tokens: Admission Date : 2018-05-24 Discharge Date : 2018-05-29 Date of Birth : 1964-03-11 Sex : M Service : CARDIOTHORACIC Allergies : Keflex / Heparin Agents Attending : James F. Bard , M.D. Chief Complaint : pt sent to ER after routine F/U for UE DVT with vascular surgery . In ER c/o dyspnea and was noted to have mental status changes . Major Surgical or Invasive Procedure : none this admission AVR ( tissue ) 05-14 History of Present Illness : s/p AVR 05-14 . Postop course c/b right upper extremity DVT and postop Afib . Discharged home 05-19 with instructions to f/u in vascular clinic . Had vascular clinic f/u on day of admission . At that time had UE duplex which revealed RUE DVT involving IJ , Axillary , subclav , brachial , and basilic veins . Then referred to ER for Tx Past Medical History : s/p AVR ( #27 pericardial ) post-op Afib HTN renal calculi ? sleep apnea seasonal allergies s/p 2 surgs. for spermatocele s/p oral surgery Social History : lives with partner professor / Kyra social worker quit smoking 20 years ago occasional ETOH Family History : non-contributory for premature CAD ; father had MI in his 70 's Physical Exam : admission PE VS : HR 103 BP 162/69 RR 14 Sat 92% RA Neuro : MAE , Follows commands , slightly confused Heent : PERRL/EOMI , no JVD Resp : CTAB CV : RRR S1-S2 , no murmur . Sternum stable Abdm : soft NT / ND / NABS Ext : + distal pulses , no edema Discharge PE VS : T 99 HR 68 BP 113/72 RR 18 Sat 98% RA Gen : comforable Neuro : A&Ox3 , MAE , Follows Commands Resp : CTA-bilat CV:RRR S1-S2 , no MRG Resp:CTA-bilat Abdm : soft , NT/ND/NABS Ext : warm well perfused No CCE Pertinent Results : 2018-05-24 08:55 PM GLUCOSE - 193 * UREA N - 23 * CREAT - 1.2 SODIUM - 138 POTASSIUM - 4.6 CHLORIDE - 101 TOTAL CO2 - 21 * ANION GAP - 21 * 2018-05-24 08:55 PM CALCIUM - 8.8 PHOSPHATE - 3.9 MAGNESIUM - 2.4 2018-05-24 08:55 PM PT - 15.0 * PTT - 107.1 * INR ( PT )- 1.3 * 2018-05-24 01:25 PM WBC - 13.3 *# RBC - 3.45 * HGB - 10.6 * HCT - 30.5 * MCV - 88 MCH - 30.6 MCHC - 34.7 RDW - 12.7 2018-05-28 01:40 PM BLOOD WBC - 12.9 * RBC - 3.37 * Hgb - 10.4 * Hct - 29.4 * MCV - 87 MCH - 30.8 MCHC - 35.3 * RDW - 13.3 Plt Ct - 345 2018-05-29 11:34 AM BLOOD PT - 39.1 * INR ( PT )- 4.4 * 2018-05-25 09:00 AM BLOOD HEPARIN DEPENDENT ANTIBODIES - positive Brief Hospital Course : Pt admitted 05-24 from ER after positive RUE DVT finding in vascular lab . During ER evaluation pt was noted to have some degree of dyspnea as well as mental status changes , including loss of short term memory and brief unresponsive period after one dose of IV Benadry and steroids prior to CT scan . The CT was negative for CVA but positive for Pulmonary embolism . He was transferred to CSRU for evaluation . Neurology was consulted and the pt also had MRI which was negative . The pt was begun on heparin gtt and was noted to have platelet drop > 50% after infusion began , hepain was d/c 'd. Argatroban was started abd a HIT panel was sent , HIT panel was positive . Hematology was consulted . By the following mornig all mental status changes had cleared and the pt was transferred to the floors for continued care . Over the next several days the patient was maintained on Argatrobanwhile coumadin therapy was initiated . On HD#6 the pt had a therapeudic INR ( 4.4 ) off Argatroban and wad discharged home . He was to have f/u INR check with Dr Lewis on 05-31 . Additionally the pt should f/u with the hematology clinic . Medications on Admission : ASA 81 ' Atorvastatin 10 ' Lisinopril 5 ' Lopressor 50 " Amiodarone 200 ' Discharge Medications : 1. Aspirin 81 mg Tablet , Delayed Release ( E.C. ) Sig : One ( 1 ) Tablet , Delayed Release ( E.C. ) PO DAILY ( Daily ) . 2. Atorvastatin 10 mg Tablet Sig : One ( 1 ) Tablet PO DAILY ( Daily ) . 3. Metoprolol Tartrate 50 mg Tablet Sig :One ( 1 ) Tablet PO BID ( 2 times a day ) . 4. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig : One ( 1 ) Tablet PO BID ( 2 times a day ) for 10 days . Disp :* 20 Tablet (s)* Refills :* 0 * 5. Amiodarone 200 mg Tablet Sig : One ( 1 ) Tablet PO DAILY ( Daily ) . 6. Warfarin 2 mg Tablet Sig : 1.5 Tablets PO as directed : 3 mg 1943-05-29 and 6/1 then as directed by Dr Mace . Disp :* 100 Tablet (s)* Refills :* 2 * Discharge Disposition : Home Discharge Diagnosis : s/p AVR 05-14 ( tissue ) readmitted 05-24 w/ pulmonary embolism , RUE DVT , HIT positive PMH : HTN , Renal calculi , sleep apnea , Discharge Condition : good Discharge Instructions : keep wounds clean and dry . OK to shower , no bathing or swimming . Take all medications as prescribed . Follow-up INR to be drawn 06-01 , by Dr Lewis @ 597-4427 Followup Instructions : Dr Pessolano in 3 days Dr Arnold in 3 weeks Hematology clinic in 1-2 weeks Messersmith della Blore MD 27-337 Completed by : MARK Yvonne NP 80-AUO 2018-05-29 @ 1552 Signed electronically by : DR. Edward von der Torros on : WED 2018-06-20 2:58 PM ( End of Report )