CONTACTS
SUBJECTS
Angiogram Cardiac Catheterization Medical Test Coronary Artery Disea
2603 -
2603 - ..
2604 - Summary/Objective
2605 -
260501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
260502 -
260503 -
260504 -
260505 -
260506 -
260508 - ..
2606 -
2607 -
2608 - Background
2609 -
260901 - On 090916 VA performed stress test, which indicated possible heart
260902 - and circulation problems.
260904 - ..
260905 - On 091002 met with Doctor Egan, Cardiologist at the VA. The doctor
260906 - advised that 10 of 11 test points in the stress test showed positive
260907 - for circulation problems, and so the doctor ordered angiogram.
260908 - ref SDS 7 1W5I
260910 - ..
260911 - On 091006 0843 Karen called and scheduled angiogram test on 091020 at
260912 - the VA in San Francisco. ref SDS 8 1W5I Received a letter from Karen
260913 - on 091006 at 1045 confirming schedule for the test which requires
260914 - arriving at the VA on 091019 to do prep for the test on 091020.
260915 - ref SDS 8 GK8L
260917 - ..
260918 - On 091007 0021 sent a letter notifying the medical team that Doctor
260919 - Egan's treatment plan is being implemented, and asked a question about
260920 - the cause of pain based on level of effort. ref SDS 9 4Z75
260922 - ..
260923 - On 091007 0818 received letter from Karen at VA in San Francisco
260924 - responding to the letter this morning asking the medical team for
260925 - cause of chest pain that correlates to level of effort. Doctor Egan
260926 - has not had time to respond. Karen attributes pain to possible
260927 - angina, but does not explain what causes pain. ref SDS 10 A68H
260929 - ..
260930 - 091019 1300 meeting at VA in Cardiology for blood test to prepare for
260931 - angiogram test tomorrow, ref SDS 11 X59F, per Karen's letter on 091007
260932 - 0818. ref SDS 10 A68H
260934 - ..
260935 - 091020 0700 meeting at VA in San Francisco for angiogram test delayed,
260936 - ref SDS 12 01F9, explained in the record on 091019 1300. ref SDS 11 VH6Q
260938 - ..
260939 - 091021 0716 Meeting at VA to complete angiogram test orientation
260940 - meeting, ref SDS 0 01F9, and perform test.
260941 -
260942 -
260944 - ..
2610 -
2611 -
2612 - Progress
2613 -
261301 - Meeting with Yunip Kim, MD, supplementing meetings last night with
261302 - Gene Quinn, MD, reported on 091020 0700, ref SDS 12 I23F, and with
261303 - Julie Ishida, MD about an hour later. ref SDS 12 I24K
261305 - ..
261306 - Explained medical history again for current problem, reported to
261307 - Doctor Egan at the Va in Martinez, on 091002 0900. ref SDS 7 1W5I,
261308 - citing the record meeting with Doctor Lee at the VA in Martinez on
261309 - scheduling a procedure to resolve achalasia, reported on 090908 1130,
261310 - ref SDS 6 MY4N, and further and cited in the letter to Karen on 091007
261311 - 0021. ref SDS 9 VM4V
261313 - ..
261314 - Yunip advised that even if the angiogram test is negative, and so is
261315 - completed today, there is still a 4 hour waiting period for evaluation
261316 - of the test entry wound healing correctly. If any repair is
261317 - performed, then the patient will stay overnight for observation to
261318 - ensure post-op medication is given correctly,
261319 -
261321 - ..
2614 -
2615 -
2616 - 0909
2617 -
261701 - Cardiac Catheterization Angiogram Test Performed Cath Lab
261702 -
261703 - Dennis arrived with a gurney in the hospital room for transport to
261704 - the Catheter Lab to perform the angiogram procedure.
261706 - ..
261707 - Was told the patient will return to this room after cardiac
261708 - catheterization (angiogram test) scheduled by Karen in her letter on
261709 - 091006 0843, ref SDS 8 7M4U, so left all belongings in the room. The
261710 - attending nurse helped store the computer behind a night stand.
261711 -
261712 - [...below, on 091021 after angiogram test, doctor prescribed
261713 - heart bypass surgery, so taken to Intensive Care Unit (ICU);
261714 - belongings were brought to ICU, which will be "home" for a few
261715 - days. ref SDS 0 7353
261717 - ..
261718 - Wheeled into a very high tech Cath lab. The main control panel is
261719 - about 4' high and 8' long, and displays from 4 - 6 very large screen
261720 - computer monitors.
261722 - ..
261723 - Dennis has just returned from vacation rafting on the Colorado river.
261724 - Sounded like the trip was for 250 miles, but he only had time for
261725 - about half, 150 miles. This was his first time rafting on the
261726 - Colorado river, but he does a lot of this type of activity. Seems to
261727 - be in very good shape.
261729 - ..
261730 - Dennis noticed I was humming a tune. He asked what kind of music I
261731 - like. Mentioned Simon and Garfunkle. Lynn, an attending nurse, then
261732 - played on her ipod the main album over the speaker system, through
261733 - most of the test. This reflects a very high effort to support
261734 - patients.
261736 - ..
261737 - Dennis, Lynn, and several others, possibly "Latisha," did terriffic
261738 - work on "preparation" for the actual test. This includes shaving
261739 - locations and setting up 5 - 10 probes for EKG monitoring; also blood
261740 - pressure. The IV set up yesterday was used to infuse fluids, think
261741 - this was just water to prevent dehydration. There is also a
261742 - connection made for urinating during the procedure. Extensive
261743 - drapping of various forms was applied. Preparation and configuration
261744 - take about 30 minutes.
261746 - ..
261747 - Asked Dennis about precautions to avoid problems from achalasia?
261749 - ..
261750 - Dennis said he was not aware of any problems. He had never heard of
261751 - achalasia.
261753 - ..
261754 - We reviewed the meeting with Doctor Kurt Hoffman on Monday, 091019
261755 - explaining achalasia that causes problems vomitting and breathing,
261756 - when laying flat. ref SDS 11 AX5J
261758 - ..
261759 - Dennis said there is nothing in record for the procedure this morning
261760 - that warns the team about breathing problems from laying flat during
261761 - the angiogram procedure.
261763 - ..
261764 - Dennis confirmed that the angiogram procedure this morning requires
261765 - the patient to lay absolutely flat. In this case, Dennis will provide
261766 - a folded towel to slightly elevate the head. He will alert the
261767 - medical team to administer a suction apparatus that relieves problems
261768 - of choking due to achalasia,
261769 -
261770 -
261772 - ..
