chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Myocardial ischaemia, Nausea, Nephrolithiasis, Peritoneal dialysis
Clinical narrative: Clinical Summary Patient is a 43 y.o. male with a history of CKD on PD, T1DM who presented to the HCF 11/24/2022 with fever, nausea and emesis.  Found to have COVID-19      1. Acute Covid-19 Virus Infection/Sepsis?POA: Home test + 11/24/2022.  Positive at HCF 11/25/2022.  Vaccinated.  No booster.  Chest x-ray does not show any acute changes.  Febrile, leukocytosis.  Procalcitonin elevated.  No Decadron or abx as per infectious disease.  S/p Paxlovid .  ID followed 2. Acute Hypoxic Respiratory Failure: Likely due to COVID.  Does not use oxygen at home.   Weaned to room air. 3. Elevated troponin: 365?316.  No chest pain.  Likely demand ischemia due to hypoxia and ESRD.   4. Hypertensive urgency: Improved.  Continued home meds.  5. ESRD: on PD, last dialysis 11/23/2022 with reported clear dialysate. Follows with Dr. (Nephrologist).  Nephrology followed 6. IDDM1: A1c 5.3?11/25/2022.  Basal home insulin was decreased initially due to hypoglycemia.  Blood sugars were then elevated due to patient's refusal to take sliding scale as advised.  Resume home dose at discharge.  Patient to follow blood sugar closely at home and use SSI as needed along with basal.  7. History of Right Foot OM: S/p right 5th ray amputation on 8/30/2019. S/p right foot debridement with partial 5th metatarsal resection and right foot application of skin substitute graft on 10/3/2019. XR Right Foot showed concerns of osteomyelitis.  No need for MRI as per infectious disease.  Follow-up with podiatry as outpatient.  Initially patient said that he has appointment for BKA, then asked for referrals?provided. 8. Abnormal CT Finding: Admit CT revealed few punctate bilateral nonobstructing renal stones, bulging annulus at L4-5 flattening anterior thecal sac. Follow up as outpatient with PCP.
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Procalcitonin increased, Pyrexia, Refusal of treatment by patient, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Clinical Summary Patient is a 43 y.o. male with a history of CKD on PD, T1DM who presented to the HCF 11/24/2022 with fever, nausea and emesis.  Found to have COVID-19      1. Acute Covid-19 Virus Infection/Sepsis?POA: Home test + 11/24/2022.  Positive at HCF 11/25/2022.  Vaccinated.  No booster.  Chest x-ray does not show any acute changes.  Febrile, leukocytosis.  Procalcitonin elevated.  No Decadron or abx as per infectious disease.  S/p Paxlovid .  ID followed 2. Acute Hypoxic Respiratory Failure: Likely due to COVID.  Does not use oxygen at home.   Weaned to room air. 3. Elevated troponin: 365?316.  No chest pain.  Likely demand ischemia due to hypoxia and ESRD.   4. Hypertensive urgency: Improved.  Continued home meds.  5. ESRD: on PD, last dialysis 11/23/2022 with reported clear dialysate. Follows with Dr. (Nephrologist).  Nephrology followed 6. IDDM1: A1c 5.3?11/25/2022.  Basal home insulin was decreased initially due to hypoglycemia.  Blood sugars were then elevated due to patient's refusal to take sliding scale as advised.  Resume home dose at discharge.  Patient to follow blood sugar closely at home and use SSI as needed along with basal.  7. History of Right Foot OM: S/p right 5th ray amputation on 8/30/2019. S/p right foot debridement with partial 5th metatarsal resection and right foot application of skin substitute graft on 10/3/2019. XR Right Foot showed concerns of osteomyelitis.  No need for MRI as per infectious disease.  Follow-up with podiatry as outpatient.  Initially patient said that he has appointment for BKA, then asked for referrals?provided. 8. Abnormal CT Finding: Admit CT revealed few punctate bilateral nonobstructing renal stones, bulging annulus at L4-5 flattening anterior thecal sac. Follow up as outpatient with PCP.
