRI C, T spine to evaluate cord', 'compression in setting of recent compression fractures, EMG to r/o ALS', 'only if patient stable for transport since will not affect outcome', 'History obtained from [**Hospital 19**] Medical records']",['EKG - At [**2158-1-24**] 11:23 PM'],57615,127312.0
8,2158-01-26 07:48:35,,"['- AF with RVR, poorly rate controlled (150-160s) on dilt drip', '- bolused amio and started drip, still not rate controlled, re-bolused', 'amio 150 mg --> rate 140-150s with BP 70/50 (MAP 60)', '- EP curbside rec DC cardioversion and continuing amiodarone to', 'maintain sinus afterwards, held off until AM and rates stayed 120-130s', 'with decent MAPs', '- received 500cc NS and 1 U PRBC to keep up pressures (Hct 26 to 23)', '- fam mtg: would not want trach or CPR, pressors OK, will continue to', 'attempt optimization for [**2-22**] d then extubate', '- cont on Zosyn for enterococcus UTI (day 7/10-14d course)', '- neuromusc attg consulted --> rec MRI C, T spine to evaluate cord', 'compression in setting of recent compression fractures, EMG to r/o ALS', 'only if patient stable for transport since will not affect outcome', 'History obtained from [**Hospital 19**] Medical records']",,57615,127312.0
9,2158-01-26 15:00:16,,"['- AF with RVR, poorly rate controlled (150-160s) on dilt drip', '- bolused amio and started drip, still not rate controlled, re-bolused', 'amio 150 mg --> rate 140-150s with BP 70/50 (MAP 60)', '- EP curbside rec DC cardioversion and continuing amiodarone to', 'maintain sinus afterwards, held off until AM and rates stayed 120-130s', 'with decent MAPs', '- received 500cc NS and 1 U PRBC to keep up pressures (Hct 26 to 23)', '- fam mtg: would not want trach or CPR, pressors OK, will continue to', 'attempt optimization for [**2-22**] d then extubate', '- cont on Zosyn for enterococcus UTI (day 7/10-14d course)', '- neuromusc attg consulted --> rec MRI C, T spine to evaluate cord', 'compression in setting of recent compression fractures, EMG to r/o ALS', 'only if patient stable for transport since will not affect outcome', 'History obtained from [**Hospital 19**] Medical records']",,57615,127312.0
10,2158-01-27 07:26:11,,[],"['- AF with RVR, poorly rate controlled (150-160s) on dilt drip', '- bolused amio and started drip, still not rate controlled, re-bolused', 'amio 150 mg --> rate 140-150s with BP 70/50 (MAP 60)', '- EP curbside rec DC cardioversion and continuing amiodarone to', 'maintain sinus afterwards, held off until AM and rates stayed 120-130s', 'with decent MAPs', '- received 500cc NS and 1 U PRBC to keep up pressures (Hct 26 to 23)', '- fam mtg: would not want trach or CPR, pressors OK, will continue to', 'attempt optimization for [**2-22**] d then extubate', '- cont on Zosyn for enterococcus UTI (day 7/10-14d course)', '- neuromusc attg consulted --> rec MRI C, T spine to evaluate cord', 'compression in setting of recent compression fractures, EMG to r/o ALS', 'only if patient stable for transport since will not affect outcome', 'History obtained from [**Hospital 19**] Medical records']",57615,127312.0
11,2158-01-27 13:20:56,,[],,57615,127312.0
0,2110-05-02 07:38:11,,"['ENDOSCOPY - At [**2110-5-1**] 12:00 PM', 'patient has diagnostic scoping done', 'EGD-  At the initial portion of the efferent limb was blood and a 2.5', 'cm linear ulcer in the setting of irregular, heaped up mucosa. This', 'occupied an approximately 6 cm area. The 10 cm of efferent limb distal', 'to this was normal. (biopsy)', 'Otherwise normal EGD to approximately 10 cm into the afferent and', 'efferent limbs']",,31969,151726.0
1,2110-05-02 12:25:35,,"['ENDOSCOPY - At [**2110-5-1**] 12:00 PM', 'patient has diagnostic scoping done', 'EGD-  At the initial portion of the efferent limb was blood and a 2.5', 'cm linear ulcer in the setting of irregular, heaped up mucosa. This', 'occupied an approximately 6 cm area. The 10 cm of efferent limb distal', 'to this was normal. (biopsy)', 'Otherwise normal EGD to approximately 10 cm into the afferent and', 'efferent limbs']",,31969,151726.0
2,2110-05-03 07:48:32,['nothing'],['nothing'],"['ENDOSCOPY - At [**2110-5-1**] 12:00 PM', 'patient has diagnostic scoping done', 'EGD-  At the initial portion of the efferent limb was blood and a 2.5', 'cm linear ulcer in the setting of irregular, heaped up mucosa. This', 'occupied an approximately 6 cm area. The 10 cm of efferent limb distal', 'to this was normal. (biopsy)', 'Otherwise normal EGD to approximately 10 cm into the afferent and', 'efferent limbs']",31969,151726.0
3,2110-05-03 11:20:16,,['nothing'],,31969,151726.0
0,2197-02-24 06:04:24,,[],,42683,192931.0
1,2197-02-24 06:13:27,,[],,42683,192931.0
0,2151-04-23 05:40:37,,['No events'],,47733,175486.0
1,2151-04-23 05:41:40,,['No events'],,47733,175486.0
0,2142-09-04 06:06:52,,"['MRI done', 'CTA done']",,19412,120014.0
1,2142-09-04 06:20:28,,[],"['MRI done', 'CTA done']",19412,120014.0
2,2142-09-04 06:45:25,['None'],['None'],,19412,120014.0
3,2142-09-04 07:43:41,,['None'],,19412,120014.0
4,2142-09-04 08:52:35,,['None'],,19412,120014.0
5,2142-09-05 07:09:58,"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']","['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",['None'],19412,120014.0
6,2142-09-05 07:41:17,,"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",,19412,120014.0
7,2142-09-05 09:50:21,,"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",,19412,120014.0
8,2142-09-05 09:56:14,['None'],['None'],"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",19412,120014.0
9,2142-09-05 10:00:25,"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']","['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",['None'],19412,120014.0
10,2142-09-05 10:07:07,['None'],['None'],"['- Lower Extremity: Nl left femoral/popliteal. Severe left tibial', 'disease. Greater in (100mmhg drop) dorsalis pedis than (16mmhg drop)']",19412,120014.0
11,2142-09-06 07:04:19,"['-Hct at [**2133**]: 26.1- no transfusions.', '- Talked to dental, who thought his Panorex films looked fine and', 'doubted that the endocarditis was caused by a dentist', ""- CT recs pending (NP came by, didn't know about date of surgery)"", '- ID recs- surgery within 15 days of presentation', ""- Changed metoprolol to 50 mg [**Hospital1 **] today.. BP's low again overnight"", ""(80's/40's) while sleeping, HR's in the 80's.""]","['-Hct at [**2133**]: 26.1- no transfusions.', '- Talked to dental, who thought his Panorex films looked fine and', 'doubted that the endocarditis was caused by a dentist', ""- CT recs pending (NP came by, didn't know about date of surgery)"", '- ID recs- surgery within 15 days of presentation', ""- Changed metoprolol to 50 mg [**Hospital1 **] today.. BP's low again overnight"", ""(80's/40's) while sleeping, HR's in the 80's.""]",['None'],19412,120014.0
12,2142-09-06 07:31:41,,"['- Talked to dental, who thought his Panorex films looked fine and', 'doubted that the endocarditis was caused by a dentist', ""- CT recs pending (NP came by, didn't know about date of surgery)"", '- ID recs- surgery within 15 days of presentation', ""- Changed metoprolol to 50 mg [**Hospital1 **] today.. BP's low again overnight"", ""(80's/40's) while sleeping, HR's in the 80's.""]",['-Hct at [**2133**]: 26.1- no transfusions.'],19412,120014.0
13,2142-09-06 08:55:25,,"['- Talked to dental, who thought his Panorex films looked fine and', 'doubted that the endocarditis was caused by a dentist', ""- CT recs pending (NP came by, didn't know about date of surgery)"", '- ID recs- surgery within 15 days of presentation', ""- Changed metoprolol to 50 mg [**Hospital1 **] today.. BP's low again overnight"", ""(80's/40's) while sleeping, HR's in the 80's.""]",,19412,120014.0
14,2142-09-06 09:21:26,,,,19412,120014.0
15,2142-09-06 09:36:11,,,,19412,120014.0
16,2142-09-09 06:47:48,,,,19412,120014.0
0,2200-05-31 05:46:01,,['MULTI LUMEN - START [**2200-5-30**] 06:50 PM'],,20578,163540.0
1,2200-05-31 05:47:11,,['MULTI LUMEN - START [**2200-5-30**] 06:50 PM'],,20578,163540.0
2,2200-05-31 09:30:38,"['- Right IJ pulled out approximately 2 cm', '- remain hemodynamically stable, no acute events']","['- Right IJ pulled out approximately 2 cm', '- remain hemodynamically stable, no acute events']",['MULTI LUMEN - START [**2200-5-30**] 06:50 PM'],20578,163540.0
3,2200-05-31 09:40:16,,"['- Right IJ pulled out approximately 2 cm', '- remain hemodynamically stable, no acute events']",,20578,163540.0
4,2200-05-31 10:02:14,['- Right IJ pulled out approximately 2 cm based on RV placement on CXR'],"['- Right IJ pulled out approximately 2 cm based on RV placement on CXR', '- remain hemodynamically stable, no acute events']",['- Right IJ pulled out approximately 2 cm'],20578,163540.0
5,2200-05-31 11:15:37,,"['- Right IJ pulled out approximately 2 cm based on RV placement on CXR', '- remain hemodynamically stable, no acute events']",,20578,163540.0
0,2195-11-20 06:11:27,,"['Persistent sinus tachycardia all night. With adequate BP. Not', 'responding to fluid boluses. Maintiaing adequate uop. Hct stable.', 'Thought to be due to post op pain. Increased dilaudid pca to 0.25.']",,44817,133724.0
1,2195-11-20 11:05:53,,"['Persistent sinus tachycardia all night. With adequate BP. Not', 'responding to fluid boluses. Maintiaing adequate uop. Hct stable.', 'Thought to be due to post op pain. Increased dilaudid pca to 0.25.']",,44817,133724.0
2,2195-11-21 07:32:48,"['- OB wants to start TPN, put pt. in for PICC', '- afebrile, tachycardic-->likely related to pain/anxiety', '- on vanc/zosyn', '- f/u pain/anxiety control-->started toradol', ""- IVF for tachycardia-->titrating to UOP of 50cc's/hr, but pt had"", 'increasing oxygen requirement, so balancing fluid with O2 sats', '- Na increasing with IVF resuscitation, likely hypovolemic hyponatremia']","['- OB wants to start TPN, put pt. in for PICC', '- afebrile, tachycardic-->likely related to pain/anxiety', '- on vanc/zosyn', '- f/u pain/anxiety control-->started toradol', ""- IVF for tachycardia-->titrating to UOP of 50cc's/hr, but pt had"", 'increasing oxygen requirement, so balancing fluid with O2 sats', '- Na increasing with IVF resuscitation, likely hypovolemic hyponatremia']","['Persistent sinus tachycardia all night. With adequate BP. Not', 'responding to fluid boluses. Maintiaing adequate uop. Hct stable.', 'Thought to be due to post op pain. Increased dilaudid pca to 0.25.']",44817,133724.0
3,2195-11-21 11:33:13,,"['- OB wants to start TPN, put pt. in for PICC', '- afebrile, tachycardic-->likely related to pain/anxiety', '- on vanc/zosyn', '- f/u pain/anxiety control-->started toradol', ""- IVF for tachycardia-->titrating to UOP of 50cc's/hr, but pt had"", 'increasing oxygen requirement, so balancing fluid with O2 sats', '- Na increasing with IVF resuscitation, likely hypovolemic hyponatremia']",,44817,133724.0
4,2195-11-21 14:04:44,,"['- OB wants to start TPN, put pt. in for PICC', '- afebrile, tachycardic-->likely related to pain/anxiety', '- on vanc/zosyn', '- f/u pain/anxiety control-->started toradol', ""- IVF for tachycardia-->titrating to UOP of 50cc's/hr, but pt had"", 'increasing oxygen requirement, so balancing fluid with O2 sats', '- Na increasing with IVF resuscitation, likely hypovolemic hyponatremia']",,44817,133724.0
5,2195-11-22 06:52:39,"['PICC LINE - START [**2195-11-21**] 12:27 PM', '- POD#2, covered broadly w vanc/zosyn, WBC trending down, Bld Cx Neg to', 'date', '- dilaudid PCA and toradol, pt states pain controlled', '- NPO.  TPN per Ob/Gyn', '- Hct 20.8 this AM; transfuse 1u pRBCs', '- consider hemolysis labs if Hct keeps dropping', '- callout to gyn floor in evening if Hct stable', '- was having chest tightness around 2:30pm, lasting for a few minutes,', 'and palpitations; no changes in vital signs, denied SOB. No EKG', 'changes.  not likely cardiac, but cardiac enzymes sent for 2:30pm today']","['PICC LINE - START [**2195-11-21**] 12:27 PM', '- POD#2, covered broadly w vanc/zosyn, WBC trending down, Bld Cx Neg to', 'date', '- dilaudid PCA and toradol, pt states pain controlled', '- NPO.  TPN per Ob/Gyn', '- Hct 20.8 this AM; transfuse 1u pRBCs', '- consider hemolysis labs if Hct keeps dropping', '- callout to gyn floor in evening if Hct stable', '- was having chest tightness around 2:30pm, lasting for a few minutes,', 'and palpitations; no changes in vital signs, denied SOB. No EKG', 'changes.  not likely cardiac, but cardiac enzymes sent for 2:30pm today']","['- OB wants to start TPN, put pt. in for PICC', '- afebrile, tachycardic-->likely related to pain/anxiety', '- on vanc/zosyn', '- f/u pain/anxiety control-->started toradol', ""- IVF for tachycardia-->titrating to UOP of 50cc's/hr, but pt had"", 'increasing oxygen requirement, so balancing fluid with O2 sats', '- Na increasing with IVF resuscitation, likely hypovolemic hyponatremia']",44817,133724.0
6,2195-11-22 07:08:43,"['- POD#2 on [**11-21**] covered broadly w vanc/zosyn, WBC trending down, Bld', 'Cx Neg to date', '- NPO.  Starting TPN per Ob/Gyn', '- Hct 20.8 [**11-21**] AM; transfused 1u pRBCs']","['PICC LINE - START [**2195-11-21**] 12:27 PM', '- POD#2 on [**11-21**] covered broadly w vanc/zosyn, WBC trending down, Bld', 'Cx Neg to date', '- dilaudid PCA and toradol, pt states pain controlled', '- NPO.  Starting TPN per Ob/Gyn', '- Hct 20.8 [**11-21**] AM; transfused 1u pRBCs', '- consider hemolysis labs if Hct keeps dropping', '- callout to gyn floor in evening if Hct stable', '- was having chest tightness around 2:30pm, lasting for a few minutes,', 'and palpitations; no changes in vital signs, denied SOB. No EKG', 'changes.  not likely cardiac, but cardiac enzymes sent for 2:30pm today']","['- POD#2, covered broadly w vanc/zosyn, WBC trending down, Bld Cx Neg to', 'date', '- NPO.  TPN per Ob/Gyn', '- Hct 20.8 this AM; transfuse 1u pRBCs']",44817,133724.0
7,2195-11-22 11:46:18,,"['PICC LINE - START [**2195-11-21**] 12:27 PM', '- POD#2 on [**11-21**] covered broadly w vanc/zosyn, WBC trending down, Bld', 'Cx Neg to date', '- dilaudid PCA and toradol, pt states pain controlled', '- NPO.  Starting TPN per Ob/Gyn', '- Hct 20.8 [**11-21**] AM; transfused 1u pRBCs', '- callout to gyn floor in evening if Hct stable', '- was having chest tightness around 2:30pm, lasting for a few minutes,', 'and palpitations; no changes in vital signs, denied SOB. No EKG', 'changes.  not likely cardiac, but cardiac enzymes sent for 2:30pm today']",['- consider hemolysis labs if Hct keeps dropping'],44817,133724.0
0,2112-03-01 07:29:30,,"[""- CXR showed kinked pacer wire, patient's pacer does not capture when"", 'he moves his arm.', '- patient has junctional rhythm at low 40s, perfusing.  Pacer set at', 'DDI for 40 overnight, no pacer wire placed.', '- Received 2mg vitamin K to reverse Coumadin for EP procedure.']",,5954,183959.0
1,2112-03-01 10:07:36,,"[""- CXR showed kinked pacer wire, patient's pacer does not capture when"", 'he moves his arm.', '- patient has junctional rhythm at low 40s, perfusing.  Pacer set at', 'DDI for 40 overnight, no pacer wire placed.', '- Received 2mg vitamin K to reverse Coumadin for EP procedure.']",,5954,183959.0
2,2112-03-01 10:09:52,,"[""- CXR showed kinked pacer wire, patient's pacer does not capture when"", 'he moves his arm.', '- patient has junctional rhythm at low 40s, perfusing.  Pacer set at', 'DDI for 40 overnight, no pacer wire placed.', '- Received 2mg vitamin K to reverse Coumadin for EP procedure.']",,5954,183959.0
0,2173-10-02 06:12:57,,"['MULTI LUMEN - START [**2173-10-1**] 07:00 PM', ' ERCP - At [**2173-10-1**] 08:25 PM', ' INVASIVE VENTILATION - START [**2173-10-1**] 10:25 PM', ' ARTERIAL LINE - START [**2173-10-1**] 11:20 PM', '- ERCP done with sphincterotomy and stent placed.  Sludge and minimal', 'pus drained.', '- Remained intubated overnight due to sedation and low lung volumes']",,79280,146846.0
1,2173-10-02 08:37:41,,"['MULTI LUMEN - START [**2173-10-1**] 07:00 PM', ' ERCP - At [**2173-10-1**] 08:25 PM', ' INVASIVE VENTILATION - START [**2173-10-1**] 10:25 PM', ' ARTERIAL LINE - START [**2173-10-1**] 11:20 PM', '- ERCP done with sphincterotomy and stent placed.  Sludge and minimal', 'pus drained.', '- Remained intubated overnight due to sedation and low lung volumes']",,79280,146846.0
2,2173-10-03 06:33:39,"['ULTRASOUND - At [**2173-10-2**] 11:12 AM', 'looking for gallbladder sludge']","['ULTRASOUND - At [**2173-10-2**] 11:12 AM', 'looking for gallbladder sludge']","['MULTI LUMEN - START [**2173-10-1**] 07:00 PM', ' ERCP - At [**2173-10-1**] 08:25 PM', ' INVASIVE VENTILATION - START [**2173-10-1**] 10:25 PM', ' ARTERIAL LINE - START [**2173-10-1**] 11:20 PM', '- ERCP done with sphincterotomy and stent placed.  Sludge and minimal', 'pus drained.', '- Remained intubated overnight due to sedation and low lung volumes']",79280,146846.0
3,2173-10-03 06:36:39,"['- Held off extubation and/or transfer back to OSH', '- Final ERCP made available', '- Re-started on a B-blocker']","['ULTRASOUND - At [**2173-10-2**] 11:12 AM', 'looking for gallbladder sludge', '- Held off extubation and/or transfer back to OSH', '- Final ERCP made available', '- Re-started on a B-blocker']",,79280,146846.0
4,2173-10-03 11:02:56,,"['ULTRASOUND - At [**2173-10-2**] 11:12 AM', 'looking for gallbladder sludge', '- Held off extubation and/or transfer back to OSH', '- Final ERCP made available', '- Re-started on a B-blocker']",,79280,146846.0
5,2173-10-04 06:35:38,"['-Renal recs- Placed foley to monitor UOP. HD for tomorrow- holding', 'metoprolol prior to HD. Renally dosed zosyn', '- No ERCP recs', '-Slight guaiac +stool during day', '-Per renal- placed foley and plan for am HD- holding metoprolol prior', 'to HD', '-Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '(normal T bili, haptoglobin and LDH)', '-Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '(up from 169 [**10-2**])', '-Hct stable', '- Cx NGTD', '-Vanc level 26 this am. Consider dosing tomorrow with HD', '-Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and', ""somnolence with staff and pt's own family""]","['-Renal recs- Placed foley to monitor UOP. HD for tomorrow- holding', 'metoprolol prior to HD. Renally dosed zosyn', '- No ERCP recs', '-Slight guaiac +stool during day', '-Per renal- placed foley and plan for am HD- holding metoprolol prior', 'to HD', '-Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '(normal T bili, haptoglobin and LDH)', '-Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '(up from 169 [**10-2**])', '-Hct stable', '- Cx NGTD', '-Vanc level 26 this am. Consider dosing tomorrow with HD', '-Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and', ""somnolence with staff and pt's own family""]","['ULTRASOUND - At [**2173-10-2**] 11:12 AM', 'looking for gallbladder sludge', '- Held off extubation and/or transfer back to OSH', '- Final ERCP made available', '- Re-started on a B-blocker']",79280,146846.0
6,2173-10-04 07:22:54,"['- Renal recs- Placed foley to monitor UOP. HD for today - holding', '- Slight guaiac +stool during day', '- Per renal- placed foley and plan for am HD- holding metoprolol prior', '- Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '- Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '- Hct stable', '- Vanc level 24 this am. Consider dosing tomorrow with HD', '- Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and']","['- Renal recs- Placed foley to monitor UOP. HD for today - holding', 'metoprolol prior to HD. Renally dosed zosyn', '- No ERCP recs', '- Slight guaiac +stool during day', '- Per renal- placed foley and plan for am HD- holding metoprolol prior', 'to HD', '- Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '(normal T bili, haptoglobin and LDH)', '- Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '(up from 169 [**10-2**])', '- Hct stable', '- Cx NGTD', '- Vanc level 24 this am. Consider dosing tomorrow with HD', '- Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and', ""somnolence with staff and pt's own family""]","['-Renal recs- Placed foley to monitor UOP. HD for tomorrow- holding', '-Slight guaiac +stool during day', '-Per renal- placed foley and plan for am HD- holding metoprolol prior', '-Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '-Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '-Hct stable', '-Vanc level 26 this am. Consider dosing tomorrow with HD', '-Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and']",79280,146846.0
7,2173-10-04 16:47:10,,"['- Renal recs- Placed foley to monitor UOP. HD for today - holding', 'metoprolol prior to HD. Renally dosed zosyn', '- No ERCP recs', '- Slight guaiac +stool during day', '- Per renal- placed foley and plan for am HD- holding metoprolol prior', 'to HD', '- Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '(normal T bili, haptoglobin and LDH)', '- Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '(up from 169 [**10-2**])', '- Hct stable', '- Cx NGTD', '- Vanc level 24 this am. Consider dosing tomorrow with HD', '- Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and', ""somnolence with staff and pt's own family""]",,79280,146846.0
8,2173-10-05 06:15:56,,[],"['- Renal recs- Placed foley to monitor UOP. HD for today - holding', 'metoprolol prior to HD. Renally dosed zosyn', '- No ERCP recs', '- Slight guaiac +stool during day', '- Per renal- placed foley and plan for am HD- holding metoprolol prior', 'to HD', '- Iron studies showed ACD. Retic count 4.1. Hemolysis labs negative', '(normal T bili, haptoglobin and LDH)', '- Pancreatic enzymes elevated at [**Doctor First Name 92**]: 348 (up from 128 [**10-1**]) Lip: 476', '(up from 169 [**10-2**])', '- Hct stable', '- Cx NGTD', '- Vanc level 24 this am. Consider dosing tomorrow with HD', '- Pt on CPAP- PS 12, PEEP 5- unable to extubate [**12-19**] incr secretions and', ""somnolence with staff and pt's own family""]",79280,146846.0
9,2173-10-05 06:19:46,,[],,79280,146846.0
10,2173-10-05 06:58:41,"['- Did not dose Vanc as trough after dialysis was 19 (redose at 15', 'usually). Recheck in AM.', '- repeat UA with >1000 RBC and WBC.', '- Did not attempt extubation as patient had no cuff leak.', '- Given Solumedrol and check again late afternoon but only small cuff', 'leak.']","['- Did not dose Vanc as trough after dialysis was 19 (redose at 15', 'usually). Recheck in AM.', '- repeat UA with >1000 RBC and WBC.', '- Did not attempt extubation as patient had no cuff leak.', '- Given Solumedrol and check again late afternoon but only small cuff', 'leak.']",,79280,146846.0
11,2173-10-05 19:29:45,,"['- Did not dose Vanc as trough after dialysis was 19 (redose at 15', 'usually). Recheck in AM.', '- repeat UA with >1000 RBC and WBC.', '- Did not attempt extubation as patient had no cuff leak.', '- Given Solumedrol and check again late afternoon but only small cuff', 'leak.']",,79280,146846.0
12,2173-10-06 07:23:51,"['INVASIVE VENTILATION - STOP [**2173-10-5**] 12:01 PM', '- Pt extubated in AM without complication', ""- D/C'd Heparin for Pneumoboots"", ""- D/C'd Pneumoboots"", '- Spoke to Dr.[**First Name (STitle) **] at [**Hospital1 183**]. Hospitalists are changing as of the', 'morning. Did not want to sign out new pt to hospitalist. Prefers we', 'keep pt here.']","['INVASIVE VENTILATION - STOP [**2173-10-5**] 12:01 PM', '- Pt extubated in AM without complication', ""- D/C'd Heparin for Pneumoboots"", ""- D/C'd Pneumoboots"", '- Spoke to Dr.[**First Name (STitle) **] at [**Hospital1 183**]. Hospitalists are changing as of the', 'morning. Did not want to sign out new pt to hospitalist. Prefers we', 'keep pt here.']","['- Did not dose Vanc as trough after dialysis was 19 (redose at 15', 'usually). Recheck in AM.', '- repeat UA with >1000 RBC and WBC.', '- Did not attempt extubation as patient had no cuff leak.', '- Given Solumedrol and check again late afternoon but only small cuff', 'leak.']",79280,146846.0
13,2173-10-06 18:07:00,,"['INVASIVE VENTILATION - STOP [**2173-10-5**] 12:01 PM', '- Pt extubated in AM without complication', ""- D/C'd Heparin for Pneumoboots"", ""- D/C'd Pneumoboots"", '- Spoke to Dr.[**First Name (STitle) **] at [**Hospital1 183**]. Hospitalists are changing as of the', 'morning. Did not want to sign out new pt to hospitalist. Prefers we', 'keep pt here.']",,79280,146846.0
0,2193-11-06 06:53:35,,"['MULTI LUMEN - START [**2193-11-5**] 07:00 PM', 'inserted  in OSH', ' EKG - At [**2193-11-5**] 08:30 PM', ' EKG - At [**2193-11-5**] 11:45 PM']",,70944,157798.0
1,2193-11-06 10:34:16,"['-Seen by plastic surgery overnight, who felt that wound could be', 'managed conservatively. Recommended consulting general surgery if', 'patient decompensated.', '-Radiology attempted LENI of LLE yesterday without success [**1-21**] to', 'patient', 's body habitus.']","['MULTI LUMEN - START [**2193-11-5**] 07:00 PM', 'inserted  in OSH', ' EKG - At [**2193-11-5**] 08:30 PM', ' EKG - At [**2193-11-5**] 11:45 PM', '-Seen by plastic surgery overnight, who felt that wound could be', 'managed conservatively. Recommended consulting general surgery if', 'patient decompensated.', '-Radiology attempted LENI of LLE yesterday without success [**1-21**] to', 'patient', 's body habitus.']",,70944,157798.0
2,2193-11-07 07:06:43,"['-Gen [**Doctor First Name **] says nothin to do since pt refuses anesthesia & any', 'debridement of ulcers in OR', '-checkin vanc trough at 1830 today prior to dose at [**2183**] as per pharm', '-off dopamine', '-IV team says cant place PICC today d/t elevated WBC']","['-Gen [**Doctor First Name **] says nothin to do since pt refuses anesthesia & any', 'debridement of ulcers in OR', '-checkin vanc trough at 1830 today prior to dose at [**2183**] as per pharm', '-off dopamine', '-IV team says cant place PICC today d/t elevated WBC']","['MULTI LUMEN - START [**2193-11-5**] 07:00 PM', 'inserted  in OSH', ' EKG - At [**2193-11-5**] 08:30 PM', ' EKG - At [**2193-11-5**] 11:45 PM', '-Seen by plastic surgery overnight, who felt that wound could be', 'managed conservatively. Recommended consulting general surgery if', 'patient decompensated.', '-Radiology attempted LENI of LLE yesterday without success [**1-21**] to', 'patient', 's body habitus.']",70944,157798.0
3,2193-11-07 07:07:03,,"['-Gen [**Doctor First Name **] says nothin to do since pt refuses anesthesia & any', 'debridement of ulcers in OR', '-checkin vanc trough at 1830 today prior to dose at [**2183**] as per pharm', '-off dopamine', '-IV team says cant place PICC today d/t elevated WBC']",,70944,157798.0
4,2193-11-07 22:14:43,"['-Gen [**Doctor First Name **] recommended conservative management for now as the pt.', 'refuses anesthesia & any debridement of ulcers in OR', '-The patient is currently off pressors and maintaining good BPs.', 'This AM, she states that her pain is under control.  Denies SOB.']","['-Gen [**Doctor First Name **] recommended conservative management for now as the pt.', 'refuses anesthesia & any debridement of ulcers in OR', '-The patient is currently off pressors and maintaining good BPs.', 'This AM, she states that her pain is under control.  Denies SOB.']","['-Gen [**Doctor First Name **] says nothin to do since pt refuses anesthesia & any', 'debridement of ulcers in OR', '-checkin vanc trough at 1830 today prior to dose at [**2183**] as per pharm', '-off dopamine', '-IV team says cant place PICC today d/t elevated WBC']",70944,157798.0
5,2193-11-08 07:57:38,"['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia']","['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia']","['-Gen [**Doctor First Name **] recommended conservative management for now as the pt.', 'refuses anesthesia & any debridement of ulcers in OR', '-The patient is currently off pressors and maintaining good BPs.', 'This AM, she states that her pain is under control.  Denies SOB.']",70944,157798.0
6,2193-11-08 08:02:23,"['- dc', 'd her heparin flush for PICC b/c concern for HIT']","['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia', '- dc', 'd her heparin flush for PICC b/c concern for HIT']",,70944,157798.0
7,2193-11-08 13:44:06,,"['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia', '- dc', 'd her heparin flush for PICC b/c concern for HIT']",,70944,157798.0
8,2193-11-08 14:17:00,,"['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia', '- dc', 'd her heparin flush for PICC b/c concern for HIT']",,70944,157798.0
9,2193-11-08 14:31:24,,"['PICC LINE - START [**2193-11-7**] 01:30 PM', ' MULTI LUMEN - STOP [**2193-11-7**] 05:34 PM', 'inserted  in OSH', '-Lantus and Humalog sliding scale doses adjusted, but still BGs in', '200s, so will need to go up further in AM', '-Switched on Depto/[**Last Name (un) **] for Abx coverage given concern for', 'Vanco-induced thrombocytopenia', '- dc', 'd her heparin flush for PICC b/c concern for HIT']",,70944,157798.0
0,2105-04-21 08:03:57,,"['EKG - At [**2105-4-20**] 10:40 AM', ' ULTRASOUND - At [**2105-4-20**] 11:17 AM', 'PT TO HAVE A U/S GUIDED FLUID ASPIRATION OF HIS RT HIP', ' BLOOD CULTURED - At [**2105-4-20**] 10:29 PM', '- 60cc drained from right hip; cell count and diff neg but gram stain', ""with 3+ PMN's, 4+ GNR's, 4+ GPC's in pairs and chains."", ""- growning GPC's in [**12-26**] blood culture bottles"", '- adenosine given due to SVT and hypotension, converted to NSR with', 'improved BP', '- weaned down pressors but then dropped BP, pressors slightly increased', 'and bolused 1 liter', '- chills this morning']",,89607,174347.0
1,2105-04-21 09:23:27,,"['EKG - At [**2105-4-20**] 10:40 AM', ' ULTRASOUND - At [**2105-4-20**] 11:17 AM', 'PT TO HAVE A U/S GUIDED FLUID ASPIRATION OF HIS RT HIP', ' BLOOD CULTURED - At [**2105-4-20**] 10:29 PM', '- 60cc drained from right hip; cell count and diff neg but gram stain', ""with 3+ PMN's, 4+ GNR's, 4+ GPC's in pairs and chains."", ""- growning GPC's in [**12-26**] blood culture bottles"", '- adenosine given due to SVT and hypotension, converted to NSR with', 'improved BP', '- weaned down pressors but then dropped BP, pressors slightly increased', 'and bolused 1 liter', '- chills this morning']",,89607,174347.0
2,2105-04-22 07:21:24,"['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']","['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']","['EKG - At [**2105-4-20**] 10:40 AM', ' ULTRASOUND - At [**2105-4-20**] 11:17 AM', 'PT TO HAVE A U/S GUIDED FLUID ASPIRATION OF HIS RT HIP', ' BLOOD CULTURED - At [**2105-4-20**] 10:29 PM', '- 60cc drained from right hip; cell count and diff neg but gram stain', ""with 3+ PMN's, 4+ GNR's, 4+ GPC's in pairs and chains."", ""- growning GPC's in [**12-26**] blood culture bottles"", '- adenosine given due to SVT and hypotension, converted to NSR with', 'improved BP', '- weaned down pressors but then dropped BP, pressors slightly increased', 'and bolused 1 liter', '- chills this morning']",89607,174347.0
3,2105-04-22 07:22:51,,"['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']",,89607,174347.0
4,2105-04-22 07:26:38,,"['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']",,89607,174347.0
5,2105-04-22 10:41:57,,"['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']",,89607,174347.0
6,2105-04-23 07:20:14,"['- growing strep agninosus (strep milleri group) in thigh fluid and', 'blood; sensitivity still pending', '- gave gent x1', '- vanco trough theraputic at 19', '- TTE: mild MR, no vegitations, o/w normal', '- cortisol 11 (equivocal), so performed [**Last Name (un) 402**] stim test: 9 --> 19.9', '- TSH 1.5 (wnl), fT4 0.76 (0.93-1.7)', '- plastics saw pt, report that sacral decub communicates with area of', 'thigh abscess and bone looks c/w osteomyelitis, recc IV abx x 6 weeks,', 'also Vac changes q3-4 days', '- ortho reccs washout again Friday, possibly also Vac change then', '- resumed outpt lovenox 30mg [**Hospital1 7**]', 'History obtained from [**Hospital 15**] Medical records']","['- growing strep agninosus (strep milleri group) in thigh fluid and', 'blood; sensitivity still pending', '- gave gent x1', '- vanco trough theraputic at 19', '- TTE: mild MR, no vegitations, o/w normal', '- cortisol 11 (equivocal), so performed [**Last Name (un) 402**] stim test: 9 --> 19.9', '- TSH 1.5 (wnl), fT4 0.76 (0.93-1.7)', '- plastics saw pt, report that sacral decub communicates with area of', 'thigh abscess and bone looks c/w osteomyelitis, recc IV abx x 6 weeks,', 'also Vac changes q3-4 days', '- ortho reccs washout again Friday, possibly also Vac change then', '- resumed outpt lovenox 30mg [**Hospital1 7**]', 'History obtained from [**Hospital 15**] Medical records']","['OR SENT - At [**2105-4-21**] 02:34 PM', ' OR RECEIVED - At [**2105-4-21**] 03:50 PM', 'Received patient after I & D from rt hip with VAC.', '- ortho took to OR and drained 300 cc frank pus', ""- d/c'd azithro"", '- remained pressor dependent']",89607,174347.0
7,2105-04-23 07:31:21,,"['- growing strep agninosus (strep milleri group) in thigh fluid and', 'blood; sensitivity still pending', '- gave gent x1', '- vanco trough theraputic at 19', '- TTE: mild MR, no vegitations, o/w normal', '- cortisol 11 (equivocal), so performed [**Last Name (un) 402**] stim test: 9 --> 19.9', '- TSH 1.5 (wnl), fT4 0.76 (0.93-1.7)', '- plastics saw pt, report that sacral decub communicates with area of', 'thigh abscess and bone looks c/w osteomyelitis, recc IV abx x 6 weeks,', 'also Vac changes q3-4 days', '- ortho reccs washout again Friday, possibly also Vac change then', '- resumed outpt lovenox 30mg [**Hospital1 7**]', 'History obtained from [**Hospital 15**] Medical records']",,89607,174347.0
8,2105-04-23 11:05:35,,"['- growing strep agninosus (strep milleri group) in thigh fluid and', 'blood; sensitivity still pending', '- gave gent x1', '- vanco trough theraputic at 19', '- TTE: mild MR, no vegitations, o/w normal', '- cortisol 11 (equivocal), so performed [**Last Name (un) 402**] stim test: 9 --> 19.9', '- TSH 1.5 (wnl), fT4 0.76 (0.93-1.7)', '- plastics saw pt, report that sacral decub communicates with area of', 'thigh abscess and bone looks c/w osteomyelitis, recc IV abx x 6 weeks,', 'also Vac changes q3-4 days', '- ortho reccs washout again Friday, possibly also Vac change then', '- resumed outpt lovenox 30mg [**Hospital1 7**]', 'History obtained from [**Hospital 15**] Medical records']",,89607,174347.0
9,2105-04-24 07:47:02,"['[**4-23**]:', '- ID reccs: dc gent; obtain repeat Cx in OR, ESR/CRP, obtain MRI, send', 'C.diff and sputum will likely switch to CTX and Flagy but keep', 'Vanc/Zosyn for now', ""- per home facility, BP's nl in 110-120/80's"", '- CVP low 4, gave one liter bolus with improved BP -> trended down on', 'neo, but still on neo', 'History obtained from Patient']","['[**4-23**]:', '- ID reccs: dc gent; obtain repeat Cx in OR, ESR/CRP, obtain MRI, send', 'C.diff and sputum will likely switch to CTX and Flagy but keep', 'Vanc/Zosyn for now', ""- per home facility, BP's nl in 110-120/80's"", '- CVP low 4, gave one liter bolus with improved BP -> trended down on', 'neo, but still on neo', 'History obtained from Patient']","['- growing strep agninosus (strep milleri group) in thigh fluid and', 'blood; sensitivity still pending', '- gave gent x1', '- vanco trough theraputic at 19', '- TTE: mild MR, no vegitations, o/w normal', '- cortisol 11 (equivocal), so performed [**Last Name (un) 402**] stim test: 9 --> 19.9', '- TSH 1.5 (wnl), fT4 0.76 (0.93-1.7)', '- plastics saw pt, report that sacral decub communicates with area of', 'thigh abscess and bone looks c/w osteomyelitis, recc IV abx x 6 weeks,', 'also Vac changes q3-4 days', '- ortho reccs washout again Friday, possibly also Vac change then', '- resumed outpt lovenox 30mg [**Hospital1 7**]', 'History obtained from [**Hospital 15**] Medical records']",89607,174347.0
10,2105-04-24 10:40:15,,"['[**4-23**]:', '- ID reccs: dc gent; obtain repeat Cx in OR, ESR/CRP, obtain MRI, send', 'C.diff and sputum will likely switch to CTX and Flagy but keep', 'Vanc/Zosyn for now', ""- per home facility, BP's nl in 110-120/80's"", '- CVP low 4, gave one liter bolus with improved BP -> trended down on', 'neo, but still on neo', 'History obtained from Patient']",,89607,174347.0
11,2105-04-25 08:01:05,"['OR SENT - At [**2105-4-24**] 12:20 PM', 'For Rt hip wash out', ' OR RECEIVED - At [**2105-4-24**] 02:00 PM', 'I & D rt hip & wound VAC placed.', '- went to OR for additional washout and bone/fluid sent for micro', '- still unable to wean neo, attempted additional fluid boluses', '- received 25 IV then 50 IV hydrocort with no improvement in BP (CVP at', 'the time was 17)']","['OR SENT - At [**2105-4-24**] 12:20 PM', 'For Rt hip wash out', ' OR RECEIVED - At [**2105-4-24**] 02:00 PM', 'I & D rt hip & wound VAC placed.', '- went to OR for additional washout and bone/fluid sent for micro', '- still unable to wean neo, attempted additional fluid boluses', '- received 25 IV then 50 IV hydrocort with no improvement in BP (CVP at', 'the time was 17)']","['[**4-23**]:', '- ID reccs: dc gent; obtain repeat Cx in OR, ESR/CRP, obtain MRI, send', 'C.diff and sputum will likely switch to CTX and Flagy but keep', 'Vanc/Zosyn for now', ""- per home facility, BP's nl in 110-120/80's"", '- CVP low 4, gave one liter bolus with improved BP -> trended down on', 'neo, but still on neo', 'History obtained from Patient']",89607,174347.0
12,2105-04-25 08:30:53,,"['OR SENT - At [**2105-4-24**] 12:20 PM', 'For Rt hip wash out', ' OR RECEIVED - At [**2105-4-24**] 02:00 PM', 'I & D rt hip & wound VAC placed.', '- went to OR for additional washout and bone/fluid sent for micro', '- still unable to wean neo, attempted additional fluid boluses', '- received 25 IV then 50 IV hydrocort with no improvement in BP (CVP at', 'the time was 17)']",,89607,174347.0
13,2105-04-25 11:32:43,,"['OR SENT - At [**2105-4-24**] 12:20 PM', 'For Rt hip wash out', ' OR RECEIVED - At [**2105-4-24**] 02:00 PM', 'I & D rt hip & wound VAC placed.', '- went to OR for additional washout and bone/fluid sent for micro', '- still unable to wean neo, attempted additional fluid boluses', '- received 25 IV then 50 IV hydrocort with no improvement in BP (CVP at', 'the time was 17)']",,89607,174347.0
14,2105-04-26 07:21:26,"['- started stress-dose steroids', '- very slow wean of pressors --> off at 8pm', '- low Hct today at 20 --> written to transfuse 2units']","['- started stress-dose steroids', '- very slow wean of pressors --> off at 8pm', '- low Hct today at 20 --> written to transfuse 2units']","['OR SENT - At [**2105-4-24**] 12:20 PM', 'For Rt hip wash out', ' OR RECEIVED - At [**2105-4-24**] 02:00 PM', 'I & D rt hip & wound VAC placed.', '- went to OR for additional washout and bone/fluid sent for micro', '- still unable to wean neo, attempted additional fluid boluses', '- received 25 IV then 50 IV hydrocort with no improvement in BP (CVP at', 'the time was 17)']",89607,174347.0
15,2105-04-26 07:23:04,,"['- started stress-dose steroids', '- very slow wean of pressors --> off at 8pm', '- low Hct today at 20 --> written to transfuse 2units']",,89607,174347.0
16,2105-04-26 07:26:21,,"['- started stress-dose steroids', '- very slow wean of pressors --> off at 8pm', '- low Hct today at 20 --> written to transfuse 2units']",,89607,174347.0
17,2105-04-26 10:26:03,,"['- started stress-dose steroids', '- very slow wean of pressors --> off at 8pm', '- low Hct today at 20 --> written to transfuse 2units']",,89607,174347.0
0,2148-01-17 06:07:01,,"['INVASIVE VENTILATION - START [**2148-1-16**] 04:00 PM', 'pt arrived intubated from OSH sp cardiac arrest', ' ARTERIAL LINE - START [**2148-1-16**] 06:00 PM', ' MULTI LUMEN - START [**2148-1-16**] 07:41 PM', ' TRAUMA LINE - START [**2148-1-16**] 08:00 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD whern able', '- radiology: head CT without acute ICP, basal ganglia calcifications;', 'CXR with pulmonary edema', '- gave lasix 40mg IV and had about 600cc UOP', '- gave 1x dose insulin (10U Humalog) for BG 422, then started on', 'insulin gtt for persistent hyperglycemia and trace ketones in urine-', '- UOP drop after at 5am, but CVP 9- 10 and lung compliance improved']",,61076,102603.0
1,2148-01-17 07:15:50,"['- reach cooling temp at 10pm last night', '- gave cisatracurium with improved ventilation']","['INVASIVE VENTILATION - START [**2148-1-16**] 04:00 PM', 'pt arrived intubated from OSH sp cardiac arrest', ' ARTERIAL LINE - START [**2148-1-16**] 06:00 PM', ' MULTI LUMEN - START [**2148-1-16**] 07:41 PM', ' TRAUMA LINE - START [**2148-1-16**] 08:00 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD whern able', '- reach cooling temp at 10pm last night', '- gave cisatracurium with improved ventilation', '- radiology: head CT without acute ICP, basal ganglia calcifications;', 'CXR with pulmonary edema', '- gave lasix 40mg IV and had about 600cc UOP', '- gave 1x dose insulin (10U Humalog) for BG 422, then started on', 'insulin gtt for persistent hyperglycemia and trace ketones in urine-', '- UOP drop after at 5am, but CVP 9- 10 and lung compliance improved']",,61076,102603.0
2,2148-01-17 10:26:25,,"['INVASIVE VENTILATION - START [**2148-1-16**] 04:00 PM', 'pt arrived intubated from OSH sp cardiac arrest', ' ARTERIAL LINE - START [**2148-1-16**] 06:00 PM', ' MULTI LUMEN - START [**2148-1-16**] 07:41 PM', ' TRAUMA LINE - START [**2148-1-16**] 08:00 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD whern able', '- reach cooling temp at 10pm last night', '- gave cisatracurium with improved ventilation', '- radiology: head CT without acute ICP, basal ganglia calcifications;', 'CXR with pulmonary edema', '- gave lasix 40mg IV and had about 600cc UOP', '- gave 1x dose insulin (10U Humalog) for BG 422, then started on', 'insulin gtt for persistent hyperglycemia and trace ketones in urine-', '- UOP drop after at 5am, but CVP 9- 10 and lung compliance improved']",,61076,102603.0
3,2148-01-17 10:40:59,,"['INVASIVE VENTILATION - START [**2148-1-16**] 04:00 PM', 'pt arrived intubated from OSH sp cardiac arrest', ' ARTERIAL LINE - START [**2148-1-16**] 06:00 PM', ' MULTI LUMEN - START [**2148-1-16**] 07:41 PM', ' TRAUMA LINE - START [**2148-1-16**] 08:00 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD whern able', '- reach cooling temp at 10pm last night', '- gave cisatracurium with improved ventilation', '- radiology: head CT without acute ICP, basal ganglia calcifications;', 'CXR with pulmonary edema', '- gave lasix 40mg IV and had about 600cc UOP', '- gave 1x dose insulin (10U Humalog) for BG 422, then started on', 'insulin gtt for persistent hyperglycemia and trace ketones in urine-', '- UOP drop after at 5am, but CVP 9- 10 and lung compliance improved']",,61076,102603.0
4,2148-01-18 07:09:53,"['EEG - At [**2148-1-17**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2148-1-17**] 11:00 AM', '- symmetric LVH, predominantly apical hypokinesis, LVEF 35-40', ' TRAUMA LINE - STOP [**2148-1-17**] 04:45 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD', ' EEG - At [**2148-1-17**] 07:00 PM', '[**1-17**]:', '- EP fellow ([**Doctor First Name **]) was concerned about prlonged QTc and bradycardia.', 'Wanted us to d/c amio for now and will await further recs.', '- hypotensive, started on levofed', '- need to obtain baseline 12-lead from PCP [**Telephone/Fax (1) 12323**]', ""- home meds: lipitor 10', metformin 1000'', flovent 2puffs '', prilosec"", ""40', zantac 150, xalatan eye drops left eye qhs, glyburide 6mg [**Hospital1 **],"", 'actos 45 daily.', '- per rads attg, initial CT abnml with possible early edema. Rpt study', 'done showing no interval change.', '- per neuro, no epilitiform activity', '- Warmed to 37 overnight, diuresis initiated with lasix drip. Peep', 'successfully weaned.', '- In evening, became interactive after discontinuation of paralytics;', 'squeezing hands, moving toes, breathing, and blinking/nodding to', 'commands. Sedation doubled to sedate pt as he was not ready for', 'extubation given PEEP of 15 and anticipated cath tomorrow.']","['EEG - At [**2148-1-17**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2148-1-17**] 11:00 AM', '- symmetric LVH, predominantly apical hypokinesis, LVEF 35-40', ' TRAUMA LINE - STOP [**2148-1-17**] 04:45 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD', ' EEG - At [**2148-1-17**] 07:00 PM', '[**1-17**]:', '- EP fellow ([**Doctor First Name **]) was concerned about prlonged QTc and bradycardia.', 'Wanted us to d/c amio for now and will await further recs.', '- hypotensive, started on levofed', '- need to obtain baseline 12-lead from PCP [**Telephone/Fax (1) 12323**]', ""- home meds: lipitor 10', metformin 1000'', flovent 2puffs '', prilosec"", ""40', zantac 150, xalatan eye drops left eye qhs, glyburide 6mg [**Hospital1 **],"", 'actos 45 daily.', '- per rads attg, initial CT abnml with possible early edema. Rpt study', 'done showing no interval change.', '- per neuro, no epilitiform activity', '- Warmed to 37 overnight, diuresis initiated with lasix drip. Peep', 'successfully weaned.', '- In evening, became interactive after discontinuation of paralytics;', 'squeezing hands, moving toes, breathing, and blinking/nodding to', 'commands. Sedation doubled to sedate pt as he was not ready for', 'extubation given PEEP of 15 and anticipated cath tomorrow.']","['INVASIVE VENTILATION - START [**2148-1-16**] 04:00 PM', 'pt arrived intubated from OSH sp cardiac arrest', ' ARTERIAL LINE - START [**2148-1-16**] 06:00 PM', ' MULTI LUMEN - START [**2148-1-16**] 07:41 PM', ' TRAUMA LINE - START [**2148-1-16**] 08:00 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD whern able', '- reach cooling temp at 10pm last night', '- gave cisatracurium with improved ventilation', '- radiology: head CT without acute ICP, basal ganglia calcifications;', 'CXR with pulmonary edema', '- gave lasix 40mg IV and had about 600cc UOP', '- gave 1x dose insulin (10U Humalog) for BG 422, then started on', 'insulin gtt for persistent hyperglycemia and trace ketones in urine-', '- UOP drop after at 5am, but CVP 9- 10 and lung compliance improved']",61076,102603.0
5,2148-01-18 07:34:12,,"['EEG - At [**2148-1-17**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2148-1-17**] 11:00 AM', '- symmetric LVH, predominantly apical hypokinesis, LVEF 35-40', ' TRAUMA LINE - STOP [**2148-1-17**] 04:45 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD', ' EEG - At [**2148-1-17**] 07:00 PM', '[**1-17**]:', '- EP fellow ([**Doctor First Name **]) was concerned about prlonged QTc and bradycardia.', 'Wanted us to d/c amio for now and will await further recs.', '- hypotensive, started on levofed', '- need to obtain baseline 12-lead from PCP [**Telephone/Fax (1) 12323**]', ""- home meds: lipitor 10', metformin 1000'', flovent 2puffs '', prilosec"", ""40', zantac 150, xalatan eye drops left eye qhs, glyburide 6mg [**Hospital1 **],"", 'actos 45 daily.', '- per rads attg, initial CT abnml with possible early edema. Rpt study', 'done showing no interval change.', '- per neuro, no epilitiform activity', '- Warmed to 37 overnight, diuresis initiated with lasix drip. Peep', 'successfully weaned.', '- In evening, became interactive after discontinuation of paralytics;', 'squeezing hands, moving toes, breathing, and blinking/nodding to', 'commands. Sedation doubled to sedate pt as he was not ready for', 'extubation given PEEP of 15 and anticipated cath tomorrow.']",,61076,102603.0
6,2148-01-18 10:21:37,,"['EEG - At [**2148-1-17**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2148-1-17**] 11:00 AM', '- symmetric LVH, predominantly apical hypokinesis, LVEF 35-40', ' TRAUMA LINE - STOP [**2148-1-17**] 04:45 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD', ' EEG - At [**2148-1-17**] 07:00 PM', '[**1-17**]:', '- EP fellow ([**Doctor First Name **]) was concerned about prlonged QTc and bradycardia.', 'Wanted us to d/c amio for now and will await further recs.', '- hypotensive, started on levofed', '- need to obtain baseline 12-lead from PCP [**Telephone/Fax (1) 12323**]', ""- home meds: lipitor 10', metformin 1000'', flovent 2puffs '', prilosec"", ""40', zantac 150, xalatan eye drops left eye qhs, glyburide 6mg [**Hospital1 **],"", 'actos 45 daily.', '- per rads attg, initial CT abnml with possible early edema. Rpt study', 'done showing no interval change.', '- per neuro, no epilitiform activity', '- Warmed to 37 overnight, diuresis initiated with lasix drip. Peep', 'successfully weaned.', '- In evening, became interactive after discontinuation of paralytics;', 'squeezing hands, moving toes, breathing, and blinking/nodding to', 'commands. Sedation doubled to sedate pt as he was not ready for', 'extubation given PEEP of 15 and anticipated cath tomorrow.']",,61076,102603.0
7,2148-01-19 06:43:47,"['EKG - At [**2148-1-18**] 12:05 PM', '- able to wean vent settings, MS did not improve enough for extubation.', '- got 2 boluses and able to d/c levofed at 10pm.', '- Overnight MS improved, aggressively weaned vent & extubated at 5am.', '- hypertensive and mildly tachy on vent -> felt [**2-27**] agitation.  Got', 'lopressor 5mg IV.', '- prior to extubation got 40 lasix IV.']","['EKG - At [**2148-1-18**] 12:05 PM', '- able to wean vent settings, MS did not improve enough for extubation.', '- got 2 boluses and able to d/c levofed at 10pm.', '- Overnight MS improved, aggressively weaned vent & extubated at 5am.', '- hypertensive and mildly tachy on vent -> felt [**2-27**] agitation.  Got', 'lopressor 5mg IV.', '- prior to extubation got 40 lasix IV.']","['EEG - At [**2148-1-17**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2148-1-17**] 11:00 AM', '- symmetric LVH, predominantly apical hypokinesis, LVEF 35-40', ' TRAUMA LINE - STOP [**2148-1-17**] 04:45 PM', 'I/O line in left knee- placed trauma OSH- to be [**Name6 (MD) 4338**] by MD', ' EEG - At [**2148-1-17**] 07:00 PM', '[**1-17**]:', '- EP fellow ([**Doctor First Name **]) was concerned about prlonged QTc and bradycardia.', 'Wanted us to d/c amio for now and will await further recs.', '- hypotensive, started on levofed', '- need to obtain baseline 12-lead from PCP [**Telephone/Fax (1) 12323**]', ""- home meds: lipitor 10', metformin 1000'', flovent 2puffs '', prilosec"", ""40', zantac 150, xalatan eye drops left eye qhs, glyburide 6mg [**Hospital1 **],"", 'actos 45 daily.', '- per rads attg, initial CT abnml with possible early edema. Rpt study', 'done showing no interval change.', '- per neuro, no epilitiform activity', '- Warmed to 37 overnight, diuresis initiated with lasix drip. Peep', 'successfully weaned.', '- In evening, became interactive after discontinuation of paralytics;', 'squeezing hands, moving toes, breathing, and blinking/nodding to', 'commands. Sedation doubled to sedate pt as he was not ready for', 'extubation given PEEP of 15 and anticipated cath tomorrow.']",61076,102603.0
8,2148-01-19 07:57:39,,"['EKG - At [**2148-1-18**] 12:05 PM', '- able to wean vent settings, MS did not improve enough for extubation.', '- got 2 boluses and able to d/c levofed at 10pm.', '- Overnight MS improved, aggressively weaned vent & extubated at 5am.', '- hypertensive and mildly tachy on vent -> felt [**2-27**] agitation.  Got', 'lopressor 5mg IV.', '- prior to extubation got 40 lasix IV.']",,61076,102603.0
9,2148-01-19 10:07:53,,"['EKG - At [**2148-1-18**] 12:05 PM', '- able to wean vent settings, MS did not improve enough for extubation.', '- got 2 boluses and able to d/c levofed at 10pm.', '- Overnight MS improved, aggressively weaned vent & extubated at 5am.', '- hypertensive and mildly tachy on vent -> felt [**2-27**] agitation.  Got', 'lopressor 5mg IV.', '- prior to extubation got 40 lasix IV.']",,61076,102603.0
10,2148-01-20 07:12:05,"['ARTERIAL LINE - STOP [**2148-1-19**] 01:54 PM', '- change vanco/cefepime to levo 750mg for planned 7 day for pna', '- started on metoprolol 25mg TID and lisinopril 5mg daily', '- d/c a-line', '- weaned O2 to 4L NC', '- patient mental status improving', '- episode of vomiting, improved with Zofran. ECG showed deeper TWI in', 'v5, ? worsening ST changes v2-v3. Faxed and spoke with Fellow who', ""didn't think it was significant.""]","['ARTERIAL LINE - STOP [**2148-1-19**] 01:54 PM', '- change vanco/cefepime to levo 750mg for planned 7 day for pna', '- started on metoprolol 25mg TID and lisinopril 5mg daily', '- d/c a-line', '- weaned O2 to 4L NC', '- patient mental status improving', '- episode of vomiting, improved with Zofran. ECG showed deeper TWI in', 'v5, ? worsening ST changes v2-v3. Faxed and spoke with Fellow who', ""didn't think it was significant.""]","['EKG - At [**2148-1-18**] 12:05 PM', '- able to wean vent settings, MS did not improve enough for extubation.', '- got 2 boluses and able to d/c levofed at 10pm.', '- Overnight MS improved, aggressively weaned vent & extubated at 5am.', '- hypertensive and mildly tachy on vent -> felt [**2-27**] agitation.  Got', 'lopressor 5mg IV.', '- prior to extubation got 40 lasix IV.']",61076,102603.0
11,2148-01-20 10:38:04,,"['ARTERIAL LINE - STOP [**2148-1-19**] 01:54 PM', '- change vanco/cefepime to levo 750mg for planned 7 day for pna', '- started on metoprolol 25mg TID and lisinopril 5mg daily', '- d/c a-line', '- weaned O2 to 4L NC', '- patient mental status improving', '- episode of vomiting, improved with Zofran. ECG showed deeper TWI in', 'v5, ? worsening ST changes v2-v3. Faxed and spoke with Fellow who', ""didn't think it was significant.""]",,61076,102603.0
12,2148-01-21 08:18:51,"['- Cr rose to 1.4 from 0.7 and then continued to 1.7 overnight with', 'decrease in UOP transiently. Per renal, urine fairly unremarkable.', '- Delerious last night with partial response to haldol 1mg po x1.', '- Lasix not given b/c pressures 90s/50s']","['- Cr rose to 1.4 from 0.7 and then continued to 1.7 overnight with', 'decrease in UOP transiently. Per renal, urine fairly unremarkable.', '- Delerious last night with partial response to haldol 1mg po x1.', '- Lasix not given b/c pressures 90s/50s']","['ARTERIAL LINE - STOP [**2148-1-19**] 01:54 PM', '- change vanco/cefepime to levo 750mg for planned 7 day for pna', '- started on metoprolol 25mg TID and lisinopril 5mg daily', '- d/c a-line', '- weaned O2 to 4L NC', '- patient mental status improving', '- episode of vomiting, improved with Zofran. ECG showed deeper TWI in', 'v5, ? worsening ST changes v2-v3. Faxed and spoke with Fellow who', ""didn't think it was significant.""]",61076,102603.0
13,2148-01-21 08:32:11,,"['- Cr rose to 1.4 from 0.7 and then continued to 1.7 overnight with', 'decrease in UOP transiently. Per renal, urine fairly unremarkable.', '- Delerious last night with partial response to haldol 1mg po x1.', '- Lasix not given b/c pressures 90s/50s']",,61076,102603.0
14,2148-01-21 12:54:22,,"['- Cr rose to 1.4 from 0.7 and then continued to 1.7 overnight with', 'decrease in UOP transiently. Per renal, urine fairly unremarkable.', '- Delerious last night with partial response to haldol 1mg po x1.', '- Lasix not given b/c pressures 90s/50s']",,61076,102603.0
15,2148-01-22 07:03:28,"['- Sputum cx w/ Coag postive staph - pan sensitive. got one dose of', 'vanco this am.  Sensitivities show MSSA so levofloxacin switched to', 'ceftriaxone', '- Renal - [**Last Name (un) **], most likely [**2-27**] ACE, lasix and low normal BP. hold', 'meds.  I/O goal even.  keep MAP>65', '- Na low at 125 from 137 on PM labs. Repeat Na 134']","['- Sputum cx w/ Coag postive staph - pan sensitive. got one dose of', 'vanco this am.  Sensitivities show MSSA so levofloxacin switched to', 'ceftriaxone', '- Renal - [**Last Name (un) **], most likely [**2-27**] ACE, lasix and low normal BP. hold', 'meds.  I/O goal even.  keep MAP>65', '- Na low at 125 from 137 on PM labs. Repeat Na 134']","['- Cr rose to 1.4 from 0.7 and then continued to 1.7 overnight with', 'decrease in UOP transiently. Per renal, urine fairly unremarkable.', '- Delerious last night with partial response to haldol 1mg po x1.', '- Lasix not given b/c pressures 90s/50s']",61076,102603.0
16,2148-01-22 13:00:28,,"['- Sputum cx w/ Coag postive staph - pan sensitive. got one dose of', 'vanco this am.  Sensitivities show MSSA so levofloxacin switched to', 'ceftriaxone', '- Renal - [**Last Name (un) **], most likely [**2-27**] ACE, lasix and low normal BP. hold', 'meds.  I/O goal even.  keep MAP>65', '- Na low at 125 from 137 on PM labs. Repeat Na 134']",,61076,102603.0
0,2181-05-01 06:45:40,,"['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor']",,83653,147696.0
1,2181-05-01 10:28:57,"['-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']","['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']",,83653,147696.0
2,2181-05-01 10:47:22,,"['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']",,83653,147696.0
3,2181-05-02 07:13:34,"['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']","['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']","['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']",83653,147696.0
4,2181-05-02 13:58:08,,"['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']",,83653,147696.0
5,2181-05-02 14:16:17,,"['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']",,83653,147696.0
6,2181-05-02 14:29:44,,"['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']",,83653,147696.0
7,2181-05-02 14:30:50,"['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']","['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']","['CARDIAC CATH - At [**2181-5-1**] 08:28 AM', ' CORDIS/INTRODUCER - STOP [**2181-5-1**] 11:00 AM', ' MULTI LUMEN - START [**2181-5-1**] 12:00 PM', ' TRANSTHORACIC ECHO - At [**2181-5-1**] 03:35 PM', '- family provides additional history of several unexplained syncopal', 'episodes in last few days', '- weaning levephed', '- changed abx from cefipime to cipro/zosyn']",83653,147696.0
8,2181-05-03 07:03:45,"['INVASIVE VENTILATION - STOP [**2181-5-2**] 11:00 AM', '- did not restart heparin b/c of bleeding around pacemaker', '- Extubated this a.m. without difficulty', '- dosing vancomycin by trough', '- ordered prednisone, but not taking POs and did not take', '- Starting IV heparin tomorrow for DVT']","['INVASIVE VENTILATION - STOP [**2181-5-2**] 11:00 AM', '- did not restart heparin b/c of bleeding around pacemaker', '- Extubated this a.m. without difficulty', '- dosing vancomycin by trough', '- ordered prednisone, but not taking POs and did not take', '- Starting IV heparin tomorrow for DVT']","['CORDIS/INTRODUCER - START [**2181-4-30**] 08:00 PM', 'Temporary pacer from OSH placed via RIJ, single lumen with no central', 'access port or sidearm', ' TRANSTHORACIC ECHO - At [**2181-4-30**] 08:59 PM', ' PAN CULTURE - At [**2181-4-30**] 11:00 PM', ' ARTERIAL LINE - START [**2181-5-1**] 01:30 AM', ' EKG - At [**2181-5-1**] 02:40 AM', ' EKG - At [**2181-5-1**] 04:30 AM', 'intrinsic rhythm on monitor', '-Overnight the patient had his pacer wire advanced so that it was in a', 'better position.', '- BP was low in the 80s-90s systolic despite 500 cc NS bolus x 4.', '- unable to wean levophed (despite only using a small dose)', '- CXR showed question of mediastinal widening, but repeat CXR was', 'stable.', '- bedside echo showed trace effusion', '- was started on empiric antibiotics', '- was given dexamethasone for concern of adrenal insufficiency', 'contributing to hypotension']",83653,147696.0
9,2181-05-03 13:14:23,['- Extubated yesterday a.m. without difficulty'],"['INVASIVE VENTILATION - STOP [**2181-5-2**] 11:00 AM', '- did not restart heparin b/c of bleeding around pacemaker', '- Extubated yesterday a.m. without difficulty']","['- Extubated this a.m. without difficulty', '- dosing vancomycin by trough', '- ordered prednisone, but not taking POs and did not take', '- Starting IV heparin tomorrow for DVT']",83653,147696.0
10,2181-05-03 15:42:41,,"['INVASIVE VENTILATION - STOP [**2181-5-2**] 11:00 AM', '- did not restart heparin b/c of bleeding around pacemaker', '- Extubated yesterday a.m. without difficulty']",,83653,147696.0
11,2181-05-04 06:50:35,"['MULTI LUMEN - STOP [**2181-5-3**] 07:29 PM', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- trouble swallowing dinner/ gagging']","['MULTI LUMEN - STOP [**2181-5-3**] 07:29 PM', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- trouble swallowing dinner/ gagging']","['INVASIVE VENTILATION - STOP [**2181-5-2**] 11:00 AM', '- did not restart heparin b/c of bleeding around pacemaker', '- Extubated yesterday a.m. without difficulty']",83653,147696.0
12,2181-05-04 11:30:38,,"['MULTI LUMEN - STOP [**2181-5-3**] 07:29 PM', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- trouble swallowing dinner/ gagging']",,83653,147696.0
13,2181-05-04 11:47:33,,"['MULTI LUMEN - STOP [**2181-5-3**] 07:29 PM', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- trouble swallowing dinner/ gagging']",,83653,147696.0
14,2181-05-05 07:31:53,"['[**5-4**]', 'EP', '- Start heparin gtt at 8am (at least 12 hours after procedure), at', 'lower sliding scale as was supratherapeutic often,', '- PA/LAT ordered', '- Got 1 dose of vanc and with ARF, no need for further abx', '- Device clinic set up 1 week', '- Dose', '[**5-3**]', '- EP aware that renal function improving, no room on schedule tomorrow', 'for pacemaker placement so will have to wait until next week (?monday)', '- ordered Speech and swallow']","['[**5-4**]', 'EP', '- Start heparin gtt at 8am (at least 12 hours after procedure), at', 'lower sliding scale as was supratherapeutic often,', '- PA/LAT ordered', '- Got 1 dose of vanc and with ARF, no need for further abx', '- Device clinic set up 1 week', '- Dose', '[**5-3**]', '- EP aware that renal function improving, no room on schedule tomorrow', 'for pacemaker placement so will have to wait until next week (?monday)', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- ordered Speech and swallow']","['MULTI LUMEN - STOP [**2181-5-3**] 07:29 PM', '- trouble swallowing dinner/ gagging']",83653,147696.0
15,2181-05-05 07:33:28,,"['[**5-4**]', 'EP', '- Start heparin gtt at 8am (at least 12 hours after procedure), at', 'lower sliding scale as was supratherapeutic often,', '- PA/LAT ordered', '- Got 1 dose of vanc and with ARF, no need for further abx', '- Device clinic set up 1 week', '- Dose', '[**5-3**]', '- EP aware that renal function improving, no room on schedule tomorrow', 'for pacemaker placement so will have to wait until next week (?monday)', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- ordered Speech and swallow']",,83653,147696.0
16,2181-05-05 13:25:25,,"['[**5-4**]', 'EP', '- Start heparin gtt at 8am (at least 12 hours after procedure), at', 'lower sliding scale as was supratherapeutic often,', '- PA/LAT ordered', '- Got 1 dose of vanc and with ARF, no need for further abx', '- Device clinic set up 1 week', '- Dose', '[**5-3**]', '- EP aware that renal function improving, no room on schedule tomorrow', 'for pacemaker placement so will have to wait until next week (?monday)', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- ordered Speech and swallow']",,83653,147696.0
17,2181-05-05 13:34:04,,"['[**5-4**]', 'EP', '- Start heparin gtt at 8am (at least 12 hours after procedure), at', 'lower sliding scale as was supratherapeutic often,', '- PA/LAT ordered', '- Got 1 dose of vanc and with ARF, no need for further abx', '- Device clinic set up 1 week', '- Dose', '[**5-3**]', '- EP aware that renal function improving, no room on schedule tomorrow', 'for pacemaker placement so will have to wait until next week (?monday)', '- hypertensive to 195/100 (in setting of family in room and struggling', 'with PO) so gave PO hydralazine and quieted room, pressures returned to', '120s', '- ordered Speech and swallow']",,83653,147696.0
0,2189-12-21 06:50:51,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
1,2189-12-21 10:35:48,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
2,2189-12-21 11:26:36,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
3,2189-12-21 11:29:51,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
4,2189-12-21 11:51:20,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
5,2189-12-21 19:14:03,,"['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",,67209,190561.0
6,2189-12-22 07:25:15,"['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']","['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']","['- cardioversion yesterday at 10:45 PM; a-fib aflutter prior to dcc hr', '128 synchron. shock 200 j x1', '- repeatedly low BP overnight with SBP in 70-80s despite good', 'mentation, urine output, well- perfused extremities', '- received in total 1.5 L']",67209,190561.0
7,2189-12-22 07:27:21,,"['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']",,67209,190561.0
8,2189-12-22 07:40:42,,"['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']",,67209,190561.0
9,2189-12-22 12:19:54,,"['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']",,67209,190561.0
10,2189-12-22 13:30:16,,"['- ECHO: LVEF 55%, There is severe aortic valve stenosis (valve area', '0.8cm2). 1+ AR.', '- Renal u/s - no hydronephrosis, no RAS.', '- OSH: rash after starting diclox, labs showed Eo 660 (mild', 'eosinophilia), dx with AIN.', '- ID: cont [**Last Name (un) 614**], vanco, cipro until sesitivities return.  Ucx pos for', 'ecoli.', '- metabolic acidosis, respiratory alk.  ph 7.33.']",,67209,190561.0
0,2171-02-15 06:54:22,,"['TRANS ESOPHAGEAL ECHO - At [**2171-2-14**] 08:34 AM', ' ARTERIAL LINE - START [**2171-2-14**] 08:00 PM', '- started on amio gtt per cards; still in afib', '- O2 sat frequently in mid- to high 80s; mentating perfectly well. CXR', 'unremarkable', '- SBP unstable from 70s to 100s in the afternoon, receiving multiple', 'small NS boluses (given EF 20%)', '- a-line placed', '- CPAP was discussed but patient declined, and O2 sat improved to low', '90s after washing and repositioning']",,92287,133462.0
1,2171-02-15 07:58:04,"['- started on amio gtt per cards; still in afib,', 'unremarkable.  Pt preferred no CPAP.', '- no diuresis [**1-29**] borderline BP', 'small NS boluses (given EF 20%) --> a-line in (? underestimated by cuff', 'because better on a-line)', '- requiring small boluses for intermittently low BP']","['TRANS ESOPHAGEAL ECHO - At [**2171-2-14**] 08:34 AM', ' ARTERIAL LINE - START [**2171-2-14**] 08:00 PM', '- started on amio gtt per cards; still in afib,', '- O2 sat frequently in mid- to high 80s; mentating perfectly well. CXR', 'unremarkable.  Pt preferred no CPAP.', '- no diuresis [**1-29**] borderline BP', '- SBP unstable from 70s to 100s in the afternoon, receiving multiple', 'small NS boluses (given EF 20%) --> a-line in (? underestimated by cuff', 'because better on a-line)', '- requiring small boluses for intermittently low BP', '- CPAP was discussed but patient declined, and O2 sat improved to low', '90s after washing and repositioning']","['- started on amio gtt per cards; still in afib', 'unremarkable', 'small NS boluses (given EF 20%)', '- a-line placed']",92287,133462.0
2,2171-02-15 08:02:05,"['- cardiology also recommended DCCV if not chemically cardioverted', '-']","['TRANS ESOPHAGEAL ECHO - At [**2171-2-14**] 08:34 AM', ' ARTERIAL LINE - START [**2171-2-14**] 08:00 PM', '- started on amio gtt per cards; still in afib,', '- cardiology also recommended DCCV if not chemically cardioverted', '- O2 sat frequently in mid- to high 80s; mentating perfectly well. CXR', 'unremarkable.  Pt preferred no CPAP.', '- no diuresis [**1-29**] borderline BP', '- SBP unstable from 70s to 100s in the afternoon, receiving multiple', 'small NS boluses (given EF 20%) --> a-line in (? underestimated by cuff', 'because better on a-line)', '- requiring small boluses for intermittently low BP', '- CPAP was discussed but patient declined, and O2 sat improved to low', '90s after washing and repositioning', '-']",,92287,133462.0
3,2171-02-15 11:21:01,,"['TRANS ESOPHAGEAL ECHO - At [**2171-2-14**] 08:34 AM', ' ARTERIAL LINE - START [**2171-2-14**] 08:00 PM', '- started on amio gtt per cards; still in afib,', '- cardiology also recommended DCCV if not chemically cardioverted', '- O2 sat frequently in mid- to high 80s; mentating perfectly well. CXR', 'unremarkable.  Pt preferred no CPAP.', '- no diuresis [**1-29**] borderline BP', '- SBP unstable from 70s to 100s in the afternoon, receiving multiple', 'small NS boluses (given EF 20%) --> a-line in (? underestimated by cuff', 'because better on a-line)', '- requiring small boluses for intermittently low BP', '- CPAP was discussed but patient declined, and O2 sat improved to low', '90s after washing and repositioning', '-']",,92287,133462.0
4,2171-02-16 07:35:23,"['- Amio switched to Dig load per cards', '- TEE/cardioversion Scheduled for Monday', '- Diuresing well overnight']","['- Amio switched to Dig load per cards', '- TEE/cardioversion Scheduled for Monday', '- Diuresing well overnight']","['TRANS ESOPHAGEAL ECHO - At [**2171-2-14**] 08:34 AM', ' ARTERIAL LINE - START [**2171-2-14**] 08:00 PM', '- started on amio gtt per cards; still in afib,', '- cardiology also recommended DCCV if not chemically cardioverted', '- O2 sat frequently in mid- to high 80s; mentating perfectly well. CXR', 'unremarkable.  Pt preferred no CPAP.', '- no diuresis [**1-29**] borderline BP', '- SBP unstable from 70s to 100s in the afternoon, receiving multiple', 'small NS boluses (given EF 20%) --> a-line in (? underestimated by cuff', 'because better on a-line)', '- requiring small boluses for intermittently low BP', '- CPAP was discussed but patient declined, and O2 sat improved to low', '90s after washing and repositioning', '-']",92287,133462.0
5,2171-02-16 07:36:21,,"['- Amio switched to Dig load per cards', '- TEE/cardioversion Scheduled for Monday', '- Diuresing well overnight']",,92287,133462.0
6,2171-02-16 10:47:21,,"['- Amio switched to Dig load per cards', '- TEE/cardioversion Scheduled for Monday', '- Diuresing well overnight']",,92287,133462.0
0,2106-04-07 08:01:17,,"['PRESEP CATHETER - START [**2106-4-6**] 06:20 PM', 'admitted from ER, mildly hypotensive but responded to 4L IVF', 'RIJ placed in ED and transferred to ICU for further monitoring', 'BP stable overnight without pressors or boluses', 'Pt doing well this am, c/o diffuse', 'all over', ' pains, present', 'intermittently at baseline. No CP/SOB.  Pt has some crampy abd pain', 'that he relates to diarrhea']",,19827,178197.0
1,2106-04-07 12:48:56,,"['PRESEP CATHETER - START [**2106-4-6**] 06:20 PM', 'admitted from ER, mildly hypotensive but responded to 4L IVF', 'RIJ placed in ED and transferred to ICU for further monitoring', 'BP stable overnight without pressors or boluses', 'Pt doing well this am, c/o diffuse', 'all over', ' pains, present', 'intermittently at baseline. No CP/SOB.  Pt has some crampy abd pain', 'that he relates to diarrhea']",,19827,178197.0
2,2106-04-08 07:31:31,"['BLOOD CULTURED - At [**2106-4-7**] 09:05 PM', ' URINE CULTURE - At [**2106-4-7**] 09:05 PM', ' FEVER - 101.1', 'F - [**2106-4-7**] 08:00 PM', ' CALLED OUT', '-- seen by plastics, feel decubitus ulcers appear to be granulating', 'appropriately with no', 'sign of infection', '-- IV team could not place PIV, kept central for access and blood draws', 'History obtained from Patient']","['BLOOD CULTURED - At [**2106-4-7**] 09:05 PM', ' URINE CULTURE - At [**2106-4-7**] 09:05 PM', ' FEVER - 101.1', 'F - [**2106-4-7**] 08:00 PM', ' CALLED OUT', '-- seen by plastics, feel decubitus ulcers appear to be granulating', 'appropriately with no', 'sign of infection', '-- IV team could not place PIV, kept central for access and blood draws', 'History obtained from Patient']","['PRESEP CATHETER - START [**2106-4-6**] 06:20 PM', 'admitted from ER, mildly hypotensive but responded to 4L IVF', 'RIJ placed in ED and transferred to ICU for further monitoring', 'BP stable overnight without pressors or boluses', 'Pt doing well this am, c/o diffuse', 'all over', ' pains, present', 'intermittently at baseline. No CP/SOB.  Pt has some crampy abd pain', 'that he relates to diarrhea']",19827,178197.0
3,2106-04-08 12:41:28,,"['BLOOD CULTURED - At [**2106-4-7**] 09:05 PM', ' URINE CULTURE - At [**2106-4-7**] 09:05 PM', ' FEVER - 101.1', 'F - [**2106-4-7**] 08:00 PM', ' CALLED OUT', '-- seen by plastics, feel decubitus ulcers appear to be granulating', 'appropriately with no', 'sign of infection', '-- IV team could not place PIV, kept central for access and blood draws', 'History obtained from Patient']",,19827,178197.0
0,2106-05-14 07:29:12,,"['PICC LINE - START [**2106-5-13**] 06:46 PM', ' PRESEP CATHETER - START [**2106-5-13**] 06:48 PM', ' URINE CULTURE - At [**2106-5-13**] 08:22 PM']",,19827,166475.0
1,2106-05-14 11:10:59,,"['PICC LINE - START [**2106-5-13**] 06:46 PM', ' PRESEP CATHETER - START [**2106-5-13**] 06:48 PM', ' URINE CULTURE - At [**2106-5-13**] 08:22 PM']",,19827,166475.0
2,2106-05-15 06:44:55,['PICC LINE - STOP [**2106-5-14**] 11:00 AM'],['PICC LINE - STOP [**2106-5-14**] 11:00 AM'],"['PICC LINE - START [**2106-5-13**] 06:46 PM', ' PRESEP CATHETER - START [**2106-5-13**] 06:48 PM', ' URINE CULTURE - At [**2106-5-13**] 08:22 PM']",19827,166475.0
3,2106-05-15 06:46:26,"['- What we thought was PICC was actually midline, so when it was', 'removed, the tip hit the bed.. still sent it to culture, keep this in', 'mind when results come back', '- foley changed', '- [**Last Name (un) 45**] stim: 7.8 --> 22.2, appropriate', '- Flu negative', '- Code status: patient is full code', '- plastics: reccs in chart. not staffed', '- Wound care: pending']","['PICC LINE - STOP [**2106-5-14**] 11:00 AM', '- What we thought was PICC was actually midline, so when it was', 'removed, the tip hit the bed.. still sent it to culture, keep this in', 'mind when results come back', '- foley changed', '- [**Last Name (un) 45**] stim: 7.8 --> 22.2, appropriate', '- Flu negative', '- Code status: patient is full code', '- plastics: reccs in chart. not staffed', '- Wound care: pending']",,19827,166475.0
4,2106-05-15 11:08:25,,"['PICC LINE - STOP [**2106-5-14**] 11:00 AM', '- What we thought was PICC was actually midline, so when it was', 'removed, the tip hit the bed.. still sent it to culture, keep this in', 'mind when results come back', '- foley changed', '- [**Last Name (un) 45**] stim: 7.8 --> 22.2, appropriate', '- Flu negative', '- Code status: patient is full code', '- plastics: reccs in chart. not staffed', '- Wound care: pending']",,19827,166475.0
5,2106-05-16 06:36:29,"['- Plastics: Signed off.  (No tissue or imaging requested)', '- SW following']","['- Plastics: Signed off.  (No tissue or imaging requested)', '- SW following']","['PICC LINE - STOP [**2106-5-14**] 11:00 AM', '- What we thought was PICC was actually midline, so when it was', 'removed, the tip hit the bed.. still sent it to culture, keep this in', 'mind when results come back', '- foley changed', '- [**Last Name (un) 45**] stim: 7.8 --> 22.2, appropriate', '- Flu negative', '- Code status: patient is full code', '- plastics: reccs in chart. not staffed', '- Wound care: pending']",19827,166475.0
6,2106-05-16 10:30:23,,"['- Plastics: Signed off.  (No tissue or imaging requested)', '- SW following']",,19827,166475.0
0,2106-06-09 07:37:37,,"['Plastics consulted, they do not feel that the sacral decubitus ulcer is', 'the likely source of his possible infection.  Wound cultures obtained.', ""-Urine cultures growing >100,000 GNR's, tobramycin started with once"", 'daily dosing.  Tobramycin level will be drawn 10 hrs post dose per', 'protocol', '-ESR/CRP mildly elevated 75/58.4', '-Third set of cardiac enzymes baseline with CK=145 and troponin=0.18', '-Diet changed to thick nectar liquids per speech and swallow evaluation', '-BP responded to fluids, received a total of 3.5L NS, with SBP 90-100,', 'no central line placed, PICC left in place', '-[**Last Name (un) **] stim: 14.6-->27', '-AM labs showing hypokalemia, hypomagnesemia, which I repleted.  He was', 'also low yesterday and was never repleted.  HCT 22, likely dilutional', 'component given large volume IVF.']",,19827,199336.0
1,2106-06-09 07:48:03,,"['Plastics consulted, they do not feel that the sacral decubitus ulcer is', 'the likely source of his possible infection.  Wound cultures obtained.', ""-Urine cultures growing >100,000 GNR's, tobramycin started with once"", 'daily dosing.  Tobramycin level will be drawn 10 hrs post dose per', 'protocol', '-ESR/CRP mildly elevated 75/58.4', '-Third set of cardiac enzymes baseline with CK=145 and troponin=0.18', '-Diet changed to thick nectar liquids per speech and swallow evaluation', '-BP responded to fluids, received a total of 3.5L NS, with SBP 90-100,', 'no central line placed, PICC left in place', '-[**Last Name (un) **] stim: 14.6-->27', '-AM labs showing hypokalemia, hypomagnesemia, which I repleted.  He was', 'also low yesterday and was never repleted.  HCT 22, likely dilutional', 'component given large volume IVF.']",,19827,199336.0
2,2106-06-09 07:49:11,,"['Plastics consulted, they do not feel that the sacral decubitus ulcer is', 'the likely source of his possible infection.  Wound cultures obtained.', ""-Urine cultures growing >100,000 GNR's, tobramycin started with once"", 'daily dosing.  Tobramycin level will be drawn 10 hrs post dose per', 'protocol', '-ESR/CRP mildly elevated 75/58.4', '-Third set of cardiac enzymes baseline with CK=145 and troponin=0.18', '-Diet changed to thick nectar liquids per speech and swallow evaluation', '-BP responded to fluids, received a total of 3.5L NS, with SBP 90-100,', 'no central line placed, PICC left in place', '-[**Last Name (un) **] stim: 14.6-->27', '-AM labs showing hypokalemia, hypomagnesemia, which I repleted.  He was', 'also low yesterday and was never repleted.  HCT 22, likely dilutional', 'component given large volume IVF.']",,19827,199336.0
3,2106-06-09 12:40:45,,"['Plastics consulted, they do not feel that the sacral decubitus ulcer is', 'the likely source of his possible infection.  Wound cultures obtained.', ""-Urine cultures growing >100,000 GNR's, tobramycin started with once"", 'daily dosing.  Tobramycin level will be drawn 10 hrs post dose per', 'protocol', '-ESR/CRP mildly elevated 75/58.4', '-Third set of cardiac enzymes baseline with CK=145 and troponin=0.18', '-Diet changed to thick nectar liquids per speech and swallow evaluation', '-BP responded to fluids, received a total of 3.5L NS, with SBP 90-100,', 'no central line placed, PICC left in place', '-[**Last Name (un) **] stim: 14.6-->27', '-AM labs showing hypokalemia, hypomagnesemia, which I repleted.  He was', 'also low yesterday and was never repleted.  HCT 22, likely dilutional', 'component given large volume IVF.']",,19827,199336.0
4,2106-06-10 07:22:31,"['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 showed...', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']","['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 showed...', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']","['Plastics consulted, they do not feel that the sacral decubitus ulcer is', 'the likely source of his possible infection.  Wound cultures obtained.', ""-Urine cultures growing >100,000 GNR's, tobramycin started with once"", 'daily dosing.  Tobramycin level will be drawn 10 hrs post dose per', 'protocol', '-ESR/CRP mildly elevated 75/58.4', '-Third set of cardiac enzymes baseline with CK=145 and troponin=0.18', '-Diet changed to thick nectar liquids per speech and swallow evaluation', '-BP responded to fluids, received a total of 3.5L NS, with SBP 90-100,', 'no central line placed, PICC left in place', '-[**Last Name (un) **] stim: 14.6-->27', '-AM labs showing hypokalemia, hypomagnesemia, which I repleted.  He was', 'also low yesterday and was never repleted.  HCT 22, likely dilutional', 'component given large volume IVF.']",19827,199336.0
5,2106-06-10 07:23:58,,"['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 showed...', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']",,19827,199336.0
6,2106-06-10 07:37:54,['Tobramycin level at 2130 0.9 (low)'],"['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 0.9 (low)', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']",['Tobramycin level at 2130 showed...'],19827,199336.0
7,2106-06-10 11:11:47,,"['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 0.9 (low)', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']",,19827,199336.0
8,2106-06-11 07:10:29,,[],"['SPUTUM CULTURE - At [**2106-6-9**] 05:57 PM', '-Urine cultures growing >100,000 Acinetobacter, tobramycin sensitive.', 'Tobramycin level at 2130 0.9 (low)', '-Desaturation in setting mucus plug, associated with transient', 'hypotension, resolved with suction, no IVF given', '-Plastics never came by to re-assess wound', '-Zosyn was stopped to narrow coverage']",19827,199336.0
9,2106-06-11 11:25:52,,[],,19827,199336.0
0,2145-08-25 07:44:52,,"['INDWELLING PORT (PORTACATH) - START [**2145-8-24**] 02:18 PM', '- restarted on home pain regimen, including nonformularies', '- no real change in swelling overnight', '- no difficulty breathing']",,89092,117191.0
1,2145-08-25 10:37:51,['- improvement in angioedema overnight'],"['INDWELLING PORT (PORTACATH) - START [**2145-8-24**] 02:18 PM', '- restarted on home pain regimen, including nonformularies', '- improvement in angioedema overnight', '- no difficulty breathing']",['- no real change in swelling overnight'],89092,117191.0
0,2142-03-15 07:52:03,,"['BLOOD CULTURED - At [**2142-3-14**] 05:14 PM', 'Continued diarrhea overnight', 'Tachycardia resolved with IVF']",,76381,159881.0
