Case 5 (8/25/2013): Subsequent Patient Management
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Case 5 is a 63 year-old female patient who presents with gastroenteritis, symptomatic ascites and lower extremity edema due to diffuse metastatic breast carcinoma (liver, bone and retroperitoneal lymph nodes). She is s/p mastectomy, currently receiving chemo/radiation/hormonal therapy. You may assume that information not listed in the patient case sheet was either not recorded or not significant.
Objective Data:
Row 15: Hemoglobin 9.4 gm/dL, MCV 88.4 fL and platelet count 131,000/uL, 3 hours 15 minutes prior to admission.
Row 19: H&P: Ascites, probably malignant due to hepatic disease…
Row 22: Hemoglobin 9.0 gm/dL and platelet count 120,000/uL, 4:55 hours post-admission.
Row 26: Unspecified Consultation, 17:49 hours post-admission: Evaluation of malignant ascities, moderate in volume; retroperitoneal lymphadenopathy; marked hepatomegaly secondary to metastatic disease; check coagulation studies.
Row 27: Ultrasound-guided abdominal paracentesis, day following admission; 5 French drainage tube with 2,845 mL fluid removed. The time of procedure is not specified.
Row 29: Hemoglobin 8.9 gm/dL, platelet count 120,000/uL, INR 1.7 and aPTT 31 seconds, 28:25 hours post-admission.
Row 39, 44, 53 and 59: Four units of plasma (1100 mL) transfused between 52:38 and 58:40 hours post-admission.
Row 64: Progress Note (GI): “Uncomfortable after therapeutic paracentesis ?”, 64:04 hours post-admission.
Row 67: Cytopathology Report, Peritoneal Effusion: non-malignant; date specimen received listed as two days post admission; date of collection not specified.
Row 69: Hemoglobin 9.2 gm/dL and platelet count 125,000/uL, 75:45 hours post-admission.
Row 76: Discharged; hospital length of stay 110:15 hours post-admission (4.6 days).
Tachycardia throughout hospitalization, 93 to 115/minute
Comment: You must download the file after opening the link in box.net, or you will not be able to easily see all of the information in the file. This discussion follows the initial patient presentation posted August 25, 2013 and gives members a chance to compare how they felt the patient should be managed with how the patient was actually managed. A commentary on the patient case management will be posted Friday. This material is Copyright © 2013 by Columbia Healthcare Analytics, Inc. and may not be used for other purpose without written permission.