October 31,2019

SICU 1 SICU 2
Layron, Angelito 65/M/CPNBB Lerios, Felipe 71/M/RPV
Dr. Madrona Dr. Gueco
9th sicu day 4th sicu day
170th (may 25, 2019) post-op day 6th post-op day

Dx: Massive UGIB sec to BPUD vs stress Gastropathy vs Dx: Acute Subdural Hematoma s/p ‘E’ craniotomy,
stress related mucosal injury-resolved, Rectal evacuation of burst lobe left, ASDH, Left
adenocarcinoma st.IIIB s/p LAR s/p 1 cycle chemo;
urothelial carcinoma with rhabdoid features CKD sec
to obstructive uropathy

S: S:
(+) flatus (+) febrile episodes
(-) abd pain (+) HPN 150/80
last BM (10/30/19) greener paste (-)desat

O: O:
Awake, coherent, NIRD with the ff V/S: GCS 10 (E4 V1 M5)
BP-140/110 CR-78 R-19 T-36 O2-99% BP-150/90 CR-93 R-19 T-38.2 O2-99%
I/O- 1900-1980 = -80 (Fluid Balance) I/O- 3894-2100 = 1494 (Fluid Balance)
UO- 95 cc/hr UO- 87 cc/hr
AS, PPC AS, PPC
SCE, CBS SCE, (+) rhonchi right
AP, DHD, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Distended abd, firm, midline incision scar, (+) tender Soft, flabby, nontender
on deep palpation, abd girth 85 cm CRT <2sec FEP
CRT < 2sec, bipedal edema
LABS:
LABS: Hgb-119 Na-152 mmol/L
FPA initial: segmental adynamic ileus susp of ascites Hct-0.36
non obstructing gas pattern WBC 9.8 (88, 9, 1, 2)
Plt- 288
A: A: Obstructive hydrocephalus sec to cerebellum ICH
s/p E EVP frontal R suboccipital craniectomy;
evacuation of FFP; HAP; elec imbalance

ARF sec to 1-HAP; 2-pulmo congestion

P: for pain mgt: paracetamol 1g IV q8 RTC, Tramadol P: serial Na monitoring q8
50 mg IVq8 RTC
Start vit L 2 amp TIV q8 Present meds:
- Piptaz 4.5 g/TIV q6 day 5
- Dravent neb q8 RTC
- NAC OD HS
October 31,2019

SICU 3 SICU 4
Trillana, Francisco Jr 72/M/ CP Umaguing, Erlinda 81/F/RPV
Dr. Lizan Dr. Perez
132nd sicu day 5th sicu day
131st post-op day 2nd post-op day

Dx: Multiple Intrcranial Hemorrhage sec to MVA s/p Dx: Acute Limb Ischemia Right foot s/p E
FTP craniectomy with evacuation of ICH ventilator embolectomy, R
dependence sec to central apnea sec to ICP s/p
tracheostomy chronic hyponatremia Obstructive hydrocephalus sec to cerebellum ICH s/p E
EVP frontal R suboccipital craniectomy; evacuation of
FFP; HAP; elec imbalance

S: S:
(+) febrile episodes (-) desat (+) Pain R leg 9/10
(-) dyspnea (-) N/V
(-) hypotension 2pm – soaked dressing, gross blood drain, pale, weak
pulse, dec bp palp 40
Given 1u prbc
6pm- change dressing, bp 100/60
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- 2318-1100 = 121 (Fluid Balance) I/O-
UO- 45 cc/hr 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 (+) pressure dressing R leg at popliteal area
(+) discoloration and swelling left lower ext
LABS:
Na- 133 LABS:
K- 3.3 PT- 18.1
INR-1.36
PTT-32.6

A: A: ARF sec to HAP

P: for pain mgt: paracetamol 1g IV q8 RTC, Tramadol P: serial Na monitoring q8
50 mg IVq8 RTC
Start vit L 2 amp TIV q8 Present meds:
- Piptaz 4.5 g/TIV q6 day 5
Meds: - Dravent neb q8 RTC
- Cipro 500mg/tab BID (D7) - NAC OD HS
October 31,2019

SICU 5 SICU 6
Bacungan, Ricardo 59/M/CP Amoroso, Eutiquino 57/M/ VMMCP
Dr. Lizan Dr. Gueco
11th sicu day 2nd sicu day
11th post-op day

Dx: Obstructive Hydroceph sec to cerebellar ICH Dx: SAH L temporal area ICH R frontal <1cc; HACVD
s/p E external ventricular drain, frontal R suboccipital, SVT ACC AHA St.B
s.p craniectomy for evac of intrcranial… cerebellar R

S: S:
(+) febrile episodes (+) DOB at 2 lpm
(+) tachypneic
(+) desat 88-90%
(+) tachycardic 130’s  SVT: cardiovert 50J to 100J to
150J
Combative  extubate 11:30pm then cxr done
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, DHD, NRRR, (-) 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 P: shift to OF feeding
CXR done pos ext
For 2d echowith DS
For 24hr ABPM
Hold metoprolol
ECG q6
Meds:
- Amlodipine 10mg/tab OD
- Rosuvastatin 20mg/tab ODHS
- Amlodipine drip
- KCL tab 2 tabs q2
- Duavent
October 31,2019

SICU 8 SICU 12
Gamez, Alfonso 76/M/ Nilayan, Josefa 88/F/ RPVD
Dr. Dr. Solomon
sicu day 25th sicu day
post-op day 13th post-op daw (EGD) UGIB prob 2 to coagulopathy

Dx: Acute ICH L thalamoganlionic with IVE obstructive Dx: SAH L temporal area ICH R frontal <1cc; HACVD
hydroceph R SVT ACC AHA St.B

S: S:
Loss of consciousness and seizure ep Inc BP x 1 ep (clonidine given 75mg/tab SL)

O: O:
Obtunded, GCS 8 (E2 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-140/90 CR-92 R-20 T-36.4 O2-98%
I/O- I/O-
UO- UO-
AS, PPC AS, PPC
SCE, CBS SCE, CBS
AP, DHD, NRRR, (-) murmur AP, DHD, NRRR, (-) murmur
Soft, flabby, nontender Soft, flabby, nontender
CRT < 2sec, (-) edema CRT < 2sec, FEP, bilateral lower ext edema

CN I- cant assess LABS:

II- Left pupil 2mm NRTL, R pupil 4mm NRTL
III, IV, VI- cant assess
V- no corneal reflex
VII- (+) facial asymmetry
VIII, IX, X, XI, XII- cant assess

LABS:
CT scan initial: Acute L thalamus ganglion bleed with
extension to the adjacent white matter perilesurial
edema approx. 50cc
Acute intraventricular hemorrhage extension
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
A: A:
P: P:
Plan for d/c noted by all services
KCL tab 1 tab TID
Metronidazole 500mg qIV q8 (D5/7)
Cipro 500mg IV q12 (D6/7)