1,2142-03-15 11:40:56,"['Continued diarrhea overnight x 10 episodes of greenish watery stool', 'since arrival to ICU', 'denies abdominal pain, nausea', 'Tachycardia resolved with IVF, HR 80 this AM']","['BLOOD CULTURED - At [**2142-3-14**] 05:14 PM', 'Continued diarrhea overnight x 10 episodes of greenish watery stool', 'since arrival to ICU', 'denies abdominal pain, nausea', 'Tachycardia resolved with IVF, HR 80 this AM']","['Continued diarrhea overnight', 'Tachycardia resolved with IVF']",76381,159881.0
0,2185-01-25 09:59:52,,"['INVASIVE VENTILATION - START [**2185-1-25**] 12:00 AM', ' LUMBAR PUNCTURE - At [**2185-1-25**] 01:12 AM', '- pt responding, opening eyes to verbal stimuli.']",,59448,127957.0
1,2185-01-25 10:18:41,,"['INVASIVE VENTILATION - START [**2185-1-25**] 12:00 AM', ' LUMBAR PUNCTURE - At [**2185-1-25**] 01:12 AM', '- pt responding, opening eyes to verbal stimuli.']",,59448,127957.0
2,2185-01-26 05:17:47,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram']","['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram']","['INVASIVE VENTILATION - START [**2185-1-25**] 12:00 AM', ' LUMBAR PUNCTURE - At [**2185-1-25**] 01:12 AM', '- pt responding, opening eyes to verbal stimuli.']",59448,127957.0
3,2185-01-26 06:16:47,,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram']",,59448,127957.0
4,2185-01-26 06:19:37,"['- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']","['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",,59448,127957.0
5,2185-01-26 16:39:01,,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",,59448,127957.0
6,2185-01-26 17:00:25,,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",,59448,127957.0
7,2185-01-26 17:13:40,,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",,59448,127957.0
8,2185-01-26 17:27:31,,"['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",,59448,127957.0
9,2185-01-27 06:32:06,"['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']","['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']","['MAGNETIC RESONANCE IMAGING - At [**2185-1-25**] 12:00 PM', ' EEG - At [**2185-1-25**] 02:30 PM', ' ULTRASOUND - At [**2185-1-25**] 03:00 PM', 'Echocardiogram', '- TTE', ' markedly dilate LA, LVH, EF > 55%, trivial MR', '- MRI/MRA', ' R ICA stenosis, R vertebral stenosis', '- Nuero recs', ' cont current [**Last Name (LF) 2934**], [**First Name3 (LF) 116**] look at MRI, will re-eval when', 'extubated']",59448,127957.0
10,2185-01-27 06:33:07,,"['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']",,59448,127957.0
11,2185-01-27 15:29:10,,"['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']",,59448,127957.0
12,2185-01-27 16:39:08,,"['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']",,59448,127957.0
13,2185-01-28 06:44:39,"['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med injestion other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']","['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med injestion other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']","['PAN CULTURE - At [**2185-1-26**] 09:00 AM', ' ULTRASOUND - At [**2185-1-26**] 02:22 PM', 'liver and gallbladder ultrasound', ' FEVER - 101.2', 'F - [**2185-1-26**] 08:00 AM', 'CXR- found to have ? retrocardiac opacity, started on vanco (per', 'nursing had some thick secretions). FYI: prelim read per radiology is', ""'lungs clear, atelectasis resolved'."", '-US abd: Multiple hypoechoic liver lesions which are nonspecific but', 'concerning for', 'malignant process. Pancreatic lesion not imaged due to overlying bowel', 'gas.', '-EEG: abnormal routine EEG due to the presence of a slow and', 'disorganized background indicative of mild encephalopathy.', 'Medication, metabolic disturbances, and infection are the most common', 'causes. Nevertheless, there were no focal, lateralized, or epileptiform', 'features noted.']",59448,127957.0
14,2185-01-28 06:49:38,['hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other'],"['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']",['hospitaliztion. Denies suicidal ideation or pain med injestion other'],59448,127957.0
15,2185-01-28 10:44:53,,"['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']",,59448,127957.0
16,2185-01-28 11:03:32,,"['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']",,59448,127957.0
17,2185-01-28 14:05:54,,"['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']",,59448,127957.0
18,2185-01-29 06:20:49,"['CALLED OUT', '- no beds available on FA10', '- no issues overnight']","['CALLED OUT', '- no beds available on FA10', '- no issues overnight']","['INVASIVE VENTILATION - STOP [**2185-1-27**] 12:37 PM', '-extubated', '-pt alert but slow to respond, does not remember events leading to', 'hospitaliztion. Denies suicidal ideation or pain med [**Year (4 digits) 2912**] other', 'than possible tylenol', '-CMV, [**Male First Name (un) 2972**] virus sent as neuro rec', '-in for IR bx of liver lesion, but IR refusing until off ASA for 5', 'days. d/ced 81mg asa, getting bleeding time this am to prove ok', '-left message with PCP', '[**Name Initial (PRE) **] need to call neuro on ? small subacute infarct on final MR [**First Name (Titles) 2973**]', '[**Last Name (Titles) 2974**]ies:', 'No Known Drug Allergies']",59448,127957.0
19,2185-01-29 07:01:59,,"['CALLED OUT', '- no beds available on FA10', '- no issues overnight']",,59448,127957.0
20,2185-01-29 12:43:00,,"['CALLED OUT', '- no beds available on FA10', '- no issues overnight']",,59448,127957.0
0,2185-08-11 05:42:12,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
1,2185-08-11 05:44:39,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
2,2185-08-11 06:27:43,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
3,2185-08-11 06:33:38,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
4,2185-08-11 07:39:40,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
5,2185-08-11 07:42:59,,"['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
6,2185-08-11 07:47:18,['LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM'],"['LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection', '-repeat LP was traumatic with opening pressure of 15mmHg']","['NASAL SWAB - At [**2185-8-10**] 11:04 AM', ' LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM']",59448,104933.0
7,2185-08-11 15:37:40,['-mucomyst and bicarbonate for renal protection with CT'],"['LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection with CT', '-repeat LP was traumatic with opening pressure of 15mmHg']",['-mucomyst and bicarbonate for renal protection'],59448,104933.0
8,2185-08-11 16:04:15,,"['LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection with CT', '-repeat LP was traumatic with opening pressure of 15mmHg']",,59448,104933.0
9,2185-08-12 06:29:20,"['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']","['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']","['LUMBAR PUNCTURE - At [**2185-8-10**] 05:30 PM', 'LP done by Dr. [**Last Name (STitle) 980**] at bedside. Dr. [**Last Name (STitle) 980**] reports CSF pressure normal at', '14. Reports previously elevated CSF pressure was falsely elevated.', ' MAGNETIC RESONANCE IMAGING - At [**2185-8-10**] 10:00 PM', '[**8-10**]', 'Neurosurgery left parietal lobe biopsy with possible REVD planned for', 'tomorrow am', '- NPO after midnight', '- MRI with contrast tonight, CT with contrast tomorrow prior to', 'procedure', '-mucomyst and bicarbonate for renal protection with CT', '-repeat LP was traumatic with opening pressure of 15mmHg']",59448,104933.0
10,2185-08-12 06:30:06,,"['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']",,59448,104933.0
11,2185-08-12 06:31:08,,"['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']",,59448,104933.0
12,2185-08-12 11:29:38,,"['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']",,59448,104933.0
13,2185-08-13 07:30:41,"['DIALYSIS CATHETER - START [**2185-8-12**] 03:54 PM', ' EKG - At [**2185-8-12**] 10:00 PM', '- R IJ Dialysis placed for CVVHD', '- CVVHD started, replacement fluid changed to B32K2', '- Pt with new cough, chills', ' Cx, CXR', '- CVVHD clotted off at 0630']","['DIALYSIS CATHETER - START [**2185-8-12**] 03:54 PM', ' EKG - At [**2185-8-12**] 10:00 PM', '- R IJ Dialysis placed for CVVHD', '- CVVHD started, replacement fluid changed to B32K2', '- Pt with new cough, chills', ' Cx, CXR', '- CVVHD clotted off at 0630']","['OR SENT - At [**2185-8-11**] 01:13 PM', '- brain biopsy-90% sure it is lymphoma', '- start steroids 4 mg IV q6 post biopsy', '- IR to place line tomorrow for CVVHD in anticipation of methotrexate', 'therapy', '- neurosurg recs BPs <140']",59448,104933.0
14,2185-08-13 10:30:35,,"['DIALYSIS CATHETER - START [**2185-8-12**] 03:54 PM', ' EKG - At [**2185-8-12**] 10:00 PM', '- R IJ Dialysis placed for CVVHD', '- CVVHD started, replacement fluid changed to B32K2', '- Pt with new cough, chills', ' Cx, CXR', '- CVVHD clotted off at 0630']",,59448,104933.0
15,2185-08-13 10:38:39,,"['DIALYSIS CATHETER - START [**2185-8-12**] 03:54 PM', ' EKG - At [**2185-8-12**] 10:00 PM', '- R IJ Dialysis placed for CVVHD', '- CVVHD started, replacement fluid changed to B32K2', '- Pt with new cough, chills', ' Cx, CXR', '- CVVHD clotted off at 0630']",,59448,104933.0
16,2185-08-14 05:43:37,"['[**8-13**]', '- initiate MTX chemotherapy, check level in the morning', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']","['[**8-13**]', '- initiate MTX chemotherapy, check level in the morning', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']","['DIALYSIS CATHETER - START [**2185-8-12**] 03:54 PM', ' EKG - At [**2185-8-12**] 10:00 PM', '- R IJ Dialysis placed for CVVHD', '- CVVHD started, replacement fluid changed to B32K2', '- Pt with new cough, chills', ' Cx, CXR', '- CVVHD clotted off at 0630']",59448,104933.0
17,2185-08-14 05:44:37,,"['[**8-13**]', '- initiate MTX chemotherapy, check level in the morning', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']",,59448,104933.0
18,2185-08-14 09:50:50,,"['[**8-13**]', '- initiate MTX chemotherapy, check level in the morning', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']",,59448,104933.0
19,2185-08-14 10:52:54,"['- received MTX chemotherapy, check level after 24 hrs, 48 hrs, 72 hrs,', 'etc']","['[**8-13**]', '- received MTX chemotherapy, check level after 24 hrs, 48 hrs, 72 hrs,', 'etc', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']","['- initiate MTX chemotherapy, check level in the morning']",59448,104933.0
20,2185-08-15 06:41:28,"['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt started', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', '-consider switching to HD or starting anticoagulation as CVVHD clots', 'frequently', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']","['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt started', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', '-consider switching to HD or starting anticoagulation as CVVHD clots', 'frequently', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']","['[**8-13**]', '- received MTX chemotherapy, check level after 24 hrs, 48 hrs, 72 hrs,', 'etc', '- ABG, urine pH, chem 10 q. 4 hrs to ensure alkalinization of urine', '- tumor lysis labs [**Hospital1 **]', '-on labetolol drip for control of HTN (increase in SBP with MTX)', '-as per neurosurgery, patient has been placed on heparin sc BID for DVT', 'prophylaxis', '- repeatedly clotting off CVVHD']",59448,104933.0
21,2185-08-15 06:54:56,,"['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt started', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', '-consider switching to HD or starting anticoagulation as CVVHD clots', 'frequently', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']",,59448,104933.0
22,2185-08-15 11:03:11,"['-hypertensive, increased clonidine to 0.2 TID, labetalol gtt initiated', 'but dc', 'd this AM']","['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt initiated', 'but dc', 'd this AM', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']","['-hypertensive, increased clonidine to 0.2 TID, labetalol gtt started', '-consider switching to HD or starting anticoagulation as CVVHD clots', 'frequently']",59448,104933.0
23,2185-08-15 11:04:52,,"['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt initiated', 'but dc', 'd this AM', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']",,59448,104933.0
24,2185-08-16 07:11:03,"['-clotted CVVHD, switched to citrate-based fluid, plan to dialyze until', 'methotrexate <0.05', '-hypotensive, responsive to fluid bolus']","['-clotted CVVHD, switched to citrate-based fluid, plan to dialyze until', 'methotrexate <0.05', '-hypotensive, responsive to fluid bolus']","['- renal recommends continuing bicarb goals until the end of CRRT on', '[**8-15**], recommends trying to keep him fluid neutral', '-hypertensive, increased clonidine to 0.2 TID, labetalol gtt initiated', 'but dc', 'd this AM', '- sirolimus level pending', '-continue checking q 24 hr methotrexate levels and continue CVVHD until', 'levels <0.05, recent level 5.7', ""-pt missed 6 PM dose of leucovorin, BMT recs giving add'l 25 leukovorin"", 'now, then increasing 6 AM and 12 noon doses to 40.']",59448,104933.0
25,2185-08-16 07:14:13,,"['-clotted CVVHD, switched to citrate-based fluid, plan to dialyze until', 'methotrexate <0.05', '-hypotensive, responsive to fluid bolus']",,59448,104933.0
26,2185-08-16 15:44:00,['-pt c/o neck pain o/n'],"['-clotted CVVHD, switched to citrate-based fluid, plan to dialyze until', 'methotrexate <0.05', '-hypotensive, responsive to fluid bolus', '-pt c/o neck pain o/n']",,59448,104933.0
27,2185-08-17 06:15:17,"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM']","['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM']","['-clotted CVVHD, switched to citrate-based fluid, plan to dialyze until', 'methotrexate <0.05', '-hypotensive, responsive to fluid bolus', '-pt c/o neck pain o/n']",59448,104933.0
28,2185-08-17 06:16:26,,"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM']",,59448,104933.0
29,2185-08-17 06:17:16,,"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM']",,59448,104933.0
30,2185-08-17 07:30:27,,"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM']",,59448,104933.0
31,2185-08-17 07:49:42,"['-enterococci in urine', '--CVVHD dc', '-1U blood given for crit drop']","['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM', '-enterococci in urine', '--CVVHD dc', '-1U blood given for crit drop']",,59448,104933.0
32,2185-08-17 07:53:14,,"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM', '-enterococci in urine', '--CVVHD dc', '-1U blood given for crit drop']",,59448,104933.0
33,2185-08-17 15:56:45,['-CVVHD dc'],"['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM', '-enterococci in urine', '-CVVHD dc', '-1U blood given for crit drop']",['--CVVHD dc'],59448,104933.0
34,2185-08-18 07:04:42,"['SPUTUM CULTURE - At [**2185-8-17**] 12:28 PM', ' FEVER - 101.3', 'F - [**2185-8-18**] 04:00 AM']","['SPUTUM CULTURE - At [**2185-8-17**] 12:28 PM', ' FEVER - 101.3', 'F - [**2185-8-18**] 04:00 AM']","['BLOOD CULTURED - At [**2185-8-16**] 10:00 PM', '1 set from dialysis line, 1 set from art line', ' FEVER - 101.9', 'F - [**2185-8-17**] 12:20 AM', '-enterococci in urine', '-CVVHD dc', '-1U blood given for crit drop']",59448,104933.0
35,2185-08-18 07:44:40,['No acute events overnight.'],"['SPUTUM CULTURE - At [**2185-8-17**] 12:28 PM', ' FEVER - 101.3', 'F - [**2185-8-18**] 04:00 AM', 'No acute events overnight.']",,59448,104933.0
36,2185-08-18 14:20:03,,"['SPUTUM CULTURE - At [**2185-8-17**] 12:28 PM', ' FEVER - 101.3', 'F - [**2185-8-18**] 04:00 AM', 'No acute events overnight.']",,59448,104933.0
37,2185-08-19 06:20:23,"['- C. diff pos, started flagyl 500mg q8h', '- febrile']","['- C. diff pos, started flagyl 500mg q8h', '- febrile']","['SPUTUM CULTURE - At [**2185-8-17**] 12:28 PM', ' FEVER - 101.3', 'F - [**2185-8-18**] 04:00 AM', 'No acute events overnight.']",59448,104933.0
38,2185-08-19 06:22:34,,"['- C. diff pos, started flagyl 500mg q8h', '- febrile']",,59448,104933.0
39,2185-08-19 07:36:33,,"['- C. diff pos, started flagyl 500mg q8h', '- febrile']",,59448,104933.0
40,2185-08-19 07:46:02,,"['- C. diff pos, started flagyl 500mg q8h', '- febrile']",,59448,104933.0
41,2185-08-19 12:48:02,"['- high blood pressure in the setting of phantom limb pain and headache', 'this am']","['- C. diff pos, started flagyl 500mg q8h', '- febrile', '- high blood pressure in the setting of phantom limb pain and headache', 'this am']",,59448,104933.0
0,2204-05-31 07:24:51,,"['MULTI LUMEN - START [**2204-5-30**] 08:49 AM', ' TRANSTHORACIC ECHO - At [**2204-5-30**] 03:00 PM', ' EKG - At [**2204-5-30**] 04:55 PM', '- ERCP - biliary stent placed, purulent bile drained, 6mm round stone', 'in biliary tree', '- on cipro/zosyn', '- TTE - LVEF 55%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6366**] dilated', '- episode of vtach, started metoprolol, hemodynamically stable']",,18629,146627.0
1,2204-05-31 11:00:58,,"['MULTI LUMEN - START [**2204-5-30**] 08:49 AM', ' TRANSTHORACIC ECHO - At [**2204-5-30**] 03:00 PM', ' EKG - At [**2204-5-30**] 04:55 PM', '- ERCP - biliary stent placed, purulent bile drained, 6mm round stone', 'in biliary tree', '- on cipro/zosyn', '- TTE - LVEF 55%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6366**] dilated', '- episode of vtach, started metoprolol, hemodynamically stable']",,18629,146627.0
2,2204-05-31 15:25:53,,"['MULTI LUMEN - START [**2204-5-30**] 08:49 AM', ' TRANSTHORACIC ECHO - At [**2204-5-30**] 03:00 PM', ' EKG - At [**2204-5-30**] 04:55 PM', '- ERCP - biliary stent placed, purulent bile drained, 6mm round stone', 'in biliary tree', '- on cipro/zosyn', '- TTE - LVEF 55%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6366**] dilated', '- episode of vtach, started metoprolol, hemodynamically stable']",,18629,146627.0
3,2204-05-31 16:23:30,,"['MULTI LUMEN - START [**2204-5-30**] 08:49 AM', ' TRANSTHORACIC ECHO - At [**2204-5-30**] 03:00 PM', ' EKG - At [**2204-5-30**] 04:55 PM', '- ERCP - biliary stent placed, purulent bile drained, 6mm round stone', 'in biliary tree', '- on cipro/zosyn', '- TTE - LVEF 55%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6366**] dilated', '- episode of vtach, started metoprolol, hemodynamically stable']",,18629,146627.0
0,2150-04-19 06:28:33,,"['CALLED OUT', '-Hct stable throughout the day', '-Advanced diet to regular', '-Echo with hyperdynamic EF >75%, no effusion', '-Called out to [**Doctor Last Name 2572**]-[**Doctor Last Name **]', 'History obtained from Patient']",,54610,100003.0
1,2150-04-19 06:36:39,,"['CALLED OUT', '-Hct stable throughout the day', '-Advanced diet to regular', '-Echo with hyperdynamic EF >75%, no effusion', '-Called out to [**Doctor Last Name 2572**]-[**Doctor Last Name **]', 'History obtained from Patient']",,54610,100003.0
2,2150-04-19 09:52:39,,"['CALLED OUT', '-Hct stable throughout the day', '-Advanced diet to regular', '-Echo with hyperdynamic EF >75%, no effusion', '-Called out to [**Doctor Last Name 2572**]-[**Doctor Last Name **]', 'History obtained from Patient']",,54610,100003.0
3,2150-04-19 09:53:50,,"['CALLED OUT', '-Hct stable throughout the day', '-Advanced diet to regular', '-Echo with hyperdynamic EF >75%, no effusion', '-Called out to [**Doctor Last Name 2572**]-[**Doctor Last Name **]', 'History obtained from Patient']",,54610,100003.0
0,2150-07-14 06:41:54,,"['BLOOD CULTURED - At [**2150-7-13**] 11:10 PM', ' NASAL SWAB - At [**2150-7-13**] 11:10 PM']",,54610,122829.0
1,2150-07-14 06:57:33,,"['BLOOD CULTURED - At [**2150-7-13**] 11:10 PM', ' NASAL SWAB - At [**2150-7-13**] 11:10 PM']",,54610,122829.0
2,2150-07-14 10:07:23,,"['BLOOD CULTURED - At [**2150-7-13**] 11:10 PM', ' NASAL SWAB - At [**2150-7-13**] 11:10 PM']",,54610,122829.0
0,2150-12-14 07:29:30,,"['INVASIVE VENTILATION - START [**2150-12-13**] 09:00 AM', ' MULTI LUMEN - START [**2150-12-13**] 09:15 AM', ' ARTERIAL LINE - START [**2150-12-13**] 10:15 AM', ' BRONCHOSCOPY - At [**2150-12-13**] 08:00 PM', '- EKG no peaked T waves although K 6.1, kayexelate given and', 'Cagluconate; repeat EKG q1hour', '- BS 70; [**1-9**] amp D50 given --> 169.  q 30min BS', '- CVP 20, but thought to be fluid low so given 2 L', '- metabolic acidosis d/t sepsis', '- renal consulted.  Asked us to recontact if K increases or volume', 'becomes an issue and needs to be emergently dialyzed.', '- contact[**Name (NI) **] ENT about P bleed, was d/t traumatic intubation.  Packed by', 'ENT.', '- need to get ICU consent from father when comes in.', '- f/u urine labs: Na, Cr, Urea, osms, eos']",,54610,147673.0
1,2150-12-14 23:20:50,"['- EKG no peaked T waves although K 6.1, kayexelate given and Ca', 'gluconate;']","['INVASIVE VENTILATION - START [**2150-12-13**] 09:00 AM', ' MULTI LUMEN - START [**2150-12-13**] 09:15 AM', ' ARTERIAL LINE - START [**2150-12-13**] 10:15 AM', ' BRONCHOSCOPY - At [**2150-12-13**] 08:00 PM', '- EKG no peaked T waves although K 6.1, kayexelate given and Ca', 'gluconate;', '- BS 70; [**1-9**] amp D50 given --> 169.  q 30min BS', '- CVP 20, but thought to be fluid low so given 2 L', '- metabolic acidosis d/t sepsis', '- renal consulted.  Asked us to recontact if K increases or volume', 'becomes an issue and needs to be emergently dialyzed.', '- contact[**Name (NI) **] ENT about P bleed, was d/t traumatic intubation.  Packed by', 'ENT.']","['- EKG no peaked T waves although K 6.1, kayexelate given and', 'Cagluconate; repeat EKG q1hour', '- need to get ICU consent from father when comes in.', '- f/u urine labs: Na, Cr, Urea, osms, eos']",54610,147673.0
2,2150-12-15 07:14:47,"['BLOOD CULTURED - At [**2150-12-14**] 04:10 PM', 'from cvp & perip', '- per renal, labs look OK so renal will hold off on HD until tomorrow.', 'Recommend continuing bicarb GTT overnight.', '- On Vanc/Zosyn/Clinda/Micafungin per ID', '- ID suggested CT to r/o perf, but not stable to go off floor so did', 'not get (for distended abdomen and fevers).  However, lactate', 'improving.', '- Bladder pressure 100, but then decreased', '- Decreased RR to 24 on vent', '- ENT leaving in nasal packings for 24 hours more, then will remove']","['BLOOD CULTURED - At [**2150-12-14**] 04:10 PM', 'from cvp & perip', '- per renal, labs look OK so renal will hold off on HD until tomorrow.', 'Recommend continuing bicarb GTT overnight.', '- On Vanc/Zosyn/Clinda/Micafungin per ID', '- ID suggested CT to r/o perf, but not stable to go off floor so did', 'not get (for distended abdomen and fevers).  However, lactate', 'improving.', '- Bladder pressure 100, but then decreased', '- Decreased RR to 24 on vent', '- ENT leaving in nasal packings for 24 hours more, then will remove']","['INVASIVE VENTILATION - START [**2150-12-13**] 09:00 AM', ' MULTI LUMEN - START [**2150-12-13**] 09:15 AM', ' ARTERIAL LINE - START [**2150-12-13**] 10:15 AM', ' BRONCHOSCOPY - At [**2150-12-13**] 08:00 PM', '- EKG no peaked T waves although K 6.1, kayexelate given and Ca', 'gluconate;', '- BS 70; [**1-9**] amp D50 given --> 169.  q 30min BS', '- CVP 20, but thought to be fluid low so given 2 L', '- metabolic acidosis d/t sepsis', '- renal consulted.  Asked us to recontact if K increases or volume', 'becomes an issue and needs to be emergently dialyzed.', '- contact[**Name (NI) **] ENT about P bleed, was d/t traumatic intubation.  Packed by', 'ENT.']",54610,147673.0
3,2150-12-15 19:58:19,,"['BLOOD CULTURED - At [**2150-12-14**] 04:10 PM', 'from cvp & perip', '- per renal, labs look OK so renal will hold off on HD until tomorrow.', 'Recommend continuing bicarb GTT overnight.', '- On Vanc/Zosyn/Clinda/Micafungin per ID', '- ID suggested CT to r/o perf, but not stable to go off floor so did', 'not get (for distended abdomen and fevers).  However, lactate', 'improving.', '- Bladder pressure 100, but then decreased', '- Decreased RR to 24 on vent', '- ENT leaving in nasal packings for 24 hours more, then will remove']",,54610,147673.0
4,2150-12-16 06:35:05,"['-ENT removed packing; leave nose packing in place until they come back', 'in 2 days (no OG tube or suction until then)', ""-[**Last Name (un) **] stim test done yesterday, include new results in today's rounds"", 'discussion', '-renal: discuss with pharmacy how/whether to change zosyn/clinda doses', 'with renal improvement (did not do this yet)', ""-hepatology rec'd: albumin, we held off on this idea"", '-KUB: wet read, no perforation, but color increasingly distended', '-into afib with RVR in the afternoon (HR to 120s), given dilt, and saw', 'HR improve to 100s', ""-transplant surgery is supposed to leave a note, didn't see it yet"", '-hepatology recommending a paracentesis today', '-id: continue zosyn, clinda, mica', ' EKG - At [**2150-12-15**] 03:02 PM']","['-ENT removed packing; leave nose packing in place until they come back', 'in 2 days (no OG tube or suction until then)', ""-[**Last Name (un) **] stim test done yesterday, include new results in today's rounds"", 'discussion', '-renal: discuss with pharmacy how/whether to change zosyn/clinda doses', 'with renal improvement (did not do this yet)', ""-hepatology rec'd: albumin, we held off on this idea"", '-KUB: wet read, no perforation, but color increasingly distended', '-into afib with RVR in the afternoon (HR to 120s), given dilt, and saw', 'HR improve to 100s', ""-transplant surgery is supposed to leave a note, didn't see it yet"", '-hepatology recommending a paracentesis today', '-id: continue zosyn, clinda, mica', ' EKG - At [**2150-12-15**] 03:02 PM']","['BLOOD CULTURED - At [**2150-12-14**] 04:10 PM', 'from cvp & perip', '- per renal, labs look OK so renal will hold off on HD until tomorrow.', 'Recommend continuing bicarb GTT overnight.', '- On Vanc/Zosyn/Clinda/Micafungin per ID', '- ID suggested CT to r/o perf, but not stable to go off floor so did', 'not get (for distended abdomen and fevers).  However, lactate', 'improving.', '- Bladder pressure 100, but then decreased', '- Decreased RR to 24 on vent', '- ENT leaving in nasal packings for 24 hours more, then will remove']",54610,147673.0
5,2150-12-16 06:50:54,"['-[**Last Name (un) **] stim test done yesterday,', '-KUB: wet read, no perforation, but colon increasingly distended', 'HR improve to 100s, had ECG done']","['-ENT removed packing; leave nose packing in place until they come back', 'in 2 days (no OG tube or suction until then)', '-[**Last Name (un) **] stim test done yesterday,', '-renal: discuss with pharmacy how/whether to change zosyn/clinda doses', 'with renal improvement (did not do this yet)', ""-hepatology rec'd: albumin, we held off on this idea"", '-KUB: wet read, no perforation, but colon increasingly distended', '-into afib with RVR in the afternoon (HR to 120s), given dilt, and saw', 'HR improve to 100s, had ECG done', '-hepatology recommending a paracentesis today', '-id: continue zosyn, clinda, mica']","[""-[**Last Name (un) **] stim test done yesterday, include new results in today's rounds"", 'discussion', '-KUB: wet read, no perforation, but color increasingly distended', 'HR improve to 100s', ""-transplant surgery is supposed to leave a note, didn't see it yet"", ' EKG - At [**2150-12-15**] 03:02 PM']",54610,147673.0
6,2150-12-16 16:30:32,"[""-hepatology rec'd: albumin, holding on that for now; also recommended"", 'paracentesis today']","['-ENT removed packing; leave nose packing in place until they come back', 'in 2 days (no OG tube or suction until then)', '-[**Last Name (un) **] stim test done yesterday,', ""-hepatology rec'd: albumin, holding on that for now; also recommended"", 'paracentesis today', '-KUB: wet read, no perforation, but colon increasingly distended', '-into afib with RVR in the afternoon (HR to 120s), given dilt, and saw', 'HR improve to 100s, had ECG done', '-id: continue zosyn, clinda, mica']","['-renal: discuss with pharmacy how/whether to change zosyn/clinda doses', 'with renal improvement (did not do this yet)', ""-hepatology rec'd: albumin, we held off on this idea"", '-hepatology recommending a paracentesis today']",54610,147673.0
7,2150-12-17 07:30:53,"['ULTRASOUND - At [**2150-12-16**] 02:00 PM', 'abdominal', ' PARACENTESIS - At [**2150-12-16**] 03:30 PM', 'for diagnostic purposes', ""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%), with"", 'reasonable ABG taken 2 hours after change. Overnight, pt desated to', 'high 80s, came up to 93% with suctioning. RT evaluated patient, made no', 'changes. Most recent ABG showed: pH 7.46 pCO2 38 pO2 68 HCO3 28. CXR: ?', 'incr fluid overload, ? diuresis.  Increased Fi02 to 60%.', '- pt also w. decr UOP overnight (20->15->10 in 3 hours), so was given', '250cc bolus with increased UOP.  Urine appeared concentrated, but CVP', 'was 19. Bladder pressure 14.  Gave Lasix 20mg IV.', '- decreased levophed to 0.06 from 0.1 over last 24 hours.', '- did diagnostic paracentesis w. WBC 11K, 86% PMNs.', '- Renal: signing off, Cr at baseline', '- ID: Agree with plan to re-tap. If no sig improvement, rec surgical', 'exploration.', '- Transplant sx: agrees with above.', '- Liver: If incr WBC or multiple organisms/fungus, would consider', 'surgical exploration.']","['ULTRASOUND - At [**2150-12-16**] 02:00 PM', 'abdominal', ' PARACENTESIS - At [**2150-12-16**] 03:30 PM', 'for diagnostic purposes', ""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%), with"", 'reasonable ABG taken 2 hours after change. Overnight, pt desated to', 'high 80s, came up to 93% with suctioning. RT evaluated patient, made no', 'changes. Most recent ABG showed: pH 7.46 pCO2 38 pO2 68 HCO3 28. CXR: ?', 'incr fluid overload, ? diuresis.  Increased Fi02 to 60%.', '- pt also w. decr UOP overnight (20->15->10 in 3 hours), so was given', '250cc bolus with increased UOP.  Urine appeared concentrated, but CVP', 'was 19. Bladder pressure 14.  Gave Lasix 20mg IV.', '- decreased levophed to 0.06 from 0.1 over last 24 hours.', '- did diagnostic paracentesis w. WBC 11K, 86% PMNs.', '- Renal: signing off, Cr at baseline', '- ID: Agree with plan to re-tap. If no sig improvement, rec surgical', 'exploration.', '- Transplant sx: agrees with above.', '- Liver: If incr WBC or multiple organisms/fungus, would consider', 'surgical exploration.']","['-ENT removed packing; leave nose packing in place until they come back', 'in 2 days (no OG tube or suction until then)', '-[**Last Name (un) **] stim test done yesterday,', ""-hepatology rec'd: albumin, holding on that for now; also recommended"", 'paracentesis today', '-KUB: wet read, no perforation, but colon increasingly distended', '-into afib with RVR in the afternoon (HR to 120s), given dilt, and saw', 'HR improve to 100s, had ECG done', '-id: continue zosyn, clinda, mica']",54610,147673.0
8,2150-12-17 15:51:05,"[""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%)."", 'Overnight, pt desated to high 80s, came up to 93% with suctioning.', '- decreased UOP overnight (20->15->10 in 3 hours), so was given 250cc', 'bolus with increased UOP.  Urine appeared concentrated, but CVP was 19.', 'Bladder pressure 14.  Gave Lasix 20mg IV.', '- Decreased levophed to 0.06 from 0.1 over last 24 hours.']","['ULTRASOUND - At [**2150-12-16**] 02:00 PM', 'abdominal', ' PARACENTESIS - At [**2150-12-16**] 03:30 PM', 'for diagnostic purposes', ""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%)."", 'Overnight, pt desated to high 80s, came up to 93% with suctioning.', '- decreased UOP overnight (20->15->10 in 3 hours), so was given 250cc', 'bolus with increased UOP.  Urine appeared concentrated, but CVP was 19.', 'Bladder pressure 14.  Gave Lasix 20mg IV.', '- Decreased levophed to 0.06 from 0.1 over last 24 hours.', '- Renal: signing off, Cr at baseline', '- ID: Agree with plan to re-tap. If no sig improvement, rec surgical', 'exploration.', '- Transplant sx: agrees with above.', '- Liver: If incr WBC or multiple organisms/fungus, would consider', 'surgical exploration.']","[""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%), with"", 'reasonable ABG taken 2 hours after change. Overnight, pt desated to', 'high 80s, came up to 93% with suctioning. RT evaluated patient, made no', 'changes. Most recent ABG showed: pH 7.46 pCO2 38 pO2 68 HCO3 28. CXR: ?', 'incr fluid overload, ? diuresis.  Increased Fi02 to 60%.', '- pt also w. decr UOP overnight (20->15->10 in 3 hours), so was given', '250cc bolus with increased UOP.  Urine appeared concentrated, but CVP', 'was 19. Bladder pressure 14.  Gave Lasix 20mg IV.', '- decreased levophed to 0.06 from 0.1 over last 24 hours.', '- did diagnostic paracentesis w. WBC 11K, 86% PMNs.']",54610,147673.0
9,2150-12-18 07:37:22,"['- Underwent CT abdomen', '- Discontinued Clinda, per ID recs']","['- Underwent CT abdomen', '- Discontinued Clinda, per ID recs']","['ULTRASOUND - At [**2150-12-16**] 02:00 PM', 'abdominal', ' PARACENTESIS - At [**2150-12-16**] 03:30 PM', 'for diagnostic purposes', ""- decreased pt's tidal volume (500->400) and Fi02 (60%-->50%)."", 'Overnight, pt desated to high 80s, came up to 93% with suctioning.', '- decreased UOP overnight (20->15->10 in 3 hours), so was given 250cc', 'bolus with increased UOP.  Urine appeared concentrated, but CVP was 19.', 'Bladder pressure 14.  Gave Lasix 20mg IV.', '- Decreased levophed to 0.06 from 0.1 over last 24 hours.', '- Renal: signing off, Cr at baseline', '- ID: Agree with plan to re-tap. If no sig improvement, rec surgical', 'exploration.', '- Transplant sx: agrees with above.', '- Liver: If incr WBC or multiple organisms/fungus, would consider', 'surgical exploration.']",54610,147673.0
10,2150-12-18 12:05:05,,"['- Underwent CT abdomen', '- Discontinued Clinda, per ID recs']",,54610,147673.0
11,2150-12-19 07:57:17,"['- ENT, packing removed, continue epistaxis precautions, appointment', 'with Dr. [**First Name (STitle) 4381**] (ENT, ORL) 1 week post discharge', '- girlfriend updated', '- [**Name2 (NI) **] [**Name (NI) 9829**] this AM, increased FiO2 to 70% and PEEP 12->15, with', 'improvement.  Now, PEEP decreased back to 12, but Fi02 still 70%.', '- Norepi drip dc', 'ed, no pressors on']","['- ENT, packing removed, continue epistaxis precautions, appointment', 'with Dr. [**First Name (STitle) 4381**] (ENT, ORL) 1 week post discharge', '- girlfriend updated', '- [**Name2 (NI) **] [**Name (NI) 9829**] this AM, increased FiO2 to 70% and PEEP 12->15, with', 'improvement.  Now, PEEP decreased back to 12, but Fi02 still 70%.', '- Norepi drip dc', 'ed, no pressors on']","['- Underwent CT abdomen', '- Discontinued Clinda, per ID recs']",54610,147673.0
12,2150-12-19 18:47:46,"['- Still on Levophed', '- All pressors off x 24 hours', ' pt still unresponsive except to painful', 'stim']","['- ENT, packing removed, continue epistaxis precautions, appointment', 'with Dr. [**First Name (STitle) 4381**] (ENT, ORL) 1 week post discharge', '- girlfriend updated', '- [**Name2 (NI) **] [**Name (NI) 9829**] this AM, increased FiO2 to 70% and PEEP 12->15, with', 'improvement.  Now, PEEP decreased back to 12, but Fi02 still 70%.', '- Still on Levophed', '- All pressors off x 24 hours', ' pt still unresponsive except to painful', 'stim']","['- Norepi drip dc', 'ed, no pressors on']",54610,147673.0
13,2150-12-20 08:17:13,"['- ARF: Concern for over-diuresis/contrast load versus hepatorenal', 'syndrome. Urine lytes showed urine Na < 10, Cr 81 (FENa 0.1%); urine', 'eos Negative. Gave pt albumin 1g/kg with increased UOP and improved BPs', '(weaned neo from 0.1 to 0.04).  Also started octreotide drip.  Can', 'consider starting Midodrine, pending hepatology recs for hepatorenal', 'syndrome.', '- AMS: started patient on lactulose. -- BMs.', '- Respiratory failure: placed esophageal baloon.', ""- ID: dc'ed micafungin per ID recs."", '- Transplant surgery: recommends repeat diagnostic paracentesis in AM.', 'trying to evaluate whether the patient is moving in the right dirction', 'and whether there is a small bowel perf not seen on CT abd for which', 'ex-lap is indicated (although pt would be an extremely poor surgical', 'candiate). Repeat lactate 2.9 (up from 1.7 on [**12-17**]).']","['- ARF: Concern for over-diuresis/contrast load versus hepatorenal', 'syndrome. Urine lytes showed urine Na < 10, Cr 81 (FENa 0.1%); urine', 'eos Negative. Gave pt albumin 1g/kg with increased UOP and improved BPs', '(weaned neo from 0.1 to 0.04).  Also started octreotide drip.  Can', 'consider starting Midodrine, pending hepatology recs for hepatorenal', 'syndrome.', '- AMS: started patient on lactulose. -- BMs.', '- Respiratory failure: placed esophageal baloon.', ""- ID: dc'ed micafungin per ID recs."", '- Transplant surgery: recommends repeat diagnostic paracentesis in AM.', 'trying to evaluate whether the patient is moving in the right dirction', 'and whether there is a small bowel perf not seen on CT abd for which', 'ex-lap is indicated (although pt would be an extremely poor surgical', 'candiate). Repeat lactate 2.9 (up from 1.7 on [**12-17**]).']","['- ENT, packing removed, continue epistaxis precautions, appointment', 'with Dr. [**First Name (STitle) 4381**] (ENT, ORL) 1 week post discharge', '- girlfriend updated', '- [**Name2 (NI) **] [**Name (NI) 9829**] this AM, increased FiO2 to 70% and PEEP 12->15, with', 'improvement.  Now, PEEP decreased back to 12, but Fi02 still 70%.', '- Still on Levophed', '- All pressors off x 24 hours', ' pt still unresponsive except to painful', 'stim']",54610,147673.0
14,2150-12-20 17:20:34,"['- Respiratory failure: placed esophageal balloon.', 'trying to evaluate whether the patient is moving in the right direction', 'candiate). Repeat lactate 2.9 -> 2.2 (up from 1.7 on [**12-17**]).']","['- ARF: Concern for over-diuresis/contrast load versus hepatorenal', 'syndrome. Urine lytes showed urine Na < 10, Cr 81 (FENa 0.1%); urine', 'eos Negative. Gave pt albumin 1g/kg with increased UOP and improved BPs', '(weaned neo from 0.1 to 0.04).  Also started octreotide drip.  Can', 'consider starting Midodrine, pending hepatology recs for hepatorenal', 'syndrome.', '- AMS: started patient on lactulose. -- BMs.', '- Respiratory failure: placed esophageal balloon.', ""- ID: dc'ed micafungin per ID recs."", '- Transplant surgery: recommends repeat diagnostic paracentesis in AM.', 'trying to evaluate whether the patient is moving in the right direction', 'and whether there is a small bowel perf not seen on CT abd for which', 'ex-lap is indicated (although pt would be an extremely poor surgical', 'candiate). Repeat lactate 2.9 -> 2.2 (up from 1.7 on [**12-17**]).']","['- Respiratory failure: placed esophageal baloon.', 'trying to evaluate whether the patient is moving in the right dirction', 'candiate). Repeat lactate 2.9 (up from 1.7 on [**12-17**]).']",54610,147673.0
15,2150-12-21 07:18:42,"['- Started Midrodrine, continued Octreotide, started Rifaximin', '- Surgery and ID recommend diagnostic tap, Renal and Liver recs pnd', ""- Micafungin d/c'ed"", '- NGT put out 200cc bloody discharge in 2 hours (same color as this', 'morning, but more volume) but most recent Hct 6 hours ago stable.', 'Changed Octreotide to drip, gave 3 units FFP, 1 unit platelets, 1 unit', ""PRBC, T&C x3 units, fyi'ed liver.  Checking 10pm and 4am CBC and coags."", '- Hct check at 23:00 22.3 <- 24.1 at 14:00.  NGT cleared with FFP.', 'Written for q6h cbc and coag checks.']","['- Started Midrodrine, continued Octreotide, started Rifaximin', '- Surgery and ID recommend diagnostic tap, Renal and Liver recs pnd', ""- Micafungin d/c'ed"", '- NGT put out 200cc bloody discharge in 2 hours (same color as this', 'morning, but more volume) but most recent Hct 6 hours ago stable.', 'Changed Octreotide to drip, gave 3 units FFP, 1 unit platelets, 1 unit', ""PRBC, T&C x3 units, fyi'ed liver.  Checking 10pm and 4am CBC and coags."", '- Hct check at 23:00 22.3 <- 24.1 at 14:00.  NGT cleared with FFP.', 'Written for q6h cbc and coag checks.']","['- ARF: Concern for over-diuresis/contrast load versus hepatorenal', 'syndrome. Urine lytes showed urine Na < 10, Cr 81 (FENa 0.1%); urine', 'eos Negative. Gave pt albumin 1g/kg with increased UOP and improved BPs', '(weaned neo from 0.1 to 0.04).  Also started octreotide drip.  Can', 'consider starting Midodrine, pending hepatology recs for hepatorenal', 'syndrome.', '- AMS: started patient on lactulose. -- BMs.', '- Respiratory failure: placed esophageal balloon.', ""- ID: dc'ed micafungin per ID recs."", '- Transplant surgery: recommends repeat diagnostic paracentesis in AM.', 'trying to evaluate whether the patient is moving in the right direction', 'and whether there is a small bowel perf not seen on CT abd for which', 'ex-lap is indicated (although pt would be an extremely poor surgical', 'candiate). Repeat lactate 2.9 -> 2.2 (up from 1.7 on [**12-17**]).']",54610,147673.0
16,2150-12-21 11:54:43,,"['- Started Midrodrine, continued Octreotide, started Rifaximin', '- Surgery and ID recommend diagnostic tap, Renal and Liver recs pnd', ""- Micafungin d/c'ed"", '- NGT put out 200cc bloody discharge in 2 hours (same color as this', 'morning, but more volume) but most recent Hct 6 hours ago stable.', 'Changed Octreotide to drip, gave 3 units FFP, 1 unit platelets, 1 unit', ""PRBC, T&C x3 units, fyi'ed liver.  Checking 10pm and 4am CBC and coags."", '- Hct check at 23:00 22.3 <- 24.1 at 14:00.  NGT cleared with FFP.', 'Written for q6h cbc and coag checks.']",,54610,147673.0
17,2150-12-21 11:55:45,,"['- Started Midrodrine, continued Octreotide, started Rifaximin', '- Surgery and ID recommend diagnostic tap, Renal and Liver recs pnd', ""- Micafungin d/c'ed"", '- NGT put out 200cc bloody discharge in 2 hours (same color as this', 'morning, but more volume) but most recent Hct 6 hours ago stable.', 'Changed Octreotide to drip, gave 3 units FFP, 1 unit platelets, 1 unit', ""PRBC, T&C x3 units, fyi'ed liver.  Checking 10pm and 4am CBC and coags."", '- Hct check at 23:00 22.3 <- 24.1 at 14:00.  NGT cleared with FFP.', 'Written for q6h cbc and coag checks.']",,54610,147673.0
18,2150-12-22 07:18:00,"['- ID and hepat recommend para - held off as would not alter management', '- TPN started', '- PEEP decr from 15 to 13 (ordered for AM ABG)', '- started daily albumin', ""- having BM's (guiac positive)""]","['- ID and hepat recommend para - held off as would not alter management', '- TPN started', '- PEEP decr from 15 to 13 (ordered for AM ABG)', '- started daily albumin', ""- having BM's (guiac positive)""]","['- Started Midrodrine, continued Octreotide, started Rifaximin', '- Surgery and ID recommend diagnostic tap, Renal and Liver recs pnd', ""- Micafungin d/c'ed"", '- NGT put out 200cc bloody discharge in 2 hours (same color as this', 'morning, but more volume) but most recent Hct 6 hours ago stable.', 'Changed Octreotide to drip, gave 3 units FFP, 1 unit platelets, 1 unit', ""PRBC, T&C x3 units, fyi'ed liver.  Checking 10pm and 4am CBC and coags."", '- Hct check at 23:00 22.3 <- 24.1 at 14:00.  NGT cleared with FFP.', 'Written for q6h cbc and coag checks.']",54610,147673.0
19,2150-12-22 17:55:21,"['- off pressors', '- PEEP decr from 15 to 13 (ordered for AM ABG), but then pt de-sat', 'to high 80s, so PEEP was increased back to 15, no RSBI this AM', ""- having multiple loose BM's (guiac positive)""]","['- off pressors', '- ID and hepat recommend para - held off as would not alter management', '- TPN started', '- PEEP decr from 15 to 13 (ordered for AM ABG), but then pt de-sat', 'to high 80s, so PEEP was increased back to 15, no RSBI this AM', '- started daily albumin', ""- having multiple loose BM's (guiac positive)""]","['- PEEP decr from 15 to 13 (ordered for AM ABG)', ""- having BM's (guiac positive)""]",54610,147673.0
20,2150-12-23 07:46:17,"['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']","['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']","['- off pressors', '- ID and hepat recommend para - held off as would not alter management', '- TPN started', '- PEEP decr from 15 to 13 (ordered for AM ABG), but then pt de-sat', 'to high 80s, so PEEP was increased back to 15, no RSBI this AM', '- started daily albumin', ""- having multiple loose BM's (guiac positive)""]",54610,147673.0
21,2150-12-23 08:31:10,,"['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']",,54610,147673.0
22,2150-12-23 10:57:33,,"['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']",,54610,147673.0
23,2150-12-23 11:48:14,,"['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']",,54610,147673.0
24,2150-12-24 07:33:06,"['- D5W x2L', '- Lasix, Spironolactone initiated', '- PM Na 150, free water flushes initiated 200mg q6h', '- TPN orders placed per nutrition recs', '- C. diff negative', '- Prolactin level sent', '- Renal consulted', '- Liver:  Tamoxifen 20mg daily for gynecomastia', '- Started SC Heparin daily for anti-coagulation effect since Tamoxifen', 'is pro-thrombogenic', '- Decreasing PEEP', '- Nighttime Na 149, written for another 2L D5W, increased free water', 'flushes to 300cc q6h, and written for Lasix 60mg IV x1 as he did not', 'put out significantly to Lasix 40mg IV in AM.', '- Cr decreased']","['- D5W x2L', '- Lasix, Spironolactone initiated', '- PM Na 150, free water flushes initiated 200mg q6h', '- TPN orders placed per nutrition recs', '- C. diff negative', '- Prolactin level sent', '- Renal consulted', '- Liver:  Tamoxifen 20mg daily for gynecomastia', '- Started SC Heparin daily for anti-coagulation effect since Tamoxifen', 'is pro-thrombogenic', '- Decreasing PEEP', '- Nighttime Na 149, written for another 2L D5W, increased free water', 'flushes to 300cc q6h, and written for Lasix 60mg IV x1 as he did not', 'put out significantly to Lasix 40mg IV in AM.', '- Cr decreased']","['- Pt switched from AC ventilation to PSV ventilation.', '- Hypernatremia: Na increased from 146 -> 149 while pt was receiving D5', 'at 100 ml/hr for 1000 ml; wrote pt for a 2nd liter of D5 at the same', 'rate.', '- Volume status: Attempted to diurese pt w. Lasix 40mg IV w. good urine', 'output (3050mL), cumulative fluid balance -50 (minus 1L D5).', '- ID: recommended changing zosyn to clinda and cipro, as less', 'nephrotoxic.']",54610,147673.0
25,2150-12-24 11:38:28,"['- secretions plentiful', '- decreased PEEP again this morning, down to 10']","['- D5W x2L', '- Lasix, Spironolactone initiated', '- PM Na 150, free water flushes initiated 200mg q6h', '- TPN orders placed per nutrition recs', '- C. diff negative', '- Prolactin level sent', '- Renal consulted', '- Liver:  Tamoxifen 20mg daily for gynecomastia', '- Started SC Heparin daily for anti-coagulation effect since Tamoxifen', 'is pro-thrombogenic', '- Decreasing PEEP', '- Nighttime Na 149, written for another 2L D5W, increased free water', 'flushes to 300cc q6h, and written for Lasix 60mg IV x1 as he did not', 'put out significantly to Lasix 40mg IV in AM.', '- Cr decreased', '- secretions plentiful', '- decreased PEEP again this morning, down to 10']",,54610,147673.0
26,2150-12-25 07:42:47,"['URINE CULTURE - At [**2150-12-24**] 11:31 AM', ' BLOOD CULTURED - At [**2150-12-24**] 11:32 AM', 'Two sets of cultures sent. Per MICU Team okay to draw from A-line and', 'CVL.', ' STOOL CULTURE - At [**2150-12-24**] 11:33 AM', 'Sent for C-diff', ' ULTRASOUND - At [**2150-12-24**] 12:10 PM', ' PARACENTESIS - At [**2150-12-24**] 04:12 PM Diagnostic paracentesis. Only', 'fluid for cultures removed.', '- did diagnostic para, RLQ', '- girlfriend updated', '- hepatology: if Cr stable in AM, could d/c octreotide (but would', 'continue midodrine); d/c albumin (done); broaden antibiotics; check cbc', 'with diff in AM (ordered)', '- I>>O, so given extra 40IV lasix in evening']","['URINE CULTURE - At [**2150-12-24**] 11:31 AM', ' BLOOD CULTURED - At [**2150-12-24**] 11:32 AM', 'Two sets of cultures sent. Per MICU Team okay to draw from A-line and', 'CVL.', ' STOOL CULTURE - At [**2150-12-24**] 11:33 AM', 'Sent for C-diff', ' ULTRASOUND - At [**2150-12-24**] 12:10 PM', ' PARACENTESIS - At [**2150-12-24**] 04:12 PM Diagnostic paracentesis. Only', 'fluid for cultures removed.', '- did diagnostic para, RLQ', '- girlfriend updated', '- hepatology: if Cr stable in AM, could d/c octreotide (but would', 'continue midodrine); d/c albumin (done); broaden antibiotics; check cbc', 'with diff in AM (ordered)', '- I>>O, so given extra 40IV lasix in evening']","['- D5W x2L', '- Lasix, Spironolactone initiated', '- PM Na 150, free water flushes initiated 200mg q6h', '- TPN orders placed per nutrition recs', '- C. diff negative', '- Prolactin level sent', '- Renal consulted', '- Liver:  Tamoxifen 20mg daily for gynecomastia', '- Started SC Heparin daily for anti-coagulation effect since Tamoxifen', 'is pro-thrombogenic', '- Decreasing PEEP', '- Nighttime Na 149, written for another 2L D5W, increased free water', 'flushes to 300cc q6h, and written for Lasix 60mg IV x1 as he did not', 'put out significantly to Lasix 40mg IV in AM.', '- Cr decreased', '- secretions plentiful', '- decreased PEEP again this morning, down to 10']",54610,147673.0
27,2150-12-25 11:23:55,"['- girlfriend updated, per girlfriend, pt had painful gynecomastia prior', 'to this hospitalization', 'continue midodrine); d/c albumin (done); broaden antibiotics (given', 'leukocytosis over last 5 days); check cbc with diff in AM']","['URINE CULTURE - At [**2150-12-24**] 11:31 AM', ' BLOOD CULTURED - At [**2150-12-24**] 11:32 AM', 'Two sets of cultures sent. Per MICU Team okay to draw from A-line and', 'CVL.', ' STOOL CULTURE - At [**2150-12-24**] 11:33 AM', 'Sent for C-diff', ' ULTRASOUND - At [**2150-12-24**] 12:10 PM', ' PARACENTESIS - At [**2150-12-24**] 04:12 PM Diagnostic paracentesis. Only', 'fluid for cultures removed.', '- did diagnostic para, RLQ', '- girlfriend updated, per girlfriend, pt had painful gynecomastia prior', 'to this hospitalization', '- hepatology: if Cr stable in AM, could d/c octreotide (but would', 'continue midodrine); d/c albumin (done); broaden antibiotics (given', 'leukocytosis over last 5 days); check cbc with diff in AM', '- I>>O, so given extra 40IV lasix in evening']","['- girlfriend updated', 'continue midodrine); d/c albumin (done); broaden antibiotics; check cbc', 'with diff in AM (ordered)']",54610,147673.0
28,2150-12-26 07:39:04,"['INVASIVE VENTILATION - STOP [**2150-12-25**] 04:33 PM', '- extubated', ""- very encephalopathic (thinks he's on a space ship--the starry"", ""backdrop on his TV probably doesn't help)."", ""- Given rising total bili, we looked at pt's smear, which showed"", 'spherocytes, target cells, burr cells, no schistocytes. Sent Coombs', 'test and direct bili (19.1), to eval for hemolysis. also obtained Abd']","['INVASIVE VENTILATION - STOP [**2150-12-25**] 04:33 PM', '- extubated', ""- very encephalopathic (thinks he's on a space ship--the starry"", ""backdrop on his TV probably doesn't help)."", ""- Given rising total bili, we looked at pt's smear, which showed"", 'spherocytes, target cells, burr cells, no schistocytes. Sent Coombs', 'test and direct bili (19.1), to eval for hemolysis. also obtained Abd']","['URINE CULTURE - At [**2150-12-24**] 11:31 AM', ' BLOOD CULTURED - At [**2150-12-24**] 11:32 AM', 'Two sets of cultures sent. Per MICU Team okay to draw from A-line and', 'CVL.', ' STOOL CULTURE - At [**2150-12-24**] 11:33 AM', 'Sent for C-diff', ' ULTRASOUND - At [**2150-12-24**] 12:10 PM', ' PARACENTESIS - At [**2150-12-24**] 04:12 PM Diagnostic paracentesis. Only', 'fluid for cultures removed.', '- did diagnostic para, RLQ', '- girlfriend updated, per girlfriend, pt had painful gynecomastia prior', 'to this hospitalization', '- hepatology: if Cr stable in AM, could d/c octreotide (but would', 'continue midodrine); d/c albumin (done); broaden antibiotics (given', 'leukocytosis over last 5 days); check cbc with diff in AM', '- I>>O, so given extra 40IV lasix in evening']",54610,147673.0
29,2150-12-26 11:03:55,,"['INVASIVE VENTILATION - STOP [**2150-12-25**] 04:33 PM', '- extubated', ""- very encephalopathic (thinks he's on a space ship--the starry"", ""backdrop on his TV probably doesn't help)."", ""- Given rising total bili, we looked at pt's smear, which showed"", 'spherocytes, target cells, burr cells, no schistocytes. Sent Coombs', 'test and direct bili (19.1), to eval for hemolysis. also obtained Abd']",,54610,147673.0
30,2150-12-27 07:17:32,"['- Speech and swallow ordered', '- Heme/Onc consulted re: hemolysis, recommended continue abx for now.', 'Ordered hapto, retic count, iron studies, fibrinogen, B12, folate.', '- Liver recs:  no steroids', '- K trending up, 5.9 in PM labs, stat K sent -> 6.2, Ca Gluconate, D50', 'and Insulin, and Kayexalate given.', '- AM labs: K 6.1, given sodium bicarb 650mg po x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone"", ""- Midodrine, Tamoxifen d/c'ed"", ""- At night, had low BP in 70's-80's systolic by cuff and a-line."", 'Mentating without change, stat CBC and gave 1L NS', ""- 1 unit PRBC given for hct 21 <- 23 and BP 80's-90's systolic, though"", 'no sign of active bleed and pt mentating well.', ""- Hypotensive to 70's-80's systolic after 1L NS (prior to 1 unit PRBC)."", 'Drawing stat CBC and lytes (early AM lytes) to make sure not breathing', 'out']","['- Speech and swallow ordered', '- Heme/Onc consulted re: hemolysis, recommended continue abx for now.', 'Ordered hapto, retic count, iron studies, fibrinogen, B12, folate.', '- Liver recs:  no steroids', '- K trending up, 5.9 in PM labs, stat K sent -> 6.2, Ca Gluconate, D50', 'and Insulin, and Kayexalate given.', '- AM labs: K 6.1, given sodium bicarb 650mg po x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone"", ""- Midodrine, Tamoxifen d/c'ed"", ""- At night, had low BP in 70's-80's systolic by cuff and a-line."", 'Mentating without change, stat CBC and gave 1L NS', ""- 1 unit PRBC given for hct 21 <- 23 and BP 80's-90's systolic, though"", 'no sign of active bleed and pt mentating well.', ""- Hypotensive to 70's-80's systolic after 1L NS (prior to 1 unit PRBC)."", 'Drawing stat CBC and lytes (early AM lytes) to make sure not breathing', 'out']","['INVASIVE VENTILATION - STOP [**2150-12-25**] 04:33 PM', '- extubated', ""- very encephalopathic (thinks he's on a space ship--the starry"", ""backdrop on his TV probably doesn't help)."", ""- Given rising total bili, we looked at pt's smear, which showed"", 'spherocytes, target cells, burr cells, no schistocytes. Sent Coombs', 'test and direct bili (19.1), to eval for hemolysis. also obtained Abd']",54610,147673.0
31,2150-12-27 09:50:28,"[""- 1 unit PRBC given for low hct 21 <- 23 and BP 80's-90's systolic,"", 'though no sign of active bleed and pt mentating well.', '- AM labs: K 6.1, given sodium bicarb 5mEq IV x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone, kayexalate given x1.  Repeat K 6.4, EKG"", 'did not show peaked T waves or shortened QT interval.', ""- Briefly on minimal dose of Neo for BP in 70's-80's systolic with"", ""adequate mentation, d/c'ed in morning and Midodrine re-started.""]","['- Speech and swallow ordered', '- Heme/Onc consulted re: hemolysis, recommended continue abx for now.', 'Ordered hapto, retic count, iron studies, fibrinogen, B12, folate.', '- Liver recs:  no steroids', '- K trending up, 5.9 in PM labs, stat K sent -> 6.2, Ca Gluconate, D50', 'and Insulin, and Kayexalate given.', '- AM labs: K 6.1, given sodium bicarb 650mg po x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone"", ""- Midodrine, Tamoxifen d/c'ed"", ""- At night, had low BP in 70's-80's systolic by cuff and a-line."", 'Mentating without change, stat CBC and gave 1L NS', ""- 1 unit PRBC given for low hct 21 <- 23 and BP 80's-90's systolic,"", 'though no sign of active bleed and pt mentating well.', ""- Hypotensive to 70's-80's systolic after 1L NS (prior to 1 unit PRBC)."", 'Drawing stat CBC and lytes (early AM lytes) to make sure not breathing', 'out', '- AM labs: K 6.1, given sodium bicarb 5mEq IV x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone, kayexalate given x1.  Repeat K 6.4, EKG"", 'did not show peaked T waves or shortened QT interval.', ""- Briefly on minimal dose of Neo for BP in 70's-80's systolic with"", ""adequate mentation, d/c'ed in morning and Midodrine re-started.""]","[""- 1 unit PRBC given for hct 21 <- 23 and BP 80's-90's systolic, though"", 'no sign of active bleed and pt mentating well.']",54610,147673.0
32,2150-12-28 07:41:25,"['BLOOD CULTURED - At [**2150-12-27**] 02:00 PM', ' URINE CULTURE - At [**2150-12-27**] 02:34 PM', ' INVASIVE VENTILATION - START [**2150-12-27**] 08:00 PM', ' PARACENTESIS - At [**2150-12-27**] 08:30 PM', ' PARACENTESIS - At [**2150-12-28**] 12:02 AM', ' DIALYSIS CATHETER - START [**2150-12-28**] 02:00 AM', '-taking PO midodrine, kayexalate, lactulose (so held on NG tube)', '-hyperkalemia continues', '-pan cultured, 50g albumin daily per hepatology', '-hemolysis labs [**Hospital1 **] per heme/onc', '-less responsive (AMS), incr work of breathing, hyperkalemic, incr', 'pressor and O2 requirement - intubated at ~7pm', '-diagnostic para - 900 WBC', '-CT torso - wetread:', 'Extremely limited examination in absence of oral and intravenous', 'contrast for evaluation of ischemia. Within these limitations, no', 'pneuoperitoneum or pneumatosis. Extensive ascites and cirrhotic liver.', 'Massively distended gallbladder and clinical correlation for', 'cholecystitis is recommended.  Suggestion of bowel wall thickening', 'involving loop of small bowel in the left upper quadrant though', 'evaluation is limited without contrast. Rectal tube, Foley catheter,', 'CVC, NGT, ETT in standard positions. Bilateral moderate', 'atelectasis. Bilateral moderate pleural effusions. Bilateral multifocal', 'non- specific opacification may represent infectious or inflammatory', 'etiology.', '-FFP, cryo, pRBC, (300cc blood suctioned - but Hct stable @ 23); OG', 'tube placed; low fibrinogen; bili rising', '-fem line; CVVH', '-intraabdominal pressure (low 20s)', '-propofol', '-lactate rising; vanc/zosyn/flagyl', '-this morning, lower O2 sat, so increased PEEP from 5 to 10 and dropped', 'FiO2 from 100 to 80']","['BLOOD CULTURED - At [**2150-12-27**] 02:00 PM', ' URINE CULTURE - At [**2150-12-27**] 02:34 PM', ' INVASIVE VENTILATION - START [**2150-12-27**] 08:00 PM', ' PARACENTESIS - At [**2150-12-27**] 08:30 PM', ' PARACENTESIS - At [**2150-12-28**] 12:02 AM', ' DIALYSIS CATHETER - START [**2150-12-28**] 02:00 AM', '-taking PO midodrine, kayexalate, lactulose (so held on NG tube)', '-hyperkalemia continues', '-pan cultured, 50g albumin daily per hepatology', '-hemolysis labs [**Hospital1 **] per heme/onc', '-less responsive (AMS), incr work of breathing, hyperkalemic, incr', 'pressor and O2 requirement - intubated at ~7pm', '-diagnostic para - 900 WBC', '-CT torso - wetread:', 'Extremely limited examination in absence of oral and intravenous', 'contrast for evaluation of ischemia. Within these limitations, no', 'pneuoperitoneum or pneumatosis. Extensive ascites and cirrhotic liver.', 'Massively distended gallbladder and clinical correlation for', 'cholecystitis is recommended.  Suggestion of bowel wall thickening', 'involving loop of small bowel in the left upper quadrant though', 'evaluation is limited without contrast. Rectal tube, Foley catheter,', 'CVC, NGT, ETT in standard positions. Bilateral moderate', 'atelectasis. Bilateral moderate pleural effusions. Bilateral multifocal', 'non- specific opacification may represent infectious or inflammatory', 'etiology.', '-FFP, cryo, pRBC, (300cc blood suctioned - but Hct stable @ 23); OG', 'tube placed; low fibrinogen; bili rising', '-fem line; CVVH', '-intraabdominal pressure (low 20s)', '-propofol', '-lactate rising; vanc/zosyn/flagyl', '-this morning, lower O2 sat, so increased PEEP from 5 to 10 and dropped', 'FiO2 from 100 to 80']","['- Speech and swallow ordered', '- Heme/Onc consulted re: hemolysis, recommended continue abx for now.', 'Ordered hapto, retic count, iron studies, fibrinogen, B12, folate.', '- Liver recs:  no steroids', '- K trending up, 5.9 in PM labs, stat K sent -> 6.2, Ca Gluconate, D50', 'and Insulin, and Kayexalate given.', '- AM labs: K 6.1, given sodium bicarb 650mg po x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone"", ""- Midodrine, Tamoxifen d/c'ed"", ""- At night, had low BP in 70's-80's systolic by cuff and a-line."", 'Mentating without change, stat CBC and gave 1L NS', ""- 1 unit PRBC given for low hct 21 <- 23 and BP 80's-90's systolic,"", 'though no sign of active bleed and pt mentating well.', ""- Hypotensive to 70's-80's systolic after 1L NS (prior to 1 unit PRBC)."", 'Drawing stat CBC and lytes (early AM lytes) to make sure not breathing', 'out', '- AM labs: K 6.1, given sodium bicarb 5mEq IV x1, calcium gluconate 1g', ""IV x1, d/c'ed spironolactone, kayexalate given x1.  Repeat K 6.4, EKG"", 'did not show peaked T waves or shortened QT interval.', ""- Briefly on minimal dose of Neo for BP in 70's-80's systolic with"", ""adequate mentation, d/c'ed in morning and Midodrine re-started.""]",54610,147673.0
33,2150-12-28 07:55:09,,"['BLOOD CULTURED - At [**2150-12-27**] 02:00 PM', ' URINE CULTURE - At [**2150-12-27**] 02:34 PM', ' INVASIVE VENTILATION - START [**2150-12-27**] 08:00 PM', ' PARACENTESIS - At [**2150-12-27**] 08:30 PM', ' PARACENTESIS - At [**2150-12-28**] 12:02 AM', ' DIALYSIS CATHETER - START [**2150-12-28**] 02:00 AM', '-taking PO midodrine, kayexalate, lactulose (so held on NG tube)', '-hyperkalemia continues', '-pan cultured, 50g albumin daily per hepatology', '-hemolysis labs [**Hospital1 **] per heme/onc', '-less responsive (AMS), incr work of breathing, hyperkalemic, incr', 'pressor and O2 requirement - intubated at ~7pm', '-diagnostic para - 900 WBC', '-CT torso - wetread:', 'Extremely limited examination in absence of oral and intravenous', 'contrast for evaluation of ischemia. Within these limitations, no', 'pneuoperitoneum or pneumatosis. Extensive ascites and cirrhotic liver.', 'Massively distended gallbladder and clinical correlation for', 'cholecystitis is recommended.  Suggestion of bowel wall thickening', 'involving loop of small bowel in the left upper quadrant though', 'evaluation is limited without contrast. Rectal tube, Foley catheter,', 'CVC, NGT, ETT in standard positions. Bilateral moderate', 'atelectasis. Bilateral moderate pleural effusions. Bilateral multifocal', 'non- specific opacification may represent infectious or inflammatory', 'etiology.', '-FFP, cryo, pRBC, (300cc blood suctioned - but Hct stable @ 23); OG', 'tube placed; low fibrinogen; bili rising', '-fem line; CVVH', '-intraabdominal pressure (low 20s)', '-propofol', '-lactate rising; vanc/zosyn/flagyl', '-this morning, lower O2 sat, so increased PEEP from 5 to 10 and dropped', 'FiO2 from 100 to 80']",,54610,147673.0
34,2150-12-28 09:41:21,"['-propofol was on o/n, now off to try to help relieve hypotension', '-now on almost highest doses of 3 pressors, holding propofol, given', '500ccNS bolus without significant BP rise']","['BLOOD CULTURED - At [**2150-12-27**] 02:00 PM', ' URINE CULTURE - At [**2150-12-27**] 02:34 PM', ' INVASIVE VENTILATION - START [**2150-12-27**] 08:00 PM', ' PARACENTESIS - At [**2150-12-27**] 08:30 PM', ' PARACENTESIS - At [**2150-12-28**] 12:02 AM', ' DIALYSIS CATHETER - START [**2150-12-28**] 02:00 AM', '-taking PO midodrine, kayexalate, lactulose (so held on NG tube)', '-hyperkalemia continues', '-pan cultured, 50g albumin daily per hepatology', '-hemolysis labs [**Hospital1 **] per heme/onc', '-less responsive (AMS), incr work of breathing, hyperkalemic, incr', 'pressor and O2 requirement - intubated at ~7pm', '-diagnostic para - 900 WBC', '-CT torso - wetread:', 'Extremely limited examination in absence of oral and intravenous', 'contrast for evaluation of ischemia. Within these limitations, no', 'pneuoperitoneum or pneumatosis. Extensive ascites and cirrhotic liver.', 'Massively distended gallbladder and clinical correlation for', 'cholecystitis is recommended.  Suggestion of bowel wall thickening', 'involving loop of small bowel in the left upper quadrant though', 'evaluation is limited without contrast. Rectal tube, Foley catheter,', 'CVC, NGT, ETT in standard positions. Bilateral moderate', 'atelectasis. Bilateral moderate pleural effusions. Bilateral multifocal', 'non- specific opacification may represent infectious or inflammatory', 'etiology.', '-FFP, cryo, pRBC, (300cc blood suctioned - but Hct stable @ 23); OG', 'tube placed; low fibrinogen; bili rising', '-fem line; CVVH', '-intraabdominal pressure (low 20s)', '-propofol was on o/n, now off to try to help relieve hypotension', '-lactate rising; vanc/zosyn/flagyl', '-this morning, lower O2 sat, so increased PEEP from 5 to 10 and dropped', 'FiO2 from 100 to 80', '-now on almost highest doses of 3 pressors, holding propofol, given', '500ccNS bolus without significant BP rise']",['-propofol'],54610,147673.0
0,2136-11-15 10:03:41,,"['- CT head negative', '- CT torso - atelectasis, stranding around pancreas', '- Laboratories improved', '- Obtained medication list from the VA']",,10174,130645.0
1,2136-11-15 10:29:14,"['- Febrile to 101.4 this morning', ' obtaining blood cultures']","['- CT head negative', '- CT torso - atelectasis, stranding around pancreas', '- Febrile to 101.4 this morning', ' obtaining blood cultures', '- Laboratories improved', '- Obtained medication list from the VA']",,10174,130645.0
2,2136-11-15 10:30:19,,"['- CT head negative', '- CT torso - atelectasis, stranding around pancreas', '- Febrile to 101.4 this morning', ' obtaining blood cultures', '- Laboratories improved', '- Obtained medication list from the VA']",,10174,130645.0
3,2136-11-16 07:52:31,"['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM']","['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM']","['- CT head negative', '- CT torso - atelectasis, stranding around pancreas', '- Febrile to 101.4 this morning', ' obtaining blood cultures', '- Laboratories improved', '- Obtained medication list from the VA']",10174,130645.0
4,2136-11-16 07:54:05,,"['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM']",,10174,130645.0
5,2136-11-16 08:57:09,"['Mr [**Known lastname 6885**] is able to talk about some recent events having to do with', 'lice and his housing and his partner', 's housing; this is much more', 'coherent than prior though still not on point. Was agitated overnight,', 'shouting', 'I request a juice drink', ' and', 'I want chocolate milk', ' as well', 'as less clear statements (e.g.,', 'Earthlings!', 'History obtained from [**Hospital 85**] Medical records']","['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM', 'Mr [**Known lastname 6885**] is able to talk about some recent events having to do with', 'lice and his housing and his partner', 's housing; this is much more', 'coherent than prior though still not on point. Was agitated overnight,', 'shouting', 'I request a juice drink', ' and', 'I want chocolate milk', ' as well', 'as less clear statements (e.g.,', 'Earthlings!', 'History obtained from [**Hospital 85**] Medical records']",,10174,130645.0
6,2136-11-16 16:55:45,,"['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM', 'Mr [**Known lastname 6885**] is able to talk about some recent events having to do with', 'lice and his housing and his partner', 's housing; this is much more', 'coherent than prior though still not on point. Was agitated overnight,', 'shouting', 'I request a juice drink', ' and', 'I want chocolate milk', ' as well', 'as less clear statements (e.g.,', 'Earthlings!', 'History obtained from [**Hospital 85**] Medical records']",,10174,130645.0
7,2136-11-16 17:03:03,,"['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM']","['Mr [**Known lastname 6885**] is able to talk about some recent events having to do with', 'lice and his housing and his partner', 's housing; this is much more', 'coherent than prior though still not on point. Was agitated overnight,', 'shouting', 'I request a juice drink', ' and', 'I want chocolate milk', ' as well', 'as less clear statements (e.g.,', 'Earthlings!', 'History obtained from [**Hospital 85**] Medical records']",10174,130645.0
8,2136-11-16 17:09:41,,"['EKG - At [**2136-11-15**] 08:15 AM', ' BLOOD CULTURED - At [**2136-11-15**] 10:10 AM', ' FEVER - 101.7', 'F - [**2136-11-15**] 03:00 PM']",,10174,130645.0
0,2153-05-16 08:08:17,,"['DIALYSIS CATHETER - START [**2153-5-16**] 03:19 AM', ' CALLED OUT', '[**5-15**]', ""Resumed home dose nadolol as BP stable at baseline of SBP 90's"", ""Titrated up humalog sliding scale as FSBG in 300's"", 'Guaiac positive brown stool', 'Had HD with removal of 3L/5.3kg', 'called out to the floor']",,29035,115770.0
1,2153-05-16 10:51:56,,"['DIALYSIS CATHETER - START [**2153-5-16**] 03:19 AM', ' CALLED OUT', '[**5-15**]', ""Resumed home dose nadolol as BP stable at baseline of SBP 90's"", ""Titrated up humalog sliding scale as FSBG in 300's"", 'Guaiac positive brown stool', 'Had HD with removal of 3L/5.3kg', 'called out to the floor']",,29035,115770.0
0,2153-07-11 07:13:08,,"['- Fistulogram was deferred until today', '- Liver recommended continuing cipro ppx, transfuse for hct<26.', '- [**Hospital1 630**] was contact[**Name (NI) **] and had given patient 1unit pRBCs each day for', 'previous 4 days PTA', '- transfused 1unit pRBCS for hct<22 and ddavp X 1 dose. During', 'transfusion was a little itchy and received benedryl.', '- Was having pain at CVL site. Looked clean. Got morphine IV X 2.']",,29035,108831.0
1,2153-07-11 07:18:32,"['- Unable to get fistulogram - to get in am [**7-11**]', '- Liver recs: cte cipro ppx, lactulose, rifaximin, midodrine, ppi.', 'Scoped (EGD) See results below.', '- Called NH ->did receive 4units pRBCs over last 4 days with no bump in', 'hct', '- transfused 1unit for hct 22.7 at 6pm. Developed itchiness during', 'transfusion and was given benedryl', '- Given ddavp X 1 for uremic platelets per GI recs', '- EGD: Blood in the duodenum', 'Blood in the stomach', 'Severe antral portal hypertensive gastropathy', 'Non-bleeding Varices at the lower third of the esophagus and', 'gastroesophageal junction', 'Otherwise normal EGD to second part of the duodenum']","['- Unable to get fistulogram - to get in am [**7-11**]', '- Liver recs: cte cipro ppx, lactulose, rifaximin, midodrine, ppi.', 'Scoped (EGD) See results below.', '- Called NH ->did receive 4units pRBCs over last 4 days with no bump in', 'hct', '- transfused 1unit for hct 22.7 at 6pm. Developed itchiness during', 'transfusion and was given benedryl', '- Given ddavp X 1 for uremic platelets per GI recs', '- EGD: Blood in the duodenum', 'Blood in the stomach', 'Severe antral portal hypertensive gastropathy', 'Non-bleeding Varices at the lower third of the esophagus and', 'gastroesophageal junction', 'Otherwise normal EGD to second part of the duodenum']","['- Fistulogram was deferred until today', '- Liver recommended continuing cipro ppx, transfuse for hct<26.', '- [**Hospital1 630**] was contact[**Name (NI) **] and had given patient 1unit pRBCs each day for', 'previous 4 days PTA', '- transfused 1unit pRBCS for hct<22 and ddavp X 1 dose. During', 'transfusion was a little itchy and received benedryl.', '- Was having pain at CVL site. Looked clean. Got morphine IV X 2.']",29035,108831.0
2,2153-07-11 10:45:19,,"['- Unable to get fistulogram - to get in am [**7-11**]', '- Liver recs: cte cipro ppx, lactulose, rifaximin, midodrine, ppi.', 'Scoped (EGD) See results below.', '- Called NH ->did receive 4units pRBCs over last 4 days with no bump in', 'hct', '- transfused 1unit for hct 22.7 at 6pm. Developed itchiness during', 'transfusion and was given benedryl', '- Given ddavp X 1 for uremic platelets per GI recs', '- EGD: Blood in the duodenum', 'Blood in the stomach', 'Severe antral portal hypertensive gastropathy', 'Non-bleeding Varices at the lower third of the esophagus and', 'gastroesophageal junction', 'Otherwise normal EGD to second part of the duodenum']",,29035,108831.0
3,2153-07-11 16:58:10,,"['- Unable to get fistulogram - to get in am [**7-11**]', '- Liver recs: cte cipro ppx, lactulose, rifaximin, midodrine, ppi.', 'Scoped (EGD) See results below.', '- Called NH ->did receive 4units pRBCs over last 4 days with no bump in', 'hct', '- transfused 1unit for hct 22.7 at 6pm. Developed itchiness during', 'transfusion and was given benedryl', '- Given ddavp X 1 for uremic platelets per GI recs', '- EGD: Blood in the duodenum', 'Blood in the stomach', 'Severe antral portal hypertensive gastropathy', 'Non-bleeding Varices at the lower third of the esophagus and', 'gastroesophageal junction', 'Otherwise normal EGD to second part of the duodenum']",,29035,108831.0
0,2114-02-27 07:33:30,,"['EKG - At [**2114-2-26**] 09:00 PM', '[**Date range (1) 14281**]', '- Chest pain in evening [**3-10**], given morphine and nitro increased to 1.7', '- Chest pain at about 4:30 a.m. - [**1-10**] - resolved.', '- Nitro presently Total morphine -', 'History obtained from Patient']",,89800,125487.0
1,2114-02-27 11:45:11,"['- Nitro presently at 1.7 Total morphine', ' 4 mg IV overnight (2 x 2 for', 'above)']","['EKG - At [**2114-2-26**] 09:00 PM', '[**Date range (1) 14281**]', '- Chest pain in evening [**3-10**], given morphine and nitro increased to 1.7', '- Chest pain at about 4:30 a.m. - [**1-10**] - resolved.', '- Nitro presently at 1.7 Total morphine', ' 4 mg IV overnight (2 x 2 for', 'above)', 'History obtained from Patient']",['- Nitro presently Total morphine -'],89800,125487.0
0,2141-11-13 06:22:38,,[],,49226,165180.0
1,2141-11-13 06:32:22,,[],,49226,165180.0
2,2141-11-13 12:02:10,['K repleted'],['K repleted'],,49226,165180.0
0,2100-09-08 07:20:56,,['Diuresed >3 L; was on lasix drip and weaned down and then off.'],,96370,121868.0
1,2100-09-08 07:24:01,"['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).']","['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).']",['Diuresed >3 L; was on lasix drip and weaned down and then off.'],96370,121868.0
2,2100-09-08 11:07:34,['Small nosebleed with nose-blowing.'],"['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).', 'Small nosebleed with nose-blowing.']",,96370,121868.0
3,2100-09-08 11:11:02,,"['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).', 'Small nosebleed with nose-blowing.']",,96370,121868.0
4,2100-09-08 13:41:10,,"['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).', 'Small nosebleed with nose-blowing.']",,96370,121868.0
5,2100-09-09 06:39:06,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']","['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']","['Diuresed >3 L; was on lasix drip and weaned down and then off', '(20', '0) as urine output per hour was significant and did not want', 'to over-diurese (concern for electrolyte abnormalities if diuresis too', 'aggressive).', 'Small nosebleed with nose-blowing.']",96370,121868.0
6,2100-09-09 06:41:32,,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']",,96370,121868.0
7,2100-09-09 06:42:00,,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']",,96370,121868.0
8,2100-09-09 06:44:44,,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']",,96370,121868.0
9,2100-09-09 09:10:36,,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']",,96370,121868.0
10,2100-09-09 09:17:30,,"['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.']","['-Renal: Continue care as is, mentions + urine cultures ESBL Kleb most', 'recent [**2100-8-19**] (also [**2100-3-17**], [**2100-5-31**], failed gent therapy).', '- Renal mentioned initiating treatment, however per urology [**2100-6-29**]', ""colonized and unless has symptoms don't treat. Patient no WBC, will not"", 'start ABx currently.']",96370,121868.0
11,2100-09-09 15:57:30,"['-Pt with RLQ pain, improving with BM.', '-right heart cath yesterday concerning for diastolic dysfunction and', 'elevated PA pressures.']","['-Pt with RLQ pain, improving with BM.', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-right heart cath yesterday concerning for diastolic dysfunction and', 'elevated PA pressures.']","['EKG - At [**2100-9-8**] 09:00 AM', ' CARDIAC CATH - At [**2100-9-8**] 10:29 AM', ' PA CATHETER - START [**2100-9-8**] 02:36 PM']",96370,121868.0
12,2100-09-10 07:03:17,,[],"['-Pt with RLQ pain, improving with BM.', '- 12:37 labs showed increase in bicarb 34 -> 42, putting out 900cc/hr', 'but Cr down-trending, continue on current lasix drip until AM.', '-RUQ pain, and (+) [**Doctor Last Name 1850**] sign but no BM in 2 days and also LFTs had', 'been trending down, so increased bowel regimen, will reassess in AM and', 'trend LFTs in AM.', '-right heart cath yesterday concerning for diastolic dysfunction and', 'elevated PA pressures.']",96370,121868.0
13,2100-09-10 07:55:32,['No CP. Breathing improved. Constipated with abdominal discomfort.'],['No CP. Breathing improved. Constipated with abdominal discomfort.'],,96370,121868.0
14,2100-09-10 13:56:58,"['No CP. Breathing improved. Constipated with associated abdominal', 'discomfort.']","['No CP. Breathing improved. Constipated with associated abdominal', 'discomfort.']",['No CP. Breathing improved. Constipated with abdominal discomfort.'],96370,121868.0
15,2100-09-10 14:00:30,,"['No CP. Breathing improved. Constipated with associated abdominal', 'discomfort.']",,96370,121868.0
16,2100-09-11 07:30:07,['PA CATHETER - STOP [**2100-9-10**] 04:29 PM'],['PA CATHETER - STOP [**2100-9-10**] 04:29 PM'],"['No CP. Breathing improved. Constipated with associated abdominal', 'discomfort.']",96370,121868.0
17,2100-09-11 09:09:04,['+ Nosebleed this morning.'],"['PA CATHETER - STOP [**2100-9-10**] 04:29 PM', '+ Nosebleed this morning.']",,96370,121868.0
18,2100-09-11 13:44:36,,"['PA CATHETER - STOP [**2100-9-10**] 04:29 PM', '+ Nosebleed this morning.']",,96370,121868.0
19,2100-09-11 17:16:53,,"['PA CATHETER - STOP [**2100-9-10**] 04:29 PM', '+ Nosebleed this morning.']",,96370,121868.0
20,2100-09-12 08:09:22,,[],"['PA CATHETER - STOP [**2100-9-10**] 04:29 PM', '+ Nosebleed this morning.']",96370,121868.0
21,2100-09-12 12:05:16,"['No acute events overnight.  Resolution of epistaxis yesterday,', 'complains of dried clots in R nostril.']","['No acute events overnight.  Resolution of epistaxis yesterday,', 'complains of dried clots in R nostril.']",,96370,121868.0
22,2100-09-12 12:27:28,,"['No acute events overnight.  Resolution of epistaxis yesterday,', 'complains of dried clots in R nostril.']",,96370,121868.0
23,2100-09-13 07:28:42,"['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']","['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']","['No acute events overnight.  Resolution of epistaxis yesterday,', 'complains of dried clots in R nostril.']",96370,121868.0
24,2100-09-13 11:11:16,,"['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']",,96370,121868.0
25,2100-09-13 12:04:08,,"['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']",,96370,121868.0
26,2100-09-13 12:11:06,,"['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']",,96370,121868.0
27,2100-09-13 17:05:24,,"['Room air maintaining sats 93-94 %', ' Milrinone at .375 mics/kkg/min. lasix drip at 3 mg/hr']",,96370,121868.0
0,2118-08-31 07:39:25,,"['[**8-30**]', '-S+S=nectar thick, soft solids', ""-rate better controlled, however SBP 80's during afternoon despite IVF,"", 'given 500cc bolus x2', '-ROMI', '-gave 1/2 NS for hypernatremia']",,17906,194014.0
1,2118-08-31 13:51:06,,"['[**8-30**]', '-S+S=nectar thick, soft solids', ""-rate better controlled, however SBP 80's during afternoon despite IVF,"", 'given 500cc bolus x2', '-ROMI', '-gave 1/2 NS for hypernatremia']",,17906,194014.0
0,2161-11-12 07:10:08,,"['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight, initially bilious, now more consistent with', 'sputum', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']",,13731,181304.0
1,2161-11-12 07:38:33,,"['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight, initially bilious, now more consistent with', 'sputum', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']",,13731,181304.0
2,2161-11-12 07:54:40,,"['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight, initially bilious, now more consistent with', 'sputum', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']",,13731,181304.0
3,2161-11-12 10:18:07,"['- Emesis x4-5 overnight (mainly prior to antibiotics), initially', 'bilious, now more consistent with sputum.', 'stable respiratory status. Nausea improved after narcan drip stopped.']","['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight (mainly prior to antibiotics), initially', 'bilious, now more consistent with sputum.', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status. Nausea improved after narcan drip stopped.', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']","['- Emesis x4-5 overnight, initially bilious, now more consistent with', 'sputum', 'stable respiratory status']",13731,181304.0
4,2161-11-12 10:36:22,,"['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight (mainly prior to antibiotics), initially', 'bilious, now more consistent with sputum.', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status. Nausea improved after narcan drip stopped.', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']",,13731,181304.0
5,2161-11-12 12:09:48,,"['SPUTUM CULTURE - At [**2161-11-12**] 02:00 AM', '- CT torso: Evidence of pneumonia L>R, initiated vancomycin, zosyn, and', 'levofloxacin after discussing PD dosing with pharmacy', '- Emesis x4-5 overnight (mainly prior to antibiotics), initially', 'bilious, now more consistent with sputum.', '- Increased narcan drip given patient was still rather somnolent to', '0.024 mcg/kg/hour, titrated off at 5 AM with patient alert, awake,', 'stable respiratory status. Nausea improved after narcan drip stopped.', 'This morning, patient relates her throat hurts and she has some nausea.', 'No abdominal pain, difficulty breathing, headache, or chest pain.']",,13731,181304.0