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin increased, Vomiting, X-ray limb abnormal
Clinical narrative: Clinical Summary Patient is a 43 y.o. male with a history of CKD on PD, T1DM who presented to the HCF 11/24/2022 with fever, nausea and emesis.  Found to have COVID-19      1. Acute Covid-19 Virus Infection/Sepsis?POA: Home test + 11/24/2022.  Positive at HCF 11/25/2022.  Vaccinated.  No booster.  Chest x-ray does not show any acute changes.  Febrile, leukocytosis.  Procalcitonin elevated.  No Decadron or abx as per infectious disease.  S/p Paxlovid .  ID followed 2. Acute Hypoxic Respiratory Failure: Likely due to COVID.  Does not use oxygen at home.   Weaned to room air. 3. Elevated troponin: 365?316.  No chest pain.  Likely demand ischemia due to hypoxia and ESRD.   4. Hypertensive urgency: Improved.  Continued home meds.  5. ESRD: on PD, last dialysis 11/23/2022 with reported clear dialysate. Follows with Dr. (Nephrologist).  Nephrology followed 6. IDDM1: A1c 5.3?11/25/2022.  Basal home insulin was decreased initially due to hypoglycemia.  Blood sugars were then elevated due to patient's refusal to take sliding scale as advised.  Resume home dose at discharge.  Patient to follow blood sugar closely at home and use SSI as needed along with basal.  7. History of Right Foot OM: S/p right 5th ray amputation on 8/30/2019. S/p right foot debridement with partial 5th metatarsal resection and right foot application of skin substitute graft on 10/3/2019. XR Right Foot showed concerns of osteomyelitis.  No need for MRI as per infectious disease.  Follow-up with podiatry as outpatient.  Initially patient said that he has appointment for BKA, then asked for referrals?provided. 8. Abnormal CT Finding: Admit CT revealed few punctate bilateral nonobstructing renal stones, bulging annulus at L4-5 flattening anterior thecal sac. Follow up as outpatient with PCP.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Blood bicarbonate increased, Blood gases, Blood lactic acid, Blood pH decreased, C-reactive protein increased
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: CD4 lymphocytes, COVID-19, Campylobacter test positive, Cardiac failure congestive, Cardiomegaly
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Chronic obstructive pulmonary disease, Clostridium test positive, Diarrhoea, Dyspnoea
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction abnormal, Enteritis, Escherichia test positive, HIV test positive
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Imaging procedure abnormal, PCO2 increased, Pleural effusion, Positive airway pressure therapy, Procalcitonin normal
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Pulmonary congestion, Pulmonary oedema, Respiratory acidosis, Respiratory failure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Stool analysis abnormal
Clinical narrative: Patient is a 67 y.o. male patient of, MD with history of COPD/emphysema with chronic respiratory failure with hypoxia on 4 L nasal cannula, who presented to Doctors Hospital with worsening shortness of breath..  He was found to be COVID-positive on 11/20   Acute on chronic respiratory failure with hypoxia and hypercapnia Concern for volume overload on imaging Respiratory acidosis-resolving on repeat VBG Chronically on 4 L nasal cannula at home Initial VBG showed pH 7.26 with PCO2 80.5 and bicarb 36.  He was placed on BiPAP in the ED.  Pulmonology consulted in ED   Repeat ABG at that time showed improvement with pH 7.34, PCO2 down to 58.1 with bicarb 31.7 and O2 saturation 98.6% CXR with mild?moderate CHF with moderate pulmonary vascular congestion with diffuse edema and small effusions ECHO showed  EF of 70% Lasix 20 mg IV x1 given 11/20.  Monitor daily weight.  Strict I's/O Procal - normal, cefepime and vancomycin discontinued Patient transitioned from BiPAP to Heated high flow nasal cannula  Weaned to nasal cannula 4 liters Pulmonology signed off   Covid-19 Virus Infection Date of onset of symptoms: 1 week prior to admission Symptoms present on admission: Shortness of breath, diarrhea Date of covid positive test: 11/20 Vaccination status: vaccinated?Johnson & Johnson times 17/13/2021 Imaging: CXR with moderate pulmonary vascular congestion and diffuse edema with small effusions with large heart size concerning for mild?moderate CHF Oxygen requirements on admission: BiPAP Current oxygen requirements:  Medical therapy: remdesivir and steroids?started on Decadron and remdesivir 11/20 Consultants following: Pulmonology, ID Anticipated special isolation end date: TBD possibly 11/30 (or 10 days from positive test) CRP 22.9 on admission.  Lactic acid was 1.1   COPD exacerbation Received multiple albuterol and DuoNeb's.   on azithromycin  Albuterol and Symbicort Decadron for COPD and COVID infection   Polymicrobial Enteritis  Stool pcr postive for C diff, campylobacter and Ecoli  Initiated on po vancomycin continue  HIV Positive  HIV-1 quantitation pending T-helper at cells CD4 count  - 453 Does not want to discuss about HIV positive status   f/u with Dr  ID
