Dr. Gretchen Marsh's Case Summary

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

This is a 68-year-old gentleman who presents to the ED stating that his legs are really swollen and draining yellow stuff. It is to be noted this patient was originally placed in observation status by the attending physician. After my clinical review of the chart and discussion with him I believe this patient warrants acute inpatient hospitalization. In the ED on presentation he is found to be anemic with a hemoglobin of 8.9, hematocrit of 27.1. He is also dehydrated with specific gravity urine greater than 1030. He has a low-grade temp of 99. On his physical exam he is noted to have a 2+ bilaterally pedal edema from his feet up to his knees, as well as chronic bilateral stasis changes in his legs with erythema and increased warmth.

This patient is a 73-year-old female who required inpatient hospitalization due to end stage renal disease secondary to persistent bacteremia and other underlying conditions. She was admitted to Truman Medical Hospital for further treatment and evaluation due to complaints of severe bilateral flank pain for three days that worsened with movement. She also reported shortness of breath and had been constipated for 3-4 days.

The patient is a 64-year-old female who has had recurrent admissions to the hospital and recently discharged after being treated for a ESBL Ecoli urinary tract infection. She presents again to the ER complaining of abdominal pain and abdominal distention. Her medical history is significant for schizophrenia, knee replacements, diabetes mellitus, hypertension, past CVA, COPD and dyslipidemia. Workup in the ED reveals her to be anemic and hemoglobin on admission is approximately 9.6 with hydration dropped to 8.5. She is also thrombocytopenic. Her labs reflect chronic kidney disease and her urinalysis reveals large amount of blood in the urine. In the ED she undergoes a CT of the abdomen and pelvis which reveals her to have ascites and

Severe weakness, fatigue, weight loss, symptoms suggestive of a possible hypoglycemia, nausea and vomiting, circulatory collapse, suggest to secondary hypoadrenalism.

On admission, the body temperature was 39ºC. Physical examination revealed an ill-appearing well-developed girl with mild pallor, and anicteric sclera. The patient had right upper quadrant abdominal tenderness with no distension or hepatomegaly. Relevant laboratory data included white blood cell count of 13.780/μL with 78% neutrophils; hemoglobin, 10.9 g/dL and C-reactive protein was 325 mg/L. Liver function tests, blood urea nitrogen and electrolytes were within reference ranges. Chest radiograph was normal.

Bernice, is an 80 year old, African American, female, who presents to the inpatient unit for further therapy after undergoing a colostomy reversal. Her history is significant for type 2 diabetes mellitus, stage 3 chronic kidney disease, and hypertension, for which she is taking a calcium channel blocker and a beta blocker. Her family history indicates that both her sisters and brother, had diabetes, as well as hypertension. Another key element is that Bernice is a former smoker. Physical examination reveals a healthy weight women, with a blood pressure of 153/71 mmHg and a heart rate of 64 bpm. Lungs are clear, and cardiac examination reveals a regular rate and rhythm. Abdomen is without bruits and peripheral pulses are equal. Laboratory results are significant for a non fasting glucose of 182 mg/dL. The patient’s blood urea nitrogen and serum creatinine are 26 mg/dL and 1.82 mg/dL.

This is a 92-year-old patient who fell apparently at home and was found lying on the floor at home. She reports decreased po intake, constipation and some episodes of bright red blood per rectum during bowel of movements. She was seen and evaluated in the emergency room. She has a past medical history of arthritis, osteoporosis, thyroid disease and frequent falls. On exam she had diffuse dry skin, she has multiple bruises on the left upper extremities and hips. She had a press pressure ulcer stage II on the right buttock area. Her laboratory work her calcium was 12.0. Her potassium was 4.3. Her BUN was 46. Her creatinine was 1.2. Her blood cell count was 14.50. The admitting diagnosis was hypovolemia, hypocalcemia, severe malnutrition

The patient is a 99-year-old female who presented to the ED because the family found her more combative and fighting. She is known to have underlying dementia. In the emergency room she was found to have a urinary tract infection, started on IV antibiotics and was admitted. Her medical history is known to be blind in the right eye secondary to a history of macular degeneration, some degree of dementia, recurrent UTIs and history of paroxysmal atrial fibrillation. Workup done in the ED CT of the head revealed that she had extensive white matter ischemic changes and atrophy no acute intracranial events. She was mildly hyponatremic at 131. Hemoglobin was stable. She did not have a white count. My clinical review of this chart is that

The patient is an 89-year-old female who resides in the Daughters of Miriam who presents to the hospital complaining of right upper quadrant abdominal pain with slight nausea, no fever no other complaints no diarrhea no fever or chills. In the ER she was had a slightly tender right upper quadrant of the abdomen and ultrasound finding consistent with calculus cholecystitis. Her past medical history is consistent with osteoarthritis, anxiety, hypertension, she's had left total hip replacement twice. Laboratory data reveals her to have a white count of 6.5. Hemoglobin and hematocrit are normal. Electrolytes are all normal. Total bili is 1.9. Alkaline phosphatase, AST and ALT all within normal limits. Urinalysis showed positive nitrates

The patient is a 44-year-old gentleman who presents to the ER because of bone pains in his hips, back and shoulders. He is known to have sickle cell disease, iron overload disease from multiple transfusions and cardiomyopathy. He has had persistent bone pain in his hips, lower back and shoulders. He was seen at an urgi center the day prior to admission where he was given IV Dilaudid and IV normal saline. The patient is presently on MS Contin 90 mg twice a day and in the ED he required a total of 18 mg and Dilantin with Motrin, Benadryl and IV fluids without any improvement. He was admitted. His hemoglobin was 8.3 with a hematocrit of 23.7 with 35% sickle cells. Retic count is 8.2. His potassium was 5. BUN is 25 and creatinine 1.76.

History of Present Illness: Onset: female (Black) patient reports symptoms of fever (102.4 in a.m.) with decreased appetite with onset of symptoms, urinary frequency, urgency, dysuria and nausea. The family also reports that for the last two days the patient has been increasingly confused, and does not recognize family.

Case: A 46-year-old woman presented to the ER with one-day history of generalized weakness, sweating, sharp non-radiating chest pain, palpitations, intractable nausea, and vomiting. She had a history of type 1 diabetes treated by continuous subcutaneous insulin via

The patient is an 80-year-old female who is brought to the ED referred from the hemodialysis unit because they discovered a history of a fall from an upright position 2 days prior to her presentation. There is no further history available except from her sister who noted fall when the patient was tryng to to get some water. There was evidently no loss consciousness or seizure activity. The patient has severe underlying dementia cannot provide additional history. Her medical history is significant for diabetes mellitus, hypertension, end-stage renal disease, she has had previous TIA, anemia and peripheral arterial disease. Initial lab work up reveals her to be anemic with a hemoglobin 8.9, hematocrit 20.4, hyponatremic with a sodium 130, chloride of 89, and albumin of

1: A 72-year-old female presented with fever, shortness of breath and decreased alertness. She was hospitalized for community-acquired pneumonia, and had a past medical history of chronic kidney disease (CKD) stage 4 (GFR 16 ml/min/1.73m2), hypertension, hypothyroidism, anemia and dementia. Renal function worsened and urgent dialysis was indicated.