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VIN. 13273510002
QlUJU. mUliY L
Neurolog Consul t
Blectronically Signed Byi TRUDELL, RAALL G 4/29/2010 1:25129 lM
CNMDNBURO
UNIVBRSITY OF TESSEE MEMORIAL HOSPITAL
1924 Aleoa H~ghway *. Xnoxville, TN 37920
(865) 305-9000
PA'tIim NAUi GRAJU, BKHY L.
MEICAL RECORD #11327351
LOCATION/ROOH#1 KCC1 MC1-09
PATIEN TYKI INPATIID
ADMISSION DATS i 04/27/2010
i
OrSCRAGlB DATE
ACCOUN Ii 13273510002
NEOLOG COSULTATION REPORT
DATE OF BI~TBi 10/07/1991
DATS OF CONSULTATIONi 04/27/2010
HISTORY OF PRESEN ILLNSS i
He~ry Granju is an 18-year-old malo brought to the University of Tenessee
Hedi~&l Center Emrgency Rooø today (04/27/10) for furthr evaluation of
being noted to be unesponsive.
There is_some history_that. the patient had some sort of assault_two~daya ago,
perhaps in a drg deal gone bad. Bowever; he - ';S awake and talking to
-
friends gn the evening-of=0~/26/i~ ~d went hom with ii friend, but was ~ound
ti: following iiorning unrlisponJive with white powdr around hiii mouth. Be
h~ø a history of polysubstanoe abuse and a urine drg soreen was positive for
m~rijuana, benzodiazepines and ooaaine.
Signifioant on his initial examination was that he hald obviously voited and
aspirated... He requirød intubation for hypxia and difficulty with
He is also noted to have blood in the externl auditory oanals
mpiriitions.
bilaterally.
.ct. scaii: of the-thorax i'i ~conBi8tent wi th aspii"tition iirid~no_evideic.e !af _ I
fraoture .on_CT.:soañ õf:-the cervio~l spinã or.of -tle skulL. He reportedly has
diffuse oerebral edem on CT of the brain.
The patient reportedly would arouse to voioe earlier prior to øadation. Be
has now been sedated in order to more efficiently ventilate him.
Ele would arouse, but not follow oomds earlier.
PBYSXCA EXAINATION;
At'thia tim, he is lying quietly in bed sedatod on a vantilator. He does
not arouse. Pupils are 3 mm bilaterally. He has a corneal reflex
bilaterally aven with sedation. With sone stimulation of his sternum there
is a little frowning. To plantar .ti~ulation, plantar response is upgoing
bilaterally. Reflexes are hypoaotive and symetric. He has periorbital
eceh~ses and blood from both earB.
LAORATORY_DATA 1_
Re':i;w-;tÏ; ci-~sc;~oBhe h;iid-doea -;ot_shoW'avidinco of skull fracture
iind.hed;'es have~.ctffuse cerebral edema. ,'-. ~ - ----
J:MPRBSSIOHi.- -- - ___
!l;;o~..lop:tbY prob~iy pr~rily ~ tõhyp*rfusioii hypxia related to his
llsplra tion iid "aar;t drig överdose.
PRINTED BY: RWAN
GRJU, BifY to
DATE 6/ 2 ~2 0 1111 iiinu miiænmlillmllmllillWIIII
~
-=0
-
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-M
FIN. 13273510002
QUNJU, HlY to
Neurology Consul t
Klectronic81ly Signed By: TRUDBLL, RAALL G 4/29/2010 1:25129 PM
The early signs of arousing and having corneal reflexes are certainly
encouraging.
We will plan to follow this patient with you.
ATTENINGl PHYSiCIA
Randa1l G. Trudell, M.D.
DDi 04/27/2010 18120 DTi 04/29/2010 01107/keg 462343/1238971
eei Richard A. Glover, M.D.
Paul Branca, M.D.
Denise K. Rivers, D.O.
Randall G. Trudell, M.D.
COpy
Page 1 of 1
glectronicelly signed Byi TRUDELL, RAALL G, H.D. 04/29/2010 13125 ROT
PRINTED BY: RWARN
GR. RBNlY L
DATE 6/212 0 ~llililinll~IWlim~~~iimID~WIIUiilmirm
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-=_r
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GRAJU, HENRY L
rXNr 13273510002
l€cOPy
History and Physical
Electronically Signed ByIBRACA, PAUL R 5/4/2010 11136107 AM
HP
UNIVERSITY OP TKNSSKE HKORIAL HOSPITAL
1924 Alcoa Highway.. Knoxville, TN 37920
(865) 305-9000
i GRJ1, HlmY
PATI!r NAM
L.
HEICA RECORD #11327351
ADKiSSiON DATEr 04/27/2010
LOCATION/ROOH#: MeCi MC1-09
PATIEN TYPE i INPATIENT
DrSCIlGE DATBi
ACCOUN #1 13273510002
DATE O~ BIRTH: 10/07/1991
HISTORY k PHYSICAL EXA
CHIEF COMPLAIN':
Overdose.
HISTORY O~ PRESENT ILLNESS:
'l (f
The pa~ient is an 18-year-old, white male who was found unresponsive by a
friend and brought by EM to the ~ergency DepArtment where he was
immediately intubated. He was apparently assaulted two days ago and the
exact circums~ancÐB are unknown at this time. The patient was found to have
UDS positive for cocaine, marijuana and benzodiazepines. ~He was also found
to have a troponin of 5.07. i spoke with a police officer who said that
jCt
~pparently an acquaintance picked the patient up from the patient i shouse
last nigh~ because the patient was going to stay at this friend's house and
go to work wi th him this morning. Per the friend, the patient aeemød high
last night and said that he had been beaten up the day before when he was
trying to buy drgs. The friend _found him this morning unresponsive with
..hite powdr around his mouth. He -cÜd navëvomiting and aspiration prior toarrival-in the Emergency Deparonent.
PAST MEDICAL HISTORYi
None.
PAST SURGICAL HISTORYi
Ear tubes as II baby.
ALLERGIES: TETANS VACCINE.
MEDICATIONS,
None.
SOCIAL HISTORY 1
The patient is a smoker. He has a history of polysubstance abuse including
iv drg abuse. Per the family, the patient spent this past Karch to October
2009 in inpatient rehab. He has had problems wi th polysubstanoe abuse since
age 14.
FAMILY HISTORY:
Noncontribu tory.
REVIEW OF SYSTEM 1
Unable to obtain.
~HYS!CAL EXANATION:
Tempurature 102.5, blood pressure 112/59, pulse 95, respirations 22, 02 94\
on vent with setting SIMY, rate of 18, tidal volume 650, pressure support of
10, PREP of 10, and Fio2 of 100\. GENERL: The patient is sedated. HEBN:
Pupils equal at 2 mm. Bilateral tympanic memranes obscured with blood.
_ Bi1aterll"- orbit.al ecchyioais.- -NECX: Without leiiion. LUNGS: Coarse breath
sounds bilaterally with decreased breath sounds at the bases. Chest with
PRINTED BY: R~~ßIiIIIIiIIIiIiIiIi~IiI!iilUlIlIllIlI~1 ii~"ii
DATE
6/2/2010
;.
--
GRAJO, RlnlllY L
FIN: i3~735iOOO~
Bigtory and Physical
Electronically Signed By
-I'
8
i
BRACA, PAUL R 5/~/2010 11:36:07 AM
i Regular rate and rhythm. No murmurs,
area.s of eochymosis. CARIOVASCUAR
rubs or gallops. ABDOMX: Soft, nondistended with decreased bowel sounds.
au: Rectal exam - normal tone with no foreign material. The patient has a
Poley in place wi th no penile or scrotal traum. BXTREMTIES: No clubbing,
cyanosis or edema. NERO: We will reassess when patient no longer paralyzed.
LABORATORY DATA/ STUDIES:
Sodium 140, potassium 3.6, chloride 110, CO2 20, BUN 24, creatinine 1.64,
glucose 103, calcium 8, ~agnesium 2.5, albumin 3.2. total protein 5.8, total
bilirubin 0.3, alkaline phosphatase 134, AST 93, ALT 67, anion gap 10, seru
osmolality 301, lipase 1l, amonia 24, lactic acid 2.5, hemoglobin 15,
hematocrit 43.8, white count 10.7, platelets 202, PT 12.6, INa 1.21. ABG
with pH 7.165, PC02 68, P02 58. 02 80', bicarb 24.5. C~-MB 4.7, CPK total
377, troponin 5.07.
Phenobarbital level 0.1, acetaminophen level 2, salicylate level 0, ETOH
level less than 10. TCA level O.
uns positive for benzodiazepines. marijuana and cocaine.
Urinalysis with 300 glucose.
Chest x-ray .hows ~rihilar edema.
(70lm¡.
C(
S! ~~e~heßP '~Qws~diffuse cerebr!i-ed~ w~h ~9_eviden~ of skull
"fracture.
CT of the C-spine shows no evidence of fracture.
CT of the thorax. abdomen and pelvis shows bilateral areas of pulmonary
consolidation oonsistent with aspiration and with additional areas of
ground-glass opacities in the perihilar region oonsistent with edema.
ASSESSMENT. PLA:
The patient is an lS-year-old, white male withi
l. Acute hypoxic respiratory failure likely secondary to toxio ingestion
status post large volume aspiration. The patient is currently
supported by mechanical ventila.tion. Ke will continue with ARSnet
settings. Status post bronchoscopy with large volume suctioned,
oul tures are pending.
2.
3.
4.
Overdose. Patient with history of polysUhstance abuse including iv
drg abuse, ODS positive for bensodiazepines, cocaine and marijuana.
believed to be unintentional.
Status post assault. IMaging is negative for fracture but with
bleeding from bilateral auditory oanals, ooncern for bilateral
tympanic membrane rupture. We will consult XN.
Non-BT-elevation myocardial infarction. Patient with history of
cocaine abuse as likely etiology. We will continue to follow cardiac
enzymes. _ . .
S. tš~~~L.:~~~.~~;~a~,~,~,,''1.;,S~:i_~~~íaj*j';~!=te!1t,.~£!tIis" post..~paÛit~ .w; ..
1:.1.~l.c~~s~!~~~~;i~Y.to ~ssist'!~th .evaluaHon. w. will maintain J
. the head of tEe bed elevated. .. f': .":
6.
A'~'i:~krenai -failure iikely-prerén;âi. We will check urine
7.
Aspiration pneumonia status post bronchoscopy. We will start the
patient on Rocephin, Zithromax and clindaycin.
Fever. We will give Tylenol as needed. We will eheck urine. sputum
and blood cultures and continue Rocephin, Zithromx and clindamycin.
Bilateral perihilar infiltrates possibly due to cocaine-induced lung
8.
9.
electrolytes.
injury.
10. OI prophylaxis with Nexium.
PRINTED BY: R~rllil~II~I!llilllllllllmiil~Il~UI~III~
DATE
6/2/2010
:.
-=0
-'"
i'
FIN r 13273510002
GRAJU. HItY L
History and Physical
Electronically Signed By
i
BRACA, FAUL R 5/4/2010 l1i36:07 AN
11. DVT prophylaxis with PAS hose. We will hold heparin and Lovenox at
this time secondary to the bleeding.
12. The patient is a full code.
Dictated by: Audrey D. Barry, M.D., RESIDENT PHYSICIAN
ATTENING PHYSICIAN
Paul Branea, M.D.
DO: 04/29/2010 11128 DT: 04/29/2010 15:25/dw 463747/1239478
cc: Richard A. Glover, M.D.
Paul Branca, M.D.
William Scott Bridges, M.D.
Denise M. Rivers, D.O.
Audrey D. Barry, M.D.
COpy
Page 1 of 1
~lectronically Signed Byi BRACA, PAUL R, M.D. 05/04/2010 11136 EDT
PRINTED BY: R~rlfßlilll~mlllilllilmllllmllilllliillimllil
DATE
6/2/2010
,.
CiRAJU, HlNRY L
~
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-
-I'
~
FrN: 13273510002
Discharge Sumry
E1Qctronically Signed By:SALITA, MU G 5/26/2010 1:24:31 PM
os
UNIVERSITY OF TENNSSEE MERIA HOSPITAL
1924 Alcoa Hiqhway ** Knoxville, TN 37920
(865) 305-9000
PATIENT NAM: GRAJU, HENR L.
MEICA RECORD #: 1327351
LOCATION/aOOMl: iSNS S740-A
PATIENT TYPE: INPATIENT
ADMISSION DATE: 04/27/2010
DISCHAGE DATE: 05/06/2010
ACCOUN #: 13273510002
DATE OF BIRTH; 10/07/l991
DISCHAGE SUMY
HOSPITAL COUE; __.
The patient wasLíla;I(LLtéd_tó~tse Intensive Care Unl.t_af.ter_an.ÃlUault t.a~'; ,
resoived acute respiratory failure, and adult respiratory distress sydrome
secondary to drg overdose and aspiration pneumonia. The patient is status
post emiric antibiotics, broad spectrum, and they have bean weaned down. Be
has completed a course with resolution of his symtoms. He is status post
ventilation. The patient was initially admtted with drug overdose and urine
drug scr_e Fsit~ve ~7.. ~riz.o~lazep'~e.;.:. cocai~e and cannabi~o.id:i.., tlrn1l~~t.
~t_~_Sa)9.~~t":,q~íi1 t''Wi~t!i..i~§ t~.ral . áûdi to'¿ .ëàiáCbleädinq . Ànd evlderiC!' Öf I
~'i1:H.4rchypi.ei~ce'i¡eíi=ili~g;Qif:'h trfuferred the' ~'ti:i out of the
uit .t~thâ~i~of ~s he ;ontinued hi~. reco~ry from his multiorqan failure in
the ~ntensive Care Unit. The plans are to discharge this patient to a
rehabilitation facility to continue deoonditioning training. etc. The
patient will go to St. Mary's Rehabilitation. It should be noted that he has
recoyered_from a myriad of problems. tiírdld.'m~~r;mrã:fìii~;Eiú~lgii"ihc!:" F
~ã,~i~~~,t. H~~7~ãV~'~ãóe?öriløy~;r ~~~a2'iräv¡t iiiùpi~' ~åWï~~';f and'
all .ëre. recovering nicely. His brain function was returning to more of a
norml level. H. was accepted by Physical HQicine and Rehabilitation. and I
refer you to their dictated consult note for more further details, but
mecally, the patient is deemed stale for discharge. It should be noted
that prior to diacharge, an MR and a repeat eohocardiogram to assure
staility of his conditions were pandinq. We do not have those results yet.
Neurology has started the patient on Aricept to help with his meory.
DISCHGE MEDICATIONS:
1. Difluoan, stop date 06/10/2010, for peile infection.
2 . Aricept Sntlliqrams a day.
3. Cipro.
4. Dexamethasone otic suspension in both ears twice a day.
5. Nexium 40 a day.
6. Vesicare 5milligram a day.
7 . Nasal saline spray.
ATT&NDING PHYSICIA
Murad Salai ta, M. D .
DO: OS!26/20L0 OB: 31 DT: OS/26/2010 10: aO/tcB 482987/1252304
CC: Murad Salaita, M.O.
William Scott Bridges, M.D.
William A. Paulsen, M.D.
Joshua A. ~ll&r, M.D.
Jeffrey S. Heoht, M.D.
Karen Mullins, D. a .
Paul Branca, M.D.
Richard A. Glover, M. 0 .
PRINTED B~J 2~1~~II~IiI~lilll~limlillmRlllm
DATE
?
GR1.J. HXY L
-
Discharge SUry
Electronically Signed By: SALITA, MU G 5/26/2010 1: 24: 31 PH
~o
-("
==
==
FI: 13273510002
Denise M. Rivers, D.O.
è3
COpy
Page 1 of
Electronically Signed By: SALTA, MU G, M.D. OS/26/2010 13:24 EDT
PRINlED B ¥ì: Rim~imiiii"i miiiii~ IIIUWlllllim
DATE
6 2/2010
;:
1
.-,
UNIVERSITY OF TENNESSEE MEMORIAL HOSPITAL
l"Ul11327JS1000:2
QR
, RKY L
,DOB:l0/07/S1 iSY M
EMERGENCY DEPARTMENT
1924 ALCOA HIGHWAY
, AD:04/27/10
HR:1327J51
KNOXVILLE, TN 37920
'- - -___ _ _. __ _ _.. _ -J
(865) 544-9000
ED ORDERS/NURSES NOTES
PHYSICIAN ORDERS
PHYSICIAN NOTIFICATION
TIME CALLED TIME ANSWERED
PHYSICIAN
LAB RADIOLOGY
TIME HERE
C8C
". REASON FOR X.RAYICT/US
8MP 0
Order Initial
Time
TIme
Given
AMY,LASE
o HCG PENDING
LIPASE
CXR PAILAT
URINECC
CXR PORTABLE
o SEE GUIDELINE ORDERS
URINE CATH
AAS (INCLUDES CXA)
o
OINT GA: LOCATION:
A8G ON
o CARDIAC MONITOR 0 PULSE OX
SERUM HCG
U/S
o
Physician Orders, Medications, LV'S, Other
o
..
URINE HCG
o FINGERSTICK GLUCOSE
CKMB ~
tV
D - DIMER
BNP
o
I
I .,
I
:L .
DISPOSITION;
o TRANSFER TO
o ADMITTO
TIME BED REQUESTED
. BED ASIGNED
ORI
CRITICAL VALUES lDISCHARGE TO:
RECEIVED BY~.
o HOME 0 POLICE 0 MORGUE
REPORTED TO 'DR ~
OAMA DATE
o OBSERVATION
o ADMISSION
AT
6727'2010
RELEASED FROM ED AT
(Page 1 of 3)
~¡Ol
AT II¡lI
AT )dr
VERSION li
+
+
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,,:IN i 13:.7351.000:.
aiJU, mwY L
o 1996 - 2008 T -Sslem, Inc. CIrcle or check affnnlilJs. bacluJa (1) "egaii~s.
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ooB110/07/91. 18Y 14
AD 104/27/10
Tennessee
University of
ii i 1327351
Medical Center
51
1924 Alcoa Hwy
Knoxville, TN 37920.
(865) 544.9000
~
EMERGENCY PROVIDER RECORD
Critical Care
TIME
SEEN: J.1.~ ROOM: f
EMS Arrrl
HISTORIAN: patient fumily §
Nursing A,,~ssment R~vj~w~d Initi.1 Vita Signs Reviewed 0 T "Iemetry
HR RR Temp
Pulse Ox- % _RA _O¡ lnter _nm! _hypoxic
INITIAL PHYSiCAL EXM
EXAM LIMITED BY:
GENERAL
UNABLE TO OBTAIN HISTORY DUE TO:
_appears well
HPI
_nmlcolor
chief complaint: fuintlng tÆresllnsive Jcar"/¡v ...-
seizre dyspnea chest pain GI bleeding ~drug overdo~
onset:
,,.
.
re
HEADI NECK
_hed atraumatlc
-pharynx nml
paramedics' Inltia! findings:
_neck supple
no respIrations
decreased respirations
~%%~
alert
con sed
ci
RESPIRATORY
,:óyspnelD
sinus rhytm
nml respirations
HR
Glucose _ mg / dl
_airway open
D-stck glucometer
JOod gag renex
BP
ISTA T parameIcs I ED
_breath sounds
equal bilateraly
_nml breath
pre-hospital treatment:
~gen
Oag:O
(
valve-
defibrilated_
intubated
IVf1uids
~
~
~
-t~
r.
CPR I thumper
~
vasopressin
~d~~
_meningismus
_no spotaeous resiratins
~absent~
:Jve3fä\
_airway obstrcted partll / (ully
-~...~'
- etl :¿
gà~muscít
=="'"00'
_decr. air movement
_wheezes 1 rale: 1 rhonchí
mg
mg
ROS
CVS
_weak 1 no pulse
_reg. rate & rhytm
_noJVD
_chest compressions
pulse wi CP- neme poor go
_irregularly irregular rhytm
reent illness / fever
LNMP _ prc¡¡ post- menop
vision change / problems
neck 1 b"ick pain
_no murmur
_no gallop
nasl drainage / congestion
leg I ankle swelling
_PMlnml
~es (ocnal
-pulse full. equal
_PM! displaced laterally
hurt to breathe I short of breath
~
mg
mg
lidocine bolus_mg
lidocaine drlp_mg I min
amiodrone
chest pain
-+
--
sounds
epinephrine
atropine
-che~d tru~
_hemotympanum
cough bloody I productve
r.h
-.VD present
_murmur grade _/6 sy / dios
lost feeling I power
confusion 1 memory loss_
--llop ( 53 I 54 )
~ressJon I anxiety
paínful urination
~I systems neg ~c"pt as marked
PAST HX
cardiac disease ASCVD MI CHF
immunosuppressed AIDS_
CV A I nA bleed deficit
hypertension
diabetes Typ I Type 2
lung disease asthma COPD _
diet /oraliinsulin neuroClY--
I (requent)
swollen glands
headache
abdominal pain
nausea / vomiting blood
diarrhea 1 black 1 bloody stools_
_old records reviewed I summary:
" ~ bradycadia
ABOOMEN/GI
_mas I organomegafy
_no mas
_distention
_tenderness
~guarding
-Karding
, .
RECTAL
. "-heme pos. stool tra
¡-ŠÕC-IAL HX- - - s-~ok~; _. - - - - - - 0rugs 5(: --e e -õ. -; ~stool nml color
: alcohol (reent / heavy / ocasianal) _ occupation :
: EXREMITES
ii:FAMILY
HX i _~I ROM
i living slrudon alone (omify (riend group care fadlit i
_reviewed, n'lt relevant : ~ulses full, equal
- - - ._---- - ---- - - ---------------- - ---- - ---------
-pedal edema
_decreased pulse(s) ( R'I L )
i
4001 15051 fJÀ
~RTIENTED
6/ 2 / 2BY:
0 iR~N
0
..
Pg 1 of2
.L
_~spo:Se to com~onfus~ 'letharic
NEURO
_nml responsivenes.
_nmlorientation
=ti£~ft\-i;n~c.
ßcL
_fixed I irregular I unequal pupils
R_mm L_mm
_no gross motor
deficits
_EOH deficit
_no gross sensory
l
+
+
+
"
deficits
_weakness
_Babinski refl
R~;po~;; ro p~ñ~ - tJ6;w gri~;~- . - - - -
witdraws ~ ex lle
RUE
0_0_0_0
lUE 0_0_0_0
RLE0_0_0_0
0_0_0_0
ILE
Reflexes
_depres.ed mood I fiat affect
PSYCH
_mood' affect nml
SKIN
_skin nsh
_nml
_decubItus
INITAL ASSESSMENT
VITAL SIGNS SEE NURSINGASSSME FOR FURTHER VIAl
- .. .. .. .. .. .. - - .. .. .. .. .. .. .. .. .. .. - .. .. .. .. .. .. .. .. .. .. .. .. .. ~ .. - .. - .. .. .. .. - .. .. .. -"
BP _,_ HR_ RR_ Temp
: _Discussed with Dr. Time: _ _ _ _ :
EKG MONITOR RHYTHM
: wiU see patient In: ED I hospital
sinus rhytm uchycardìa wi I narro bradycardia
P.ULSE OXIMETER
% 02 saturation
AA02_Ll%
time:
I of1ec A: :
1_ ~~~~I!~~ ~~~~_ iiJ£~~o~!t~~;~_~~~e_sh¡~_i
C L1NICAL IMPRESSION
ALTEm MENAL STATUS GI BLED
NP mask BVM
~~ONARY AR HYPSION
___ SEPSIS I SIRS
LABS, EKG &XRAYS
. _"'!Y'2~lloÉ !O~ !O.!ge; ~'! ~~~ o.n _iJe .;r:"!~ IoJi !"J2~ . _ _ _ _ _ _ . _ _ _ . ..
