tokens: Admission Date : 2018-10-25 Discharge Date : 2018-10-31 Date of Birth : 1951-06-15 Sex : M Service : CARDIOTHORACIC Allergies : Patient recorded as having No Known Allergies to Drugs Attending : Michael D. Christensen , M.D. Chief Complaint : Shortness of Breath Major Surgical or Invasive Procedure : Coronary Artery Bypass Graft x3 ( Left internal mammary -> left anterior descending , saphaneous vein graft -> obtuse marginal , saphaneous vein graft -> posterior descending artery ) 2018-10-25 History of Present Illness : 67 y/o male with worsening shortness of breath. Had abnormal ETT and referred for cath . Cath revealed severe 3 vessel disease . Then referred for surgical intervention . Past Medical History : Carpal tunnel syndrome , Hypertension , Hyperlipidemia , Arthritis , h/o Bell's Palsy , HOH , s/p Tonsillectomy Social History : Denies ETOH , rare Tobacco . Electrician . Family History : Father with MI in 50 's and underwent CABG . Physical Exam : VS : 65 20 160/100 5 ' 7 " 180 # General : WD/WN male in NAD HEENT : EOMI , PERRL , NC/AT Neck : Supple , FROM , - JVD , - carotid bruits Chest : CTAB - w/r/r Heart : RRR - c/r/m/g Abd : Soft , NT/ND +BS Ext : Warm , well-perfused - edema , - varicosities Neuro : A&Ox3 , MAE , non-focal Pertinent Results : Echo 10-25 : PRE-BYPASS : Left ventricular wall thicknesses are normal . The left ventricular cavity size is normal . There is mild inferior wall hypokinesis . There is akinesis / dyskinesis and thinning of the mid to distal inferior septum and the apex . Overall left ventricular systolic function is mildly depressed . Right ventricular chamber size and free wall motion are normal . The descending thoracic aorta is mildly dilated . There are simple atheroma in the descending thoracic aorta . There are three aortic valve leaflets . There is no aortic valve stenosis . No aortic regurgitation is seen . The mitral valve leaflets are mildly thickened . Trivial mitral regurgitation is seen . POST-BYPASS : LV and RV function is unchanged . Aorta is unchanged . Other findings are unchanged . CXR 10-30 : Left lower lobe atelectasis has partially cleared . Upper lungs are clear . Mild postoperative widening of the cardiomediastinal silhouette is stable . No pneumothorax . 2018-10-25 11:15 AM BLOOD WBC - 18.3 *# RBC - 3.42 * Hgb - 10.9 * Hct - 31.6 * MCV - 92 MCH - 31.7 MCHC - 34.4 RDW - 13.3 Plt Ct - 134 * 2018-10-31 06:25 AM BLOOD WBC - 13.6 * RBC - 2.72 * Hgb - 8.6 * Hct - 24.6 * MCV - 91 MCH - 31.7 MCHC - 35.0 RDW - 14.0 Plt Ct - 314 2018-10-25 11:15 AM BLOOD PT - 13.3 * PTT - 30.0 INR(PT) - 1.2 * 2018-10-29 06:50 AM BLOOD PT - 11.9 INR(PT) - 1.0 2018-10-25 12:36 PM BLOOD UreaN - 17 Creat - 0.7 Cl - 111 * HCO3 - 23 2018-10-31 06:25 AM BLOOD Glucose - 91 UreaN - 19 Creat - 0.8 Na - 134 K - 4.0 Cl - 98 HCO3 - 26 AnGap - 14 Brief Hospital Course : Mr. Kammerer was a same day admit and on 10-25 was brought to the operating room where he underwent a coronary artery bypass graft x 3 . Please see operative report for surgical details . He tolerated the procedure well and was transferred to the CSRU for invasive monitoring in stable condition . Later on op day he was weaned from sedation , awoke neurologically intact , and extubated . Beta blockers and diuretics were initiated on post-op day one . He was diuresed towards his pre-op weight . He appeared to be doing well and was transferred to the SDU on this day . He did have burst of atrial fibrillation and was started on a Amiodarone gtt . His beta blockers were also titrated for maximal BP and HR control . Chest tubes were removed on post-op day two and epicardial pacing wires on post-op