0,2157-01-20 06:25:27,,['None'],,68140,190006.0
1,2157-01-20 09:24:42,,['None'],,68140,190006.0
0,2129-03-18 07:42:44,,"['EKG - At [**2129-3-17**] 08:00 AM', ' ENDOSCOPY - At [**2129-3-17**] 01:15 PM', '[**2129-3-17**]', 'EGD- ? ulceration distal esophagus vs at site if hiatal hernia.', 'Injected several times and clip placed blindly. Plan to transfuse', 'aggresivelly and EGD again in AM.']",,83690,192846.0
1,2129-03-18 10:42:10,['Transfused 2 units PRBC'],"['EKG - At [**2129-3-17**] 08:00 AM', ' ENDOSCOPY - At [**2129-3-17**] 01:15 PM', '[**2129-3-17**]', 'EGD- ? ulceration distal esophagus vs at site if hiatal hernia.', 'Injected several times and clip placed blindly. Plan to transfuse', 'aggresivelly and EGD again in AM.', 'Transfused 2 units PRBC']",,83690,192846.0
2,2129-03-18 11:04:45,,"['EKG - At [**2129-3-17**] 08:00 AM', ' ENDOSCOPY - At [**2129-3-17**] 01:15 PM', '[**2129-3-17**]', 'EGD- ? ulceration distal esophagus vs at site if hiatal hernia.', 'Injected several times and clip placed blindly. Plan to transfuse', 'aggresivelly and EGD again in AM.', 'Transfused 2 units PRBC']",,83690,192846.0
0,2188-09-27 07:18:54,,"['PAN CULTURE - At [**2188-9-26**] 04:26 PM', ' WOUND CULTURE - At [**2188-9-26**] 06:00 PM', 'pt had large aspirate of purulent fluid by surgery dr. [**Last Name (STitle) **] tolerated', 'proceedure well.', ' FEVER - 101.7', 'F - [**2188-9-26**] 04:00 PM']",,30273,123414.0
1,2188-09-27 07:34:32,,"['PAN CULTURE - At [**2188-9-26**] 04:26 PM', ' WOUND CULTURE - At [**2188-9-26**] 06:00 PM', 'pt had large aspirate of purulent fluid by surgery dr. [**Last Name (STitle) **] tolerated', 'proceedure well.', ' FEVER - 101.7', 'F - [**2188-9-26**] 04:00 PM']",,30273,123414.0
2,2188-09-27 14:04:46,[' torso CT performed'],"['PAN CULTURE - At [**2188-9-26**] 04:26 PM', ' WOUND CULTURE - At [**2188-9-26**] 06:00 PM', 'pt had large aspirate of purulent fluid by surgery dr. [**Last Name (STitle) **] tolerated', 'proceedure well.', ' FEVER - 101.7', 'F - [**2188-9-26**] 04:00 PM', ' torso CT performed']",,30273,123414.0
3,2188-09-28 08:31:46,,[],"['PAN CULTURE - At [**2188-9-26**] 04:26 PM', ' WOUND CULTURE - At [**2188-9-26**] 06:00 PM', 'pt had large aspirate of purulent fluid by surgery dr. [**Last Name (STitle) **] tolerated', 'proceedure well.', ' FEVER - 101.7', 'F - [**2188-9-26**] 04:00 PM', ' torso CT performed']",30273,123414.0
4,2188-09-28 08:32:37,,[],,30273,123414.0
5,2188-09-28 12:39:27,['Pt went to OR this AM for wash out & exploration of'],['Pt went to OR this AM for wash out & exploration of'],,30273,123414.0
6,2188-09-28 12:52:16,"['Pt went to OR this AM for wash-out & exploration of back abscess.', 'Abscess reportedly extends to spinal hardware.', 'Cx']","['Pt went to OR this AM for wash-out & exploration of back abscess.', 'Abscess reportedly extends to spinal hardware.', 'Cx']",['Pt went to OR this AM for wash out & exploration of'],30273,123414.0
7,2188-09-28 15:55:41,['Bld cx growing MRSA.'],"['Pt went to OR this AM for wash-out & exploration of back abscess.', 'Abscess reportedly extends to spinal hardware.', 'Bld cx growing MRSA.']",['Cx'],30273,123414.0
8,2188-09-29 07:25:16,"['POD #1 s/p wash out back abscess', '- Confused & agitated overnight.  Given zyprexa w/ effect.  Oxycodone', 'held.']","['POD #1 s/p wash out back abscess', '- Confused & agitated overnight.  Given zyprexa w/ effect.  Oxycodone', 'held.']","['Pt went to OR this AM for wash-out & exploration of back abscess.', 'Abscess reportedly extends to spinal hardware.', 'Bld cx growing MRSA.']",30273,123414.0
9,2188-09-29 07:37:25,,"['POD #1 s/p wash out back abscess', '- Confused & agitated overnight.  Given zyprexa w/ effect.  Oxycodone', 'held.']",,30273,123414.0
10,2188-09-29 07:57:08,,"['POD #1 s/p wash out back abscess', '- Confused & agitated overnight.  Given zyprexa w/ effect.  Oxycodone', 'held.']",,30273,123414.0
11,2188-09-29 15:52:54,,"['POD #1 s/p wash out back abscess', '- Confused & agitated overnight.  Given zyprexa w/ effect.  Oxycodone', 'held.']",,30273,123414.0
0,2152-07-02 06:41:50,,"['[**7-1**]', '- received NS boluses 250 cc x 2', ""- decreased pacing to 60, but hypotensive to 70's-80's even after fluid"", 'boluses, increased rate again to 80']",,92919,189019.0
1,2152-07-02 07:24:34,,"['[**7-1**]', '- received NS boluses 250 cc x 2', ""- decreased pacing to 60, but hypotensive to 70's-80's even after fluid"", 'boluses, increased rate again to 80']",,92919,189019.0
2,2152-07-02 09:57:03,,"['[**7-1**]', '- received NS boluses 250 cc x 2', ""- decreased pacing to 60, but hypotensive to 70's-80's even after fluid"", 'boluses, increased rate again to 80']",,92919,189019.0
3,2152-07-02 10:51:36,,"['[**7-1**]', '- received NS boluses 250 cc x 2', ""- decreased pacing to 60, but hypotensive to 70's-80's even after fluid"", 'boluses, increased rate again to 80']",,92919,189019.0
4,2152-07-03 07:31:51,"['- spoke to PCP coverage, Cr in [**11-5**] was 1.9 and pt has atrophic', 'kidneys on U/S. Also has distant EtOH and carotid dz.', '- patient reverted to sinus rhythm at 15:30.', '- pt very delirious after 5pm. Given 50mg seroquel and 2.5mg zyprexa', 'w/o any improvement.  Then given IV haldol x 3mg.  Patient increasingly', 'tremulous and agitated.']","['- spoke to PCP coverage, Cr in [**11-5**] was 1.9 and pt has atrophic', 'kidneys on U/S. Also has distant EtOH and carotid dz.', '- patient reverted to sinus rhythm at 15:30.', '- pt very delirious after 5pm. Given 50mg seroquel and 2.5mg zyprexa', 'w/o any improvement.  Then given IV haldol x 3mg.  Patient increasingly', 'tremulous and agitated.']","['[**7-1**]', '- received NS boluses 250 cc x 2', ""- decreased pacing to 60, but hypotensive to 70's-80's even after fluid"", 'boluses, increased rate again to 80']",92919,189019.0
5,2152-07-03 13:28:31,,"['- spoke to PCP coverage, Cr in [**11-5**] was 1.9 and pt has atrophic', 'kidneys on U/S. Also has distant EtOH and carotid dz.', '- patient reverted to sinus rhythm at 15:30.', '- pt very delirious after 5pm. Given 50mg seroquel and 2.5mg zyprexa', 'w/o any improvement.  Then given IV haldol x 3mg.  Patient increasingly', 'tremulous and agitated.']",,92919,189019.0
6,2152-07-03 17:42:02,,"['- spoke to PCP coverage, Cr in [**11-5**] was 1.9 and pt has atrophic', 'kidneys on U/S. Also has distant EtOH and carotid dz.', '- patient reverted to sinus rhythm at 15:30.', '- pt very delirious after 5pm. Given 50mg seroquel and 2.5mg zyprexa', 'w/o any improvement.  Then given IV haldol x 3mg.  Patient increasingly', 'tremulous and agitated.']",,92919,189019.0
0,2179-09-17 06:57:16,,[],,11638,133678.0
1,2179-09-17 06:59:08,['-pt stable'],['-pt stable'],,11638,133678.0
2,2179-09-17 07:00:18,,['-pt stable'],,11638,133678.0
3,2179-09-17 12:00:49,"['-pt stable, denies CP, SOB, new symptomatology']","['-pt stable, denies CP, SOB, new symptomatology']",['-pt stable'],11638,133678.0
4,2179-09-18 07:47:23,,[],"['-pt stable, denies CP, SOB, new symptomatology']",11638,133678.0
5,2179-09-18 16:20:17,['No acute events overnight.'],['No acute events overnight.'],,11638,133678.0
6,2179-09-18 17:05:22,,['No acute events overnight.'],,11638,133678.0
7,2179-09-18 17:06:31,,['No acute events overnight.'],,11638,133678.0
0,2179-11-22 06:58:55,,"['BLOOD CULTURED - At [**2179-11-21**] 08:00 PM', ' SPUTUM CULTURE - At [**2179-11-21**] 08:15 PM', ' BLOOD CULTURED - At [**2179-11-21**] 08:45 PM', ' FEVER - 101.2', 'F - [**2179-11-21**] 02:00 PM', '- Ortho: films of affected joints, check sed rate, CRP; joint aspirated', '- repeat CXR: substantial clearing of the right upper lung', 'opacification - suggests expectoration of a mucous plug with relief of', 'volume loss', '- INR 11.2, transfused 2 units FFP, repeat INR 3.3', '- dig level 3.8: dig held, likely d/c on 125mg every other day', '- OSH results: MRSA in joint fluid; blood cx x2 [**11-21**]- ngtd; urine cx']",,11638,122879.0
1,2179-11-22 10:32:21,"['- OSH results: MRSA in joint fluid; blood cx', ' GPC in clusters/pairs']","['BLOOD CULTURED - At [**2179-11-21**] 08:00 PM', ' SPUTUM CULTURE - At [**2179-11-21**] 08:15 PM', ' BLOOD CULTURED - At [**2179-11-21**] 08:45 PM', ' FEVER - 101.2', 'F - [**2179-11-21**] 02:00 PM', '- Ortho: films of affected joints, check sed rate, CRP; joint aspirated', '- repeat CXR: substantial clearing of the right upper lung', 'opacification - suggests expectoration of a mucous plug with relief of', 'volume loss', '- INR 11.2, transfused 2 units FFP, repeat INR 3.3', '- dig level 3.8: dig held, likely d/c on 125mg every other day', '- OSH results: MRSA in joint fluid; blood cx', ' GPC in clusters/pairs']",['- OSH results: MRSA in joint fluid; blood cx x2 [**11-21**]- ngtd; urine cx'],11638,122879.0
2,2179-11-22 13:35:33,,"['BLOOD CULTURED - At [**2179-11-21**] 08:00 PM', ' SPUTUM CULTURE - At [**2179-11-21**] 08:15 PM', ' BLOOD CULTURED - At [**2179-11-21**] 08:45 PM', ' FEVER - 101.2', 'F - [**2179-11-21**] 02:00 PM', '- Ortho: films of affected joints, check sed rate, CRP; joint aspirated', '- repeat CXR: substantial clearing of the right upper lung', 'opacification - suggests expectoration of a mucous plug with relief of', 'volume loss', '- INR 11.2, transfused 2 units FFP, repeat INR 3.3', '- dig level 3.8: dig held, likely d/c on 125mg every other day', '- OSH results: MRSA in joint fluid; blood cx', ' GPC in clusters/pairs']",,11638,122879.0
3,2179-11-23 06:58:17,,,,11638,122879.0
4,2179-11-23 06:59:15,,,,11638,122879.0
5,2179-11-23 07:05:27,,,,11638,122879.0
6,2179-11-23 10:06:59,,,,11638,122879.0
7,2179-11-23 11:32:52,,,,11638,122879.0
8,2179-11-23 11:56:47,,,,11638,122879.0
9,2179-11-24 06:54:47,,,,11638,122879.0
10,2179-11-24 06:56:08,,,,11638,122879.0
11,2179-11-24 07:05:01,"['- having multiple PVCs, dopamine turned down, K repleted.', '- TEE - thrombus in the left atrial appendage.  No vegetation, see OMR']",,"['- having multiple PVCs, dopamin turned down,K repleted.', '- needs PM lytes', '- TEE - thrombus in he left atrial appendage.  No vegetation, see OMR']",11638,122879.0
12,2179-11-24 08:05:17,,,,11638,122879.0
13,2179-11-24 14:05:02,"['- Micro Data: OSH blood cx with S aureus, sensitivities pending; L', 'shoulder with GPC and blood cx positive on [**11-23**]', '- pt made DNR/DNI, discussed with health care proxy and Dr. [**First Name (STitle) **]', '- Ortho: wants to reintubate for shoulder arthroscopy and left hip', 'aspiration', 'joint fluid for cell counts, Gstain and cx.', 'for full report.  Restarted on heparin  drip']",,"['- OSH Micro: BCx - Staph aureus, will fax sensitivities tomorrow', '- pt made DNR/DNI, d/w proxy, d/w Dr. [**First Name (STitle) **].  She wants to readdress in', 'AM.', '- Ortho: wants to reintubate for arthoscopy tomorrow.  Want MRI for', 'possible hip tap.  Pt unable to get MRI given ICD.', 'joint fluid for cts, Gstain and cx.', 'for full report.', '- Our labs show GPCs in shoulder and blood.  Sensitivities pending.']",11638,122879.0
14,2179-11-24 14:52:51,,,,11638,122879.0
15,2179-11-25 07:07:10,"['- Pt will have left shoulder arthroscopy and left hip/ right MCP', 'aspiration tomorrow am.  Agrees to intubation for procedure', '- vit K 10mg x 1 to reverse INR, heparin gtt to be turned off at 2am,', 'NPO after midnight', '- gave 1 U FFP and had 1UFFP on call for OR', '- OSH BCx: Staph aureus, sensitive to Vanc, Gent', '- decreased UOP: 250cc NS, increased Dopa (6)']",,"['- Micro Data: OSH blood cx with S aureus, sensitivities pending; L', 'shoulder with GPC and blood cx positive on [**11-23**]', '- pt made DNR/DNI, discussed with health care proxy and Dr. [**First Name (STitle) **]', '- Ortho: wants to reintubate for shoulder arthroscopy and left hip', 'aspiration', '- having multiple PVCs, dopamine turned down, K repleted.', '- ID: Vanco goal trough 15-20, follow cx, athrocentesis of L hip, send', 'joint fluid for cell counts, Gstain and cx.', '- TEE - thrombus in the left atrial appendage.  No vegetation, see OMR', 'for full report.  Restarted on heparin  drip']",11638,122879.0
16,2179-11-25 07:10:23,,,,11638,122879.0
17,2179-11-25 07:11:14,,,,11638,122879.0
18,2179-11-25 07:11:49,,,,11638,122879.0
19,2179-11-25 13:46:42,"['- vit K 10mg x 1 to reverse INR, heparin gtt turned off at 2am, NPO', 'after midnight', '- gave 1 U FFP and had 1UFFP in OR, also received 1.5 L of fluids', '- had washout of gross pustular septic arthritis in L shoulder and R', 'MCP, aspiration of L hip with GPC in gram stain']",,"['- Pt will have left shoulder arthroscopy and left hip/ right MCP', 'aspiration tomorrow am.  Agrees to intubation for procedure', '- vit K 10mg x 1 to reverse INR, heparin gtt to be turned off at 2am,', 'NPO after midnight', '- gave 1 U FFP and had 1UFFP on call for OR']",11638,122879.0
20,2179-11-26 07:26:42,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off']",,"['- vit K 10mg x 1 to reverse INR, heparin gtt turned off at 2am, NPO', 'after midnight', '- gave 1 U FFP and had 1UFFP in OR, also received 1.5 L of fluids', '- OSH BCx: Staph aureus, sensitive to Vanc, Gent', '- decreased UOP: 250cc NS, increased Dopa (6)', '- had washout of gross pustular septic arthritis in L shoulder and R', 'MCP, aspiration of L hip with GPC in gram stain']",11638,122879.0
21,2179-11-26 10:21:10,"['- vit K 10mg x 1 to reverse INR, heparin gtt turned off at 2am, NPO', 'after midnight', '- gave 1 U FFP and had 1UFFP in OR, also received 1.5 L of fluids', '- OSH BCx: Staph aureus, sensitive to Vanc, Gent', '- decreased UOP: 250cc NS, increased Dopa (6)', '- had washout of gross pustular septic arthritis in L shoulder and R', 'MCP, aspiration of L hip with GPC in gram stain']",,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off']",11638,122879.0
22,2179-11-26 17:12:50,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off', 'Complains of pain in infected joints, controlled with pain meds.  NO', 'chest pain, SOB, nausea, or abdominal pain.']",,"['- vit K 10mg x 1 to reverse INR, heparin gtt turned off at 2am, NPO', 'after midnight', '- gave 1 U FFP and had 1UFFP in OR, also received 1.5 L of fluids', '- OSH BCx: Staph aureus, sensitive to Vanc, Gent', '- decreased UOP: 250cc NS, increased Dopa (6)', '- had washout of gross pustular septic arthritis in L shoulder and R', 'MCP, aspiration of L hip with GPC in gram stain']",11638,122879.0
23,2179-11-27 07:05:24,"['- allowed to eat non cardiac, but still low salt diet.', '- intraarticular abx not shown to work', '- UOP > 100cc/hr, turned down lasix drip', '- if goes into afib, go down on dopa and give IV amio']",,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off', 'Complains of pain in infected joints, controlled with pain meds.  NO', 'chest pain, SOB, nausea, or abdominal pain.']",11638,122879.0
24,2179-11-27 13:09:55,,,,11638,122879.0
25,2179-11-27 14:02:13,"['Pt ate dinner last night.  Feels like she may have a BM today.', 'Continues to complain of pain in her right MCP and Left shoulder.  Hip', 'does not bother her as much.', 'No chest pain, shortness of breath,', 'nausea, vomiting.']",,"['- if goes into afib, go down on dopa and give IV amio']",11638,122879.0
26,2179-11-28 07:00:56,"['- ortho: L hip - Abx course, will consider I&D only if not improving', '- ID: continue Vanc, f/u BCx, CIS, minimize lines prn']",,"['- allowed to eat non cardiac, but still low salt diet.', '- intraarticular abx not shown to work', '- UOP > 100cc/hr, turned down lasix drip', 'Pt ate dinner last night.  Feels like she may have a BM today.', 'Continues to complain of pain in her right MCP and Left shoulder.  Hip', 'does not bother her as much.', 'No chest pain, shortness of breath,', 'nausea, vomiting.']",11638,122879.0
27,2179-11-28 07:01:46,,,,11638,122879.0
28,2179-11-28 07:08:00,,,,11638,122879.0
29,2179-11-28 11:09:11,,,,11638,122879.0
30,2179-11-28 11:48:57,,,,11638,122879.0
31,2179-11-29 07:55:47,"['- Left shoulder drain came out of place; ortho aware', '- weaned off of dopamine, restarted on digoxin: will need to recheck', 'levels in [**2-17**] days']",,"['- ortho: L hip - Abx course, will consider I&D only if not improving', '- ID: continue Vanc, f/u BCx, CIS, minimize lines prn']",11638,122879.0
32,2179-11-29 12:28:56,,,,11638,122879.0
33,2179-11-29 12:29:17,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off', 'Complains of pain in infected joints, controlled with pain meds.  NO', 'chest pain, SOB, nausea, or abdominal pain.']",,"['- Left shoulder drain came out of place; ortho aware', '- weaned off of dopamine, restarted on digoxin: will need to recheck', 'levels in [**2-17**] days']",11638,122879.0
34,2179-11-29 12:30:38,"['- Left shoulder drain came out of place; ortho aware', '- weaned off of dopamine, restarted on digoxin: will need to recheck', 'levels in [**2-17**] days']",,"['OR RECEIVED - At [**2179-11-25**] 09:45 AM', ' CORDIS/INTRODUCER - STOP [**2179-11-25**] 11:28 AM', 'placed over a wire exchanged for triple lumen. swan attempted', '- Left shoulder, right MCP washout with gross pustular fluid; Left hip', 'aspiration with GPC.  Tolerated the procedure well and was able to be', 'extubated following surgery', '- NPO after midnight, did not start coumadin in case pt needs L hip', 'washout tomorrow', '- continued on dopamine, unable to wean and start dobutamine secondary', 'to relative hypotension and underlying afib with HR in 110s', '- started lasix gtt at 10pm as urine output dropped off', 'Complains of pain in infected joints, controlled with pain meds.  NO', 'chest pain, SOB, nausea, or abdominal pain.']",11638,122879.0
35,2179-11-30 06:19:40,"['- doing well, called out to floor', '- d/c Lasix drip, Lasix 40mg [**Hospital1 **] started, Goal: even', '- requires Vanco trough for AM, and restart Vanco at 750mg daily if', 'trough less than 21; ID following', '- ortho: no planned proc, ok to start coumadin', '- started coumadin 1mg PO daily', '- ECHO: LV is moderately dilated with severe global hypokinesis. LVEF =', '20 %. Estimated CI 2.0-2.5L/min/m2. very small circumferential', 'effusion.', '- 2PIVs placed, called out.  Still here.']",,"['- Left shoulder drain came out of place; ortho aware', '- weaned off of dopamine, restarted on digoxin: will need to recheck', 'levels in [**2-17**] days']",11638,122879.0
36,2179-11-30 12:13:23,"['- requires Vanco trough for AM, and restart Vanco at 500mg daily if', '- 2PIVs placed, d/c', 'd central line']",,"['- requires Vanco trough for AM, and restart Vanco at 750mg daily if', '- 2PIVs placed, called out.  Still here.']",11638,122879.0
0,2180-01-13 06:50:08,,"['MULTI LUMEN - START [**2180-1-12**] 05:34 PM', ' MIDLINE - START [**2180-1-12**] 05:34 PM', '- poor UOP to 2.5 and 5mg/hr lasix drip.']",,11638,155878.0
1,2180-01-13 11:20:24,,"['MULTI LUMEN - START [**2180-1-12**] 05:34 PM', ' MIDLINE - START [**2180-1-12**] 05:34 PM', '- poor UOP to 2.5 and 5mg/hr lasix drip.']",,11638,155878.0
2,2180-01-14 08:40:31,"['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']","['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']","['MULTI LUMEN - START [**2180-1-12**] 05:34 PM', ' MIDLINE - START [**2180-1-12**] 05:34 PM', '- poor UOP to 2.5 and 5mg/hr lasix drip.']",11638,155878.0
3,2180-01-14 08:43:32,,"['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']",,11638,155878.0
4,2180-01-14 08:44:09,,"['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']",,11638,155878.0
5,2180-01-14 12:27:54,,"['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']",,11638,155878.0
6,2180-01-15 06:21:37,"['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']","['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']","['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']",11638,155878.0
7,2180-01-15 11:05:12,"['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']","['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']","['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']",11638,155878.0
8,2180-01-15 11:06:55,"['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']","['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']","['- confirmed DNR, acemaker turned off', '- despite lasix gtt, diuresis poor yesterday']",11638,155878.0
9,2180-01-16 07:12:28,"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']","['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']","['[**1-14**]:', '- diuresed ~2L over the day', '- PM lytes & Cr [**Doctor Last Name **] solid']",11638,155878.0
10,2180-01-16 07:13:16,,"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']",,11638,155878.0
11,2180-01-16 07:14:24,,"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']",,11638,155878.0
12,2180-01-16 10:03:34,,"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']",,11638,155878.0
13,2180-01-16 11:28:42,,"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']",,11638,155878.0
14,2180-01-17 06:41:27,,[],"['- MS Contin 15 [**Hospital1 **], was getting 22 mg IV morph qday', '- pulled EJ']",11638,155878.0
15,2180-01-17 06:43:49,,[],,11638,155878.0
16,2180-01-17 07:46:23,"['- MS contin increased to 30mg [**Hospital1 **] last night, received 2 doses w pills', 'crushed, complained of nausea after each', '- Has not had a BM for four days', '- PT ordered yesterday']","['- MS contin increased to 30mg [**Hospital1 **] last night, received 2 doses w pills', 'crushed, complained of nausea after each', '- Has not had a BM for four days', '- PT ordered yesterday']",,11638,155878.0
17,2180-01-17 11:51:13,['- complains of pain at 8/10'],"['- MS contin increased to 30mg [**Hospital1 **] last night, received 2 doses w pills', 'crushed, complained of nausea after each', '- complains of pain at 8/10', '- Has not had a BM for four days', '- PT ordered yesterday']",,11638,155878.0
18,2180-01-18 09:59:04,,"['- MS contin increased to 30mg [**Hospital1 **] last night, received 2 doses w pills', 'crushed, complained of nausea after each', '- complains of pain at 8/10', '- Has not had a BM for four days', '- PT ordered yesterday']",,11638,155878.0
19,2180-01-19 06:55:25,"['- DCed milrinone and diuretics 11:30am', ""- Family mtg held with patient's 3 sisters and multiple other family"", 'members, Dr. [**First Name (STitle) **], then (P&PC) Dr. [**First Name4 (NamePattern1) 3373**] [**Last Name (NamePattern1) **] --> everybody in', 'agreement w plan to DC milrinone, to give small 250cc boluses as needed', 'if BP drops and morphine for symptoms if lungs become overloaded w', 'fluid ; Hold on Rehab for now', '- Likely transfer pt to floor tomorrow w PPC following', '- BPs still stable 88-96 SBP (maps>60) at 1am, though family had been', 'concerned occasionally that she looked like she had more difficulty', 'breathing or increased apneic episodes, though nursing does not feel', 'that she has had any difficulty breathing (pt has not needed any 250cc', 'boluses at this point)', '- 0430am systolic BPs low 70s, but mentating well, not symptomatic -->', '1 bag 250ccs NS']","['- DCed milrinone and diuretics 11:30am', ""- Family mtg held with patient's 3 sisters and multiple other family"", 'members, Dr. [**First Name (STitle) **], then (P&PC) Dr. [**First Name4 (NamePattern1) 3373**] [**Last Name (NamePattern1) **] --> everybody in', 'agreement w plan to DC milrinone, to give small 250cc boluses as needed', 'if BP drops and morphine for symptoms if lungs become overloaded w', 'fluid ; Hold on Rehab for now', '- Likely transfer pt to floor tomorrow w PPC following', '- BPs still stable 88-96 SBP (maps>60) at 1am, though family had been', 'concerned occasionally that she looked like she had more difficulty', 'breathing or increased apneic episodes, though nursing does not feel', 'that she has had any difficulty breathing (pt has not needed any 250cc', 'boluses at this point)', '- 0430am systolic BPs low 70s, but mentating well, not symptomatic -->', '1 bag 250ccs NS']","['- MS contin increased to 30mg [**Hospital1 **] last night, received 2 doses w pills', 'crushed, complained of nausea after each', '- complains of pain at 8/10', '- Has not had a BM for four days', '- PT ordered yesterday']",11638,155878.0
20,2180-01-19 07:53:01,,"['- DCed milrinone and diuretics 11:30am', ""- Family mtg held with patient's 3 sisters and multiple other family"", 'members, Dr. [**First Name (STitle) **], then (P&PC) Dr. [**First Name4 (NamePattern1) 3373**] [**Last Name (NamePattern1) **] --> everybody in', 'agreement w plan to DC milrinone, to give small 250cc boluses as needed', 'if BP drops and morphine for symptoms if lungs become overloaded w', 'fluid ; Hold on Rehab for now', '- Likely transfer pt to floor tomorrow w PPC following', '- BPs still stable 88-96 SBP (maps>60) at 1am, though family had been', 'concerned occasionally that she looked like she had more difficulty', 'breathing or increased apneic episodes, though nursing does not feel', 'that she has had any difficulty breathing (pt has not needed any 250cc', 'boluses at this point)', '- 0430am systolic BPs low 70s, but mentating well, not symptomatic -->', '1 bag 250ccs NS']",,11638,155878.0
21,2180-01-19 13:42:49,,"['- DCed milrinone and diuretics 11:30am', ""- Family mtg held with patient's 3 sisters and multiple other family"", 'members, Dr. [**First Name (STitle) **], then (P&PC) Dr. [**First Name4 (NamePattern1) 3373**] [**Last Name (NamePattern1) **] --> everybody in', 'agreement w plan to DC milrinone, to give small 250cc boluses as needed', 'if BP drops and morphine for symptoms if lungs become overloaded w', 'fluid ; Hold on Rehab for now', '- Likely transfer pt to floor tomorrow w PPC following', '- BPs still stable 88-96 SBP (maps>60) at 1am, though family had been', 'concerned occasionally that she looked like she had more difficulty', 'breathing or increased apneic episodes, though nursing does not feel', 'that she has had any difficulty breathing (pt has not needed any 250cc', 'boluses at this point)', '- 0430am systolic BPs low 70s, but mentating well, not symptomatic -->', '1 bag 250ccs NS']",,11638,155878.0
0,2122-09-06 07:37:33,,"['DIALYSIS CATHETER - START [**2122-9-5**] 08:19 PM', 'Neurology wants MRI and LP.', 'Cultures pending.', 'Need to call nephrology fellow to see if thinks change in MS might be', 'from something associated with HD.', 'Required 5mg Haldol o/n and another 1mg this am to control delirium']",,32247,105172.0
1,2122-09-06 07:43:07,,"['DIALYSIS CATHETER - START [**2122-9-5**] 08:19 PM', 'Neurology wants MRI and LP.', 'Cultures pending.', 'Need to call nephrology fellow to see if thinks change in MS might be', 'from something associated with HD.', 'Required 5mg Haldol o/n and another 1mg this am to control delirium']",,32247,105172.0
2,2122-09-06 10:15:48,['Loose stoolsX2 this am. Cdiff sent.'],"['DIALYSIS CATHETER - START [**2122-9-5**] 08:19 PM', 'Neurology wants MRI and LP.', 'Cultures pending.', 'Need to call nephrology fellow to see if thinks change in MS might be', 'from something associated with HD.', 'Required 5mg Haldol o/n and another 1mg this am to control delirium', 'Loose stoolsX2 this am. Cdiff sent.']",,32247,105172.0
0,2122-09-23 06:58:49,,"['BLOOD CULTURED - At [**2122-9-22**] 12:26 PM', ' EEG - At [**2122-9-22**] 03:26 PM', ' DIALYSIS CATHETER - START [**2122-9-22**] 07:00 PM', ' SPUTUM CULTURE - At [**2122-9-23**] 12:00 AM', ' BLOOD CULTURED - At [**2122-9-23**] 04:00 AM', 'Head CT negative for acute change.  Neuro consult feels that angioedema', 'likely due to ativan.  Recommended continuing Valproate.  EEG done at', 'bedside-- not actively seizing at that time.  Started on heparin gtt.', 'Had episode of Afib with RVR (in setting of ABG) to 160s at 0400.', 'Given fentanyl 50, lopressor 5 mg IV and restarted on metoprolol 50', 'TID.', 'Mental status cleared significantly overnight, currently awake,', 'following commands.', 'Angioedema also significantly improved overnight.']",,32247,113222.0
1,2122-09-23 10:55:19,,"['BLOOD CULTURED - At [**2122-9-22**] 12:26 PM', ' EEG - At [**2122-9-22**] 03:26 PM', ' DIALYSIS CATHETER - START [**2122-9-22**] 07:00 PM', ' SPUTUM CULTURE - At [**2122-9-23**] 12:00 AM', ' BLOOD CULTURED - At [**2122-9-23**] 04:00 AM', 'Head CT negative for acute change.  Neuro consult feels that angioedema', 'likely due to ativan.  Recommended continuing Valproate.  EEG done at', 'bedside-- not actively seizing at that time.  Started on heparin gtt.', 'Had episode of Afib with RVR (in setting of ABG) to 160s at 0400.', 'Given fentanyl 50, lopressor 5 mg IV and restarted on metoprolol 50', 'TID.', 'Mental status cleared significantly overnight, currently awake,', 'following commands.', 'Angioedema also significantly improved overnight.']",,32247,113222.0
2,2122-09-24 06:46:32,"['Patient did well on SBP with RSBI in 30s.', 'Patient did not get IR guided midline because IV nurse did not come up', 'to try for line at bedside.', 'Heparin drip was discontinued while awaiting midline placement.', 'Amlodipine resumed at reduced dose for hypertension.', 'Valproate dose was recommended per neurology.']","['Patient did well on SBP with RSBI in 30s.', 'Patient did not get IR guided midline because IV nurse did not come up', 'to try for line at bedside.', 'Heparin drip was discontinued while awaiting midline placement.', 'Amlodipine resumed at reduced dose for hypertension.', 'Valproate dose was recommended per neurology.']","['BLOOD CULTURED - At [**2122-9-22**] 12:26 PM', ' EEG - At [**2122-9-22**] 03:26 PM', ' DIALYSIS CATHETER - START [**2122-9-22**] 07:00 PM', ' SPUTUM CULTURE - At [**2122-9-23**] 12:00 AM', ' BLOOD CULTURED - At [**2122-9-23**] 04:00 AM', 'Head CT negative for acute change.  Neuro consult feels that angioedema', 'likely due to ativan.  Recommended continuing Valproate.  EEG done at', 'bedside-- not actively seizing at that time.  Started on heparin gtt.', 'Had episode of Afib with RVR (in setting of ABG) to 160s at 0400.', 'Given fentanyl 50, lopressor 5 mg IV and restarted on metoprolol 50', 'TID.', 'Mental status cleared significantly overnight, currently awake,', 'following commands.', 'Angioedema also significantly improved overnight.']",32247,113222.0
3,2122-09-24 07:56:26,"['to try for line at bedside and IR would not take her until the IV team', 'signs off.', 'Valproate dose was increased per neurology.', 'Dialyzed.']","['Patient did well on SBP with RSBI in 30s.', 'Patient did not get IR guided midline because IV nurse did not come up', 'to try for line at bedside and IR would not take her until the IV team', 'signs off.', 'Heparin drip was discontinued while awaiting midline placement.', 'Amlodipine resumed at reduced dose for hypertension.', 'Valproate dose was increased per neurology.', 'Dialyzed.']","['to try for line at bedside.', 'Valproate dose was recommended per neurology.']",32247,113222.0
4,2122-09-24 10:14:01,,"['Patient did well on SBP with RSBI in 30s.', 'Patient did not get IR guided midline because IV nurse did not come up', 'to try for line at bedside and IR would not take her until the IV team', 'signs off.', 'Heparin drip was discontinued while awaiting midline placement.', 'Amlodipine resumed at reduced dose for hypertension.', 'Valproate dose was increased per neurology.', 'Dialyzed.']",,32247,113222.0
5,2122-09-25 07:36:52,"['- Patient with continued periods of apnea when allowed to initiate', 'breaths on own. ABG on pressure support was 7.46/40/120/29', '- Switched back to MMV after']","['- Patient with continued periods of apnea when allowed to initiate', 'breaths on own. ABG on pressure support was 7.46/40/120/29', '- Switched back to MMV after']","['Patient did well on SBP with RSBI in 30s.', 'Patient did not get IR guided midline because IV nurse did not come up', 'to try for line at bedside and IR would not take her until the IV team', 'signs off.', 'Heparin drip was discontinued while awaiting midline placement.', 'Amlodipine resumed at reduced dose for hypertension.', 'Valproate dose was increased per neurology.', 'Dialyzed.']",32247,113222.0
6,2122-09-25 07:54:29,"['Switched back to MMV after this. \\', 'Neuro recommended increasing Keppra dosing, and tapering down Valproate', 'dose over several days.', 'Hemodialysis performed.', 'PICC was not placed, but IR states that it will be placed today.']","['- Patient with continued periods of apnea when allowed to initiate', 'breaths on own. ABG on pressure support was 7.46/40/120/29', 'Switched back to MMV after this. \\', 'Neuro recommended increasing Keppra dosing, and tapering down Valproate', 'dose over several days.', 'Hemodialysis performed.', 'PICC was not placed, but IR states that it will be placed today.']",['- Switched back to MMV after'],32247,113222.0
7,2122-09-25 12:12:56,['Switched back to MMV after this.'],"['- Patient with continued periods of apnea when allowed to initiate', 'breaths on own. ABG on pressure support was 7.46/40/120/29', 'Switched back to MMV after this.', 'Neuro recommended increasing Keppra dosing, and tapering down Valproate', 'dose over several days.', 'Hemodialysis performed.', 'PICC was not placed, but IR states that it will be placed today.']",['Switched back to MMV after this. \\'],32247,113222.0
8,2122-09-26 06:51:51,"['MIDLINE - START [**2122-9-25**] 01:17 PM', 'Midline placed.', 'Extubated in the presence of anesthesia-- did very well. Restarted on', 'home coumadin regimen.', 'Overnight had an episode of hypoglycemia to 60; resolved with [**Location (un) **]', 'juice.']","['MIDLINE - START [**2122-9-25**] 01:17 PM', 'Midline placed.', 'Extubated in the presence of anesthesia-- did very well. Restarted on', 'home coumadin regimen.', 'Overnight had an episode of hypoglycemia to 60; resolved with [**Location (un) **]', 'juice.']","['- Patient with continued periods of apnea when allowed to initiate', 'breaths on own. ABG on pressure support was 7.46/40/120/29', 'Switched back to MMV after this.', 'Neuro recommended increasing Keppra dosing, and tapering down Valproate', 'dose over several days.', 'Hemodialysis performed.', 'PICC was not placed, but IR states that it will be placed today.']",32247,113222.0
9,2122-09-26 07:41:50,,"['MIDLINE - START [**2122-9-25**] 01:17 PM', 'Midline placed.', 'Extubated in the presence of anesthesia-- did very well. Restarted on', 'home coumadin regimen.', 'Overnight had an episode of hypoglycemia to 60; resolved with [**Location (un) **]', 'juice.']",,32247,113222.0
10,2122-09-26 14:24:18,,"['MIDLINE - START [**2122-9-25**] 01:17 PM', 'Midline placed.', 'Extubated in the presence of anesthesia-- did very well. Restarted on', 'home coumadin regimen.', 'Overnight had an episode of hypoglycemia to 60; resolved with [**Location (un) **]', 'juice.']",,32247,113222.0
11,2122-09-26 14:28:09,,"['MIDLINE - START [**2122-9-25**] 01:17 PM', 'Midline placed.', 'Extubated in the presence of anesthesia-- did very well. Restarted on', 'home coumadin regimen.', 'Overnight had an episode of hypoglycemia to 60; resolved with [**Location (un) **]', 'juice.']",,32247,113222.0
0,2122-12-25 07:08:09,,['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM'],,32247,127308.0
1,2122-12-25 07:42:23,"['Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']","['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM', 'Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']",,32247,127308.0
2,2122-12-25 07:46:56,,"['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM', 'Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']",,32247,127308.0
3,2122-12-25 08:01:44,,"['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM', 'Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']",,32247,127308.0
4,2122-12-25 08:26:08,,"['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM', 'Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']",,32247,127308.0
5,2122-12-25 11:43:20,,"['ARTERIAL LINE - START [**2122-12-25**] 01:19 AM', 'Labetalolol gtt discontinued.', 'NG tube placed last night for med administration']",,32247,127308.0
0,2152-04-01 08:35:47,,"['- Family meeting, - cont. abx & O2 & morphine for pain/comfort. If', 'deteriorates, will meet again to discuss CMO.', '- Periodic desats, which resolve with suctioning which he resists', ' ULTRASOUND - At [**2152-3-31**] 02:16 PM', 'Upper extremity vein u/s']",,91867,106929.0
1,2152-04-01 11:23:24,,"['- Family meeting, - cont. abx & O2 & morphine for pain/comfort. If', 'deteriorates, will meet again to discuss CMO.', '- Periodic desats, which resolve with suctioning which he resists', ' ULTRASOUND - At [**2152-3-31**] 02:16 PM', 'Upper extremity vein u/s']",,91867,106929.0
2,2152-04-01 11:32:27,,"['- Family meeting, - cont. abx & O2 & morphine for pain/comfort. If', 'deteriorates, will meet again to discuss CMO.', '- Periodic desats, which resolve with suctioning which he resists', ' ULTRASOUND - At [**2152-3-31**] 02:16 PM', 'Upper extremity vein u/s']",,91867,106929.0
3,2152-04-01 11:36:32,,"['- Family meeting, - cont. abx & O2 & morphine for pain/comfort. If', 'deteriorates, will meet again to discuss CMO.', '- Periodic desats, which resolve with suctioning which he resists', ' ULTRASOUND - At [**2152-3-31**] 02:16 PM', 'Upper extremity vein u/s']",,91867,106929.0
4,2152-04-02 06:26:26,"['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']","['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']","['- Family meeting, - cont. abx & O2 & morphine for pain/comfort. If', 'deteriorates, will meet again to discuss CMO.', '- Periodic desats, which resolve with suctioning which he resists', ' ULTRASOUND - At [**2152-3-31**] 02:16 PM', 'Upper extremity vein u/s']",91867,106929.0
5,2152-04-02 06:29:37,,"['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']",,91867,106929.0
6,2152-04-02 06:43:20,,"['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']",,91867,106929.0
7,2152-04-02 07:33:28,,"['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']",,91867,106929.0
8,2152-04-02 11:21:38,,"['- Family meeting held regarding goals of care. Family decided to place', 'patient on morphine gtt, but wished to consider antibiotic tx for', 'another 24 hrs to see if any improvement.', '-Scopolamine patch started']",,91867,106929.0
0,2173-06-10 07:27:26,,"['- received 3L NS IVF', '- repeat Hct was 30 (down 8 pts) so transfused 2units PRBCs', '- repeat Hct post-txf 34', '- BMs bloody but liquid after [**3-16**] Golytely', '- GI and General Surgery aware of pt', 'History obtained from [**Hospital 15**] Medical records']",,45628,140703.0
1,2173-06-10 07:31:41,,"['- received 3L NS IVF', '- repeat Hct was 30 (down 8 pts) so transfused 2units PRBCs', '- repeat Hct post-txf 34', '- BMs bloody but liquid after [**3-16**] Golytely', '- GI and General Surgery aware of pt', 'History obtained from [**Hospital 15**] Medical records']",,45628,140703.0
2,2173-06-10 09:42:00,,"['- received 3L NS IVF', '- repeat Hct was 30 (down 8 pts) so transfused 2units PRBCs', '- repeat Hct post-txf 34', '- BMs bloody but liquid after [**3-16**] Golytely', '- GI and General Surgery aware of pt', 'History obtained from [**Hospital 15**] Medical records']",,45628,140703.0
3,2173-06-11 07:39:34,"['COLONOSCOPY - At [**2173-6-10**] 11:00 AM', ""- - scope'd with active lower GIB at site of polypectomy, clipped"", '- HCT stable: 30->25->29->24->26', '- not orthostatic', '- mild abd pain after colonoscopy']","['COLONOSCOPY - At [**2173-6-10**] 11:00 AM', ""- - scope'd with active lower GIB at site of polypectomy, clipped"", '- HCT stable: 30->25->29->24->26', '- not orthostatic', '- mild abd pain after colonoscopy', 'History obtained from [**Hospital 15**] Medical records']","['- received 3L NS IVF', '- repeat Hct was 30 (down 8 pts) so transfused 2units PRBCs', '- repeat Hct post-txf 34', '- BMs bloody but liquid after [**3-16**] Golytely', '- GI and General Surgery aware of pt']",45628,140703.0
4,2173-06-11 09:41:15,,"['COLONOSCOPY - At [**2173-6-10**] 11:00 AM', ""- - scope'd with active lower GIB at site of polypectomy, clipped"", '- HCT stable: 30->25->29->24->26', '- not orthostatic', '- mild abd pain after colonoscopy', 'History obtained from [**Hospital 15**] Medical records']",,45628,140703.0
0,2162-05-17 07:26:41,,"['INVASIVE VENTILATION - START [**2162-5-16**] 04:25 PM', ' ULTRASOUND - At [**2162-5-16**] 05:21 PM', 'le u/s.']",,74185,101011.0
1,2162-05-17 07:45:23,['- IVC filter placed by IR'],"['INVASIVE VENTILATION - START [**2162-5-16**] 04:25 PM', ' ULTRASOUND - At [**2162-5-16**] 05:21 PM', 'le u/s.', '- IVC filter placed by IR']",,74185,101011.0
2,2162-05-17 07:49:33,,"['INVASIVE VENTILATION - START [**2162-5-16**] 04:25 PM', ' ULTRASOUND - At [**2162-5-16**] 05:21 PM', 'le u/s.', '- IVC filter placed by IR']",,74185,101011.0
3,2162-05-18 07:39:48,"['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']","['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']","['INVASIVE VENTILATION - START [**2162-5-16**] 04:25 PM', ' ULTRASOUND - At [**2162-5-16**] 05:21 PM', 'le u/s.', '- IVC filter placed by IR']",74185,101011.0
4,2162-05-18 08:03:30,,"['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']",,74185,101011.0
5,2162-05-18 10:01:11,,"['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']",,74185,101011.0
6,2162-05-18 11:30:02,,"['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']",,74185,101011.0
7,2162-05-19 07:29:52,"['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']","['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']","['EKG - At [**2162-5-17**] 08:07 AM', ' BLOOD CULTURED - At [**2162-5-17**] 01:00 PM', ' SPUTUM CULTURE - At [**2162-5-17**] 01:00 PM', ' URINE CULTURE - At [**2162-5-17**] 01:00 PM', ' TRANSTHORACIC ECHO - At [**2162-5-17**] 01:30 PM', ' BLOOD CULTURED - At [**2162-5-17**] 04:00 PM', ' FEVER - 101.6', 'F - [**2162-5-18**] 04:00 AM', '[**2162-5-17**]', '- TTE showed ""thrombus-in-transit"" in RA/RV', '- Cardiology consulted for lysis --> received TPA with improvement of', 'O2-sats and tachycardia', '- Did become hypotensive post-TPA (SBP ~80), Hct stable in 30s -->', 'received 4L NS IVF boluses to keep MAP >60', 'History obtained from Medical records']",74185,101011.0
8,2162-05-19 07:30:29,,"['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']",,74185,101011.0
9,2162-05-19 07:32:57,,"['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']",,74185,101011.0
10,2162-05-19 10:52:29,,"['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']",,74185,101011.0
11,2162-05-20 07:46:38,"['PAN CULTURE - At [**2162-5-19**] 06:17 PM', ' ARTERIAL LINE - START [**2162-5-19**] 08:53 PM', ' MULTI LUMEN - START [**2162-5-19**] 10:35 PM', ' FEVER - 101.3', 'F - [**2162-5-19**] 08:00 PM', '[**5-19**]', '- spiking fevers', '- sputum with GNR, started on Zosyn', ""- BP dropped to SBP high 70's/low 80's, MAP's 50's"", '- central line placed, a-line placed', '- started on a small dose of levophed', 'History obtained from Medical records']","['PAN CULTURE - At [**2162-5-19**] 06:17 PM', ' ARTERIAL LINE - START [**2162-5-19**] 08:53 PM', ' MULTI LUMEN - START [**2162-5-19**] 10:35 PM', ' FEVER - 101.3', 'F - [**2162-5-19**] 08:00 PM', '[**5-19**]', '- spiking fevers', '- sputum with GNR, started on Zosyn', ""- BP dropped to SBP high 70's/low 80's, MAP's 50's"", '- central line placed, a-line placed', '- started on a small dose of levophed', 'History obtained from Medical records']","['TRANSTHORACIC ECHO - At [**2162-5-18**] 11:00 AM', '- called that [**1-17**] blood Cx bottles w/ GPCs, started [**Last Name (LF) 339**], [**First Name3 (LF) **] another', 'blood Cx x1', '- C.diff positive --> started PO Flagyl', '- TTE: mass in RA is [**2-15**] lipomatous hypertrophy of the interatrial', 'septum.', '- PM Hct stable at 31.9, fibrinogen 125 (near normal)']",74185,101011.0
12,2162-05-20 08:04:54,,"['PAN CULTURE - At [**2162-5-19**] 06:17 PM', ' ARTERIAL LINE - START [**2162-5-19**] 08:53 PM', ' MULTI LUMEN - START [**2162-5-19**] 10:35 PM', ' FEVER - 101.3', 'F - [**2162-5-19**] 08:00 PM', '[**5-19**]', '- spiking fevers', '- sputum with GNR, started on Zosyn', ""- BP dropped to SBP high 70's/low 80's, MAP's 50's"", '- central line placed, a-line placed', '- started on a small dose of levophed', 'History obtained from Medical records']",,74185,101011.0
13,2162-05-20 10:27:34,,"['PAN CULTURE - At [**2162-5-19**] 06:17 PM', ' ARTERIAL LINE - START [**2162-5-19**] 08:53 PM', ' MULTI LUMEN - START [**2162-5-19**] 10:35 PM', ' FEVER - 101.3', 'F - [**2162-5-19**] 08:00 PM', '[**5-19**]', '- spiking fevers', '- sputum with GNR, started on Zosyn', ""- BP dropped to SBP high 70's/low 80's, MAP's 50's"", '- central line placed, a-line placed', '- started on a small dose of levophed', 'History obtained from Medical records']",,74185,101011.0
14,2162-05-21 07:49:48,"['[**5-20**]', '- low grade temp 100.6 during the day', '- started lasix gtt with very good UOP', '- did not require levophed', '- fent/versed gtt weaned off and still required PRN fent boluses', 'overnight which improved his tachycardia. He did not need propofol']","['[**5-20**]', '- low grade temp 100.6 during the day', '- started lasix gtt with very good UOP', '- did not require levophed', '- fent/versed gtt weaned off and still required PRN fent boluses', 'overnight which improved his tachycardia. He did not need propofol']","['PAN CULTURE - At [**2162-5-19**] 06:17 PM', ' ARTERIAL LINE - START [**2162-5-19**] 08:53 PM', ' MULTI LUMEN - START [**2162-5-19**] 10:35 PM', ' FEVER - 101.3', 'F - [**2162-5-19**] 08:00 PM', '[**5-19**]', '- spiking fevers', '- sputum with GNR, started on Zosyn', ""- BP dropped to SBP high 70's/low 80's, MAP's 50's"", '- central line placed, a-line placed', '- started on a small dose of levophed', 'History obtained from Medical records']",74185,101011.0
15,2162-05-21 10:12:07,,"['[**5-20**]', '- low grade temp 100.6 during the day', '- started lasix gtt with very good UOP', '- did not require levophed', '- fent/versed gtt weaned off and still required PRN fent boluses', 'overnight which improved his tachycardia. He did not need propofol']",,74185,101011.0
16,2162-05-22 07:25:21,"['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', 'History obtained from Medical records']","['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', 'History obtained from Medical records']","['[**5-20**]', '- low grade temp 100.6 during the day', '- started lasix gtt with very good UOP', '- did not require levophed', '- fent/versed gtt weaned off and still required PRN fent boluses', 'overnight which improved his tachycardia. He did not need propofol']",74185,101011.0
17,2162-05-22 07:30:40,"['- GI consulted, no endoscopy now,but will scope prior to discharge']","['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', '- GI consulted, no endoscopy now,but will scope prior to discharge', 'History obtained from Medical records']",,74185,101011.0
18,2162-05-22 09:30:51,,"['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', '- GI consulted, no endoscopy now,but will scope prior to discharge', 'History obtained from Medical records']",,74185,101011.0
19,2162-05-22 18:50:44,,"['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', '- GI consulted, no endoscopy now,but will scope prior to discharge', 'History obtained from Medical records']",,74185,101011.0
20,2162-05-23 07:32:48,"['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']","['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']","['BLOOD CULTURED - At [**2162-5-21**] 01:00 PM', ""one set BC's drawn from A-line and 2nd set drawn from Central line."", ' SPUTUM CULTURE - At [**2162-5-21**] 01:00 PM', ' FEVER - 101.4', 'F - [**2162-5-21**] 12:00 PM', ""- Vanc d/c'd yesterday"", '- Blood Cx sent x2 at 1230pm', '- changed from AC --> PSV', '- got a 500cc NS bolus for hypotension, then resumed Lasix gtt', '- electrolytes repleted', '- per nursing, responding a bit more as well as more', 'tachycardic/agitated -> propofol PRN overnight for sedation instead of', 'Fentanyl / Versed', '- GI consulted, no endoscopy now,but will scope prior to discharge', 'History obtained from Medical records']",74185,101011.0
21,2162-05-23 07:37:45,,"['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']",,74185,101011.0
22,2162-05-23 07:38:18,,"['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']",,74185,101011.0
23,2162-05-23 09:42:11,,"['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']",,74185,101011.0
24,2162-05-24 07:56:19,"['INVASIVE VENTILATION - STOP [**2162-5-23**] 09:54 AM', '[**5-23**]', '- extubated, intially very tachypneic, but then settled and did well', '- menatal status improved', '- NGt placed', '- changed from hep gtt to lovenox', '- diuresed on lasic gtt']","['INVASIVE VENTILATION - STOP [**2162-5-23**] 09:54 AM', '[**5-23**]', '- extubated, intially very tachypneic, but then settled and did well', '- menatal status improved', '- NGt placed', '- changed from hep gtt to lovenox', '- diuresed on lasic gtt']","['BLOOD CULTURED - At [**2162-5-22**] 10:07 AM', 'BCs from LIJ and aline', ' FEVER - 101.3', 'F - [**2162-5-23**] 12:00 AM', '[**5-22**]:', '- restarted Vanc for GPC in sputum', '- restarted lasix gtt', '- obtain head CT: neg for bleeding', '- sedation held all day until 6pm when pt became tachpnic and', 'hypertensive-> propofol restarted']",74185,101011.0
25,2162-05-24 23:27:24,,"['INVASIVE VENTILATION - STOP [**2162-5-23**] 09:54 AM', '[**5-23**]', '- extubated, intially very tachypneic, but then settled and did well', '- menatal status improved', '- NGt placed', '- changed from hep gtt to lovenox', '- diuresed on lasic gtt']",,74185,101011.0
26,2162-05-25 07:28:01,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']","['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']","['INVASIVE VENTILATION - STOP [**2162-5-23**] 09:54 AM', '[**5-23**]', '- extubated, intially very tachypneic, but then settled and did well', '- menatal status improved', '- NGt placed', '- changed from hep gtt to lovenox', '- diuresed on lasic gtt']",74185,101011.0
27,2162-05-25 07:29:57,,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",,74185,101011.0
28,2162-05-25 07:35:18,,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",,74185,101011.0
29,2162-05-25 07:49:59,,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",,74185,101011.0
30,2162-05-25 07:53:10,,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",,74185,101011.0
31,2162-05-25 07:54:16,,"['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",,74185,101011.0
32,2162-05-25 10:30:17,"['- Mental status noted to be improved', '- Failed Speech / Swallow --> NPO and getting tube feeds', '- Culture growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,']","['- Mental status noted to be improved', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- Failed Speech / Swallow --> NPO and getting tube feeds', '- Culture growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']","['ARTERIAL LINE - STOP [**2162-5-24**] 04:00 PM', '- failed Speech / Swallow --> NPO', '- mental status improving', '- Cx growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,']",74185,101011.0
33,2162-05-26 07:10:33,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)', '- Started on Percocet']","['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)', '- Started on Percocet']","['- Mental status noted to be improved', '- Lasix gtt changed to Lasix boluses TID for diuresis', ""- A-line d/c'd"", '- Failed Speech / Swallow --> NPO and getting tube feeds', '- Culture growing: {CITROBACTER FREUNDII COMPLEX, AEROMONAS HYDROPHILA,', 'STAPH AUREUS COAG +}; Citrobacter pan-sensitive, others pending']",74185,101011.0
34,2162-05-26 07:33:48,"['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', '- Percocet started for back pain']","['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)', '- Percocet started for back pain']","['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', '- Started on Percocet']",74185,101011.0
35,2162-05-26 07:51:50,,"['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)', '- Percocet started for back pain']",,74185,101011.0
36,2162-05-26 07:55:44,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of']","['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)']","['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', '- Percocet started for back pain']",74185,101011.0
37,2162-05-26 08:07:37,,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)']",,74185,101011.0
38,2162-05-26 08:09:13,,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)']",,74185,101011.0
39,2162-05-26 11:44:04,,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)']",,74185,101011.0
40,2162-05-26 11:50:31,,"['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)']",,74185,101011.0
41,2162-05-26 11:53:05,"['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', '- Percocet started for back pain']","['- Spiked to 101.3 --> pan cultured', ""- Tachycardic so d/c'd lasix and bolused 500 cc NS"", '- PM hct stable', '- Trazadone for sleep/ aggitation at night (he wanted to get out of', 'bed)', '- Percocet started for back pain']","['- spiked to 101.3 --> pan cultured', ""- tachycardic so d/c'd lasix and bolused 500 cc NS"", '- pm hct stable', '- trazadone for sleep/ aggitation at night (he wanted to get out of']",74185,101011.0
0,2185-08-04 07:36:09,,"['INDWELLING PORT (PORTACATH) - START [**2185-8-4**] 05:13 AM', ' FEVER - 102.1', 'F - [**2185-8-4**] 04:20 AM']",,98969,134756.0
1,2185-08-05 07:20:53,"['non-contrast CT abd/pelvis - 1. No evidence of free air.', '2. Diffuse bowel wall thickening involving both large and small bowel,', 'which', 'is likely related to anasarca/liver failure, although infection would', 'be', 'difficult to exclude.', '3. Small bilateral pleural effusion and adjacent atelectasis.', '4. Ascites.', '5. Hepatosplenomegaly.']","['non-contrast CT abd/pelvis - 1. No evidence of free air.', '2. Diffuse bowel wall thickening involving both large and small bowel,', 'which', 'is likely related to anasarca/liver failure, although infection would', 'be', 'difficult to exclude.', '3. Small bilateral pleural effusion and adjacent atelectasis.', '4. Ascites.', '5. Hepatosplenomegaly.']","['INDWELLING PORT (PORTACATH) - START [**2185-8-4**] 05:13 AM', ' FEVER - 102.1', 'F - [**2185-8-4**] 04:20 AM']",98969,134756.0
2,2185-08-05 07:41:40,"['[**4-15**] BCx', ' GPC pairs/chairs, GNR', 'non-contrast CT abd/pelvis (prelim) - 1. No evidence of free air.', 's/p 3 U PRBC', ' Hct 22.1', '26.1']","['[**4-15**] BCx', ' GPC pairs/chairs, GNR', 'non-contrast CT abd/pelvis (prelim) - 1. No evidence of free air.', '2. Diffuse bowel wall thickening involving both large and small bowel,', 'which', 'is likely related to anasarca/liver failure, although infection would', 'be', 'difficult to exclude.', '3. Small bilateral pleural effusion and adjacent atelectasis.', '4. Ascites.', '5. Hepatosplenomegaly.', 's/p 3 U PRBC', ' Hct 22.1', '26.1']",['non-contrast CT abd/pelvis - 1. No evidence of free air.'],98969,134756.0
3,2185-08-05 15:33:36,,"['[**4-15**] BCx', ' GPC pairs/chairs, GNR', 'non-contrast CT abd/pelvis (prelim) - 1. No evidence of free air.', '2. Diffuse bowel wall thickening involving both large and small bowel,', 'which', 'is likely related to anasarca/liver failure, although infection would', 'be', 'difficult to exclude.', '3. Small bilateral pleural effusion and adjacent atelectasis.', '4. Ascites.', '5. Hepatosplenomegaly.', 's/p 3 U PRBC', ' Hct 22.1', '26.1']",,98969,134756.0
4,2185-08-05 15:46:26,,"['[**4-15**] BCx', ' GPC pairs/chairs, GNR', 'non-contrast CT abd/pelvis (prelim) - 1. No evidence of free air.', '2. Diffuse bowel wall thickening involving both large and small bowel,', 'which', 'is likely related to anasarca/liver failure, although infection would', 'be', 'difficult to exclude.', '3. Small bilateral pleural effusion and adjacent atelectasis.', '4. Ascites.', '5. Hepatosplenomegaly.', 's/p 3 U PRBC', ' Hct 22.1', '26.1']",,98969,134756.0
0,2130-12-22 05:30:54,,['Patient had no further bradycardia or hypotension once in the CCU.'],,43400,124673.0
1,2130-12-22 10:44:21,"['This am the patient denies chest pain, SOB, or other complaints.']","['Patient had no further bradycardia or hypotension once in the CCU.', 'This am the patient denies chest pain, SOB, or other complaints.']",,43400,124673.0
0,2154-02-02 07:33:10,,"['CORDIS/INTRODUCER - START [**2154-2-1**] 11:29 PM', 'U/S prelim- At least no diastolic component which may demonstrate some', 'reversal of flow focally in the region of the hilum with persistently', 'elevated resistive indices in the upper/mid/ lower poles. Rejection/ATN', 'are of concern.', 'Pt reports abdominal pain improved.']",,29035,152710.0
1,2154-02-02 10:24:31,,"['CORDIS/INTRODUCER - START [**2154-2-1**] 11:29 PM', 'U/S prelim- At least no diastolic component which may demonstrate some', 'reversal of flow focally in the region of the hilum with persistently', 'elevated resistive indices in the upper/mid/ lower poles. Rejection/ATN', 'are of concern.', 'Pt reports abdominal pain improved.']",,29035,152710.0
2,2154-02-03 08:09:37,"['- per renal tx team, consider adding flagyl (added), checking for BK', 'virus', '- needs meropenem approval', '- AS slightly worse on ECHO', '- Tx team reviewed abd CT from OSH, they are not concerened over', 'abdominal infection.', '- renal function improved significantly']","['- per renal tx team, consider adding flagyl (added), checking for BK', 'virus', '- needs meropenem approval', '- AS slightly worse on ECHO', '- Tx team reviewed abd CT from OSH, they are not concerened over', 'abdominal infection.', '- renal function improved significantly']","['CORDIS/INTRODUCER - START [**2154-2-1**] 11:29 PM', 'U/S prelim- At least no diastolic component which may demonstrate some', 'reversal of flow focally in the region of the hilum with persistently', 'elevated resistive indices in the upper/mid/ lower poles. Rejection/ATN', 'are of concern.', 'Pt reports abdominal pain improved.']",29035,152710.0
3,2154-02-03 08:34:54,,"['- per renal tx team, consider adding flagyl (added), checking for BK', 'virus', '- needs meropenem approval', '- AS slightly worse on ECHO', '- Tx team reviewed abd CT from OSH, they are not concerened over', 'abdominal infection.', '- renal function improved significantly']",,29035,152710.0
4,2154-02-03 13:17:14,,"['- per renal tx team, consider adding flagyl (added), checking for BK', 'virus', '- needs meropenem approval', '- AS slightly worse on ECHO', '- Tx team reviewed abd CT from OSH, they are not concerened over', 'abdominal infection.', '- renal function improved significantly']",,29035,152710.0
5,2154-02-04 07:11:27,"['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']","['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']","['- per renal tx team, consider adding flagyl (added), checking for BK', 'virus', '- needs meropenem approval', '- AS slightly worse on ECHO', '- Tx team reviewed abd CT from OSH, they are not concerened over', 'abdominal infection.', '- renal function improved significantly']",29035,152710.0
6,2154-02-04 07:13:11,,"['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']",,29035,152710.0
7,2154-02-04 07:14:30,,"['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']",,29035,152710.0
8,2154-02-04 07:17:16,,"['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']",,29035,152710.0
9,2154-02-04 13:10:41,,"['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']",,29035,152710.0
10,2154-02-05 06:42:23,"['URINE CULTURE - At [**2154-2-4**] 09:10 PM', 'urine sent for BK Virus by PCR', '- ESBL klebsiella in OSH urine cx -> sensitivities getamycin mic < 4,', 'ertapenem mic < 0.5, impenem', '- CT final read: mural thickening at the gastric fundus could represent', 'peristalsis/focal collapse. However, correlation is advised to', 'determine if there are epigastric clinical symptoms.  stable right', 'adrenal mass (myelolipoma), stable Left adnexal cyst', '- OSH blood cx from [**2154-2-1**] NGTD as of [**2-3**]', '- ordered heparin gtt for hx splenic vein thrombosis on [**2153-11-8**] but', 'held [**3-12**] persistent hematuria with multiple clots despite CBI', '- EP: preliminary plan to place pacemaker on [**2-4**].  will d/c heparin', 'gtt at 2am prior to procedure', '- renal recs: increase prograf to 2.0 mg [**Hospital1 **]', '- adjusted dosing of abx based on improving renal function: now [**Last Name (un) 430**]', '500mg q 6hrs but would consider uptitrating to 1gm q 8 based on BMI in', 'am', '- ID recs: d/ced flagyl/ vanco.  Cont meropenem likely for 2 week', 'course.  Also sent serum adenovirus/BK/EBV/HHV6 PCR; urine BK PCR;', 'nasopharyngeal swab and placed on contact [**Name (NI) **] until r/o flu', '- started low dose ativan for anxiety', '- tried ditropan 10mg x 1 for bladder spasm']","['URINE CULTURE - At [**2154-2-4**] 09:10 PM', 'urine sent for BK Virus by PCR', '- ESBL klebsiella in OSH urine cx -> sensitivities getamycin mic < 4,', 'ertapenem mic < 0.5, impenem', '- CT final read: mural thickening at the gastric fundus could represent', 'peristalsis/focal collapse. However, correlation is advised to', 'determine if there are epigastric clinical symptoms.  stable right', 'adrenal mass (myelolipoma), stable Left adnexal cyst', '- OSH blood cx from [**2154-2-1**] NGTD as of [**2-3**]', '- ordered heparin gtt for hx splenic vein thrombosis on [**2153-11-8**] but', 'held [**3-12**] persistent hematuria with multiple clots despite CBI', '- EP: preliminary plan to place pacemaker on [**2-4**].  will d/c heparin', 'gtt at 2am prior to procedure', '- renal recs: increase prograf to 2.0 mg [**Hospital1 **]', '- adjusted dosing of abx based on improving renal function: now [**Last Name (un) 430**]', '500mg q 6hrs but would consider uptitrating to 1gm q 8 based on BMI in', 'am', '- ID recs: d/ced flagyl/ vanco.  Cont meropenem likely for 2 week', 'course.  Also sent serum adenovirus/BK/EBV/HHV6 PCR; urine BK PCR;', 'nasopharyngeal swab and placed on contact [**Name (NI) **] until r/o flu', '- started low dose ativan for anxiety', '- tried ditropan 10mg x 1 for bladder spasm']","['FEVER - 101.6', 'F - [**2154-2-3**] 10:43 AM', '- CT a/p: neg for cause of abdominal pain.  Air in bladder and kidney', 'most likey from foley cath.', '- Renal - I/O goal even. hold diuretics & ace', '- Transplant - abd pain possibly [**3-12**] constipation. inc bowel regimen', 'and patient had BM without relief in pain.', '- hematuria noted', '- pt with OSA, uses CPAP at home.  Resp consult requested.']",29035,152710.0
11,2154-02-05 08:01:24,['- EP: preliminary plan to place pacemaker on [**2-5**].  will d/c heparin'],"['URINE CULTURE - At [**2154-2-4**] 09:10 PM', 'urine sent for BK Virus by PCR', '- ESBL klebsiella in OSH urine cx -> sensitivities getamycin mic < 4,', 'ertapenem mic < 0.5, impenem', '- CT final read: mural thickening at the gastric fundus could represent', 'peristalsis/focal collapse. However, correlation is advised to', 'determine if there are epigastric clinical symptoms.  stable right', 'adrenal mass (myelolipoma), stable Left adnexal cyst', '- OSH blood cx from [**2154-2-1**] NGTD as of [**2-3**]', '- ordered heparin gtt for hx splenic vein thrombosis on [**2153-11-8**] but', 'held [**3-12**] persistent hematuria with multiple clots despite CBI', '- EP: preliminary plan to place pacemaker on [**2-5**].  will d/c heparin', 'gtt at 2am prior to procedure', '- renal recs: increase prograf to 2.0 mg [**Hospital1 **]', '- adjusted dosing of abx based on improving renal function: now [**Last Name (un) 430**]', '500mg q 6hrs but would consider uptitrating to 1gm q 8 based on BMI in', 'am', '- ID recs: d/ced flagyl/ vanco.  Cont meropenem likely for 2 week', 'course.  Also sent serum adenovirus/BK/EBV/HHV6 PCR; urine BK PCR;', 'nasopharyngeal swab and placed on contact [**Name (NI) **] until r/o flu', '- started low dose ativan for anxiety', '- tried ditropan 10mg x 1 for bladder spasm']",['- EP: preliminary plan to place pacemaker on [**2-4**].  will d/c heparin'],29035,152710.0
12,2154-02-05 10:55:33,,"['URINE CULTURE - At [**2154-2-4**] 09:10 PM', 'urine sent for BK Virus by PCR', '- ESBL klebsiella in OSH urine cx -> sensitivities getamycin mic < 4,', 'ertapenem mic < 0.5, impenem', '- CT final read: mural thickening at the gastric fundus could represent', 'peristalsis/focal collapse. However, correlation is advised to', 'determine if there are epigastric clinical symptoms.  stable right', 'adrenal mass (myelolipoma), stable Left adnexal cyst', '- OSH blood cx from [**2154-2-1**] NGTD as of [**2-3**]', '- ordered heparin gtt for hx splenic vein thrombosis on [**2153-11-8**] but', 'held [**3-12**] persistent hematuria with multiple clots despite CBI', '- EP: preliminary plan to place pacemaker on [**2-5**].  will d/c heparin', 'gtt at 2am prior to procedure', '- renal recs: increase prograf to 2.0 mg [**Hospital1 **]', '- adjusted dosing of abx based on improving renal function: now [**Last Name (un) 430**]', '500mg q 6hrs but would consider uptitrating to 1gm q 8 based on BMI in', 'am', '- ID recs: d/ced flagyl/ vanco.  Cont meropenem likely for 2 week', 'course.  Also sent serum adenovirus/BK/EBV/HHV6 PCR; urine BK PCR;', 'nasopharyngeal swab and placed on contact [**Name (NI) **] until r/o flu', '- started low dose ativan for anxiety', '- tried ditropan 10mg x 1 for bladder spasm']",,29035,152710.0
13,2154-02-06 06:31:09,"['CARDIAC CATH - At [**2154-2-5**] 04:10 PM', 'Pt sent to EP lab for PPM', ' CORDIS/INTRODUCER - STOP [**2154-2-5**] 07:50 PM', ' CARDIAC CATH - At [**2154-2-5**] 07:50 PM']","['CARDIAC CATH - At [**2154-2-5**] 04:10 PM', 'Pt sent to EP lab for PPM', ' CORDIS/INTRODUCER - STOP [**2154-2-5**] 07:50 PM', ' CARDIAC CATH - At [**2154-2-5**] 07:50 PM']","['URINE CULTURE - At [**2154-2-4**] 09:10 PM', 'urine sent for BK Virus by PCR', '- ESBL klebsiella in OSH urine cx -> sensitivities getamycin mic < 4,', 'ertapenem mic < 0.5, impenem', '- CT final read: mural thickening at the gastric fundus could represent', 'peristalsis/focal collapse. However, correlation is advised to', 'determine if there are epigastric clinical symptoms.  stable right', 'adrenal mass (myelolipoma), stable Left adnexal cyst', '- OSH blood cx from [**2154-2-1**] NGTD as of [**2-3**]', '- ordered heparin gtt for hx splenic vein thrombosis on [**2153-11-8**] but', 'held [**3-12**] persistent hematuria with multiple clots despite CBI', '- EP: preliminary plan to place pacemaker on [**2-5**].  will d/c heparin', 'gtt at 2am prior to procedure', '- renal recs: increase prograf to 2.0 mg [**Hospital1 **]', '- adjusted dosing of abx based on improving renal function: now [**Last Name (un) 430**]', '500mg q 6hrs but would consider uptitrating to 1gm q 8 based on BMI in', 'am', '- ID recs: d/ced flagyl/ vanco.  Cont meropenem likely for 2 week', 'course.  Also sent serum adenovirus/BK/EBV/HHV6 PCR; urine BK PCR;', 'nasopharyngeal swab and placed on contact [**Name (NI) **] until r/o flu', '- started low dose ativan for anxiety', '- tried ditropan 10mg x 1 for bladder spasm']",29035,152710.0
14,2154-02-06 07:45:11,,"['CARDIAC CATH - At [**2154-2-5**] 04:10 PM', 'Pt sent to EP lab for PPM', ' CORDIS/INTRODUCER - STOP [**2154-2-5**] 07:50 PM', ' CARDIAC CATH - At [**2154-2-5**] 07:50 PM']",,29035,152710.0
15,2154-02-06 10:54:50,,"['CARDIAC CATH - At [**2154-2-5**] 04:10 PM', 'Pt sent to EP lab for PPM', ' CORDIS/INTRODUCER - STOP [**2154-2-5**] 07:50 PM', ' CARDIAC CATH - At [**2154-2-5**] 07:50 PM']",,29035,152710.0
0,2204-08-06 07:11:53,,"['MIDLINE - START [**2204-8-5**] 03:30 PM', ' MULTI LUMEN - START [**2204-8-5**] 06:00 PM', ' URINE CULTURE - At [**2204-8-6**] 12:30 AM', ' STOOL CULTURE - At [**2204-8-6**] 02:26 AM', 'c.diff cx', ' BLOOD CULTURED - At [**2204-8-6**] 03:35 AM', 'CVL', '-Triple lumen placed - Left subclavian', '-Surgery consulted who suggested vascular surgery consult and CT of', 'lower extremeties. Showed no evidence of necrotizing fascitis. They', 'were also concerned for abdominal tenderness fo Non-contrast CT', 'abd/pelvis obtained. Final read pending.', '-IVF with bicarb given for borderline low BP (systolic in the 90s)']",,3513,186086.0
1,2204-08-06 10:17:54,,"['MIDLINE - START [**2204-8-5**] 03:30 PM', ' MULTI LUMEN - START [**2204-8-5**] 06:00 PM', ' URINE CULTURE - At [**2204-8-6**] 12:30 AM', ' STOOL CULTURE - At [**2204-8-6**] 02:26 AM', 'c.diff cx', ' BLOOD CULTURED - At [**2204-8-6**] 03:35 AM', 'CVL', '-Triple lumen placed - Left subclavian', '-Surgery consulted who suggested vascular surgery consult and CT of', 'lower extremeties. Showed no evidence of necrotizing fascitis. They', 'were also concerned for abdominal tenderness fo Non-contrast CT', 'abd/pelvis obtained. Final read pending.', '-IVF with bicarb given for borderline low BP (systolic in the 90s)']",,3513,186086.0
2,2204-08-07 07:56:18,"['ULTRASOUND - At [**2204-8-6**] 09:00 AM', 'arteriogram and LENIS', ' TRANSTHORACIC ECHO - At [**2204-8-6**] 01:30 PM']","['ULTRASOUND - At [**2204-8-6**] 09:00 AM', 'arteriogram and LENIS', ' TRANSTHORACIC ECHO - At [**2204-8-6**] 01:30 PM']","['MIDLINE - START [**2204-8-5**] 03:30 PM', ' MULTI LUMEN - START [**2204-8-5**] 06:00 PM', ' URINE CULTURE - At [**2204-8-6**] 12:30 AM', ' STOOL CULTURE - At [**2204-8-6**] 02:26 AM', 'c.diff cx', ' BLOOD CULTURED - At [**2204-8-6**] 03:35 AM', 'CVL', '-Triple lumen placed - Left subclavian', '-Surgery consulted who suggested vascular surgery consult and CT of', 'lower extremeties. Showed no evidence of necrotizing fascitis. They', 'were also concerned for abdominal tenderness fo Non-contrast CT', 'abd/pelvis obtained. Final read pending.', '-IVF with bicarb given for borderline low BP (systolic in the 90s)']",3513,186086.0
3,2204-08-07 14:37:12,,"['ULTRASOUND - At [**2204-8-6**] 09:00 AM', 'arteriogram and LENIS', ' TRANSTHORACIC ECHO - At [**2204-8-6**] 01:30 PM']",,3513,186086.0
4,2204-08-08 07:19:53,"['BLOOD CULTURED - At [**2204-8-7**] 11:16 PM', '-Renal reassessed yesterday and feels that renal function may be', 'recoverable, still hold of on HD.', '-Vascular [**Doctor First Name 458**] understands risk of angio to assess PAD.', 'Revascularization may be necessary for LE wound healing, but is not', 'emergent at this time.  Vascular will discuss timetable with team', 'today.', '- ID did not feel that GAS septicemia was contraindication to', 'revascularization procedure or or stent placement.  Patient still', 'refusing majority of care including PO meds and cleaning.']","['BLOOD CULTURED - At [**2204-8-7**] 11:16 PM', '-Renal reassessed yesterday and feels that renal function may be', 'recoverable, still hold of on HD.', '-Vascular [**Doctor First Name 458**] understands risk of angio to assess PAD.', 'Revascularization may be necessary for LE wound healing, but is not', 'emergent at this time.  Vascular will discuss timetable with team', 'today.', '- ID did not feel that GAS septicemia was contraindication to', 'revascularization procedure or or stent placement.  Patient still', 'refusing majority of care including PO meds and cleaning.']","['ULTRASOUND - At [**2204-8-6**] 09:00 AM', 'arteriogram and LENIS', ' TRANSTHORACIC ECHO - At [**2204-8-6**] 01:30 PM']",3513,186086.0
5,2204-08-08 14:10:39,"['revascularization procedure or or stent placement.', '-Patient still refusing majority of care including PO meds and', 'cleaning.']","['BLOOD CULTURED - At [**2204-8-7**] 11:16 PM', '-Renal reassessed yesterday and feels that renal function may be', 'recoverable, still hold of on HD.', '-Vascular [**Doctor First Name 458**] understands risk of angio to assess PAD.', 'Revascularization may be necessary for LE wound healing, but is not', 'emergent at this time.  Vascular will discuss timetable with team', 'today.', '- ID did not feel that GAS septicemia was contraindication to', 'revascularization procedure or or stent placement.', '-Patient still refusing majority of care including PO meds and', 'cleaning.']","['revascularization procedure or or stent placement.  Patient still', 'refusing majority of care including PO meds and cleaning.']",3513,186086.0
6,2204-08-09 07:11:37,"['- Ca repleated', '- PIC team did not come by. PIV not in place. After gets PIV (hopefully', '[**8-9**]) can get other unnecessary lines discontinued.', '-pt not eating and several blod sugars in 60s. Need to discuss goals of', 'care, including this with son']","['- Ca repleated', '- PIC team did not come by. PIV not in place. After gets PIV (hopefully', '[**8-9**]) can get other unnecessary lines discontinued.', '-pt not eating and several blod sugars in 60s. Need to discuss goals of', 'care, including this with son']","['BLOOD CULTURED - At [**2204-8-7**] 11:16 PM', '-Renal reassessed yesterday and feels that renal function may be', 'recoverable, still hold of on HD.', '-Vascular [**Doctor First Name 458**] understands risk of angio to assess PAD.', 'Revascularization may be necessary for LE wound healing, but is not', 'emergent at this time.  Vascular will discuss timetable with team', 'today.', '- ID did not feel that GAS septicemia was contraindication to', 'revascularization procedure or or stent placement.', '-Patient still refusing majority of care including PO meds and', 'cleaning.']",3513,186086.0
7,2204-08-09 12:14:35,['-per daughters'],"['- Ca repleated', '- PIC team did not come by. PIV not in place. After gets PIV (hopefully', '[**8-9**]) can get other unnecessary lines discontinued.', '-pt not eating and several blod sugars in 60s. Need to discuss goals of', 'care, including this with son', '-per daughters']",,3513,186086.0
8,2204-08-09 12:28:07,"['-gen [**Name2 (NI) 458**] evaluated wounds and did not think this was nec fasc, and', 'infact thought that LE wounds appeared improved.', '-wound care suggested dermatology c/s.']","['- Ca repleated', '- PIC team did not come by. PIV not in place. After gets PIV (hopefully', '[**8-9**]) can get other unnecessary lines discontinued.', '-pt not eating and several blod sugars in 60s. Need to discuss goals of', 'care, including this with son', '-per daughters', '-gen [**Name2 (NI) 458**] evaluated wounds and did not think this was nec fasc, and', 'infact thought that LE wounds appeared improved.', '-wound care suggested dermatology c/s.']",,3513,186086.0
9,2204-08-10 07:57:12,"['-PTH elevated at 491, ordered per derm', '-Dr. [**Last Name (STitle) 832**] had long conversation with son-> pt now DNR/DNI; after', 'conversation son also decided NO NG tube; ?HD', '-pm cr trending down', '-per derm; ?calciphylaxis.  Will return for punch biopsy tomorrow.', 'Thinks bullae on hand from edema/tape trauma.  Recs miconazole for', 'under breasts and something for feet but unclear what kind of', 'antifungal for tinea pedis', '-per ID, increased Unasyn to 3G', '-pan-sensitive GAS culture from blood', '-line and blood ctx sent']","['-PTH elevated at 491, ordered per derm', '-Dr. [**Last Name (STitle) 832**] had long conversation with son-> pt now DNR/DNI; after', 'conversation son also decided NO NG tube; ?HD', '-pm cr trending down', '-per derm; ?calciphylaxis.  Will return for punch biopsy tomorrow.', 'Thinks bullae on hand from edema/tape trauma.  Recs miconazole for', 'under breasts and something for feet but unclear what kind of', 'antifungal for tinea pedis', '-per ID, increased Unasyn to 3G', '-pan-sensitive GAS culture from blood', '-line and blood ctx sent']","['- Ca repleated', '- PIC team did not come by. PIV not in place. After gets PIV (hopefully', '[**8-9**]) can get other unnecessary lines discontinued.', '-pt not eating and several blod sugars in 60s. Need to discuss goals of', 'care, including this with son', '-per daughters', '-gen [**Name2 (NI) 458**] evaluated wounds and did not think this was nec fasc, and', 'infact thought that LE wounds appeared improved.', '-wound care suggested dermatology c/s.']",3513,186086.0
10,2204-08-10 13:31:02,,"['-PTH elevated at 491, ordered per derm', '-Dr. [**Last Name (STitle) 832**] had long conversation with son-> pt now DNR/DNI; after', 'conversation son also decided NO NG tube; ?HD', '-pm cr trending down', '-per derm; ?calciphylaxis.  Will return for punch biopsy tomorrow.', 'Thinks bullae on hand from edema/tape trauma.  Recs miconazole for', 'under breasts and something for feet but unclear what kind of', 'antifungal for tinea pedis', '-per ID, increased Unasyn to 3G', '-pan-sensitive GAS culture from blood', '-line and blood ctx sent']",,3513,186086.0
0,2115-08-21 07:43:05,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
1,2115-08-21 09:33:16,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
2,2115-08-21 09:41:38,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
3,2115-08-21 09:45:01,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
4,2115-08-21 09:46:15,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
5,2115-08-21 09:46:39,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
6,2115-08-21 09:48:15,,"['FEVER - 102.0', 'F - [**2115-8-20**] 08:00 PM -> blood cultures sent', 'asymptomatic sinus bradycardia into 40s while sleeping', 'History obtained from Patient']",,43529,194815.0
0,2115-09-21 08:06:41,,"['-got tagged RBC; blush was positive in the RUQ near the hepatic flexure', '(site of polypectomy within last week); went to angio and angiography', 'was negative for bleeding site; no intervention. GI is following;', 'decided to bowel prep and go for colonoscopy during the night.', '-repeat HCT was 19 - >23.5 -> 28 this AM:  transfused a total of 3 [**Location **] O/N.  Put out 300 ccs of blood in bowel movements around midnight', '-family updated on plan', '3 units of pBRCs']",,43529,172162.0
0,2146-05-17 07:44:49,,['INDWELLING PORT (PORTACATH) - START [**2146-5-16**] 01:39 PM'],,75454,122286.0
1,2146-05-17 09:24:23,,['INDWELLING PORT (PORTACATH) - START [**2146-5-16**] 01:39 PM'],,75454,122286.0
2,2146-05-17 10:06:58,,['INDWELLING PORT (PORTACATH) - START [**2146-5-16**] 01:39 PM'],,75454,122286.0
3,2146-05-18 07:22:15,"['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']","['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']",['INDWELLING PORT (PORTACATH) - START [**2146-5-16**] 01:39 PM'],75454,122286.0
4,2146-05-18 10:36:38,,"['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']",,75454,122286.0
5,2146-05-18 12:03:14,,"['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']",,75454,122286.0
6,2146-05-18 12:26:09,,"['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']",,75454,122286.0
7,2146-05-19 07:22:13,"['- received 1st dose of XRT yesterday; recs --> aquaphor ointment and', 'zofran peri-xrt', '- started on clears', '- no further episodes of diarrhea']","['- received 1st dose of XRT yesterday; recs --> aquaphor ointment and', 'zofran peri-xrt', '- started on clears', '- no further episodes of diarrhea']","['- f/u hct stable', '- GI scoped the patient - found a large ulcerated mass on the lesser', 'curvature of the stomach, biopsy taken.', '- getting radiation tomorrow AM', '- GEN [**Doctor First Name **]: hold off surgery, defer to IR', '- recieved 2 units of PRBCs']",75454,122286.0
8,2146-05-19 11:10:45,,"['- received 1st dose of XRT yesterday; recs --> aquaphor ointment and', 'zofran peri-xrt', '- started on clears', '- no further episodes of diarrhea']",,75454,122286.0
9,2146-05-19 11:37:30,,"['- received 1st dose of XRT yesterday; recs --> aquaphor ointment and', 'zofran peri-xrt', '- started on clears', '- no further episodes of diarrhea']",,75454,122286.0
0,2184-08-04 16:17:31,,"['INVASIVE VENTILATION - STOP [**2184-8-3**] 02:47 PM', ' INCREASED O2 REQUIREMENT-given 10mg IV lasix X2', ' CALLED OUT', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: somnolent']",,32526,156527.0
1,2184-08-08 07:02:01,"['-Patient underwent bronchoscopy for RLL atelectasis and mediastinal', 'shift.  Repeat CXR showing improved aeration, with persistent shift', ""-After bronchoscopy, the patient's BP dropped to SBP 80s, and HR to"", '150s.  Bolused three liters of NS with SBP rebound to 110-120 and HR in', '110 range.  UOP minimal.', '-A line placed for ABG monitoring']","['-Patient underwent bronchoscopy for RLL atelectasis and mediastinal', 'shift.  Repeat CXR showing improved aeration, with persistent shift', ""-After bronchoscopy, the patient's BP dropped to SBP 80s, and HR to"", '150s.  Bolused three liters of NS with SBP rebound to 110-120 and HR in', '110 range.  UOP minimal.', '-A line placed for ABG monitoring']","['INVASIVE VENTILATION - STOP [**2184-8-3**] 02:47 PM', ' INCREASED O2 REQUIREMENT-given 10mg IV lasix X2', ' CALLED OUT', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: somnolent']",32526,156527.0
2,2184-08-08 07:12:48,"['-Low grade temp to 100.7, cultures sent']","['-Patient underwent bronchoscopy for RLL atelectasis and mediastinal', 'shift.  Repeat CXR showing improved aeration, with persistent shift', ""-After bronchoscopy, the patient's BP dropped to SBP 80s, and HR to"", '150s.  Bolused three liters of NS with SBP rebound to 110-120 and HR in', '110 range.  UOP minimal.', '-A line placed for ABG monitoring', '-Low grade temp to 100.7, cultures sent']",,32526,156527.0
3,2184-08-08 10:23:18,,"['-Patient underwent bronchoscopy for RLL atelectasis and mediastinal', 'shift.  Repeat CXR showing improved aeration, with persistent shift', ""-After bronchoscopy, the patient's BP dropped to SBP 80s, and HR to"", '150s.  Bolused three liters of NS with SBP rebound to 110-120 and HR in', '110 range.  UOP minimal.', '-A line placed for ABG monitoring', '-Low grade temp to 100.7, cultures sent']",,32526,156527.0
