88 y/o with femoral fracture..crap

On call...88 y/o from Mexico who rarely gets out of bed comes in for a femoral neck fracture that needs repaired (apparently). My resident tells me he doubts this gentlemen's mental capacity is good enough for anything reliable. He told the ER he was DNR, but he tells us he can't remember ever saying that. Anyway, our online computer system has NO RECORD of anything on this guy and he doesn't know much about his medical history. Somehow the fleas and rats are able to dig up some information. COPD with recent increase in cough and sputum production. 95% on 2L NC. On a bunch of inhalers. B cell lymphoma IVC filter Polymyalgia rheumatica on steroids CKD stage 3 - last known Cr in 1.4 in April 2013. Cr 1.2 today. Diastolic Dysfunction - no further information Cardiac physical exam - unable to appreciate much heart tones at all. Labs: H/H 13.0/38.8. Plt 178. INR 1.2. Chem normalish with K of 4.6. BUN 17. CO2 26 EKG to me looks like he has had an inferiolateral infarct, possible anterior infarct. He denies any cardiac history. 1rst degree AV block. I also think he has an LAFB. We asked cards for a stress echo, but they couldn't get good TTE windows because of lung hyperinflation. CXR shows elevated right hemi diaphragm of unknown etiology. He has a prominent mediastinal silhouette that is very concerning for an aortic aneurysmal dilation with tracheal deviation. CT of pelvis concerning for some metastatic disease in the iliac wings. He has an infrarenal...
Source: Student Doctor Network Forums - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums