+++
History of Present Illness
++
RW is a 67-year-old man who was transported to Acute Care Medical Center (ACMC) after being struck by a car while crossing First Avenue on foot. He has been hospitalized at ACMC for 6 days and is in the trauma ICU due to several fractures sustained in the motor vehicle accident. The patient has been intubated and on mechanical ventilation since admission 6 days ago. During ICU rounds the next morning, the nurse notes he has had increased, yellow/green secretions overnight.
++
++
++
Mother died from a myocardial infarction at age 84. Father is still living in nursing home, has past history of prostate cancer.
++
The patient is an engineering professor at the State University. He is married and lives at home with his wife. He has 2 college-age kids attending college outside of the metro area. As per his wife, he has not traveled outside the local area for the past 6 months, but he traveled to Germany about a year ago. There are no pets in the home. He drinks 2 to 3 beers per week.
++
Sodium chloride 0.9% (NS) @ 150 mL/hr
++
Heparin 5000 units subcutaneously q8 h
++
Insulin infusion titrated to maintain BG 80-110
++
Fentanyl intravenous infusion at 25 mcg/hr
++
Dexmedetomidine intravenous infusion titrated to RASS 0 to –2
++
++
Lisinopril/hydrochlorothiazide 20/12.5 mg PO daily
++
++
No recent antibiotic use within the past 6 months
++
Temp 101.3°F, BP 110/72 mm Hg, HR 80 to 90 bpm, RR 21 breaths per minute, SpO2 92% on mechanical ventilation
++
++
Intubated, no acute distress
++
Normocephalic, atraumatic, EOMI, PERRLA, MMM, no adenopathy
++
++
Crackles in the right posterior base with dullness: left lung clear
++
Soft, non-tender, non-distended with positive bowel sounds
++
Urinary (Foley) catheter is in place
++
LLE in ace wrap and post-op bandages, LUE in post-op bandages
++