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Accidental overdose, Acute kidney injury, Acute respiratory failure, Anxiety, Blood creatinine increased
Clinical narrative: Patient is a 64 y.o. female patient of CNP with history of COPD on 4L NC chronically along with BiPAP at night time, paroxysmal AFib, chronic hypotension, hypothyroidism, and RLS presented with mental status changes in setting of likely unintentional overdose.   COVID-19 viral infection Tested positive on routine check for SNF placement delaying discharge for 10 days Completed course of steroids for ACOPDE Completed 10 days of isolation   Acute toxic metabolic encephalopathy, resolved In setting on unintentional overdose with hypercapnia and ACOPDE Regulate sleep/wake cycle  Continue management as below   Acute on chronic respiratory failure with hypoxia and hypercapnia COPD exacerbation Discharged on steroid taper following last admit; baseline O2 ~4L NC Significant expiratory wheezing on admission requiring BiPAP  Completed course of Azithromycin and steroids Bronchodilators (Symbicort and Spiriva), BiPAP HS and with naps Improved- on nasal cannula this morning   Overdose, unintentional Per hospice RN notes, pt appears to have taken ~24mg of Haldol between 3am and 7am Suspecting confusion due to hypercapnia lead patient taking more than indicated Evaluated by BH and cleared.    Anxiety  Likely multifactorial due to dyspnea and hospitalization  Started on Buspirone due to adverse events on Haldol (will be held at discharge) Morphine PRN   Epistaxis Noted to have right anterior epistaxis  ENT consulted. S/p FloSeal instilled in left nasal cavity due to prominent left caudal nasal vessel by Dr.. If re-rebleeds, apply 4-5 sparys of Afrin followed by nasal clamp for 20 mins.  Resolved  AKI, resolved Cr 1.2 on presentation Baseline creatinine wnl  Resolved with IV fluids   Atrial fibrillation Recent diagnosis for patient, rate controlled Continue home Toprol-XL, and Eliquis Diltiazem held this admission due to hypotension. Defer to PCP when safe to resume   Chronic HFrEF No evidence of volume overload on exam Takes Lasix PRN Continue Toprol-XL   Hypotension Chronic hypotension due to likely being on prolonged steroids Continue Florinef   RLS Takes Gabapentin 300mg HS PRN   Hypothyroidism Continue Synthroid   GERD Unclear as to why on both PPI and H2 blocker BID Continue Famotidine only at this time   Goals of care Given potential suicide attempt, code status was changed to full code briefly BH cleared of suicide precautions Changed code status back to DNR-CC after discussion with POA Goals are hospice
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Circadian rhythm sleep disorder, Condition aggravated, Confusional state
Clinical narrative: Patient is a 64 y.o. female patient of CNP with history of COPD on 4L NC chronically along with BiPAP at night time, paroxysmal AFib, chronic hypotension, hypothyroidism, and RLS presented with mental status changes in setting of likely unintentional overdose.   COVID-19 viral infection Tested positive on routine check for SNF placement delaying discharge for 10 days Completed course of steroids for ACOPDE Completed 10 days of isolation   Acute toxic metabolic encephalopathy, resolved In setting on unintentional overdose with hypercapnia and ACOPDE Regulate sleep/wake cycle  Continue management as below   Acute on chronic respiratory failure with hypoxia and hypercapnia COPD exacerbation Discharged on steroid taper following last admit; baseline O2 ~4L NC Significant expiratory wheezing on admission requiring BiPAP  Completed course of Azithromycin and steroids Bronchodilators (Symbicort and Spiriva), BiPAP HS and with naps Improved- on nasal cannula this morning   Overdose, unintentional Per hospice RN notes, pt appears to have taken ~24mg of Haldol between 3am and 7am Suspecting confusion due to hypercapnia lead patient taking more than indicated Evaluated by BH and cleared.    Anxiety  Likely multifactorial due to dyspnea and hospitalization  Started on Buspirone due to adverse events on Haldol (will be held at discharge) Morphine PRN   Epistaxis Noted to have right anterior epistaxis  ENT consulted. S/p FloSeal instilled in left nasal cavity due to prominent left caudal nasal vessel by Dr.. If re-rebleeds, apply 4-5 sparys of Afrin followed by nasal clamp for 20 mins.  Resolved  AKI, resolved Cr 1.2 on presentation Baseline creatinine wnl  Resolved with IV fluids   Atrial fibrillation Recent diagnosis for patient, rate controlled Continue home Toprol-XL, and Eliquis Diltiazem held this admission due to hypotension. Defer to PCP when safe to resume   Chronic HFrEF No evidence of volume overload on exam Takes Lasix PRN Continue Toprol-XL   Hypotension Chronic hypotension due to likely being on prolonged steroids Continue Florinef   RLS Takes Gabapentin 300mg HS PRN   Hypothyroidism Continue Synthroid   GERD Unclear as to why on both PPI and H2 blocker BID Continue Famotidine only at this time   Goals of care Given potential suicide attempt, code status was changed to full code briefly BH cleared of suicide precautions Changed code status back to DNR-CC after discussion with POA Goals are hospice