'~C . Chern U.À ABG's:
i: C_
segs_ Na ~ pHll i ~"- wffC!g,..
Hgb bands_ K " pCoiJ :
: nrol excet platelets_ nml ex~ept ~ except RAIOl i:
: Het Iymphs_ BUN_ i& HCOl,~:
:
CreaLpm
512 :
i
Glue
COHb
L_ __ _
Present On Admission decubits I UTI wI fotey
DispositIon Order Time
~...R..~~~_§_tr_e_~.2~~_~~__~~RlfVC ____0_.______.___...___... ..; DISPOSITON. 0 home )idmitud 0 OBS 0 exire
: ~ inter by ~ider Rate _NSR _A-fib :
o HeartfStre Center
: diagn _nmt _abnmt i
o AHA (S' MI templa # 73) 0 t",nsfe~t~ ~
i nml intlYois _nmJ axi _nmJ QRS _nor;spedc srrr chn¡:es :
CONDITION. 0 unehanged 0 improved ~ ~K\h_
~_~~e.t EKG- .__ unchanged ___~~~KG-_-~r,a~:.c!..date: _._...____~ úrii trnsfelTed to HD I DO' HLP TIme: _ _ __
: CXR interreted by ED provider unles noted otherwise :
MDIDO
l/PIPA
1/ 0 na infilrates _nml heart size _nml mediartnum :
: nmfJ~D :
Rr:
: Old CXR- uncanged date: i
i CT Scan ead cont st I O/Kantras! i
LOX
~._._:: -------..... ..--- ._---_.._---....._-='-_.......__._-_._._.._--_........-..._--..
Prvlcr #
IDX Prvide ø _ _ _ __
o I perion~11y s:w and .""¡ne the patient I have reviewe and agree with the
",udenù findngs, inluding all dlaonlc interetations, lld treatment plans as
I_-=_ .. .... _ _ _ _ _ .. .. _ .. .. .. .. .. .. - ...... _.. .. .... - .. - .. .. - .. .. .. - - .. .. .. .. .. .._, wnwin. I wu prese or the key p . er any procure peormed and th
PROGRESS 0 see additiona template: # 94
¡"elusle time no in y cr. . me
uñ hanged improve
MDIDO
Critical Car.51 Pg 2 of2 Rev. II f 09
PR:U~D ~: ,eifN
4001 i5051~TE (Of t?ì~~010
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(; /996 - 2008 T-Syitem, Inc Circle or check alfrmatlvej, backslash (\ negativs.
AmID'/27/10
1l:1327351
Tennessee
Medical Center
University of
51a
1924 Alcoa Hwy
Knoxville, TN 37920
(865) 544-9000
i¡ M
EMERGENCY PROVIDER RECORD
Procedures / Critical Care Add-on
PROCEDURAL SEDATION NOTE
INTUBATION NOTE
Airway
abnomial 3-3-2 rule
Evaluation
large I
Pre-tx
_100%°1
other
~Idate
-
OSee Nursing notes for VIS monitoring
Sedation type:
dee
-
Indications:
other
moderate
HPI 0 see patient template
Induction
oiter:
TIme.____
las meal
Past Hx d see patit's template
. .
prior compJlc:dons to genera anestesia
loose teeth
Mallampatl Class:
ofv." I,cae tongue
i
~ous secretions ~'¿, -4 5
midazolam
E.
-
Paralysis 0 n~traindicatiOnS to succlnychollne
Equipment 0l I LMA siz:IG
. lidocaine
_ Glidescope I McGrath
iq
_Bogie
other
Post.intubatlon management:
Err primary ~ confirmation ~
Emergent conditio'ns applies
~nomatry_mm Hg ~COi change
PI. Normal healthy patient
P2. Patient with a mild sysmic disease
PL. Patient with.;i severe sysr~ic disease
P4. Patient with a severe systemic disease that is a constant threat to life
P5. Moribund patlent who is nor expected to survive w/o the operation
Vent settings: 0 per Respiratory Therapy
Physical Exam D see patient' template
Mode: CMV AC SIMV PS CPAP
AIRWAY
_obeSe
_nml anatomy
_large ~ngui; I teem
rect visualization _ est rise
_tu~ in good position on CXR
_tuba repositioned and re.confirmed with CXR
-
Settngs:
.-
_angioedema
abnormal rule 3-3-2 rile
TV_ Fl0i- R- PS_ PEEP_
other
Ventilator sedation: propfol drip I
~ilioiiai Notes:
\~ht~
--ossible upper airway obstructon
~neck immobilty
-propofol
_rocuronium _ ucclnylcholine
other
prior complications to procedural sedation
Allergies ",NKDA see nurses note
brevitl
etomld:ite fentayl
ketamine
mjdaolam morpine nitrous oxide propofol
_. .. . ..
other
ASA ClassIfication
+
FIN: 13273510002
GR, HRY L
DOBt10/07/91 iay.
..
Mallampatl Classification
Class r . Soft palate, anterior ¡-po~ tonsillar pillars, and uvula visible CIa.s2. Tonsilar pilla. and uvula hidden by base of tongue
. -
CI:us3. Only sòft palate visible
CENTRAL LINE
Class"l. Soft palate not visible
Preparation
_CDC Sterile inserton guIdelines followed
--lan explained:
to patlent. . to parent / guardian
_consent signed (see hospital consent)
:-oxlmetry during procedure
_capnometry during procedure
IV acces obtained .
--
_suction Immediately available
Sedation
cardiac monitor used
versed
etomidate
_2% chlorlexldlne prep
_local anesthetic: lidocaine 1%/2% _mL
bupivacaine D.25% / O.5%_mL
catheter
Fr single I triple lumen PreSep
location: R I L U/ ~uíded lj subavian supraclavicular
supraclavicular brachial femoral
complications: none
CXR post-procedure:
._propofol
_fentanyl
ketamlne. .
Reversal
none
Complications
during I after
.. .
.
. . - _. .
_narean
_romazicon
TIME OUT called at:
for
TIME OUT called at:
for
none vomJrlng_ _ apnea O¡ deseuration
requIred BVM.PP hypotension agitation
TIME OUT called at:
for
procedureother
Post Sedation Recovery Score D see sedation record
-
I personally performed D sedation and I or D procedure
31-45 min
_'1.(, min
Intra.service time: 30 min or less
-
NP/PA MD/DO
.
Rcsl¡cnt
IDX PTvldttl ~detl_____
MD/DO
. . . A1¡¿iilni:
PRINTED BY: RWAPrvld&r#_l'3~ß 0 Template Complete
300 11451 A~ÀTE
6/ 2/ 2 0 i 0 0 Written Addendum
Pg I on
+
.l
~
+
+
Wound Description I Repair
Early Goal Directed Therapy
mmHg (8-12)
_fluid resuscitation to CVP of
_vasopressors for HAP.. 65 mmHG (SBP': 90)
dopamine
vasopressin
norepinephrine
em location
flp
stellate
irregular
dean contaminate moderaely I hei:'rly
length
linear
Into: sub
cut , muscle
distal NVT: neurovascular Intact no tendon ¡nfury
anesthesia: local digit block topical _ lidocaine
_steriods: hydroortone
Intubation for ScVO,.: 70%
_endotrcheal
,
+
marcalne
epi' bIcarb _mL
_trasfusion to Het~ 30%
prep:
_dobutamine Infusion for SeVO,.: 70%
irrigated wI saline exenvely cleaned
debrided mod. lextenslve
wound explored
wound margins revised
%
_final ScVOi'
_antibiotics (c: 3hrs)
Betadlne , Shur-Clens I saline I
LP
_discussed risk¡, benefits, alternatives; Jarenúguardlan consents
lying
betadine prep
fluid color_RB
wac
sterile technique
glucose
lymph
L3.4
protein
L4.5
poly
monos--m st_
reuire ins;umentatn / exension
Wound dosed wi: wound adhesve / steristrlps
repair:
siting'
multiple flaps aligned
to base / in bloodle field
no foreign body Identified
foreign material removed
SKIN.
SUBCUT-
#
OTHER.
#
_-0 nylon' prolene I stale_
_-0 vlcry I chromic
_-0
#
FRACTURE I DISLOCATION I REDUCTION I SPLINTING
Loction:
local bloc / reginal bloc / joint I
Sedation: see proedural sedation I
(raaure block I betadine prep I stn1e procedure
Anesthetic: lidocaine / bupivacaine I £PI 0.25% 0.5 % ,%
2%
mL
amount of anesthetic
Preprocedure DNVT status: see Physal Exam
ARTERIAL LINE
Tlthnlque:
_CDC Sterile Insertion guidelines followed
_2% chlorhexidine prep
Traction - Counter Tractn / ScciuJar Rotation / Hennepin /
Stmson I Whiser lather
_local anesthetic: Iidixine 1% / 2% _mL
bupivocaine 0.25% / O.5%_mL
Fr Ulguided blind
catheter
Post-procedure DNVT statuii
normal
_unchanged from pre-procedural baseline
location: R / L
_no comparent sydrome thought to be present
other
Post reuction Imaging
_deformity is completely reduced
_deformity Is acceptably reduced
_deformity Is unacceptaly reduced
CARDIOVERSION
-:Procedure discussed with Pat~nt I Guardia and consent obtained.
unchanged Improved re-eamined
Time
- - cardloverted at
Splint type: Velcro I Fib~lass I Plaer I Aluminum-foam / metal Volar I
Exenr I Thumb spica I Sugar tong I Gutter strrup /
Poserkr Ace Wra I Boot ortos I Air splint / Buddy tap I
lang I shalt
J
-post cardioverslon rate
--ost cardioverslo rhytm
NSR
afib
a.utter
splint loction:
_V.fib
_V-tach
Provider RN Tech
Provider post-spllnting NVT check & splInt appllcaUon check:
applied by:
splint In good posit & NVS norml
other
ii
ti
CHEST
other
TUBE
(_French)
ches wbe Inserted
Betadine prep
NPIPA
_mL local lidocaine I mi:rcaine I
mid I anter I txst
axlJary line
Interspace
position confirmed on CXR
conneaed to suctian
sutured in place
~tu air I blood
IDX Provider ft
Kd/dl:
MDlDa
IDX Prvider ø
MDIDO
AI1~tfri
IDX Provfder tt _ _ _ _ _ 0 Template Complete
o Written Addendum
Procure 1 Critical Car Add-in - 5 i a Pg 2 of 2 Rev. 08 1 09
TIME OUT called at:
lor
TIME OUT called at
for
TIME OUT called at
for
PRINTED BY: RWAN
3001 1451A~E 6/2/2010
..
VINi13273510002
QR, HENY i.
DOBll0/07/91 lSY M
ADi04/27/10
MRi13:l7351
.¡
LJNIVERSITY OF BJN::SS~ M:MORIAL HOSPITAL
1924 ALCOA HW . KNOXVILLi;.TN 37920
(8õ5) 305.9000
~f5
~- EMERGENCY
==
rZll11327351000:i
QRAJU, BD'l Ii
DODt10/07/il iey M
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"--- ---- -- .'
i At t 0'/27/10
i MRt1327351
DEPARTMENT GUIDELINES
NAME MR# ENCOUNTER#
DATE_
io inia¡D
- au.Jrrs
. Dlace YO inillS iii .rt 8DlDre box (cæc
- acJ¡iol !Jes as ltarerJ & selea x.msJ Sian ~ boom of ¡he for
0
oreed PAIN/SOB
caiti. in nature
I 0 CHEST
STOKE I ACUTE NEURO
Açliv;le hos¡jlal oroioc
2L 02 via NC, cardiac
STAT EKG
2l 02 via NC, carlie; r.,
pulse oximetr, INT
CSC. BI. CPK isnz, TIo¡(nin
2l 02 via NC. cartiac
moi1r. poise oxt!), INT
Fingemicl; blood glucose
C8C, CM? CPK isnz.
ir"!0nin, UA
Manesium
sm: to tab In black bag
PCX
Of Sys0lic 81' 'SO)
CT H8Id - For acue ste
S..alo.. Sc
ere:: dyslbn
2l 02 via NC. caia~
EKG
CSC, 8MP. PTI?TI,
t inQuire ato reæ\ usa 01 dn. for
o HCG rn Indl:.ed
Obtin ¡iÆVous re:ordsl EKG
I-
c
EKG
Finger stk blood glucoe
-
C8::, 8M?, UDS. ETOH,
Atlamlrip!en IMl
CTHea
Sa:; level, TCA I~,
PCXR
Semosmol
UDS, ::TOH (i mi:~)
0
PCX
.
Gren gown
:i
HCG Iff ir:ao¡
H:AINJURY
PT Cd 00 COmaln)
-CTI=
eNP (it shonmiss at cralh)
t (criy" \: Df consi:usnes 0: en
Couman; or owr ê5 years: fA su::
PLEURmC CHEST PAm
altered mental stat)
:KG, pul;¡ oximei.)', mo~o;, CXK
0
KNOWN SÐZURE D~ORDER
1°
SHDRTN:SS OF BREATH.
0
0
Gl BLE:D
02 via NC. pulse oxmet
monlt,lNT
CX¡ \'5 PCR (dlde one)
Repiraoi therpy cosiH
CaC,8MP
i'ngercl bloo ghlt:ou
t: Drp ~e!s zs Booroaie
.
.-
NEW ON~E! S=~URES
1°
"'
0
BCi2 (~Iebile or otne
lnòi:ed)
0
Ini!!entions hsied abO"B plus)
BM? UDS. ~O~.
CT Head
POSlõlLE S::PSIS;
TEMP' 'O'~S', AND OVER Sl Y"..RS
2L 02 via NC, ClroI2.
0
2! 02 via NC. csa; mo:.
.
CBC.CMP, PT
ü i& S (~lndtaled
Q
Gren gown
cee, BM.", VA
bleifri)
0
0
HYlOGL'1CEPlIA
HYl:RGLYCEMlACbl:i oluro , 400)
Fingeri; blDod gluco
Fingmtick blood glucos
CBC, BMP, UP. Urie Ci.S. BCx2
::XR (reason: fave
EKG
cardia: moiror, pulse
Fingmticl blood glucose
oxirrlI,INT
Fin~r stil; blocx glucose
Nolit Transplani servce r. ini:ai
CBC. BMP, CPK
BMP
30 min ~ inleiori
lsonzeg,
Diet ny
ttan ever hour
Trapan", UA
amp D50 IV xl for as ~ 50
Reverse isolalioo (il patient Is
0
AllERGIC RECTION
0
LOWER ABO PAIN AND/OR VAGINA
BLEEDING - ore meol)ussl female
0
0
':
T to S (I Indicaled)
Fetal hear¡ lones if' 12 weeks pregnant
0
SUSPECTED i. PYLONEPHRIS
cac, eMP, UA
HCG (I Ir01ed)
ABDOi.INA PAIN
INT
CBC, CM.D, UA
0
-
UII
cac, aMP, BCx1 (ff febrile)
0
MEDICAL CLERACE FOR
G~~n
c
HCG (r.lrdcaied)
e8C, BMP, UDS, ETOH
0 HCG ~f indicatd)
::
Upa¡¡ (ff pain in I.r
0
::
Quadrants)
EKG (ff inócaie, upper abd)
0
LACERA TlONS
.
Irri9aie wond '1M normal
-
Hay injur erea rd
selin
suspcr b;isn .t:y
NoUty nu~ng suparror If
patiem ¡s sulcldll andJor
homl:ldil
PATIEtI ON COUMA01N
Pulse axini.INi
CBC, PT
c UrineC&S
c HCG ¡if indicaled)
PSYCHIATRIC !:VALUATION
SusCled 10 be p'egnanl
c
0
0
0
cae, UP,
ü ABO ru ff vapinal tielling AND
SUSPIòCTED RENA coiic
INT
Serum HCG 0t ¡;lienI is known 10 be
~ lô wee ~9nenl)
,
HCG (I indicated)
oximetr,INT .
RT conult Çnindicaed)
Noti MD STAT Ie severe reition
CBC, 8MP. UA
IV NS 1L
evcry hour
PCXR \' CXR (cile one)
':
cardia: monitor, puise
or frctre)
. Suture cart to bedside
c Teiars-tipioona 0.5 mL 1M C'
indi::l!dl
EXR9IIT INJURY
Deiermill menanism and exet b:ti
of pain ORDER APPROPRlAT:ò X-RAY
Immobillz". eleva!e, ice
:i Righi I Lef (ciclr
c
ETOH. uas
c iV NS allNO (~ iiÌ'ly
Immunoomoro~ed
:i
.
Ortosiali::
2L 02 via N:; cariiie;
monlior. pu~ oxim!:i, INT
:: HCG I~ iriicaled)
~ Lßetaie (~suscted ~sJs)
c: llce:ainoonen 19 POiR lor T , 101.5'
c:
Pulse oximeir, INT
FiIlrs:J bloo gl=s
pulse cidmeiry, Iarve ixre INi
I
monr, pulse oximetr, INT
c
SYNCOPE! NEAR SYNCOPE
ëlOH linOXICATlON
I
no Clao In naMe
Puse oximetr)', moio, INT
i
SUSPECTE OVEOSE
m:nilO., puse oximeiry, INT
moior. pulse oximetr, INT
pain
10
0
ALTER:òO MEIIAl STATUS
EKG
PCXR vs CXR (i;itie cie)
""¡inn 324 mg PO ~~ed rrl ro Asnn allergy)
Niirlycen ü4 mg SL Q 5 min x3 for Chesi
=
-'
0
OEFFICIATE SYIiPTOIiS
PRI Medi:ilion (with IiD order)
c: Tyfeii 19 POIP fo
T"101.5
c Qnßneiro (Zolr)4mg IVßM
DRUG LEVLS (w YO Df ar
D
AOOlTNAlA lwl ~D cmer)
::
0 Digoxi
0
1horyfoM
0 PheYtn (Dilarrn)
0 Garbmayeine (T egQ
0 lJalp'd: Acid (Delme)
PT
BNP
c \. HCG
c
D-rn
Q
Amrnia
Rigt I Lel (;udel.
l 1 forNN
INT rd inòi:led
c Albleiol Alronl neulizer
Q
c ta"1te
trent pe rssrJrato
Iherap for SOB
0
0
RN PriV Init
Time
PRINTED BY: RWAN
DATE 6/2/2010
WI Signatu Time
ED GtOc!li. 932527 - ED (D"lom, Rev 11m. 12/8.01110)
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hw. Knoxville, TN 37920
(865) 305- 9058
Radiology Consul ta tion Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account #:
BRACA, PAUL R
Consulting Dr.: N/A
7 SNS- S7 4 O-A
Male
18 years
13273510002
Accession #:MI-10-0007106
Radiology Report:
Ordering MD:
05/06/10
03:05:47
MRI Brain & Stem Wi thout Contrast
Nurs ing-Order,
Nursing-Order
(nL,c
,l~~j~TJQN+ ~r.,'t~ll~r." itight skuil base fracture,: Evaluate fbi- cortical or r
,\
L i/ Ie
t"'Wàterslied inJ ury. .
I
Technique: Multiple MR sequences of the brain without gadolinium
enha ncement.
COMPARISON: Multiple prior head CTs, most recent dated 5/5/2010 at 0838.
FINDINGS:
Diffuse diffusion restriction within the deep white matter in the watershed
regions of the bilateral frontal, parietal, and occipital lobes has
developed with corresponding low signal intensity on the ADC map. Blooming
arti fact on gradient sequence along the inferior aspect of the anterior
falx may reflect a sequela of remote hemorrhage. No acute hemorrhage is
identified No mass effect, hydrocephalus, or midline shift.
Mucosal thickening involves the posterior right ethmoid air cells, right
sphenoid sinus, and right maxillary sinus.
IMPRESSION:
Areas of diffusion restriction within the deep white matter in the
watershed regions of the bi a onta~etal, and occipital lobes
would be compatible wit ypope,fusion inc h5Sù. atèt~
C: C r f ó- ci b
GRAJU, HENRY L
Abr/ 'h / V)L : VI cJ
1:.
~ ~0"-
Page
1
of
f2rry
PRINTED BY: RWAN
DATE 6/2/2010
WL, ~ Ý/S"~
~C"
,~
~ rj
~a/
2
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(423) 544-9060
Radiology Consultation Report
GRAJU,
HENRY L
MR. :
Location:
Sex:
1327351
Age:
Attending
Dr. :
BRACA, PAUL R
Consulting
Dr. :
N/A
Accession #:
Radiology Report:
MR Brain & Stem Without Contrast
Account #:
7SNS S740
A
Male
is years
13273510002
MI - 10-0007106
Ordering MD:
05/06/10
03:05:47
Nurs ing-Order,
Nursing-Order
Blooming artifact in the midline of the low frontal lobes may reflect the
sequela of occult hemorrhage.
Authenticated by: LAING, GEOFFREY G
10:55
05/06/2010
Resident: Thurman (Resident), Robert D
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxvil Ie, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
7 SNS- S7 40-A
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: DX-10-004 144 9
Radiology Report:
Cervical Spine, Lat, Flex. & Exten.
05/03/10
18:42:23
Ordering MD:
MILLER, JOSHUA A
Results
tR~gaiTr;'':~fà liria;? \
Neutral, flexion and extension views o~ the cervical spine are obtaLned.
There is slight kyphotic angulation at the C4-C5 level without obvious
generally. .
~~~tu~~ No-abnõrmai-motion is identified on the flexion/extension views
however the degree of motion is quite limi ted
CONCLUSION: Limited exam without gross abnormality.
Authenticated By: GASH, JUSON R - Radiologist
05/03/2010
19: 08
**FINAL REPORT"'*
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
--~..
_8
=
-C'
FrH. 13273510003
QIlJO, HZN1Y (,
History and Physical
Blectronically Signed ayiRIDER, STEVN P 5/26/2010 710':22 PH
HP
UNIVERSITY OF TENNESSEE MEMORIAL HOSPITAL
1924 Alcoa Highway ** Knoxville, TN 37920
(865) 305-9000
PATIENT NAME: GRANJU, HENRY L.
MEDICAL RECORD #: 1327351
LOCATION/ROOMI: 10EAST 1018-A
PATIENT TYPE: INPATIENT
ADMISSION DATE: OS/25/2010
DISCHARGE DATE:
ACCOUNT #: 13273510003
DATE OF BIRTH: 10/07/1991
HISTORY & PHYSICAL EXAM
CHIEF COMPLAINT:
History of decline in mental status, obtundation, possible seizures at rehab,
HISTORY OF PRESENT ILLNESS:
lIenr:y.,§r,êJiJ;i 15.... ~rl l8-year-old gentleman who has Lâ;jñištõl;Y~f.':7ãirifšsãüit"';ãira.r.
~ ¡~li~.rìFã;'p§ssibie..;'òv'erÇl~s-,~~ ~eing found unresponsi vè w:tth a drug .screen posi ti ve
for opiates, cocaine, and cannabinoids on 04/27/2010.. The patient had some
problems with cerebral edema~£t~~~g.~~íiJ-Uryt~oxic injury with
respiratory failure with treatment for aduit respiratory distress syndrome
(ARDSj. The patient stabilized nicely and in fact improved fairly
significantly and was at rehabilitation where he was able to regain ability
to walk and would talk and was undergoing cognitive rehabilitation. Over the
past 72 hours the patient has had a decline. The patient had a restless
night Sunday night and then had an episode of possible seizure activity
characterized by an episode of collapse, syncope, and vomiting on Sunday with
a loss of awareness and consciousness during this episode as well as frequent
episodes of paroxysmal abnormal behaviors characterized by waking up looking
scared and/or waking up, turning pale, and becoming diaphoretic with
difficulty following commands with an inability to speak during these
episodes. The episodes are relatively short in duration but occurred
frequently during Monday and some this morning. The patient was started on
Keppra but it caused some sedation so the patient was then placed on
Lamictal, but given some concern for continued seizure the patient was placed
on Depakote last evening, The decision was made to transfer the patient from
St. Mary' s Rehab to UT Medical Center on OS/24/2010 after an MRI of the brain
was performed at St. Mary r s Hospital on the morning of OS/25/2010 as the
patient had difficulty undergoing this test given some movement problems and
also given findings of increased cerebral edema/whi te matter change on head
CT performed when the patient had an episode of seizure-like episode St.