day three . Over the next several days he continued to improve his ambulation and mobility with physical therapy . He had no further episodes of AFIB while on po Amiodarone . On post-op day five he appeared to have left arm phlebitis and was started on antibiotics . He was discharged home on post-op day six with antibiotics and appropriate meds . He will have VNA services and make the appropriate follow-up appointments . Medications on Admission : Aspirin 81 mg qd , Toprol XL 50 mg qd , MVI , Flexeril 10 mg qhs , Plavix 75 mg qd ( last on 10-18 ) Discharge Medications : 1. Docusate Sodium 100 mg Capsule Sig : One ( 1 ) Capsule PO BID ( 2 times a day ). Disp :* 60 Capsule (s)* Refills :* 0 * 2. Aspirin 81 mg Tablet , Delayed Release ( E.C. ) Sig : One ( 1 ) Tablet , Delayed Release ( E.C. ) PO DAILY ( Daily ). Disp:* 30 Tablet , Delayed Release ( E.C. )(s)* Refills :* 0 * 3. Ranitidine HCl 150 mg Tablet Sig : One ( 1 ) Tablet PO BID ( 2 times a day ). Disp :* 60 Tablet (s)* Refills :* 0 * 4. Oxycodone - Acetaminophen 5-325 mg Tablet Sig : 1-2 Tablets PO Q4H ( every 4 hours ) as needed for pain . Disp :* 40 Tablet (s)* Refills :* 0 * 5. Atorvastatin 10 mg Tablet Sig : One ( 1 ) Tablet PO DAILY ( Daily ). Disp :* 30 Tablet (s)* Refills :* 0 * 6. Amiodarone 200 mg Tablet Sig : Two ( 2 ) Tablet PO BID ( 2 times a day ): please take 400 mg twice a day until 11-02 then decrease to 400 mg once a day for 1 week and then decrease to 200 mg once a day . Disp :* 40 Tablet (s)* Refills :* 0 * 7. Metoprolol Succinate 50 mg Tablet Sustained Release 24 HR Sig : One ( 1 ) Tablet Sustained Release 24 HR PO DAILY ( Daily ). Disp :* 30 Tablet Sustained Release 24 HR (s)* Refills :* 0 * 8. Ferrous Gluconate 300 mg Tablet Sig : One ( 1 ) Tablet PO DAILY ( Daily ). Disp :* 30 Tablet (s)* Refills :* 0 * 9. Ascorbic Acid 500 mg Tablet Sig : One ( 1 ) Tablet PO BID ( 2 times a day ). Disp :* 60 Tablet (s)* Refills :* 0 * 10. Cephalexin 500 mg Capsule Sig : One ( 1 ) Capsule PO Q6H ( every 6 hours ) for 6 days : please complete full course . Disp :* 24 Capsule (s)* Refills :* 0 * 11. Furosemide 20 mg Tablet Sig : One ( 1 ) Tablet PO once a day for 2 weeks . Disp :* 14 Tablet (s)* Refills :* 0 * 12. Potassium Chloride 10 mEq Capsule , Sustained Release Sig : One ( 1 ) Capsule , Sustained Release PO DAILY ( Daily ) for 2 weeks . Disp :* 14 Capsule , Sustained Release (s)* Refills :* 0 * 13. Lisinopril 5 mg Tablet Sig : 0.5 Tablet PO DAILY ( Daily ). Disp :* 15 Tablet (s)* Refills :* 0 * Discharge Disposition : Home with Service Discharge Diagnosis : Coronary artery disease s/p Coronary Artery Bypass Graft x3 PMH : Carpal tunnel syndrome , Hypertension , Hyperlipidemia , Arthritis Discharge Condition : good Discharge Instructions : May shower , no baths or swimming Monitor wounds for infection - redness , drainage , or increased pain Report any fever greater than 101 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams , lotions , powders , or ointments to incisions No driving for approximately one month No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns Left Arm continue with elevation , ice , and complete all antibiotics Followup Instructions : Dr Day in 4 weeks (( 469 ) 587-0462 ) please call for appointment Dr Miller in 1 week ( 262-575-0600 ) please call for appointment Dr Scott Raines in 2-3 weeks please call for appointment Wound check appointment 4 East as instructed by nurse ( 280-5326 ) For surgical incision and left arm Craig Douglas MD 10-898 Completed by : Reyes Marengo PA 80 - BMD 2018-11-19 @ 1536 Signed electronically by : DR. Jeffrey Collins on : WED 2018-11-21 9:28 AM ( End of Report )