Result type: ED Note   Result date: February 13, 2019 20:29 PST   Result status: Auth (Verified)   Result Title/Subject: ED Note   Performed By/Author: MD on February 13, 2019 20:37 PST   Verified By: MD on February 13, 2019 20:37 PST    Patient Age:  72 Years    Gender: Female  Date/Time:  02/06/19 13:25      Time of my initial contact with patient:  Patient was seen at 1327   Mode of Arrival:  POV/Walk-in     Triage Narrative:  PT BROUGHT TO ED FROM PT SESSION VIA GURNEY WITH C/O SPASTIC MOVEMENTS OF ARMS LEGS. PER EMPLOYEE IN PT; THIS EPISODE LASTED 1 HR 15 MINUTES.. PT'S SPOUSE AT BEDSIDE. SEIZURE PADS PLACED ON BED RAILS, PT AWAKE, ALERT, ORIENTED, DR AT BEDSIDE. PT STATES SHE HAD A COLONOSCOPY YESTERDAY.         Chief Complaint:  Involuntary movement   History of Present Illness:  This is a 72-year-old unfortunate female who has been suffering a series of episodes of movement disorder like choreoathetoid spastic events she was being evaluated in the hospital and started having 1 of these episodes and was brought into the emergency room with concerns of a possible seizure certainly patient was quite awake and alert knowing that she could not inhibit these upper and lower extremity spastic type of movements she can that the rectum patient did not seem to be too upset by them and seemed to be some events that she has suffered through multiple times her husband is at the bedside patient has already been evaluated by neuro neurology and has been referred to a motor disorder department.  Both the patient and his and her husband do not want to initiate a complete workup has been done several times in the emergency room just wanted to see if we could help her with some Ativan and they are already pending a scheduled appointment this is a sick specifically patient denies any headache any chest pain any palpitations no history of trauma or fever  Problem List & Past Medical/Surgical History:  Acid reflux                                                                  Asthma                                                                       Brain aneurysm                                                               Chronic pain                                                                 Ex-smoker                                                                    Movement disorder                                                            Thyroid disease                                                                  Family History:  Family history is significant for the absence of any motor disorders  Social History:  Patient states no history of tobacco use  Patient specifically denies any previous use ofDrugs or previous trauma  Allergies:   Dilantin (Rash)  codeine (Acute vomiting, Rash, ITCHING)  fentaNYL (Shortness of breath)  morphine (vomiting, itching)  opioid-like analgesics (Rash)  tetanus toxoids (Edema, fever)  traMADol (itchy)   Medications:  Available Med List Reviewed   Review of Systems:  All other systems reviewed and are negative except per HPI     Physical Exam:  Vital Signs  BP: 177/85 mmHg   Temp (Temporal): 36.3 DegC ( 97.3 DegF)   HR: 80 bpm   Resp: 18 br/min   SpO2: 100 %  [Patient is alert, cooperative, no acute distress] Vital signs as noted HEENT: [Normocephalic, atraumatic, pupils were equal and reactive to light, extraocular movements movements are intact, neck is supple, no thyromegaly] RESP: [Respiratory rate normal is noted,  patient is breathing  comfortably in no acute distress, with no adventitious breath sounds. specifically no wheezing no rhonchi no rales] CV: [Regular rate and heart rate noted,  patient has no S3, no gallop, perfusion confirmed normal] GI: [Patient's abdomen is soft nontender, no rebound, no guarding] Neuro: [GCS of 15,  mentation is normal, thought content and processes intact, motor and sensory both upper and lower extremities normal.] Skin: [Good color and normall  capillary refill, no rash] MS:[Patient exhibits a spastic type of upper and lower extremity movements which seem to be having no rhythmical sequence she continues being alert and oriented throughout these episodes they seem to subside after a few minutes and with no obvious precipitant begin again  Test Results:  Labs Results    Laboratory and workup and imaging was refused by the patient as they have had that several times      Diagnostic Results  Imaging Studies Reviewed      Emergency Department Course and Procedures:  Medications, IV's and Blood Products Ordered  LORazepam (Ativan)  1 mg = 1 tab once PO     Critical care patient underwent a critical care observation irrespective of any procedures during her stay in the emergency room a total duration of approximately 42 minutes with concerns of her safety and her neurological status to protected from injury and to monitor her cardiovascular respiratory and neurological organs        Medical Decision Making:  And reexaminations patient spastic events seem to subside only slightly this is a 72-year-old female presents with a motor disorder of unclear etiology already extensive ER and internal medicine workups has already seen neurology I did speak with the neurologist of the patient tonight to ascertain if there was anything other than Ativan that I could attempt and to also ascertain that she did have a follow-up with her referral motor disorder specialist  Impression:  Choreoathetotic movements of unclear etiology  Plan:   Discharge  Discharge   Follow Up  Follow up with primary care provider  Within: 3-5 days    Comments: Return to ER for any concern     Referral for suspected pre-hypertension or hypertension was given.        MD     Please note: Unless specifically stated, all procedures mentioned, tests done and medications given were performed/interpreted by the emergency physician, or were under the direct supervision of the emergency physician.