2618 -
2619 -
2620 - 0930
2621 -
262101 - Doctor Alexis Beatty, MD applied anenesthetic to the groin. This is
262102 - done in two steps. The first needle injection is very evident, but
262103 - only for a few seconds. The second is barely noticable.
262105 - ..
262106 - A nurse or someone placed a folded towel under the head, and placed a
262107 - suction tube slightly down the throat which the patient could control
262108 - by closing the mouth to relieve any backflow. This was monitored
262109 - continuously to ensure patient comfort and safety during the entire
262110 - procedure, implementing Dennis' plan, per above. ref SDS 0 KH32
262111 -
262112 - [...below on 091021 0716 at 1429 discussed achalasia
262113 - problems with Doctor Tseng and CT team; explained remedies
262114 - during angiogram test. ref SDS 0 NX6M
262116 - ..
262117 - Doctor Shunk performed cardiac catheritization for angiogram test
262118 - investigating and filming the coronary circulatory system. This took
262119 - about 20 minutes.
262121 - ..
262122 - Doctor Shunk seemed to say the angiogram test discovered 2 very severe
262123 - blood flow blockages, called stenosis or strictures. He said there
262124 - may be a 3rd blockage, but it is not severe.
262125 -
262126 - [...below on 091021 0716 at 1344 Craig does another
262127 - sonogram test to check heart and cross check for blood flow
262128 - blockages that guide scope of CABG surgery. ref SDS 0 0C66
262130 - ..
262131 - [On 091022 0700 quadruple heart bypass surgery performed by
262132 - Doctor Tseng, and her team; took about 16 hours. ref SDS 13
262133 - LO3G
262135 - ..
262136 - [On 100928 0706 review medical chart shows angiogram test
262137 - found 3 vessel cad (coronary artery disease). ref SDS 22
262138 - H24L
262140 - ..
262141 - The doctor said: "Rod, let me show you what we are seeing."
262143 - ..
262144 - Patient was rolled onto left side to view about 6 large screen
262145 - monitors. The doctor showed film from the test. He stopped the film
262146 - to show still pictures of specific problems, which he explained as
262147 - follows...
262148 -
262149 - 1. Heart shows no evidence of damage nor weakness of function
262150 - commonly associated with heart problems.
262152 - ..
262153 - 2. On the right side of the heart, the artery has a single but
262154 - severe restriction/blockage. Computer monitor shows blood
262155 - flowing freely under high pressure squirting past a blockage.
262156 - There was an impression that blood was actually squirting out
262157 - of the artery, like a leak in a hose, or similar to holding a
262158 - finger over a nossel. Doctor Shunk advised this blockage can
262159 - be treated successfully today with a stent.
262161 - ..
262162 - 3. On the left side of the heart the artery has another single but
262163 - severe blood flow restriction. This blockage is located where
262164 - the main left artery branches into 2 smaller arteries. Doctor
262165 - Shunk advised that he can apply a stent to this location today,
262166 - which would conclude treatment, implementing the process
262167 - described by Kurt on Monday, 091019 1300. ref SDS 11 0Y67
262168 - Doctor Shunk advised that the location of the left restriction
262169 - (stenosis) presents significant risks of early failure, because
262170 - of difficulty configuring a bend and/or Y shaped stent; the
262171 - doctor further assessed a 10% risk of heart attack or other
262172 - complication, including death, attempting to apply a stent at
262173 - this location.
262175 - ..
262176 - 4. Third stenosis was not expressly shown nor discussed.
262178 - ..
262179 - There is no appearance of blood clots on either of the 2 blood flow
262180 - blockages shown on the computer monitor. Doctor Shunk did not
262181 - diagnose nor otherwise mention blood clots, thrombus, and embolism at
262182 - any time, while performing cardiac catheritization for the angiogram
262183 - test and making findings, per above. ref SDS 0 AL9O
262185 - ..
262186 - Blood flow restriction discovered in the angiogram test today may
262187 - align with report of high cholesterol in the lab on 090813 1500,
262188 - ref SDS 5 4N5H, also shown in graph of patient history, ref SDS 5
262189 - NQ86, and ordered by Doctor Sandhu the day before on 090812 1030.
262190 - ref SDS 4 MA6I
262192 - ..
262193 - Doctor Shunk asked about symptoms from these three (3) severe blood
262194 - flow strictures? He advised that the patient should have severe chest
262195 - pain on the order of a "heart attack" from sitting and walking around
262196 - the house or from the parking lot to the store, i.e., from very minor
262197 - exertion.
262198 -
262199 - [On 100928 0706 review medical chart shows angiogram test
262200 - found 3 vessel cad (coronary artery disease). ref SDS 22
262201 - H24L
262203 - ..
262204 - Reviewed the record on 090908. ref SDS 6 MY51 In this case there have
262205 - never been symptoms of any kind with even mild exertion. Mild chest
262206 - pain recently began occurring doing heavy exercise, hiking up hills at
262207 - Lafayette Reservoir on a 3 mile route with 2 or 3 steep and long
262208 - hills. If the pace is reduced there is no pain on the entire route,
262209 - but hiking the same fast pace used the past 4 years, suddenly about 6
262210 - weeks ago began to feel pain after going up the 2 main hills, and
262211 - would continue until the pace was reduced, and then there would be no
262212 - symptoms hiking at a reduced pace.
262214 - ..
262215 - Doctor Shunk seemed to feel this record conflicts with normal symptoms
262216 - associated with severe blood flow blockages observed today during the
262217 - angiogram test, per above. ref SDS 0 7L47 He explained these major
262218 - artery restrictions should have caused pain walking, even getting up
262219 - from a chair or out of bed.
262221 - ..
262222 - We reviewed the record again, showing no reports of any such pain nor
262223 - difficulties of any kind doing normal activities, nor doing very
262224 - strenuous hiking 3 - 14 miles per day doing 3 mile laps about 4 - 6
262225 - times per week at Lafayette Reservoir over the past 5 years, since
262226 - 2004. The only possible signal was heart rate getting to about 220
262227 - running the hills, and then takes about 6 hours to return to normal at
262228 - about 65 beats per minute. This was only checked rarely because we
262229 - used the heart rate monitor to check Millie's condition, who was
262230 - being treated for stage 4 cancer.
262232 - ..
