workups


A/P: 62 yo CM with h/o DMII and HLD admitted for left-sided weakness X 3 days. 

Left-sided weakness 

- DDX: brain tumor, CNS infection, fall/trauma, hypoglycemia, migraine, MS (MRI ordered), sz d/o, SAH, vertigo, drugs. These are low on the list at this point but require consideration. 

- Risk factors for stroke: obesity, DMII, HLD, smoking. 

- ABCD2 score: *** 1(age>60), 0(BP>140/90), 2(weakness), 1(DM), 2(>60min) = 6 high risk of stroke (8.1%) AAFP 2012 

- No personal or family h/o hypercoagulability d/o. 

- ASA given in ER *** , *** past window for tPA 

- CT head - ***

- admit to med surg neuro 

- cardiac monitoring 

- saline lock 

- FBS QAC / QHS 

- EKG - *** sinus rhythm - no history of Afib reported 

- Echocardiogram ordered (looking for PFO, valvular ds, cardiac thrombus, atherosclerosis). 

- Speech therapy - *** passed swallow test. 

- PT evaluate and treat. 

- IP consult to neurology 

- Neuro checks Q4H 

- MRI angiogram head without contrast 

- MRI brain without contrast 

DMII 

- A1c 

- Holding glipizide, pioglitazone, sitaGLIPtin-metformin 

- low dose corrective scale 

- notify md for BGL <50 or >350 

- goal premeal - 80-120 mg/dl 

- FSBS QAC, QHS 

HLD 

- continue genfibrozil 600 mg daily 

- lipid panel ordered 

FEN/PPX: SCDs, senna-docusate, acetaminophen 650 mg fever/pain PRN, 45 gm CC, 

Modifiable risk factors: HTN, smoking, obesity, diet, inactivity, anti-platelet therapy. 

CODE Status: Full 

DISPO: Admit for monitoring. Following neuro. 


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