Mary r s on Sunday.
REVI EW OF SYSTEMS:
The patient is not able provide much in the way of review of systems, however
he does describe that he has a headache but does not have and also describes
that he does feel uncomfortable. The patient is able to follow some
commands. The remainder of the review of systems is according to the
patient i s family. The patient was doing better in rehab until this weekend
when he has had a significant downturn. In the past, the patient has had
problems with substance abuse and had undergone a stay in rehab. The patient
has had some problems with anxiety in the past. The patient has had an
injury to his urethra from his Foley catheter as well and this has caused
some painful urination. The patient has had a low grade temperature of 100.2
at rehab on OS/24/2010. The patient has had an episode of skin
breakdown/skin ulceration on his heels from being in bed.
PRINTED
DATE
BY: R~ARfßlI ~~nn iiiiiiiiiimi Diiiiiiim 11111
6/2/2010
1m 1111
~
---('
_8
-
GR.J1. HEN'l to
PIN. 13273510002
Rehab Consul t
Electronically signed Byi HECHT, JEFFREY S S/lO/20l0 6:31:43 PM
CNBDREHA
('
UNIVERSITY Of TENNESSEE MEMORIAL HOSPITAL
1924 Alcoa Highway ~* Knoxville, TN 37920
(865) 305-9000
PATIENT NAME: GRANJU, HENRY L.
MEDICAL RECORD ff: 1327351
ADMISSION DATE: 04/27/2010
LOCATION/ROOMff: 7SNS S740-A
PATIENT TYPE: INPATIENT
ACCOUNT ff: 13273510002
DISCHARGE DATE:
REHABILITATIVE CONSULTATION REPORT
DATE Of BIRTH: 10/07/1991
DATE OF CONSULTATION: 05/05/2010
REASON FOR CONSULTATION:
Evaluate rehabilitative needs, advise regarding rehabilitative care.
PATIENT'S CHIEF CONCERN: Not healing.
MOTHER'S CHIEF CONCERN:
To deal with these physical problems first and then the drug and alcohol
problems.
FATHER AND STEPMOTHER i S CHI EF CONCERN: The same as mother.
HISTORY OF PRESENT ILLNESS:
This 18-year-old right-handed male (DOB 10/07/1991) has a history of A&D
issues since age 18 as well as history of anxiety disorder was reportedly
assaulted on 04/25/2010 and found to be unresponsive by a friend on
04/27/2010 and brought emergently to UT Medical Center. He was reportedly
awake but confused and "high" the evening of 04/26/2010 and unresponsive the
morning of 04/27/2010. He was brought to UT Medical Center and he was found
to have evidence of varni ting and aspiration on his Emergency Department
evaluation. He was admitted by Dr. Paul Branca to the intensivist service
with acute hypoxic respiratory failure and required mechanical ventilation.
He stabilized with the ARDSNet settings and had bronchoscopy with large
volume suctioned from the airways. His drug screen was posi ti ve for
benzodiazepines, marijua na, and cocaine. 1~?:-ffii'd~~~eYi8êti-ce~õ£ blqoq :.Iri:. b6t:lt:'l
~~ff1~udiï:6-ry::'cánaÜ àI1d there was conc~-;n th~t ¡:~.1íad -biYei"¿rai..:riiptu~è I
f9..f.";tJ:eü:yrpå.rilê' meriranesi ~e had bilateral e~chymòses of the eye canals.
The exam at that time do not note whether there was any bruising over the
mastoids. He has since been extubated and transferred to the floor. He has
been trea ted with Rocephin, zithromaxi and clindamycin. He had evidence of
elevated troponin and .wãsifieYE to have suffered cardiac injury associated
wi th the cocaine. He hã-a-..trõ~ble with confusion and had diffuse cerebral
edema. He was seen in consultation by Dr. Randall G. Trudell of Neurology
and was noted to have hypoperfusion hypoxia related to aspiration and drug
overdose. He was seen by Dr. Karen Mullins who noted improvements. Dr.
Trudell commented on the periorbital ecchymoses and blood in both ears. He
was started in therapy and noted to have profound balance problems.
PAST MEDICAL HI STORY:
His primary care physician is Dr. Richard Glover. This is his pediatrician
and he is not normally on medications. However, he has been tried on several
medications ror OCD behavior and anxiety problems. Last year he was tried on
Lexapro but it "made him crazy" and he was on Wellbutrin that he stopped
since he felt it increased his anxiety and caused insomnia and he tried it
PRINTED BY: RWARN
GRAoT, H!:Y L
DATE
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GRANJU, HiiNRY L
FIN. 13.7351000.
Rehab Consul t
Electronically Signed By: HECHT, JEFFRY S 5/10/2010 6:31:43 PM
for 4 weeks. Mother feels anxiety is a primary problem and notes
fairly severe panic attacks. He has had a good response to Xanax (bought on
the street, she says). He has not been diagnosed with bipolar disorder. He
has been involved in 2 recent alcohol and drug treatment programs. One was a
Wilderness program, one I believe in Phoenix, and the other at Cramer Creek
in Montana. He reportedly checked himself out of the programs when he turned
18 and he had returned to drug use problems.
SOCIAL/FUNCTIONAL HISTORY:
Henry was fairly functional until age 14 and then has not been able to
function in high school while essentially being truant throughout high
school, not being able to attend at all since age 16. He even attended the
Laurel School for special needs. He got his GED though. He normally walked
without any assistive device and was physically independent though "living on
the street" lately and just doing drug and shooting u~ medication. His
favorite was marijuana but he was also "addicted to opiates" according to his
mother and he used benzodiazepines as favorite help to relax. He has
never been on BuSpar. "He would take whatever he could get" and this
includes cocaine. The patient is not able to respgnd ~eii~en9ugh for him to
descEil'e_if it. madë'i'iñ reet better or worse": - He has had a personality
change~with-this, before he was sharp and respoñsive but now he is flat,
. before he would argue_and now he does not care. He .is superficially into
what is going on. H; spè~ks-in~Shdrt~phrasesl siñglë ~ord answers, whereas
before he was very articulate. Before he had opinions and now he is flat
affect and mother described him just starring at boring things for a long
time such as an add in the classifieds. Mother is Katie and father is Chris,
he is married to Melissa. Katie and Chris of course are divorced now. Henry
is one of 5 children, actually the youngest. He has declined vis a vis all
acti vities before and had a decline in hobby type interests. He is a
smoker.
fAMILY HISTORY:
Maternal grandfather having trouble with anxiety and depression and being
high functioning until the last 10 years of his life when he was diagnosed
wi th atypical bipolar disorder and suicide. He had panic as a young person
and Prozac would set off mania. He was never tried on lithium. Depakote was
not effective. He also used alcohol.
REVIEW OF SYSTEMS:
A compreh~nsive review of systems reflects that Henry lost weight, had ear
tubes as a child. No hearing problems now. No swallowing trouble. He
admi ts to seeing 2 of things and has had complaints of blurred vision lately.
He denies any paresthesias, numbness in the limbs, healing problems, or
endocrine problems. He admits to memory problems. He denies having any
trouble with memory, attention, judgement, or emotions. It has become apparent
that he cannot empty his bladder. He did remove catheter while inflated and
has been seen by Urology for the trauma. There is some concern that he could
have neurogenic bladder as well. He has had a CT of the head showing a
cerebral edema , but not findings of skull fracture as no special views of
the basilar skull. .. He h~T of C sp"ioe._showing. no-abnormalities and
he had bila teral pulmonary consolida tion on admission wi th ground-glass
opåëîci~~. --Hi~ labs showed-low albumin at 3.2, elevated AST of 93 and ALT 67
initially with an elevated lactate of 2.5. He did have troponin elevated at
over 5 and CPK elevated at over 370. His creatinine was elevated at 1.64 on
admission and lactic acidosis was diagnosed at 2.5. He was felt to have a
non-ST elevation MI. ENT has been consulted here. Otherwise review of
systems is unremarkable.
PHYSICAL EXAMINATION:
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GRAJU. HIUlIlY L
FIN, 13273510002
Rehab Consul t
Electronically Signed By: HECHT. JBFFREY S 5/10/2010 6131143 PM
GENERAL: Somewhat sleepy, arousable young man with curly dark hair. He no
longer has the ecchymosis around the eyes and does not have a Battle i s sign
and I do not see trauma about the head now. He has symetrical faces. NECK:
Supple. No brui ts about the head or neck. No jugular venous distention.
LUNGS: Clear. CARDIOVASCULAR: No murmurs. Regular rate and rhythm.
ABDOMSN: Soft, nontender. NEURO: He has very slight left pronator drift on
Barré testing. He still has somewhat upgoing plantar responses on both feet
less prominent I believe than when Dr. Trudell saw him at which time
he had Babinski with plantar stimulation; there were no Hoffman responses.
He had equal pupils and they are responsive.
He has trouble with memory and focus though is
alert enough to share information about recent events such as who is the
President. His general cognitive function is impaired. He has
impaired balance. He has reduced coordination.
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_ -.__ ~.- J .... _.- ~ _... _. - - _., reported. . He does not "nave tnese signs now. He does have the Battle's signs
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but his history is fairly classic and often it does not show up on standard
x-rays. He also suffered some hypoxic insult with cerebral edema. MRI scan
of the brain could be helpful to define where there is ongoing brain insult
from hypoxia. It is a more.sensitive test, especially now that the cerebral
edema is resolved. I suspect tha t Henry had anxiety disorder and there is
some OCD type behaviors. I feel he would benefit from a trial with
medications to help with this such as BuSpar supplemented by benzodiazepine
use very cautiously and administered by an adult in his Ii fe for the
long-term since he is not to be trusted with medications. He is counseled
that alcohol is a toxin to the brain and needs to be avoided lifelong but at
least for the next 3-5 years since it would be a poison to the brain,
interfere with recovery, and lower the seizure threshold. He may benefit
from use of medication to help protect against mania such as Lamictal,
Trileptal, or perhaps even Depakote¡ though I would be concerned that it
might not be as effective since it was not effective in his grandfather. If
it were tried he probably would need higher doses wi thin the
therapeutic range, perhaps 85-9, and check LeTs and this will only be started
if these were clear. This was associated with bilateral
aspira tian pneumonia. He would benefit from ongoing alcohol and drug
r.ehabili ta tion
as part of the inpatient physical rehab program that was carried
out to work on balance, mobility, transfers, and self care skills. Henry is
not capable of handling his own affairs even though he is 18. I recommend he
have a legal guardian. The family did discuss this. I feel he is not
competent. He does show some evidence of nondominant parietal lobe syndrome
and had motor extinction and had left side sensory extinction to double
simultaneous stimulation. The next time I see him it would be helpful to do
clock drawing and see if there is some clear visual perceptual deficit
manifested on this testing.
I understand Sheperd Spinal Center has been recommended. That is a fine
facility but I spoke with a liaison today and they do not have any special
program dealing wi th both brain inj ury and alcohol and drug problems. The
St. Mary's Rehab Care Center has availability of psychiatrist that can
consult. I also recommend we ask Dr. Josh Williams to see him to initiate
the discussion of these issues and for affective disorder and then carryon
in the rehab center if he does go to St. Mary's as that is very close and
convenient for his mother who lives just 3 blocks away. I would also like to
at the rehab center at PNRC at Fort Sanders. Going to deal with A&D issues
GRAJtI, HElY L
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PIN, 13273510002
Rehab Consul t
Electronically Signed By: HECHT, JEPFREY S 5/10/2010 6131il3 PM
while doing physical rehab would possibly make sense though the parents
pre fer to focus on the physical rehab now. I agree wi th using Aricept
starting at a low dose but it might be helpful to get some baseline memory
testing before starting such a drug as it could be difficult to tell if he is
getting benefit
and also there are potential side effects such as anti-cholinergic affects
tha t could be a problem with his voiding issues. He is on other medications
including Lovenox 40 milligrams subcutaneously daily, Nexium 40 milligrams
daily, Diflucan 100 milligrams daily, and Ciprodex otic suspension 3 drops in
both ears. He may benefit from a multivitamin daily. Consider checking 812,
folic acid, and vitamin D as these deficiencies can have implications for
healing and recovery. I also recommend checking 86.
Thank you for asking me to assist with your patient i s rehabilitative care. I
had a lengthy discussion with the family today.
ADDENDUM:
I was able to get an ophthalmoscope and return to add further information.
His aunt is present in the room now. I had to interrupt the previous
evaluation since a tech arrived to perform an echocardiogram. That result is
still pending. However, I did review the EKGs and note that on 04/27/2010
his EKG did show ST elevation in the lateral leads. Dr. Besozzi interpreted
that as showing ST-T wave changes but Dr. Baljepally observed on 04/28/2010
"no longer ST elevation in lateral leads". It was clearly elevated on
04/27/2010. His EKG also recently showed incomplete right bundle branch
block and T wave inversions earlier, less prominent on the later studies.
He loves music. He plays guitar, both lead and base.
in
a band.
I was able to get an ophthalmoscope and find that he did not show optic
a trophy. He did show pulsations of veins. Did not show any AV nicking or
other problems. However, the pupils are dilated and respond slightly but it
is very easy to look at fundi. The right appeared to be a bit more sluggish
than the left though. No ptosis is noted. No field cuts. No
ophthalmoplegia. Tongue is midline. No cranial nerve II-XII abnormalities.
His mental status exam showed him to remember i of 3 objects at 5 minutes.
He had difficulty reversing numbers but when he finally did he was able to
reverse 2 but not 3. His aunt was able to do it with alacrity. Serial 7s
reflected inattention "100, 97", and we stopped there. Initially he was abstract
with similarities and apple and orange were fruits and ant and elephant were
both animals but he said the similarity between a sailboat and a car were
"they both had motors" and "both ran". I was able to loca te an otoscope and
found the blood that was obscuring the tympanic membranes bilaterally had
retracted. The drum is intact on the left side without problems. However,
no drum is visible behind the blood and I can see some bloody måterial in
what appears to be the middle ear on the right.
Addi tional impression is I wish to correct where I said he had a non-ST
elevation MI and change that to say he did have an ST elevation MI but no
non-Q wave MI and he has ongoing EKG abnormalities with incomplete right
bundle branch block. Echocardiogram is pending to determine whether..therec __ ...,
are_any_ongoingweii motion abnormalities. i (.iaiÙciñ:ã'l-lyj7;:hè~ñâg:~7ã~i!¡fpt~~à'l'3'óf""
Lff11ff:'tYfpanra?lrr~ff~~à-Ì1~~i~.~'fd¥umTi! , Recommend MRI scan. Although CT scan of
the bones of the basal skull could help with making a diagnosis of fracture I
think it is clear enough clinically that it is not needed and it is not
needed to expose this young man to the amount of radiation needed to do the
study.
GIlJU. HZNlY L
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FIN. 13273510002
QIlJtl. HENRY L
Rehab Consul t.
Electronically Signed By: HECHT, J&rFREY S 5/10/2010 6: 31: 43 PM
ATTENDING PHYSICIAN
Jeffrey S. Hecht, M. D.
DO: 05/05/2010 16:40 DT: 05/06/2010 16: 19/ksh 468325/1242956
EDD: 05/05/201017:22 ETD: 05/06/201017:23 /ksh 468396
CC: Richard A. Glover, M.D.
Murad Salaita, M.D.
William Scott Bridges, M. D.
William A. Paulsen, M. O.
Joshua A. Miller, M. D.
Murad Salaita, M.D.
Paul Branca, M. D.
Denise M. Rivers, D.O.
Jeffrey S. Hecht, M. D.
COpy
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Report Modified Byi BECHT, JEFFREY S, M.D. 05/10/2010 18:31 EDT
Electronically Signed By: BECHT, JEFFRY 8, M.D. 05/10/2010 18131 EDT
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GRAJU. !lENRY L
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FIYi 13~73510002
Nephrology Consul t
Electronically Signed Byi RIVES, DENISE M 4/28/2010 5133159 PM
CNNEPERO
UNVERSITY or TBHBS!! MXORIAL HOSPITAL
1924 Alcoa Highway.. Enoxvilla. TN 37920
(865) 305-!lOOO
lATIim NAli GRJU, HENY
L.
MEDICA RECORD #11327351
LOCATION!ROOMll MCCl HC1-09
ADMISSION DATEi
DISCBAGB DATE;
04/27/2010
PATIENT TYPE; INPATIEN
ACCOUNT #1
13273510002
NEPHROLOGY CONSULTATION REPORT
DATE or BIRTHi 10/07/1991
DATE OF CONSOLTATIONi Ol/27/2010
REQUESTING PHYSICIANiPaul R. Branca, KD, FCCP
CHIEP COLAINT i Increased intracranial edem, acidosis.
¡n:STORY 01' pusmr :ILLlSSI Tbia is an 18-year-old whita male who waa foun
down unespoiisive by ei friend. Brought 1n by EMS to the emergGlncy departDent
where he was intubated. Apparently assaulted two ~ys ago, exact issue was
unown. Be was found to have a positive urina drg screen for cocaine, TØC.
and benzodiazepines. Dis mother and stepfather tell me be was smking crack.
Police of!ice picked up the ~tient from his house last night. Be seemed high
at tht tiie. Baid that he had been beaten up the day before when he was
trying to buy nroxies. n The friend found h1m this morning unresponsive with
white powder around his mouth, positive emsis, and he did aspirate in the
amulance. He was unable to give any history. The majority of my hiatory is
fro the parent.s and the chart.
FAMILY HISTORYi Unable to obtain seoondary to patient intubated and sedated.
SO(J:AL HxsoroaYi Unable to obt.ain aecondlry to pet:ient intubated and sedated.
REIEW OF SYSTBMB: Unable to obtain secondAry to patient intubated and
sedated.
PHYSICA JaINATIONi VITI.L SIGNS
i Haimum temperature on arriv.l 102.5,
heart ~ate ~5, respiratory rate 22 on the ventilator, blood pressure 112/59.
saturation o~gen 9" in the Ea, satur~tion 100\ now on 100 flow lim. BBBNI
Bilateral blOod from hi. earø. Periorbital erythema. He has no cuts or
bruises in the eyes. No obvious issues there. Positive battle sign per the
i Rate, rhyth reglar.
i Soft. HET
intake resident. ABDOM
BXTRETIBBi No edema, but multiple bruising. He has a tattoo on his left
forearm of his nae.
LAORATORYiHis initial AB was 7.16. pC02 68. PA02 58, 02 saturation 80\ on
100\ Fi02. Flow lim waa started. He was trans~erred up to the intensive oare
unit and his repat ABQ was 7.31, PC02 48, PA02 67,02 saturation 91\.
CAT Bcan shows diffuse corebral edea ~ith partial effacement of lateral
ventricles and cisterns. No midline shift. No intracranial hemorrhage. No
mastoid effusion. Hinimal maxillary sinus and ethid sinus mucosal
thicleiing. No evidence of depressed skull fracture. Cervical spine is
intact. Thorax, bilateral dependent areas of pulmonary conaolidAtion
con.lstent with aspiration. Qround glass opacity and superimaed mild ed~.
amall focus of air to the 1aft pectoralis musole. No solid organ injury. Mild
periorbital edema. Small amount of free fluid in the pelvis.
ABBISSMX/PLAiCerebral øde~. Will follow CAT soan. Neurologic response.
Get Neurolog involved. If there is need for CRT to help with fluid or
stabilize an acid bas~~~~nEf! ~se, we will be available for
GRAJl. HElY L DATE
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GUBJU. HI!W1C L
7IS, 13~735iooo~
Nephrology Consult
Blectronically Signed Byi RIVERS, DENISE H 4/28/2010 5:33:59 PM
that. As of right now, he se~s to be stabilizing well. We will follow his
labs and his lab work, ~d be available to you as needed for acid base
stab:ilh:ation.
ATTEINQ PHYSICIAN
Denise M. Rivers, D.O.
DOi Ol/27/2010 16132 OT: 04/28/2010 16156/vf 462229/1238822
CCi Denise M. Rivera, D.O.
Paul Branoa, X.D.
COpy
Page 1 of 1
Slectronically Signed Byi RIVES, DENSE M, X.D. 04/28/2010 17: 33 EDT
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GRJU. III:miT L
DATE 6/ 2l 2 0 ~lWllllilm~mlillruml~llmlliinUnlmllil
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p'rNI13:l7351000:i
DOBiiO/07/9l iey M
GR. HlY L
JiiO(/27/10
MR:13:l7351
PSYCHOLOGICAL CONSULTATION
Room 740
Date a Time OS/Q6/2010 10:00.11:00
Treatment summary: The potjent is an 18-yeir-oJd white male 00 odmissjon with lJI MelDoÒa! Hospital fOrlriaiit ofieidi efIcw
of a rçent drg oyerdose. A complete medical history can be found within the medical reord He wa sçen by psychiatst Dr Gibson lW
days !lIlO At thot time Dr. Gibson decólx a hjçh!y retjcenl adlescent mole Famjly rart indicaie a history of wiote deendence cocaipe
dependence as well as 0 host of oter uewifed dni¡s A ¡iycbolo!!ical consultation bas ben requested for assisiiiie with differtial
diagposis and trtment ofewoljonaJ and beavionil jssues, The pll!Ìenlis seen for Qne hour !his AM be js acmQlied by his WOdmolherwhp
is asked to leaye the room The patint is supine in hjs be:, He remained suffciently aler and intentiye to conduct this inieryty. At times it
was diffcult to djsce piisjye-ayojdant resoonse frm reidual cognjtiye lacunae with organic eliolo~ (encephalopa!hjç) He spes in
cQmplete sentences at an iipnropÓa!; YQliie with good synta and a brod yocbulaQ', I uuderiad frm siaffand the pa\jgil confirms that he is
bilngul jn Eng!isb and Frch, The iitien(s moo an arrec! are essentially Oal Ibm js a long laten in hi, response to Questons and he
sometimes appears to need to haye QlJstions reeated The wtien! devies psyclitic features, He admiis to being depre. He denjes suicidal
idçatioD. He also denies suicidal integt in his ret oyerdse. "I Wll just lQ'ing to get a bu,. Th patikJt sties !hat he hIl liiiIe or po recgJl for
tlc; events ic'ding W!o hjs hõsjjãiî!jii i;;riy admits to ¡¡!! drgs oyer a siznificatperõ(foftjme. Wb;bas ii¡;nal usc of~QCine aod marjbuana he refer to his drugs of chojce as "dowers" referrg 10 Bezoillepjne family pf drgs. He ha! mor!l a pa'ijng
fewjliariiy with izcr¡:on dni~ bv name lind ii!ion
The patient report thaI he is se1luaJly actiye with his gjrl freod Ljz, He states that he and Ljzz were hayjnii sex in !be yaw "we were having
sçx jn 8 va and got puJled Qye They fowid drg siu(fnnd we go! biiled" Apparntly the parieur bas had hjs crimina! ctwiies droppe.