262233 - During the meeting at the VA in Martinez for a stress test, the
262234 - cardiology doctor theorized that heavy exercise expanded capillaries
262235 - to carry more of the load to and from the heart making up for loss of
262236 - blood flow caused by restrictions in arteries observed today during
262237 - coronary catheritization for the angiogram test. This was effective
262238 - until the rate of loss due to artery restriction began to exceed the
262239 - capacity of capillaries to expand, reported on 091002 0900.
262240 - ref SDS 7 789N
262242 - ..
262243 - The doctor advised that findings from the Cath Lab angiogram test this
262244 - morning have been reported to Cardiology and to the Cardiothoracic
262245 - Surgery people.
262247 - ..
262248 - Doctor Shunk feels that heart by-pass surgery (also CABG - coronary
262249 - artery bypass graft) will be less risky and provide a longer solution
262250 - than stents. He advised that stents wear out after a few years and
262251 - have to be done again.
262252 -
262253 - [On 091022 0700 quadruple heart bypass surgery performed by
262254 - Doctor Tseng, and her team; took about 16 hours. ref SDS 13
262255 - LO3G
262257 - ..
262258 - This recommendation today aligns with Doctor Eagan's work plan at VA
262259 - Martinez during meeting on 091002, ref SDS 7 M266, and confirmed in
262260 - the doctor's medical chart. ref SDS 7 7S8M
262262 - ..
262263 - The doctor's notice that stents require continual return for follow up
262264 - repairs aligns with numerous questions from the Cardiology staff on
262265 - Monday, asking if this is the "first time" getting the angiogram test
262266 - procedure, reported yesterday on 091019 1300, ref SDS 11 CW6G
262267 - Actually, another doctor asked the same thing last night after being
262268 - admitted to the hospital, shown on 091020 0700. ref SDS 12 C46L
262270 - ..
262271 - Doctor Shunk explained that the team sometimes sees the same patient
262272 - numerous times for repairs to correct circulatory problems resulting
262273 - from continual failure of stents, indicated in discussion with Karen
262274 - yesterday on 091020 0700, ref SDS 12 3C9J, and considering experience
262275 - reported earlier in the morning. ref SDS 12 U59M
262277 - ..
262278 - Doctor Shunk related that the cardiology team in consultation with the
262279 - Cardio Thoracic Surgery Department reviewed angiogram test results
262280 - today. Both Surgery and Cardiology recommend heart bypass surgery, as
262281 - presenting less risks, and providing a longer, more reliable solution
262282 - than attempting to apply stent surgery today, per analysis above.
262283 - ref SDS 0 7L64
262284 -
262285 - [...below Doctor Tseng, attending physician for
262286 - cardiothoracic surgery team, also feels that CABG is more
262287 - reliable than stents; but did not indicate mean-time-to
262288 - failure for bypass grafts. ref SDS 0 FO7I
262290 - ..
262291 - [On 091022 0700 quadruple heart bypass surgery performed by
262292 - Doctor Tseng, and her team; took about 8 hours. ref SDS 13
262293 - LO3G
262295 - ..
262296 - [On 170314 0817 discuss participating clinical trial MRI
262297 - coronary angiography evaluate regress atherosclerosis hike
262298 - 11 miles - 15 miles per day, follow up CCTA 151019.
262299 - ref SDS 28 EO7M
262301 - ..
262302 - Asked if the test today showed any evidence of aspiration into the
262303 - lungs, based on years of vomitting several times during almost every
262304 - meal?
262306 - ..
262307 - The doctor indicated the test found no evidence of lung injury from
262308 - aspiration, and further found no evidence of cancer.
262310 - ..
262311 - Doctor Shunk indicated his examination today found that the strength
262312 - of the heart from patient history of exercise running 4 - 12 miles
262313 - from about age 23 to 38, and subsequent hiking 3 - 15 miles per day at
262314 - Lafayette reservoir beginning in 2003, together with evident vitality
262315 - without history of sickness nor maladies, e.g., diabetes, stroke,
262316 - cancer, and without life-style issues of drug, smoking nor alcholol
262317 - abuse, nor obesity, all present patient profile ideal for heart
262318 - bypass, who can tolerate the procedure, and recover quickly.
262320 - ..
262321 - Asked about recovery?
262323 - ..
262324 - Doctor Shunk advised that after heart bypass surgery patients can
262325 - return to prior life-style of heavy exercise, within 3 - 6 months.
262326 - Circulatory problems will be largely solved permenantly with
262327 - understanding that patient history of problems identified today
262328 - establish the biology has disposition for circulatory restriction
262329 - which requires directed effort to avoid.
262331 - ..
262332 - Asked when the surgery would be performed, in a week, a month?
262334 - ..
262335 - The doctor advised that, if the patient chooses to repair artery
262336 - stenosis problems with stents, he can do it now, and it will take
262337 - about 40 minutes to an hour.
262339 - ..
262340 - If the patient approves medical recommendations for heart bypass
262341 - surgery, the work will be performed tomorrow morning at 0700, by
262342 - Doctor Tseng, so it will not be necessary to re-schedule, and go
262343 - through all the tests and preparation again. IV's will remain in
262344 - place, and the patient will be taken to the "Intensive Care Unit"
262345 - (ICU) for preparation, rather than returned back to the hosptal room
262346 - used last night, per discussion with Dennis, above. ref SDS 0 025B
262348 - ..
262349 - [...below, meeting with Doctor Tseng, and Cardio Thoracic
262350 - (CT) surgery team. ref SDS 0 P34P
262352 - ..
262353 - [On 130315 0700 patients not given choice whether to have
262354 - general anesthetic during c-section surgical child birth,
262355 - doctor's force patients to be awake and observe surgery
262356 - after administering local anesthetic with spinal epidermal.
262357 - ref SDS 26 F63F
262359 - ..
262360 - Agreed to heart bypass surgery tomorrow based on professional advice
262361 - that it provides a stronger, longer-term soution with less risks in
262362 - this case. ref SDS 0 WB3K Nobody so far has indicated durability -
262363 - mean time to failure - of coronary artery bypass grafts (CABG).
262365 - ..
262366 - Subjecting stent technology to frequent, high pressure from heavy
262367 - exercise could increase failure rates for stents. Therefore, CABG
262368 - surgery seems like the best solution in this case to enable continued
262369 - healthy lifestye.
262370 -
262371 - [...below, signed electronic document approving coronary artery
262372 - bypass graft (CABG) surgery. ref SDS 0 04G6
262374 - ..
262375 - Thanked Doctor Shunk, Alexis, Dennis, Lynn, and the entire Cath Lab
262376 - team for a great experience performing the angiogram test, including
262377 - high quality of professional analysis, per above. ref SDS 0 7L47
262378 -
262379 - [On 091022 0700 quadruple heart bypass surgery performed by
262380 - Doctor Tseng, and her team; took about 8 hours. ref SDS 13 01F9
262381 -
262382 -
262384 - ..