4,2184-08-09 05:45:46,"['- Restarted on Cefepime and Vancomycin', '- Family would like to have meeting today to address goals of care']","['- Restarted on Cefepime and Vancomycin', '- Family would like to have meeting today to address goals of care']","['-Patient underwent bronchoscopy for RLL atelectasis and mediastinal', 'shift.  Repeat CXR showing improved aeration, with persistent shift', ""-After bronchoscopy, the patient's BP dropped to SBP 80s, and HR to"", '150s.  Bolused three liters of NS with SBP rebound to 110-120 and HR in', '110 range.  UOP minimal.', '-A line placed for ABG monitoring', '-Low grade temp to 100.7, cultures sent']",32526,156527.0
5,2184-08-09 05:47:17,,"['- Restarted on Cefepime and Vancomycin', '- Family would like to have meeting today to address goals of care']",,32526,156527.0
6,2184-08-09 12:16:07,,"['- Restarted on Cefepime and Vancomycin', '- Family would like to have meeting today to address goals of care']",,32526,156527.0
7,2184-08-10 05:54:49,"['INVASIVE VENTILATION - STOP [**2184-8-9**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2184-8-9**] 01:30 PM', 'Family updated, ID team part of discussion', 'Family requested not to give updates to other visitors']","['INVASIVE VENTILATION - STOP [**2184-8-9**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2184-8-9**] 01:30 PM', 'Family updated, ID team part of discussion', 'Family requested not to give updates to other visitors']","['- Restarted on Cefepime and Vancomycin', '- Family would like to have meeting today to address goals of care']",32526,156527.0
8,2184-08-10 05:56:18,,"['INVASIVE VENTILATION - STOP [**2184-8-9**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2184-8-9**] 01:30 PM', 'Family updated, ID team part of discussion', 'Family requested not to give updates to other visitors']",,32526,156527.0
9,2184-08-10 10:25:55,,"['INVASIVE VENTILATION - STOP [**2184-8-9**] 10:15 AM', ' TRANSTHORACIC ECHO - At [**2184-8-9**] 01:30 PM', 'Family updated, ID team part of discussion', 'Family requested not to give updates to other visitors']",,32526,156527.0
0,2114-12-08 06:26:51,,"['- The patient developed sinus tachycardia overnight (his HR trended up', ""from the 90's to the 110's)."", '- He spiked a temp to 101.1 and BCx were sent.', 'This am he denies pain, shortness of breath, dizziness, or other', 'symptoms.']",,42892,153259.0
1,2114-12-08 11:18:46,,"['- The patient developed sinus tachycardia overnight (his HR trended up', ""from the 90's to the 110's)."", '- He spiked a temp to 101.1 and BCx were sent.', 'This am he denies pain, shortness of breath, dizziness, or other', 'symptoms.']",,42892,153259.0
2,2114-12-09 07:03:30,"[""- Continued to be tachy throughout day in 100's - per OMR notes,"", ""baseline hr in 90's"", ""- Did not call out because of persisent tachycardia, bp's stable,"", 'patient not in pain, cultures still pending', '- CT wet read: At least two sub-6-mm hyperdense foci within the lower', 'pole of the left kidney suspicious for residual calculi. Air within the', 'left renal collecting system, likely related to recent procedure. New', 'L1 compression fracture compared to the CT of [**2112**]. A large volume of', 'stool within the rectal vault.']","[""- Continued to be tachy throughout day in 100's - per OMR notes,"", ""baseline hr in 90's"", ""- Did not call out because of persisent tachycardia, bp's stable,"", 'patient not in pain, cultures still pending', '- CT wet read: At least two sub-6-mm hyperdense foci within the lower', 'pole of the left kidney suspicious for residual calculi. Air within the', 'left renal collecting system, likely related to recent procedure. New', 'L1 compression fracture compared to the CT of [**2112**]. A large volume of', 'stool within the rectal vault.']","['- The patient developed sinus tachycardia overnight (his HR trended up', ""from the 90's to the 110's)."", '- He spiked a temp to 101.1 and BCx were sent.', 'This am he denies pain, shortness of breath, dizziness, or other', 'symptoms.']",42892,153259.0
3,2114-12-09 08:33:56,"['Pt denies complaints this morning.  No back pain, chest pain, SOB, N/V,', 'palpitations.']","[""- Continued to be tachy throughout day in 100's - per OMR notes,"", ""baseline hr in 90's"", ""- Did not call out because of persisent tachycardia, bp's stable,"", 'patient not in pain, cultures still pending', '- CT wet read: At least two sub-6-mm hyperdense foci within the lower', 'pole of the left kidney suspicious for residual calculi. Air within the', 'left renal collecting system, likely related to recent procedure. New', 'L1 compression fracture compared to the CT of [**2112**]. A large volume of', 'stool within the rectal vault.', 'Pt denies complaints this morning.  No back pain, chest pain, SOB, N/V,', 'palpitations.']",,42892,153259.0
4,2114-12-09 23:23:35,,"[""- Continued to be tachy throughout day in 100's - per OMR notes,"", ""baseline hr in 90's"", ""- Did not call out because of persisent tachycardia, bp's stable,"", 'patient not in pain, cultures still pending', '- CT wet read: At least two sub-6-mm hyperdense foci within the lower', 'pole of the left kidney suspicious for residual calculi. Air within the', 'left renal collecting system, likely related to recent procedure. New', 'L1 compression fracture compared to the CT of [**2112**]. A large volume of', 'stool within the rectal vault.', 'Pt denies complaints this morning.  No back pain, chest pain, SOB, N/V,', 'palpitations.']",,42892,153259.0
0,2115-06-29 08:20:41,,"['EKG - At [**2115-6-28**] 09:30 PM', ' FEVER - 102.0', 'F - [**2115-6-28**] 08:30 PM', '- received gentle boluses early on, at night dropped pressures from', '130s to 80s, received total of 4L boluses with effect', '- changed gent to tobra for better coverage given sensitivity history', '- repleated phos of 0.6']",,42892,139885.0
1,2115-06-29 08:27:06,,"['EKG - At [**2115-6-28**] 09:30 PM', ' FEVER - 102.0', 'F - [**2115-6-28**] 08:30 PM', '- received gentle boluses early on, at night dropped pressures from', '130s to 80s, received total of 4L boluses with effect', '- changed gent to tobra for better coverage given sensitivity history', '- repleated phos of 0.6']",,42892,139885.0
2,2115-06-29 11:34:06,,"['EKG - At [**2115-6-28**] 09:30 PM', ' FEVER - 102.0', 'F - [**2115-6-28**] 08:30 PM', '- received gentle boluses early on, at night dropped pressures from', '130s to 80s, received total of 4L boluses with effect', '- changed gent to tobra for better coverage given sensitivity history', '- repleated phos of 0.6']",,42892,139885.0
3,2115-06-29 13:18:51,,"['EKG - At [**2115-6-28**] 09:30 PM', ' FEVER - 102.0', 'F - [**2115-6-28**] 08:30 PM', '- received gentle boluses early on, at night dropped pressures from', '130s to 80s, received total of 4L boluses with effect', '- changed gent to tobra for better coverage given sensitivity history', '- repleated phos of 0.6']",,42892,139885.0
4,2115-06-30 07:38:19,"['FEVER - 102.5', 'F - [**2115-6-29**] 09:00 PM']","['FEVER - 102.5', 'F - [**2115-6-29**] 09:00 PM']","['EKG - At [**2115-6-28**] 09:30 PM', ' FEVER - 102.0', 'F - [**2115-6-28**] 08:30 PM', '- received gentle boluses early on, at night dropped pressures from', '130s to 80s, received total of 4L boluses with effect', '- changed gent to tobra for better coverage given sensitivity history', '- repleated phos of 0.6']",42892,139885.0
5,2115-06-30 07:50:33,"['-Febrile to 102.5 overnight', '- given 1 liter of normal saline because tachycardia up to 120s-130s.', '- U/As look grossly positive.']","['-Febrile to 102.5 overnight', '- given 1 liter of normal saline because tachycardia up to 120s-130s.', '- U/As look grossly positive.']","['FEVER - 102.5', 'F - [**2115-6-29**] 09:00 PM']",42892,139885.0
6,2115-06-30 12:10:20,,"['-Febrile to 102.5 overnight', '- given 1 liter of normal saline because tachycardia up to 120s-130s.', '- U/As look grossly positive.']",,42892,139885.0
7,2115-06-30 12:21:10,,"['-Febrile to 102.5 overnight', '- given 1 liter of normal saline because tachycardia up to 120s-130s.', '- U/As look grossly positive.']",,42892,139885.0
8,2115-06-30 12:32:35,,"['-Febrile to 102.5 overnight', '- given 1 liter of normal saline because tachycardia up to 120s-130s.', '- U/As look grossly positive.']",,42892,139885.0
0,2169-03-13 06:47:25,,"['Urinary catheter fell out and pt. began complaining of pain unable to', 'localize.']",,73488,183302.0
1,2169-03-13 10:27:12,"['Neurology suggested LP, MRI']","['Urinary catheter fell out and pt. began complaining of pain unable to', 'localize.', 'Neurology suggested LP, MRI']",,73488,183302.0
2,2169-03-14 06:57:39,"['- Neurology attempted LP, unsuccessful.', '- Went to IR, had LP.', '- Transfused total 2 units of platelets.  PLT at 9pm 68', '- Concern that patient may be having complex partial seizures - patient', 'had some lip smacking, responded to Ativan 0.5mg IV.', '- In light of seizure concern, patient was switched from Meropenem to', 'Doripenem.', '- Continuous EEG ordered but was not done.', '- CSF studies done.  Gram stain negative.  Cx Pending.  HSV pending.', '- C-Peptide, IGF pending', '- [**Last Name (un) 1398**] stim WNL', '- [**Location (un) 78**] BCx, UCx show NGTD', '- Switched from Tegretol to Keppra.  Loaded 1g IV and started on 500mg', 'IV BID as renal function may be changing.']","['- Neurology attempted LP, unsuccessful.', '- Went to IR, had LP.', '- Transfused total 2 units of platelets.  PLT at 9pm 68', '- Concern that patient may be having complex partial seizures - patient', 'had some lip smacking, responded to Ativan 0.5mg IV.', '- In light of seizure concern, patient was switched from Meropenem to', 'Doripenem.', '- Continuous EEG ordered but was not done.', '- CSF studies done.  Gram stain negative.  Cx Pending.  HSV pending.', '- C-Peptide, IGF pending', '- [**Last Name (un) 1398**] stim WNL', '- [**Location (un) 78**] BCx, UCx show NGTD', '- Switched from Tegretol to Keppra.  Loaded 1g IV and started on 500mg', 'IV BID as renal function may be changing.']","['Urinary catheter fell out and pt. began complaining of pain unable to', 'localize.', 'Neurology suggested LP, MRI']",73488,183302.0
3,2169-03-14 16:36:07,,"['- Neurology attempted LP, unsuccessful.', '- Went to IR, had LP.', '- Transfused total 2 units of platelets.  PLT at 9pm 68', '- Concern that patient may be having complex partial seizures - patient', 'had some lip smacking, responded to Ativan 0.5mg IV.', '- In light of seizure concern, patient was switched from Meropenem to', 'Doripenem.', '- Continuous EEG ordered but was not done.', '- CSF studies done.  Gram stain negative.  Cx Pending.  HSV pending.', '- C-Peptide, IGF pending', '- [**Last Name (un) 1398**] stim WNL', '- [**Location (un) 78**] BCx, UCx show NGTD', '- Switched from Tegretol to Keppra.  Loaded 1g IV and started on 500mg', 'IV BID as renal function may be changing.']",,73488,183302.0
4,2169-03-14 17:03:35,,"['- Neurology attempted LP, unsuccessful.', '- Went to IR, had LP.', '- Transfused total 2 units of platelets.  PLT at 9pm 68', '- Concern that patient may be having complex partial seizures - patient', 'had some lip smacking, responded to Ativan 0.5mg IV.', '- In light of seizure concern, patient was switched from Meropenem to', 'Doripenem.', '- Continuous EEG ordered but was not done.', '- CSF studies done.  Gram stain negative.  Cx Pending.  HSV pending.', '- C-Peptide, IGF pending', '- [**Last Name (un) 1398**] stim WNL', '- [**Location (un) 78**] BCx, UCx show NGTD', '- Switched from Tegretol to Keppra.  Loaded 1g IV and started on 500mg', 'IV BID as renal function may be changing.']",,73488,183302.0
5,2169-03-15 06:22:34,"['-hematology feels anemia & pancytopenia likely due to marrow', 'suppression secondary  to an infectious process superimposed on MDS.', 'If counts do not recover after tx infection a repeat BM bx would be', 'indicated.  (Meds: vancomycin, h2 blocker, statin can cause marrow', 'suppression)', '-cardiology recs continue ASA, BB, statin.  said even if ACS would', 'likely manage medically.', '-pt seen by ouch today and had baclofen pump interrogated, pt scheduled', 'for MRI in the AM.  at time he leaves for MRI ouch should be paged b/c', 'they need to interrogate the pump after', '-no new neuro recs??????????', '-HCT continue to be low got CT head, abd, pelvis', '-urine grew eneterococcus', '-normal echo', '-CT scan of head showed no sulci, ? edema but on old films, poor film', 'very limited from artifact', '-CT abd/pelvis no rp bleed, focus in low mid abd 3.7 by 3.6 by 6cm left', 'common iliac (bifurcation) could be blood.  has air in it- concerning', 'that it could be infected. looks like could hematoma.  Is high', 'density.  Extrensive calcification around hips bilaterally from prior', 'hemorrhage but no current hemorrhage there.']","['-hematology feels anemia & pancytopenia likely due to marrow', 'suppression secondary  to an infectious process superimposed on MDS.', 'If counts do not recover after tx infection a repeat BM bx would be', 'indicated.  (Meds: vancomycin, h2 blocker, statin can cause marrow', 'suppression)', '-cardiology recs continue ASA, BB, statin.  said even if ACS would', 'likely manage medically.', '-pt seen by ouch today and had baclofen pump interrogated, pt scheduled', 'for MRI in the AM.  at time he leaves for MRI ouch should be paged b/c', 'they need to interrogate the pump after', '-no new neuro recs??????????', '-HCT continue to be low got CT head, abd, pelvis', '-urine grew eneterococcus', '-normal echo', '-CT scan of head showed no sulci, ? edema but on old films, poor film', 'very limited from artifact', '-CT abd/pelvis no rp bleed, focus in low mid abd 3.7 by 3.6 by 6cm left', 'common iliac (bifurcation) could be blood.  has air in it- concerning', 'that it could be infected. looks like could hematoma.  Is high', 'density.  Extrensive calcification around hips bilaterally from prior', 'hemorrhage but no current hemorrhage there.']","['- Neurology attempted LP, unsuccessful.', '- Went to IR, had LP.', '- Transfused total 2 units of platelets.  PLT at 9pm 68', '- Concern that patient may be having complex partial seizures - patient', 'had some lip smacking, responded to Ativan 0.5mg IV.', '- In light of seizure concern, patient was switched from Meropenem to', 'Doripenem.', '- Continuous EEG ordered but was not done.', '- CSF studies done.  Gram stain negative.  Cx Pending.  HSV pending.', '- C-Peptide, IGF pending', '- [**Last Name (un) 1398**] stim WNL', '- [**Location (un) 78**] BCx, UCx show NGTD', '- Switched from Tegretol to Keppra.  Loaded 1g IV and started on 500mg', 'IV BID as renal function may be changing.']",73488,183302.0
6,2169-03-15 16:38:12,,"['-hematology feels anemia & pancytopenia likely due to marrow', 'suppression secondary  to an infectious process superimposed on MDS.', 'If counts do not recover after tx infection a repeat BM bx would be', 'indicated.  (Meds: vancomycin, h2 blocker, statin can cause marrow', 'suppression)', '-cardiology recs continue ASA, BB, statin.  said even if ACS would', 'likely manage medically.', '-pt seen by ouch today and had baclofen pump interrogated, pt scheduled', 'for MRI in the AM.  at time he leaves for MRI ouch should be paged b/c', 'they need to interrogate the pump after', '-HCT continue to be low got CT head, abd, pelvis', '-urine grew eneterococcus', '-normal echo', '-CT scan of head showed no sulci, ? edema but on old films, poor film', 'very limited from artifact', '-CT abd/pelvis no rp bleed, focus in low mid abd 3.7 by 3.6 by 6cm left', 'common iliac (bifurcation) could be blood.  has air in it- concerning', 'that it could be infected. looks like could hematoma.  Is high', 'density.  Extrensive calcification around hips bilaterally from prior', 'hemorrhage but no current hemorrhage there.']",['-no new neuro recs??????????'],73488,183302.0
7,2169-03-15 17:04:52,,"['-hematology feels anemia & pancytopenia likely due to marrow', 'suppression secondary  to an infectious process superimposed on MDS.', 'If counts do not recover after tx infection a repeat BM bx would be', 'indicated.  (Meds: vancomycin, h2 blocker, statin can cause marrow', 'suppression)', '-cardiology recs continue ASA, BB, statin.  said even if ACS would', 'likely manage medically.', '-pt seen by ouch today and had baclofen pump interrogated, pt scheduled', 'for MRI in the AM.  at time he leaves for MRI ouch should be paged b/c', 'they need to interrogate the pump after', '-HCT continue to be low got CT head, abd, pelvis', '-urine grew eneterococcus', '-normal echo', '-CT scan of head showed no sulci, ? edema but on old films, poor film', 'very limited from artifact', '-CT abd/pelvis no rp bleed, focus in low mid abd 3.7 by 3.6 by 6cm left', 'common iliac (bifurcation) could be blood.  has air in it- concerning', 'that it could be infected. looks like could hematoma.  Is high', 'density.  Extrensive calcification around hips bilaterally from prior', 'hemorrhage but no current hemorrhage there.']",,73488,183302.0
0,2129-07-06 07:37:58,,"['- BP low in am (60s). A line placed and started on levophed. Hct', 'checked and low (27->22) so transfused 1 unit. F/U hcts stable', '(28->28->27.5). (Attempted to wean pressor but then would have', 'pressures in low 60s so kept on levophed.', '- Hemolysis labs were negative', '- GI cls suggests tentative plan to EGD tomorrow. Would like o/p hcts', 'and BPs from PCP (Dr. [**Last Name (STitle) 6802**]', '- CXR FR said NGT in wrong place but did not have NGT. ?Wrong patient.', '- Lactate sent for ?ischemic bowel since hypotensive - was 0.5.']",,99894,127380.0
1,2129-07-06 22:55:38,['- Pt feels same today. C/o chronic rectal pain but no abdominal pain'],"['- BP low in am (60s). A line placed and started on levophed. Hct', 'checked and low (27->22) so transfused 1 unit. F/U hcts stable', '(28->28->27.5). (Attempted to wean pressor but then would have', 'pressures in low 60s so kept on levophed.', '- Hemolysis labs were negative', '- Lactate sent for ?ischemic bowel since hypotensive - was 0.5.', '- Pt feels same today. C/o chronic rectal pain but no abdominal pain']","['- GI cls suggests tentative plan to EGD tomorrow. Would like o/p hcts', 'and BPs from PCP (Dr. [**Last Name (STitle) 6802**]', '- CXR FR said NGT in wrong place but did not have NGT. ?Wrong patient.']",99894,127380.0
2,2129-07-07 05:45:32,"['- Noted to have bradycardic episodes to 40s in setting of hypotension', '- GI: EGD not done as Hct stable. Reviewed CT abd/pelvis with Rads;', 'thought transverse colon wall thickening more c/w ischemic rather than', 'infectious or inflammatory changes.', '- Neuro attg Dr. [**Last Name (STitle) **]: C/o weakness concerning for MS progression.', 'Autonomic dysfunction possible but usually positional. Concern for', 'infection as T>98 considered fever in MS pts.', '- Given persistence of BP drops, started on midodrine for possible', 'autonomic dysfunction as well as given 500cc bolus, NPO diet changed to', 'clears. Pt weaned off levophed.', '- Urine cx grew out enterococcus, GP bacteria.']","['- Noted to have bradycardic episodes to 40s in setting of hypotension', '- GI: EGD not done as Hct stable. Reviewed CT abd/pelvis with Rads;', 'thought transverse colon wall thickening more c/w ischemic rather than', 'infectious or inflammatory changes.', '- Neuro attg Dr. [**Last Name (STitle) **]: C/o weakness concerning for MS progression.', 'Autonomic dysfunction possible but usually positional. Concern for', 'infection as T>98 considered fever in MS pts.', '- Given persistence of BP drops, started on midodrine for possible', 'autonomic dysfunction as well as given 500cc bolus, NPO diet changed to', 'clears. Pt weaned off levophed.', '- Urine cx grew out enterococcus, GP bacteria.']","['- BP low in am (60s). A line placed and started on levophed. Hct', 'checked and low (27->22) so transfused 1 unit. F/U hcts stable', '(28->28->27.5). (Attempted to wean pressor but then would have', 'pressures in low 60s so kept on levophed.', '- Hemolysis labs were negative', '- Lactate sent for ?ischemic bowel since hypotensive - was 0.5.', '- Pt feels same today. C/o chronic rectal pain but no abdominal pain']",99894,127380.0
3,2129-07-07 09:18:36,,"['- Noted to have bradycardic episodes to 40s in setting of hypotension', '- GI: EGD not done as Hct stable. Reviewed CT abd/pelvis with Rads;', 'thought transverse colon wall thickening more c/w ischemic rather than', 'infectious or inflammatory changes.', '- Neuro attg Dr. [**Last Name (STitle) **]: C/o weakness concerning for MS progression.', 'Autonomic dysfunction possible but usually positional. Concern for', 'infection as T>98 considered fever in MS pts.', '- Given persistence of BP drops, started on midodrine for possible', 'autonomic dysfunction as well as given 500cc bolus, NPO diet changed to', 'clears. Pt weaned off levophed.', '- Urine cx grew out enterococcus, GP bacteria.']",,99894,127380.0
4,2129-07-08 07:48:28,"['- patient called back in for hypotension to 70s systolic.', '- Neurology consult called for ? MS contribution to hypotension, or', 'autonomic dysfunction.', '- Neurology questioned RCA ischemia.  Stopped midodrine.  Cardiac', 'markers were negative.', '- Anion gap improved with IV fluids and allowing her to eat.', '- Urine Cx with Enterococcus [**Last Name (un) 46**] to Ampicillin and strep viridans ->', 'transitioned to Ampicillin.']","['- patient called back in for hypotension to 70s systolic.', '- Neurology consult called for ? MS contribution to hypotension, or', 'autonomic dysfunction.', '- Neurology questioned RCA ischemia.  Stopped midodrine.  Cardiac', 'markers were negative.', '- Anion gap improved with IV fluids and allowing her to eat.', '- Urine Cx with Enterococcus [**Last Name (un) 46**] to Ampicillin and strep viridans ->', 'transitioned to Ampicillin.']","['- Noted to have bradycardic episodes to 40s in setting of hypotension', '- GI: EGD not done as Hct stable. Reviewed CT abd/pelvis with Rads;', 'thought transverse colon wall thickening more c/w ischemic rather than', 'infectious or inflammatory changes.', '- Neuro attg Dr. [**Last Name (STitle) **]: C/o weakness concerning for MS progression.', 'Autonomic dysfunction possible but usually positional. Concern for', 'infection as T>98 considered fever in MS pts.', '- Given persistence of BP drops, started on midodrine for possible', 'autonomic dysfunction as well as given 500cc bolus, NPO diet changed to', 'clears. Pt weaned off levophed.', '- Urine cx grew out enterococcus, GP bacteria.']",99894,127380.0
5,2129-07-08 12:33:04,,"['- patient called back in for hypotension to 70s systolic.', '- Neurology consult called for ? MS contribution to hypotension, or', 'autonomic dysfunction.', '- Neurology questioned RCA ischemia.  Stopped midodrine.  Cardiac', 'markers were negative.', '- Anion gap improved with IV fluids and allowing her to eat.', '- Urine Cx with Enterococcus [**Last Name (un) 46**] to Ampicillin and strep viridans ->', 'transitioned to Ampicillin.']",,99894,127380.0
6,2129-07-08 16:45:13,,"['- patient called back in for hypotension to 70s systolic.', '- Neurology consult called for ? MS contribution to hypotension, or', 'autonomic dysfunction.', '- Neurology questioned RCA ischemia.  Stopped midodrine.  Cardiac', 'markers were negative.', '- Anion gap improved with IV fluids and allowing her to eat.', '- Urine Cx with Enterococcus [**Last Name (un) 46**] to Ampicillin and strep viridans ->', 'transitioned to Ampicillin.']",,99894,127380.0
0,2150-05-04 10:51:56,,"['EKG - At [**2150-5-3**] 07:12 PM', '[**2150-5-3**]:', '-Continues with tachycardia overnight to 110s-120s.  Received home dose', 'dilt/metoprolol with minimal improvement. Received 40mg IV lasix due to', 'pulmonary edema.']",,6279,128899.0
1,2150-05-05 07:01:08,"['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improveme to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']","['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improveme to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']","['EKG - At [**2150-5-3**] 07:12 PM', '[**2150-5-3**]:', '-Continues with tachycardia overnight to 110s-120s.  Received home dose', 'dilt/metoprolol with minimal improvement. Received 40mg IV lasix due to', 'pulmonary edema.']",6279,128899.0
2,2150-05-05 07:29:21,,"['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improveme to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']",,6279,128899.0
3,2150-05-05 07:59:06,,"['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improveme to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']",,6279,128899.0
4,2150-05-05 10:38:32,['metoprolol x 2 and 5 mg IV dilt x 1 with minimal improvement to'],"['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improvement to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']",['metoprolol x 2 and 5 mg IV dilt x 1 with minimal improveme to'],6279,128899.0
5,2150-05-06 07:17:52,"['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']","['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']","['TRANS ESOPHAGEAL ECHO - At [**2150-5-4**] 11:08 AM', '- TTE: LVH, EF >55%, diastolic dysfunction, moderate pulmonary artery', 'HTN, no pericardial effusion.', '- BNP: 10,550', '- Tachycardic to 130s-140s around midnight; received 75 mg PO', 'metoprolol with minimal effect. Checked urine lytes given poor UOP and', 'appeared prerenal, so gave 500cc bolus NS. BPs were low earlier in day', 'to SBPs in 80s, but came up overnight to 100s. Patient remained', 'tachycardic (up to 150s) after bolus so additional 75 mg metoprolol PO', 'given.', '- Given RV dysfxn on TTE, added on cardiac enzymes to labs in case RV', 'hypokinesis is related to recent ischemic event', '- Despite prior interventions, RVR increased to 160s. Given 5 mg IV', 'metoprolol x 2 and 5 mg IV dilt x 1 with minimal improvement to', '130s-140s. Digoxin 0.25 mg IV given (per prior OMR records, this was', 'effective for rate control on previous admission for A-fib with RVR).']",6279,128899.0
6,2150-05-06 07:28:36,,"['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']",,6279,128899.0
7,2150-05-06 07:57:15,,"['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']",,6279,128899.0
8,2150-05-06 12:03:06,,"['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']",,6279,128899.0
9,2150-05-11 07:09:54,['MIDLINE - START [**2150-5-10**] 11:32 PM'],['MIDLINE - START [**2150-5-10**] 11:32 PM'],"['[**2150-5-5**]:', '- Improved control of heart rate (90-80s during the day, 60s overnight)', 'on current regimen of digoxin, metoprolol, and diltiazem.', '- Given lasix (10mg IV x1, 20mg IV x1) during day and then 20mg IV', 'overnight. Respiratory status improved from 95% high flow mask to 5L', 'nasal canula.', '- TTE: normal LV systolic function (EF >55%), the right ventricular', 'cavity is moderately dilated with mild global free wall hypokinesis,', 'there is abnormal septal motion/position consistent with right', 'ventricular pressure/volume overload. to moderate ([**1-24**]+) mitral', 'regurgitation is seen. The left ventricular inflow pattern suggests a', 'restrictive filling abnormality, with elevated left atrial pressure.', 'The tricuspid valve leaflets are mildly thickened. Moderate [2+]', 'tricuspid regurgitation is seen. There is moderate pulmonary artery', 'systolic hypertension. There is no pericardial effusion.']",6279,128899.0
10,2150-05-11 10:49:31,,['MIDLINE - START [**2150-5-10**] 11:32 PM'],,6279,128899.0
11,2150-05-12 06:49:03,"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)']","['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)']",['MIDLINE - START [**2150-5-10**] 11:32 PM'],6279,128899.0
12,2150-05-12 06:50:00,,"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)']",,6279,128899.0
13,2150-05-12 07:08:54,,"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)']",,6279,128899.0
14,2150-05-12 12:05:42,['- Speech/swallow recs pending'],"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)', '- Speech/swallow recs pending']",,6279,128899.0
15,2150-05-12 12:30:54,,"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)', '- Speech/swallow recs pending']",,6279,128899.0
16,2150-05-12 12:31:30,,"['- CT CHEST: pulmonary edema, RML pneumonia, left upper lung improved,', 'stable pleural effusions with left collapse unchanged.', '- During the day continued to sat in the low 90s on 4L, O/N put on', 'facemask as breathes through her mouth, continuing broad spectrum', 'antibiotics and diuresis with lasix boluses (~250cc/24hr)', '- Speech/swallow recs pending']",,6279,128899.0
0,2135-08-14 06:26:57,,"['- Post Cath Check without hematoma, bruit, or tenderness on palpation.', '2+ DP pulses bilaterally.', '- Lopressor held last pm secondary to low MAP.']",,46620,134031.0
1,2135-08-14 09:33:59,,"['- Post Cath Check without hematoma, bruit, or tenderness on palpation.', '2+ DP pulses bilaterally.', '- Lopressor held last pm secondary to low MAP.']",,46620,134031.0
2,2135-08-14 10:55:51,,"['- Post Cath Check without hematoma, bruit, or tenderness on palpation.', '2+ DP pulses bilaterally.', '- Lopressor held last pm secondary to low MAP.']",,46620,134031.0
0,2164-05-06 06:30:41,,"['[**2164-5-5**]', '- CXR 1V - No evidence of hemothorax or pneumothorax', '- TTE (to assess for pericardial effusion s/p pacer lead removal) -', 'mild symmetric LVH; severe resting LVOT obstruction (>64mmHg); 2+ MR.', '- Hct trend since CCU admission:  33.3 > 25.3 > 23.8 (transfused 2', 'units pRBCs) > 29.3', '- Taut left breast; no evidence of bleeding elsewhere, and patient is', 'hemodynamically stable', '- Per EP recs, also ordered 2V; if stable, call out to [**Hospital Ward Name 383**] 3 on', '[**2164-5-6**]; antibiotics 7 days; follow-up in one week in device clinic', '- Per EP, on interrogation, atrial tachycardia overnight [**2164-5-4**]', '- K 3.8 at midnight, KCl 20mEq PO x1 given']",,59402,171805.0
1,2164-05-06 11:12:04,"['- Per EP recs, also ordered 2 units pRBCs; if stable, call out to [**Hospital Ward Name 383**]', '3 on [**2164-5-6**]; antibiotics 7 days; follow-up in one week in device', 'clinic']","['[**2164-5-5**]', '- CXR 1V - No evidence of hemothorax or pneumothorax', '- TTE (to assess for pericardial effusion s/p pacer lead removal) -', 'mild symmetric LVH; severe resting LVOT obstruction (>64mmHg); 2+ MR.', '- Hct trend since CCU admission:  33.3 > 25.3 > 23.8 (transfused 2', 'units pRBCs) > 29.3', '- Taut left breast; no evidence of bleeding elsewhere, and patient is', 'hemodynamically stable', '- Per EP recs, also ordered 2 units pRBCs; if stable, call out to [**Hospital Ward Name 383**]', '3 on [**2164-5-6**]; antibiotics 7 days; follow-up in one week in device', 'clinic', '- Per EP, on interrogation, atrial tachycardia overnight [**2164-5-4**]', '- K 3.8 at midnight, KCl 20mEq PO x1 given']","['- Per EP recs, also ordered 2V; if stable, call out to [**Hospital Ward Name 383**] 3 on', '[**2164-5-6**]; antibiotics 7 days; follow-up in one week in device clinic']",59402,171805.0
2,2164-05-06 11:12:37,,"['[**2164-5-5**]', '- CXR 1V - No evidence of hemothorax or pneumothorax', '- TTE (to assess for pericardial effusion s/p pacer lead removal) -', 'mild symmetric LVH; severe resting LVOT obstruction (>64mmHg); 2+ MR.', '- Hct trend since CCU admission:  33.3 > 25.3 > 23.8 (transfused 2', 'units pRBCs) > 29.3', '- Taut left breast; no evidence of bleeding elsewhere, and patient is', 'hemodynamically stable', '- Per EP recs, also ordered 2 units pRBCs; if stable, call out to [**Hospital Ward Name 383**]', '3 on [**2164-5-6**]; antibiotics 7 days; follow-up in one week in device', 'clinic', '- Per EP, on interrogation, atrial tachycardia overnight [**2164-5-4**]', '- K 3.8 at midnight, KCl 20mEq PO x1 given']",,59402,171805.0
3,2164-05-06 14:31:57,,"['[**2164-5-5**]', '- CXR 1V - No evidence of hemothorax or pneumothorax', '- TTE (to assess for pericardial effusion s/p pacer lead removal) -', 'mild symmetric LVH; severe resting LVOT obstruction (>64mmHg); 2+ MR.', '- Hct trend since CCU admission:  33.3 > 25.3 > 23.8 (transfused 2', 'units pRBCs) > 29.3', '- Taut left breast; no evidence of bleeding elsewhere, and patient is', 'hemodynamically stable', '- Per EP recs, also ordered 2 units pRBCs; if stable, call out to [**Hospital Ward Name 383**]', '3 on [**2164-5-6**]; antibiotics 7 days; follow-up in one week in device', 'clinic', '- Per EP, on interrogation, atrial tachycardia overnight [**2164-5-4**]', '- K 3.8 at midnight, KCl 20mEq PO x1 given']",,59402,171805.0
0,2119-07-23 07:32:42,,"['DIALYSIS CATHETER - START [**2119-7-22**] 09:16 AM', ' EKG - At [**2119-7-22**] 10:30 AM', ' BLOOD CULTURED - At [**2119-7-22**] 12:00 PM', 'LSC HD line', '- sinus tachy: IVFx2 lt and oxycodone for joint pain x2 doses']",,6428,164632.0
1,2119-07-23 09:03:03,"['- Received Tylenol and Oxycodone overnight for HA', '- Continues to complain of headache this morning']","['DIALYSIS CATHETER - START [**2119-7-22**] 09:16 AM', ' EKG - At [**2119-7-22**] 10:30 AM', ' BLOOD CULTURED - At [**2119-7-22**] 12:00 PM', 'LSC HD line', '- sinus tachy: IVFx2 lt and oxycodone for joint pain x2 doses', '- Received Tylenol and Oxycodone overnight for HA', '- Continues to complain of headache this morning']",,6428,164632.0
2,2119-07-23 09:03:24,,"['DIALYSIS CATHETER - START [**2119-7-22**] 09:16 AM', ' EKG - At [**2119-7-22**] 10:30 AM', ' BLOOD CULTURED - At [**2119-7-22**] 12:00 PM', 'LSC HD line', '- sinus tachy: IVFx2 lt and oxycodone for joint pain x2 doses', '- Received Tylenol and Oxycodone overnight for HA', '- Continues to complain of headache this morning']",,6428,164632.0
3,2119-07-24 09:33:26,"['ULTRASOUND - At [**2119-7-23**] 03:58 PM', 'LUE', '- Blood cultures: NGTD', '- U/S Left arm showed thrombus in previously known location', '- Started Prednisone 20 mg daily and HISS', '- Plan to call Rheum C/S in am']","['ULTRASOUND - At [**2119-7-23**] 03:58 PM', 'LUE', '- Blood cultures: NGTD', '- U/S Left arm showed thrombus in previously known location', '- Started Prednisone 20 mg daily and HISS', '- Plan to call Rheum C/S in am']","['DIALYSIS CATHETER - START [**2119-7-22**] 09:16 AM', ' EKG - At [**2119-7-22**] 10:30 AM', ' BLOOD CULTURED - At [**2119-7-22**] 12:00 PM', 'LSC HD line', '- sinus tachy: IVFx2 lt and oxycodone for joint pain x2 doses', '- Received Tylenol and Oxycodone overnight for HA', '- Continues to complain of headache this morning']",6428,164632.0
4,2119-07-24 09:34:26,,"['ULTRASOUND - At [**2119-7-23**] 03:58 PM', 'LUE', '- Blood cultures: NGTD', '- U/S Left arm showed thrombus in previously known location', '- Started Prednisone 20 mg daily and HISS', '- Plan to call Rheum C/S in am']",,6428,164632.0
5,2119-07-24 12:29:48,"['- Patient received 1.5 L of IVFs yesterday afternoon.  She developed', 'increased shortness of breath and crackles on physical exam yesterday', 'afternoon.  She was given Morphine 1-2 mg IV prn for shortness of', 'breath']","['ULTRASOUND - At [**2119-7-23**] 03:58 PM', 'LUE', '- Blood cultures: NGTD', '- U/S Left arm showed thrombus in previously known location', '- Started Prednisone 20 mg daily and HISS', '- Plan to call Rheum C/S in am', '- Patient received 1.5 L of IVFs yesterday afternoon.  She developed', 'increased shortness of breath and crackles on physical exam yesterday', 'afternoon.  She was given Morphine 1-2 mg IV prn for shortness of', 'breath']",,6428,164632.0
6,2119-07-24 12:30:20,,"['ULTRASOUND - At [**2119-7-23**] 03:58 PM', 'LUE', '- Blood cultures: NGTD', '- U/S Left arm showed thrombus in previously known location', '- Started Prednisone 20 mg daily and HISS', '- Plan to call Rheum C/S in am', '- Patient received 1.5 L of IVFs yesterday afternoon.  She developed', 'increased shortness of breath and crackles on physical exam yesterday', 'afternoon.  She was given Morphine 1-2 mg IV prn for shortness of', 'breath']",,6428,164632.0
0,2122-01-16 07:24:53,,[],,90155,132055.0
1,2122-01-20 06:55:48,"['EKG - At [**2122-1-19**] 08:41 AM', ' SPUTUM CULTURE - At [**2122-1-19**] 04:26 PM', ' ARTERIAL LINE - START [**2122-1-19**] 05:00 PM', ' INVASIVE VENTILATION - START [**2122-1-19**] 05:56 PM', ' SPUTUM CULTURE - At [**2122-1-19**] 06:00 PM', ' FEVER - 101.8', 'F - [**2122-1-19**] 06:00 PM', '[**2122-1-19**]', '- Intubated/Sedated for airway protection, suctioning, ?bronchoscopy', '- L A-line placed', '- Hypernatremic, D5 1/2NS started']","['EKG - At [**2122-1-19**] 08:41 AM', ' SPUTUM CULTURE - At [**2122-1-19**] 04:26 PM', ' ARTERIAL LINE - START [**2122-1-19**] 05:00 PM', ' INVASIVE VENTILATION - START [**2122-1-19**] 05:56 PM', ' SPUTUM CULTURE - At [**2122-1-19**] 06:00 PM', ' FEVER - 101.8', 'F - [**2122-1-19**] 06:00 PM', '[**2122-1-19**]', '- Intubated/Sedated for airway protection, suctioning, ?bronchoscopy', '- L A-line placed', '- Hypernatremic, D5 1/2NS started']",,90155,132055.0
2,2122-01-20 06:57:10,,"['EKG - At [**2122-1-19**] 08:41 AM', ' SPUTUM CULTURE - At [**2122-1-19**] 04:26 PM', ' ARTERIAL LINE - START [**2122-1-19**] 05:00 PM', ' INVASIVE VENTILATION - START [**2122-1-19**] 05:56 PM', ' SPUTUM CULTURE - At [**2122-1-19**] 06:00 PM', ' FEVER - 101.8', 'F - [**2122-1-19**] 06:00 PM', '[**2122-1-19**]', '- Intubated/Sedated for airway protection, suctioning, ?bronchoscopy', '- L A-line placed', '- Hypernatremic, D5 1/2NS started']",,90155,132055.0
3,2122-01-20 14:09:07,,"['EKG - At [**2122-1-19**] 08:41 AM', ' SPUTUM CULTURE - At [**2122-1-19**] 04:26 PM', ' ARTERIAL LINE - START [**2122-1-19**] 05:00 PM', ' INVASIVE VENTILATION - START [**2122-1-19**] 05:56 PM', ' SPUTUM CULTURE - At [**2122-1-19**] 06:00 PM', ' FEVER - 101.8', 'F - [**2122-1-19**] 06:00 PM', '[**2122-1-19**]', '- Intubated/Sedated for airway protection, suctioning, ?bronchoscopy', '- L A-line placed', '- Hypernatremic, D5 1/2NS started']",,90155,132055.0
4,2122-01-21 07:08:38,"['TRANSTHORACIC ECHO - At [**2122-1-20**] 12:30 PM', ' EKG - At [**2122-1-20**] 01:00 PM', ' FEVER - 101.2', 'F - [**2122-1-21**] 05:00 AM', 'No acute events']","['TRANSTHORACIC ECHO - At [**2122-1-20**] 12:30 PM', ' EKG - At [**2122-1-20**] 01:00 PM', ' FEVER - 101.2', 'F - [**2122-1-21**] 05:00 AM', 'No acute events']","['EKG - At [**2122-1-19**] 08:41 AM', ' SPUTUM CULTURE - At [**2122-1-19**] 04:26 PM', ' ARTERIAL LINE - START [**2122-1-19**] 05:00 PM', ' INVASIVE VENTILATION - START [**2122-1-19**] 05:56 PM', ' SPUTUM CULTURE - At [**2122-1-19**] 06:00 PM', ' FEVER - 101.8', 'F - [**2122-1-19**] 06:00 PM', '[**2122-1-19**]', '- Intubated/Sedated for airway protection, suctioning, ?bronchoscopy', '- L A-line placed', '- Hypernatremic, D5 1/2NS started']",90155,132055.0
5,2122-01-21 07:09:55,,"['TRANSTHORACIC ECHO - At [**2122-1-20**] 12:30 PM', ' EKG - At [**2122-1-20**] 01:00 PM', ' FEVER - 101.2', 'F - [**2122-1-21**] 05:00 AM', 'No acute events']",,90155,132055.0
6,2122-01-21 13:46:55,,"['TRANSTHORACIC ECHO - At [**2122-1-20**] 12:30 PM', ' EKG - At [**2122-1-20**] 01:00 PM', ' FEVER - 101.2', 'F - [**2122-1-21**] 05:00 AM', 'No acute events']",,90155,132055.0
7,2122-01-22 07:50:47,"['PAN CULTURE - At [**2122-1-21**] 04:27 PM', ' FEVER - 102.5', 'F - [**2122-1-21**] 04:00 PM', '-Re intubated [**2-9**] hypoxia, using glidoscope had witnessed aspiration to', 'lungs', '-Required 2 L IVF to keep pressures up', '-Temp spike overnight, was cultured, abx already broad']","['PAN CULTURE - At [**2122-1-21**] 04:27 PM', ' FEVER - 102.5', 'F - [**2122-1-21**] 04:00 PM', '-Re intubated [**2-9**] hypoxia, using glidoscope had witnessed aspiration to', 'lungs', '-Required 2 L IVF to keep pressures up', '-Temp spike overnight, was cultured, abx already broad']","['TRANSTHORACIC ECHO - At [**2122-1-20**] 12:30 PM', ' EKG - At [**2122-1-20**] 01:00 PM', ' FEVER - 101.2', 'F - [**2122-1-21**] 05:00 AM', 'No acute events']",90155,132055.0
8,2122-01-22 07:53:30,,"['PAN CULTURE - At [**2122-1-21**] 04:27 PM', ' FEVER - 102.5', 'F - [**2122-1-21**] 04:00 PM', '-Re intubated [**2-9**] hypoxia, using glidoscope had witnessed aspiration to', 'lungs', '-Required 2 L IVF to keep pressures up', '-Temp spike overnight, was cultured, abx already broad']",,90155,132055.0
9,2122-01-22 15:53:32,"['Patient responds to commands but unable to verbalize despite lack of', 'sedation.']","['PAN CULTURE - At [**2122-1-21**] 04:27 PM', ' FEVER - 102.5', 'F - [**2122-1-21**] 04:00 PM', '-Re intubated [**2-9**] hypoxia, using glidoscope had witnessed aspiration to', 'lungs', '-Required 2 L IVF to keep pressures up', '-Temp spike overnight, was cultured, abx already broad', 'Patient responds to commands but unable to verbalize despite lack of', 'sedation.']",,90155,132055.0
10,2122-01-23 06:58:33,"['ARTERIAL LINE - STOP [**2122-1-22**] 02:00 PM', ' SPUTUM CULTURE - At [**2122-1-22**] 10:00 PM', ' BLOOD CULTURED - At [**2122-1-22**] 11:28 PM', ' URINE CULTURE - At [**2122-1-23**] 01:45 AM', ' FEVER - 101.9', 'F - [**2122-1-23**] 05:00 AM', '[**2122-1-22**]', '- Biting on tube during suctioning--> Afib with RVR--> Lopressor +', 'Sedation, resolved', '- Hiccups with tube feeds at 10.  Reposition doboff?']","['ARTERIAL LINE - STOP [**2122-1-22**] 02:00 PM', ' SPUTUM CULTURE - At [**2122-1-22**] 10:00 PM', ' BLOOD CULTURED - At [**2122-1-22**] 11:28 PM', ' URINE CULTURE - At [**2122-1-23**] 01:45 AM', ' FEVER - 101.9', 'F - [**2122-1-23**] 05:00 AM', '[**2122-1-22**]', '- Biting on tube during suctioning--> Afib with RVR--> Lopressor +', 'Sedation, resolved', '- Hiccups with tube feeds at 10.  Reposition doboff?']","['PAN CULTURE - At [**2122-1-21**] 04:27 PM', ' FEVER - 102.5', 'F - [**2122-1-21**] 04:00 PM', '-Re intubated [**2-9**] hypoxia, using glidoscope had witnessed aspiration to', 'lungs', '-Required 2 L IVF to keep pressures up', '-Temp spike overnight, was cultured, abx already broad', 'Patient responds to commands but unable to verbalize despite lack of', 'sedation.']",90155,132055.0
11,2122-01-23 06:59:25,,"['ARTERIAL LINE - STOP [**2122-1-22**] 02:00 PM', ' SPUTUM CULTURE - At [**2122-1-22**] 10:00 PM', ' BLOOD CULTURED - At [**2122-1-22**] 11:28 PM', ' URINE CULTURE - At [**2122-1-23**] 01:45 AM', ' FEVER - 101.9', 'F - [**2122-1-23**] 05:00 AM', '[**2122-1-22**]', '- Biting on tube during suctioning--> Afib with RVR--> Lopressor +', 'Sedation, resolved', '- Hiccups with tube feeds at 10.  Reposition doboff?']",,90155,132055.0
12,2122-01-23 13:33:51,"['The patient was less responsive this AM, not withdrawing to pain.']","['ARTERIAL LINE - STOP [**2122-1-22**] 02:00 PM', ' SPUTUM CULTURE - At [**2122-1-22**] 10:00 PM', ' BLOOD CULTURED - At [**2122-1-22**] 11:28 PM', ' URINE CULTURE - At [**2122-1-23**] 01:45 AM', ' FEVER - 101.9', 'F - [**2122-1-23**] 05:00 AM', '[**2122-1-22**]', '- Biting on tube during suctioning--> Afib with RVR--> Lopressor +', 'Sedation, resolved', '- Hiccups with tube feeds at 10.  Reposition doboff?', 'The patient was less responsive this AM, not withdrawing to pain.']",,90155,132055.0
13,2122-01-24 06:50:42,"[""- Discussed plan with patient's wife and son.  They would like to see"", 'how he does with the lasix drip over the next two days then reevaluate', 'on Sunday night.  If it does not appear that he is improving, they', 'would like to remove the mechanical ventilations.  Their goal would be', 'for him to go home with hospice care.  Confirmed with family to make', 'him DNR.', '- Put out good UOP with lasix', '- The patient has episodes of tachycardia up to the 160s overnight,', 'appeared to be sinus tachycardia.  Getting EKG this AM', ' FEVER - 102.4', 'F - [**2122-1-23**] 06:00 PM']","[""- Discussed plan with patient's wife and son.  They would like to see"", 'how he does with the lasix drip over the next two days then reevaluate', 'on Sunday night.  If it does not appear that he is improving, they', 'would like to remove the mechanical ventilations.  Their goal would be', 'for him to go home with hospice care.  Confirmed with family to make', 'him DNR.', '- Put out good UOP with lasix', '- The patient has episodes of tachycardia up to the 160s overnight,', 'appeared to be sinus tachycardia.  Getting EKG this AM', ' FEVER - 102.4', 'F - [**2122-1-23**] 06:00 PM']","['ARTERIAL LINE - STOP [**2122-1-22**] 02:00 PM', ' SPUTUM CULTURE - At [**2122-1-22**] 10:00 PM', ' BLOOD CULTURED - At [**2122-1-22**] 11:28 PM', ' URINE CULTURE - At [**2122-1-23**] 01:45 AM', ' FEVER - 101.9', 'F - [**2122-1-23**] 05:00 AM', '[**2122-1-22**]', '- Biting on tube during suctioning--> Afib with RVR--> Lopressor +', 'Sedation, resolved', '- Hiccups with tube feeds at 10.  Reposition doboff?', 'The patient was less responsive this AM, not withdrawing to pain.']",90155,132055.0
14,2122-01-24 06:52:25,,"[""- Discussed plan with patient's wife and son.  They would like to see"", 'how he does with the lasix drip over the next two days then reevaluate', 'on Sunday night.  If it does not appear that he is improving, they', 'would like to remove the mechanical ventilations.  Their goal would be', 'for him to go home with hospice care.  Confirmed with family to make', 'him DNR.', '- Put out good UOP with lasix', '- The patient has episodes of tachycardia up to the 160s overnight,', 'appeared to be sinus tachycardia.  Getting EKG this AM', ' FEVER - 102.4', 'F - [**2122-1-23**] 06:00 PM']",,90155,132055.0
15,2122-01-24 11:46:18,,"[""- Discussed plan with patient's wife and son.  They would like to see"", 'how he does with the lasix drip over the next two days then reevaluate', 'on Sunday night.  If it does not appear that he is improving, they', 'would like to remove the mechanical ventilations.  Their goal would be', 'for him to go home with hospice care.  Confirmed with family to make', 'him DNR.', '- Put out good UOP with lasix', '- The patient has episodes of tachycardia up to the 160s overnight,', 'appeared to be sinus tachycardia.  Getting EKG this AM', ' FEVER - 102.4', 'F - [**2122-1-23**] 06:00 PM']",,90155,132055.0
16,2122-01-25 06:20:20,"['-Restarted lasix drip-titrate to UOP of 125 cc/hour', '-5 mg IV test dose of metoprolol, tolerated well and started on 12.5', 'TID, remained rate controlled with good pressure overnight', '-unable to place PICC']","['-Restarted lasix drip-titrate to UOP of 125 cc/hour', '-5 mg IV test dose of metoprolol, tolerated well and started on 12.5', 'TID, remained rate controlled with good pressure overnight', '-unable to place PICC']","[""- Discussed plan with patient's wife and son.  They would like to see"", 'how he does with the lasix drip over the next two days then reevaluate', 'on Sunday night.  If it does not appear that he is improving, they', 'would like to remove the mechanical ventilations.  Their goal would be', 'for him to go home with hospice care.  Confirmed with family to make', 'him DNR.', '- Put out good UOP with lasix', '- The patient has episodes of tachycardia up to the 160s overnight,', 'appeared to be sinus tachycardia.  Getting EKG this AM', ' FEVER - 102.4', 'F - [**2122-1-23**] 06:00 PM']",90155,132055.0
17,2122-01-25 06:21:38,,"['-Restarted lasix drip-titrate to UOP of 125 cc/hour', '-5 mg IV test dose of metoprolol, tolerated well and started on 12.5', 'TID, remained rate controlled with good pressure overnight', '-unable to place PICC']",,90155,132055.0
18,2122-01-25 11:00:53,,"['-Restarted lasix drip-titrate to UOP of 125 cc/hour', '-5 mg IV test dose of metoprolol, tolerated well and started on 12.5', 'TID, remained rate controlled with good pressure overnight', '-unable to place PICC']",,90155,132055.0
19,2122-01-26 06:53:55,"['- Extubated', '- Dobhoff removed', '- CMO with lasix/morphine gtt', ' INVASIVE VENTILATION - STOP [**2122-1-25**] 03:16 PM']","['- Extubated', '- Dobhoff removed', '- CMO with lasix/morphine gtt', ' INVASIVE VENTILATION - STOP [**2122-1-25**] 03:16 PM']","['-Restarted lasix drip-titrate to UOP of 125 cc/hour', '-5 mg IV test dose of metoprolol, tolerated well and started on 12.5', 'TID, remained rate controlled with good pressure overnight', '-unable to place PICC']",90155,132055.0
20,2122-01-26 06:55:54,,"['- Extubated', '- Dobhoff removed', '- CMO with lasix/morphine gtt', ' INVASIVE VENTILATION - STOP [**2122-1-25**] 03:16 PM']",,90155,132055.0
21,2122-01-26 13:02:29,,"['- Extubated', '- Dobhoff removed', '- CMO with lasix/morphine gtt', ' INVASIVE VENTILATION - STOP [**2122-1-25**] 03:16 PM']",,90155,132055.0
0,2156-12-23 06:57:41,,[],,68589,152895.0
1,2156-12-23 09:18:34,,[],,68589,152895.0
2,2156-12-24 05:04:38,"['- Chest CT: f/u with radiologist who said that fluid collections were', 'too small to tap; no IR/VATS', '- TSH = 5.9', '- Ventilation: on pressure support overnight [**11-26**]/%50', '- EEG: diffuse generalized slowing, no focal deficits or sz activity.', '- Passed [**Last Name (un) 567**] stim test.', '- Attempted to balance diuresis with borderline BP.', '- Fluids: +3.5L', ' ULTRASOUND - At [**2156-12-23**] 01:30 PM', 'liver/gallbladder', ' ARTERIAL LINE - STOP [**2156-12-23**] 02:30 PM', ' ARTERIAL LINE - START [**2156-12-23**] 03:20 PM']","['- Chest CT: f/u with radiologist who said that fluid collections were', 'too small to tap; no IR/VATS', '- TSH = 5.9', '- Ventilation: on pressure support overnight [**11-26**]/%50', '- EEG: diffuse generalized slowing, no focal deficits or sz activity.', '- Passed [**Last Name (un) 567**] stim test.', '- Attempted to balance diuresis with borderline BP.', '- Fluids: +3.5L', ' ULTRASOUND - At [**2156-12-23**] 01:30 PM', 'liver/gallbladder', ' ARTERIAL LINE - STOP [**2156-12-23**] 02:30 PM', ' ARTERIAL LINE - START [**2156-12-23**] 03:20 PM']",,68589,152895.0
3,2156-12-24 05:06:16,,"['- Chest CT: f/u with radiologist who said that fluid collections were', 'too small to tap; no IR/VATS', '- TSH = 5.9', '- Ventilation: on pressure support overnight [**11-26**]/%50', '- EEG: diffuse generalized slowing, no focal deficits or sz activity.', '- Passed [**Last Name (un) 567**] stim test.', '- Attempted to balance diuresis with borderline BP.', '- Fluids: +3.5L', ' ULTRASOUND - At [**2156-12-23**] 01:30 PM', 'liver/gallbladder', ' ARTERIAL LINE - STOP [**2156-12-23**] 02:30 PM', ' ARTERIAL LINE - START [**2156-12-23**] 03:20 PM']",,68589,152895.0
4,2156-12-24 13:49:09,,"['- Chest CT: f/u with radiologist who said that fluid collections were', 'too small to tap; no IR/VATS', '- TSH = 5.9', '- Ventilation: on pressure support overnight [**11-26**]/%50', '- EEG: diffuse generalized slowing, no focal deficits or sz activity.', '- Passed [**Last Name (un) 567**] stim test.', '- Attempted to balance diuresis with borderline BP.', '- Fluids: +3.5L', ' ULTRASOUND - At [**2156-12-23**] 01:30 PM', 'liver/gallbladder', ' ARTERIAL LINE - STOP [**2156-12-23**] 02:30 PM', ' ARTERIAL LINE - START [**2156-12-23**] 03:20 PM']",,68589,152895.0
5,2156-12-24 14:20:07,,[],"['- Chest CT: f/u with radiologist who said that fluid collections were', 'too small to tap; no IR/VATS', '- TSH = 5.9', '- Ventilation: on pressure support overnight [**11-26**]/%50', '- EEG: diffuse generalized slowing, no focal deficits or sz activity.', '- Passed [**Last Name (un) 567**] stim test.', '- Attempted to balance diuresis with borderline BP.', '- Fluids: +3.5L', ' ULTRASOUND - At [**2156-12-23**] 01:30 PM', 'liver/gallbladder', ' ARTERIAL LINE - STOP [**2156-12-23**] 02:30 PM', ' ARTERIAL LINE - START [**2156-12-23**] 03:20 PM']",68589,152895.0
6,2156-12-25 05:11:42,"['- RUQ ultrasound wnl', '- Central venous sat 83%', '- Diuresis limited by BP', '- Linezolid for 21 day course', '- Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'clonipin TID', '- IP willing to place PEG tube next week']","['- RUQ ultrasound wnl', '- Central venous sat 83%', '- Diuresis limited by BP', '- Linezolid for 21 day course', '- Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'clonipin TID', '- IP willing to place PEG tube next week']",,68589,152895.0
7,2156-12-25 17:40:48,"['RUQ ultrasound wnl', 'Central venous sat 83%', 'Diuresis limited by BP but put on Lasix gtt', 'Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'IP contact[**Name (NI) **] and willing to place PEG tube next week']","['RUQ ultrasound wnl', 'Central venous sat 83%', 'Diuresis limited by BP but put on Lasix gtt', 'Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'clonipin TID', 'IP contact[**Name (NI) **] and willing to place PEG tube next week']","['- RUQ ultrasound wnl', '- Central venous sat 83%', '- Diuresis limited by BP', '- Linezolid for 21 day course', '- Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', '- IP willing to place PEG tube next week']",68589,152895.0
8,2156-12-25 19:47:32,,"['RUQ ultrasound wnl', 'Central venous sat 83%', 'Diuresis limited by BP but put on Lasix gtt', 'Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'clonipin TID', 'IP contact[**Name (NI) **] and willing to place PEG tube next week']",,68589,152895.0
9,2156-12-26 05:32:31,"['Clonazepam increased to 1mg PO TID', 'Lasix gtt yesterday, turned down for diureses -1.3L', 'Discussed with daughter PEG tube for [**Name (NI) 501**] (need to call IR [**Name (NI) 501**]', 'morning)']","['Clonazepam increased to 1mg PO TID', 'Lasix gtt yesterday, turned down for diureses -1.3L', 'Discussed with daughter PEG tube for [**Name (NI) 501**] (need to call IR [**Name (NI) 501**]', 'morning)']","['RUQ ultrasound wnl', 'Central venous sat 83%', 'Diuresis limited by BP but put on Lasix gtt', 'Zyprexa started, but not sufficient, & stopped; changed to 0.5 mg', 'clonipin TID', 'IP contact[**Name (NI) **] and willing to place PEG tube next week']",68589,152895.0
10,2156-12-26 18:41:19,"['Spoke with the IP team who suggested that the MICU resident page the on', 'call IR-MD to place PEG on [**Name (NI) 501**] morning.']","['Clonazepam increased to 1mg PO TID', 'Lasix gtt yesterday, turned down for diureses -1.3L', 'Discussed with daughter PEG tube for [**Name (NI) 501**] (need to call IR [**Name (NI) 501**]', 'morning)', 'Spoke with the IP team who suggested that the MICU resident page the on', 'call IR-MD to place PEG on [**Name (NI) 501**] morning.']",,68589,152895.0
11,2156-12-27 05:26:03,"['- CT head ordered for today per neursurgery recs.', ""- D/C'd TF at midnight for possible PEG placement: need to ensure that"", 'proper consent has been obtained.  Will need to page IR for placement', 'in the morning.', '- LFTs cont. to trend downward.', '- Lipase = 833.  Propofol subsequently discontinued, and pt placed on', 'versed instead.  Tolerated change well.', '- Diuresis goals not met because of hypotension.', ' SPUTUM CULTURE - At [**2156-12-26**] 03:10 PM']","['- CT head ordered for today per neursurgery recs.', ""- D/C'd TF at midnight for possible PEG placement: need to ensure that"", 'proper consent has been obtained.  Will need to page IR for placement', 'in the morning.', '- LFTs cont. to trend downward.', '- Lipase = 833.  Propofol subsequently discontinued, and pt placed on', 'versed instead.  Tolerated change well.', '- Diuresis goals not met because of hypotension.', ' SPUTUM CULTURE - At [**2156-12-26**] 03:10 PM']","['Clonazepam increased to 1mg PO TID', 'Lasix gtt yesterday, turned down for diureses -1.3L', 'Discussed with daughter PEG tube for [**Name (NI) 501**] (need to call IR [**Name (NI) 501**]', 'morning)', 'Spoke with the IP team who suggested that the MICU resident page the on', 'call IR-MD to place PEG on [**Name (NI) 501**] morning.']",68589,152895.0
12,2156-12-27 05:27:12,,"['- CT head ordered for today per neursurgery recs.', ""- D/C'd TF at midnight for possible PEG placement: need to ensure that"", 'proper consent has been obtained.  Will need to page IR for placement', 'in the morning.', '- LFTs cont. to trend downward.', '- Lipase = 833.  Propofol subsequently discontinued, and pt placed on', 'versed instead.  Tolerated change well.', '- Diuresis goals not met because of hypotension.', ' SPUTUM CULTURE - At [**2156-12-26**] 03:10 PM']",,68589,152895.0
13,2156-12-27 16:58:44,"['- TG = 833.  Propofol subsequently discontinued, and pt placed on', 'proper consent has been obtained.  IP to place in AM', '- Climbing WBC.']","['- CT head ordered for today per neursurgery recs.', '- TG = 833.  Propofol subsequently discontinued, and pt placed on', 'versed instead.  Tolerated change well.', ""- D/C'd TF at midnight for possible PEG placement: need to ensure that"", 'proper consent has been obtained.  IP to place in AM', '- LFTs cont. to trend downward.', '- Diuresis goals not met because of hypotension.', '- Climbing WBC.', ' SPUTUM CULTURE - At [**2156-12-26**] 03:10 PM']","['proper consent has been obtained.  Will need to page IR for placement', 'in the morning.', '- Lipase = 833.  Propofol subsequently discontinued, and pt placed on']",68589,152895.0
14,2156-12-28 06:28:17,"['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', '-Head CT - no significant change', '-IP will not place PEG, contact another service', '-Updated daughter via telephone', '-Unsuccessful R subclavian line attempt', '-R lung effusion considered too small to tap', '-Diamox 250 [**Hospital1 **] x 2 days + KCl', '-Neuro recs: slow versed taper (over days) and increase standing', 'antipsychotics']","['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', '-Head CT - no significant change', '-IP will not place PEG, contact another service', '-Updated daughter via telephone', '-Unsuccessful R subclavian line attempt', '-R lung effusion considered too small to tap', '-Diamox 250 [**Hospital1 **] x 2 days + KCl', '-Neuro recs: slow versed taper (over days) and increase standing', 'antipsychotics']","['- CT head ordered for today per neursurgery recs.', '- TG = 833.  Propofol subsequently discontinued, and pt placed on', 'versed instead.  Tolerated change well.', ""- D/C'd TF at midnight for possible PEG placement: need to ensure that"", 'proper consent has been obtained.  IP to place in AM', '- LFTs cont. to trend downward.', '- Diuresis goals not met because of hypotension.', '- Climbing WBC.', ' SPUTUM CULTURE - At [**2156-12-26**] 03:10 PM']",68589,152895.0
15,2156-12-28 17:02:49,"['Head CT - no significant change', 'IP consulted for PEG tube placement and would not do procedure', 'Unsuccessful R subclavian line attempted', 'R lung effusion considered too small to tap', 'Diamox 250 [**Hospital1 **] x 2 days + KCl']","['Head CT - no significant change', 'IP consulted for PEG tube placement and would not do procedure', 'Unsuccessful R subclavian line attempted', 'R lung effusion considered too small to tap', 'Diamox 250 [**Hospital1 **] x 2 days + KCl']","['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', '-Head CT - no significant change', '-IP will not place PEG, contact another service', '-Updated daughter via telephone', '-Unsuccessful R subclavian line attempt', '-R lung effusion considered too small to tap', '-Diamox 250 [**Hospital1 **] x 2 days + KCl', '-Neuro recs: slow versed taper (over days) and increase standing', 'antipsychotics']",68589,152895.0
16,2156-12-29 03:40:00,"['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', 'LENIs - showed no DVTs', 'Abx broadened to Linezolid/Levo/Flagyl given persistent fevers', 'New subclavian line inserted and old line pulled', 'Lasix gtt for diuresis']","['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', 'LENIs - showed no DVTs', 'Abx broadened to Linezolid/Levo/Flagyl given persistent fevers', 'New subclavian line inserted and old line pulled', 'Lasix gtt for diuresis']","['Head CT - no significant change', 'IP consulted for PEG tube placement and would not do procedure', 'Unsuccessful R subclavian line attempted', 'R lung effusion considered too small to tap', 'Diamox 250 [**Hospital1 **] x 2 days + KCl']",68589,152895.0
17,2156-12-29 12:16:19,['Lasix gtt for diuresis with -1 as of this morning.'],"['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', 'LENIs - showed no DVTs', 'Abx broadened to Linezolid/Levo/Flagyl given persistent fevers', 'New subclavian line inserted and old line pulled', 'Lasix gtt for diuresis with -1 as of this morning.']",['Lasix gtt for diuresis'],68589,152895.0
18,2156-12-30 05:23:44,"['* d/c levoquin', '* start meropenem', '* diuresed 1700cc', '* A-line d/c b/c of erythema', ""* 3 episodes of hypotension (MAP's always above 60) -> gave 3x 250cc"", 'NS boluses, d/c lasix drip', ""* tachycardic to 120's, improved w/lopressor"", '* repleted Ca', '* Diuresis: -900cc (did not meet goal)', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']","['* d/c levoquin', '* start meropenem', '* diuresed 1700cc', '* A-line d/c b/c of erythema', ""* 3 episodes of hypotension (MAP's always above 60) -> gave 3x 250cc"", 'NS boluses, d/c lasix drip', ""* tachycardic to 120's, improved w/lopressor"", '* repleted Ca', '* Diuresis: -900cc (did not meet goal)', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']","['ULTRASOUND - At [**2156-12-27**] 04:58 PM', 'At bedside by MICU', 'LENIs - showed no DVTs', 'Abx broadened to Linezolid/Levo/Flagyl given persistent fevers', 'New subclavian line inserted and old line pulled', 'Lasix gtt for diuresis with -1 as of this morning.']",68589,152895.0
19,2156-12-30 05:24:29,,"['* d/c levoquin', '* start meropenem', '* diuresed 1700cc', '* A-line d/c b/c of erythema', ""* 3 episodes of hypotension (MAP's always above 60) -> gave 3x 250cc"", 'NS boluses, d/c lasix drip', ""* tachycardic to 120's, improved w/lopressor"", '* repleted Ca', '* Diuresis: -900cc (did not meet goal)', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']",,68589,152895.0
20,2156-12-30 05:25:18,,"['* d/c levoquin', '* start meropenem', '* diuresed 1700cc', '* A-line d/c b/c of erythema', ""* 3 episodes of hypotension (MAP's always above 60) -> gave 3x 250cc"", 'NS boluses, d/c lasix drip', ""* tachycardic to 120's, improved w/lopressor"", '* repleted Ca', '* Diuresis: -900cc (did not meet goal)', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']",,68589,152895.0
21,2156-12-30 14:35:38,"['* Levaquin changed to Meropenem', ""* 3 episodes of hypotension overnight (MAP's always above 60) -> gave"", '3x 250cc NS boluses, d/c lasix drip; urine output continues to be', 'adequate', '* A-line pulled due to bleeding']","['* Levaquin changed to Meropenem', ""* 3 episodes of hypotension overnight (MAP's always above 60) -> gave"", '3x 250cc NS boluses, d/c lasix drip; urine output continues to be', 'adequate', '* A-line pulled due to bleeding', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']","['* d/c levoquin', '* start meropenem', '* diuresed 1700cc', '* A-line d/c b/c of erythema', ""* 3 episodes of hypotension (MAP's always above 60) -> gave 3x 250cc"", 'NS boluses, d/c lasix drip', ""* tachycardic to 120's, improved w/lopressor"", '* repleted Ca', '* Diuresis: -900cc (did not meet goal)']",68589,152895.0
22,2156-12-31 05:54:25,"['-Lasix drip turned up', '-d/c NGT, OG tube below diaphragm on CXR', '-wean midazolam by 1/d', 'BP goal MAP >60 uo 30cc/hour', '-Nasal saline, pseudoephedrine, Afrin', '-C. diff positive']","['-Lasix drip turned up', '-d/c NGT, OG tube below diaphragm on CXR', '-wean midazolam by 1/d', 'BP goal MAP >60 uo 30cc/hour', '-Nasal saline, pseudoephedrine, Afrin', '-C. diff positive']","['* Levaquin changed to Meropenem', ""* 3 episodes of hypotension overnight (MAP's always above 60) -> gave"", '3x 250cc NS boluses, d/c lasix drip; urine output continues to be', 'adequate', '* A-line pulled due to bleeding', ' ARTERIAL LINE - STOP [**2156-12-29**] 03:33 PM', ' EKG - At [**2156-12-29**] 09:00 PM', ' STOOL CULTURE - At [**2156-12-30**] 02:00 AM', 'CDIFF', ' BLOOD CULTURED - At [**2156-12-30**] 03:00 AM', 'x1 from central line with am labs']",68589,152895.0
23,2157-01-01 00:31:58,['C. Diff resulted as positive.'],['C. Diff resulted as positive.'],"['-Lasix drip turned up', '-d/c NGT, OG tube below diaphragm on CXR', '-wean midazolam by 1/d', 'BP goal MAP >60 uo 30cc/hour', '-Nasal saline, pseudoephedrine, Afrin', '-C. diff positive']",68589,152895.0
24,2157-01-01 05:52:05,"['Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.']","['Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.']",['C. Diff resulted as positive.'],68589,152895.0
25,2157-01-01 05:53:04,['Received 2mg Lorazepam for worsened agitation.'],"['Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.', 'Received 2mg Lorazepam for worsened agitation.']",,68589,152895.0
26,2157-01-01 05:53:23,['Received 2mg Lorazepam for agitation.'],"['Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.', 'Received 2mg Lorazepam for agitation.']",['Received 2mg Lorazepam for worsened agitation.'],68589,152895.0
27,2157-01-01 20:52:48,"['-Desaturated to the high 80s after positioning, got ABG and CXR which', '-Received 2mg po Lorazepam for agitation.']","['-Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.', '-Received 2mg po Lorazepam for agitation.']","['Desaturated to the high 80s after positioning, got ABG and CXR which', 'Received 2mg Lorazepam for agitation.']",68589,152895.0
28,2157-01-01 21:09:24,,"['-Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.', '-Received 2mg po Lorazepam for agitation.']",,68589,152895.0
29,2157-01-02 06:39:30,"[""* patient w/tachycardia - up to rate of 150's - looked like NSVT."", 'checked ekg, was unchanged.', '* stable overnight, weaning vent settings and sedation']","[""* patient w/tachycardia - up to rate of 150's - looked like NSVT."", 'checked ekg, was unchanged.', '* stable overnight, weaning vent settings and sedation']","['-Desaturated to the high 80s after positioning, got ABG and CXR which', 'looked okay, replaced O2 probe and sat pt more upright and improved.', '-Received 2mg po Lorazepam for agitation.']",68589,152895.0
30,2157-01-02 06:40:46,,"[""* patient w/tachycardia - up to rate of 150's - looked like NSVT."", 'checked ekg, was unchanged.', '* stable overnight, weaning vent settings and sedation']",,68589,152895.0
31,2157-01-02 17:24:46,,"[""* patient w/tachycardia - up to rate of 150's - looked like NSVT."", 'checked ekg, was unchanged.', '* stable overnight, weaning vent settings and sedation']",,68589,152895.0
32,2157-01-03 06:06:23,"['SPUTUM CULTURE - At [**2157-1-3**] 03:06 AM', '- Weaned to pressure support', '- seroquel increased to 75 mg TID for agitation', '- Goal diuresis -500 cc', '- updated family', '- To be done - check with surgery re: PEG', '- pulled up OGT with tongue so NGT placed', '- hematuria, UA & culture sent']","['SPUTUM CULTURE - At [**2157-1-3**] 03:06 AM', '- Weaned to pressure support', '- seroquel increased to 75 mg TID for agitation', '- Goal diuresis -500 cc', '- updated family', '- To be done - check with surgery re: PEG', '- pulled up OGT with tongue so NGT placed', '- hematuria, UA & culture sent']","[""* patient w/tachycardia - up to rate of 150's - looked like NSVT."", 'checked ekg, was unchanged.', '* stable overnight, weaning vent settings and sedation']",68589,152895.0
33,2157-01-03 13:40:59,"['Pt able to be weaned to pressure support', 'Seroquel increased to 75 mg TID for agitation', 'Pt pulled up OGT with tongue so NGT placed', 'Pt had hematuria, UA & culture sent']","['SPUTUM CULTURE - At [**2157-1-3**] 03:06 AM', 'Pt able to be weaned to pressure support', 'Seroquel increased to 75 mg TID for agitation', 'Pt pulled up OGT with tongue so NGT placed', 'Pt had hematuria, UA & culture sent']","['- Weaned to pressure support', '- seroquel increased to 75 mg TID for agitation', '- Goal diuresis -500 cc', '- updated family', '- To be done - check with surgery re: PEG', '- pulled up OGT with tongue so NGT placed', '- hematuria, UA & culture sent']",68589,152895.0
34,2157-01-04 06:02:32,"['EKG - At [**2157-1-3**] 09:00 PM', 'Psych consulted - recommended starting Haldol with Ativan taper, d/c', 'Seroquel, Clonazepam, Versed', 'Episode of desaturation at 9pm after sliding down bed and obstructing', 'trach mask, put on vent after this with gas unchanged Agitated all', 'night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at 1am', 'At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X 2', 'Head CT negative (f/u final read)', 'F/U ECG this morning', 'NPO p midnight for PEG today']","['EKG - At [**2157-1-3**] 09:00 PM', 'Psych consulted - recommended starting Haldol with Ativan taper, d/c', 'Seroquel, Clonazepam, Versed', 'Episode of desaturation at 9pm after sliding down bed and obstructing', 'trach mask, put on vent after this with gas unchanged Agitated all', 'night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at 1am', 'At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X 2', 'Head CT negative (f/u final read)', 'F/U ECG this morning', 'NPO p midnight for PEG today']","['SPUTUM CULTURE - At [**2157-1-3**] 03:06 AM', 'Pt able to be weaned to pressure support', 'Seroquel increased to 75 mg TID for agitation', 'Pt pulled up OGT with tongue so NGT placed', 'Pt had hematuria, UA & culture sent']",68589,152895.0
35,2157-01-04 13:05:11,"['* EKG - At [**2157-1-3**] 09:00 PM', ' S1Q3T3, sinus tachycardia, QTc WNL.', '* Psych consulted - recommended starting d/c Seroquel, Clonazepam,', 'Versed and give Haldol with Ativan taper', '* Episode of desaturation at 9pm after sliding down bed and', 'obstructing trach mask, put on vent after this with gas unchanged', '* Agitated all night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at', '1am.  At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X', '2.  At 8am, agitated again, got Haldol 5mg and Ativan 2mg.', '* Head CT negative', '* NPO p midnight for PEG today']","['* EKG - At [**2157-1-3**] 09:00 PM', ' S1Q3T3, sinus tachycardia, QTc WNL.', '* Psych consulted - recommended starting d/c Seroquel, Clonazepam,', 'Versed and give Haldol with Ativan taper', '* Episode of desaturation at 9pm after sliding down bed and', 'obstructing trach mask, put on vent after this with gas unchanged', '* Agitated all night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at', '1am.  At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X', '2.  At 8am, agitated again, got Haldol 5mg and Ativan 2mg.', '* Head CT negative', '* NPO p midnight for PEG today']","['EKG - At [**2157-1-3**] 09:00 PM', 'Psych consulted - recommended starting Haldol with Ativan taper, d/c', 'Seroquel, Clonazepam, Versed', 'Episode of desaturation at 9pm after sliding down bed and obstructing', 'trach mask, put on vent after this with gas unchanged Agitated all', 'night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at 1am', 'At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X 2', 'Head CT negative (f/u final read)', 'F/U ECG this morning', 'NPO p midnight for PEG today']",68589,152895.0
36,2157-01-04 13:06:48,,"['* EKG - At [**2157-1-3**] 09:00 PM', ' S1Q3T3, sinus tachycardia, QTc WNL.', '* Psych consulted - recommended starting d/c Seroquel, Clonazepam,', 'Versed and give Haldol with Ativan taper', '* Episode of desaturation at 9pm after sliding down bed and', 'obstructing trach mask, put on vent after this with gas unchanged', '* Agitated all night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at', '1am.  At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X', '2.  At 8am, agitated again, got Haldol 5mg and Ativan 2mg.', '* Head CT negative', '* NPO p midnight for PEG today']",,68589,152895.0
37,2157-01-04 14:13:41,,"['* EKG - At [**2157-1-3**] 09:00 PM', ' S1Q3T3, sinus tachycardia, QTc WNL.', '* Psych consulted - recommended starting d/c Seroquel, Clonazepam,', 'Versed and give Haldol with Ativan taper', '* Episode of desaturation at 9pm after sliding down bed and', 'obstructing trach mask, put on vent after this with gas unchanged', '* Agitated all night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at', '1am.  At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X', '2.  At 8am, agitated again, got Haldol 5mg and Ativan 2mg.', '* Head CT negative', '* NPO p midnight for PEG today']",,68589,152895.0
38,2157-01-05 06:46:31,"['EKG - At [**2157-1-5**] 12:07 AM', ' SPUTUM CULTURE - At [**2157-1-5**] 01:35 AM', ""* tachycardic to 140's to 150's -> EKG showed sinus tachycardia ->"", 'gave all PRNs w/out improvement -> then gave 1x 25mg Metoprolol PO,', '1mg Ativan', '* CTA: negative for PE', '* LENI: neg for DVT', '* fentanyl NOT weaned yesterday/overnight (b/c of agiation? should', 'clarify w/nurses)', '* Needs discussion with case management RE rehab (probably does not', 'need [**Hospital 2733**] rehab)']","['EKG - At [**2157-1-5**] 12:07 AM', ' SPUTUM CULTURE - At [**2157-1-5**] 01:35 AM', ""* tachycardic to 140's to 150's -> EKG showed sinus tachycardia ->"", 'gave all PRNs w/out improvement -> then gave 1x 25mg Metoprolol PO,', '1mg Ativan', '* CTA: negative for PE', '* LENI: neg for DVT', '* fentanyl NOT weaned yesterday/overnight (b/c of agiation? should', 'clarify w/nurses)', '* Needs discussion with case management RE rehab (probably does not', 'need [**Hospital 2733**] rehab)']","['* EKG - At [**2157-1-3**] 09:00 PM', ' S1Q3T3, sinus tachycardia, QTc WNL.', '* Psych consulted - recommended starting d/c Seroquel, Clonazepam,', 'Versed and give Haldol with Ativan taper', '* Episode of desaturation at 9pm after sliding down bed and', 'obstructing trach mask, put on vent after this with gas unchanged', '* Agitated all night; got Haldol 5mg X 2, then Ativan 1mg, 2mg at', '1am.  At 5am, agitated again, got Haldol 5mg X 1, then Ativan 1mg X', '2.  At 8am, agitated again, got Haldol 5mg and Ativan 2mg.', '* Head CT negative', '* NPO p midnight for PEG today']",68589,152895.0
39,2157-01-05 15:47:57,"['* Patient continues to be tachycardic in the 140s-150s.  ECG shows', 'sinus tachycardia.  Not affected by Metoprolol or Ativan.', '* fentanyl weaned at 80mcg/hour currently']","['EKG - At [**2157-1-5**] 12:07 AM', ' SPUTUM CULTURE - At [**2157-1-5**] 01:35 AM', '* Patient continues to be tachycardic in the 140s-150s.  ECG shows', 'sinus tachycardia.  Not affected by Metoprolol or Ativan.', '* CTA: negative for PE', '* LENI: neg for DVT', '* fentanyl weaned at 80mcg/hour currently']","[""* tachycardic to 140's to 150's -> EKG showed sinus tachycardia ->"", 'gave all PRNs w/out improvement -> then gave 1x 25mg Metoprolol PO,', '1mg Ativan', '* fentanyl NOT weaned yesterday/overnight (b/c of agiation? should', 'clarify w/nurses)', '* Needs discussion with case management RE rehab (probably does not', 'need [**Hospital 2733**] rehab)']",68589,152895.0
40,2157-01-06 05:27:40,"['EKG - At [**2157-1-5**] 10:00 AM', ' TRANSTHORACIC ECHO - At [**2157-1-5**] 02:17 PM', ' INVASIVE VENTILATION - START [**2157-1-5**] 03:00 PM', 'placed back on vent for PEG', ' PEG INSERTION - At [**2157-1-5**] 03:04 PM', ' INVASIVE VENTILATION - STOP [**2157-1-5**] 10:42 PM', 'placed back on vent for PEG', '- [**1-5**] EKG ok', '- ECHO wnl', '- Abx through [**1-12**]', '- meropenem dose increased per pharmacy', '- PEG placed', '- PICC today?', '- need to update case management']","['EKG - At [**2157-1-5**] 10:00 AM', ' TRANSTHORACIC ECHO - At [**2157-1-5**] 02:17 PM', ' INVASIVE VENTILATION - START [**2157-1-5**] 03:00 PM', 'placed back on vent for PEG', ' PEG INSERTION - At [**2157-1-5**] 03:04 PM', ' INVASIVE VENTILATION - STOP [**2157-1-5**] 10:42 PM', 'placed back on vent for PEG', '- [**1-5**] EKG ok', '- ECHO wnl', '- Abx through [**1-12**]', '- meropenem dose increased per pharmacy', '- PEG placed', '- PICC today?', '- need to update case management']","['EKG - At [**2157-1-5**] 12:07 AM', ' SPUTUM CULTURE - At [**2157-1-5**] 01:35 AM', '* Patient continues to be tachycardic in the 140s-150s.  ECG shows', 'sinus tachycardia.  Not affected by Metoprolol or Ativan.', '* CTA: negative for PE', '* LENI: neg for DVT', '* fentanyl weaned at 80mcg/hour currently']",68589,152895.0
41,2157-01-06 16:42:17,"['- TTE normal', '- stopped metoprolol, started Diltiazem 60 Q6h', '- for PICC today?']","['- [**1-5**] EKG ok', '- TTE normal', '- meropenem dose increased per pharmacy', '- PEG placed', '- stopped metoprolol, started Diltiazem 60 Q6h', '- for PICC today?', '- need to update case management', '- Abx through [**1-12**]']","['EKG - At [**2157-1-5**] 10:00 AM', ' TRANSTHORACIC ECHO - At [**2157-1-5**] 02:17 PM', ' INVASIVE VENTILATION - START [**2157-1-5**] 03:00 PM', 'placed back on vent for PEG', ' PEG INSERTION - At [**2157-1-5**] 03:04 PM', ' INVASIVE VENTILATION - STOP [**2157-1-5**] 10:42 PM', 'placed back on vent for PEG', '- ECHO wnl', '- PICC today?']",68589,152895.0
42,2157-01-07 06:01:47,"['PICC LINE - START [**2157-1-6**] 01:01 PM', 'left basilic vein', ' EKG - At [**2157-1-6**] 02:12 PM', ""sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", ' MULTI LUMEN - STOP [**2157-1-7**] 12:00 AM', 'PMV in place', 'Cardiology consulted, recommended b-blockade, CCB so Metoprolol added,', 'good response during the night', 'Free air seen on Xray, surgery consulted, recommended repeat in AM', 'PICC line placed, central line removed', 'Valium being tapered with 10mg PO TID yesterday', '(follow-up', ' speech and swallow eval?, PT?)']","['PICC LINE - START [**2157-1-6**] 01:01 PM', 'left basilic vein', ' EKG - At [**2157-1-6**] 02:12 PM', ""sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", ' MULTI LUMEN - STOP [**2157-1-7**] 12:00 AM', 'PMV in place', 'Cardiology consulted, recommended b-blockade, CCB so Metoprolol added,', 'good response during the night', 'Free air seen on Xray, surgery consulted, recommended repeat in AM', 'PICC line placed, central line removed', 'Valium being tapered with 10mg PO TID yesterday', '(follow-up', ' speech and swallow eval?, PT?)']","['- [**1-5**] EKG ok', '- TTE normal', '- meropenem dose increased per pharmacy', '- PEG placed', '- stopped metoprolol, started Diltiazem 60 Q6h', '- for PICC today?', '- need to update case management', '- Abx through [**1-12**]']",68589,152895.0
43,2157-01-07 16:16:57,"[""- EKG: sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", 'Cardiology consulted, recommended b-blockade with CCB and BB together', '-  good response during the night', '- PMV used w/out significant desaturation', '- PICC line placed in the left basilic vein, central line removed', '- Free air seen on Xray for picc placement, surgery consulted and said', 'it was OK w/bedside peg, examined patient and recommended repeat in AM', '- Valium being tapered with 10mg PO TID yesterday']","[""- EKG: sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", 'Cardiology consulted, recommended b-blockade with CCB and BB together', '-  good response during the night', '- PMV used w/out significant desaturation', '- PICC line placed in the left basilic vein, central line removed', '- Free air seen on Xray for picc placement, surgery consulted and said', 'it was OK w/bedside peg, examined patient and recommended repeat in AM', '- Valium being tapered with 10mg PO TID yesterday']","['PICC LINE - START [**2157-1-6**] 01:01 PM', 'left basilic vein', ' EKG - At [**2157-1-6**] 02:12 PM', ""sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", ' MULTI LUMEN - STOP [**2157-1-7**] 12:00 AM', 'PMV in place', 'Cardiology consulted, recommended b-blockade, CCB so Metoprolol added,', 'good response during the night', 'Free air seen on Xray, surgery consulted, recommended repeat in AM', 'PICC line placed, central line removed', 'Valium being tapered with 10mg PO TID yesterday', '(follow-up', ' speech and swallow eval?, PT?)']",68589,152895.0
44,2157-01-08 05:56:36,"['EKG - At [**2157-1-7**] 03:52 PM', 'increased metoprolol to 62.5mg [**Hospital1 **] -> HR controlled at 80-100']","['EKG - At [**2157-1-7**] 03:52 PM', 'increased metoprolol to 62.5mg [**Hospital1 **] -> HR controlled at 80-100']","[""- EKG: sustained HR 140-160 ST with pac's/pvc's. BP 132/76"", 'Cardiology consulted, recommended b-blockade with CCB and BB together', '-  good response during the night', '- PMV used w/out significant desaturation', '- PICC line placed in the left basilic vein, central line removed', '- Free air seen on Xray for picc placement, surgery consulted and said', 'it was OK w/bedside peg, examined patient and recommended repeat in AM', '- Valium being tapered with 10mg PO TID yesterday']",68589,152895.0
45,2157-01-08 05:57:52,,"['EKG - At [**2157-1-7**] 03:52 PM', 'increased metoprolol to 62.5mg [**Hospital1 **] -> HR controlled at 80-100']",,68589,152895.0
46,2157-01-08 16:24:50,,"['EKG - At [**2157-1-7**] 03:52 PM', 'increased metoprolol to 62.5mg [**Hospital1 **] -> HR controlled at 80-100']",,68589,152895.0
47,2157-01-09 05:36:04,"['EKG - At [**2157-1-8**] 09:00 AM', '- haldol changed to PO, need to taper', '- starts valium 10 mg PO BID today', '- metoprolol increased to 75 mg tid', '- rehab screening in process']","['EKG - At [**2157-1-8**] 09:00 AM', '- haldol changed to PO, need to taper', '- starts valium 10 mg PO BID today', '- metoprolol increased to 75 mg tid', '- rehab screening in process']","['EKG - At [**2157-1-7**] 03:52 PM', 'increased metoprolol to 62.5mg [**Hospital1 **] -> HR controlled at 80-100']",68589,152895.0
48,2157-01-09 16:49:44,"['Haldol 5mg PO TID started yesterday', 'Valium 10mg PO BID started today', 'Metoprolol increased to 75mg PO TID']","['EKG - At [**2157-1-8**] 09:00 AM', 'Haldol 5mg PO TID started yesterday', 'Valium 10mg PO BID started today', 'Metoprolol increased to 75mg PO TID']","['- haldol changed to PO, need to taper', '- starts valium 10 mg PO BID today', '- metoprolol increased to 75 mg tid', '- rehab screening in process']",68589,152895.0
49,2157-01-09 16:49:57,,"['EKG - At [**2157-1-8**] 09:00 AM', 'Haldol 5mg PO TID started yesterday', 'Valium 10mg PO BID started today', 'Metoprolol increased to 75mg PO TID']",,68589,152895.0
