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Clinical Conference

Clinical Conference. October 18 th , 2006. 53 y.o. AAF w/ h/o DM, ESRD on HD, HTN, morbid obesity -Transferred from OSH on 9/19/06 for evaluation of possible ICH. Time course of events: 9/10/06: admitted to OSH for c/o arm/leg weakness during dialysis;

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Clinical Conference

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  1. Clinical Conference October 18th, 2006

  2. 53 y.o. AAF w/ h/o DM, ESRD on HD, HTN, morbid obesity -Transferred from OSH on 9/19/06 for evaluation of possible ICH.

  3. Time course of events: 9/10/06: admitted to OSH for c/o arm/leg weakness during dialysis; 9/10-9/18: neuro w/u suggested severe diabetic polyneuropathy 9/18/06: Episode of witnessed tonic-clonic limb movements; -unresponsiveness w/ subsequent intubation for airway protection -BP 220/110, improved to SBP 160’s -unable to perform Head CT at OSH, transferred to UIC Neurosurg for eval -Head CT neg

  4. Other Medical history: -asthma -HL -h/o GIB, unclear etiology All: baclofen Transfer Meds: valsartan, verapamil, simva, celexa, albuterol, EPO, famotidine SH: 40 py tob; FH: no early CAD

  5. Exam: AF, 123/61, P100 Gen: morbidly obese, intubated, sedated Neck: thick, unable to eval JVP CV; RRR, soft heart sounds, no clear murmur, PMI difficult to appreciate Lungs: vent sounds GI: soft Ext: no edema, no trauma

  6. -pan labs revealed: CK 339555 (4 hours apart) MB 14.4 (RI 42%)  21.5 (RI 39%) Trop 3.38  11.63 WBC 18K (nl at OSH), Hgb 10, Plt 300 Na 135, K 4.5, CO2 26, BUN 93, Cr 16.6

  7. Baseline from 12/05

  8. 9/18/06 at 1857

  9. EKG at 2152

  10. Cardiac enzyme trend over ~36 hours: Trop 31117 12 7… MB: 42 38  22  15… CK: 339  555  916  400 …

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