2624 -
2625 -
2626 - 1015
2627 -
262701 - Dennis and Lynn broke down the configuration for this test in the Cath
262702 - Lab, and wheeled the gurney into an adjacent waiting area seemed like
262703 - an administrative area with folks working on a bank of computers.
262705 - ..
262706 - While we waited, I said something like...
262707 -
262708 - Gee, all those miles Millie got me to hike with her the past 4
262709 - years didn't seem to do any good."
262711 - ..
262712 - Dennis said...
262713 -
262714 - "You're wrong Rod. Your patient history of healthy life-style
262715 - is evident in the findings of the angiogram. I was in the
262716 - Control Room checking monitors to provide images and angles
262717 - requested by Doctor Shunk, and so saw everything the doctor
262718 - observed. You can thank Millie because your heart is very
262719 - strong. You should recover quickly and be better than ever.
262721 - ..
262722 - Dennis commented that investment in exercise the past 40
262723 - years makes the decision to perform heart bypass a cost effective
262724 - choice in this case.
262725 -
262726 - [On 091023 0445 the day after heart bypass surgery, Neal, one
262727 - of the doctors on the cardiothoracic team who performed the
262728 - surgery advised that Doctor Tseng expects recovery ahead of
262729 - schedule due to patient good health. ref SDS 15 VR4G
262731 - ..
262732 - Dennis will coordinate to have belongings brought to ICU from the
262733 - hospital room, which was planned to be the recovery location tonight
262734 - if a stint procedure was needed, per above. ref SDS 0 025B
262735 -
262736 - [On 170130 1742 letter to Karen in Cardiology
262737 - Administration asking to meet with Dennis thanking him for
262738 - really great care. ref SDS 27 QG8F
262739 -
262740 -
262741 -
2628 -
SUBJECTS
Heart Bypass Surgery Pre-op Tests Coronary Artery Bypass Graft CABG
3703 -
3704 - 1045
370501 - ..
370502 - Intensive Care Unit ICU Prepare for Heart Surgery Tomorrow
370503 - Heart Bypass Surgery Pre-op Tests Coronary Artery Bypass Graft CABG
370504 -
370505 - Arrived in ICU. Thanked Dennis and Lynn for the ride, and further for
370506 - highly professional work and care they have provided.
370508 - ..
370509 - Met Arvine, who provides nursing support for ICU activity.
370511 - ..
370512 - Arvine got everything set up and connected test equipment that
370513 - monitors patient condition. This was very complicated. Arvine was
370514 - exceptional getting things done quickly, accurately, and with
370515 - attention to patient physical and emotional comfort.
370516 -
370517 - [On 091023 0445 day after heart surgery returned to ICU, and
370518 - Arvine did initial setup again. ref SDS 15 6951
370520 - ..
370521 - A nurse from the 2nd floor TCU went and brought belongings to the ICU
370522 - room, which were left on the 3rd floor this morning, including the
370523 - computer, per above. ref SDS 0 025B
370524 -
370525 -
370526 -
3706 -
SUBJECTS
Default Null Subject Account for Blank Record
3903 -
3904 - 1130
390501 - ..
390502 - Blood Draw Lab Tests Reqires IV Catheter Avoid Muliple Penetrations
390503 -
390504 - Dave drew blood. This was done on the right arm above the wrist on
390505 - the left side. Dave explained he cannot use the PIV on the top of the
390506 - left hand, because the blood draw is testing for oxygen, and this
390507 - requires an artery which is on the right side, while veins are on the
390508 - left side.
390510 - ..
390511 - Dave removed the needle after drawing blood. He explained there was
390512 - no need for a continuing IV because he only needed a little bit of
390513 - blood for the test he was supporting.
390514 -
390515 - [...below Kevin visited to draw more blood, but had
390516 - difficulty finding a source for adequate flow, and so left
390517 - without completing the work. ref SDS 0 737P
390519 - ..
390520 - [...below Sue and Steven tried to set an IV catheter and
390521 - had more problems. ref SDS 0 BU5I
390522 -
390523 -
390524 -
390525 -
3906 -
SUBJECTS
Default Null Subject Account for Blank Record
4003 -
4004 - 1207
400501 - ..
400502 - Sonogram Test Blood Flow to Brain Adequate for Heart Bypass Surgery
400503 -
400504 - Irene visited to perform ecco (sonogram - ultrasound) test on the left
400505 - and right side of the neck to evaluate blood flow to the brain. Heart
400506 - surgery requires evidence that the brain is getting adequate blood
400507 - supply, and if not, then procedures will be implemented to increase
400508 - blood flow sufficient for heart bypass surgery.
400509 -
400510 - [...below on 091021 0716 at 1344 Craig does another
400511 - sonogram test to check heart and cross check for blood flow
400512 - blockages. ref SDS 0 0C66
400514 - ..
400515 - Irene takes a lot of pride in her work, and seems very skilled using
400516 - the equipment, working quickly and purposefully. She has been doing
400517 - this work for several years.
400519 - ..
400520 - Results will be read by a radiologist, who will prepare a written
400521 - report for the medical team to evaluate on suitability for the heart
400522 - surgery operation currently scheduled tomorrow.
400524 - ..
400525 - Irene said nothing jumped out that looked like a blood flow or other
400526 - problem.
400527 -
400528 - [On 091030 0810 Irene did another sonogram to confirm DVT
400529 - caused by Cordis IV, that required resolution prior to
400530 - release from hospital. ref SDS 16 1N5P She was especially
400531 - considerate of patient's time and objectives, by arranging
400532 - to have the patient wheeled back to telemetry in order to
400533 - work for an hour or so concurrent with the Sonogram
400534 - Department working through a surge of patients, and then
400535 - sent someone to wheel the patient back to Radiology for
400536 - performing a 10 minute test. ref SDS 16 1N8W
400538 - ..
400539 - [On 091208 1300 follow up sonogram finds no evidence of DVT
400540 - nor blood clotting of any kind in location discovered
400541 - today; Doctor Stewart orders treatments with Coumadin to
400542 - end, which is needed for Heller Myotomy surgery to resolve
400543 - achalasia swallowing problems, scheduled on 091216, but
400544 - with findings 091208, Coumadin need not be resumed after
400545 - surgery. ref SDS 20 D24G
400546 -
400547 -
400548 -
400549 -
400550 -
4006 -
SUBJECTS
Default Null Subject Account for Blank Record
4103 -
4104 - 1325
410501 - ..
410502 - Kevin came by to draw more blood, and place another PIV on the right
410503 - side, because when Dave drew blood earlier today at 1130, he did not
410504 - leave the needle in place for future work, per above. ref SDS 0 7369
410506 - ..
410507 - Kevin had difficulty finding an artery in the right arm for the PIV,
410508 - which he said had to stay in place for the operation tomorrow. This
410509 - seems conflicting with Dave's report earlier today after successfully
410510 - setting an IV, and removing it on grounds that the catheter would no
410511 - longer be needed, per above. ref SDS 0 035B
410513 - ..
410514 - Decided to avoid the inner elbow, because an IV at this location would
410515 - make using the keyboard difficult.
410517 - ..
410518 - Continued difficulty finding a location for the IV caused frustration
410519 - and fatigue, so Kevin eventually took a break. He said that for some
410520 - reason finding a vein or artery is more difficult today than for most
410521 - other patients.
410522 -
410523 - [...below Sue and Steven tried to set an IV catheter and
410524 - had more problems. ref SDS 0 BU5I
410526 - ..
410527 - [On 091022 0700 Doctor Sarah Gebauer and Justin arrived in
410528 - ICU to set IVs for surgery; had problems getting blood
410529 - flow, so planned to use sonogram technology in surgery OR
410530 - for completing the work. ref SDS 13 Z65L
410532 - ..
410533 - [On 110429 1230 case study on similar problems at VA in
410534 - Martinez, getting adequate blood flow through IV catheter,
410535 - related to dehydration from heavy exercise and low water
410536 - intake hours before medical care; solved by getting another
410537 - nurse to complete work. ref SDS 25 SR8M
410538 -
410539 -
410541 - ..
4106 -
4107 -
4108 - 1344
4109 -
410901 - Sonogram Test Heart Complement Angiogram Identify Surgery Issues
410902 -
410903 - Craig arrived to perform another sonogram (ecco) test (following up
410904 - work with Irene earlier, per above, ref SDS 0 04CH). This test checks
410905 - for damage to the heart and looks for blockages, complementing what
410906 - can be seen from the angiogram test performed in the Cath Lab this
410907 - morning, per above. ref SDS 0 7L43 At that time, Doctor Shunk
410908 - indicated the heart looks strong. He found 2 locations where bypass
410909 - surgery is urgently needed, and indicated there might be a 3rd
410910 - location. ref SDS 0 7L47
410912 - ..
410913 - Craig did this in two steps. After he got set up and started work,
410914 - Doctor Tseng and her Cardiothoracic (CT) surgery team arrived. Craig
410915 - paused his setup, and took a break while the patient met with the CT
410916 - team, reported in the record below. ref SDS 0 FB5N
410918 - ..
410919 - After the CT surgery folks left the room, Craig continued the sonogram
410920 - radiology procedure.
410944 - ..
410945 - On completing the sonogram (ecco) test, Craig indicated the CT surgery
410946 - team will review results to plan scope of CABG tomorrow morning.
410947 -
410948 - [On 091022 0700 quadruple heart bypass surgery performed by
410949 - Doctor Tseng, and her team; took about 16 hours. ref SDS 13
410950 - LO3G
410951 -
410952 -
410953 -
410954 -
410955 -
410956 -
410957 -
410959 - ..
4110 -
4111 -
4112 - 1415
4113 -
411301 - Meeting with Joe, one of the attending physicians.
411302 -
411303 - Joe explained the operation recommended by Doctor Shunk in the Cath
411304 - Lab earlier this morning, per above. ref SDS 0 7L61
411306 - ..
411307 - Based on findings from angiogram test, see above, ref SDS 0 7L47,
411308 - electronically signed consent for surgery.
411309 -
411310 - [On 100928 0706 received medical chart from VA, and it
411311 - shows actual consent document. ref SDS 22 KC6N
411312 -
411313 -
411314 -
4114 -
SUBJECTS
Heart Bypass Meeting Prepare Coronary Artery Bypass Graft CABG Surge
5403 -
5404 - 1429
540501 - ..
540502 - Patient History Not Accessible VA Computers Restated 12 Times
540503 - Meeting Cardio Thoracic CT Surgery Team Pre-op Orientation
540504 -
540505 - Doctor Tseng and large team of about 5 or 6 colleagues crowded into
540506 - the ICU patient room. This included KC, Paula, Joe, Neal, and several
540507 - others, possibly students. This is the cardiothoricic surgery team
540508 - that will perform work tomorrow, and follow up for post-surgery
540509 - recovery.
540511 - ..
540512 - Explanation of medical titles is located at...
540513 -
540514 - About Health
540515 - Understanding Different Types of Physicians
540516 -
540517 - http://surgery.about.com/od/questionsanswers/a/Interns-Residents-Fellows-Attending-Physicians.htm
540519 - ..
540520 - Attending Physician
540521 - Doctor/Physician
540522 - Fellows
540523 - Resident
540524 - Interns
540526 - ..
540527 - Doctor Tseng advised that heart bypass surgery (also "Coronary Artery
540528 - Bypass Graft - CABG) was recommended by the cardiology team that
540529 - reviewed results from the angiogram test this morning performed by
540530 - Doctor Shunk. She confirmed understanding that in this case, CABG is
540531 - a less risky and more reliable solution than stents, as indicated by
540532 - Doctor Shunk in the Cath Lab this morning, per above. ref SDS 0 7L61
540533 - The doctor did not present durability of artery bypass grafts.
540535 - ..
540536 - Doctor Tseng asked about patient history of the current problem?
540538 - ..
540539 - Presented the record meeting with Doctor Lee at the VA in Martinez
540540 - listing patient history of swallowing disorder shown on 090908 1130.
540541 - ref SDS 6 FT6M, and schedulng procedure to resolve achalasia, also
540542 - reported on 090908 1130. ref SDS 6 MY4N Doctor Egan's excellent
540543 - analysis in the computer at the VA in Martinez, summarizes patient
540544 - history of long-term achalasia, ref SDS 7 MU4O, and recent chest
540545 - pains, ref SDS 7 MV33, leading to diagnosis of triple vessel disease
540546 - TVD, and medical tests for coronary artery disease CAD, ref SDS 7
540547 - 7S8M, and subsequently explained to...
540548 -
540549 - [On 101117 0530 Doctor Zimmet commended Doctor Eagan's
540550 - excellent cardiology practice. ref SDS 23 SV3T
540552 - ..