Howcyçr hjs girlfrend rertly failed to show up for her CO!Jl i1tç and is now in jail. The patient hll ha DO contact with her "( staed to
think about writing IQ ber yes!erdii but i neyer go! it done n
ACTION: Despite his initial retice() ! be!jeye thai tbe patient ni I establisli a reaonable rapport in ibe cours pf this jnimjew, The pptieii
was suiÒsjngly rcçeptjye to ¡be suggestion tht he miçht beefi frm pn admission tQ an inpatient Alcohol wi Drg Rebabi1iia!iQn nrogr
once his physical and mcdcal nçids bave ben adÇ3Btely addrese, He is also reeotjye to fyrter jnieucliogs with ths wá!er At this lime the
patients diswsirioD is unclea, He may be ¡cavin!! tA Univerity Hospital an gojp~ to cilhc: the Paircjii Neal Rebajltaioo Centc: or th
Mercy Hospital Rehabi!ti1ion Ceoler, ((he procds to the latter I wj! be a2rieable to staring osychPthenpy wi!h him in !hat YkJue. 10 any
ca be wil oeed a referrl to po A & D program when be is djsçbaied from hQspital can family inlerentioo iylla!sQ be an essential
cpmponent (or any furore jntereiiijoos Qr plpns,
If th pgtlent doe not r;elVQ any fuijb9r psychologIcal and psychIatri Interention be wil be arelY AT.
RISK for futuu acting out nnd self-hanD.
Thpnk YOu (Qr this thoughtful and timely refqrl
DX Impressioo:
AXis
I:
292.9 Cone-Relate Disord NOS (appeim to be remitting)
296.32 Major Depressive DIsorder, Recurrent, Moderate
304 Opold Dependence
rIo 304.6 Polysubstance dependence
AXIS II:
V71.0 no goosls on Axis II / l 0
cc: Dr. Jeffey Hecht
PRINTED BY: RWAN
DATE 6/2/2010
F:IH 13273510002
aaAJU, ø:Y L
00&:10/07/91 lBY M
AD:041:l7l10
MRil3i7351
PSYCHOLOGICAL CONSULTATION
Room 740
Date Br Time 05/Q612Q10 10;QO-11;QQ
Treatment symmary: The patjent is nn i g-yeir-old white male 00 admjssjon with lI MemoÒal Hpspital for treatmt of
reidual e!Teets
of a rçcnt drg oYere. A complet medical histor can be found wjuiin the medcal m:ord. He was sen by psbiatrst Dr. Gibson two
day ago Al thaI lime Dr. Gibson deribc a hjghly !'iceDt adolesent male Family rert jodicile a history ofQpja!e de¡indcoc coaine
depdece as well a: a host Q(other unspecified drgs. A psycbological consultatiQn bii be reuested (or llistance with differentÌill
diag/Kis and treatment Qfemotjonal and bebayjoral issues. The ~tieni is seen (Qr ope bour this AM he is ocompiioicd by his grdmother whQ
is asked to leay the rom The patient is sUQine in his bed He remained suffcieotly aler ADd jntcrcriye to conduct thjs jn!eryiew. At times it
was diffcult tQ discrn passive-avoidat response frm reidu.l cQgnitive locunae with Qrganic etjQIQgy (eicepbalopathjc) He s!lks in
complet SÇI!ences !It an appropñ!l!e yolume with gQRd syta Bnd a bro vocbulary I underi;od lim staff
and the DAtien! cQnfinns that bç is
biJngiml in Eng\jsh and Freh. The patjçnts mood god affect au csientjal!y Oat Ther is a IQng In!ey in his respori to Quesons and hç
s9wctirn appears to nee to havç gys:tions reeated Thç patient denies psychotic (eatires He admiis 19 beiDg depressd He denies sujcidal
ideatiQn He also dçniçs suicidal jntet in his renl pyrdos -I was JUS! !Ning to gei a buz." The pB!icyt stales that be has Iiule or nQ recall (or
the eyents leading up to bis hospiiaHzatjon He readily mils tQ abusing drugS oyer a sjgnjficant oeåod of time Wljle be has ocasioiaJ us of
c!KiD; aod marjbUanll h; refer t( his dr~ Qfchoicç as "dpwner" referrng jo BenzRdjiieiine famjly ofdrugs He ba mQre th a piing
fqmilariy with pa:scptioi dr~ by name nnd actjQn.
The patient repo thai be is sexually actjye with his girl frend Lim He states that he lld LiW wer haying seX in the yan' "we Wer baving;
sex in a vin aid gO! pulled Qyer They fOund drg stiffand we got busd," Apiartly the patient' has had his crinal charges druo,
Howevr his gjrlfrçn ß1rtcdy faUed to s!ww lI for hercoii dale and is now in jaU The patient !l bad no contact with ii "I staed to
think. ahQu! wrting to he yestery but i neyer gQt it done "
ACI!OjS: Despite hjs injtial rçticence I beljeye that the paticit and I s:tablished a reaonable rart in the CQUrs Qfthjs inteiew The patient
was sumrisjogly rçepiiye tQ the suggeston that he might befit lim an admissiQD to AD iopatent Alcohol and Drg RelibiltatjQD prornm
once his physical and medical nee have ben ade.iiieJy addrssed Hç is plso reçeptjye 10 fuher interctjops wjib ths wrter At this time the
patient's disiitiOD is ynclear He may be leavjng !be Univerity Hosital and ~oiog tQ i:Uier the Patrcia Neal Rchiiiliition CelkT Qr lhe
Mimy Hosital Rçbabiltatjon Ci:tq, ifli pree to the latt r wil be agreable to stang psycbQ!hcrnpy wjth bim jg that venue In any
case he wil need 8 rçfem! to rin A & 0 prgram when be is djchl\ged from hospital cm Fami1y joierÇlljop will also be an e5nÙ¡i.
componenl for any fitu interentjons Qr plans,
"the mlgn! mil DOt mcetve any further pischololca! and psyhiatc Interv9!lon he WILL be guiatly AT-
RISK fo Mum acting out and ulf-brm.
Thank you for this thoowifuJand timely referrL.
DX Impression:
AXIS
I:
292.9 CQcaine-RelBted Disordr NOS (appear to be remiuiDg)
296.32 Major Depreive DIsorder, ReC1rrent, Moderate
304 OpoTd Dependence
rIo 304,8 Polysubstance dependence
AXIS II: V71.09 no diagnosis on Axis II
Joshua Wiliams. Ph,D. CHoical Psycbolo&ist
CC: Dr. Jeffrey Hecht
PRINTED BY: RWAN
DATE 6/2/2010
--=0-..
--g
QllJU. HltllY L
FXNI 13~73510003
History and Physical
Electronically Signed By iRIDER, STEV P S/26/20L0 7 i 04 I 22 PH
PAST MEDICAL HISTORY:
The patient has had no previous history of seizures or head .trij9.ry".or other
as_;~' I
J~~.~~'~~t-~z~.~~;~B:f~~P6.~~.*î,~Ur~~'~~~.~ë;;~:~li::~fi£~:~~ciosi
~..~.,." '..1,"'.,.~~~ --. ''i .l _'" ....'t... ..' ~ . " - '- ."' ;..i:;ltç,~
\~ ~...1i __ - _ .
..wei.i as a histöry of assault wiUí closed head inJiiry~ ,
PAST SURGICAL HISTORY: The patient has had no recent surgeries.
SOCIAL HISTORY:
The patient has smoked in the past but he is no longer currently smoking. He
is no longer currently using cocaine, amphetamines, opiates, or
benzodiazepines recreationally.
FAMILY HISTORY:
Notable for a history of anxiety and depression as well as a history of
bipolar disorder in a grandfather. .
MEDICATIONS:
i.
2.
3.
4.
S.
Depakote 500 milligrams twice a day.
Aricept 5milligrams at bedtime.
Lovenox 40milliequivalents subcutaneous daily.
Nexium 40milligrams at bedtime.
Remeron 30milligrams at bedtime.
6. Mul ti vi tamin once a day.
7. Senna laxative l7. 2milligrams a day.
8. Vesicare 5milligrams daily.
9. Reglan as needed.
10. Oxy IR as needed for pain.
ALLERGIES: The patient has allergy to TETANUS TOXOID.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 99.3degrees, heart rate 64, respirations ia, blood
pressure 122/79, oxygen saturation 98% on room air. HEENT: Conjunctivae and
sclerae are clear with no inj ection. No carotid bruits were auscultated.
EXTREMITIES: No meningismus. CARDIAC: Regular rate and rhythm. PULMONARY:
Clear to auscultation bilaterally. SKIN: The patient does have some areas
of breakdown on his heels bilaterally and is currently in boots for this.
NEUROLOGIC EXAMINATION:
The patient will open his eyes and alert to voice and answer one-word
commands. He has normal speech. He demonstrates a paucity of language at
this point in time but will answer questions appropriately. He will follow
commands intermittently. He does not follow complex commands. He is very
somnolent. Cranial nerve examination demonstrates pupils approximately 4mm
in si ze and reactive to light near. He has normal facial symetry and
strength. His palate will elevate bilaterally. His tongue protrudes in the
midline and shows no tremor or fasciculations. On strength examination the
patient has increased tone of the spastic type in all four extremities with
reflexes 3+ and symetric with a flexor plantar response bilaterally.
Sensory examination demonstrates intact sensation to light touch throughout
(he responses to light touch in all four extremities). On cerebellar
examination the patient will not perform finger-to-nose testing. Gait
examination is deferred given the patient's current mental status/obtundation.
LABORATORY AND DIAGNOSTIC DATA:
MRI of the brain performed OS/25/2010 compared to the MRI of 05/06/2010
PRINTED BY: R~llilmllmlliillilil"miil~Ulillillilm~
DATE
6/2/2010
::
--
=
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rXN. 13273510003
(3 JU. H:i Y L
History and Phy.ical
Klectronically Signed Byi RIDER, STKV P 5/26/2010 7 i 04 i ~i PM
demonstrates evidence of some subtle areas of restricted diffusion
consistent with bilateral watershed infarcts in the frontal parietal
occipital lobes as well as some moving artifact in the frontal lobes
concerning for sequela of occult hemorrhage, this was done 05/06/2010. MRI
preliminarily per my report on OS/25/2010 demonstrates evidence of increasing
T2 hyperintensity in the patient's subcortical white matter and his
frontoparietal and occipital cortex compared to the MRI of 05/06/2010.
IMPRESSION/PLAN: . ...
Henry Granju is an l8-year-old who has rñistoryot:è.ä"cî'is.,é'å~ll~á'd-iiìrú.'lft'
hypoxic episode in association with th~";íT~e";6f-tocaLne.and' opiate,s with .1
episode of respiratory arrest. The patient has had a decline in his mental
status functioning with possible sei zure acti vi ty. The patient is going to
be admitted to UT Medical Center for EEG and further monitoring and possible
further testing including spinal tap given a low grade temperature that
patient had at rehab. He may have further MRI testing including MR
spectroscopy to further differentiate the white matter changes. It is of
concerned that the patient may have a delayed hypoxic leukoencephalopathy
given his history of a multisubstance overdose in the face of hypoKia. He
will be started on steroids given this concern at 60milligrams of prednisone
daily as well as Coenzyme QI0 100milligrams three times a day. He will stay
on Depakote 500 milligrams twice a day which has been started for seizure
prevention. I f there is further clinical concern for seizures he will
undergo video EEG moni toring. Speech, Physica 1 Therapy, and Occupational
Therapy will be continued. He will have boots supplied for areas of skin
breakdown on his heels. I will check a cac, CMP, and Depakote level in the
morning as well as a sed rate in the morning. I will also check a PT, INR,
and PTT. I will discuss comparisons of this patient's film from OS/25/2010
with the radiologist prior to any lumbar puncture being performed. I have
discussed my plans and concerns with the patient's family this evening.
Myself and someone from our group will follow this patient during his
hospital course and make further recommendations based on the results of his
testing and clinical course.
ATTENDING PHYSICIAN
Steven Patrick Rider, M. D.
DO: OS/25/2010 22: 15 DT: OS/26/2010 13: 45/ksh 482897/1252585
CC: Richard A. Glover, M.D.
Steven Patrick Rider, M.D.
Jeffrey S. Hecht, M.D.
COpy
1 of
Page
Repcrt Modified Byi RID~R, STEVE P, H.D. OS/26/2010 19.04 BDT
Electronically Signed Byi RIDER, STEV P, M.D. OS/26/2010 19104 ED
PRINTED
DATE
BY: R~l~11I1 III ~II 11~1I11~11 IIIU111 11111 11111111
6/2/2010
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UNIVERSITY OF TENNESSEE MEMORIAL HOSPITAL
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lÐ:1327351
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CONSULTATION
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MR #: I Ô2. 73~1 ENCOUNTERIf
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Notification Date:
Notification called by:
Notification received by:
nursing unit staf
physician office I answering service staff
Our findings suggest the following problem(s):
Prority: _ STAT
Please give your opinion and advice: (Instructions checked)
_ Prary Service will write orders
ASAP
within 24 hours
_ Please write orders pertaining to above probJem(s)
_ at your convenience
_ Please consider accepting patient's transfer to your service
Contact#
Primary Service Physician
Date
Physician Notes
Date & Time:
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NAME'
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1924 Alcoa HIghway. Knoxvile, 'lN 37920
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FIN. 13273510002
Q1JU, BKNY L
CT Surgery Consul t
Eleotronically Signed Byi GAINES, THOM K 4/29/2010 311110a PM
CNBURGCRDHOR
UNIVESITY OF TENESSEZ MEOaIAL HOSP:rTAL
1924 Alcoa Highway.. Xnoxvi11e, TN 37920
(865) 305-9000
PATIKN NAMEI GRAJU, HENRY L.
MEICAL RECORD #11327351
LOCATION/ROOM~1 KCCl K01-09
PATIENT TYB i INPATIEN
ADMISSION DATEI 04/27/2010
DISCRGK DATil i
ACCOUN li 13273510002
CAIOTHORACIC SURGERY CONSULTATION. REPORT
i 10/07/l991
DATE OF BIRTH
DATB OF COHSULTATIONi 04/28/2010
RESON FOR CONBULTATIONi
Large perioardial effusion with evidence of some pericardial tamponade.
BRIEF HISTORY i
Henry is an ia-year-old male who was found to be unesponsive by a friend.
Ultimately he wai: fowi to have a P9sitive drg soreen, and it was estimted
. tha t ~CP~\~,~,:~~~ liÎì1i~lifd;i.;:i~~i'fci';gbl'uÍr t:ra~~~~:;*,;i~i.tfá!g;i' "
t~~i~gc.l..ii~i_st~~~~tÈRe was t~en found unesponrive the followiiig morning
affer having h4d emesii: and indeed aspiration.
PAST XBDICAL HISTORYi
Negative.
PAST SuaGICAL HISTORY.
B:ar tubes.
MJi:CAT:rONB i
The patient does not take any medioines.
I!AKLY HISTORY,
No contributing family history.
SOCIAL BISTORYi
positive smker. History of cocaine, marijuana, benzos, and other narcotics.
RXEW OP SYSTEMS i
At this time, patient is intubated and tolerating only mild fluids in tha
form of antibiotics. Otherwse 13-point review of systems is negative.
PHYSICAL EXA!NATIONi
At this time, he haa a temperature of 99.6, a heart rate ranging anywhere
from 10~ "130. His blood pre~.ure is currently 115/70 with a mean arterial
presøure of 82. His heart is slightly taohyoardia. The heart sounds are not
muffled, and there is no overt muur being noted. He does have bilateral
breath sounds tand_baøA'!~~_ClJ:acltlÐs on each ~ide.._.. Ria._.~~e~,.i~-"ø"c,t,~.,~~
nondis tended. ~i,qiriirii~ll~iiil:;t~:'t¡rç1!~Pi~t.fR~ì~fiyj'~d.oëiÛliìr'~tt( ,
Again he is intUbated and does have -ãñ apprõimatoly 6 cæ area of ecchymsis
on his ohest. He has no peripheral ød4a. His pulses are within normal
rang'e at this current point in time.
LAORATORY
1
He has a lactic acid of 2.6. Chemstry otherwise shows a sodium of 142,
potassium of 3.7, chloride ioa. C02 22, BUN 16, creatinine 1.07, phoi:phorus
2.3, magnesium 1.7. CBC reveals a hemglobin and hetoorit of LS and 42,
white blood cell count ~rl~ÈTPW!l~N'f 142. He haa had elevated
GRAJ1 , HimY 1.
DATE 6/ 2l 2 0 ~iuIIIIlIIIIIlIIIIIIMII~lill1ll1ll1lnllii
;;
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FIB, 13273510002
OIlJU. øXlY L
CT Surgery Consul t
Eleotronioally Signed Byi GAINES, THOMAS! '/~9/~OLO 3111108 PM
troponins, likely secondary to trauma, anywhere from l. 25, l. 27, to 2.57 on
04/28/2010 this a.m.
!chooardiogram reoeived yesterday, 04/~7 /~010, revealed a morately large
pericardial affusion with an ejection fraction of 40\ with evidence of
~erio ard1il tamonade.J ~Jl1~~~~,~.f.::~:~o_~..~i.ö.õf.iii6li"';!~!_~~~~;~Õl ff~S,;
t;~,r,~f.~f~",i~~~~.~'!l?;~::e.~~u.!~onary
oonøoll~:He,a;g~~!t:~~h~HJï
aspire,tlon. In .'èddiêian "lie has periportal
edema, likely seoondary to his
decreased ejection fraction.
~~e;,~~-~~~~,~_p~,I... "' ,,": ~',~. - - - - ..',- - - - -- ','
~~a~.UB;.-:.8i'n~:~t.=-as.ho~:e~l.,_.:.~'ipir"d."il~a..iL.:c.t;'o~'~:'r~.QS"!m_i.'s~l..;"aBsaui t., .Wtth a 'larg~ ~riQardillJ; effusion". ,"
t.~.=..$:..-,!,..i.;";¡'~~"'~'~'~"~~"'.!D,,_. ... Although he is hemdyically st8ble at
this point, he does in fact Deed a pericardial window for drainage of his
pericardial effusion in the near future.
I will discuss the patient with Dr. Gaines and likely sohedule patient.
Diotated byi LaMr O. Maok, H.D., RBSIDBNT PHYSICIAN
ATTENING PHYS:rCIAN
Thomas E. Gaines, K.D.
DDi 0'/28/2010 10103 DTi 04/2~/2010 1S101/vf '62610/1239449
eei Denise M. Rivers, D.O.
William Scott Bridges, M.D.
Paul Branca, M.D.
LaMr O. Hack, M.D.
Thoms B. Glaines, M.D.
COpy
Page 1 of 1
Electronically Signed Byi GAINES, THOHAS E, M.D. 04/29/2010 15111 BDT
PRINTED BY: RWARN
QIUJU, a:imiy II
DATE 6/2/2 0 ~1I11111111~HlillilmßIII~lmlililmlnl
:.
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
EMERGENCY PHYSICIAN, .
Account #:
ER- Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: .CT-10-0017004
Radiology Report:
Ordering MD:
CT Head Without IV Contrast
04/27/10
13:42:10
PATEL, ANAN N
Resul ts
CT brain without contrast
INDICATION: Unresponsive
COMPARISON: None available
FINDINGS:
There is accentuation of the gray-white matter differentiation diffusely
wi th small ventricles. Basilar cisterns are patent but relatively small in
si ze. There is no midline shift or definite evidence of intracranial
hemorrhage.
No evidence of significant mastoid effusion. Minimal maxillary sinus and
ethmoid sinus mucosal thickening.
No evidence of depressed skull fracture.
IMPRESSION:
Findings of diffuse cerebral edema with partial effacement of the
lateral ventricles and cisterns
Authenticated By: PETRUZZI, PETER T - Radiologist
04/27/2010
13: 47
"'''FINAL REPORT"'''
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account #:
EMERGENCY PHYSICIAN,
ER- -
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: . CT-10-001 7005
Radiology Report:
Ordering MD:
CT C-Spine, Without Contr
04/27/10
13:42:10
PATEL, ANAN N
Results
Indication: Unresponsive.
Technique: Noncontrast CT of the C-spine including sagittal and coronal
reformats obtained under bone algorithm without comparison.
Findings:
Vertebral body heights and disc spaces are maintained without evidence of
fracture. No evidence of dislocation or subluxation. Prevertebral soft
tissues are unremarkable.
Mucosal thickening and fluid involves the sphenoid sinus. Interstitial and
airspace opacities are noted in the visible lungs.
Impression:
No evidence of cervical spine fracture
Authenticated By: PETRUZZI, PETER T - Radiologist
04/27/2010
14: 05
Resident: Waddell (Resident), Nicholas R
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees wi th the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consul ta tion Report
Location:
GRAJUr HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account #:
EMERGENCY PHYSICIAN,
ER- -
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: CT-10-0017024
Radiology Report:
Ordering MD:
CT Thorax Abd Pel wi th contrast
04/27/10
13:42:10
PATEL, ANAN N
Resul ts
Clinical History: Unresponsive
Technical factors: 5 mr contiguous transverse images were obtained through
the chest, abdomen and pelvis after administration of IV contrast.
Subsequent sagittal and coronal reconstructions performed.
Chest findings:
Endotracheal tube approximately 3.5 cm above carina.
Distal end of enteric tube in stomach.
Large areas of dependent consolidation wi thin the lower lobes and to a
lesser extent upper lobes. There are also perihilar groundglass opacities.
No evidence of pneumothorax. No evidence of aortic injury or mediastinal
hematoma. Small foci of air deep to the the left pectoral muscled (image
15) .
Abdomen/pel vic findings:
No evidence of focal liver inj ury with periportal edema present. Spleen is
unremarkable. No evidence of adrenal gland mass. Pancreas are unremarkable.
Rotated right kidney. No hydronephrosis. Hyperenhancing adrenal glands may
be s equ el a of hypope rf us ion although the IVC is well-distended.
Foley catheter is present wi thin the bladder. Tiny amount of free fluid in
the pel vis. No evidence of bowel obstruction. No findings of
pneumoperi toneum.
Suspected bone island in the rightward sacrum.
No evidence of thoracolumbar spine fracture.
IMPRESSION:
Page 1 of 2
GRAJU, HENRY L
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(423) 544-9060
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
EMERGENCY PHYSICIAN, .
ER
Sex: Male
Age: 18 years
Account #: 13273510002
Consulting Dr.: N/A
Accession #: CT-I0-0017024
Radiology Report:
Ordering MD:
CT Thorax Abd Pel with contrast
04/27/10
13:42:10
PATEL, ANAN N
Bilateral dependent areas of pulmonary consolidation consistent with
aspiration. Additional groundglass opacities in the perihilar regions may
represent superimposed mild edema.
Small focus of air deep to the left pectoralis muscles of uncertain
etiology
No evidence of solid organ injury.
Mild periportal edema and small amount of free fluid in the pelvis.
Authenticated By: PETRUZZI, PETER T - Radiologist
04/27/2010
14: 02
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account #:
BRACA, PAUL R
MCC1- MC1-09
Male
18 years
13273510002
Consul ting Dr.: N/ A
Accession #: . CT-10-001 7052
Radiology Report:
Ordering MD:
CT Head Wi thout iv Contrast
04/28/10
03:49:00
Barry (Resident,
OB/GYN), Audrey 0
Resul ts
INDICATION: Cerebral edema.
COMPARISON: CT of the head dated 4/27/2010.
TECHNIQUE: CT of the head without contrast.
FINDINGS:
Gray-whi te matter differentiation remains diffusely accentuated. The basal
cisterns are patent, but the suprasellar cistern remains small. No midline
shift, intracranial hemorrhage, or extra-axial fluid collection is
identified. Mucosal thickening and air-fluid levels are worsened in the
interval involving the right maxillary sinus, right ethmoid air cells, and
bilateral sphenoid sinuses. The frontal sinuses and mastoid air cells
remain clear. The orbits are unremarkable. No acute osseous abnormality is
identified.
IMPRESSION:
No significant interval change.
Authenticated By: FOX, DANIEL R - Radiologist
04/28/2010
12: 08
Resident: Dupree (Resident), Brian S
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
MCC1- MC1-09
Male
Age:
Account #:
BRACA, PAUL R
1S years
13273510002
Consulting Dr.: N/A
Accession #: CT-10-0017439
Radiology Report:
Ordering MD:
CT Head Wi thout iv Contrast
04/30/10
10:36:02
Barry (Resident,
OBI GYN), Audrey D
Results
Reason: Cerebral edema.