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Epistaxis, Hypercapnia, Hypotension, Hypoxia
Clinical narrative: Patient is a 64 y.o. female patient of CNP with history of COPD on 4L NC chronically along with BiPAP at night time, paroxysmal AFib, chronic hypotension, hypothyroidism, and RLS presented with mental status changes in setting of likely unintentional overdose.   COVID-19 viral infection Tested positive on routine check for SNF placement delaying discharge for 10 days Completed course of steroids for ACOPDE Completed 10 days of isolation   Acute toxic metabolic encephalopathy, resolved In setting on unintentional overdose with hypercapnia and ACOPDE Regulate sleep/wake cycle  Continue management as below   Acute on chronic respiratory failure with hypoxia and hypercapnia COPD exacerbation Discharged on steroid taper following last admit; baseline O2 ~4L NC Significant expiratory wheezing on admission requiring BiPAP  Completed course of Azithromycin and steroids Bronchodilators (Symbicort and Spiriva), BiPAP HS and with naps Improved- on nasal cannula this morning   Overdose, unintentional Per hospice RN notes, pt appears to have taken ~24mg of Haldol between 3am and 7am Suspecting confusion due to hypercapnia lead patient taking more than indicated Evaluated by BH and cleared.    Anxiety  Likely multifactorial due to dyspnea and hospitalization  Started on Buspirone due to adverse events on Haldol (will be held at discharge) Morphine PRN   Epistaxis Noted to have right anterior epistaxis  ENT consulted. S/p FloSeal instilled in left nasal cavity due to prominent left caudal nasal vessel by Dr.. If re-rebleeds, apply 4-5 sparys of Afrin followed by nasal clamp for 20 mins.  Resolved  AKI, resolved Cr 1.2 on presentation Baseline creatinine wnl  Resolved with IV fluids   Atrial fibrillation Recent diagnosis for patient, rate controlled Continue home Toprol-XL, and Eliquis Diltiazem held this admission due to hypotension. Defer to PCP when safe to resume   Chronic HFrEF No evidence of volume overload on exam Takes Lasix PRN Continue Toprol-XL   Hypotension Chronic hypotension due to likely being on prolonged steroids Continue Florinef   RLS Takes Gabapentin 300mg HS PRN   Hypothyroidism Continue Synthroid   GERD Unclear as to why on both PPI and H2 blocker BID Continue Famotidine only at this time   Goals of care Given potential suicide attempt, code status was changed to full code briefly BH cleared of suicide precautions Changed code status back to DNR-CC after discussion with POA Goals are hospice
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Mental status changes, Positive airway pressure therapy, SARS-CoV-2 test positive, Toxic encephalopathy, Wheezing
Clinical narrative: Patient is a 64 y.o. female patient of CNP with history of COPD on 4L NC chronically along with BiPAP at night time, paroxysmal AFib, chronic hypotension, hypothyroidism, and RLS presented with mental status changes in setting of likely unintentional overdose.   COVID-19 viral infection Tested positive on routine check for SNF placement delaying discharge for 10 days Completed course of steroids for ACOPDE Completed 10 days of isolation   Acute toxic metabolic encephalopathy, resolved In setting on unintentional overdose with hypercapnia and ACOPDE Regulate sleep/wake cycle  Continue management as below   Acute on chronic respiratory failure with hypoxia and hypercapnia COPD exacerbation Discharged on steroid taper following last admit; baseline O2 ~4L NC Significant expiratory wheezing on admission requiring BiPAP  Completed course of Azithromycin and steroids Bronchodilators (Symbicort and Spiriva), BiPAP HS and with naps Improved- on nasal cannula this morning   Overdose, unintentional Per hospice RN notes, pt appears to have taken ~24mg of Haldol between 3am and 7am Suspecting confusion due to hypercapnia lead patient taking more than indicated Evaluated by BH and cleared.    