540553 - 1. Doctor Lee............................ 090908 1130, ref SDS 6 FT6M
540554 - 2. Doctor Egan........................... 091002 0900, ref SDS 7 1W5I
540555 - 3. Doctor Hoffman........................ 091019 1300, ref SDS 11 PQSR
540556 - 4. Doctor Quinn.......................... 091020 0700, ref SDS 12 I23F
540557 - 5. Doctor Ishida......................... 091020 0700, ref SDS 12 I24K
540558 - 6. Doctor Kim............................ 090121 0716, ref SDS 0 01F9
540559 - 7. Doctor Shunk.......................... 090121 0716, ref SDS 0 7M3T
540560 - 8. Doctor Tseng.......................... 090121 0716, ref SDS 0 P34P
540561 - 9. Doctor Brezinski...................... 091022 0700, ref SDS 13 JF9K
540562 - 10. Doctor Ratcliff....................... 090126
540563 - 11. Doctor Garg........................... 090126
540564 - 12. Doctor Stewart........................ 091030 0810, ref SDS 16 KE3B
540565 - 13. Doctor Penn........................... 091103 0347, ref SDS 17 YJ4O
540566 - 14. Doctor Tabrizi........................ 091208 1300, ref SDS 19 QB7H
540567 -
540568 - [On 091022 0700 anesthesia team difficulty finding patient
540569 - history on achalasia reported in VA computer, and to
540570 - prepare for heart surgery scheduled a few hours later.
540571 - ref SDS 13 JF9L
540573 - ..
540574 - [On 100911 0800 VA credited for improving speed of access
540575 - to computer records; discussed "Knowledge Management loop"
540576 - that redundancy and ignoring the record collapses
540577 - productivity and vitiates care because health care
540578 - professionals do not have command and control of the record
540579 - on patient history, ref SDS 21 OL50, citing case study of
540580 - work at VA today on 091021. ref SDS 0 FB5N
540582 - ..
540583 - [On 100928 0706 received VA's medical records for heart
540584 - surgery and treating achalasia; showing that despite
540585 - numerous reports on effects of achalaia, the VA reported on
540586 - 091021 2133 that the patient has no swallowing problems, no
540587 - vomitting, has not lost weight, has no cought nor choking
540588 - when swallowing, and that food does not get stuck in the
540589 - throat. ref SDS 22 7J5N
540591 - ..
540592 - Doctor Tseng explained that the procedure will start tomorrow at 0700
540593 - preparing the patient for surgery. The patient will be sedated for
540594 - preparation and surgery, and will experience post-surgery discomfort
540595 - and weakness. Medication will be provided to reduce pain. Sounded
540596 - like should be out of recovery and back in ICU room by 1500, so it
540597 - will be a long day.
540599 - ..
540600 - [On 091022 0700 quadruple heart bypass surgery anesthesia work
540601 - commenced, ref SDS 13 01F9; Doctor Tseng attending, with Neal,
540602 - Paula, KC, Joe, and others; operation took about 12 hours.
540603 - ref SDS 13 PQWU
540605 - ..
540606 - [On 091023 0445 woke up in panic with tubes in the throat that
540607 - seemed to restrict breathing and prevented talking, so could
540608 - not explain to the nurse extreme duress. ref SDS 15 01F9
540610 - ..
540611 - The CT team has collaborated with Doctor Shunk and the cardiology
540612 - department. Findings from the angiogram test this morning, per above,
540613 - ref SDS 0 WB3K, will be used to plan heart bypass surgery tomorrow.
540615 - ..
540616 - Asked to see the record of meetings and consultations on planning
540617 - heart bypass surgery, showing application of findings from angiogram
540618 - test, reported above. ref SDS 0 AL9O
540620 - ..
540621 - Doctor Tseng said that planning for the procedure will be reported in
540622 - the medical chart.
540623 -
540624 - [On 100928 0706 received 600 pages of medical chart for
540625 - medical services performing CABG 4x on 091022, at the VA in
540626 - San Francisco; cannot find record planning CABG in this
540627 - case. ref SDS 22 SW6I
540629 - ..
540630 - She further advised that the patient will be hospitaled for 5 - 7 days
540631 - while monitoring daily recovery and safety.
540633 - ..
540634 - The patient will be examined at the hospital a week or 2 later, as an
540635 - outpatient.
540637 - ..
540638 - In 3 - 4 weeks care will be transferred to the cardiologist, possibly
540639 - at the VA in Martinez.
540641 - ..
540642 - Cannot pickup or carry anything heavier than 20 pounds for several
540643 - months while the incision heals, including the breastbone, which will
540644 - be "wired" together, along with the skin being stitched.
540646 - ..
540647 - The patient can resume walking and hiking within a week or so of the
540648 - operation. Hiking is good therapy to aid healing from heart surgery,
540649 - and improve health.
540651 - ..
540652 - Doctor Tseng asked if there is anything in patient history that might
540653 - affect the operation tomorrow?
540655 - ..
540656 - We reviewed achalasia, presented on 091019 during pre-op interview
540657 - with Doctor Kurt Hoffman, noting that breathing and vomitting problems
540658 - occur, when laying flat for surgery. ref SDS 11 AX5J This morning the
540659 - Cath Lab placed a folded towel to slightly elevate the head, and a
540660 - suction tube was used to prevent vomitting and breathing problems
540661 - during the angiogram test, per above. ref SDS 0 KH6L Further noted
540662 - that stopped eating on Monday, so vomitting should be minimized, per
540663 - instructions from Doctor Hoffman, reported on 091019 1300. ref SDS 11
540664 - ZZ80
540666 - ..
540667 - Doctor Tseng feels that not eating since Monday reduces problems of
540668 - vomitting from achalasia. The doctor indicated that heart surgery
540669 - takes 4 - 6 hours, so a stronger solution will be needed than was used
540670 - for the 20 minute angiogram test this morning. Doctor Tseng assured
540671 - that the CT team will provide effective remedies to avoid choking and
540672 - breathing problems during heart surgery tomorrow, based on patient
540673 - notice to everyone during the meeting today.
540674 -
540675 - [On 091022 0700 Doctor Brezinski was not aware of achalasia
540676 - problem, ref SDS 13 JF9K; the doctor performed research on VA
540677 - computer to verify diagnosis and scope of the problem,
540678 - ref SDS 13 JF9L, Doctor Brezinski made arrangements to use a
540679 - pulmonary heart bypass pump as part of the remedies during
540680 - surgery for avoiding risks of vomitting and breathing problems
540681 - caused by achalasia. ref SDS 13 GX4J
540683 - ..