50,2157-01-10 05:59:40,"['HR better on Metoprolol and Diltiazem.  Haldol decreased to 5mg PO', 'BID.  Diazepam dose not changed yesterday (psych recommends 5 days at', '[**Hospital1 **] dose).']","['HR better on Metoprolol and Diltiazem.  Haldol decreased to 5mg PO', 'BID.  Diazepam dose not changed yesterday (psych recommends 5 days at', '[**Hospital1 **] dose).']","['EKG - At [**2157-1-8**] 09:00 AM', 'Haldol 5mg PO TID started yesterday', 'Valium 10mg PO BID started today', 'Metoprolol increased to 75mg PO TID']",68589,152895.0
51,2157-01-10 17:33:45,,"['HR better on Metoprolol and Diltiazem.  Haldol decreased to 5mg PO', 'BID.  Diazepam dose not changed yesterday (psych recommends 5 days at', '[**Hospital1 **] dose).']",,68589,152895.0
52,2157-01-11 05:24:59,"['* PT/OT consult ordered', '* D/W psych resident, valium d/c.  Try to use haldol only, but ativan', 'iv prn if need.', '* needs restraint orders renewed periodically']","['* PT/OT consult ordered', '* D/W psych resident, valium d/c.  Try to use haldol only, but ativan', 'iv prn if need.', '* needs restraint orders renewed periodically']","['HR better on Metoprolol and Diltiazem.  Haldol decreased to 5mg PO', 'BID.  Diazepam dose not changed yesterday (psych recommends 5 days at', '[**Hospital1 **] dose).']",68589,152895.0
53,2157-01-11 05:26:09,,"['* PT/OT consult ordered', '* D/W psych resident, valium d/c.  Try to use haldol only, but ativan', 'iv prn if need.', '* needs restraint orders renewed periodically']",,68589,152895.0
54,2157-01-11 13:57:06,"['* PT/OT to see patient today', '* Rehab screening in process']","['* PT/OT to see patient today', '* Rehab screening in process']","['* PT/OT consult ordered', '* D/W psych resident, valium d/c.  Try to use haldol only, but ativan', 'iv prn if need.', '* needs restraint orders renewed periodically']",68589,152895.0
55,2157-01-11 14:06:14,,"['* PT/OT to see patient today', '* Rehab screening in process']",,68589,152895.0
56,2157-01-12 05:43:06,"['- haldol only prn', '- valium stopped; ativan prn', '- going to rehab today - need to call daughter to inform']","['- haldol only prn', '- valium stopped; ativan prn', '- going to rehab today - need to call daughter to inform']","['* PT/OT to see patient today', '* Rehab screening in process']",68589,152895.0
57,2157-01-12 15:49:46,['- going to rehab ([**Hospital1 **]) today - need to call daughter to inform'],"['- haldol only prn', '- valium stopped; ativan prn', '- going to rehab ([**Hospital1 **]) today - need to call daughter to inform']",['- going to rehab today - need to call daughter to inform'],68589,152895.0
0,2117-01-17 06:42:08,,"['MULTI LUMEN - START [**2117-1-16**] 05:43 PM', ' INVASIVE VENTILATION - START [**2117-1-16**] 06:09 PM', ' TRAUMA LINE - START [**2117-1-16**] 08:24 PM', ' ARTERIAL LINE - START [**2117-1-16**] 10:22 PM', '- started on artic sun, dopamine, propofol', '- sedation insufficient; started on fent/versed and later cisatricurium', '- a line placement impossible in radial and axillary. Placed in left', 'femoral', '- pt brady to 20, rewarmed, epi drip started', '- still anuric', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: Sedated, Unresponsive']",,97351,158101.0
1,2117-01-17 07:14:29,,"['MULTI LUMEN - START [**2117-1-16**] 05:43 PM', ' INVASIVE VENTILATION - START [**2117-1-16**] 06:09 PM', ' TRAUMA LINE - START [**2117-1-16**] 08:24 PM', ' ARTERIAL LINE - START [**2117-1-16**] 10:22 PM', '- started on artic sun, dopamine, propofol', '- sedation insufficient; started on fent/versed and later cisatricurium', '- a line placement impossible in radial and axillary. Placed in left', 'femoral', '- pt brady to 20, rewarmed, epi drip started', '- still anuric', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: Sedated, Unresponsive']",,97351,158101.0
2,2117-01-17 09:24:41,,"['MULTI LUMEN - START [**2117-1-16**] 05:43 PM', ' INVASIVE VENTILATION - START [**2117-1-16**] 06:09 PM', ' TRAUMA LINE - START [**2117-1-16**] 08:24 PM', ' ARTERIAL LINE - START [**2117-1-16**] 10:22 PM', '- started on artic sun, dopamine, propofol', '- sedation insufficient; started on fent/versed and later cisatricurium', '- a line placement impossible in radial and axillary. Placed in left', 'femoral', '- pt brady to 20, rewarmed, epi drip started', '- still anuric', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: Sedated, Unresponsive']",,97351,158101.0
3,2117-01-18 06:03:56,"['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication', '- ABG better (PaO2=70)after turning to lie on right side']","['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication', '- ABG better (PaO2=70)after turning to lie on right side']","['MULTI LUMEN - START [**2117-1-16**] 05:43 PM', ' INVASIVE VENTILATION - START [**2117-1-16**] 06:09 PM', ' TRAUMA LINE - START [**2117-1-16**] 08:24 PM', ' ARTERIAL LINE - START [**2117-1-16**] 10:22 PM', '- started on artic sun, dopamine, propofol', '- sedation insufficient; started on fent/versed and later cisatricurium', '- a line placement impossible in radial and axillary. Placed in left', 'femoral', '- pt brady to 20, rewarmed, epi drip started', '- still anuric', 'History obtained from Family / Friend', '[**Name (NI) **] unable to provide history: Sedated, Unresponsive']",97351,158101.0
4,2117-01-18 07:36:01,"['but since 6pm, HR in the 60s-70s, sBP in the 130s.  Overnight, dopamine', 'titrated down to 5, isoproterenol down to 1. HR 50-60s, sBP in the', '100s.']","['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.  Overnight, dopamine', 'titrated down to 5, isoproterenol down to 1. HR 50-60s, sBP in the', '100s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication']","['but since 6pm, HR in the 60s-70s, sBP in the 130s.', '- ABG better (PaO2=70)after turning to lie on right side']",97351,158101.0
5,2117-01-18 09:45:25,,"['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.  Overnight, dopamine', 'titrated down to 5, isoproterenol down to 1. HR 50-60s, sBP in the', '100s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication']",,97351,158101.0
6,2117-01-18 10:22:43,,"['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.  Overnight, dopamine', 'titrated down to 5, isoproterenol down to 1. HR 50-60s, sBP in the', '100s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication']",,97351,158101.0
7,2117-01-19 07:08:50,"['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']","['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']","['EKG - At [**2117-1-17**] 09:00 AM', ' EEG - At [**2117-1-17**] 11:30 AM', ' TRAUMA LINE - STOP [**2117-1-17**] 12:45 PM', ' EKG - At [**2117-1-17**] 04:05 PM', ' DIALYSIS CATHETER - START [**2117-1-17**] 06:47 PM', '- on dopamine 15, isoproterenol 2, HR initially around 40, sBP 110s,', 'but since 6pm, HR in the 60s-70s, sBP in the 130s.  Overnight, dopamine', 'titrated down to 5, isoproterenol down to 1. HR 50-60s, sBP in the', '100s.', '- EKG sinus rhythm', '- neuro recs: will consider cold caloric testing since currently', 'completely no brainstem function seen on exam other than patient', 'breathing over the vent.', '- family meeting held, family wants everything done, including HD.', 'Blessing by monk done in the room', '- INR reversed with FFP for HD line placement', '- HD line put in by renal, CVVH started', '- after FFP wore off, INR and PTT were [**Last Name (LF) 3779**], [**First Name3 (LF) **] heparin gtt was held', '- intraosseous access removed without complication']",97351,158101.0
8,2117-01-19 09:45:17,,"['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']",,97351,158101.0
9,2117-01-19 11:23:47,,"['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']",,97351,158101.0
10,2117-01-20 07:02:29,"['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']","['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']","['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']",97351,158101.0
11,2117-01-20 07:03:49,,"['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']",,97351,158101.0
12,2117-01-20 07:32:59,,"['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']",,97351,158101.0
13,2117-01-20 10:15:37,,"['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']",,97351,158101.0
14,2117-01-21 07:10:23,"['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']","['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']","['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']",97351,158101.0
15,2117-01-21 10:03:22,"['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']","['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']","['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']",97351,158101.0
16,2117-01-21 10:04:40,"['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']","['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']","['- family meeting: patient DNR, waiting for one more family member from', '[**Country 249**]', ""- Sputum grows Moraxella (he's covered with Ceftriaxone)"", '- Blood from fem-line growing Gram positive cocci', '- making urine at 30cc/hr', '- ABG is excellent', '- Liver enzymes trending down']",97351,158101.0
17,2117-01-21 10:16:26,"['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']","['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']","['- Final urine culture, no growth', '- Neuro recs: reiterates poor prognosis and absence of brainstem', 'function save for spontaneous respirations, continue EEG for now', '- Switched to pressure support (16/5 on 80% FiO2) as ABG looked good &', 'breathing above vent', ""- LFT's climbing (ALT/AST/LDH 1758/1345/1208), T bili 2.0, INR 3.0"", '- Sputum noted by respiratory to be bloody', '- Spiked temp to 102 at 5pm, blood & sputum cx sent', '- CRRT filter clotted off, so on hold for now', '- family, including wife, at bedside in late evening, no family', 'decisions yet']",97351,158101.0
18,2117-01-21 10:36:55,,"['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']",,97351,158101.0
19,2117-01-22 07:19:20,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']","['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']","['[**1-20**]:', '- family discussion: no escalation of care (no pressors, DNR, do not', 're-intubate)', '- PIV x2 in, femoral CVL line, HD line and A-line removed', '- another daughter is coming from [**Country 249**] on [**Name (NI) 1583**]', '- family is ok with us removing the C-collar, but per spine, need MRI', 'to clear c-spine', '- blood culture from [**1-18**] (drawn from A-line) also grew out GPC in', 'clusters 2/4 bottles', '- blood culture from [**1-16**] grew out coag neg staph', '- [**Month/Day (4) **] trough: 12.7, given another dose of [**Last Name (LF) **], [**First Name3 (LF) 116**] recheck tomorrow', 'at 11am', '- palliative care: no recs', '- neuro: low threshould to start anti-epileptic meds if noting sz', 'activities.  Meaningful recovery is very unlikely.', 'History obtained from Medical records']",97351,158101.0
20,2117-01-22 07:31:06,,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",,97351,158101.0
21,2117-01-22 07:51:01,,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",,97351,158101.0
22,2117-01-22 07:52:06,,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",,97351,158101.0
23,2117-01-22 10:19:09,,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",,97351,158101.0
24,2117-01-22 14:46:56,,"['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",,97351,158101.0
25,2117-01-23 06:40:08,"['- decreased pressure support to 12', '- 1158: looked uncomfortable, gave 4 of morphine', '- 4pm: family meeting --> family prepared a statement, very thankful', 'for the care Mr. [**Known lastname **] received; wants pt to be made CMO at 10am on', 'Saturday', '- PS back up to 14 at 8pm; pt hyperventilating at 34, gave 4mg IV', 'Morphine', '- patient has fever of 103.2 at 5 AM']","['- decreased pressure support to 12', '- 1158: looked uncomfortable, gave 4 of morphine', '- 4pm: family meeting --> family prepared a statement, very thankful', 'for the care Mr. [**Known lastname **] received; wants pt to be made CMO at 10am on', 'Saturday', '- PS back up to 14 at 8pm; pt hyperventilating at 34, gave 4mg IV', 'Morphine', '- patient has fever of 103.2 at 5 AM']","['SPUTUM CULTURE - At [**2117-1-21**] 08:30 PM', '- re-sputum cx', '- no change in abx for now, can add cefepime if becomes hemodynamically', 'unstable', '- morphine 2mg x 1 for ? pain, did not appear to change RR, repeated x', '1 at 4mg', '- family mtg. with interpreter at 4pm Friday']",97351,158101.0
26,2117-01-23 09:52:59,,"['- decreased pressure support to 12', '- 1158: looked uncomfortable, gave 4 of morphine', '- 4pm: family meeting --> family prepared a statement, very thankful', 'for the care Mr. [**Known lastname **] received; wants pt to be made CMO at 10am on', 'Saturday', '- PS back up to 14 at 8pm; pt hyperventilating at 34, gave 4mg IV', 'Morphine', '- patient has fever of 103.2 at 5 AM']",,97351,158101.0
27,2117-01-23 10:47:35,,"['- decreased pressure support to 12', '- 1158: looked uncomfortable, gave 4 of morphine', '- 4pm: family meeting --> family prepared a statement, very thankful', 'for the care Mr. [**Known lastname **] received; wants pt to be made CMO at 10am on', 'Saturday', '- PS back up to 14 at 8pm; pt hyperventilating at 34, gave 4mg IV', 'Morphine', '- patient has fever of 103.2 at 5 AM']",,97351,158101.0
0,2154-10-27 08:06:32,,"['INVASIVE VENTILATION - START [**2154-10-26**] 02:30 PM', ' EKG - At [**2154-10-26**] 04:15 PM']",,62505,110115.0
1,2154-10-27 10:09:20,,"['INVASIVE VENTILATION - START [**2154-10-26**] 02:30 PM', ' EKG - At [**2154-10-26**] 04:15 PM']",,62505,110115.0
2,2154-10-28 07:16:36,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']","['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']","['INVASIVE VENTILATION - START [**2154-10-26**] 02:30 PM', ' EKG - At [**2154-10-26**] 04:15 PM']",62505,110115.0
3,2154-10-28 07:17:32,,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']",,62505,110115.0
4,2154-10-28 07:18:20,,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']",,62505,110115.0
5,2154-10-28 07:19:39,,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']",,62505,110115.0
6,2154-10-28 10:24:32,,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']",,62505,110115.0
7,2154-10-28 14:57:53,,"['NASAL SWAB - At [**2154-10-27**] 08:52 AM', ' INVASIVE VENTILATION - STOP [**2154-10-27**] 09:36 AM', '- extubated without complications', '- IP recs: continue wall suction to 20 with repeat CXR in AM as still', 'with air leak', '- d/c azithromycin', '- on clears --> ADAT', '- HSQ started', '- d/c Foley', '- SW c/s placed', '- theophylline level 1.9 (subtherapeutic)', '- medication reconciliation performed via his pharmacy', '- family updated']",,62505,110115.0
0,2136-11-01 06:03:10,,[],,8799,124439.0
1,2136-11-01 06:03:43,,[],,8799,124439.0
2,2136-11-01 06:04:19,,[],,8799,124439.0
3,2136-11-01 07:52:25,"['Pt attempted trial of PO intake but had nausea overnight with some', 'emesis. Insulin drip discontinued overnight. FSBS trended up.']","['Pt attempted trial of PO intake but had nausea overnight with some', 'emesis. Insulin drip discontinued overnight. FSBS trended up.']",,8799,124439.0
4,2136-11-02 05:57:19,"['HCG Negative', 'U/A marginally positive, pt started on PO Cipro for uncomplicated UTI', 'Ca, Phos, K repleted', 'BCx x2 sent, UCx pending']","['HCG Negative', 'U/A marginally positive, pt started on PO Cipro for uncomplicated UTI', 'Ca, Phos, K repleted', 'BCx x2 sent, UCx pending']","['Pt attempted trial of PO intake but had nausea overnight with some', 'emesis. Insulin drip discontinued overnight. FSBS trended up.']",8799,124439.0
5,2136-11-02 07:44:36,['Seen by [**Last Name (un) 276**]'],"['U/A marginally positive, pt started on PO Cipro for uncomplicated UTI', 'Seen by [**Last Name (un) 276**]']","['HCG Negative', 'Ca, Phos, K repleted', 'BCx x2 sent, UCx pending']",8799,124439.0
6,2136-11-02 07:46:11,,"['U/A marginally positive, pt started on PO Cipro for uncomplicated UTI', 'Seen by [**Last Name (un) 276**]']",,8799,124439.0
7,2136-11-02 12:14:32,,"['U/A marginally positive, pt started on PO Cipro for uncomplicated UTI', 'Seen by [**Last Name (un) 276**]']",,8799,124439.0
0,2190-11-17 09:33:31,,"['- cont. Vanc/Zosyn for UTI', '- off dilt gtt', 'History obtained from Family / [**Hospital 56**] Medical records']",,30316,189322.0
1,2190-11-18 07:29:39,"[""-d/c'd dilt gtt"", ""-heparin gtt d/c'd as INR therapeutic"", '-incr metoprolol to 125 mg TID', '-restarted TF via PEG', '-lasix 40 mg IV at 1030 put out 1000 cc', '-lasix 40 mg IV at 1700 put out 700 cc', '-lasix 80 mg IV at 2300 put out 700+ cc', 'History obtained from Patient']","[""-d/c'd dilt gtt"", ""-heparin gtt d/c'd as INR therapeutic"", '-incr metoprolol to 125 mg TID', '-restarted TF via PEG', '-lasix 40 mg IV at 1030 put out 1000 cc', '-lasix 40 mg IV at 1700 put out 700 cc', '-lasix 80 mg IV at 2300 put out 700+ cc', 'History obtained from Patient']","['- cont. Vanc/Zosyn for UTI', '- off dilt gtt', 'History obtained from Family / [**Hospital 56**] Medical records']",30316,189322.0
2,2190-11-18 07:31:45,,"[""-d/c'd dilt gtt"", ""-heparin gtt d/c'd as INR therapeutic"", '-incr metoprolol to 125 mg TID', '-restarted TF via PEG', '-lasix 40 mg IV at 1030 put out 1000 cc', '-lasix 40 mg IV at 1700 put out 700 cc', '-lasix 80 mg IV at 2300 put out 700+ cc', 'History obtained from Patient']",,30316,189322.0
3,2190-11-18 10:50:05,,"[""-d/c'd dilt gtt"", ""-heparin gtt d/c'd as INR therapeutic"", '-incr metoprolol to 125 mg TID', '-restarted TF via PEG', '-lasix 40 mg IV at 1030 put out 1000 cc', '-lasix 40 mg IV at 1700 put out 700 cc', '-lasix 80 mg IV at 2300 put out 700+ cc', 'History obtained from Patient']",,30316,189322.0
0,2106-04-18 07:06:54,,['None'],,291,125726.0
1,2106-04-18 07:09:52,,['None'],,291,125726.0
2,2106-04-18 10:54:31,,['None'],,291,125726.0
0,2169-10-18 06:27:26,,"['EKG - At [**2169-10-17**] 08:59 AM', ' BLOOD CULTURED - At [**2169-10-17**] 10:10 AM', ' BLOOD CULTURED - At [**2169-10-17**] 01:10 PM', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']",,73488,185762.0
1,2169-10-18 06:55:12,,"['EKG - At [**2169-10-17**] 08:59 AM', ' BLOOD CULTURED - At [**2169-10-17**] 10:10 AM', ' BLOOD CULTURED - At [**2169-10-17**] 01:10 PM', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']",,73488,185762.0
2,2169-10-18 07:16:20,"['Bradycardic event- EKG, warmed, stat labs']","['Bradycardic event- EKG, warmed, stat labs', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']","['EKG - At [**2169-10-17**] 08:59 AM', ' BLOOD CULTURED - At [**2169-10-17**] 10:10 AM', ' BLOOD CULTURED - At [**2169-10-17**] 01:10 PM']",73488,185762.0
3,2169-10-18 09:18:36,"['Bradycardic event (down to 38) - EKG, warmed (for hypothermia), stat', 'labs, pads placed. Has h/o bradycardia.', '=intubated']","['Bradycardic event (down to 38) - EKG, warmed (for hypothermia), stat', 'labs, pads placed. Has h/o bradycardia.', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', '=intubated', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']","['Bradycardic event- EKG, warmed, stat labs']",73488,185762.0
4,2169-10-18 10:25:05,,"['Bradycardic event (down to 38) - EKG, warmed (for hypothermia), stat', 'labs, pads placed. Has h/o bradycardia.', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', '=intubated', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']",,73488,185762.0
5,2169-10-19 07:09:29,['INVASIVE VENTILATION - STOP [**2169-10-18**] 11:38 AM'],['INVASIVE VENTILATION - STOP [**2169-10-18**] 11:38 AM'],"['Bradycardic event (down to 38) - EKG, warmed (for hypothermia), stat', 'labs, pads placed. Has h/o bradycardia.', ' INVASIVE VENTILATION - START [**2169-10-17**] 03:30 PM', '=intubated', ' MAGNETIC RESONANCE IMAGING - At [**2169-10-18**] 02:00 AM', ' FEVER - 101.6', 'F - [**2169-10-17**] 08:00 AM']",73488,185762.0
6,2169-10-19 14:13:03,,['INVASIVE VENTILATION - STOP [**2169-10-18**] 11:38 AM'],,73488,185762.0
0,2169-12-08 07:50:45,,"['PICC LINE - START [**2169-12-7**] 08:14 PM', 'dressing change [**2169-12-7**]', '- No major events']",,73488,199332.0
1,2169-12-08 10:57:30,,"['PICC LINE - START [**2169-12-7**] 08:14 PM', 'dressing change [**2169-12-7**]', '- No major events']",,73488,199332.0
0,2151-02-28 08:08:53,,['No Events'],,41004,167004.0
1,2151-02-28 09:39:59,,['No Events'],,41004,167004.0
2,2151-03-01 06:52:38,"['- weaned off neo in the AM', '- spoke with ortho, restarted heparin sq ppx', '- FeUrea: 15%', '- pt Hct 29.4 <-- 34.8, pt also with low UOP 20-30cc/hr. Instead of', 'giving IVF decided to transfuse 1U pRBC. UOP improved to 40-50cc/hr']","['- weaned off neo in the AM', '- spoke with ortho, restarted heparin sq ppx', '- FeUrea: 15%', '- pt Hct 29.4 <-- 34.8, pt also with low UOP 20-30cc/hr. Instead of', 'giving IVF decided to transfuse 1U pRBC. UOP improved to 40-50cc/hr']",['No Events'],41004,167004.0
3,2151-03-01 10:51:42,,"['- weaned off neo in the AM', '- spoke with ortho, restarted heparin sq ppx', '- FeUrea: 15%', '- pt Hct 29.4 <-- 34.8, pt also with low UOP 20-30cc/hr. Instead of', 'giving IVF decided to transfuse 1U pRBC. UOP improved to 40-50cc/hr']",,41004,167004.0
4,2151-03-02 07:43:22,"['-Bronch:', '-Gave 20mg IV Lasix at 1pm [**3-2**] poor UOP', ""-BP improved with add'l Lasix""]","['-Bronch:', '-Gave 20mg IV Lasix at 1pm [**3-2**] poor UOP', ""-BP improved with add'l Lasix""]","['- weaned off neo in the AM', '- spoke with ortho, restarted heparin sq ppx', '- FeUrea: 15%', '- pt Hct 29.4 <-- 34.8, pt also with low UOP 20-30cc/hr. Instead of', 'giving IVF decided to transfuse 1U pRBC. UOP improved to 40-50cc/hr']",41004,167004.0
5,2151-03-02 07:45:14,"['-Ortho recs: okay to start aspirin', '-3pm Hct check:30.9; holding aspirin', '-Repeat Hct 9pm: 31.5']","['-Ortho recs: okay to start aspirin', '-3pm Hct check:30.9; holding aspirin', '-Repeat Hct 9pm: 31.5']","['-Bronch:', '-Gave 20mg IV Lasix at 1pm [**3-2**] poor UOP', ""-BP improved with add'l Lasix""]",41004,167004.0
6,2151-03-02 11:45:51,,"['-Ortho recs: okay to start aspirin', '-3pm Hct check:30.9; holding aspirin', '-Repeat Hct 9pm: 31.5']",,41004,167004.0
7,2151-03-03 07:46:59,"['Pt with inc confusion as night progressed. Pt given ambienat 2200. pt', 'has not slept a wink. Talking to people who are not in the room or even', 'alive. Pt removed o2 and dropped o2 sat to the 80']","['Pt with inc confusion as night progressed. Pt given ambienat 2200. pt', 'has not slept a wink. Talking to people who are not in the room or even', 'alive. Pt removed o2 and dropped o2 sat to the 80']","['-Ortho recs: okay to start aspirin', '-3pm Hct check:30.9; holding aspirin', '-Repeat Hct 9pm: 31.5']",41004,167004.0
8,2151-03-03 07:49:38,,"['Pt with inc confusion as night progressed. Pt given ambienat 2200. pt', 'has not slept a wink. Talking to people who are not in the room or even', 'alive. Pt removed o2 and dropped o2 sat to the 80']",,41004,167004.0
9,2151-03-03 11:25:55,,"['Pt with inc confusion as night progressed. Pt given ambienat 2200. pt', 'has not slept a wink. Talking to people who are not in the room or even', 'alive. Pt removed o2 and dropped o2 sat to the 80']",,41004,167004.0
0,2195-08-19 07:20:51,,"['ID and derm concur with dx of lyme disease.', 'Per ID, giving CTX 2g Q24 and continuing doxy, sent CSF for Lyme']",,81770,168100.0
1,2195-08-19 11:58:29,,"['ID and derm concur with dx of lyme disease.', 'Per ID, giving CTX 2g Q24 and continuing doxy, sent CSF for Lyme']",,81770,168100.0
0,2193-12-26 06:13:55,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
1,2193-12-26 06:18:32,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
2,2193-12-26 07:01:06,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
3,2193-12-26 09:29:48,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
4,2193-12-26 09:33:07,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
5,2193-12-26 09:36:03,,"['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",,85230,153781.0
6,2193-12-27 06:54:43,"['TRANSTHORACIC ECHO - At [**2193-12-26**] 10:15 AM', 'Echo with bubble study', ' EKG - At [**2193-12-26**] 12:00 PM', ' FEVER - 102.1', 'F - [**2193-12-26**] 04:00 PM']","['TRANSTHORACIC ECHO - At [**2193-12-26**] 10:15 AM', 'Echo with bubble study', ' EKG - At [**2193-12-26**] 12:00 PM', ' FEVER - 102.1', 'F - [**2193-12-26**] 04:00 PM']","['INVASIVE VENTILATION - START [**2193-12-25**] 01:17 PM', ' ARTERIAL LINE - START [**2193-12-25**] 03:01 PM', ' MULTI LUMEN - START [**2193-12-25**] 03:02 PM', ' BRONCHOSCOPY - At [**2193-12-25**] 04:45 PM', 'LLL BAL done sample sent to Lab.', ' BLOOD CULTURED - At [**2193-12-25**] 06:45 PM']",85230,153781.0
7,2193-12-27 06:55:36,,"['TRANSTHORACIC ECHO - At [**2193-12-26**] 10:15 AM', 'Echo with bubble study', ' EKG - At [**2193-12-26**] 12:00 PM', ' FEVER - 102.1', 'F - [**2193-12-26**] 04:00 PM']",,85230,153781.0
8,2193-12-27 10:22:41,,"['TRANSTHORACIC ECHO - At [**2193-12-26**] 10:15 AM', 'Echo with bubble study', ' EKG - At [**2193-12-26**] 12:00 PM', ' FEVER - 102.1', 'F - [**2193-12-26**] 04:00 PM']",,85230,153781.0
9,2193-12-28 08:00:32,"['BRONCHOSCOPY - At [**2193-12-27**] 04:45 PM -watery secretions seen', ' FEVER - 101.3', 'F - [**2193-12-27**] 12:00 PM', 'esophageal balloon placed', 'flu negative', 'po2 much better than sat would have predicted, fio2 weaned to 60% from', '70']","['BRONCHOSCOPY - At [**2193-12-27**] 04:45 PM -watery secretions seen', ' FEVER - 101.3', 'F - [**2193-12-27**] 12:00 PM', 'esophageal balloon placed', 'flu negative', 'po2 much better than sat would have predicted, fio2 weaned to 60% from', '70']","['TRANSTHORACIC ECHO - At [**2193-12-26**] 10:15 AM', 'Echo with bubble study', ' EKG - At [**2193-12-26**] 12:00 PM', ' FEVER - 102.1', 'F - [**2193-12-26**] 04:00 PM']",85230,153781.0
10,2193-12-28 08:02:14,,"['BRONCHOSCOPY - At [**2193-12-27**] 04:45 PM -watery secretions seen', ' FEVER - 101.3', 'F - [**2193-12-27**] 12:00 PM', 'esophageal balloon placed', 'flu negative', 'po2 much better than sat would have predicted, fio2 weaned to 60% from', '70']",,85230,153781.0
11,2193-12-28 11:47:42,,"['BRONCHOSCOPY - At [**2193-12-27**] 04:45 PM -watery secretions seen', ' FEVER - 101.3', 'F - [**2193-12-27**] 12:00 PM', 'esophageal balloon placed', 'flu negative', 'po2 much better than sat would have predicted, fio2 weaned to 60% from', '70']",,85230,153781.0
12,2193-12-29 06:55:23,"['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']","['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']","['BRONCHOSCOPY - At [**2193-12-27**] 04:45 PM -watery secretions seen', ' FEVER - 101.3', 'F - [**2193-12-27**] 12:00 PM', 'esophageal balloon placed', 'flu negative', 'po2 much better than sat would have predicted, fio2 weaned to 60% from', '70']",85230,153781.0
13,2193-12-29 06:56:16,,"['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']",,85230,153781.0
14,2193-12-29 07:02:01,,"['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']",,85230,153781.0
15,2193-12-29 13:01:34,,"['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']",,85230,153781.0
16,2193-12-30 06:16:32,"['ARTERIAL LINE - START [**2193-12-29**] 06:43 PM', 'rt foot', ' ULTRASOUND - At [**2193-12-29**] 08:00 PM', 'Left IJ CVL attempted yesterday without success, +difficulty threading', 'catheter.', 'Right IJ CVL meeting resistance with flushing yesterday afternoon.', 'Given difficulty with Left IJ insertion and new resistance of Right IJ,', 'concern was for clot.  Bilateral Upper Extremity U/S ordered but Right', 'side was only done by tech.  +DVT or Right Brachial Vein.  Heparin gtt', 'was started, CTA Chest ordered for this morning for evaluation.', 'Patient was on wall suction yesterday [**3-18**] high Tube Feed residual,', '+bilious fluid.  Abdomen soft.  No bowel movement in last few days.', 'Fleet enema ordered this morning.', 'Right Distal Pedal Arterial Line placed, Blood pressures not accurate', 'but able to get ABG.', 'Vent weaned down to FiO2 60% with PEEP 18.']","['ARTERIAL LINE - START [**2193-12-29**] 06:43 PM', 'rt foot', ' ULTRASOUND - At [**2193-12-29**] 08:00 PM', 'Left IJ CVL attempted yesterday without success, +difficulty threading', 'catheter.', 'Right IJ CVL meeting resistance with flushing yesterday afternoon.', 'Given difficulty with Left IJ insertion and new resistance of Right IJ,', 'concern was for clot.  Bilateral Upper Extremity U/S ordered but Right', 'side was only done by tech.  +DVT or Right Brachial Vein.  Heparin gtt', 'was started, CTA Chest ordered for this morning for evaluation.', 'Patient was on wall suction yesterday [**3-18**] high Tube Feed residual,', '+bilious fluid.  Abdomen soft.  No bowel movement in last few days.', 'Fleet enema ordered this morning.', 'Right Distal Pedal Arterial Line placed, Blood pressures not accurate', 'but able to get ABG.', 'Vent weaned down to FiO2 60% with PEEP 18.']","['ARTERIAL LINE - STOP [**2193-12-28**] 07:00 PM', ' BLOOD CULTURED - At [**2193-12-29**] 03:00 AM', 'BC x 2', ' URINE CULTURE - At [**2193-12-29**] 03:00 AM', ' FEVER - 101.4', 'F - [**2193-12-29**] 03:00 AM', 'O2 worse with FiO2 of 60%--> increased to 70%--> 65%', 'still quite positional, better with L lung down now', '-not absorbing anything po, lots of residuals, TFs stopped']",85230,153781.0
17,2193-12-30 06:17:15,,"['ARTERIAL LINE - START [**2193-12-29**] 06:43 PM', 'rt foot', ' ULTRASOUND - At [**2193-12-29**] 08:00 PM', 'Left IJ CVL attempted yesterday without success, +difficulty threading', 'catheter.', 'Right IJ CVL meeting resistance with flushing yesterday afternoon.', 'Given difficulty with Left IJ insertion and new resistance of Right IJ,', 'concern was for clot.  Bilateral Upper Extremity U/S ordered but Right', 'side was only done by tech.  +DVT or Right Brachial Vein.  Heparin gtt', 'was started, CTA Chest ordered for this morning for evaluation.', 'Patient was on wall suction yesterday [**3-18**] high Tube Feed residual,', '+bilious fluid.  Abdomen soft.  No bowel movement in last few days.', 'Fleet enema ordered this morning.', 'Right Distal Pedal Arterial Line placed, Blood pressures not accurate', 'but able to get ABG.', 'Vent weaned down to FiO2 60% with PEEP 18.']",,85230,153781.0
18,2193-12-30 11:45:41,,"['ARTERIAL LINE - START [**2193-12-29**] 06:43 PM', 'rt foot', ' ULTRASOUND - At [**2193-12-29**] 08:00 PM', 'Left IJ CVL attempted yesterday without success, +difficulty threading', 'catheter.', 'Right IJ CVL meeting resistance with flushing yesterday afternoon.', 'Given difficulty with Left IJ insertion and new resistance of Right IJ,', 'concern was for clot.  Bilateral Upper Extremity U/S ordered but Right', 'side was only done by tech.  +DVT or Right Brachial Vein.  Heparin gtt', 'was started, CTA Chest ordered for this morning for evaluation.', 'Patient was on wall suction yesterday [**3-18**] high Tube Feed residual,', '+bilious fluid.  Abdomen soft.  No bowel movement in last few days.', 'Fleet enema ordered this morning.', 'Right Distal Pedal Arterial Line placed, Blood pressures not accurate', 'but able to get ABG.', 'Vent weaned down to FiO2 60% with PEEP 18.']",,85230,153781.0
19,2193-12-31 07:11:46,"['ULTRASOUND - At [**2193-12-30**] 04:15 PM', 'LUE and bilater lower extremities looking for clots.', ' FEVER - 102.0', 'F - [**2193-12-30**] 04:00 PM', '- second US of UE notable for partially occlusive clot of one brachial', 'vein; she has b/L UE DVTs', '- CT scan with moderate right sided effusion (as expected), received 20', 'IV lasix in the afternoon with good UOP and a second dose in the', 'evening; may need [**Female First Name (un) 231**] if little improvement.', '- prelim read regarding SVC clot pending']","['ULTRASOUND - At [**2193-12-30**] 04:15 PM', 'LUE and bilater lower extremities looking for clots.', ' FEVER - 102.0', 'F - [**2193-12-30**] 04:00 PM', '- second US of UE notable for partially occlusive clot of one brachial', 'vein; she has b/L UE DVTs', '- CT scan with moderate right sided effusion (as expected), received 20', 'IV lasix in the afternoon with good UOP and a second dose in the', 'evening; may need [**Female First Name (un) 231**] if little improvement.', '- prelim read regarding SVC clot pending']","['ARTERIAL LINE - START [**2193-12-29**] 06:43 PM', 'rt foot', ' ULTRASOUND - At [**2193-12-29**] 08:00 PM', 'Left IJ CVL attempted yesterday without success, +difficulty threading', 'catheter.', 'Right IJ CVL meeting resistance with flushing yesterday afternoon.', 'Given difficulty with Left IJ insertion and new resistance of Right IJ,', 'concern was for clot.  Bilateral Upper Extremity U/S ordered but Right', 'side was only done by tech.  +DVT or Right Brachial Vein.  Heparin gtt', 'was started, CTA Chest ordered for this morning for evaluation.', 'Patient was on wall suction yesterday [**3-18**] high Tube Feed residual,', '+bilious fluid.  Abdomen soft.  No bowel movement in last few days.', 'Fleet enema ordered this morning.', 'Right Distal Pedal Arterial Line placed, Blood pressures not accurate', 'but able to get ABG.', 'Vent weaned down to FiO2 60% with PEEP 18.']",85230,153781.0
20,2193-12-31 07:13:08,,"['ULTRASOUND - At [**2193-12-30**] 04:15 PM', 'LUE and bilater lower extremities looking for clots.', ' FEVER - 102.0', 'F - [**2193-12-30**] 04:00 PM', '- second US of UE notable for partially occlusive clot of one brachial', 'vein; she has b/L UE DVTs', '- CT scan with moderate right sided effusion (as expected), received 20', 'IV lasix in the afternoon with good UOP and a second dose in the', 'evening; may need [**Female First Name (un) 231**] if little improvement.', '- prelim read regarding SVC clot pending']",,85230,153781.0
21,2193-12-31 11:20:30,['- prelim read regarding SVC clot negative'],"['ULTRASOUND - At [**2193-12-30**] 04:15 PM', 'LUE and bilater lower extremities looking for clots.', ' FEVER - 102.0', 'F - [**2193-12-30**] 04:00 PM', '- second US of UE notable for partially occlusive clot of one brachial', 'vein; she has b/L UE DVTs', '- CT scan with moderate right sided effusion (as expected), received 20', 'IV lasix in the afternoon with good UOP and a second dose in the', 'evening; may need [**Female First Name (un) 231**] if little improvement.', '- prelim read regarding SVC clot negative']",['- prelim read regarding SVC clot pending'],85230,153781.0
22,2194-01-01 06:33:16,"['STOOL CULTURE - At [**2193-12-31**] 03:00 PM', ' FEVER - 102.5', 'F - [**2194-1-1**] 04:00 AM', 'heparin gtt stopped at midnight for possible thoracentesis today', ""didn't tolerate FiO2 of 50%---> back up to 60%"", 'got 20mg IV lasix x3 with good urine output', 'Tm 102.5 this AM']","['STOOL CULTURE - At [**2193-12-31**] 03:00 PM', ' FEVER - 102.5', 'F - [**2194-1-1**] 04:00 AM', 'heparin gtt stopped at midnight for possible thoracentesis today', ""didn't tolerate FiO2 of 50%---> back up to 60%"", 'got 20mg IV lasix x3 with good urine output', 'Tm 102.5 this AM']","['ULTRASOUND - At [**2193-12-30**] 04:15 PM', 'LUE and bilater lower extremities looking for clots.', ' FEVER - 102.0', 'F - [**2193-12-30**] 04:00 PM', '- second US of UE notable for partially occlusive clot of one brachial', 'vein; she has b/L UE DVTs', '- CT scan with moderate right sided effusion (as expected), received 20', 'IV lasix in the afternoon with good UOP and a second dose in the', 'evening; may need [**Female First Name (un) 231**] if little improvement.', '- prelim read regarding SVC clot negative']",85230,153781.0
23,2194-01-01 06:34:13,,"['STOOL CULTURE - At [**2193-12-31**] 03:00 PM', ' FEVER - 102.5', 'F - [**2194-1-1**] 04:00 AM', 'heparin gtt stopped at midnight for possible thoracentesis today', ""didn't tolerate FiO2 of 50%---> back up to 60%"", 'got 20mg IV lasix x3 with good urine output', 'Tm 102.5 this AM']",,85230,153781.0
24,2194-01-01 12:49:32,,"['STOOL CULTURE - At [**2193-12-31**] 03:00 PM', ' FEVER - 102.5', 'F - [**2194-1-1**] 04:00 AM', 'heparin gtt stopped at midnight for possible thoracentesis today', ""didn't tolerate FiO2 of 50%---> back up to 60%"", 'got 20mg IV lasix x3 with good urine output', 'Tm 102.5 this AM']",,85230,153781.0
25,2194-01-02 07:04:35,"['BLOOD CULTURED - At [**2194-1-1**] 08:00 AM', 'from a-line.', ' BLOOD CULTURED - At [**2194-1-1**] 08:30 AM', 'from TLC.', ' URINE CULTURE - At [**2194-1-1**] 08:30 AM', ' THORACENTESIS - At [**2194-1-1**] 02:00 PM', 'R lung.', ' FEVER - 101.5', 'F - [**2194-1-2**] 04:00 AM', '[**Female First Name (un) **] done yesterday with removal of 800cc of serous fluid.', 'Pleural', 'fluid analysis consistent with exudative effusion.  Lasix gtt was', 'ordered and then discontinued when analysis returned as exudate.', 'PEEP down to 15, FiO2 60%.']","['BLOOD CULTURED - At [**2194-1-1**] 08:00 AM', 'from a-line.', ' BLOOD CULTURED - At [**2194-1-1**] 08:30 AM', 'from TLC.', ' URINE CULTURE - At [**2194-1-1**] 08:30 AM', ' THORACENTESIS - At [**2194-1-1**] 02:00 PM', 'R lung.', ' FEVER - 101.5', 'F - [**2194-1-2**] 04:00 AM', '[**Female First Name (un) **] done yesterday with removal of 800cc of serous fluid.', 'Pleural', 'fluid analysis consistent with exudative effusion.  Lasix gtt was', 'ordered and then discontinued when analysis returned as exudate.', 'PEEP down to 15, FiO2 60%.']","['STOOL CULTURE - At [**2193-12-31**] 03:00 PM', ' FEVER - 102.5', 'F - [**2194-1-1**] 04:00 AM', 'heparin gtt stopped at midnight for possible thoracentesis today', ""didn't tolerate FiO2 of 50%---> back up to 60%"", 'got 20mg IV lasix x3 with good urine output', 'Tm 102.5 this AM']",85230,153781.0
26,2194-01-02 07:05:10,,"['BLOOD CULTURED - At [**2194-1-1**] 08:00 AM', 'from a-line.', ' BLOOD CULTURED - At [**2194-1-1**] 08:30 AM', 'from TLC.', ' URINE CULTURE - At [**2194-1-1**] 08:30 AM', ' THORACENTESIS - At [**2194-1-1**] 02:00 PM', 'R lung.', ' FEVER - 101.5', 'F - [**2194-1-2**] 04:00 AM', '[**Female First Name (un) **] done yesterday with removal of 800cc of serous fluid.', 'Pleural', 'fluid analysis consistent with exudative effusion.  Lasix gtt was', 'ordered and then discontinued when analysis returned as exudate.', 'PEEP down to 15, FiO2 60%.']",,85230,153781.0
27,2194-01-02 10:36:42,,"['BLOOD CULTURED - At [**2194-1-1**] 08:00 AM', 'from a-line.', ' BLOOD CULTURED - At [**2194-1-1**] 08:30 AM', 'from TLC.', ' URINE CULTURE - At [**2194-1-1**] 08:30 AM', ' THORACENTESIS - At [**2194-1-1**] 02:00 PM', 'R lung.', ' FEVER - 101.5', 'F - [**2194-1-2**] 04:00 AM', '[**Female First Name (un) **] done yesterday with removal of 800cc of serous fluid.', 'Pleural', 'fluid analysis consistent with exudative effusion.  Lasix gtt was', 'ordered and then discontinued when analysis returned as exudate.', 'PEEP down to 15, FiO2 60%.']",,85230,153781.0
28,2194-01-03 07:15:10,"['MULTI LUMEN - START [**2194-1-3**] 12:25 AM', 'VIA LEFT EJ', ' FEVER - 101.1', 'F - [**2194-1-2**] 08:00 PM', '- Line by IR in EJ and c/b local hematoma. Heparin restarted overnight,', 'if Hct and hematoma stable, plan for d/c of old triple lumen', '- PEEP decreased by 2 ro 13']","['MULTI LUMEN - START [**2194-1-3**] 12:25 AM', 'VIA LEFT EJ', ' FEVER - 101.1', 'F - [**2194-1-2**] 08:00 PM', '- Line by IR in EJ and c/b local hematoma. Heparin restarted overnight,', 'if Hct and hematoma stable, plan for d/c of old triple lumen', '- PEEP decreased by 2 ro 13']","['BLOOD CULTURED - At [**2194-1-1**] 08:00 AM', 'from a-line.', ' BLOOD CULTURED - At [**2194-1-1**] 08:30 AM', 'from TLC.', ' URINE CULTURE - At [**2194-1-1**] 08:30 AM', ' THORACENTESIS - At [**2194-1-1**] 02:00 PM', 'R lung.', ' FEVER - 101.5', 'F - [**2194-1-2**] 04:00 AM', '[**Female First Name (un) **] done yesterday with removal of 800cc of serous fluid.', 'Pleural', 'fluid analysis consistent with exudative effusion.  Lasix gtt was', 'ordered and then discontinued when analysis returned as exudate.', 'PEEP down to 15, FiO2 60%.']",85230,153781.0
29,2194-01-03 07:16:17,,"['MULTI LUMEN - START [**2194-1-3**] 12:25 AM', 'VIA LEFT EJ', ' FEVER - 101.1', 'F - [**2194-1-2**] 08:00 PM', '- Line by IR in EJ and c/b local hematoma. Heparin restarted overnight,', 'if Hct and hematoma stable, plan for d/c of old triple lumen', '- PEEP decreased by 2 ro 13']",,85230,153781.0
30,2194-01-03 11:26:57,['- PEEP decreased to 13'],"['MULTI LUMEN - START [**2194-1-3**] 12:25 AM', 'VIA LEFT EJ', ' FEVER - 101.1', 'F - [**2194-1-2**] 08:00 PM', '- Line by IR in EJ and c/b local hematoma. Heparin restarted overnight,', 'if Hct and hematoma stable, plan for d/c of old triple lumen', '- PEEP decreased to 13']",['- PEEP decreased by 2 ro 13'],85230,153781.0
31,2194-01-04 05:30:47,"['BRONCHOSCOPY - At [**2194-1-3**] 02:51 PM', ' MULTI LUMEN - STOP [**2194-1-3**] 03:00 PM', 'R IJ d/c-ed']","['BRONCHOSCOPY - At [**2194-1-3**] 02:51 PM', ' MULTI LUMEN - STOP [**2194-1-3**] 03:00 PM', 'R IJ d/c-ed']","['MULTI LUMEN - START [**2194-1-3**] 12:25 AM', 'VIA LEFT EJ', ' FEVER - 101.1', 'F - [**2194-1-2**] 08:00 PM', '- Line by IR in EJ and c/b local hematoma. Heparin restarted overnight,', 'if Hct and hematoma stable, plan for d/c of old triple lumen', '- PEEP decreased to 13']",85230,153781.0
32,2194-01-04 05:31:44,,"['BRONCHOSCOPY - At [**2194-1-3**] 02:51 PM', ' MULTI LUMEN - STOP [**2194-1-3**] 03:00 PM', 'R IJ d/c-ed']",,85230,153781.0
33,2194-01-04 10:37:13,,"['BRONCHOSCOPY - At [**2194-1-3**] 02:51 PM', ' MULTI LUMEN - STOP [**2194-1-3**] 03:00 PM', 'R IJ d/c-ed']",,85230,153781.0
34,2194-01-05 07:21:27,"['PEEP decreased to 9 overnight.', 'Lasix continued, UOP even at midnight.']","['PEEP decreased to 9 overnight.', 'Lasix continued, UOP even at midnight.']","['BRONCHOSCOPY - At [**2194-1-3**] 02:51 PM', ' MULTI LUMEN - STOP [**2194-1-3**] 03:00 PM', 'R IJ d/c-ed']",85230,153781.0
35,2194-01-05 07:22:14,,"['PEEP decreased to 9 overnight.', 'Lasix continued, UOP even at midnight.']",,85230,153781.0
36,2194-01-06 00:27:28,,"['PEEP decreased to 9 overnight.', 'Lasix continued, UOP even at midnight.']",,85230,153781.0
37,2194-01-06 07:50:27,"['-Able to wean PEEP over the course of the day, PSV had to be increased', 'overnight', '-Awake & interactive', '-Fentanyl patch started']","['-Able to wean PEEP over the course of the day, PSV had to be increased', 'overnight', '-Awake & interactive', '-Fentanyl patch started']","['PEEP decreased to 9 overnight.', 'Lasix continued, UOP even at midnight.']",85230,153781.0
38,2194-01-06 07:51:41,,"['-Able to wean PEEP over the course of the day, PSV had to be increased', 'overnight', '-Awake & interactive', '-Fentanyl patch started']",,85230,153781.0
39,2194-01-06 11:53:24,,"['-Able to wean PEEP over the course of the day, PSV had to be increased', 'overnight', '-Awake & interactive', '-Fentanyl patch started']",,85230,153781.0
40,2194-01-07 05:37:11,"['INVASIVE VENTILATION - STOP [**2194-1-6**] 09:27 AM', ' ARTERIAL LINE - STOP [**2194-1-6**] 05:15 PM', 'rt foot', 'Extubated successfully', 'Started diomox', 'd/c-ed lasix gtt', 'Speech and swallow consulted', 'nauseated']","['INVASIVE VENTILATION - STOP [**2194-1-6**] 09:27 AM', ' ARTERIAL LINE - STOP [**2194-1-6**] 05:15 PM', 'rt foot', 'Extubated successfully', 'Started diomox', 'd/c-ed lasix gtt', 'Speech and swallow consulted', 'nauseated']","['-Able to wean PEEP over the course of the day, PSV had to be increased', 'overnight', '-Awake & interactive', '-Fentanyl patch started']",85230,153781.0
41,2194-01-07 05:38:03,,"['INVASIVE VENTILATION - STOP [**2194-1-6**] 09:27 AM', ' ARTERIAL LINE - STOP [**2194-1-6**] 05:15 PM', 'rt foot', 'Extubated successfully', 'Started diomox', 'd/c-ed lasix gtt', 'Speech and swallow consulted', 'nauseated']",,85230,153781.0
42,2194-01-07 13:36:14,,"['INVASIVE VENTILATION - STOP [**2194-1-6**] 09:27 AM', ' ARTERIAL LINE - STOP [**2194-1-6**] 05:15 PM', 'rt foot', 'Extubated successfully', 'Started diomox', 'd/c-ed lasix gtt', 'Speech and swallow consulted', 'nauseated']",,85230,153781.0
0,2165-01-07 06:37:30,,"['TRANSTHORACIC ECHO - At [**2165-1-6**] 11:48 AM', ' FEVER - 103.8', 'F - [**2165-1-6**] 11:14 AM', '- Bolused on multiple occassions to keep UOP up.', '- LUE Negative for DVT', '- PM Hct slightly decreased to 28 from 30.']",,56224,188791.0
1,2165-01-07 06:45:31,,"['TRANSTHORACIC ECHO - At [**2165-1-6**] 11:48 AM', ' FEVER - 103.8', 'F - [**2165-1-6**] 11:14 AM', '- Bolused on multiple occassions to keep UOP up.', '- LUE Negative for DVT', '- PM Hct slightly decreased to 28 from 30.']",,56224,188791.0
2,2165-01-07 14:01:48,,"['TRANSTHORACIC ECHO - At [**2165-1-6**] 11:48 AM', ' FEVER - 103.8', 'F - [**2165-1-6**] 11:14 AM', '- Bolused on multiple occassions to keep UOP up.', '- LUE Negative for DVT', '- PM Hct slightly decreased to 28 from 30.']",,56224,188791.0
3,2165-01-08 06:37:14,"['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']","['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']","['TRANSTHORACIC ECHO - At [**2165-1-6**] 11:48 AM', ' FEVER - 103.8', 'F - [**2165-1-6**] 11:14 AM', '- Bolused on multiple occassions to keep UOP up.', '- LUE Negative for DVT', '- PM Hct slightly decreased to 28 from 30.']",56224,188791.0
4,2165-01-08 06:56:30,,"['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']",,56224,188791.0
5,2165-01-08 18:17:59,,"['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']",,56224,188791.0
6,2165-01-08 22:53:56,,"['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']",,56224,188791.0
7,2165-01-15 06:26:42,"['Tachycardia improved to 110s with pRBCs and IVF, but HCT continued to', 'drop despite ongoing transfusions. He also continued to have large', 'amounts of maroon liquid stool. NGT placement was planned but refused', 'by the patient. No additional peripheral access was able to be', 'obtained.', 'Given his evidence of ongoing bleeding, GI was consulted and advised a', 'PPI gtt, IV fluid, blood products, and intubation prior to any', 'endoscopy. Pt was intubated at 1:30AM, and then central access was', ""attempted at both IJ's prior to being achieved at the right femoral"", 'vein. OG lavage returned copious amounts of RB and clot. Surgery was', 'consulted in case of progressive hemorrhage.', 'The patient received a total of 4 units pRBCs overnight, without', 'appropriate bump, as well as 2 units of FFP. GI was to perform', 'endoscopy this AM.', ' INVASIVE VENTILATION - START [**2165-1-15**] 01:30 AM', 'Ventilation started @ 0130, [**2165-1-15**]', ' MULTI LUMEN - START [**2165-1-15**] 05:13 AM', ' ARTERIAL LINE - START [**2165-1-15**] 06:00 AM', ' ENDOSCOPY - At [**2165-1-15**] 06:02 AM']","['Tachycardia improved to 110s with pRBCs and IVF, but HCT continued to', 'drop despite ongoing transfusions. He also continued to have large', 'amounts of maroon liquid stool. NGT placement was planned but refused', 'by the patient. No additional peripheral access was able to be', 'obtained.', 'Given his evidence of ongoing bleeding, GI was consulted and advised a', 'PPI gtt, IV fluid, blood products, and intubation prior to any', 'endoscopy. Pt was intubated at 1:30AM, and then central access was', ""attempted at both IJ's prior to being achieved at the right femoral"", 'vein. OG lavage returned copious amounts of RB and clot. Surgery was', 'consulted in case of progressive hemorrhage.', 'The patient received a total of 4 units pRBCs overnight, without', 'appropriate bump, as well as 2 units of FFP. GI was to perform', 'endoscopy this AM.', ' INVASIVE VENTILATION - START [**2165-1-15**] 01:30 AM', 'Ventilation started @ 0130, [**2165-1-15**]', ' MULTI LUMEN - START [**2165-1-15**] 05:13 AM', ' ARTERIAL LINE - START [**2165-1-15**] 06:00 AM', ' ENDOSCOPY - At [**2165-1-15**] 06:02 AM']","['TRANSTHORACIC ECHO - At [**2165-1-7**] 01:00 PM', ""- BP dropped down to 80's systolic with ketamine at 10, decreased to 5"", '- Pt complained of nausea and received zofran']",56224,188791.0
8,2165-01-15 07:23:16,"['appropriate bump, as well as 2 units of FFP. GI is to perform endoscopy', 'this AM.']","['Tachycardia improved to 110s with pRBCs and IVF, but HCT continued to', 'drop despite ongoing transfusions. He also continued to have large', 'amounts of maroon liquid stool. NGT placement was planned but refused', 'by the patient. No additional peripheral access was able to be', 'obtained.', 'Given his evidence of ongoing bleeding, GI was consulted and advised a', 'PPI gtt, IV fluid, blood products, and intubation prior to any', 'endoscopy. Pt was intubated at 1:30AM, and then central access was', ""attempted at both IJ's prior to being achieved at the right femoral"", 'vein. OG lavage returned copious amounts of RB and clot. Surgery was', 'consulted in case of progressive hemorrhage.', 'The patient received a total of 4 units pRBCs overnight, without', 'appropriate bump, as well as 2 units of FFP. GI is to perform endoscopy', 'this AM.', ' INVASIVE VENTILATION - START [**2165-1-15**] 01:30 AM', 'Ventilation started @ 0130, [**2165-1-15**]', ' MULTI LUMEN - START [**2165-1-15**] 05:13 AM', ' ARTERIAL LINE - START [**2165-1-15**] 06:00 AM', ' ENDOSCOPY - At [**2165-1-15**] 06:02 AM']","['appropriate bump, as well as 2 units of FFP. GI was to perform', 'endoscopy this AM.']",56224,188791.0
9,2165-01-16 08:07:11,"['-- extubated on am rounds', '-- was still very sleepy (though easily arousable) during the day', '-- Hct dropped to 25.7 from 28.2 on 10 pm draw; had another maroon', 'colored stool; HD stable; transfused 1 unit RBC', ""-- was on dilaudid PCA; wasn't taking PO's overnight b/c was refusing"", 'This AM, refusing exam, angry, wants to leave']","['-- extubated on am rounds', '-- was still very sleepy (though easily arousable) during the day', '-- Hct dropped to 25.7 from 28.2 on 10 pm draw; had another maroon', 'colored stool; HD stable; transfused 1 unit RBC', ""-- was on dilaudid PCA; wasn't taking PO's overnight b/c was refusing"", 'This AM, refusing exam, angry, wants to leave']","['Tachycardia improved to 110s with pRBCs and IVF, but HCT continued to', 'drop despite ongoing transfusions. He also continued to have large', 'amounts of maroon liquid stool. NGT placement was planned but refused', 'by the patient. No additional peripheral access was able to be', 'obtained.', 'Given his evidence of ongoing bleeding, GI was consulted and advised a', 'PPI gtt, IV fluid, blood products, and intubation prior to any', 'endoscopy. Pt was intubated at 1:30AM, and then central access was', ""attempted at both IJ's prior to being achieved at the right femoral"", 'vein. OG lavage returned copious amounts of RB and clot. Surgery was', 'consulted in case of progressive hemorrhage.', 'The patient received a total of 4 units pRBCs overnight, without', 'appropriate bump, as well as 2 units of FFP. GI is to perform endoscopy', 'this AM.', ' INVASIVE VENTILATION - START [**2165-1-15**] 01:30 AM', 'Ventilation started @ 0130, [**2165-1-15**]', ' MULTI LUMEN - START [**2165-1-15**] 05:13 AM', ' ARTERIAL LINE - START [**2165-1-15**] 06:00 AM', ' ENDOSCOPY - At [**2165-1-15**] 06:02 AM']",56224,188791.0
10,2165-01-16 08:38:00,,"['-- extubated on am rounds', '-- was still very sleepy (though easily arousable) during the day', '-- Hct dropped to 25.7 from 28.2 on 10 pm draw; had another maroon', 'colored stool; HD stable; transfused 1 unit RBC', ""-- was on dilaudid PCA; wasn't taking PO's overnight b/c was refusing"", 'This AM, refusing exam, angry, wants to leave']",,56224,188791.0
0,2202-05-04 06:35:55,,[],,16088,166969.0
1,2202-05-04 10:01:58,,[],,16088,166969.0
2,2202-05-04 10:22:38,['No overnight events'],['No overnight events'],,16088,166969.0
3,2202-05-05 06:57:03,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']","['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",['No overnight events'],16088,166969.0
4,2202-05-05 07:12:46,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
5,2202-05-05 07:13:09,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
6,2202-05-05 09:14:14,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
7,2202-05-05 09:24:37,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
8,2202-05-05 09:26:08,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
9,2202-05-05 14:32:37,,"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
10,2202-05-05 14:33:36,['No overnight events'],['No overnight events'],"['EKG - At [**2202-5-4**] 09:06 AM', ' EKG - At [**2202-5-4**] 12:06 PM', ' CARDIAC CATH - At [**2202-5-4**] 01:30 PM', ' SHEATH - START [**2202-5-4**] 04:30 PM', ' SHEATH - STOP [**2202-5-4**] 07:11 PM', ' NASAL SWAB - At [**2202-5-4**] 09:31 PM', '[**5-4**]', 'Take back to cath lab...', ""*OM lesion crossed with wire but not amenable to intervention (couldn't"", 'be certain they were intraluminal)', '*BMS to LAD lesion', '*70 cc dye total', 'sheath pull at 6PM', '- post procedure chest burning in am, akin to heartburn, ekg unchanged,', 'cxr improved, enzymes improved, improved with maalox and compazine', '- became unresponsive to tactile stimulation for 30 min, pinpoint', 'pupils, ABCs intact, ABG attempted x 2 without success, VBG showed', '7.48/41/42, CXR showed worse pulmonary edema, gave Lasix 40mg IV ONCE', '- Pt became oliguric, gave another 60mg lasix IV ONCE (did not give', 'fluid because tenuous O2 requirement on NRB)', '- Pt remained anuric after 1am, no further interventions done as pt not', 'septic, and anuria prob from intravascular dehydration', 'History obtained from [**Hospital 85**] Medical records']",16088,166969.0
11,2202-05-06 07:43:06,"['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']","['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']",['No overnight events'],16088,166969.0
12,2202-05-06 07:47:49,,"['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']",,16088,166969.0
13,2202-05-06 12:50:37,,"['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']",,16088,166969.0
14,2202-05-06 15:39:57,,"['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']",,16088,166969.0
15,2202-05-07 07:20:14,"['[**5-6**]', '- IP saw plenty of fluid, but it was loculated and tricky to approach.', 'Therefore, they felt that risks of pneumo or hemothorax in light of', 'asa/plavix may outweigh risk of empyema. They still felt that empyema', 'was possible however so they said if pt spikes another fever, or white', 'count still worsening that they would return for a diagnostic [**Female First Name (un) **]', 'tomorrow (Friday)', '- renal: HD tunneled line tomorrow with IR, check c3/c4, try lasix', '120+gtt', '- stopping hep gtt at 5 am in caase IR wants to place line']","['[**5-6**]', '- IP saw plenty of fluid, but it was loculated and tricky to approach.', 'Therefore, they felt that risks of pneumo or hemothorax in light of', 'asa/plavix may outweigh risk of empyema. They still felt that empyema', 'was possible however so they said if pt spikes another fever, or white', 'count still worsening that they would return for a diagnostic [**Female First Name (un) **]', 'tomorrow (Friday)', '- renal: HD tunneled line tomorrow with IR, check c3/c4, try lasix', '120+gtt', '- stopping hep gtt at 5 am in caase IR wants to place line']","['[**5-5**]', '- BNP 78,000+', '- started ipratropium', '- anuric (5 cc, nonsterile collection) FENa = 1.8; FEUrea = 10.1, rare', '+ eos', '- 250 cc bolus + 1 unit blood, eating & drinking, BP stable held off on', 'further IVF', '- pm lytes w/ worsened renal fxn creat 2.7 -> 3.6', '- renal u/s w/ dopplers - no hydronephrosis, good blood flow to both', 'kidneys but pt unable to breath hold for exam', '- CT chest d/t concern for loc effusions & ?empyema on CXR showed:', 'bilat mod sized pleural effusions. R is dependent, L is loculated.', 'Multifocal opacity & ground glass consolidation.  Mediastinal', 'lymphadenopathy.  Enhancement of renal parenchyma, likely retained', 'contrast', '- Decided not to give furhter fluid, because was already 1.4 L positive', 'for the day.']",16088,166969.0
16,2202-05-07 07:25:01,,"['[**5-6**]', '- IP saw plenty of fluid, but it was loculated and tricky to approach.', 'Therefore, they felt that risks of pneumo or hemothorax in light of', 'asa/plavix may outweigh risk of empyema. They still felt that empyema', 'was possible however so they said if pt spikes another fever, or white', 'count still worsening that they would return for a diagnostic [**Female First Name (un) **]', 'tomorrow (Friday)', '- renal: HD tunneled line tomorrow with IR, check c3/c4, try lasix', '120+gtt', '- stopping hep gtt at 5 am in caase IR wants to place line']",,16088,166969.0
17,2202-05-07 13:40:51,,"['[**5-6**]', '- IP saw plenty of fluid, but it was loculated and tricky to approach.', 'Therefore, they felt that risks of pneumo or hemothorax in light of', 'asa/plavix may outweigh risk of empyema. They still felt that empyema', 'was possible however so they said if pt spikes another fever, or white', 'count still worsening that they would return for a diagnostic [**Female First Name (un) **]', 'tomorrow (Friday)', '- renal: HD tunneled line tomorrow with IR, check c3/c4, try lasix', '120+gtt', '- stopping hep gtt at 5 am in caase IR wants to place line']",,16088,166969.0
18,2202-05-08 06:29:40,"['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', 'History obtained from [**Hospital 85**] Medical records']","['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', 'History obtained from [**Hospital 85**] Medical records']","['[**5-6**]', '- IP saw plenty of fluid, but it was loculated and tricky to approach.', 'Therefore, they felt that risks of pneumo or hemothorax in light of', 'asa/plavix may outweigh risk of empyema. They still felt that empyema', 'was possible however so they said if pt spikes another fever, or white', 'count still worsening that they would return for a diagnostic [**Female First Name (un) **]', 'tomorrow (Friday)', '- renal: HD tunneled line tomorrow with IR, check c3/c4, try lasix', '120+gtt', '- stopping hep gtt at 5 am in caase IR wants to place line']",16088,166969.0
19,2202-05-08 06:37:18,,"['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
20,2202-05-08 10:49:15,,"['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
21,2202-05-08 11:02:46,,"['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', 'History obtained from [**Hospital 85**] Medical records']",,16088,166969.0
22,2202-05-09 06:44:21,"['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']","['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']","['BLOOD CULTURED - At [**2202-5-7**] 11:49 AM', ' URINE CULTURE - At [**2202-5-7**] 11:49 AM', 'History obtained from [**Hospital 85**] Medical records']",16088,166969.0
23,2202-05-09 11:48:26,,"['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']",,16088,166969.0
24,2202-05-09 12:11:59,,"['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']",,16088,166969.0
25,2202-05-09 12:58:34,,"['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']",,16088,166969.0
26,2202-05-10 06:54:08,"['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']",16088,166969.0
27,2202-05-10 07:00:35,,"['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']",,16088,166969.0
28,2202-05-10 08:12:29,"['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']","['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']",16088,166969.0
29,2202-05-10 10:35:16,"['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-8**]', '- restarted warfarin, [**Month (only) 38**] asa to 81 mg', '- went back to 2g Na diet per renal recs', '- pm creatinine from 5.7 to 6.5', '[**5-7**]', '- Na noted to be dropping, SCr rising on PM labs; Lasix infusion and', 'metolazone held', '- heparin gtt restarted', ' EKG - At [**2202-5-8**] 08:00 PM', ' EKG - At [**2202-5-9**] 04:30 AM']",16088,166969.0
30,2202-05-11 07:41:15,"['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']",16088,166969.0
31,2202-05-11 07:47:06,,"['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']",,16088,166969.0
32,2202-05-11 10:41:58,"['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']",16088,166969.0
33,2202-05-11 10:49:16,"['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**5-9**]', '- renal: hyponatremia is ATN, free water excess, no role for ADH', 'receptor antagonist at this time', '- got zolpidem 2.5 mg for restless leg syndrome']",16088,166969.0
34,2202-05-12 07:36:57,"['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']",16088,166969.0
35,2202-05-12 07:45:46,,"['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']",,16088,166969.0
36,2202-05-12 09:10:18,"['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']",16088,166969.0
37,2202-05-12 13:08:18,"['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['[**5-10**]', '- renal: hyponatremia may be multifactorial (ATN, free water excess).', 'No role for ADH receptor antagonist at this time. Would continue to', 'trend Na; would not use hypertonic saline unless clear symptoms.']",16088,166969.0
38,2202-05-12 13:18:22,,"['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']",,16088,166969.0
39,2202-05-13 07:07:42,"['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']","['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']",16088,166969.0
40,2202-05-13 07:17:56,,"['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']",,16088,166969.0
41,2202-05-13 12:17:02,"['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']","['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']",16088,166969.0
42,2202-05-13 14:15:24,"['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']","['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']","['[**Date range (1) 12146**]', '- Renal - would not start hypertonic saline, trend Na', '- started [**1-30**] home Imdur dose', '- passed a tablespoon-sized blood clot in the evening', '- Hct came back as 22 (from 27)', '- a.m. [**5-12**] made diet high protein', '- Stopped heparin']",16088,166969.0
43,2202-05-13 14:54:29,,"['PICC LINE - START [**2202-5-12**] 06:00 PM', 'left brachial', '[**5-12**]/-[**5-13**]', '- 1 unit of RBCs transfused without trouble breathing', '- got PICC placed']",,16088,166969.0
0,2114-12-27 07:38:55,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
1,2114-12-27 08:00:20,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
2,2114-12-27 09:58:19,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
3,2114-12-27 09:58:40,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
4,2114-12-27 09:59:35,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
5,2114-12-27 12:42:30,,"['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",,3145,169807.0
6,2114-12-28 07:33:04,"['- D/cd Antibioitcs which were empiric for CAP, but afebrile with normal', 'WBC', '- Receive IV Vitamin K x1', '- Started Cipro empirically per liver for mildly positive UA', '- Repeat Hct stable 26.3 < 24.2 < 25.6. Did not give FFP because Hct', 'stable (which liver had advised earlier in the day)', '- Worsening hypoxemia around 1600. CXR appeared more volume overloaded.', 'Received lasix 20 mg IV x3 with brisk response but continue to be more', 'Hypoxic. Intubated around 10 pm with sats in 70s.', '- Hypotensive to SBP 70s-80s post intubation. Started levophed to limit', 'fluid over-resusication', '- Rising lactate 4.4 > 5.5. Did not give fluids becuase appears', 'overloaded and worsening oxygenation.', 'History obtained from Medical records']","['- D/cd Antibioitcs which were empiric for CAP, but afebrile with normal', 'WBC', '- Receive IV Vitamin K x1', '- Started Cipro empirically per liver for mildly positive UA', '- Repeat Hct stable 26.3 < 24.2 < 25.6. Did not give FFP because Hct', 'stable (which liver had advised earlier in the day)', '- Worsening hypoxemia around 1600. CXR appeared more volume overloaded.', 'Received lasix 20 mg IV x3 with brisk response but continue to be more', 'Hypoxic. Intubated around 10 pm with sats in 70s.', '- Hypotensive to SBP 70s-80s post intubation. Started levophed to limit', 'fluid over-resusication', '- Rising lactate 4.4 > 5.5. Did not give fluids becuase appears', 'overloaded and worsening oxygenation.', 'History obtained from Medical records']","['- MELD 27', '- Liver consult: stop prednisone, albumin challenge, NGT with TFs,', 'check AFP, GGT, IGG, [**Last Name (un) 5861**], hep C viral load', '- CT chest: volume overload, intraperitoneal hemorrhage likely from', 'paracentesis', '- Bladder pressure 17', '- levophed weaned', '- had hct drop 35 -> 27.8 -> 26.5. Got 5mg vit K.', '- Son [**Name (NI) 4857**] takes care of [**Known firstname 845**] [**Known lastname 11267**] for the past 6 months or so', 'given worsening mental status.  He noticed that she was drinking 1', 'liter of vodka per day.  He forced her to stop and then after that she', 'was drinking 3-4 beers per day.  She had a male friend that would', 'provide her with klonopin 2mg pills (5 pills at a time).  She was only', 'drinking beer and taking klonopin but not eating any other food or', 'leaving her bed.  The son then left for two days after getting into a', ""fight with his mother's male friend for one day and then his mother's"", 'friend stated that she was becoming more jaundice and was brought to', 'the hospital.', '-per son the only medication is metformin', '-per son she is currently full code but will come in for a meeting w/', 'the medical team tomorrow [**12-27**].  He also requests if she improves that', 'she has a prolonged 3 month inpt stay somewhere to prevent her from', 'drinking ETOH.', '-SW consult ordered- son would like to talk to SW when he comes in', 'tomorrow.', '-[**Known firstname 11268**] friend is ""[**Name2 (NI) **]"" and we should not provide him w/ any medical', 'information.  If [**Doctor Last Name **] comes to see him we should have security search', 'him for substances prior to his visit.', 'History obtained from Patient, Family / [**Hospital 56**] Medical records']",3145,169807.0
7,2114-12-28 09:25:31,,"['- D/cd Antibioitcs which were empiric for CAP, but afebrile with normal', 'WBC', '- Receive IV Vitamin K x1', '- Started Cipro empirically per liver for mildly positive UA', '- Repeat Hct stable 26.3 < 24.2 < 25.6. Did not give FFP because Hct', 'stable (which liver had advised earlier in the day)', '- Worsening hypoxemia around 1600. CXR appeared more volume overloaded.', 'Received lasix 20 mg IV x3 with brisk response but continue to be more', 'Hypoxic. Intubated around 10 pm with sats in 70s.', '- Hypotensive to SBP 70s-80s post intubation. Started levophed to limit', 'fluid over-resusication', '- Rising lactate 4.4 > 5.5. Did not give fluids becuase appears', 'overloaded and worsening oxygenation.', 'History obtained from Medical records']",,3145,169807.0
8,2114-12-29 08:00:55,"['BLOOD CULTURED - At [**2114-12-28**] 09:18 AM', 'blood cultures drawn from femoral CVL', ' SPUTUM CULTURE - At [**2114-12-28**] 10:00 AM', ' BLOOD CULTURED - At [**2114-12-28**] 10:00 AM', 'blood cultures drawn from PICC', ' URINE CULTURE - At [**2114-12-28**] 10:20 AM', ' ESOPHOGEAL BALLOON - At [**2114-12-28**] 02:30 PM', '-patient hypotensive requiring max dose levophed and vasopressin, as', 'well as intermittent neosynephrine', '-hydrocortisone 50mg IV q6hrs started (serving dual purpose for alcohol', 'hepatitis and as stress dose steroids)', '-given hypotension patient pan-cultured and started on broad spectrum', 'antibiotics', '-respiratory viral screen negative', '-50g albumin given', '-CVO2 75%', '-Rifaximin started', '-lactulose uptitrated - pt had 1 BM, started dulcolax and senna', '-Esophageal balloon placed, PEEP uptitrated to 22', '-hct relatively stable', '-insulin drip initiated', '-Vigileo initiated, Stroke volume variation 13- 1L fluid challenege, no', 'change in BP, over course of night SVV increased to 19.  Gave 1L IVF', 'and 25g of albumin in 500cc.', '-attempted calling son x 2 overnight given worsening clinical status', '-Additional 500cc bolus NS given and 50g IV albumin ordered', '-ABG 7.14 / 39 / 140 on AC 400 x 30- breathing at a rate of 35 and w/', 'tidal volumes of 500.  RR increased to 36, and pt breathing at 40 after', 'this.  PaO2 140, PEEP 25, FiO2 100%.  2 amps of bicarb given.', '-patient dysynchronous w/ the ventilator despite 70 of propofol and', '150mcg of fentanyl.  Unresponsive.', 'Peak pressures increasing to low', '40s (previously mid / low 30s) and unable to control PCO2 / normalize', 'pH- decision made to paralyze.']","['BLOOD CULTURED - At [**2114-12-28**] 09:18 AM', 'blood cultures drawn from femoral CVL', ' SPUTUM CULTURE - At [**2114-12-28**] 10:00 AM', ' BLOOD CULTURED - At [**2114-12-28**] 10:00 AM', 'blood cultures drawn from PICC', ' URINE CULTURE - At [**2114-12-28**] 10:20 AM', ' ESOPHOGEAL BALLOON - At [**2114-12-28**] 02:30 PM', '-patient hypotensive requiring max dose levophed and vasopressin, as', 'well as intermittent neosynephrine', '-hydrocortisone 50mg IV q6hrs started (serving dual purpose for alcohol', 'hepatitis and as stress dose steroids)', '-given hypotension patient pan-cultured and started on broad spectrum', 'antibiotics', '-respiratory viral screen negative', '-50g albumin given', '-CVO2 75%', '-Rifaximin started', '-lactulose uptitrated - pt had 1 BM, started dulcolax and senna', '-Esophageal balloon placed, PEEP uptitrated to 22', '-hct relatively stable', '-insulin drip initiated', '-Vigileo initiated, Stroke volume variation 13- 1L fluid challenege, no', 'change in BP, over course of night SVV increased to 19.  Gave 1L IVF', 'and 25g of albumin in 500cc.', '-attempted calling son x 2 overnight given worsening clinical status', '-Additional 500cc bolus NS given and 50g IV albumin ordered', '-ABG 7.14 / 39 / 140 on AC 400 x 30- breathing at a rate of 35 and w/', 'tidal volumes of 500.  RR increased to 36, and pt breathing at 40 after', 'this.  PaO2 140, PEEP 25, FiO2 100%.  2 amps of bicarb given.', '-patient dysynchronous w/ the ventilator despite 70 of propofol and', '150mcg of fentanyl.  Unresponsive.', 'Peak pressures increasing to low', '40s (previously mid / low 30s) and unable to control PCO2 / normalize', 'pH- decision made to paralyze.']","['- D/cd Antibioitcs which were empiric for CAP, but afebrile with normal', 'WBC', '- Receive IV Vitamin K x1', '- Started Cipro empirically per liver for mildly positive UA', '- Repeat Hct stable 26.3 < 24.2 < 25.6. Did not give FFP because Hct', 'stable (which liver had advised earlier in the day)', '- Worsening hypoxemia around 1600. CXR appeared more volume overloaded.', 'Received lasix 20 mg IV x3 with brisk response but continue to be more', 'Hypoxic. Intubated around 10 pm with sats in 70s.', '- Hypotensive to SBP 70s-80s post intubation. Started levophed to limit', 'fluid over-resusication', '- Rising lactate 4.4 > 5.5. Did not give fluids becuase appears', 'overloaded and worsening oxygenation.', 'History obtained from Medical records']",3145,169807.0
9,2114-12-29 09:10:42,,"['BLOOD CULTURED - At [**2114-12-28**] 09:18 AM', 'blood cultures drawn from femoral CVL', ' SPUTUM CULTURE - At [**2114-12-28**] 10:00 AM', ' BLOOD CULTURED - At [**2114-12-28**] 10:00 AM', 'blood cultures drawn from PICC', ' URINE CULTURE - At [**2114-12-28**] 10:20 AM', ' ESOPHOGEAL BALLOON - At [**2114-12-28**] 02:30 PM', '-patient hypotensive requiring max dose levophed and vasopressin, as', 'well as intermittent neosynephrine', '-hydrocortisone 50mg IV q6hrs started (serving dual purpose for alcohol', 'hepatitis and as stress dose steroids)', '-given hypotension patient pan-cultured and started on broad spectrum', 'antibiotics', '-respiratory viral screen negative', '-50g albumin given', '-CVO2 75%', '-Rifaximin started', '-lactulose uptitrated - pt had 1 BM, started dulcolax and senna', '-Esophageal balloon placed, PEEP uptitrated to 22', '-hct relatively stable', '-insulin drip initiated', '-Vigileo initiated, Stroke volume variation 13- 1L fluid challenege, no', 'change in BP, over course of night SVV increased to 19.  Gave 1L IVF', 'and 25g of albumin in 500cc.', '-attempted calling son x 2 overnight given worsening clinical status', '-Additional 500cc bolus NS given and 50g IV albumin ordered', '-ABG 7.14 / 39 / 140 on AC 400 x 30- breathing at a rate of 35 and w/', 'tidal volumes of 500.  RR increased to 36, and pt breathing at 40 after', 'this.  PaO2 140, PEEP 25, FiO2 100%.  2 amps of bicarb given.', '-patient dysynchronous w/ the ventilator despite 70 of propofol and', '150mcg of fentanyl.  Unresponsive.', 'Peak pressures increasing to low', '40s (previously mid / low 30s) and unable to control PCO2 / normalize', 'pH- decision made to paralyze.']",,3145,169807.0
0,2111-08-14 06:35:10,,"['PA CATHETER - START [**2111-8-13**] 05:59 PM', ' ARTERIAL LINE - START [**2111-8-13**] 06:00 PM', ' PA CATHETER - STOP [**2111-8-13**] 07:00 PM', ' CORDIS/INTRODUCER - START [**2111-8-13**] 07:00 PM', 'patient has cordis when she came from PACU', 'Patient was not fully sedated overnight, in early am was agitated and', 'indicating she wanted to be extubated, clamped down on ET tube and', ""desatted to 68.  Quickly returned to 90's after event.""]",,29817,162936.0
1,2111-08-14 06:39:47,,"['PA CATHETER - START [**2111-8-13**] 05:59 PM', ' ARTERIAL LINE - START [**2111-8-13**] 06:00 PM', ' PA CATHETER - STOP [**2111-8-13**] 07:00 PM', ' CORDIS/INTRODUCER - START [**2111-8-13**] 07:00 PM', 'patient has cordis when she came from PACU', 'Patient was not fully sedated overnight, in early am was agitated and', 'indicating she wanted to be extubated, clamped down on ET tube and', ""desatted to 68.  Quickly returned to 90's after event.""]",,29817,162936.0
2,2111-08-14 11:49:06,['Extubated this AM without difficulty'],"['PA CATHETER - START [**2111-8-13**] 05:59 PM', ' ARTERIAL LINE - START [**2111-8-13**] 06:00 PM', ' PA CATHETER - STOP [**2111-8-13**] 07:00 PM', ' CORDIS/INTRODUCER - START [**2111-8-13**] 07:00 PM', 'patient has cordis when she came from PACU', 'Patient was not fully sedated overnight, in early am was agitated and', 'indicating she wanted to be extubated, clamped down on ET tube and', ""desatted to 68.  Quickly returned to 90's after event."", 'Extubated this AM without difficulty']",,29817,162936.0
3,2111-08-15 13:09:56,"['ARTERIAL LINE - STOP [**2111-8-14**] 02:30 PM', ' CORDIS/INTRODUCER - STOP [**2111-8-15**] 05:15 AM', 'T max of 100.4 overnight. Cultured.', 'NG placed. Drained 500cc bilious fluid. Self-d/ced due to discomfort.', '+ liquid stool and gas. PRN bowel regimen.', ' CALLED OUT']","['ARTERIAL LINE - STOP [**2111-8-14**] 02:30 PM', ' CORDIS/INTRODUCER - STOP [**2111-8-15**] 05:15 AM', 'patient has cordis when she came from PACU', 'T max of 100.4 overnight. Cultured.', 'NG placed. Drained 500cc bilious fluid. Self-d/ced due to discomfort.', '+ liquid stool and gas. PRN bowel regimen.', ' CALLED OUT']","['PA CATHETER - START [**2111-8-13**] 05:59 PM', ' ARTERIAL LINE - START [**2111-8-13**] 06:00 PM', ' PA CATHETER - STOP [**2111-8-13**] 07:00 PM', ' CORDIS/INTRODUCER - START [**2111-8-13**] 07:00 PM', 'Patient was not fully sedated overnight, in early am was agitated and', 'indicating she wanted to be extubated, clamped down on ET tube and', ""desatted to 68.  Quickly returned to 90's after event."", 'Extubated this AM without difficulty']",29817,162936.0
0,2159-05-05 06:22:49,,"['EKG - At [**2159-5-4**] 02:00 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:25 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:34 PM', ' URINE CULTURE - At [**2159-5-4**] 04:34 PM', ' MULTI LUMEN - START [**2159-5-4**] 05:36 PM', '.', '- urology requested pulling epidural catheter which was done', '- having ongoing pain, uptitrated IV dilaudid prn', '- no further episodes of hypotension, making good urine', '- CVP 6', '- more confused, ABG 7.44/56/36 on 3L-->increased to 5L NC']",,44768,169033.0
1,2159-05-05 06:32:18,,"['EKG - At [**2159-5-4**] 02:00 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:25 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:34 PM', ' URINE CULTURE - At [**2159-5-4**] 04:34 PM', ' MULTI LUMEN - START [**2159-5-4**] 05:36 PM', '.', '- urology requested pulling epidural catheter which was done', '- having ongoing pain, uptitrated IV dilaudid prn', '- no further episodes of hypotension, making good urine', '- CVP 6', '- more confused, ABG 7.44/56/36 on 3L-->increased to 5L NC']",,44768,169033.0
2,2159-05-05 07:53:06,"['- more confused, O2 Sats 88%, ABG 7.44/56/36 on 3L-->increased to 6L', 'NC', 'less confused']","['EKG - At [**2159-5-4**] 02:00 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:25 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:34 PM', ' URINE CULTURE - At [**2159-5-4**] 04:34 PM', ' MULTI LUMEN - START [**2159-5-4**] 05:36 PM', '.', '- urology requested pulling epidural catheter which was done', '- having ongoing pain, uptitrated IV dilaudid prn', '- no further episodes of hypotension, making good urine', '- CVP 6', '- more confused, O2 Sats 88%, ABG 7.44/56/36 on 3L-->increased to 6L', 'NC', 'less confused']","['- more confused, ABG 7.44/56/36 on 3L-->increased to 5L NC']",44768,169033.0
3,2159-05-05 10:51:03,,"['EKG - At [**2159-5-4**] 02:00 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:25 PM', ' BLOOD CULTURED - At [**2159-5-4**] 04:34 PM', ' URINE CULTURE - At [**2159-5-4**] 04:34 PM', ' MULTI LUMEN - START [**2159-5-4**] 05:36 PM', '.', '- urology requested pulling epidural catheter which was done', '- having ongoing pain, uptitrated IV dilaudid prn', '- no further episodes of hypotension, making good urine', '- CVP 6', '- more confused, O2 Sats 88%, ABG 7.44/56/36 on 3L-->increased to 6L', 'NC', 'less confused']",,44768,169033.0
0,2144-01-29 07:04:48,,"['INDWELLING PORT (PORTACATH) - START [**2144-1-28**] 09:00 PM', ' MULTI LUMEN - START [**2144-1-28**] 09:38 PM', ' NASAL SWAB - At [**2144-1-28**] 11:04 PM']",,97437,122767.0
1,2144-01-29 07:06:35,,"['INDWELLING PORT (PORTACATH) - START [**2144-1-28**] 09:00 PM', ' MULTI LUMEN - START [**2144-1-28**] 09:38 PM', ' NASAL SWAB - At [**2144-1-28**] 11:04 PM']",,97437,122767.0
2,2144-01-29 07:16:18,,[],"['INDWELLING PORT (PORTACATH) - START [**2144-1-28**] 09:00 PM', ' MULTI LUMEN - START [**2144-1-28**] 09:38 PM', ' NASAL SWAB - At [**2144-1-28**] 11:04 PM']",97437,122767.0
3,2144-01-29 11:43:41,,[],,97437,122767.0
4,2144-01-30 07:45:18,"['[**2144-1-29**]:', '- GI consult thought possibly ischemic colitis, lactate only 2.2, had', 'no more bloody BM (had one liquid BM, unable to send), ab exam stable', '- went into new onset AF with RVR in afternoon', '- had low BPs, responded well to IVF, CVP was 3', '- d/w Dr. [**Last Name (STitle) 12540**] and [**First Name4 (NamePattern1) 965**] [**Last Name (NamePattern1) **] (onc team), they are aware of his', 'course and will try to stop by tomorrow', '- pt needs discussion of code status, daughter [**Name (NI) **] has tried with', 'Dr. [**First Name (STitle) **] before, but patient refused to talk about it, SW c/s placed', '- surveillance blood cx drawn peripherally and from [**Last Name (LF) 9279**], [**First Name3 (LF) **] not', 'remove [**First Name3 (LF) 9279**] unless more evidence of infection (currently only 1 of', '2 sets, 2/2 bottles growing CoNS)', '- KUB done, no read yet but distended bowel, no air-fluid levels', '- if need more cards hx, cardiologist is [**First Name8 (NamePattern2) 1046**] [**Last Name (NamePattern1) 12541**] [**Telephone/Fax (1) 12542**]']","['[**2144-1-29**]:', '- GI consult thought possibly ischemic colitis, lactate only 2.2, had', 'no more bloody BM (had one liquid BM, unable to send), ab exam stable', '- went into new onset AF with RVR in afternoon', '- had low BPs, responded well to IVF, CVP was 3', '- d/w Dr. [**Last Name (STitle) 12540**] and [**First Name4 (NamePattern1) 965**] [**Last Name (NamePattern1) **] (onc team), they are aware of his', 'course and will try to stop by tomorrow', '- pt needs discussion of code status, daughter [**Name (NI) **] has tried with', 'Dr. [**First Name (STitle) **] before, but patient refused to talk about it, SW c/s placed', '- surveillance blood cx drawn peripherally and from [**Last Name (LF) 9279**], [**First Name3 (LF) **] not', 'remove [**First Name3 (LF) 9279**] unless more evidence of infection (currently only 1 of', '2 sets, 2/2 bottles growing CoNS)', '- KUB done, no read yet but distended bowel, no air-fluid levels', '- if need more cards hx, cardiologist is [**First Name8 (NamePattern2) 1046**] [**Last Name (NamePattern1) 12541**] [**Telephone/Fax (1) 12542**]']",,97437,122767.0
5,2144-01-30 07:52:51,,"['[**2144-1-29**]:', '- GI consult thought possibly ischemic colitis, lactate only 2.2, had', 'no more bloody BM (had one liquid BM, unable to send), ab exam stable', '- went into new onset AF with RVR in afternoon', '- had low BPs, responded well to IVF, CVP was 3', '- d/w Dr. [**Last Name (STitle) 12540**] and [**First Name4 (NamePattern1) 965**] [**Last Name (NamePattern1) **] (onc team), they are aware of his', 'course and will try to stop by tomorrow', '- pt needs discussion of code status, daughter [**Name (NI) **] has tried with', 'Dr. [**First Name (STitle) **] before, but patient refused to talk about it, SW c/s placed', '- surveillance blood cx drawn peripherally and from [**Last Name (LF) 9279**], [**First Name3 (LF) **] not', 'remove [**First Name3 (LF) 9279**] unless more evidence of infection (currently only 1 of', '2 sets, 2/2 bottles growing CoNS)', '- KUB done, no read yet but distended bowel, no air-fluid levels', '- if need more cards hx, cardiologist is [**First Name8 (NamePattern2) 1046**] [**Last Name (NamePattern1) 12541**] [**Telephone/Fax (1) 12542**]']",,97437,122767.0