Study compared to the to previous exams from 427 and 4/28/2010.
On the cur rent exam, I bel i eve the appea rance of the brain is now wi thin
normal limits with some slight reexpansion of the lateral ventricles as
well as the basilar cisterns without significant mass effect or effacement.
No focal abnormalities were evidence of hemorrhage. There is right
maxillary sinus disease.
CONCLUSION:
1. No definite acute intracranial findings as described.
disease
2. Right maxillary sinus
Authenticated By: GASH, JUSON R - Radiologist
04/30/2010
11: 00
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305- 9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Consul ting Dr.:
1327351
Sex:
Age:
Account if:
BRACA, PAUL R
MCC1- MC1-09
Male
18 years
13273510002
N/A
Accession if: . CT-10-001 7642
Radiology Report:
CT C-Spine, Without Contr
05/01/10
12:13:43
Ordering MD:
MILLER, JOSHUA A
Resul ts
CT C-spine
History: Pain after assault
COMPARISON: 4/27/2010
Technical factors: Multiple thin contiguous transverse images were obtained
through the cervical spine without contrast with subsequent multiplanar
reconstructions performed.
Findings:
No evidence of fracture, dislocation or prevertebral soft tissue
swelling/hematoma. Disc spaces are maintained.
In the included lung apices there are multiple areas of nodular like
consolidation.
IMPRESSION:
No acute cervical spine findings or significant change. Considering
persistent pain, MRI of the cervical spine may be beneficial to exclude
soft tissue/ligamentous injury.
Persistent bilateral areas of nodular like consolidation which may be
sequela trauma or infectious/inflammatory process
Authenticated By: PETRUZZI, PETER T - Radiologist
12:32
05/01/2010
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees wi th the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hw. Knoxville, TN 37920
(865) 305-9058
Radiology Consul ta tion Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
7SNS-. S740-A
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: .CT-10-0018081
Radiology Report:
CT Head Wi thout iv Contrast
05/05/10
08:41:12
Ordering MD:
SALAITA, MU G
Results
INDICATION: Evaluate cerebral edema
TECHNIQUE: CT without iv contrast enhancement.
COMPARISON: Multiple CTs of the head including most recent 4/30/2010
FINDINGS:
No mass lesion or midI ine shift. No CT evidence of intracranial hemorrhage.
The gray-white matter differentiation is preserved. No findings to suggest
acute infarct. The diffuse cerebral swelling seen on previous CTs has
resolved. The ventricles and basal cisterns are symetric, midline, and of
normal size.
Decrease in paranasal sinus opacification with remnant opacification of the
right maxillary sinus, right posterior ethmoid air cells, and sphenoid
sinuses. The mastoid air cells are clear.
IMPRESSION:
No acute intracranial abnormalities.
Authenticated By: FOX, DANIEL R - Radiologist
10: 11
05/05/2010
Resident: Medina (Resident), Josue A
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospi tal
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
EMERGENCY PHYSICIAN, .
Account #:
ER- -
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: .DX-10-0039563
Radiology Report:
04/27/10
13:08:24
Chest, 1 View
Ordering MD:
PATEL, ANAN N
Results
FINDINGS:
Portable chest radiograph shows endotracheal tube approximately 2 cm above
carina .Enteric tube descends below diaphragms.
Perihilar opacity. No evidence of pneumothorax.
IMPRESSION:
Findings most compatible with perihilar edema
Authenticated By: PETRUZZI, PETER T - Radiologist
13: 41
04/27/2010
Resident: Waddell (Resident), Nicholas R
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
MCC1- MC1-09
Male
18 years
13273510002
Consul ting Dr.: N/ A
Accession #: .DX-10-0039648
Radiology Report:
04/28/10
Chest, 1 View
04: 25: 59
Ordering MD:
Barry (Resident,
OBI GYN), Audrey D
Results
DESCRIPTION: Portable view of the chest compared to April 27, 2010.
Endotracheal tube is approximately 6 cm above the carina. Enteric tube
courses below the diaphragm. Right central pulmonary opaci fication has
minimal residual opacity in the left perihilar region.
No pleural abnormality.
decreased. There is
IMPRESSION: Decreasing central pulmonary opacities. Support devi ces in
appropriate position.
Authenticated By: PEEKE, JEFFRY WILSON - Radiologist
04/28/2010
09: 01
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
GRAJU, HENRY L
MR. :
Attending Dr.:
Location:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
MCC1- MC1-09
Male
18 years
13273510002
Consul ting Dr.: N/ A
Accession #: DX-10-0040069
Radiology Report:
Abdomen, Single
04/28/10
18:15:40
Ordering MD:
BRACA, PAUL R
Resul ts
INDICATION: NG tube placement.
Frontal view of the abdomen. NG tube is in the distal stomach. Bowel gas
pattern
unremarkable.
IMPRESSION: NG tube is in the distal stomach
Authenticated By: HUSON, KATHLEEN B - Radiologist
18: 3 9
04/28/2010
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account if:
BRACA, PAUL R
MCC1- MC1-09
Male
18 years
13273510002
Consulting Dr.: N/A
Accession if: . DX-10-004 0182
Radiology Report:
Ordering MD:
04/29/10
05:39:49
Chest, 1 View
Carringer
(Resident) ,
Christie M
Resul ts
This exam has just been made available for interpretation on the fax unit
at 1750 6:00 p.m. on April 29, 2010.
Frontal view of the chest compared April 28. Endotracheal tube tip is 2.5
cm above the carina enteric tube is in the stomach. Bibasal or perihilar
opacities are noted right greater than left. This is improved from April 27
and is not significantly changed from April 28. Heart size is stable
IMPRESSION: Perihilar opacities right greater than left improved from April
27 not significant change from April 28 allowing for differences in
posi tioning
.'
Authenticated By: HUSON, KATHLEEN B - Radiologist
18: 01
04/29/2010
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees wi th the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consul ta tion Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
MCC1- MC1-09
Sex: Male
Age: 18 years
Account #: 13273510002
BRACA, PAUL R
Consulting Dr.: N/A
Accession #: .DX-10-0040224
Radiology Report:
04/30/10
03:36:12
Chest, 1 View
Ordering MD:
Barry (Resident,
OB/ GYN), Audrey D
Results
Reason: Respiratory failure on ventilator
FINDINGS: Tubes are in unchanged position since yesterday's exam. Dense
opacification around the right hilum has mildly worsened but has improved
around the left. Heart size remains normal. No pneumothorax or large
effusion.
IMPRESSION: Worsened right and improved left perihilar airspace
opacification may be due to edema
Authenticated By: RULE, KENNTH A - Radiologist
08: 20
04/30/2010
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The Uni versi ty of Tennessee Memorial Hospi ta 1
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
MCC1- MC1-09
Male
lS years
13273510002
Consul ting Dr.: N/ A
Accession #: DX-10-0040587
Radiology Report:
05/01/10
03:04:21
Chest, 1 View
Ordering MD:
Barry (Resident,
OBI GYN), Audrey D
Resul ts
Examination: Single AP view of the chest, May 1, 2010, 3: 10
COMPARISON: Single AP view of the chest, April 30, 2010, 3: 37
INDICATION: ---resp failure
FINDINGS:
Unchanged cardiomediastinal contour. Interval extubation and removal of
enteric tube. Interval improvement in right perihi1ar airspace opacity.
Persistent mild left perihilar airspace opacity. Due to rapid interval
change, this likely represents improving pulmonary edema.
IMPRESSION:
Interval extubation and removal of enteric tube with a decrease in
pulmonary edema as described above..
Authenticated By: BALIUS, ANASTASIA MAIE
08: 20
05/01/2010
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
1327351
Sex:
Age:
Account #:
BRACA, PAUL R
MCCI-. MCI-09
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: .DX-10-0041076
Radiology Report:
Cervical Spine, Lat, Flex. & Exten.
05/01/10
15:59:37
Ordering MD:
MILLER, JOSHU A
Resul ts
Exam: Neutral/extension lateral views of the cervical spine
Comparison: CT C-spine performed same date.
Findings/ impress ion:
Study is limited secondary to inability of the patient to complete the
study. Lateral views including C1-C6 provided demonstrate no gross evidence
of fracture or subluxation.
Prevertebral soft tissues and atlantodental interval are wi thin normal
limits. No dynamic instability with limited extension extension.
Authenticated By: ZENG, RONG - Radiologist
22: 28
05/01/2010
Resident: Pirkle (Resident), Jacob K
**FINAL REPORT**
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
The University of Tennessee Memorial Hospital
1924 Alcoa Hwy. Knoxville, TN 37920
(865) 305-9058
Radiology Consultation Report
Location:
GRAJU, HENRY L
MR. :
Attending Dr.:
Sex:
1327351
Age:
Account #:
BRACA, PAUL R
7SNS- S740-A
Male
18 years
13273510002
Consulting Dr.: N/A
Accession #: .DX-10-0041988
Radiology Report:
Ordering MD:
Chest, 2 Views, PA & Lat.
05/05/10
08:59:07
SALAITA, MU G
Resul ts
Reason: Fall
FINDINGS: PA and lateral views of the chest compared with 5/1/2010.
Bilateral lower lobe, perihilar opacities are improved with mild residual
airspace opacities. No pneumothorax or pleural effusion. The heart size is
normal.
Impression:
Improved bilateral lower lobe atelectasis
Authenticated By: PEEKE, .JEFFRY WILSON - Radiologist
05/05/2010
10: 19
Resident: DeWitt (Resident), Cheryl D
""FINAL REPORT""
This exam and report have been reviewed by an attending physician who
agrees with the findings.
PRINTED BY: RWAN
DATE 6/2/2010
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University of
Tennesee Memorial Hospital
1924 Alcoa Highway Knoxvile, TN 37920 Phone (865) 305-9000
Oter
Other
Discharge Instrction Form
\-~
Cardiac Prdent
Patient: Q-rc\fi) ,
DIET: Reglar
(cerci, if tlprjaltf)
(Circl, if approprialtf)
ACTIVITY LEV
RESTRIClIONS: No Heavy Lifting
(Clrclt1 if appropriate)
Other:
"There are significat health risks with smoking"
WOUN CAR: _See Attched Sheet Other
Encounter#
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University of Tennessee Memorial Hospital
1924 Alcoa Highway Knoxvile, TN 37920 Phone (865) 305-9000
DOSE
MR# lbg-r~5\
Discharge Instruction Form
MEDICATION NAME
Patient c:rc\Û,\ l) L \-t~tA
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On this admissIon you received your Pneumonia Vaccine on this date
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On this admissIon you received your Influenza Vaccine on this date
Food Drug Interactions Instruction: (circle response)
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My dlscha!.~ 1nst\~ns hav~i:plned ~ me and I understand these instructions.
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FIN: 13.73510002
PH
UNIVERSITY O? TENNSSER MRORIAL HOSPITAL
192l Alcoa Highway.. lnoxville, TN 37920
(865) 305-9000
:: N
-C'
PATIKN NAM i . GRJU, HEY
MEICA RECORD 111327351
LOCTION/ROO#1 KCC1 XC1-09
PATIBN TYEi INPATIBN
L.
ADISSION DATBi 04/27/2010
DISCHR.Qit DATE i
ACCOUN #1 13273510D02
PROCBDuaP: ROIl!
DATB OP PROCEURi 04/21/2010
PRBOPERATrv DIAGNOSIS i
1. Aspi~ation pneumnia with respiratory failure and hypoxemia.
PROCEDUR:
1. Plberoptic bronchoscopy with BAL of right middle lobe.
INDrCATIONI Bilateral lower lobe infiltrates with respiratory failure and
refractory hypxemia.
MEICATIONS: Psntsnyl and Versed drips.
PROCEURE: Informed consent wall obtained troD. the parents and the hand held
bronchoscope was inserted via the 31' tUb into the trachea. The t~acheal
mucosa was intensely erythemtous. Thick mucous secretions were auctioned out
Era. the trachea. The carina was sharp, ~idline, non-displaced. The right
side was examined first. The right upper lobs did not show any bleeding or
any endobronchial lesions. The right middle l~ was similar. The right
lower lobe showed a lot of aspirated gastric contents which was suctioned
out. Subsequently Bl was carried out from the right middle lobe, medial
segment wi th three aliquots of 0.9 percent norml saline, 60 cc' s each and
the return wls folUY, reddish in nature and about 50' in quantity_
The left side was exained subsequently and similar findings with the left
upper lobe without any secretions, just intensely erythsmatoua mucosa and the
le~t lower lobe revealed aspirated gastric contents which were auctioned out
and washed out. The bronehoacope was then withdrawn under constant suction.
The patient tolerated the procedure very well without any episodes of
hypoxemia.
P'INDINQS i
1. Erythemtous tracheobronchial tree.
2. Aspirated gastric contents in both lower lobes.
SPBCIHlI
1. BAL from right middle lobe.
PLANi
1.
Pollow up micro and cytological specimen.
The procedure was supervised by Dr. Paul Branca.
PRINTED B~; 2 ~::lllwlmliililllimllmlHllIlI~11I11l1
DATE
;,
PIUI 13273510002
GllJU. HEiny L
--=0
-t"
-
Dictated byi Aait Dhingra, M.D., Pulmonary Pellow, RESIDEN PHYSICIAN
ATTENING ~HYSICIAN
Paul Branca, M.D.
:: N
DDi 04/27/2010 15102 DTi 0'/28/2010 03:1B/lgs 462094/1238330
CCI l'aul Branca, M.D.
Richard A. Glover. M.D.
Oenise H. Rivers, D.O.
Amit Dhingra, M.D.
COpy
Page i of i
Electronioally Signed By: BRACA, PAUL R, M.D. 04/28/2010 14134 EDT
PRINTED B ~ ~ 2 ~~lUlI miinilll imiiimm miiii ~ 1111
DATE
;;
QRAJU. Hnmy L
---0
-
PH
UNrvSITY OF TENSSEE MEORIAL ROSPITAL
192~ Alcoa Highway.. Knoxville, TN 37920
_"4
(865) 305-9000
PATIlm NAKi GlRAJO, KEY L.
g
.
~IN, 13273510002
MXICAL RECORD ni1327351
ADMISSION DATE t 04/27/2010
LOCA'tON/ROOH# i MCCl MC1-09
DISCHGE DATE i
13273510002
ACCOmr #1
PATIENT TYiB: INPATIEN
PROCUR ROTii
DATE OF PROCEDURE: 04/28/2010
This patient was seen earlier in today with an echocardiog~&m which aeemed to
demonstrate a pericardial ef~usion with periaardial tamponade. Gliven his
critical state, it was felt that if this indeed were the case pericardial
drainage would be appropriate. The patient was, therefore, brought to the
operating room, but because the CT soan appeared to be discordant with the
echocardiogram it was fel t that trans8sophageal echocardiography in the
operating roo would be an appropriate way of the resolving the issue without
actually performing a surgical procedure.
Transesophageal echocardiography was accomplished in the operating room and
the patient had a very modest pericardia1 effusion with no signs of
tamponade. The study was revie_d with Anesthesiolog and with Dr.
Baljepally from Cardiology. :rt was felt, therefore, tht pericardial
drainage was not indicated and tha surgieal procedue was aborted.
ATTBNING PHYSICIA
Thomas E. Gaines, M.D.
DDi 04/30/2010 08121 DTi 04/30/i010 09i38!dw 464453/1239716
cc: Denise H. Rivers, D.O.
William Scott Bridges, H.D.
Thomas Z. Gaines, M.D.
Paul Branca, M.D.
COpy
lage 1 of 1
Electronically Signed Byi GAINBS, THOMA E, M.D. O~/30/i010 10109 EDT
PRINTED
DATE
B~; 2 ~;=iliiiiii ~111111I1I illlll~lIllllltmlml,,1
". .
Laboratory Corporation of America
University Pathologists, P.C. Drawer U-108
1924 Alcoa Highway, Knoxville, TN 37920
(865) 305-9080 Fax (865) 305-6866
CYTOLOGY REPORT
Patient: GRAJU, HENRY L Accession #: N10-2087 Taken: 4/27/2010
MR: 1327351 Account #: 13273510002 Received: 4/28/2010 06: 53
DOB/Sex: 10/7/1991 (Age: 18) M Client: 0000 Reported: 4/28/2010
SSN: Location: Medical Cri tical Care One MC1
Physician (s): Paul R. Branca, M.D.
Pathologist: Stuart Van Meter, M.D.
Cytotech: Ashley N. Hundley, CT (ASCP)
TISSUE SOURCE:
A: RIGHT MIDDLE LOBE BRONCHOALVEOLAR LAVAGE DIFF
FINAL DIAGNOSI S :
RIGHT MIDDLE LOBE, BRONCHOALVEOLA LAVAGE:
NEGATIVE FOR MAIGNANCY.
FRQUENT ACUTE INFLATORY CELLS.
SMALL NUERS OF MIXED BACTERIA.
CELLULA DIFFERENTIAL:
50% NEUTROPHILS
30% CILIATED BRONCHIAL EPITHELIAL CELLS
15% MACROPHAGES
5% SUPERFICIAL SQUAMOUS CELLS
GMS STAIN IS NEGATIVE FOR FUGAL ORGANSMS.
*** Report Electronically Signed ***
Stuart Van Meter, M. D.
4/28/2010
GROSS DESCRIPTION:
Received is 20cc of cloudy fluid. Slides are prepared using ThinPrep
concentration technique and cytospin concentration technique. GMS stain is
requested and is performed on one slide.
ICD-9 (s) :
SNO:
A: M09450 P1250 T20000
B: E1000
C: T05128 TOX160 T26000 T28010
GRAJU, HENRY L
FIN: 13273510002
PRINTED BY: RWAN
DATE 6/2/2010
Page 1
Laboratory Corporation of America
University Pathologists, P.C. Drawer U-108
1924 Alcoa Highway, Knoxville, TN 37920
(865) 305-9080 Fax (865) 305-6866
CYTOLOGY REPORT
D: E0004
GRANJU, HENRY L
FIN: 13273510002
PRINTED BY: RWAN
DATE 6/2/2010
Page 2
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITI UNIVERSITY HEALTH SYSTEMS, mc
1924 ALCOA BIGHRAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCT': 13273510002
Age: 18 YRS
V", : (0000) 1 32 7351
it Dr. BRACA, PAUL (5-210)
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
S740A
~ LAORATORY ADDENUM REPORT /
DOB: 070CT91 Sex: MA
NO REFERRllG PHYSICIAN Order Dr. SALITA.KU
DSCH DATE: 06MAY10
PR DATE:
OBMAY10
PRIN TIME: 0301
PAGE:
1
27APRlO
Ti 001
1501_
RE RAGE
UNTS
Reference Laboratory Te3ting
Legionella Cult ~ Comment f
27APR10 1501 Culture Report:
No Legione11a specie3 i301ated.
Performed At: BN
LabCorp Burlington
1447 York Court
Burlington, NC 272153361
Hacock William F MD
Phone: 8007624344
KEY TO SYMBOLS
f Footnote
~ ~ Legionel1a Cult ~Performed at PER LOC: LabCorp (34D0655059)
Patient Name:
SEND OUT TESTS
GR JU HEY L
S740A
Continued on next page...
Print Date: OBHAY10
PRINTD BY: RWAR
6/2/2010
DATE
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNSHIP WITH UNIVERSITY HEALTR SYSTEMS. INC
1924 ALCOA HIGHAY (865) 305-9101
:KOXVLL. TESSEE 37920
Patient Name: GRAJU HENRY L
ACCT': 13273510002
IF/OP
Age: 18 YRS
i-l: (0000) 1327351
it Dr. BRACA, PAUL (S-210)
DSCH DATE: 06MAY10
S740A
, LAORATORY ADDENUM REPORT /
DOB: 070CT91 Sex: MA
PRIN DATE: OBHAY10
PRI TIME: 0301
NO REFERRING PHSICIA Orde r Dr. SALTA. MU
PAGE:
2
ACCESSION' 10-126-1377
CULTU, URIN
RECEIVED, 06MAYIO 1317
STARTED: 06MAY10 1613
COLLECTED: 06HAY10 1305
SOURCE: URNE URIN
PRE
LIHINAY
07MAYIO 2259
Specimen ha" been received and te"ting i" in proce"".
~**7*~ Pending Laboratory Te3ts TT7 ***
C EUG LC
C AFB
VI TD-D
il
C HYCOPLA
C URIN
Patient Name:
Req Col Date:
Req Col Date:
Req Col Date:
Req Col Da te:
Req Col Date:
04/27/10
04/27/10
05/06/10
04/27/10
05/06/10
Order Statu,,: RECVD Co11t Statu,,: RECVD
Order
Order
Order
Order
Status:
Status:
Statu",
Statu",
STAIN
RECVD
RECVD
PRELIM
GR JU HEY L
Col1t
Col1t
Col1t
Co11t
S740A
ROUTINE CULTURE PXNDING ORDERS
PRINTD BY: RWAR
6/2/2010
DATE
Status:
Status:
Status:
Status:
RECVD
RECVD
RECVD
RECVD
End of Chart...
Print Date: 08MAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS, INC
(CLIA 44D0690507)
1924 ALCOA HIGHWAY (865) 305-9101
KNOXVLLE. TESSEE 37920
Patient Name: GRAJU HENRY L
IE/OP
ACCT': 13273510002
HRl: (0000)1327351
Age: 18 YRS
,it Dr:. BRACA, PAUL (S-210)
S740A
~ LAORATORY ADDENUM REPORT :;
DOB: 070CT91 Sex: MA
DSCR DATE: 06MAY10
PRIN DATE: 09MAY10
NO REEEIUING PHYSICIAN Or:der: Dr:. SALTA. MU
CULTU, URIN
PRI TIME: 0300
PAGE:
1
ACCESSION * 10-126-1377
COLLECTED: 06MAYI0 1305
RECEIVED: 06HAY10 1317
SOURCE: URINE URIN
STARTED: 06HAY10 1613
FINAL REPORT
08MAYI0 1016
10,000-25.000 colony for:ng unit5 per: mL
Staphylococcu5 5pecie5-coagula5e negative
SUSCEPTIBILITY TESTllG
ST_COAGN
NITROFUROIN
RIFAMIN
LINZOLID
VACOMYCIN
GENAMICIN
LEVOFLOXACIN
OXACILLIN
PENCILLIN
T/S
CLINAHCIN
ERYTOMYCIN
TETRCYCLIN
C MYCOPLA
C FUG LC
C AEB
Req
Req
Req
Req
Col
Col
Col
Col
SUS
S
S
S
,=0.25
C IPROFLOXAC IN
VITD-DIH
HIC
~=32
Date:
Date:
Date:
Date:
~=2
2
S
F4
F16
F8
F8
F16
R
R
R
R
_IV __ C05t/Dos age __ PO __Cost/ D05age
600 mg
600 mg
1 gm
400 mg
80 mg
100 mg
300 mg
S61
S57
600 rng
500 mg
$3
500 mg
,$1
,$1
,$1
,S1
,S1
$2
S4
2 mil
R
NA
NA
NA
NA
NA
NA
10 ml
600 mg
1 gm
~S1
$42
S4
$14
2 gm
R
160
,S1
$4
U
,$1
DS
300 mg
500 mg
500 mg
$3
$3
****** Pending Labor:atory Te5t5 **"****
05/06/10 Orner StatU5 :
04/27 flO Order Statu5:
04/27 flO Order Statu5:
04/27/10 Orner Status:
RECVD
RECVD
RECVD
STAIN
Patient Name: GRJU HEY L
Co11t StatU5:
Collt Statu5:
Co1lt Statu5:
Collt Status:
S740A
ROUTIN CULTU PENING ORDERS
PRINTED BY: RWAR
DATE
6/2/2010
RECVD
RECVD
RECVD
RECVD
End of Chart...
