Nov 2,2019

SICU 1 SICU 2
Layron, Angelito 65/M/CPNBB Lerios, Felipe 71/M/RPV
Dr. Madrona Dr. Gueco
9th sicu day 6th sicu day
171st (may 25, 2019) post-op day 8th post-op day

Dx: Massive UGIB sec to BPUD vs stress Gastropathy vs stress Dx: BURST LOBE, LEFT ACUTE SUBDURAL HEMORRHAGE
related mucosal injury-resolved, Rectal adenocarcinoma st.IIIB s/p FTP, LEFT, S/P EVACUATION OF BURST LOBE LEFT, ARF
LAR s/p 1 cycle chemo; urothelial carcinoma with rhabdoid features TYPE I SEC TO 1 HAP VS 2 PULMONARY CONGESTION,
CKD sec to obstructive uropathy PRESUMTPIVE PTB, COPD SUSPECT, HASCVD ACC/AHA ST.
B
S: S:
(+) flatus (-) febrile episodes
(+) abd pain raditating to right lower chest area PS 6/10 (+) HPN 140/80
(+) hypertensive episodes (BP 170/110) (-) desat
last BM (10/31/19) greener paste

O: O:
Awake, coherent, NIRD with the ff V/S: GCS 10 (E4 VT M5)
BP-150/100 CR-103 R-20 T-36.4 O2-96% BP-150/90 CR-93 R-19 T-38.2 O2-99%
I/O- I/O-
UO- UO-
AS, Pale palpebral conj AS, PPC
SCE, CBS SCE, (+) rhonchi right
AP, DHD, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Distended abd, firm, midline incision scar, (+) tender on deep Soft, flabby, nontender
palpation, abd girth 85 cm  92 cm CRT <2sec FEP
CRT < 2sec, bipedal edema
LABS:
LABS: Hgb-112 Na-146 mmol/L
Ph- 7.3 Pco2-28 po2-28 hco3-13.8 sao2-98% Hct-0.34 Crea- 116
WBC 12.2 (77, 12, 2, 4) K-4.1
UA: Y, sl turbid, 1.024, ph 5, neg gluc, +1 chon, wbc 8-10, rbc 3-5, Plt- 177 Ca-2.1 Alb- 25 ↓
some bacteria, few squamous cells

BUN- 21 Crea- 282 Na- 137 K- 3.9 Cl- 107, Ca-2.1, Mg- 0.9

CBC- Hgb 139, Hct 0.43, plt 338, WBC 12.8 (0.87, 0.11, 0.02)
FPA initial 10/31: segmental adynamic ileus susp of ascites non
obstructing gas pattern
FPA initial 11/2: small bowel ileus with some air fluid level on left
lateral decubitus cannot rule out partial bowel obstruction pheboliths
OA-15
A: prob Malignant Ascites A: ARF sec to 1-HAP; 2-pulmo congestion
P: for pain mgt: paracetamol 1g IV q8 RTC, Tramadol 50 mg IVq8 P: serial Na monitoring q8
RTC
Present meds:
Start NaHCO3 tab TID - Piptaz 4.5 g/TIV q6 day 7
Repeat crea - Dravent neb q8 RTC
Dec fluconazole 100mg/tab OD - NAC OD HS
- For packed dressing to prevent emphysema
- Dec mannitol to 80 cc q6

SICU 3 SICU 4
Trillana, Francisco Jr 72/M/ CP Umaguing, Erlinda 81/F/RPV
Dr. Lizan Dr. Perez
Nov 2,2019

134th sicu day 7th sicu day

133rd post-op day 4th post-op day

Dx: Multiple Intracranial Hemorrhage sec to MVA s/p FTP Dx: Acute Limb Ischemia Right foot s/p E embolectomy, R S/P
craniectomy with evacuation of ICH ventilator dependence sec to BKA right S/P IJ catheter insertion right
central apnea sec to ICP s/p tracheostomy chronic hyponatremia

S: S:
(-) febrile episodes (+) desat 92 to 96 (+) minimal post op pain
(-) dyspnea (-) N/V Dry dressing
(-) hypotension Hypertensive ep (140’s)
O: O:
GCS 10 (E3 V1 M5) with the ff V/S: GCS 15 hook on 02 at 2 lpm
BP-120/90 CR-76 R-19 T-36 .1 O2-99% BP-170/90 CR-96 R-20 T-36.1 O2-98%
I/O- I/O-
UO- UO-
AS, PPC AS, PPC
SCE, (+) bibasal rales SCE, (+) rales on LLB
AP, DHD, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Soft, flabby, nontender Soft, flabby, nontender
CRT < 2sec, (+) edema (+) dry pressure dressing R leg at popliteal area
(+) cynosis of left foot, cold to touch, with no dorsalis pedis pulse, no
LABS: sensation
Na- 132
K- 3.6 LABS:
Cl- 97 BUN- 12.6 PT-14 INR-1.05 PTT-30
Mg- 0.7 Crea-341 Hgb- 89 Hct-0.27 WBC-9.2 (79 19
1 1)
Na-137 plt- 262
K- 3.9
Cl-105
Ca- 2
Mg- 0.7

A: A: ARF sec to HAP

P: for pain mgt: paracetamol 1g IV q8 RTC, Tramadol 50 mg IVq8 P: serial Na monitoring q8
RTC
Start vit L 2 amp TIV q8 Present meds:
Bed turning q2 - Piptaz 2.5 g/TIV q6
For daily RSBI (rapid shallow breathing index) - Duavent neb q8 RTC
Meds: - NAC OD HS
- Cipro 500mg/tab BID (D7) - Paracetamol 1g IV q8 x 6 doses
- NaCl tab TID - Tramadol drip 300mg in 500cc pnss to run for 24 hrs
- Gabapentin 300mg/cap 1 cap ODHS
WOF: soaked dressing, post op pain, hpn

SICU 5 SICU 6
Bacungan, Ricardo 59/M/CP Amoroso, Eutiquino 57/M/ VMMCP
Dr. Lizan Dr. Gueco
13th sicu day 4th sicu day
13th post-op day
Nov 2,2019

Dx: OBSTRUCTIVE HYDROCEPHALUS SEC TO CEREBELLR ICH, S/P ‘E’ EVD Dx: ACUTE ICH LEFT TEMPORAL AREA WITH PERILESIONAL EDEMA
FRONTAL RIGHT, SUBOCCIPITAL CRANIOTOMY WITH EVACUATION OF APPROXIMATELY 50 CM. SAH LEFT PARIETAL AREA, LEFT FRONTAL,
CEREBELLAR ICH; HAP; ELEVATED TRANSAMINASES HASCVD AF W/ RVR, ACC/AHA ST. B

S: S:
(+) febrile episodes (+) hypotensive palp 90  80/50  120/80
(+) tachycardic 130’s
(+) dec UO
O: O:
GCS 6 (E1 V1 M4) with the ff V/S: GCS 15 hook on 02 at 2 lpm
BP-110/90 CR-79 R-19 T-36 .1 O2-99% BP-170/90 CR-96 R-20 T-36.1 O2-98%
I/O- I/O-
UO- UO-
AS, PPC AS, PPC
SCE, (+) rhonchi both lung fields SCE, (+) bibasal crackles; dec BS LLF
AP, DHD, NRRR, (-) murmur AP, tachycardic, irregular rhythm, (-) murmur
Soft, flabby, nontender Soft, flabby, nontender
CRT < 2sec, (+) edema CRT < 2sec, FEP

LABS: LABS:
CT scan initial: acute ICH L temporal lobe 2.3.4cm with perilesunal
edema approx. 50cc; punctate hemorrhage, left frontal; minimal
SAH, Left FP area; small air pocket collection cortex right, Both
ethmoid and max sinusitis; no midline shift

CXR: prob mid hilar congestive changes underlying pneumonia RLL

not ruled out; ruled out PE Right

A: A:
P: serial Na monitoring q8 Amiodarone for 24hrs
Dobutamine drip 4 amp in 250cc D5w x 20 mmhg

SICU 8 SICU 10
Gamez, Alfonso 76/M/RPV ABELLA, ARTURO 83/M/RPV
Dr. Gueco Dr. H. Cruz
2nd sicu day
post-op day _sicu day

Dx: ACUTE ICH LEFT, THALAMOGANGLIONIC WITH IVE; OBSTRUCTIVE Dx: PARTIAL INTESTINAL OBSTRUCTION PROB SEC TO SMALL BOWEL
HYDROCEPHALUS WITH IVE NEW GROWTH
Nov 2,2019

S: S: vomiting and abd pain

Desat -90%-98% RR-26 O2 at 10 lpm
2 days PTA, pt complain of no BM but with flatus x 3days assoc
with : (+) N/V x 3 ep 1 cup brownish, (+) abd pain, (+) abd
distention took Dulcolax with partial relief

1 day PTC, s/sx persisted. Consult at Asian hospi FPA and other labs
done. NGT inserted draining 1L billous vomiting. Due to RPV status
pt was referred in this institution.

O: O:
Obtunded, GCS 7 (E1 V1 M5) with the ff V/S: GCS 15 hook on 02 at 2 lpm
BP- 140/90 CR-101 R-22 T-37 O2-99% BP-100/60 CR-76 R-22 T-36.4 O2-98%
I/O- I/O-
UO- UO-
AS, PPC AS, Pale conj
SCE, (+)rhonchi SCE, CBS
AP, tachycardic, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Soft, flabby, nontender Soft, distended, tympanitic, (+) direct tenderness on all quadrant
CRT < 2sec, (-) edema (AG: 122cm), no mass, DRE collapse rectal vault with fecal matter
on examining finger
CN I- cant assess CRT < 2sec, FEP, pale nail beds, (-) edema
II- Left pupil 2mm NRTL, R pupil 4mm NRTL
III, IV, VI- cant assess LABS:
V- no corneal reflex Hgb-114 BUN- 42.1 AST-12
VII- (+) facial asymmetry Hct-0.35 Crea- 890 ALT- 25
VIII, IX, X, XI, XII- cant assess WBC- 7.7 ( 51 18 6 15) Na-134 Alb- 43
CT- 6min K- 6
LABS: BT-2.30 min Cl- 84
CT scan initial: Acute L thalamus ganglion bleed with extension to PT-14.1 Ca- 7.3
the adjacent white matter perilesurial edema approx. 50cc INR-1.06 in P- 3.8
Acute intraventricular hemorrhage extension PTT-24.5 Mg- 1.3
Post horn of the R lateral ventricle and L lat ventricle midline shift to
the R approx. 0.03 cm; obstructed R bilateral maxillary sinus dse FPA: gen ileus, non obstructing pattern of left lateral decubitus susp
ascites

CXR: PE left
A: A:
P: start nicardipine drip 10mg +/- 5mg to maintain <140/90 P:
Hook to 10 lpm via facemask NPO
Nebulized salbu + ipratropium q15 x 3 doses Metronidazole
Still on DNI/DNR status Omeprazole
Hydrocortisone 250mg/TIV now Tramadol
paracetamol

SICU 11 SICU 12
GRUSPE, PERFECTO 65/M/RPV Nilayan, Josefa 88/F/ RPVD
Dr. Gueco Dr. Solomon
27th sicu day
_ sicu day 15th post-op daw (EGD) UGIB prob 2 to coagulopathy
post-op day

Dx: ACUTE ICH (ICH SCORE 1), CAP MR, PLEURAL EFFUSION RIGHT PROB Dx: ACUTE ICH LEFT, THALAMOGANGLIONIC WITH IVE; OBSTRUCTIVE
SEC TO PARAPNEUMONIC VOLUME OVERLOAD; HASCVD SEC TO AHA ST. B HYDROCEPHALUS WITH IVE
SR; T2DM; AKI ON TOP OF PROB CKD; PTB TREATMENT COMPLETED (2007,
2014)

S: S:
Nov 2,2019

Known hypertensive DM PTB tx completed in 2014. Condition Inc BP x 1 ep (clonidine given 75mg/tab SL)
started 4 days PTA, (+) neck pain and Headache with 3 ep of (-)hematochezia
vomiting of prev ingested food. Sought consult at local hospi advised
admission due to financial constraint opted to transfer in this
institution
O: O:
GCS 15 with the ff V/S: GCS 15 hook on 02 at 2 lpm
BP- 140/90 CR-101 R-22 T-37 O2-99% BP-140/90 CR-92 R-20 T-36.4 O2-98%
I/O- I/O-
UO- UO-
AS, PPC AS, PPC
SCE, (+) rales both, dec BS right base SCE, CBS
AP, tachycardic, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Soft, flabby, nontender Soft, flabby, nontender
CRT < 2sec, (-) edema, (+) hyperpigmentation both lower ext CRT < 2sec, FEP, bilateral lower ext edema

Intact CN, no motor and sensory deficit LABS:

Hgb-97
LABS: Hct-0.29
Hgb-126 BUN- 19.8
Hct-0.39 Crea- 629
WBC- 19.9 ( 88 4 1 1) Na-131
AST- 18 K- 3.8
ALT- 40 Cl- 99
Alb- 41

ECG: NSR
CXR: PE right, pneumonia

CT scan- acute ICH, R ventilation nucleus extension to the R normal

RBC approx. 3 cm with surrounding edema, subthalamic hematoma
0.2 cm development bilateral; right sinus dse, small hydrceph noted
in right side of pons

A: A:
P: P:
Ceftriaxone Plan for d/c noted by all services
Azith KCL tab 1 tab TID
Salb + ipra Metronidazole 500mg qIV q8 for 7 more days
Amlo Cipro 500mg IV q12 for 7 more days
Atorvast
Humulin R 6u
Gliclazide