6,2144-01-30 13:32:32,,"['[**2144-1-29**]:', '- GI consult thought possibly ischemic colitis, lactate only 2.2, had', 'no more bloody BM (had one liquid BM, unable to send), ab exam stable', '- went into new onset AF with RVR in afternoon', '- had low BPs, responded well to IVF, CVP was 3', '- d/w Dr. [**Last Name (STitle) 12540**] and [**First Name4 (NamePattern1) 965**] [**Last Name (NamePattern1) **] (onc team), they are aware of his', 'course and will try to stop by tomorrow', '- pt needs discussion of code status, daughter [**Name (NI) **] has tried with', 'Dr. [**First Name (STitle) **] before, but patient refused to talk about it, SW c/s placed', '- surveillance blood cx drawn peripherally and from [**Last Name (LF) 9279**], [**First Name3 (LF) **] not', 'remove [**First Name3 (LF) 9279**] unless more evidence of infection (currently only 1 of', '2 sets, 2/2 bottles growing CoNS)', '- KUB done, no read yet but distended bowel, no air-fluid levels', '- if need more cards hx, cardiologist is [**First Name8 (NamePattern2) 1046**] [**Last Name (NamePattern1) 12541**] [**Telephone/Fax (1) 12542**]']",,97437,122767.0
0,2130-12-24 07:32:33,,"['- per EP, 900 mg of amio over 12 hours, then 300 mg of amio over ~10', 'hours, then will decide how to proceed with antiarrhythmic therapy', '- changed BB from carvedilol to metoprolol to allow room for', 'uptitration', '- sedation/anxiety relief with ativan prn', '- length between VT episodes gradually increased to several hours', 'separating episodes']",,65393,109702.0
1,2130-12-24 08:16:01,,"['- per EP, 900 mg of amio over 12 hours, then 300 mg of amio over ~10', 'hours, then will decide how to proceed with antiarrhythmic therapy', '- changed BB from carvedilol to metoprolol to allow room for', 'uptitration', '- sedation/anxiety relief with ativan prn', '- length between VT episodes gradually increased to several hours', 'separating episodes']",,65393,109702.0
2,2130-12-24 10:37:36,,"['- per EP, 900 mg of amio over 12 hours, then 300 mg of amio over ~10', 'hours, then will decide how to proceed with antiarrhythmic therapy', '- changed BB from carvedilol to metoprolol to allow room for', 'uptitration', '- sedation/anxiety relief with ativan prn', '- length between VT episodes gradually increased to several hours', 'separating episodes']",,65393,109702.0
3,2130-12-25 06:55:45,"['- Amiodarone dose increased to 1.25mg/min  x 10 hrs and then dropped to', '0.5 mg until 7am Sunday. Restarted on 0.5 mg later in morning-but again', '[**6-14**] successive episiodes', 'of VT shocked out from ICD- so rebolused w', '150 mg and increased gtt to 1 mg/hr [**12-24**] Sunday.  Plan for EPS', 'Tuesday.  EP fellow was aware.', '- valium 5mg Q12, then increased Metoprolol to 75mg TID.', '- NPO at midnight for EP study on tuesday.']","['- Amiodarone dose increased to 1.25mg/min  x 10 hrs and then dropped to', '0.5 mg until 7am Sunday. Restarted on 0.5 mg later in morning-but again', '[**6-14**] successive episiodes', 'of VT shocked out from ICD- so rebolused w', '150 mg and increased gtt to 1 mg/hr [**12-24**] Sunday.  Plan for EPS', 'Tuesday.  EP fellow was aware.', '- valium 5mg Q12, then increased Metoprolol to 75mg TID.', '- NPO at midnight for EP study on tuesday.']","['- per EP, 900 mg of amio over 12 hours, then 300 mg of amio over ~10', 'hours, then will decide how to proceed with antiarrhythmic therapy', '- changed BB from carvedilol to metoprolol to allow room for', 'uptitration', '- sedation/anxiety relief with ativan prn', '- length between VT episodes gradually increased to several hours', 'separating episodes']",65393,109702.0
4,2130-12-25 06:57:01,,"['- Amiodarone dose increased to 1.25mg/min  x 10 hrs and then dropped to', '0.5 mg until 7am Sunday. Restarted on 0.5 mg later in morning-but again', '[**6-14**] successive episiodes', 'of VT shocked out from ICD- so rebolused w', '150 mg and increased gtt to 1 mg/hr [**12-24**] Sunday.  Plan for EPS', 'Tuesday.  EP fellow was aware.', '- valium 5mg Q12, then increased Metoprolol to 75mg TID.', '- NPO at midnight for EP study on tuesday.']",,65393,109702.0
5,2130-12-26 06:37:55,,"['- Amiodarone dose increased to 1.25mg/min  x 10 hrs and then dropped to', '0.5 mg until 7am Sunday. Restarted on 0.5 mg later in morning-but again', '[**6-14**] successive episiodes', 'of VT shocked out from ICD- so rebolused w', '150 mg and increased gtt to 1 mg/hr [**12-24**] Sunday.  Plan for EPS', 'Tuesday.  EP fellow was aware.', '- valium 5mg Q12, then increased Metoprolol to 75mg TID.', '- NPO at midnight for EP study on tuesday.']",,65393,109702.0
6,2130-12-26 07:27:08,"['- around 9PM - VT runs to 140s, shocked x 11, re-amio loaded, drip to', '1, Lidocaine boluses x 2, on lido drio EP came in, increased threshold', 'to 160']","['- around 9PM - VT runs to 140s, shocked x 11, re-amio loaded, drip to', '1, Lidocaine boluses x 2, on lido drio EP came in, increased threshold', 'to 160']","['- Amiodarone dose increased to 1.25mg/min  x 10 hrs and then dropped to', '0.5 mg until 7am Sunday. Restarted on 0.5 mg later in morning-but again', '[**6-14**] successive episiodes', 'of VT shocked out from ICD- so rebolused w', '150 mg and increased gtt to 1 mg/hr [**12-24**] Sunday.  Plan for EPS', 'Tuesday.  EP fellow was aware.', '- valium 5mg Q12, then increased Metoprolol to 75mg TID.', '- NPO at midnight for EP study on tuesday.']",65393,109702.0
7,2130-12-26 11:49:30,,"['- around 9PM - VT runs to 140s, shocked x 11, re-amio loaded, drip to', '1, Lidocaine boluses x 2, on lido drio EP came in, increased threshold', 'to 160']",,65393,109702.0
8,2130-12-26 15:33:14,,"['- around 9PM - VT runs to 140s, shocked x 11, re-amio loaded, drip to', '1, Lidocaine boluses x 2, on lido drio EP came in, increased threshold', 'to 160']",,65393,109702.0
9,2130-12-27 07:18:19,"['- shocked x 2 this AM, intubated and intra-aortic balloon pump was', 'placed to try to decrease LV work', '- ultimate plan after discussion with Drs. [**Name5 (PTitle) 2830**] & [**Doctor Last Name **] is to tx', 'to [**Hospital1 586**] for heart transplant when stable', '- shocked x 3 this PM, dopamine stopped and switched to phenylephrine', 'for pressure support']","['- shocked x 2 this AM, intubated and intra-aortic balloon pump was', 'placed to try to decrease LV work', '- ultimate plan after discussion with Drs. [**Name5 (PTitle) 2830**] & [**Doctor Last Name **] is to tx', 'to [**Hospital1 586**] for heart transplant when stable', '- shocked x 3 this PM, dopamine stopped and switched to phenylephrine', 'for pressure support']","['- around 9PM - VT runs to 140s, shocked x 11, re-amio loaded, drip to', '1, Lidocaine boluses x 2, on lido drio EP came in, increased threshold', 'to 160']",65393,109702.0
10,2130-12-27 09:57:21,,"['- shocked x 2 this AM, intubated and intra-aortic balloon pump was', 'placed to try to decrease LV work', '- ultimate plan after discussion with Drs. [**Name5 (PTitle) 2830**] & [**Doctor Last Name **] is to tx', 'to [**Hospital1 586**] for heart transplant when stable', '- shocked x 3 this PM, dopamine stopped and switched to phenylephrine', 'for pressure support']",,65393,109702.0
0,2186-07-02 07:06:15,,"['PICC LINE - START [**2186-7-1**] 04:00 PM', 'L brachial', ' MULTI LUMEN - START [**2186-7-1**] 04:00 PM', 'inserted in ED', ' INVASIVE VENTILATION - START [**2186-7-1**] 04:15 PM', ' PICC LINE - STOP [**2186-7-1**] 07:30 PM', 'L brachial', ' ARTERIAL LINE - START [**2186-7-1**] 07:30 PM', ' URINE CULTURE - At [**2186-7-1**] 09:27 PM']",,31692,116133.0
1,2186-07-02 07:09:49,,"['PICC LINE - START [**2186-7-1**] 04:00 PM', 'L brachial', ' MULTI LUMEN - START [**2186-7-1**] 04:00 PM', 'inserted in ED', ' INVASIVE VENTILATION - START [**2186-7-1**] 04:15 PM', ' PICC LINE - STOP [**2186-7-1**] 07:30 PM', 'L brachial', ' ARTERIAL LINE - START [**2186-7-1**] 07:30 PM', ' URINE CULTURE - At [**2186-7-1**] 09:27 PM']",,31692,116133.0
2,2186-07-02 11:41:14,"['L radial A-line placed, d/c', 'd L brachial midline', 'Has had persistently poor oxygenation and ventilation, with escalating', 'FiO2 and pressure support; changed to PSV 18/10/100% - on these', 'settings, O2sat 86-96%, Vt 550-700, RR 19-22, 7.21/87/85/28']","['L radial A-line placed, d/c', 'd L brachial midline', 'Has had persistently poor oxygenation and ventilation, with escalating', 'FiO2 and pressure support; changed to PSV 18/10/100% - on these', 'settings, O2sat 86-96%, Vt 550-700, RR 19-22, 7.21/87/85/28']","['PICC LINE - START [**2186-7-1**] 04:00 PM', 'L brachial', ' MULTI LUMEN - START [**2186-7-1**] 04:00 PM', 'inserted in ED', ' INVASIVE VENTILATION - START [**2186-7-1**] 04:15 PM', ' PICC LINE - STOP [**2186-7-1**] 07:30 PM', 'L brachial', ' ARTERIAL LINE - START [**2186-7-1**] 07:30 PM', ' URINE CULTURE - At [**2186-7-1**] 09:27 PM']",31692,116133.0
3,2186-07-02 12:02:53,,"['L radial A-line placed, d/c', 'd L brachial midline', 'Has had persistently poor oxygenation and ventilation, with escalating', 'FiO2 and pressure support; changed to PSV 18/10/100% - on these', 'settings, O2sat 86-96%, Vt 550-700, RR 19-22, 7.21/87/85/28']",,31692,116133.0
0,2193-01-13 06:11:43,,"['- Patient informed about cocaine positivity - upset and in denial.', 'Eventually calmers', ""- given 500cc bolus for BP in low 80's"", 'History obtained from [**Hospital 19**] Medical records']",,48693,105902.0
1,2193-01-13 09:28:39,,"['- Patient informed about cocaine positivity - upset and in denial.', 'Eventually calmers', ""- given 500cc bolus for BP in low 80's"", 'History obtained from [**Hospital 19**] Medical records']",,48693,105902.0
2,2193-01-13 09:32:25,,"['- Patient informed about cocaine positivity - upset and in denial.', 'Eventually calmers', ""- given 500cc bolus for BP in low 80's"", 'History obtained from [**Hospital 19**] Medical records']",,48693,105902.0
3,2193-01-14 06:10:18,"['- started dilt and ACEI, but sBP ranged from 70s-100s and HR 60s-70s,', 'so dilt was held, ACEI continued', '- s/p 500cc NS for hypotension, sBP around 100 afterwards', '- was going to be called out, but due to hypotension pt stayed in CCU']","['- started dilt and ACEI, but sBP ranged from 70s-100s and HR 60s-70s,', 'so dilt was held, ACEI continued', '- s/p 500cc NS for hypotension, sBP around 100 afterwards', '- was going to be called out, but due to hypotension pt stayed in CCU']","['- Patient informed about cocaine positivity - upset and in denial.', 'Eventually calmers', ""- given 500cc bolus for BP in low 80's"", 'History obtained from [**Hospital 19**] Medical records']",48693,105902.0
4,2193-01-14 07:42:10,,"['- started dilt and ACEI, but sBP ranged from 70s-100s and HR 60s-70s,', 'so dilt was held, ACEI continued', '- s/p 500cc NS for hypotension, sBP around 100 afterwards', '- was going to be called out, but due to hypotension pt stayed in CCU']",,48693,105902.0
5,2193-01-14 09:39:58,"['- pt states her BP has always been running low, sBP in the 80s', '- pt states she has had a heart murmur since when she was a child']","['- started dilt and ACEI, but sBP ranged from 70s-100s and HR 60s-70s,', 'so dilt was held, ACEI continued', '- s/p 500cc NS for hypotension, sBP around 100 afterwards', '- was going to be called out, but due to hypotension pt stayed in CCU', '- pt states her BP has always been running low, sBP in the 80s', '- pt states she has had a heart murmur since when she was a child']",,48693,105902.0
6,2193-01-14 10:25:09,,"['- started dilt and ACEI, but sBP ranged from 70s-100s and HR 60s-70s,', 'so dilt was held, ACEI continued', '- s/p 500cc NS for hypotension, sBP around 100 afterwards', '- was going to be called out, but due to hypotension pt stayed in CCU', '- pt states her BP has always been running low, sBP in the 80s', '- pt states she has had a heart murmur since when she was a child']",,48693,105902.0
0,2180-01-29 08:10:26,,"['-bil LENIs negative for DVT.', '-switched from dilt drip to po digoxin with close EKG monitoring as', ""patient's SBP was low in the 80s and it was felt that digoxin would"", 'provide rate control with less effects on blood pressure. Patient', 'converted to NSR overnight, now on 0.125 mg daily of digoxin.', '-.', '-Per Dr. [**Last Name (STitle) 852**]: intubation is warranted in the acute setting since he', 'will likely improve his respiratory status within the next 24-48 hours', 'and his overall outlook from his non-small-cell lung cancer is not that', 'grim (his median survival for patients with EGFR mutated', 'adenocarcinomas and stage IV disease is around 24 months). No ertonolib', 'tx this admission.', '-IP saw pt per Dr.[**Name (NI) 11944**] request for palliative throracentesis; not', 'done as fluid amt too small to provide substantial benefit.']",,61502,171971.0
1,2180-01-29 08:25:39,,"['-bil LENIs negative for DVT.', '-switched from dilt drip to po digoxin with close EKG monitoring as', ""patient's SBP was low in the 80s and it was felt that digoxin would"", 'provide rate control with less effects on blood pressure. Patient', 'converted to NSR overnight, now on 0.125 mg daily of digoxin.']","['-.', '-Per Dr. [**Last Name (STitle) 852**]: intubation is warranted in the acute setting since he', 'will likely improve his respiratory status within the next 24-48 hours', 'and his overall outlook from his non-small-cell lung cancer is not that', 'grim (his median survival for patients with EGFR mutated', 'adenocarcinomas and stage IV disease is around 24 months). No ertonolib', 'tx this admission.', '-IP saw pt per Dr.[**Name (NI) 11944**] request for palliative throracentesis; not', 'done as fluid amt too small to provide substantial benefit.']",61502,171971.0
2,2180-01-30 08:29:12,"['- afib converted with dig yesterday', '- satting ok on facemask, desats when off', '- he is on home pain reg', '- desatted this am to 86 of FM, up to 100% on 100% NRB, cxr, abg', 'ordered']","['- afib converted with dig yesterday', '- satting ok on facemask, desats when off', '- he is on home pain reg', '- desatted this am to 86 of FM, up to 100% on 100% NRB, cxr, abg', 'ordered']","['-bil LENIs negative for DVT.', '-switched from dilt drip to po digoxin with close EKG monitoring as', ""patient's SBP was low in the 80s and it was felt that digoxin would"", 'provide rate control with less effects on blood pressure. Patient', 'converted to NSR overnight, now on 0.125 mg daily of digoxin.']",61502,171971.0
3,2180-01-30 08:51:17,,"['- afib converted with dig yesterday', '- satting ok on facemask, desats when off', '- he is on home pain reg', '- desatted this am to 86 of FM, up to 100% on 100% NRB, cxr, abg', 'ordered']",,61502,171971.0
4,2180-01-30 15:31:48,,"['- afib converted with dig yesterday', '- satting ok on facemask, desats when off', '- he is on home pain reg', '- desatted this am to 86 of FM, up to 100% on 100% NRB, cxr, abg', 'ordered']",,61502,171971.0
5,2180-01-31 07:13:01,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']","['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']","['- afib converted with dig yesterday', '- satting ok on facemask, desats when off', '- he is on home pain reg', '- desatted this am to 86 of FM, up to 100% on 100% NRB, cxr, abg', 'ordered']",61502,171971.0
6,2180-01-31 07:40:02,,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",,61502,171971.0
7,2180-01-31 10:08:41,,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",,61502,171971.0
8,2180-01-31 11:02:59,,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",,61502,171971.0
9,2180-01-31 11:07:14,,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",,61502,171971.0
10,2180-01-31 11:23:05,,"['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",,61502,171971.0
11,2180-02-01 07:35:23,"['- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime empirically', '- stopped lovenox, started heparin gtt', '- spiked fever to 102.2 at 8:00pm', '-', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']","['- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime empirically', '- stopped lovenox, started heparin gtt', '- spiked fever to 102.2 at 8:00pm', '-', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']","['- Patient and family notified of possibility of intubation if worsening', 'status; patient confirms he is full code', '- patient intubated due to worsening respiratory distress, tachycardia', 'with frequent runs of SVT to 160s that responded to vagal maneuvers,', 'and tiring', '- patient went into a. fib with RVR following intubation', '- hypotensive requiring neo after intubation', '- Right subclavian, a. line placed (by [**Doctor First Name **])', '- Started ARDSnet ventilation AC 400 x 20, 80%, PEEP 8 started at']",61502,171971.0
12,2180-02-01 11:57:57,,"['- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime empirically', '- stopped lovenox, started heparin gtt', '- spiked fever to 102.2 at 8:00pm', '-', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']",,61502,171971.0
13,2180-02-01 14:17:49,"['- attempted to decrease FiO2, now still at 100.', '- increased PEEP to 15, now back down to 12', '- increased RR to 34, Vt to 450', '- started vanc/cefepime', '- switched lovenox to heparin gtt']","['- attempted to decrease FiO2, now still at 100.', '- increased PEEP to 15, now back down to 12', '- increased RR to 34, Vt to 450', '- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime', '- switched lovenox to heparin gtt', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']","['- started vanc/cefepime empirically', '- stopped lovenox, started heparin gtt', '- spiked fever to 102.2 at 8:00pm', '-']",61502,171971.0
14,2180-02-01 14:40:32,,"['- attempted to decrease FiO2, now still at 100.', '- increased PEEP to 15, now back down to 12', '- increased RR to 34, Vt to 450', '- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime', '- switched lovenox to heparin gtt', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']",,61502,171971.0
15,2180-02-01 14:45:46,,"['- attempted to decrease FiO2, now still at 100.', '- increased PEEP to 15, now back down to 12', '- increased RR to 34, Vt to 450', '- Discussion held with family regarding expectations and goals of care.', 'There was disagreement amongst family members regarding', 'extubation/making pt [**Name (NI) 115**].  Overnight, he was continued on pressors and', 'full medical treatment.', '- started vanc/cefepime', '- switched lovenox to heparin gtt', ' EKG - At [**2180-1-31**] 09:27 AM', ' BLOOD CULTURED - At [**2180-1-31**] 09:46 AM', 'art', ' FEVER - 102.2', 'F - [**2180-1-31**] 08:06 PM']",,61502,171971.0
0,2123-11-20 08:10:58,,['none'],,13948,169928.0
1,2123-11-20 08:27:55,,['none'],,13948,169928.0
2,2123-11-20 10:54:31,,['none'],,13948,169928.0
0,2131-03-28 06:00:50,,"['-Got trach in OR', '-Pt did not tolerate propofol for sedation as she dropped her BP', '-Changed sedation to versed and fentanyl', '-Pt dropped oxygen sat to 80%']",,85258,179741.0
1,2131-03-28 06:15:53,"['-Pt dropped oxygen sat to 80%, RR increased to 40s. Put on 100% sats', 'increased to mid 90s.  RR normalized.', '-Emergent bronch done showed patent airway', '-CXR concerning for ARDS and question fluid increased in L lung.  Vent', 'setting fio2 50 PEEP 5 PIP 16 TV 300 RR 20', '-Antibiotics coverage broadened an pt has received in last 24 hrs', 'levofloxacin, clindamycin, metronidazole, vancomycin, and cefepime.', '-L arm noted to be colder than right arm thought secondary to Bp cuff', '-A line attempted by multiple team members, trying to aoid L arm.', 'Ultimately surgery resident placed line in L arm.', '-ABG pending']","['-Got trach in OR', '-Pt did not tolerate propofol for sedation as she dropped her BP', '-Changed sedation to versed and fentanyl', '-Pt dropped oxygen sat to 80%, RR increased to 40s. Put on 100% sats', 'increased to mid 90s.  RR normalized.', '-Emergent bronch done showed patent airway', '-CXR concerning for ARDS and question fluid increased in L lung.  Vent', 'setting fio2 50 PEEP 5 PIP 16 TV 300 RR 20', '-Antibiotics coverage broadened an pt has received in last 24 hrs', 'levofloxacin, clindamycin, metronidazole, vancomycin, and cefepime.', '-L arm noted to be colder than right arm thought secondary to Bp cuff', '-A line attempted by multiple team members, trying to aoid L arm.', 'Ultimately surgery resident placed line in L arm.', '-ABG pending']",['-Pt dropped oxygen sat to 80%'],85258,179741.0
2,2131-03-28 06:45:38,,"['-Got trach in OR', '-Pt did not tolerate propofol for sedation as she dropped her BP', '-Changed sedation to versed and fentanyl', '-Pt dropped oxygen sat to 80%, RR increased to 40s. Put on 100% sats', 'increased to mid 90s.  RR normalized.', '-Emergent bronch done showed patent airway', '-CXR concerning for ARDS and question fluid increased in L lung.  Vent', 'setting fio2 50 PEEP 5 PIP 16 TV 300 RR 20', '-Antibiotics coverage broadened an pt has received in last 24 hrs', 'levofloxacin, clindamycin, metronidazole, vancomycin, and cefepime.', '-L arm noted to be colder than right arm thought secondary to Bp cuff', '-A line attempted by multiple team members, trying to aoid L arm.', 'Ultimately surgery resident placed line in L arm.', '-ABG pending']",,85258,179741.0
3,2131-03-28 11:23:17,"['increased to mid 90s.  RR normalized.  Dropped BP and started on', 'pressors.']","['-Got trach in OR', '-Pt did not tolerate propofol for sedation as she dropped her BP', '-Changed sedation to versed and fentanyl', '-Pt dropped oxygen sat to 80%, RR increased to 40s. Put on 100% sats', 'increased to mid 90s.  RR normalized.  Dropped BP and started on', 'pressors.', '-Emergent bronch done showed patent airway', '-CXR concerning for ARDS and question fluid increased in L lung.  Vent', 'setting fio2 50 PEEP 5 PIP 16 TV 300 RR 20', '-Antibiotics coverage broadened an pt has received in last 24 hrs', 'levofloxacin, clindamycin, metronidazole, vancomycin, and cefepime.', '-L arm noted to be colder than right arm thought secondary to Bp cuff', '-A line attempted by multiple team members, trying to aoid L arm.', 'Ultimately surgery resident placed line in L arm.', '-ABG pending']",['increased to mid 90s.  RR normalized.'],85258,179741.0
4,2131-03-29 06:53:21,"['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head', '- Thoracics to upsize trach on friday']","['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head', '- Thoracics to upsize trach on friday']","['-Got trach in OR', '-Pt did not tolerate propofol for sedation as she dropped her BP', '-Changed sedation to versed and fentanyl', '-Pt dropped oxygen sat to 80%, RR increased to 40s. Put on 100% sats', 'increased to mid 90s.  RR normalized.  Dropped BP and started on', 'pressors.', '-Emergent bronch done showed patent airway', '-CXR concerning for ARDS and question fluid increased in L lung.  Vent', 'setting fio2 50 PEEP 5 PIP 16 TV 300 RR 20', '-Antibiotics coverage broadened an pt has received in last 24 hrs', 'levofloxacin, clindamycin, metronidazole, vancomycin, and cefepime.', '-L arm noted to be colder than right arm thought secondary to Bp cuff', '-A line attempted by multiple team members, trying to aoid L arm.', 'Ultimately surgery resident placed line in L arm.', '-ABG pending']",85258,179741.0
5,2131-03-29 15:38:59,,"['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head', '- Thoracics to upsize trach on friday']",,85258,179741.0
6,2131-03-29 15:52:39,"['- 2UPRBCs, HCT responded appropriately']","['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs, HCT responded appropriately', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head']","['- 2UPRBCs', '- Thoracics to upsize trach on friday']",85258,179741.0
7,2131-03-29 16:00:01,,"['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs, HCT responded appropriately', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head']",,85258,179741.0
8,2131-03-30 06:58:04,"['-Failed pressure support on FiO2 of 0.3', '-Weaned off levo', '-MAP> 65', '-Required 3L NS Bolus yesterday to maintain CVP', '-Restarted methadone', '-LFTs normal', '-Phos repleated']","['-Failed pressure support on FiO2 of 0.3', '-Weaned off levo', '-MAP> 65', '-Required 3L NS Bolus yesterday to maintain CVP', '-Restarted methadone', '-LFTs normal', '-Phos repleated']","['- Abx changed to clinda/vanc/cefepime', '- ENT said no steroids (will not stop vocal cords from coapting-likely', 'tumor invading nerves)', '- Central line placed CVPs low', '- 2UPRBCs, HCT responded appropriately', '- Echo normal', '- Blood cultures pending', '- Unable to wean levo', '- Lactate 0.8, mixed venous O2=81%', '- Family meeting held, aggressive measures for now but open to', 'discussion if things go wrong way.', '- Checking [**Last Name (un) 402**] stim', '- Radiation field determined to be likely upper throat and head']",85258,179741.0
9,2131-03-30 17:39:18,['-bolused 1L this AM for CVP 7'],"['-Failed pressure support on FiO2 of 0.3', '-Weaned off levo', '-MAP> 65', '-Required 3L NS Bolus yesterday to maintain CVP', '-Restarted methadone', '-LFTs normal', '-Phos repleated', '-bolused 1L this AM for CVP 7']",,85258,179741.0
10,2131-03-31 05:30:07,['-'],['-'],"['-Failed pressure support on FiO2 of 0.3', '-Weaned off levo', '-MAP> 65', '-Required 3L NS Bolus yesterday to maintain CVP', '-Restarted methadone', '-LFTs normal', '-Phos repleated', '-bolused 1L this AM for CVP 7']",85258,179741.0
11,2131-03-31 06:27:25,"['[**2131-3-30**]', '-did poorly on pressure support', '-HCT 25 -> 28.2', '-ph 1.4 and was repleated', '-MAP WAS in 60s', '-started Tube feeds', '-Wean Sedation XXXXXXXXX', '-If pt goes to floor should repeat SW consult there', '-Case Management pt may benefit from hospice and ultimate goal is to go', 'home']","['[**2131-3-30**]', '-did poorly on pressure support', '-HCT 25 -> 28.2', '-ph 1.4 and was repleated', '-MAP WAS in 60s', '-started Tube feeds', '-Wean Sedation XXXXXXXXX', '-If pt goes to floor should repeat SW consult there', '-Case Management pt may benefit from hospice and ultimate goal is to go', 'home']",['-'],85258,179741.0
12,2131-03-31 12:37:36,['-Sedation weaned'],"['[**2131-3-30**]', '-did poorly on pressure support', '-HCT 25 -> 28.2', '-ph 1.4 and was repleated', '-MAP WAS in 60s', '-started Tube feeds', '-Sedation weaned', '-If pt goes to floor should repeat SW consult there', '-Case Management pt may benefit from hospice and ultimate goal is to go', 'home']",['-Wean Sedation XXXXXXXXX'],85258,179741.0
13,2131-04-01 06:57:26,"['Weaned to trach collar', 'Stopped  filgrastim not neutrapenic anymore', 'BPs remained stable w/o boluses']","['Weaned to trach collar', 'Stopped  filgrastim not neutrapenic anymore', 'BPs remained stable w/o boluses']","['[**2131-3-30**]', '-did poorly on pressure support', '-HCT 25 -> 28.2', '-ph 1.4 and was repleated', '-MAP WAS in 60s', '-started Tube feeds', '-Sedation weaned', '-If pt goes to floor should repeat SW consult there', '-Case Management pt may benefit from hospice and ultimate goal is to go', 'home']",85258,179741.0
14,2131-04-01 14:38:39,,"['Weaned to trach collar', 'Stopped  filgrastim not neutrapenic anymore', 'BPs remained stable w/o boluses']",,85258,179741.0
15,2131-04-02 06:28:39,"['- Stable on trach collar', '- d/c [**Name (NI) 6797**]', '- PT/Sp and Sw consult', '- Omed aware of patient']","['- Stable on trach collar', '- d/c [**Name (NI) 6797**]', '- PT/Sp and Sw consult', '- Omed aware of patient']","['Weaned to trach collar', 'Stopped  filgrastim not neutrapenic anymore', 'BPs remained stable w/o boluses']",85258,179741.0
16,2131-04-02 18:02:44,"['- d/c A-Line yesterday', '- Omed aware of patien', '-Pt coughing a lot this AM but able to cover her trach and talk']","['- Stable on trach collar', '- d/c A-Line yesterday', '- PT/Sp and Sw consult', '- Omed aware of patien', '-Pt coughing a lot this AM but able to cover her trach and talk']","['- d/c [**Name (NI) 6797**]', '- Omed aware of patient']",85258,179741.0
17,2131-04-03 07:00:11,"['-stable on trach collar', '-advanced to ice chips', '-family decided to stay with small trach', '-hospice can take the patient back with trach', '-d/c foley']","['-stable on trach collar', '-advanced to ice chips', '-family decided to stay with small trach', '-hospice can take the patient back with trach', '-d/c foley']","['- Stable on trach collar', '- d/c A-Line yesterday', '- PT/Sp and Sw consult', '- Omed aware of patien', '-Pt coughing a lot this AM but able to cover her trach and talk']",85258,179741.0
18,2131-04-03 14:40:30,,"['-stable on trach collar', '-advanced to ice chips', '-family decided to stay with small trach', '-hospice can take the patient back with trach', '-d/c foley']",,85258,179741.0
19,2131-04-04 06:21:32,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']","['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']","['-stable on trach collar', '-advanced to ice chips', '-family decided to stay with small trach', '-hospice can take the patient back with trach', '-d/c foley']",85258,179741.0
20,2131-04-04 06:23:03,,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']",,85258,179741.0
21,2131-04-04 06:38:37,,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']",,85258,179741.0
22,2131-04-04 13:22:44,,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']",,85258,179741.0
23,2131-04-04 14:27:34,,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']",,85258,179741.0
24,2131-04-04 14:33:58,,"['Called out to BMT but no bed', 'Got a PICC', 'Blood glucose 191', 'Ambulating around [**Hospital1 **] w/ assistance']",,85258,179741.0
0,2131-05-03 07:05:23,,"['- Started on vanc/zosyn/azithro', '- Restarted tube feeds in AM', '- Ca 13.5 -> started IVF 200 cc/h']",,85258,125297.0
1,2131-05-03 10:23:04,"['- No complaints this AM, breathing much improved. No fevers or chills.']","['- Started on vanc/zosyn/azithro', '- Restarted tube feeds in AM', '- Ca 13.5 -> started IVF 200 cc/h', '- No complaints this AM, breathing much improved. No fevers or chills.']",,85258,125297.0
0,2196-12-03 05:21:40,,[],,12712,113665.0
1,2196-12-03 10:39:09,"['Admitted overnight for hemodynamic instability, abdominal pain and', 'intraperitoneal GI bleed.', 'The patient is calm today and her pain is controlled on Morphine.']","['Admitted overnight for hemodynamic instability, abdominal pain and', 'intraperitoneal GI bleed.', 'The patient is calm today and her pain is controlled on Morphine.']",,12712,113665.0
0,2144-11-23 07:45:41,,"['- CT Chest official read', '1. Left lower lobe segmental pulmonary embolism.', '2. Wedge-shaped peripheral consolidation in the superior segment of the', 'right', 'lower lobe. Differential considerations include infectious or', 'inflammatory', 'processes; atelectasis is less likely.', '3. Thoracic vertebral compression fracture, unchanged in comparison to', '- Cyclosporine 177 (wnl)', '- Continue Vanc/Zosyn/Azithro', '- Heparin gtt- PTT supratherapeutic, so heparin gtt held and then', 'restarted at 425 units/hr', '- Bilateral LENIs - deferred until Mon', '- TTE - deferred until Mon', '- RUQ U/s (chr abd pain) - deferred until Mon', '- ECG - wavy baseline, but wnl', '- BMT reccs - continue azithro/zosyn/vanco, heparin, cyclosporn,', 'prednisone, ppx with bactrim/vori/acyclovir']",,21202,106481.0
1,2144-11-23 07:47:29,,"['- CT Chest official read', '1. Left lower lobe segmental pulmonary embolism.', '2. Wedge-shaped peripheral consolidation in the superior segment of the', 'right', 'lower lobe. Differential considerations include infectious or', 'inflammatory', 'processes; atelectasis is less likely.', '3. Thoracic vertebral compression fracture, unchanged in comparison to', '- Cyclosporine 177 (wnl)', '- Continue Vanc/Zosyn/Azithro', '- Heparin gtt- PTT supratherapeutic, so heparin gtt held and then', 'restarted at 425 units/hr', '- Bilateral LENIs - deferred until Mon', '- TTE - deferred until Mon', '- RUQ U/s (chr abd pain) - deferred until Mon', '- ECG - wavy baseline, but wnl', '- BMT reccs - continue azithro/zosyn/vanco, heparin, cyclosporn,', 'prednisone, ppx with bactrim/vori/acyclovir']",,21202,106481.0
2,2144-11-23 11:58:29,,"['- CT Chest official read', '1. Left lower lobe segmental pulmonary embolism.', '2. Wedge-shaped peripheral consolidation in the superior segment of the', 'right', 'lower lobe. Differential considerations include infectious or', 'inflammatory', 'processes; atelectasis is less likely.', '3. Thoracic vertebral compression fracture, unchanged in comparison to', '- Cyclosporine 177 (wnl)', '- Continue Vanc/Zosyn/Azithro', '- Heparin gtt- PTT supratherapeutic, so heparin gtt held and then', 'restarted at 425 units/hr', '- Bilateral LENIs - deferred until Mon', '- TTE - deferred until Mon', '- RUQ U/s (chr abd pain) - deferred until Mon', '- ECG - wavy baseline, but wnl', '- BMT reccs - continue azithro/zosyn/vanco, heparin, cyclosporn,', 'prednisone, ppx with bactrim/vori/acyclovir']",,21202,106481.0
3,2144-11-24 07:24:33,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']","['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']","['- CT Chest official read', '1. Left lower lobe segmental pulmonary embolism.', '2. Wedge-shaped peripheral consolidation in the superior segment of the', 'right', 'lower lobe. Differential considerations include infectious or', 'inflammatory', 'processes; atelectasis is less likely.', '3. Thoracic vertebral compression fracture, unchanged in comparison to', '- Cyclosporine 177 (wnl)', '- Continue Vanc/Zosyn/Azithro', '- Heparin gtt- PTT supratherapeutic, so heparin gtt held and then', 'restarted at 425 units/hr', '- Bilateral LENIs - deferred until Mon', '- TTE - deferred until Mon', '- RUQ U/s (chr abd pain) - deferred until Mon', '- ECG - wavy baseline, but wnl', '- BMT reccs - continue azithro/zosyn/vanco, heparin, cyclosporn,', 'prednisone, ppx with bactrim/vori/acyclovir']",21202,106481.0
4,2144-11-24 07:46:58,,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",,21202,106481.0
5,2144-11-24 11:41:53,,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",,21202,106481.0
6,2144-11-24 17:01:12,,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",,21202,106481.0
7,2144-11-24 17:26:58,,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",,21202,106481.0
8,2144-11-25 01:03:17,,"['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",,21202,106481.0
9,2144-11-25 07:00:05,"['-Induced sputum with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND', 'CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii', '(carinii).', '-[**11-22**] Respiratory Viral Culture: with RESPIRATORY SYNCYTIAL VIRUS (RSV)', 'LIKE CYTOPATHIC EFFECT.  CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.', '- On a lasix drip for most of the day for gentle diuresis.', '- fever to 101.6 after tylenol.', ' FEVER - 101.6', 'F - [**2144-11-25**] 05:00 AM']","['-Induced sputum with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND', 'CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii', '(carinii).', '-[**11-22**] Respiratory Viral Culture: with RESPIRATORY SYNCYTIAL VIRUS (RSV)', 'LIKE CYTOPATHIC EFFECT.  CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.', '- On a lasix drip for most of the day for gentle diuresis.', '- fever to 101.6 after tylenol.', ' FEVER - 101.6', 'F - [**2144-11-25**] 05:00 AM']","['TRANSTHORACIC ECHO - At [**2144-11-23**] 11:00 AM', ' ULTRASOUND - At [**2144-11-23**] 04:47 PM', 'Pt transported to US in stretcher for BLE U/S, liver/abd US.', '-TTE showed LV function appears hyperdynamic, EF 75%', '-CXR [**11-23**]:', 'The left basal opacities have slightly increased in the interim, most', 'likely representing a combination of', 'atelectasis and developing infarct given the presence of left lower', 'lobe', 'pulmonary embolism. The upper lungs are unremarkable. There is no', 'appreciable pleural effusion or pneumothorax. No evidence of pulmonary', 'edema', 'is present.', '-RUQ U/S unremarkable on wet read.', ""-LENI's showed no DVT."", ""-Adding on RSV, viral cx's. Induced sputum ordered."", '-Starting CPAP', '-Switched to Lovenox from Heparin gtt']",21202,106481.0
10,2144-11-25 07:09:26,"['-Induced sputum [**11-24**] with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS,', 'AND CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii']","['-Induced sputum [**11-24**] with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS,', 'AND CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii', '(carinii).', '-[**11-22**] Respiratory Viral Culture: with RESPIRATORY SYNCYTIAL VIRUS (RSV)', 'LIKE CYTOPATHIC EFFECT.  CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.', '- On a lasix drip for most of the day for gentle diuresis.', '- fever to 101.6 after tylenol.', ' FEVER - 101.6', 'F - [**2144-11-25**] 05:00 AM']","['-Induced sputum with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND', 'CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii']",21202,106481.0
11,2144-11-25 14:12:58,,"['-Induced sputum [**11-24**] with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS,', 'AND CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii', '(carinii).', '-[**11-22**] Respiratory Viral Culture: with RESPIRATORY SYNCYTIAL VIRUS (RSV)', 'LIKE CYTOPATHIC EFFECT.  CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.', '- On a lasix drip for most of the day for gentle diuresis.', '- fever to 101.6 after tylenol.', ' FEVER - 101.6', 'F - [**2144-11-25**] 05:00 AM']",,21202,106481.0
12,2144-11-26 07:02:46,"['FEVER - 101.7', 'F - [**2144-11-25**] 08:00 AM', '- Received lasix 20 iv x1 in am', '- I/O - -700 cc at 1400 ; -1.2 L at 2130; -80 cc since mn @ 0400', '- BMT - repeat Palivuzimab 7.5 mg/kg to complete total of 15 mg/kg', 'dose, would add ribavirin if decompensates,', 'continue antibx', '- Cx data - repeat b and u cx [**11-25**] - ngtd', '- Afebrile after 0800', '- O2 weaned to 4l NC']","['FEVER - 101.7', 'F - [**2144-11-25**] 08:00 AM', '- Received lasix 20 iv x1 in am', '- I/O - -700 cc at 1400 ; -1.2 L at 2130; -80 cc since mn @ 0400', '- BMT - repeat Palivuzimab 7.5 mg/kg to complete total of 15 mg/kg', 'dose, would add ribavirin if decompensates,', 'continue antibx', '- Cx data - repeat b and u cx [**11-25**] - ngtd', '- Afebrile after 0800', '- O2 weaned to 4l NC']","['-Induced sputum [**11-24**] with 3+  GRAM POSITIVE COCCI. IN PAIRS, CHAINS,', 'AND CLUSTERS. 2+  BUDDING YEAST. NEGATIVE for Pneumocystis jirovecii', '(carinii).', '-[**11-22**] Respiratory Viral Culture: with RESPIRATORY SYNCYTIAL VIRUS (RSV)', 'LIKE CYTOPATHIC EFFECT.  CONFIRMED BY MONOCLONAL FLUORESCENT ANTIBODY.', '- On a lasix drip for most of the day for gentle diuresis.', '- fever to 101.6 after tylenol.', ' FEVER - 101.6', 'F - [**2144-11-25**] 05:00 AM']",21202,106481.0
13,2144-11-26 08:00:19,,"['FEVER - 101.7', 'F - [**2144-11-25**] 08:00 AM', '- Received lasix 20 iv x1 in am', '- I/O - -700 cc at 1400 ; -1.2 L at 2130; -80 cc since mn @ 0400', '- BMT - repeat Palivuzimab 7.5 mg/kg to complete total of 15 mg/kg', 'dose, would add ribavirin if decompensates,', 'continue antibx', '- Cx data - repeat b and u cx [**11-25**] - ngtd', '- Afebrile after 0800', '- O2 weaned to 4l NC']",,21202,106481.0
14,2144-11-26 12:56:13,,"['FEVER - 101.7', 'F - [**2144-11-25**] 08:00 AM', '- Received lasix 20 iv x1 in am', '- I/O - -700 cc at 1400 ; -1.2 L at 2130; -80 cc since mn @ 0400', '- BMT - repeat Palivuzimab 7.5 mg/kg to complete total of 15 mg/kg', 'dose, would add ribavirin if decompensates,', 'continue antibx', '- Cx data - repeat b and u cx [**11-25**] - ngtd', '- Afebrile after 0800', '- O2 weaned to 4l NC']",,21202,106481.0
15,2144-11-27 07:44:52,"['Afebrile for 48 hours', '- unable to tolerate nasal mask CPAP overnight;  changed to full face', 'mask (small), tol ~ 6 hours on with occ periods of apnea up to 6 sec,', '02 10 lpm bled in for sp02 92-97%', '-rx x2 with neb albuterol, audible exp wheeze unchanged with rx, thick', 'white secretions']","['Afebrile for 48 hours', '- unable to tolerate nasal mask CPAP overnight;  changed to full face', 'mask (small), tol ~ 6 hours on with occ periods of apnea up to 6 sec,', '02 10 lpm bled in for sp02 92-97%', '-rx x2 with neb albuterol, audible exp wheeze unchanged with rx, thick', 'white secretions']","['FEVER - 101.7', 'F - [**2144-11-25**] 08:00 AM', '- Received lasix 20 iv x1 in am', '- I/O - -700 cc at 1400 ; -1.2 L at 2130; -80 cc since mn @ 0400', '- BMT - repeat Palivuzimab 7.5 mg/kg to complete total of 15 mg/kg', 'dose, would add ribavirin if decompensates,', 'continue antibx', '- Cx data - repeat b and u cx [**11-25**] - ngtd', '- Afebrile after 0800', '- O2 weaned to 4l NC']",21202,106481.0
16,2144-11-27 07:51:30,['- RSV nasal swab repeated'],"['Afebrile for 48 hours', '- unable to tolerate nasal mask CPAP overnight;  changed to full face', 'mask (small), tol ~ 6 hours on with occ periods of apnea up to 6 sec,', '02 10 lpm bled in for sp02 92-97%', '-rx x2 with neb albuterol, audible exp wheeze unchanged with rx, thick', 'white secretions', '- RSV nasal swab repeated']",,21202,106481.0
0,2145-09-08 07:23:04,,,,21202,106349.0
1,2145-09-08 09:13:44,,,,21202,106349.0
2,2145-09-09 07:35:46,,,,21202,106349.0
3,2145-09-09 07:40:42,,,,21202,106349.0
4,2145-09-09 11:57:46,,,,21202,106349.0
0,2146-02-15 07:45:33,,"['No acute events overnight. Pt maintained on non rebreather [**Date Range **]', 'overnight, with O2 sat between 93-98%. This morning, O2 sat dropped to', '85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti [**Last Name (LF) **], [**First Name3 (LF) **] pt was', 'switched back to the non rebreather.  Pt remained afebrile overnight.', 'He was started on maintenance fluids and also bolused with 1L NS, and', 'remained hemodynamically stable. Second and third cardiac enzymes were', 'negative.', 'This morning, he reports feeling much better, though he woke up', 'drenched in sweat. He reports continued productive cough but denies', 'dyspnea, chest pain (including pleurisy), nausea, abd pain, dizziness,', 'palpitations. His chronic LUE pain is well controlled.']",,21202,155154.0
1,2146-02-15 11:14:26,"['No acute events overnight.', 'For hypoxia, pt maintained on non rebreather mask overnight, with O2', 'sat between 93-98%.  On attempt to lower FiO2 this morning, O2 sat', 'dropped to 85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti mask.', 'Pt was switched back to the non rebreather, then transitioned to a cool', 'nebulizer, with O2 sat maintained at approx 95%.', 'Pt remained afebrile and hemodynamically stable overnight. He received', 'a 1L NS bolus and was started on maintenance fluids, given no PO', 'intake.', 'Cardiac enzymes #2 and #3 returned negative.', 'This morning, pt reports feeling much better, though he woke up', 'drenched in sweat. He reports increased productive cough but denies', 'palpitations, headache. His chronic LUE pain is well controlled. He', 'expressed an interest in breakfast.']","['No acute events overnight.', 'For hypoxia, pt maintained on non rebreather mask overnight, with O2', 'sat between 93-98%.  On attempt to lower FiO2 this morning, O2 sat', 'dropped to 85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti mask.', 'Pt was switched back to the non rebreather, then transitioned to a cool', 'nebulizer, with O2 sat maintained at approx 95%.', 'Pt remained afebrile and hemodynamically stable overnight. He received', 'a 1L NS bolus and was started on maintenance fluids, given no PO', 'intake.', 'Cardiac enzymes #2 and #3 returned negative.', 'This morning, pt reports feeling much better, though he woke up', 'drenched in sweat. He reports increased productive cough but denies', 'dyspnea, chest pain (including pleurisy), nausea, abd pain, dizziness,', 'palpitations, headache. His chronic LUE pain is well controlled. He', 'expressed an interest in breakfast.']","['No acute events overnight. Pt maintained on non rebreather [**Date Range **]', 'overnight, with O2 sat between 93-98%. This morning, O2 sat dropped to', '85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti [**Last Name (LF) **], [**First Name3 (LF) **] pt was', 'switched back to the non rebreather.  Pt remained afebrile overnight.', 'He was started on maintenance fluids and also bolused with 1L NS, and', 'remained hemodynamically stable. Second and third cardiac enzymes were', 'negative.', 'This morning, he reports feeling much better, though he woke up', 'drenched in sweat. He reports continued productive cough but denies', 'palpitations. His chronic LUE pain is well controlled.']",21202,155154.0
2,2146-02-15 11:36:21,"['For hypotension, pt received a 1L NS bolus last night and was started', 'on maintenance fluids, given no PO intake. He remained afebrile and', 'hemodynamically stable overnight.', 'Cardiac enzyme sets 2 and 3 returned negative. Repeat EKG @ 8pm', 'demonstrated NSR @ 86bpm; 1mm ST-segment depression in V4=V5,', 'persistent T-wave inversions in V2-V6.', 'History obtained from Patient, Family / Friend']","['No acute events overnight.', 'For hypoxia, pt maintained on non rebreather mask overnight, with O2', 'sat between 93-98%.  On attempt to lower FiO2 this morning, O2 sat', 'dropped to 85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti mask.', 'Pt was switched back to the non rebreather, then transitioned to a cool', 'nebulizer, with O2 sat maintained at approx 95%.', 'For hypotension, pt received a 1L NS bolus last night and was started', 'on maintenance fluids, given no PO intake. He remained afebrile and', 'hemodynamically stable overnight.', 'Cardiac enzyme sets 2 and 3 returned negative. Repeat EKG @ 8pm', 'demonstrated NSR @ 86bpm; 1mm ST-segment depression in V4=V5,', 'persistent T-wave inversions in V2-V6.', 'This morning, pt reports feeling much better, though he woke up', 'drenched in sweat. He reports increased productive cough but denies', 'dyspnea, chest pain (including pleurisy), nausea, abd pain, dizziness,', 'palpitations, headache. His chronic LUE pain is well controlled. He', 'expressed an interest in breakfast.', 'History obtained from Patient, Family / Friend']","['Pt remained afebrile and hemodynamically stable overnight. He received', 'a 1L NS bolus and was started on maintenance fluids, given no PO', 'intake.', 'Cardiac enzymes #2 and #3 returned negative.']",21202,155154.0
3,2146-02-15 11:56:32,,"['No acute events overnight.', 'For hypoxia, pt maintained on non rebreather mask overnight, with O2', 'sat between 93-98%.  On attempt to lower FiO2 this morning, O2 sat', 'dropped to 85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti mask.', 'Pt was switched back to the non rebreather, then transitioned to a cool', 'nebulizer, with O2 sat maintained at approx 95%.', 'For hypotension, pt received a 1L NS bolus last night and was started', 'on maintenance fluids, given no PO intake. He remained afebrile and', 'hemodynamically stable overnight.', 'Cardiac enzyme sets 2 and 3 returned negative. Repeat EKG @ 8pm', 'demonstrated NSR @ 86bpm; 1mm ST-segment depression in V4=V5,', 'persistent T-wave inversions in V2-V6.', 'This morning, pt reports feeling much better, though he woke up', 'drenched in sweat. He reports increased productive cough but denies', 'dyspnea, chest pain (including pleurisy), nausea, abd pain, dizziness,', 'palpitations, headache. His chronic LUE pain is well controlled. He', 'expressed an interest in breakfast.', 'History obtained from Patient, Family / Friend']",,21202,155154.0
4,2146-02-16 07:54:13,"['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was gradually lowered', 'througout the day with O2 sats maintained in low-to-mid 90s.']","['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was gradually lowered', 'througout the day with O2 sats maintained in low-to-mid 90s.']","['No acute events overnight.', 'For hypoxia, pt maintained on non rebreather mask overnight, with O2', 'sat between 93-98%.  On attempt to lower FiO2 this morning, O2 sat', 'dropped to 85% on RA, 88% on 6L NC, and 88% on 35% FiO2 via Venti mask.', 'Pt was switched back to the non rebreather, then transitioned to a cool', 'nebulizer, with O2 sat maintained at approx 95%.', 'For hypotension, pt received a 1L NS bolus last night and was started', 'on maintenance fluids, given no PO intake. He remained afebrile and', 'hemodynamically stable overnight.', 'Cardiac enzyme sets 2 and 3 returned negative. Repeat EKG @ 8pm', 'demonstrated NSR @ 86bpm; 1mm ST-segment depression in V4=V5,', 'persistent T-wave inversions in V2-V6.', 'This morning, pt reports feeling much better, though he woke up', 'drenched in sweat. He reports increased productive cough but denies', 'dyspnea, chest pain (including pleurisy), nausea, abd pain, dizziness,', 'palpitations, headache. His chronic LUE pain is well controlled. He', 'expressed an interest in breakfast.', 'History obtained from Patient, Family / Friend']",21202,155154.0
5,2146-02-16 08:10:33,,"['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was gradually lowered', 'througout the day with O2 sats maintained in low-to-mid 90s.']",,21202,155154.0
6,2146-02-16 12:04:06,"['hemodynamically stable. His O2 requirement was lowered gradually to 3L', 'NC with O2 sats maintained in low-to-mid 90s.']","['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was lowered gradually to 3L', 'NC with O2 sats maintained in low-to-mid 90s.']","['hemodynamically stable. His O2 requirement was gradually lowered', 'througout the day with O2 sats maintained in low-to-mid 90s.']",21202,155154.0
7,2146-02-16 12:47:28,,"['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was lowered gradually to 3L', 'NC with O2 sats maintained in low-to-mid 90s.']",,21202,155154.0
8,2146-02-17 07:53:15,"['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.']","['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.']","['No acute events overnight. Patient remained afebrile and', 'hemodynamically stable. His O2 requirement was lowered gradually to 3L', 'NC with O2 sats maintained in low-to-mid 90s.']",21202,155154.0
9,2146-02-17 08:09:39,"['Preliminary sputum cx', ' commensal flora.']","['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.', 'Preliminary sputum cx', ' commensal flora.']",,21202,155154.0
10,2146-02-17 12:26:52,[' commensal flora. Antibiotics were continued'],"['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.', 'Preliminary sputum cx', ' commensal flora. Antibiotics were continued']",[' commensal flora.'],21202,155154.0
11,2146-02-17 12:41:43,"['despite low suspicion for bacterial superinfection, given pt is s/p', 'BMT.']","['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.', 'Preliminary sputum cx', ' commensal flora. Antibiotics were continued', 'despite low suspicion for bacterial superinfection, given pt is s/p', 'BMT.']",,21202,155154.0
12,2146-02-17 12:59:50,,"['CALLED OUT', 'Afebrile. Hemodynamically stable. Able to ambulate around pod', 'maintaining O2 sat >90% on RA. On 2L NC while in bed, switched to 3L NC', 'overnight after O2 sat <90%. This AM: on 3L NC, with O2 sat 97%. Per', 'patient, he was wheezing overnight, but not this AM. No cough, SOB, CP.', 'Preliminary sputum cx', ' commensal flora. Antibiotics were continued', 'despite low suspicion for bacterial superinfection, given pt is s/p', 'BMT.']",,21202,155154.0
0,2158-11-29 06:48:39,,['- was on insulin gtt with D5 to close anion gap. Now off insulin gtt'],,28508,145742.0
1,2158-11-29 07:07:05,"['- was on insulin gtt with D5. Picture felt to be more consistant with', 'HONK there gtt stoped when glucose normalized', '-this am BG back up to 270s']","['- was on insulin gtt with D5. Picture felt to be more consistant with', 'HONK there gtt stoped when glucose normalized', '-this am BG back up to 270s']",['- was on insulin gtt with D5 to close anion gap. Now off insulin gtt'],28508,145742.0
2,2158-11-29 11:52:33,,"['- was on insulin gtt with D5. Picture felt to be more consistant with', 'HONK there gtt stoped when glucose normalized', '-this am BG back up to 270s']",,28508,145742.0
3,2158-11-29 12:06:16,,"['- was on insulin gtt with D5. Picture felt to be more consistant with', 'HONK there gtt stoped when glucose normalized', '-this am BG back up to 270s']",,28508,145742.0
4,2158-12-05 07:09:50,"['- Made NPO past MN for potential VATS today', '- PD overnight']","['- Made NPO past MN for potential VATS today', '- PD overnight']","['- was on insulin gtt with D5. Picture felt to be more consistant with', 'HONK there gtt stoped when glucose normalized', '-this am BG back up to 270s']",28508,145742.0
5,2158-12-05 07:15:04,['- Sputum and pleural fluid - gram stain with GPC in pair and clusters'],"['- Made NPO past MN for potential VATS today', '- PD overnight', '- Sputum and pleural fluid - gram stain with GPC in pair and clusters']",,28508,145742.0
6,2158-12-05 09:33:31,,"['- Made NPO past MN for potential VATS today', '- PD overnight', '- Sputum and pleural fluid - gram stain with GPC in pair and clusters']",,28508,145742.0
7,2158-12-05 11:27:32,['- Made NPO past MN for OR today'],"['- Made NPO past MN for OR today', '- PD overnight', '- Sputum and pleural fluid - gram stain with GPC in pair and clusters']",['- Made NPO past MN for potential VATS today'],28508,145742.0
8,2158-12-06 08:02:00,"['Hypotensive to the 70s overnight and febrile, responsive to fluids', 'bolused 2 U PRBCs for post-op post-transfusion Hct <21', 'bolused 1 liter', 'started neo, then switched to dopamine, still using peripheral access', 'cultures pending', 'stayed the course on antibiotic choice']","['Hypotensive to the 70s overnight and febrile, responsive to fluids', 'bolused 2 U PRBCs for post-op post-transfusion Hct <21', 'bolused 1 liter', 'started neo, then switched to dopamine, still using peripheral access', 'cultures pending', 'stayed the course on antibiotic choice']","['- Made NPO past MN for OR today', '- PD overnight', '- Sputum and pleural fluid - gram stain with GPC in pair and clusters']",28508,145742.0
9,2158-12-06 12:34:22,['bolused 1 liter ND'],"['Hypotensive to the 70s overnight and febrile, responsive to fluids', 'bolused 2 U PRBCs for post-op post-transfusion Hct <21', 'bolused 1 liter ND', 'started neo, then switched to dopamine, still using peripheral access', 'cultures pending', 'stayed the course on antibiotic choice']",['bolused 1 liter'],28508,145742.0
10,2158-12-06 12:40:35,,"['Hypotensive to the 70s overnight and febrile, responsive to fluids', 'bolused 2 U PRBCs for post-op post-transfusion Hct <21', 'bolused 1 liter ND', 'started neo, then switched to dopamine, still using peripheral access', 'cultures pending', 'stayed the course on antibiotic choice']",,28508,145742.0
11,2158-12-07 07:58:00,"['BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM- thick dark red thick phlegm', ' FEVER - 101.1', 'F - [**2158-12-7**] 12:00 AM - blood cultures sent', 'No extubation as even with forceful cough patient has no leak with cuff', 'down, per surgery likely lots of trauma to throat during difficult', 'intubation requiring > 3 tries', 'Peritoneal Dialysis is resulting in no fluid exchange, unable to run', 'patient even, I/O + 300', 'Periodic hypotension, MAP 58, O/N bladder pressure 16 during period of', 'hypotension - not due to abdominal distension', 'Started insulin drip [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs as they think she is type 1 DM --', 'patient with repeated hypoglycemia on drip', 'HCT fell O/N 26.6 --> 22.5', 'History obtained from Patient, Interpreter']","['BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM- thick dark red thick phlegm', ' FEVER - 101.1', 'F - [**2158-12-7**] 12:00 AM - blood cultures sent', 'No extubation as even with forceful cough patient has no leak with cuff', 'down, per surgery likely lots of trauma to throat during difficult', 'intubation requiring > 3 tries', 'Peritoneal Dialysis is resulting in no fluid exchange, unable to run', 'patient even, I/O + 300', 'Periodic hypotension, MAP 58, O/N bladder pressure 16 during period of', 'hypotension - not due to abdominal distension', 'Started insulin drip [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs as they think she is type 1 DM --', 'patient with repeated hypoglycemia on drip', 'HCT fell O/N 26.6 --> 22.5', 'History obtained from Patient, Interpreter']","['Hypotensive to the 70s overnight and febrile, responsive to fluids', 'bolused 2 U PRBCs for post-op post-transfusion Hct <21', 'bolused 1 liter ND', 'started neo, then switched to dopamine, still using peripheral access', 'cultures pending', 'stayed the course on antibiotic choice']",28508,145742.0
12,2158-12-07 10:26:01,"['OFF DOPAMINE', ' BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM-  dark red thick phlegm', ' think fluid shifts with', 'PD']","['OFF DOPAMINE', ' BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM-  dark red thick phlegm', ' FEVER - 101.1', 'F - [**2158-12-7**] 12:00 AM - blood cultures sent', 'No extubation as even with forceful cough patient has no leak with cuff', 'down, per surgery likely lots of trauma to throat during difficult', 'intubation requiring > 3 tries', 'Peritoneal Dialysis is resulting in no fluid exchange, unable to run', 'patient even, I/O + 300', 'Periodic hypotension, MAP 58, O/N bladder pressure 16 during period of', 'hypotension - not due to abdominal distension', ' think fluid shifts with', 'PD', 'Started insulin drip [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs as they think she is type 1 DM --', 'patient with repeated hypoglycemia on drip', 'History obtained from Patient, Interpreter']","['BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM- thick dark red thick phlegm', 'HCT fell O/N 26.6 --> 22.5']",28508,145742.0
13,2158-12-08 08:52:49,"['- Started Solu-Medrol 20 mg IV Q4H', '- Discontinued flagyl', '- AFB negative x 3, d/c precautions', '- Repeat hematocrit stable', '- Started lisinopril', '- Held tube feeds for potential extubation', 'History obtained from Patient, Family / Friend, Interpreter']","['- Started Solu-Medrol 20 mg IV Q4H', '- Discontinued flagyl', '- AFB negative x 3, d/c precautions', '- Repeat hematocrit stable', '- Started lisinopril', '- Held tube feeds for potential extubation', 'History obtained from Patient, Family / Friend, Interpreter']","['OFF DOPAMINE', ' BRONCHOSCOPY - At [**2158-12-6**] 03:32 PM-  dark red thick phlegm', ' FEVER - 101.1', 'F - [**2158-12-7**] 12:00 AM - blood cultures sent', 'No extubation as even with forceful cough patient has no leak with cuff', 'down, per surgery likely lots of trauma to throat during difficult', 'intubation requiring > 3 tries', 'Peritoneal Dialysis is resulting in no fluid exchange, unable to run', 'patient even, I/O + 300', 'Periodic hypotension, MAP 58, O/N bladder pressure 16 during period of', 'hypotension - not due to abdominal distension', ' think fluid shifts with', 'PD', 'Started insulin drip [**First Name8 (NamePattern2) **] [**Last Name (un) 276**] recs as they think she is type 1 DM --', 'patient with repeated hypoglycemia on drip', 'History obtained from Patient, Interpreter']",28508,145742.0
14,2158-12-08 11:37:48,,"['- Started Solu-Medrol 20 mg IV Q4H', '- Discontinued flagyl', '- AFB negative x 3, d/c precautions', '- Repeat hematocrit stable', '- Started lisinopril', '- Held tube feeds for potential extubation', 'History obtained from Patient, Family / Friend, Interpreter']",,28508,145742.0
15,2158-12-09 08:27:54,"['CENTRAL LINE for access', 'CT neck = tight airway, and patient with no clear leak with balloon', 'down around ET tube', 'Calcium acetate ordered for high phos; lanthamum not dissolving for', 'admin via tube', 'History obtained from Patient, Family / Friend']","['CENTRAL LINE for access', 'CT neck = tight airway, and patient with no clear leak with balloon', 'down around ET tube', 'Calcium acetate ordered for high phos; lanthamum not dissolving for', 'admin via tube', 'History obtained from Patient, Family / Friend']","['- Started Solu-Medrol 20 mg IV Q4H', '- Discontinued flagyl', '- AFB negative x 3, d/c precautions', '- Repeat hematocrit stable', '- Started lisinopril', '- Held tube feeds for potential extubation', 'History obtained from Patient, Family / Friend, Interpreter']",28508,145742.0
16,2158-12-09 12:59:09,"['CT neck = tight airway', 'CT chest =', 'left sided loculated effusion following chest tube', 'placement that is now high attenuation suggesting complex', 'fluid/hemorrhage. Left sided consolidation with locules of air', 'representing pneumonia/necrotizing pneurmonia.']","['CENTRAL LINE for access', 'CT neck = tight airway', 'CT chest =', 'left sided loculated effusion following chest tube', 'placement that is now high attenuation suggesting complex', 'fluid/hemorrhage. Left sided consolidation with locules of air', 'representing pneumonia/necrotizing pneurmonia.', 'Calcium acetate ordered for high phos; lanthamum not dissolving for', 'admin via tube', 'History obtained from Patient, Family / Friend']","['CT neck = tight airway, and patient with no clear leak with balloon', 'down around ET tube']",28508,145742.0
17,2158-12-10 07:29:46,"['EXTUBATED', 'thoracics evaluated chest tubes, feel in correct place, and no further', 'surgery needed at this time, plan to pull a chest tube in am', 'lantus increased and patient stated on PO diet', 'given vitamin K for elevated INR', 'increased metoprolol 37.5 [**Hospital1 **] ( on 100 [**Hospital1 **] at home)', 'restarted home valsartan at half dose 40 mg daily']","['EXTUBATED', 'thoracics evaluated chest tubes, feel in correct place, and no further', 'surgery needed at this time, plan to pull a chest tube in am', 'lantus increased and patient stated on PO diet', 'given vitamin K for elevated INR', 'increased metoprolol 37.5 [**Hospital1 **] ( on 100 [**Hospital1 **] at home)', 'restarted home valsartan at half dose 40 mg daily']","['CENTRAL LINE for access', 'CT neck = tight airway', 'CT chest =', 'left sided loculated effusion following chest tube', 'placement that is now high attenuation suggesting complex', 'fluid/hemorrhage. Left sided consolidation with locules of air', 'representing pneumonia/necrotizing pneurmonia.', 'Calcium acetate ordered for high phos; lanthamum not dissolving for', 'admin via tube', 'History obtained from Patient, Family / Friend']",28508,145742.0
18,2158-12-10 07:38:22,,"['EXTUBATED', 'thoracics evaluated chest tubes, feel in correct place, and no further', 'surgery needed at this time, plan to pull a chest tube in am', 'lantus increased and patient stated on PO diet', 'given vitamin K for elevated INR', 'increased metoprolol 37.5 [**Hospital1 **] ( on 100 [**Hospital1 **] at home)', 'restarted home valsartan at half dose 40 mg daily']",,28508,145742.0
19,2158-12-10 12:28:13,"['- Extubated', '- Thoracics evaluated chest tubes, feel in correct place, and no', 'further surgery needed at this time', '- Lantus increased and patient stated on PO diet', '- Increased metoprolol 37.5 mg [**Hospital1 **] (on 100 mg [**Hospital1 **] as outpatient)', '- Restarted home valsartan at half dose 40 mg daily', '- Given vitamin K for elevated INR']","['- Extubated', '- Thoracics evaluated chest tubes, feel in correct place, and no', 'further surgery needed at this time', '- Lantus increased and patient stated on PO diet', '- Increased metoprolol 37.5 mg [**Hospital1 **] (on 100 mg [**Hospital1 **] as outpatient)', '- Restarted home valsartan at half dose 40 mg daily', '- Given vitamin K for elevated INR']","['EXTUBATED', 'thoracics evaluated chest tubes, feel in correct place, and no further', 'surgery needed at this time, plan to pull a chest tube in am', 'lantus increased and patient stated on PO diet', 'given vitamin K for elevated INR', 'increased metoprolol 37.5 [**Hospital1 **] ( on 100 [**Hospital1 **] at home)', 'restarted home valsartan at half dose 40 mg daily']",28508,145742.0
20,2158-12-10 12:37:42,,"['- Extubated', '- Thoracics evaluated chest tubes, feel in correct place, and no', 'further surgery needed at this time', '- Lantus increased and patient stated on PO diet', '- Increased metoprolol 37.5 mg [**Hospital1 **] (on 100 mg [**Hospital1 **] as outpatient)', '- Restarted home valsartan at half dose 40 mg daily', '- Given vitamin K for elevated INR']",,28508,145742.0
21,2158-12-10 12:42:53,,"['- Extubated', '- Thoracics evaluated chest tubes, feel in correct place, and no', 'further surgery needed at this time', '- Lantus increased and patient stated on PO diet', '- Increased metoprolol 37.5 mg [**Hospital1 **] (on 100 mg [**Hospital1 **] as outpatient)', '- Restarted home valsartan at half dose 40 mg daily', '- Given vitamin K for elevated INR']",,28508,145742.0
22,2158-12-10 12:43:47,,"['- Extubated', '- Thoracics evaluated chest tubes, feel in correct place, and no', 'further surgery needed at this time', '- Lantus increased and patient stated on PO diet', '- Increased metoprolol 37.5 mg [**Hospital1 **] (on 100 mg [**Hospital1 **] as outpatient)', '- Restarted home valsartan at half dose 40 mg daily', '- Given vitamin K for elevated INR']",,28508,145742.0
0,2134-05-22 07:17:23,,[],,89448,158518.0
1,2134-05-22 07:23:34,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']","['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
2,2134-05-22 10:59:19,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
3,2134-05-22 11:49:30,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
4,2134-05-22 11:52:20,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
5,2134-05-22 12:02:17,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
6,2134-05-22 12:06:16,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
7,2134-05-22 12:39:19,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
8,2134-05-22 13:50:18,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
9,2134-05-22 14:17:32,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
10,2134-05-22 15:42:15,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
11,2134-05-22 15:51:24,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
12,2134-05-22 16:18:45,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
13,2134-05-22 16:19:46,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with transudate; total protein ascites 1.7 vs. serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
14,2134-05-22 16:36:07,"['consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5']","['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",['consistent with transudate; total protein ascites 1.7 vs. serum 6.5'],89448,158518.0
15,2134-05-23 07:41:52,"['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']","['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']","['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",89448,158518.0
16,2134-05-23 08:06:31,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']","['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']","['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']",89448,158518.0
17,2134-05-23 09:56:13,,"['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",,89448,158518.0
18,2134-05-23 10:05:55,"['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']","['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']","['- Ultrasound-guided paracentesis (1.4L removed); peritoneal fluid', 'consistent with SBP; ceftriaxone 1g IV daily x5 days, albumin 1.5g/kg', '- SAAG = serum albumin - peritoneal fluid albumin = 3.4-1.1 = 2.3,', 'consistent with portal hypertension; total protein ascites 1.7 vs.', 'serum 6.5', '- TTE with AS, valve area 0.9cm2; mild LVH with presernved EF;', 'PCWP>18mmHg; 2+ MR; mild pulmonary artery systolic hypertension; no', 'pericardial effusion', '- UA with blood, mod leuk est, 35 WBC; Foley removed', '- RUQ duplex u/s:  Normal Doppler patency and flow of the hepatic', 'veins, portal vein', '- Fe urea nitrogen 27.5%, urine sodium 20; prerenal, does not exclude', 'hepatorenal', '- Right shoulder pain x1 week; written for Tylenol, 2g maximum']",89448,158518.0
19,2134-05-23 10:09:11,,"['- Hct drop to 25.9 with am labs. Guaiac neg. Repeat Hct 28.2', '- Fena 0.3', '- Code status confirmed as FULL', '- Renal c/s - More c/w Pre-renal azotemia. Urine sediment with many', 'casts more c/w ATN. Less likely HRS given normal BPs and active', 'sediment. Added on Urine Eos.', '- Liver c/s - Did not see patient, but suggested midodrine and', 'octreotide. Decision deferrred until Liver team can see the patient in', 'person', '- EP recs none', 'History obtained from Patient']",,89448,158518.0
0,2118-05-17 07:42:15,,"['INVASIVE VENTILATION - START [**2118-5-16**] 10:30 PM', ' MULTI LUMEN - START [**2118-5-16**] 10:38 PM', '.', 'Weaned to 50% FiO2 and PEEP 5', '.', 'Seems to be following some commands', 'History obtained from Medical records']",,42830,161671.0
1,2118-05-17 07:45:28,,"['INVASIVE VENTILATION - START [**2118-5-16**] 10:30 PM', ' MULTI LUMEN - START [**2118-5-16**] 10:38 PM', '.', 'Weaned to 50% FiO2 and PEEP 5', '.', 'Seems to be following some commands', 'History obtained from Medical records']",,42830,161671.0
2,2118-05-17 08:15:18,,"['INVASIVE VENTILATION - START [**2118-5-16**] 10:30 PM', ' MULTI LUMEN - START [**2118-5-16**] 10:38 PM', '.', 'Weaned to 50% FiO2 and PEEP 5', '.', 'Seems to be following some commands', 'History obtained from Medical records']",,42830,161671.0
3,2118-05-18 07:32:27,"['EEG - At [**2118-5-17**] 02:38 PM', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]']","['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']","['INVASIVE VENTILATION - START [**2118-5-16**] 10:30 PM', ' MULTI LUMEN - START [**2118-5-16**] 10:38 PM', 'Weaned to 50% FiO2 and PEEP 5', 'Seems to be following some commands']",42830,161671.0
4,2118-05-18 07:36:29,,"['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']",,42830,161671.0
5,2118-05-18 07:40:12,,"['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']",,42830,161671.0
6,2118-05-18 07:41:43,,"['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']",,42830,161671.0
7,2118-05-18 10:40:59,,"['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']",,42830,161671.0
8,2118-05-19 07:58:15,"['INVASIVE VENTILATION - STOP [**2118-5-18**] 09:05 AM', ' MULTI LUMEN - STOP [**2118-5-18**] 04:23 PM', '- Extubated, did well, advanced diet', '- Pulled off line dressing, central line removed by RN, PIV placed', 'History obtained from Patient']","['INVASIVE VENTILATION - STOP [**2118-5-18**] 09:05 AM', ' MULTI LUMEN - STOP [**2118-5-18**] 04:23 PM', '- Extubated, did well, advanced diet', '- Pulled off line dressing, central line removed by RN, PIV placed', 'History obtained from Patient']","['EEG - At [**2118-5-17**] 02:38 PM', '.', '- Son [**Name (NI) 1053**] contact person, unable to reach but left message (#', '[**Telephone/Fax (1) 7652**])', '- T4/T3 pending, PM Hct stable', '- Resistence 17', '- Tolerated PSV well and settings weaned, also awakened more in the', 'evening', '- Prepared for potential extubation this AM [**5-18**]', 'History obtained from Medical records']",42830,161671.0
9,2118-05-19 08:00:17,,"['INVASIVE VENTILATION - STOP [**2118-5-18**] 09:05 AM', ' MULTI LUMEN - STOP [**2118-5-18**] 04:23 PM', '- Extubated, did well, advanced diet', '- Pulled off line dressing, central line removed by RN, PIV placed', 'History obtained from Patient']",,42830,161671.0
10,2118-05-19 08:01:35,,"['INVASIVE VENTILATION - STOP [**2118-5-18**] 09:05 AM', ' MULTI LUMEN - STOP [**2118-5-18**] 04:23 PM', '- Extubated, did well, advanced diet', '- Pulled off line dressing, central line removed by RN, PIV placed', 'History obtained from Patient']",,42830,161671.0
11,2118-05-19 12:21:20,,"['INVASIVE VENTILATION - STOP [**2118-5-18**] 09:05 AM', ' MULTI LUMEN - STOP [**2118-5-18**] 04:23 PM', '- Extubated, did well, advanced diet', '- Pulled off line dressing, central line removed by RN, PIV placed', 'History obtained from Patient']",,42830,161671.0
0,2160-03-12 07:54:54,,[],,69739,188087.0
1,2160-03-12 11:13:37,,[],,69739,188087.0
0,2168-06-16 07:28:05,,"['MULTI LUMEN - START [**2168-6-15**] 06:10 PM', ' INDWELLING PORT (PORTACATH) - START [**2168-6-15**] 06:11 PM', 'placed over a year ago per the patient, accessed it in the clinic']",,71127,123482.0
1,2168-06-16 07:35:03,,"['MULTI LUMEN - START [**2168-6-15**] 06:10 PM', ' INDWELLING PORT (PORTACATH) - START [**2168-6-15**] 06:11 PM', 'placed over a year ago per the patient, accessed it in the clinic']",,71127,123482.0
2,2168-06-16 11:34:14,,"['MULTI LUMEN - START [**2168-6-15**] 06:10 PM', ' INDWELLING PORT (PORTACATH) - START [**2168-6-15**] 06:11 PM', 'placed over a year ago per the patient, accessed it in the clinic']",,71127,123482.0
3,2168-06-17 07:52:57,"['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']","['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']","['MULTI LUMEN - START [**2168-6-15**] 06:10 PM', ' INDWELLING PORT (PORTACATH) - START [**2168-6-15**] 06:11 PM', 'placed over a year ago per the patient, accessed it in the clinic']",71127,123482.0
4,2168-06-17 07:58:01,,"['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']",,71127,123482.0
5,2168-06-17 07:58:45,,"['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']",,71127,123482.0
6,2168-06-17 10:00:24,,"['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']",,71127,123482.0
7,2168-06-17 10:03:28,,"['MULTI LUMEN - STOP [**2168-6-16**] 08:42 PM', 'Developed hyperglycemia overnight, not called out to floor']",,71127,123482.0
0,2199-07-30 06:57:26,,"['- RIJ successfully placed', '- Milrinone bolus and gtt started around 11:30pm, with adjunctive', 'neosynephrine for BP support', '-  Multiple episodes of Non Sustained V Tach.', 'Overnight, patient reports no new chest pain, shortness of breath,', 'fevers, chills, or dizziness.']",,98815,195726.0
1,2199-07-30 09:20:58,"['neosynephrine for BP support.  This was stopped relatively soon as BP', 'responded.', '- Good UOP', '-  Multiple episodes of Non Sustained V Tach, most less than 8 beats,', 'some runs of Vtach longer.', '- Overnight, patient reports no new chest pain, shortness of breath,']","['- RIJ successfully placed', '- Milrinone bolus and gtt started around 11:30pm, with adjunctive', 'neosynephrine for BP support.  This was stopped relatively soon as BP', 'responded.', '- Good UOP', '-  Multiple episodes of Non Sustained V Tach, most less than 8 beats,', 'some runs of Vtach longer.', '- Overnight, patient reports no new chest pain, shortness of breath,', 'fevers, chills, or dizziness.']","['neosynephrine for BP support', '-  Multiple episodes of Non Sustained V Tach.', 'Overnight, patient reports no new chest pain, shortness of breath,']",98815,195726.0
2,2199-07-30 11:15:05,,"['- RIJ successfully placed', '- Milrinone bolus and gtt started around 11:30pm, with adjunctive', 'neosynephrine for BP support.  This was stopped relatively soon as BP', 'responded.', '- Good UOP', '-  Multiple episodes of Non Sustained V Tach, most less than 8 beats,', 'some runs of Vtach longer.', '- Overnight, patient reports no new chest pain, shortness of breath,', 'fevers, chills, or dizziness.']",,98815,195726.0
3,2199-08-01 06:51:48,"['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']","['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']","['- RIJ successfully placed', '- Milrinone bolus and gtt started around 11:30pm, with adjunctive', 'neosynephrine for BP support.  This was stopped relatively soon as BP', 'responded.', '- Good UOP', '-  Multiple episodes of Non Sustained V Tach, most less than 8 beats,', 'some runs of Vtach longer.', '- Overnight, patient reports no new chest pain, shortness of breath,', 'fevers, chills, or dizziness.']",98815,195726.0
4,2199-08-01 07:52:41,,"['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']",,98815,195726.0
5,2199-08-01 11:01:31,,"['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']",,98815,195726.0
6,2199-08-01 15:47:38,,"['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']",,98815,195726.0
7,2199-08-02 07:43:05,"['- Still diuresing well (-3L in in 24 hours as of 2pm)', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.']","['- Still diuresing well (-3L in in 24 hours as of 2pm)', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.']","['Pt continued with diuresis, with non sustained ventricular tachycarcia.', 'Patient reguired 0.5 mcg/kg/min overnight with MAPS 60 -70.', 'Pt only notes some left knee pain which developed over the last day.', 'Hasn', 't had this pain before in knee but describes it as anterior knee', 'and increases with bending. Pt states shortness of breath at night has', 'improved. Denies chest pain and dizziness. States he can occasionally', 'feel episodes of VT.']",98815,195726.0
8,2199-08-02 07:46:06,,"['- Still diuresing well (-3L in in 24 hours as of 2pm)', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.']",,98815,195726.0
9,2199-08-02 08:04:05,"['- Still diuresing well -7 Liters', 'Continuing to have numerous episodes of NSVT (longest run of 18 beats)']","['- Still diuresing well -7 Liters', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.', 'Continuing to have numerous episodes of NSVT (longest run of 18 beats)']",['- Still diuresing well (-3L in in 24 hours as of 2pm)'],98815,195726.0
10,2199-08-02 10:25:00,,"['- Still diuresing well -7 Liters', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.', 'Continuing to have numerous episodes of NSVT (longest run of 18 beats)']",,98815,195726.0
11,2199-08-03 08:25:06,,"['- Still diuresing well -7 Liters', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.', 'Continuing to have numerous episodes of NSVT (longest run of 18 beats)']",,98815,195726.0
12,2199-08-03 08:56:42,"['- Still diuresing well (-6L since midnight at 5:30pm) but increased', 'Lasix gtt to 30/hr', '- increased KCL to 40mEq daily', '- 2pm lytes Cr 1.7, K 4.2 (pt will get 40mEq this evening)']","['- Still diuresing well (-6L since midnight at 5:30pm) but increased', 'Lasix gtt to 30/hr', '- increased KCL to 40mEq daily', '- 2pm lytes Cr 1.7, K 4.2 (pt will get 40mEq this evening)']","['- Still diuresing well -7 Liters', '- Added KCl 20mEq po daily', '- Lytes 1400: Sodium 130 (from 129), K 3.6, Crt 1.7 (from 1.6), Mag:', '2.1. Patient given 60 total K with dinner. Written for 20 K daily.', 'Continuing to have numerous episodes of NSVT (longest run of 18 beats)']",98815,195726.0
13,2199-08-03 09:08:48,,"['- Still diuresing well (-6L since midnight at 5:30pm) but increased', 'Lasix gtt to 30/hr', '- increased KCL to 40mEq daily', '- 2pm lytes Cr 1.7, K 4.2 (pt will get 40mEq this evening)']",,98815,195726.0
14,2199-08-03 11:10:18,,"['- Still diuresing well (-6L since midnight at 5:30pm) but increased', 'Lasix gtt to 30/hr', '- increased KCL to 40mEq daily', '- 2pm lytes Cr 1.7, K 4.2 (pt will get 40mEq this evening)']",,98815,195726.0
15,2199-08-04 08:31:23,"['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']","['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']","['- Still diuresing well (-6L since midnight at 5:30pm) but increased', 'Lasix gtt to 30/hr', '- increased KCL to 40mEq daily', '- 2pm lytes Cr 1.7, K 4.2 (pt will get 40mEq this evening)']",98815,195726.0
16,2199-08-04 10:10:42,,"['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']",,98815,195726.0
17,2199-08-04 13:50:19,,"['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']",,98815,195726.0
18,2199-08-05 06:28:05,"['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 128/Cl 79', '- negative 7.2L over the last 24 hours', '- Gout improved L foot. Developed diarrhea secondary to the Colchicine.', 'Added on Imodium.', '- One episode. Non sustained Vtach, 15 beats.']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 128/Cl 79', '- negative 7.2L over the last 24 hours', '- Gout improved L foot. Developed diarrhea secondary to the Colchicine.', 'Added on Imodium.', '- One episode. Non sustained Vtach, 15 beats.']","['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']",98815,195726.0
19,2199-08-05 06:41:02,"['- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']","['- Hyponatremia/Hypochloremia persists Na 128/Cl 79', '- negative 7.2L over the last 24 hours', '- Gout improved L foot. Developed diarrhea secondary to the Colchicine.', 'Added on Imodium.', '- One episode. Non sustained Vtach, 15 beats.']",98815,195726.0
20,2199-08-05 06:52:30,"['Colchicine.  Added on Imodium, now diarrhea improved on Imodium.']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']",['Colchicine.  Added on Imodium.'],98815,195726.0
21,2199-08-05 06:56:30,,"['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']",,98815,195726.0
22,2199-08-05 10:04:44,,"['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']",,98815,195726.0
23,2199-08-05 11:37:03,"['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']","['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']",98815,195726.0
24,2199-08-05 11:38:45,"['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']","['- At 1700 net negative -5200 cc; at 11pm -7629', '- Lytes at 1600: K 4.1 Cr 1.7 Ca [**00**].3; at 4am, K 4.2, Cr 1.7. Repleting', 'K this a.m.', '- continue 40 meq IV with each meal for now and monitor lytes [**Hospital1 7**]']",98815,195726.0
25,2199-08-06 06:24:41,"['- Patient collapsed to floor, telemetry showed polymorphic VTach, ICD', 'fired and patient lifted back to bed.  Electrolytes at the time stable', 'from the morning.', '- Milrinone changed to 0.375mcg/kg/min (as needs to be dose adjusted', 'for new lower weight) - likely milrinone precipitated VT event? - will', 'watch for afterload increase after decreasing dose of milrinone and', 'will wean phenylephrine as needed', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']","['- Patient collapsed to floor, telemetry showed polymorphic VTach, ICD', 'fired and patient lifted back to bed.  Electrolytes at the time stable', 'from the morning.', '- Milrinone changed to 0.375mcg/kg/min (as needs to be dose adjusted', 'for new lower weight) - likely milrinone precipitated VT event? - will', 'watch for afterload increase after decreasing dose of milrinone and', 'will wean phenylephrine as needed', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']","['- Aldactone increased to 50 mg Daily', '- Hyponatremia/Hypochloremia persists Na 129/Cl 77 today', '- negative 7.2L over the last 24 hours (total length of stay -43L)', '- Gout improved L foot.  Developed diarrhea secondary to the', 'Colchicine.  Added on Imodium, now diarrhea improved on Imodium.', '- Continued episodes of non-sustained Vtach (one episode of 15 beats,', 'one episode of 8 beats).']",98815,195726.0