540684 - [On 100928 0706 review medical chart shows no consideration in
540685 - Neil's preop check list, ref DRP 6 L44F, to avoid aspiration
540686 - from achalasia. ref SDS 22 L44F
540688 - ..
540689 - Thanked Doctor Tseng and the team for a good meeting. Everything
540690 - seems lined up today for a successful operation tomorrow.
540691 -
540692 - [On 091022 0700 quadruple heart bypass surgery performed by
540693 - Doctor Tseng, and her team; took about 8 hours. ref SDS 13 01F9
540694 -
540695 - [On 091023 0445 woke up in panic with tubes in the throat that
540696 - seemed to restrict breathing and prevented talking, so could
540697 - not explain to the nurse extreme duress. ref SDS 15 01F9
540698 -
540699 -
540701 - ..
5408 -
5409 -
5410 - 1508
5411 -
541101 - Sue Hallahan and Steven Collinson arrived to complete work setting
541102 - IVs, begun by Kevin per above. ref SDS 0 737P
541104 - ..
541105 - They performed "pick line" blood draws. Steven advised that this case
541106 - does not require "pick line" IV, but he and Sue are helping Kevin.
541108 - ..
541109 - After Steven made several trys, Sue took several more trys to
541110 - eventually complete the work setting an IV catheter for surgery
541111 - tomorrow, started by Kevin to place an IV catheter in the right arm on
541112 - the bicep above the inner elbow, per above. ref SDS 0 737P
541113 -
541114 - [On 110429 1230 case study on similar problems at VA in
541115 - Martinez, getting adequate blood flow through IV catheter,
541116 - related to dehydration from heavy exercise and low water
541117 - intake hours before medical care; solved by getting another
541118 - nurse to complete work. ref SDS 25 SR8M
541119 -
541120 -
541121 -
541122 -
541124 - ..
5412 -
5413 -
5414 - 1548
5415 -
541501 - Annie, the charge nurse for the cardio surgery department visited
541502 - with another doctor pulling along another computer.
541504 - ..
541505 - They reviewed in detail the consent document for the heart bypass
541506 - surgery tomorrow, which was online in the computer.
541508 - ..
541509 - Annie is familiar with Lafayette Reservoir. She belongs to the health
541510 - club down the street from the reservoir, and runs that route often.
541512 - ..
541513 - Annie indicated during the meeting that the operation tomorrow will
541514 - result in the patient not being active for most of the day on
541515 - Thursday, and possibly on Friday.
541517 - ..
541518 - Decided that Millie should not visit tomorrow.
541519 -
541520 -
541522 - ..
5416 -
5417 -
5418 - 1552
5419 -
541901 - Karen visited while Annie and the doctor were still reviewing consent
541902 - issues.
541904 - ..
541905 - She was very surprised about findings that require heart bypass
541906 - surgery. Karen was glad that Doctor Shunk and Doctor Tseng have
541907 - scheduled the work for tomorrow; she advised that normally these
541908 - procedures are not done on Thursdays, so this is "VIP" treatment.
541910 - ..
541911 - Discussed with Annie and Karen the problem of Millie getting
541912 - chemotherapy treatment today, and so side effects of fatigue will hit
541913 - her on Friday - Sunday.
541915 - ..
541916 - Karen will call Millie and suggest she not visit until Friday or
541917 - Saturday, and that she consider getting Janna to come with her to
541918 - drive or at least monitor to make sure Millie is okay driving over
541919 - from Concord.
541921 - ..
541922 - Thanked Karen for strong patient support.
541924 - ..
541925 - Karen left.
541927 - ..
541928 - Completed review and signed the consent document, based on findings
541929 - from angiogram test this morning, per above, ref SDS 0 7L43, and
541930 - recommendations of Doctor Shunk citing consultations with Cardiology
541931 - Department. ref SDS 0 7L61
541932 -
541933 -
541934 -
541935 -
541937 - ..
5420 -
5421 -
5422 - 1640
5423 -
542301 - Edwin arrives for PFT test ordered by Doctor Tseng.
542302 -
542303 - PFT FEV1 needs to be over a liter. My test shows 2.22, predict to
542304 - be 3.20
542306 - ..
542307 - Actual Target
542309 - ..
542310 - FVC 3.18 4.06 78%
542311 - FEV1 2.22 3.20 69%
542312 - FEV1% 70 79 89%
542313 - * FEF2575 1.38 3.13 44%
542314 - Expectory flow 6.06 7.56 80%
542316 - ..
542317 - Edwin indicated that if FEV1 was at 40% this could present a problem
542318 - for surgery tomorrow.
542319 -
542320 -
542321 -
542323 - ..
5424 -
5425 -
5426 - 1721
5427 -
542701 - Sarah Gebauer, MD, UCSF, resident anesthesiologist.
542702 -
542703 - Sarah explained the operation tomorrow, called a...
542705 - ..
542706 - CABG (pronounced "caggage")...
542708 - ..
542709 - Cornorary Artery Bypass Graft (CABG)
542710 -
542711 - 1. Preop
542712 - 2. Hook up IVs
542713 - 3. Arterial catheter IV - expect right
542714 - 4. Operating Room
542715 - 5. Move to surgery table
542716 - 6. Sticky pads for warming and cooling on back
542717 - defibulator
542718 - 7. Cordis IV in neck for fast acting medicines and fluids
542719 - 8. Mask to breathing oxygen
542720 - 9. Anesthesia given
542722 - ..
542723 - [On 091022 0700 quadruple heart bypass surgery performed
542724 - by Doctor Tseng, and her team; took about 8 hours.
542725 - ref SDS 13 01F9
542727 - ..
542728 - 10. Cardio pulmonary bypass pump
542730 - ..
542731 - Reviewed achalasia problems of choking and drowning from having to lay
542732 - flat on the surgery table, as occurred for the angiogram test this
542733 - morning. Will address the problem this evening by minimizing eating
542734 - and drinking tonight, and vomitting to clear throat as much as
542735 - possible tonight and before surgery begins tomorrow.
542737 - ..
542738 - Sarah and anesthesia team will be aware to prevent choking during
542739 - surgery tomorrow.
542740 -
542741 - [On 091022 0700 Doctor Brzenski not aware of achalasia
542742 - problem, ref SDS 13 JF9K; collaborates with patient to
542743 - find VA records on medical history, ref SDS 13 JF9L;
542744 - develops work plan using cardio pulmonary bypass pump
542745 - applied to control problems from achalasia. ref SDS 13
542746 - GX4J
542748 - ..