Anxiety  Likely multifactorial due to dyspnea and hospitalization  Started on Buspirone due to adverse events on Haldol (will be held at discharge) Morphine PRN   Epistaxis Noted to have right anterior epistaxis  ENT consulted. S/p FloSeal instilled in left nasal cavity due to prominent left caudal nasal vessel by Dr.. If re-rebleeds, apply 4-5 sparys of Afrin followed by nasal clamp for 20 mins.  Resolved  AKI, resolved Cr 1.2 on presentation Baseline creatinine wnl  Resolved with IV fluids   Atrial fibrillation Recent diagnosis for patient, rate controlled Continue home Toprol-XL, and Eliquis Diltiazem held this admission due to hypotension. Defer to PCP when safe to resume   Chronic HFrEF No evidence of volume overload on exam Takes Lasix PRN Continue Toprol-XL   Hypotension Chronic hypotension due to likely being on prolonged steroids Continue Florinef   RLS Takes Gabapentin 300mg HS PRN   Hypothyroidism Continue Synthroid   GERD Unclear as to why on both PPI and H2 blocker BID Continue Famotidine only at this time   Goals of care Given potential suicide attempt, code status was changed to full code briefly BH cleared of suicide precautions Changed code status back to DNR-CC after discussion with POA Goals are hospice
Age: 57.0
Sex: F
Vaccine: PNC20, VARZOS
Symptoms: Erythema, Peripheral swelling, Skin warm
Clinical narrative: Patient notified pharmacy 3 days after vaccine that her arm  starting to get red, swollen, and warm starting a day after vaccination.  She went to urgent care 3 days after and prescriber thought that patient may have cellulitis or an injection site reaction. Prescriber wrote a prescription for antibiotics to treat possible cellulitis.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood sodium decreased, Blood thyroid stimulating hormone normal, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Complication of device removal, Computerised tomogram head normal, Dyspnoea, Endotracheal intubation
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Extubation, Fraction of inspired oxygen, Glycosylated haemoglobin normal, Hyperglycaemia, Hypernatraemia
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Laryngeal oedema, Lung infiltration, Mental status changes, Metabolic encephalopathy
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Obesity, Pneumonia bacterial, Positive airway pressure therapy, Positive end-expiratory pressure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Sepsis, Sputum culture positive, Staphylococcal infection, Stridor, Thyroid mass
Clinical narrative: Patient is a 67 y.o. female patient of local CNP with history of asthma, DM-2, HTN, hypercholesterolemia, hyperthyroidism, multinodular goiter, papillary thyroid carcinoma, and paroxysmal atrial fibrillation who presented with shortness of breath and altered mentation and was found to have acute respiratory failure requiring intubation due to Covid/PNA. She failed extubation twice due to thyroid mass, so will be transferred to Hospital for ENT surgery   Acute respiratory failure  Intubated 11/7 due to covid/PNA with underlying asthma Pulm/CC consulted Extubated 11/8 and reintubated shortly after due to stridor IV lasix x1 on 11/9 Extubated 11/10 and reintubated 11/11 with vocal cord edema noted on reintubation  FiO2 (%): 40% S RR: 18br/min S VT: 320ml PEEP/CPAP (cm H2O): 5cmH2O MAP (mmHg):  [71-91] 73 Transfer to Hospital   Covid -19 infection Bacterial pneumonia Severe sepsis Sepsis present on admission CXR with b/l infiltrates Urinary antigens negative Vaccinated Covid positive 11/7 Started on rocephin/azithro, decadron and remdesivir Change decadron to solumedrol due to stridor Back on decadron 11/12 Azithro/remdesivir completed 11/11 Sputum culture MRSA 11/16 Vancomycin started 11/15  Acute metabolic encephalopathy - Resolved Likely due to hypoxia from above HeadCT negative 11/7 and 11/11 Follows commands, alert, oriented, and appropriate Has capacity and communicating by writing   DMT2 A1c 6.8 On lantus 55U and metformin at home Currently on lantus 50U qAM and lantus 30U at bedtime with SSI with ongoing hyperglycemia Change to insulin gtt 11/10 Transition to lantus/SSI on 11/12 On lantus 45U and SSI   Hyperthyroidism Papillary thyroid carcinoma S/p partial thyroidectomy TSH wnl Failed extubation x2 as above CT chest/neck on 11/11 with soft tissue mass from thyroid invading into airway ENT consulted 11/12; discussed patient has extensive involvement of tumor into thyroid cartilage, pharynx/trachea and likely involving the recurrent laryngeal nerve causing vocal cord paralysis. She is unsafe for a trach or extubation at this time and would need an extensive surgery at Hospital for stable airway and tumor resection   Hypernatremia - Resolved Na+ 153 on 11/12; add free water Na+ 148 on 11/13 Na+ 136 - 11/16 Stopped FWF   HTN Home lisinopril and hydrochlorothiazide held on admit Start lopressor and hydralazine prn 11/10   Obese BMI 38