Pr:int Date: 09HAY10
LABCORP-KNOXVILLE
(CLIA 4400690507)
A LABORATORY PARTNRSBIP WITH UNIVERSITY HEALTH SYSTEMS, INC
1924 ALCOA HIGHWAY (865) 305-9101
KNOXVLLE. TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP ACCT': 13273510002
'. (0000)1327351 Age: 18 Y.S
Lt Dr. BRACA. PAUL (5-210)
S740A
.: LAORATORY ADDENUM REPORT ;,
DOB: 070CT91 Sex: MA
NO REFERRING :PS ICIA Orde r Dr. SALTA, HU
DSCH DATE: 06MAY10
PRIN DATE: 12HAY10
PRIN TIME: 0300
:PAGE:
1
06MAno
Tf 010
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
0105_
RE RAGE
UNTS
---- ------ ---- ---- -- ----- Re fe renee Labora to LY Tes ting ----------- ----------------------------------------
10.0-75.0
1. 25-DiOH Vit D ~ 45.5 f
pg/mL
06HAYI0 0105 :Performed At: BN
LabCorp Burlington
1447 York Court
Burlington, NC 272153361
Hacock William F MD
:Phone: 8007624344
T*T*~* Pending Laboratory Tests **777*
C HYCO:PLA
C FUG LC
C AFB
Req Col Date:
Req Col Date:
Req Col Date:
04/27/10 Order Status: RECVD Col1t Status: RECVD
04/27/10 Order Status: RECVD Collt Status: RECVD
04/27/10 Order Status: STAIN Coli t Status: RECVD
KEY TO SYMBOLS ----
f Footnote
e ~ 1.25-DiOH Vit 0 ~PerfoDned at PER LOC: LabCorp (3400655059)
Patient Name:
SEND OUT TESTS
GR JU HEY L
S740A
End of Chart...
Print Date: 12MAYlO
PENING ORDERS
PRINTD BY: RWAJ
6/2/2010
DATE
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNSHIP WITH UNVERSITY HEALTH SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE. TESSEE 37920
SHOA
Patient Name: GRAJU HENRY L
IP/OP
ACCTI: 13273510002
'~4: (0000) 1327351
Age: 18 Y.S
Lt Dr. BRACA. PAUL (S-210)
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
.. LAORATORY ADDENUM REPORT :;
DOB: 070CT91 Sex: MA
NO REFERRING PHYSICIAN Order Dr. SALITA.=
DSCH DATE: 06MAY10
PRI DATE: 14MAY10
PRI TIME: 0301
PAGE:
1
27APRlO
TOE 001
_1500_
REF RAGE
UNTS
Reference Laboratocy Testing
Mycoplasma Cult ~ Comment f
27APR10 1500 No Mycoplasma pneumoniae isolated.
Performed At: BN
LabCorp Burlington
1447 York Court
Burlington. NC 272153361
Hacock William F MD
Phone: 8007624344
~**T~* Pending Laboratory Tests **+***
C :rG LC
C AFB
Reg Col Date:
Reg Col Date:
04/27/10 Order Status: RECVD Collt Status: RECVD
04/27/10 Order Status: STALN Collt Status: RECVD
KEY TO SYMBOLS
f Footnote
~ = Mycoplasma Cult =Perfonned at PER LOC: LabCorp (3400655059)
Patient Name:
SEND OUT TESTS
GR JU HEY L
S740A
End of Chart. . .
Print Date: l4MAY10
PENING ORDERS
PRINTD BY: RWAl
DATE
6/2/2010
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA HIGHAY (865) 305-9101
:KOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCTf: 13273510002
Age: 18 YRS
HRf: (0000) 1327351
it Dr. BRACA. PAUL (S-210)
DSCH DATE: 06MAY10
26MAY10
S740A
.( LAORATORY ADDENUM REPORT ?
PR DATE:
DOB: 070CT91 Sex: MA
PRll TIME: 0301
PAGE:
NO REFERRING PHYSICIAN Order Dr: SALTA.HU
1
27APRlO 27APR10
SPECIME DATE
TO 001 TI 001
1501_ _1459_
DAY/DAY OF STAY
COLLECTION THil
RE RAGE
UNTS
Reference Laboratory Testing
Fungus Culture ~ see fn f
27APR10 1501 Result: Final report
Fungal
CultRes1 ~ Comment f
27APR10 1459 No yeast or mold isolated
after 4 weeks.
Performed At: MB
LabCorp Bi r:ingham
1801 First Avenue South
Bir:ingham. AL 352331935
Elgin John HD
Phone: 2055813500
Source-Culture ~ LAVAGE
*1:*1d'.* Pending Laboratory Tests **+*'*+
C AFB
Req Col Date: 04/27/10 Order Status: STAIN Collt Status: RECVD
KEY TO SYMBOLS ----
f Footnote
~ = Fungus Culture. Fungal CultResl. Source-Culture ~Perfor:ed at PERF LOC: LabCorp (3400655059)
Patient Name:
SEND OUT TESTS
GR JU HEY L
S740A
End of Chart...
Print Date: 26MAY10
PENING ORDERS
PRINTD BY: RWAR
6/2/2010
DATE
LABCORP-KNOXVILLE
(CLlA 44D0690507)
A LABORATORY PARTNSHIP WIll UNIVERSITY HEALll SYSTEMS, ilC
1924 ALOA HI~AY (865) 305-9101
KNOXVLLE, TESSEE 37920
IP/OP
ACCT': 13273510002
NO REFERRilG PlSICIAN Order Dr. SALlTA.H1
it Dr. BRACA. PAUL (S-210)
SPECIME DATE
137
Chloride-Cl
106
Pota""ium-K
BUN
Creatinine
Gluco"e
Calcium-Ca
Ca. Corr for Alb
Pho"phoru"-P04
Magne"ium-Hg
Total Protein
Albumin
Total Bili
04MAY10
009
0631
WED
Sodium-Na
C02
--
05lfY10
DAY/DAY OF STAY
COLLECTION TIME
PRI DATE: 07MAY10
PR TIME: 0302
DOB: 070CT91 Sex: MA
Age: 18 YRS
,,,t: (0000)1327351
DSCH DATE: 06MAYlO
S740A
.( LAORATORY FilAL REPORT ;,
Patient Name: GRAJU HENRY L
4.2
21
TU 008
0050
134
3.4
105
19
.
..
.
HON
- -- -
007
1140
139
SU 006
0350
01HYLO
SAT 005
0310
139
141
110 ..
18 ..
105
02HAY10
03MAYlO
3.7
3.8
109
20
3.3
..
20
PAGE:
1
30AP10
FRl 004
0200
137
3.3
..
105
22
RE RAGE
136-147
3.5-5.3
98-109
20-29
UNTS
meq/L
meq/L
meq/L
meq/L
-- -- --- ----- -- -- ---- -- -- - - -- -- -- ------ -- -- ---- -- -- -- ------ -- ------ -- -- ------ -- -- ------ -- -- ---- -- -- -- -- ---mg/dl
7-25
19
17
15
9
10
11
mg/dl
0.70-1. 50
0.70
0.68 ..
0.57 ~
0.63 ..
0.64 ~
0.63 .
-- -- ------ -- -- -------- -- - --- -- -- --- --- ---- ------ -- -- ------ -- -- ---- -- -- ---------- ------ -------- -- -- -- -- - ---
mg/dl
70-99
ios ..
103 ..
93
94
90
101 ..
---- ------ -- -- ---- -- -- -- ---- -- -------- ---- ------ -- -- ------ -- ------ ---- -- ---- -- ---- -------- ---- ---- -- --- -_.
8.4-10.6 mg/dl
8.3 ..
9.1
8.8
8.7
8.5
8.4-10.6 mg/el
9.2
9.6
9.5
9.5
9.3
mg/dl
2.7-4.5
2.0 ..
2.6 ..
mg/dl
1.6-2.6
2.1
2.2
2.2
2.7 ..
-- -- ------ -- -- ---- -- -- -- ---- -- -- -- ---- -- -- ------ -- -- ------ -- -- --- - -- -- -- ---- -- ------- --- -- ------ -- -- -- - -_.
6.4-8.3
g/d1
6.1 ..
7.5
6.5
6.6
6.6
3.5-5.0
g/d1
2.9 ..
3.4 ..
3.0 ..
3.1 ..
3.0 ..
mg/dl
0.2-1.
0
0.9
1.0
0.6
0.5
0.4
-- -- ------ -- -- ---- -- -- -- ---- -- -- -------- -- -------- -- ------ -- ----- - -- -- -- ---- -- -- ----- --- -- ------ -- -- -- ---"
9.2
All: Pho3phata"e
95
22
(SGOT) AST
(SGPT) ALT
56 ..
CPK
10.0
Anion Gap
O"molality Calc
272. 7 ~
10.0
99
95
22
267.4 ..
66 ..
171
10.0
276.0
33
97 ..
410 ..
123
66 ..
169 ..
1264 ..
Calculated Re"ul t"
16.0
11.0
283.1
278.1
108
118 ..
219 ..
1006 ..
10.0
276.4
53-148
5-34
0-55
38-174
U/L
U/L
U/L
U/L
7.0-16.0 meq/L
275.0-290. a mO"mlL
KEY TO SYMBOLS ----
~ ~ Abn Alpha Re"ul t
Patient Name:
GR JU HEY L
S740A
Continued on next page. ..
Print Date: 07MAY10
CHEMISTRY
PRINTD BY: RWAR
6/2/2010
DATE
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNHIP WITI UNVERSITY BEAL'l SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
Patient Name: GR1JU
11'/01'
KNOXVLL, TESSEE 37920
HEY L
lil': (0000) 1327351
Age: 18 YRS
"-ait Dr. BRACA. PAUL (S-210)
SPECIME DATE
DAY IDAY OE STAY
~ LAORATORY FIN REPORT ).
DOB: o70CT91 Sex: MA
NO REFERRING PHYSICIAN Order Dr.
29APRlO 28APR10 28APRlo
THO 003 WED 002 WED 002
0401_ _0355_ _0055
COLLECTION TIME
Sodium-Na
141
3.9
Potassium-K
Ch1oride-Cl
108
C02
24
116 T
Calcium-Ca
8.3 T
Ca. Corr for Alb
9.2
Pho:3phoru:3-P04
Hagnesium-Hg
5.9
2.9
0.8
Total Protein
Albumin
Total Bili
Direct Bili
TU 001 TO 001
_1950_ _1650
T
..
109
220 ..
211 T
CPK
RE R1GE
136-147
2
108
22
98-109
20-29
3.5-5.3
UNTS
meq/L
meq/L
meq/L
meq/L
7-25
0.70-1. 50
mg/dl
mg/dl
101 ..
70-99
mg/dl
8.2 ..
mg/dl
2.3 T
8.4-10.6
8.4-10.6
2.7-4.5
1. 7
1. 6-2. 6
8.9
6.0
3.1
0.5
6.3
3.6
0.5
0.3
0.2
T
..
..
150 ..
126 ..
88 ..
119
115 ..
92 ..
826 ..
2.6" 2.7" 3.4"
Lactic Acid
PAGE:
142
Bili Indirect
Alk Phosphatase
(SGOT) AST
(SGPT) ALT
PRIN DATE: 07MAY10
PRIN TIME: 0302
27AiI0
TU 001
_1600_
16
1. 07
0.79
G1uco:3e
27APRlo 27APRlO
SALITA.HU
3.7
19
BUN
Creatinine
DSCH DATE: 06MAY10
S740A
ACCT': 13273510002
6.4-8.3
3.5-5.0
0.2-1.0
0.1-0.5
0.0-0.7
53-148
5-34
0-55
38-174
0.5-2.2
mg/dL
mg/dl
mg/dl
g/dl
g/dl
mg/dl
mg/dl
mg/dl
U/L
U/L
U/L
U/L
mmo1/L
--------------------------------- Calculated Re:3u1 ts
9.0
284.5
Anion Gap
O:3molality Calc
12.0
7.0-16.0 meq/L
284.4
275.0-290.0 mO:3m/L
-------------------------------- -- Urine Chemist ri es ------------------------- -- --------------------------
76
488
Na Random Urine
tT Random Urin
76.04
~a Random Ur
meq/L
mg/dl
HG/DL
KEY TO SYMBOLS ----
T = Abn Alpha Re:3ul t
Patient Name:
GR JU HEY L
S740A
Continued on next page...
Print Date: 07MAY10
CHMISTRY
PRID BY: RWAR
DATE
6/2/2010
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS, INC
1924 ALOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
MJU: (0000) 1327351
ACCT': 13273510002
Age: 18 YRS
'.t Dr. BRACA, PAUL (S-210)
SPECIME DATE
DAY IDAY OF STAY
COLLECTION TIME
27APRlO
TUE 001
_1430_
Sodium-Na
141
Chloride-Cl
108
22
Potassiwn-K
C02
llUN
Creatinine
Glucose
Calcium-Ca
Ca, Corr for Alb
Hagnesium-Hg
Total Protein
A1bwnin
Total llili
Alk Phospha tase
(SGOT) AST
(SGPT) ALT
Lipase
Lactic Acid
Anonia-NH
DSCH DATE: 06MAY10
S740A
;: LAORATORY FINAL REPORT ;,
DOll: 070CT91 Sex: MA
NO REFERRING PHYSICIAN Order Dr.
PRIN DATE: 07MAY10
SALITA. HU
PAGE:
3
27APR10
- TU 001
1240
RE RlGE
136-147
140
3.6
PRI TIME: 0302
3.5-5.3
INTRFER *f
110 *
98-109
20-29
20
UNTS
meq/L
meq/L
meq/L
meq/L
-- -- ------ ---- ---- -- ---- -- ---- -- -- - --- -- -- --- --- -- -- ------ -- ---- ---- -- -- -------- ------ -- -- -- ---- -- -- ------
mg/dl
7-25
24
0.70-1.50 mg/dl
1.64 *
-- -------- -- -- ---- -- ---------- -- -------- -- -------- -- -------- ------ -- ---- ---- ---- ------ -- -- -- ---- -- -- -- ---mg/dl
70-99
103 *
92
-- -------- -- -- ---- -- -- -- -------- -- ------ -- ------ -- -- ------ -- -- ---- -- -- -- ---- -- -------- -- ---- -- -- ---- -----8.4-10.6 mg/dl
7.4 *
7.5 *
8.4-10.6 mg/dL
8.0 ..
8.1 ..
mg/dl
1.6-2.6
2.1
2.5
22
1.29
-- ---------- -- ---- ---- -- -------- ------ ---- ------ -- -- ------ -- ------ -- -- -- --- - ---------- -- ---- ---- -- -- ------
6.4-8.3
g/d1
INRFER *f
3.5-5.0
g/d1
3.2 *
mg/dl
0.2-1.0
0.3
-- -- ------ -- -- ---- -- -- -- ------ -- -- ---- -- -------- -- -- ------ -- -- ---- -- -- -------- -- ------ -- -- -- ---- -- -- -----5.8 *
3.3 ..
0.5
53-148
134
136
5-34
0-55
93 *
67 *
104 *
75 *
U/L
U/L
U/L
-- ---------- -- ---- -- -- -- -- -- -- -- -- ---- -- -- ------ ---- ------ -- -- ---- ---- -- ---- -- -- -------- -- -- ---- -- -- -----U/L
B-78
14
-- -- -------- -- ---- -- -- -------- -- -- ---- ---- -------- -- ------ -- -- ---- -- -- -- - ----- -------------- ---- -- -- -----irol/L
0.5-2.2
2.5 *
18-72
24
UMOL/L
KEY TO SYMBOLS ---.. = Abn Alpha Resul t, f = Eootnote
Potassium-K.. .. 27AP10
1240 An assay interference ha5 been detected for tests re5ulted a5 IN. If
re5ul t i5 needed, please reorder te5t or ensure test ha5 been reordered by lab
so a new specimen can be recollected and assayed.
Cause of INRF: SPECIM HEHOLYZED
Name of caregiver: TERESA HILL IN ER 04/27/10 14:12
Total Protein.. 27APR10 1240
An aS5ay interference ha5 been detected for tests resulted a5 INR. If
re5u1t is needed, please reorder test or ensure test has been reordered by lab
so a new specimen can be recollected and assayed.
CaU5e of INRF: SPECIM HEMOLYZED
Name of caregiver: TERESA HILL IN ER 04/27/iO 14: 13
Patient Name:
CEHISTRY
GRJU HEY L
S740A
Continued on next page. ..
Print Date: 07HAY10
PRINTD BY: RWAR
6/2/2010
DATE
LABGORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNSHIP WITI UNIVERSITY BEALTI SYSTEMS, INC
Patient Name: GRAJU
11'/01'
HEY L
1924 ALOA HIGHWAY (865) 305-9101
KNOXVLLE. TESSEE 37920
ACCT': 13273510002
Age: 18 TIS
HR,: (0000) 1327351
.it Dr. BRACA,PAUL (S-210)
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
27AlRlO
TI 001
_1430
SHOA
.( LAORATORY FINAL REPORT ,.
DOB: 070CT91 Sex: MA
NO REFERRING PHYS ICIA Orde r Dr. SALITA. Ml
DSCH DATE: 06MAyiO
PRI DATE: 07MAyiO
PRI TIME: 0302
PAGE:
4
27APR10
- TI 001
1240
RE RAGE
UNTS
------------ ---------- ------ -- -- - Galcul ated Re3u1 t" --------- ------ -- -- ----------------------------------
11.0
284.2
Anion Gap
Osmolality Calc
10.0
283.7
7.0-16.0 ineq/L
275.0-290.0 inO"inL
275-295
301 ..
Osmolality. Ser
inO"inL
KEY TO SYMBOLS ---.. ~ Abn Alpha Re3u1 t
Patient Name:
CHEMISTRY
GR JU HEY L
S740A
Continued on next page...
Print Date: 07MAY10
PRINTD BY: RWA:
DATE
6/2/2010
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WIlR UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA HIGHWAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCT': 13273510002
Age: 18 YRS
KRI: (0000) 1327351
''tit Dr. BRACA. PAUL (5-210)
COLLECTION TIME
30APRI0
30APRlO
SPECIME DATE
DAY /DAY OF STAY
FRI 004
_0948
FRI 004
_0312
DSCH DATE: 06HAYIO
SHOA
.( LAORATORY FIN REPORT :;
DOB: 070CT91 Sex: HA
NO REFERRING PHSICIA Orde r Dr.
29APRlO
THO 003
_1318
29APRlO
- TH 003
0325
28AIR10
WED 002
1757
SALTA, HU
--
PRIN DATE: 07HAYIO
PRI TlHE: 0302
PAGE:
5
28API0
WED 002
0408
REF RAGE
UNTS
-------------------------------- Arterial Blood Gase 5 ____ ____ ____ __ __ ______ -- -- ------ -- -- ------ -- -------0
7.466 * 7.447 * 7.509 * 7.467 *
pH Art
30.7 * 32.6 * 30.1 * 35.2 *
68.0 * 96.0 72.0 * 122.0 *
pC02 Art
p02 Art
95.0 * 98.0 96.0 * 99.0
22.2 * 22.5 * 24.0 25.5
% Sat Oxyg Art
HC03 Art
Base Excess Art
Total C02 Art
-2.0
1.0 2.0
23 -2.0
23 25
27
1.446 * 7.452 * 7.360-7.440
35.4 * 34.8 * 38.0-41.0 mmG
77.0 * 145.0 * 80.0-100.0 mmG
96.0 * 99.0 97.0-100.0 %mmol/L
24.3 24.3 23.0-26.0
0.0
25 0.0
25
mmol/L
mmol/L
- - -- ---- -- -- -- -- -- -- - - -- - ----- -- -- ---- -- -- ---- -- -- -- --- --- -- -- ---- -- -- -- - -- - -- -- ---- -- ---- --- --- -- -- -- - --0.60
0.50
0.55
0.40
0.40
0.55
Perf+
Perf+
Perf+
Perf+
Perf+
Perf+
:R
LR
LR
LR
LR
LR
FI02 (Lab)
Allen's Test
Specimen Site
02 Del Device
Vent Hode
Resp Rate
Pressure Suppor
VENT
VET
VE
SIHV VC
PS
AC VC
AC VC
AC VC
10
10
30
3D
30
8
5
5
5
5
10
480
RN
RN
RN
RN
RN
VE
VM
PEEP
Tidal Volume
Alert
RN
VET
cm/H20
KEY TO SYMBOLS ----
* ~ Abn Alpha Resul t
GRJU HEY L
Patient Name:
S740A
Continued on next page...
Print Date: 01HAYIo
CARIOPULMONARY
PRID BY: RWAR
DATE
6/2!2010
LABCORp-XNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTs SYSTEMS, INC
1924 ALCOA BIGBAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP ACCT': 13273510002
MR': (0000)1327351 Age: 18 YRS
. '."it Dr. BRACA.
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
pH Art
pC02 Art
p02 Art
% Sat Oxyg Art
HC03 Art
Base Excess Art
Total C02 Art
FI02 (Lab)
Al1en's Test
Specimen Site
02 Del Device
Vent Hade
Resp Rate
PAUL (S-210)
27APRlO
TO 001
2029_
27ApR10
TUE 001
- 1811
DOB: 070CT91 Sex: MA
NO REFERRING PHYSICIAN Order Di:.
TUE 001
1618
Tidal Volume
Alei:t
pm DATE:
SALITA. Hl
pm TIME:
PAGE:
0302
6
27ApRI0 27APRlO
27APRlO
TO 001 TO 001
_1522_ _1300
REF R1GE
UNTS
-------------------------------- Artei:ial Blood Ga5es ---- -- -- ---- -- -- -- ---- -- -- -- ---- -- -- ------ -- --------
7.347 ~ 7.356 ~ 7.335 ~ 7.315 ~
42.3 ~ 40.2 45.2 ~ 48.1 ~
134.0 ~ 85.0 157.0 ~ 67.0 ~
99.0 96.0 ~ 99.0 91.0 ~
23.2 22. 5 ~ 24.1 24.5
-3.0 -3.0 -2.0 -2.0
24 24 25 26
7.165
C 7.360-7.440
68.0
C
38.0-41.0 rnG
58.0
~
80.0-100.0
rnG
80.0
~
97.0-100.0
24.5 23.0-26.0 %mmol/L
-4.0
27
0.80
Perf+
1.00
Pei:f+
0.99
Perf+
RR
RR
VENT
VE
RR
VENT
VET
VE
AC VC
AC VC
26
AC VC
24
SIHV VC
26
SIMV VC
14
12
12
RR
480
480
10
480
RN
RN
RN
18
10
10
650
RN
mmol/L
mmol/L
0.99
0.80
Perf+
Pressure Suppoi:
PEEP
DSCH DATE: 06MAYlO
07MAYlO
S740A
.~ LAORATORY FINAL REPORT ,.
Pei:f+
LR
10
10
650
cm/H20
RN
KEY TO SYMBOLS ---C = Ci:itical, ~ = Abn Alpha Result
Patient Name:
GR JU HEY L
S740A
Continued on next page...
Print Date: 07MAY10
CARIOPULMONARY
PRINTD BY: RWAR
6/2/2010
DATE
LABCORP-XNOXVILLE
(CLIA 44D0690501)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA HIGHWAY (865) 305-9101
Patient Name: GRAJU
IP/OP
HEY L
HRø: (0000) 1327351
KNOXVLLE, TESSEE 31920
ACCTØ: 13213510002
Age: 18 YRS
it Dr. BRACA. PAUL (S-210)
SPECIME DATE
DAY /DAY OF STAY
COLLECTION TIME
04MAY10
TOE 008
_0050
S140A
.. LAORATORY FINAL REPORT
DaB: 010CT91 Sex: MA
NO REFERRING PHSICIAN Or:der: Dr:.