542749 - [On 100928 0706 received CD with VA medical records on
542750 - heart surgery, showing incorrectly patient was "educated"
542751 - which means notified to be prepared for post-op
542752 - conditions that cause anxiety and fear, in this case
542753 - having a tube inserted into the throat needed to prevent
542754 - complications from achalasia during heart surgry.
542755 - ref SDS 22 4Q4N
542756 -
542757 -
542758 -
542760 - ..
5428 -
5429 -
5430 - 1825
5431 -
543101 - Theresa came with a mobile xray system.
543102 -
543103 - This test took about 5 minutes.
543104 -
543106 - ..
5432 -
5433 -
5434 - 1921
5435 -
543501 - Doctor Alexis Beatty, MD visited to review post-op issues.
543502 -
543503 - Alexis read the record of the meeting today with the Cath Lab team,
543504 - and concurred with understandings, per above, ref SDS 0 02E6,
543505 - including findings, ref SDS 0 7L47, and recommendations. ref SDS 0
543506 - 7L61
543508 - ..
543509 - The doctor explained that an artery from left subclavian will be
543510 - removed to replace the major problem with the left artery at the y
543511 - branching location, per above. ref SDS 0 7L5U Alexis seemed to
543512 - indicate that using this artery will provide a long-term solution that
543513 - could last forever.
543515 - ..
543516 - Alexis related dietary changes that will include reduced cholesterol
543517 - and less salt. The Nutritionist will present dietary objectives
543518 - before discharge from the hospital to go home.
543520 - ..
543521 - We reviewed "I Can't Believe It's Not Butter."
543523 - ..
543524 - Alexis seemed to say that since this spread is presented as having no
543525 - cholesterol, there may be no restrictions.
543526 -
543527 -
543528 -
543529 -
543530 -
543531 -
543532 -
5436 -
SUBJECTS
Salt Medical Necessity Avoid Overuse Reduce Heart Disease Hypertensi
6303 -
630401 - ..
630402 - Salt Medical Necessity Avoid Overuse Reduce Heart Disease
630403 -
630404 - Asked about salt.
630406 - ..
630407 - Alexis explained that low sodium on labs does not per se establish the
630408 - patient's salt intake is adequate for coronary health. She believes
630409 - the test tracks a relationship between water and salt.
630411 - ..
630412 - Actually, this much of the record remains confusing.
630414 - ..
630415 - The doctor seemed to say that salt causes the body to retain water,
630416 - and extra water has negative effects causing the heart to work harder,
630417 - so it "wears out" sooner. These effects are long-term, and cannot be
630418 - assessed by medical tests.
630420 - ..
630421 - This presents a case management problem.
630423 - ..
630424 - Long-term effects of increased water from high sodium cause gradual
630425 - destruction to the heart, which does not provide opportunity for
630426 - repair nor recovery. Either the patient gradually loses heart
630427 - function and vitality, which cannot then be repaired; or, suffers
630428 - sudden heart attack, causing death, or, in the case of Richard, have
630429 - significant loss of vitality, reported on 020705. ref SDS 1 0X6N
630430 -
630431 - [On 091104 0718 VA Heart Surgery Discharge guidance
630432 - recommends not adding salt to food. ref SDS 18 US7I
630434 - ..
630435 - [On 091104 0718 research indicates that benefits of salt
630436 - restriction in daily diet is not established by evidence.
630437 - ref SDS 18 D58G
630439 - ..
630440 - [On 101207 0906 lab report on blood test shows salt (NA
630441 - 137) near danger level of being too low. ref SDS 24 GM65
630442 -
630443 -
630444 -
630446 - ..
6305 -
6306 -
6307 - 1947
6308 -
630801 - Joe arrived and was briefed by Benny for changing shift at 2000. He
630802 - will be the next nurse for the night shift.
630804 - ..
630805 - Benny went off shift.
630807 - ..
630808 - She is not working tomorrow, so she will not see me tomorrow after
630809 - surgery, where I will be located on the other side of the ICU.
630811 - ..
630812 - Thanked Benny for attentive and thorough care today. She was
630813 - terriffic helping move the computer around so everthing could be done
630814 - to prepare for the work tomorrow.
630815 -
630817 - ..
6309 -
6310 -
6311 - 2028
6312 -
631201 - Eddie called.
631202 -
631203 - He had called the house to discuss the Yankees Angles game, and
631204 - Millie told him I am scheduled for heart surgery tomorrow.
631206 - ..
631207 - Explained there was not a heart attack, and reviewed background per
631208 - above. ref SDS 0 LJ7L
631210 - ..
631211 - Ed will call tomorrow night to discuss the next game scheduled to
631212 - start OA 1900, because the teams are playing on the West coast.
631213 -
631214 -
631216 - ..
6313 -
6314 -
6315 - 2133
6316 -
631601 - VA medical chart shows a report was filed by Douglas South at this
631602 - time today, and includes a "Nutrition Screen". ref DRP 6 6R6N
631603 -
631604 - [On 100928 1500 received VA medical records on a CD that
631605 - report filing at 2133, ref SDS 22 7J5N, and saying the
631606 - patient reported no swallowing problems as part of a
631607 - nutrition screen. ref SDS 22 Z87G
631609 - ..
631610 - There was no actual discussion at this time. The report may summarize
631611 - various questions presented throughout the day. In any case none of
631612 - the answers entered are correct, since they are negative for
631613 - swallowing problems, and in fact the patient has severe swallowing
631614 - problems, presented to Doctor Tseng and her team earlier today, per
631615 - above. ref SDS 0 NX6M
631616 -
631617 -
631618 -
631619 -
631620 -
631622 - ..
6317 -
6318 -
6319 - 2311
6320 -
632001 - Completed work on the record for today, and planning for tomorrow.
632002 -
632003 - Jenine visited Joe. She works at the other end of the ICU floor.
632005 - ..
632006 - Joe advised that after surgery tomorrow, heart patients initially get
632007 - very specialized care by Jenine at the other end of the ICU. In the
632008 - late morning or early afternoon, care is transferred back to this part
632009 - of the ICU. Therefore belongings can stay in this room, since the
632010 - patient will return here tomorrow afternoon. Joe feels he will be the
632011 - nurse again tomorrow night.
632013 - ..
632014 - Thanked Joe for providing continuity of care.
632015 -
632016 -
632017 -
632018 -
632019 -
632020 -
632021 -
6321 -