Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Peripheral arterial occlusive disease, Peripheral coldness, Peripheral ischaemia, Thrombolysis, Vascular stent occlusion
Clinical narrative: Patient ID:    Age: 67 y.o.   Admit Date: 8/17/2022  3:21 PM  Discharge Date: ? 8/20/2022       Discharge Diagnosis:  Principal Problem:    PAD (peripheral artery disease)  Active Problems:    Tobacco abuse    Athscl native arteries of extrm w intrmt claud, right leg           HPI: Patient is a 67 y.o. female. History of peripheral arterial disease.  Presenting  As a direct admit for left lower extremity ischemia.  In-stent stenosis/occlusion of left common iliac artery stent.  Pain worse with exertion, better with rest.  No discoloration.  Mild temperature change compared to right leg.  Cold to touch at level of foot.  Being admitted for thrombolysis, and possible bypass.     Hospital Course: Patient is a 67-year-old female who was admitted to Medical Center on 8/17/2022 after presenting with left leg pain. She was found to have ischemic limb with stenosis of previous stent and history of peripheral artery disease. Vascular surgery was consult to evaluate the patient.  She underwent lysis of the occluded vessel and left CIA stent was placed. Plavix was added to her current regimen of aspirin for the DAPT. She did have a mild left groin hematoma following the procedure but this appeared stable and was not painful or causing any issues with the patient. Her hemoglobin did fall to 10.0 after the procedure from 11. This was checked before discharge 12 hours later and had rose to 10.2. She is now stable for discharge home and will follow-up with her PCP within one week.                 Most recent Assessment and Plan:  * PAD (peripheral artery disease)  L CIA Occluded stent  / Ischemic left leg   - Extensive vascular surgery history, was off asa for 7-10 for lumbar injections   - Currently undergoing thrombolysis with EKOS    - Plans to return to lab today for re-eval     Nausea  - Continue antiemetics prn      COPD  - Former smoker, nebs PRN      Heparin   Full Code                              Physical Exam on the Date of Discharge:  Physical Exam  Vitals reviewed.  Constitutional:       Appearance: Normal appearance.  HENT:      Head: Normocephalic and atraumatic.     Nose: Nose normal.     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:      Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:      Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:      Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal.     Palpations: Abdomen is soft.   Musculoskeletal:         General: Normal range of motion.     Comments: Range of motion intact in both bilateral lower extremity, minimal edema, some mild ecchymosis on the inner thigh   Skin:     General: Skin is warm.     Comments: Inner thigh of the left leg with some bruising as expected  Neurological:      General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time. Mental status is at baseline.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.                        Consults:    IP CONSULT TO VASCULAR SURGERY     Significant Diagnostic Studies:     labs: Hemoglobin 10.0 this morning which was down from 11 before the procedure. Rechecked hemoglobin 12 hours after and increased to 10.2 so is stable        Disposition:  home     Discharge Condition:  good