COURSE IN THE WARD Date/Time of shift Doctors Order September 1523,2012

Patient seen and examined at 12:35pm.(sept.15) Triage to critical bed. For C BG: 195mg/dL Hook to cardiac monitor and pulse oximeter. Start IVF: PNSS 1L x 100cc/hr. Please give lidocaine 50g TIV For intubation now. Using ET tube size 1.5cm, hook to monitor for continuous Ambubag. Mannitol (20%) 250ml Citicoline 2gm TIV now, then ofloxacin Labs: for 12 led ECG CBC, PT, PTT CxR, protein, creatinine, serum NaCl ABG, CT scan, urinalysis. For insertion of NGT, keep end open at bedside bottle. For insertion of individually foley catheter attached to urine bag. Hook to mechanical ventilator with the following set up: o FiO2- 100% o TV- 350 NPO temporary CBG q8 while on NPO. ASA 80mg/tab 1tab OD Atorvastatin 40mg/tab ODHS Lactulose 30ml ODHS Start of feeding 1750 kcal/day o CHO: 218.75gm/day o CHON: 131.25 gm/day o Fats: 38.9 Ofloxacin 20mg TIV BID (-) ANST Omeprazole 40g TIV OD Paracetamol 300mg TIV q4 PRN for fever T: 37.8 Paracetamol 300mg TIV q4 PRN for fever T: 37.8

Nurses Response

Evaluation

BUN: 16 mode: AIC

 Kalium durule 75g/tab 1tab BID Paracetamol 300mg TIV q4 PRN for fever T: 37.8 Kalium durule 75g/tab 1tab BID ICU TTRANSFER (September 16, 2012 4:00pm) Patient and examined. IVF to ff: PNSS 1L x 40cc/hr. o ROM Citicoline 2gm TIV q8 Atorvastatin 40g/tab 1tab ODHS Omeprazole 40g/tab 1tab ODHS Lactulose 30cc ODHS, hold if BM > 3x/day Mechanical Ventilator settings as follows: - AC mode - PR- 40 - TV- 350 - PBBP- 5 - BUR- 16 - FiO2- 70% For repeat ABG prior to ICU transfer. Please inform MROD once results available. Relative informed regarding patients status and prognosis. Monitor and maintain back rest. For carotid duplex 3am once stable. Hook to cardiac monitor and pulse oximeter. ICU RECEIVING (September 16,2012 8:00pm) For 12 LED ECG with long LED II. Attach to mechanical ventilator o Mode: AC o TV: 360 o BUR: 16 o TF: 40

o Deep: 5 Decrease FiO2 by 10% every hour to reach 30% Repeat ABG in AM out 30% FiO2 Strict aspiration precaution oral care w/ hexetidine solution swab the oral cavity TID for fecalysis revise lactulose o 30cc prn at bedtime if no BM x 3 days or w/o constipation moderate high back rest Please replace current mechanical ventilator bemet or Newport o TV : 360 o FI O2 : 30% o PF : 40 o RR: 8 o PS: 10 Facilitate turning of patient Q2 To secure egg crate mattress To secure anti-embolic stocking Start mannitol : o o o o o 9/19 150cc Q6 9/20 150cc Q8 9/21 160cc Q8 9/22 160cc Q12 9/23 discontinue

Please continue NVS monitoring Start amlodipine 10mg/tab 1 tab Moderate high back rest

September 24, 2012 (6am-2pm)

Please apply warm and cold compress to all affected area ABG in arm Discontinue CBG monitoring Give acetycylsitiene

 Shift omeprazole to pantoprazole cap 40g 1 cap ODHS Continue physical therapy Please do gentle suctioning

(2pm-10pm)

Patient extubated because unable to tolerate weaning : diazepam 5mg IV now Re etubated w/ ET tube size 7 at level 22 Hook to mechanical ventilator Hold aspirin