03MAYlO 02MAY10
HON 001 SUN 006
_1140_ _0350
DSCR DATE: 06MAY10
/
SALITA. HU
PRI DATE: 01MAY10
PRI TIME: 0302
1
PAGE:
OlHYlO 30APRlO 29APR10
SAT 005 ERI 004 TH 003
_0310_ _0200_ _0401_
REF RAGE
UNTS
__________________ ---------- -------- Blood Cell Count ------ ---------------- -------------- ---------- ------
13.1 T 13.0 * 12.8 * 14.1 12.0 * 12.1 * 14.0-18.0 g/dl
36.6 * 37.4 * 36.9 * 40.6 * 34.1 * 35.4 * 42.0-52.0 %
Hemoglobin
Hematocrit
7.3
9.9 132
10.3130-400
4.8-12.5 x10-3
x10-3
292 7.4
29011.4
221 14.1
191 *161
WEC
Platelet
Neut
Lymph
Hono
Eo"
Baso
__ ________ -- ------ -- -- --------- Au tomated Di fferen ti al ------- ---- -- -- -- ------------------ -------- -- -----.
13.9 12.9 82.0 * 85.2 * 86.3 * 90.5 * 42.2-15.2 %
13.3 * 13.7 * B.4 * 7.1 * B.9 * 6.5 * 20.5-51.1 %
%
%
%
%
%
11.6
12.10.8
* B.6
4.1 0.0
2.9 1.1-10.0
0.9 *1.0
0.21.40.2
, 10.0 %%
o . 3 O. 3 0 .2 a ~ 1 0 ~ 5 0.1 0.0- 2.0 %
5.4
5.4
9.3
* 12.5
* *B.6
* *9.3
** 1.4-6.5
x10-3
1.0
*
1.0
~
1.0
*
1.0
0.9
0.7
1.2-3.4
xlO-3
0.8
0.9
*
1.0
*
1.1
*
0.4
0.3
0.0-0.8
xlO-3
0.1 0.1 0.1 0.0 0.0 0.0 0.0-0.1 x10-3
____ __ ____________ ---- -- ---- -- Ab"ol ute Leukocyte Count -- ---- ------ -- -- ---- ------------ ------------ -----.
Neut Ct
Lymh Ct
Hono Ct
0.0 0.0 0.0 0.0 0.0 0.0 0.0-0.2 xl0-3
Eo" Ct
Baso Ct
B9.5
91.6 31.6
91.1 32.0
92.1 31.1
91.B 31.B
93.2 27.0-34.0
80.0-95.0 pg
fL
31.9
31.8
35.1
12.6 34.7
13.1 34.5
13.2 34.1
13.2 34.5
12.9 34.1
13.433.0-31.0
11.5-14.5g/dl
%
__ __ __ ____ __ __ ---- -- -- -- ---- -- -- -- --- Ce 11 Indice" - -------- -- ---- -- -- -- ---- -- -- -------- -- ------ ---- --- --'
MCV
MCH
HCRC
ROW
MPV
REC
6.6 * 6.7 * 1.0 * 1.1 * 7.3 * 1.1 * 7.4-10.4 fL
4.09 * 4.0B * 4.03 * 4.41 3.1B * 3.80 * 4.10-5.60 xl0-6
-- -- ------ ---- ---- -- -- -- ---- ---- -- ---- -- -- ------ -- -- ------ ---- ---- -- ---- ---- -- ---------- -------- -- -- ----_.
SUSPCT'D *
Imat Gran,,/LS
Slide Review
VALID
VALID
SUSPCT'D *
VALID
KEY TO SYMBOLS ----
T ~ Abn Alpha Re"u1 t
Patient Name:
GR JU HEY L
S740A
HEMATOLOGY
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
1 MAY 10
Print Date: o
LABCOR:P-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITa UNIVERSITY HEALTR SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
SHOA
Patient Name: GRAJU HENRY L
.( LA0RATORY FINAL REPORT :;
ACCTf: 13273510002
I:P/OP
DOB:
070CT91
Sex: MA
Age: 18 YRS
HRø: (0000) 1327351
NO REFERRING PHSICIAN Order Dr.
-it Dr. BR1CA, PAUL (S-210)
SPECIME DATE
DAY /DAY OF STAY
COLLECTION TIME
--
DSCB DATE: 06MAY10
SALITA, HU
PRIN DATE: 07MAY10
PRIN TIME: 0302
:PAGE:
8
27APR10
28APRlO
WED 002
0355_
TU 001
1240
REF RAGE
UNTS
---- ---------------- ---- ---- ---- ---- Blood Cell Count - ------------------------- --------------------------
Hemoglobin
Hematocrit
WEC
Platelet
Neut
%
Lymph
Mono
%
%
Eo"
%
Basa
%
Neut Ct
Lymh Ct
Hono Ct
Eo" Ct
Baso Ct
MCV
MeR
HCBC
ROW
MPV
REC
130-400
202
142
Automated Differential
87.1
8.0
4.9
0.0
0.0
70.9
*
*
21. 5
7.4
0.0
0.2
42.2-75.2
20.5-51.1
1. 7-10.0
10.0
.(
g/d1
%
x10-3
xl0-3
%
%
%
%
%
0.0-2.0
Ab"olute Leukocyte Count
x10-3
1.4-6.5
7.6 *
8.9 *
x10-3
1.2-3.4
2.3
0.8 *
x10-3
O.O-O.B
0.8
0.5
x10-3
0.0-0.7
0.0
0.0
xl0-3
0.0-0.2
0.0
0.0
-- ---- ---- -- ---- - - -- ---- ---- -- -- ----- Ce 11 Indice" - --- - ------ -- -- -- -- -- - --- -- -- ---------- -------- -- -- ---80.0-95.0 fL
93.5
92 .2
27.0-34.0 pg
32.0
32.4
33.0-37.0 g/dl
34.2
35.2
%
11.5-14 .5
13.1
13.3
7.4-10.4 fL
6.9 *
7.2 *
4.10-5.60 x10-6
4.68
4. 60
-- -- ------ -- -- -- ---- -- -- - --- ---- ------ ---- -------- -- --- - -- -- ---- -- -- -- --- --- -- ------------ ------ -- ----- ---
Imat Gran,,/LS SUSPCT'D *
Large Plate1e t"
Anü,ocyo"i"
14.0-18.0
42.0-52.0
4.8-12.5
15.0
43.8
10.7
14.9
42.4
10.3
CONFR'D *
CONFR'D
CONFR'D
HiCi:OCyt03is
CONF'D
Slide Review
TECH
KEY TO SYMBOLS ----
* = Abn Alpha Re"ul t
GRJU HEY L
Patient Name:
S740A
HEMATOLOGY
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07MAY10
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA HIGHWAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
HRø: (0000) 1327351
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
DOB: 070CT91 Sex: MA
Age: 18 YRS
NO REFERRING PHYSICIAN Order Dr.
- . üt Dr. BRACA, PAUL (S-210)
01HAY10
SAT 005
0312
28APR10
WED 002
0955
DSCH DATE: 06MAY10
SHOA
;: LAORATORY FINAL REPORT ;,
ACCT': 13273510002
28APRlO 27APR10
WED 002 TU 001
0355_ _2210_
27APR10
TOE 001
1600
SALITA,MU
PRI DATE: 07HAY10
PRI TIME: 0302
PAGE:
9
27AP10
TOE 001
_1430_
RE RAGE
UNTS
CPK ME
CPK Total
HB/CPK Index
T roponin- STAT
01HAY10 0312
28APR10 0955
28APR10 0355
27AP10 2210
27APR10 1600
27APR10 1430
critical
cri tical
critical
Troponin re"ult to
Troponin re"u1t to
Troponin re"u1t to
cri tical Troponin re"u1 t to
14.7 *
1. 42 *f
38.3 *f
Prothrombin 'I
INR
PTT
KEY TO SYMBOLS ---C = Critical. * ~ Abu Alpha Result, f
Patient Name:
GR JU HEY L
9.3-11 .3
Sec
24.4-31. 4
Sec
0.90-1.10
Footnote
S740A
CARIAC/COAG
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07HAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS, INC
(CLIA 4400690507)
1924 ALCOA HIGHWAY (865) 305-9101
:KOXVLLE. TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCTf: 13273510002
HRf: (0000) 1327351
PAUL (S-210)
- '-'lt Dr. BRACA.
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TUil
CPK MB
CPK Total
Age: 18 YRS
S740A
'= LAORATORY FINAL REPORT
DSCH DATE: 06MAY10
J
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
PRIN DATE: 07MAY10
SALTA, MU
PRI TIME: 0302
PAGE: 10
27APRlO
- TU 001
1240
REF RAGE
UNTS
--------------------------------- CK MB Direct Assay ----------------------------------------------------.
4.7
0.0-5.0
NG/HL
377 *
38-174
1.2 f
M:/CPK Index
U/L
---------- -------- ---- -- -----Othe r Cardi ac Assays -------------------------- ---------- -------------- -----.
T roponin- STAT
5.07 Cf
27APR10 1240 Critical results repeated phoned to and read back by:AMER WAR RN 04/27/10
13:48
Coagulation Studies
Prothrombin Tm
12.6 ..
INR
1. 21 *f
HB/CPK Index (30MAY07 -- Current)
(Note: Due to CK assay sensitivity constraints, results
0.00-0.15
ng/ml
9.3-11.3
0.90-1.10
Sec
between 0.0 and 0.7 ng /mL should be considered simply less
than 0.7 ng/in)
If CK-HE J 5 ng/ml with Total CPK '= 400 HIU/ml
Myocardial Injury Possible
If CK-HE J 5 ng/ml with Total CPK J 400 MIU/ml
Use Index to assess the likelihood that the elevated
results are due to Myocardial Injury.
If Index J 2 then Myocardial Injury is possible
If Index J 1 but , 2 then results are Inconclusive.
If Index '= 1 then Myocardial Inj ury is not likely.
Serial CK-HE results provide optimal clinical information
especially in the case of small and/or evolving infarction.
If Total CPK levels are high (eg.. skeletal muscle trauma
or shock) use of the CK-HE/T.CPK index may be useful in
factoring out the small percent of CK-ME present in SKeletal
muscle as noted above.
(The CP./CK ratio is only valid if the CPK Total is
400 IU/L or greater.)
?onin-STAT (27JANO -- Current)
This Troponin-I assay is calibrated against the new NIST
Reference Material. Three troponin concentration limits are
considered clinically useful for detection of acute coronary
syndromes as noted below. Results are flagged on reports as
elevated based on tbe American College of Cardiology (ACC)
KEY TO SYMBOLS
C = Critical, '*
Patient Name:
Ahn Alpha Resul t. f
GR JU HEY L
Footnote
S740A
CARIAC/COAG
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07MAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WITH UNVERSITY HEALTH SYSTEMS. INC
Patient Name: GRAJU HENRY L
IP/OP
(CLIA 4 4D0690S07)
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE. TESSEE 37920
ACCT': 13273510002
HR,: (0000) 1327351
Age: 18 YRS
Admit Dr. BRACA, PAUL (5-210)
SHOA
-e LAORATORY FIN REPORT ;,
DOB: 070CT91 Sex: MA
NO REFERRING PHYSICIAN Order Dr.
DSCH DATE: 06MAY10
SALITA. MU
PRI DATE: 07MAYlO
PRDI TIME: 0302
PAGE:
11
)ponin-STAT (27JANO -- Current)
guideline limi ts.
99th Percentile Limit of the Normal Range
Cutoff based on ACC/ESC Guidelines
Cutoff based on waD Guidelines
0.04 ng/mL
0.16 ng/mL
0.30 ng/mL
Note: Due to Troponin assay sensitivity constraints, results
between 0.0 and 0.02 ng/mL should be considered simply less
than 0.02 ng/rn.
INR (16JAN7 -- Current)
The following rN ranges are referenced in the University
CLINCAL STATE DESIRD IN
of Tennessee Medical Center Hospital Formulary.
Prophylaxis-venous thromboembolism (high risk surgery) 2-3
Treatment of deep vein thrombosis or Pulmonary Embolism 2-3
To prevent systemic embolism in patients with:
atrial fibrillation
valvular heart disease
tissue heart valves
acute myocardial infarction
recurrent myocardial infarction
Bi1eaflet mechanical valve in aortic position
(with no additional risk factors)
2-3
2-3
2-3
2-3
2.5-3.5
2-3
2.5-3.5
Mechanical prosthetic valves (high risk)
IN ranges are not well studied in children. Adult-based
ranges should be used;
howeve
r. limited available data suggest
that children may respond clinically at lower rN values.
PTT (03OCT07 -- Current)
FTT MElI = 28.0 SEC
FTT therapeutic range has been established as 40-62 seconds
which is the expected range for heparin blood levels of
0.2 - 0.4 u/m1.
Patient Name:
GRJU HEY L
S740A
Continued on next page...
Print Date: 07MAYI0
PRINTD BY: RWAR
6/2/2010
DATE
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSffP WITH UNIVERSITY HEALTR SYSTEMS. INC
1924 ALCOA ffGBAY (865) 305-9101
KNOXVLL, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCT': 13273510002
,MRf: (0000)1327351
SPECIME DATE
DAY /DAY OF STAY
COLLECTION TIME
Type Collection
Appearance
Color
Spec Gravity
06HAYIO
TH 010
Protein
G1ucose
Ketone..
2BAPRIO
WED 002
27APRlO
Til 001
0522
1255
etc
random
cath
CLEAR
CLEAR
CLEAR
YELLOW
YELLOW
YELLOW
NEG f
1.021
6.0
30 HG/DL 'f
NEG
NEG
NEG
NEG
NEG
NEG
Nitrite..
urobilinogen
Bile
WBC E..ter=e
Biood, Urine
MA
NO REFERRING PHSICIAN Order Dr.
1305
1.021
5.5
pH
DOB: o70CT91 Sex:
Age: IB YRS
~it Dr. BRACA. PAUL (S-210)
NEG
TRCE ..
NEG
NEG
NEG
NEG
SH '
SM ..
DSCH DATE: 06HAY10
S740A
-( LAORATORY FINAL REPORT ;:
SALTA. HU
PRI DATE: 07HAY10
PRI TIME: 0302
PAGE:
REF RAGE
12
UNTS
Ur:ine MaCI:05COpic
NA
1.005-1.030
1.010
5.0
4.5-7.0
NEG f
300 ..
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
NEG
-- -- ------ -- -- --- --- ---- ---- ---- -- Urine Hie r05cop ic -- ----- -- ------ -- ------ -- ---- ------ -- ------ -- -- -----0-5
2
2
1
IHPF
WBC
19 ..
RBC
o
3
o
Epithelial Cell
o
Hucous
FEW '
Protein (19JU98 Current)
0-5
IHPF
IHPF
REF RAGE
UNTS
o
Thi" ana1y..i" i" mo..t "ensitive in the detection of albumn; it i" Ie....
"en"itive to other urinary protein". Pure monoclonal kappa and lamda light
chains (Bence-Jone.. Proteins) are not detected. If the latter is suspected.
urine imunofixatioD i3 3ugge3ted.
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
Dr Other
1 Count
; Count
27APRlO
Til 001
1501
27Al'R10
TU 001
_1500_
----------------------- Bronchiole/Alveolar Lavage Diffe rential
SEE CYTO
Bronchiole/Alveolar Lavage Cell Count
%
CUH
CUH
83
48
KEY TO SYMOLS ----
.. ~ Abn Alpha Re"ult. f ~ Footnote
Patient Name:
BODY FLUIDS
GR JU HEY L
S740A
Continued on next page...
URINALYSIS
PRINTD BY: RWAJ
6/2/2010
DATE
Print Date: 07MAY10
LABCORP-KNOXVILLE
(CLIA 4400690507)
A LABORATORY PARTNRSHIP WIll UNVERSITY BEALll SYSTEMS. INC
1924 ALCOA HIGHAY (865) 305-9101
irOXVLLE. TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP ACCTf: 13273510002
1m,: (0000)1327351 Age: 18 YRS
~ .'."it Dr. BRACA, PAUL (S-210)
SPECIME DATE
DAY /DAY OF STAY
COLLECTION TIME
SHOll
~ IAORATORY FlN REPORT
DSCH DATE: 06MAY10
/
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
SALITA. MU
PRIN DATE: 07HAYlO
PRIN TIME: 0302
13
PAGE:
06MAY10 30APR10 27APRlO
TH 010 ERI 004 TOE 001
_0105_ _0200_ _1600_
Hepatitis Serology
Hep BS Ag Scrn
Negative E
0.08 E
Hep Bc-IgM Ab
Hep A IgM Ab
NOlACT f
REE RAGE
UNTS
Negative
~ 0.80
Index
NONRACT
KEY TO SYMBOLS
f - Footnote
Rep BS Ag Scrn (120CT07 -- Current)
The results from positive Hepatitis B Surface Antigen
(ElSAg) tests should be considered preliminary until they
are confirmed positive by neutralization studies that will
be performed automatically and reported when complete.
Rep Bc-IgM Ab (05FEB07 -- Current)
This assay determines the qualitative amount of IgM antibody
to Hepatitis B Core Antigen (IgM ant
i-HB
c) present in the
submitted samle. The detection of IgM anti-BEc suggests
possible acute BEV infection.
Index Measured
Result
/ 1.2 Reactive
Presumptive evidence of IgM anti-HBc
0.80 to 1.20 Gray Zone - Reactive
Presumptive evidence of IgM anti-BEc. Patients with
specimens exhibiting gray zone reactive test results should
be retested at approximately one-week intervals.
~ 0.8 NonReactive
IgM anti-Elc not detected. Does not exclude the possihili ty
of exposure to or infection with HBV.
, A IgM Ab (21FEB07 -- Current)
***New Methodology Ahbot AxSym by HEIA Method****
AXSYM BAVI-M (BEP AIGM) RESULT IJRPRETATION
A) REACTIVE - Presumtive evidence of IgM antibodies to BAV.
B) GRYZONE - IgM antibodies to HAV mayor may not be present.
Patients with specimens exhibiting grayzone reactive results
should be retested at one-week intervals.
C)NONRCTIV - IgM antibodies to BAV not detected; does
not exclude early acute or recovered HAV infection
Patient Name:
GRJU HEY L
S740A
Continued on next page...
Print Date: 07HAYlO
MI SCELLAOU S
PRID BY: RWAR
DATE
6/2/2010
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNSHIP WITH UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA BIGBWAY (865) 305-9101
KNOXVLLE, TESSEE 37920
ACCT': 13273510002
IPIOP
MR': (0000) 1327351
Age: 18 TIS
-'lit Dr. BRACA. PAUL (S-210)
SPECIME DATE
06MAY10
TH 010
DAY IDAY OE STAY
0105_
COLLECTION TIME
DSCR DATE: 06MAYlO
SHOll
Patient Name: GRAJU HENRY L
30APRIO
- -
PRIN DATE: 07MAY10
.. LAORATORY FINAL REPORT 7
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Orde r Dr.
SALITA. HU
0200
1600_
HIY Assays
.:48 f
TO SYMBOLS ---Footnote
BIY-l YiralLoad
C Ab (17AUG09 --
14
TUE 001
0.45 f
HIV-l YiralLoad ø
KEY
f =
~ =
Hep
PAGE:
27APRlO
FlU 004
--------~---------------------- Hepati tis Serology
Hep C i\
PR1 TIME: 0302
REF RAGE
UNTS
0.00-0.79
SiCa
0.0-0.0
xlO-3
=Perforred at PER LOC: LabCorp (34D0655059)
Current)
(s/co = Samle to Cutoff Ratio)
NONRCTIVE: 0.00 to 0.79
GRAYZONE: 0.80 to 0.99
REACTIVE: 71.00
Positive results for RIBA Anti-RCV indicate a
past or present HCV infection. Qualitative RCV
RNA testing will differentiate active from resolved
infection. Nonreactive results for AntiHCV indicate
no infection with Rev, unle53 recent infection is
suspected or other evidence exists to indicate HCY
infection.
-1 YiralLoad (03JA97 -- Current)
The results of this test are reported in HI-l (viral particles) genome
equivalents in lOOO's/ml
HIY-l RNA is detected in a multi-step process involving first the in vitro
synthesis of cDNA followed by amplification of the target sequence by the
polymerase chain reaction (PCR*) and detection of HI-l arlicons using
specific DNA probes (AHLICOR(tm) my Monitor assay). BIY-1 RN
quantitation is achieved by co-amlifying internal quantitation standards.
*PGR is performed under license from Roffman-LaRoche. Inc.
Patient Name:
GR JU HEY L
S740A
HI SCELLAOU S
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Print Date: 07MAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WIll UNIVERSITY HEALTH SYSTEMS, INC
Patient Name: G:RJU HENRY L
IP/OP
ACCT': 13273510002
HR,: (0000)1327351
Age: 18 YRS
Admit Dr. BRACA,
PAUL (S-210)
SPECIME DATE
DAY /DAY OF STAY
COLLECTION TIME
(CLIA 44D0690507)
1924 ALOA HIGHAY (865) 305-9101
:KOXVLLE. TESSEE 37920
06HAY10 30APR10
TH 010 ERI 004
0105_ _0200_
S740A
~ LAORATORY FINAL REPORT
DOB: 070CT91 Sex:
DSCE DATE: 06MAY10
J
MA
NO REFERRING PHYSICIA Order Dr.
PRIN DATE: 07MAY10
SALTA. Hl
PRI TIHE: 0302
PAGE:
15
27APRlO
TUE 001
1600
NON REAC f NON REC
UNTS
208-963
pg/ml
ng/ml
REF RAGE
-- -- ------------------ ---------- --- HIV As says --------------------- ---------------------- -------- -------
HI Ab
1095 *
9.4
Vitamin B12
Folate
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
7.2-15.4
30APRlO
FR 004
0200
RE RAGE
UNTS
---- ------ -- -- --- - -- -- -- - Imunology/ S er01 og ---- -- ------ -- -- ---- ---- -- ---- -- -- -------- -- --- --- -- -------
CRP
Pre-Albumin
CRP (11APR06
0.0-0.8
13.6 *f
12 *
Current)
18-45
mg/dl
mg/dl
**"'*ote*+*
Due to C-Reactive Protein assay sensitivity constraints,
results between 0.0 and 0.5 mg/dL should be considered
simply less than 0.5 mg/dL.
KEY TO SYMBOLS ---T = Abn Alpha Result. f = Footnote
EIV Ab (050CT07 -- Current)
**IF THS TEST is PART OF A NEEDLE STICK (N STICK) PANL AN THE TEST RESULT
IS NOT DONE (ND). PLEASE SEE THE RESULT FOR TE OTHER HIV TEST (mV SUDS)
IN THS PANL**
HIV Ab is a test for detecting the presence of IgG & IgM antibodies to
HIV Tye-l and HI Tye-2 in human serum. THS IS A SCRING TEST.
Reactive results should be considered TEATIV until confirmed by
Western-Blot or other appropriate methods. Reactive screens are NOT
reflexively confirmed by Western-Blot at this institution and must be
requested by the ordering physician.
Patient Name:
GRJU HEY L
S740A
HI SCELLAOU S SEROLOGY
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07MAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCTØ: 13273510002
MR': (0000) 1327351
Age: 18 Y.S
"'drit Dr. BRACA. PAUL (S-210)
SPECIME DATE
DAY/DAY OF STAY
COLLECTION TIME
30APRlO
FR 004
0845
(CLIA 44D0690507)
S740A
.. LAORATORY FINAL REPORT
DOB: 070CT9l Sex:
J
MA
NO :RFERRING PHSICIA Order Dr.