26,2199-08-06 06:34:34,,"['- Patient collapsed to floor, telemetry showed polymorphic VTach, ICD', 'fired and patient lifted back to bed.  Electrolytes at the time stable', 'from the morning.', '- Milrinone changed to 0.375mcg/kg/min (as needs to be dose adjusted', 'for new lower weight) - likely milrinone precipitated VT event? - will', 'watch for afterload increase after decreasing dose of milrinone and', 'will wean phenylephrine as needed', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",,98815,195726.0
27,2199-08-06 07:26:01,"['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.']","['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']","['- Patient collapsed to floor, telemetry showed polymorphic VTach, ICD', 'fired and patient lifted back to bed.  Electrolytes at the time stable', 'from the morning.', '- Milrinone changed to 0.375mcg/kg/min (as needs to be dose adjusted', 'for new lower weight) - likely milrinone precipitated VT event? - will', 'watch for afterload increase after decreasing dose of milrinone and', 'will wean phenylephrine as needed']",98815,195726.0
28,2199-08-06 09:25:56,,"['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",,98815,195726.0
29,2199-08-06 09:38:47,,"['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",,98815,195726.0
30,2199-08-06 09:40:21,,"['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",,98815,195726.0
31,2199-08-06 10:43:10,,"['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",,98815,195726.0
32,2199-08-07 07:54:14,"['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']","['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']","['Pt notes no chest pain, shortness of breath. Only notes', 'left gouty toe and left knee tendonitis. Pt very concerned by events', 'and would like to discuss goals of treatment.', '-Two episodes of VT @220.  First, at 1330 ([**8-5**]) patient collapsed to', 'floor, ICD fired. Milrinone reduced to .375 mcg/kg/min. Second, at 0400', '([**8-6**]) patient felt palpitations/rapid heart beat and then passed out', 'device fired. Milrinone turned off. After both events patient returned', 'to vpaced rhythm. Electrolytes at the time stable from the morning.', ""- Patient actually had low bp's after milrinone decreased, increased"", 'neosynephrine slightly', '- Talked to pharm re: SC heparin dose in obese patients.  Stated that', 'they don\'t typically adjust dose based on body weight but they ""have', 'seen 7500units TID used before"" and if we want to switch to that, we', 'can.  Left it at 5000units TID.']",98815,195726.0
33,2199-08-07 09:24:10,,"['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']",,98815,195726.0
34,2199-08-07 09:30:30,,"['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']",,98815,195726.0
35,2199-08-07 11:02:34,,"['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']",,98815,195726.0
36,2199-08-08 07:11:03,"['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg Am', '1400 K (4.2)+ 40 KCL.', 'Toprol XL 200mg first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to PO.']","['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg Am', '1400 K (4.2)+ 40 KCL.', 'Toprol XL 200mg first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to PO.']","['- Patient with Cr increase to 2.0 at 1400 today. Reduced Lasix gtt to', '20 from 30.', '- Q 8 K checks: at 1400: 4.3; at 2200: 4.4.', '-Had several K boluses yesterday, for a total of 200mEq in last 24hr', '-This morning, Cr =2.2.K = 4.8', '- Remained in NSR at 1640, no ICD firing or fast Vtach epoisodes']",98815,195726.0
37,2199-08-08 07:49:56,,"['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg Am', '1400 K (4.2)+ 40 KCL.', 'Toprol XL 200mg first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to PO.']",,98815,195726.0
38,2199-08-08 09:58:20,,"['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg Am', '1400 K (4.2)+ 40 KCL.', 'Toprol XL 200mg first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to PO.']",,98815,195726.0
39,2199-08-08 10:17:47,"['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg qam', '- 1400 K (4.2)+ 40 KCL.', '- Switched to Toprol XL 200mg po daily first dose 7/23.', '- Changed K to oral from IV.']","['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg qam', '- 1400 K (4.2)+ 40 KCL.', '- Switched to Toprol XL 200mg po daily first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to oral from IV.']","['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg Am', '1400 K (4.2)+ 40 KCL.', 'Toprol XL 200mg first dose 7/23.', '- Changed K to PO.']",98815,195726.0
40,2199-08-08 15:03:22,,"['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg qam', '- 1400 K (4.2)+ 40 KCL.', '- Switched to Toprol XL 200mg po daily first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to oral from IV.']",,98815,195726.0
41,2199-08-11 06:34:45,"['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']","['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']","['- Lasix gtt stopped, Switched to Torsemide 80mg [**Hospital1 7**], Metolazone 5mg qam', '- 1400 K (4.2)+ 40 KCL.', '- Switched to Toprol XL 200mg po daily first dose 7/23.', '- Difficulty weaning phenylephrine. Afternoon dose of Metoprolol held', 'and Digoxin 0.5mg PO, then Digoxin 0.5mg three hours later. Weaned to', 'off @ 2200.', '- Changed K to oral from IV.']",98815,195726.0
42,2199-08-11 07:13:42,,"['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']",,98815,195726.0
43,2199-08-11 07:44:34,,"['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']",,98815,195726.0
44,2199-08-11 09:08:01,,"['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']",,98815,195726.0
45,2199-08-11 10:54:08,,"['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']",,98815,195726.0
46,2199-08-12 07:06:56,"['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM']","['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM']","['- EP Recs: Changed ATP in hopes to pace out of VT. Only other', 'consideration would be amio. Mentioned possibility of heart transplant.', '- Stopped digoxin', '- Bowel Regimen increased.', ""- Creatinine bumped to 2.4 today. DC'd all diuretics until rounds to"", ""discuss regimen with Dr. [**First Name (STitle) **] (All doses 7/25 were given). DC'd"", 'potassium until diuretic regimen can be determined.', '-Telemetry shows frequent PVC']",98815,195726.0
47,2199-08-12 07:25:59,['Minimal NSVT- greatest 6 beat run'],"['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM', 'Minimal NSVT- greatest 6 beat run']",,98815,195726.0
48,2199-08-12 09:37:42,,"['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM', 'Minimal NSVT- greatest 6 beat run']",,98815,195726.0
49,2199-08-12 11:46:41,,"['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM', 'Minimal NSVT- greatest 6 beat run']",,98815,195726.0
50,2199-08-13 06:43:16,"['- Held all diuretics in the last 24 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']","['- Held all diuretics in the last 24 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']","['- Diuretics held', '-putting out 100cc/hr of urine consistently since midnight, given 40mEq', 'of K at 3pm', 'Yesterday given 60 mEq in AM', 'Minimal NSVT- greatest 6 beat run']",98815,195726.0
51,2199-08-13 07:33:32,,"['- Held all diuretics in the last 24 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']",,98815,195726.0
52,2199-08-13 07:34:57,['- Held all diuretics in the last 48 hours'],"['- Held all diuretics in the last 48 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']",['- Held all diuretics in the last 24 hours'],98815,195726.0
53,2199-08-13 09:41:02,,"['- Held all diuretics in the last 48 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']",,98815,195726.0
54,2199-08-13 11:15:41,,"['- Held all diuretics in the last 48 hours', '- Given 40 mEq po KCl [**Hospital1 7**]', '- Lots of PVC', 's on telemetry, no runs of Vtach', '- Total length of stay fluid balance: negative 63.5L']",,98815,195726.0
0,2145-06-10 06:56:56,,"['-Improved with frequent suctioning, nebs, mouth care', '-Weaned off to 4L NC']",,30341,174592.0
1,2145-06-10 10:09:08,"['-Improved with frequent suctioning, mouth care, with good response to', 'albuterol nebs  (increased to q4h prn)', '- Reports subjective improvement in respiratory status today', '- Diarrhea also improved']","['-Improved with frequent suctioning, mouth care, with good response to', 'albuterol nebs  (increased to q4h prn)', '- Reports subjective improvement in respiratory status today', '- Diarrhea also improved']","['-Improved with frequent suctioning, nebs, mouth care', '-Weaned off to 4L NC']",30341,174592.0
0,2145-07-27 06:06:25,,"['SHEATH - START [**2145-7-26**] 05:48 PM', 'venous sheath for TPA with side port infusing heparin', ' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59 PM', '- started had TPA treatment', 'History obtained from Patient']",,30341,121351.0
1,2145-07-27 12:05:00,,"['SHEATH - START [**2145-7-26**] 05:48 PM', 'venous sheath for TPA with side port infusing heparin', ' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59 PM', '- started had TPA treatment', 'History obtained from Patient']",,30341,121351.0
2,2145-07-27 14:05:19,"[' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59', '- [**2145-7-26**] started on TPA and heparin  for port associated clot']","['SHEATH - START [**2145-7-26**] 05:48 PM', 'venous sheath for TPA with side port infusing heparin', ' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59', '- [**2145-7-26**] started on TPA and heparin  for port associated clot', 'History obtained from Patient']","[' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59 PM', '- started had TPA treatment']",30341,121351.0
3,2145-07-27 14:27:01,,"['SHEATH - START [**2145-7-26**] 05:48 PM', 'venous sheath for TPA with side port infusing heparin', ' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59', '- [**2145-7-26**] started on TPA and heparin  for port associated clot', 'History obtained from Patient']",,30341,121351.0
4,2145-07-28 05:45:28,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']","['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']","['SHEATH - START [**2145-7-26**] 05:48 PM', 'venous sheath for TPA with side port infusing heparin', ' INDWELLING PORT (PORTACATH) - START [**2145-7-26**] 06:59', '- [**2145-7-26**] started on TPA and heparin  for port associated clot', 'History obtained from Patient']",30341,121351.0
5,2145-07-28 05:48:41,,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']",,30341,121351.0
6,2145-07-28 06:29:39,,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']",,30341,121351.0
7,2145-07-28 06:30:31,,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']",,30341,121351.0
8,2145-07-28 11:45:43,"['somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.']","['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']","['somewhat but is still there. No intervention at this time. Heparinf', 'drip at 200u/hr through sheath and TPA through catheter intil 5PM.', 'Restart therapeutic Heparin after catheter removed.']",30341,121351.0
9,2145-07-28 12:39:48,"['To L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. Heparin drip at 200u/hr through sheath and', 'TPA through catheter intil 5PM. Heparin restarted at 1400 U at 5 PM', '-pt re-seen by IR for venography and clot retrieval on morning of [**7-28**],', 'IR states residual clot persists, plan to remove sheath today.', '-pt denies new weakness']","['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'To L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. Heparin drip at 200u/hr through sheath and', 'TPA through catheter intil 5PM. Heparin restarted at 1400 U at 5 PM', '-pt re-seen by IR for venography and clot retrieval on morning of [**7-28**],', 'IR states residual clot persists, plan to remove sheath today.', '-pt denies new weakness']","['to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']",30341,121351.0
10,2145-07-28 12:56:19,,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'To L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. Heparin drip at 200u/hr through sheath and', 'TPA through catheter intil 5PM. Heparin restarted at 1400 U at 5 PM', '-pt re-seen by IR for venography and clot retrieval on morning of [**7-28**],', 'IR states residual clot persists, plan to remove sheath today.', '-pt denies new weakness']",,30341,121351.0
11,2145-07-29 06:15:46,"['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '[**7-28**]', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given']","['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '[**7-28**]', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given']","['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'To L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. Heparin drip at 200u/hr through sheath and', 'TPA through catheter intil 5PM. Heparin restarted at 1400 U at 5 PM', '-pt re-seen by IR for venography and clot retrieval on morning of [**7-28**],', 'IR states residual clot persists, plan to remove sheath today.', '-pt denies new weakness']",30341,121351.0
12,2145-07-29 06:16:58,,"['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '[**7-28**]', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given']",,30341,121351.0
13,2145-07-29 06:18:17,,"['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '[**7-28**]', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given']",,30341,121351.0
14,2145-07-29 07:07:25,,"['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '[**7-28**]', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given']",,30341,121351.0
15,2145-07-29 14:02:59,"['-500cc fluid bolus given for tachycardia in the setting of NPO status', 'for scheduled portacath removal', '- IR and oncology decided not to remove portacath: continue', 'anticoagulation and monitor status']","['[**7-28**]', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given', '-500cc fluid bolus given for tachycardia in the setting of NPO status', 'for scheduled portacath removal', '- IR and oncology decided not to remove portacath: continue', 'anticoagulation and monitor status']","['SHEATH - STOP [**2145-7-28**] 12:30 PM', 'venous sheath for TPA with side port infusing heparin', ' ULTRASOUND - At [**2145-7-28**] 03:00 PM', ' CALLED OUT', '-plan to remove portacath in am, NPO after midnight, to go home on', 'Lovenox']",30341,121351.0
16,2145-07-29 14:03:57,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']","['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']","['[**7-28**]', '-IR sheath removed afternoon [**7-27**]', '-1x 5mg Ambien given', '-500cc fluid bolus given for tachycardia in the setting of NPO status', 'for scheduled portacath removal', '- IR and oncology decided not to remove portacath: continue', 'anticoagulation and monitor status']",30341,121351.0
17,2145-07-29 14:04:35,,"['ANGIOGRAPHY - At [**2145-7-27**] 12:25 PM', 'to L2 for angiography of clot in SVC. Found that clot has dissolved', 'somewhat but is still there. No intervention at this time. Heparin drip', 'at 200u/hr through sheath and TPA through catheter intil 5PM. Restart', 'therapeutic Heparin after catheter removed.', '-pt seen by IR for venography and clot retrieval.  Pt to return to IR', 'for further clot removal on [**7-28**].', ""-IR recommended dc'ing TPA and starting 1400 units heparin"", '-HR to 110']",,30341,121351.0
0,2190-04-22 07:43:21,,"['ULTRASOUND - At [**2190-4-21**] 04:24 PM', ' ENDOSCOPY - At [**2190-4-21**] 06:00 PM', ' INVASIVE VENTILATION - START [**2190-4-21**] 06:45 PM', ' ENDOSCOPY - At [**2190-4-21**] 07:00 PM', 'EGD showing duodenal ulcers and stigmata of variceal bleeding, one', 'varices clipped']",,52777,169328.0
1,2190-04-22 07:53:53,"['-', 'EGD showing duodenal ulcers and stigmata of variceal', 'bleeding, one varices clipped', '-', 'attempted paracentesis, unsucessful']","['ULTRASOUND - At [**2190-4-21**] 04:24 PM', ' ENDOSCOPY - At [**2190-4-21**] 06:00 PM', ' INVASIVE VENTILATION - START [**2190-4-21**] 06:45 PM', ' ENDOSCOPY - At [**2190-4-21**] 07:00 PM', '-', 'EGD showing duodenal ulcers and stigmata of variceal', 'bleeding, one varices clipped', '-', 'attempted paracentesis, unsucessful']","['EGD showing duodenal ulcers and stigmata of variceal bleeding, one', 'varices clipped']",52777,169328.0
2,2190-04-22 07:54:19,,"['ULTRASOUND - At [**2190-4-21**] 04:24 PM', ' ENDOSCOPY - At [**2190-4-21**] 06:00 PM', ' INVASIVE VENTILATION - START [**2190-4-21**] 06:45 PM', ' ENDOSCOPY - At [**2190-4-21**] 07:00 PM', '-', 'EGD showing duodenal ulcers and stigmata of variceal', 'bleeding, one varices clipped', '-', 'attempted paracentesis, unsucessful']",,52777,169328.0
3,2190-04-22 10:11:31,"['EGD with blood in stomach, stigmata of variceal bleeding,', 'one varix banded, duodenal ulcers one of which looked ulcerated and', 'suspicious for malignancy']","['ULTRASOUND - At [**2190-4-21**] 04:24 PM', ' ENDOSCOPY - At [**2190-4-21**] 06:00 PM', ' INVASIVE VENTILATION - START [**2190-4-21**] 06:45 PM', ' ENDOSCOPY - At [**2190-4-21**] 07:00 PM', '-', 'EGD with blood in stomach, stigmata of variceal bleeding,', 'one varix banded, duodenal ulcers one of which looked ulcerated and', 'suspicious for malignancy', '-']","['EGD showing duodenal ulcers and stigmata of variceal', 'bleeding, one varices clipped', 'attempted paracentesis, unsucessful']",52777,169328.0
4,2190-04-22 11:06:39,,"['ULTRASOUND - At [**2190-4-21**] 04:24 PM', ' ENDOSCOPY - At [**2190-4-21**] 06:00 PM', ' INVASIVE VENTILATION - START [**2190-4-21**] 06:45 PM', ' ENDOSCOPY - At [**2190-4-21**] 07:00 PM', '-', 'EGD with blood in stomach, stigmata of variceal bleeding,', 'one varix banded, duodenal ulcers one of which looked ulcerated and', 'suspicious for malignancy', '-']",,52777,169328.0
0,2194-06-20 07:34:40,,['tachycardia'],,31580,140595.0
1,2194-06-20 12:12:37,"['Tachycardia continues to 130s.', 'Patient continues to have pain in back radiating around to abdomen.', 'he had some nausea & vomiting earlier this morning and put out 700 cc', 'from NGT suction.', 'Patient feels well besides pain.']","['Tachycardia continues to 130s.', 'Patient continues to have pain in back radiating around to abdomen.', 'he had some nausea & vomiting earlier this morning and put out 700 cc', 'from NGT suction.', 'Patient feels well besides pain.']",['tachycardia'],31580,140595.0
2,2194-06-21 07:36:29,"['[**2194-6-20**] ECHO: Suboptimal image quality. Small pericardial effusion.', 'Normal global biventricular systolic function. Small secundum ASD vs.', 'stretched PFO. Borderline pulmonary hypertension.', 'Compared with the prior study (images reviewed) of [**2194-4-2**], the atrial', 'septal defect is new. The severity of tricuspid regurgitation is', 'reduced. The rhythm now appears to be atrial fibrillation with a rapid', 'ventricular response.  LVEF 55%.', 'A-fib: Poor rate control overnight on max dosage of metoprolol']","['[**2194-6-20**] ECHO: Suboptimal image quality. Small pericardial effusion.', 'Normal global biventricular systolic function. Small secundum ASD vs.', 'stretched PFO. Borderline pulmonary hypertension.', 'Compared with the prior study (images reviewed) of [**2194-4-2**], the atrial', 'septal defect is new. The severity of tricuspid regurgitation is', 'reduced. The rhythm now appears to be atrial fibrillation with a rapid', 'ventricular response.  LVEF 55%.', 'A-fib: Poor rate control overnight on max dosage of metoprolol']","['Tachycardia continues to 130s.', 'Patient continues to have pain in back radiating around to abdomen.', 'he had some nausea & vomiting earlier this morning and put out 700 cc', 'from NGT suction.', 'Patient feels well besides pain.']",31580,140595.0
3,2194-06-21 08:11:13,,"['[**2194-6-20**] ECHO: Suboptimal image quality. Small pericardial effusion.', 'Normal global biventricular systolic function. Small secundum ASD vs.', 'stretched PFO. Borderline pulmonary hypertension.', 'Compared with the prior study (images reviewed) of [**2194-4-2**], the atrial', 'septal defect is new. The severity of tricuspid regurgitation is', 'reduced. The rhythm now appears to be atrial fibrillation with a rapid', 'ventricular response.  LVEF 55%.', 'A-fib: Poor rate control overnight on max dosage of metoprolol']",,31580,140595.0
4,2194-06-21 15:30:33,"['A-fib: rate control (HR<120) overnight on max dosage of metoprolol XL', '200mg [**Hospital1 **]', 'Itching on dilaudid; document as ADR; started on hydrocodone for', 'breakthrough pain.']","['[**2194-6-20**] ECHO: Suboptimal image quality. Small pericardial effusion.', 'Normal global biventricular systolic function. Small secundum ASD vs.', 'stretched PFO. Borderline pulmonary hypertension.', 'Compared with the prior study (images reviewed) of [**2194-4-2**], the atrial', 'septal defect is new. The severity of tricuspid regurgitation is', 'reduced. The rhythm now appears to be atrial fibrillation with a rapid', 'ventricular response.  LVEF 55%.', 'A-fib: rate control (HR<120) overnight on max dosage of metoprolol XL', '200mg [**Hospital1 **]', 'Itching on dilaudid; document as ADR; started on hydrocodone for', 'breakthrough pain.']",['A-fib: Poor rate control overnight on max dosage of metoprolol'],31580,140595.0
5,2194-06-22 07:05:37,"['Afib with RVR - Cards consulted and preferred rate control.  did not', ""think that fixing patient's ASD would help with AFib.  Also decided not"", 'to start digoxin.', 'Elevated INR to 6.9 --> given Vit K and check DIC labs.', 'pain...']","['Afib with RVR - Cards consulted and preferred rate control.  did not', ""think that fixing patient's ASD would help with AFib.  Also decided not"", 'to start digoxin.', 'Elevated INR to 6.9 --> given Vit K and check DIC labs.', 'pain...']","['[**2194-6-20**] ECHO: Suboptimal image quality. Small pericardial effusion.', 'Normal global biventricular systolic function. Small secundum ASD vs.', 'stretched PFO. Borderline pulmonary hypertension.', 'Compared with the prior study (images reviewed) of [**2194-4-2**], the atrial', 'septal defect is new. The severity of tricuspid regurgitation is', 'reduced. The rhythm now appears to be atrial fibrillation with a rapid', 'ventricular response.  LVEF 55%.', 'A-fib: rate control (HR<120) overnight on max dosage of metoprolol XL', '200mg [**Hospital1 **]', 'Itching on dilaudid; document as ADR; started on hydrocodone for', 'breakthrough pain.']",31580,140595.0
6,2194-06-22 12:57:24,"[""think that fixing patient's ASD is a necessary intervention.  Also"", 'decided not to start digoxin.', 'Elevated INR to 6.9 --> given Vit K and monitoring DIC labs', 'Patient', 's abdominal pain is well controlled on current regimen.', 'Having constipation and given lactulose overnight with BM this morning.', 'Patient reports decreased appetite but tolerating fully liquid diet', 'with ensure.']","['Afib with RVR - Cards consulted and preferred rate control.  did not', ""think that fixing patient's ASD is a necessary intervention.  Also"", 'decided not to start digoxin.', 'Elevated INR to 6.9 --> given Vit K and monitoring DIC labs', 'Patient', 's abdominal pain is well controlled on current regimen.', 'Having constipation and given lactulose overnight with BM this morning.', 'Patient reports decreased appetite but tolerating fully liquid diet', 'with ensure.']","[""think that fixing patient's ASD would help with AFib.  Also decided not"", 'to start digoxin.', 'Elevated INR to 6.9 --> given Vit K and check DIC labs.', 'pain...']",31580,140595.0
0,2197-07-17 06:49:06,,"['-started vanco, levoquin for PNA', '-spiked this am, sent Urine cult', '- urine legionella sent']",,31516,197262.0
1,2197-07-17 07:49:49,"['-spiked this am to 100.9, sent Urine cult (no pyuria on UA)']","['-started vanco, levoquin for PNA', '-spiked this am to 100.9, sent Urine cult (no pyuria on UA)', '- urine legionella sent']","['-spiked this am, sent Urine cult']",31516,197262.0
2,2197-07-17 08:09:28,,"['-started vanco, levoquin for PNA', '-spiked this am to 100.9, sent Urine cult (no pyuria on UA)', '- urine legionella sent']",,31516,197262.0
3,2197-07-17 12:33:34,"['-started vanco, levoquin for PNA. Will discuss adding gentamicin with', 'ID', '- S&S concerning for aspiration, NG tube palced']","['-started vanco, levoquin for PNA. Will discuss adding gentamicin with', 'ID', '-spiked this am to 100.9, sent Urine cult (no pyuria on UA)', '- urine legionella sent', '- S&S concerning for aspiration, NG tube palced']","['-started vanco, levoquin for PNA']",31516,197262.0
4,2197-07-17 12:52:14,,"['-started vanco, levoquin for PNA. Will discuss adding gentamicin with', 'ID', '-spiked this am to 100.9, sent Urine cult (no pyuria on UA)', '- urine legionella sent', '- S&S concerning for aspiration, NG tube palced']",,31516,197262.0
5,2197-07-18 06:27:16,"['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements']","['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements']","['-started vanco, levoquin for PNA. Will discuss adding gentamicin with', 'ID', '-spiked this am to 100.9, sent Urine cult (no pyuria on UA)', '- urine legionella sent', '- S&S concerning for aspiration, NG tube palced']",31516,197262.0
6,2197-07-18 06:30:33,,"['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements']",,31516,197262.0
7,2197-07-18 07:32:10,,"['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements']",,31516,197262.0
8,2197-07-18 12:23:15,['Ongoing poor respiratory status [**1-7**] secretions'],"['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements', 'Ongoing poor respiratory status [**1-7**] secretions']",,31516,197262.0
9,2197-07-19 06:27:43,"['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending.', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']","['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending.', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']","['NG Tube placed', 'CT Head [**7-17**]- prelim showed lacunar infarcts, f/u final read', 'Added Cefepime, have ID approval', 'Initially called out, but ended up staying.  Will plan on transfer to', 'floor in morning- team concerned about nursing requirements', 'Ongoing poor respiratory status [**1-7**] secretions']",31516,197262.0
10,2197-07-19 06:29:07,,"['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending.', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']",,31516,197262.0
11,2197-07-19 07:16:12,,"['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending.', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']",,31516,197262.0
12,2197-07-19 07:18:59,['cultures pending. Sputum stain positive for two morphologies of GNRs'],"['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending. Sputum stain positive for two morphologies of GNRs', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']",['cultures pending.'],31516,197262.0
13,2197-07-19 13:03:28,,"['URINE CULTURE - At [**2197-7-18**] 06:27 PM', ' BLOOD CULTURED - At [**2197-7-18**] 06:27 PM', ' SPUTUM CULTURE - At [**2197-7-18**] 08:00 PM', ' BLOOD CULTURED - At [**2197-7-18**] 08:15 PM', 'from peripheral iv', ' FEVER - 101.2', 'F - [**2197-7-18**] 06:00 PM', 'Geriatrics consulted. Felt delirious from multiple causes.', '- Vit D increased to 800units QD.', '- PCP is geriatrician and he will need f/u as o/p with this doctor [**First Name (Titles) **]', '[**Female First Name (un) 4242**] service here for continuity of care.', 'Spiked temp to 101.2. Pan cultured. U/A clean except RBCs. Final', 'cultures pending. Sputum stain positive for two morphologies of GNRs', 'K this am 3.6. On KCl SS but supposed to be through CVL. Gave 40mEq PO', 'KCl and changed SS.']",,31516,197262.0
0,2190-05-10 06:18:56,,"['PICC LINE - START [**2190-5-10**] 12:00 AM', '- Admitted overnight', '- Seen by CT surgery', '- Completed 2 pRBC transfusion']",,95147,180407.0
1,2190-05-10 09:47:48,,"['PICC LINE - START [**2190-5-10**] 12:00 AM', '- Admitted overnight', '- Seen by CT surgery', '- Completed 2 pRBC transfusion']",,95147,180407.0
2,2190-05-11 07:08:09,"['-CT [**Doctor First Name 91**] no new recs', '-CXR repeated w/ slightly larger R pleural effusion', '-hct trended, relatively stable', '-TSH added on, 5.7- free T4 ordered for a.m.', '-sputum cx ordered, none produced', '-PO lopressor uptitrated', '-vanc / zosyn approved by ID']","['-CT [**Doctor First Name 91**] no new recs', '-CXR repeated w/ slightly larger R pleural effusion', '-hct trended, relatively stable', '-TSH added on, 5.7- free T4 ordered for a.m.', '-sputum cx ordered, none produced', '-PO lopressor uptitrated', '-vanc / zosyn approved by ID']","['PICC LINE - START [**2190-5-10**] 12:00 AM', '- Admitted overnight', '- Seen by CT surgery', '- Completed 2 pRBC transfusion']",95147,180407.0
3,2190-05-11 09:47:45,,"['-CT [**Doctor First Name 91**] no new recs', '-CXR repeated w/ slightly larger R pleural effusion', '-hct trended, relatively stable', '-TSH added on, 5.7- free T4 ordered for a.m.', '-sputum cx ordered, none produced', '-PO lopressor uptitrated', '-vanc / zosyn approved by ID']",,95147,180407.0
4,2190-05-12 06:13:35,"['ULTRASOUND - At [**2190-5-11**] 04:00 PM', 'IP fellow in - US of r side of chest', '-AM CXR concerning for worsening fluid accumulation. CT chest done', 'without change from [**5-9**] [**Location (un) 3**] study. CT [**Doctor First Name 91**] contact[**Name (NI) **] [**Name2 (NI) **] for', 'consideration of Pigtail catheter. After discussion with pt and', 'daughter plan for conservative approach and diuresis to try to treat', 'effusion for now.  1 L neg at midnight', '-pm HCT stable', '-AF/RVR this afternoon to 140s. Received 2 doses IV Metoprolol and', 'increased metoprolol to 100 mg tid. Gave 250 cc bolus.  Persisted, gave', 'additional 25 mg po metoprolol and increased to 125 mg tid with', 'improved HR after midnight dose.', 'History obtained from Patient']","['ULTRASOUND - At [**2190-5-11**] 04:00 PM', 'IP fellow in - US of r side of chest', '-AM CXR concerning for worsening fluid accumulation. CT chest done', 'without change from [**5-9**] [**Location (un) 3**] study. CT [**Doctor First Name 91**] contact[**Name (NI) **] [**Name2 (NI) **] for', 'consideration of Pigtail catheter. After discussion with pt and', 'daughter plan for conservative approach and diuresis to try to treat', 'effusion for now.  1 L neg at midnight', '-pm HCT stable', '-AF/RVR this afternoon to 140s. Received 2 doses IV Metoprolol and', 'increased metoprolol to 100 mg tid. Gave 250 cc bolus.  Persisted, gave', 'additional 25 mg po metoprolol and increased to 125 mg tid with', 'improved HR after midnight dose.', 'History obtained from Patient']","['-CT [**Doctor First Name 91**] no new recs', '-CXR repeated w/ slightly larger R pleural effusion', '-hct trended, relatively stable', '-TSH added on, 5.7- free T4 ordered for a.m.', '-sputum cx ordered, none produced', '-PO lopressor uptitrated', '-vanc / zosyn approved by ID']",95147,180407.0
5,2190-05-12 06:15:22,,"['ULTRASOUND - At [**2190-5-11**] 04:00 PM', 'IP fellow in - US of r side of chest', '-AM CXR concerning for worsening fluid accumulation. CT chest done', 'without change from [**5-9**] [**Location (un) 3**] study. CT [**Doctor First Name 91**] contact[**Name (NI) **] [**Name2 (NI) **] for', 'consideration of Pigtail catheter. After discussion with pt and', 'daughter plan for conservative approach and diuresis to try to treat', 'effusion for now.  1 L neg at midnight', '-pm HCT stable', '-AF/RVR this afternoon to 140s. Received 2 doses IV Metoprolol and', 'increased metoprolol to 100 mg tid. Gave 250 cc bolus.  Persisted, gave', 'additional 25 mg po metoprolol and increased to 125 mg tid with', 'improved HR after midnight dose.', 'History obtained from Patient']",,95147,180407.0
6,2190-05-12 10:08:33,,"['ULTRASOUND - At [**2190-5-11**] 04:00 PM', 'IP fellow in - US of r side of chest', '-AM CXR concerning for worsening fluid accumulation. CT chest done', 'without change from [**5-9**] [**Location (un) 3**] study. CT [**Doctor First Name 91**] contact[**Name (NI) **] [**Name2 (NI) **] for', 'consideration of Pigtail catheter. After discussion with pt and', 'daughter plan for conservative approach and diuresis to try to treat', 'effusion for now.  1 L neg at midnight', '-pm HCT stable', '-AF/RVR this afternoon to 140s. Received 2 doses IV Metoprolol and', 'increased metoprolol to 100 mg tid. Gave 250 cc bolus.  Persisted, gave', 'additional 25 mg po metoprolol and increased to 125 mg tid with', 'improved HR after midnight dose.', 'History obtained from Patient']",,95147,180407.0
0,2184-11-23 06:10:44,,"['S/p [**Country **] stent, with renal artery angiography showing b/l renal artery', 'stenosis, 90% on the left and about 80% on right (Per Dr. [**First Name (STitle) 1616**], this', 'will be addressed in sequential order after [**Country **] stent.  Baseline Cr.', 'of 2.1 on [**2184-11-17**], 1.5 on [**11-9**].  AM labs pending.  BPs in 100-130', 'systolic range, w/ two episodes of < 100, 92 and 97 systolic.', ""No event's on.""]",,67931,126210.0
1,2184-11-23 07:22:46,"['Pt had bleeding at groin site o/n. Pt received epi and lidocaine', 'injectiono; bleeding stopped, pressure held.']","['S/p [**Country **] stent, with renal artery angiography showing b/l renal artery', 'stenosis, 90% on the left and about 80% on right (Per Dr. [**First Name (STitle) 1616**], this', 'will be addressed in sequential order after [**Country **] stent.  Baseline Cr.', 'of 2.1 on [**2184-11-17**], 1.5 on [**11-9**].  AM labs pending.  BPs in 100-130', 'systolic range, w/ two episodes of < 100, 92 and 97 systolic.', 'Pt had bleeding at groin site o/n. Pt received epi and lidocaine', 'injectiono; bleeding stopped, pressure held.']","[""No event's on.""]",67931,126210.0
0,2100-12-24 10:55:52,,"['HD stable', 'History obtained from Patient']",,65579,127074.0
1,2100-12-24 11:03:57,,"['HD stable', 'History obtained from Patient']",,65579,127074.0
0,2112-02-01 06:28:57,,"[""- Cont'd on Levophed and Bicarb drips."", ""- Called for pt's abg of  7.47/29/88/22 at 10pm labs -- cont'd bicarb"", ""drip, given pt's K still 5.4 but decreased tidal volume 450 -> 400.""]",,55935,116770.0
1,2112-02-01 14:13:12,,"[""- Cont'd on Levophed and Bicarb drips."", ""- Called for pt's abg of  7.47/29/88/22 at 10pm labs -- cont'd bicarb"", ""drip, given pt's K still 5.4 but decreased tidal volume 450 -> 400.""]",,55935,116770.0
2,2112-02-01 14:17:32,,"[""- Cont'd on Levophed and Bicarb drips."", ""- Called for pt's abg of  7.47/29/88/22 at 10pm labs -- cont'd bicarb"", ""drip, given pt's K still 5.4 but decreased tidal volume 450 -> 400.""]",,55935,116770.0
3,2112-02-01 14:46:58,,"[""- Cont'd on Levophed and Bicarb drips."", ""- Called for pt's abg of  7.47/29/88/22 at 10pm labs -- cont'd bicarb"", ""drip, given pt's K still 5.4 but decreased tidal volume 450 -> 400.""]",,55935,116770.0
4,2112-02-02 07:51:39,"['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', '- ECHO: LVEF >55%, mild global free wall hypokinesis right ventricle.', '- CT TORSO: Multiple mets to lungs bilaterally, volume loss secondary', 'to elevated right hemidiaphragm, no evidence of bowel obstruction (po', 'contrast to neoterminal ileum. Significant increase in disease burden', 'since [**10-15**] of [**2111**]. - Final Read Pending.', '- Family meeting planned for [**2-2**] at 1300.', '- Cortisol AM: 50 this AM. No Cosyntropinin Stimulation Test needed.', '- Oncology: Note by Dr. [**First Name (STitle) 12403**] ([**Numeric Identifier 12404**]) notes no further anti-neoplastic', 'options. Onc would advise family as to extremly poor prognosis.']","['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', '- ECHO: LVEF >55%, mild global free wall hypokinesis right ventricle.', '- CT TORSO: Multiple mets to lungs bilaterally, volume loss secondary', 'to elevated right hemidiaphragm, no evidence of bowel obstruction (po', 'contrast to neoterminal ileum. Significant increase in disease burden', 'since [**10-15**] of [**2111**]. - Final Read Pending.', '- Family meeting planned for [**2-2**] at 1300.', '- Cortisol AM: 50 this AM. No Cosyntropinin Stimulation Test needed.', '- Oncology: Note by Dr. [**First Name (STitle) 12403**] ([**Numeric Identifier 12404**]) notes no further anti-neoplastic', 'options. Onc would advise family as to extremly poor prognosis.']","[""- Cont'd on Levophed and Bicarb drips."", ""- Called for pt's abg of  7.47/29/88/22 at 10pm labs -- cont'd bicarb"", ""drip, given pt's K still 5.4 but decreased tidal volume 450 -> 400.""]",55935,116770.0
5,2112-02-02 07:52:46,,"['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', '- ECHO: LVEF >55%, mild global free wall hypokinesis right ventricle.', '- CT TORSO: Multiple mets to lungs bilaterally, volume loss secondary', 'to elevated right hemidiaphragm, no evidence of bowel obstruction (po', 'contrast to neoterminal ileum. Significant increase in disease burden', 'since [**10-15**] of [**2111**]. - Final Read Pending.', '- Family meeting planned for [**2-2**] at 1300.', '- Cortisol AM: 50 this AM. No Cosyntropinin Stimulation Test needed.', '- Oncology: Note by Dr. [**First Name (STitle) 12403**] ([**Numeric Identifier 12404**]) notes no further anti-neoplastic', 'options. Onc would advise family as to extremly poor prognosis.']",,55935,116770.0
6,2112-02-02 13:54:09,"['LVEF >55%, mild global free wall hypokinesis right ventricle.']","['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', 'LVEF >55%, mild global free wall hypokinesis right ventricle.']","['- ECHO: LVEF >55%, mild global free wall hypokinesis right ventricle.', '- CT TORSO: Multiple mets to lungs bilaterally, volume loss secondary', 'to elevated right hemidiaphragm, no evidence of bowel obstruction (po', 'contrast to neoterminal ileum. Significant increase in disease burden', 'since [**10-15**] of [**2111**]. - Final Read Pending.', '- Family meeting planned for [**2-2**] at 1300.', '- Cortisol AM: 50 this AM. No Cosyntropinin Stimulation Test needed.', '- Oncology: Note by Dr. [**First Name (STitle) 12403**] ([**Numeric Identifier 12404**]) notes no further anti-neoplastic', 'options. Onc would advise family as to extremly poor prognosis.']",55935,116770.0
7,2112-02-02 21:21:38,,"['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', 'LVEF >55%, mild global free wall hypokinesis right ventricle.']",,55935,116770.0
8,2112-02-03 06:49:11,"['- Family meeting: family agreed to no HD, no [**Hospital 12420**] medical management', 'only, are in process of discussing possible extubation. In process of', 'making patient no CPR, chemical code only', '- Polystyrene extracted in total from stomach (no gastric emptying)', '- Gave fentanyl bolus this a.m. when patient became aggitated.', '- Patient is hypocalcemic, but held on giving more Ca given high', 'phosphate.  Will re-check Ca in a.m. and reevaluate.']","['- Family meeting: family agreed to no HD, no [**Hospital 12420**] medical management', 'only, are in process of discussing possible extubation. In process of', 'making patient no CPR, chemical code only', '- Polystyrene extracted in total from stomach (no gastric emptying)', '- Gave fentanyl bolus this a.m. when patient became aggitated.', '- Patient is hypocalcemic, but held on giving more Ca given high', 'phosphate.  Will re-check Ca in a.m. and reevaluate.']","['TRANSTHORACIC ECHO - At [**2112-2-1**] 09:15 AM', 'LVEF >55%, mild global free wall hypokinesis right ventricle.']",55935,116770.0
9,2112-02-03 13:37:36,"['- Polystyrene extracted in total from stomach (no gastric emptying),', 'tube feeds stopped']","['- Family meeting: family agreed to no HD, no [**Hospital 12420**] medical management', 'only, are in process of discussing possible extubation. In process of', 'making patient no CPR, chemical code only', '- Polystyrene extracted in total from stomach (no gastric emptying),', 'tube feeds stopped', '- Gave fentanyl bolus this a.m. when patient became aggitated.', '- Patient is hypocalcemic, but held on giving more Ca given high', 'phosphate.  Will re-check Ca in a.m. and reevaluate.']",['- Polystyrene extracted in total from stomach (no gastric emptying)'],55935,116770.0
10,2112-02-04 07:33:51,"['- Patient restarted on Versed drip for increased agitation', '- PM K+ stable at 5.8 despite 2 amps NaHCO3']","['- Patient restarted on Versed drip for increased agitation', '- PM K+ stable at 5.8 despite 2 amps NaHCO3']","['- Family meeting: family agreed to no HD, no [**Hospital 12420**] medical management', 'only, are in process of discussing possible extubation. In process of', 'making patient no CPR, chemical code only', '- Polystyrene extracted in total from stomach (no gastric emptying),', 'tube feeds stopped', '- Gave fentanyl bolus this a.m. when patient became aggitated.', '- Patient is hypocalcemic, but held on giving more Ca given high', 'phosphate.  Will re-check Ca in a.m. and reevaluate.']",55935,116770.0
11,2112-02-04 12:43:51,,"['- Patient restarted on Versed drip for increased agitation', '- PM K+ stable at 5.8 despite 2 amps NaHCO3']",,55935,116770.0
12,2112-02-05 06:41:51,"['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']","['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']","['- Patient restarted on Versed drip for increased agitation', '- PM K+ stable at 5.8 despite 2 amps NaHCO3']",55935,116770.0
13,2112-02-05 07:06:16,,"['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']",,55935,116770.0
14,2112-02-05 09:57:00,,"['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']",,55935,116770.0
15,2112-02-05 19:22:12,,"['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']",,55935,116770.0
16,2112-02-06 07:14:59,"['- Family gradually becoming more accustomed to prognosis.', '- Needed some Versed again overnight for agitation associated with', 'tachycardia and increased BP.', '- A-line patency poor and will likely need to be rewired or replaced.', 'Unable to get labs from portacath this a.m.', '- passed BM overnight']","['- Family gradually becoming more accustomed to prognosis.', '- Needed some Versed again overnight for agitation associated with', 'tachycardia and increased BP.', '- A-line patency poor and will likely need to be rewired or replaced.', 'Unable to get labs from portacath this a.m.', '- passed BM overnight']","['- Social Work consult placed for Family', '- Dr. [**Last Name (STitle) 775**] spoke with family, no final decision has been reached', 'regarding extubation, CMO, etc.', ""- DC'd Insulin Sliding Scale, Patient has not required insulin since"", 'sliding scale was started.']",55935,116770.0
17,2112-02-06 16:02:03,"['- Family gradually becoming more accustomed to prognosis. At family', 'meeting yesterday, transition to CMO discussed, but pt not ready to', 'change goals of care towards comfort yet.', '- still obstipated']","['- Family gradually becoming more accustomed to prognosis. At family', 'meeting yesterday, transition to CMO discussed, but pt not ready to', 'change goals of care towards comfort yet.', '- Needed some Versed again overnight for agitation associated with', 'tachycardia and increased BP.', '- A-line patency poor and will likely need to be rewired or replaced.', 'Unable to get labs from portacath this a.m.', '- still obstipated']","['- Family gradually becoming more accustomed to prognosis.', '- passed BM overnight']",55935,116770.0
18,2112-02-07 07:00:18,"['ARTERIAL LINE - STOP [**2112-2-6**] 07:40 PM', '- Again addressed goals of care with family.  Still not ready to make', ""pt [**Name (NI) 580**], as husband wants to contact rest of pt's family.  Will consider"", 'withdrawing care in [**3-9**] days, if no significant improvement.  Do not', 'want any escalation of care (e.g. resuscitation), but OK to add another', 'pressor if needed.', ""- Given pt's elevated potassium (5.7) this am, obtained ECG, which"", 'showed sinus tachycardia at 120 as well as 0.5mm ST elevation in V1 and', 'V2 w. depressions in V5/V6.  No peaked Ts. Obtained CEs (trending down,', 'trop 0.04 from 0.08) and gave ASA.', ""- Pt's A-line is no longer working (now pulled) and cannot draw from"", 'Port, although pt is receiving medications/pressors through port.  Will', 'need to address this with the family, and either place new A-line or', 'central access for labs.']","['ARTERIAL LINE - STOP [**2112-2-6**] 07:40 PM', '- Again addressed goals of care with family.  Still not ready to make', ""pt [**Name (NI) 580**], as husband wants to contact rest of pt's family.  Will consider"", 'withdrawing care in [**3-9**] days, if no significant improvement.  Do not', 'want any escalation of care (e.g. resuscitation), but OK to add another', 'pressor if needed.', ""- Given pt's elevated potassium (5.7) this am, obtained ECG, which"", 'showed sinus tachycardia at 120 as well as 0.5mm ST elevation in V1 and', 'V2 w. depressions in V5/V6.  No peaked Ts. Obtained CEs (trending down,', 'trop 0.04 from 0.08) and gave ASA.', ""- Pt's A-line is no longer working (now pulled) and cannot draw from"", 'Port, although pt is receiving medications/pressors through port.  Will', 'need to address this with the family, and either place new A-line or', 'central access for labs.']","['- Family gradually becoming more accustomed to prognosis. At family', 'meeting yesterday, transition to CMO discussed, but pt not ready to', 'change goals of care towards comfort yet.', '- Needed some Versed again overnight for agitation associated with', 'tachycardia and increased BP.', '- A-line patency poor and will likely need to be rewired or replaced.', 'Unable to get labs from portacath this a.m.', '- still obstipated']",55935,116770.0
19,2112-02-07 11:14:42,['- Still no BMS'],"['ARTERIAL LINE - STOP [**2112-2-6**] 07:40 PM', '- Again addressed goals of care with family.  Still not ready to make', ""pt [**Name (NI) 580**], as husband wants to contact rest of pt's family.  Will consider"", 'withdrawing care in [**3-9**] days, if no significant improvement.  Do not', 'want any escalation of care (e.g. resuscitation), but OK to add another', 'pressor if needed.', ""- Given pt's elevated potassium (5.7) this am, obtained ECG, which"", 'showed sinus tachycardia at 120 as well as 0.5mm ST elevation in V1 and', 'V2 w. depressions in V5/V6.  No peaked Ts. Obtained CEs (trending down,', 'trop 0.04 from 0.08) and gave ASA.', ""- Pt's A-line is no longer working (now pulled) and cannot draw from"", 'Port, although pt is receiving medications/pressors through port.  Will', 'need to address this with the family, and either place new A-line or', 'central access for labs.', '- Still no BMS']",,55935,116770.0
20,2112-02-07 15:48:39,,"['ARTERIAL LINE - STOP [**2112-2-6**] 07:40 PM', '- Again addressed goals of care with family.  Still not ready to make', ""pt [**Name (NI) 580**], as husband wants to contact rest of pt's family.  Will consider"", 'withdrawing care in [**3-9**] days, if no significant improvement.  Do not', 'want any escalation of care (e.g. resuscitation), but OK to add another', 'pressor if needed.', ""- Given pt's elevated potassium (5.7) this am, obtained ECG, which"", 'showed sinus tachycardia at 120 as well as 0.5mm ST elevation in V1 and', 'V2 w. depressions in V5/V6.  No peaked Ts. Obtained CEs (trending down,', 'trop 0.04 from 0.08) and gave ASA.', ""- Pt's A-line is no longer working (now pulled) and cannot draw from"", 'Port, although pt is receiving medications/pressors through port.  Will', 'need to address this with the family, and either place new A-line or', 'central access for labs.', '- Still no BMS']",,55935,116770.0
21,2112-02-07 17:51:24,,"['ARTERIAL LINE - STOP [**2112-2-6**] 07:40 PM', '- Again addressed goals of care with family.  Still not ready to make', ""pt [**Name (NI) 580**], as husband wants to contact rest of pt's family.  Will consider"", 'withdrawing care in [**3-9**] days, if no significant improvement.  Do not', 'want any escalation of care (e.g. resuscitation), but OK to add another', 'pressor if needed.', ""- Given pt's elevated potassium (5.7) this am, obtained ECG, which"", 'showed sinus tachycardia at 120 as well as 0.5mm ST elevation in V1 and', 'V2 w. depressions in V5/V6.  No peaked Ts. Obtained CEs (trending down,', 'trop 0.04 from 0.08) and gave ASA.', ""- Pt's A-line is no longer working (now pulled) and cannot draw from"", 'Port, although pt is receiving medications/pressors through port.  Will', 'need to address this with the family, and either place new A-line or', 'central access for labs.', '- Still no BMS']",,55935,116770.0
0,2120-05-20 12:23:54,,"['ARTERIAL LINE - START [**2120-5-19**] 09:21 AM', ' MULTI LUMEN - START [**2120-5-19**] 10:18 PM', ' EKG - At [**2120-5-20**] 12:03 AM', 'nonanion gap metabolic acidosis yesterday afternoon', 'Failed PS trial yesterday', 'R IJ CVL placed', 'Hypotensive this am 66/24 received 1L NSS', 'ABG 7.45/38/122  lactate 1.9']",,74891,192552.0
1,2120-05-20 16:02:12,,"['ARTERIAL LINE - START [**2120-5-19**] 09:21 AM', ' MULTI LUMEN - START [**2120-5-19**] 10:18 PM', ' EKG - At [**2120-5-20**] 12:03 AM', 'Failed PS trial yesterday', 'R IJ CVL placed', 'Hypotensive this am 66/24 received 1L NSS', 'ABG 7.45/38/122  lactate 1.9']",['nonanion gap metabolic acidosis yesterday afternoon'],74891,192552.0
2,2120-05-21 07:45:43,"['ULTRASOUND - At [**2120-5-20**] 09:26 AM', 'lenis done', 'constipation improved with increased lactulose', 'phenylephrine continued to maintain BP']","['ULTRASOUND - At [**2120-5-20**] 09:26 AM', 'lenis done', 'constipation improved with increased lactulose', 'phenylephrine continued to maintain BP']","['ARTERIAL LINE - START [**2120-5-19**] 09:21 AM', ' MULTI LUMEN - START [**2120-5-19**] 10:18 PM', ' EKG - At [**2120-5-20**] 12:03 AM', 'Failed PS trial yesterday', 'R IJ CVL placed', 'Hypotensive this am 66/24 received 1L NSS', 'ABG 7.45/38/122  lactate 1.9']",74891,192552.0
3,2120-05-21 16:07:44,,"['ULTRASOUND - At [**2120-5-20**] 09:26 AM', 'lenis done', 'constipation improved with increased lactulose', 'phenylephrine continued to maintain BP']",,74891,192552.0
4,2120-05-22 06:55:09,"['Discussed goals of therapy with family [**2120-5-21**].  Pt was made DNR/DNI.', 'Will have meeting today with family to discuss withdrawal of care.', 'CT chest [**2120-5-21**]: Large left sided pleural effusion. Small right sided', 'pleural effusion.  Large left hilar mass with resultant bronchial', 'obstruction. Confluent liver metastases. Large right paratracheal lymph', 'node with mass effect on the SVC.', 'C.diff toxin [**2120-5-21**]: negative', 'Decreased requirement for phenylephrine for treatment of hypotension.']","['Discussed goals of therapy with family [**2120-5-21**].  Pt was made DNR/DNI.', 'Will have meeting today with family to discuss withdrawal of care.', 'CT chest [**2120-5-21**]: Large left sided pleural effusion. Small right sided', 'pleural effusion.  Large left hilar mass with resultant bronchial', 'obstruction. Confluent liver metastases. Large right paratracheal lymph', 'node with mass effect on the SVC.', 'C.diff toxin [**2120-5-21**]: negative', 'Decreased requirement for phenylephrine for treatment of hypotension.']","['ULTRASOUND - At [**2120-5-20**] 09:26 AM', 'lenis done', 'constipation improved with increased lactulose', 'phenylephrine continued to maintain BP']",74891,192552.0
5,2120-05-22 12:42:11,,"['Discussed goals of therapy with family [**2120-5-21**].  Pt was made DNR/DNI.', 'Will have meeting today with family to discuss withdrawal of care.', 'CT chest [**2120-5-21**]: Large left sided pleural effusion. Small right sided', 'pleural effusion.  Large left hilar mass with resultant bronchial', 'obstruction. Confluent liver metastases. Large right paratracheal lymph', 'node with mass effect on the SVC.', 'C.diff toxin [**2120-5-21**]: negative', 'Decreased requirement for phenylephrine for treatment of hypotension.']",,74891,192552.0
6,2120-05-22 12:43:45,,"['Discussed goals of therapy with family [**2120-5-21**].  Pt was made DNR/DNI.', 'Will have meeting today with family to discuss withdrawal of care.', 'CT chest [**2120-5-21**]: Large left sided pleural effusion. Small right sided', 'pleural effusion.  Large left hilar mass with resultant bronchial', 'obstruction. Confluent liver metastases. Large right paratracheal lymph', 'node with mass effect on the SVC.', 'C.diff toxin [**2120-5-21**]: negative', 'Decreased requirement for phenylephrine for treatment of hypotension.']",,74891,192552.0
0,2119-05-14 07:07:17,,"['- Admitted for acute alcohol withdrawl.', '- Managed on CIWA with valium po/iv without complication']",,93949,113347.0
1,2119-05-14 07:09:26,,"['- Admitted for acute alcohol withdrawl.', '- Managed on CIWA with valium po/iv without complication']",,93949,113347.0
2,2119-05-14 07:12:31,,"['- Admitted for acute alcohol withdrawl.', '- Managed on CIWA with valium po/iv without complication']",,93949,113347.0
3,2119-05-14 10:52:40,,"['- Admitted for acute alcohol withdrawl.', '- Managed on CIWA with valium po/iv without complication']",,93949,113347.0
0,2193-08-01 07:07:30,,"['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am _______', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min']",,73695,108174.0
1,2193-08-01 07:41:49,,"['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am _______', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min']",,73695,108174.0
2,2193-08-01 08:17:52,"['-Pt able to move L arm , head.  Coughs with suction.']","['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am _______', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min', '-Pt able to move L arm , head.  Coughs with suction.']",,73695,108174.0
3,2193-08-01 08:24:48,"['accurate (ranging in low 20s). Given 250ml bolus at 5am, no change in', 'urine output. (1.6L positive yesterday)', '-Pt able minimally able to move L arm , head.  Coughs with suction.', 'Does not respond to voice or follow commands.']","['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am, no change in', 'urine output. (1.6L positive yesterday)', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min', '-Pt able minimally able to move L arm , head.  Coughs with suction.', 'Does not respond to voice or follow commands.']","['accurate (ranging in low 20s). Given 250ml bolus at 5am _______', '-Pt able to move L arm , head.  Coughs with suction.']",73695,108174.0
4,2193-08-01 11:27:38,"['accurate (ranging in low 20s). Given 250ml bolus at 5am, minimal', 'increase in urine output, rebolus 500 ccs with improvement in urine', 'output. (1.6L positive yesterday)', '-Pt able minimally able to move L arm , [**Name6 (MD) 450**] [**Name8 (MD) 77**] RN overnight.  Coughs', 'with suction.  Does not respond to voice or follow commands.']","['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am, minimal', 'increase in urine output, rebolus 500 ccs with improvement in urine', 'output. (1.6L positive yesterday)', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min', '-Pt able minimally able to move L arm , [**Name6 (MD) 450**] [**Name8 (MD) 77**] RN overnight.  Coughs', 'with suction.  Does not respond to voice or follow commands.']","['accurate (ranging in low 20s). Given 250ml bolus at 5am, no change in', 'urine output. (1.6L positive yesterday)', '-Pt able minimally able to move L arm , head.  Coughs with suction.', 'Does not respond to voice or follow commands.']",73695,108174.0
5,2193-08-02 07:15:37,"['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuo signed off.']","['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuo signed off.']","['-Patient', 's UOP low overnight (ranging 20-50ml/hr) which was similar to', 'her UOP in the CCU. Cr also increased from 1.1 -> 1.6. Unclear if CVP', 'accurate (ranging in low 20s). Given 250ml bolus at 5am, minimal', 'increase in urine output, rebolus 500 ccs with improvement in urine', 'output. (1.6L positive yesterday)', '-Tried to wean down on propofol overnight, but when patient down to', '5mcg/kg/min of propofol, RR up to 40s, pulling at line so propofol', 'increased back to 10mcg/kg/min', '-Pt able minimally able to move L arm , [**Name6 (MD) 450**] [**Name8 (MD) 77**] RN overnight.  Coughs', 'with suction.  Does not respond to voice or follow commands.']",73695,108174.0
6,2193-08-02 07:42:20,,"['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuo signed off.']",,73695,108174.0
7,2193-08-02 11:50:59,['-Rheum and neuro signed off'],"['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuro signed off']",['-Rheum and neuo signed off.'],73695,108174.0
8,2193-08-02 16:03:00,,"['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuro signed off']",,73695,108174.0
9,2193-08-02 16:08:29,,"['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuro signed off']",,73695,108174.0
10,2193-08-03 06:28:26,"['-Steroids were tapered from 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']","['-Steroids were tapered from 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']","['-Developed worsening ARF; FENa 0.2; urine output did not  pick up with', 'fluid challenge or with lasix challenge', '-Sedation weaned, pt became dyssynchronous with vent, but moved L arm,', 'L leg, R leg and head.  (Did not move R arm).  Did not follow commands,', 'no tracking.', '-Rheum and neuro signed off']",73695,108174.0
11,2193-08-03 07:41:17,,"['-Steroids were tapered from 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']",,73695,108174.0
12,2193-08-03 07:44:45,,"['-Steroids were tapered from 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']",,73695,108174.0
13,2193-08-03 14:34:13,,"['-Steroids were tapered from 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']",,73695,108174.0
14,2193-08-03 14:51:21,['-Steroids were tapered from solumedrol 40 q8hr to 40 q12 hour'],"['-Steroids were tapered from solumedrol 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']",['-Steroids were tapered from 40 q8hr to 40 q12 hour'],73695,108174.0
15,2193-08-04 07:15:15,"['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM']","['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM']","['-Steroids were tapered from solumedrol 40 q8hr to 40 q12 hour', '-Haldol 5 mg [**Hospital1 **] was started in order to minimize sedation', '- Trial on PS was unsuccessful --> ABG worsened, so was switched back', 'to AC', '- Renal evaluated patient and noted ?RBC casts.  They performed a', 'biopsy of the kidneys.  They requested C3 and C4 and anticardiolipin be', 'sent.  Differential is APL syndrome, post-infectious', 'glomerulonephritis, thrombotic/emolic event, versus pulmonary renal', 'syndrome.  Renal ultrasound also performed.', '- TEE performed and did not show vegetations, no ASD or PFO, no LA/RA', 'thrombus, no aortic atheroma, and 2+ MR noted.', '- Neurology felt AMS likely secondary to toxic encephalopathy, but', 'recommended EEG and MRI.  They felt LP is likely to be un-revealing but', 'would be useful if EEG and MRI were negative.  Patient was unable to', 'get MRI due to recent BMS placement for NSTEMI.', '-PCP reported that she had no history of thrombus in past.  He never', 'tested her for HIV in the past.', '- Patient febrile in spite of broad spectrum antiobiotics and steroids', '- ID recommended stopping vancomycin and aztreonam.  They recommended', 'checking T cell subtypes and immunoglobulins.', ' URINE CULTURE - At [**2193-8-2**] 11:00 AM', ' ULTRASOUND - At [**2193-8-2**] 11:30 AM', 'RENAL  U/S', ' EKG - At [**2193-8-2**] 12:00 PM', ' TRANS ESOPHAGEAL ECHO - At [**2193-8-2**] 03:30 PM', ' BLOOD CULTURED - At [**2193-8-3**] 12:22 AM', ' FEVER - 101.8', 'F - [**2193-8-2**] 12:00 PM']",73695,108174.0
16,2193-08-04 07:28:21,"['- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']","['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",,73695,108174.0
17,2193-08-04 07:46:32,,"['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",,73695,108174.0
18,2193-08-04 07:54:22,,"['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",,73695,108174.0
19,2193-08-04 16:39:39,,"['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",,73695,108174.0
20,2193-08-04 17:51:45,,"['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",,73695,108174.0
21,2193-08-05 07:41:25,"['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']","['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']","['STOOL CULTURE - At [**2193-8-3**] 11:00 AM', 'c-diff', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-3**] 11:20 AM', 'Head MRI', ' FEVER - 101.9', 'F - [**2193-8-4**] 12:00 AM', '- PEEP decreased to 5, trial of weaning down sedation with', 'premedication with haldol but patient was agitated, biting down on tube', 'when propofol off so she was restarted on low dose propofol', '- MR head without contrast showed interval resolution of diffusion', 'abnormalities indications evolving brain infarcts in frontal and', 'occipital regions', '- T lymphocyte panel sent']",73695,108174.0
22,2193-08-05 07:42:44,,"['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']",,73695,108174.0
23,2193-08-05 13:59:27,,"['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']",,73695,108174.0
24,2193-08-05 14:03:44,,"['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']",,73695,108174.0
25,2193-08-05 20:53:40,,"['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']",,73695,108174.0
26,2193-08-06 07:13:02,"['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']","['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']","['Continues to have fevers.', 'Awaiting Trach/Peg today.', ' FEVER - 102.7', 'F - [**2193-8-4**] 10:00 AM']",73695,108174.0
27,2193-08-06 07:48:22,,"['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']",,73695,108174.0
28,2193-08-06 07:50:35,,"['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']",,73695,108174.0
29,2193-08-06 12:01:42,,"['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']",,73695,108174.0
30,2193-08-06 12:05:06,,"['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', 'Continues to have daily fevers.', 'Her Hct remains stable.']",,73695,108174.0
31,2193-08-06 13:11:52,"['- Patient evaluated by Thoracics who will place tracheostomy on', '- Her Hct remains stable.']","['- Patient evaluated by Thoracics who will place tracheostomy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', '- Her Hct remains stable.']","['Patient evaluated by Thoracics who will perform bronchoscopy on', 'Continues to have daily fevers.', 'Her Hct remains stable.']",73695,108174.0
32,2193-08-06 13:35:20,"['- Patient evaluated by Thoracic Surgery who will place tracheostomy on', '- Her Na was elevated so started on free water boluses', '- Her Hct remains stable', '- Spiked a fever to 101.5 this AM so pan cultured', ' BCx, UCx, sputum Cx', 'sent', '- RSBI 44 this AM, but when sedation lightened, patient still', 'struggling and coughing with tube']","['- Patient evaluated by Thoracic Surgery who will place tracheostomy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', '- Her Na was elevated so started on free water boluses', '- Her Hct remains stable', '- Spiked a fever to 101.5 this AM so pan cultured', ' BCx, UCx, sputum Cx', 'sent', '- RSBI 44 this AM, but when sedation lightened, patient still', 'struggling and coughing with tube']","['- Patient evaluated by Thoracics who will place tracheostomy on', '- Her Hct remains stable.']",73695,108174.0
33,2193-08-07 07:11:54,"['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed.', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']","['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed.', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']","['- Patient evaluated by Thoracic Surgery who will place tracheostomy on', 'Wednesday.  Patient will not get PEG at that time due to difficult', 'anatomy as a result of her h/o gastric bypass.', '- Her Na was elevated so started on free water boluses', '- Her Hct remains stable', '- Spiked a fever to 101.5 this AM so pan cultured', ' BCx, UCx, sputum Cx', 'sent', '- RSBI 44 this AM, but when sedation lightened, patient still', 'struggling and coughing with tube']",73695,108174.0
34,2193-08-07 07:14:30,"['today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased']","['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']",['today. Pre-op eval completed.'],73695,108174.0
35,2193-08-07 07:18:12,,"['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']",,73695,108174.0
36,2193-08-07 07:27:09,,"['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']",,73695,108174.0
37,2193-08-07 07:37:00,,"['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']",,73695,108174.0
38,2193-08-07 10:21:23,"['- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria, sputum Cx: 4+', 'GNR and GN diplococci', '- RR increased to 40s, PEEP increased to 8, pressure support increased', 'to 15']","['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria, sputum Cx: 4+', 'GNR and GN diplococci', '- RR increased to 40s, PEEP increased to 8, pressure support increased', 'to 15', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']","['- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria']",73695,108174.0
39,2193-08-08 06:34:05,"['Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam, however', 'this was a lab error, so antibiotics discontinued.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'Bolused with total of 2L NS after trach- no change in urine output.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']","['Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam, however', 'this was a lab error, so antibiotics discontinued.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'Bolused with total of 2L NS after trach- no change in urine output.', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']","['- Fever spike to 101.5 AM of [**8-6**] -> BCx, UCx, sputum Cx, and stool Cx', '- Tube feeds stopped at midnight for trach placement by thoracic [**Doctor First Name 91**]', 'today. Pre-op eval completed. T/C for 1 unit preop.', '- Started on D5 at slow rate as NPO and Na is increased', '- ID recs', ' trend fever curve, consider adding back abx and pan CT scan', 'if fever curve increases or pt unstable.', '- Renal recs- no new recs', '- UA from [**8-6**] with large leuks, 149 WBCs, few bacteria, sputum Cx: 4+', 'GNR and GN diplococci', '- RR increased to 40s, PEEP increased to 8, pressure support increased', 'to 15', ' BLOOD CULTURED - At [**2193-8-6**] 10:30 AM', 'bc x2', ' URINE CULTURE - At [**2193-8-6**] 10:30 AM', ' SPUTUM CULTURE - At [**2193-8-6**] 11:00 AM', ' FEVER - 101.9', 'F - [**2193-8-6**] 04:00 PM']",73695,108174.0
40,2193-08-08 07:50:22,"['- Patient had trach placement late last night without any events', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam,', 'however this was a lab error, so antibiotics discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.']","['- Patient had trach placement late last night without any events', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam,', 'however this was a lab error, so antibiotics discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']","['Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam, however', 'this was a lab error, so antibiotics discontinued.', 'Bolused with total of 2L NS after trach- no change in urine output.']",73695,108174.0
41,2193-08-08 07:54:21,['- Trying patient on [**4-1**] this AM.'],"['- Patient had trach placement late last night without any events', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam,', 'however this was a lab error, so antibiotics discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.', '- Trying patient on [**4-1**] this AM.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,73695,108174.0
42,2193-08-08 11:01:06,"['- Patient had trach placement late last night without any events, now', 'on 35% trach collar', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam.', 'However, this was called as a lab error so aztreonam discontinued.']","['- Patient had trach placement late last night without any events, now', 'on 35% trach collar', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam.', 'However, this was called as a lab error so aztreonam discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']","['- Patient had trach placement late last night without any events', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam,', 'however this was a lab error, so antibiotics discontinued.', '- Trying patient on [**4-1**] this AM.']",73695,108174.0
43,2193-08-08 11:03:10,,"['- Patient had trach placement late last night without any events, now', 'on 35% trach collar', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam.', 'However, this was called as a lab error so aztreonam discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",,73695,108174.0
44,2193-08-09 07:20:50,"['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'A. line removed.', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']","['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'A. line removed.', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']","['- Patient had trach placement late last night without any events, now', 'on 35% trach collar', '- Sputum initially returned +for [**Last Name (LF) 634**], [**First Name3 (LF) **] restarted on aztreonam.', 'However, this was called as a lab error so aztreonam discontinued.', '- Bolused with total of 2L NS after trach- no change in urine output.', ' OR SENT - At [**2193-8-7**] 09:10 PM', 'FOR TRACH PLACEMENT', 'Trach placed without immediate complication by thoracic surgery.', ' OR RECEIVED - At [**2193-8-7**] 10:40 PM', 'History obtained from Patient, Family / [**Hospital 216**] Medical records']",73695,108174.0
45,2193-08-09 07:55:58,"['Difficulty getting O2 sat, inability to get ABG after multiple', 'attempts. Put back on vent due to tachypnea']","['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'Difficulty getting O2 sat, inability to get ABG after multiple', 'attempts. Put back on vent due to tachypnea', 'A. line removed.', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']",,73695,108174.0
46,2193-08-09 08:01:24,,"['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'Difficulty getting O2 sat, inability to get ABG after multiple', 'attempts. Put back on vent due to tachypnea', 'A. line removed.', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']",,73695,108174.0
47,2193-08-09 19:06:21,"['Arterial line removed, after which there was difficulty getting O2 sat,', 'inability to get ABG after multiple attempts. Put back on vent due to', 'tachypnea']","['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'Arterial line removed, after which there was difficulty getting O2 sat,', 'inability to get ABG after multiple attempts. Put back on vent due to', 'tachypnea', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']","['Difficulty getting O2 sat, inability to get ABG after multiple', 'attempts. Put back on vent due to tachypnea', 'A. line removed.']",73695,108174.0
48,2193-08-09 19:07:18,,"['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'Arterial line removed, after which there was difficulty getting O2 sat,', 'inability to get ABG after multiple attempts. Put back on vent due to', 'tachypnea', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']",,73695,108174.0
49,2193-08-10 07:00:07,"['- patient', 's renal function worse, trialed on fluid challenge with 1L NS', 'in AM, BUN/Cr slightly improved. RIJ by US full indicating volume', 'overload, so given 120mg IV lasix', '- renal recs: trial diuresis, and consider RRT today. Possible evidence', 'of microangiopathy on 2^nd look at renal biopsy. Sent hemolysis workup', 'and smear for schistocytes. Metoprolol discontinued as has been held,', 'also to leave BP room for possible RRT', '- neuro recs: her current exam consistent with brainstem pathology.', 'Most likely etiology toxic/metabolic vs uremia. Serum copper and zinc', 'sent', '- Order placed for PICC line placement', ' INVASIVE VENTILATION - START [**2193-8-10**] 04:43 AM']","['- patient', 's renal function worse, trialed on fluid challenge with 1L NS', 'in AM, BUN/Cr slightly improved. RIJ by US full indicating volume', 'overload, so given 120mg IV lasix', '- renal recs: trial diuresis, and consider RRT today. Possible evidence', 'of microangiopathy on 2^nd look at renal biopsy. Sent hemolysis workup', 'and smear for schistocytes. Metoprolol discontinued as has been held,', 'also to leave BP room for possible RRT', '- neuro recs: her current exam consistent with brainstem pathology.', 'Most likely etiology toxic/metabolic vs uremia. Serum copper and zinc', 'sent', '- Order placed for PICC line placement', ' INVASIVE VENTILATION - START [**2193-8-10**] 04:43 AM']","['Patient got lasix 40 then lasix 80 with poor urine output.  His', 'extremities were cool and is BUN and Cr continued to rise, so got 500', 'cc fluid bolus x 3.', 'Arterial line removed, after which there was difficulty getting O2 sat,', 'inability to get ABG after multiple attempts. Put back on vent due to', 'tachypnea', 'SW consulted because patient', 's half sister has requested that patient', 'father not be permitted to visit [**Name (NI) 655**].', ' ARTERIAL LINE - STOP [**2193-8-8**] 01:00 PM']",73695,108174.0
50,2193-08-10 07:55:27,,"['- patient', 's renal function worse, trialed on fluid challenge with 1L NS', 'in AM, BUN/Cr slightly improved. RIJ by US full indicating volume', 'overload, so given 120mg IV lasix', '- renal recs: trial diuresis, and consider RRT today. Possible evidence', 'of microangiopathy on 2^nd look at renal biopsy. Sent hemolysis workup', 'and smear for schistocytes. Metoprolol discontinued as has been held,', 'also to leave BP room for possible RRT', '- neuro recs: her current exam consistent with brainstem pathology.', 'Most likely etiology toxic/metabolic vs uremia. Serum copper and zinc', 'sent', '- Order placed for PICC line placement', ' INVASIVE VENTILATION - START [**2193-8-10**] 04:43 AM']",,73695,108174.0
51,2193-08-10 12:02:28,,"['- patient', 's renal function worse, trialed on fluid challenge with 1L NS', 'in AM, BUN/Cr slightly improved. RIJ by US full indicating volume', 'overload, so given 120mg IV lasix', '- renal recs: trial diuresis, and consider RRT today. Possible evidence', 'of microangiopathy on 2^nd look at renal biopsy. Sent hemolysis workup', 'and smear for schistocytes. Metoprolol discontinued as has been held,', 'also to leave BP room for possible RRT', '- neuro recs: her current exam consistent with brainstem pathology.', 'Most likely etiology toxic/metabolic vs uremia. Serum copper and zinc', 'sent', '- Order placed for PICC line placement', ' INVASIVE VENTILATION - START [**2193-8-10**] 04:43 AM']",,73695,108174.0
52,2193-08-11 07:53:06,"['Got diuresed with lasix and diuril.', 'HD initiated, but line clotted during dialysis, so only 1 kg removed.', 'Patient was hypotensive following dialysis so, 500 cc bolus x 2 given,', 'then patient started on Levophed.', ' DIALYSIS CATHETER - START [**2193-8-10**] 05:00 PM', ' SPUTUM CULTURE - At [**2193-8-10**] 08:00 PM', ' FEVER - 101.3', 'F - [**2193-8-10**] 04:00 PM']","['Got diuresed with lasix and diuril.', 'HD initiated, but line clotted during dialysis, so only 1 kg removed.', 'Patient was hypotensive following dialysis so, 500 cc bolus x 2 given,', 'then patient started on Levophed.', ' DIALYSIS CATHETER - START [**2193-8-10**] 05:00 PM', ' SPUTUM CULTURE - At [**2193-8-10**] 08:00 PM', ' FEVER - 101.3', 'F - [**2193-8-10**] 04:00 PM']","['- patient', 's renal function worse, trialed on fluid challenge with 1L NS', 'in AM, BUN/Cr slightly improved. RIJ by US full indicating volume', 'overload, so given 120mg IV lasix', '- renal recs: trial diuresis, and consider RRT today. Possible evidence', 'of microangiopathy on 2^nd look at renal biopsy. Sent hemolysis workup', 'and smear for schistocytes. Metoprolol discontinued as has been held,', 'also to leave BP room for possible RRT', '- neuro recs: her current exam consistent with brainstem pathology.', 'Most likely etiology toxic/metabolic vs uremia. Serum copper and zinc', 'sent', '- Order placed for PICC line placement', ' INVASIVE VENTILATION - START [**2193-8-10**] 04:43 AM']",73695,108174.0
53,2193-08-11 07:55:50,['Febrile to 101.3'],"['Got diuresed with lasix and diuril.', 'HD initiated, but line clotted during dialysis, so only 1 kg removed.', 'Patient was hypotensive following dialysis so, 500 cc bolus x 2 given,', 'then patient started on Levophed.', 'Febrile to 101.3', ' DIALYSIS CATHETER - START [**2193-8-10**] 05:00 PM', ' SPUTUM CULTURE - At [**2193-8-10**] 08:00 PM', ' FEVER - 101.3', 'F - [**2193-8-10**] 04:00 PM']",,73695,108174.0
54,2193-08-11 15:30:53,['Blood cultures positive for GPCs in clusters.'],"['Got diuresed with lasix and diuril.', 'HD initiated, but line clotted during dialysis, so only 1 kg removed.', 'Patient was hypotensive following dialysis so, 500 cc bolus x 2 given,', 'then patient started on Levophed.', 'Febrile to 101.3', 'Blood cultures positive for GPCs in clusters.', ' DIALYSIS CATHETER - START [**2193-8-10**] 05:00 PM', ' SPUTUM CULTURE - At [**2193-8-10**] 08:00 PM', ' FEVER - 101.3', 'F - [**2193-8-10**] 04:00 PM']",,73695,108174.0
55,2193-08-12 06:54:15,"['Blood cultures through RIJ positive for GPCs.  Patient given', 'vancomycin.  Right IJ pulled.  Left subclavian placed.', 'Dialyzed yesterday to keep her even.', 'Weaned off levophed.', ' EEG - At [**2193-8-11**] 08:19 PM', ' MULTI LUMEN - STOP [**2193-8-11**] 11:53 PM', 'THIS LINE WAS UNABLE TO BE INSERTED']","['Blood cultures through RIJ positive for GPCs.  Patient given', 'vancomycin.  Right IJ pulled.  Left subclavian placed.', 'Dialyzed yesterday to keep her even.', 'Weaned off levophed.', ' EEG - At [**2193-8-11**] 08:19 PM', ' MULTI LUMEN - STOP [**2193-8-11**] 11:53 PM', 'THIS LINE WAS UNABLE TO BE INSERTED']","['Got diuresed with lasix and diuril.', 'HD initiated, but line clotted during dialysis, so only 1 kg removed.', 'Patient was hypotensive following dialysis so, 500 cc bolus x 2 given,', 'then patient started on Levophed.', 'Febrile to 101.3', 'Blood cultures positive for GPCs in clusters.', ' DIALYSIS CATHETER - START [**2193-8-10**] 05:00 PM', ' SPUTUM CULTURE - At [**2193-8-10**] 08:00 PM', ' FEVER - 101.3', 'F - [**2193-8-10**] 04:00 PM']",73695,108174.0
56,2193-08-12 07:57:14,,"['Blood cultures through RIJ positive for GPCs.  Patient given', 'vancomycin.  Right IJ pulled.  Left subclavian placed.', 'Dialyzed yesterday to keep her even.', 'Weaned off levophed.', ' EEG - At [**2193-8-11**] 08:19 PM', ' MULTI LUMEN - STOP [**2193-8-11**] 11:53 PM', 'THIS LINE WAS UNABLE TO BE INSERTED']",,73695,108174.0
57,2193-08-12 14:22:32,['vancomycin.  Right IJ pulled.  New right subclavian line placed.'],"['Blood cultures through RIJ positive for GPCs.  Patient given', 'vancomycin.  Right IJ pulled.  New right subclavian line placed.', 'Dialyzed yesterday to keep her even.', 'Weaned off levophed.', ' EEG - At [**2193-8-11**] 08:19 PM']","['vancomycin.  Right IJ pulled.  Left subclavian placed.', ' MULTI LUMEN - STOP [**2193-8-11**] 11:53 PM', 'THIS LINE WAS UNABLE TO BE INSERTED']",73695,108174.0
58,2193-08-13 07:00:17,"['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']","['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']","['Blood cultures through RIJ positive for GPCs.  Patient given', 'vancomycin.  Right IJ pulled.  New right subclavian line placed.', 'Dialyzed yesterday to keep her even.', 'Weaned off levophed.', ' EEG - At [**2193-8-11**] 08:19 PM']",73695,108174.0
59,2193-08-13 07:42:40,,"['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']",,73695,108174.0
60,2193-08-13 10:27:25,,"['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']",,73695,108174.0
61,2193-08-13 10:30:36,,"['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']",,73695,108174.0
62,2193-08-13 10:31:07,,"['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']",,73695,108174.0
63,2193-08-14 06:27:10,"['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM']","['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM']","['- patient tolerated trach mask yesterday and overnight', '- had HD yesterday, with 1.4L removed. Given 1gm vancomycin after HD.', 'Level this AM of 32.1 was not trough.', '- rheumatology: thought patient could have livedo reticularis', 'suspicious for thromboembolic event or vasculitis, elevated CK could be', '[**12-29**] propofol infusion syndrome vs critical illness myopathy vs skeletal', 'vasculitis. Recommended derm bx of skin lesions, sending off more lab', 'tests including [**Last Name (un) **] stim this AM', '- plan for possible IR-guided placement of tunneled line catheter as', 'current HD catheter will likely need to be pulled. Renal to touch base', 'early this AM.', ' INVASIVE VENTILATION - STOP [**2193-8-12**] 09:00 AM']",73695,108174.0
64,2193-08-14 06:28:55,"[' no DVT, but limited by', 'extensive SC edema']","['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' no DVT, but limited by', 'extensive SC edema', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM']",,73695,108174.0
