Mr. Callais Case Summary

At this point, we do not know exactly what are the settings, we have previous requested pacemaker operative report from Regions. Unfortunately, from what he is telling today, his date of the birth was not correct as such dose report were not same. He noted that he thinks he came back from the hospital, he has not had similar complaint or concern or report of chest pain. It should be noted that hospital records, with a troponin that was negative, 12-lead EKG was similar to the one that was obtained here, essentially identifying sinus bradycardia with first-degree AV block, left ventricular hypertrophy with repolarization abnormality. QT was prolonged, similar EKG obtained at facility also identified pretty much the same abnormality pattern. Troponin was negative. Other workup included chest x-ray in the hospital were all unremarkable. Today he is not reporting any chest pain, no shortness of breath, no nausea or emesis. He has got healed ____ scar to the left chest from pacemaker implantation which is completely healed but slightly

BH reports that he takes his medications as prescribed and reports he has tried to adjust his diet in order to decrease his glucose, triglycerides, and cholesterol. He continues to consume

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

Mr. Bishop is here for routine followup of his chronic illness. He is treated with Alvesco 160 mcg two puffs twice daily, Atrovent two puffs three times daily and Ventolin as needed for his COPD. He reports good compliance and uses these inhalers as prescribed. He generally uses his Ventolin with exercise. He reports that he is running 1-2 miles a day and also doing a step tape daily and reports good exercise tolerance. He does not wake at night coughing or feeling short of breath. For his hypertension, he takes hydrochlorothiazide 25 mg, and amlodipine 5 mg, and simvastatin 20 mg for his hyperlipidemia. He takes these as prescribed and denies any side effects. He denies

Lung function tests have revealed normal spirometry, gas transfer and static lung volumes. There appears to be a fall in pre-bronchodilator FEV1, but not so FVC and TLCO comparing back to 2007??. Maximal respiratory pressures are reduced indicative of respiratory muscle/diaphragm weakness. This is consistent with what has previously been observed and the previous diagnosis of mild left hemidiaphragm weakness. I note from Tony Dortimer’s most recent letter that the coronary angiogram

Mrs. K., A 68 year-old white woman, has been admitted to the critical care unit with shortness of breath at rest. Vital signs are BP, 218/100 mm Hg; HR, 110 beats/min; and RR, 3 breath/min. She has run out of her antihypertensive medication for the fourth time this year and only came to the hospital because of her breathing difficulties.

Ed Mersereau is the Division Chief of ADAD, or as he put it, somewhat like the “CEO of the division.” He is responsible for running the division, and his job requires him to deal with the legislature and work with budgets. However, Mr. Mersereau is relatively new to his position; he has only been the chief for five month and the current legislative session is his first. Although he has not been the chief for long, he has worked in a supervision position for 15 years. He said that while he loved direct practice and thoroughly enjoyed working with families, he realized that “policy level is where it’s really at for making an impactful change.” This realization drew him to pursue a manager’s position. He found policy work, or as he described it,

What are the clues that helped the paramedic determine why the nitroglycerin did not alleviate the man’s angina?

One to two patients presented in the clinic area has heart murmurs heard on auscultation. The patients are asymptomatic, and the primary care will continue to monitor the patient. One particular patient stands out. A 6-year-old child verbalizes she will need a pacemaker as she gets older. She experienced shortness of breath, dizziness, severe fatigue (tiredness), fainting spell, and poor appetite. The child blood works were typical, expect the EKG showed completed heart block. She wore a Holter monitor for 24 hours, and echocardiography from the cardiologist. On assessment, the heart rate was 65pbm and regular, no chest discomfort, dizziness, palpitation or shortness of breath. The mother calms she checked her daughter pulse rate and records

Vital signs are in the chart. Reviewed, appear stable. Alert male, no acute distress. Pleasant and cooperative. Heart: Regular rate and rhythm without

Mr. Markham is seen this afternoon at MCCRC on 03/02/2018. Mr. Markham is seen this afternoon after dialysis, which has exhausted him and he says his blood pressure dropped and he felt terrible as if he might pass out. He does not know why they were so aggressive. Other times, he has come back from dialysis with diastolics in the range of 110. His discharge is tentative for next Wednesday. He has had no chest pain. He has had some pain in his left knee but it has neither been warm, hot, or with atypical prednisone effusion that he has with gouty attacks. Mr. Jones has started him on allopurinol 100 mg daily.

Cardiac: rRegular rate and rhythm, no murmurs, rubs, or gallops; no JVD, thrills, or heaves; PMI non-displaced at 5th intercostal space

Cardiac arrhythmias noted, heart rate (HR) 106 beat per minute; heart rhythm was irregularly irregular, but no evidence of blood loss or internal bleeding, radial pulses was strong bilaterally.

Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and