28APR10
_0955_
Ace taminophen
WED 002
Acetaminophen (11APR06 -- Current)
0.1 *
28APRlO 27APRIO
WED 002 TU ODI
DSCH DATE: 06MAYIO
07MAYIO
PR DATE:
SALITA. l£
27APRIO
27APIO
1600
TOE 001
_1255_
0355_ _2210_
TO 001
Therapeutic Drug Monitoring
0.0* 0.0*
0.0 *
PRI TIME: 0302
PAGE:
16
REF RAGE
UNTS
10.0-30.0
ug/mL
5.0-10.0
ug/mL
Therapeutic Range: 5 - 20 ug/mL
Toxic: J 100 ug/mL (4 hrs after ingestion)
Vancomycin, Teoii
J 40 ug/mL (12 hrs after ingestion)
4.6 *
unk
Time of Dose
Opiates, Ur
Cocaine Sci Ur
Amhetamines. Ur
Bai:biturates. Ur
Cannabinoids
Benzodiazepine3
Phencyclidine
Creatinine, Ur
Drug Info
------ ---- -------- -- ----- Drug Profile. Urine -- ---- -------------------- ------ ---------------- ------ -- ---.
NEG
NEG
NG/HL
POS *
NEG
NG/HL
NEG
NEG
NG/HL
NEG
NEG
NG/HL
POS *
NEG
NG/HL
POS *
NEG
NG/HL
NEG
NEG
NG/HL
109.92
FtNote
-
f
mg/ci
KEY TO SYMBOLS
* = Abn Alpha Result. f = Footnote
Drug Info (14SEP07 -- Current)
Posi tive results from this or any imnological Urine Drug Screen suggest
that a drug having the general structui:e of drugs of that class is present
in the urine sample. A final determnation about the presence of a drug of
abuse in urine can be made through confinnatory testing (e.g.. by GeMS
analyais) .
** Result Interpretation: Levels above the cut-off point are suggestive for
presence of the drug in question. Urine samles will be reported as positive
for a drug class if levels exceed the cutoff levels shown below.
*** Cutoff Levels for Positive ***
THC (Cannabinoids) 50 ng/mL
Opiates300 ng/mL
Amphetamine 1000 ng/mL
Cocaine300 ng /mL
Barbiturates 200 ng/mL
Benzodiazepine.s 200 ng/mL
Phencyclidine
(PCP) 25 ng/mL
** Opiate Caution: Routine urine di:ug screens foi: opiates are about 20X less
sensitive for detection of oxycodone (ti:adename: oxycontin) than for opiates
like codeine and morphine. (it would take 6.000 ng/mL of urine oxycodone to
show a positive opiate screen vs 300 ng/mL of morphine). If testing for
oxycodone is needed a separate assay foi: oxycodone should be ordered.
Patient Name:
GR JU HEY L
S740A
TOKICOLOGY
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Pi:int Date: 07HAYIO
LABCORP-XNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WIll UNIVERSITY BEAL'l SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
:KOXVLLE, TESSEE 37920
Patient Name: GRAJU BENRY L
IP/OP
Age: 18 YRS
HR,: (0000) 1327351
1it Dr. BRACA.
DSCl DATE: 06MAY10
SHOA
ACCTf: 13273510002
PAUL (5-210)
-: LAORATORY FINAL REPORT .,
DOB: 070CT91 Sex:
MA
NO REF.RRING PHSICIAN Order Dr.
SALTA, HU
PRDI DATE: 07MAYIO
PRD TIML: 0302
PAGE: 17
..i:ug Info (14SEP07 -- Current)
Oxyrorphone, Naloxone. and Meperidine are not detected.
** Amhetamine Caution: If the amhetamine drug screen test is positive.
specific identification of the drug detected (e.g. methamhetamne.
amphetamine) can be done by ordering confirmatory testing by GC/HS. Most
over the counter antihistamnes are not detected by this method (e.g.,
pseudoephedrine and ephedrine) .
** PCP Caution: Cross Reactivities causing false positives for PCP have been
seen with use of cold medications containing Dextromethoi:han.
** THC Caution: pantoprazole (e.g..Pi:otonix/Somac) can cause false positive
urine TaG re~ult3.
** BENZODIAZEPIN Caution: Sertraline (e.g., Zo1oft,
Lustral, Apo-Sertral. Agentra, Gladem, Serlift, Stimuloton,
Xydep. Serlain. Concorz) can cause false positive
urine benzodazepine resul t3 .
Patient Name:
GR JU HEY L
S740A
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07HAYI0
LABCORP-XNOXVILLE
(CLIA 44D0690501)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS. INC
1924 ALCOA HIG~AY (865) 305-9101
:KOXVLLE. TESSEE 31920
Patient Name: GRAJU HENRY L
ACCT': 13213510002
IP/OP
Age: 18 TIS
MR' : (0000) 1321351
lit Dr. BRACA.
SPECIME DATE
DAY/DAY OF STAY
COLLECTION THil
PAUL (5-210)
DSCH DATE: 06MAY10
SHOA
.. IAORATORY FINAL REPORT :;
DOB: 010CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
PRDI DATE: 01MAY10
PRI TIME: 0302
SALITA, MU
PAGE:
18
21APRlO
TU 001
1240_
RE RAGE
UNTS
__ ____________ ___________ Therapeu tic Drug Moni toring --------------------------------------------------ug/mL
10.0-30.0
Ace taminophen 2 . 0 ~
Acetaminophen (11APR06 -- Current)
Therapeutic Range: 5 - 20 ug/mL
Toxic: :; 100 ug/mL (4 hr~ after inge~tion)
Phenobarb. Rand
Time of Do~e
Salicylate
:; 40 ug/mL (12 hr~ after inge~tion)
0.1 ~
am
0.0 ~f
15.0-40.0
2.8-20.0
ug/mL
mg/dl
KEY TO SYMBOLS ---T = Abn Alpha Result. f = Footnote
Salicylate (Initial -- Current)
Patient Name:
Therapeutic: 2.8-20.0 mg/d1
Toxic: ;, 30 mg/dl
Severe Toxicity: ;, 50 mg/dl
GR JU HEY L
S140A
TOXICOLOGY
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Print Date: 01MAY10
LABCORP-KNOXVILLE
(CLIA ~4D0690507)
A LABORATORY PARTNRSilP WITI UNVERSITY HEALTI SYSTEMS. INC
Patient Name: GRJU
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE. TESSEE 37920
ACCTØ: 13273510002
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
PRDI DATE: 07MAY10
SALITA, HU
PRD TIKE: 0302
PAGE:
19
27APRlO
SPECIME DATE
TO 001
DAY IDAY OE STAY
COLLECTION TIME
Tricyclic Sc
Age: lS YRS
PAUL (S-2L0)
~1mit Dr. BRACA,
DSCH DATE: 06MAYlO
S740A
;: LAORATORY FINAL REPORT :;
HENRY L
IP/OP
MRø: (0000) 1327351
1240_
RE RAGE
UNTS
Toxicology Studies --- -- -- ------ -- -- --- ----- -- --- - -- -- ------ -- -- ------ -- -- -- ---
of
;:
50
ng/lI
KEY TO SYMBOLS ---f ~ Eootnote
Tricyclic Sc (12APR06 -- Current)
The following tricyclic antidepressants and metabolites will
produce positive results with the Abbott TCA assay above the
sensitivity (20.00 ng/ml)
Compound Concentration Tested (ng/mL)
Amitriptyline 100
Clomipramne
100
Desipriamne
100
Doxepin 100
Cis-l0-Hydroxyamit riptyline 300
Cis-l0-Hydroxyort riptyline 300
2-Hydroxydesipramne 300
2-Bydroxyimipramine 300
Imipramne-N-Oxide 75
Nordoxepin
SOD
Nortriptyline 100
Prot
riptyline 100
Trimipramine
100
Positive results may be obtained when the specimen contains
seve ral drugs or metabolites whose cumulative response
exceeds the positive/ negative decision level even though
an individual drug may be present at levels less than those
given above. Because of variable metabolite levels and the
broad antibody specificity, no specific concentration can be
associated with a positive result. Positive results should
be confirmed and quantitated by an alternate methodology.
*** Cross-reactivity info: Carbarazepine, when present at
concentrations ranging from 2 ug/mL to 20 ug/mL
(therapeutic range for Carbamazepine is 4 to 12 ugmL). will
produce positive TCA values using the Abbott AxSym assay.
Please consider thi5 when evaluating patient results ~
Patient Name:
GRJU HEY L
S740A
TOXICOLOGY
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Print Date: 07HAY10
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNSHIP WITH UNIVERSITY BEALTH SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU BENRY L
IP/OP
MRI: (0000)1327351
ACCT': 13273510002
Age: 18 TIS
PAUL (S-210)
it Dr:. BRACA.
DSCR DATE: 06MAY10
SHOA
.( LAORATORY FINAL REPORT ;,
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr:.
SALITA, MU
PRIN DATE: 07MAY10
PRIN TIME: 0302
PAGE: 20
27AlR10
TOE 001
SPECIME DATE
_1240_
DAY/DAY OF STAY
COLLECTION TIME
REF RAGE
UNTS
__ __ ______ __ -- --- - -- -- -- - Toxi col ogy S tudi e3 --- ---- ------ ---- ---- ------ ---- ---- ------ -- -- ------ -- - - ------
0-100
,10.0 f
Alcohol
mg/dl
27AlR10
SPECIME DATE
TO 001
_1501_
DAY /DAY OF STAY
COLLECTION TIME
Sour:ce-Culture ~
REF RAGE
UNTS
Refer:ence Labor:atory Te3ting --- -- -- ------ ---- --- - -- -- --- - -- ---- -- -- -- -- -- --- ---
LAVAGE
KEY TO SYMBOLS ---f ~ Footnote
§ = Sour:ce-Cultur:e =Perfor:med at PERF LOC: LabCorp (34D0655059)
Alcohol (19DEC05 -- Cur:r:ent)
(NOTE: Intoxication i3 often pre3umed at alcohol (ethanol) leve13 equal to
or greater than 80 mg/dL). To conver:t thi3 re3ult to the gram3/weight
unt3 u5ed in legal ca3e3 the decimal point need3 to be moved three place3
to the left. Since clinical lab3 te3t 3erum r:ather than whole blood the
alcohol level r:e5ult3 will range from 1.10 to 1.35 time3 higher in 3erum
than in blood alcohol levels in concur:r:ently collected samples. (Nature
217: 693-694. 1968). The degree of elevation of serum over whole blood
alcohol levels i5 dependent almost entir:ely on the amount of red blood cells
in the patients whole blood samle expessed as hematocrit. A rough
approximation of whole blood alcohol, based on serum alcohol levels, can be
made using the following formula:
Whole Blood Alcohol = ((seru alcohol)/(decimal fraction of BeT)) * 0.35
as an example ~ ((100 mg/dL)/(0.45 RCT)) * 0.35 78 mg/dL
Patient Name:
S740A
GR JU HEY L
TOXICOLOGY SE OUT TESTS
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Print Date: 07MAYIO
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNHIP WITH UNIVERSITY BEALTa SYSTEMS, INC
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
KRB: (0000) 1327351
ACCT': 13273510002
Age: 18 YRS
DOB: 070CT91 Sex:
BLOOD
DSCR DATE: 06MAY10
/
MA
NO REFERRING PHYSICIAN Order Dr.
Admit Dr. BRACA. PAUL (S-210)
_JLTU.
S740A
, LAORATORY FINAL REPORT
PRIN DATE: 07MAYlO
PRll TIME: 0302
PAGE: 21
SALITA. MU
ACCESSION
COLLECTED: 30APR10 1250
SOURCE: BLOOD
BLOOD
l
10-120-1154
RECEIVED: 30APRlO 1315
STARTED: 30APR10 1406
FINAL REPORT
No growth at 5
CULTU.
06MAY10 0645
day"
ACCESSION
BLOOD
COLLECTED: 30APR10 1245
SOURCE: BLOOD
BLOOD
l
10-120-1153
RECEIVED: 30APRlO 1315
STARTED: 30APR10 1406
FINAL REPORT
No growth at
CULTU.
5
06MAY10
day"
0645
BLOOD
ACCESSION
l
ACCESSION
l
COLLECTED: 29APR10 0912
SOURCE: BLOOD
BLOOD
FINAL REPORT
No growth at 5
CULTU.
05MAY10
day"
10-119-0800
RECEIVED: 29APRlO 0921
STARTED: 29APRlO 1023
0703
BLOOD
COLLECTED: 29APR10 0905
SOURCE: BLOOD
BLOOD
10-119-0798
RECEIVED: 29APRlO 0920
STARTED: 29APRlO 1023
FINAL REPORT
No growth at 5
CULTU.
05MAY10 0703
day"
ACCESSION
BLOOD
COLLECTED: 27APR10 1430
SOURCE: BLOOD
BLOOD
l
10-117-1383
RECEIVED: 27APR10 1437
STARTED: 27APRlO 1634
FINAL REPORT
No growth at 5
Patient Name:
BLOOD CULTURS
day"
GR JU HEY L
03MAY10 0629
S740A
Continued on next page...
Print Date: 07HAY10
PRINTD BY: RWAR
DATE
6/2/2010
LABCORP-XNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS, INC
Patient Name: GRAJU
IP/OP
1924 ALOA HIGHWAY (865) 305-9101
KNOXVLLE. TESSEE 37920
EEY L
.ACCT': 13273510002
Age: 18 YRS
HR,: (0000) 1327351
it Dr. BRACA, PAUL (S-210)
DSCH DATE: 06HAY10
S740A
, LAORATORY EINAL REPORT ;,
DOB: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
SALITA, MU
PRIN DATE: 07HAYIO
PRIN TIME: 0302
22
PAGE:
ACCESSION f 10-117-1384
CULTU. BLOOD
RECEIVE: 27APR10 1253
COLLECTED: 27APRIO 1240
STARTED: 27APRlO 1308
SOURCE: BLOOD BLOOD
EINAL REPORT
01HAYI0 1103
Staphylococcua apeciea-coagulaae negative
in lout of 2 cultures drawn
Viridan streptococcus group
in lout of 2 cultures drawn
SUSCEPTIB ILITY TESTING
ST COAGN
AUGME
IN
AM /SULBACTAM
CEEAZOLIN
CEEEPIME
CEETRONE
CLINAHCIN
GENAMICIN
IHIPEN
LEVOELOXACIN
OXACILLIN
HOXIELOXACIN
RIEAHIN
T/S
LINZOLID
VACOMYCIN
DAPTOMYCIN
HIC
,=4/2
,=8/4
SUS
S
,=8
S
~=8
S
S
S
,=4
,=0.25
,=1
S
S
S
S
S
S
~=1
,=0.5
,=0.25
,=2
~=1
,=.5/9.5
s
1
1
,=0.25
,=2
_ IV __Coat/Dos age __ PO __Cost I Doa age
S
S
ERTAPEN
NA
NA
HIC
,=0.25
,=0.25
,=0.25
2
,=0.06
1
0.12
0.12
0.5
SUS
CEEEPIME
LEVOELOXACIN
KEOPEN
PENICILLIN
VACOMYCIN
AZ ITHOHYC IN
ERYTOMYCIN
Patient Name:
BLOOD CULTURS
,Sl
$57
600 mg
,Sl
OS
$7
~$1
$42
$4
S
1 gm
CHLORA
40 rI
300 rI
$4
10 ml
600 ii
1 gm
R
R
CLINAHCIN
$33
$61
$3
$2
60 a ii
;,4
;,8
CEEOTAXIME
CEETRIAXONE
,Sl
$25
$30
2 gm
400 ii
1 gm
ST_VIID
300 rI
$4
1 gm
600 ii
80 mg
BLac
BLac
ERYTOMYCIN
TETRCYCLINE
$3
$12
3 gm
1 gm
2 gm
8
AMICILLIN
PENCILLIN
500 rI
S
S
S
S
S
S
S
S
S
S
R
R
;,2
;,0.5
2
mil
U
$2
$4
$3
ii
rI
rI
,Sl
~Sl
~Sl
_IV __Cost/Dosage __ PO __Cost/Dos age
2 gm
$25
1 gm
$8
1 gm
$30
1 gm
$4
300 ii
~Sl
60 a ii
$3
$28
1 gm
$4
$4
sao rI
,$1
1 gm
1 gm
$3
500 ii
,$1
2 mil
U
GRJU HEY L
S740A
PRID BY: RWAR
DATE
500
500
500
6/2/2010
Continued on next page...
07MAY10
Print Date:
LABCORP-KNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEMS. DlC
1924 ALOA HIGHAY (865) 305-9101
Patient Name: GRAJU
HEY L
IF/OP
KNOXVLLE. TESSEE 37920
ACCT': 13273510002
Age: 18 YRS
lfI: (0000)1327351
iit Dr. BRACA. PAUL (S-210)
DSCH DATE: 06MAYlO
07MAYlO
S740A
, IAORATORY FINlI REPORT ,.
DOn: 070CT91 Sex: MA
NO REFERRING PHSICIAN Order Dr.
PR DATE:
SALITA, H1
PAGE:
23
ACCESSION l 10-117-1384
CULTI. BLOOD
RECEIVED: 27APR10 1253
COLLECTED: 27APRI0 1240
STARTED: 27APRlO 1308
SOURCE: BLOOD BLOOD
SUSCEPTIBILITY TESTDIG
ST_VIRID
PRI TIME: 0302
TETRCYCLIN
T/S
HIC
,.4
2/38
SUS
R
NA
_ IV __Cost/Dos age __PO __Cost /Dos age
500 ID ,Sl
10 ml ,Sl DS
':$1
04/28/10 05:59
Critical results phoned to and read back by:BECKY HORROW RN/MCCl
Patient Name:
BLOOD CULTURS
GR JU HEY L
S740A
PRINTD BY: RWAJ
6/2/2010
DATE
Continued on next page...
Print Date: 07MAY10
LABCORP-RNOXVILLE
(CLIA 44D0690507)
A LABORATORY PARTNHIP WITI UNIVERSITY HEALTH SYSTEMS, mc
1924 ALCOA HIGHAY (865) 305-9101
KNOXVLLE, TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
MRl: (0000) 1327351
DSCH DATE: 06MAY10
S740A
Age: is YRS
iit Dr. BRACA. PAUL (S-210)
PRI DATE: 07MAY10
PRI TIME: 0302
~ IAORATORY FIN REPORT ;:
ACCTf: 13273510002
DOB: 070CT91 Sex: MA
NO REEERRING PHYSICIAN Order Dr.
SALTA. MU
PAGE:
24
ACCESSION f 10-120-1979
CULTI, SPUTU
RECEIVED: 30APRlO 1650
STARTED: 30APRlO 1802
COLLECTED: 30APR10 1640
SOURCE: SPUTU SPUT
STAINS & PREPS
GRA STAIN
30AP10 2013
No ~quamou~ epithelial ce11~ 5een
~10 polymorphonuclear ce115 ~een
No bacteria 3een
FINAL REPORT
02HAY10 0729
Scant growth (1+)
Candida albican
ACCESSION #
CULTl, URTI
COLLECTED: 30APR10 1639
SOURCE: URINE URIN
FINAL REPORT
10-120-1973
RECEIVED: 30APR10 1650
STARTED: 3 OAPRl 0 1825
OlHY10 1458
No Growth in 16-24 hour5
ACCESSION
CULTI, HRSA SCRE
#
COLLECTED: 27APRlO 1650
SOURCE: NASAL SW NASAL SWAB
FINAL REPORT
10-117-24.5
RECEIVE: 27APRlO 1730
STATED: 27APR10 2151
28AP10 2125
NEGATIVE
ACCESSION f
CULTl. BACTERIAL. ROUTIN
COLLECTED: 27APR10 1500
SOURCE: BRONCH L RM llAL
STAINS & PREPS
GRA STAIN
10-117-1862
RECEIVD: 27APRlO 1530
STARTED: 27APRlO 1553
27AP10 1912
No bacte ria seen
FINAL REPORT
29APR10 1221
1.000 to 10,000 colony forming uni t5 per mL
Alpha-hemolytic Streptococci
1.000 to 10,000 colony foi:ng uni t5 per mL
Neisse ria 5pecies
Patient Name:
GRJU HEY L
S740A
ROUTIN CULTUR
PRID BY: RWAR
DATE
6/2/2010
Continued on next page...
Print Date: 07HAY10
LABCORP-KNOXVILLE
A LABORATORY PARTNRSHIP WI1H UNIVERSITY BEAL1H SYSTEMS. INC
(CLIA 44D0690507)
1924 ALOA HIGHAY (865) 305-9101
KNOXVLLE. TESSEE 37920
Patient Name: GRAJU HENRY L
IP/OP
ACCT': 13273510002
KRf: (0000)1327351
Age: 18 TIS
1'oiit Dr. BRACA. PAUL (S-210)
S740A
~ LAORATORY FINAL REPORT :;
DOB: 070CT91 Sex: MA
DSCH DATE: 06MAYIO
NO REFERRING PHYSICIAN Order Dr. SALTA.HU
CULTU. SPUTU
PRI DATE: 07MAY10
PRI TIME: 0302
PAGE:
25
ACCESSION' 10-117-1445
COLLECTED: 27APR10 1306
RECEIVED: 27APRlO 1312
STARTED: 27APRlO 1408
SOURCE: SPUTU SPUT
GRA STAIN
STAINS & PREPS
27APR10 1415
,10 squamous epi thelial cells seen
/25 polymorphonuclear cells seen
2+ mixed bacteria
FINAL REPORT
Moderate growth (3+)
29APR10 0656
Routine respiratory tract flora present
CULTU. URDl
ACCESSION' 10-117-1426
COLLECTED: 27 APR10 1255
RECEIVED: 27APRlO 1300
STARTED: 27APRlO 1407
SOURCE: URINE URIN
FINAL REPORT
28AP10 1024
No Growth in 16-24 hours
Patient Name:
GR JU HEY L
S740A
ROUTIN CULTUR
Continued on next page. ..
Print Date: 07MAY10
PRINTD BY: RWAl
DATE
6/2/2010
LABCORP-XNOXVILLE
(CLlA 44D0690507)
A LABORATORY PARTNRSHIP WITH UNIVERSITY HEALTH SYSTEHS, INC
1924 ALCOA HIG~AY (865) 305-9101
:KOXVLL, TESSEE 37920
Patient Name: GRAJU HENRY L
ACCT': 13273510002
IP/OP
Age: 18 YRS
i.,: (0000) 1327351
it Dr. BRACA. PAUL (5-210)
S740A
.. LAORATORY FINAL REPORT
DOB: 070CT91 Sex:
DSCH DATE:
/
MA
NO REFERRING EHSICIA Orde r Dr.
o 6MAYl
0
PRI DATE: 07MAY10
PRIN TIME: 0302
SALITA. HI
PAGE:
26
ACCESSION I 10-117-1866
PNEUMOCYSTIS STAIN
COLLECTED: 27 APR1 0 1500
RECEIVD: 27APR10 1530
STARTED: 27APRlO 1554
SOURCE: BRONCH L :RL BAL
FINAL REPORT
28AP10 0741
No PneumoCY5ti5 carinii 5een by DFA.
ACCESSION l 10-117-1945
RECEIVD: 27APRlO 1540
CULTU. ACID FAST BACT W/SM
COLLECTED: 27APR10 1540
STARTED: 27APRlO 1553
SOURCE: BRONCH L :RL BAL
AF SH
STAINS & PREPS
27APR10 2232
No acid-fa5t bacilli 5een
ACCESSION l 10-117 -1886
OVA " PARITES-BRONCH ONLY
COLLECTED: 27APR10 1532
RECEIVED: 27APR10 1532
STARTED: 27APRlD 1553
SOURCE: BRONCH L RH BAL
FINAL REPORT
27APR10 1639
No ova or parasites Been
Patient Name:
GR JU .HY L
S740A
HICROBIOLOGY
AF CULTURS PARSITOLOGY
PRINTD BY: RWAR
6/2/2010
DATE
Continued on next page...
Print Date: 07MAYI0