12/12/2024
Good Thursday Morning Facebook Friends !!!
First and foremost, a GIGANTIC THANK YOU to everyone for their comments, prayers and monetary support. I am blessed beyond all measure to have such wonderful friends and acquaintances who are supporting me through this crisis...
Now, that said, those of you who know me from my Business, My Food, My Reputation and or Personal Interaction, well, you know I'm not generally one to blow smoke up anyone's butt. If that statement offends you, you may want to jump ahead a couple of paragraphs, because a "So Called Friend" messaged me last night...
Basically I was called, in no particular order, a "Drama Queen", a "Mooch". a "Case of Bad Timing for posting a "please feel sorry for me" money grab before Christmas", and, my personal favorite: "I always thought you were a waste of oxygen"...
In all fairness, I am sure he is not the only human being who may feel this way, but in all honesty it DID get me to thinking... I am sure we have all thought, at some point, "I don't want to get scammed". And I would understand completely seeing as to what we see on the news about faked Cancer scams, faked death to collect insurance money, etc.
SO !!!
Just because I want everyone to realize -on this subject-, at least, I am an "open book" and since _I_ am the one sharing, there is no HIPPA law garbage between me, you and the truth. After all, _WE_ are all friends here and you deserve the truth, just like you would expect from any friend...
So the following is my "Intake and initial Triage/first stage treatment" as per the ER Doktor before things "Got Real" after I got up to ICU.
I tried to enlist Bill Curtis for added drama, but he won't return my calls...something about me being too dramatic even for him...
Anyway my edits to the narrative will be between the 2 * marks. Questions or comments feel free to reach out. I still have about 90 pages of Doktor (yes, I know, I just like spelling it that way) and Nurse notes to wade through, but as you can imagine, it's not all that easy to get through without taking dog Todd for a stroll around the block to shake it all off...
Granted a lot of this is absolute "greek" to me, but in terms of being transparent this is directly from my Chart's notes...and believe it or not, it got worse...
***************
ED Provider Notes by Physician Khristopher Faiss, D.O. at 11/17/2024 4:43 AM
COURSE & MEDICAL DECISION MAKING
ASSESSMENT, COURSE AND PLAN
Care Narrative:
65-year-old male history of atrial flutter, heart failure presents encephalopathic complaining of abdominal pain and had an episode of diarrhea prior to arrival. * "episode of diarrhea" is rather understated as a hazmat team was discussed by the poor paramedics that had to "squeegee" me and the gruney upon delivery to the ER *
Arrives febrile tachycardic and hypotensive.
Evidence of poor perfusion includes encephalopathy, unable to palpate pulses, unable to get a manual or automatic blood pressure. * Generally "unable to get a blood presure" means I was at or close to my previous record of 37 over 18 *
Aggressive fluid resuscitation is initiated. His previous echo from this year shows a relatively normal EF, clinically he looks volume depleted. We will start with 2 L of normal saline. * That's over 4 PINTS (!!!) to my non-metric friends *
We are able to get a blood pressure although poor is 64/40 with a poor MAP.
Norepinephrine is started. Patient has several sufficient peripheral access including 18-gauge is. I considered central line and will proceed with this if necessary.
Considerations at this time include septic shock, aortic dissection, mesenteric ischemia, closed head injury * this from me doing my best "American Loggers" Impression of a Giant Redwood being felled in my living room * or intracranial hemorrhage, metabolic encephalopathy
With norepinephrine and 2 L of fluid patient has normal MAP and blood pressure. His encephalopathy is rapidly clearing with a perfusing blood pressure.
He received empiric ceftriaxone and metronidazole for presumed abdominal source for likely septic shock.
EKG initially at a rate of 130 or 140 does demonstrate what I appreciate to be sinus tachycardia although may be in atrial flutter. With adequate perfusion the patient's heart rate decreased to close to 100 further suggesting sinus tachycardia to compensate for hypotension and poor perfusion
Patient is leukopenic, has no anemia, his procalcitonin is markedly elevated. On CMP he has evidence of dehydration with a bicarb of 16, anion gap of 21. He has a creatinine of 2.13 with that chart review history of prior mild CKD but worsened in comparison today.
Ammonia returns mildly elevated at 53, lactic acid returns at 7.
VBG demonstrates respiratory compensation likely for metabolic acidosis/lactic acidosis. And a normal pH.
CT head with no intracranial hemorrhage
CT abdomen pelvis demonstrates no acute abnormalities. Urine is still pending but not seeming to be the obvious source of his metabolic and vital sign derangements.
Patient will be admitted to the intensive care unit for treatment of hypotension either from hypovolemia or septic shock, need for vasopressors, lactic acid greater than 7.
Hydration: Based on the patient's presentation of Hypotension and Sepsis the patient was given IV fluids. IV Hydration was used because oral hydration was not adequate alone. Upon recheck following hydration, the patient was improved.
CRITICAL CARE
The very real possibilty of a deterioration of this patient's condition required the highest level of my preparedness for sudden, emergent intervention. I provided critical care services, which included medication orders, frequent reevaluations of the patient's condition and response to treatment, ordering and reviewing test results, and discussing the case with various consultants. The critical care time associated with the care of the patient was 33 minutes. Review chart for interventions. This time is exclusive of any other billable procedures.
Point of Care Ultrasound
ED POINT OF CARE ULTRASOUND: RUSH EXAM
Limited Cardiac
93308-26
Indication for exam: Hypotension and Shock
LVEF: Hyperdynamic
Pericardial Effusion: not present
RV Strain: not present
Image retained through Haiku as seen below:
Additional interpretation:none
Other Findings:
This study is a limited ultrasound examination performed and interpreted to evaluate for limited conditions as outlined above. There may be other clinically important information contained in the images that is outside this scope. When clinically warranted, a comprehensive ultrasound through the appropriate department is considered.
ADDITIONAL PROBLEM LIST
Septic shock
Anion gap acidosis
DISPOSITION AND DISCUSSIONS
I have discussed management of the patient with the following physicians and APP's:
Intensivist
Discussion of management with other QHP or appropriate source(s): None
Barriers to care at this time, including but not limited to: None .
Decision tools and prescription drugs considered including, but not limited to: Antibiotics for empiric abdominal infection treatment .
FINAL DIANGOSIS
1. Septic shock (HCC) Acute
2. AKI (acute kidney injury) (HCC) Acute
3. Lactic acidosis Acute
4. Bacteremia Active
5. Toxic metabolic encephalopathy Temporary
I, Niccolo Ripamonti (Scribe), am scribing for, and in the presence of, Khristopher R Faiss, D.O..
Electronically signed by: Niccolo Ripamonti (Scribe), 11/17/2024
I, Khristopher R Faiss, D.O. personally performed the services described in this documentation, as scribed by Niccolo Ripamonti in my presence, and it is both accurate and complete.
The note accurately reflects work and decisions made by me. Khristopher R Faiss, D.O. 11/17/2024 7:24 AM
********************************
And Yes, I have already reached out with profuse thanks to Dr. Faiss and his team for saving my life. He was the first, but not the last to "go above and beyond"...
I'll update as my mental state allows me to get through all the notes...