65,2193-08-14 07:50:15,,"['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' no DVT, but limited by', 'extensive SC edema', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM']",,73695,108174.0
66,2193-08-14 12:45:08,"['Patient with hypotension with SBPs in 80s, so was started on low dose', 'of levophed']","['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' no DVT, but limited by', 'extensive SC edema', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM', 'Patient with hypotension with SBPs in 80s, so was started on low dose', 'of levophed']",,73695,108174.0
67,2193-08-14 13:13:42,,"['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' no DVT, but limited by', 'extensive SC edema', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM', 'Patient with hypotension with SBPs in 80s, so was started on low dose', 'of levophed']",,73695,108174.0
68,2193-08-15 06:56:04,"['Derm pathology results consistent with thrombotic microangiopathy.', 'Rheuamtology feels patient has no evidence of vasculitis.  They are', 'reccomending considering systemic anticoagulation.', 'Renal feels she has TTP and needs ADAMTS tested and should get', 'plasmapharesis.  They recommended renal ultrasound to evaluate for', 'arterial or venous thrombus, which was non-diagnostic due to limited', 'study.', 'Heme/onc feeels she has early DIC and recommended checking serial DIC', 'labs.  Another possibility is an embolic source, so recommending repeat', 'TEE.', 'Neurology feels that is is okay to get systemic anticoagulation and do', 'not feel she needs further imaging.', 'Patient was tachypneic overnight with increased bloody pulmonary', 'secretions.  Patient was tachypneic to 40s.  PTT initially elevated', 'after dialsysi (with heparin) but then trended down and pulmonary', 'bleeding resolved.  Patient placed on vent due to concern for tiring.', 'Patient seemed aware and anxious during this episode, so 1 mg of ativan', 'given.', 'Echo performed which showed increased MR and no valvular vegetations.', ' EKG - At [**2193-8-14**] 01:30 PM', ' EEG - At [**2193-8-14**] 03:00 PM', ' ULTRASOUND - At [**2193-8-14**] 04:00 PM', 'Renal U/S', ' INVASIVE VENTILATION - START [**2193-8-15**] 12:01 AM']","['Derm pathology results consistent with thrombotic microangiopathy.', 'Rheuamtology feels patient has no evidence of vasculitis.  They are', 'reccomending considering systemic anticoagulation.', 'Renal feels she has TTP and needs ADAMTS tested and should get', 'plasmapharesis.  They recommended renal ultrasound to evaluate for', 'arterial or venous thrombus, which was non-diagnostic due to limited', 'study.', 'Heme/onc feeels she has early DIC and recommended checking serial DIC', 'labs.  Another possibility is an embolic source, so recommending repeat', 'TEE.', 'Neurology feels that is is okay to get systemic anticoagulation and do', 'not feel she needs further imaging.', 'Patient was tachypneic overnight with increased bloody pulmonary', 'secretions.  Patient was tachypneic to 40s.  PTT initially elevated', 'after dialsysi (with heparin) but then trended down and pulmonary', 'bleeding resolved.  Patient placed on vent due to concern for tiring.', 'Patient seemed aware and anxious during this episode, so 1 mg of ativan', 'given.', 'Echo performed which showed increased MR and no valvular vegetations.', ' EKG - At [**2193-8-14**] 01:30 PM', ' EEG - At [**2193-8-14**] 03:00 PM', ' ULTRASOUND - At [**2193-8-14**] 04:00 PM', 'Renal U/S', ' INVASIVE VENTILATION - START [**2193-8-15**] 12:01 AM']","['DIALYSIS CATHETER - START [**2193-8-13**] 06:08 PM', ' ULTRASOUND - At [**2193-8-13**] 09:00 PM', ' no DVT, but limited by', 'extensive SC edema', ' DIALYSIS CATHETER - STOP [**2193-8-14**] 12:22 AM', 'Patient with hypotension with SBPs in 80s, so was started on low dose', 'of levophed']",73695,108174.0
69,2193-08-15 07:59:39,,"['Derm pathology results consistent with thrombotic microangiopathy.', 'Rheuamtology feels patient has no evidence of vasculitis.  They are', 'reccomending considering systemic anticoagulation.', 'Renal feels she has TTP and needs ADAMTS tested and should get', 'plasmapharesis.  They recommended renal ultrasound to evaluate for', 'arterial or venous thrombus, which was non-diagnostic due to limited', 'study.', 'Heme/onc feeels she has early DIC and recommended checking serial DIC', 'labs.  Another possibility is an embolic source, so recommending repeat', 'TEE.', 'Neurology feels that is is okay to get systemic anticoagulation and do', 'not feel she needs further imaging.', 'Patient was tachypneic overnight with increased bloody pulmonary', 'secretions.  Patient was tachypneic to 40s.  PTT initially elevated', 'after dialsysi (with heparin) but then trended down and pulmonary', 'bleeding resolved.  Patient placed on vent due to concern for tiring.', 'Patient seemed aware and anxious during this episode, so 1 mg of ativan', 'given.', 'Echo performed which showed increased MR and no valvular vegetations.', ' EKG - At [**2193-8-14**] 01:30 PM', ' EEG - At [**2193-8-14**] 03:00 PM', ' ULTRASOUND - At [**2193-8-14**] 04:00 PM', 'Renal U/S', ' INVASIVE VENTILATION - START [**2193-8-15**] 12:01 AM']",,73695,108174.0
70,2193-08-15 23:36:57,"['recommending considering systemic anticoagulation and also repeat MRI.', 'Patient was tachypneic overnight around 10pm with increased bloody', 'pulmonary secretions.  Patient was tachypneic to 40s.  PTT initially', 'elevated after dialsysi (with heparin) but then trended down and', 'pulmonary bleeding resolved.  Patient placed on vent due to concern for', 'tiring.  Patient seemed aware and anxious during this episode, so 1 mg', 'of ativan given.', 'EEG showed mild encephalopathy']","['Derm pathology results consistent with thrombotic microangiopathy.', 'Rheuamtology feels patient has no evidence of vasculitis.  They are', 'recommending considering systemic anticoagulation and also repeat MRI.', 'Renal feels she has TTP and needs ADAMTS tested and should get', 'plasmapharesis.  They recommended renal ultrasound to evaluate for', 'arterial or venous thrombus, which was non-diagnostic due to limited', 'study.', 'Heme/onc feeels she has early DIC and recommended checking serial DIC', 'labs.  Another possibility is an embolic source, so recommending repeat', 'TEE.', 'Neurology feels that is is okay to get systemic anticoagulation and do', 'not feel she needs further imaging.', 'Patient was tachypneic overnight around 10pm with increased bloody', 'pulmonary secretions.  Patient was tachypneic to 40s.  PTT initially', 'elevated after dialsysi (with heparin) but then trended down and', 'pulmonary bleeding resolved.  Patient placed on vent due to concern for', 'tiring.  Patient seemed aware and anxious during this episode, so 1 mg', 'of ativan given.', 'Echo performed which showed increased MR and no valvular vegetations.', 'EEG showed mild encephalopathy', ' EKG - At [**2193-8-14**] 01:30 PM', ' EEG - At [**2193-8-14**] 03:00 PM', ' ULTRASOUND - At [**2193-8-14**] 04:00 PM', 'Renal U/S', ' INVASIVE VENTILATION - START [**2193-8-15**] 12:01 AM']","['reccomending considering systemic anticoagulation.', 'Patient was tachypneic overnight with increased bloody pulmonary', 'secretions.  Patient was tachypneic to 40s.  PTT initially elevated', 'after dialsysi (with heparin) but then trended down and pulmonary', 'bleeding resolved.  Patient placed on vent due to concern for tiring.', 'Patient seemed aware and anxious during this episode, so 1 mg of ativan', 'given.']",73695,108174.0
71,2193-08-16 07:50:31,"['BRONCHOSCOPY - At [**2193-8-15**] 12:30 PM', '-No significant findings on bronchoscopy.', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-15**] 08:30 PM', '-Awaiting read, prelim: no acute change.', ' FEVER - 101.1', 'F - [**2193-8-15**] 08:00 PM', 'HIT antibody returned negative.', 'Renal recommended rechecking APL Ab, this was resent.', 'ADAMTS13 cancelled.', 'Restarted on heparin drip.', 'A-line placement was attempted; but unsuccessful.']","['BRONCHOSCOPY - At [**2193-8-15**] 12:30 PM', '-No significant findings on bronchoscopy.', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-15**] 08:30 PM', '-Awaiting read, prelim: no acute change.', ' FEVER - 101.1', 'F - [**2193-8-15**] 08:00 PM', 'HIT antibody returned negative.', 'Renal recommended rechecking APL Ab, this was resent.', 'ADAMTS13 cancelled.', 'Restarted on heparin drip.', 'A-line placement was attempted; but unsuccessful.']","['Derm pathology results consistent with thrombotic microangiopathy.', 'Rheuamtology feels patient has no evidence of vasculitis.  They are', 'recommending considering systemic anticoagulation and also repeat MRI.', 'Renal feels she has TTP and needs ADAMTS tested and should get', 'plasmapharesis.  They recommended renal ultrasound to evaluate for', 'arterial or venous thrombus, which was non-diagnostic due to limited', 'study.', 'Heme/onc feeels she has early DIC and recommended checking serial DIC', 'labs.  Another possibility is an embolic source, so recommending repeat', 'TEE.', 'Neurology feels that is is okay to get systemic anticoagulation and do', 'not feel she needs further imaging.', 'Patient was tachypneic overnight around 10pm with increased bloody', 'pulmonary secretions.  Patient was tachypneic to 40s.  PTT initially', 'elevated after dialsysi (with heparin) but then trended down and', 'pulmonary bleeding resolved.  Patient placed on vent due to concern for', 'tiring.  Patient seemed aware and anxious during this episode, so 1 mg', 'of ativan given.', 'Echo performed which showed increased MR and no valvular vegetations.', 'EEG showed mild encephalopathy', ' EKG - At [**2193-8-14**] 01:30 PM', ' EEG - At [**2193-8-14**] 03:00 PM', ' ULTRASOUND - At [**2193-8-14**] 04:00 PM', 'Renal U/S', ' INVASIVE VENTILATION - START [**2193-8-15**] 12:01 AM']",73695,108174.0
72,2193-08-16 16:46:51,,"['BRONCHOSCOPY - At [**2193-8-15**] 12:30 PM', '-No significant findings on bronchoscopy.', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-15**] 08:30 PM', '-Awaiting read, prelim: no acute change.', ' FEVER - 101.1', 'F - [**2193-8-15**] 08:00 PM', 'HIT antibody returned negative.', 'Renal recommended rechecking APL Ab, this was resent.', 'ADAMTS13 cancelled.', 'Restarted on heparin drip.', 'A-line placement was attempted; but unsuccessful.']",,73695,108174.0
73,2193-08-17 06:38:16,,[],"['BRONCHOSCOPY - At [**2193-8-15**] 12:30 PM', '-No significant findings on bronchoscopy.', ' MAGNETIC RESONANCE IMAGING - At [**2193-8-15**] 08:30 PM', '-Awaiting read, prelim: no acute change.', ' FEVER - 101.1', 'F - [**2193-8-15**] 08:00 PM', 'HIT antibody returned negative.', 'Renal recommended rechecking APL Ab, this was resent.', 'ADAMTS13 cancelled.', 'Restarted on heparin drip.', 'A-line placement was attempted; but unsuccessful.']",73695,108174.0
74,2193-08-17 07:49:00,,[],,73695,108174.0
75,2193-08-17 11:26:52,,[],,73695,108174.0
76,2193-08-17 12:01:13,,[],,73695,108174.0
77,2193-08-17 12:22:02,,[],,73695,108174.0
78,2193-08-18 07:19:36,"['Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Now at 0.18.', 'CK and WBC trending down.']","['Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Now at 0.18.', 'CK and WBC trending down.']",,73695,108174.0
79,2193-08-18 07:48:16,,"['Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Now at 0.18.', 'CK and WBC trending down.']",,73695,108174.0
80,2193-08-18 10:53:04,,"['Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Now at 0.18.', 'CK and WBC trending down.']",,73695,108174.0
81,2193-08-18 18:27:51,"['Patient with increased ischemic areas on feet bilaterally, extremities', 'cooler than prior', 'Levophed rate increased overnight due to hypotension. Peak at 0.18.']","['Patient with increased ischemic areas on feet bilaterally, extremities', 'cooler than prior', 'Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Peak at 0.18.', 'CK and WBC trending down.']",['Levophed rate increased overnight due to hypotension. Now at 0.18.'],73695,108174.0
82,2193-08-18 18:29:37,,"['Patient with increased ischemic areas on feet bilaterally, extremities', 'cooler than prior', 'Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Peak at 0.18.', 'CK and WBC trending down.']",,73695,108174.0
83,2193-08-19 07:12:16,"['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']","['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']","['Patient with increased ischemic areas on feet bilaterally, extremities', 'cooler than prior', 'Patient started on steroids.', 'FS are improved (60 - 170), patient now on 50 cc/hour of D10.  Free', 'water flushes reduced due to hyponatremia.', 'Patient transfused 1 unit of crypoprecipitate due to low fibrinogen.', 'Vancomycin course completed.', 'Levophed rate increased overnight due to hypotension. Peak at 0.18.', 'CK and WBC trending down.']",73695,108174.0
84,2193-08-19 07:33:54,,"['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']",,73695,108174.0
85,2193-08-19 07:50:58,,"['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']",,73695,108174.0
86,2193-08-19 12:37:49,,"['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']",,73695,108174.0
87,2193-08-20 07:20:48,,[],"['-', 'Patient given fentanyl boluses and Ativan 1mg IV x 1 for', 'tachypnea, possible increased discomfort', '-', 'Started on heparin gtt without bolus (goal PTT 50-60) for', 'increased limb ischemia thought to be [**12-29**] thomboembolic event and', 'pressors', '-', 'Lactate increased to 6.0 so pan scan CT showed no abcess.', 'Unable to definitively r/o PE as unable to give IV contrast.', '-', 'Started on CVVH due to increased academia, goal to run', 'patient even', '-', 'Given 1 unit pRBCs for Hct 22', '-', 'Patient more awake but no localizing response']",73695,108174.0
88,2193-08-20 07:31:34,,[],,73695,108174.0
89,2193-08-20 12:07:14,"['-', 'Levophed weaned to 0.1 from 0.12', '-', 'Unable to place a-line', '-']","['-', 'Levophed weaned to 0.1 from 0.12', '-', 'Unable to place a-line', '-']",,73695,108174.0
90,2193-08-20 12:15:34,,"['-', 'Levophed weaned to 0.1 from 0.12', '-', 'Unable to place a-line', '-']",,73695,108174.0
91,2193-08-21 07:26:13,"['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM']","['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM']","['-', 'Levophed weaned to 0.1 from 0.12', '-', 'Unable to place a-line', '-']",73695,108174.0
92,2193-08-21 07:36:07,,"['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM']",,73695,108174.0
93,2193-08-21 14:39:38,"['- Small amt vaginal bleeding noted yesterday', '- Started Gangcyclovir q 24h, awaiting ID recs', '- CVVH line cracked, CVVH held pending repair of line', '- Sputum [**8-19**] with heavy growth GNR, started [**Last Name (un) 350**]/Cipro/Vanc', '- hct dropped to 20 from 23, transfused one unit pRBC', '- Lactate rose to 4.6', '- Transiently off, on again with Levophed', '- Spiked to 101 this AM']","['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM', '- Small amt vaginal bleeding noted yesterday', '- Started Gangcyclovir q 24h, awaiting ID recs', '- CVVH line cracked, CVVH held pending repair of line', '- Sputum [**8-19**] with heavy growth GNR, started [**Last Name (un) 350**]/Cipro/Vanc', '- hct dropped to 20 from 23, transfused one unit pRBC', '- Lactate rose to 4.6', '- Transiently off, on again with Levophed', '- Spiked to 101 this AM']",,73695,108174.0
94,2193-08-21 14:46:53,,"['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM', '- Small amt vaginal bleeding noted yesterday', '- Started Gangcyclovir q 24h, awaiting ID recs', '- CVVH line cracked, CVVH held pending repair of line', '- Sputum [**8-19**] with heavy growth GNR, started [**Last Name (un) 350**]/Cipro/Vanc', '- hct dropped to 20 from 23, transfused one unit pRBC', '- Lactate rose to 4.6', '- Transiently off, on again with Levophed', '- Spiked to 101 this AM']",,73695,108174.0
95,2193-08-22 08:03:42,"['FEVER - 101.6', 'F - [**2193-8-21**] 09:00 AM', '- ID saw, agrees with gancyclovir', '- Less bloody secretions from trach', '- Worsened foot ischemia', '- Off levophed, lactate 4, BP dropped so back on levophed', '- 10 PM gas: 7.42/33/153/22', '- Sputum cx: Acinetobacter baumanii ([**Last Name (un) 46**] to Ceftaz, cefepime, cipro,', 'imipenem) - pt currently on [**Last Name (un) 350**]/Cipro/Vanc, ID agrees with keeping', 'thse abx for now']","['FEVER - 101.6', 'F - [**2193-8-21**] 09:00 AM', '- ID saw, agrees with gancyclovir', '- Less bloody secretions from trach', '- Worsened foot ischemia', '- Off levophed, lactate 4, BP dropped so back on levophed', '- 10 PM gas: 7.42/33/153/22', '- Sputum cx: Acinetobacter baumanii ([**Last Name (un) 46**] to Ceftaz, cefepime, cipro,', 'imipenem) - pt currently on [**Last Name (un) 350**]/Cipro/Vanc, ID agrees with keeping', 'thse abx for now']","['ARTERIAL LINE - START [**2193-8-20**] 06:48 PM', ' FEVER - 101.1', 'F - [**2193-8-21**] 06:30 AM', '- Small amt vaginal bleeding noted yesterday', '- Started Gangcyclovir q 24h, awaiting ID recs', '- CVVH line cracked, CVVH held pending repair of line', '- Sputum [**8-19**] with heavy growth GNR, started [**Last Name (un) 350**]/Cipro/Vanc', '- hct dropped to 20 from 23, transfused one unit pRBC', '- Lactate rose to 4.6', '- Transiently off, on again with Levophed', '- Spiked to 101 this AM']",73695,108174.0
96,2193-08-22 12:34:09,,"['FEVER - 101.6', 'F - [**2193-8-21**] 09:00 AM', '- ID saw, agrees with gancyclovir', '- Less bloody secretions from trach', '- Worsened foot ischemia', '- Off levophed, lactate 4, BP dropped so back on levophed', '- 10 PM gas: 7.42/33/153/22', '- Sputum cx: Acinetobacter baumanii ([**Last Name (un) 46**] to Ceftaz, cefepime, cipro,', 'imipenem) - pt currently on [**Last Name (un) 350**]/Cipro/Vanc, ID agrees with keeping', 'thse abx for now']",,73695,108174.0
97,2193-08-22 13:59:05,,"['FEVER - 101.6', 'F - [**2193-8-21**] 09:00 AM', '- ID saw, agrees with gancyclovir', '- Less bloody secretions from trach', '- Worsened foot ischemia', '- Off levophed, lactate 4, BP dropped so back on levophed', '- 10 PM gas: 7.42/33/153/22', '- Sputum cx: Acinetobacter baumanii ([**Last Name (un) 46**] to Ceftaz, cefepime, cipro,', 'imipenem) - pt currently on [**Last Name (un) 350**]/Cipro/Vanc, ID agrees with keeping', 'thse abx for now']",,73695,108174.0
98,2193-08-23 07:26:01,"['-', 'Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro', '-']","['-', 'Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro', '-']","['FEVER - 101.6', 'F - [**2193-8-21**] 09:00 AM', '- ID saw, agrees with gancyclovir', '- Less bloody secretions from trach', '- Worsened foot ischemia', '- Off levophed, lactate 4, BP dropped so back on levophed', '- 10 PM gas: 7.42/33/153/22', '- Sputum cx: Acinetobacter baumanii ([**Last Name (un) 46**] to Ceftaz, cefepime, cipro,', 'imipenem) - pt currently on [**Last Name (un) 350**]/Cipro/Vanc, ID agrees with keeping', 'thse abx for now']",73695,108174.0
99,2193-08-23 07:33:12,,"['-', 'Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro', '-']",,73695,108174.0
100,2193-08-23 08:09:06,,"['-', 'Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro', '-']",,73695,108174.0
101,2193-08-23 14:33:37,,"['-', 'Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro', '-']",,73695,108174.0
102,2193-08-24 07:32:15,"['Decreased PS given alkalosis', 'Continues on CVVH']","['-', 'Decreased PS given alkalosis', '-', 'Continues on CVVH', '-']","['Sputum from [**8-19**]: pan-sensitive Acinetobacter and', 'enterobacter skazakii, on Cipro']",73695,108174.0
103,2193-08-24 07:35:33,,"['-', 'Decreased PS given alkalosis', '-', 'Continues on CVVH', '-']",,73695,108174.0
104,2193-08-24 12:36:58,['Back on levophed'],"['-', 'Decreased PS given alkalosis', '-', 'Continues on CVVH', '-', 'Back on levophed']",,73695,108174.0
105,2193-08-25 08:02:03,"['- Periodic episodes of bursts of ST vs SVT', '- 10PM 7.56/26/184 on PS 8/5 40%, changed to 5/5 with gas', '7.52/29/171/29', '- Transfused one unit pRBCs', '- Iron studies sent: Fe 20, TIBC 291, Ferritin 135, TRF 224']","['- Periodic episodes of bursts of ST vs SVT', '- 10PM 7.56/26/184 on PS 8/5 40%, changed to 5/5 with gas', '7.52/29/171/29', '- Transfused one unit pRBCs', '- Iron studies sent: Fe 20, TIBC 291, Ferritin 135, TRF 224']","['-', 'Decreased PS given alkalosis', '-', 'Continues on CVVH', '-', 'Back on levophed']",73695,108174.0
106,2193-08-25 11:30:15,,"['- Periodic episodes of bursts of ST vs SVT', '- 10PM 7.56/26/184 on PS 8/5 40%, changed to 5/5 with gas', '7.52/29/171/29', '- Transfused one unit pRBCs', '- Iron studies sent: Fe 20, TIBC 291, Ferritin 135, TRF 224']",,73695,108174.0
107,2193-08-26 07:41:59,"['- cortisol 40', '- intermittent periods of apnea, started on AC 40%, 600, 12, 5 ABG', '7.52/29/174 --> reduced TV to 500 ABG 7.48/31/151', '- has been off pressors since the AM. MAPS >60', '- intermittent SVT to 140s, comes down sponeteously vs with', 'stimulation.']","['- cortisol 40', '- intermittent periods of apnea, started on AC 40%, 600, 12, 5 ABG', '7.52/29/174 --> reduced TV to 500 ABG 7.48/31/151', '- has been off pressors since the AM. MAPS >60', '- intermittent SVT to 140s, comes down sponeteously vs with', 'stimulation.']","['- Periodic episodes of bursts of ST vs SVT', '- 10PM 7.56/26/184 on PS 8/5 40%, changed to 5/5 with gas', '7.52/29/171/29', '- Transfused one unit pRBCs', '- Iron studies sent: Fe 20, TIBC 291, Ferritin 135, TRF 224']",73695,108174.0
108,2193-08-26 07:42:51,,"['- cortisol 40', '- intermittent periods of apnea, started on AC 40%, 600, 12, 5 ABG', '7.52/29/174 --> reduced TV to 500 ABG 7.48/31/151', '- has been off pressors since the AM. MAPS >60', '- intermittent SVT to 140s, comes down sponeteously vs with', 'stimulation.']",,73695,108174.0
109,2193-08-26 12:12:12,,"['- cortisol 40', '- intermittent periods of apnea, started on AC 40%, 600, 12, 5 ABG', '7.52/29/174 --> reduced TV to 500 ABG 7.48/31/151', '- has been off pressors since the AM. MAPS >60', '- intermittent SVT to 140s, comes down sponeteously vs with', 'stimulation.']",,73695,108174.0
110,2193-08-27 08:01:54,"['FEVER - 102.2', 'F - [**2193-8-26**] 08:00 PM', '- Could not draw off of dialysis line--tubing changed, catheter', 'rotated. IR called and was unable to fit in schedule yesterday, will', 'plan for exchange of line today.', '- Sister called, will come in around 4 PM for family meeting.', 'Nephrology attending, social work to attend as well.', '- Neurology called, they will round on patient and comment on prognosis', 'this morning prior to meeting.', '- Spiked a fever to 102.2 at 8 PM.']","['FEVER - 102.2', 'F - [**2193-8-26**] 08:00 PM', '- Could not draw off of dialysis line--tubing changed, catheter', 'rotated. IR called and was unable to fit in schedule yesterday, will', 'plan for exchange of line today.', '- Sister called, will come in around 4 PM for family meeting.', 'Nephrology attending, social work to attend as well.', '- Neurology called, they will round on patient and comment on prognosis', 'this morning prior to meeting.', '- Spiked a fever to 102.2 at 8 PM.']","['- cortisol 40', '- intermittent periods of apnea, started on AC 40%, 600, 12, 5 ABG', '7.52/29/174 --> reduced TV to 500 ABG 7.48/31/151', '- has been off pressors since the AM. MAPS >60', '- intermittent SVT to 140s, comes down sponeteously vs with', 'stimulation.']",73695,108174.0
111,2193-08-27 13:26:21,['- Levophed back on 0.04'],"['FEVER - 102.2', 'F - [**2193-8-26**] 08:00 PM', '- Could not draw off of dialysis line--tubing changed, catheter', 'rotated. IR called and was unable to fit in schedule yesterday, will', 'plan for exchange of line today.', '- Sister called, will come in around 4 PM for family meeting.', 'Nephrology attending, social work to attend as well.', '- Neurology called, they will round on patient and comment on prognosis', 'this morning prior to meeting.', '- Spiked a fever to 102.2 at 8 PM.', '- Levophed back on 0.04']",,73695,108174.0
112,2193-08-28 07:58:41,"['BLOOD CULTURED - At [**2193-8-27**] 09:36 AM', ' DIALYSIS CATHETER - STOP [**2193-8-27**] 12:00 PM', ' DIALYSIS CATHETER - START [**2193-8-27**] 12:00 PM', '- New HD line placed', '- Family meeting: stay the course', '- Neuro c/s: recommend labs (anti VGKC, anti-NMDAR, anti-Yo, anti-Ri,', 'anti-Hm), somatosensory evoked potentials, repeat EEG (ordered), and LP', '!!!', '- Lactate climbed to 7.7 overnight, maintained BP on levophed (stable', 'dose)', '- PS trial on [**4-1**]: 7.41/26/131/17', '- Looked uncomfortable, placed on rate after ABG 7.49/21/182/16']","['BLOOD CULTURED - At [**2193-8-27**] 09:36 AM', ' DIALYSIS CATHETER - STOP [**2193-8-27**] 12:00 PM', ' DIALYSIS CATHETER - START [**2193-8-27**] 12:00 PM', '- New HD line placed', '- Family meeting: stay the course', '- Neuro c/s: recommend labs (anti VGKC, anti-NMDAR, anti-Yo, anti-Ri,', 'anti-Hm), somatosensory evoked potentials, repeat EEG (ordered), and LP', '!!!', '- Lactate climbed to 7.7 overnight, maintained BP on levophed (stable', 'dose)', '- PS trial on [**4-1**]: 7.41/26/131/17', '- Looked uncomfortable, placed on rate after ABG 7.49/21/182/16']","['FEVER - 102.2', 'F - [**2193-8-26**] 08:00 PM', '- Could not draw off of dialysis line--tubing changed, catheter', 'rotated. IR called and was unable to fit in schedule yesterday, will', 'plan for exchange of line today.', '- Sister called, will come in around 4 PM for family meeting.', 'Nephrology attending, social work to attend as well.', '- Neurology called, they will round on patient and comment on prognosis', 'this morning prior to meeting.', '- Spiked a fever to 102.2 at 8 PM.', '- Levophed back on 0.04']",73695,108174.0
113,2193-08-28 15:08:03,,"['BLOOD CULTURED - At [**2193-8-27**] 09:36 AM', ' DIALYSIS CATHETER - STOP [**2193-8-27**] 12:00 PM', ' DIALYSIS CATHETER - START [**2193-8-27**] 12:00 PM', '- New HD line placed', '- Family meeting: stay the course', '- Neuro c/s: recommend labs (anti VGKC, anti-NMDAR, anti-Yo, anti-Ri,', 'anti-Hm), somatosensory evoked potentials, repeat EEG (ordered), and LP', '!!!', '- Lactate climbed to 7.7 overnight, maintained BP on levophed (stable', 'dose)', '- PS trial on [**4-1**]: 7.41/26/131/17', '- Looked uncomfortable, placed on rate after ABG 7.49/21/182/16']",,73695,108174.0
114,2193-08-29 07:21:54,"['- per renal very small amount of lactate in CVVH', '- Lactate came down with volume challange 6.6->4.9, gave 1 unit of', 'blood, likely volume down', '- Off levo, maintaining MAPs >60 since 10pm', '- c diff positive: started PO vanc']","['- per renal very small amount of lactate in CVVH', '- Lactate came down with volume challange 6.6->4.9, gave 1 unit of', 'blood, likely volume down', '- Off levo, maintaining MAPs >60 since 10pm', '- c diff positive: started PO vanc']","['BLOOD CULTURED - At [**2193-8-27**] 09:36 AM', ' DIALYSIS CATHETER - STOP [**2193-8-27**] 12:00 PM', ' DIALYSIS CATHETER - START [**2193-8-27**] 12:00 PM', '- New HD line placed', '- Family meeting: stay the course', '- Neuro c/s: recommend labs (anti VGKC, anti-NMDAR, anti-Yo, anti-Ri,', 'anti-Hm), somatosensory evoked potentials, repeat EEG (ordered), and LP', '!!!', '- Lactate climbed to 7.7 overnight, maintained BP on levophed (stable', 'dose)', '- PS trial on [**4-1**]: 7.41/26/131/17', '- Looked uncomfortable, placed on rate after ABG 7.49/21/182/16']",73695,108174.0
115,2193-08-29 10:59:40,,"['- per renal very small amount of lactate in CVVH', '- Lactate came down with volume challange 6.6->4.9, gave 1 unit of', 'blood, likely volume down', '- Off levo, maintaining MAPs >60 since 10pm', '- c diff positive: started PO vanc']",,73695,108174.0
116,2193-08-30 08:04:28,"['- Hematology will get back to team re: utility of bone marrow biopsy', '- Given one unit of PRBCs for borderline blood pressure (MAP 60-65),', 'lactate noted to be 4 (just prior to PRBCs).', '- Mouthed ""ice"" and ""yes""', '- Lactate up to 5.2 at 4 AM']","['- Hematology will get back to team re: utility of bone marrow biopsy', '- Given one unit of PRBCs for borderline blood pressure (MAP 60-65),', 'lactate noted to be 4 (just prior to PRBCs).', '- Mouthed ""ice"" and ""yes""', '- Lactate up to 5.2 at 4 AM']","['- per renal very small amount of lactate in CVVH', '- Lactate came down with volume challange 6.6->4.9, gave 1 unit of', 'blood, likely volume down', '- Off levo, maintaining MAPs >60 since 10pm', '- c diff positive: started PO vanc']",73695,108174.0
117,2193-08-30 08:06:51,,"['- Hematology will get back to team re: utility of bone marrow biopsy', '- Given one unit of PRBCs for borderline blood pressure (MAP 60-65),', 'lactate noted to be 4 (just prior to PRBCs).', '- Mouthed ""ice"" and ""yes""', '- Lactate up to 5.2 at 4 AM']",,73695,108174.0
118,2193-08-30 15:18:43,"['- Lactate up to 5.2 at 4 AMm back down to 3.2,']","['- Hematology will get back to team re: utility of bone marrow biopsy', '- Given one unit of PRBCs for borderline blood pressure (MAP 60-65),', 'lactate noted to be 4 (just prior to PRBCs).', '- Mouthed ""ice"" and ""yes""', '- Lactate up to 5.2 at 4 AMm back down to 3.2,']",['- Lactate up to 5.2 at 4 AM'],73695,108174.0
119,2193-08-31 08:22:56,"['TRANSTHORACIC ECHO - At [**2193-8-30**] 05:15 PM', '- 10 pm ABG on [**7-2**]: 7.60/25/167 --> switched to [**4-1**]', ""- D/c'd plavix (? assoc with plavix and microangiopathic thrombosis)"", '- TTE performed', '- Transfusion Med to see Saturday re: possible plasmapheresis', '- Gave 1 u FFP for rising lactate, ? benefit (sort of like', 'plasmapheresis)']","['TRANSTHORACIC ECHO - At [**2193-8-30**] 05:15 PM', '- 10 pm ABG on [**7-2**]: 7.60/25/167 --> switched to [**4-1**]', ""- D/c'd plavix (? assoc with plavix and microangiopathic thrombosis)"", '- TTE performed', '- Transfusion Med to see Saturday re: possible plasmapheresis', '- Gave 1 u FFP for rising lactate, ? benefit (sort of like', 'plasmapheresis)']","['- Hematology will get back to team re: utility of bone marrow biopsy', '- Given one unit of PRBCs for borderline blood pressure (MAP 60-65),', 'lactate noted to be 4 (just prior to PRBCs).', '- Mouthed ""ice"" and ""yes""', '- Lactate up to 5.2 at 4 AMm back down to 3.2,']",73695,108174.0
120,2193-08-31 13:16:51,,"['TRANSTHORACIC ECHO - At [**2193-8-30**] 05:15 PM', '- 10 pm ABG on [**7-2**]: 7.60/25/167 --> switched to [**4-1**]', ""- D/c'd plavix (? assoc with plavix and microangiopathic thrombosis)"", '- TTE performed', '- Transfusion Med to see Saturday re: possible plasmapheresis', '- Gave 1 u FFP for rising lactate, ? benefit (sort of like', 'plasmapheresis)']",,73695,108174.0
121,2193-09-01 08:19:02,"['ULTRASOUND - At [**2193-8-31**] 01:00 PM', '- lactate up, despite FFP (300cc)', '- Mixed venous o2 sat 36% --> 1 unit of blood.', '- changed vanc to ceftax to cover acinetobacter in sputum.', '- episide around 1pm where rate up tpo 180-200 and blood pressure down', 'to 60s, this resolved within 2-3 minutes without intervention', '- 250ns blous then the unit of blood', '- dialysis line clotted,--> tPA. it worked, but high pressures all', 'night. have tried changing ports and flushing and changing positions.', '- RUQ for increasing AP and Tbili: normal liver and gall bladder,', 'alternating hepatopedal/hepatofugal flow', '- repeat lactate and svo2 after blood: Lactate 7.2 and SVo2 16% -->', 'lactate 7.0 and SvO2 25 later with no intervention', '- transfusion medicine-- attgs talked and said to try FFP instead', 'because there are no antiodies to pheres off.', '- family meeting Modnay 2pm., will check with Dr. [**Last Name (STitle) 560**]', '- tolerated trach mask for 2 hours yesterday, became apneic (fentanyl),', 'and on PS overnight. Gas before putting back on vent was: 7.36/44/166,', 'more alkalotic when on vent']","['ULTRASOUND - At [**2193-8-31**] 01:00 PM', '- lactate up, despite FFP (300cc)', '- Mixed venous o2 sat 36% --> 1 unit of blood.', '- changed vanc to ceftax to cover acinetobacter in sputum.', '- episide around 1pm where rate up tpo 180-200 and blood pressure down', 'to 60s, this resolved within 2-3 minutes without intervention', '- 250ns blous then the unit of blood', '- dialysis line clotted,--> tPA. it worked, but high pressures all', 'night. have tried changing ports and flushing and changing positions.', '- RUQ for increasing AP and Tbili: normal liver and gall bladder,', 'alternating hepatopedal/hepatofugal flow', '- repeat lactate and svo2 after blood: Lactate 7.2 and SVo2 16% -->', 'lactate 7.0 and SvO2 25 later with no intervention', '- transfusion medicine-- attgs talked and said to try FFP instead', 'because there are no antiodies to pheres off.', '- family meeting Modnay 2pm., will check with Dr. [**Last Name (STitle) 560**]', '- tolerated trach mask for 2 hours yesterday, became apneic (fentanyl),', 'and on PS overnight. Gas before putting back on vent was: 7.36/44/166,', 'more alkalotic when on vent']","['TRANSTHORACIC ECHO - At [**2193-8-30**] 05:15 PM', '- 10 pm ABG on [**7-2**]: 7.60/25/167 --> switched to [**4-1**]', ""- D/c'd plavix (? assoc with plavix and microangiopathic thrombosis)"", '- TTE performed', '- Transfusion Med to see Saturday re: possible plasmapheresis', '- Gave 1 u FFP for rising lactate, ? benefit (sort of like', 'plasmapheresis)']",73695,108174.0
122,2193-09-01 12:14:35,,"['ULTRASOUND - At [**2193-8-31**] 01:00 PM', '- lactate up, despite FFP (300cc)', '- Mixed venous o2 sat 36% --> 1 unit of blood.', '- changed vanc to ceftax to cover acinetobacter in sputum.', '- episide around 1pm where rate up tpo 180-200 and blood pressure down', 'to 60s, this resolved within 2-3 minutes without intervention', '- 250ns blous then the unit of blood', '- dialysis line clotted,--> tPA. it worked, but high pressures all', 'night. have tried changing ports and flushing and changing positions.', '- RUQ for increasing AP and Tbili: normal liver and gall bladder,', 'alternating hepatopedal/hepatofugal flow', '- repeat lactate and svo2 after blood: Lactate 7.2 and SVo2 16% -->', 'lactate 7.0 and SvO2 25 later with no intervention', '- transfusion medicine-- attgs talked and said to try FFP instead', 'because there are no antiodies to pheres off.', '- family meeting Modnay 2pm., will check with Dr. [**Last Name (STitle) 560**]', '- tolerated trach mask for 2 hours yesterday, became apneic (fentanyl),', 'and on PS overnight. Gas before putting back on vent was: 7.36/44/166,', 'more alkalotic when on vent']",,73695,108174.0
123,2193-09-02 07:39:58,"['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']","['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']","['ULTRASOUND - At [**2193-8-31**] 01:00 PM', '- lactate up, despite FFP (300cc)', '- Mixed venous o2 sat 36% --> 1 unit of blood.', '- changed vanc to ceftax to cover acinetobacter in sputum.', '- episide around 1pm where rate up tpo 180-200 and blood pressure down', 'to 60s, this resolved within 2-3 minutes without intervention', '- 250ns blous then the unit of blood', '- dialysis line clotted,--> tPA. it worked, but high pressures all', 'night. have tried changing ports and flushing and changing positions.', '- RUQ for increasing AP and Tbili: normal liver and gall bladder,', 'alternating hepatopedal/hepatofugal flow', '- repeat lactate and svo2 after blood: Lactate 7.2 and SVo2 16% -->', 'lactate 7.0 and SvO2 25 later with no intervention', '- transfusion medicine-- attgs talked and said to try FFP instead', 'because there are no antiodies to pheres off.', '- family meeting Modnay 2pm., will check with Dr. [**Last Name (STitle) 560**]', '- tolerated trach mask for 2 hours yesterday, became apneic (fentanyl),', 'and on PS overnight. Gas before putting back on vent was: 7.36/44/166,', 'more alkalotic when on vent']",73695,108174.0
124,2193-09-02 07:46:18,,"['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']",,73695,108174.0
125,2193-09-02 11:54:43,,"['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']",,73695,108174.0
126,2193-09-02 12:07:31,,"['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']",,73695,108174.0
127,2193-09-03 08:11:52,"['- Transfusion Med: no plasmapheresis', '- Re-ordered ADAMST13', '- Problems w/ CVVH machine --> plan for HD on Tuesday', '- On Dobuatmine, titrating up: lactate 6.5-->4.2-->2.7-->2.5; ScVO2', '25-->29-->51-->48', '- Back on levophed 3 AM for low BPs']","['- Transfusion Med: no plasmapheresis', '- Re-ordered ADAMST13', '- Problems w/ CVVH machine --> plan for HD on Tuesday', '- On Dobuatmine, titrating up: lactate 6.5-->4.2-->2.7-->2.5; ScVO2', '25-->29-->51-->48', '- Back on levophed 3 AM for low BPs']","['- Central oxygen venous saturation 16, consistent with degree of', 'cardiogenic shock. Given ectopy, mild tachycardia at times, amiodarone', 'started to help with rhythm control and atrial kick, and dobutamine', 'started to increase cardiac output. Repeat oxygen saturation up to 48,', 'but follow up down to 23. Lactate, however, down to 4.8 from 7.0.', '- Family meeting to take place at 2 PM, renal attending is available']",73695,108174.0
128,2193-09-03 13:20:07,,"['- Transfusion Med: no plasmapheresis', '- Re-ordered ADAMST13', '- Problems w/ CVVH machine --> plan for HD on Tuesday', '- On Dobuatmine, titrating up: lactate 6.5-->4.2-->2.7-->2.5; ScVO2', '25-->29-->51-->48', '- Back on levophed 3 AM for low BPs']",,73695,108174.0
129,2193-09-04 07:16:43,,[],"['- Transfusion Med: no plasmapheresis', '- Re-ordered ADAMST13', '- Problems w/ CVVH machine --> plan for HD on Tuesday', '- On Dobuatmine, titrating up: lactate 6.5-->4.2-->2.7-->2.5; ScVO2', '25-->29-->51-->48', '- Back on levophed 3 AM for low BPs']",73695,108174.0
130,2193-09-04 07:18:01,,[],,73695,108174.0
131,2193-09-04 12:45:42,['-'],['-'],,73695,108174.0
132,2193-09-05 07:51:14,"['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', 'New HD line placed (L fem)', 'Underwent HD and tolerated, 2kg removed', 'Marrow bx pending', 'Continued Gangiclovir', 'Totrated captopril to 12.5 TID, dobuta down to 1.5', 'mcg/kg/min', 'Restarted heparin']","['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', '-', 'New HD line placed (L fem)', '-', 'Underwent HD and tolerated, 2kg removed', '-', 'Marrow bx pending', '-', 'Continued Gangiclovir', '-', 'Totrated captopril to 12.5 TID, dobuta down to 1.5', 'mcg/kg/min', '-', 'Restarted heparin', '-']",,73695,108174.0
133,2193-09-05 07:52:56,,"['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', '-', 'New HD line placed (L fem)', '-', 'Underwent HD and tolerated, 2kg removed', '-', 'Marrow bx pending', '-', 'Continued Gangiclovir', '-', 'Totrated captopril to 12.5 TID, dobuta down to 1.5', 'mcg/kg/min', '-', 'Restarted heparin', '-']",,73695,108174.0
134,2193-09-05 07:58:07,,"['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', '-', 'New HD line placed (L fem)', '-', 'Underwent HD and tolerated, 2kg removed', '-', 'Marrow bx pending', '-', 'Continued Gangiclovir', '-', 'Totrated captopril to 12.5 TID, dobuta down to 1.5', 'mcg/kg/min', '-', 'Restarted heparin', '-']",,73695,108174.0
135,2193-09-05 12:03:12,"['Titrated captopril to 12.5 TID, dobutamine down to 1.5']","['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', '-', 'New HD line placed (L fem)', '-', 'Underwent HD and tolerated, 2kg removed', '-', 'Marrow bx pending', '-', 'Continued Gangiclovir', '-', 'Titrated captopril to 12.5 TID, dobutamine down to 1.5', 'mcg/kg/min', '-', 'Restarted heparin', '-']","['Totrated captopril to 12.5 TID, dobuta down to 1.5']",73695,108174.0
136,2193-09-06 07:09:29,"['- ADAMST 13 is still low --> Transfusion says no pheresis', '- HD took off 3.8 L today', '- Trended LFTs, steadily rising since [**8-30**] (started vanco [**8-30**])', ""- Tonight PLTs 24 from 77 --> stopped heparin, sent HIT, d/c'd"", 'captopril and gancyclovir, Heme reviewed smear and no schistocytes', '- FYI: Vanco can cause thrombocytopenia (see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1648**] et [**Doctor Last Name **]. NEJM', '356(9): 904-10)']","['- ADAMST 13 is still low --> Transfusion says no pheresis', '- HD took off 3.8 L today', '- Trended LFTs, steadily rising since [**8-30**] (started vanco [**8-30**])', ""- Tonight PLTs 24 from 77 --> stopped heparin, sent HIT, d/c'd"", 'captopril and gancyclovir, Heme reviewed smear and no schistocytes', '- FYI: Vanco can cause thrombocytopenia (see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1648**] et [**Doctor Last Name **]. NEJM', '356(9): 904-10)']","['DIALYSIS CATHETER - START [**2193-9-4**] 05:07 PM', '-', 'New HD line placed (L fem)', '-', 'Underwent HD and tolerated, 2kg removed', '-', 'Marrow bx pending', '-', 'Continued Gangiclovir', '-', 'Titrated captopril to 12.5 TID, dobutamine down to 1.5', 'mcg/kg/min', '-', 'Restarted heparin', '-']",73695,108174.0
137,2193-09-06 07:21:42,"['- Used PMV, said', ' and BF', 's name']","['- ADAMST 13 is still low --> Transfusion says no pheresis', '- HD took off 3.8 L today', '- Used PMV, said', ' and BF', 's name', '- Trended LFTs, steadily rising since [**8-30**] (started vanco [**8-30**])', ""- Tonight PLTs 24 from 77 --> stopped heparin, sent HIT, d/c'd"", 'captopril and gancyclovir, Heme reviewed smear and no schistocytes', '- FYI: Vanco can cause thrombocytopenia (see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1648**] et [**Doctor Last Name **]. NEJM', '356(9): 904-10)']",,73695,108174.0
138,2193-09-06 12:08:54,,"['- ADAMST 13 is still low --> Transfusion says no pheresis', '- HD took off 3.8 L today', '- Used PMV, said', ' and BF', 's name', '- Trended LFTs, steadily rising since [**8-30**] (started vanco [**8-30**])', ""- Tonight PLTs 24 from 77 --> stopped heparin, sent HIT, d/c'd"", 'captopril and gancyclovir, Heme reviewed smear and no schistocytes', '- FYI: Vanco can cause thrombocytopenia (see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1648**] et [**Doctor Last Name **]. NEJM', '356(9): 904-10)']",,73695,108174.0
139,2193-09-07 08:00:59,"['- HIT: negative', '- dialysis: 5L off', '- f/u heme reccs: Bone marrow with areas of necrosis, seen in emaciated', 'patients and with infection (fungal and AFB). unlikely HIT  because', 'platelet dropped too much. would not treat for HIT at this time.', '- platelets: going up modestly from this AM, pink tinged trach', 'secretions', '- lactate down after dialysis, then 2.1--> 2.3']","['- HIT: negative', '- dialysis: 5L off', '- f/u heme reccs: Bone marrow with areas of necrosis, seen in emaciated', 'patients and with infection (fungal and AFB). unlikely HIT  because', 'platelet dropped too much. would not treat for HIT at this time.', '- platelets: going up modestly from this AM, pink tinged trach', 'secretions', '- lactate down after dialysis, then 2.1--> 2.3']","['- ADAMST 13 is still low --> Transfusion says no pheresis', '- HD took off 3.8 L today', '- Used PMV, said', ' and BF', 's name', '- Trended LFTs, steadily rising since [**8-30**] (started vanco [**8-30**])', ""- Tonight PLTs 24 from 77 --> stopped heparin, sent HIT, d/c'd"", 'captopril and gancyclovir, Heme reviewed smear and no schistocytes', '- FYI: Vanco can cause thrombocytopenia (see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1648**] et [**Doctor Last Name **]. NEJM', '356(9): 904-10)']",73695,108174.0
140,2193-09-07 08:02:00,,"['- HIT: negative', '- dialysis: 5L off', '- f/u heme reccs: Bone marrow with areas of necrosis, seen in emaciated', 'patients and with infection (fungal and AFB). unlikely HIT  because', 'platelet dropped too much. would not treat for HIT at this time.', '- platelets: going up modestly from this AM, pink tinged trach', 'secretions', '- lactate down after dialysis, then 2.1--> 2.3']",,73695,108174.0
141,2193-09-07 11:03:00,,"['- HIT: negative', '- dialysis: 5L off', '- f/u heme reccs: Bone marrow with areas of necrosis, seen in emaciated', 'patients and with infection (fungal and AFB). unlikely HIT  because', 'platelet dropped too much. would not treat for HIT at this time.', '- platelets: going up modestly from this AM, pink tinged trach', 'secretions', '- lactate down after dialysis, then 2.1--> 2.3']",,73695,108174.0
142,2193-09-08 07:40:01,,[],"['- HIT: negative', '- dialysis: 5L off', '- f/u heme reccs: Bone marrow with areas of necrosis, seen in emaciated', 'patients and with infection (fungal and AFB). unlikely HIT  because', 'platelet dropped too much. would not treat for HIT at this time.', '- platelets: going up modestly from this AM, pink tinged trach', 'secretions', '- lactate down after dialysis, then 2.1--> 2.3']",73695,108174.0
143,2193-09-08 07:42:23,"['- Ultrafiltrated for 5 kilograms (initially subclavian line used,', 'however then transitioned to femoral line)', '- Heme: Clinical picture and laboratories not consistent with HIT,', 'agree with re-starting Heparin--> heparin gtt re-started.', '- More interactive, mouthing more words, shaking head yes and no', 'consistently to questions', '- Lactate stable at 2', '- Platelets up to 45']","['- Ultrafiltrated for 5 kilograms (initially subclavian line used,', 'however then transitioned to femoral line)', '- Heme: Clinical picture and laboratories not consistent with HIT,', 'agree with re-starting Heparin--> heparin gtt re-started.', '- More interactive, mouthing more words, shaking head yes and no', 'consistently to questions', '- Lactate stable at 2', '- Platelets up to 45']",,73695,108174.0
144,2193-09-08 11:34:22,,"['- Ultrafiltrated for 5 kilograms (initially subclavian line used,', 'however then transitioned to femoral line)', '- Heme: Clinical picture and laboratories not consistent with HIT,', 'agree with re-starting Heparin--> heparin gtt re-started.', '- More interactive, mouthing more words, shaking head yes and no', 'consistently to questions', '- Lactate stable at 2', '- Platelets up to 45']",,73695,108174.0
145,2193-09-09 06:28:39,"['BLOOD CULTURED - At [**2193-9-9**] 06:00 AM', ' SPUTUM CULTURE - At [**2193-9-9**] 06:00 AM', '- Improved MS over weekend', '- Restarted Captopril 6.25 PO TID as PLTs stabilized', '- Vascular c/s for feet: will staff', '- ? need new tunneled HD line on Tuesday', '- 2 hrs after Captopril, BP dropped to 70s, transiently on Levophed,', 'quickly weaned off, 1 u pRBCs transfused, ? related to large volume', 'removed Saturday by HD + captopril, also concern for sepsis as off all', 'abx except PO Flagyl', '- BP stable off levophed, s/p 1 unit pRBCs', '- Switched Flagyl to IV from PO as WBC increasing, temp trending up;', 'blood cx, sputum cx sent']","['BLOOD CULTURED - At [**2193-9-9**] 06:00 AM', ' SPUTUM CULTURE - At [**2193-9-9**] 06:00 AM', '- Improved MS over weekend', '- Restarted Captopril 6.25 PO TID as PLTs stabilized', '- Vascular c/s for feet: will staff', '- ? need new tunneled HD line on Tuesday', '- 2 hrs after Captopril, BP dropped to 70s, transiently on Levophed,', 'quickly weaned off, 1 u pRBCs transfused, ? related to large volume', 'removed Saturday by HD + captopril, also concern for sepsis as off all', 'abx except PO Flagyl', '- BP stable off levophed, s/p 1 unit pRBCs', '- Switched Flagyl to IV from PO as WBC increasing, temp trending up;', 'blood cx, sputum cx sent']","['- Ultrafiltrated for 5 kilograms (initially subclavian line used,', 'however then transitioned to femoral line)', '- Heme: Clinical picture and laboratories not consistent with HIT,', 'agree with re-starting Heparin--> heparin gtt re-started.', '- More interactive, mouthing more words, shaking head yes and no', 'consistently to questions', '- Lactate stable at 2', '- Platelets up to 45']",73695,108174.0
146,2193-09-09 06:35:06,,"['BLOOD CULTURED - At [**2193-9-9**] 06:00 AM', ' SPUTUM CULTURE - At [**2193-9-9**] 06:00 AM', '- Improved MS over weekend', '- Restarted Captopril 6.25 PO TID as PLTs stabilized', '- Vascular c/s for feet: will staff', '- ? need new tunneled HD line on Tuesday', '- 2 hrs after Captopril, BP dropped to 70s, transiently on Levophed,', 'quickly weaned off, 1 u pRBCs transfused, ? related to large volume', 'removed Saturday by HD + captopril, also concern for sepsis as off all', 'abx except PO Flagyl', '- BP stable off levophed, s/p 1 unit pRBCs', '- Switched Flagyl to IV from PO as WBC increasing, temp trending up;', 'blood cx, sputum cx sent']",,73695,108174.0
147,2193-09-09 11:09:05,"['- As WBC increasing, temp trending up; blood cx, sputum cx sent']","['BLOOD CULTURED - At [**2193-9-9**] 06:00 AM', ' SPUTUM CULTURE - At [**2193-9-9**] 06:00 AM', '- Improved MS over weekend', '- Restarted Captopril 6.25 PO TID as PLTs stabilized', '- Vascular c/s for feet: will staff', '- ? need new tunneled HD line on Tuesday', '- 2 hrs after Captopril, BP dropped to 70s, transiently on Levophed,', 'quickly weaned off, 1 u pRBCs transfused, ? related to large volume', 'removed Saturday by HD + captopril, also concern for sepsis as off all', 'abx except PO Flagyl', '- BP stable off levophed, s/p 1 unit pRBCs', '- As WBC increasing, temp trending up; blood cx, sputum cx sent']","['- Switched Flagyl to IV from PO as WBC increasing, temp trending up;', 'blood cx, sputum cx sent']",73695,108174.0
148,2193-09-10 08:03:03,"['BLOOD CULTURED - At [**2193-9-9**] 03:15 PM', ' URINE CULTURE - At [**2193-9-9**] 03:15 PM', '- needed levophed after captopril dose last night', '- decreased dobutamine to 3, tolerated captopril dose this morning.']","['BLOOD CULTURED - At [**2193-9-9**] 03:15 PM', ' URINE CULTURE - At [**2193-9-9**] 03:15 PM', '- needed levophed after captopril dose last night', '- decreased dobutamine to 3, tolerated captopril dose this morning.']","['BLOOD CULTURED - At [**2193-9-9**] 06:00 AM', ' SPUTUM CULTURE - At [**2193-9-9**] 06:00 AM', '- Improved MS over weekend', '- Restarted Captopril 6.25 PO TID as PLTs stabilized', '- Vascular c/s for feet: will staff', '- ? need new tunneled HD line on Tuesday', '- 2 hrs after Captopril, BP dropped to 70s, transiently on Levophed,', 'quickly weaned off, 1 u pRBCs transfused, ? related to large volume', 'removed Saturday by HD + captopril, also concern for sepsis as off all', 'abx except PO Flagyl', '- BP stable off levophed, s/p 1 unit pRBCs', '- As WBC increasing, temp trending up; blood cx, sputum cx sent']",73695,108174.0
149,2193-09-10 15:18:12,,"['BLOOD CULTURED - At [**2193-9-9**] 03:15 PM', ' URINE CULTURE - At [**2193-9-9**] 03:15 PM', '- needed levophed after captopril dose last night', '- decreased dobutamine to 3, tolerated captopril dose this morning.']",,73695,108174.0
150,2193-09-11 07:11:23,"['ANGIOGRAPHY - At [**2193-9-10**] 04:16 PM', 'Placement of left subclavian dailysis catheter.', ' DIALYSIS CATHETER - STOP [**2193-9-10**] 04:45 PM', ' DIALYSIS CATHETER - START [**2193-9-10**] 06:19 PM']","['ANGIOGRAPHY - At [**2193-9-10**] 04:16 PM', 'Placement of left subclavian dailysis catheter.', ' DIALYSIS CATHETER - STOP [**2193-9-10**] 04:45 PM', ' DIALYSIS CATHETER - START [**2193-9-10**] 06:19 PM']","['BLOOD CULTURED - At [**2193-9-9**] 03:15 PM', ' URINE CULTURE - At [**2193-9-9**] 03:15 PM', '- needed levophed after captopril dose last night', '- decreased dobutamine to 3, tolerated captopril dose this morning.']",73695,108174.0
151,2193-09-11 13:03:04,"['- Had replacement of dysfunctional tunnelled dialysis catheter', 'yesterday - Pulled left femoral HD catheter, pressure held directly for', ""45 minutes, continued heparin gtt - Rec'd captopril peri- line pull,"", 'transiently dropped MAPs from 60s to 50s -- she is on dobutamine for', 'cardiogenic shock primarily, weaning from 3-->2.5-->2, but re-increased', 'to 2.5 -- gave 250cc bolus as CVP was [**1-31**], not great tracing but best', 'estimate we could get - prob UF off in AM - Vascular surgery following']","['ANGIOGRAPHY - At [**2193-9-10**] 04:16 PM', 'Placement of left subclavian dailysis catheter.', ' DIALYSIS CATHETER - STOP [**2193-9-10**] 04:45 PM', ' DIALYSIS CATHETER - START [**2193-9-10**] 06:19 PM', '- Had replacement of dysfunctional tunnelled dialysis catheter', 'yesterday - Pulled left femoral HD catheter, pressure held directly for', ""45 minutes, continued heparin gtt - Rec'd captopril peri- line pull,"", 'transiently dropped MAPs from 60s to 50s -- she is on dobutamine for', 'cardiogenic shock primarily, weaning from 3-->2.5-->2, but re-increased', 'to 2.5 -- gave 250cc bolus as CVP was [**1-31**], not great tracing but best', 'estimate we could get - prob UF off in AM - Vascular surgery following']",,73695,108174.0
152,2193-09-12 07:22:33,"['- Renal recs: consider warfarin rather than heparin to decrease fluid', 'intake.  UF will be done later this week.', '- A-line reinspected and was without erythema, fluctuance or', 'purulence.  Heparin gtt restarted and a-line not resited.', '- Captopril discontinued', '- Dobutamine weaned to 1.5 @ 10pm, repeat 4am lactate 1.7.  Continues @', '1.5.']","['- Renal recs: consider warfarin rather than heparin to decrease fluid', 'intake.  UF will be done later this week.', '- A-line reinspected and was without erythema, fluctuance or', 'purulence.  Heparin gtt restarted and a-line not resited.', '- Captopril discontinued', '- Dobutamine weaned to 1.5 @ 10pm, repeat 4am lactate 1.7.  Continues @', '1.5.']","['ANGIOGRAPHY - At [**2193-9-10**] 04:16 PM', 'Placement of left subclavian dailysis catheter.', ' DIALYSIS CATHETER - STOP [**2193-9-10**] 04:45 PM', ' DIALYSIS CATHETER - START [**2193-9-10**] 06:19 PM', '- Had replacement of dysfunctional tunnelled dialysis catheter', 'yesterday - Pulled left femoral HD catheter, pressure held directly for', ""45 minutes, continued heparin gtt - Rec'd captopril peri- line pull,"", 'transiently dropped MAPs from 60s to 50s -- she is on dobutamine for', 'cardiogenic shock primarily, weaning from 3-->2.5-->2, but re-increased', 'to 2.5 -- gave 250cc bolus as CVP was [**1-31**], not great tracing but best', 'estimate we could get - prob UF off in AM - Vascular surgery following']",73695,108174.0
153,2193-09-12 12:47:42,,"['- Renal recs: consider warfarin rather than heparin to decrease fluid', 'intake.  UF will be done later this week.', '- A-line reinspected and was without erythema, fluctuance or', 'purulence.  Heparin gtt restarted and a-line not resited.', '- Captopril discontinued', '- Dobutamine weaned to 1.5 @ 10pm, repeat 4am lactate 1.7.  Continues @', '1.5.']",,73695,108174.0
154,2193-09-13 07:56:52,"['BLOOD CULTURED - At [**2193-9-13**] 12:05 AM', ' SPUTUM CULTURE - At [**2193-9-13**] 01:00 AM', ' FEVER - 101.6', 'F - [**2193-9-13**] 04:00 AM']","['BLOOD CULTURED - At [**2193-9-13**] 12:05 AM', ' SPUTUM CULTURE - At [**2193-9-13**] 01:00 AM', ' FEVER - 101.6', 'F - [**2193-9-13**] 04:00 AM']","['- Renal recs: consider warfarin rather than heparin to decrease fluid', 'intake.  UF will be done later this week.', '- A-line reinspected and was without erythema, fluctuance or', 'purulence.  Heparin gtt restarted and a-line not resited.', '- Captopril discontinued', '- Dobutamine weaned to 1.5 @ 10pm, repeat 4am lactate 1.7.  Continues @', '1.5.']",73695,108174.0
155,2193-09-13 22:19:23,"['-NG tube replaced', '-weaned dobutamine to 0.5 after lactate decreased to 1.4, then lactate', 'increased to 3.0, increased dobutamine back to 1.0', '-spiked fever to 101 this morning, pan-cultured.']","['BLOOD CULTURED - At [**2193-9-13**] 12:05 AM', ' SPUTUM CULTURE - At [**2193-9-13**] 01:00 AM', ' FEVER - 101.6', 'F - [**2193-9-13**] 04:00 AM', '-NG tube replaced', '-weaned dobutamine to 0.5 after lactate decreased to 1.4, then lactate', 'increased to 3.0, increased dobutamine back to 1.0', '-spiked fever to 101 this morning, pan-cultured.']",,73695,108174.0
156,2193-09-14 07:41:45,"['- recultured - GNRs in sputum (had previously)', '- No blood cultures have grown yet', '- Tried to replace RIJ and resite femoral line; both failed', '- foley changed after culture from [**9-9**] grew yeast']","['- recultured - GNRs in sputum (had previously)', '- No blood cultures have grown yet', '- Tried to replace RIJ and resite femoral line; both failed', '- foley changed after culture from [**9-9**] grew yeast']","['BLOOD CULTURED - At [**2193-9-13**] 12:05 AM', ' SPUTUM CULTURE - At [**2193-9-13**] 01:00 AM', ' FEVER - 101.6', 'F - [**2193-9-13**] 04:00 AM', '-NG tube replaced', '-weaned dobutamine to 0.5 after lactate decreased to 1.4, then lactate', 'increased to 3.0, increased dobutamine back to 1.0', '-spiked fever to 101 this morning, pan-cultured.']",73695,108174.0
157,2193-09-14 07:42:33,,"['- recultured - GNRs in sputum (had previously)', '- No blood cultures have grown yet', '- Tried to replace RIJ and resite femoral line; both failed', '- foley changed after culture from [**9-9**] grew yeast']",,73695,108174.0
158,2193-09-14 12:35:16,,"['- recultured - GNRs in sputum (had previously)', '- No blood cultures have grown yet', '- Tried to replace RIJ and resite femoral line; both failed', '- foley changed after culture from [**9-9**] grew yeast']",,73695,108174.0
159,2193-09-15 07:41:07,"['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']","['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']","['- recultured - GNRs in sputum (had previously)', '- No blood cultures have grown yet', '- Tried to replace RIJ and resite femoral line; both failed', '- foley changed after culture from [**9-9**] grew yeast']",73695,108174.0
160,2193-09-15 07:41:39,,"['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']",,73695,108174.0
161,2193-09-15 12:34:28,,"['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']",,73695,108174.0
162,2193-09-15 12:35:03,,"['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']",,73695,108174.0
163,2193-09-16 07:10:44,"['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']","['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']","['URINE CULTURE - At [**2193-9-14**] 10:46 AM', ' BLOOD CULTURED - At [**2193-9-14**] 11:00 AM', 'HD line', ' ARTERIAL LINE - STOP [**2193-9-15**] 12:12 AM', ' FEVER - 101.7', 'F - [**2193-9-14**] 08:00 AM', '============', '1.', 'Increased Dobutamine to 3 after she got hypotensive on HD', '2.', 'Trended lactate,2.3 to 2.2, Dobutamine maintained at 3.5', 'mcg/hr', '4.', 'Femoral line with 10-15 mmHG increase over noninvasive', 'monitoring.', '5.', 'Femoral A-line pulled', '6.', 'Bolused 250 x 2 and 500cc x 1 for BP 72/39 on NBP, then', 'dobutamine increased to 4', '7.', 'Added PO Vanc for Cdiff coverage', '8.', 'Added IV Vanc for presumed line infection.', '9.', 'Rectal swab for VRE sent', '10.']",73695,108174.0
164,2193-09-16 07:14:48,,"['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']",,73695,108174.0
165,2193-09-16 07:42:25,,"['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']",,73695,108174.0
166,2193-09-16 12:06:45,,"['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']",,73695,108174.0
167,2193-09-16 12:29:24,,"['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']",,73695,108174.0
168,2193-09-17 07:26:55,"['BLOOD CULTURED - At [**2193-9-16**] 09:00 AM', 'HD line', ' ULTRASOUND - At [**2193-9-16**] 01:45 PM', 'Renal', ' ANGIOGRAPHY - At [**2193-9-16**] 03:30 PM', 'Arterial line placement in IR', ' ARTERIAL LINE - START [**2193-9-16**] 04:30 PM', '===================', '- Family meeting held to provide update for family', '- Urine grew yeast so meropenem discontinued', '- continued on dobutamine; had been increased up to 5 but decreasing', 'now again following lactate/SvO2', '- Heme consultants suggested additional testing for G6PD and antiplt ab', 'that was sent', '- Platelets continued to drop overnight', '- Femoral Arterial line replaced in IR', '- WBC slowly rising agaiin 12->13->14.7']","['BLOOD CULTURED - At [**2193-9-16**] 09:00 AM', 'HD line', ' ULTRASOUND - At [**2193-9-16**] 01:45 PM', 'Renal', ' ANGIOGRAPHY - At [**2193-9-16**] 03:30 PM', 'Arterial line placement in IR', ' ARTERIAL LINE - START [**2193-9-16**] 04:30 PM', '===================', '- Family meeting held to provide update for family', '- Urine grew yeast so meropenem discontinued', '- continued on dobutamine; had been increased up to 5 but decreasing', 'now again following lactate/SvO2', '- Heme consultants suggested additional testing for G6PD and antiplt ab', 'that was sent', '- Platelets continued to drop overnight', '- Femoral Arterial line replaced in IR', '- WBC slowly rising agaiin 12->13->14.7']","['BLOOD CULTURED - At [**2193-9-15**] 01:45 PM', 'venipuncture.', ' BLOOD CULTURED - At [**2193-9-15**] 04:30 PM', 'CVL', ' FEVER - 101.4', 'F - [**2193-9-15**] 07:00 AM', '===========================', '-started on meropenem for positive UA', '-tried transitioning dobutamine to levophed, developed afib w/ RVR,', ""dc'd levophed"", '- family meeting at 4pm today, family requesting podiatrist be present']",73695,108174.0
169,2193-09-17 07:28:46,,"['BLOOD CULTURED - At [**2193-9-16**] 09:00 AM', 'HD line', ' ULTRASOUND - At [**2193-9-16**] 01:45 PM', 'Renal', ' ANGIOGRAPHY - At [**2193-9-16**] 03:30 PM', 'Arterial line placement in IR', ' ARTERIAL LINE - START [**2193-9-16**] 04:30 PM', '===================', '- Family meeting held to provide update for family', '- Urine grew yeast so meropenem discontinued', '- continued on dobutamine; had been increased up to 5 but decreasing', 'now again following lactate/SvO2', '- Heme consultants suggested additional testing for G6PD and antiplt ab', 'that was sent', '- Platelets continued to drop overnight', '- Femoral Arterial line replaced in IR', '- WBC slowly rising agaiin 12->13->14.7']",,73695,108174.0
170,2193-09-17 12:49:55,,"['BLOOD CULTURED - At [**2193-9-16**] 09:00 AM', 'HD line', ' ULTRASOUND - At [**2193-9-16**] 01:45 PM', 'Renal', ' ANGIOGRAPHY - At [**2193-9-16**] 03:30 PM', 'Arterial line placement in IR', ' ARTERIAL LINE - START [**2193-9-16**] 04:30 PM', '===================', '- Family meeting held to provide update for family', '- Urine grew yeast so meropenem discontinued', '- continued on dobutamine; had been increased up to 5 but decreasing', 'now again following lactate/SvO2', '- Heme consultants suggested additional testing for G6PD and antiplt ab', 'that was sent', '- Platelets continued to drop overnight', '- Femoral Arterial line replaced in IR', '- WBC slowly rising agaiin 12->13->14.7']",,73695,108174.0
171,2193-09-18 07:30:18,['1.'],['1.'],"['BLOOD CULTURED - At [**2193-9-16**] 09:00 AM', 'HD line', ' ULTRASOUND - At [**2193-9-16**] 01:45 PM', 'Renal', ' ANGIOGRAPHY - At [**2193-9-16**] 03:30 PM', 'Arterial line placement in IR', ' ARTERIAL LINE - START [**2193-9-16**] 04:30 PM', '===================', '- Family meeting held to provide update for family', '- Urine grew yeast so meropenem discontinued', '- continued on dobutamine; had been increased up to 5 but decreasing', 'now again following lactate/SvO2', '- Heme consultants suggested additional testing for G6PD and antiplt ab', 'that was sent', '- Platelets continued to drop overnight', '- Femoral Arterial line replaced in IR', '- WBC slowly rising agaiin 12->13->14.7']",73695,108174.0
172,2193-09-18 16:06:20,,['1.'],,73695,108174.0
173,2193-09-19 07:58:48,"['EKG - At [**2193-9-18**] 01:08 PM', ' EKG - At [**2193-9-18**] 03:09 PM', '1.Vanc discontinued', '2. discontinued heparin gtt', ""3.Had SVT to 140's during HD. Transiently responsive to fluids,"", 'essentially bolused back all fluid which was removed during HD. BP', ""marginally low. increased dobutamine. HR decreased to 90's, SBP in 90s."", '4.Weaned dobutamine overnight to 1.5']","['EKG - At [**2193-9-18**] 01:08 PM', ' EKG - At [**2193-9-18**] 03:09 PM', '1.Vanc discontinued', '2. discontinued heparin gtt', ""3.Had SVT to 140's during HD. Transiently responsive to fluids,"", 'essentially bolused back all fluid which was removed during HD. BP', ""marginally low. increased dobutamine. HR decreased to 90's, SBP in 90s."", '4.Weaned dobutamine overnight to 1.5']",['1.'],73695,108174.0
174,2193-09-19 18:35:17,,"['EKG - At [**2193-9-18**] 01:08 PM', ' EKG - At [**2193-9-18**] 03:09 PM', '1.Vanc discontinued', '2. discontinued heparin gtt', ""3.Had SVT to 140's during HD. Transiently responsive to fluids,"", 'essentially bolused back all fluid which was removed during HD. BP', ""marginally low. increased dobutamine. HR decreased to 90's, SBP in 90s."", '4.Weaned dobutamine overnight to 1.5']",,73695,108174.0
175,2193-09-20 07:35:59,"['EKG - At [**2193-9-19**] 08:15 AM', ' ULTRASOUND - At [**2193-9-19**] 08:42 AM', 'cardiac', ' STOOL CULTURE - At [**2193-9-19**] 11:12 AM', 'C-Diff spec sent', ' BLOOD CULTURED - At [**2193-9-19**] 04:31 PM', 'blood cultures x2 due to temp 101 \\', '=============', 'Dobutamine off; doing okay', 'Lactate 2.2 --> 2.2 --> 2.3']","['EKG - At [**2193-9-19**] 08:15 AM', ' ULTRASOUND - At [**2193-9-19**] 08:42 AM', 'cardiac', ' STOOL CULTURE - At [**2193-9-19**] 11:12 AM', 'C-Diff spec sent', ' BLOOD CULTURED - At [**2193-9-19**] 04:31 PM', 'blood cultures x2 due to temp 101 \\', '=============', 'Dobutamine off; doing okay', 'Lactate 2.2 --> 2.2 --> 2.3']","['EKG - At [**2193-9-18**] 01:08 PM', ' EKG - At [**2193-9-18**] 03:09 PM', '1.Vanc discontinued', '2. discontinued heparin gtt', ""3.Had SVT to 140's during HD. Transiently responsive to fluids,"", 'essentially bolused back all fluid which was removed during HD. BP', ""marginally low. increased dobutamine. HR decreased to 90's, SBP in 90s."", '4.Weaned dobutamine overnight to 1.5']",73695,108174.0
176,2193-09-20 11:06:11,['blood cultures x2 due to temp 101'],"['EKG - At [**2193-9-19**] 08:15 AM', ' ULTRASOUND - At [**2193-9-19**] 08:42 AM', 'cardiac', ' STOOL CULTURE - At [**2193-9-19**] 11:12 AM', 'C-Diff spec sent', ' BLOOD CULTURED - At [**2193-9-19**] 04:31 PM', 'blood cultures x2 due to temp 101', '=============', 'Dobutamine off; doing okay', 'Lactate 2.2 --> 2.2 --> 2.3']",['blood cultures x2 due to temp 101 \\'],73695,108174.0
177,2193-09-21 07:26:58,"['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to ___ by rounds.']","['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to ___ by rounds.']","['EKG - At [**2193-9-19**] 08:15 AM', ' ULTRASOUND - At [**2193-9-19**] 08:42 AM', 'cardiac', ' STOOL CULTURE - At [**2193-9-19**] 11:12 AM', 'C-Diff spec sent', ' BLOOD CULTURED - At [**2193-9-19**] 04:31 PM', 'blood cultures x2 due to temp 101', '=============', 'Dobutamine off; doing okay', 'Lactate 2.2 --> 2.2 --> 2.3']",73695,108174.0
178,2193-09-21 07:47:39,['good response. Titrated to 0.05 by rounds.'],"['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to 0.05 by rounds.']",['good response. Titrated to ___ by rounds.'],73695,108174.0
179,2193-09-21 11:40:54,,"['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to 0.05 by rounds.']",,73695,108174.0
180,2193-09-21 12:28:59,,"['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to 0.05 by rounds.']",,73695,108174.0
181,2193-09-22 06:32:22,"['BLOOD CULTURED - At [**2193-9-21**] 08:19 PM', ' TRANSTHORACIC ECHO - At [**2193-9-21**] 09:09 PM', ' CARDIAC ARREST - At [**2193-9-22**] 04:40 AM', 'SEE ARREST SHEET FOR DETAILS', ' CARDIAC ARREST - At [**2193-9-22**] 05:35 AM', 'SEE ARREST SHEET FOR DETAILS-PEA WITH EPI AND ATROPINE; vfib shock', 'given, regular rhythm returned, epi/atropine given', '1.PH precipitously dropped to 6.8, lactate 10, bicarb 4.', ""2.BP in 80's, levophed maxed out, added vasopressin"", '3.TTE without pericardial effusion, no RV dilation, globally', 'hypokinetic, likely from acidemia', '4.CVVh dialysate switched to provide maximum bicarbonate', '5. given 11 amps of bicarbonate, pH increased to 7.08, lactate climbed', 'to 15.', '6.cardiac enzymes negative', '7.LFTs elevated, amylase elevated, bowel ischemia?', ""8.family believes fentanyl is responsible, adamantly oppose it's use."", 'fentanyl was discontinued.', '9.Hypotensive, started on dopamine and neosinephrine.', '10. PEA arressted, CPR for 90 seconds, given epinephrine and atropine,', 'pulse returned', '11.PEA arrested 1 hour later, torsades, shocked, PEA, given bicarb,']","['BLOOD CULTURED - At [**2193-9-21**] 08:19 PM', ' TRANSTHORACIC ECHO - At [**2193-9-21**] 09:09 PM', ' CARDIAC ARREST - At [**2193-9-22**] 04:40 AM', 'SEE ARREST SHEET FOR DETAILS', ' CARDIAC ARREST - At [**2193-9-22**] 05:35 AM', 'SEE ARREST SHEET FOR DETAILS-PEA WITH EPI AND ATROPINE; vfib shock', 'given, regular rhythm returned, epi/atropine given', '1.PH precipitously dropped to 6.8, lactate 10, bicarb 4.', ""2.BP in 80's, levophed maxed out, added vasopressin"", '3.TTE without pericardial effusion, no RV dilation, globally', 'hypokinetic, likely from acidemia', '4.CVVh dialysate switched to provide maximum bicarbonate', '5. given 11 amps of bicarbonate, pH increased to 7.08, lactate climbed', 'to 15.', '6.cardiac enzymes negative', '7.LFTs elevated, amylase elevated, bowel ischemia?', ""8.family believes fentanyl is responsible, adamantly oppose it's use."", 'fentanyl was discontinued.', '9.Hypotensive, started on dopamine and neosinephrine.', '10. PEA arressted, CPR for 90 seconds, given epinephrine and atropine,', 'pulse returned', '11.PEA arrested 1 hour later, torsades, shocked, PEA, given bicarb,']","['BLOOD CULTURED - At [**2193-9-20**] 12:00 PM', 'off CVl and Aline- unable to get peripheral. Dr. [**Last Name (STitle) 1806**] notified.', '1. Called Thoracics to downsize trach, has original 8.0 trach, no recs', 'yet', '2. Cardiology recs: consider dobutamine vs. IABP during surgery. Ok to', 'resume ASA as needed.', '3. Renal to HD today', ' had 2L removed.', '4. Patient hypotensive to 70s, given 2.5L and placed on Levophed with', 'good response. Titrated to 0.05 by rounds.']",73695,108174.0
0,2192-05-27 07:32:08,,"['Pt had IVC filter placed on [**5-26**]. Continues on heparin gtt. HD stable', 'overnight.']",,80428,176838.0
1,2192-05-27 12:05:22,,"['Pt had IVC filter placed on [**5-26**]. Continues on heparin gtt. HD stable', 'overnight.']",,80428,176838.0
0,2187-12-26 05:38:13,,"['Patient remained on a heparing gtt, asa, and plavix while awaiting', 'cath.']",,64601,193271.0
1,2187-12-26 11:38:54,"['Patient remained on a heparin gtt, ASA, and plavix while awaiting cath', 'overnight.  Was anxious overnight.  This am he denied chest pain, SOB,', 'or dizziness.']","['Patient remained on a heparin gtt, ASA, and plavix while awaiting cath', 'overnight.  Was anxious overnight.  This am he denied chest pain, SOB,', 'or dizziness.']","['Patient remained on a heparing gtt, asa, and plavix while awaiting', 'cath.']",64601,193271.0
2,2187-12-27 05:37:40,"['to cath today', 'per renal, HD tomorrow', 'called out to [**Hospital Ward Name 383**] 3 but no beds available', 'Lisinopril increased to 40mg PO BID', 'Nefedipine changed to Diltiazem in the morning, but in the evening HR', 'was in the 50s, Diltiazem stopped.  Toprol XL dose (100mg) was held in', 'the evening as HR was trending down to the 40s while sleeping']","['to cath today', 'per renal, HD tomorrow', 'called out to [**Hospital Ward Name 383**] 3 but no beds available', 'Lisinopril increased to 40mg PO BID', 'Nefedipine changed to Diltiazem in the morning, but in the evening HR', 'was in the 50s, Diltiazem stopped.  Toprol XL dose (100mg) was held in', 'the evening as HR was trending down to the 40s while sleeping']","['Patient remained on a heparin gtt, ASA, and plavix while awaiting cath', 'overnight.  Was anxious overnight.  This am he denied chest pain, SOB,', 'or dizziness.']",64601,193271.0
3,2187-12-27 14:14:06,"['Pt schedule for cath today.', 'Will likely have HD s/p cath.  Pt remained in CCU as no bed available.', 'Lisinopril was increased to 40mg PO BID', 'was in the 50s, Diltiazem was thus stopped.  Toprol XL dose (100mg) was', 'held in the evening as HR was trending down to the 40-50s while', 'sleeping.  Since that time, HR has recovered to 60s.  Digoxin was', 'discontinued.', 'Pt. c/o of LE pain b/l that is chronic.  He denies CP, SOB.']","['Pt schedule for cath today.', 'Will likely have HD s/p cath.  Pt remained in CCU as no bed available.', 'Lisinopril was increased to 40mg PO BID', 'Nefedipine changed to Diltiazem in the morning, but in the evening HR', 'was in the 50s, Diltiazem was thus stopped.  Toprol XL dose (100mg) was', 'held in the evening as HR was trending down to the 40-50s while', 'sleeping.  Since that time, HR has recovered to 60s.  Digoxin was', 'discontinued.', 'Pt. c/o of LE pain b/l that is chronic.  He denies CP, SOB.']","['to cath today', 'per renal, HD tomorrow', 'called out to [**Hospital Ward Name 383**] 3 but no beds available', 'Lisinopril increased to 40mg PO BID', 'was in the 50s, Diltiazem stopped.  Toprol XL dose (100mg) was held in', 'the evening as HR was trending down to the 40s while sleeping']",64601,193271.0
4,2187-12-28 04:49:28,"['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM']","['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM']","['Pt schedule for cath today.', 'Will likely have HD s/p cath.  Pt remained in CCU as no bed available.', 'Lisinopril was increased to 40mg PO BID', 'Nefedipine changed to Diltiazem in the morning, but in the evening HR', 'was in the 50s, Diltiazem was thus stopped.  Toprol XL dose (100mg) was', 'held in the evening as HR was trending down to the 40-50s while', 'sleeping.  Since that time, HR has recovered to 60s.  Digoxin was', 'discontinued.', 'Pt. c/o of LE pain b/l that is chronic.  He denies CP, SOB.']",64601,193271.0
5,2187-12-28 04:50:41,"['guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after', 'post cath check']","['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after', 'post cath check']","['guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM']",64601,193271.0
6,2187-12-28 04:53:28,['post cath check.  Has been in Afib all night.'],"['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after', 'post cath check.  Has been in Afib all night.']",['post cath check'],64601,193271.0
7,2187-12-28 05:39:12,"['guaiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after']","['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guaiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after', 'post cath check.  Has been in Afib all night.']","['guiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after']",64601,193271.0
8,2187-12-28 14:15:58,"['guaiac positive stool, HCT 29 - 30, stable.  Has been in Afib all', 'night.', 'This am the patient denies chest pain, or dizziness, but does admit to', 'slight SOB.']","['Went to cath, RCA stented.  Completed HD.  Now off heparin gtt.  Had a', 'guaiac positive stool, HCT 29 - 30, stable.  Has been in Afib all', 'night.', 'This am the patient denies chest pain, or dizziness, but does admit to', 'slight SOB.']","['guaiac positive stool, HCT 29 - 30, stable.  Likely to [**Hospital Unit Name 3031**] in AM after', 'post cath check.  Has been in Afib all night.']",64601,193271.0
0,2189-03-30 07:07:47,,"['- Continued on vanc/zosyn', '- Nasal swab done']",,92170,105063.0
1,2189-03-30 11:17:19,,"['- Continued on vanc/zosyn', '- Nasal swab done']",,92170,105063.0
2,2189-03-30 11:17:48,,"['- Continued on vanc/zosyn', '- Nasal swab done']",,92170,105063.0
3,2189-03-31 06:58:20,"['-sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight and given NS 500ml as well.', '-Pall care seen, not in OMR. D/w family code status, still full code.', '-Cortisol added on to am labs - 25.', '-C. diff sent.']","['-sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight and given NS 500ml as well.', '-Pall care seen, not in OMR. D/w family code status, still full code.', '-Cortisol added on to am labs - 25.', '-C. diff sent.']","['- Continued on vanc/zosyn', '- Nasal swab done']",92170,105063.0
4,2189-03-31 06:59:22,,"['-sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight and given NS 500ml as well.', '-Pall care seen, not in OMR. D/w family code status, still full code.', '-Cortisol added on to am labs - 25.', '-C. diff sent.']",,92170,105063.0
5,2189-03-31 15:43:58,"['-Pt seen by family care with decision by family to maintain full code', 'status for now.', '-Sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight with AM Na 121 (erroneous Na of', '135 on initial AM labs)', '-SBP to 80s overnight; pt received NS 500cc bolus. AM cortisol checked', 'and nl.', '-No new complaints this AM. Cough improving. Pt still very lethargic', 'but mental status may be slightly improved per son.']","['-Pt seen by family care with decision by family to maintain full code', 'status for now.', '-Sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight with AM Na 121 (erroneous Na of', '135 on initial AM labs)', '-SBP to 80s overnight; pt received NS 500cc bolus. AM cortisol checked', 'and nl.', '-No new complaints this AM. Cough improving. Pt still very lethargic', 'but mental status may be slightly improved per son.']","['-sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight and given NS 500ml as well.', '-Pall care seen, not in OMR. D/w family code status, still full code.', '-Cortisol added on to am labs - 25.', '-C. diff sent.']",92170,105063.0
6,2189-04-01 07:30:40,"['-serial sodium-121, 126, 128, 126', '-serial urine osms-376, 421, 472', '-continued vanco/Zosyn for HAP', '-called Dr. [**Last Name (STitle) 7363**] consider hospice', '-palliative care- wants team meeting', '-micro data-', '-viral nasal swab- NEG', '-blood cx- NEG', '-urine Lg- NEG', '-urine cx- NEG', '-C dif- ordered', '-S+S- nectar thick liquids and pureed solids', '-renal consult- fluid restrict to 1L/d, d/c all IVF, high-protein diet,', 'continue q6h sodium checks, if stable >127, q8h checks are okay,', 'consider furosemide on [**4-1**] if edema is a serious issue', '-**I have arranged for meeting with Dr. [**Last Name (STitle) 353**], family, and palliative', 'care at 11AM. No interpreter available, so will need [**Doctor Last Name 458**] +/- family.**']","['-serial sodium-121, 126, 128, 126', '-serial urine osms-376, 421, 472', '-continued vanco/Zosyn for HAP', '-called Dr. [**Last Name (STitle) 7363**] consider hospice', '-palliative care- wants team meeting', '-micro data-', '-viral nasal swab- NEG', '-blood cx- NEG', '-urine Lg- NEG', '-urine cx- NEG', '-C dif- ordered', '-S+S- nectar thick liquids and pureed solids', '-renal consult- fluid restrict to 1L/d, d/c all IVF, high-protein diet,', 'continue q6h sodium checks, if stable >127, q8h checks are okay,', 'consider furosemide on [**4-1**] if edema is a serious issue', '-**I have arranged for meeting with Dr. [**Last Name (STitle) 353**], family, and palliative', 'care at 11AM. No interpreter available, so will need [**Doctor Last Name 458**] +/- family.**']","['-Pt seen by family care with decision by family to maintain full code', 'status for now.', '-Sodium improved to 113 --> 112 --> 114.  Patient placed on hypertonic', 'saline at 60ml/hr for 500ml overnight with AM Na 121 (erroneous Na of', '135 on initial AM labs)', '-SBP to 80s overnight; pt received NS 500cc bolus. AM cortisol checked', 'and nl.', '-No new complaints this AM. Cough improving. Pt still very lethargic', 'but mental status may be slightly improved per son.']",92170,105063.0
7,2189-04-01 17:41:25,"['- Renal evaluated, likely underlying SIADH exacerbated by excessive po', 'fluid intake at home. Na stable at 126-128.', '- No intervention for SBP in 80s.', '- No new complaints this AM. Fatigue/alertness slightly improved per', 'family']","['- Renal evaluated, likely underlying SIADH exacerbated by excessive po', 'fluid intake at home. Na stable at 126-128.', '- No intervention for SBP in 80s.', '- No new complaints this AM. Fatigue/alertness slightly improved per', 'family']","['-serial sodium-121, 126, 128, 126', '-serial urine osms-376, 421, 472', '-continued vanco/Zosyn for HAP', '-called Dr. [**Last Name (STitle) 7363**] consider hospice', '-palliative care- wants team meeting', '-micro data-', '-viral nasal swab- NEG', '-blood cx- NEG', '-urine Lg- NEG', '-urine cx- NEG', '-C dif- ordered', '-S+S- nectar thick liquids and pureed solids', '-renal consult- fluid restrict to 1L/d, d/c all IVF, high-protein diet,', 'continue q6h sodium checks, if stable >127, q8h checks are okay,', 'consider furosemide on [**4-1**] if edema is a serious issue', '-**I have arranged for meeting with Dr. [**Last Name (STitle) 353**], family, and palliative', 'care at 11AM. No interpreter available, so will need [**Doctor Last Name 458**] +/- family.**']",92170,105063.0
8,2189-04-02 03:35:04,"['-Family mtg: D/c home with hospice, full code.', '-Renal: Cont fluid restrict', '-Abx changed to cefpodoxime for dispo as MRSA screen negative and', 'pseudomonas unlikley']","['-Family mtg: D/c home with hospice, full code.', '-Renal: Cont fluid restrict', '-Abx changed to cefpodoxime for dispo as MRSA screen negative and', 'pseudomonas unlikley']","['- Renal evaluated, likely underlying SIADH exacerbated by excessive po', 'fluid intake at home. Na stable at 126-128.', '- No intervention for SBP in 80s.', '- No new complaints this AM. Fatigue/alertness slightly improved per', 'family']",92170,105063.0
9,2189-04-02 07:09:14,"['pseudomonas unlikely', '[**Hospital 7395**] hospice bed']","['-Family mtg: D/c home with hospice, full code.', '-Renal: Cont fluid restrict', '-Abx changed to cefpodoxime for dispo as MRSA screen negative and', 'pseudomonas unlikely', '[**Hospital 7395**] hospice bed']",['pseudomonas unlikley'],92170,105063.0
10,2189-04-02 11:34:34,"['-Comforatble, denies pain this morning (family is concerned that he is', 'not eating)']","['-Family mtg: D/c home with hospice, full code.', '-Renal: Cont fluid restrict', '-Abx changed to cefpodoxime for dispo as MRSA screen negative and', 'pseudomonas unlikely', '[**Hospital 7395**] hospice bed', '-Comforatble, denies pain this morning (family is concerned that he is', 'not eating)']",,92170,105063.0